Prednisolone for pancreatitis -- BG all over the place!

[Debbie & Mishka]

I don't even know where to start other than Mishka hasn't been eating well the past two months. Per vet bloodwork indicated pancreatitis and I started on Cerenia, bupe, and Zofran. We didn't get an ultrasound because I didn't want to put Mishka through that stress. No significant improvement with the meds. Mishka never vomited or had diarrhea but seemed nauseas because he sniffing food, walking away, licking lips. At least with the meds, I'm not having to open 10 cans of food just to get him to eat, only to have him NOT eat the same food the next day. Vet suggested prednisolone and I was hesitant, but so overwhelmed, I finally agreed. First dose was last Saturday evening and it's been a nightmare with BG since. For the first two days Mishka ate well and seemed generally feeling well. He continues to eat, but he does not feel well. Mostly sleeping in the corner and no purrs, not at all like himself. I continued the bupe even though I'm not sure he's in pain anymore. I'm rambling, but just worried about the BG and how to get this under control. With the CKD, his kidneys are taking a serious hit with the high BG. I know my spreadsheet is not that great and probably needed more mid-cycle numbers previously. But, with a husband with dementia and being alone in all this, I'm stressed, worried and mostly just crying all the time. I regret putting Mishka on the pred -- maybe it works for some -- but at this point I'm seeing the vet on Monday and asking how to taper off.....I'm overwhelmed and don't have all the updated labs, etc. and just tired of constantly trying to research and understand....sorry for the rambling.

 

[Paigeworthy]

I don't even know where to start other than Mishka hasn't been eating well the past two months. Per vet bloodwork indicated pancreatitis and I started on Cerenia, bupe, and Zofran. We didn't get an ultrasound because I didn't want to put Mishka through that stress. No significant improvement with the meds. Mishka never vomited or had diarrhea but seemed nauseas because he sniffing food, walking away, licking lips. At least with the meds, I'm not having to open 10 cans of food just to get him to eat, only to have him NOT eat the same food the next day. Vet suggested prednisolone and I was hesitant, but so overwhelmed, I finally agreed. First dose was last Saturday evening and it's been a nightmare with BG since. For the first two days Mishka ate well and seemed generally feeling well. He continues to eat, but he does not feel well. Mostly sleeping in the corner and no purrs, not at all like himself. I continued the bupe even though I'm not sure he's in pain anymore. I'm rambling, but just worried about the BG and how to get this under control. With the CKD, his kidneys are taking a serious hit with the high BG. I know my spreadsheet is not that great and probably needed more mid-cycle numbers previously. But, with a husband with dementia and being alone in all this, I'm stressed, worried and mostly just crying all the time. I regret putting Mishka on the pred -- maybe it works for some -- but at this point I'm seeing the vet on Monday and asking how to taper off.....I'm overwhelmed and don't have all the updated labs, etc. and just tired of constantly trying to research and understand....sorry for the rambling.

Oh Debbie. I'm so sorry you are feeling so alone right now, though reading aboutMishka's troubles i can't imagine how you wouldn't be feeling stressed!!
I'm new so don't have advice, except to hang in. We see you.

 

[Debbie & Mishka]

Thanks Paige...Mishka and I are trying to hang in there.

 

[Chris & China (GA)]

I'm seeing the vet on Monday and asking how to taper off.

I think this is a good idea....steroids always make it harder to get the BG under control. His numbers before the prednisolone weren't all that bad so the short amount of time he's been on them probably hasn't really hurt his kidneys as much as you think.

Something you might think about is trying a different insulin too....ProZinc is a good insulin, but some cats do better on Lantus or Levemir.

 

[Crista & Ming]

Hi Debbie. I'm really new too but Ming is taking 1.25 mg pred twice daily everyday for pancreatitis. His SS is a nightmare and I can't say for sure if it's because of the pred or just Ming being Ming but perhaps you could ask your vet to see if putting Mishka on a low dose of pred will be beneficial. 5 mgs a day is the normal dose for cats. Or of course, tapering off would be best.

My vet is thinking of keeping him on pred long term. It's been more than a month of him on pred.

I know @Phoebes uses pred as well. I asked her a while ago what she noticed with starting pred and said they did have to increase Phoebe's insulin dose after starting.

 

[Debbie & Mishka]

Something you might think about is trying a different insulin too....ProZinc is a good insulin, but some cats do better on Lantus or Levemir.[/QUOTE]

Thanks Chris. Worth talking to the vet about for sure. But I think the vet is more comfortable with ProZinc. Might be searching for another vet given his advice on the pred. Always the same answer -- try the pred and "work around" the BG.

 

[Crista & Ming]

Sorry, I also wanted to say you can keep Mishka on bupe as often as every 8 hours if you think he is in pain. I've also doubled his dose before but please, check with your vet first. This is just from my experience and speaking to my vets and working at a vet hospital.

 

[Chris & China (GA)]

But I think the vet is more comfortable with ProZinc.

Might bring up the fact that he's been on it almost a year.....usually if they're going to respond well, you'll see it within 6 months or so.

Of course that's not every cat....but it sure can't hurt to talk to him about it.

By the way, he's gorgeous!

 

[Debbie & Mishka]

Hi Debbie. I'm really new too but Ming is taking 1.25 mg pred twice daily everyday for pancreatitis. His SS is a nightmare and I can't say for sure if it's because of the pred or just Ming being Ming but perhaps you could ask your vet to see if putting Mishka on a low dose of pred will be beneficial. 5 mgs a day is the normal dose for cats. Or of course, tapering off would be best.

My vet is thinking of keeping him on pred long term. It's been more than a month of him on pred.

I know @Phoebes uses pred as well. I asked her a while ago what she noticed with starting pred and said they did have to increase Phoebe's insulin dose after starting.

Thanks Crista. I guess I just don't see how the pred has even helped Mishka's pancreatitis.....I had stopped the Cerenia because pilling was stressing both Mishka and I out multiple times a day. But since then have read that Cerenia has anti-inflammatory properties. So maybe stop the pred and start Cerenia again...worries, worries, worries....

 

[Debbie & Mishka]

Sorry, I also wanted to say you can keep Mishka on bupe as often as every 8 hours if you think he is in pain. I've also doubled his dose before but please, check with your vet first. This is just from my experience and speaking to my vets and working at a vet hospital.

Thanks Crista. Vet originally prescribed bupe at .2 ML every 12 hours but at that dose Mishka was so spacey and staring at the wall all night, I reduced by half. But might try increasing a little. He just lays around and never seems to feel good. Vet did not want him too sedated that he wouldn't eat.

 

[Debbie & Mishka]

Thanks Chris -- yes Mishka is my handsome boy! Hard to believe 17 years ago, I almost chose his sister because her markings were more symmetrical...LOL. Appreciate your suggestions.

 

[Crista & Ming]

Have you tried pill pockets or mixing the cerenia in food? I hate pilling too and just stick it in Ming's food. Sometimes I crush it up and mix it in his food. But I know Mishka isn't eating well so that's when pilling is necessary.

I've also heard that cerenia has anti-inflammatory properties as well.

I guess I just don't see how the pred has even helped Mishka's pancreatitis...

A few members have said that pred hasn't 100% been proven to work and by the time it "works", it could be because of anything. I chose to try pred because Ming was getting pancreatitis flare ups almost every month and half. It was time to do something. And with such a low dose, I felt comfortable with it. At the same time, I switched insulins from PZI to Lantus.

So that's where I'm at with Ming. There's a lot going on and I can't show you "nice" results but I've never had nice results with Ming and his BGs. At least we know that Mishka was doing great before the pancreatitis.

Thanks Crista. Vet originally prescribed bupe at .2 ML every 12 hours but at that dose Mishka was so spacey and staring at the wall all night, I reduced by half. But might try increasing a little. He just lays around and never seems to feel good. Vet did not want him too sedated that he wouldn't eat.

That's when every 8 hours on a reduced dose might be more beneficial if it's something you can do. So you can give him some pain relief without getting him all spaced out.

 

[Debbie & Mishka]

Thanks Crista so much for your advice! It helps to know I'm not the only one going through this. I'll probably try increasing the bupe tomorrow a.m. just to see if it makes Mishka more comfortable. It's hard to tell if he is in pain -- mostly I just go by the fact that he doesn't like to be combed anymore (lots of tail twitches) when he used to LOVE it. He would roll over on his back and love his belly combing.... Difficult to dose every 8 hours though because of work. And I did figure out how to give his pills in gel caps now which makes it easier. I hate to even try putting pills in his food and he won't touch the pill pockets.

 

[Debbie & Mishka]

@Crista & Ming -- vet now wants to increase pred to 10 mg a day. Has your vet ever suggested that for Ming? I'm uncomfortable with increase because of the BGs totally out of control. Main concern with Mishka is he is sooooo lethargic. Doesn't act like he used too...hardly ever purrs....just laying on his side sleeping. He is eating (almost normal amount most days) and no vomiting and doesn't appear nauseated. I was thinking maybe I was giving too much BUPE, but only giving .1 ML every 12 hours. Or maybe he's in pain and I should give more....UGHHHHH.... Maybe time for an ultrasound to see if something else going on. I guess I'm just venting.

 

[Crista & Ming]

No my vet was very cautious about pred. We were at 3.75 mgs a day with two different doses day and night and after we looked at his SS, she decided to even out the dose and hence we are at 1.25 mg twice daily. Except perhaps your vet is just thinking of pred as a short term drug but even then... if you’re uncomfortable with this plan, you have every right to refuse. Mishka is YOUR cat. You get to decide what he gets. The vet can only suggest it. Perhaps you can look for another vet for a second opinion. There’s no harm in that.

Sorry, I’m on mobile and on the go so I apologize if you’ve answered these questions already: are you checking for ketones? How is Mishka’s hydration? Is he still eating?

ETA: his 1.25 mg pred twice daily dose is most likely a long term treatment btw.

 

[Debbie & Mishka]

No my vet was very cautious about pred. We were at 3.75 mgs a day with two different doses day and night and after we looked at his SS, she decided to even out the dose and hence we are at 1.25 mg twice daily. Except perhaps your vet is just thinking of pred as a short term drug but even then... if you’re uncomfortable with this plan, you have every right to refuse. Mishka is YOUR cat. You get to decide what he gets. The vet can only suggest it. Perhaps you can look for another vet for a second opinion. There’s no harm in that.

Sorry, I’m on mobile and on the go so I apologize if you’ve answered these questions already: are you checking for ketones? How is Mishka’s hydration? Is he still eating?

ETA: his 1.25 mg pred twice daily dose is most likely a long term treatment btw.

Thanks Crista -- yes, I think the vet is thinking increasing the dose short term, but still getting BG under control has been a nightmare for me and I'm not sure it has made a difference in how Mishka feels. Yes, he is still eating. Basically his normal amount (@ 12 oz. FF/day). Some days a little less. No vomiting. My main concern is he is just so very lethargic. He just lies prone most of the time and even when I pet him he sometimes doesn't respond. I guess it's either severe pain or too much Bupe. But I'm only dosing Bupe .1 ML every 12 hours and he didn't respond this way at first. So I'm thinking it is severe pain. So tonight I increased slightly and he'll at least sleep more comfortably. I have been thinking of getting a second opinion, but the stress of all the repeat tests etc. will likely stress Mishka out.

Yes -- testing for Ketones. Last test 4 days ago -- no ketones -- and planning to test again tonight if I can stay awake and catch him in the litter box. I believe his hydration is ok, but hard to tell. I was never good at judging whether the skin was quickly going back into place...LOL. Probably should feel his gums, but that's hard to do with him to. And YES he is still eating. I just want to make sure I'm not doing more harm than good (with the pred....). Thanks Again! Hope Ming feels better soon!

 

[Crista & Ming]

Eating is a great sign!!!

Which makes me not understand why the increase in pred. Lethagy doesn't make sense to me to give MORE pred... Maybe someone with more experience can come up with some reason....... Did your vet say why?

Have you already started the 10 mgs per day?

 

[Debbie & Mishka]

Eating is a great sign!!!

Which makes me not understand why the increase in pred. Lethagy doesn't make sense to me to give MORE pred... Maybe someone with more experience can come up with some reason....... Did your vet say why?

I probably didn't do a good job of describing what was still going on with Mishka -- perhaps I didn't emphasize that the only thing going on right now is that Mishka sleeps ALL the time. Vet never believed that Mishka was in pain with the pancreatitis even though every thing I've read says it is very painful and standard protocol is to treat for pain. And he wasn't convinced that he was nauseas because there was no vomiting. So I guess all in all I'm very hesitant to go with anything the vet says now.

NO! I have not increased the pred and I'm not going to. I haven't checked in with the vet to tell him I changed my mind about the increase. But as you said, ultimately it is my decision. Mishka's BG the past couple of days has been trending lower (crossing fingers). Just concerned about the lethargy. Think I'll at least get full blood work done to see if maybe something else is off. Also he lays on paper ALL the time! Is that a sign of trying to keep warm? Thanks again for all your advice!!!