? 1/9 Pearl AMPS +263, Prednisolone timing??

[Margaret and Pearl (GA)]

Hi and good morning!

Today finally it looks to me for sure like Pearl has cleared her last bounce, and her numbers are evening out throughout last night and into this morning. This is new for her, to be so even in the night and AMPS reading.

I need to administer Prednisolone this morning (every 3rd day). I never thought about timing in regards to insulin interaction. Can I administer at same time as insulin or is it best to wait a few hous? Does anyone know?

Previous days posts: https://www.felinediabetes.com/FDMB...nking-of-switching-to-tr.241148/#post-2715381

https://www.felinediabetes.com/FDMB...-2-332-4-241-6-256-9-234.241209/#post-2715332

Thanks!!
Margaret and Pearl

 

[Butters & Lyla]

Good morning Can't answer your question about Prednisolone, But @Tomlin Amy's kitty is on it, so I'm tagging her in case she is around as she may be able to offer some advice.

Nice to see Pearl hanging out in the lemon tree instead of those pink numbers. Even better would be some more blue! Work that juice, Pearl!!

 

[Margaret and Pearl (GA)]

Good morning Can't answer your question about Prednisolone, But @Tomlin Amy's kitty is on it, so I'm tagging her in case she is around as she may be able to offer some advice.

Nice to see Pearl hanging out in the lemon tree instead of those pink numbers. Even better would be some more blue! Work that juice, Pearl!!

Lol, thanks for your encouraging message. Yes! I am so glad we got an entire cycle with no huge jumps or swings! Hopefully Amy might have some insight on the Pred timing.

 

[Butters & Lyla]

Lol, thanks for your encouraging message. Yes! I am so glad we got an entire cycle with no huge jumps or swings! Hopefully Amy might have some insight on the Pred timing.

I suspect she might, if she is around this weekend.
If others have experience with the pred/insulin combo, they'll probably see your title and respond as well.

 

[Tomlin]

Can I administer at same time as insulin or is it best to wait a few hous? Does anyone know?

Good morning !

You are able to administer it either way. When & how long the Prednisolone effects a cats BG is not always predictable. For my T, most of the time, I will see a change in his BG begin around +3 after getting the Prednisolone & the most influence with respect to how high the BG increases around the +6 point. The BG then begins to decrease. Every cat & then even within the same cat, the timing may be different even from one day to the next.

I give T his Prednisolone with his evening insulin given that he is a cat who has lower BG during the early morning hours. This allows me to take advantage of the lower BG to offset the effects of the Prednisolone to some extent.

At one time I did try to time his Pred dose so that the increase in BG would occur around the same time as his nadir . Like a fun math story problem.....if train A leaves at 8am & train B leaves at 10pm . It all looked good on paper, but unfortunately, as I mentioned earlier, the timing is not always exact or predictable (with the pred OR nadir) so after seeing the variability, I decided to give him the Pred with his dinner & insulin & call it a day .

 

[Margaret and Pearl (GA)]

Good morning !

You are able to administer it either way. When & how long the Prednisolone effects a cats BG is not always predictable. For my T, most of the time, I will see a change in his BG begin around +3 after getting the Prednisolone & the most influence with respect to how high the BG increases around the +6 point. The BG then begins to decrease. Every cat & then even within the same cat, the timing may be different even from one day to the next.

Hi Amy! Thank you for this helpful information - I was really nervous about timing, so I am glad to know it's really likely I won't be able to have conclusive answers, so I will monitor at the +3 and +6ish to see what is going on.

 

[Margaret and Pearl (GA)]

Good morning !


I give T his Prednisolone with his evening insulin given that he is a cat who has lower BG during the early morning hours. This allows me to take advantage of the lower BG to offset the effects of the Prednisolone to some extent.

This is a very interesting point. Up to now, Pearl's BG generally spikes at the AMPS - but perhaps that is bc she is bobbling around. I will have to watch over time and see if she is lower AMPS or PMPS and will adjust the Pred accordingly. Thanks!!!

 

[Tomlin]

Hi Amy! Thank you for this helpful information - I was really nervous about timing, so I am glad to know it's really likely I won't be able to have conclusive answers, so I will monitor at the +3 and +6ish to see what is going on.

The timing may very well be different for your cat. There are days when the Prednisolone effects him more later than +3. On those days, the next morning I may see higher than usual pre shot BG & the drop in BG will happen during the early hours after his insulin....which means a faster & more substantial drop because of the insulin added to the mix.

 

[Margaret and Pearl (GA)]

The timing may very well be different for your cat. There are days when the Prednisolone effects him more later than +3. On those days, the next morning I may see higher than usual pre shot BG & the drop in BG will happen during the early hours after his insulin....which means a faster & more substantial drop because of the insulin added to the mix.

So do you recommend then NOT increasing her dose the day after Pred? Today I administered Pred, and haven't noticed anything unusual yet.

On Pearl's chart, every single time we have a red AMPS, it's the morning after I administered Pred.

 

[Tomlin]

How much Prednisolone was Pearl getting and for how long before the change in dose?

One concern I would have & it is something you will have to watch is do you see BG rise during the 2nd half of the the cycle (PM) on days you give the Pred & then the BG rises even more so the next morning after it’s been 24 hours since the Pred? Also, on days when there is no Pred given how do those BG look.

Given that the IBD & Asthma are both inflammatory conditions, as you reduce the Prednisolone dose, you have to watch for indications that inflammation may be increasing due to the decrease in Pred—one indicator is you will see increased BG (like those very high BGs early morning 24 hours after the Prednisolone).

While it is always ideal & nice if Prednisolone is able to be stopped, sometimes the underlying medical conditions require immunosuppression. This doesn’t mean you have to stick with Pred—at least not for IBD. Budesonide is a possible option depending on where the GI tract is effected (works better when it is the upper vs lower GI tract). Budesonide can still effect BG but tends to effect it less than Prednisolone. Just some additional info to keep in mind IF this trial to reduce & discontinue the Pred becomes an issue. The other option is to stick with Pred & adjust the insulin so long as BG is able to be managed. Otherwise, there are some other options as well .

 

[Margaret and Pearl (GA)]

How much Prednisolone was Pearl getting and for how long before the change in dose?

One concern I would have & it is something you will have to watch is do you see BG rise during the 2nd half of the the cycle (PM) on days you give the Pred & then the BG rises even more so the next morning after it’s been 24 hours since the Pred? Also, on days when there is no Pred given how do those BG look.

Given that the IBD & Asthma are both inflammatory conditions, as you reduce the Prednisolone dose, you have to watch for indications that inflammation may be increasing due to the decrease in Pred—one indicator is you will see increased BG (like those very high BGs early morning 24 hours after the Prednisolone).

While it is always ideal & nice if Prednisolone is able to be stopped, sometimes the underlying medical conditions require immunosuppression. This doesn’t mean you have to stick with Pred—at least not for IBD. Budesonide is a possible option depending on where the GI tract is effected (works better when it is the upper vs lower GI tract). Budesonide can still effect BG but tends to effect it less than Prednisolone. Just some additional info to keep in mind IF this trial to reduce & discontinue the Pred becomes an issue. The other option is to stick with Pred & adjust the insulin so long as BG is able to be managed. Otherwise, there are some other options as well .

Hi,

Yes, Pearl is on Pred (2.5mg) primarily for the asthma, not the IBD. She is also on Flovent 250mcg (so we are talking about some pretty significant asthma flare ups that also result in pneumonias - think 4-5 bouts of pneumonia in the past each all requiring 4-7 weeks on Veraflox also).

So, while I am trying to wean the Pred as low as I can go, the jury is still out on whether I will be able to stop altogether. I am watching for her asthma symptoms to worsen. If they stay good, I will keep weaning.

I am piecing together the Pred story. I have the Pred indicated on my BG chart if you have a moment to take a peek. Now that I understand better that the Pred effect can take a day or so to show up, as I read my chart that can really explain a lot of the red and pink flopping around. When she is stable and not bobbing up and down, Pearl is usually in the yellows.

Right now the Pred is every 3rd day. I administered today. Tomorrow is the day scheduled for her to up her dose from 1.25 to 1.5U. I am just not sure if I should up it IF the Pred gives her a red AMPS tomorrow morning? Or do I wait for that Pred effect to calm down? How did you deal with that with your kitty?

Thanks for all your good advice!

 

[Tomlin]

Now that I understand better that the Pred effect can take a day or so to show up,

Actually that is not the case. The effect is pretty immediate....within hours. For T, his evening cycle is effected by the 5mgs of Prednisolone so he gets a higher dose of insulin in the evening than he gets in the morning when he does not get the Pred. Many times vets will recommend BID dosing for cats with DM so that the dosing is able to remain the same AM & PM.

So, if you look at 1/6, you will see how the BGs are clearly effected by the Pred AM & how they are lower PM.

This is important to keep in mind because as you increase the dose, the higher dose may be ok for the AM cycle with the Pred but may end up resulting in low BGs in the PM & also on days when you are not giving the Prednisolone.

 

[Tomlin]

Sorry for the 2nd post but I see in your signature that you are following TR?

I would personally not recommend using TR until you are able to discontinue the Prednisolone secondary to safety reasons—especially when you are giving it every 3rd day right now & the dosing may change again. This can really effect BGs during the cycles (as you are seeing).

SLGS may make the most sense for now. Keep in mind there are some recommendations for SLGS but it is not a set protocol like TR. It provides some solid guidelines/framework for someone if they are doing it on their own. Therefore, once you have data & understand onset, nadir, duration for your cat, there is definitely room to modify it with the help of some experienced members .

 

[Margaret and Pearl (GA)]

Sorry for the 2nd post but I see in your signature that you are following TR?

I would personally not recommend using TR until you are able to discontinue the Prednisolone secondary to safety reasons—especially when you are giving it every 3rd day right now & the dosing may change again.

I am happy to hold the dose as long as I need to in order to feel comfortable increasing. I know that her medications can affect the insulin. So I won't be automatically increasing every six cycles - so if that is the hard definition of TR, I suppose I am more "loose". I have to know her levels are stable in order to increase her insulin given her asthma. To be honest, the Pred might never go away. I can ask my vet about dosing BID instead of the one time. I am still trying to figure out how the Pred actually affects her. I do not think that the 1/06 AMPS is the Pred - I administered the Pred after that. So her levels went down all day that day, and spiked the next day (I suspect because she bounced). But I don't understand that part b/c I was expecting the Pred to increase her values.

Thanks for your input as I try to navigate this!!

 

[Tomlin]

I do not think that the 1/06 AMPS is the Pred - I administered the Pred after that. So her levels went down all day that day, and spiked the next day (I suspect because she bounced)

I am not saying the AMPS (pre shot) on 1/6 was because of the Pred. I know that the BG was before the Pred and before the insulin that day. I am saying if you look at your morning BGs as compared to the evening BGs, the Prednisolone is clearly effecting the morning BGs.

 

[Tomlin]

I can ask my vet about dosing BID instead of the one time.

In most cases, this is the easier way to manage the Pred with the insulin . However, if it is given every 3rd day, that is going to add a variable but a variable that is able to be worked with.

Again, if you look at 1/6, yes, there is a response to the insulin which is great—the numbers decreased. However, in the evening when that Pred was not influencing the glucose as much, the response to the insulin was even better . Every cat is different with how Pred will effect the BG. 2.5 mgs is not much Prednisolone and it looks like it isn’t effecting the glucose in ways it may effect another cat and that is really great.

I would change your signature to SLGS-modified while adjusting Prednisolone dosing. That helps people help you with dosing if/when needed.

 

[Margaret and Pearl (GA)]

Thank you so much for all your insights. So, if I am monitoring and keeping records like I would with TR, and am just going about changing doses a bit slower rather than every 6 cycles for sure (to make sure I am capturing her responses to the insulin/Pred combo), that equals SLGS-modified?? I am just wanting to make sure I understand completely (it's late here and my brain doesn't do so hot at night!).

I am so glad to have spoken with someone else who has done the Pred combo before, thank you. I appreciate all the help.

 

[Tomlin]

Thank you so much for all your insights. So, if I am monitoring and keeping records like I would with TR, and am just going about changing doses a bit slower rather than every 6 cycles for sure (to make sure I am capturing her responses to the insulin/Pred combo), that equals SLGS-modified?? I am just wanting to make sure I understand completely (it's late here and my brain doesn't do so hot at night!).

I am so glad to have spoken with someone else who has done the Pred combo before, thank you. I appreciate all the help.

Yes & it is awesome that you are monitoring closely to be able to get a good look at the trends. The trends help guide the dosing decisions.

I have done the Pred combo and have also been in your shoes with trying to lower the Prednisolone dose while adjusting insulin and watching for any signs of inflammation/clinical issues as well as increases in BG indicating an issue with the trial. It is a juggling act for sure but you are doing an amazing job as you take it day by day and gather data !

No matter what happens, this combo is able to be managed in most cats when necessary. I think the trial was much harder than actually regulating him once we determined the Pred needed to stay on board. I am keeping my fingers and toes crossed, maybe you won’t need it .

 

[Margaret and Pearl (GA)]

Yes & it is awesome that you are monitoring closely to be able to get a good look at the trends. The trends help guide the dosing decisions.

I have done the Pred combo and have also been in your shoes with trying to lower the Prednisolone dose while adjusting insulin and watching for any signs of inflammation/clinical issues as well as increases in BG indicating an issue with the trial. It is a juggling act for sure but you are doing an amazing job as you take it day by day and gather data !

No matter what happens, this combo is able to be managed in most cats when necessary. I think the trial was much harder than actually regulating him once we determined the Pred needed to stay on board. I am keeping my fingers and toes crossed, maybe you won’t need it .

Thank you so much. She did really well last night, didn't drop then bounce. So I put her up to her 1.5U dose today and we will see how she does on this. She was definitely more predictable on the 1.25 than her starting dose at 1U.

 

[Tomlin]

Thank you so much. She did really well last night, didn't drop then bounce. So I put her up to her 1.5U dose today and we will see how she does on this. She was definitely more predictable on the 1.25 than her starting dose at 1U.

Excellent !! Love to see that nice gradual step down in BG. Best with the new dose! Excited to see the progress.