12/2 Pearl - need to restart insulin. Dosing?

Margaret and Pearl (GA)

Margaret and Pearl (GA)

Member Since 2020
I can't believe I'm saying this. After just writing you on 11/30 that Pearl is doing SO WELL, she is....not.

The last time I had checked her BG was 11/11 - again, holding steady in the high 70s, low 80s. And then i had a brain blip - Pearl went to the vet on 11/11 and was put on Budesonide for IBD. Our vet said her BG was "perfect" at that time - and forgot to warn me about adding in a new steroid, even though techincally it is less likely (than Pred) that she would react with high BGs. Also, since Pearl wasn't eating, I had to add in some 13% carb food to her 0% (making her mix about 7% which is very high for a Pearl dependent on insulin) - but I figured NO PROBLEM PEARL. I honestly don't know WHY my brain didn't realize I need to check insulin weekly with these two changes (esp with the Budesonide).

I am pretty sure the Budesonide has brought her out of remission. I have STOPPED THAT, as well as switched back to ONLY 0% FOOD (and am praying she eats it). I thought maybe her body would right itself with stopping the Budesonide and would adjust itself back to her normal 70s-80s BG, but I don't know that this is what's happening. Last night and today so far, her BG has been 200-280. Yikes. I am so upset with myself - I cannot believe I never put 2+2 = 4 together that Budesonide might spike her. I am so angry.

What do I do? Do I start insulin again tonight, and do I do a drop dose, 0.25U, 0.5U, etc? Not sure where to go from here and appreciate any insight. Please note that right now, she is on no steroid. If I do add one back in, it will be the Pred every 4th day (she is fine on that in remission).

Thanks.

11/30 post: https://www.felinediabetes.com/FDMB/threads/11-30-hello-from-pearl.256105/#post-2883607
 
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While some cats do get raised bg on budesonide it’s less common. I know @Kyle & Simon is still in remission on it. I don’t think he gets it daily but not sure. Kyle is never online any more but her ss might help. I think it can take a few weeks for the steroid to totally be out of the picture to determine if that is the issue.
If you restart, I would start low. @Wendy&Neko Do you think .10 or .25?

I checked her ss but it’s no help. Don’t bother.
 
tiffmaxee said:
While some cats do get raised bg on budesonide it’s less common. I know @Kyle & Simon is still in remission on it. I don’t think he gets it daily but not sure. Kyle is never online any more but her ss might help. I think it can take a few weeks for the steroid to totally be out of the picture to determine if that is the issue.
If you restart, I would start low. @Wendy&Neko Do you think .10 or .25?

I checked her ss but it’s no help. Don’t bother.
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I think I’m going to put her back on Pred every 4th day eventually if needed since i know she can tolerate this whole being in remission.

It’s encouraging news that the Budesonide might take time to leave her system. I honestly don’t know what else it could be other than Budesonide combo with the A/D food. Both are now gone from her as of yesterday.
 
Is she perhaps sick? Any fever? Sneezing, runny eyes or nose?

Mr kitty got sick last week and he was way up in the 200s
 
FrostD said:
Is she perhaps sick? Any fever? Sneezing, runny eyes or nose?

Mr kitty got sick last week and he was way up in the 200s
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I think she isn’t sick she is actually acting pretty good lately. The increase in her appetite consistent orthopedic the FD didn’t start until very recently
 
I think I would start with.25. You could also start with .10. She might have an initial strong response or it could take time for the depot to build so you want to be able to monitor closely. Maybe pm Marje and Wendy and link this as they aren’t on her much so might miss your condo.
 
tiffmaxee said:
I think I would start with.25. You could also start with .10. She might have an initial strong response or it could take time for the depot to build so you want to be able to monitor closely. Maybe pm Marje and Wendy and link this as they aren’t on her much so might miss your condo.
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Thanks so much and yes I’ll PM Wendy and Marje now to let them know what’s going on! Hugs!
 
Sorry that's Pearl is back on the juice, Margaret. Hopefully it's short lived once she's back on the pred. There are a few other kitties here with what looks like budesonide induced diabetes because it's so commonly prescribed for IBD.
 
Katherine&Ruby said:
Sorry that's Pearl is back on the juice, Margaret. Hopefully it's short lived once she's back on the pred. There are a few other kitties here with what looks like budesonide induced diabetes because it's so commonly prescribed for IBD.
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Hi Katherine! Who would have ever thought the Pred would be better than Budesonide for a diabetic?! Lord have mercy, I should never have tried it.
 
Margaret (and Pearl) said:
Hi Katherine! Who would have ever thought the Pred would be better than Budesonide for a diabetic?! Lord have mercy, I should never have tried it.
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I think budesonide could be ok for a nondiabetic. Since Pearl is diabetic, she is sensitive and prone. Given all that you have going on, I would not be hard on yourself for not realizing this. A LOT of people told me that I needed to put Ruby on budesonide for her SCL because she is diabetic and it would not affect BGs that much but I am glad I listened to her oncologist and went with the pred. It knocked Ruby out of FD remission but it's done loads for her inflammation.
 
Katherine&Ruby said:
I think budesonide could be ok for a nondiabetic. Since Pearl is diabetic, she is sensitive and prone. Given all that you have going on, I would not be hard on yourself for not realizing this. A LOT of people told me that I needed to put Ruby on budesonide for her SCL because she is diabetic and it would not affect BGs that much but I am glad I listened to her oncologist and went with the pred. It knocked Ruby out of FD remission but it's done loads for her inflammation.
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I am really so happy to hear the Pred has helped Ruby and that she has improvement with the inflammation! I don't know how to ease Pearl back into her every 4th day Pred, and I never ever thought Pred would be preferable to Budesonide, I am still somewhat in disbelief with what has happened.

Thanks for your encouragement. I am really feeling pretty low. I am so hopeful Pearl (and I) can recover from this quickly.
 
Margaret (and Pearl) said:
I can't believe I'm saying this. After just writing you on 11/30 that Pearl is doing SO WELL, she is....not.

The last time I had checked her BG was 11/11 - again, holding steady in the high 70s, low 80s. And then i had a brain blip - Pearl went to the vet on 11/11 and was put on Budesonide for IBD. Our vet said her BG was "perfect" at that time - and forgot to warn me about adding in a new steroid, even though techincally it is less likely (than Pred) that she would react with high BGs. Also, since Pearl wasn't eating, I had to add in some 13% carb food to her 0% (making her mix about 7% which is very high for a Pearl dependent on insulin) - but I figured NO PROBLEM PEARL. I honestly don't know WHY my brain didn't realize I need to check insulin weekly with these two changes (esp with the Budesonide).

I am pretty sure the Budesonide has brought her out of remission. I have STOPPED THAT, as well as switched back to ONLY 0% FOOD (and am praying she eats it). I thought maybe her body would right itself with stopping the Budesonide and would adjust itself back to her normal 70s-80s BG, but I don't know that this is what's happening. Last night and today so far, her BG has been 200-280. Yikes. I am so upset with myself - I cannot believe I never put 2+2 = 4 together that Budesonide might spike her. I am so angry.

What do I do? Do I start insulin again tonight, and do I do a drop dose, 0.25U, 0.5U, etc? Not sure where to go from here and appreciate any insight. Please note that right now, she is on no steroid. If I do add one back in, it will be the Pred every 4th day (she is fine on that in remission).

Thanks.

11/30 post: https://www.felinediabetes.com/FDMB/threads/11-30-hello-from-pearl.256105/#post-2883607
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Hi, Margaret! I am so sorry that you are in this place with Pearl. Do not blame yourself for giving Pearl life-saving medications that may have happened to increase her BG and throw her out of remission. If she has been prescribed the Budesonide for IBD, it is crucial that she receive it. I am going to tag @Katherine&Ruby because she can be of great help here. Ruby has SCL and is on pred. Katherine has learned how to manage this very well. You, Margaret, are so skilled with handling Pearl and he other conditions like asthma … all on top of her diabetes… so I am certain that you can manage her IBD with the diabetes… even with the addition of Budesonide. Katherine has been on a business trip, but I know she will want to help. Take care, Margaret
 
Suzanne & Darcy said:
So funny that I am writing to you about Katherine and she’s writing at the same time to help! Psyche! knew she could help. Ive had cats on long- term steroids many tomes, but not my FD kitty. So I yield the floor to Katherine on that topic! :)
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Margaret is no stranger to pred. I looked at Pearl's spreadsheet time and time again when Ruby was starting on pred because Margaret managed Pearl's BGs so well on it. You've got this covered, Margaret. You will get her back into remission soon enough. :bighug:
 
Margaret (and Pearl) said:
Who would have ever thought the Pred would be better than Budesonide for a diabetic?!
Click to expand...
Budesonide is an ECID kind of thing. Most cats don't see much of a number bump from it. Neko didn't at all, and it helped her. Like any steroid, don't stop giving it abruptly, you need to taper it.

You started A/D and started budesonide at the same time. Hard to say if it was either of those, or the inflammation from the IBD that is causing her numbers bump. Zero % food not necessary, most people feed in the 3-6% range Feeding Lowest/Zero Carb vs Lower Carb Foods, though some do fine on higher % LC. Was she tested for pancreatitis? That can also cause a numbers bump.
 
Wendy&Neko said:
Budesonide is an ECID kind of thing. Most cats don't see much of a number bump from it. Neko didn't at all, and it helped her. Like any steroid, don't stop giving it abruptly, you need to taper it.

You started A/D and started budesonide at the same time. Hard to say if it was either of those, or the inflammation from the IBD that is causing her numbers bump. Zero % food not necessary, most people feed in the 3-6% range Feeding Lowest/Zero Carb vs Lower Carb Foods, though some do fine on higher % LC. Was she tested for pancreatitis? That can also cause a numbers bump.
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Hi Wendy! Yes, she was tested for Pancreatitis, totally normal there. I'll go back on the Pred (every 4th day), she knows that the best, and I can keep her BG regulated with it :)

I'm also not sure whether it was the A/D or the Budesonide or both - theoretically from past experience, the A/D shouldn't cause that much of a rise for her on its own. So I really have no idea, and I'm not sure whether her AMPS just now (111) 4:45AM EST indicates that she is clearing the A/D and Budesonide (now almost 3 days without either).
 
tiffmaxee said:
While some cats do get raised bg on budesonide it’s less common. I know @Kyle & Simon is still in remission on it. I don’t think he gets it daily but not sure. Kyle is never online any more but her ss might help. I think it can take a few weeks for the steroid to totally be out of the picture to determine if that is the issue.
If you restart, I would start low. @Wendy&Neko Do you think .10 or .25?

I checked her ss but it’s no help. Don’t bother.
Click to expand...

Hi there! Not sure if this is helpful, but Simon is still in remission after a year and a half on budesonide. I am still feeding him fancy feast pate, and he only gets 1 mg of budesonide a day.

Im sorry Pearl has gone out of remission!

Wishing you luck!
Kyle
 
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