? Blood sugar spike and dermatitits

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Tosca

Tosca

Member Since 2022
Tosca's blood sugar values before her shots were at around 120. Yesterday and today she was 243 before the shot. I thought it was because I gave her a wrong food yesterday, but now I see that her medication (started yesterday) for dermatitis, prescribed by her vet, has a corticosteroid. It is Viaderm K.C. and has Triamcinolone that is a corticosteroid. What can I do? Do I continue to put cream on her? Is it normal for a cream applied locally to increase the glucose so much? Not sure what to do...Is there another local antibiotic for cats without corticosteroid in it?
 
I would call your vet. It may not be a frequently occurring side effect but a topical steroid can cause a rise in blood glucose levels. Your vet may tell you it's not due to the steroid but to be honest, I've seen this happen with topical steroids including ear drops. You might ask your vet if there's an antihistamine or shampoo that would do the job.
 
Some topical steroids can raise glucose levels, but it's not as common as oral steroids. What I found out through research is that what usually happens to make the levels increase from topical steroids is:
  1. Being applied to broken skin, and getting systemic access that way
  2. Applied to a vascular area with thin skin (like the ears) that allows easier systemic access than thicker skin
  3. Applied in an area that the cat then licks, ingesting the topical ointment. Sometimes this is part of the reason why cats are recommended to wear an e-collar or something similar to prevent them from ingesting the medication
And sometimes they're just sensitive to it! Figured out Cadmium is rather recently. If it's temporary, your vet could also suggest to temporarily bump up the insulin to try and counter the insulin resistance the steroids are causing. If it becomes really problematic, there is also the option of discontinuing use of the medication. Just make sure to discuss with your vet all possible options, and to keep them in the loop if something goes awry.
 
Triamcinolone is a potent steroid and would likely raise BG. I would apply the Triamcinolone consistently until you stop. One you stop it is likely that BG will decrease and thus insulin needs will also likely decrease.
 
Thank you everybody for responses. Tosca had a value of 240 at nadir that didn't happened since we started insulin.
I finally contacted the vet as recommended, and they prescribed an antibiotic cream to try instead, called Taro-Mupirocin. If it doesn't work, we need to go back to Triamcinolone, and in that case will have to increase insulin, I guess .25 increase at a time? I will be afraid to increase more than that. Will see how this Mupirocin works for now.
 
If you need to raise Tosca's dose, you can raise it by 0.25u. Her numbers aren't terrible so you want to raise doses the way you would when following TR.
 
I just increased now, I gave 1.25. Her BG before the shot was 306!?! I am so worried. I hope is not something else, as I didn't put any steroid cream today. Can this be because of the steroid cream from yesterday?
If it is like this, can I give 1.5 tomorrow morning?
 
Tosca said:
I just increased now, I gave 1.25. Her BG before the shot was 306!?! I am so worried. I hope is not something else, as I didn't put any steroid cream today. Can this be because of the steroid cream from yesterday?
If it is like this, can I give 1.5 tomorrow morning?
Click to expand...
It is possible the 306 is from the steroid yesterday. Give it time to get out of the system.
I would stick with the 1.25 U for now and give it time for the depot to fill. I would not increase the dose.
Did you check for ketones in the urine?
 
No, I never checked for ketones, because I got her controlled early on. The vet couldn't explain how to measure for ketones at home.
I am not sure what to look for in Canada to measure ketones. Tosca went a little down at nadir, 260. She seems ok otherwise, eats very well her wet food. If I have to measure ketones, I could look for that tomorrow morning.
 
To test for ketones you need a bottle of Ketostix or Keto Diastix which you can buy cheaply from a pharmacy. You need to collect a urine sample from Tosca and then dip the test strip into the urine and read exactly 15 seconds later. There should be no ketones. Anything above a trace, tell the vet. It’s an easy test, the hardest thing is getting the urine if your kitty is not cooperative.
I suggested checking because the BG had gone up and it’s always a good idea to check for ketones if the BG is higher and you are not sure why.
 
I was so tired and stressed this morning, saying to myself do not fail the shot... that I did a fur shot, or partial at least. I was so upset when I smelled the insulin on my hand and her fur that I cried.
But at least Tosca is at 220 now close to nadir, despite me messing up her injection. So she is going down.
For the keto sticks, I don't think she will allow me go to near the litter box to get her urine for it. She is so private, and she had 2 severe constipation episodes recently (to the point of anesthesia to unblock her), that I am now worried she might get constipated if I stress her and she avoids the box.
And I remember that I have Abbot ketone and blood reader, so I can buy Abott sticks. Would they work for cats?
Also, a cat can have ketones if she is well hydrated and fed and behaves normally?
Thank you so much for all input!
 
The Abbott ketone meter (Precision Xtra) should be fine. Just keep in mind that the strips are really expensive.

The "recipe" for ketones is not enough insulin + not enough calories + an infection/inflammation. Hydration helps to lessen the effect of ketones. Likewise, most cats who have ketones don't feel well and are at the very least, lethargic. However, if you're catching ketones early, you can intervene before it's a critical situation.

For some cats, especially if they have had a bout of diabetic ketoacidosis (DKS), they seem to be more prone to developing ketones. Others, not so much. When my cat with diagnosed with diabetes, she was in DKA, had pancreatitis and hepatic lipidosis. She never had another episode of DKA nor did she develop ketones ever again. Not everyone is that lucky. We tend to err on the side of caution and if a cat is in high numbers, urge the caregiver to occasionally test for ketones as a precaution. DKA means an expensive hospital stay.
 
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