Hi
@Lulu's person!
That is exactly what happened - but I did get notified of the PM. Obviously answering in the thread because the board rules don't allow medical advice to be given privately. Thank you for the suggestion.
I do indeed have a cat with both Addison's and DM. Her Addison's is the result of an adrenalectomy for a tumor that was causing Cushing's - her surgery was about 6 years ago now. Her remaining adrenal never recovered sufficient function so she is now reliant on steroids. She did, in fact, have an Addison's crisis which I attribute to the first IM who she saw and who was managing her case pre- and post-surgery. He had seen the warning signs on her weekly blood work, but instead of starting treatment he chose to give it "one more week". When she went into crisis, he then refused to approve starting treatment until he had personally examined her, leaving her hospitalized for 5 days on fluid therapy only and quite obviously actively dying due to lack of any real treatment. We pulled her from there and took her to another ER half a mile away where they saved her life.
According to Roxi's second IM, this combination should not really be possible in cats. His feeling was that because she had already been a long-term diabetic, there was just too much underlying destruction of beta cells in her pancreas for it ever to recover insulin production. With that said, I have not seen the kind of breakdown on an ACTH stim result that you have there so I have no idea if there is high progesterone in her results. According to the information on the results you have, high progesterone could be the cause of raised glucose levels which may not actually be true diabetes. That might at least partially explain the difficulty in finding a dose that adequately manages her glucose at all times.
Roxi started her Addison's journey on both prednisolone and Desoxycorticosterone pivalate (commonly known as DOCP and sold under the brand names of Zycortal and Percorten-V). DOCP is generally preferred over fludrocortisone for dogs and cats and is administered by a sub-q injection every 25-35 days (depending on the pet's individual response). For her, we were gradually able to wean her off the prednisolone - again, her IM specialist was not fully able to explain why she was OK off that one because most cats do need both and atypical Addison's (the condition that only requires one steroid) needs prednisolone but not DOCP. We do keep a small amount of pred on hand for stressful events as we were told she would likely need it if she was under stress. Fortunately, because I work in a clinic, she doesn't suffer huge amounts of stress when she comes to work with me for blood work etc because she can see me the whole time and has got used to the idea that sometimes she will spend the day at work with me.
If Lulu was my cat, given how borderline her glucocorticoid level was post-ACTH and the fact that she was stressed at the time (and therefore likely producing to her maximum capacity), I would ask to try a low dose of pred. Because Addison's tends to cause dehydration due to blood work imbalances, especially in electrolytes, this may be enough to at least partially resolve the dehydration and reduce the amount of fluids you need to give. I would also ask about switching the fludrocortisone for DOCP - it's easier to administer and works better in cats. Fludrocortisone doesn't control sodium levels well in cats, and often leaves the sodium level low compared to DOCP which could very easily be a major cause of her dehydration.
If you have other questions that I haven't answered here, please let me know - when I reply once to a thread, I do then start getting notifications. I had to learn most of what I know as we went along given how rare Addison's is in cats - if what I learned the hard way can be helpful to you, I'm more than happy to share information.
