? Vesper, AMPS 374 - Update from Internist

Kelly and Vesper

Kelly and Vesper

Member
Yesterday's post: https://www.felinediabetes.com/FDMB/threads/2-11-vesper-amps-375.298267/#post-3245135

Hi all,

Vesper continues to have barely any appetite despite being on cerenia, ondansetron, and Miratz. We finally got in with an internist today who said that her exam and initial bloodwork seem okay. She does not appear dehydrated or have any obvious red flags in the boodwork (no signs of DKA), though they are sending the blood out for more in-depth testing and will have results in 24h.

The vest suspects this is a pancreatitis flare and gave us 3 options: (1) add in a very low dose prednisone (recognizing that has risks/can worsen diabetes); (2) do further imaging tests (but unlikely to yield any info considering that she already had abdominal ultrasounds last week); (3) put her on a feeding tube to help get her through this flare.

Vesper has a bad history with feeding tubes, so we opted for #1. The vet is going to start her on the lowest dose of prednisone and wants us to watch her closely for 24h. She said it could either be a magic bullet or worsen things. If things worsen, she will need to be hospitalized again.

The vet agreed with everything else we were doing (offering a buffet of choices, keeping her on the antinauseas and appetite stimulant, letting her eat whatever food she will eat). She recommended that we consider bumping up the Lantus to 2 units so long as she's eating a little, given that we are adding in a steroid.

Does anyone have experience with steroids and diabetes? How much of a risk is this approach? Would appreciate any guidance.
 
Kelly and Vesper said:
Yesterday's post: https://www.felinediabetes.com/FDMB/threads/2-11-vesper-amps-375.298267/#post-3245135

Hi all,

Vesper continues to have barely any appetite despite being on cerenia, ondansetron, and Miratz. We finally got in with an internist today who said that her exam and initial bloodwork seem okay. She does not appear dehydrated or have any obvious red flags in the boodwork (no signs of DKA), though they are sending the blood out for more in-depth testing and will have results in 24h.

The vest suspects this is a pancreatitis flare and gave us 3 options: (1) add in a very low dose prednisone (recognizing that has risks/can worsen diabetes); (2) do further imaging tests (but unlikely to yield any info considering that she already had abdominal ultrasounds last week); (3) put her on a feeding tube to help get her through this flare.

Vesper has a bad history with feeding tubes, so we opted for #1. The vet is going to start her on the lowest dose of prednisone and wants us to watch her closely for 24h. She said it could either be a magic bullet or worsen things. If things worsen, she will need to be hospitalized again.

The vet agreed with everything else we were doing (offering a buffet of choices, keeping her on the antinauseas and appetite stimulant, letting her eat whatever food she will eat). She recommended that we consider bumping up the Lantus to 2 units so long as she's eating a little, given that we are adding in a steroid.

Does anyone have experience with steroids and diabetes? How much of a risk is this approach? Would appreciate any guidance.
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Hi Kelly, Sending you and Vesper lots of good vines and hoping she feels better.
I don’t have experience with these issues but am hoping you get some good suggestions soon. ❤️
:bighug::bighug::bighug:
 
I'm so glad she has no signs of DKA. You might want to invest in a blood ketone meter to have on hand just in case, as they can tell if there are ketones faster than the urine strips.
Have you seen this information about pancreatitis?
My diabetic had a few flare ups of pancreatitis and he received buprenorphine for pain, along with the antinausea drugs, fluids, appetite stimulant (I preferred cyproheptadine).
I do not have experience with steroids, but I have read (I've been around a long time) that you want Prednisolone rather than prednisone, and if you can get Budesonide instead it has less effect on the BGs.
Try doing a search on Budesonide in the Search bar on this site.
I'm so glad Vesper is getting the care she needs from you. Big Hugs.
 
Dyana said:
I'm so glad she has no signs of DKA. You might want to invest in a blood ketone meter to have on hand just in case, as they can tell if there are ketones faster than the urine strips.
Have you seen this information about pancreatitis?
My diabetic had a few flare ups of pancreatitis and he received buprenorphine for pain, along with the antinausea drugs, fluids, appetite stimulant (I preferred cyproheptadine).
I do not have experience with steroids, but I have read (I've been around a long time) that you want Prednisolone rather than prednisone, and if you can get Budesonide instead it has less effect on the BGs.
Try doing a search on Budesonide in the Search bar on this site.
I'm so glad Vesper is getting the care she needs from you. Big Hugs.
Click to expand...

Thanks for linking the info about pancreatitis. I'll take a look! Good to know about buprenorphine and cyproheptadine. I'll ask our vet about those when we talk next.

She was prescribed prednisolone, not prednisone. Her dose is 1/2 of a 5mg tablet every 24h. The vet said this medication is not being prescribed lightly for Vesper.
 
Leroy takes budesonide for his IBD and asthma. In fact, the prednisolone he was taking for IBD is what caused him to become diabetic :facepalm: For him, budesonide does spike his bgs. He gets budesonide with dinner and bgs always spike for the PM cycle. It usually wears off by AMPS. AM cycle has much better numbers. ECID :)

Leroy had pancreatitis recently. Has your vet done the FPLI test to determine pancreatitis? Leroy's level was way off the chart :eek: The vet didn't treat him with anything special. He just told me to continue with budesonide and use Mirataz if needed. Fortunately Leroy recovered quickly.
 
squeem3 said:
Leroy takes budesonide for his IBD and asthma. In fact, the prednisolone he was taking for IBD is what caused him to become diabetic :facepalm: For him, budesonide does spike his bgs. He gets budesonide with dinner and bgs always spike for the PM cycle. It usually wears off by AMPS. AM cycle has much better numbers. ECID :)

Leroy had pancreatitis recently. Has your vet done the FPLI test to determine pancreatitis? Leroy's level was way off the chart :eek: The vet didn't treat him with anything special. He just told me to continue with budesonide and use Mirataz if needed. Fortunately Leroy recovered quickly.
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Thanks for sharing this info. I'm going to ask our vet about budesonide. I think they are doing the FPLI test. I'll have more info about bloodwork results tomorrow. Glad Leroy's recovery was quick. I hope hers is too!
 
Your vet will probably have you get the budesonide through Wedgewood Pharmacy. It's a compounded medicine. Leroy gets the tiny tabs but there are other options like a flavored chew treat and capsules. I'm pretty sure the capsules can be pulled apart and the medicine mixed directly into some canned food or something like canned tuna without any loss of effectiveness but ask the vet to be sure. A local compounding pharmacy may also be an option.
 
I dealt with chronic pancreatitis for a long time in Charlie; he had it very bad for quite awhile. Pain meds were imperative — Buprenex (buprenorphine) was the go-to along with subQ fluids and anti-nausea meds (back then we used famotidine; if what you’re using isn’t working, you could always ask about trying it).

Charlie had IBD, and both pred and budesonide prescribed for IBD are what tipped him into diabetes. For what it’s worth, the steroids were not prescribed for the pancreatitis and the IM vet discontinued the steroids as soon as he became diabetic in lieu of other treatments. Does Vesper have IBD?

Before starting steroids, I might ask about giving something like Buprenex for pain control. Some vets like to give gabapentin or tramadol but I personally wouldn’t opt for those—they just don’t seem to help much for pancreatitis from what I’ve seen. Depending on the length of time and dose, you typically have to wean off steroids.

I’m glad they’re doing the fPLI test. Hopefully that’ll give you some answers.

Have you been syringe feeding at all? You can always consider doing that in small, frequent amounts as long as Vesper is keeping the food down (and only after you have anti-nausea meds on board).
 
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