08.08, PORTO, AMPS 274, +5 361, PMPS 449 + 2 416, +4 370, +6 317 - budesonide Q, please help

[Manu & Porto]

condo

We´ve been absent these days, Porto has been on mirtazapine to stimulate his appetite and Ive desperately been looking for info and a vet open to working with us on trying budesonide. It has become very difficult, lately, to find a food for him, no matter how hard I tried. This was the last one that went with his tummy and he refused it at times even with the appetite stimulant. We are still on hold with the teeth check, so next week we will look into options.
Last night he started budesonide but this vet has never worked with budesonide before, as well as the other vets I consulted with before, but seeing me so desperate, she agreed to try. We are being cautious, so we started with a smaller dose, 0,5. In need, we could increase later, she said.
Right now his BG has raised, aprox +180 higher (449) than it was this morning (274) . He received it last night and it is late acting, so I assumed it started acting at around +10 h after administration.
I dont know if I should dose again tonight, or can I take a day off and administer tomorrow, just to see how it reacts. I understand the next dose will be realeased after 10 hours, again, but not sure how it works, honestly. Id have two questions..
1. Right now I figured I will measure his BG, before next dose of bude, and if the BG still grows, even after the administered pm insulin (we increased with 0,25), may I skip tonights dose of budesonide without causing havoc? Ive seen examples of budesonide EOD dosing but not sure if it is doable when starting or just when decreasing the dose?
2. Also, we were 4 days on 1,75 and we just increased to 2 ud. Should or could we increase more rapidly the dose because we are giving the budesonide? And not necessarily more rapidly, maybe up the dose with 0,5 instead of 0,25? Or should we stick with the SLGS rules and increase in 0,25 every 5 days in case there is no drop?
Tomorrow we phone the vet to let her know about changes after first administrations but until then, we are on our own. I hope she has some advice as this is such new ground for us.
Maybe someone worked with budesonide on lantus before and could share some experience, we would be so grateful for any tip.

 

[Tracey&Jones (GA)]

I answered on my thread but will answer here as well:

I would keep to the prescribed dosing of bude. If this is what he needs to keep the IBD under control then you will find your insulin dose to match. After awhile you will find his body may "regulate" the steriod use and the affect is not as extreme. I would keep to the SLGS approach during this time as you are getting used to how Porto will react to the bude. Keep notes as you are - they are good to have. Jones would get a +6 to +8 steriod bump sometimes.

It may take a bit to get things all regulated. That said, I don't use bude. @Wendy&Neko used bude. Would love to see what she says.

 

[Beth 73]

No expertise from me but hugs and prayers to you and beautiful Porto

 

[Wendy&Neko]

I too would keep on the dose of budesonide. My Neko took 1 mg a day. I thought I noticed some changes in her blood sugars the first couple of days on the budesonide, but I wasn't sure because she started 2 other medicines at the same time. After a couple of days, there was no impact on her blood sugar. It definitely improved her bowels. In her follow on ultrasound, the thickening went down 30%.

Porto's higher numbers today are probably due to a bounce from the blues last night, not the budesonide. It's been a while since he last saw blues.

I am glad you increased, although it's not what SLGS would have you do. According to SLGS, you wait 7 days on a dose before increasing. You only waited 4. Do not increase more rapidly because Porto is on budesonide. It may or may not impact his blood sugars. Too early to tell.

Sorry to hear Porto is still being fussy about his food. Is he getting any anti nausea medicine like Cerenia or ondansetron? Giving an appetite stimulant to a nauseous cat isn't a good idea. He will develop food aversions.

 

[Manu & Porto]

I answered on my thread but will answer here as well:

I would keep to the prescribed dosing of bude. If this is what he needs to keep the IBD under control then you will find your insulin dose to match. After awhile you will find his body may "regulate" the steriod use and the affect is not as extreme. I would keep to the SLGS approach during this time as you are getting used to how Porto will react to the bude. Keep notes as you are - they are good to have. Jones would get a +6 to +8 steriod bump sometimes.

It may take a bit to get things all regulated. That said, I don't use bude. @Wendy&Neko used bude. Would love to see what she says.

Thank you for your insight, so valuable to me, given you and Jones have been going through this for a longer time! The lower dose has been suggested more by me, his BG has been high and since it is more like an experiment here, at this point, using this budesonide form, with these excipients, the vet agreed. I have to say I am still looking for a compounded form, gonna try to order next week, when they said the lab opens. Right now, in august, everything colapses here, due to holidays. So I have to do it by myself, I have to squint hard when counting every little pebble and then I recount to make sure the count was correct.

I hope 0,5 does the trick and I did catch your reply and gave the dose again. He is dropping, at least, shows a bit of a curve, so that gives some room for when he will go high again. So far, so good. He had a nice poop and is sleeping so relaxed

Sweet dreams to Jones from us, for when he takes a nap, and lots of hugs for both!!

 

[Manu & Porto]

No expertise from me but hugs and prayers to you and beautiful Porto

Thank you so much, we send double back to you!

 

[Manu & Porto]

I too would keep on the dose of budesonide. My Neko took 1 mg a day. I thought I noticed some changes in her blood sugars the first couple of days on the budesonide, but I wasn't sure because she started 2 other medicines at the same time. After a couple of days, there was no impact on her blood sugar. It definitely improved her bowels. In her follow on ultrasound, the thickening went down 30%.

Porto's higher numbers today are probably due to a bounce from the blues last night, not the budesonide. It's been a while since he last saw blues.

I am glad you increased, although it's not what SLGS would have you do. According to SLGS, you wait 7 days on a dose before increasing. You only waited 4. Do not increase more rapidly because Porto is on budesonide. It may or may not impact his blood sugars. Too early to tell.

Sorry to hear Porto is still being fussy about his food. Is he getting any anti nausea medicine like Cerenia or ondansetron? Giving an appetite stimulant to a nauseous cat isn't a good idea. He will develop food aversions.

Thank you, Wendy! I have been looking at old condos of yours, while starting on budesonide especially, there is useful information that I received so thank you for that and for this! I thought 5 days is alright for now but good to be reminded and set on the right track. We will wait 7.

Can we up the dose of bude later on if this doesnt work with him? We just didnt know how his BG would react to it, the budesonide is destined for human use , comes in 3 mg capsules, and the vet is also at first try with it. It was this or not sure what, because we ran out of options for food. He received Cerenia every 5 days with two days of relax because he was more or less eating and not seemed nauseated, and I got to give him some wet in between some meals and he seemed to enjoy that. He did however stopped eating for 6 hours right in the last hours of the mirtazapine so he seems to go back to lack of appetite when off it. Id love-love to give him some food he likes but that would start the chain reaction of diarrea and getting back from that it has been so hard.
Hopefully it was a bounce and we get some nice numbers soon, thank you again!

 

[Wendy&Neko]

I think you should be able to increase the dose of budesonide later. I actually lowered it at one point. I got it compounded into a liquid, so it was much easier to measure smaller amounts. The 1 mg pills were very small and hard to cut accurately.

Cerenia can be given every day. You don't need the two days off in between. That is an old way of dosing Cerenia. Hopefully the budesonide will make him feel better and he'll get his appetite back.