11/27 remi AMPS 95,+1 86,+4 77,+6 83, PMPS 97,+2 95,+5 86

Status
Not open for further replies.
phlika29

phlika29

Member Since 2014
Hi everyone

Today is not a good day. Remi had an asthma attack last night and I was up with him from 4am trying to get it under control with the ventolin. Today he is still wheezy. Since coming off the oral steroids when he got his diabetes diagnosis his asthma hasn't been under the best control and when I turned the heating on it got worse. So today I am pretty fed up, I felt he was getting close to being diet controlled but now I feel that I am back to square one. I have spoken to the vet and he feels that a short sharp steroid shock will help knock back the inflammation and hopefully not upset his diabetic control too much. So he has prescribed 5 mg prednicare and he literally wants me to just give him one tonight and then if that doesn't do the job another tomorrow night up to a max of five nights.

So I have lots of questions but my main ones are: how to I dose him tonight? I would tend to give the steroid with his other tablets half an hour before his insulin shot and food. Is that the best time or should I wait until after his insulin? is there any rough guide as to how much his blood glucose will go up and should I increase his dose just in case or do I have to wait to see and increase in the next round.

He is under tight regulation at the moment and whilst unrealistic I would like to keep him there. I am desperately trying to get over my disappointment as I know breathing trumps everything but I had set my hopes on having him diet controlled by xmas and was working hard to achieve it. Now it is slipping away.

Thanks for the helpful comments about the food in yesterdays thread. I will comment on them when I get home in a bit.viewtopic.php?f=9&t=129040
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

While it can be frustrating to know that there's a very good chance that the steroids may cause a rise in Remi's numbers, the good news is that the insulin dose can be worked around what Remi needs. There isn't a "formula" that will tell you how much of a dose increase will be needed. Basically, you follow the principles of Tight Regulation and increase the dose based on where Remi's nadirs fall.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

responding to your PM here.

Not all cats see a rise in numbers when they start prednisolone. Some do, so you'll just have to see. It sounds like you're just giving a short course of steroids, so the good news is that you should be able to get his numbers back under control quickly once he's off as long as you don't let glucose toxicity take hold.

Timing - Remi is pretty flat these days, so you should be able to time it however is convenient for you.

You're good at testing and you're good at interpreting your data - my suggestion would be to respond quickly if you see the numbers rise. Of course don't panic and get crazy with increasing the dose impulsively, but if you find yourself thinking "this isn't working" then go ahead and increase to try to keep his numbers in range as much as you can. Just recognize that once the steroids are gone, he'll probably need to come back down in dose and that might happen quickly too. Go back and study Jill's spreadsheet for some ideas.

Regarding dose increases - one thing to keep in mind as your watching his numbers is that some cats have markedly different (higher) numbers in the cycle when they receive the steroid vs. the one when they don't. If you give the pill at night, his numbers might be higher at night than during the day. If that is the case, then I would base the dosing on the lower cycle. You don't want to let him go *too* low during the day just because you're trying to keep the nighttime numbers from getting too high.

If it turns out that the steroids need to be long term, then so be it. We have seen cats go OTJ with steroids too, though unfortunately it's not that common.

BTW, I saw this in yesterday's condo:

When I went to to the vet a few weeks ago remi's BUN level was raised and the vet said that this could be a result of various things including his high protein diet.
Click to expand...
I'm not a kidneys expert by any means, but I have observed elevated BUN in my own cats. My vet also said that is common with cats on an all wet food diet. She was not that concerned because their other renal values are good. I'm not sure how high is too high, though. I seem to remember thinking Jazzy's BUN was quite high, but her Creatinine was fine and everything else was fine so the vet said not to worry.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

Max has had a high normal or slightly over for years but his creatinine is great so my vet said it is not a concern. BUN does change with diet and would be higher if the testing was not done on a fast as well. I hope the pred doesn't cause any issues.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

Thanks Libby for your detailed reply. I think I was just so focused on getting remi off the juice that I lost what I was working towards. In the end I want a happy cat and if that means being on the insulin and steroids then so be it.

It's great advice as per usual. I guess I will just have to play it by ear as much as I really wish there was a manual :-D I will keep testing and watch his numbers carefully. I am not 100% sure when glucose toxicity occurs. Is it anything over 120? I dearly would like to keep him tightly regulated and hope I can learn the new dance quickly.

Having said that I wont actually be starting the steroid tonight now as we have a change of plan. My vet spoke to a specialist and she advised that there could be an underlying bacterial infection some sort of mycoplasma ??? Sorry I forget the name. So I have been issued with an antibiotic Ronaxan and advised to start with this tonight and if no improvement by tomorrow night to add in the 5 mg steroid tablets for 2 or 3 days. In addition tonight I will also be starting him on accolate in the hope that this eases inflammation and works with the oral steroid.

So I am part relieved for now and part worried. The vet thinks that there are underlying issues to remi's asthma and this is why he is not well controlled on inhaled steroids and the ventolin doesn't seem to work well at opening his airways. Maybe bronchitis, maybe this bacterial infection.

Fingers crossed the antibiotics work. I can't bear to hear him struggle to breath .

Libby and TIiff With regards the BUN Level yes his creatinine is fine. It is reassuring to know that others cats have the same thing. I was worried high BUN might actually cause kidney issues but he vet confirmed no that wasn't the case and your experiences back that up. Thank you for the reassurance and advice.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

Sienne and Gabby said:
While it can be frustrating to know that there's a very good chance that the steroids may cause a rise in Remi's numbers, the good news is that the insulin dose can be worked around what Remi needs. There isn't a "formula" that will tell you how much of a dose increase will be needed. Basically, you follow the principles of Tight Regulation and increase the dose based on where Remi's nadirs fall.
Click to expand...

Thankyou Sienne. I guess I am just going to have to play it by ear. Tonight I am meant to just be starting him on an antibiotic however when I picked him up to give it he started wheezing again and to be honest if it doesnt improve by the time I go to bed I will also give the steroid as it is very stressful to hear him like this. I am gutted that he went from being okay being like this in 24 hours.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

no additional advice from me, just a big hug because i know how scary it is when your kitty isn't doing well.

:YMHUG:
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83-back on steroids-ad

Sending all sorts of vines for Remi's little lungs. I hope the antibiotic is the ticket.

Like Libby said, some kitties show just a brief reaction to the steroid so it's best to see how Remi's BG reacts to it. Mariko's Lucy would react for less than one cycle, so Mariko ended up giving her pred in the morning so Lucy would be safe during the day while she worked.

Higher BUN is also a documented result for raw food diets (which Neko is on).

You also asked about glucose toxicity. Another of my reading lately that I'm going to add to the posts when I complete my list, is a talk by Dr. Kathy Lunn on Endocrine Updates. Dr. Lunn is one of the foremost US internal medicine vets when it comes to acromegaly. Check out the section starting page 2 on glucose toxicity.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83, PMPS 97,+2 95,+5 8

Thanks Julie and Wendy

Remi's had his first dose of antibiotics and now the accolate. He is still wheezy and so I think I am going to try to get him to sleep with me on the sofa tonight rather than in bed as per usual. I worry that there are more allergens in the bedroom.

I do feel bad that I was so focused on the diabetes that I let the asthma slide more than I should and now am worried that it has progressed to a point of no return.

Hopefully tomorrow will see an improvement. If not I will give him the steroid.

Thanks again for everyone's kind thoughts, wishes and advice.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83, PMPS 97,+2 95,+5 8

HAPPY THANKSGIVING!!

I hope you and Remi get some sleep tonight. Don't beat yourself up....it's only natural to put out the fire at your feet first. Sending good breathing vines for Remi.
 
Re: 11/27 remi AMPS 95,+1 86,+4 77,+6 83, PMPS 97,+2 95,+5 8

Hi Sarah.

I'm sorry Remi's asthma is flaring up. I hope you are able to get it under control Cinco was briefly on Pred and it did not seem to affect his numbers at all that I could tell. I have a Civvie that's been on it for a couple of years and she has so far shown no signs of developing FD (anti-jinx). So Remi may not react to it at all. Paws crossed!

Sending good breathing vines for Remi and hugs for you. You are doing a great job - do not sell yourself short! :YMHUG:
 
Status
Not open for further replies.
Back
Top