? 3/12 Chico AMPS166, +6 241 - Insulin dosing with prednisolone

Marina & Chico

Marina & Chico

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Previous post: ? - 2/8 Chico PMPS 119 | Feline Diabetes Message Board - FDMB

Hello all,

After an anxious period the vet finally prescribed Chico 5mg/day of prednisolone separated in 2 different doses with the insulin preshot. We started giving him pred yesterday. As expected his numbers are raising and we would like to ask for advice when should we start considering increasing insulin dose and by how much.

Our experience with insulin says to wait for 3 days and only then consider a dose increase. Is that the correct thing to do or do we decide sooner to take action?

@Margaret and Pearl (GA) thank you soo much for your offer to help with the dosing, this would be very much appreciated :bighug:

@Karen and Chispa (GA) thank you Karen as well for your kind support and messages, having this community here really feels really comforting.
 
The only reason I could think of for splitting the pred dose is to try to even out the blood sugars each cycle. I've seen people decide which cycle to give the entire dose, based on what works for him. One person gave it in the AM, so her kitty would be safe while she was at work during the day. Another gave it at night to get more sleep.

With confirmed IBD, another alternative to pred is budesonide. For many cats, including Neko, budesonide does not impact the blood sugars. It is a steroid that acts locally, mostly in the GI system.

As far as dosing goes, increases are by 0.25 units at a time, unless he's solidly above 300, which he isn't. You had three cycles of skipped doses in there, so that impacts the depot. I'd give him another cycle after today (ie. tonight) and if he's continuing to trend up, increase in the AM. That's only 7 cycles after the skips, but his numbers should be going down as cycles go by, not up. Looks like the pred influence if he continues the upward tonight. The other possibility besides the steroid is a bounce - is it possible to get tests past +2 at night?
 
Leroy is a weirdo cat because budesonide does affect his blood glucose levels :rolleyes: He gets budesonide with dinner so while PMPS might be blue or green, AMPS is always yellow. I give budesonide with dinner because I don't have the energy to mess with more stuff in the morning:p

Are you treating the IBD in any other way? Probiotics, digestive enzymes, novel protein diet, B12 injections, etc?
 
Wendy&Neko said:
As far as dosing goes, increases are by 0.25 units at a time, unless he's solidly above 300, which he isn't. You had three cycles of skipped doses in there, so that impacts the depot. I'd give him another cycle after today (ie. tonight) and if he's continuing to trend up, increase in the AM. That's only 7 cycles after the skips, but his numbers should be going down as cycles go by, not up. Looks like the pred influence if he continues the upward tonight. The other possibility besides the steroid is a bounce - is it possible to get tests past +2 at night?
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Thank you Wendy for the advice, i only read your message after giving him the norning dose but we will increase tonight.
 
squeem3 said:
Leroy is a weirdo cat because budesonide does affect his blood glucose levels :rolleyes: He gets budesonide with dinner so while PMPS might be blue or green, AMPS is always yellow. I give budesonide with dinner because I don't have the energy to mess with more stuff in the morning:p

Are you treating the IBD in any other way? Probiotics, digestive enzymes, novel protein diet, B12 injections, etc?
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Thank you for your reply and for sharing your experience.

We tried for years managing his ibd with diet and it worked well until last summer when he started having diarrhea again. We switched from the raw diet he was on to a commercial sheep protein (no gluten, single protein for digestive issues) and it worked for 1 or 2 months and he started again having diarheea and continued vomiting. Chico has another weird symptom, he coughs. We did several tests and nothing seemed wrong with his lungs so we assume his cough is due to inflamation in his digestive system that iritates his lungs.
Just to clarify, the reason we switched to commercial brand is because there is not other raw novel protein we can find in our region that we could feed him.
We are giving him probiotics. We will get to visbione as well, but not yet.
 
tiffmaxee said:
Why separate the doses of prednisolone? I was always told to give it all at once. You see seeing green si I epii go of not increase yet. See what others think. @Bron and Sheba (GA) @Wendy&Neko
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Splitting the Pred keeps the BG from going super high one part of the day and then low the other part of the day - if the cat can clear the Pred effects in that timeframe. Evens it out for higher Pred doses daily especially. When Pearl would get lower Pred doses, I would give it all at once. For me personally, trying to do the insulin dosing with 5mg daily for long periods, it was really tough to have any kind of regulation with the diabetes. This is what we did and it helped. But I also know there is no hard and fast rule as to how Pred will work and some cats may not have that spike one cycle go low one cycle (or some combo like that). I definitely experimented to find what would work best for us. With Pred for IBD or gut issues my vet had told me it didn't really matter all at once or split, from that perspective diabetes not considered.

Hope this helps @Marina & Chico. As for dose increases, you would do it under the same criteria as always, that doesn't change. But the NADIR might change, the patterns you see in the BG may change, you may notice a hard onset of the Pred where the BG shoots up and then see it come back down (if Chico will be obvious about clearing Pred effects). And know that the changes in BG patterns will perhaps not be limited to each cycle separately, the effects of the morning Pred may spill over into the nighttime BG cycle and then you've got the nighttime Pred dose, so it may take some time for you to figure out how the Pred is affecting things and what you can expect/predict. He may also become more bouncy - you have to just know it will be some learning because the Pred does change things.
 
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Hi Marina,

I'm glad your vet agreed to try prednisolone, and I hope you'll start to see his GI symptoms improve soon. I think it takes a week or two to really get in there and start working.

About splitting the dose, I've heard different things from different vets. Some think a steady level in the system is best, while others say it's more effective delivered in one big hit. It probably depends on the cat. Once you have a handle on how it's affecting Chico's BG, you can adjust according to his and your needs, like Wendy said.

If the pred works and his GI symptoms stabilize, maybe you can try budesonide at some point. It's good that you're doing probiotics as well. Good luck with all of it, and keep us posted! :bighug::cat:
 
Margaret and Pearl (GA) said:
Splitting the Pred keeps the BG from going super high one part of the day and then low the other part of the day - if the cat can clear the Pred effects in that timeframe. Evens it out for higher Pred doses daily especially. When Pearl would get lower Pred doses, I would give it all at once. For me personally, trying to do the insulin dosing with 5mg daily for long periods, it was really tough to have any kind of regulation with the diabetes. This is what we did and it helped. But I also know there is no hard and fast rule as to how Pred will work and some cats may not have that spike one cycle go low one cycle (or some combo like that). I definitely experimented to find what would work best for us. With Pred for IBD or gut issues my vet had told me it didn't really matter all at once or split, from that perspective diabetes not considered.

Hope this helps @Marina & Chico. As for dose increases, you would do it under the same criteria as always, that doesn't change. But the NADIR might change, the patterns you see in the BG may change, you may notice a hard onset of the Pred where the BG shoots up and then see it come back down (if Chico will be obvious about clearing Pred effects). And know that the changes in BG patterns will perhaps not be limited to each cycle separately, the effects of the morning Pred may spill over into the nighttime BG cycle and then you've got the nighttime Pred dose, so it may take some time for you to figure out how the Pred is affecting things and what you can expect/predict. He may also become more bouncy - you have to just know it will be some learning because the Pred does change things.
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Thank you so much for your input, that really answered most of our questions :bighug:
 
Karen and Chispa (GA) said:
Hi Marina,

I'm glad your vet agreed to try prednisolone, and I hope you'll start to see his GI symptoms improve soon. I think it takes a week or two to really get in there and start working.

About splitting the dose, I've heard different things from different vets. Some think a steady level in the system is best, while others say it's more effective delivered in one big hit. It probably depends on the cat. Once you have a handle on how it's affecting Chico's BG, you can adjust according to his and your needs, like Wendy said.

If the pred works and his GI symptoms stabilize, maybe you can try budesonide at some point. It's good that you're doing probiotics as well. Good luck with all of it, and keep us posted! :bighug::cat:
Click to expand...
Thank you so luch for you input, it is really helpful and reassuring :bighug:
 
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