Advice Needed - Prednisolone affects on PZ Insulin

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Laura and Harley (GA)

Laura and Harley (GA)

Very Active Member
Hi everyone,

I'm reaching out to all beans with extra sweet kitties who also have pancreatitis and use prednisolone. I need your help!

The short version of the story is that my sugarkitty, Harley, has been on micro-doses of ProZinc usually between 0.10-0.25u. Up until a few days ago I've been able to regulate him and keep his BGs under 180. After 3 trips to 3 different vets this week he has also been diagnosed with pancreatits and prescribed prednisolone.

For the full history, please see the following topics in PZI:

viewtopic.php?f=24&t=38874

viewtopic.php?f=24&t=39219

viewtopic.php?f=24&t=39301

He is currently on 5mg prednisolone SID given in the evening, 100cc SubQ fluids SID which I give him in the morning, buprenex BID for pain which I give him both morning and evening, and lactulose or miralax which I'm giving as needed for constipation. (He hates the pumpkin I've tried to get him to eat.)

I desperately need advice on what to shoot tonight. His numbers which were once in the mid to high 100s are now climbing into the 400s. (Please see my spreadheet which is current and up to date.) I'm thinking it's the prednisolone inhibiting the insulin action. But I don't know what to shoot. I have no data on what his normal profile of action would be if I shot 1 or 2 units so I can't even predict what he'd do with the pred. on board. I'm scared to death to give him another pred. tonight as I'm afraid it'll drive his BGs higher. He hasn't let me test for ketones yet so I don't know if he's going into DKA.

Should I stop the pred? Cut the dose in half and give 1/2 pill BID? What do I shoot? Or should I take him to the ER vet?

I'm so sorry I'm panicing here but I'm at a total loss. I'm trying to keep my boy safe but I seem to be screwing everything up.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Why did your vet start Harley on pred? The usual regimen for pancreatitis is fluids, pain meds, lower fat diet, and denamarin if liver values are elevated.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Kelly & Oscar said:
Why did your vet start Harley on pred? The usual regimen for pancreatitis is fluids, pain meds, lower fat diet, and denamarin if liver values are elevated.
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To bring down the inflamation. The vet who prescribed it wasn't my regular vet. (My regular vet was closed on Wednesday and I couldn't get ahold of her.) He did a full blood panel workup including the spec-fPL test and that result was 20. The other values (liver & kidney) were normal.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Just increase insulin as needed -- the nice thing about PZI is you don't have to keep a steady dose like the L's -- you can adjust the dose according to BG at shot time.

That said -- you don't have a lot of data to refer back to... (i.e. knowing what effect a 1u dose will have...)

I would increase to a full 1u with a BG of 400+ and test this evening to see how much drop.

Keep in mind that when Harley is feeling better and done with the Pred -- dose will need to go back down.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Phoebe_Tiggy_NortonGA said:
Just increase insulin as needed -- the nice thing about PZI is you don't have to keep a steady dose like the L's -- you can adjust the dose according to BG at shot time.

That said -- you don't have a lot of data to refer back to... (i.e. knowing what effect a 1u dose will have...)

I would increase to a full 1u with a BG of 400+ and test this evening to see how much drop.

Keep in mind that when Harley is feeling better and done with the Pred -- dose will need to go back down.
Click to expand...

That's why I'm in panic mode. No data. ohmygod_smile
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Based on yur data and my experience with temporarily using prednisolone for my Thunder I would start at one unit and move up (or down) as necessary). Before starting the pred Thundeer was good on 0.8 unit Lantus. I got up to 3 units while on 2.5 mg bid and 4 with 5 mg bid. After he was on the pred for a while his insulin needs went down a little.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Thank you to everyone for your replies. To add to the mix, I called the ER vet who I'd taken Harley too a week ago for his constipation (the fun which started this whole adventure) and he too asked why I was given prednisolone for pancreatitis. He said some vets prescribe it and some don't, but in this case because Harley's diabetic, he said I could either play it safe and stop the steroid or keep on giving it, but not exceed 1u in dose. At least to get me through until Monday so long as Harley is eating and using the litter box.

Harley is eating somewhat, I've gotten 1 jar of Gerber Baby Turkey, a few tsp of 9Lives, and 2 feedings of 1/4 can of Fancy Feast into him.This is about 3.5 to 4 oz. of food. He hasn't used the litterbox since this morning and is hiding. By this time yesterday he'd used the box about 3 times.

I'm going to stop this steriod. But I still haven't decided on what to shoot for tonight.

If he doesn't urinate tonight, should I rush him to the ER vet for ketone testing? I don't have a ketone meter, only the stix. Should I give him more SubQ fuilds? He feels dehydrated.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Got a ketone test just now and just for grins did 2 strips. ONe was negative and the other a faint hint of pink. PMPS is 374. I'll remove the 911 now, and figure out what to shoot thanks to everyone's advice.

Thank you much for all your quick feedback! I'm sorry if I'm a nervous Nellie - so used ot micro-dosing that zooming numbers freak me out.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Food for thought for you - I have a close friend that has a diabetic kitty that is on a low dose of pred for IBD. She got pancreatitis and her fPLi value was over 50 and the vet didn't increase her pred dose.

If another vet is questioning the pred too, then I'd be inclined to cut that out if Harley is responding to the sub-Q fluids, bupe, etc. At the very least, I'd try splitting that 5mg dose into a 2.5mg BID dose so it doesn't hit the system so hard.

The raise in numbers isn't solely due to the pred. The numbers started raising into the 200s before the pred was started if I read the spreadsheet right. The pred *may* be the reason why you are seeing 400s right now though.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Kelly & Oscar said:
Food for thought for you - I have a close friend that has a diabetic kitty that is on a low dose of pred for IBD. She got pancreatitis and her fPLi value was over 50 and the vet didn't increase her pred dose.

If another vet is questioning the pred too, then I'd be inclined to cut that out if Harley is responding to the sub-Q fluids, bupe, etc. At the very least, I'd try splitting that 5mg dose into a 2.5mg BID dose so it doesn't hit the system so hard.

The raise in numbers isn't solely due to the pred. The numbers started raising into the 200s before the pred was started if I read the spreadsheet right. The pred *may* be the reason why you are seeing 400s right now though.
Click to expand...

Hi Kelly, You're right, he started spiking 200s on Thursday before I got the first dose into him and I assumed that was his pain.

I swear you are a mind reader! After I posted above that I wasn't going to give the pred. I have been re-thinking that choice and toying with giving 2.5 mg BID instead to make his response more even and predictable. I've already given his evening bupe, roughly 2.5mg of Pepcid AC, and I shot 0.5u. I still haven't given the pred. though, trying to calm down, think rationally and work up my courage. Do you think 2.5mg pred. combined with 0.5u would be conservative choices?

As an aside, I did have to handle him to give the pill and bupe and he is experiencing discomfort. His right side is warm to the touch.
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

If he isn't a happy kitty right now you can either skip the pred tonight or wait an hour or two for him to calm down.

Try the 2.5mg BID dose with the 0.5u PZI for a day or two and see if there is any difference. How long did vet #2 want you giving the pred?
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Kelly & Oscar said:
If he isn't a happy kitty right now you can either skip the pred tonight or wait an hour or two for him to calm down.

Try the 2.5mg BID dose with the 0.5u PZI for a day or two and see if there is any difference. How long did vet #2 want you giving the pred?
Click to expand...

A 10 day course. 5mg SID. He asked me to call next week to give a progress update, sooner if Harley wasn't eating. My regular vet said she wanted me to touch base on Monday. I was thinking of calling them both on Monday and giving them an update on whatever I decide to do. I'll be out of bupe on Monday morning anyway. I only received a 3 day supply.

I spoon fed him 2 tsp FF Roasted Chicken with FortiFlora just now but sadly, I fear he may need a little of the appetite stimulation of the prednisolone. I also have cyproheptadine but when I tried to give that on Wednesday night and Thursday morning, Harley frothed, drooled and vomited up the contents of his stomach.

Bless you and thank you so much for all your help and hand holding. I'm so sorry to be such a bother to everyone. I'm trying listen and absorb all the advice. It's so bewildering trying to figure out what will be safe and healing for him. :-D
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Don't worry at all... we may seem confident ourselves, but when a crisis hits with one of our own, I'd be posting up too just to get reassurance :-D

Definitely keep us posted with his progress!
 
Re: Emergency Advice Needed - Prednisolone affects on PZ Ins

Harley came out of hiding, has eaten a little and played a little. Right now his idea of playing is me dangling a cat toy in front of him and he batting at it without moving. I've decided to skip the prednisolone for tonight and evaluate what the 0.5u is doing without it on board. That should give some data on which to base tomorrow morning's dose when I restart the pred. at 2.5mg bid.

Thanks everyone who responded in such a short time! Harley and I really do appreciate your help and reassurance!
 
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