Budesonide knocked Pants out of remission. Now what?

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membeth

membeth

Member Since 2017
Anyone have experience with steroid induced hyperglycemia in a diabetic kitty? How long did it take for the BG to go down after stopping steroids? Or did it not fall at all?

Here's my situation (sorry for the long post, but my poor kitty has a lot going on):

Pants was in remission for a year but intermittently barfing and slowly losing weight. Turns out she also has EPI (insufficient pancreatic enzyme), IBD, and B12 deficiency. She's on pancreatic enzyme (in tuna), B12 injections, and we switched to Royan Canin PR canned (limited ingredient, but higher carb than I'd like at 15%). None of that changed her BG.

Then a specialist internal medicine vet pushed budesonide. When I raised concerns, the vet assured me it wouldn't spike her BG, and if it did go up somewhat, it'd go down immediately if I stopped the steroid.

Bad advice! In a couple of days on budesonide, Pants went from 124 to 482. Three weeks later after stopping the steroid, her BG has fallen some, but not enough -- she's now between 290 - 350.

So far, other than peeing more, she seems fine. There's glucose in her urine, but no ketones so far. She's playing, eating, and seems happy. She's even gained back a bit of weight.

She can't stay at 290 - 350 indefinitely, but I'm terrified of having her back on insulin because she is super sensitive to it (300 point BG drop from 1/2 unit of Lantus) and had two near fatal hypos within a week of starting on insulin. She survived and it triggered remission, but we may not be so lucky next time...

So, now what?

Wait longer and see if it goes down more?

Hospitalize her so they can try insulin but she's safe if she crashes?

Take her off the special allergy food (Royal Canin PR - canned, but 15% carbs) and put her on a lower carb food, but risk another round of barfing/weight loss?

Some other option I'm missing?
 
Poor girl does have a lot going on, but it sounds like you are on top of things! I’ve never used budesonide, so I’m not sure what to tell you, but it seems like 3 weeks off would be long enough to know. One person I know that has used it is @Wendy&Neko she’s also familiar with multiple conditions, so maybe will have some insight.
 
I know many cats do OK on budesonide, but it seems like the only possible cause of the sudden change in her BG levels. The spike in her BG was big and immediate and she'd been pretty stable before taking the steroid. Also, her BG did drop a lot after she stopped taking it, just not enough. The vet checked for signs of some other unrelated problem (UTI, tooth issues, other infection) that could have caused the sudden jump in her BG and found nothing. So despite the prior assurances that this couldn't possibly happen, both the specialist vet and the regular vet are pretty sure it's from the budesonide.
 
Sharon14 said:
Poor girl does have a lot going on, but it sounds like you are on top of things! I’ve never used budesonide, so I’m not sure what to tell you, but it seems like 3 weeks off would be long enough to know. One person I know that has used it is @Wendy&Neko she’s also familiar with multiple conditions, so maybe will have some insight.
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Thanks.
 
I found that a grain free limited ingredient single protein canned food worked very well for my IBD cat. There are lower carb pates you can use in lieu of the Royal Canin that your IBD kitty may be able to tolerate.
It seems the Budesonide reacts differently in different cats. My IBD cat was on it for 4 days and developed congestive heart failure. His specialist and cardiologist were surprised as it was not supposed to have the systemic effects that pred has. Apparently my cat was developing HCM heart disease but had no symptoms yet and the budesonide unmasked all of it. Balancing IBD and diabetes gets complicated because food is always a major issue. I hate to say it because I'm not a fan of Hills cat food but my IBD kitty also did well on the Hills ZD hydrolized canned food.
 
My kitty did fine on budesonide as far as her blood sugars, but we do have one other member whose kitty became diabetic because of it. Not sure if @jayla-n-Drevon is on often. I believe she tapered off the budesonide and started insulin as long as he needed it and he's now in remission. Her kitty went on budesonide because his heart could not handle pred, same reason Neko went on budesonide.

Given Pant's high numbers, you are right you can't leave him there. I wouldn't delay because his body will get used to those numbers. We have some people here on even smaller doses of Lantus, such as 0.25 units or 0.1 units. Maybe you could try a really tiny dose and see what happens. Also, what happened over a year ago is old news as far as the pancreas goes.

This website has a good discusion on food for IBD kitties: http://www.ibdkitties.net/
 
She seems to be acutely sick now -- diarrhea so bad she didn't make it to the box. So we're on our way to the vet later this morning. Sigh. She's still eating and seems not to feel poorly, but her BG was even higher at 368. Still no ketones, fortunately. Hopefully this is something minor. And if we're really lucky, maybe it's a little infection contributing to the BG being up and a round of antibiotics will help even things out. Wish us luck.
 
So the immediate problem is minor -- we got some antibiotics and she'll be fine, tummy wise, in short order. But she needs to go back on insulin.

I am so so angry and upset. If I had trusted my gut instead of the specialist vet, we wouldn't be in this situation. And I feel absolutely awful that something I did hurt her.

The regular vet wants her back in the care of an internal medicine vet to start insulin, and agrees it probably has to be done in the hospital, given her history. So now I'm trying to get in to a different internal medicine specialist, since I don't trust the one who got us into this mess.
 
Wendy&Neko said:
My kitty did fine on budesonide as far as her blood sugars, but we do have one other member whose kitty became diabetic because of it. Not sure if @jayla-n-Drevon is on often. I believe she tapered off the budesonide and started insulin as long as he needed it and he's now in remission. Her kitty went on budesonide because his heart could not handle pred, same reason Neko went on budesonide.

Given Pant's high numbers, you are right you can't leave him there. I wouldn't delay because his body will get used to those numbers. We have some people here on even smaller doses of Lantus, such as 0.25 units or 0.1 units. Maybe you could try a really tiny dose and see what happens. Also, what happened over a year ago is old news as far as the pancreas goes.

This website has a good discusion on food for IBD kitties: http://www.ibdkitties.net/
Click to expand...
Hi,
Yes my Rico started drinking much more after starting the steroid (he had been on pred as Wendy said but we were at a cardio from that awful heart episode due to the pred. So the cardio put him on budesonide 1mg.
He was still spiking so I started insulin I dosed very carefully because I knew his pancreas worked.
Then I started tinkering with the budesonide dose and we found a dose that keeps his IBD under control and he his
sugar in check, he been in remission for almost 2 years. It is a delicate balance but it is worth it because all the inflammation from the IBD I think would cause more damage than having to treat FD.
He gets about 1/2 a mg with his other meds in the gel cap as well as vetmedin and other supplements When this was all happening the vets were preparing me for him not recovering ...he is 20 years old now (this was about 2 years ago)
His heart seems to have recovered as well because he is getting fluids again too--small amounts and I have a good stethoscope.
It may take a while to find the right balance it took me a few weeks. Good Luck :)
 
jayla-n-Drevon said:
Hi,
Yes my Rico started drinking much more after starting the steroid (he had been on pred as Wendy said but we were at a cardio from that awful heart episode due to the pred. So the cardio put him on budesonide 1mg.
He was still spiking so I started insulin I dosed very carefully because I knew his pancreas worked.
Then I started tinkering with the budesonide dose and we found a dose that keeps his IBD under control and he his
sugar in check, he been in remission for almost 2 years. It is a delicate balance but it is worth it because all the inflammation from the IBD I think would cause more damage than having to treat FD.
He gets about 1/2 a mg with his other meds in the gel cap as well as vetmedin and other supplements When this was all happening the vets were preparing me for him not recovering ...he is 20 years old now (this was about 2 years ago)
His heart seems to have recovered as well because he is getting fluids again too--small amounts and I have a good stethoscope.
It may take a while to find the right balance it took me a few weeks. Good Luck :)
Click to expand...

Thanks so much for telling me about your experience. Pants started out on 1/2 a mg of budesonide, so if the IBD is bad enough that she really needs a steroid, I think she's going to remain insulin dependent. We're going in to the new internal medicine specialist Tuesday morning. Her stomach bug seems to be mostly under control, but she still seems a bit off, so I'm glad they were able to get us in so quickly.
 
membeth said:
Thanks so much for telling me about your experience. Pants started out on 1/2 a mg of budesonide, so if the IBD is bad enough that she really needs a steroid, I think she's going to remain insulin dependent. We're going in to the new internal medicine specialist Tuesday morning. Her stomach bug seems to be mostly under control, but she still seems a bit off, so I'm glad they were able to get us in so quickly.
Click to expand...
I would do the same to control the fd first just because we have some control of that and I think the IBD would cause more damage than the FD. Good luck with new doctor :)
 
The new vet seemed good and hospitalized her immediately. They had her fast for 24 hours and her BG fell from 344 this morning (10 hours in to the fast) to 206 this evening. They're going to start her on .5 of Lantus if she goes back up (which unfortunately, I assume she will).

In many cats, I know the IBD is more problematic than diabetes, but neither my regular vet nor the new internal medicine vet seems to think that's true of her. It's not clear her IBD required more than a dietary change. Switching to the Royal Canin PR almost totally stopped the barfing/hairballs, and they think her failure to gain back weight is from the EPI. It may be that if they can get her in remission, all she needs is pancreatic enzyme, monthly B12 shots, and limited ingredient food.

Fingers crossed!
 
She's been between 180 - 280 for another 24 hours without receiving any insulin. She's still hospitalized and they'll start Lantus if it creeps back up, but for now, they're just observing her. She's stressed and incredibly pissed off, which you'd think would make her blood sugar go up, but so far, she seems to be naturally trending down. Cats are just so weird.
 
Wendy&Neko said:
My kitty did fine on budesonide as far as her blood sugars, but we do have one other member whose kitty became diabetic because of it. Not sure if @jayla-n-Drevon is on often. I believe she tapered off the budesonide and started insulin as long as he needed it and he's now in remission. Her kitty went on budesonide because his heart could not handle pred, same reason Neko went on budesonide.

Given Pant's high numbers, you are right you can't leave him there. I wouldn't delay because his body will get used to those numbers. We have some people here on even smaller doses of Lantus, such as 0.25 units or 0.1 units. Maybe you could try a really tiny dose and see what happens. Also, what happened over a year ago is old news as far as the pancreas goes.

This website has a good discusion on food for IBD kitties: http://www.ibdkitties.net/
Click to expand...
Wendy is correct about Jayla’s Rico. He has not needed insulin since she cut back on his budesonide. When it did spike she also gave a tiny dose as needed.
 
Pants spent Tuesday - Friday hospitalized, but bizarrely, without getting any insulin, she fell from 359 when admitted Tuesday morning to 206 by Tuesday afternoon and remained between 190 - 280 the whole time she was there and had no symptoms. No glucose in her urine after the first day, no excessive thirst/peeing, nothing. They never started her on insulin. Their best guess was some combination of time and antibiotics dealt with the hyperglycemia.

Now she's home and seems fine but her numbers are back up. She was at 336 at noon today. Argh!

How can her BG possibly be LOWER in the high stress environment of an animal hospital where she's pissed off and hissing at everyone than at home where she's purring her head off and happy???

I'm hoping this is just the stress of a transition and she'll be back in the low 200s tomorrow and fall from there. But, really? Four days of lower BG there, then back up as soon as she's home? Soooo aggravating!

Cats are just so weird.
 
My Neko often dropped her BG at the vet. Blood pressure on the other hand, through the roof. Any chance Pants didn't eat as much at the vet? I hope she's feeling better now.
 
She seems to feel perfectly fine, but is at 350. And yes, I think she must have eaten less, as she lost a little weight.
 
We're up to 402. It's 1 AM here and she'd been fast asleep before I tested and hadn't eaten in a couple of hours. We're going to have to go back in to the vet. This is so upsetting and frustrating.

They wanted her hospitalized to start insulin because of how sensitive she is, then once hospitalized her numbers were too low for them to start insulin. Four days of hospitalization, four days of missing her, four days of her being miserable, and $1700 later, they concluded she's headed into remission on her own, and sent her home having done nothing at all besides observe her. And once home, she's right back at the terrible numbers.
 
Down to 270 this morning. And she's had no symptoms at all -- she seems her usual self, has plenty of energy, is eating and drinking normally, and I just did the box, and she's peeing her usual amount.
 
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