Chlorambucil and BG spike?

[Margaret and Pearl (GA)]

Hi everyone!

I’m writing to ask if anyone has experienced chlorambucil spiking your cats BG?

I haven’t posted in quite awhile. Pearl is still alive and trying to thrive. She is back on insulin now for a year due to increased Pred dosing for IBD/SCL.

Recently my vet agreed for me to add in Chlorambucil, in efforts to maybe be able to wean the Pred dose down. Well…her BG has been spiking since starting chlorambucil and staying high - high 200s. I’m pretty unhappy with this, given that Pearl is already on 4 units BID.

If you know about Pearl you know how tightly regulated I used to keep her, how lovely and green she always was, how she loved earning reductions by staying in normal numbers for weeks at a time. So this is a big deal for me. I am very upset at even needing 4 units BID which I know is quite hefty. It’s partly caused by the higher carb wet food which is the only food under the sun Pearl will eat (and also means I can’t do TR which means her BG normally runs in the blues with pops into green). But the chlorambucil has her high up in the lemon tree.

I have not kept my spreadsheet up to date, long story, so please don’t look there. Unless you want to see how greeeeen Pearls BG used to be and how well controlled.

 

[tiffmaxee]

I’m sorry you need to add chlorambucil. Have you posted this on groupsio? One of mine now has IBD or scl too so you have given me hope. I don’t know why you can’t do TR since you are not feeding any dry food. If not you could maybe do custom dosing? Let’s see what Wendy has to say.

 

[Margaret and Pearl (GA)]

Hi Elise and thanks for your reply!

I feel like I can’t do TR bc I don’t have any food to bring her up when she goes low. And she is not as flat anymore, she can dive around with the higher carb food on board (point of reference - with the Pred she needs 2U BID. It’s the darned higher carb food that drives it up to 4U BID and causes her to dive around, and it’s the Hills A/D so around 8% carb. Pearl is ultra carb sensitive). I haven’t found any food she will eat other than what she currently gets. And she boycotts that food whenever I add even a teaspoon of her low carb food in. I can’t even coax her to eat it. So I have no way of dealing with lower numbers foodwise.

Pearl has done great only on 5mg Pred daily - the tumors disappeared within a few months. Current ultrasound shows some diffuse thickening so something is there, but the Pred is managing things well. I wanted to add chlorambucil to deal with the Pred mess and try to deal with her BG better, but the opposite is happening and it’s awful (for me). It is also difficult because I don’t have the income to think about going through pens quickly with higher doses. So I am really trying to get her dose under control and lower it.

I think another reason I wanted to do the chlorambucil is because although the tumors disappeared only with Pred, I know that doesn’t mean any possible cancer is actually gone, and the Pred may be masking the tumor issue. She has also had some big weight gain so she is now a plump gal, and has had some fur loss. I really don’t want to ask for Cushings to happen so this is also why I wanted to try to use the chlorambucil and reduce the Pred.

But it is looking like only Pred may be the lesser of two evils at this point!

I am sorry to hear you are also dealing with IBD/SCL. Historically my gals have done great only on a steroid (I’ve had some on Budesonide, and now Pearl on Pred. She has other inflammatory conditions and crazy as it seems Budesonide also spikes her BG). I hope you get to the bottom of your situation in a treatment manner that gives you some peace.

 

[Sarah & Charlie-cat]

Oh hei, Margaret and Pearl, I found you here. I also look back at Charlie's old numbers from December and January with a drop dose and I get so sad. Especially because trying to get him off prednisolone seemed to start a sh*tstorm that has yet to subside.

Does Pearl have the talkative Siamese thing? Charlie is very talkative. Apparently, he's been known to lead other cats at the vet in a round of the song of their people.

 

[Wendy&Neko]

Sorry to see Pearl back here.

Neko was on chlorambucil for SCL. Made no difference to her BG's. With most meds I would sometimes see a day or two of fluctuation before she steadied out, seems her body needed that time to adjust to the new med. Are you predosing her with ondansetron, about 20-30 minutes before hand, to handle any possible nausea? Also, how much and how often are you giving the chlorambucil? What format is it? I used to give the Leukeran pills (brand name), cause it's cheap in Canada.

SCL does not produce tumours, you just see thickened bowels, so not sure why you are seeing something disappear with pred.

Side note, have had two non diabetics on pred+chlorambucil, also no BG spikes. I've seen other SCL kitties here on chlorambucil, can't remember any with BG impacts.

I'd be reluctant to add chlorambucil without a definitive diagnosis of SCL. Chlorambucil can be carcinogenic, so not something I'd add unless I had to. I'd much rather stick with just pred. Which is all I'm now I'm giving my current kitty in SCL remission - she also has IBD, so I need to give some pred to keep that in check. But I was so happy to stop the chlorambucil.

Honey/karo/syrup added to regular food makes HC, and can be used if she won't eat anything else that is HC. I can't make any other comments on dosing without at least the last couple weeks data on the spreadsheet.