CodieBear. Diabetes from steroid medication (VERY long post)

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CodieBear

Member Since 2016
Hello everyone,
As the title suggests my cat went into a diabetic condition following a course of steroids. Codies history is:
approx 14 years old
greedy moggy cat

Codie moved in after we found out he was sneeking in and stealing our resident cats food. We found out, stopped leaving food out through the night, so he came an woke us up for it :) Neighbours said we could keep him.
Eventually he got to over 8kg (as we were nursing a cat (Felix) that was dying from HCM, in order to give Felix his meds hidden in food, we fed Codie to keep him distracted. Felix wouldnt eat if a door was shut or any routine was changed, he would freak out and hide), if we let them both at it; Codie would just eat all the food and Felix would walk away.

Felix passed, it was very traumatic as it coincided with a home relocation - probably shortened Felixs life by a few months due to all the change - as said, he didnt even like having a door closed if it wasnt usually.
A few months after we moved, Codie seemed off, I couldnt explain what was wrong, it seemed to be more that moving stress. Vet discovered a heart murmur. He is on Fortekor and Frusemide. That was 3 years ago. Felix had a heart murmur that we knew about for years, the vets didnt feel the need to medicate till the end. I often wonder if Codie has been put on meds prematurely, I have raised it with the vets but they think he is doing well so leave him to it.

He had the imaging tests but I dont have the details, something in my memory suggest 1-1.7 on the ventricular size comparison.
He was very overweight, we put him on the Hills prescription metabolic diet. He got down to 6kg(ish). I didnt like the whole prescription diet thing which is full off cereals etc.
We tried the raw food approach, he responded OK but we didnt stick with it. Around the same time, he developed a massive infection that led him to be in kitty hospital for 3 days on IVs etc. We had left if a day or so to see if he would get better himself, I subsequently found out that cats not eating for more than a day is very serious, I suspect he went into hepatic lipidosis.
Fast forward approx 18 months, Codie has an autoimmune condition. I mentioned what I thought was dirty claws to the vet, they were massively infected - possibly from the 18 months previously!! The vet sedated him to clean them out, turns out they were all infected and the autoimmune disease had caused swelling which subsequently led to the infection in his claws.

It also explained why I was repeatedly taking him to the vets for possible eye infections, having observed swelling around his eyes over the previous couple of years. We feel bad that it went on so long without us realising.

After the autoimmune diagnosis, Codie was put on steroids. An initial high dose which then tailed off. His eyes were beautifully clear, no swelling, no pinkness. Beautiful! He was eating and drinking a lot! Dr Google said that was because of the steroids so I left it.
We went away for a (prebooked) week, and our cat sitter came round to look after the cats. We returned to find a bowl full of food and a cat that had lost a lot of weight. The cat sitter said he had been eating until that very last day, my thoughts suggest otherwise. We thought perhaps it was the stress of us being away. I left it a day - it was more that the stress, so we booked a vet appointment. They took bloods, we were worried it was his kidneys. He had dropped from approx 6.2kg to 5.74kg within about 2-3wks (taking account of his last consult time). The vet took bloods.He came home and ate some 'metabolic' kibble and some 'gourmet' pate that I bought to tempt him to eat. Codie is a moggy but actually a very large cat, 5.74kg meant we could very easily feel the bumps in his spine and hips.

I spoke to the vet the following morning, tests show he is diabetic, kidneys fine. I dont know the glucose measurement from the test. He hadnt eaten very much so we hadnt given him his steroids as we didnt want to put him off his food. He is not on them now, his eyes are puffy again.

The following morning, the vets were discussing admitting him for NG tubes and IV fluids. I said he had actually eaten with some enthusiasm (though not his usual level of enthusiasm) the night before and in the morning. I really didnt want to admit him unless absolutely necessary as he is a very sensitive boy - he hid from us for a week after getting his claws cleaned.
I took him back to learn how to inject insulin that morning.
He is on 2ml of 4oCannusulin twice per day.
The vet said about putting him on Hills prescription diabteic diet, I wanted to try raw feeding again to reduce carbs. The vet said it was a fad, diabetic cats need complex carbs. I respectfully disagreed.

In the last week I have bought the pre-made raw/frozen food and 'Wainwrights' pouch food - for the tempting smell. He is eating heartily. I continue to give him some 'metabolic' kibble in the evening as I am continuing to give him insulin and dont want him to hypo. I bought a Glucometer from the chemist today, it came with a lancet pen, I practiced on myself first....it hurts!!!! I have watched the youtube vids and will get some lancets to prick his ears to home test.

In the meantime, I will continue to give him some kibble so I dont send him into a hypo from the insulin.

The next appointment is in 2 weeks for a fructosamine test. I dont have my vets nor my husbands support in the raw food diet. My husband is not an idiot, he is fully into Paleo for people, but would prefer to follow vets advice when it comes to our cats, I think he is nervous of putting our cats in jeopardy which is understandable. If the raw feeding works out, he wouldnt continue to be a naysayer for the sake of it.

I am guessing that they long script above is something of cathartic, but also, I wanted to give a full account in the hope of getting some direction. I dont want to take Codie off kibble without removing the insulin. I havent begun home testing yet, and to be honest Im a little scared of it though he toleterates the insulin jabs ok - he protests mildly, he is such a sweet, good boy. I dont want to take Codie to the vets unnecessarily.

I have floated the idea to my husband of withdrawing the insulin and kibble and just monitoring the drinking/urination to see if he develops diabetic symptoms again, my husband would prefer that I leave it until we have the vet test results and take further advice from them. My concern is that my vet seems a little medication ready and even if it all looks good they will keep him on insulin and it would be a battle to get him on low carb and off insulin.

Thank you for reading such and epic. Your thoughts are much appreciated.

Regards.
 
First...welcome to FDMB. It is unfortunate that Codie has developed diabetes from the steroids, but if the shots are necessary then you need to stay with then you have to stick with them. Codie has a number of issues and the steroids seem to be needed to keep these in check. With diabetic kitties that have other conditions, you treat the other conditions first and adjust insulin to make up for the meds.




The vet said about putting him on Hills prescription diabteic diet, I wanted to try raw feeding again to reduce carbs. The vet said it was a fad, diabetic cats need complex carbs. I respectfully disagreed.

This comment is so far off base that it would be considered a joke, except that it is coming from a vet. :eek: Raw food if properly supplemented with the necessary vitamins is a great way to go if Codie is accepting. Otherwise most members here will use a low carb wet food such as Friskies or fancy Feast pate rather than buying expensive prescription food that is relly no better than regular. It is suggested that food not have any more than 10% carbs, since kitties DO NOT NEED CARBS and it raises the glucose levels. Dry food is also a bad choice for any kitty, but especially for a diabetic kitty. Once you are home testing on a regular basis you can start to remove the dry food from Codies's diet. Some kitties can drop 100s of points just from changing to an all wet low carb diet.


You sound like you are on the right track with where you plan on going with Codie's treatments. If you have specific questions please feel free to post on the Feline Health forum, where there is a lot of traffic and lots of experienced members:

http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/

It will take some time to get everything into perspective but with the help and support from members here you will do great!!
 
I am all too familiar with steroid induced diabetes. That is what happened to Squeaker and he also had an undiagnosed heart problem. Except the vet that caused it lied to me and after lab work told me there was nothing wrong with him.

This precipitated a physical collapse with multiple potentially fatal complications that nearly killed him .

First, wet food is a must. Little Friskies Classic Pate are good choices. A number of reasons for that include: low carb which all cats need particularly diabetic cats (with the exception of Mixed Grill); they are also lower in sodium which any cat who has a heart problem and is on a diuretic should be on them to help reduce fluid retention (with the exception of Turkey & Giblets loaded with sodium).

As for insulin, Lantus is a very good insulin and helps to increase the chance at remission (Squeaker was on insulin for 2 months before entering remission). You might want to have a discussion with your vet about switching insulin. There are no guarantees that a combination of low carb food and Lantus will bring about remission but it can tip the odds in your favor.

Are you home testing glucose? That is a must especially when giving insulin. An inexpensive human meter will work you don't need the AlphaTrak. Walmart's Relion brand meters can be used and the lancets and test strips are inexpensive.

Have you had Codie's heart evaluated by a board certified cardiologist? Given Codie's age it is possible he has a cardiomyopathy and since you are familiar with HCM an evaluation and medication could help with that (Squeaker had RCM).

I would also suggest that you monitor Codie for signs of congestive heart failure for the next two or three months. In a cat with a heart problem, steroids can induce CHF (Squeaker experienced CHF 2 months after he went off insulin but the cardio's opinion was it was the result of steroids). The symptoms to watch for are open mouthed breathing and an increased respiration/labored breathing. It would be a good idea to check the Resting Respiratory Rate (RRR) every 12 hours. To check RRR, with a stop watch count the number of breaths your cat takes in 10 seconds; multiply by 6. If more than 35 or you notice he is breathing through his mouth it is an emergency and needs immediate treatment. Make sure to count the breaths when Codie is either asleep, or just resting quietly but not if he is purring.

After Squeaker had CHF, I was told that the prognosis was 6 months. The cardiologist put him on Pimobendan, and Plavix to reduce the chances of throwing a clot. To these meds I added Omega 3, CoEnzyme, and L-carnitine. Squeaker lived for 28 months after the CHF despite the 6 month prognosis. I just lost him in Jan from renal failure as his kidneys were damaged during the health crisis caused by the steroids in July 2013.
 
Just checking on the insulin measurement.
U-40 insulin has 40 units per mL. You're actually giving 2 units, yes?


And while blood testing on your finger hurts, a cat's ear has fewer nerve endings. Start with a lancet labeled for alternate site testing (26-28 gauge) and as the ear develops more capillaries, you can move to a thinner lancet (30 gauge or higher).

Cat Info, written by veterinarian Dr Lisa Pierson, has a food list showing the percent of carbohydrate calories in many US foods, as well as several of the prescription diets (which have nothing prescription in them, its a marketing ploy!)
 
First...welcome to FDMB. It is unfortunate that Codie has developed diabetes from the steroids, but if the shots are necessary then you need to stay with then you have to stick with them. Codie has a number of issues and the steroids seem to be needed to keep these in check. With diabetic kitties that have other conditions, you treat the other conditions first and adjust insulin to make up for the meds.

This comment is so far off base that it would be considered a joke, except that it is coming from a vet. :eek: Raw food if properly supplemented with the necessary vitamins is a great way to go if Codie is accepting. Otherwise most members here will use a low carb wet food such as Friskies or fancy Feast pate rather than buying expensive prescription food that is relly no better than regular. It is suggested that food not have any more than 10% carbs, since kitties DO NOT NEED CARBS and it raises the glucose levels. Dry food is also a bad choice for any kitty, but especially for a diabetic kitty. Once you are home testing on a regular basis you can start to remove the dry food from Codies's diet. Some kitties can drop 100s of points just from changing to an all wet low carb diet.

I know, its crazy! This is what has brought me here. I dont understand why the treatment for cats defies logic so much! The fact that I want to test before giving insulin seems so controversial. But if a human gave themselves insulin without testing their glucose levels first everyone would think they were crazy. Codie is off the steroids with the vets blessing and we're monitoring to see how he does without them, I wash his paws with hibiscrub just to help prevent any infections, at the moment it looks OK.
 
I am all too familiar with steroid induced diabetes. That is what happened to Squeaker and he also had an undiagnosed heart problem. Except the vet that caused it lied to me and after lab work told me there was nothing wrong with him.

This precipitated a physical collapse with multiple potentially fatal complications that nearly killed him .

First, wet food is a must. Little Friskies Classic Pate are good choices. A number of reasons for that include: low carb which all cats need particularly diabetic cats (with the exception of Mixed Grill); they are also lower in sodium which any cat who has a heart problem and is on a diuretic should be on them to help reduce fluid retention (with the exception of Turkey & Giblets loaded with sodium).

As for insulin, Lantus is a very good insulin and helps to increase the chance at remission (Squeaker was on insulin for 2 months before entering remission). You might want to have a discussion with your vet about switching insulin. There are no guarantees that a combination of low carb food and Lantus will bring about remission but it can tip the odds in your favor.

Are you home testing glucose? That is a must especially when giving insulin. An inexpensive human meter will work you don't need the AlphaTrak. Walmart's Relion brand meters can be used and the lancets and test strips are inexpensive.

Have you had Codie's heart evaluated by a board certified cardiologist? Given Codie's age it is possible he has a cardiomyopathy and since you are familiar with HCM an evaluation and medication could help with that (Squeaker had RCM).

I would also suggest that you monitor Codie for signs of congestive heart failure for the next two or three months. In a cat with a heart problem, steroids can induce CHF (Squeaker experienced CHF 2 months after he went off insulin but the cardio's opinion was it was the result of steroids). The symptoms to watch for are open mouthed breathing and an increased respiration/labored breathing. It would be a good idea to check the Resting Respiratory Rate (RRR) every 12 hours. To check RRR, with a stop watch count the number of breaths your cat takes in 10 seconds; multiply by 6. If more than 35 or you notice he is breathing through his mouth it is an emergency and needs immediate treatment. Make sure to count the breaths when Codie is either asleep, or just resting quietly but not if he is purring.

After Squeaker had CHF, I was told that the prognosis was 6 months. The cardiologist put him on Pimobendan, and Plavix to reduce the chances of throwing a clot. To these meds I added Omega 3, CoEnzyme, and L-carnitine. Squeaker lived for 28 months after the CHF despite the 6 month prognosis. I just lost him in Jan from renal failure as his kidneys were damaged during the health crisis caused by the steroids in July 2013.

That sounds like a horrible experience! Sorry for your recent loss.

Re the food, Im in the UK so it appears that we do not have the Friskies canned food. I think the 'fancy feast' in the US is branded 'Gourmet' here, which is good as he does like it, I think I may have been turned on to Gourmet before when looking for lower sodium foods for our cat Felix. I have used it mixed in with raw food to bribe him to eat it.

We're not currently home testing, I bought him a monitor but need to buy more appropriate lancets before I test him.

We monitor his heart condition as you describe, the vets put him on meds pretty quick. With out last cat, we didnt even know there was a problem until he was coughing up liquid from the CHF. We have never had such symptoms with Codie to date. I have been wanting to get a second opinion re his heart meds for a while - just found a Cardiologist so will follow that up.
 
I know, its crazy! This is what has brought me here. I dont understand why the treatment for cats defies logic so much! The fact that I want to test before giving insulin seems so controversial. But if a human gave themselves insulin without testing their glucose levels first everyone would think they were crazy. Codie is off the steroids with the vets blessing and we're monitoring to see how he does without them, I wash his paws with hibiscrub just to help prevent any infections, at the moment it looks OK.

Well thank goodness YOU have some sense, unlike your vet. As you said a human diabetic would NOT be blindly giving shots without testing before the shot and during the cycle. At least a person can recognize when they are going hypo and take steps to control it, but our kitties can't tell us how they feel and without testing we wouldn't know.

If Codie is now off the steroids that could make a huge difference in his glucose levels. For myself, I have tried both paw and ear testing and for both my kitties I find the ear pokes easier, both for me and for them. My more recently diagnosed kitty seriously hates being confined and is a major wiggler, but has been amazingly good about accepting the ear pokes. Kitties have very few nerves in the outer edge of the ears and I find that doing the poke freehand is the easiset foe me anyway.. But whatever works for you is fine...doing the testing is the most important thing.

:bighug:
 
Just checking on the insulin measurement.
U-40 insulin has 40 units per mL. You're actually giving 2 units, yes?


And while blood testing on your finger hurts, a cat's ear has fewer nerve endings. Start with a lancet labeled for alternate site testing (26-28 gauge) and as the ear develops more capillaries, you can move to a thinner lancet (30 gauge or higher).

Cat Info, written by veterinarian Dr Lisa Pierson, has a food list showing the percent of carbohydrate calories in many US foods, as well as several of the prescription diets (which have nothing prescription in them, its a marketing ploy!)

Yes, but went and double checked. Caninsulin 40IU/ML. 2 IU/ 12 hours apart. Red topped IU40 needle - 2 units in that needle

I will definately go and locate those lancets. I returned to the pharmacy yesterday to get some but because I didnt know what I was talkng about and they were behind the counter, I ended up not getting any, the pharamsist seemed to think I was a little weird with the questions as I didnt want to just buy a particular brand.

I think that website may be what brought me here. Im in the UK but some of the brands do crossover. I am completely on board with the low carb/high quality protein diet. I think I have found some solutions in the UK but am often worried that some of it is a marketing ploy as they dont list carb count and my research isnt turning up much info.

Im currently transitioning to this:
http://www.nutriment.co/cat-food/

and using this to make the food smell more tempting:

http://www.petsathome.com/shop/en/pets/wainwrights-cat-mature-tuna-pouches-12-x-85g

Hope links are ok to put up.

Also, because of the advice on that site, I havent got him completely low carb yet as Im still not testing him and he is still getting insulin, so he still has some kibble.

I cant believe im giving him kibble to counteract his medication.:banghead:
 
Well thank goodness YOU have some sense, unlike your vet. As you said a human diabetic would NOT be blindly giving shots without testing before the shot and during the cycle. At least a person can recognize when they are going hypo and take steps to control it, but our kitties can't tell us how they feel and without testing we wouldn't know.

If Codie is now off the steroids that could make a huge difference in his glucose levels. For myself, I have tried both paw and ear testing and for both my kitties I find the ear pokes easier, both for me and for them. My more recently diagnosed kitty seriously hates being confined and is a major wiggler, but has been amazingly good about accepting the ear pokes. Kitties have very few nerves in the outer edge of the ears and I find that doing the poke freehand is the easiset foe me anyway.. But whatever works for you is fine...doing the testing is the most important thing.

:bighug:

Thank you, that is definitely the next step then, i think he would tolerate ear pokes more.....off to buy the appropriate lancets!
 
Hi Codie's mum, and welcome to you both.

I cant believe im giving him kibble to counteract his medication.:banghead:
I'm in the UK too, and I thought it was utter insanity for the vet to want to switch Saoirse's diet to one with even more carbs than the carp Rx diet she had been on when she was started on Caninsulin. When I asked about lower carb food the vet said it had to be Hill's w/d dry Rx food. When I asked her why, her sole argument amounted to: "Because it does. Neh!" The woman hadn't a clue. When I first brought Saoirse to her with diabetes poster kitty symptoms she point blank refused my requests to run diagnostic tests and packed us off with a Dx of 'old lady'. I was back at the practice a couple of weeks later armed with food and water consumption data. I saw a locum vet that time and I insisted that Saoirse be checked for diabetes. I give thanks every day that I found FDMB and for the education and support I have received from the incredibly well-informed, kind and generous members here.

I dont understand why the treatment for cats defies logic so much!
Limited diabetes education at college, lack of time to research enough to keep abreast of improvements in FD treatment modalities. And sometimes sheer professional hubris. :banghead:

For future reference you can get good deals on Amazon and ebay for lancets, for example:

http://www.ebay.co.uk/itm/Boxof-FRE...625620?hash=item33b2a711d4:g:EMEAAOSwh-1W1zXB

Check both sites when buying as sometimes one has better deals than the other. You can get good deals at the above sites on human meter test strips and urine test strips, too. (You'll need urine test strips to monitor for ketones.) Always check the expiration dates when ordering from Amazon and ebay. (Note: if ever at some stage in the future you might need to use U100 0.3ml demi syringes they're cheaper via Amazon and ebay, too. I've only bought Caninsulin syringes from online veterinary outlets or direct from our erstwhile vet.)

Here's a link to UK food info (which has a link to the current UK food list):

http://www.felinediabetes.com/FDMB/...-including-link-to-low-carb-food-list.137376/

Zooplus.co.uk and the Happy Kitty Company do some of the best quality diabetic-friendly, species-appropriate foods. :)

For other veterinary supplies (including Caninsulin syringes) check out www.animeddirect.co.uk - they've been the cheapest online supplier for quite some time (and they offer free delivery).


Mogs
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^^^ Thank you for this Critter Mom. I have found it very useful. I typed in the Pets at home wainwrights food which is coming up as zero carb. I dont quite believe it but everything I am reading online does seem to back up that it is a good food. He is eating it, its not kibble and I can mix it with his raw food.

I gave codie more of his original prescription/metabolic food yesterday, as discussed I still didnt want to go completely low carb because I hadnt started testing, he seemed a little off and I was worried about hypos. I woke up this morning to hear him drinking water from the glass, he has been back a couple of times. Nothing huge but was noted.

Anyway, result is that his glucose is high, Im going to monitor throughout the day. He had breakfast at about 7.30 and I took his reading at 9.30. It was 17.5mmol or 315mg/dl. I know this is high and concerning. I am reluctant to give him more insulin right now, vets not open until tomorrow etc.

I plucked up the courage to use the diabetes monitor on him. I had bought a accu-chek mobile from Boots the chemist not wanting to wait for a delivery. It came with a lancet but thought it was bound to hurt him and wanted to lance him freehand. He didnt even flinch! However, I have just been trying again and I have stuck him about 6 times and havent been able to get the blood, Its a fast-clix type, part of the reason I didnt want to use it because it comes as a kind of barrell so I cant see exactly where the lnacet will come out, I guess I just got lucky this morning.
 
because it comes as a kind of barrell so I cant see exactly where the lnacet will come out,
Many lancet pen come with a clear cap the replaces the opaque one normally installed. The clear cap is used for alternate site testing (other than the finger tips) on humans.
Also, make sure yo backup the ear where you prick. I use a cotton cosmetic pad.
 
Until you can get some loose lancets try practising with the Fastclix device on the edge of a piece of paper. And make sure you warm the ear for what feels like a really long time. :)


Mogs
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Hi all,
I just wanted to pop in to say that Codiebear's diabetes is under control (touch wood). I have kept him mostly on raw but put some tinned stuff in as he was still always hungry yet it was difficult to get him to eat his tablets with raw food alone.
We have had to keep with the metabolic tinned food as his weight has increased (way too much, he's very food obsessed, pulls fur out etc when hungry) when we have tried other, better quality foods, despite portion control.
He was in the cattery for a week and was on metabolic only, I am sure he had a little flare up from his autoimmune condition as a result - his eyelids etc seemed more inflamed, so think the raw food helps keep this in check also.

His blood glucose did go way too low at one point. He was behaving oddly, like ill but not drinking lots of water. Your guidance on testing helped me get the confidence to take control, test and determine his blood glucose was way too low and make the decision to not give insulin and monitor. I put my foot down with the husband and stated that we're stopping the insulin whilst only feeding raw with his glucose so low, (he wanted to keep giving the insulin anyway as vet prescribed, understandably worried about going against vets orders but ultimately had faith in the self education from sites like this). You helped us to avoid disaster.

^^^I wanted to include this in case any new searcher out there decided to go low carb whilst still giving insulin.

The new vet at the practice is more on board with raw feeding and owner led diabetes management where appropriate, so she influenced old vet also I think. I dont have to glaze over during a lecture any more :)

Also - buying the kit, which I lent to a colleague, helped him diagnose he had prediabetes and with the docs support and slimming world he has since lost > 2 stone.

I followed the advice you gave. The lancets suggested were a real help, as was really warming his ear - sometimes it was just easier to catch him when he was sunbathing though ;)

So anyway - thank you for your help, we're all very grateful.

:cat:
 
How wonderful that Codiebear's diabetes is under control. With removing the steroids and changing to a proper low carb wet food that can make such a difference. And of course the home testing is such an important part of keeping our kitties safe. So glad you chose to educate yourself about FD rather than blindly following vet's instructions. Thank you so much for posting about your experience..it may certainly help another newer member to make the same decisions that you did. :bighug: :bighug:
 
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Great to hear that Codie's doing so well; it's wonderful to read good news like this!

Thank you for taking time to post such a great testimonial to the benefits of home testing.

:bighug:


Mogs
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