Diabetes and Prednisolone

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nepenthe

nepenthe

Member Since 2010
My male 12 yr old cat has been diabetic since March 09. He fell out of being diabetic for over a year until needing to come back on insulin (glargine) in mid-2010. Since his diagnosis in 09, he has been fed nothing but canned food (Fancy Feast - Salmon).

The problems I am having now stem from him getting pancreatitis in Jan 2011 (he also is suspected of having IBD). Since his overnight hospitalization for his pancreatitis back then, he has been on 5mg prednisolone EOD. This has made managing his diabetes a challenge.

Before getting the pred, he was testing usually between 5-10mmol with .5 units twice a day. Since then its been 2-2.5 units twice a day with his numbers being all over the map, ranging from as low as a 7mmol to as high as a 21 mmol.

To make things worse, last week the vet pointed out that the meter I was using was a human BG meter ("Freestyle Lite") and that this could give a lower reading. Her meter ("AlphaTrak") is a cat-specific meter and he tested at 19.2mmol. When I got him home 30 minutes later, he tested at 15.2 on my meter. Although the higher reading could have also been due to stress at the vet, it is cause for concern as he could have been getting less insulin than he needs for the past 2 yrs (his numbers have typically been between 8mmol - 17mmol from Jan 2011 till now). He did test at a 9mmol this past March at the vet's on her meter, so he can get quite low from time to time for no apparent reason.

I bought that veterinary AlphaTrak meter last week and testing with it since has seen his numbers higher than what I've been used to seeing - as low as 12.2mmol and as high as 21mmol. He is fed the same food, same amount all the time.

I am guessing that its the prednisolone that is causing the huge variability in his BG values. Because of this, I don't dare increase his dose, as he does read low from time to time (he was 7.7 a month ago). I plan on tapering him off of the pred over the next few weeks, even though the vet isn't keen on this idea. I'm going to taper him to 2.5 mg EOD for a few weeks and then off and see if any of the IBD-ish symptoms come back (intermittent vomiting etc, or pancreatitis flare-ups etc) I do believe that putting him on the pred when he had the bad bout of pancreatitis likely saved his life or at least hastened his recovery (and maybe prevented any recurrances)

Its really a matter of hedging the odds - is the pred helping prevent pancreatitis/triaditis from returning or progressing to something like lymphoma - or is its effect on the diabetes doing more harm to his health than the risks of the former?

Could tapering/taking him off of the prednisolone lower his BG values, or might irreparable damage have been done already?
 
Stopping the pred should lower the BG/reduce insulin needs.
I would talk to your vet about using the steroid Budesonide. It has little effect on BG.
 
Thanks - I am betting this will be the case. Vet wants me to taper him off starting next week. Will post the results of that.
 
Putting Boo on prednisone for IBD (diagnosed when it became critical in conjunction with the sudden onset of pancreatitis) has caused a return of his diabetes, previously in remission. We're also in the tapering-down/off phases (2.5mg every other day), though we've seen no reduction in his high BG from the reduced dose (he was started on 10mg/day at first); in fact, his numbers had been climbing until his most-recent Lantus dose increase. (We had originally asked the vet about budesonide, but he said he'd seen just as many side effects from it as from prednisone and prednisolone.) We know he needs more insulin, but we're kind of stuck, as we don't want to cause problems if his numbers do finally drop with the next prednisone reduction, nor provoke the vet who isn't keen on our FDMB-based diabetes-treatment approach (grrr). I don't really have anything helpful to add here, except that we're in the same boat. :sad:
 
I should probably add that if you post BG readings taken with your new veterinary meter, be sure to specify that. Virtually all of us use human meters, and the numbers used on the forum reflect those readings.
 
You may also want to inquire about vitamin B12 injections. You can get the fluid and inject at home using the same syringes at insulin. The dose is usually ~25u (0.25ml) once per week at first, then going to every 2 weeks.
 
Hi Vidya & Boo, tks. My vet isn't keen on tapering him off the prednisolone. She thinks that its actually safer for him to be in the 10-16 mmol range (180-288) than the 3-8mmol (54-144), as she is worried about a hypo more than anything.

FWIW, its hard to tell if the prednisolone is doing anything, he hasn't had any IBD/pancreatitis symptoms since he's been on it, so its hard to tell whether its because of the pred or just that its not as bad as it once was.

Why is B12 so helpful for IBD cats? (going to get some from the pharmacy, its pretty cheap here, like $7 for a 10ml vial)

Also, you asked me to specify posted readings with the vet meter (alpha trak) as such, is that because they typically read higher?
 
nepenthe said:
Why is B12 so helpful for IBD cats? (going to get some from the pharmacy, its pretty cheap here, like $7 for a 10ml vial)

Also, you asked me
Click to expand...

I found this helpful in figuring out why B12 is good for IBD kitties. http://www.ibdkitties.net/B12.html

My own little man used to get B12 injections bi-weekly. He suffered from IBD as well other issues.
 
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