Diabetes caused by steroid injections for IBD

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Nightbird

Nightbird

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Hello all. I'm a newbie to the forum, to IBD, and to Diabetes. My 7 year old Anastasia, a Himalayan/Siamese mix, began having pooping outside the box and diarrhea issues 14 months ago. Over the course of the last year my vet and I tried a multitude of different food diets, with no success. Stasia continued to lose weight and got more and more sick. Finally, about 6 weeks ago, the vet decided to treat her for IBD and gave her a steroid injection. She did well for about 3 weeks; her stools were hardening and she was using the litterbox more. At 3 weeks the shot wore off and the effect was drastic. The soft stools came back and she started vomitting when she ate. So we gave her another steroid injection with an antibiotic. The vet warned me of the risk of diabetes with the steroid injections. Sure enough, on Monday her glucose tested at 599, and although she has beautiful stools, she is skinnier than ever and even more ill. Because the diabetes came on so fast, most likely due to the steroid injection, we have agreed to treat the diabetes and are hopeful that it will go into remission quickly once this steroid injection wears off. We will try an oral steroid at that time for the IBD, as the vet feels an oral steroid will be less likely to interfere with her glucose/insulin levels. In the meantime, since the IBD diagnosis 6 weeks ago, I have her on the Hills ZD dry food. The vet has recommended mixing it with the Hills ZD wet food, instead of switching her over to a diabetic-specific food due to the IBD. Has anyone else had the dilemma of what to feed a cat with both IBD and Diabetes? From what I've read, it seems that she only has high glucose because of the IBD injections, so its a dilemma for me!
Tonight I will administer Stasia's first insulin injection. I've read up on how to do the home glucose testing. Wish me luck! Thanks!
 
Which insulin did your vet give you? Oral steroids can alter glucose levels just as much as injected unfortunately. Many control IBD through a grain/gluten free diet, and additions of supplements like Miralax, Flagyl, etc.

Here is the ingredients list:
Brewers Rice, Hydrolyzed Chicken Liver, Soybean Oil (preserved with BHA, propyl gallate and citric acid), Calcium Carbonate, Powdered Cellulose, Calcium Sulfate, Glyceryl Monostearate, DL-Methionine, Potassium Chloride, vitamins (Vitamin E Supplement, L-Ascorbyl-2-Polyphosphate (source of vitamin C), Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Riboflavin, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Folic Acid, Vitamin D3 Supplement,) Dicalcium Phosphate, Taurine, Choline Chloride, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), Iodized Salt, Ethoxyquin (a preservative), Beta-Carotene.
Click to expand...

Unfortunately there is very little quality protein in here, which can cause serious issues for diabetes. There are a few flavors of Fancy Feast that are gluten free and high protein/low carb. I know that some other IBD people feed the Wellness flavors that are high protein/low carb too. Hopefully others will chime in here with some more specific food suggestions for you.
 
Is there any reason your veterinarian has decided to go with steroid injections for inflammatory bowel disease? There is a drug available called budesonide, which is a steroid you give orally. Budesonide's main action is on the GI tract and it is supposed to have less systemic effects.

I currently have two cats on budesonide; both have IBD confirmed by biopsy. My local compounding pharmacy can even add tuna flavor to the budesonide liquid, so that my cats just lick it out of the bowl. It has done a wonderful job of controlling their IBD.

Having said that, one of my budesonide kitties has recently become diabetic, but we know that she's had pancreas problems as well and I can't say if the budesonide has any role in the diabetes. It's definitely worth discussing with your veterinarian though.
 
Ditto on the above info; many cats here have both IBD and Diabetes. Proper diet, NOT Hils ZD and possibly budesonide or other options are much more suitable.

Check out Dr Lisa's page at www.catinfo.org
 
Thank you both for the input. I found this forum through the catinfo.org website. We initially tried the steroid injection (it was either Depo-Medrol or Prednisone - whichever is injectable. I can't remember.) because Stasia is such a bad pill taker. Just this last visit on Monday, the vet mentioned an oral liquid steroid that can be compound with the flavors as you suggested. So that is what we'll try when the steroid injection wears off. If she told me the name of it, I don't recall. I'll ask if it is budesonide. I am encouraged to hear that my cat may even lap it up out of a bowl! If she still has diabetes problems from that, the vet tells me I can try an antibiotic that comes in liquid form that may work for the IBD.
As for diet, I label read for months and months and tried to follow the recommendations on catinfo.org the best that I could given the lack of real information on the labels, but nothing seemed to make a difference. If anything, dry foods seemed to be a little better than wet foods; like she needed the fiber to give some substance to the stool. Since the IBD diagnosis and steroid treatments, I've been following Dr.'s orders with the Hills ZD because she said that Stasia's body is rejecting protein and therefore needs the "hydrolized" protein in the ZD. I was skeptical because I've never heard of that, but her stools have hardened. But she also has the steroid in her....
The insulin that she starts tonight is Lantus (glargine).
What is Miralax and Flagyl?
Shoot, I probably still have the Fancy Feast flavors in the cupboard that you mention. I could try it again.
 
Miralax is a laxative since some kitties with IBD get constipated. Flagyl is an antibiotic that targets the GI tract. How did your vet determine that your kitty's body is rejecting protein? I'd be interested to see if the gluten free varieties of FF would work now that there is a steroid in your kitty's system. Also remember that not every gluten free food is created equal with IBD - it is a trial and error game. Some cats (IBD aside) are also sensitive to beef - so it might be good to avoid that protein anyway.
 
Miralax you don't need right now, that's for constipation. Flagyl is an antibiotic/anti infamatory that targets the gut, that may be helpful once the stools are loose again.

We manage Tucker's IBD by using gluten free canned food. If your kitty needs a single protein source food, have you thought about raw? You should be able to find single protein canned food at any high end pet food store. Duck or Venison foods.

If you do need a steroid for the IBD, then I agree with the above also. Tucker is actually on prednisolone, which has helped his IBD a lot, but he's on it for a brain tumor, if needed a steroid for IBD only, I'd go with budesonide.

My cat Bean was a steroid induced diabetic. Once we stopped the steroid shots and she moved in with me and her diet changed, she went off insulin. I hope that your kitty will have the same luck.
 
My Charlie had IBD confirmed by biopsy. The prednisolone used to treat it caused diabetes. He went back to normal BG values once we pulled him from the prednisolone and then about a year later we tried budesonide. Although the effects are supposed to remain more localized to the GI tract, unfortunately in Charlie the budesonide also threw him back into diabetes.

Charlie also had chronic pancreatitis, which meant food was even trickier to balance (diabetes, CP, and IBD often have seemingly contradictory food requirements).

Charlie had a bad case of IBD so feeding for IBD and CP trumped feeding for diabetes. The good news was that a raw food diet met most of the criteria for his illnesses. I purchased raw ground rabbit and added supplements. I also fed commercially available Nature's Variety frozen raw rabbit. He did extremely well on those for quite some time.

However, he had other medical setbacks and eventually refused to eat raw, so I had to find an alternative. This from the cat who one bite of "forbidden" food would cause projectile vomiting and explosive diarrhea (read: all over the floor, wall, etc.). I had already tried most of the commerical IBD foods w/novel proteins (Z/D, D/D rabbit, Royal Canin duck, etc.) After much experimentation, I found that he could eat Merrick Thanksgiving Day Dinner mixed with canned pumpkin. That combo held things relatively static for the last year or two of his life.

Charlie had a complex medical history and the IM vet wanted to control the IBD without steroids and the complicating factor of diabetes, if possible. Charlie successfully stayed OFF steroids while he was on raw and the Thanksgiving/pumpkin combo. That in turn held the diabetes at bay, making his overall medical picture a bit easier to manage.

Typically you need to feed and medicate for the "big ticket" problems and work everything else around that.
 
I would give Smokey his prednisolone (oral steroid) for his IBD by crushing it and mixing
into his food.

Or a small bit of baby food chicken or turkey. There is more than one way to 'pill' a cat.
 
JL and Chip said:
My Charlie had IBD confirmed by biopsy. The prednisolone used to treat it caused diabetes. He went back to normal BG values once we pulled him from the prednisolone and then about a year later we tried budesonide. Although the effects are supposed to remain more localized to the GI tract, unfortunately in Charlie the budesonide also threw him back into diabetes.
Click to expand...

I've also had reason to question how localized the budesonide really stays. My Selkie, an indoor-only kitty, caught ringworm last may. At that time she was on budesonide and very low dose pred. We immediately took her off the pred. When we couldn't clear the ringworm with oral meds and lime sulfur by August we reduced the budesonide half dose, and then reduced it again in September to half dose every other day. The ringworm is still active, though there has been improvement in the past week or so. I have to wonder if the budesonide is playing a role in her failure to get over the fungus.

Since we reduced the budesonide so low, I'm at least comfortable in thinking that Selkie's new diabetes is probably related to the triaditis instead of her steroid medications.
 
This is a VERY familiar story to me. My Flame had CONSTANT diarrhea for nearly 2 years. I was cleaning up loose poop outside the box every single day. I was told after many tests and lots of $$, that he had IBD.

My vet at the time (who is NO LONGER my vet) insisted that they only way to treat his IBD was to give him a combination of Prednisone and Flagyl and to feed him HIlls Z/D dry. He had several courses of this treatment and the improvement would be minimal and short-lived. Then, they tried him on Medrol and Tylan... this didn't work either.

Flame, just like your kitty, developed diabetes because of the treatment protocol the vet used. He was one sick little boy, but the diabetes diagnosis was a blessing in disguise.

After finding this site and reading as much as I could get my hands on, I started to switch his diet to a high quality GRAIN AND GLUTEN FREE food over the course of a few weeks. Slowly, his stools started to improve. For Flame, within a month, his diarrhea stopped completely with NO medication. The diet change was what he needed. Apparently, the grains and glutens were devastating to his little body and he could just not process them. If you look at the ingredient list on the Hills Z/D, you will see that it is not an ideal diet for ANY cat but especially a cat with IBD. I eventually switched to feeding both my guys a combination of homemade raw food (but you can buy commercially available raw food too) and the gluten free varieties of Fancy Feast.

I am happy to report that Flame has had completely normal stools for 2.5 years now with not one incident of loose poop, and that after getting him off all dry food and all steroids, his diabetes went into remission 12 weeks after starting insulin. This will not happen for all cats, but with Flame, I firmly believe that his diabetes was caused by the combination of dry food and steroids.

Be patient, with some cats, it does not happen overnight and you may have to try different foods. Don't give up if you don't see improvement immediately.

I would stick with ONE protein source at first and see how she does. So start with something mild, like chicken or turkey. You can also try a novel protein... something the cat has never had before... duck, venison, rabbit, etc.

With IBD, it can take a while for their gut to heal completely.

I am not a vet and can only speak from my experience and what I've seen work for others. But, I would certainly give diet change a try before I continued to give steroids, antibiotics, etc. on a long term basis. I know it's hard sometimes not to follow the advice of a vet, but all I can tell you is that if I had not found the FDMB and read and researched and made my own informed decisions about both the diabetes and the IBD (despite what my vet was telling me), I know that my Flame would not still be with me.
Now, he is a healthy, happy, playful boy again with bright eyes, a shiny coat and the love of my life!!

One word of caution though.... please hometest your cat! There are lots of us here who can help you with that! Sometimes, a change of diet alone to an all wet food diet can be enough to dramatically reduce the cat's insulin requirement.

Good luck with your kitty and I hope you'll keep us posted.
 
Wow. This is all great information. It is so comforting and encouraging to hear your stories, to know that others have gone through what I've been going through! I can certainly relate to the explosive bowels and vomitting and food experiments! Thank you all for sharing. This gives me hope that I can be knowledgeable, endure the various treatments (injection, glucose testing, etc), find a more agreeable diet, and maybe even, as in the case of Donna and Flame, return to a normal life!
I was finally able to test Anastasia's glucose again last night, with my dear husband's help. It took us several tries, but we finally got enough blood to get a reading. We had a very compliant patient. It read 521. So we fed her and gave her first insulin injection. Two hours later we tested the glucose again and while I expected it to be a little lower, it was actually higher: 551. Was it because of the food? We tried to glucose test again this morning but didn't have any luck getting blood, before running late for work. I did not give more insulin because it had not been 12 hours since we gave it to her last night. I'm very anxious about the every 12 hours, truthfully. It is going to be very difficult with our schedules to make that happen consistently, but we're determined to try. Is there a general rule of thumb about that? Such as, don't give it sooner that 12 hours but its okay to give it later, such as 15 hours?

PetSmart ran out of the ZD canned food and I haven't had a chance to go anywhere else, so yesterday I tapped into my cupboard full of the other foods that I had experimented with before, that are closer to those suggested in your posts before. I guess the reason the vet decided Stasia's body was rejecting protein is because we had tried so many, and that is why she suggested the ZD with the hyrolyzed protein.

Right now I feel like everything is a shotgun approach and I won't know what caused what. Donna, when you switched Flame to the grain and gluten free food, were you still giving him steroids and insulin? In what order did you stop the meds and switch the food? Thank you for your encouraging story - it sounds like a dream come true to have his health fully restored!
 
I to have a cat with IBD and now diabetes. The IBS diagnosis came in August after Picasso nearly quit eating and had soft stools. His vomiting and bad breath were part of it too. The oral steroid did great until about a month ago when he started urinating and drinking a lot. A couple of weeks ago his apatite dropped again. I finally took him in to find out he has diabetes and a UTI. We're getting him off the steroid and I hope he won't need insulin for long. So an oral steroid is no guarantee that a cat won't develop diabetes.

Thanks for the tips on food for an IBD cat and I'm glad I'm not alone. Alternatives to the steroids is just what I was looking for. Too bad Picasso is rather picky and only seems to like fish/seafood foods. I think he's IBD is also partly triggered by separation anxiety.
 
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