I cannot speak to your situation, but I will tell you that cats are commonly treated with doses of Prednisolone such as 5mgs. Ultimately, the goal is always to use the least effective dose. What is common practice is to use a treating dose which is higher and then once a flare is under control, very slowly lower the dose every couple of weeks and then if possible, use an every other day dose as the maintenance dose. Every cat is going to be different so maybe one cat is able to be maintained on 2.5mgs every other day, while another cat may need daily medication. If the pancreatitis is chronic, there may be times when you need to bump the dose up again, treat the issue, and then, once again, lower back down to a lowest effective maintenance dose.
The options/scenarios are:
1) Budesonide. Again, with some cats it will not effect their BG, however in other cats it does. Although it has less systemic effects than Prednisolone it still does have a systemic effect. This is the reason why it works well in some cats with pancreatitis but not in other cats. If the problem is primarily with the pancreas and not GI, it may not be effective. It is worth a try. Again, it is not uncommon for cats who have been diagnosed with pancreatitis to also have IBD and the Budesonide’s action is primarily in the GI tract (albeit upper more than lower. I believe there is a formulation—I think is an extended release formulation that tends to do a better job of getting to some of the lower GI tract)
2) Prednisolone. Despite the fear, there are cats treated daily with 5mgs who never develop DM. It is tolerated better in cats than in dogs and humans. However, if your cat has diabetes, and it is never able to be regulated on Prednisolone, then they will try to switch the drug to Budesonide.
3) Cyclopsorine. I’ve been told this is NOT a drug to be used as a primary treating medication. It is a drug that can be added to Prednisolone if you need to lower the dose of Pred but the lower dose is not effective. I was cautioned that they have seen that cats may not have any side effects upon starting the drug but then develop serious ones approx 1-1.5 years later. There was a recent study that found that it destroyed B Cells—so obviously with a cat with DM that is not good. There are currently studies at TAMU using Prednisolone and Cyclosporin
https://vetmed.tamu.edu/gilab/research/feline-chronic-pancreatitis/
4) Chlorambucil. I was told this should be a last line drug to be added to a primary treating medication for chronic pancreatitis due to its side effects. So, for example, if you cannot get inflammation under
control with a reasonable amount of Prednisolone, it is added OR if you need to lower the dose due to DM, it can be added to find that balance.
My personal experience has been that my cat has done extremely well on Prednisolone. He is currently on 3.75mgs but I will be trying to lower it to 2.5mgs and then eventually 2.5mg EOD. I go slow because inflammation can take some time to creep back up. It can seem like all is good the first week after a reduction but then by 1.5-2 weeks, there can be issues again. One mistake that happens is rushing reductions. Patience is key, otherwise you have to get inflammation back under control, so it’s not worth trying to rush it. At one point I had thought about trying Budesonide given that Ts DM is definitely steroid induced, however, after a failed discontinuation and My poor guy crashing, myself along with the team I work with, made the decision that it is not worth the risk. He is happy and has an incredible quality of life. Not one vet had much confidence in the Budesonide with T after the crash so it just wasn’t worth the risk with him specifically. Decisions must be made based on the cat and that particular cats history/course of illness/treatments etc.
