dosing pred twice vs once/day for better regulation

[carolynandlatte]

I was wondering if anyone out there (other than cheryl and winnie, who suggested this) and use pred have gone to twice/day dosing vs one time a day.

Latte gets it at night with pm shot. PM cycle is sky high, AM cycle can be pretty good. If I increase her insulin (lantus) she plummets too low in the AM cycle and I have to decrease. As soon as I decrease she goes sky high in the p.m. again, which also elevates a.m. cycle a little more than I like. it's become a terrible viscous circle. Right now we are stuck on literally two small drop difference in insulin - the greater brings her too low in the day, the lesser amount keeps her too high all around.

My questions with twice/day dosing of pred:
1. Might I end up seeing all around high numbers? or will the fact that she is getting less in each cycle bring down her numbers a bit?

2. I may not be able to give the pred 12/12. I could give it at 6pm with evening shot, but easier at 8am , 2hrs AFTER a.m. shot. Part of this has to do with her potential vomiting right before or after her shot in the a.m. I would rather give it with the rest of her a.m. meds between 7-8 am, after she has eaten. this shouldnt be a problem should it?

3. Might this affect how the pred is working for her right now? Quite frankly its not doing what it used to for her appetite, but (anti--jinx), her vomiting has become much less frequent. so it must be doing something. I just feel like she has such a fragile equilibrium with all her health issues (see our profile in sig for more info),that Im afraid this might mess things up. I just dont know what else to do about her BG's though!

4. If she runs high, overall,I could increase her insulin. I just fear that increasing and having her vomit the pred (thats only happened once or twice before - antijinx), w/a much higher dose of insulin could turn into a dangerous situation. As cheryl said about winnie to me once, her diabetes was very much steroid driven. Latte's FD is steroid induced and driven. If she was not on the steroid, her current dose of insulin would be an OD for sure.

I think that might cover it for now. Her regular vet had a tech return my call to let me know I could go twice a day. I really wanted to talk to him about my concerns and hopes. Im not sure he even knows why I want to do this. Her specialist is out for a few weeks. I could call the university,where her specialist is and see if someone else will talk to me. Its not likely tho. I will try that tomorrow a.m.

I know ECID. But has anyone else tried this? Can anyone tell me what they think might happen...anyone with a really good understanding of a cat's fd driven by a steroid?

I appreciate any thoughts! Thank you!

 

[Joanna & Bix (GA)]

Re: dosing pred twice vs once/day???

If it is for IBD, have you tried Budesonide? As I understand it, it is not a systemic steroid, so does not affect the BGs as much, but works more topically on their stomach & possibly intestinal tract. I don't know if that would be appropriate for her, but just wanted to mention it, as my cat switched to that from Pred (IBD, mostly stomach problems) with his diabetes diagnosis, and it has worked well for him.

 

[carolynandlatte]

Hi Joanna,
Thank you for the reply.
One year ago I took Latte in for a u/s (realized crf was not the main cause of her lack of appetite/vomiting). The university said it was either ibd or lymphoma. I did not do a biopsy because of both financial reasons AND all she had been through already. The University specialists always focus on her likely having lymphoma. They insist she could live a long time with it, even if not treated (tho miserable). her regular vet insists she could not live this long w/o chemo... maybe even with. So who really knows. We tried chemo after the pred caused FD, but that went over so poorly I called the vet and asked for our pred back (donated to clinic) and said if she did not improve in next 24hrs i would have to pts. She was as bad, if not worse than she was during the ARF. Pred worked almost immediately. It does seem it has been peetering out lately...just a tad. In some ways I think its doing more harm than good (she seems to be having funny breathing sounds more and more lately). But overall, symptoms are better.

The bud.was something we were going to try once we got her back on track after her reaction to chemo, but never have. i think there is a part of me worried that Im going to mess up that equilibrium by doing a switch. If it doesnt work, I might not get her back-ya know? None of the vets or specialists have brought up the idea of switching, so Im assuming they feel the same way as I do.

Because of her age, what she has been through, so many complications, and my financial constraints our main goal is QOL. No heroic measures are left to be taken. Im often amazed with why she is still here. But she is, and generally seems to be content. Honestly,the swing in the BG's I think is what makes her feel the worst:
SUPER HIGH (300+)- drinks obsessively, chokes on water, lethargic, unhappy
SUPER LOW (50's) - drinks obsessively, chokes on water, does not eat, uncomfortably restless
BIG DROPS (100+'ers)- drinks obsessively, chokes on water...but DOES eat
MODERATE LEVELS (100's)- happy, soft, eats better, does not drink obsessively, eats alright

Thanks again for the response. I dont know if the bud would be appropriate. It might. But if it was not, Im afraid of what the results would bring.

 

[Joanna & Bix (GA)]

Awwww (((((hugs))))). I probably wouldn't switch either in your shoes, too delicate a balance to mess with it. That's good if the Pred is helping. I had a kitty with stomach/intestinal lymphoma (GA a couple years ago), who also had a bad reaction to the Leuk (sorry to read that in your profile).

I switched Bix's Bude to BID instead of the SID he was on for the same reason you are looking at, but I never had clear enough data to know if it made a difference. Plus of course it is different than Pred anyway so I can't say if BID Pred would help you, but maybe worth a try anyway if you don't get a definitive answer on how to best time it with the insulin.

Hope you are able to get the Pred/BG situation sorted out.

 

[KarenRamboConan]

Believe it or not, once a day dosing is best, and preferably before 9am. Our bodies produce natural steroids in the early morning. By giving steroids at the same time, it mimics the body's own production better.

If it's a large dose, however, splitting it would probably be OK. When Astrophe was on 30mg/day, I split it into two 15mg doses. It only lasts in the blood stream for a few hours, so for her anaemia, we wanted it in there for longer. Now that she's on a maintenance dose of 1.25 mg/day, she just gets it first thing in the morning.

 

[carolynandlatte]

Believe it or not, once a day dosing is best, and preferably before 9am. Our bodies produce natural steroids in the early morning. By giving steroids at the same time, it mimics the body's own production better.

Oh yes, I understand that. She is only on 5mg/day, and has always gotten it at night. I want to switch it to twice daily to see if she would have better regulation of the FD and/or more even cycles. If you look at her ss, you will see she is anywhere between high 200's - 400's in pm , and can dip into 50's during the day. those are big swings which cant feel good to her, and make dosing absolutely frustrating. Im sure some of her pm highs are also related to bouncing from the days low.