Help Koda with Prednisolone Induced Diabetes

fridawu

fridawu

Member Since 2026
Hello everyone,

This group was recommended to me by the Lymphoma group, because Koda has prednisolone induced diabete treating her small cell lymphoma. I have attached her blood work here.

She started peeing and drinking more. I took her for a recheck for her lymphoma and we found that her blood glucose on october 28th is 14.2 mmol/L. She did a fructosamine test then and her result was only one point over the max healthy range. We did a retest next week with a full panel with urine. She was fasted for this. Her blood sugar was 17mmol/L and she has large amount of sugar in her urine (3+). We are tapering her off the prednisolone at the moment (trying to do in 10days). She started prednisolone only in July (4.3mg BID). All her blood work pre prednisolone was unremarkable. My internal medicine doctor told me that Koda will need insulin right away (Toujeo) and he said that diabetes is reversible (40%) but he thinks in her case she needs insulin to do that. Can someone give me some insight on this please? Do we really need to start insulin right away? Could we see if tapering would help her first? I got a second opinion from another internal med vet, because I feel like the first one has put Koda on so many meds and she ended up having more complications than she started. But the second vet is off until Tuesday, so I am waiting to hear back from her.

My goal now that Koda is having so many complications from her lymphoma treatment is try to do less harm to her, because it seems like we have hit the jackpot of rare complications from the standard treatment. I would like to know if she could hold off on adding insulin right now and see if things get better after stopping prednisolone. This also unfortunately lined up with my out of country trip end of the month to get home to my family for three weeks. I would like to keep her as stable as possible while I am away. I worry that insulin might put to much uncertainty in her health with her off pred and chemo to help with the complications.

Thank you for having me in this forum. I hope there is someone here who has similar experience that could help little Koda out. I am having a hard time making another decision for her because it seems like the past decisions with chemo and prednisolone harmed her more than do her good. She is now worse than when she was diagnosed.

Thank you,
Frida and Koda from Canada
 

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Hi Frida, glad to see you made it over here from the lymphoma group. Can you tell me what food Koda is eating now? Diabetic cats need to have low carb food, and we've seen cats go into remission if there is a big change in the amount of carbs they need. How is Koda's appetite now?

Regarding insulin, have you bought the Toujeo yet? The insulins recommended here are either Lantus or Prozinc. Lantus (glargine is the generic) is also a human insulin available in human pharmacies. At least in BC, I can get it without a prescription. The downside to Toujeo is that it is a U-300 insulin and you have to use the pen as there aren't U-300 syringes. Only U-100 syrines like the ones used for Lantus. I'm saying this because kitties need so much smaller doses than humans and we made just small changes in dose that you can only do with a syringe, like 0.5 or 0.25 unit changes. The pen only allows 1 unit changes, so it's possible to overshoot a good in between insulin dose. What dose did the vet suggest you start at?

And lastly, did the vet talk to you about home testing her blood sugars? With a reduction in prednisolone and possible change in food, Koda's insulin needs can change dramatically, you do want to monitor her daily blood sugars at home. We can help you learn how to do this. On another topic of monitoring, are you testing her for ketones? You can get Ketostix or similar at human pharmacies. Here is a post on testing for ketones: Tips to catch and test a urine sample Any ketones present mean insulin needs to be started ASAP. Think of ketones testing as insurance against DKA, a possible life threatening condition.

Lastly, the question of whether or not to start insulin is complicated. If you are leaving in a couple weeks, then gone for 3 weeks, that 5 weeks is too long to leave her without insulin if she needs it. The other thing to consider is that the sooner a cat gets on insulin, the faster they will be regulated and the greater the change she will go into remission. Ketones and diet are also factors to be considered. I'm also a little worried that subsequent tests of her blood sugars shows it increasing.

Do you have petsitters lined up to treat Koda while you are gone? The capability of petsitters is also a consideration.
 
Hello!

Koda is eating with the help of appetite stimulant. No food change yet recommended by the first vet, but from everything you have said here, I am not sure if this first vet will work out for us anymore. Koda is eating hills I/D right now. I saw about food change in the forum and unfortunately she only eats dry food. I will bring this up to the second internist on Tuesday and make sure we can find a low carb dry food for her.

I have not bought the insulin. He hasnt told me the dosage yet. He just said to consider starting insulin on Tuesday. I told him that we need to think about it because i dont want to add another thing in her so soon. But thanks for the insulin recommendations. I will make sure to ask about this on Tuesday.

Regarding at home testing blood sugar, he said this is only needed if we start insulin. Can you let me know what you mean her blood sugar will need to be monitored with food change and reduced prednisolone? Do you mean her blood sugar could crash? Regarding ketone, no we have not done that. Could this be done while we are doing her blood and urine panel at the vet? She need her liver values rechecked at the vet next week, can this be added in? Also based on your reply, hope I understand this correctly, did you mean that the decision making on whether insulin is needed or not is to see whether there is ketone in the urine or not?

I am so gutted on this trip. I cant cancel because I havent seen my family for three years and my mom was just recently hospitalized, but I am so worried about Koda and I need her care to be figured out and finalized before I go. How many times a day does koda need her blood sugar to be tested at home? I have a house sitter at home most days who are not able to handle medication for Koda, so I hired a vet tech to be here twice a day (morning and night) to give her medication. Does ketone need to be monitored many times a day as well at home?

Frida and Koda from Canada
 
I just looked up your post on the lymphoma group, sounds like she was eating the Hill's Biome food? Both the wet and dry versions are over 30% carbs on a dry matter basis, way too high for a diabetic. And is she now eating the I/D dry or wet? The I/D dry is also well over 30% carbs. The wet is at least in the mid 20% range, so better, but still what we call high carb food. Has she ever eaten wet food? Does she like it? Just wondering if you could switch to a commercially available low carb wet food, and add a probiotic (Visbiome is good) and a prebiotic like psyllium husk fiber to help with any diarrhea. The probiotic might also help her GI system feel better given she is getting metronidazole. Not sure what that is for.

Her urinalysis does show negative for ketones, which is good, but ketones can change quickly so good to keep monitoring, especially if not on insulin.
 
We were typing at the same time! Have you ever tried wet food with her? We have had people here do the transition, but it dose take time. The only lower carb dry food options I know of in Canada is Squarepet Powercat, available in some Bosley's. I think you can also get Dr. Esley's Clean Protein from Amazon. Some people feed air dried raw (Ziwipeak) or freeze dried raw to cats that need crunch, but I know the lymphoma group suggests you don't feed any raw if giving chemo.

The value in home testing blood sugars is that you can find out at home whether the prednisoline reduction and food change are having an impact in her blood sugar numbers. She won't "crash" as a result of those changes. You can keep taking her to the vet for testing, which is expensive, but some cats will also show higher blood sugar numbers at the vet due to stress. I had a non diabetic kitty test at 12.3 (221) at the stressful for him vet visit, and 2.9 (53) at home the next day. Note that I am using the American or dg/ml numbers for blood sugars in brackets. Most of the people here are from the US, so we use their reference ranges for blood sugars. You just need to multiply by 18.

Ketostix are a urine dipstick, you can do it at home. Ketone changes can literally happen overnight. Even more important if she doesn't keep up her calorie intake or shows any lethargy.

For blood sugar testing, another option is the Freestyle Libre which can be attached to the cat, and send blood sugar values to your phone or a petsitter. They are only good for a couple weeks so might need to be replaced part way through if she is on insulin while you are gone. The tech might be able to handle that, we have people here who do that themselves. The petsitter plus vet tech is a good option.
 
I can try the wet food transition, but knowing how picky she is and we have tried many wet food since she was a kitten, I dont think this will be successful.

Yes, I will avoid taking Koda to the vet as much as I can unless she is sick and needs vet attention. She is a very sensitive kitty. It took 1 month for her to get used to the vet tech we hired to give her med while we are gone. Libre is the one the first internist recommended to use to monitor her blood sugar when start insulin. I will ask about this on Tuesday when I hear back from the second internist. I hope this is not too long of a wait for Koda. We have a mouthy kitten that likes to wrestle with Koda, so I guess we will have to take extra care in this if she has a libre monitor. However, this sounds like a more doable option for us to monitor her blood sugar while we gone. How many times at home are we supposed to test blood sugar at home? Does it need to be before and after meals ? Does this mean that the vet tech being here twice a day (morning and night) won't be sufficient enough for her blood sugar monitoring?

I will keep the ketone stix in mind as well. I am making a list of things to talk to the vet on Tuesday. You have given me great information here. Just wondering, if the vet on Tuesday tells me that she doesnt think insulin is needed yet, what would I say? Is there anything specific I should ask her on why she thinks it is not needed? Do I ask for more testing to back this up or do I push for insulin?

Thanks.
 
More reading on diet Transitioning your cat from dry to wet food

Some tips on the Libre: Getting Started With Continuous Glucose Monitors (CGMs) for Diabetic Cats. You will need some type of wrap to cover the Libre with that kitten around.

Typically home testing, if done with a blood glucose meter, is before each shot (AM and PM) to make sure it's safe to give insulin, then another test part way between the shots, ideally AM and PM. The PM one can be before bed. You want to know how low the insulin dose is taking the cat as that's how we determine how to change the dose. Blood sugars with insulin tend to be a downward curve to somewhere in the middle (the nadir), then back up. You don't need a pet meter - vets will tend to push the AT, but the test strips for pet meters are really expensive. A human meter needing a small blood drop is fine, and test strips much cheaper. One of the ones I used, the Freestyle Lite, has cheaper test strips in Canada. Some tips and videos on testing here: Hometesting Links and Tips
 
fridawu said:
Just wondering, if the vet on Tuesday tells me that she doesnt think insulin is needed yet, what would I say? Is there anything specific I should ask her on why she thinks it is not needed? Do I ask for more testing to back this up or do I push for insulin?
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I would just ask why or why not the vet suggests insulin. They are seeing Koda, not us. They may have a perspective we don't see. Make sure they know your concern about your trip away and not being able to monitor as closely as when you'll be home. If they do suggest insulin, they may suggest a more conservative dose to start as a result.
 
I really appreciate everything. I will report back this week and hopefully by then I will have some good news or plan going forward.
 
Hello everyone, just an update.

I got the call from the second vet regarding results. We booked an appointment on Friday to retest her blood and urine. Koda is on 0.21ml prednisolone once a today from 0.43ml BID. I have seen a decent improvement in her behaviors (more curious and active). She is more curious in human and dog food. I haven't seen her out and about in the house and wants to be involved in random human activities for awhile. She is also drinking a bit less and yesterday she is back to peeing twice again. Things are looking like it is trending well, but this has only been the 4th day prednisolone tapering, so I feel like I am just waiting for the other shoe to drop.

Doctor said she will want to check one more time and see if Koda's blood sugar is down a bit or has less glucose in her urine now that we are aggressively tapering off prednisolone and we have seen less clinical sign with thirst and urination. She doesn't want to add insulin right now while tapering prednisolone because she said it could potentially put her in hypoglycemia. But if things doesn't change, we will start insulin right away. She also suggested an inhibitor which she said is "more safe" in a sense that Koda will have less chance to go into hypoglycemia, but she also explained that it makes their kidneys work harder as well as it could potentially induce very bad diarrhea. I remember someone said in the SCL group that SCL cats are not good candidates for these inhibitors. It doesn't sound like she prefers this over insulin, but just giving us all the options. All will depend on this blood and urine test on Friday. But Koda doesn't sound like a good candidate regardless. And based on her rare reactions to all these medications, I feel like I am not willing to risk it.

I will keep you updated. Thanks for giving me a place to have this discussion. I have been feeling so overwhelmed with all her health issues. You guys have been so wonderful.

Frida and Koda from Canada
 
That's fabulous news. Especially the part about Koda feeling better and reduced peeing. If you want to check glucose in urine at home, you can buy Ketodiastix that will measure that for you.

Can you tell me how many mg per ml of prednisolone in the bottle? We normally talk in mg for amount of pred.

Is the "inhibitor" either Senvelgo or Bexacat? They are SGLT2 inhibitors, more information on them, including contraidications, in this post: New Treatments for Feline Diabetes. Liver concerns are one of the contraindicators. One concern is that kitty needs to be monitored closely for a few weeks. Not sure when you are leaving town. Good to hear the vet isn't suggesting it other than mentioning as an option. They do work well in the right circumstances.
 
Hi,

We did mention about checking her at home but since we have to check her liver value anyways and we are close to the vet, the vet suggested we bring her in. She said she will interpret the results with stress in mind. We will also fast Koda before the test.

Her prednisolone dosage was 4.3mg BID since July 7th. She was 4.3kg at the time. She is having 2.1mg once daily right now. If it goes well for the next two days, we will reduce it to 1mg per day for three days and stop it completely.

I believe the inhibitor she talked about sounds like Senvelgo. If liver is a concern then, no, Koda would not be a great candidate since her liver values are already sky high (not sure from what yet). We are gonna be gone from Nov 29 to Dec 18. The vet knows this now and will make appropriate plan depending on what Koda's results are this Friday.
 
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