? Help! Possible diabetic

[Nicole dorsey]

Good evening,

Quick question or two for the group. My cat has crf, pancreatitis and possible diabetes. I'm trying to learn more about diabetes before rushing into insulin but I also don't not want to do it if I need to. Long story short, he has chronic pancreatitis,ckd. Recently not eating much. He was on prednisolone at high doses by the IM doc in June and tapered down to one dose in mid towards end of July. Transitioned to budesonide approximately two weeks ago (which seems to be when his appetite started decreasing can't say 100% certain if that or pancreas but it seems to coincide with the transition to budesonide. . His blood glucose from 3/13 - 6/16 was/ranged from 114-220. High dose of pred started and glucose was around 400 on 7/6. 7/11 bg 201, 7/19 228 (on one poll of pred). Started budesonide 7/27. Bg around 8/2 to 8/6 360. Frutcosamine level done 7/11 and doctors notes say mild elevation and was around 350-375
(This was in between the high dose of pred and low dose of pred). He's seeing a different place because doctor on maternity leave. Had urine test thus week which showed sugar in urine. This doctor stating to monitor urine at home and if still like this in a day or two start insulin. Are they reacting to the current levels and while on budesonide? Can panc flare cause these to escalate? Is the urine the best indicator of glucose or the frutcosamine? I feel like mo one is looking at the whole picture and not sure what to do next. Also what is best type of insulin and how often and do you have to monitor them for hours after insulin ? And must it be given with food and how much as he doesn't have too great of an appetite unless promoted since switch to budesonide. Appreciate any input.

 

[Kris & Teasel]

I'll try to get you started with some basic info:

• steroids can cause diabetes in cats but some cats will go into remission fairly quickly after steroids are discontinued
• they might need insulin for a while, although switching to an all low carb wet food diet can help significantly to lower BG
• urine test strips are a very rough guide to the BG level whereas blood testing gives a much better indicator
• fructosamine tests give only an average BG over the previous couple of weeks but don't tell you whether it's fluctuating a little or a lot
• any infection or inflammation (including pancreatitis) can cause an elevation of BG
• Lantus and Levemir are both very good insulins for cats. People on this forum use those (Lantus more than Lev) but ProZinc is also a good insulin for cats that works a bit differently.
• here's the basic testing routine we recommend:

Blood Glucose Testing Routine

Here's how to approach finding the good dose range:

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

 

[Sienne and Gabby (GA)]

Kris provided a good overview. If your kitty is going to need to be on pred indefinitely, once you have a clearer idea of the pred dose and blood glucose (BG) levels, that will help to guide you as to whether insulin in needed. Pancreatitis, in addition to the pred, may increase the likelihood that your cat will need insulin. Are you seeing other symptoms of diabetes (e.g., increased urine output, increased water intake)?

I would also look seriously at getting your kitty on a low carbohydrate, canned food diet. Fancy Feast pate style is a good example. This website on feline nutrition has a food chart with carb levels listed. You want to be feeding your cat a variety that is less than 10% carbs (although most of us tend to give our cats food that's around 5% carb). Many cats have a drop in their BG numbers just be transitioning to a low carb diet.

Given that you're posting in the Lantus/Levemir forum, the people here use either of these 2 types of insulin. The American Animal Hospital Assn recommends either Lantus or Prozinc for the management of feline diabetes. (Levemir is very similar to Lantus.) The biggest downside for Lantus is cost. Many people here will buy their insulin from Canada (e.g., Marks Marine Pharmacy) due to the price for Lantus. If you call around, you may be able to purchase a single Lantus "pen" and then order from Marks. One of the benefits of Lantus or Lev is that the onset (when insulin becomes active and starts to bring numbers down) isn't for about 2 hours after a shot. That means if your cat isn't eating well or is a grazer, you have time between the shot and when the insulin kicks in. However, is your cat not eating due to pancreatitis? If this is the case, is your cat getting pain meds (e.g., buprenorphine) and an anti-nausea medication (Cerenia or ondansatron) and an appetite stimulant (e.g., mirtazepine or cyproheptadine) may help.

As for monitoring, the minimum amount of testing for blood glucose levels (not urine glucose) is 4 times per day. You want to get a test before you give a shot (we call this AMPS or PMPS -- AM or PM Pre-Shot) and somewhere close to around 6 hours after a shot. This is where the lowest point of the cycle falls for many cats who are using Lantus. The low point (i.e., nadir) is later in the cycle with Lev. Most of us test more than this but that's the minimum.

 

[tiffmaxee]

Welcome. The problem with fancy feast is it's high in phosphorus. I'd look for a lower phosphorus low carb canned food. My Max had chronic pancreatitis and after several years became diabetic and he never had a steroid. Just getting a steroid can cause some to become diabetic as well.