? High Blood Glucose after Depo Medrol Shots / monitoring and treatment

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The Chonk

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Hello all, first post. The cat facts: Chunky, 11yo female, healthy weight (not chunky at all its just her name), all labs aside from BG are perfect. In the nutshell she was on depo medrol for pain. After several shots I asked "shouldn't you be monitoring?" & the vet said no....I went to another vet for 2nd opinion and sure enough the cat's blood sugar was high. At 10 days after shot BG was 271. The vet put on a Freestyle Libre sensor to track BG. While BG decreased a bit, apparently it wasn't enough. Today is 28 days post depo shot. The ranges were mid to low 200's, with an occasional dip down into the 100s and also spike up to the 300s. Tuesday she'll get a glucose regimen. I was in the store when they called and I swear they said "come for a low dose of insulin on Tuesday, and then in 5 days he'll attach another Freestyle sensor". Has anyone had a similar situation? I'd like to know more of what this could mean. Is this a dose to hopefully force remission? I have fears of hypoglycemia since a few times it did go down to 150-175 ish on its own. Thank you for any information.
 
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I will say so far I really do trust this doctor. He seems much more on the ball than the past one. I just wish I could have spoken to him today and not just the front desk. He explains everything well.
 
Meantime until someone replies back
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.

The signature is at the end of everyone's post in gray ,information about our cats
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC it
    • t" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Also almost all of us use human meters that's what our numbers are based on
Just to show you about the Spreadsheet
Don't be nervous about the spreadsheet
About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers



You can look at any members spreadsheet to see what it looks like, it's at the end of everyone's signature just tap on it
 
Depo-medrol is a steroid and it looks like she could have steroid-induced diabetes. What pain was being treated by steroids?

What food does she eat? Do you know if a urinalysis was done and did it show ketones? If there are no ketones at diagnosis, you want to switch her to a low carb diet and see if her blood sugar can be brought under control with only a change in diet. Some lucky cats get regulated with just a food change and end up not needing insulin.

Is there a reason you're using a Libre and not a regular meter?
 
Welcome to FDMB!

As Bhooma noted, depo-medrol is a steroid and your instincts to have your cat monitored when on the medication were great! Steroid-induced diabetes can be a short term condition although it's not always the case. We tend to approach any situation where you're giving insulin carefully in order to ensure your cat is safe for exactly the reason you noted -- hypoglycemia. That said, we'd encourage you to get a glucometer so you can keep track of how insulin is affecting your cat's blood glucose numbers. A Libre is fine. The sensor should last 2 weeks. (They don't always last that long and some cats are part magician and manage to remove the sensor.)

There's no way to "force" remission safely. There are cats who will drop into remission after a hypoglycemic event but personally, I'd err on the side of getting to remission without the drama.

I'd suggest switching to a low carb diet now and seeing what happens to your cat's blood glucose numbers. Since it sounds like you've already got a Libre on your cat, you will be able to gauge what the effect of a low carb diet is. This is a link to a chart that has the carb levels for most canned foods available in the US. You want to select food that is less than 10% carb although, most members opt for food that is in the 5% range. Fancy Feast and Friskies pate style foods are probably the most popular here.
 
Thank you all for the replies. I don't have all of the info right now and the vet appt to begin insulin is on Tuesday. At the moment the only facts are:

-Last medrol shot 10/3/23 from old vet.
-At new vet: BG test with result of 271 on 10/14/23
-New vet advised two weeks of low carb food, wet only, and tracking via Freestyle Libre. This just ended Thursday 11/2/23, and apparently the numbers did not decrease enough. Average BG was still in low to mid 200's, down from high 200's but still high.
-Going to vet 11/7/23 for an insulin regimen. He prescribed Lantus, which i have already from pharmacy. Will report back at on Tuesday when I'm given the insulin routine and plan.

Thank you!
 
The back story for the pain which caused this whole depo/diabetes journey--the cat suddenly had pain/mobility issue about a year ago which resulted in a series of vets and treatments.

Vet 1: Assumed arthritis and tried Solensia, which did not help. I asked for xray, other alternatives and they said no keep going with Solensia even with no improvement after 4 months. Went to vet 2.

Vet 2: Tried the depo medrol which did provide relief to cat. However, after several shots I asked about concerns re diabetes, heart issues etc. He said not to worry, keep going w 6-week depo shots, offered no other options and refused request for xray or blood work. Weird, right? What vet won't be willing to charge for more tests?

Vet 3: Seems to be of a completely different variety than Vet 1 and Vet 2. Immediately did thorough exam, blood work, neuro exam, xray. The x ray result shows some sort of hip trauma with remaining inflammation. Makes total sense as the cat was a parkour expert & very athletic prior to the sudden onset of pain. I would not be surprised if one of her stunts caused an injury. Nobody saw it happen as we were away, so it was a mystery. Now we know for sure & this makes sense. The pain issue will have to be addressed as the depo wears off but right now the concern is to control the BG and hopefully reach remission.
 
The good news is you found a vet that is thorough and sounds like is responsive to your concerns. Even better, the vet prescribed an appropriate insulin!!

I'm a bit nervous asking but what was The Chonk's food changed to? Some of the prescription "diabetic" foods are not particularly low in carbs.
 
I settled on ProPlan Kitten Chicken/ liver and fish variety. The vet did not offer an Rx food (yet). At this point all dry food was eliminated and this left her eating some basic FF pates (she's not a huge fan of these) and mostly ProPlan Kitten fish or chicken variety. I chose these by looking at the guaranteed anaysis and adding up protein+fat+moisture+fiber+ash. The ProPlan appeared to have decent ingredients and lower carbs at .5 and 1 doing that calculation.
 
You can't actually get the carbs from the information on the labels. In addition, the formula for calculating carbs isn't a matter of just adding the numbers in the guaranteed analysis. However, what you're feeding your cat is under 5% carb (the fish variety is 4% and the chicken/liver is 2%). And just to complicate matters further, it's preferable to have the nutritional content based on the "as fed" values rather than the guaranteed analysis. The latter is usually listed as a minimum or maximum so you really don't know what's in the can. A vet, Lisa Pierson, DVM has an active interest in feline nutrition. on her website, she has compiled an extensive chart listing most of the canned foods available in the US along with their nutritional contend, including carbs. Her calculations are based on the as fed values.
 
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