IBD Treatment Options for Diabetic

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Kelly & Logan

Kelly & Logan

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Logan was just diagnosed with IBD. We will begin treatment next week. I'd just like some thoughts from people who have experience with IBD.

The internist is suggesting we start with prednisolone. He's on metronidazole and she wants us to continue that for now. She also mentioned a B12 supplement.
 
> Logan was just diagnosed with IBD.

Is it the more common diarrheal form, or the less common constipating form? Is Logan an active diabetic or in remission? And is he prone to pancreatitis?


> The internist is suggesting we start with prednisolone.
> He's on metronidazole and she wants us to continue that for now.

Both can help control IBD and, depending on what happens with his symptoms, you may or may not be able to wean him off the steroids.


> She also mentioned a B12 supplement.

IBD tends to interfere with the absorption of B12, which leads to additional problems digesting food properly, which can make things worse. Many IBD cats are on B12 supplementation, generally through subcutaneous injections -- just like insulin, really. We even use our insulin syringes to give it. Most folks start B12 supplementation following the TAMU protocol here http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml, and then adjust it for their own needs.
 
Budesinide is also commonly used instead of pred. The standard dose is 1 mg bd. My civi Spot was on metronitizole and budesinde. My Bailey is presently on budesinide.
 
JJ & Gwyn said:
> Logan was just diagnosed with IBD.

Is it the more common diarrheal form, or the less common constipating form? Is Logan an active diabetic or in remission? And is he prone to pancreatitis?


> The internist is suggesting we start with prednisolone.
> He's on metronidazole and she wants us to continue that for now.

Both can help control IBD and, depending on what happens with his symptoms, you may or may not be able to wean him off the steroids.


> She also mentioned a B12 supplement.

IBD tends to interfere with the absorption of B12, which leads to additional problems digesting food properly, which can make things worse. Many IBD cats are on B12 supplementation, generally through subcutaneous injections -- just like insulin, really. We even use our insulin syringes to give it. Most folks start B12 supplementation following the TAMU protocol here http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml, and then adjust it for their own needs.
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Logan occasionally has some diarrhea, but his main symptom has been inappetance. He was in remission from Jan 2007 until Sept 2009. He's never had pancreatitis. They said the IBD was moderate and it's located in the small intestines, only. So the B12 can be injected using insulin syringes? That's good - I get monthly B12 shots and the needle is pretty big and it hurts so I was already worrying about that! I hate causing him pain!
 
Hi Kelly --

> Logan occasionally has some diarrhea, but his main symptom has been
> inappetance. He was in remission from Jan 2007 until Sept 2009. He's
> never had pancreatitis.

Okay, good. You might want to try a raw food diet. Those are usually fine for regular cats and good for diarrheal cats, but can be problematic in cats with constipation issues. Some of the commercial raw food diets can be high in fat, and thus can be contra-indicated in some pancreatitis cats; and ISTR that there are a few that are higher-than-we'd-normally-like in carbs, at least for diabetics. The raw food numbers are at the bottom of the canned food charts.

You can get raw food from some pet retailers; the one time we tried raw food, we went with Nature's Variety, solely because they had a trial buy-one-get-one-free offer, which is still available here http://www.naturesvariety.com/tryit. In order to get the coupon, you'll need to know the name of a local store which carries the raw food; you can find that out here http://www.naturesvariety.com/locator.

You can also make your own raw cat food; there are recipes on Dr Lisa's site here http://www.catinfo.org/makingcatfood.htm. That'll let you control the specifics of the diet, including percentage of fat, and will probably save you some money. But you might want to try one of the commercial diets first to see if Logan takes to it and how well he does on it before you invest in a meat grinder.


I will say that when we tried the raw food diet, I had problems getting Gwyn interested in it. I think that's partly because it was served cold from the fridge and she just didn't like that. I did try microwaving it for a few seconds to warm it up; she liked that better, but the food seemed to go stale faster. Tried adding warm water to the medallions, but I didn't like the resulting consistency. What finally worked for us was for me to take the defrosted medallion out of the fridge and beat it strenuously with a fork until it was a sort of puree. That made it easier for Gwyn to lap it out of the bowl (she has lingual dexterity issues due to a stroke), and it also warmed it up to a temperature that she liked without letting it go stale early. If you do decide to try a raw food diet, you might try posting for hints on making it more appealing to cats.


> They said the IBD was moderate and it's located in the small intestines, only.
> So the B12 can be injected using insulin syringes? That's good - I get monthly
> B12 shots and the needle is pretty big and it hurts so I was already worrying
> about that! I hate causing him pain!

I give Gwyn 1/4 cc (or 25 units on the insulin syringes we use ;) ) twice a week, and it gets injected just like the insulin -- we even use the same site rotation. It'll make a little larger under-skin lump than the insulin, but they're pretty much painless. And any excess B12 is generally just urinated away, so it's safe as well.

You should be able to get injectible B-12 from your vet; I've been able to special order it at about half the pharmacies I've tried, but you often (always?) need a prescription; and a lot of folks have found it available without a prescription at their local feed stores. I spend $10-15 per vial and it lasts me over a year. Please note that B-12 is light-sensitive and, to preserve it's effectiveness, I keep it in a dark cabinet despite the brown bottle.


Also, I'm glad that you're trying prednisolone. Sometimes vets recommend prednisone (prednisone turns into prednisolone after being processed by the body), but prednisolone can have the same impact with a lesser dose. At least in most cats; as always, Gwyn seems to do better on prednisone than prednisolone :shrugs: . But my recommendation would be for prednisolone first.

You'll probably have to do the steroids for a while, to try to get the IBD under control, and then hopefully you'll be able to wean Logan off them, particularly if you can control the symptoms in other ways. Note that steroids in general tend to increase appetite, so expect his appetite to decrease somewhat during the weaning process and don't panic when you notice it decrease ;)

You may also want to speak with your vet about whether putting Logan on Pepcid A/C or Zantac might be beneficial. I know that Zantac has helped my Gwyn a lot.


Finally, you may want to joint the feline IBD group at Yahoo here http://pets.groups.yahoo.com/group/FelineIBD. Most of the cats there are dealing with the diarrheal form and they may be able to provide you with more specialised help should you need it. (Since Gwyn has the constipating form, they've been less able to help her and I don't spend a lot of time on their group; if you ever want to PM me, please do it here.) Their first suggestions, however, will be the B12 supplementation and to suggest trying a raw food diet.

If you've any other questions, feel free to ask :)

Peace --

Jean and her Gwyn
 
I use Pred and treat the resulting DM. Also feeding a no grain diet can help with IBD. H's case is serious.

Please read:
http://petdiabetes.wikia.com/wiki/IBD

What testing have you had done? What kind of IBD does your kitty have?

I've also developed a custom diet for H which is linked in our signature.
 
We get B12 out of Canada, I believe it's under $15 per vial, I've ordered three times so far and have good luck. Tucker always feels better after his injection.

Tucker's IBD presents with constipation so I'm not sure I can offer much help. From what I've learned with him, he is allergic to wheat gluten. After a phone consult with Dr. Lisa in May 06 we removed the gluten and Tucker was able to come off the meds and does great now. Before that we were getting enimas at the vet for almost monthly.

When Tucker's IBD does flare he takes the metronitizole, and he gets a couple of weeks worth of steroids, either prednilosone or the budesine (can't spell it, sorry). We have injectible pepcid on hand for the times that his belly is acting up, but that may be more for his pancreatitis flares.
 
Hi Kelly,

We have been lucky enough to avoid IBD but I have noticed that lots of cats do very well on a raw diet. Is this an option for you? Dr. Lisa has done a great deal of work in the IBD/diet area so you might want to talk with her.
 
My head is spinning! :YMSIGH:
My cat has IBD too, but his symptom is puking.
He was on pred and it worked great, but it gave him diabetes.
Now he's on budesonide and it's just as good as pred but more money. Apparently bude isn't absorbed like pred is. Not sure why the heck she didn't put him on bude in the beginning, maybe he wouldn't have gotten diabetes!!!
He also gets B-12 to help with absorption of nutrients. He now gets it once a month. (in the beginning he got it more) They give it me for some reason in a HUGE needle, but it's quick so he tolerates it. I'd ask for it in a insulin needle though. Why have a huge needle if you don't need to???

I am so tired of pet-sickness!!!!!
 
i recommend budesonide highly. it raised my cat's BG levels by about 20 points but that's it. it targets the GI tract specifically, which i think is quite helpful.
 
Hi- Wish this question had gone up a few months ago... I've been lurking for a while.

My diabetic cat Miles had diarrhea for months and occasional vomiting. Vet could feel what was he thought was thickening in his intestines and fluid, or possibly a mass in his abdomen (!), could have been IBD or lots of other things. Put him on metronidazole and a prescribed dry food with no results. Vet wanted to biopsy and check it out, but Miles' troubles had begun after an earlier surgery, I didn't want to exacerbate them. I didn't have the money to take him to get scans done and get a firmer diagnosis.

Long story short (too late!), after consulting with the nutrition guy at our pet store (Whiskers in NYC), I started feeding Miles Nature's Variety Instinct canned, the Venison kind. We mix in canned pumpkin for fiber , it's worked great, and we can feed it to both our cats, who love it. Because of the change in food I finally started home testing his bg (vet wasn't enthused about home testing, and Miles was doing so well so it didn't seem necessary, now I wish I'd done it from the beginning). AND HE'S GONE OFF THE JUICE!! I'm getting readings around the low 100s. He was getting one unit of PZI twice a day. The Nature's Variety is pricey, but we'll save on the PZI if he stays on holiday.

Miles is gaining weight back, is happier and more energetic and alert than he's been in a long time. Highly recommend Nature's Variety canned. Even if it doesn't completely fix your cat's problems, giving them great nutrition can only help.

Good luck! I hope you find the right solution quickly.
 
> We mix in canned pumpkin for fiber

Canned pumpkin can work great for both diarrhea and constipation.

Depending on the size of the can and the number of cats, the pumpkin may start to go bad in the fridge before you're done with the can. As your cat can tell this way before anything visible appears, you may end up frustrated not nderstanding why the cat isn't eating and the cat may end up hungry and annoyed with you ("Mom! You're trying to poison me!"). So: open the can of pumpkin and spread it in an ice cube tray. Put the tray in the freezer until everything's solid, then pop the pumpkin cubes out and put them in a ziploc freezer bag. Defrost as necessary.
 
Thanks for the frozen pumpkin advice. Wouldn't ya know, as soon as I posted about our success, Miles vomited and had a bad poo. Tested the bg, it was around 102. First tummy episode in weeks though, so I'm hoping it clears up.

Will try the pumpkin ice cubes!
 
Logan was diagnosed after exploratory surgery. They did biopsies of his stomach, liver, pancreas and the small intestines. The IBD is moderate and is in the small intestines only. A little over a month ago, an ultra sound showed inflammation in his liver, spleen and small intestines. The internist wants to start him on prednisolone tomorrow. He'll get 2 5mg tablets twice a day for 3 days and then 1 5mg tablet twice a day for 1-2 weeks.

He currently has a feeding tube in and will not eat on his own. When he went back on insulin in September 2009, I switched him to Wellness canned food. After a month or so of eating that really well, he had an episode of not feeling well and stopped eating it. We then put him on Wellness Core (canned), which he loved. He had a few episodes of not eating well and then finally stopped eating it all together. Since then, we've tried all kinds of foods, just trying to find something that he will eat. He's now at the point where he doesn't feel like eating much of anything - surgery didn't help! I haven't discussed diet yet with the internist so I'm not sure what she's going to suggest that we try. I'm just hoping that Logan will start feeling better after a few doses of the pred and will start to eat on his own so we can get this tube out of him. :(

He's been insulin resisitant and is now at 4.5 units of Lantus bid. His BG doesn't come out of the 300s. It holds fairly steady in the mid 300s regardless of the insulin dose. How much of a spike should I expect from the pred?
 
> How much of a spike should I expect from the prednisolone?
It's hard to say: some cats don't have much of a BG reaction to steroids; some do. It's good that you're going with prednisolone instead of prednisone, as that's usually more effective (so you'll need to give less).


misc thoughts:

The IBD may be the reason he came out of diabetes remission. IBD = *inflammatory* bowel disease, and inflammation can raise BG levels. So maybe if you can get the IBD under control, the diabetes will back off as well.

Given his lack of appetite, have you spoken with the vet about trying Pepcid A/C or Zantac? Both are pretty safe drugs and can help with stomach issues like nausea that can occur with IBD. And have you talked with the vet about an appetite stimulant? Steroids like prednisolone can also trigger appetite increase, but that's a comparatively low dose for a short-ish time, so I don't know how much of an effect it'll have.
 
JJ & Gwyn said:
> How much of a spike should I expect from the prednisolone?
It's hard to say: some cats don't have much of a BG reaction to steroids; some do. It's good that you're going with prednisolone instead of prednisone, as that's usually more effective (so you'll need to give less).


misc thoughts:

The IBD may be the reason he came out of diabetes remission. IBD = *inflammatory* bowel disease, and inflammation can raise BG levels. So maybe if you can get the IBD under control, the diabetes will back off as well.

Given his lack of appetite, have you spoken with the vet about trying Pepcid A/C or Zantac? Both are pretty safe drugs and can help with stomach issues like nausea that can occur with IBD. And have you talked with the vet about an appetite stimulant? Steroids like prednisolone can also trigger appetite increase, but that's a comparatively low dose for a short-ish time, so I don't know how much of an effect it'll have.
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I think the IBD is what brought him out of remission, as well. Prior to the surgery, we had him on pepcid and an appetite stimulant. We didn't see much of a difference with either one. I think i'll start the pepcid back up tonight. The stimulant would cause him to ask for food every hour the first day (it was the 3 day one) but he wouldn't eat more than a bite. I think he's hungry, he just doesn't feel well enough to actually eat. It's so frustrating! I'm so afraid he's not going to want to eat on his own. :(
 
Which appetite stimulant?

Cyproheptadine has worked very well for us while mirtazapine is just kind of so-so. But when H really doesn't want to eat, even that will not help. We had no luck with pepcid either.

H gets 5mg once a day of the pred. He would normally probably not need insulin, and he now gets about 0.5U.

Have you tried any other insulins besides Lantus? The BCP PZI insulin is an all beef insulin which is a closer match for kitty insulin.

Another aspect is pain management. If your kitty is in pain they may not want to eat. You may want to try buprenorphine or maybe a fentanyl patch. However, my one experiment with buprenorphine was followed by constipation - so I would advise to keep an eye on that.

Out of curiosity, did the biopsies show any cancer, or helicobacter? Good work on having the surgery done to confirm it - it takes a lot of will to do that.

I've found that a no-grain, medium fat, low carb diet has been crucial to the long term management of H's triaditis [IBD, liver-itis and pancreatitis] & DM. Raw is a good option but not the only option.
 
Gator & H said:
Which appetite stimulant?

Cyproheptadine has worked very well for us while mirtazapine is just kind of so-so. But when H really doesn't want to eat, even that will not help. We had no luck with pepcid either.

H gets 5mg once a day of the pred. He would normally probably not need insulin, and he now gets about 0.5U.

Have you tried any other insulins besides Lantus? The BCP PZI insulin is an all beef insulin which is a closer match for kitty insulin.

Another aspect is pain management. If your kitty is in pain they may not want to eat. You may want to try buprenorphine or maybe a fentanyl patch. However, my one experiment with buprenorphine was followed by constipation - so I would advise to keep an eye on that.

Out of curiosity, did the biopsies show any cancer, or helicobacter? Good work on having the surgery done to confirm it - it takes a lot of will to do that.

I've found that a no-grain, medium fat, low carb diet has been crucial to the long term management of H's triaditis [IBD, liver-itis and pancreatitis] & DM. Raw is a good option but not the only option.
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It was Mirtazapine. We haven't tried the cypro yet. We started on Vetsulin, but I switched him after about 10 days. That stuff was crap! We haven't tried the PZI. Is that what you use? I've tried giving him buprenorphine, but it didn't seem to do a whole lot. He was on pain meds the first week after the surgery. He's going in tomorrow for an incision check so I may ask for a refill of the pain meds. He's seemed pretty uncomfortable the last few days w/o them.

The biopsies showed absolutely no cancer, thank God! No helicobacter, either...just the IBD in the small intestines. An ultra sound had shown inflammation in the liver/spleen and they aspirated some samples at that time, but they came back negative. We were very torn about doing the surgery, but we wanted to be sure he didn't have lymphoma. We haven't had the best of luck with Logan, so we felt we couldn't gamble with him! And he's not quite 6 yet, so we went for it. They did tell us that the scope would not have reached far enough to get the sample needed to diagnose the IBD. We're so thankful it's not cancer. Still sucks! But, we'll manage. I'm pretty scared of the high dose of steroids, but she said it's necessary to knock out the inflammation and we'll switch him to a low dose as soon as we can.

Once he's showing some interest in food, I'll try to find a low carb/med fat/grain free food. I may try your recipe! I'm not sure how I feel about the raw diet. We have two other kitties that eat Wellness and love it. One was a dry food addict and wouldn't even touch treats. He now cries for his wet food.

When he went back on insulin, I was so determined that we'd get him OTJ again in no time...now I'm just hoping and praying we can get him regulated and eating well. Funny how your outlook on things change. I'd be so happy to just see him below 300 for a change. I know that's not going to happen while he's on 20mg of pred a day, but maybe in a month or two when the inflammation is hopefully under control.
 
Do try the Cypro if you can. It is relatively cheap. For some time H only needed 1mg once a day but I think you can give up to 2mg three times a day. Currently H is getting 2mg twice a day. The Mirt is a little tricky to deal with too when also dealing with DM because it starts off strong and then wanes over 3 days. By the end of three days H would not be eating mych and it would play serious havoc with our dosing. We did do will with Mirt for a while by giving 1/8th of a pill every 1.5 days, but that was when his appetite was better. And it's hard to cut them that small too.

If you do try my [diet] route - I do mix [my home cooked which is very low fat] with Wellness which is a relatively high fat food. So I get the blend. Also makes the home cooked last longer and I can change out flavors when he's sick of one.

Several of the the Merrick flavors are also a good choice but H will not eat them :-(

I do use a flavor of PZI [ProZinc] but it is a human analog, just as Lantus is. I've not used the BCP.
 
In actuality, ProZinc is NOT an insulin analog. It is simply a recombinant human protamine zinc insulin. It is basically R human insulin mixed with protamine zinc to extend its duration. I is like the old human ultralenta insulin which was human recombinant insulin mixed with a zince compound to extent its duration. Both Lantus and Levimer, as well as some very short acting insulins such as Humalog, are called analogs since they allow the body to absorb glucose but in a different mechanism than insulin.

Gator & H said:
Do try the Cypro if you can. It is relatively cheap. For some time H only needed 1mg once a day but I think you can give up to 2mg three times a day. Currently H is getting 2mg twice a day. The Mirt is a little tricky to deal with too when also dealing with DM because it starts off strong and then wanes over 3 days. By the end of three days H would not be eating mych and it would play serious havoc with our dosing. We did do will with Mirt for a while by giving 1/8th of a pill every 1.5 days, but that was when his appetite was better. And it's hard to cut them that small too.

If you do try my [diet] route - I do mix [my home cooked which is very low fat] with Wellness which is a relatively high fat food. So I get the blend. Also makes the home cooked last longer and I can change out flavors when he's sick of one.

Several of the the Merrick flavors are also a good choice but H will not eat them :-(

I do use a flavor of PZI [ProZinc] but it is a human analog, just as Lantus is. I've not used the BCP.
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