Jack--need help due to changes from prednisolone.

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kozykitty

kozykitty

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Jack, my 10 year old diabetic kitty has been well controlled on Prozinc for 4 years. He was up to 4 units but with some diet changes, I had gotten him down to 2.5 units and he has been stable for the last few months at that point. I noticed weightloss, in spite of the fact that his appetite was the same, even though there were no changes in his BG or his behavior other than pooping outside of the litter box. We went right to the internal medicine specialist as Jack had a bout of intestinal disease before being diagnosed as a diabetic. The internist performed an abdominal ultrasound and a number of blood tests. Jack showed signs of pain in one of his kidneys. The ultra sound showed thickening of the intestines, issues with the kidneys and in one lymph node. A needle biopsy was done of the lymph node and the oncologist on staff thought it might be large cell lymphoma. After considering the courses of treatment, I decided to go with steroids 5 mg of prednisolone which was started Saturday morning. The vet visit and tests were performed on Friday (5 days ago) Since then, the tissue sample came back not being large cell lymphoma but possibly small cell lymphoma or even possibly another type of inflammatory disease so we are waiting on the results of further testing.

Jack's blood sugar has risen due to the prednisolone and I'm unsure as to how much or how often to increase his insulin dose. When he was regulated, he would usually be in the 200's at shot time. That increased to the 300's after he was one prednisolone for 2 days so I went from 2.5 to 2.75 units on Sunday then to 3 units yesterday when he was in the 400's. This morning he was at 503 11 hours after his evening shot. I gave him 3 units. At the 5 hour point he was at 501, 6 hour point he was 439 and the 7 hour point he was at 422. I'll be testing him again in 30 minutes. These numbers are way too high. Should I just increase it more? Should I keep him at the 3 units for a few days more? I'm at a loss. He is eating frequently which is good. I had his diabetes so well controlled and now we have something else to throw in the mix. It's so frustrating.
 
The general advice here is that if steroids are needed to treat another serious health concern you have to dose the insulin around the effects of the steroid. I'd keep raising the dose in 0.25 u increments every 3 cycles until you start seeing better numbers. Because you're moving into new dosing territory some mid cycle BG tests would by useful info.
 
I can't measure .25 unit on these syringes. The space between the full unit markings is pretty small. They're the ones that Prozinc sells. I can manage a half unit and I did actually increase by about .25 on Saturday but it made no difference. His numbers just seem to be going up.
 
kozykitty said:
I can't measure .25 unit on these syringes. The space between the full unit markings is pretty small. They're the ones that Prozinc sells. I can manage a half unit and I did actually increase by about .25 on Saturday but it made no difference. His numbers just seem to be going up.
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You can dose ProZinc using U100 syringes and a conversion chart. If you buy U100s, get the ones with half unit marks. You'll have a ton of dosing options then.
http://www.felinediabetes.com/insulin-conversions.htm
 
Thanks. Given his numbers, I suspect .25 won't be enough. In the meantime, I'll keep him at 3 for another day.
 
So his BG was 503 at shot time. +5 was 501, +6 was 439, +7 was 422 and +8 is 436 so it looks like the insulin peaked at +7. Should I shoot him earlier with a larger dose?
 
It's generally recommended to stay with the 12 hour shooting schedule. I understand the urgency to get the numbers under control. Kris gave you the best advice. If you really don't think you can manage eyeballing the 0.25u increase, you are showing numbers that would allow you to do a 0.5u increase. Do hold it for at least three cycles though before the next increase, and please continue to monitor mid-cycles since the bigger increase can cause some bouncing. It looks like Jack's numbers have been too high for quite awhile. It would be great if we can figure out how to dose around the prednisone and get him into better territory.
 
At hour 10 he dropped down to 399 after going up in hour 8. I'm continuing to test him and I'll give him 3 units again tonight. That will be the 4th cycle at this dosage. If it's high in the morning like it was today, I'll increase to 3.5. He used to be on 4 units but that was months ago and it was too much as every third shot or so, I'd have to skip due his BG being too low. We gradually tapered down to 2.5 which seemed consistent until recently. I suspect his illness is playing a part of this as well as the prednisolone. He's down to 10 pounds from 14.5. Unlike 5 years ago when he had intestinal disease and fatty liver, he hasn't been acting sickly and he's been eating his normal amount. I hadn't weighed him in a few months as he doesn't look thin. He just feels thin. There was a nodule on his thyroid which I thought could be hyperthyroid which could cause the weight loss but his thyroid blood test came out normal. This is so perplexing.
 
If he's feeling poorly, it can effect his BG as well. Give the pred a few days and see if that helps him feel better...as the others have said, I think you're best just dosing around it at this point, because we have to do what we have to do! If the pred is what he needs, that's okay.

I know how frustrating this is, Vicki, but you're doing the right things, and now we just have to figure out the best way to dose around the pred so Jack can feel better and have better numbers. You'll get there as you did before! :bighug:
 
Yong said:
She uses a different insulin but still might be able to help
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Sorry Yong, I have been feeling ill the last couple days and this is my first time back to the board.
kozykitty said:
At hour 10 he dropped down to 399 after going up in hour 8
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I would expect that to be the pred affect as I call it. It is when the steroid starts to hit the system and boost up the BG's. The advice that Kris gave is the best one. You need to give enough insulin to offset the pred and it may take a bit to figure out what works for your kitty. I have gone down and up on the amount of pred Jones gets. He is on 5 mg a day now- 2.5 mg BID, and if you check his chart, it started to come back down after I increased his dose for like 4 cycles. I was holding for a week and that was not getting him any where, came here for advise and whola!

Tricks I have learned...
  1. Are you giving the pred at the same time as the insulin? I was testing at first to see when the pred affect would happen on Jones, which was around +2 hours after administration. I was also moving when I gave the pred +1 or +1.5 after injection. I see that black @ +5 yesterday, maybe get a few test earlier to see if you can see the spike. I would then time the onset of the insulin to the onset of the pred. So if your insulin starts onset at +4 and the pred starts +2 after administration - the give the pred 2 hours after the insulin. So Jack doesn't get a big peak and then steep dive.
  2. The pred affect can change as their bodies get used to the consistency of it's use. Watch for that especially when increasing dose.
  3. And are you giving the 5mg twice a day or just 5 mg once a day? If you are giving 5 mg once a day - I would invest in a $2 pill cutter and cut it in half and give twice a day. It is the same dose - just in a smaller amount over the day. If you don't want to do that - give it at night when their BG's are naturally lower. At least you can get some sleep then.
  4. It can take up to 6 weeks to find balance again. The last increase in pred took about that long and the latest increase took about 3 weeks to figure it out. I also found when we were lowering his dose of pred - it took a little while to see the full impact of it.
  5. Use those days off on curves! It is always good to see how they are doing when you are not working and it will help you see the patterns.
Let me know how it goes.
 
Thanks. He gets 5 mg of prednisolone once a day. I've been giving it in the morning. I test, feed and give him his insulin and the prednisolone when he's eating. How can you tell when the predisnolone affect kicks in?

I'm worried as we're supposed to go away for one night on Aug. 12. Before this diagnosis, Jack could miss a shot with no problem. I've yet to find anyone else who can give him a shot. Only my husband and me. It's a struggle for my husband and for a stranger, it's really bad--if they can even find him. My husband doesn't test him but will give shots. I have to be out of town for 4 days at the end of August and I'm frantic about that. Normally, it wouldn't be an issue.
 
kozykitty said:
Thanks. He gets 5 mg of prednisolone once a day. I've been giving it in the morning. I test, feed and give him his insulin and the prednisolone when he's eating. How can you tell when the predisnolone affect kicks in?
.
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His BG's went up even though the Lantus had onset. See Jones' sheet - Feb 2 to Feb 10 - see how his highest number is at +6 from his PMPS? That should of been around his lowest number.
I would give it twice a day - that will even out any upswing from the prednisolone and you may find you need less insulin to get him back on track. I had Jones and once a day for awhile but I gave it at night.

I also had Jones on every other day once a day - don't do that - split the dose and give it every day.

I had a catsitter while I was gone on my vacation. That helped me out a lot, she gave him his shot and gave him his pill. She is a vet tech. Does your vet have anyone they can recommend?
 
Nope. I've had a cat sitter for years. Jack just doesn't like strangers. So you think it would help to switch the pred to night. When at night should I give it? His shot schedule is 8 am and 8 pm give or take an hour. Sometimes it fluctuates by 15 minutes or so. I always test him prior to shooting. Should I give the prednisolone right after testing and shooting him at 8 pm or should I wait until 10 pm to give him his pill? My cats eat throughout the day if that matters. I've been feeding Jack whenever he wants since he's lost so much weight.
 
kozykitty said:
Nope. I've had a cat sitter for years. Jack just doesn't like strangers. So you think it would help to switch the pred to night. When at night should I give it? His shot schedule is 8 am and 8 pm give or take an hour. Sometimes it fluctuates by 15 minutes or so. I always test him prior to shooting. Should I give the prednisolone right after testing and shooting him at 8 pm or should I wait until 10 pm to give him his pill? My cats eat throughout the day if that matters. I've been feeding Jack whenever he wants since he's lost so much weight.
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I see you don't have much mid cycle testing to know what his normal cycle before pred was, so I would keep doing what you are doing for timing for now. If it was me? I would split the dose. Jones is on 5mg a day - I split the dose in half and give 2.5 mg each time I shoot. If you look at his sheet right now, I am getting some good nadirs in after about about 3 weeks and a dose increase. I think this is optimum for controlling the BG's and allowing Jack's body the chance to regulate everything.



ETA: I would do some mid cycle tests over the next couple of days. +3, +6, 9 and see the affect.
 
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I hope to get more mid cycle testing done. Sometimes I'm out which accounts for the lapses. I'm concerned when we go away for a night on Aug. 12 in that he may have to miss his shot. He'll get his pred in the late morning on the 12th and in the afternoon on the 13th but he may have to go that amount of time without insulin if I can't make arrangements. This was never a problem before he was on pred. We'll see how it goes.
 
Hopefully if you are giving the dose twice a day vs. 1 a day his numbers will not increase as bad if he misses a dose. And that is a few weeks away, lots can change in that time especially if you can get his numbers back down again.
 
Of course he'll miss part of his prednisolone too. If I'm leaving late morning on the 12th and coming back late afternoon on the 13th, should I just skip the half doses at night 8/12 and morning 8/13 and give him a whole dose before I leave and a whole dose when I get home? Also--should I just start the half dose in the morning tomorrow? Is there a medical reason for giving a whole dose that would be a reason not to change that? Thanks for all of your help.
 
That may be a plan - it is important to keep the pred dose every day. With Jones it seems a missed day of anything causes issues. That said if you do that you may see some very high numbers on your return...so don't panic and over dose when you get back. We shall see where he is at when you go...we have lots of time to sort everything out.
 
He is doing better today. He's gained .7 of a pound since Monday! I still gave his Prednisone in the morning. When we go away, I suppose I could just give him a whole one when I leave in the morning and another one the next day in the late afternoon when we get home then go to back to the half doses the next day.
 
No. I thought I'd start that Monday. We will be out of state for the day tomorrow and I was afraid with the smaller pred dose, he might be more at risk for a hypo episode. I'd rather wait until Monday when I'm home all week. It's a bit high today--more so than yesterday.
 
Does anyone here use Alphatrak 2 meter and strips? I ran out of strips this morning after having two error readings yesterday. My new vial is supposed to arrive today via Amazon but I just got a text that the order is delayed. I know of nowhere locally that I can purchase them. I'm frantic with Jack's numbers bouncing and I started his pred at half the dose this morning so I don't want to give him too much insulin. Is there another brand strip I can use temporarily? I remember reading somewhere there was. Thanks. I'm desperate.
 
If you can't get more AT2 strips from your Vet, in a pinch you can grab some Freestyle Lite test strips. :) They look exactly like the AT2 strips because they kind of are. @MrWorfMen's Mom explained this to me :)

ETA: Just keep the same code from your last bottle of AT2 strips. Don't change it to human code on FSL strips.
 
Yong said:
If you can't get more AT2 strips from your Vet, in a pinch you can grab some Freestyle Lite test strips. :) They look exactly like the AT2 strips because they kind of are. @MrWorfMen's Mom explained this to me :)

ETA: Just keep the same code from your last bottle of AT2 strips. Don't change it to human code on FSL strips.
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My codes for my Alphtrak strips have been all over the place. The vial I just finished was coded at 37 for cat. The one before it was at 8. I've also had then in the 90's.
 
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