? Milo's BG staying high - not sure why.

[MayL]

Hi everyone,

Milo had a little dosing scare back on April 11 when his glucose dipped to 67 on the Alphatrak meter. We were using the Alphatrak meter to get BG numbers for the vet but my primary meter is ReliOn. If you look at my ReliOn tab of the SS, you can see Milo has been running high and I have been slowing increasing his insulin dose. It seems the days of greens/blues are long gone and even with increases I am still seeing a lot of reds and yellows

He did start budesonide for IBD issues on April 19 (I highlighted that date row dark orange in the SS) and maybe that's part of the reason why he's running high. But leading up to April 19 he was already not quite responding to the insulin like he did in weeks prior. He did have a low-ish reading on April 27 AMPS of 154.

He has good days and bad days. On his good days, he eats just fine and on bad days he wants to eat but he is feeling nauseous and he's drinking or hovering by his water bowl. Maybe his IBD issues is keeping him high?

Any thoughts are welcomed! I uploaded his most recent blood work in case that is helpful.
BTW, Milo turned 18 years old yesterday!!! See picture below

 

[Djamila]

Happy Birthday, Milo! Has Milo been tested for pancreatitis? It looks like the IBD diagnosis was by ultrasound. Did you also do a biopsy?

The short answer is that budesonide is a steroid, and steroids raise BG and lower insulin response, so you'll need to increase the dose even more in response to that. So just keep going with 0.25u increases every three to six cycles until you start to see better responses.

As you noticed though, he was already heading higher even before the steroid, which is what made me wonder if he might have pancreatitis instead of IBD....or maybe in addition to IBD. What made the vet decide to start a steroid now? Was he showing new/worse symptoms? Has he been on this before?

 

[MayL]

Happy Birthday, Milo! Has Milo been tested for pancreatitis? It looks like the IBD diagnosis was by ultrasound. Did you also do a biopsy?

The short answer is that budesonide is a steroid, and steroids raise BG and lower insulin response, so you'll need to increase the dose even more in response to that. So just keep going with 0.25u increases every three to six cycles until you start to see better responses.

As you noticed though, he was already heading higher even before the steroid, which is what made me wonder if he might have pancreatitis instead of IBD....or maybe in addition to IBD. What made the vet decide to start a steroid now? Was he showing new/worse symptoms? Has he been on this before?

Hi @Djamila - thanks for your response!

Milo has not been tested for pancreatitis. Someone else asked if he's been tested for EPI. I asked my internal specialist and she said that it's rare for a cat and especially an older cat to have EPI. She also thinks any issues related to the pancreas is second to his IBD.

He had two ultrasounds, but no biopsy. With everything that is going on, I decided it would be too hard on him. When Milo was first diagnosed with IBD, it was done with an ultrasound in Sept 2017. He went on pred and was doing very well - until December 2017 when he crashed really badly. He developed diabetes, hyperthyroidism and his CKD was getting worse.

We took him off pred and he was miserable. He has had chronic diarrhea since December (when he never did before), he's nauseous and hovering by his water bowl and continuing to lose weight. We tried tylosin and metronidazole for his IBD, didn't work. His last blood work which I attached in my original post, his BG was in the normal range and all his liver values were normal. The second ultrasound in December 2017 showed that his liver was enlarged and swollen from the diabetes. So my vet decided that his recent blood work now is good enough for him to start budesonide.

Any thoughts now with this additional information? Thanks!!!

 

[Kris & Teasel]

I don't have any expertise here but you need to treat any other issue in whatever way is needed to preserve Milo's health and quality of life. The insulin dose can be worked around that.

And a big Happy Birthday to your handsome lad!

 

[Djamila]

Yes, to dosing around the steroids. If he needs them, the insulin can just be adjusted to deal with it. And I don't blame you for skipping the biopsy. I did too. If they have the symptoms and respond to the treatment, it's probably the right diagnosis!

Is he on a probiotic for the IBD? It's worked wonders for Sam's. It takes time though, it's not an instant fix. I would say 4-6 weeks or so to see improvement. Most folks around here use s. boulardii. It's tasteless and you can just mix it into food. I've also heard really good things about this one: https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372 from one of the pancreatitis groups I'm in.

Is he taking anything for the nausea? The two meds recommended for that are cerenia and ondansetron. The first is more common, but the second is stronger, so considering his other conditions, may be the better option. If the anti-nausea meds aren't enough to get him eating again, you might also ask the vet for an appetite stimulant such as Cyproheptadine or Mirtazapine. Mirtazapine does make them walk around and meow like crazy, so that can be a little disturbing I've heard (I haven't tried either yet). So maybe an anti-nausea med and then try some other tricks to entice him like bonito flakes, tuna water, fortiflora, parmesan cheese, etc.

I would really recommend adding at least a probiotic and one of the anti-nausea meds to your routine soon to try to keep him from losing more weight, and to bring him some comfort.