New member, IBD and now diabetes

[alio]

Hi all!

My name is Ali and my cat is named Cinna. He's a senior rescue I adopted a couple of years ago. He's nearly 16.5 years old (estimated of course). He has a food sensitivity to chicken.

Late last year he developed chronic diarrhea. We tried all the usual steps but nothing helped, so to rule out any other food sensitivities we put him on Royal Canin HP dry food. Diet change alone could take months to resolve though and we ran out of time when he started going off his food and losing weight, so we decided to get him on Budesonide. This turned things around and his poops have been stable now for a few months.

My intention was always to try and get him off this steroid and back onto a normal wet food diet (in the hopes the IBD was triggered by a food sensitivity). I took him in for a senior health check and worked out a plan to do this with my vet. The next day she called to give me the results of his blood and urinalysis which came back showing he's now diabetic. We think we've caught it fairly early.

My husband is a type 1 diabetic so we're pretty familiar with diabetes in humans. There seems to be a fair bit of overlap with diabetes in cats but we're also being careful not to make assumptions in that regard.

Cinna mostly eats at night and will wake us up for more food (another problem we are trying to solve). We suspected was due to him having his Budisonide at dinner time so we switched to giving him it in the morning. So far he's still mostly eating at night though and is effectively free feeding. During the day he's less interested and eats on a schedule.

For now, our plan is 1 unit of Lantis every 12hrs and to reduce his Budisonide from one pill (1mg) a day to one every second day. We think his diet is still a big part of the problem, primarily what he's eating is pretty carb-heavy. To the point where we are wondering if it's causing more problems than the steroid is.

Last night he was 361 before his shot. Before his shot this morning, he was 689. These readings are from an AlphaTrak2 meter. He hadn't eaten much during the day but ate a lot during the night, which makes me suspect a lot of the issue is his food.

He only got diagnosed on Friday and has been on Lantis since Sunday night, so it's fairly early days. Those numbers are really high though and I suspect they are not going to drop without further changes.

Having looked through the food lists on here, I couldn't see anything that was HP and didn't have high carbs. This means potentially switching to a novel protein wet food. My only hesitation here is if his diarrhea returns it'll be harder to know if it was from the reduction in steroid or the food itself. Alternatively, I could give more insulin but I'm not sure how fast I should be increasing his dose.

TLDR: Cinna has IBD, is on HP dry food and Budisonide, and now has diabetes. He's having 1U Lantis twice a day since Sunday, his Budisonide is reduced to 1mg pill every second day (instead of every day). He's still high as a kite.

Any suggestions on next steps would be really appreciated.

I'll work on putting his spreadsheet together in the meantime (DONE). Lastly, I'm really thankful to all of you who've contributed here, this looks like a really awesome community.

 

[KPassa]

Hey there! I don't stop by too much anymore but I saw your post and wanted to offer some because I also have a diabetic and IBD kitty. Finn has been diabetic since before I got him around 5 years ago and was just diagnosed with IBD at the end of last year. I honestly thought I was going to have to say goodbye to Finn at the end of last year but now he's doing great and I'm thrilled to have so much extra time with him.

Prior to Finn's IBD diagnosis, I suspected for the last 2-3 years that he had pancreatitis and IBS so I was able to treat him without steroids for a while with the following:

• Weekly cyano-b12 shots
  
• Slippery elm as needed for foam/bile vomit (I also let him eat grass)
• S. Boulardi for intestinal soothing
• Probiotics (I use Proviable)
• Best overall IBD sites: https://www.rawfeedingforibdcats.org/ and https://www.ibdkitties.net/
• I also did the animal biome test and got their gut health maintenance (it's S.boulardi and probiotics so don't waste your money on that and just buy them separately) and the fecal pill replacement. I've only done about a week of the fecal pill so far so I can't really say whether it helps or not.

Then, late last year, Finn went from IBS to full-blown IBD and now requires steroids. Here are some things that have helped us so far:

• Food elimination diet that revealed he can only eat "novel" proteins like rabbit, wild boar, and kangaroo (wet food only). All other foods give him stinky, "pudding" diarrhea (without the budesonide, it was liquid diarrhea)
  • The first time I tried the rabbit, he wasn't on the steroid yet and it was the first time he had a solid bowel movement in ~2 months. Specifically 100% rabbit protein; there are rabbit varieties that contain pork and he also can't eat those.
    
  • CANNOT EAT: chicken, turkey, lamb, venison, seafood, beef, pork
  • He can still have some dairy (i.e. cream cheese on his steroid pill, string cheese to chase it down so he's not dry swallowing, parmesan as a food topper to entice him to eat) and some freeze-dried chicken as a treat
• Steroid pill works best mid-insulin cycle. He gets his insulin (Levemir) at 8 and 8 and he gets his steroid between 12-2 and it leads to much more even curves
  • I initially started him out with steroid pill at PM shot time but his curve ended up being super high numbers at shot times and super lows at mid-cycle (I need to update his spreadsheet still so don't bother looking )
  • I now pay attention to the low numbers more-so than the high numbers. If he's hitting ~low 100s mid-cycle then that's good even if he's 300-400 at shot time.
• We increased his dose to 1.5 mg of budesonide because it seemed to wear off about 4-8 hours before his next pill. He is doing much better on the increase and is gaining some weight back so don't be afraid to increase if Cinna needs it. Finn will also probably need to be on steroids for the rest of his life
  • I also let him eat as much as he wants as often as he wants. Finn went from 11 pounds down to 8 pounds and I'm still trying to get the weight back on him (he's currently around 9 pounds and has started gaining again since we increased his steroid dose)

I'll leave off there for now as I'm sure others will have suggestions on food and shots but I hope this helps!

 

[Sienne and Gabby (GA)]

There is a great website that discusses raw feeding for IBD cats. There is information about managaging various aspects (e.g., nausea/vomiting, diarrhea) with supplements, nutrition, etc. even if you do not want to give your cat a raw diet. Most cats with IBD will do best on a diet of novel proteins. There are a number of good options with canned foods (e.g., ZiwiPeak). The same web-based group also has a Facebook page where you can get many of your questions answered.

It sounds like what you're currently feeding your cat is high in carbs. Fundamentally, that presents a problem when trying to manage diabetes. I would encourage you to find a low carb, canned food that Cinna likes and see how it effects your cat's blood glucose (BG). I would transition to a low carb diet slowly, though. The change to a lower carb diet is likely to have a marked effect on lowering BG numbers.

It's great that you've already started home testing. With Lantus, it's important to not only test prior to giving a shot, it's also important to get at least one test during both the AM and PM cycles. Lantus dosing is based on how low the dose drops your cat's numbers. Typically the lowest point in the cycle (i.e., the nadir) is somewhere in the vicinity of +6. Do be aware that some cats have early or late nadirs and that the nadir is not a fixed point -- it can move around.

You may want to take a look at this post on helping us to help you. There's some basic information on getting started included. In addition, there are instructions for adding some information to your signature so we don't keep asking you the same questions repeatedly.

 

[KPassa]

There is a great website that discusses raw feeding for IBD cats.

Yes! I accidentally copy/pasted the wrong site. rawfeedingforibdcats.org is the best overall (the other one is great, too, though).

A word of caution on the ZiwiPeak is that their rabbit also contains lamb and Finn doesn't seem to be able to eat lamb either (ymmv). It is also quite expensive (at least where I'm at). Walk About has better prices and single-source novel proteins.

May I also ask for more info on why you're not giving budesonide every day/reducing the steroid?

 

[alio]

@Sienne and Gabby (GA), thanks for the info! I'll check that out. I totally agree about the food Cinna is on being a big problem and will work to get him transitioned over to a good wet food. I do remember seeing that Lantis curve at a class my husband was on for his diabetes now that you mention it, so I'll see if I can get some midcycle testing in. Thanks for the reminder about the signature, I did see that and totally spaced doing it. I'll try and get it updated soon.

@KPassa, thanks for taking the time to write up that detailed info. That's also really helpful to know how Finn is reacting to the budesonide. To answer your question about Cinna's budesonide dose, basically, he's been on 1mg per day thus far. From what I understand, typically the idea is to get them stable and then reduce the dosage as much as possible. So now that he's stable, part of my recent trip to the vet, besides getting his senior panel and general health check, was to get a plan together to drop his dosage and get him back on wet food. Prior to developing chronic diarrhea last year, we knew he was intolerant of chicken. I had him on wet food of duck, lamb, fish, and rabbit, and he was doing great. He developed chronic diarrhea a couple of weeks after having surgery to remove ear polyps that had started to cause constant ear infections. It's basically been whack-a-mole with this poor old man, we get one health issue under control and another pops up.

 

[KPassa]

I was also initially told by one of the vets that diagnosed Finn was that the goal is to reduce the steroid pill but from what I understand, that can take months or even years, and even then, it depends on if it's IBD, SCL, or both. (With IBD, it usually doesn't taper off.)

How are things going with Cinna?

 

[FrostD]

The only other thing I would add to what's already been said is that for the vast majority of cats, budesonide does not affect BG. So far I've only seen one cat that it did, and there are several cats here on it.

How you choose to manage concurrent diagnoses is so caregiver-dependent, but I would focus more on managing the IBD/SCL as he needs it (because that can cause so many other issues) and then managing diabetes with whatever insulin he needs. Hopefully food change gets rid of the issue, at least for a little while.

In case you aren't aware - prednisolone is usually the first choice for IBD/SCL. That said a lot of people are "scared" of it due to diabetes. The flipside to budesonide is it may not be as effective but also is metabolized much more heavily in the liver, so be sure to keep an eye on that.

So far I've not had to start a steroid yet for IBD/SCL but when I do it will have to be pred because his liver values are already fairly elevated

 

[alio]

Thanks, both for checking in, really appreciate it. =)

Interesting about the budesonide not typically increasing BG... hopefully, that is the case with Cinna as well.

I should probably clarify; we never did the biopsy required to officially diagnose Cinna with IBD vs SCL vs ?. His chronic diarrhea started just over 8 months ago, 2 weeks after having surgery to remove some ear polyps that were giving him constant ear infections (surgery went great, no more ear infections or weekly cleanings!). Eventually, we had to get him on steroids because he started not eating and losing weight, I went with budesonide because it generally has fewer side effects and is more targeted to the gut. His poops normalized after about a month and have been regular and mostly normal for the last 5 months. So we never really determined what exactly was the cause. His liver values are looking good though per his blood test last week.

Aside from still having really high BG, Cinna doesn't seem to know he's sick. He's enjoying the Koha Rabbit Pate as I slowly transition him off the dry food. He feeds on a schedule during the day, but, at night it's a little more chaotic. I thought it was the budesonide making him hungry all night because I was giving it to him at dinner time, but moving it to the morning hasn't changed that problem. Might be time for some tough love there because he can't really be snacking all night anymore.

My vet has been really great, she's checked out his spreadsheet and is happy with what we're doing so far. She wants to wait till 10-14 days to do a curve and is fine with me doing it at home. We got a prescription and picked up some Freestyle Libre sensors today, so, I'll probably get that on him next week. His poor little ears are getting savaged by my unskilled poking, and, I want more data. I was expecting to pay about $70 but we got them for $42 from Walmart.

Seeing his levels so high all the time freaks me out a bit to be honest. We're changing his diet, reducing budesonide, and starting insulin all at once so maybe it makes sense in this context to go slowly?

 

[FrostD]

Yes, definitely go slow with food change and insulin specifically. Eventually you'll time meals for optimal BG curve, but one step at a time.

*If* the budesonide affects BG, it will take some time to figure out ideal timing where the insulin offsets the BG increase - but cross that bridge if you get there, it won't really become clear until he's more regulated.

I am unable to do the biopsy for Mr Kitty as the anesthesia is too risky for him. Regardless, the treatment is largely the same. For IBD you would start novel protein and see if that helps, but you've already passed that. Novel protein doesn't really factor in for SCL but it doesn't hurt either. If the diet didn't help, that's when you'd go budesonide or pred....and if budesonide didn't work probably time to strongly consider pred. Then, if even that isn't working (as far as you could tell, again ultrasounds and such would be needed) - chemo would be last step for SCL (but not IBD obviously).

 

[Wendy&Neko]

My kitty Neko also could not have the biopsy (heart anaesthesia issues) to determine if IBD or SCL, though the internal medicine vet was pretty sure it was SCL. She was already on a raw protein diet at the time and switching to novel proteins (elk for one!) didn't help so probably was SCL. Neko also got budesonide because her heart couldn't handle prednisolone. She was pretty well regulated at the time, so I could see the differences food and medicines made. Budesonide made no difference to her blood sugar numbers, but a subsequent ultrasound did show her bowel wall thickness was reduced. And it made a world of difference for her GI symptoms.

I want to stress what Melissa said above, go slow with the changes, make one change at a time. If the budesonide is helping, keep it up.

And one other thing the treatments for IBD and SCL are NOT the same. With SCL, food doesn't make a difference, you give a mild chemo drug preferably on the every other week protocol, and eventually can taper off the steroid. The majority of SCL kitties can go into remission. IBD, depending what caused it, is all about the food and probiotics and if you need steroids, it could be long term. Visbiome is a good probiotic designed for IBD. Proviable's third ingredient is maltodextrin which is a type of sugar.

I am currently on my third cat with SCL, the latter one also has IBD. Chemo is NOT the last step for SCL and in fact delaying it can make the chance of remission worse as giving a steroid can mask the problem for a while, until it doesn't, when it can be too late for the chemo to clean up the damage. If you can swing it, getting a proper diagnosis is key.

 

[alio]

Thanks both for confirming about taking it slow. It's hard to be patient when those black boxes are staring at me. =)

Dr. Uri Burstyn (aka Helpful Vancouver Vet) has a pretty good video explaining IBD & Lymphoma; I found it pretty helpful when Cinna started having problems. They're both horrible diseases, it's really sad that they're one of the third most common in older cats.

I had a foster cat once who had diarrhea for like 3 months; he was acting totally fine otherwise. We tried all the regular stuff before moving to a strict HP diet, it took like 3 months with no improvements then magically one day his poops were normal again. I couldn't believe it. Apparently, sometimes it takes that long. We tried the same with Cinna but he never improved and started getting worse so eventually we moved to steroids. I'm still holding out a little hope it's food triggered and we can eventually control it with diet alone, but that's maybe wishful thinking. Worst case he's on budesonide and insulin long-term but so far his quality of life remains good for a really old man, so I'm pretty happy about that at least.

@Wendy&Neko - 3 with SCL? So sorry you're dealing with that on repeat, that's really hard.

 

[Wendy&Neko]

Dr. Uri Burstyn (aka Helpful Vancouver Vet) has a pretty good video explaining IBD & Lymphoma; I

That was a pretty hard video to watch, with errors in it. I belong to an online group for SCL kitties that has an internal medicine vet specializing in SCL active in it. My most recent cat was diagnosed by endoscopy, which you can do if the disease is in the right spot to be reached. The most current treatment for SCL is not a pill every day, every other or every third day. That was the old style treatment that makes many cats very nauseous. And he kept on calling budesonide "budenoside". I'll stop there. 3 cats with the disease and you get opinions.

I see that 202 mid cycle today - awesome progress!

 

[alio]

@Wendy&Neko certainly didn't mean to propagate bad information with that video; I just ran across it a while back and found it a helpful explanation of the different conditions.

I belong to an online group for SCL kitties that has an internal medicine vet specializing in SCL active in it.

That's so awesome, I hope I never need to join, but I love that an actual specialist is taking time to be active with a community like that. It's pretty clever really, there is a wealth of experience and data gathering from caregivers that could be tapped. It definitely seems like that has been the case with feline diabetes. I'm really impressed that a bunch of laypersons developed TR and it eventually got published, it'd be great if that sort of thing happened more often.

That 202 at AM+5 today made me happy, but also a little alarmed at how much he dropped from an AMPS of 480. I wasn't expecting that at all; he's back up to 326 at AM+9, so should be interesting to see what he is at PMPS...

 

[Wendy&Neko]

You will likely see a bounce, he's not used to those low yellows - yet.

 

[alio]

PMPS 434; correct me if I'm wrong, Cinna bounces by releasing his stored glucose from the liver/pancreas in response to going "low" (or yellow since he's used to being much higher). If he goes "low" again, his body has nothing left to dump. In the meantime, his liver/pancreas will try and replenish their stocks... which drives him lower?

Given I'm also in the middle of transitioning him from dry to wet, I'm effectively reducing his carbs... anything I should adjust tonight/tomorrow? I was planning to feed roughly the same tomorrow as today.

 

[Wendy&Neko]

Bouncing means wonky and higher numbers for up to six cycles. Over time his body will get used to lower numbers again, and not bounce so much. But until then, any time he drops quickly or lower than he's used to, there's a good chance he'll bounce. Perfectly normal for newly diagnosed diabetics.

Transition from dry to wet slowly, maybe 10% change per day? That'll give you time to see the impact on his numbers and reduce if he starts going lower.

 

[alio]

Transition from dry to wet slowly, maybe 10% change per day? That'll give you time to see the impact on his numbers and reduce if he starts going lower.

Sounds good, thanks so much for the guidance on this!