New Member; Tazzy. Steroid induced Diabetes

Status
Not open for further replies.
Hi Nicole,

Is there any chance you could change the permissions on your spreadsheet, because it's currently not visible.


Spreadsheet Sharing Permissions

To set spreadsheet sharing permissions:

* At the top right of the spreadsheet screen click on 'Share'.

* In the pop-up dialog box click on the 'Get Link' section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click 'Done' to save the changes.


Mogs
.
 
Tomlin said:
Hi.

I have a cat with chronic pancreatitis and Prednisolone is actually very commonly & routinely prescribed for cats with a primary diagnosis of chronic pancreatitis. While Budesonide can certainly be tried, the reason for its trial—it generally has less systemic effect vs Prednisolone—is often the very reason that it may not work well for cats with a primary diagnosis of chronic pancreatitis vs a secondary issue with the pancreas caused by a GI disease. Budesonide is going to have a localized effect in the GI tract which is often very effective for GI issues, but if you need control of the inflammation elsewhere, even within the lower end of the GI tract, it is often not very effective. With that being said, it still does have some systemic effect and the extent of that effect will differ from one cat to the next.

One of the leading researchers & thought leaders with respect to treating chronic pancreatitis is at TAMU & he is currently studying adding cyclosporine to Prednisolone with cases where the Prednisolone is no longer controlling the issue. The recommendation from him, as well as other specialists from a few universities my vet and I consulted with when my cat was first diagnosed with DM was, knowing that we had what is most likely an autoimmune mediated pancreatitis vs pancreatitis driven by GI issues, continue with Prednisolone and maximize its dose before adding chlorambucil or cyclosporine. The consensus was that both are add on drugs and are not best for use as first line treatment. I will also share that one internal medicine specialist and I decided to attempt one last try to lower the Prednisolone dose since we hadn’t tried it in awhile, with the thoughts of possibly trying Budesonide IF he did well on a tiny every other day dose of Prednisolone (tiny=2.5mgs)—again, keeping in mind that the Budesonide was NOT going to do much outside the GI tract. The result was similar to previous attempts to reduce Pred—increase in inflammation of the pancreas and a very sick & miserable cat—and an increase in BG. Since that time, my cats blood glucose is well controlled and a big reason for this is that the inflammation is well controlled. All of the consultants spoke to the fact that inflammation will cause DM to be unregulated & a challenge to manage, so find the least effective dose of the most effective drug and use it.

In addition, as already mentioned in a previous post, the steroid may not have caused the DM. There are quite a few studies and also specialists who use it routinely and generally it is not a problem. There is the belief that there is an underlying predisposition, just like with people.

In the end, my choice is a happy, healthy cat enjoying life taking Prednisolone and getting 2X/Day insulin OR a miserable cat who is nauseated, in pain, unable to eat or live a quality life.

Please give yourself and your cat time to adjust to some of the changes :). It does seem overwhelming at times in the beginning but it is more manageable than you think. One other suggestion that I did not see mentioned in prior posts was to buy a timed autofeeder. Since you will be at work, an auto feeder with ice packs that opens at set times will help. There are also options for insulins and options for management that can work for what will work best given your particular situation. While some people tightly regulate their cats similar to what is done with humans , there are also various looser regulation protocols that work as well. I just do not want you to think this can’t be done/managed with your work schedule &/or additional responsibilities :).....take one step at a time and people are here (as well as you vet hopefully) to help you. A plan that works best for you and Tazzy will come together with time :bighug:.
Click to expand...


Well Max had chronic pancreatitis that started a few years before he became diabetic and my Board Certified Internal Medicine Vet does not routinely suggest steroids for pancreatitis. Nonif None of the many professional articles I have read do either. I’m not saying it doesn’t work or is not required for some cats but it is not routinely used.
 
tiffmaxee said:
Well Max had chronic pancreatitis that started a few years before he became diabetic and my Board Certified Internal Medicine Vet does not routinely suggest steroids for pancreatitis. Nonif None of the many professional articles I have read do either. I’m not saying it doesn’t work or is not required for some cats but it is not routinely used.
Click to expand...

I am happy you responded because I just recently obtained a couple of the latest articles/updates on the treatment of pancreatitis as well as triaditis. Really, really great information and I highly recommend reading them for the latest info not only regarding current standards of treatment but also re: diagnostics, including complicating issues with diagnosis of these disease states.

While you are absolutely correct that Prednisolone is not routinely used for Acute pancreatitis (especially during an acute issue & before ruling out other potential illnesses/diseases that could be occurring) that is not the case with respect to the treatment of Chronic pancreatitis & it is important for people to be aware of this current info, especially, and most definitely if a feline is continuing to struggle.

I am going to attach a chart from one of these most recent article/reviews which lists the treatments for each, pancreatitis, ILD & IBD. As you will see, the chart notates next to each treatment what is used, or if it is not a common treatment modality, it is listed as “uncommon”. When it comes to chronic pancreatitis, immunotherapy is in fact a commonly used treatment for each disease state & has been found to be beneficial for all of them, including chronic pancreatitis. The immunotherapy drug of choice is Prednisolone, unless there is another medical problem that prevents it from being used. This is primarily because the other medication options carry some serious side effects as well. You will also see that the authors who have included this chart in the article site multiple sources for the treatment information. I am going to include those publication sources as well since I am unable to include the entire article due to copyright laws. Note that one of the lead authors for the publication that included this chart is from TAMU GI Lab-aka where then full panel GI Lab that include the gold standard for diagnosing pancreatitis, the spec fPLI, is sent. Obviously the lead author from TAMU isn’t the only source in the chart, but he & others are TAMU are major world thought leaders Re: these disease states.

Again, and this would go into an even lengthier post, these disease states are so complicated and often multiple organs end up impacted at one point or another. The other issue is managing the immune system component with all 3 disease states.

The source for the attached chart is:
“Triaditis: Truth and Consequences”
Vet Clin Small Anim 50 (2020) 1135-1156
Jonathan A Lidbury BVMS, MRCVS, PhD
Shankumar Mooyottu, DVM, PhD
Albert E. Jergens, DVM, PhD

Additional sources for the Pancreatitis treatment column used in the chart:

Simpson, KW. Pancreatitis and Triaditis in Cats: Causes and Treatment. J Small Anim Practice 2015; 56:40-9

Nvy R., Kaplanov, A, Kuzi S et al. A Retrospective Study of 157 hospitalized cats with Pancreatitis in a tertiary care center: clinical imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med 2018; 32: 1874-85

I hope this information is helpful. Science is ever evolving and changing, including diagnostics and treatment, so it always great to tap into the latest publications and thought leaders for the standards of care &/or treatment options.

Best :bighug:
 

Attachments

Last edited:
This (chart) is not pertaining to just Triaditis but addresses each disease state. The chart pertains to each disease state because even with cases of Triaditis, there is usually a most problematic organ and they must figure out how to best manage it while also paying attention to the others as well.

The inflammation and the immune system is definitely at play.....unfortunately just like many human disease states as well. I recently learned that because of DM, there is often inflammatory issues with a cats GI, even if there wasn’t an issue before the DM, so it it is something that needs to be kept in mind and monitored.
 
Last edited:
Tomlin said:
This (chart) is not pertaining to just Triaditis but addresses each disease state. The chart pertains to each disease state because even with cases of Triaditis, there is usually a most problematic organ and they must figure out how to best manage it while also paying attention to the others as well.

I do keep up with literature. That’s why I belong to a pancreatitis group as well.
Click to expand...
 
I am sure you do :) . I literally just got the 2 articles and they are really informative—especially regarding questions of diagnosis—for multiple reasons. I will send you the info for access to the additional article that was in the same journal as the article with the chart I sent.....both are definite reads since you like the science!

Update: ADDITIONAL ARTICLE:

Is It Being Overdiagnosed? Feline Pancreatitis
Julien Bazelle, DVM, MRCVS,
Penny Watson, MA, VetMD, DSAM, FRCVS

Vet Clin Small Anim 50 (2020) 1107-1121
 
Last edited:
ADDITIONAL ARTICLE:

Really in-depth review of current diagnostics, including issues with them and implications

Is It Being Overdiagnosed? Feline Pancreatitis
Julien Bazelle, DVM, MRCVS,
Penny Watson, MA, VetMD, DSAM, FRCVS

Vet Clin Small Anim 50 (2020) 1107-1121
 
Status
Not open for further replies.
Back
Top