Possible Steroid Induce Hyperglycemia - treating

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BewBear

BewBear

Member Since 2015
Hello!

I am a vet tech. I pride myself on paying pretty good attention to my own animals. That being said, I feel pretty dumb about missing Max's signs for so long. He was PU/PD for at least 2 months, and when I finally twigged to the fact that something was wrong, I brought him to work with me yesterday suspecting FLUTD. Oh well. Surprise! His BG was 475 and his Urine glucose was over 2000. He also had trace ketones.

I have had Max since he was 2 days old. He was a super demanding bottle baby that turned into a "failed foster". Failed in that I failed to get rid of him. He has been my little jerk (all this is said with the utmost affection) for the last 9 years. Unfortunately, when he was two he was diagnosed with degenerative joint disease in both back hips and then 6 months later with feline asthma. He has had cat scan, untrasound, (not to mention yearly xrays and blood work at LEAST every 6 months) since then. Unfortunately, the only effective treatment we could find to keep him breathing normally has been prednisone and he has been on it daily for the last 2 years.

All that being said, I'm pretty sure that the diabetes is actually insulin resistance caused by long term steroid usage. I'm hoping it is anyway. We are weaning him off of the steroids and starting inhaled albuterol for the asthma. I am treating the diabetes to prevent DKA, but I'm hoping that once his body starts making its own steroids, (at a normal level) that the hyperglycemia will disappear.

Because I have started him on the diabetic regimen at the same time that I am weaning him off the steroids, I am particularly concerned (terrified really) about him becoming hypoglycemic. I've started him on canned Hills M/D as well as PZI insulin at two units twice a day. It's a low dose, but I gave him his first dose tonight and I'm doing a curve to watch what his BG does. So far so good.

Phew. It feels good to get all that out. Most people I've tried to talk to are like "I thought you just had to give him shots?"
 
Welcome to FDMB.

Check out Fritz The Brave for info on the AeroKat for feline asthmatics. Albuterol alone may not be enough.

And check out Cat Info for a veterinary perspective on feline nutrition. Low carb, canned, over the counter food may reduce the glucose levels 100-200 mg/dL. I feed all of mine Friskies pates.
 
Went through steroid induced diabetes with Squeaker 18 months ago. I put him on low carb wet and the IM started him on Lantus (glargine). In two months he was in remission and off insulin. Unfortunately the steroids also damaged his heart and he went in congestive heart failure but managed to survive that too.

One additional thought is might want to check the pancreas to make sure he doesn't have pancreatitis also.

Anita and Squeaker
 
Thanks for your introduction over in the "Welcome to the Group Forum". Here is a link to that post for continuity.

Max has 3 and possibly 4 risk factors for the diabetes. Male, overweight, steroid use, and Bombay species is often outcrossed with Burmese which have a 1 in 50 incidence of diabetes.

But the good news is that feline diabetes is easily treatable. Cats with diabetes can live long and healthy lives. You may be able to get Max OTJ (off-the-juice) and in remission with a course of insulin and low carb food and weight loss. Lots of us here have plenty of day to day experience with diabetic cats and we'll help you however we can.

1. Do you have your hypo kit ready just in case?
2. Ketone urine test strips? You said Max had trace ketones so it's going to be super important for you to urine test daily. Urine catching tips here.
3. You are already using one of the good insulins for cats and home testing. Great job!!!!
4. You already switched to a lower carb food so good for you! We use this food chart and look for foods that are <10% carbs so you have lots of choices for feeding Max.
5. We have a protocol for Prozinc. Here is that Prozinc protocol which is actually more a set of general guidelines to help you.

Remember, this is a marathon, not a sprint. It took time for Max to become diabetic. It will take time to get him feeling better and acting like his old self.
 
Thanks everyone for the information and the welcome!

I guess I forgot to introduce myself, (clearly I am not the important one here- :-D ) My name is Laura. Also, my precious little human larvae's name is Paisley. She is in love with all the cats, but is terrified of needles so she's giving Max a wide berth right now.

So, its actually part of my job to do glucose curves on other peoples cats on a weekly basis, but I never thought I'd be sticking my own kitty! Not to mention the fact that he is a total hellion for EVERY. OTHER. PROCEDURE. But he has been a perfect angel about the ear sticks. In fact, when he sees me getting the little black wallet out, he comes over and sits in my lap! (after a day...we'll see where we are at the end of the week). Last night I gave him his first injection of insulin, and I was completely unsure what was going to happen, so I did a mini curve. I only went up to 5 hours post injection, but now that I've read the Prozinc protocol info (Thanks Deb!) I'm thinking I should have gone to 7, or even nine. Below is my raw data points. (I made a chart, but I'm new to posting, so I'll stick with data for now).

5:30 pm - 417
5:30 pm - fed a can of M/D
6:00 pm - gave 2 units of Prozinc
7:00 pm- 429
9:00 pm- 302
11:00 pm - 258

I am wishing I had kept going, but we fell asleep. This morning when I took his BG before feeding and insulin, it was back up to 481.

Anita, thanks for sharing that Squeaker got over the hyperglycemia/diabetes. I am really hoping that Max does too, but I won't be distraught if he doesn't.

Deb, I didn't know that Burmese had such a high incidence of diabetes! That is super interesting. Unfortunately, I did know about the obesity. I'm ashamed to admit that the beast weighs in at a (not so) healthy 21 pounds.

Someone asked me to update my signature to include more info. I will work on that. Thank you all for your help!
 
You may find that a switch to low carb food will drop the weight due to the lower calorie concentration per volume.
 
Hi and welcome. I too have a asthmatic Burmese (who also got diabetes most likely through steroid use.

With regards the asthma you know you can give inhaled steroids to cats through a spacer? Flixotide is the inhaled steroid we give to cats as albuterol won't be enough to manage the symptoms long term. Inhaled steroids aren't absorbed into their system and thus doesn't affect a cats diabetes but it takes about 10 days to build up in their system so until then your cat may need some kind of steroid.

For the best info I would recommend you check out

http://www.fritzthebrave.com

http://felineasthma.org/medications/

I am a member of this yahoo asthma group
https://groups.yahoo.com/neo/groups/felineasthma/info

This is the inhaler for cats. You should be able to buy it from suppliers in the US.
http://www.trudellmed.com/animal-health/aerokat
 
Hi Laura! Thanks for introducing yourself and your daughter Paisley. Hope that Paisley gets less scared of needles (but still maintains a healthy respect for them) and will give some loving to Max. He probably misses cuddles from her.

So you're an old hand at curving a cat. That's great, but as you said, when it comes to your own family, it's a bit tougher.

Just remember those bribes, I mean treats at test time. Some sort of pure protein meat, either raw, cooked or freeze dried is a great inducement for our diabetic kitties to accept the hokey pokey part of this sugardance.

The AAHA Diabetes Management Guidelines for Dogs and Cats (page 218) recommends wet food for various reasons including for it's lower calorie content, making your kitty feel fuller and helping to lose weight. Lots of us add extra water to the canned food, think applesauce consistency, to make a sort of gravy and add more liquid to our sugar kitties diet. With the P/U (polyuria) it's easy for a diabetic cat to be somewhat dehydrated.
 
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