Prednisolone effect on BG

[NyCatMom]

Good morning,
I'd like to ask any group members about their experience giving prednisolone to their diabetic cats. My cat, Moochie, has been a well controlled diabeticand I dont currently have a spreadsheet. He had what we initially thought were hypo incidents but unfortunately our vets now think he has a brain tumor. After many heart rending discussions, we opted for palliative care rather than brain surgery and radiation and he has responded quite well to the steroids. He initially was on 5MG prednisolone for several and his bg was 450+ but we're slowly easing down to find the lowest level to balance his bg vs neurological issues. When we moved to 2.5mg this week, we put a libre on him. His numbers are ranging 350-150. This weekend we started every other day dosing. That has me nervous, as I don't know what to expect as far as his blood sugar levels and I'm holding my breath that his neurological symptoms don't return. Has anyone here used an alternating dose and did you get crazy bg numbers? Any advice?

 

[Christie & Maverick]

Hi there, I remember you and Moochie. Sorry to hear of the latest . I don’t have any experience with prednisolone and diabetic cats, but will tag @Wendy&Neko to see if she can help you.

 

[Christie & Maverick]

Adding also @Sienne and Gabby (GA) who I think has experience with prednisolone.

 

[Sienne and Gabby (GA)]

My experience with pred is with my non-diabetic, IBD cat. Wendy has more experience with a diabetic. One possibility is to talk to your vet about budisonide. It's also a steroid but absorbed different. However, If Moochi is doing well on pred, I'd lean toward sticking with it. I've tapered my cat's steroid dose down. He's on a small, alternating day dose and does fine. The most important aspect for my guy was to taper the dose.

 

[Wendy&Neko]

I only have experience with budesonide in a diabetic cat, and prednisolone in non diabetics with GI issues. Neko took budesonide. It is a locally acting steroid, meaning it mostly acts in the gut where it is absorbed. Good for things like IBD or small cell lymphoma, but not for cancer in other locations if that is what Moochie is dealing with.

One non diabetic kitty of mine had his normal BG numbers go up to the 90's on 10mg/day of pred, and down to 70 on 5 mg. He was normally a 50's kind of guy. Second kitty had been on pred for years and her lab BG values are still in the normal range. I tried doing every other day dosing with her, but when I tapered down to a certain point her GI system complained. Pred seems to make more difference in BG with diabetics or borderline diabetics.

My experience watching diabetics here on pred is that their response can be ECID (every cat is different). Some have a delayed reaction, meaning higher numbers come later. We had one member who used that to advantage to give the pred to her kitty so she'd be higher while she was at work. The higher numbers also don't tend to last all the time, but for a period of time less than a day. Every other dosing means you'll have a cycle or two of higher numbers, followed by not. I suggest testing Moochie and entering the data in a spreadsheet so you can see what Moochie's pattern is on pred. You may or may not need to increase the insulin dose.

 

[NyCatMom]

My experience with pred is with my non-diabetic, IBD cat. Wendy has more experience with a diabetic. One possibility is to talk to your vet about budisonide. It's also a steroid but absorbed different. However, If Moochi is doing well on pred, I'd lean toward sticking with it. I've tapered my cat's steroid dose down. He's on a small, alternating day dose and does fine. The most important aspect for my guy was to taper the dose.

Unfortunately, Budesonide works on the GI tract and not the brain, so it's not an option. We're trying to relieve the pressure so he doesn't get seizures or unstable gait. He had been falling over which we initially thought was diabetic neuropathy but then he developed a head tilt so we knew it wasn't related to his diabetes. I'm happy he's leaving the libre sensor alone. I take some comfort in seeing how the drugs affect him. Right now he's happy as can be eating turkey breast and riding out his steroid dose. I'd be happier if we was reading below 300 but the neurological issues are the number one issue. He was miserable before we started the steroids.

 

[NyCatMom]

I only have experience with budesonide in a diabetic cat, and prednisolone in non diabetics with GI issues. Neko took budesonide. It is a locally acting steroid, meaning it mostly acts in the gut where it is absorbed. Good for things like IBD or small cell lymphoma, but not for cancer in other locations if that is what Moochie is dealing with.

One non diabetic kitty of mine had his normal BG numbers go up to the 90's on 10mg/day of pred, and down to 70 on 5 mg. He was normally a 50's kind of guy. Second kitty had been on pred for years and her lab BG values are still in the normal range. I tried doing every other day dosing with her, but when I tapered down to a certain point her GI system complained. Pred seems to make more difference in BG with diabetics or borderline diabetics.

My experience watching diabetics here on pred is that their response can be ECID (every cat is different). Some have a delayed reaction, meaning higher numbers come later. We had one member who used that to advantage to give the pred to her kitty so she'd be higher while she was at work. The higher numbers also don't tend to last all the time, but for a period of time less than a day. Every other dosing means you'll have a cycle or two of higher numbers, followed by not. I suggest testing Moochie and entering the data in a spreadsheet so you can see what Moochie's pattern is on pred. You may or may not need to increase the insulin dose.

Hello Wendy

Thanks for the insights. I had to go out today and gave him his prednisolone this morning as insurance while I was out. It pushed him out of the 200s and into the low 300s where you can see it trying to drop and then coming back up. I'm loving the smaller libre but the app doesn't give you the ability to see specific readings- just trends. The person I met today for lunch is diabetic and told me there's another app called libre linkup. Its meant for a third party to monitor 12 hrs of readings remotely, so I can leave my phone at home and use another device to watch his readings. That will be helpful when I set up a spreadsheet and when I'm at work. If he starts going low I'll have my nurse neighbor give him higher carb foods.

Tomorrow is a skip day, so I'll be interested in seeing how quickly he stabilizes. I'm going to the office on Monday, so he'll be getting the steroid early that day too. It definitely affects him but I'll just have to figure it out. I'll start posting a spreadsheet. Thanks again.

 

[Christie & Maverick]

You are doing such an amazing job for Moochie, sending over some special Canadian healing vines

 

[NyCatMom]

I only have experience with budesonide in a diabetic cat, and prednisolone in non diabetics with GI issues. Neko took budesonide. It is a locally acting steroid, meaning it mostly acts in the gut where it is absorbed. Good for things like IBD or small cell lymphoma, but not for cancer in other locations if that is what Moochie is dealing with.

One non diabetic kitty of mine had his normal BG numbers go up to the 90's on 10mg/day of pred, and down to 70 on 5 mg. He was normally a 50's kind of guy. Second kitty had been on pred for years and her lab BG values are still in the normal range. I tried doing every other day dosing with her, but when I tapered down to a certain point her GI system complained. Pred seems to make more difference in BG with diabetics or borderline diabetics.

My experience watching diabetics here on pred is that their response can be ECID (every cat is different). Some have a delayed reaction, meaning higher numbers come later. We had one member who used that to advantage to give the pred to her kitty so she'd be higher while she was at work. The higher numbers also don't tend to last all the time, but for a period of time less than a day. Every other dosing means you'll have a cycle or two of higher numbers, followed by not. I suggest testing Moochie and entering the data in a spreadsheet so you can see what Moochie's pattern is on pred. You may or may not need to increase the insulin dose.

Holy Moly Wendy,

I woke up this morning and see the libre stayed on high ( over 400) all night. Before I start tinkering with dosing, I think I'll call our vet and see if I can get a compounded 1.25 MG dose to give daily instead of skipping days. I had expected a few hours elevation but he went straight up to 400 after the prednisolone and hasn't come back down.

 

[JL and Chip]

My Charlie was a steroid-induced diabetic. Both prednisolone and budesonide triggered high BG and diabetes. Once the steroids were stopped, he ultimately went back to normal range. I don’t recall how long it took to go off insulin but the impact of steroids was almost immediate in raising BG.

Just out of curiosity … no Solensia and no inner ear infection, correct?

 

[jillnc1]

Good morning,
I'd like to ask any group members about their experience giving prednisolone to their diabetic cats. My cat, Moochie, has been a well controlled diabeticand I dont currently have a spreadsheet. He had what we initially thought were hypo incidents but unfortunately our vets now think he has a brain tumor. After many heart rending discussions, we opted for palliative care rather than brain surgery and radiation and he has responded quite well to the steroids. He initially was on 5MG prednisolone for several and his bg was 450+ but we're slowly easing down to find the lowest level to balance his bg vs neurological issues. When we moved to 2.5mg this week, we put a libre on him. His numbers are ranging 350-150. This weekend we started every other day dosing. That has me nervous, as I don't know what to expect as far as his blood sugar levels and I'm holding my breath that his neurological symptoms don't return. Has anyone here used an alternating dose and did you get crazy bg numbers? Any advice?

My non-diabetic cat became diabetic on prednisolone. After slowly stopping the pred he went into remission within the month.

He then fell out of remission about 2 years later. He is a geriatric cat, has arthritis and previously has had pancreatitis (which is what we used steroid for). I would expect an impact using pred but since he is already on insulin maybe he will just need a little more.

 

[NyCatMom]

My Charlie was a steroid-induced diabetic. Both prednisolone and budesonide triggered high BG and diabetes. Once the steroids were stopped, he ultimately went back to normal range. I don’t recall how long it took to go off insulin but the impact of steroids was almost immediate in raising BG.

Just out of curiosity … no Solensia and no inner ear infection, correct?

Good morning,

We are treating him for a possible inner ear infection. In addition to the prednisolone, he's on a months worth of zeniquin. The only way to know for sure if it's that or a brain tumor is to do an MRI. We had a cat with renal lymphoma in which we tried CHOP chemotherapy, so we're accustomed to high vet bills , but we were stunned by the MRI quote of $8,500. Brain surgery was another $10 -$12k with possible radiation therapy for another $6k. Even if money were not an issue, I'm not sure its fair to him to put him through that level of treatment. So, we opted to treat for an inner ear infection without confirmation. He has 7 more days left on the antibiotics.
The libre is showing he's over 400 since yesterday afternoon. I'm going to call my vet tomorrow to see if we can get a 1.25mg dose instead of skipping days and raise his insulin to get him back to some kind of normalcy. He's on these tiny compounded 2.5mg melting pills right now that fall apart if you try to split them.

 

[NyCatMom]

Hi there, I remember you and Moochie. Sorry to hear of the latest . I don’t have any experience with prednisolone and diabetic cats, but will tag @Wendy&Neko to see if she can help you.

Hi There Christie & Maverick,

Thank you for the positive vibes. Moochie was my foster but is now ours. His bff is another cat named Gimpy, who came to my yard after getting his leg broken in a car engine ( per the neighbor who used to feed him). He was previously a stray in the street behind me. I don't know how he scaled a fence with a broken leg but I think he wanted to avoid the coyotes. Anyway, even though Gimpy is semi feral, he and Moochie are best buds. I couldn't separate them so we adopted Mooch.

 

[Jodey&Eddie&Blue]

Good morning,
I'd like to ask any group members about their experience giving prednisolone to their diabetic cats. My cat, Moochie, has been a well controlled diabeticand I dont currently have a spreadsheet. He had what we initially thought were hypo incidents but unfortunately our vets now think he has a brain tumor. After many heart rending discussions, we opted for palliative care rather than brain surgery and radiation and he has responded quite well to the steroids. He initially was on 5MG prednisolone for several and his bg was 450+ but we're slowly easing down to find the lowest level to balance his bg vs neurological issues. When we moved to 2.5mg this week, we put a libre on him. His numbers are ranging 350-150. This weekend we started every other day dosing. That has me nervous, as I don't know what to expect as far as his blood sugar levels and I'm holding my breath that his neurological symptoms don't return. Has anyone here used an alternating dose and did you get crazy bg numbers? Any advice?

Good morning. I may be late to this conversation but I have a 7-year experience with prednisolone for Eddie and Blue. They both had acromegaly, which is a benign tumour on the pituitary and when the tumour was surgically removed, so was the pituitary meaning that prednisolone was for life. While it's true steroids affect BG, in the case of having hypophysectomy and radiation, that was the go-to medication. Do you know if Moochie has acromegaly or is the tumour something else? If acromegaly is suspected--one of the first signs is increasing insulin needs--you'll need an IGF-1 test, which is readily available and to my knowledge accurate at diagnosing the condition. I should add that in spite of the Prednisolone, insulin doses went down after treatment (surgery, radiation). Hope Moochie gets some relief.

 

[NyCatMom]

Good morning. I may be late to this conversation but I have a 7-year experience with prednisolone for Eddie and Blue. They both had acromegaly, which is a benign tumour on the pituitary and when the tumour was surgically removed, so was the pituitary meaning that prednisolone was for life. While it's true steroids affect BG, in the case of having hypophysectomy and radiation, that was the go-to medication. Do you know if Moochie has acromegaly or is the tumour something else? If acromegaly is suspected--one of the first signs is increasing insulin needs--you'll need an IGF-1 test, which is readily available and to my knowledge accurate at diagnosing the condition. I should add that in spite of the Prednisolone, insulin doses went down after treatment (surgery, radiation). Hope Moochie gets some relief.

Hello,
My original sugar cat, Honey, is in my profile picture. She had Acromegly and I miss her dearly. Moochie was fairly regulated until we started the prednisolone. Around Halloween he started wobbling when he walked. Our vet suggested upping his insulin and adding Zobaline because she thought it was diabetic neuropathy. Then we had two incidents, one in which we couldn't wake him and the other when he was flopping around trying to get up. In hindsight, it might have been a seizure. He was hospitalized for a day for observation because they thought it might have been a hypo event but his bg was good. The wobbling continued and then he developed a head tilt. We were scheduled for a Neuro consult in a few weeks but I took him an hour away to another er vet who had a neurologist on site that day. The specialist we were supposed in a nearby hospital wasn't available because he was speaking at a conference. Without an MRI we can't tell if its a brain tumor (meningioma), vertigo or an inner ear infection. We decided to treat with antibiotics to see if he improved in a month. A few days later he could barely stand and I had to place him in the litter box. That's when our regular vet added the steroids. Within a few days he was back on his feet and looking great. The game plan is to finish the antibiotic and then slowly wean the him off the steroids and see if the symptoms return. The Neuro team I originally scheduled a consult with called when I told them about the er vet and were very gracious. They agreed with the approach and said at this point, since he's showing no Neuro symptoms, it would be a waste of time to bring him in. The er vet quoted us $8.5k for the MRI which was certainly more than we were expecting. Our vet was surprised by that number too. I'm calling tomorrow to see if I can get a lower dose prednisolone so I'm not skipping days. I'm worried about his numbers but he's content eating some left over turkey breast.
I'm curious, for your Acromegly cat, did your cat have brain surgery or did you use radiation to treat the pituitary tumor? How are they doing post surgery?

 

[JL and Chip]

Has Moochie received any Solensia injections?

 

[Wendy&Neko]

I get prednisolone compounded into chew treats. Which are fairly easy to split for reduced dosing. Just mentioning as an option if the compounder can do it.

 

[Jodey&Eddie&Blue]

Hello,
My original sugar cat, Honey, is in my profile picture. She had Acromegly and I miss her dearly. Moochie was fairly regulated until we started the prednisolone. Around Halloween he started wobbling when he walked. Our vet suggested upping his insulin and adding Zobaline because she thought it was diabetic neuropathy. Then we had two incidents, one in which we couldn't wake him and the other when he was flopping around trying to get up. In hindsight, it might have been a seizure. He was hospitalized for a day for observation because they thought it might have been a hypo event but his bg was good. The wobbling continued and then he developed a head tilt. We were scheduled for a Neuro consult in a few weeks but I took him an hour away to another er vet who had a neurologist on site that day. The specialist we were supposed in a nearby hospital wasn't available because he was speaking at a conference. Without an MRI we can't tell if its a brain tumor (meningioma), vertigo or an inner ear infection. We decided to treat with antibiotics to see if he improved in a month. A few days later he could barely stand and I had to place him in the litter box. That's when our regular vet added the steroids. Within a few days he was back on his feet and looking great. The game plan is to finish the antibiotic and then slowly wean the him off the steroids and see if the symptoms return. The Neuro team I originally scheduled a consult with called when I told them about the er vet and were very gracious. They agreed with the approach and said at this point, since he's showing no Neuro symptoms, it would be a waste of time to bring him in. The er vet quoted us $8.5k for the MRI which was certainly more than we were expecting. Our vet was surprised by that number too. I'm calling tomorrow to see if I can get a lower dose prednisolone so I'm not skipping days. I'm worried about his numbers but he's content eating some left over turkey breast.
I'm curious, for your Acromegly cat, did your cat have brain surgery or did you use radiation to treat the pituitary tumor? How are they doing post surgery?

Well, it sounds as if the step-by-step elimination of conditions is the right way to go. I'm totally surprised though at the $8.5K for an MRI. The MRIs that Eddie and Blue have had over the years cost about $2.5k CDN per session. The transphenoidal hypophysectomy, which both Eddie and Blue had (Blue 2018, Eddie 2020) was done at Washington State Veterinary Teaching Hospital (Tina Owen surgeon) and the radiation, which both Eddie and Blue had, was done in Canada.
Unfortunately, I have lost both Eddie and Blue. As you probably know, acromegaly increases risk of heart condition and I had to let Blue go while he was under sedation in 2023 as he had heart failure. Then this year Eddie was under sedation for his MRI which showed the tumour had increased in size and was pressing on his brainstem. I was with him as I was with Blue. Blue was diagnosed in 2017 and Eddie in 2020. I did all I could but acromegaly is a bi&ch. I missed them everyday.
Again, hope all goes well for you and Moochie.

 

[Mikey’sDad]

Sorry to hear about Moochie! i
My cat is on Pred. As he gets cystitis that is probably not bacterial so he gets the steroid for 7 days when it happens. I have found that the BG does range a bit higher but not that much and he bounces, but after I stop he returns to his normal.
Tom

 

[NyCatMom]

Hello, Can I ask someone to look at Moochie's spreadsheet in this thread or do I need to post a new one? My regular vet is taking time off and a new vet at the practice suggested I drop his dose after reviewing his libre output. You all have a lot more experience looking at patterns than a newly minted vet and so I'd like your opinion on what you think is going on. Do the "hi" libre readings for full days represent a "bounce" . If so, I see the advice of this group is to stick it out with the new dose vs dropping it back to where he was stable. I deleted the previous spreadsheet from my Acro kitty and posted the new one under my signature.

PS He lost his libre 3 this morning so I applied a libre 2 midday today so there is no data this am.