Prednisolone induced Diabetes- New here!

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H Allen

H Allen

Member Since 2022
Hi All!
I have a bengal cat which has been on prednisolone since August and now seems to have developed 'psuedo' diabetes from it. We thought this was happening back in October and had bought a box full of Largine pens and treated once before we never had to treat again until now. We started with 1 unit on Friday April 1 2x daily- I'm in Canada so we look at mMol /l- and we were consistently around 22 mmol/l- 1 unit didn't seem to budge it....so we increased to 2 units...still nothing ......today I started reading more about largine and discovered the 'pen" I was using was actually expired because it was opened in October- has anyone experienced insulin going 'off' after being opened - the box date says Feb 2024 expiry...so I just opened a new pen and gave him 2 units....I am going to be testing again in a couple hours to see if I see any effects with the 'new' pen- any experiences? Maybe prenisolone induced diabetes won't respond well? Maybe I need to go higher? Maybe it was the expired pen?
 
Welcome. We have had and do have many cats here with steroid induced diabetes. The pens and vials typically last at least 5-6 months once opened if stored properly. That means in the refrigerator and don’t have any particles in the vial or pen. Actually cats taken off steroids often do become diet regulated if fed a low carb wet or raw diet.

What’s your cat’s name? What the prednisolone? What other medical issues? What are you feeding? Are you using a human or pet meter? How long since you restarted insulin? How often are you testing? We suggest you test before every shot and then the rest depends on your dosing method.

We are very data oriented here so need you to start a spreadsheet. Once downloaded enter what data you have since you started insulin this time.
 
Hi!

Yes- the pen has been in the fridge since opened in October. Will see what the new pen reading says in an hour. I think I've attached my spread sheet to date. Testing with Human meter and one reading on Monday night was while at vet office.

Cat is Victor- a 14 year old Bengal - male neutered- I've owned him 13 years. In Summer of 2021 he presented with imbalance- blood and neurological tests all normal- took to neurologist and he believe ear infection related- advised us against MRI or CT scan because of age of cat and fact we already had some balance issues. Treated with antibiotic and symptoms subsided. They returned in October 2022- returned to vet- yeast infection found in ears- treated with ear packing- tri something? 24 hours after packing the ears symptoms were worse and excessive vomitting- took back to vet- xrayed and see a little tiny spot- this 'new' vet hypothesis was "cancer". Opted not to do biopsy or ultrasound because of sedation ie. balance issues. Chose pallative route- prednisolone. Regular vet things vomitting/worse balance was due to the packing and we should have given cerrenia- as 48 hours AFTER the packing symptoms almost completely disappeared. Continued with prednisolone - tried weaning again starting in early February- (Pred was 2.5 mg once daily) - weaning went to 2.5 mg every other day- within 7 days of doing this had ear infection- treated with ear packing after cerennia intake and symptoms all subsided- went back to regular prednisolone. Starting weaning again 2 weeks ago Friday April 1st. Notice increased drinking and urination. At the 2 week mark head shaking - looked in ears full of puss (I bought an otiscope in fall). We had a check up apt for Monday April 4th so decided NOT to pack ears so we could do culture and find correct antibiotic for bacteria- still waiting on culture results. Checked insulin on Thursday night after noticing excess drinking /urination and started insulin treatment. At vet apt Monday night BG 27.72- vet believes it is stress/pred related because of excessive ear infection. After taking culture treated with cerenia and packed ears again. Since packing balance has significantly improved again. Waiting on culture results expected end of week first of next. Today was reading about the largine/lantus pens after becoming fustrated with no results on insulin treatement. Will test again in 45 minutes and post result with 'fresh' pen. Attached my BG tests to date- haven't done a 'true' curve yet.

Bengals seem to be tough medical cases when something happens- I have 4- and all of them have something weird. Victor has been in perfect health until the past year
 
I was advised in October to start at 1 unit and after first dose his BG stayed below 8- so I used the pen once and then never again. I had 5 others brand new in fridge still but thought logic was to use up the one we started in October....We started at 1 unit again but I was getting basically no response to the insulin as you'll see in the link above if you can see it? I will test again at top of the hour - that will be 6 hrs since injection with new pen.....
 
Sorry- he weights in at 11 pounds 13 oz...his body condition score is 9/10
I mentioned above I have 4 bengals- with many issues such as FLUTD, PRA, EPI, Skin issues- I free range feed because of numerous medical issues.....
 
We also did 17 panel blood test on Monday- EVERYTHING was well within normal- except bilrubin- it was elevated- Vet thought also due to prednisolone and not high enough to be concerned just to recheck in 60 days because the ALB, ALT, ALKP were all well within normal levels.
 
I feed all Royal Canin Foods- Urinary, Dental, Bengal......Very particular eaters in this house.....Victor does not eat wet food- only my female with EPI does and it is RC Kitten instinctive....
 
Ok so update- his insulin came down some with the new pen- at the 3 hour mark we are at 21.7 vs 28.2 at time of injection? Fluke?
 
H Allen said:
Hi All!
I have a bengal cat which has been on prednisolone since August and now seems to have developed 'psuedo' diabetes from it. We thought this was happening back in October and had bought a box full of Largine pens and treated once before we never had to treat again until now. We started with 1 unit on Friday April 1 2x daily- I'm in Canada so we look at mMol /l- and we were consistently around 22 mmol/l- 1 unit didn't seem to budge it....so we increased to 2 units...still nothing ......today I started reading more about largine and discovered the 'pen" I was using was actually expired because it was opened in October- has anyone experienced insulin going 'off' after being opened - the box date says Feb 2024 expiry...so I just opened a new pen and gave him 2 units....I am going to be testing again in a couple hours to see if I see any effects with the 'new' pen- any experiences? Maybe prenisolone induced diabetes won't respond well? Maybe I need to go higher? Maybe it was the expired pen?
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Hello! My guy had Diabetes from a high dose of Prednisone for IBD. Since taking him off it and switching to Budesonide he is in Food Remission. It’s took about 5-6 months but it is possible! We started with 1 unit and we’re told to increase to 2u after a week. I however was not checking his glucose the first week. The day I increased to 2u I started testing and I’m so glad I did. He dropped to 50. We went up and down with a unit until eventually he was in OTJ. It was a long road, but I’m so happy with his results. I was told if they do not go into remission within 6 months, it might not be possible but I’m not sure how correct this is! Good luck, this board saved our lives.
 
@Amanda Comet’s Mom We have seen cats go into remission anywhere from a few weeks on a low cab or raw diet to a year or two. Some that eat dry food do as well but most eat low carb, either Young Again or Dr. Elsey’s. Epigen might also make a low carb dry food.
Does he eat all three of those foods?
 
Thank you for the info. It helps. I think the foods he’s eating are very high carb. That will make it harder to regulate his bg.

Would you please set up our spreadsheet? Most of us use US bg numbers and you use the world. Our spreadsheet will convert the numbers for us. It’s also color coded which really helps us see what’s going on with a glance.

If you choose to follow one of our dosing methods it would be SLGS. I’ll give you the link to read about it. Cats generally start on 1.0 if on a dry diet. Increases are in .25 increments. You hold the dose for a week unless your cat drops under 90 on a human meter. Spot checks are good as lantus is dosed upon how low it takes your cat. Lantus likes consistency and it being a depot insulin changing the dose daily doesn’t work.
 
tiffmaxee said:
@Amanda Comet’s Mom We have seen cats go into remission anywhere from a few weeks on a low cab or raw diet to a year or two. Some that eat dry food do as well but most eat low carb, either Young Again or Dr. Elsey’s. Epigen might also make a low carb dry food.
Does he eat all three of those foods?
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Unfortunately no, he was eating Weruva Pate LC and Low Protein/Phosphorus food (he has CKD/Renal disease) and now he is on Renal Prescription food.
 
tiffmaxee said:
Thank you for the info. It helps. I think the foods he’s eating are very high carb. That will make it harder to regulate his bg.

Would you please set up our spreadsheet? Most of us use US bg numbers and you use the world. Our spreadsheet will convert the numbers for us. It’s also color coded which really helps us see what’s going on with a glance.

If you choose to follow one of our dosing methods it would be SLGS. I’ll give you the link to read about it. Cats generally start on 1.0 if on a dry diet. Increases are in .25 increments. You hold the dose for a week unless your cat drops under 90 on a human meter. Spot checks are good as lantus is dosed upon how low it takes your cat. Lantus likes consistency and it being a depot insulin changing the dose daily doesn’t work.
Click to expand...

I think I set up the spreadsheet- can you confirm it's in my signautre? We are using the pen to dose!
 
Getting extremely frustrated- I can NOT get the BG out of the red/black zone- any suggestions?
 
Good morning. Looking now. It works!

Let the depot build. We pass around patience pants a lot. I am sure we have some in your size. :bighug:
 
Let the Depot build? Yeah Patience is not my virtue- he does seem to have decreased his drinking and urination. today is a Prednisolone day (EOD 5 mg is now the dose we've been rx'd). I am just analytical and want to see results in the numbers!
 
Now please add a signature so we don’t keep asking you the same questions over and over.

This is important. When feeding dry food you can’t follow TR. The food you are feeding is high carb. My suggestion is to find a low carb wet or dry food. Have you tried fancy feast pates?

For most it’s a marathon and not a race. Max was not on steroids but did have chronic pancreatitis so it took me about 7-8 months to get him controlled. If you feed high carb since he’s on a steroid it’s going to be really hard I think to get your boy controlled. I hope not. Dry food stays with them too long. Most of us use high carbs to bring up the bg if they are too low. You are already feeding high carbs. Make sure you have karo or honey in case the bg needs to be brought up fast. I know right now it’s not needed but it could be.
 
What should I put in my signature besides the spreadsheet?

Yes we have honey on hand in a syringe at all times!

I will look into a low carb dry food- but with all the others issues it is very difficult to separate feeding......I get it though! I will try! Have you see the Performin Ultra dry before? I don't see that on the food charts? We are waiting on the bacteria culture for the ear infection if we can get that under control with the right antibiotic I'm hopeful we can further reduce pred and 'stress' from inflammation?
 
We have had many on steroids for the ears and once off it all turns around. It can take a few to several months.

Look at my signature. Don’t include the dose though. Mine was done many years ago.

I am going to get you thinks to figuring out carb counts and the signature. I’ll be back.
 
If you need honey don’t overdo it. Just a little on the gums should bring the bg up in 15 minutes. If he eats food with it it will last longer. Post for help if the bg is ever in lime green on the spreadsheet
 
Ok I think I have the signature complete now! I ordered some more BG strips off ebay should be here next week so I have lots to do a curve with. Also we should have the culture by tomorrow or Monday and be able to identify the proper antibiotic to treat ear infection. WHY OH WHY do we get ear infections every single time we try to wean pred! Bengals are finicky I get it!
 
I'm so frustrated- before I had bengals I had a black DSH- Matilda- she got diabetes at 14 and responded very quick and we were able to regulate her easy....Victor is a whole other story!
 
Steroids reduce immunity. I think a culture should have been done and antibiotics used with possibly the addition of a steroid if the antibiotics didn’t work but I am not a vet. Others hear have successfully treated ear infections although it was not easy. Once gone and the steroid remove there’s a good change insulin won’t be needed. Fingers and paws crossed.
 
This has been going on since last summer- because he's 14 I refuse to put him through an MRI or CT scan becuase his balance/stability was the issue and thus the steroid came into the picture as 'palliative' care......hopefully now that we've done a culture we get a better idea of what is going on!
 
I hope you get answers. It’s very possible that the balance issues are due to tge ear infection. You need to see the results of the culture. Was one ever done before? It could be yeast and an infection.
 
In October it was a yeast infection- this time it's definetly a bacteria infection as we are dealing with yellow puss filled ears and not brown/yeasty crumbles.....
 
I think that 2 units may be too high of a dose.. I would reduce to 1 ¼ after you get 3/10 cc insulin syringes with ½ unit markings.
 
I got the 3/10 cc syringes last night- will begin today....why do you think I should reduce when I'm not seeing any drops as it stands now with 2 units?
 
H Allen said:
I got the 3/10 cc syringes last night- will begin today....why do you think I should reduce when I'm not seeing any drops as it stands now with 2 units?
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Frequently if dose is too high BG will not drop or rise over the day, at least for awhile. Then you may see a very large BG reduction and maybe a hypo. But sometimes a flat curve means you need more insulin. Your spreadsheet only starts aon 3/31/2022 so it is hard to tell what is going on.
 
Yes- I just talked to my vet too- she really thinks this is stress induced by the ear infection and we may not even see a reaction to the Largine?
 
RIght now we are waiting on culture which should be back Monday. We did pack the ears Monday night with enro/keto/triamcin. He gets 5 mg prednisolone every other day- but vet today suggests increasing it to daily until we get the ear infection under control as she doesn't think he will respond to largine as his diabetes is stressed induced due to infection- thoughts?
 
Note that triamcin (Triamcinolone) is a corticosteroids and will tend to raise BGs. I have used other ear meds with different corticosteroids and some corticosteroids raise BG and others have litle effect. I have found that Dexamethasone neomycin sulfate is the worst corticosteroid which is used in Tresaderm.​
 
Hi! Thanks for the info. BG was elevated prior to the Trmcin/keto/enro ear packing- we started our documentation of BG March 31- and we didn't have the ear packing done until April 4th- and not much has changed in terms of the BG between now and then...Pred has always been on board - we had been on 2.5 mg every other day then were changed to 5 mg every other day on april 4th and now being recommended to go every day....Thanks for your thoughts!
 
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