Prednisone and diabetes..need help pls

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Marje and Gracie

Marje and Gracie

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I wrote in previously on my 3-year old, Gracie's urine glucose of 3+. Gracie has interstitial cystitis (IC) and was on pred for several months
last year and then we weaned her off. She had another IC episode a couple weeks ago with alot of blood in her urine so we put her on
2.5 mg pred 2xday for 6 days and took in a UA on Wed after she had been on pred 5 days (she's never had bacteria or crystals in her urine). All was
normal except her urine glucose was 3+. We rechecked Thursday..same. We started to decrease the pred on Thurs to 2.5 mg once a day and
on Friday did a blood chemistry, another UA, and fructosamine. Her BG was 107, her urine glucose had dropped to 1+, but the fructosamine
test wasn't back yet. Vet advised to continue slowly dropping pred, give her 50 mls LRS daily to bring USG (1.065) down, and gave me glucochips
to put in her litter box. Sat looked like there was a little glucose reaction on chips but by Monday, I couldn't really tell anything specific about the glucochips in her clumping corn litter so I caught a urine sample from her using a little tray from the vet and I just put some of the chips right into the urine...all chips stayed negative. I then bought some Bayer Clinistix and tested on fresh urine, following the instructions to the "T", and did three in a row...all negative. Today we got the fructosamine tests back and her fructosamine level was 477...that was from blood taken 8 hours before the urine where the glucose had dropped to 1+. Gracie has absolutely no clinical signs of anything...she is not overweight, she hasn't lost weight, her coat is incredible, no vomiting/diarrhea, she is not PU/PD, no lethargy...nothing. My vet would like me to keep tapering off pred (we are at 2.5 mg EOD) and will be done this Friday, continue
checking urine glucose, and mid-week next week, bring her back in for blood chem panel and UA. She said we probably won't do fructosamine
again at that time as it still would be an overlap of this week and that we should wait a couple weeks. Right now, she does not believe that Gracie
is diabetic but that the pred has caused this and that the fructosamine level will come back down as we are seeing downward trend in urine glucose but she wants us to continue to closely monitor her. While I am very encouraged that her BG was normal and urine glucose dropping, I was actually shocked at the fructosamine level esp since Gracie has really had no symptoms (and we watch closely for changes in our cats). Any thoughts on this or has anyone seen something like this? I would appreciate any ideas or information.
 
Re: new user..question on diagnosing

Marjorie,

I am sorry you haven't received any ideas. I am not positive but I thought over 500 was considered diabetic on the fruitosamine test so it may be that Gracie is just borderline. I do know that prednisone does affect bg levels.

I don't know enough to help much. You might try changing your topic line to ask about prednisone and diabetes. That might attract attention of people whose cats have been affected.
 
Re: new user..question on diagnosing

Thank you very much. Yes, my vet did say she starts to get really concerned when fructosamine is 500 or over and anything between 450-500, she watches closely along with other values and clinical symptoms. I'll change my topic heading. Thanks again.
 
Marjorie - just a few thoughts and questions:

1. what are you feeding Gracie??

2. In people prednisone can indeed increase BG - even in normal people - enough so that some of them need insulin short term. If a person was borderline or impaired glucose tolerance steroids could potentially be the "straw that breaks the camels back" and they may cont to have higher numbers

3. Cats don't necessarily - like people - show symptoms when they are borderline or early diabetic

4. Goes back to the first question - what are you feeding Gracie?? Cause she is having this problem - even if it is steroid induced at this time - she may have trouble in the future. If you are not feeding Gracie low carb foods FULL TIME I would start now. There are many cats on board here with just a diet change to the Low carb foods who have obtained good sugar control. Janet and Binkey's Chart has list of carb % for many of the commercial foods. THere is usually a link for the chart in Health.

5. My cat is on steroids right now along with her Lantus. The steroids cause her numbers to jump 100-150 points more than she was running. We are tapering now but needed to increase her insulin to compensate - and now are decreasing the dose again.
 
ITA with what Joyce has said. I'd also like to note that anything that causes pain, infection or inflammation can increase BG levels -- and cystitis is an inflammation of the bladder. So in this case, there are two things involved that may be increasing BG levels: the bladder inflammation and the steroids being used to treat the inflammation.

I'm also curious as to whether Gracie may have any other medical conditions going on, as three seems a bit young for a cat to be leaning towards diabetes.
 
Thank you all for your responses. Gracie is a Scottish Fold who I got at 13 weeks. She had been fed only canned food but when I got her, I slowly transitioned her onto a raw diet which she ate for six months. Interestingly, her IC started up while she was on a raw diet. However, after six months, she just refused to eat raw anymore. Because I've had cats constantly for the last 48 years, I knew that one of the worst things for them was a high carb diet so we do not feed dry food. I've tried to get Gracie back on raw but she just refuses no matter how small I try or whether I cook it a little or not. The higher protein, less grain diet she is on, the better for her IC. I have her on a rotation of Wellness, Precise, and Pet Guard...all canned. I have looked at Janet and Binky's charts many times before as I had a CRF cat and they are very helpful. I tried Merrick's Before Grain canned but she absolutely refused to eat it...in fact, none of my cats would eat it. Gracie is a good water drinker...she has two fountains and several bowls. Other than her IC, she has been totally healthy. We have run all kinds of tests trying to solve this IC problem and it just gets down to stress...she does not like change so it stresses her when I have to travel for work or if we have workers at the house doing a project, etc. Last week she had a full work up after this rise in glucose in her urine....all of her blood chem is great ...it was just the fructosamine that came back higher than I was hoping. Her fPLI test for pancreatitis is not back but she has absolutely no symptoms and I'd be surprised if that was it plus I also had her ultrasounded last Friday and the vet who U/S her is board certified in radiology....she said everything looked great...kidneys, bladder, adrenal gland, pancreas, intestines....everything. My cats are not vaccinated after their kitten FVRCPs and one-year booster as they are all indoors and have no contact with other cats. So......she doesn't appear to have any other health issues going on. I have a couple of questions if you don't mind:

1. There are still some glucotest chips in her litter box and after she peed last night, I took the entire clump out and let it sit for a while (20 mins) and then pulled it apart. Only one of the chips had a little bit of color change in it but the others were all normal; I looked at them again this morning and the same one chip was alot pinker. I called Purina Veterinary this morning as they make the chips. They said the best time to read them is 30 mins-one hour and the darkest color is the reading so I am assuming that 9 hours later, I shouldn't worry too much about what the color was. They also said you disregard the ones that don't turn and only use the one that does. Also, they said you can't just put the chips directly in urine (which I had done for a few of them). HOWEVER, last night and this morning, I held a Bayer Clinistix under her bottom when she peed so that the urine went right on the stick and then I let the excess drip off and counted ten seconds. It recorded totally negative. Which is more reliable? The Purina person said she would not trust the Bayer Clinistix as they are made for humans not cats but seems like alot of people with diabetic cats are using the Bayer sticks too. Any thoughts on that?
2. If the IC caused the increase in BG, would the fructosamine level still be that high? Doesn't the fructosamine test separate out stress from actual hyperglycemia from diabetes? Or, since the IC episodes last 2-3 days, I suppose that could affect her glucose level over a longer period of time than just White Coat Syndrome and so added to the steroid...it could be what caused it?
3. I really couldn't find any studies per se that address whether cats on steroids (without a diabetes predisposition) show higher levels of BG and urine glucose. In other words, how many pets who are temporarily or long-term on steroids have their blood/urine routinely tested during that timeframe UNLESS they have problems...so do we really know or not if this is something that might occur in more animals than we realize?

Thank you all, again, for your thoughts and info. I really appreciate your experience and I hope your kitties are doing well. I am crossing my fingers that we get her through this and she gets totally back to normal on her blood/urine and we don't have a recurring problem. She is too young to have this and we are trying to find other ways to address her IC...I have an appt next week with a specialist to do muscle/nutritional testing.
 
One of the folks here who are vet techs may have more ideas; from where I'm sitting, it sounds like you're doing everything right -- foods, tests, etc.

Regarding your questions:

1. I've never (successfully) used the glucotest chips, so I would follow Purina's instructions on how best to read them. I have no idea whether the test chips are more or less accurate than the Clinistix; I would suspect that they're roughly equal and Purina has a vest interest in saying theirs is more reliable.

Regarding folks here using the Clinistix: actually, most folks here don't use them, as they give only a summary idea of what the blood sugar levels have been over the past few hours, and we prefer more recent and accurate idea than the Clinistix give us. Most of us use blood sugar testing for that information, though there are some folks who's cats are untestable and use alternate means.

You may possibly be confusing Clinistix with ketostix. Clinistix give an idea what the sugar level of the urine is; ketostix indicate whether ketones are present or not. And there's another type of stick called a ketodiastix, which will indicate both sugar and ketone levels. Many folks here *do* use ketostix to test for ketones when they believe their cat is unregulated or under-regulated, because ketones can be Very Bad if they're not caught early.


> 2. If the IC caused the increase in BG, would the fructosamine level still be that high? Doesn't the fructosamine
> test separate out stress from actual hyperglycemia from diabetes?

The fructosamine test simply measures BG levels; it does nothing to detect what caused the high (or low) levels in the first place. Also, remember that the cystitis was probably present for several days before Gracie became symptomatic enough for you to notice the flare-up.


> 3. I really couldn't find any studies per se that address whether cats on steroids (without a diabetes predisposition)
> show higher levels of BG and urine glucose. In other words, how many pets who are temporarily or long-term on
> steroids have their blood/urine routinely tested during that timeframe UNLESS they have problems

I don't know. I know that Gwyn was on steroids for 14 years before she developed diabetes, and that we did a full blood work-up at least once a year (often more frequently). We saw a *lot* of vets and specialists during those 14 years, and not one of them mentioned anything wrong with her blood sugar levels until she was actively diabetic.

Good luck to you and to Gracie --

Jean and her Gwyn
 
Jean

Thank you so much for your detailed reply. I understand now...yes, I have read that if your cat is actively diabetic that it requires much
more monitoring than just using the sticks to check glucose in urine and that most of you use BG monitors. I have heard of the Diastiks, too.
I am going to sit down with the vet again tonight and go over stuff....may run a UA in again to see where we are "officially". We are just going
to have to monitor her closely with lab work through the vet for a few weeks...it might be expensive but we have pet insurance and I don't want
to invest in all the equipment to monitor her BG unless I know for sure that she is diabetic esp since she has no clinical symptoms right now.

I hope your Gwyn is doing well....she must be a trooper!

Marjorie and Grace
 
> We are just going to have to monitor her closely with lab work through the vet for a few weeks...it might be expensive
> but we have pet insurance and I don't want to invest in all the equipment to monitor her BG unless I know for sure that
> she is diabetic esp since she has no clinical symptoms right now.

Okay. I *would* suggest double-checking your pet insurance policy, though. Some of them have limits on the amount that they'll pay out per illness, or lifetime limits on the amount they'll pay out, period. Depending on what the policy says, it might be worth investing in the at-home monitoring stuff and holding back the insurance for when you really need it.

If it helps, I got my initial supplies from Walmart: $10 for the glucometer, $22 for 50 test strips, and $4 for 100 lancets. Even tossing in some ketostix, a bag of cotton balls and some neosporin, it was still less than either a fructosamine test or a full-day blood curve at the vet's, and roughly equivalent to the cost of four on-the-spot blood sugar tests at the vet's.


> I hope your Gwyn is doing well....she must be a trooper!

She was. She died a couple months ago, the day after her 20th birthday. I'm just really having a hard time adapting and I'm just not ready to (GA) yet, especially since this is a shared PC and I have to login for each visit. If I had to (GA) every time, I don't know *when* I'd be ready to come back.

Peace --

Jean and her Gwyn
 
JJ

I am SO sorry...I did not realize you had lost Gwyn. My deepest sympathy and apologies What a tribute to you that she lived 20 years!! I know
how hard it is....it has only been four months since I lost my Maxie to PKD. He was the most awesome cat ever and lived with that horrible
disease much longer than anyone expected (he was just short of 13). Every day is still a struggle....I miss him so much.

Thanks for your advice on the glucose meter...I had no idea the supplies were that inexpensive so you are right...and yes, my policy does
have limits. I've learned though some of the tricks like how to submit things as "secondary" to a primary issue and get paid differently. I think
we will have the vet do the blood chem panel and urine next week and then we'll go from there but I like your idea very much and it would
give me alot more peace of mind AND would keep Gracie's stress down.

Thank you for helping....I know it is very difficult. I will post next week again after we get some results.
 
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