wombat88
Active Member
I'm back again with some questions about how to deal with Shaikha. She has steroid-induced diabetes from prednisolone used to treat intractable pancreatitis and IBD. After her fairly severe pancreatitis refused to wane much, we ended up trying leukeran last May. That drug unfortunately gave her severe anemia, so we had to stop it after only a few doses. It was suggested that we switch to cyclosporine, but I decided against it and just continued with steroids because I was afraid it wouldn't work for her pancreatitis and might create problems similar to leukeran. She did relatively well on pred alone until February of this year. We had some flares of pancreatitis, but they usually were of short duration and managed with fluids and buprenorphine.
In February she developed symptoms that pancreatitis was returning -- soft stools, followed by rising blood glucose levels, then pain, skittishness/hiding, and inappetence. Then she developed a very high fever (UTI, we think), which had to be treated with IV fluids and antibiotics for several days. Her BG levels also went dangerously high due to her fever, so much so that she ended up with diabetic neuropathy. After she recovered, we debated what to do about steroids, since the higher the dose, the worse her BG levels are. I tried using half what we'd been using (2.5 mg vs. 5 mg) daily, but her symptoms got worse. My vet felt she had more problems with IBD, so we added in flagyl to her treatment and also changed her food since she refused to touch the d/d anymore. After posting here, I decided to try budesonide. Unfortunately, that hasn't been the success I'd hoped for. I was not able to taper her off pred totally, and in fact, even with the slowest taper possible, the lower the pred dose got, the worse she got. Eventually I had to increase her back up to 5mg pred in addition to the budesonide. Unfortunately, throughout this period, her blood glucose levels have not been very predictable and have been way too high (over 350-450 pre-meal), so obviously we need to figure out how to fix this. To complicate matters, during the period we started the budesonide I had to switch to PZI insulin.
Though I know that budesonide has worked well for some, I'm thinking the combination of steroids is too much and at least for her pancreatitis, doesn't seem to be working for her. I'm doing a taper off budesonide now as we've given it 1.5 months. Another reason for trying to reduce the steroids is that her red cell counts are dropping again (21% post-infection and 17.9% on Friday) and we are not sure why. It could be a GI bleed, but BUN is fine and we've not been able to find blood in her stools and they look very normal. I am hoping that being off the budesonide will make her BG levels improve, but it also could be that the PZI just isn't working and we may need to switch to another insulin like Lantus. Retic counts show only mild regeneration (1.3%) despite the anemia, which is a concern as well.
I've got two questions for you all:
1. For budesonide users, any idea what a normal taper should be like? I'm doing every other day, then was going to switch to every two days before stopping, but since it isn't very systemic I wasn't sure if it needed to be tapered a lot or not.
2. My vet is suggesting we consider putting her on cyclosporine, since he thinks it may help her IBD and anemia. My concern is that it can also cause inappetance, which isn't good for diabetes, and the last time I'd posted about this after the leukeran debacle it also seems that it can cause issues with pancreatitis. If it won't fix the pancreatitis, then we can't get her off steroids, and if we can't get her off steroids, then we can't fix a GI bleed if one exists.
I guess the big question is whether the IBD has caused the pancreatitis, so if we can get that controlled by something then perhaps the other symptoms would go away, but budesonide alone doesn't appear to be working to calm her pancreas so I'm not sure cyclosporine would either. And of course, cyclosporine can also suppress bone marrow, and she's got issues with that already. I'd love to be able to find something that would reduce her steroid use as it would help the diabetes, but not if it causes other problems. I do have her on a new hypoallergenic food that is giving her the best stools I've seen in ages, so that's a good thing.
Any ideas? This has not come at the best time for me, as I had to help another of my cats to the Bridge on Wednesday due to complications from anemia and renal failure. I found out the day after I'd lost Tabriz that Shaikha's HCT had fallen below 20%. I'm a little overwhelmed right now. What is worse, I've got an overseas trip planned for work in May, and I really need to have Shaikha stable and in a safe zone for PCV before I leave. We did put her on Nutrived and I've added folic acid in addition to her B12 shots, but not sure what else we can do to reverse the anemia.
In February she developed symptoms that pancreatitis was returning -- soft stools, followed by rising blood glucose levels, then pain, skittishness/hiding, and inappetence. Then she developed a very high fever (UTI, we think), which had to be treated with IV fluids and antibiotics for several days. Her BG levels also went dangerously high due to her fever, so much so that she ended up with diabetic neuropathy. After she recovered, we debated what to do about steroids, since the higher the dose, the worse her BG levels are. I tried using half what we'd been using (2.5 mg vs. 5 mg) daily, but her symptoms got worse. My vet felt she had more problems with IBD, so we added in flagyl to her treatment and also changed her food since she refused to touch the d/d anymore. After posting here, I decided to try budesonide. Unfortunately, that hasn't been the success I'd hoped for. I was not able to taper her off pred totally, and in fact, even with the slowest taper possible, the lower the pred dose got, the worse she got. Eventually I had to increase her back up to 5mg pred in addition to the budesonide. Unfortunately, throughout this period, her blood glucose levels have not been very predictable and have been way too high (over 350-450 pre-meal), so obviously we need to figure out how to fix this. To complicate matters, during the period we started the budesonide I had to switch to PZI insulin.
Though I know that budesonide has worked well for some, I'm thinking the combination of steroids is too much and at least for her pancreatitis, doesn't seem to be working for her. I'm doing a taper off budesonide now as we've given it 1.5 months. Another reason for trying to reduce the steroids is that her red cell counts are dropping again (21% post-infection and 17.9% on Friday) and we are not sure why. It could be a GI bleed, but BUN is fine and we've not been able to find blood in her stools and they look very normal. I am hoping that being off the budesonide will make her BG levels improve, but it also could be that the PZI just isn't working and we may need to switch to another insulin like Lantus. Retic counts show only mild regeneration (1.3%) despite the anemia, which is a concern as well.
I've got two questions for you all:
1. For budesonide users, any idea what a normal taper should be like? I'm doing every other day, then was going to switch to every two days before stopping, but since it isn't very systemic I wasn't sure if it needed to be tapered a lot or not.
2. My vet is suggesting we consider putting her on cyclosporine, since he thinks it may help her IBD and anemia. My concern is that it can also cause inappetance, which isn't good for diabetes, and the last time I'd posted about this after the leukeran debacle it also seems that it can cause issues with pancreatitis. If it won't fix the pancreatitis, then we can't get her off steroids, and if we can't get her off steroids, then we can't fix a GI bleed if one exists.
I guess the big question is whether the IBD has caused the pancreatitis, so if we can get that controlled by something then perhaps the other symptoms would go away, but budesonide alone doesn't appear to be working to calm her pancreas so I'm not sure cyclosporine would either. And of course, cyclosporine can also suppress bone marrow, and she's got issues with that already. I'd love to be able to find something that would reduce her steroid use as it would help the diabetes, but not if it causes other problems. I do have her on a new hypoallergenic food that is giving her the best stools I've seen in ages, so that's a good thing.
Any ideas? This has not come at the best time for me, as I had to help another of my cats to the Bridge on Wednesday due to complications from anemia and renal failure. I found out the day after I'd lost Tabriz that Shaikha's HCT had fallen below 20%. I'm a little overwhelmed right now. What is worse, I've got an overseas trip planned for work in May, and I really need to have Shaikha stable and in a safe zone for PCV before I leave. We did put her on Nutrived and I've added folic acid in addition to her B12 shots, but not sure what else we can do to reverse the anemia.
so we'd been preoccupied mostly with trying to keep him alive and he didn't have time to research more. To be cautious, we tapered, though we plan a faster taper than I would have done with pred.