? Recent remission, higher end of normal BG levels on steroid

Hello FDMB!
Kyo reached her 14 days without insulin mark just yesterday! Thanks for all those who celebrated with us! Unfortunately, shes been dealing with some reoccurring ear infections that we are treating with a new medicine (tresaderm) that contains Dexamethasone (steroid). My vet did inform me of this and to keep an eye on her blood sugar levels, so I have still be testing her until the medicine runs its course (4 drops every 12 hours for 7 days). I have noticed that her levels have gone up to the higher end of normal, using the AT2 she read 174 @ PMPS. Tested her later using the ReliOn Micro and it was 57 @ +5.

This morning I gave her ears a break (now wishing I didn't) and tested her for PMPS only using the AT2 again and she gave me a 173 which is pretty high for her. I will be testing her again using my ReliOn Micro around her nadir to see if she has a nice cycle, but the higher normal numbers worry me a bit since we still have 4 more days of using this medicine.

Do I have to worry about this steroid knocking her out of remission?

 

Steroids can knock kitty out of remission. I suggest you get a BG test at the usual time tomorrow AM. Test Harukyo again at +3 after her morning meal. If BG is lower, then her pancreas is working and doing what it's supposed to do. If BG is steady or higher, it's possible, Harukyo may need some more insulin support and you'll have to keep monitoring to make that determination. It's tough when they have a secondary condition that needs to be treated with meds that contain steroids but sometimes it just can't be avoided.

 

Thanks Linda! I will definitely get those mid tests in to see what steps need to be taken. I asked the same question to the vet tech after our vet gave us this medicine and she said "No, the doctor would have said if the medicine would knock her out of remission" ....I'm learning its always best to get a second opinion..lol. Another vet tech disagreed with my terminology of calling Kyo in "remission" and kept telling me that shes has "transitioned" out of diabetes. I was told once a diabetic always a diabetic so I looked at her kind of funny but listened and then moved on with the conversation about Kyo's ears.

 

Yeah...102 @ +5. Going to see what AMPS is and if its following that same pattern, maybe I should try a drop dose? See if shes sensitive to it for a cycle or two before moving up.

 

You are testing with the AT2 so those numbers are still well within normal range (with meter variance they could still be green readings) and not a concern at this point. The elevated BG might just be from the ear issue so I would just continue to monitor for now without insulin. If BGs start elevating past 125 or so, then it might be time to consider a tiny dose but I think you are going to have just take this one day at a time. I'd keep checking BG regularly for another week or 2 once the ear drops are finished just to be sure the steroids haven't set Kyo back. I think the likelihood of the ear drops causing her Kyo to fall out of remission are small compared to a steroid shot.

 

She read 194 AMPS this morning on AT2 so I went ahead and gave her a drop dose to help her along. The minimum time for the medicine is 5 days so Im thinking about stopping it at day 5 rather than my original plan of 7 days. Will be updating with a +3 reading!

 

Oh NO on the BG! I'm glad you are planning on a +3. I'd be careful giving insulin based on one high reading (those low blues were not high although higher than what she had been reading). It could be that Kyo heard something you didn't or saw a bird/squirrel outside that got her excited and pumped that number up somewhat. The top end of the glucose normal according to IDEXX labs is 175 while most references indicate 150 being the high end of normal so all things considered, Kyo isn't that much above normal. We don't want our kitties sitting at the high end of normal over the long term when in remission but there's the infection and steroids to consider in that elevated BG this morning and the possibility of something else exciting her so monitor her closely as BG may come down as any possible excitement subsides and as the infection clears.

 

Yeah that's why I thought I'd help her along with some insulin but very carefully since I'm not sure how sensitive she will be to it. I agree that those low blues weren't super concerning. If she would have read me another 140ish to 160ish I would have held off like you said because I think she could have handled that herself. I don't want her pancreas stressing its self out trying to curb an almost yellow number though, im eager to see what her +3 will be!

 

If she reads back in those numbers you suggested tonight, I think I'll skip giving her another drop dose. @Djamila said I don't have to be consistent with a dose that small, though I hope that's all Kyo will need to get through this. Thanks for all your help Linda! It's such an on going battle trying to find the balance for everything with FD but we get through it!

 

179 @ +3 with AT2. Was hoping for more of a drop than that think she might need more insulin? Going to see what PMPS is and possibly raise dose to .1 u if it's still high end of normal.

 

I hear what you are saying and agree you don't want to let this get ahead of you but I'd give the drop dose a bit more of a chance to work before considering increasing it. When the infection is dealt with her BG could suddenly drop again and too much insulin could drop her too low. Nadir with ProZinc usually occurs in the +4 to +7 timeframe so test her again to see if she has dropped more.

 

Gotcha! I will keep the drop dose for tonights cycle and get in some more testing.

 

Actually, upon testing PMPS tonight she read 146 so I didn't give her any insulin. Will still be testing her throughout the night. She tends to run high in the morning and lower at night.

 

203 @AMPS, so about the same as yesterday morning. Gave drop dose. Wondering if I should do the drop dose at night as well even if she reads 140ish again. What do you think @MrWorfMen's Mom

Luckily, I got the okay from the vet to stop the medicine on day 5 (which is after tonight's dose) so once the steroid clears from her system hopefully she will return to normal BG levels?

 

You could try the drop dose at 140 or above and see if you can get her down a bit more. Is the vet going to check her ears again to make sure the infection is cleared? This is a bit of a puzzle because it could be the steroids, the infection or she could have fallen out of remission for no particular reason or a combination of any of these. If today is the last day of ear drops, then I'd expect any BG elevation from infection should have cleared by now if the meds were successful. The other thing that makes the elevation less likely from the infection is that her BG was fine seemingly until you started the eardrops. I think you are just going to have to take this day by day.

 

Yes! We already have an appt scheduled sometime next week. She went into remission while she had the infection so I'm pretty sure it's the steroid that's causing her elevated levels. That's why I'm being so cautious with the insulin because once I stop the ear drops she might go back down on her own again.

 

Hey @Djamila and @Bron and Sheba ! I'm going to tag you guys in this one too since you guys are pretty familiar with how Kyo reacts to ProZinc. She just had her last dose of the tresaderm tonight and her BG levels were reading high on the AT2, 275 @PMPS, gave .1u of insulin (.25 on u-100) and she went down to 234. So not that much of a response. Do you think I should continue with this dose even though shes high since the steroid will start clearing from her system?

 

I’d rather @Djamila answered the Prozinc questions as I have never used it.
I sure hope Kyo comes back down soon.

 

Lauren, can you fill in the actual numerical readings instead of just a colour on the spreadsheet. There is a big difference between a reading of 101 and 199 or 201 and 299 and with this elevation now lasting more than a day or two, we really need to be able to look at the SS and see what the pattern is looking like. I agree it would be helpful to get Djamila's take on this. The other thing that would be helpful is to get some tests during the day cycle when you can in the expected nadir timeframe between +4 and +7 hours post shot. There could be a bounce in there that we are not going to see without at least one mid cycle test. That said, I doubt there has been any bouncing so far since the 0.1u dose last night didn't do much.
It will probably take a week or 2 for the steroid influence to totally clear her system so if that is what is causing the elevation, caution is of the utmost importance. I'd be inclined to try the 0.1 dose for a few cycles and see if she start coming down at all but get mid cycle tests whenever you can.

 

My apologies for my spreadsheet being confusing (I'm realizing some of its flaws now), I recorded all the numerical reading that I take with my AT2 on a separate tab called "AT2/for vet 2019" and any reading I take with my human meter is put on my "ProZinc 2019" sheet. I intend to continue to use my human meter sheet and was only using the AT2 to avoid having to get a frutosamine test done. I'm out of AT2 strips now and will only be using my human meter on my "ProZinc 2019" sheet again. Let me know if that helps,

 

Also I will definitely be getting those mid cycle tests in. Unfortunately, for this cycle I will only be able to get in one test at +4, but tonight I can get in more for sure.

 

Ok I get it now.

 

Thanks for sticking with us!! I appreciate all your input so much! Kyo had her last dose of the tresaderm last night so I expect her number to be quite high this morning as well, but like you said I'm being kind of cautious in dosing her. I would like to give her more insulin since she didn't react very much last night to .1u and I know this steroid will take some time to leave her system. Do you think her being this high for a couple of days will be hard on her? Or should I just keep supporting her with small doses of exogenous insulin and let her pancreas do the rest?

 

The dilemma here is that you really don't know for sure if it is just the steroids or if her pancreas is working up to snuff although the time lines are really suspicious for the steroid. Better to be high for few days than too low at all but if the steroid takes a couple of weeks to clear her system I think she probably does need a little insulin support. Ideally you want to keep her below renal threshold which would mean keeping her below roughly 200 to 225. The threshold is different for each cat. Let's see what she does today although with the human meter your readings will be lower anyway and it will be difficult to tell for sure if she is still climbing or leveling off until you have a few human meter readings to compare to.

 

Alright, sounds good. I've got one last AT2 test strip luckily so in an hour she's gets tested and breakfast. Will update you then!

 

First of all, great job getting her back on insulin support right away. Normally I would suggest waiting a day or two, but given the steroid-BG connection, I think this was the right choice. If the ear infection hasn't cleared, I would ask your vet to research other options for treatment, and do some research yourself to see if Dr. Google might know of other options besides using a steroid. There may be an antibiotic or even an OTC option that could help clear the infection without taxing her pancreas like this. My civvie had an ear infection a couple of months ago, and the vet said I could give him an antibiotic BID for ten days, or I could clean his ears daily BID and he'd likely be better in a week or two So I opted to just clean his ears and sure enough he was better in about the same amount of time the meds would have taken. Sometimes time heals as well as any medication (however, it depends on the type of infection of course, so this likely wouldn't work in all situations).

As far as dosing, I tend to lean towards being rather aggressive when a steroid is involved since getting a good insulin response while on a steroid is so difficult. However at this point, since the steroid is off the table and it's just a matter of waiting for it to clear her system, it's going to be harder to predict - as Linda said already. As long as you're available to test, I would keep the insulin going until the numbers are very clearly telling you to stop. And if they don't start dropping today, I wouldn't hesitate to give even a bit more (assuming you can monitor, of course). Hopefully, fingers crossed, knock on wood, those numbers will start to come down quickly now though and none of that will matter.

Lauren, you do such a great job with Kyo! And I've loved seeing you posting and helping out other folks. Thanks for helping to keep this board going!

 

Yay!! I'm glad the judgement that I've learned from this board is paying off! It was such a bittersweet moment having to fill up the syringe with insulin again literally the day after kyo went OTJ. I almost felt like I had an egg on my face for making a post and everything, but I wasn't going to let my emotions get the better of me and I knew Kyo needed some help keeping in good numbers. This was our first encounter with a steroid and now that I know how it effects her I'll be much more cautious of them and in using them as a last resort. I will definitely be talking to my vet about those options for future ear infections.

I'm just about to get a reading on her in a couple of minutes. Depending on what she reads I might just cancel plans I had today because I would like to give her more than .1u if she needs it. I can already tell from her mood that she's feeling groggy.

Also glad I could help out in anyway I can! I still don't feel confident enough to give out proper advice like you and the pros do so I always like to add the *am not an expert* to my comments, haha. But I share my experience with kyo and what worked for us and hopefully it helps others in some way!

 

Okay, 296 AMPS on our last AT2 strip. Increase to .25 or .5?

 

Was going to suggest 0.25u and taking it up slowly at the moment but I see you already shot. Good dose choice IMHO.

 

Yes! I think just slight raises until we see lower PS numbers would be best after mulling it over. Sorry about that not waiting, I didn't want to miss my 12 hour window. I'm not sure how long you can stall a ProZinc shot, I'll have to look into that! Glad two heads agree on the dose!

 

You can stall as long as you want. Stall time is geared to your need to stay on a schedule. Shooting late might cause numbers to be higher than usual but it's shooting too early (more than an hour early) that could lead to more dangerous consequences in some cases.

 

Right, I know the overlap in dosing would be bad. Good to know about the stalling! I can keep that in mind if I ever need to move around my schedule. Might come in handy with classes starting for me in August!

 

Back to my human meter now, 192 @ +4. Decent reduction, still might call for an increase to .5u tonight?

 

Hard to tell because there is no way to know what that reading might have been on the AT2. My guess from doing copious AT2/human meter comparisons would be that probably isn't as much of a drop as you think. Let's see what tonight brings and compare apples with apples (human to human meter) before making any decisions.

 

So sorry about not updating omg. Okay so Kyo read 197 on my Relion Micro @PMPS. I held the .25u dose and at her nadir she hit 86 @+4 and is 83 @+9. Going to see what AMPS is and will reduce/hold dose accordingly! Things are looking up!

 

That sounds encouraging. Fingers crossed!

ETA nadir is the lowest point in the cycle so nadir would be at +9 which could suggest the dose is a bit too high.

 

Yeah she read me 81 for AMPS so I'm going to skip the dose for this morning. I think you're right and it is too high. Man, her body hates the skips, I'm sure I'll see that reflected tonight for PMPS.

 

Maybe the steroids are clearing her system faster than expected and she's now using the insulin more efficiently again. Fingers crossed this was just a blip in time and you'll soon be celebrating remission again. Anxious to see what she does tonight. You might want to check her BG about 3 hours post meal today. If her pancreas is working and she is using the insulin efficiently BG should be lower.

 

I got a +4, and she's at 57 without any insulin right now. Sorry about that, I was out for a bit and couldn't get the +3

 

Well that +4 is just fine and still indicates she is using the insulin and keeping her circulating glucose at normal levels. YEAH! FINGERS CROSSED!

 

78 @ PMPS, I don't think I'm going to give her any insulin tonight either

 

I'm thrilled to see that BG tonight. Go Kyo!
Topical steroids such as ear drops don't usually cause adverse systemic issues for diabetics but there are always exceptions to the rule and from the timing of those higher BGs it appears Kyo may be that exception. As we say around here ECID.....every cat is different!

 

I'm glad we were able to monitor and catch that in a safe and controlled way! Now I'll know to be cautious of steroids in the future! I'm always so surprised as how resilient Kyo is, I was expecting to be supporting her with exogenous insulin for a week at least. Will be updating with a +4 in an hour

 

Just catching up on your news.
I’m so glad the steroid has finished and Kyo is looking better in the numbers.
Don’t go near steroids again if you can help it. You are doing a great job!

 

Kyo was sleeping so peacefully during +4 time that I let her sleep another hour lol
got a read at +5 and shes cruising at 59 all by herself

 

Lovely number! And what a gorgeous photo. She looks so peaceful!

 

She gorgeous! She almost looks like she's smiling! Happy girl! Great BG!

 

Sleeping kitties are the best! There are a ridiculous number of photos of my sleeping cats on my phone . I'm so glad to see that the steroid is getting out of her system so quickly! Hooray!!!

 

Haha, I particularly love the sink picture in your avatar! It makes me smile every time I get a close look at it