Prednilosone - BG Worries (Repost from Main Forum)

Discussion in 'Prozinc / PZI' started by Debbie & Mishka, Nov 25, 2018.

  1. Debbie & Mishka

    Debbie & Mishka Member

    Joined:
    Feb 18, 2018
    Posted this in main forum and decided to repost here. Thanks in advance.

    I don't even know where to start other than Mishka hasn't been eating well the past two months. Per vet bloodwork indicated pancreatitis and I started on Cerenia, bupe, and Zofran. We didn't get an ultrasound because I didn't want to put Mishka through that stress. No significant improvement with the meds. Mishka never vomited or had diarrhea but seemed nauseas because he sniffing food, walking away, licking lips. At least with the meds, I'm not having to open 10 cans of food just to get him to eat, only to have him NOT eat the same food the next day. Vet suggested prednisolone and I was hesitant, but so overwhelmed, I finally agreed. First dose was last Saturday evening and it's been a nightmare with BG since. For the first two days Mishka ate well and seemed generally feeling well. He continues to eat, but he does not feel well. Mostly sleeping in the corner and no purrs, not at all like himself. I continued the bupe even though I'm not sure he's in pain anymore. I'm rambling, but just worried about the BG and how to get this under control. With the CKD, his kidneys are taking a serious hit with the high BG. I know my spreadsheet is not that great and probably needed more mid-cycle numbers previously. But, with a husband with dementia and being alone in all this, I'm stressed, worried and mostly just crying all the time. I regret putting Mishka on the pred -- maybe it works for some -- but at this point I'm seeing the vet on Monday and asking how to taper off.....I'm overwhelmed and don't have all the updated labs, etc. and just tired of constantly trying to research and understand....sorry for the rambling.
     
  2. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Oh Debbie! I wish I could just be there and give you a hug and help out! It's so hard doing this without any help and with your husband needing care too I'm sure, it's just got to be overwhelming.

    Well first, yes the pred will raise BG. That's just the way the steroids work. Which is not to say we never use them here...sometimes you have to do what you have to do and dose around it. However, if it doesn't really seem to be helping, yes I'd work on tapering off. I don't have much experience with that, but the vet should be able to give you an idea how to taper off. The spike in BG looks like it happened right when you started pred, so the good news is that when you take Mishka off the pred, it might go back down. As that happens, he should start to feel better...then you just have to treat the pancreatitis symptoms. I don't have any experience with that one either, but I know others do, so please let us know if you have questions! We can help!

    You're not totally alone in this Debbie. I know you don't have us there to help you, but we're here and we'd be happy to offer advice, be a shoulder, let you vent, etc. We get the need to do that sometimes! :bighug::bighug::bighug:
     
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  3. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Oh Debbie! I'm so sorry you're dealing with all of this!!!

    This is tricky. If Mishka is eating better, that's a really good thing. The fact that he isn't feeling better is probably due to the higher numbers. I wonder if it might be worth leaving him on the pred for a little bit longer if it's helping him, and just keep increasing the dose to try to get the BG under control? That should help him feel better. It's just going to take some practice to figure out how to compensate for the steroid.

    I know it's hard to see those high numbers. I got a pink last night myself and cried a little.

    If you don't feel like the pred is really helping, then tapering down is the right way to go. If it's helping, then we can help you figure out how to dose around it.

    As far as dosing for now: he is going to need more insulin than you're used to. It looks like he had a pretty decent cycle today. I think if he his evening pre-shot number is similar to this morning, I'd stick with 1.25u. If he is pink, it looks like that 1.5u was fine.

    As Rachel said, you are not alone. I would encourage you to keep posting and we can all work together to help you get this figured out one way or another.
     
  4. Debbie & Mishka

    Debbie & Mishka Member

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    Feb 18, 2018
    Thanks Djamila -- as always your advice is very much appreciated. Yes, crying a lot lately. I don't think the pred is helping, but noticed today with the lower numbers Mishka wasn't eating as much. But I increased the Bupe, so that could be the reason as well. But the first two days of pred there was a NOTICEABLE difference in everything, eating, demeanor, etc. Now, all Mishka does is sleep in the corner. I'm never sure whether it is because of the Bupe or because not enough Bupe and he's in pain. I'll talk to the vet tomorrow. Thanks! Debbie
     
  5. Debbie & Mishka

    Debbie & Mishka Member

    Joined:
    Feb 18, 2018
    Thanks Rachel -- yes it is so very overwhelming. Thanks for the kind words and encouragement. I am overwhelmed, but thank goodness I re-discovered this group and decided to post because I know you all have been through it! It's hard to watch Mishka deteriorate and hear the vet say it's because he is old. I KNOW two months ago he was feeling fine and not laying in the corner all day. I just have to convince the vet that this is not normal behavior for Mishka. Well, I'm probably rambling again. Just know that your kind words are very, very much appreciated.
     
  6. Crista & Ming

    Crista & Ming Well-Known Member

    Joined:
    Jun 10, 2018
    I thought I would post here instead because I’d feel more comfortable if Rachel, Djamila, Kris or anyone else at PZI was watching the thread.

    Here’s the main forum thread for continuity: http://www.felinediabetes.com/FDMB/threads/prednisolone-for-pancreatitis-bg-all-over-the-place.206989/

    So far: vet has said to increase pred to 10 mgs a day but Debbie has not done this. Mishka is sleeping all day but otherwise eating well. Debbie’s main concern is his lethargy and BGs. As well she’s thinking of doing bloodwork.

    Any more advice?

    I’m all for getting a second opinion and tapering off the steroids. Have you also experimented with the bupe? You could try one day without the bupe and see what Mishka does.

    As for Mishka laying on paper, how is he laying? Is he hunched? How’s his expression? Pictures welcome.
     
  7. Rachel

    Rachel Well-Known Member

    Joined:
    Aug 25, 2013
    @Debbie & Mishka your vet said to increase to 10mg/day? Why did he suggest that? Did you talk to him about tapering off? Just trying to figure out where your vet is coming from. :)

    I can't recall was Mishka acting okay before the pancreatitis diagnosis? Was he doing the sleeping all day thing? Or did that start after the pred? Just trying to narrow down a cause...I wonder if the pred just doesn't agree with him. Is he on any other meds than pred and bupe? I know you mentioned Zofran and Cerenia above. Bupe can cause sleepiness but with mine it usually just relaxes them some instead of causing them to fall right asleep.

    My honest advice is to get a second opinion too. I did that once and MAN did I find an amazing vet who worked with me and allowed me to have more control over my cat's lives. That's how I reached the place we're at now where I can get pain meds for them whenever I need as long as I bring them in once a year for a checkup...which of course we need to do anyway! Another vet might be able to get a better handle on what is going on and give you better advice.
     
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  8. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Great advice from Rachel. I have no experience with Pred but I know that pancreatitis is often treated without the use of steroids.
     
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  9. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    Hey Debbie, how is everything going?
     
  10. Debbie & Mishka

    Debbie & Mishka Member

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    Feb 18, 2018
    Hi Crista -- thanks for reposting here for me. Mishka had ultrasound on Friday and initial impression by the tech was she didn't seeing anything that jumped out as being really bad. The pancreas was enlarged, a couple of cysts on his kidneys (which she says are normally benign). We got home from the vet and Mishka was like a new kitty. Ate with gusto, groomed and generally just seemed like himself. Purring, bright eyed, etc.... That lasted into the next morning, then he deteriorated, sleeping, lethargic, etc. I started back on the Cerenia thinking that maybe that would help, but no improvement. I continued with the Ondansetron. Tried reducing the Bupe, not giving the Bupe, etc. and still the same. Had bloodwork done and waiting for results. His appetite has slowed down today and as always afraid I'll give him too much insulin and he will not eat. Thank you so much for all your advice and being here! I'm talking to the vet tomorrow about just stopping the pred and see what happens. Ughhhhh…...
     
  11. Debbie & Mishka

    Debbie & Mishka Member

    Joined:
    Feb 18, 2018
    Rachel -- honestly I think the vet is at a loss and throws pred at everything. I didn't I increase the pred and don't plan to. Mishka had an abdominal ultrasound on Friday, so waiting on those results. Mishka was acting ok before the pancreatitis symptoms of inappetence and nausea. He only vomited 2x. I just failed to recognize what was going on. Generally before the diagnosis, Mishka slept a lot -- of course at 17 :) -- but he groomed, purred, enjoyed combing and was loving. He certainly didn't lay in the corner all day. I think I'm just going to tell the vet I want to stop the pred and see how Mishka does. The first two days on pred, he was great and now, no improvement. Well, at least he continues to eat, but I sure hate to see him like this. Thanks Rachel!!
     
  12. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi Debbie! I've been wondering how the two of you are doing! Thank you for posting a little update. I'm so sorry that Mishka is still having a tough time. When Sam is having a panc flare (like right now), I make sure to keep some high carb treats around because I know that he'll eat at least a bite or two - so things like those Temptations treats. They are insanely high in carbs so I know that if he isn't eating well and starts to go low, I can get a couple of those into him. I also keep gravy foods, and a hidden stash of high-carb kibble (and of course karo). None of those are things I would feed him unless it was really bad, but having them on hand makes me feel better about being able to manage him.

    It looks like you're doing well with increasing the insulin to compensate for the pred. The 1.5u is looking promising. See how he does with that little reduction tonight - if he goes up then you'll know that 1.5u is safe on a PS like you had tonight. If he goes down, then you'll know the reduction was the way to go.

    Sending you both love and healing vines.
     
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  13. Debbie & Mishka

    Debbie & Mishka Member

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    Feb 18, 2018
    Thanks Djamila -- I do keep some FF with gravy in the pantry and I only hope that Mishka will eat it if he starts to go to low. He has never been keen on the temptation treats, but I haven't tried them in a long time. I'll have to get some. Yes, I have Karo on hand for sure!!! I probably shouldn't have reduced tonight because he's already up from PS. I've noticed BG usually increases at +2 or so because he is slower at finishing his PS food. I've always basically been free feeding, but he always ate about half of his food before the shot. Thanks for the thoughts and healing vines! Hopefully Sam's flare will end soon!!!!
     
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  14. Crista & Ming

    Crista & Ming Well-Known Member

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    Jun 10, 2018
    I was also thinking the other day that maybe Mishka feels bad because his BG is high and he's not used to it. Just a thought. I know the first few times Ming went low, he was feeling bad and even for humans too. Their bodies get so used to a certain number even though it's a bad number and any different number can make them feel bad. But definitely call the vet and tell him you want to taper off ASAP.
     
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  15. Debbie & Mishka

    Debbie & Mishka Member

    Joined:
    Feb 18, 2018
    Yes Crista, I thought of that too. We had follow up with the vet yesterday and vet sent me home with fluids to administer sub-q 2x a week. Thinking his kidney #s may be contributing to not feeling well even though for CKD the values aren't all that high. Vet said he'd refer us to an internist who would run all the same tests again and then probably want to do an endoscopy and biopsy. The ultrasound didn't show too much regarding the pancreas and all in all was inconclusive. Pancreas was normal in size but pancreatic duct is enlarged which radiologist says can be normal in a cat this age. Pancreas is "otherwise unremarkable" with no peripancreatic changes and pancreatitis is thought to be less likely. Sooo….vet's thinking is there may be some intestinal cancer which hasn't progressed to a degree that it shows up in bloodwork, etc. I'm confused so may not be expressing everything correctly. My main concern is still Mishka's disinterest, lethargy, etc. I want to taper off the pred, but vet says "no" because he'll stop eating. I'm willing to risk that for a few days and calling the vet tomorrow for a taper schedule. Crossing my fingers. Mishka continues to eat which is a good thing. Some "blue" BG readings PMPS which are throwing me off and making me afraid of hypo, so I'm probably not giving enough insulin. Hope Ming is doing better and you both are hanging in there! These late nights are killing me, hence the absence of data in my spreadsheet. :) @Djamila -- here's an update for you. Hope Sam's flare is lessening. :bighug::bighug:
     
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