8/7/2017 Jones - AMPS 234, +3 94, +4 88, +7 194..Question on Pred and dosage

[Tracey&Jones (GA)]

I know I haven't tested a lot lately due to illness on my part however I think I have enough data to be concerned.

I did try the .1 unit and it took him below 50 in three cycles and there was a bunch of steering in there with high carb food. Which is below my adjusted level of 70 even on SLGS. So I dropped to two drops and held that with many cycles and thought there was some nice numbers there until his numbers started creeping up again. I went back up to just 1 drop and today will be our sixth cycle on that and I stayed up last night to see what his numbers are to +6 on the night cycle.

I have thought to move his night med dosage from shoot time to +1, to see if it helps with the onset because I think you can see that his numbers are higher at night then the morning. Which is weird as his dose is the same - day and night but the absorption seems of the pred seems to have a bigger impact at night. His metronidazole is different in case you think that is the issue -he gets a bigger dose at night vs. morning.

I am beginning to question whether I need to be more aggressive with increases or have made the mistake of giving too much. Or if my approach on the administration of the meds needs to be adjusted first and see if that works. It is like his whole M.O. has changed and I didn't get the update.

Previous Condo

 

[Tracey&Jones (GA)]

Just a note: We have been on the same dosage of meds for the last 2 weeks - for all of them. I have received a suggestion to give the pred all once - not sure if it would need to be day or night.

His appy is good and the loose stool seems to be under control.

No change in diet over the 3-4 weeks.

 

[Marvin's Mom - Nat]

I don't have alot of experience but it looks like bounces to me.

 

[Tracey&Jones (GA)]

I was wondering that too except he was pretty steady before we went to the 5.mg of pred BID. I had it so the onset of the insulin would set about the time of the pred onset but was wondering if things could of changed. Maybe it is a combination of the two. Since that last pred increase I haven't been able to keep him stable.

 

[Marvin's Mom - Nat]

I don't have experience with Pred, so hoping a more experience memeber will chime in. Jones may just need a bit more time than usual.
@Wendy&Neko @rhiannon and shadow (GA) may have suggetions

 

[rhiannon and shadow (GA)]

my opinion with Pred is that as long as you have to use it.... the numbers are going to waffle....

I do not believe that one could be otj and take pred.
so you may wind up in a situation where you have to just keep doing what you are doing....
@Marje and Gracie might have something more to add

 

[Tracey&Jones (GA)]

I do not believe that one could be otj and take pred.

Wasn't worried about that, more worried about the peak and valleys - would like to smooth that out some if I can.

 

[Wendy&Neko]

The only experience I have with pred is with a civie. I did test him periodically cause I was worried he might go diabetic. It did impact his numbers, but he still stayed in normal range. I only gave pred once a day.

When Jones goes green lately, he seems to be getting there by taking steep dives from yellow, which are probably setting off bounces. You could either try moving the pred dose to the AM and see if that flattens him out, or try giving him some slightly higher carbs to slow down the drop. From what I've seen of other cats on pred, it's a bit ECID. You just have to try it and see. We had one member give pred in the AM cause that's when she went to work and it would keep her safe. Of course it meant the odd lower night time monitoring.

 

[Tracey&Jones (GA)]

@Wendy&Neko
So not changing the dose, my thoughts are with Lantus it works best with even dosing and every 12. So if I keep the pred every 12 doesn't help even things out? I agree on the bounce...so if I give a little tsp of MC/HC at administration time it might slow his roll enought to prevent the bounce. Wish we could go back to the 2.5 mg dose.

 

[Wendy&Neko]

Correct, try sticking to the same Lantus dose for now, the nadirs are fine where you are. Try changing the pred and fuds to see if you can level him out. If he ends up with higher nadirs as a result, maybe you can increase the insulin then.

 

[Tracey&Jones (GA)]

Correct, try sticking to the same Lantus dose for now, the nadirs are fine where you are. Try changing the pred and fuds to see if you can level him out. If he ends up with higher nadirs as a result, maybe you can increase the insulin then.

Ok, I gave him a tsp of the HC I had on hand with the pred. Man did he eat that up after giving his meds! I will see if that will give a bump up as the insulin heads him down. I think any bounce should clear with in a cycle or two - which is his usual Jonesy style. I am not home during the day and as of tomorrow I will not be able to get mid day tests until about +8 when DS gets home from work.

The HC is 18% - which is way higher than his normal 2-4%. I will see if I can find a nice 10-12% instead. I have some 9% at home - will give that a try after a few days of the 18% and see how it goes - both work well with his allergies.

ETA: Wonder if maybe a few Wiskas treats would help with that vs. wet food? A question...as dry food takes about 2 hours for BG impact? Gravy is like 20 mins and wet food about an hour is it 2 hours as well?

 

[Marje and Gracie]

It's actually best to give steroids in the evening in terms of functioning of the adrenal glands. The adrenals release steroids in the morning and it wanes as the day progresses so evening dosage of pred is typically preferred. You might get some good info from this discussion about Steroids.

I'm just curious if you have tried budesonide if the pred is for the IBD? While it is still a steroid, there's a good chance it might have less impact on his BG. It is ECID but budesonide will also have other less systemic side effects.

Insofar as the Whiskas treats....I'm not familiar with these but if they are like Temptations, it might be a good option. We've had members over the years that have been able to give one or two Temptations to control low numbers.

 

[Tracey&Jones (GA)]

I'm just curious if you have tried budesonide if the pred is for the IBD?

We did and it didn't seem to go well. However, at that point I think I didn't give it enough time and changed to many variables and I am not sure I did it in the right manner. Our regular vet didn't give advice on that just gave me the script.

I can bring that up again with the IM Vet however as I am due for another email update in about a week.

It's actually best to give steroids in the evening in terms of functioning of the adrenal glands. The adrenals release steroids in the morning and it wanes as the day progresses so evening dosage of pred is typically preferred

Ok, that may explain why it worked well when he was on just once a day before. It seems we did well on the 2.5mg dose BID but the 5.0Mg a day is creating some chaos like when he was first diagnosed FD. I am not sure the gains on the increased dose is outweighing the losses at this point.