? Budesonide, Diabetes & IBD

Hello all!

My cat, Imogen, a 16-17 year old female, has been diagnosed with diabetes since October 2017 and has been on ProZinc. It's been more or less under control under July of this year, when she started vomiting every day and gradually stopped wanting to eat. She spent 5 days in the hospital, another couple weeks on a feeding tube, and another month of antibiotics. Through it all, except for the ER stay, I was able to keep her diabetes roughly as in control as it had been.

After a month, the vomiting started again, and I took her back in. I never learned what actually caused the issue in the first place. The vets at the hospital wanted to do a biopsy of her liver, but to me, treatment was more important than the cause, and both potential causes I was given, lymphoma or IBD, would both need roughly the same treatment (obviously if it were lymphoma, which didn't make sense to me, would need chemotherapy), so I decided to treat for IBD first.

A sidenote - I suspected that it might potentially be a food allergy that caused this. Imogen has always been a picky eater, but I used the feeding tube experience to "switch" her from Fancy Feast chicken to Wellness Core Turkey and Instinct Vennison.

I was given another month of antibiotics for her, as well as a prescription for Budesonide. While she was on the antibiotics, her blood sugar levels were manageable. But since she's been off the Clavamax, her blood sugar has been out of control. Whereas before she got tiny doses - 0.5ml to .75ml most days (averaging under 220 overall on a monthly basis), or none at all, these days even doses up to 1.5ml are completely ineffective (she's currently averaging 300 over the past 14 days).

I can't figure out what could be causing this increase after the antibiotics went away. Could they even be related? I don't know. Imogen just had a checkup at the vet, and all her liver values are normal, and the IBD appears to be under control.

I'm sad and scared and don't just want to keep giving her more and more insulin. I'm considering stopping the Budesonide for a couple of days and just seeing if it brings her down. I've had a suspicion it was an allergy to chicken (or guar gum or some other ingredient in her old food) and have considered either keeping her on her current food and stopping the Budesonide, or switching her back to her old food and keeping up the Budesonide.

Does anyone have any advice or knowledge at all about how these drugs, the food, etc interact? At this point I very much feel helpless with it all, and the phrase "well, which way do I want to kill her?" has been in my head since July. Either the diabetes is under control, or the IBD is, and finding an equilibrium for them both has proven incredibly frustrating.

If anything, thank you for reading! I'm trying my best to give my little girl the best life she can possibly have. I'll be happy to give any additional information I can.

 

Hey Danny....I don't have a lot of experience with IBD, but there are quite a few people here that do. Hopefully you'll get some more help tomorrow.

What's she currently eating? Kind of hard to figure out. A lot of IBD cats need to be on a novel protein diet....a food with a protein source she's never had before like rabbit, bison, quail, kangaroo, lamb, etc.

Just a housekeeping note.....GA means "Gone ahead" or "Guardian Angel"....it's the prefix we use when one of our kitties has passed away. You might want to change your prefix to the ? instead.

 

Oh my gosh I'm sorry. I thought it meant "general advice." I meant no offense. Changing it now.

Imogen is currently on Instinct Venisson and Wellness Core Turkey. It's VERY hard to find food without chicken. Even food that's a different flavor still has chicken in it. Even "fish" flavored pill pockets have chicken in them!

 

My IBD kitty has not been on steroids, but I also suspect she has food allergies that cause her flare ups, specifically chicken and beef. She is doing great on Instinct Rabbit. Their venison food that you’re feeding is also a good option, but if it were my cat, I would also cut out the turkey if you notice any issues, as it is a similar protein to chicken and can cause issues for some cats that have a chicken allergy. I gave Sophie and small amount of turkey lunch meat and it made her stomach upset for about two days, which also made her BG spike during that time. She also went through a similar thing when she was first diagnosed and before I switched her food, where she was feeling great while she was on antibiotics but as soon as I stopped them, she felt bad again. Do you think it’s possible Imogen is feeling off and just hiding it well?

When you change two variables at a time (both the food and starting steroids), it does make it harder to know which one is helping, or if it’s both. The budesonide is not supposed to affect BG, but that’s not to say it can’t for some cats. If it were my cat, I would be inclined to stick to feeding her only the venison food and weaning her off the steroids to see first if she can be managed on the food change alone, and if it doesn’t get better I would start the steroids back up. But at the end of the day, she needs the insulin she needs and she may just need more insulin to be able to manage her diabetes and IBD together

 

Have you noticed any blood sugar spikes with the Rabbit? I've considered that for Imogen, but she is VERY carb sensitive and from CatFoodDB it appeared that the Rabbit had slightly over 6% carbs. I will definitely give it a shot though, because Imogen is a picky eater so I've been hesitant to have her only eating Venison for both breakfast and dinner.

That is a great idea and point about the Turkey and I'm going to give that a shot before messing with anything else. Imogen hides her illnesses VERY well (which is why her initial ER stay ended up with her with a feeding tube - silly girl showed no symptoms until it was almost too late).

I know her very well, and I definitely let intuition lead me in a lot of ways, but I do like to have some objective data to back it up. These days I'm MUCH quicker to get her into the vet for some blood work than I was in the past. For the cost of the hospital stay and the feeding tube I could have had about 20 complete blood counts done!

Thank you for the suggestions and I'm going to start her on only Venison for a few days and track any changes there. That's an excellent "first step."

 

I have not noticed any spikes, but I am currently only feeding her the rabbit because she has a very sensitive stomach, so I like to stick to one food at a time. And because of how frustratingly limited the options are, I’m holding on to the venison in case rabbit isn’t an option for her anymore lol. When Sophie is being picky, usually crumbling up some treats on top does the trick. Purebites freeze dried salmon and Vital Essential freeze dried rabbit are current faves.

From Dr. Piersons chart in regards to carbs:

“I often see diabetic cat caregivers taking this value far too literally...assuming that 6% vs 9% is statistically significant when it is not”

So it’s possible that 3% vs 6% carbs really doesn’t make much of a difference. But if you want to feed both, it may just be a matter of keeping track of what you feed and when and seeing how Imogen responds to it.

I know that some cats that can’t tolerate chicken have no problem with turkey, but I’ve learned that mine does. She got less than 1/4 of a slice of lunch meat, and that was enough to make her feel crummy enough to spike her BG over 100 points! She didn’t even overly look like she felt bad, just acting very Blah and not wanting to eat a lot, which prompted me to test her.

It is definitely frustrating dealing with both illnesses, so I hope you find somewhat of a balance!

 

I used budesonide on a couple of my diabetic cats and say little effect on BG/insulin needs.