Newbie here... IBD, steroids, now diabetes. Vet stumped?

Hello everyone, newbie here. I feel so lucky to have found this wonderful site.  My tony is 10 years old, a big 20 lb. orange bundle of love.  Poor Tony had diarrhea for a year. Vet said he thinks its IBD, or possibly lymphoma. He's been on  prednisolone (1 ml twice a day) about 6 months now and that helped the diarrhea, but he became ravenously hungry and thirsty and was using the litter box @8x/day. Then recently he stopped eating and drinking for 4 days, was throwing up, could barely walk and was stumbling around, seemed disoriented, had glazed look, looked awful, severely dehydrated. As of yesterday Vet says he is diabetic, his # is over 700. 
After finding this site, i learned that prednisolone can cause diabetes. Wish my vet had warned me. He prescribed lantus, 1 notch on the syringe 2x/day. He did not mention glucose testing at all. He did not (nor has he ever) suggested a particular diet. Right now i put out dry food (purina one "vibrant maturity") and give him the pred in a small amount of canned 9 lives. 
He said there could be a kidney issue but that we would re-test for that after tony started eating and drinking again.  He also said we had a problem because the pred and insulin dont work well together/ counteract each other, or something like that. He said he would have to ask a colleague for suggestions of how best to deal with that.
Tony is much better now, i am giving him fluids 1x/day and started lantus yesterday. He is eating and drinking a little and seems almost back to normal. 
Im just looking for any help or suggestions here. Im so worried, ive spent a couple hours reading here, and i am concerned that my vet doesnt seem sure how to proceed, and never mentioned glucose testing or diet. Any help/advice would be greatly appreciated, but my main questions are:
1. Do i need to do at home glucose testing? Or keytones testing?
2. Does anyone recommend a particular food?  If so, should i change food now, or wait til his diabetes is better, or do it gradually?
3. Should i ask the vet about trying budesonide instead of prednisolone?
Thanks for reading. 
-Cindy

 

For home testing, yes, it's best to test or how else will you know how Tony is doing?
For food, stick with the pates .... many people just feed the Fancy Feast pates, or even Friskies pates are quite decent.
For the meds, I have no experience, so I won't comment.

 

Did the vet not test for ketones :shock: as I was reading Tony's symptoms I was thinking he's got ketoacidosis. Whether or not the vet checked (if he didn't with a BG of 700 and those symptoms I'll be astounded) you need to get some ketostix (for humans) from the pharmacy to test Tony's urine. You need to test regularly with the BG so high as ketones can strike quickly and are very dangerous.

Home testing is vital so while you're at the pharmacy pick up a glucometer. You also need to get rid of the dry food altogether and switch to low carb canned - see Binky's list http://binkyspage.tripod.com/canfood.html . Normally we'd want you testing BG before you make the change as insulin needs can drop dramatically just from a change in diet. However in Tony's case it is most likely that he has steroid induced diabetes and since he's just started on one unit I think you are okay to ditch the dry and higher carb wet immediately.

Some diabetic cats need pred for whatever reason, it doesn't mean you can't use lantus it just means that you are likely to need a higher dose than you otherwise would. Here's some info on bude for you to consider http://www.marvistavet.com/html/body_budesonide.html

You have found the right place Cindy, unfortunately there doesn't seem to be many vets out there that are up to date about treatment for FD but luckily for us there is FDMB. It's all very scary and confusing when you get the diagnosis but the experienced people here will help you get it under control.

When you start testing you will want to set up a spreadsheet for Tony's numbers, here's the link to show you how http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130&p=831668#p831668. You will probably want to start posting in one of the lantus forums then (the tight regulation protocol has the highest rates of remission and is the busiest board) and people there will be able to help you with dosing - all you will need your vet for is for non-FD issues and to get your lantus.

Serryn

p.s. to prepare Tony for BG testing before you pick up your glucometer I suggest you start rubbing his ears as often as you think about it to get him used to you messing with them, you can also click a pen near his ear to get him used to the noise the lancing device will make.

 

Why is Tony on prednisone in the first place? I think Kate has had a shot or two because she has skin allergies that flare up once in a while, but never on a pill for an extended about of time. Did the vet not do a blood panel on Tony? If not, I would have him do one. Gives an over all look of how things are going health wise. I was scared to death to get one for my Katekate, but it showed that her liver and kidney function were fine, her thyroid was fine, so on and so forth except her BG. I would (in the most polite manner possible) ask what he advises for his other patients with similar symptoms. I don't want to make an off the cuff judgement, because I've only seen this one post, but the vet seems to very adept at prescrbing things quick, fast and in a hurry with out finding out what the problem really boils down to. Second opinion maybe?

Home testing is vital... and I just started doing it yesterday. My Kate was Dx'ed with diabetes, but we are starting with a conservative treatment of changing her diet before immediately going to insulin. Now, I don't agree with the food my vet recommended, but she's willing to let me find my own food solution to see if we can get this under control.

If I were you, I would change his food now... taking the necessary precautions about switching from dry to wet food. Dry food has lots of carbs. Switching will help you get his diabetes to a manageable level faster. Now, he is going to poo and it will smell to high heaven. And I do mean high heaven, but once his tummy gets used to it, the smell won't be so God awful. Trust me Kate's was so bad, it woke me up from a dead sleep at night. Oh My Jesus!

The folks here are fantastic and will give you so much help. I am new so I am probably of little help. My Katekate is 10 years old as well and she's a petite 7 pounds. I know the folks here are ready and willing to help you through these issues and I hope Tony gets better soon.

 

Hi Cindy-
I am sorry to hear about your kitty, but glad you are researching and being proactive for his care.

My cat was diagnosed with IBD/lymphoma. We initially did a diet change (grain free/gluten free/novel protein) which helped for a while. Eventually I had to start her on prednisolone, which did wonders, but also caused diabetes. Once diagnosed, I tried weaning her off the pred and tried a chemo drug. That did not go over well. Due to finances, I could not afford the budesonide, so we went back on the pred. I attempted to manage her FD around the steroid the best I could. Every cat will respond differently. I can't say we had an easy time working the insulin around the steroid. I have seen others do it gracefully, and some struggle slightly. There are a lot of factors involved. I will say if your cat needs a steroid to reduce IBD symptoms, than you just do the best you can with the insulin.

Can I ask how the diagnosis came about? What kind of tests did your vet do to determine the IBD/lymphoma (there is really only one way to determine the difference - which is invasive). It sounds like you find the steroid is helpful in your cat's situation, yes? It would definitely be worth looking into budesonide as an alternative to prednisolone. Budesonide is still a steroid, but less of it goes into the entire 'system' than prednisolone, often times reducing certain side effects such as diabetes. It's not a guarantee, but certainly worth a try. Here are some websites with information on IBD and treatments.
http://veterinarycalendar.dvm360.co...se-and-/ArticleStandard/Article/detail/588608
http://www.ibdkitties.net/
http://pets.groups.yahoo.com/group/felineibd1/
*Yahoo group, which used to be and still seems to be pretty active. I found them very supportive when Latte was first diagnosed*

Regarding the hunger/thirst...this is a sign of FD. It is also a side effect of steroids. Combine them and you have a ravenous kitty whose litter box needs to be cleaned out multiple times/day. :? I am glad you got him in to the vet and are ready to start treating the FD. If you continue to treat the diabetes with steroid use, you have to keep an eye out for infections. Steroids are immune suppressants. This will make your kitty more susceptible to infections and illness. When a kitty has high blood sugar, they dump some of it into their urine. The urinary tract system then becomes a breeding ground for infection (warm + urine + sugar). Since the kitty has a hard time fighting off infections in general, these UTI's can become frequent until the diabetes is regulated. To frustrate matters more, if there is an infection it is very difficult to regulate the diabetes. Make sense?? :? You have to be vigilant about paying attention to symptoms for a UTI and possibly having regular. Here are some links with info on bladder/uti's and how to properly test:
http://www.marvistavet.com/html/urinary_tract_infection.html
http://www.cat-world.com.au/urinalysis
http://www.catinfo.org/?link=urinarytracthealth

Here is how I would go about things...
1. Start hometesting blood sugar. There are a lot of folks on this website who can guide you through that part. THIS IS ONE OF THE MOST IMPORTANT THINGS YOU CAN DO RIGHT NOW!

2. Consider changing food (probably 2nd most important thing you can do right now). Dry food is not going to help with the IBD, FD, or any possible kidney issues. In fact it is going to make all of them worse. You will want to slowly transition your cat to a wet food only diet. I never went the raw food route, due to expenses and fear of further disease. Some people claim it is extremely helpful for IBD. I would just make sure you get all the info gathered before doing so, especially if treating with a steroid (immune suppresant) as well. Food suggestions would be low carb, grain free. You may need to look into novel protein (protein your kitty has never eaten before such as duck, rabbit, or venison). Examples of these foods may be: Wellness grain free varieties, Fancy feast pate grain free varieties, Merricks, Instinct (they have novel protein). A lot of kitties with IBD have food allergies. You may have to play around to find out what works.

Suggestions and info on transitioning to wet food can be found here:
http://www.catinfo.org/docs/Tips for Transitioning PDF 1-14-11.pdf

3. Go to the pharmacy and pick up some "ketostix" to test for ketones daily.

4. Talk to your vet about switching to budesonide.

5. Have a proper urinalysis done soon (see links above as to how it should be done), to rule out infection.

6. Join, read, and introduce yourself to the folks on the feline ibd yahoo group.

7. Keep reading, posting questions, and advocating for your cat as you are right now.

8. Go give your kitty a kiss...and do it often! :mrgreen:

Best of luck to you guys!

 

Cindy said her cat was diagnosed with IBD, possibly lymphoma. Unfortunately one of the most effective medications to treat symptoms related to these diseases IS a steroid, usually daily and long term. There are other options to try, but in the end most kitties wind up having to go this route. If symptoms are not treated, they may lead to life threatening conditions.

I do understand why Cindy's vet chose to wait on labs- especially if Tony is extremely dehydrated from vomiting and liquid poo. The labs could have findings that show other issues, but could also be related to dehydration alone. That said, I would not wait too long to get a full panel. And/or, if things do not change I would take him in asap for labwork to see if other tx needs to be considered.

 

HI Cindy, your story sounds quite a bit like mine. My cat (who is 19 yo) was losing weight and not eating. After ultrasound found thickening in intestines internal medicine vet said IBD or slow growing cancer. I opted not to do an endoscopy because of Sitka's age (18 at the time), procedure cost ($3,000 range), and her kidney disease which made anesthesia incredibly risky (vet said she couldn't guarantee Sitka would live through procedure). So we opted to try budesonide to see how Sitka responded and hope for the best. It turned out to be a good guess because a year and a half later Sitka's doing great - she is diabetic now (from the budesonide) but is well regulated. So I would do what everyone else is recommending - switch your cats food to low carb canned, definitely switch to budesonide - its more expensive because it has to be compounded (I pay $45.00 a month for mine), and start home testing. Once you put insulin in you can't take it out. Just this morning when I tested Sitka before shooting she came in at 45 (she was 200 last night) so if I had given insulin she would have hypo'ed for sure. I don't know where you are or your vet situation but if you can find a internal medicine vet - they specialize in diseases that affect the whole body - it might be worth it in the long run. Jan

 

My cat Boomer (GA) had IBD and diabetes from pred. We switched him to budesonide and he was able to get off insulin! He was on lantus which is an excellent insulin for cats.

You're getting a TON of great information here. I know you must be overwhelmed and also thinking - how can these people on an internet message board know more than my vet? All I can say is the folks here are experienced and live this stuff day in and day out. I did too before I lost Boomer.

Boomer had the throwing up kind of IBD as opposed to the poop kind. He had an ultrasound and had thickening of the intestines. He was a really sick guy with other issues too, but the budesonide worked and it would be a great alternative for you. He eventually had an endoscopy which confirmed he had IBD. IBD can only be dx'd officially through a biopsy. Before he ever had the tests we did the same thing - gave him the meds for what the vet suspected it was.

You DO need to test your cat at home no matter what your vet says. Remember - human diabetics test themselves before every injection and that's what is done here for our cats. No shooting (insulin) blind. You can get a meter and strips at WalMart for a good price-the strips are what cost the money-not the meter. People here can give you suggestions. I used to use the ReliOn micro but I've recently seen that WalMart may have changed their brand name.

You will learn this stuff and you will be able to start helping your little guy get the best care.

Hugs to you!!!!