prednisolone and insulin demand

Summary:
Do Not dose the same higher insulin dose if you miss a steroid dose.
Monitor closely and dose less insulin for the next 2 days.

Details:
Leo is on:
- chlorambucil (chemo) for small cell lymphoma (every second day dose)
- prednisolone (steroid) for swelling and chemo help (every day dose)
- levemir insulin for acro and probably pancreatic diabetes, and steroid-driven diabetes (twice daily dose)
- B12 to help with neuropathy (~ weekly dose)

So far so good. But I learned something yesterday.

Leo is getting levemir, (4.0 - 5.5) units/dose.
- Aug 10 (Friday) - she forgot to dose his pred.
- I continued BG testing and insulin dosing as usual. This was a mistake.
- Aug 11 (Saturday) - he received pred in the morning
- Aug 11 (Saturday) - he had a minor hypo (BG=56) in the afternoon, using the same insulin dose range

We caught the hypo before he went lower. I learned that prednisolone has a pretty dramatic effect the following day after a missed dose. Even though Leo got pred on Saturday morning...
>>> the missed steroid dose from the previous day
>>> reduced his insulin demand the following day substantially.

So, the steroid must be absorbing slow, or at least affecting him slowly. One nice implication is that most of his acro must be gone. I bet he would be in the (1.0-3.0 unit) dose range if he was not on steroids.

The next time we miss a steroid dose, I will dose Leo a lot less insulin. Better safe than Hypo'ed. Leo was back to "normal" just one hour after the issue. Today...he's chillin' with Little Dude. And he just ate some diced chicken. Our sweet fur-kids.

 

When Rico got fd from budesonide and I started weaning off while using lev when he needed it. I got him off lev in about the same month he went off bedesonide.
I agree you have to be very careful I am glad you posted as many cats are on steroids for a brief time and it is crazy how it raises the bg!

 

How is Leo doing, Jeff? And Little Dude fully recovered?

 

Hi Yong. Thanks for asking. Leo is doing great, and there is a longer post of the details in his thread here. There were no after-effects from the minor hypo. For all his health issues, he generally acts like a healthy cat. We hope that continues for awhile.

Little Dude is fully recovered. He was a partial outside cat. Another cat attacked him and tore his chest open. Then he healed for ~1 month with chest tube. He also didn't eat for 10 days at the vet. Now, 2 months later he is acting like "What me? Nothing ever happened to me?" So that is great too.

Blurry picture below. Theresa loves it when they all hang with her, especially LD and Leo.

 

Aww, what mushy boys! Very sweet.

Thank you for the info it's definitely something I need to watch for. I'm going to print out your post. I leave the bottle out to remind me but I still miss sometimes.

 

We were really surprised the lack of 1 day's worth of steroid had such a big impact. We have reverted to the tried and true method below.

We have a paper sheet withcolumns. We record, date, time, BG, dose, notes including drugs given.
In the notes column we write a little box manually - for chemo or for pred.
We give the chemo or the pred, then we walk right back to the paper and make a checkmark. Now we are 100% sure.

There have been too many low-sleep nights. This gets us in the habit of being 100% sure. Every 1/2 - 2.0 days I take the paper and type it into the online version.

 

What lucky boys your kitties are! You're doing a great job!

 

The the time to maximum blood serum level of prednisolone in cats is only 0.77 hours with a half life of of excretion is 0.66 hours. Thus, missing a dose of prednisolone would be expected to affect BG/insulin needs.
http://www.vetcontact.com/dermatology/art.php?a=640

 

Thanks for that link.

 

Thanks for the link and the info Larry. The pred seems to affect his BG for awhile, even after the half life of absorption. Too bad the article didn't also show measurement of BG...or even a couple of graphs!

Interesting to see that oral prednisolone seems to be better than oral prednisone.

 

Half live means halve is gone 0.77 hours. After the next 0.77 hours 1/4 of the original is left. After another 0.77 hour there is still 1/8 left. Thus, the pred says in the body for a while. Also, the article did not, as you mentioned, did not discuss of how the pred effected BG. There is likely a lag between pred blood level and how that effects BG

 

Yes, thanks. I understand half-life decay as it applies here. Even if we round the numbers to 1 hour (instead of 0.77):
0 hr - 100% administered
1 hr - 50%
2 hr - 25%
3 hr - 12%
4 hr - 6%
5 hr - 3% - almost negligible

So that would mean even at the 6 hour nadir mark for insulin, the prednisolone is not even there. But somehow the prednisolone is having a longer term effect on blood glucose.

Leo is not a classic case. However, before the steroid, he was in the dosage range of (1.0 - 3.0 units).
Now after being on prednisolone for awhile, he is in the dosage range of (3.0 - 5.5 units). And he is pretty challenging to regulate, before and after the steroids.
.