Question ongoing steroid use and retaining diabetic remission

Hi everyone

Quick recap

Remi has been in diabetic remission since Xmas eve. He also has IBD and asthma and the two things got really bad by March having stopped steroids following his diabetic diagnosis. So after a major asthma attack for the last month he has been on 1.25 mg prednicare eod and has been doing much better.

The combination of the new novel protein food and 1.25 mg steroid has helped to get his IBD under control. He is happy, his fur is good, his poo is solid and he is interested in going outside. No burping, no tummy gurgling and so his asthma is much better. He is even jumping up on everything again and seeking out any form of plastic that he can munch on.

So far so good. The only down side is that his blood glucose levels have slowly been trending g upwards and the last week or so he has become much more hungry again. Before he started back on the steroids his blood glucose (taken first thing in the morning or before his evening meals) was typically anywhere between 4.6 and 5.6. The most recent tests show that in the morning after I give 1.25 mg steroid dose is 6.4 and another was 6.2. Before that it was 5.7. Usually by the evening it had dropped back to about 5.6.

So my concern is that this post morning number has risen slightly even though the dose hasn't and that is getting closer to the diabetic number. What do you think about these options?

Eek out the dose do that I give 1.25 mg every third day or even every 2.5 days. Allowing the body to recover for longer.
Drop the dose to 0.75 mg (or 1 mg) eod but am not actually sure if that will make any difference in the long term.
Change over to the budensoide -sp?? Steroid.

What is the half life of the steroid? Will it make a difference to make it last longer? Is there a risk that Remi will become allergic to the new food if he hasn't got as much steroid in his system? He see,d to improve when he went on the new food but maybe that was just the steroid helping dampen down the response (he was still burping, diarrhoea, etc when on the steroid and the old chicken food).

I do fancy trying the other steroid that is meant to have a more local affect-what do you think? What is the blood glucose number I need to really be concerned about?

Any advice gratefully received.

Kind regards

Sarah

 

You might want to try the budensoide....we have a lot of other IBD kitties and most of them tolerate it well and it doesn't seem to cause the problems other steroids do

Lantus craves consistency, so constantly changing the dose really isn't recommended

We want their BG to be in normal numbers as much as possible since that gives their pancreas the best chance at healing and resuming producing it's own insulin. That means keeping them between 50-120 as much as possible (we use US numbers here more frequently so it'll help if you convert your numbers by multiplying by 18) ....that's 2.8-6.7 for you

Numbers over about 230 (ECID) mean there's damage being done to the kidneys and glucose is spilling over into the urine, which increasing the chances of UTI's too (bacteria love sugar!)

Have you been updating your spreadsheet? The only numbers I'm seeing on it are from 2014

 

Hi Chris

Thanks for your reply.

Remi has been a diet controlled diabetic since Xmas 2014 and so hasn't had any insulin since then. My aim is to keep him that way for as long as possible whilst controlling his IBD.

With your cats that take budensoide what side effects do they have? Does it affect their blood glucose at all?

I still regularly check remi's blood glucose (just keep them on a written diary as the spreadsheet played up for me) and so far it appears to maintaining below the 120 before the meals (just). I also use the pee sticks on him and so far so good too.

 

@Chris & China may I ask about the budensoide. My vet is happy for me to give it to Remi but has limited experience of dose and brand and so I said I would ask others what they are doing.

He said there were three brands budenofalk, entocort, pulmicort. Which one do you use (or anyone else?). What dose do you give?

Many thanks

Sarah

 

I've been lucky not to have to deal with IBD, but there are quite a few here who do

Right now, the only one I can think of is @MollynSkooter but if I think of others, I'll come back and tag them too

The Pulmicort is an inhaled form used for asthma, so that's probably not going to help his intestines too much...LOL

The Entocort is a sustained release version and it looks like the Budenofalk is more of a "plain pill" (although it comes in other forms too)...but I think your vet knows your cat best as far as starting dose, so I'd let him decide where to start him at. (He can research it just like we can!)

I think mostly what's used is a generic anyway (so budensoide would be on the label) , which is probably just the plain budenofalk

Edited to add...the reason it's used so much is because it doesn't seem to have the same effect that other steroids do on the blood glucose numbers so hopefully using it instead of the steroid you've been using won't cause any problems with his BG...but ECID so it's something we can't know for sure until you're trying it and getting blood tests

It'd be really helpful if you are if you'd start charting the numbers on the spreadsheet again so we can see how he's doing...we're just so used to the spreadsheet and feel it's a very important tool

 

I have used the sustained-release budesonide for I thin four of my cats. Some had little effect on BG/insulin required and others required more insulin to maintain BG

 

Hi @Larry and Kitties so was that the entocort? I understand that it only comes in 3 mg capsules (I might be wrong) So did you have to split the capsule to give a smaller dose. Remi is currently on 1.25 mg eod although I am going to drop it to once every three days.

 

Many thanks Chris for all the information. I will endeavour to fill out my chart but I do have a bit of a love hate relationship with it as it never worked well for me.

I am monitoring his blood glucose as I want to catch any issues very early and will continue to monitor closely when I switch over.

I am a member of the IBD forum (but don't post) so will ask about the drug over there too.

 

Greetings! Skooter is an IBD kitty who was switched to Budesonide after his Diabetes diagnosis. He started the budesonide before the insulin, so I cannot comment on if it changes the blood sugar, but I can certainly say that it has not hindered Skooter any either.

He was on between 5 to 5.5 units insulin BID last summer and currently on 0.25 BID after he recently earned a reduction for being in normal numbers for 7 consecutive days/14 cycles.

Skooter is a pill to pill, so he actually has a liquid form of Budesonide, it is chicken flavored and again, does not appear to mess with his numbers any. I wish I could remember what his pred dose was, but he has been steady on 0.5mL of budesonide 2 mg/ml susp 30 mL. I will also say, his IBD has actually been better controlled on this than it was the pred.

In the beginning the vet said it MAY raise his numbers slightly, so I just used that to my advantage. He gets it once a day in the morning, so if it is gonna raise him, it will happen when I am at work. But again, take a look at his spreadsheet, it really hasn't seemed to effect his BG readings. Since is it a compound, the price varies anywhere from $65 to $70 per bottle and a bottle lasts me usually 6 - 8 weeks. It is shipped form Wedgewood Pharmacy in NJ and normally arrives within a week of ordering it through the vet's office.

 

Yes, 1/2 mg of budesonide is the standard cat dose.

 

Shadow was on budesonide for a while.... it did raise her bg.....
I talked my vet into letting me give it every other day and it wasn't so drastic ....

but now we are on gengraf ( modified cyclosporin) for the ibd.... and prednisolone which we are tapering off....
Shadow gets insulin again but her numbers are good for now with these two medications.

 

Thanks everyone for your replies. It is really helpful to hear other people's/cat's experiences.

Many thanks @MollynSkooter skooter sounds like he is doing well and interesting that is is doing better on the bedesonide. If you have been able to reduce his insulin dose and are down to 0.25 of a unit that is great. I will have a look at his spreadsheet. Are far as I know there aren't the compounding pharmacies in the UK that you have in the U.S. If I am wrong and someone could point me in the direction of one in the UK that would be great. Remi is absolutely fine to pill so I don't need a liquid medication.

@Larry and Kitties

This seems to be a much lower dose than the usual prednicare dose. Is it because you are giving it every day? I will be trying to give it eod (as Remi isn't on any insulin so I don't need to worry about the consistency thing) so would you think 1 mg tablet might okay? I promise I won't hold you to anything just trying to other people's opinion before I discuss it with my vet again. When I discussed it briefly with him on Friday he looked it up in the medication book thing he mentioned between 1-3 mg for cats and dogs.

This article http://veterinarycalendar.dvm360.co...homa-cats-proceedings?id=&sk=&date=&&pageID=1 mentions :

I would rather go for a smaller dose if possible and it seems that others are having success with the lower dose.

I have found 1 mg tablets for sale from the Wedgwood pharmacy that Molly mentions above.
http://www.wedgewoodpetrx.com/items/budesonide-tiny-tabs.html
I could cut these tablets in half if necessary but not sure if I can get them in the UK. i don't think they are like the entocort ones that have that protective coating.

Hi @rhiannon and shadow glad to hear that shadow is doing okay. Do you remember what dose of Budesonide she was on when her glucose was affected?
What was it that knocked her out of remission. I don t know much about cyclosporin but good to hear that it is working for shadow.

 

Shadow was on 1 mg of budesonide. When we started, I was giving it like every 3 or 4 days.
I would notice she felt better on the day I gave it.

i have to look at my ss for notes... on 3/23 she started with severe diarrhea.... so bad that she got hemorrhoids.
the month before, I had started giving her higher carb /gravy foods because she wasn't eating.
So something in the canned food bothers her...

the gengraf is new for treating inflammation. The only issue with it is if a kitty has ever been exposed to toxoplasmosis.

It was the prednisolone that knocked her out of remission altho' my gut tells me that if we could discontinue the pred,
she would go right back. Her numbers have been great.

 

I made a mistake,. Th standard cat dose is 1/3 of 3 MG capsule. I am using the 3 mg capsules and dividing it up in threes.
prednicare is a trade name for pone manufacture's prednesolone. Budesonide is a different steroid than prednesolone and thus there is no real correlation on does of the two.

 

I should add that Shadow is no longer on budesonide. We switched to the other two drugs.

 

Thanks @Larry and Kitties for the clarification. So I will either have to divide up the capsule or try to get hold of those little 1 mg tablets.

Sorry Larry I have one more question! Do you divide up the capsules by eye? Or do you somehow the powder?

Cheers

 

Thanks @rhiannon and shadow for the extra information. I have found that Remi has greatly improved since switching from chicken to a novel protein food (rabbit). He was already on prednicare but it was switching food that helped almost as much.

I am hoping the new steroid does help him in the same way as the prednicare. If not I will talk to the vet about that gengraf.

Best wishes

 

I divide by eye. I fill up three #3 gelcaps from one 3 mg gelcap so the are equal in height. I use a # 3 gelcap since I also put in 1/4 of a 259 mg metronidizole tabeand 1/4 of a 10 mg Pepcid AC tab. A % gelcap will hold it fine. My budesonide caps come in #4 gelcaps.

 

Sarah, there was a recent study done on cats and remission - you might be interested in it:
Glycemic Status and Predictors of Relapse for Diabetic Cats in Remission

One important message in it is that most of the diabetic cats (in remission) that they tested, still had an abnormal response to glucose. In other words, they were in remission only because they still were being treated as diabetics, maintained with low carb canned food, etc.

As far as Remi's blood sugar goes, the normal range is under 120, and mostly under 100. I'm not fluent in mmol, but I can figure out that 6x18 = 108, so that's still in normal range, but pushing the limit. Can you increase his exercise? That can help the glucose get into the cells and out of the bloodstream. I'm not sure if that's enough to make a difference in your situation, or if it's a problem with his asthma, but it's an idea.

 

Hi @julie & punkin (ga) many thanks for your reply.

Yes I saw that article the other day and it worried me! Especially as remi's levels are rising. I will increase his exercise. Do you have any idea about when I should do it and how often? Remi does love to play but I find I don't make it a priority but I will now.

Over the weekend we had dropped to giving the steroid once every three days and his levels were better but as we are planning on starting the Budesonide every other day at least to begin with I thought I had better go back to that dosing regime until we get hold of the new tablets in the next day or two but now having read what you wrote I wishes I hadn't.

 

Hindsight . . . all you can do is make the best choices you can with what you know at the moment.

 

Hi @julie & punkin (ga) I have some more questions that I wonder if you or anyone else (@Marje and Gracie , @Wendy&Neko, @Chris & China ) can answer as I have got myself in abit of a tiz again about remi's blood glucose.

I had it in my head that anything under 120 was okay but following on from what you said in an earlier message about blood glucose in cats in remission best being under 100 I reviewed remi's levels and following on from his steroid use in the last couple of weeks his levels have drifted over 100 (but under 120). I filled out a new spreadsheet tonight and it really highlighted this. I linked the new sheet but havent finished filling it out.

So my questions are if we stopped the prednicare would his levels fall back again? or have they sort of got used to being at this higher level? is it doing any damage to him if it is under 120?
Besides exercise is there anything else I could do to help bring his levels down naturally?
It is better to not go too long without food but is there an optimum time between mini meals? At the moment he has three mini meals in the morning and then again in the evening but he doesnt eat after about miday until the early evening and again after modnight until the morning.

I have now got hold of some budesonide but am going to see how remi does for the next few days not having any steroids. my worry is that his levels wont drop back again.

Any advice gratefully recieved.

PS i dont think the spreadsheet is displaying properly in my link so have copied the address in the link bar and pasted it here
https://docs.google.com/spreadsheets/d/17cwP_ZlsIT7X6DPlOorMsq58wkkT-pdxiXrp3EhcsLo/edit#gid=0


Sarah

 

Sarah

The only way to know if his numbers will come back down is to wean him off the pred. Don't just stop...it has to be tapered. We will then have to see if his numbers drop back down.

You can try feeding him a little LC food three or so hours before you test him and see if thst brings his numbers down....in other words, is his pancreas working?

I'm not sure what else could bring his numbers back down naturally besides play, LC food, and weaning him off steroids provided he does ok without them.

Ideally, he would be under 100 for the majority of the time. i don't think being around 120 does any damage but we'd really like to see him lower for most of the time. If it were me, I'd feed him, test three hours later, see how he's responding. Incorporate 15 mins or so of play twice a day. Watch the trend and see if he's just spiking up around 120 occasionally or spending most of his time between 100-120. I think spreading his meals out during the day in whatever manner he's used to is fine.

 

The ss in the link in your post says that you have to give permission for it to be seen. You might check your sharing settings.

Does he need the pred? Because if he needs it, then the pred takes precedence in importance over his glucose. If his blood sugar goes up high enough to become a problem while he's on the pred, then i'd assume it would be better to have him back on insulin and getting the pred (assuming he needs it).

 

Hopefully the budesonide will work well enough in him that you can wean him off the pred

Is he still doing better with the novel protein?

 

Thanks @Marje and Gracie @julie & punkin (ga) @Chris & China for your replies.

I checked the spreadsheet and I am sure it had all the right permissions. My laptop is playing up so will check again when I get to work and try to fill it is a little more.

Remi has been on 1.25 pred eod and then down to every third day so the last week so it has been tapering off somewhat. I was due to start the budesonide last night but I wanted to see if he was okay without any steroid for a few days as yes the novel protein diet has also helped his IBD. My plan is to maybe just continue with the no steroids until I see any symptoms again. I have already noticed a slight change so am expecting to have to start the Budesonide in the next few days.

I always test at the old preshot times so perhaps that isn't the best time as he wont have eaten for maybe 5 or 6 hours. When I have tested him a couple of hours after he has eaten his numbers have always dropped back down to the 70 or 80's. Maybe I should change when I do him or always do a second test a few hours after his pre breakfast one.

Thanks for all the advice. I will continue with the play ( he loves it) and change up the testing times to ensure I check after food as well. I do think he will end up always needing a steroid of some description and yes I agree that they may just mean he has to be on the insulin again. I would dearly love to just avoid having to do it for as long as possible and especially before my summer holidays so I can have some nice days out down the beach !

 

I'd also talk to my vet about the possibility of using cerenia. Recent findings are that it works as a non steroidal anti inflammatory and cats tolerate it quite well over the long-term. A friend of mine has had her cat on it for about 8 mos now for I D. Kitty has stopped vomiting and gained weight and is stable.

 

@Marje and Gracie Oh really that very interesting. I will speak to my vet about that as that could be a good option for us as Remi has 1/4 of tablet of ondansetron ever 12 hours so we could maybe deal with two things at the same time.

Is there any research on the cerenia on working for inflammation that I could give to my vet ? How did your friend persuade the vet to try it in the long term?

So far I have not had to give the Budesonide. I am just keeping a close eye on him. It would be great if I could try something else instead. Today his level was just under 100 in the am and 90 in the pm. I have played with him a few times and he has been out with me in the garden.

Another thing that occurred to me was that remi's novel protein rabbit food is higher in carb. According to the chart that Elizabeth kindly drew up it is closer to 10% carbs. But it suits Remi much more then his previous food. I doubt it has as much affect as the steroid but it might affect it slightly I guess.

 

Google for "cerenia as anti-inflammatory for asthma in cats" and you will find some information

 

One of the first articles I came across for cerenia and asthma was this
http://www.winnfelinefoundation.org...antagonism-on-feline-asthma-final-summary.pdf

And it wasn't very encouraging

I have found a couple of articles on cerenia and IBD, as this is my main concern right now, so will send these to the vet.

 

So Remi had diarrhoea this morning and so at lunchtime I went ahead and gave him 1 mg of Budesonide. I now feel bad for not starting it straight away but then I guess I would never have known he needed it.

Now my main concern is whether the compounded tablet my vet got from summit vets in the UK works as well as the capsules with the beads that have the protective coating.

 

@Larry and Kitties can I ask when you give the Budesonide. I gave Remi first dose on an empty stomach about an hour before giving food. Have you noticed any difference if you dose at different times.

His blood glucose was 4.9/ 88 before giving the Budesonide 1 mg. he then ate and went to sleep for a few hours. Now it is +4.5 hours and he is due for his dinner. I just retested his blood glucose and it is 113. I must say I am very disappointed. I had really hoped that I wouldn't see much if any difference.

I did read that 1 mg of Budesonide is equivalent to 2.50 mg of prednicare. Does anyone know more about this? Remi was on 1.25 mg prednicare eod. So maybe he doesn't need the whole 1 mg tablet?

 

Talk to your vet about the dose of budesonide

 

I will be talking to my vet as soon as I can get hold of him after the weekend. I was just hoping in the meantime to get the advice or hear the experiences of other members having to deal with the same issues. I find these issues always arise when the vets office are closed!

 

Posting in case others may find this useful in the future.
the type of Budesonide (enteric coating) used and how this affects absorption into the body is whether it becomes systemic rather than localised:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1375021/pdf/gut00544-0123.pdf

Some general info
http://www.veterinarypartner.com/Content.plx?A=2065

Info from US compounding pharmacy about Budesonide tablets. They question the need for the enteric coating in animals
http://www.wedgewoodpetrx.com/learn...monographs/budesonide-for-veterinary-use.html

 

Great info. My Riley has IBD and my vet started giving Depo shots in January every 30 days. He believes this caused his diabetes diagnosis. He also has me giving him 1 mg of azrithromycin (anitbiotic) 2 times a week. Do you guys know anyone who gets the Depo shot? Why does Riley need the antibiotic? I'm going to talk to my vet about budesonide.
So far with the help of the ANGELS on this forum Riley is doing great from 3 weeks ago. He went from 2.5 to .5 units of Prozinc. I'm concerned he is due for another shot on the 20th and I don't want his numbers going sky high agian.

 

Go for the pre-emptive strike and ask the vet now, not during a scheduled visit for something you may not want. So long as Riley isn't awful to pill, going with an oral med may allow the daily dose to be low enough to avoid serious glucose spikes.

 

Ok I will call tomorrow. Another question, my vet always orders the meds for me and charges a fortune!!! Can I ask him if I can get the meds somewhere else? I feel like I'm cheating on him but hello, I'm not rich!
He said it was fine to get Prozinc offline (he charges 150.00 per vial and Foster and Smith 100.00) but I wasnt sure about compounded meds since they usually do it right there in office.

 

Ask for a prescription to fill elsewhere, or ask if he'll match the prices locally.
- Check your area for compounding pharmacies and get quotes.
- Or, if he'll eat a piece of processed cheese, you can wrap it in a bit of cheese and feed it to him.