Diabetic Cat on Prednisolone

dilly

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I just had Bart at the vet, hes's been on pred for 3 years for stomatitis.

The vet drew blood and his gluclose was at 342, nearly double what it was when he was tested in May.

I took him to the vet because he's lost some weight, and been drinking and peeing alot more latley.

I know one of the side effects of pred is diabetes.

Course the vet is already talking inulin. I want to try to manage it thru diet.

But what I'm wondering is, is that possible with him still on the prednisolone?

I have to take Bart back to the vet on Monday, because he had, had his pred this morning, and the vet wants to recheck on a day he hasn't had any pred, to be sure.
 

maewkaew

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 I doubt you are going to be able to do this with diet alone since he is on the steroid and 342 mg/dL is not just borderline hyperglycemia

A normal blood glucose level for a healthy non-diabetic cat ranges from about 50-100 in their home environment. (At the vet it is often a bit higher due to stress.   ( Non-diabetic feline housemates of diabetic cats from the Feline Diabetes Message Board)    So  in May if he was over 170, he was already  in hyperglycemic numbers.   At that level,  I would definitely just try a diet change. 

At 342,  I understand the vet talking insulin.   But  there's nothing wrong with a SHORT delay,  and first  change to a very low carb diet  (this does not only mean prescription food.  The only one of those that is really low carb is the canned version of Purina DM.  but there are commercial options that are just as good or even lower in carbs.  ) 

 The benefit of doing the diet change before starting the insulin is that if he still does need to go on insulin,  then you won't have to worry about how the diet change will affect his insulin needs.    So maybe first get him on a low carb food for 4 - 7 days , and get yourself a glucometer so you'll be ready to start testing. ( the ones for human diabetics work  fine for cats,  for example Walmart has one called Reli-On that has very good reviews,  and the test strips cost less than most of the brands.) 

If the diet change doesn't work to keep him under 150 mg/dL ,  then start him on a long-acting insulin like Lantus (glargine) ,  and start testing blood glucose at home.     Get syringes that have half-units  printed on the barrel.  ( like 0.5,  1.0, 1.5, 2.0, 2.5,   etc.)  That makes it easier to do dose changes of half a unit at a time.   

I had the other way round,   I had a diabetic cat who was on prednisilone,  only as a last resort as part of treatment for lymphoma.   It was very difficult to manage his blood glucose but he had multiple health problems

Dr. Pierson has a good intro article on feline diabetes,  http://www.catinfo.org/?link=felinediabetes and her site also has a chart showing protein, fat, carbohydrate etc.  amounts for many kinds of canned cat food from the U.S.  to help you choose some foods.

Good luck,   I hope things will work out well for Bart.   With the steroid you probably won't be able to regulate him very tightly ,   but hopefully you may be able to keep him from extremely high numbers most of the time.
 

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The vet is talking about inulin or insulin for your kitty? Steroids are great drugs when we need them, but diabetes is always a risk. It's possible that you may be able to control it through diet alone, but when I was a member at www.felinediabetes.com message boards, I'd read about plenty of cats that still needed insulin even when on the lowest carb diets available commercially. My best advice to you at this time is to learn to home test kitty's blood glucose and carry your meter with you when kitty is tested at the vet's. You can check your meter against theirs under similar conditions.

They've gotten a lot better with dosing kitties with insulin and the types of insulin we can use. Learning how to home test makes a big difference in managing a diabetic cat, even if you end up not needing to use insulin.
 
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dilly

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Thanks for the replies.
I had a feeling with the pred diet alone wouldn't work.
I'll get him going on a low carb diet and see if I can reschedule him for Wednesday.
I meant the vet wants to get him on insulin.
I'm nervous about testing and dosing him.
 

goholistic

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I'm just curious. I also have a cat on pred for chronic pancreatitis/IBD. What was Bart's dosage of pred?
 

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He get 1.5mg every other day
Thanks. That's a pretty low dose. Sebastian is on 5 mg every day. In his thread, others have noted that sometimes there is a genetic predisposition to the development of diabetes. 


I wouldn't be too worried about administering the insulin. The vet can show you how it's done. You'll be nervous at first, but will get the hang of it. I felt that way when I first started sub-q fluids at home for Sebastian. But now I'm a pro!
 

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Everyone is nervous at first!   but just about every person and cat can learn to do it.  
     I found giving the shot was easier than testing at the beginning.   I just gave the shot while he was eating and he was so focused on his food that it seemed like most of the time he hardly paid attention to the shot.   

With the blood glucose testing,  I had a harder time initially than many people seem to,  so I backed up and  started going through practice runs where I would go through all the motions , but without actually poking him.   That way he got used to the whole routine and the equipment,  and having his ear rubbed / touching something to his ear that makes a click.    ( My favorite lancing device is the One Touch Penlet Plus) .   We got the hang of it, my cat learned to accept it and would actually come running for his test ( because he knew he would get his beloved dried salmon snacks) .   I never would have believed that at first when I heard people tell stories like that.   

Some tips for getting blood:  Use test strips that suck up the blood and   and that only require a very small sample size of under 1 μL.  ( Today  I think nearly all of them 'suck' the blood,  and I think most of them now only need 0.6 μL or less.  

Don't start out with a lancet that is too small ( too high gauge) . A 31 may make it too difficult to get blood.  You may want a 28 or even 26.

  Warm the ear first,  with a sock full of rice warmed up in the microwave.  But make sure it is not TOO hot.  

  Have a bright light so you can see well.  

Rub a very thin coat of vaseline or triple antibiotic ointment on the ear before doing the ear prick -- this makes the drop of blood 'bead up'  and makes it MUCH easier.   Once I learned that trick I always used it.
 

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In addition to maewkaew's great advice, I washed my hands then did the ear prick, then scraped the blood off onto my fingernail before little miss ear-flick could fling my only good poke for blood across the room.  I'd put the sippy strip to my nail and voila!

And yes, I had the most gentle and sweet cat but my nervousness caused me many episodes of tears and frustration trying to get blood for glucose numbers.  My first curve, I seriously had to break out the wine by that evening.  I should have started with wine, it actually helped!  LOL!
 
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dilly

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Thank you both for the great advice!
 
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dilly

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Ok, I took Bart back to the vet to be retested yesterday.

He is diabetic. He gets 2 units of insulin twice a day.

I decided to give it 7:30 a.m, and p.m.

But I feed earlier than that.

I ususally feed at 5a.m on wkdays, and about 5, or 5:30p.m. But on wkends we like to sleep in a little.

That's why I went with 7:30.

How long Is too long between eating and his insulin? And how important is giving the insualin right on time?
Can it be given a little early or late?
 

peaches08

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Which insulin is it? There are different peak times of action depending on the type of insulin.

I am not an expert on different types of insulin and cats, but in addition to here ask this question at the feline diabetes message board I mentioned. They're going to ask about home testing, glucose curves, food, and etc. And they'll walk you through the whole process. That site saved my Grey for many years.
 
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dilly

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It's Prozinc.

Ok, will do:)
 

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I started by giving insulin shot to the cat in front of the food dishes (even just for a little snack). That way, the cat was distracted by eating, didn't even notice the shot, and I can be sure that there is at least something in his stomach. Now, the cat has the timing down perfectly. He tells me when it's time or when I'm a few minutes late, then heads to the food dish when I open the fridge to get the insulin out.
 

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 Prozinc is a veterinary U-40 insulin specifically approved for cats, and it's one of the insulins that would usually be a good choice  --  better than some that are shorter acting and tend to work better for dogs.  Cats usually have faster metabolisms than dogs or people.

I would not usually want to feed a big meal at +10   ( 10 hours after his last shot).   Feeding just before the shot would be better,   because by the time you feed , his last shot will be at least wearing off,  and his blood sugar may end up rising up higher than it should by the time the shot kicks in.  That could give a sort of uncomfortable feeling of up and down.  

Maybe you can gradually adjust your feeding times so you are just feeding later.  ( I know they will complain at first!   so maybe at first you could feed him just a small snack at the normal time,  and then feed his breakfast at about 7:15 just before his shot.   

 In any case,   I would at least give him some kind of treat with the shot  so that he has some kind of positive association.

 Actually, diabetic cat often end up doing better on a few small meals a day.      

  You'll end up finding out data by doing curves and spot checks,  ( a curve is where you test before a shot,  then every 2 hours    -- or you can sometimes make it every 3   -- until time for the next shot) as well as regular pre-shot tests.

 You will learn from the testing about  his usual time of: 

>  onset ( how long it takes the insulin to take effect)  

>  peak  insulin effect / nadir of blood glucose (the time when blood glucose goes lowest)

>  duration ( how long the shot lasts him.    For good control ,  it should not wear off and allow the BG to zoom way up by the time for the next shot.     Ideally you want to see not a huge variation.   The duration is something most easy to see when it's NOT long enough.   because really it should last LONGER than 12 hours . 

  ( IF it should turn out the Pro-zinc doesn't hold him long enough,  you will still have other options for even longer -acting insulins --  Lantus (glargine) or Levemir (detemir) which are  insulins manufactured for humans that are also used for cats ( but in humans they're dosed once a day, in cats it's nearly always twice a day)     I'm not saying the Prozinc won't be fine!    A lot of cats do well on it.  but every cat is different; some have faster metabolisms than others,   and  I don't know how the prednisilone might affect it.   )

 You'll also start to get some kind of idea how food affects him.   You deinitely should choose a food where the carbs are under about 8% of calories.  ( see the chart I linked),   and foods that are under 5% carbs are probably best.    Some cats are more carb-sensitive than others.  

   Your vet probably told you  that Prozinc is at a different concentration (U40)  from the human insulins that are U100 ,  so you either need to buy  U-40 syringes  ( and you probably would want to do that at first -- you have enough things to get used to without having to convert the dosage amounts! ),  or else you can get small size 0.3 ml (30 unit)  U100 syringes (maybe for cheaper since more of them are made and there's more competition) and  use a conversion chart http://www.felinediabetes.com/insulin-conversions.htm

I know it is a LOT to learn about at first and can feel very overwhelming.    Just know that a lot of people have been at the same place & felt probably a lot of what you are feeling,  and it does get easier.   Just focus on the immediate things you need to do,   and learn as you go..   I second the advice to check out the FMDB for specific advice from people who are  familiar with using Prozinc & other PZI insulins.

  Your cat is very lucky to have such a caring person.  
 
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dilly

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I'm on my phone and trying to read at stop lights lol so. I'll have to read more thoroughly. But I did on FMDB everybody has been great! I've been giving Bart a midday meal too. And thought about a bedtime meal?
 
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dilly

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 Prozinc is a veterinary U-40 insulin specifically approved for cats, and it's one of the insulins that would usually be a good choice  --  better than some that are shorter acting and tend to work better for dogs.  Cats usually have faster metabolisms than dogs or people.

I would not usually want to feed a big meal at +10   ( 10 hours after his last shot).   Feeding just before the shot would be better,   because by the time you feed , his last shot will be at least wearing off,  and his blood sugar may end up rising up higher than it should by the time the shot kicks in.  That could give a sort of uncomfortable feeling of up and down. 

Maybe you can gradually adjust your feeding times so you are just feeding later.  ( I know they will complain at first!   so maybe at first you could feed him just a small snack at the normal time,  and then feed his breakfast at about 7:15 just before his shot.  

 In any case,   I would at least give him some kind of treat with the shot  so that he has some kind of positive association.

 Actually, diabetic cat often end up doing better on a few small meals a day.    

  You'll end up finding out data by doing curves and spot checks,  ( a curve is where you test before a shot,  then every 2 hours    -- or you can sometimes make it every 3   -- until time for the next shot) as well as regular pre-shot tests.

 You will learn from the testing about  his usual time of:

>  onset ( how long it takes the insulin to take effect)

>  peak  insulin effect / nadir of blood glucose (the time when blood glucose goes lowest)

>  duration ( how long the shot lasts him.    For good control ,  it should not wear off and allow the BG to zoom way up by the time for the next shot.     Ideally you want to see not a huge variation.   The duration is something most easy to see when it's NOT long enough.   because really it should last LONGER than 12 hours .

  ( IF it should turn out the Pro-zinc doesn't hold him long enough,  you will still have other options for even longer -acting insulins --  Lantus (glargine) or Levemir (detemir) which are  insulins manufactured for humans that are also used for cats ( but in humans they're dosed once a day, in cats it's nearly always twice a day)     I'm not saying the Prozinc won't be fine!    A lot of cats do well on it.  but every cat is different; some have faster metabolisms than others,   and  I don't know how the prednisilone might affect it.   )

 You'll also start to get some kind of idea how food affects him.   You deinitely should choose a food where the carbs are under about 8% of calories.  ( see the chart I linked),   and foods that are under 5% carbs are probably best.    Some cats are more carb-sensitive than others. 

   Your vet probably told you  that Prozinc is at a different concentration (U40)  from the human insulins that are U100 ,  so you either need to buy  U-40 syringes  ( and you probably would want to do that at first -- you have enough things to get used to without having to convert the dosage amounts! ),  or else you can get small size 0.3 ml (30 unit)  U100 syringes (maybe for cheaper since more of them are made and there's more competition) and  use a conversion chart http://www.felinediabetes.com/insulin-conversions.htm

I know it is a LOT to learn about at first and can feel very overwhelming.    Just know that a lot of people have been at the same place & felt probably a lot of what you are feeling,  and it does get easier.   Just focus on the immediate things you need to do,   and learn as you go..   I second the advice to check out the FMDB for specific advice from people who are  familiar with using Prozinc & other PZI insulins.

  Your cat is very lucky to have such a caring person. 
Ok, I've finally had a chance to sit down and read through you're post.

First have to say Barty, is felling much better!!:) Yay!

I'm definatley feeling a little overwhelmed, just seems to be a lot to worry about that can go wrong.

I've been doing a lot of research and it seems Prozinc is good if meal times are a little spaced apart

He needs to put on some weight, but I'm a little scared about feeding him LOL. I don't want to make him too high or low and casue a reaction.
 
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dilly

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Ok, I've finally had a chance to sit down and read through you're post.

First have to say Barty, is felling much better!!:) Yay!

I'm definatley feeling a little overwhelmed, just seems to be a lot to worry about that can go wrong.

I've been doing a lot of research and it seems Prozinc is good if meal times are a little spaced apart

He needs to put on some weight, but I'm a little scared about feeding him LOL. I don't want to make him too high or low and casue a reaction.
Oh, and the vet gave me some U40 syringes, and a sharps disposal container
 

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Hi Dilly. 

I'm sorry I didn't answer sooner.  I have not been on here much lately.    I am SO glad Barty is feeling a lot better!    I think you will be seeing him gradually putting back on weight / muscle mass ,  now that the insulin is helping his body again able to use more of his food.

The midday meal is a great idea,  and a bedtime meal  like at around 11 pm or midnight ,would be great, too.  I assume you'd also be feeding dinner when he has his 7:30 PM insulin.  

I'm sorry if I made things more  overwhelming and complicated or scary by what I said about feeding.   Some cats do better if they don't eat ( or at least not a big meal)  after  about +6 or +7.    That  is NOT a rule written in stone and it's not like it would be actually dangerous to feed him at any time!    It was not about danger,  it was just about regulation and greater comfort.    It's just that feeding a large meal at a time when the shot is wearing off could send the blood glucose up higher than it would if you feed earlier when the insulin is working at a stronger effect.    Temporary high blood glucose is not actually life threatening.   It could just make him feel sluggish,  and then when you give the shot,  the feeling of his blood glucose going down a long way, must be a bit  uncomfortable, especially if it's fast.    ( at least according to a human diabetic friend )

 But in any case,  the way he is feeling overall is certainly a lot better than how he has been feeling before when he had high blood glucose probably for months.    

  If you're testing,  you'll eventually come to learn yourself how feeding at various times in the cycle affects his blood glucose. 

Feeding him will never cause a reaction to make his blood glucose go too low.      Low blood glucose can be followed by it then bouncing high ,  due to the liver reacting by making some emergency glucose.   But it does not work the other way round.  The blood glucose going high won't cause a reaction of it then dropping too low.   

Low blood glucose (hypoglycemia) can  happen if the insulin dose is too high  or if he didn't eat and had his regular dose,    or the body starts to being able to use the insulin better than it could or produce more of his own endogenous insulin    And cats do often heal .  That's one reason that regular home BG testing is helpful,   so you see what is going on.  

Too high blood glucose over a long period is not healthy,  as you have seen.    But it's the "too low"  that can be dangerous in a short term.    That doesn't mean you need to totally panic if it goes under 50.  Many cats on a very low carb wet diet and long acting insulin seem to tolerate low levels OK.    When BG goes under 50 I would just feed some wet food right away,  maybe a wet food with higher carb level  especially if it goes under 40.   and then continue to monitor.    I myself would only give syrup or glucose/ dextrose gel if a cat is actually having a full blown hypoglycemic episode with seizures.   That may never happen to Bart but it is good to be informed and prepared just in case.   On FDMB you will find info on hypoglycemia .  

 Louis only had hypos with seizures at the end of his life when he had  cancer and it was causing crazy things with the blood glucose.
 
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dilly

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Hi Dilly.

I'm sorry I didn't answer sooner.  I have not been on here much lately.    I am SO glad Barty is feeling a lot better!    I think you will be seeing him gradually putting back on weight / muscle mass ,  now that the insulin is helping his body again able to use more of his food.

The midday meal is a great idea,  and a bedtime meal  like at around 11 pm or midnight ,would be great, too.  I assume you'd also be feeding dinner when he has his 7:30 PM insulin. 

I'm sorry if I made things more  overwhelming and complicated or scary by what I said about feeding.   Some cats do better if they don't eat ( or at least not a big meal)  after  about +6 or +7.    That  is NOT a rule written in stone and it's not like it would be actually dangerous to feed him at any time!    It was not about danger,  it was just about regulation and greater comfort.    It's just that feeding a large meal at a time when the shot is wearing off could send the blood glucose up higher than it would if you feed earlier when the insulin is working at a stronger effect.    Temporary high blood glucose is not actually life threatening.   It could just make him feel sluggish,  and then when you give the shot,  the feeling of his blood glucose going down a long way, must be a bit  uncomfortable, especially if it's fast.    ( at least according to a human diabetic friend )

 But in any case,  the way he is feeling overall is certainly a lot better than how he has been feeling before when he had high blood glucose probably for months.  

  If you're testing,  you'll eventually come to learn yourself how feeding at various times in the cycle affects his blood glucose.

Feeding him will never cause a reaction to make his blood glucose go too low.      Low blood glucose can be followed by it then bouncing high ,  due to the liver reacting by making some emergency glucose.   But it does not work the other way round.  The blood glucose going high won't cause a reaction of it then dropping too low.  

Low blood glucose (hypoglycemia) can  happen if the insulin dose is too high  or if he didn't eat and had his regular dose,    or the body starts to being able to use the insulin better than it could or produce more of his own endogenous insulin    And cats do often heal .  That's one reason that regular home BG testing is helpful,   so you see what is going on. 

Too high blood glucose over a long period is not healthy,  as you have seen.    But it's the "too low"  that can be dangerous in a short term.    That doesn't mean you need to totally panic if it goes under 50.  Many cats on a very low carb wet diet and long acting insulin seem to tolerate low levels OK.    When BG goes under 50 I would just feed some wet food right away,  maybe a wet food with higher carb level  especially if it goes under 40.   and then continue to monitor.    I myself would only give syrup or glucose/ dextrose gel if a cat is actually having a full blown hypoglycemic episode with seizures.   That may never happen to Bart but it is good to be informed and prepared just in case.   On FDMB you will find info on hypoglycemia . 

 Louis only had hypos with seizures at the end of his life when he had  cancer and it was causing crazy things with the blood glucose.
Thanks Maekaew
 
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