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? Help with dosing - Phoebe is trending lower

Hannah and Phoebe

Hannah and Phoebe

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Hi all,
Phoebe is now fully weaned off of prednisolone. She had her final (for now anyway) 2.5mg dose yesterday (8/16) morning. Her insulin has been reduced pretty dramatically over the last 5 days or so due to low nadirs and advice from this board. Last night I also started introducing a small amount of wet food. I replaced a small amount of her dry food with 0.5oz of Instinct wet. Last night she had a pretty sustained low period from PMPS +4 to +6. I wasn't sure if it was the right thing to do but I reduced again this morning. She is in another low period as we speak. I am monitoring her very closely and I don't think she is in danger. She had some high carb food about 30 minutes ago. But I'm looking ahead to this evening and wondering what to do if she is still low pre-shot. I feel like I want to err on the side of giving less insulin, but I also have read that changing the dose to quickly can have negative effects. Any and all advice is appreciated!
 
Don’t use kibble to raise BG. It takes too long to raise BG and lasts too long after it finally does kick in. Use HC wet food and/or karo syrup or honey. HC food is best although if you get a ReliOn number below 50, add in a drop or two of Karo or honey.
 
And generally speaking, no HC unless you’re below 50. Medium carb food or even just LC food is usually able to stabilize glucose. Of course you would test in 20 minutes to make sure and move to higher carb or karo/honey if not.
 
Unless I am misunderstanding the spreadsheet numbers, she didn’t have any real lime green numbers last night. All the ReliOn readings were in safe territory above 50. Same for today, no lime green, everything above 50 on the ReliOn. (Very glad about that!)
 
Suzanne and Darcy said:
Unless I am misunderstanding the spreadsheet numbers, she didn’t have any real lime green numbers last night. All the ReliOn readings were in safe territory above 50. Same for today, no lime green, everything above 50 on the ReliOn. (Very glad about that!)
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Yes, no true lime-green numbers! Should I base the colors on the ReliOn readings only?
 
All of these are HC. It’s the dry matter basis that is what counts:

Product Name: Fancy Feast Gravy Lovers Beef
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 18%

Product Name: Fancy Feast Gravy Lovers Chicken & Beef
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 17.9%

Product Name: Fancy Feast Gravy Lovers Chicken
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 17.8%

Product Name: Fancy Feast Gravy Lovers Chicken Hearts & Liver
Carbohydrate As-Fed: 3.6%
Carbohydrate Dry Matter: 18.3%

Product Name: Fancy Feast Gravy Lovers Turkey
Carbohydrate As-Fed: 3.9%
Carbohydrate Dry Matter: 17.9%

Product Name: Fancy Feast Gravy Lovers Salmon and Sole Feast
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 18%

Product Name: Fancy Feast Gravy Lovers Salmon
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 18%

Product Name: Fancy Feast Gravy Lovers Ocean Whitefish & Tuna
Carbohydrate As-Fed: 3.5%
Carbohydrate Dry Matter: 17.8%
 
Suzanne and Darcy said:
Yes. The Libre reads excessively low in the lower numbers and it will be the ReliOn we use for making decisions about reductions. But she’s definitely needing less insulin as expected without the pred. I hope she’s feeling okay.
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Yes, I didn't expect it to be that much lower! Her tummy is not doing very well to be honest. She seems to be very constipated at the moment and in pain. It's making me second guess if I've done the right thing. I'm really eager to get her on this LC wet novel protein food, but don't want to introduce it too quickly either, as I understand the switch from dry to wet can reduce insulin need as well. I am not sure how slow to go with the dry to wet transition.
 
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Hannah and Phoebe said:
Yes, I didn't expect it to be that much lower! Her tummy is not doing very well to be honest. She seems to be very constipated at the moment and in pain. It's making me second guess if I've done the right thing. I'm really eager to get her on this LC wet novel protein food, but don't want to introduce it too quickly either, as I understand the switch from dry to wet can reduce insulin need as well. I am not sure how slow to go with the dry to wet transition.
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Oh no. I am sorry to hear that. Are you sure it is wise to eliminate the Prednisolone all together? Have you consulted with your veterinarian about it. I don’t think I would change more than one thing at a time (food and medication.)
 
Since Phoebe has presumed IBD, you actually will need to feed her a single protein food and in order to adjust carbs you can kind of create your own medium protein high carb food by adding in a drop or two … or more of karo syrup or honey and mixing it in — without introducing completely different foods that will mess up her whole GI system.

When I started helping you just recently, you had already begun to reduce the Pred and then yesterday you stopped it. I really think that finding a food that works for her will be the hardest part and will take time. I understand because I have a cat with confirmed IBD via surgical biopsy— it has taken me months to find food he can eat. It took about 6 months on 5 mg. Pred daily (and the dose was higher before that) to where I could reduce to 5 mg one day and 2.5 the next. Then finally (more months) to reduce to 2.5 daily. One day I hope to reduce to 2.5 mg. Every other day with the help of the Visbiome vet probiotic, which is the best probiotic out there.
 
Suzanne and Darcy said:
Oh no. I am sorry to hear that. Are you sure it is wise to eliminate the Prednisolone all together? Have you consulted with your veterinarian about it. I don’t think I would change more than one thing at a time (food and medication.)
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Yes, the vet was in favor of eliminating the pred, but I have yet to consult with her since our last update when Phoebe was half-way through the wean. For many years we had not been able to get Phoebe regulated, as she would have pre-shot numbers in the high 300s-400s, but also still have nadirs in the 60s or even 50s frequently. It now really seems like that was mainly the pred. But perhaps there is a happy medium. I will call tomorrow morning and see what the vet thinks. I am so happy to see the numbers we are seeing after so long in high numbers territory. But the GI issues must also be addressed. She has never been on wet food before in her whole 12 years since my vet, somewhat strangely I've come to learn, advocates against it in favor of science diet dry food. And she's always had poultry as well. I'm very interested to see how she does on a wet novel protein diet, but also trying to stay realistic about the need for steroids.

How long would you suggest waiting before starting the food transition?
 
Has she ever had an abdominal ultrasound? I don’t think she has. This would be about the bare minimum that should be done to see what’s going on in there. Or has a GI panel (bloodwork) ever been done (Texas A&M GI panel.)
 
Suzanne and Darcy said:
Has she ever had an abdominal ultrasound? I don’t think she has. This would be about the bare minimum that should be done to see what’s going on in there. Or has a GI panel (bloodwork) ever been done (Texas A&M GI panel.)
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She has never had an ultrasound or a GI panel. I will ask the vet about that on Monday as well. Thank you for the suggestions. I am looking at the Visbiome website and it looks like there are several different products. Is there one in particular you recommend?
 
Hannah and Phoebe said:
I've come to learn, advocates against it in favor of science diet dry food.
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Unfortunately there are vets out there who are completely sold out to those foods. Their nutritional “education” consists mostly of the sales pitch of the reps who visit their offices. Those food manufacturers actually pay for vet students way through school. I have met a few of those vets and this is what they told me.

personally, I would have done it the other way around— change food first and then gradually reduce the pred.

This was written by a vet who worked with this group for many years.

Sticky - Dry Food - Consider More Than Carbohydrate Content
 
I really feel like
Hannah and Phoebe said:
She has never had an ultrasound or a GI panel. I will ask the vet about that on Monday as well.
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you should get the ultrasound done if at all possible because a qualified vet (to do ultrasound, I mean — a lot of vets cannot do them and only use their ultrasound to confirm pregnancy in a dog or to guide them when getting a urine sample via cystocentesis.)…. Anyway a vet who is proficient in using the ultrasound needs to look at all the abdominal organs and take measurements of everything including intestinal thicknesses for each layer, etc.
 
I see Phoebe is back in the blue now so that’s good. I am worried about her tummy though. Definitely take that additional .5 unit reduction tonight You can give her a break from testing with the ReliOn now because at those numbers they should track more closely (the Libre and the ReliOn). In the higher numbers sometimes it’s actually the ReliOn that reads higher but our experience here is that Libre reads lower in the lower numbers under 100 and especially as they go lower.
 
I am
Hannah and Phoebe said:
For many years we had not been able to get Phoebe regulated, as she would have pre-shot numbers in the high 300s-400s, but also still have nadirs in the 60s or even 50s frequently. It now really seems like that was mainly the pred. But perhaps there is a happy medium.
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just thinking about this some more…. Some of that diving down could just have been that she was not on the correct food (I mean wet food) and not on a feeding schedule where she got snacks at certain points in the cycle. You have to “feed the curve” and dry food can really give you some unpredictable numbers, which is why we only allow cats eating dry food to follow SLGS and not MPM (or TR if they use Lantus) — it’s for safety.
 
Oh gosh. I was just counting up the number of cells on your spreadsheet and I was saying to myself…. How in the world can you have more than 12 hours between shots (16 cells for the 12 hours in between shots!)
 
Suzanne and Darcy said:
Oh gosh. I was just counting up the number of cells on your spreadsheet and I was saying to myself…. How in the world can you have more than 12 hours between shots (16 cells for the 12 hours in between shots!)
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Oh ya sorry about that! I have been so often testing on the half-hour that it started to get really cluttered, so I added some half-hour columns. But now its kind of cluttered in a different way! Should I change it back?
 
My Luciole also has IBD, diagnosed through our vet who specializes in imaging. After a course of Pred, he put her on Budesonide, gradually tapering her down to once every 3 days, which is what she gets now, and will for life.

Budesonide is specifically for the intestines, and much more gentle on her body than Pred. So after she got under control with Pred, she's now on something that specifically targets and prevent inflammation. It's worked wonders for her.

"Budesonide reaches very high topical concentrations in the lining of intestinal tract tissue, exerting great anti-inflammatory and immune-suppressing activity localized to the gut.

But it is otherwise largely eliminated from the body by a process called a first-pass metabolism effect in the liver. This keeps it from reaching high concentrations throughout the rest of the body.

Although budesonide has more of a limited, localized effect, it should not be thought of as a “weak” steroid. In fact, budesonide is actually a very potent steroid.

In terms of efficacy, many veterinarians consider budesonide and prednisolone to have the same level of effectiveness for treating inflammatory bowel conditions in cats. Budesonide should simply be thought of as a good alternative if there are concerns for systemic steroid use, especially due to diabetes or cardiac conditions."

Budesonide for Cats: Dosage, Safety & Side Effects - Cats.com
 
Yes. We discussed Budesonide a few days ago when I suggested it due to it having less impact on blood glucose. Some cats do very well on it (sadly not all, but it would be worth trying.). I believe you @Hannah and Phoebe were going to look back through Phoebe’s vet records to see if she had ever taken it before.
 
Suzanne and Darcy said:
Yes. We discussed Budesonide a few days ago when I suggested it due to it having less impact on blood glucose. Some cats do very well on it (sadly not all, but it would be worth trying.). I believe you @Hannah and Phoebe were going to look back through Phoebe’s vet records to see if she had ever taken it before.
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I've just finished going through all of Phoebe's records and making notes. She has not been on budesonide before. So this is definitely something to consider!

Another thing I found is that she HAS had an abdominal ultrasound. It was done at a different vet clinic when my vet was out of town in Dec 2021. The ultrasound showed "thickened gastric antral mucosa and proximal duodenal mucosa" and the conclusion was a Dx of either IBD or GI small cell lymphoma. The trail runs cold there, and I will call my vet tomorrow to confirm, but I believe the lymphoma was ruled out at a later date by my regular vet through other (perhaps blood?) tests. I have no record or memory of a biopsy of any kind.
 
Well, I don’t believe you can rule out lymphoma via blood tests although there is a blood test that is being developed. If she had it though then you probably would know about it by now since it’s been 4 years— except…. the thing is that it has been found that Feline Inflammatory Bowel Disease can lead to intestinal lymphoma because the chronic inflammation from IBD may weaken the cat's immune system, making it more susceptible to cancerous changes in the intestinal cells. This progression is not guaranteed, but it is a potential risk for cats with long-term IBD. The treatment for small cell lymphoma is steroids and usually a chemo drug called chlorambucil that many cats do really well on. My own cat had several years of fantastic quality of life while on chlorambucil (I would have lost him without it.)
 
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