How to move forward with IBD and diabetes? Experience with Budesonide?

Telling Vivian's story is mentally exhausting. As briefly as possible, Vivian presented with loose stool with fresh blood and mucus and weight loss a year ago, originally thought to be caused by a benign thyroid tumor and hyperthyroidism. After surgery and a return to normal thyroid function, the  diarrhea did not resolve. Ultrasound revealed thickening of the colon (entire large intestine) but needle biopsy was not conclusive for cancer. B12 and folate tests suggest a malabsorption problem as well.  She has been treated for presumed IBD with diet change, metronidazole, probiotic, pancreatic enzyme, B12 injections and more but to no avail. Prednisilone did offer her some but not total relief from symptoms for three months, until it caused or facilitated diabetes this June. She has been on Lantus insulin, is weaning from pred, has been put on chlorambucil, and is transitioning to a low carb diet. Whew. Which leads us to the present. Vivian's blood glucose is improved almost to the point of remission, but from what I understand she can't go into remission without getting completely off the pred. Originally at 5 mg pred daily, she is now a 2.5 mg pred every other day, but her loose stool with blood and mucus are worsening. Chlorambucil has little effect, other than to make her feel lousy and ironically give her diarrhea in the first 24 hours after administration. Yesterday the vet said it may be that Vivian is just not going to tolerate going without pred, which means she will stay diabetic and therefore be managed for the long haul with both pred and insulin. This prospect is so disheartening. I started thinking about "colitis" - which is essentially what she has - and specifically treating that as opposed to generalized IBD, possibly cancer, etc.

Does anyone have a cat whose colitis symptoms have been successfully treated, at least to some degree, without potentially harmful prescription drugs? I feel like this cat has enough drugs swimming through her system and I am at my wit's end with this med helping that problem but causing another problem and that med not helping any problem but making her feel sick, etc. Advice welcome!

thank you

Laura

I don't have experience but I wanted to lend my support! How very wonderful of you to go all this way for this kitty. I pray you find a solution

Have you asked on the message board over at FelineDiabetes.com? I know from past experience that members there have helped others with IBD/diabetic cats. Steroid use can induce diabetes in some cats, which may have been what happened to your cat.

Cat Pal said:

 
 Vivian's blood glucose is improved almost to the point of remission, but from what I understand she can't go into remission without getting completely off the pred.

Yesterday the vet said it may be that Vivian is just not going to tolerate going without pred, which means she will stay diabetic and therefore be managed for the long haul with both pred and insulin. This prospect is so disheartening.

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Remember to keep your cat's whole health in focus, not just the diabetes or the IBD. Diabetes isn't a death sentence as long as you can manage it well with insulin and diet. Yes, it would be great if your cat could go into remission but don't make remission your ultimate goal. You need to balance both the diabetes and IBD so there has to be some give and take. If some steroid use helps the IBD, then I suggest keeping using it and continue to give your cat insulin to keep the blood glucose levels in check.

It seems pretty certain that steroid use did induce diabetes in Vivian's case, which is any case is not going to go away with continued steroid use.

Having put an enormous amount of mental energy, not mention organizing my time so I am home for insulin injections, it is really hard for me to accept that she will need to stay on both pred and insulin. But a talk with the vet and a look in the litter box this morning is sort of driving home that concept. She is as bad as she was last summer before any diagnostics or treatment. Something must be done. I think I need to reinstate pred at its "last effective dose" My heart breaks for tis animal

What a delicate tug of war you have.     I've also been dealing with abnormal stools (soft and off color) in Sebastian for several months. We've tried everything. Honestly, traditional medicine seems to helped the least in this area (but helpful for other things). High dose pred - no change. Metronidazole - no change. Tylosin - no change. He seems to have benefitted the most from alternative remedies suggested by our integrative TCVM vet and from remedies I've learned from other cat parents (which I got approval to try from the integrative vet). Have you tried this different area of veterinary medicine?

Considering you've seen quite an improvement in her numbers since reducing the pred, it sounds like she has a good chance of going into remission if the pred is eliminated. Have you asked about other types of steroids less likely to induce diabetes (budesonide, dexamethasone, etc.). Budesonide works more locally in the GI tract rather than systematically and is less likely to affect blood sugar. It might not be as effective as pred, but it might be just enough for Vivian to manage both issues. It might be worth discussing with your vet and giving it a try rather than taking her completely off a steroid...at least for now while you are juggling.

Of course you're right, I need to adjust my thinking and my goal here. I have been so determined to make Vivian's need for insulin a TEMPORARY measure and getting her off it ASAP that it has been difficult for me to accept that Vivian's body is calling shots here, not me. And Vivian's body needs pred, or something other than what I've been giving her (pred reductions and chlorambucil) to keep inflammation to at bay. That is now abundantly clear to me; yesterday I increased her pred, not all the way back to what it was but half way back up. There is some improvement in the litter box today, with a lot of room for improvement. I have asked her vets about another steroid, they were not really responsive to that, not sure why.

I have transitioned her to a low carb dry food EVO, and am working on transitioning to a low carb canned food that she will accept and tolerate.

I don't know where we're headed from here but at this point I have accepted that this is the best thing for Vivian, even though it pains me to accept diabetes as a long term condition. So I guess better two chronic diseases that can be managed than one that is out of control. Hoping...

Okay. Well, my point was that if you haven't tried another type of steroid and you haven't tried alternative ways to address Vivian's diarrhea and inflammation, then it sounds like you'll keep ending up where you are. You've accepted that this is the best thing. I'm not trying to be contrary, but I see opportunity going unexplored.

I know it's a lot to juggle and it is mentally exhausting. I give you props for getting this far. 

Best of luck to you.

Thank you goholistic for making your point again. I think I got it the first time, but was also addressing LT's suggestion of keeping the whole cat in focus and maybe she needs some steroid and some insulin right now to get her back on track. There is great wisdom in that statement. I certainly would like to see Vivian tolerate being without pred, I think I've stated that pretty clearly, and I haven't given up on that. Please understand, however, that Vivian's need for symptom relief had become rather immediate by yesterday afternoon, I have pred, I have nothing else, and vets who have nothing else to suggest. You say that your cat with loose stool has benefitted from some alternative therapies, but you don't say what they are.

Would you like to share?

Cat Pal said:

 
You say that your cat with loose stool has benefitted from some alternative therapies, but you don't say what they are.

Would you like to share?

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Sure. To address pancreatic/intestinal inflammation and loose stools (in no particular order):

• high dose probiotics
• high potency plant enzymes (he can't tolerate pancreatic enzymes)
• pancreas glandular supplement
• saccharomyces boulardii
• clay and bile salt supplement
• two Chinese herbal blends
• homeopathy blend
• curcumin
• antioxidant therapy (vitamin e, quercetin w/ bromelain, selenium)
• fluid therapy
• increased amount and frequency of B12 injections (this is the most recent change and has really seemed to help; the "standard" dose every other week just wasn't cutting it)

There's always something I'm forgetting, but that's it off the top of my head. He's on all these things right now.

I've been there with needing immediate symptom relief and have made similar decisions myself when their quality of life takes precedence over all else. I hope she gets back on track soon!

     

Since my last post here I have been away for a few days, and have been in contact again with Vivian's vet concerning Budesonide as an alternative to Prednisolone. This time I got as far as having her say she has never used this drug, would check with internal med specialist and she looked it up in her Plumb's Veterinary Drug Handbook. The handbook states pros and cons of using this drug with cats, the largest cons being that there is very little empirical evidence on effectiveness and side effects with use in cats and it can be prohibitively expensive. I understand a generic form can be compounded into capsules for less money than name brand - any experiences with this? Also what dose have folks given cats with intestinal disease to replace pred and how has your cat done? 

thank you

Laura

I asked my vet about this steroid shortly after my kitty was diagnosed and started on the Pred.  This was over 4 years ago.  At the time the Budesonide was the latest, greatest and googling feline IBD brought up all kinds of glowing articles about it.  My vet had already tried it and was not impressed.  This is a cat's only clinic with a reputation for being the best in the area so they manage a lot of chronically ill kitties.  She tried it with her patient's that needed a steroid and were diabetic.  She said that she seen little if any difference in it's effect on blood sugar numbers as compared to the Prednisolone.  She quit prescribing it because she didn't feel it was worth the extra expense.

My cat Mittens was on budesonide for 2 years for her IBD. Her problems were vomiting and constipation. Before she started it she was vomiting 1-3 times daily and after I started her on Budesonide she vomited 1-3 times per month. I ordered it from wedgewood pet rx and it wasn't all that expensive. It sounds like Vivian has a pretty severe case of IBD and of course there's a chance it might not be strong enough but I say why not give it a try. Another good thing about Budesonide is that it's usually only given once a day. Mittens took 1 1mg pill per day.

I know many cats with IBD and diabetes. They follow the most recommended method of diabetes management on the felinediabetes message board, and switch to a raw diet and use probiotics, S boulardii, and things like cerenia and slippery elm to manage the IBD if the raw diet alone doesn't resolve the problem. In humans, IBD has been definitively linked to gut dysbiosis (overgrowth of unhealthy bacteria), and thus the use of probiotics is a first-line actual treatment. It is the gut dysbiosis that causes the inflammation.

http://www.thecatsite.com/t/283161/saccharomyces-boulardii-use-for-diarrhea-and-gi-disease-incl-ibd

S boulardii, if diarrhea is a main symptom, often works very well, but the bacterial probiotics are still needed to re-establish healthy colonies in the gut.

I also know cats with IBD and budesonide - it often works as well as pred. The problem is that over time, some cats become sensitive to it, and I have seen IBD cats on budesonide develop diabetes.

The budesonide is on order from the compounding pharmacy. Vivian's blood glucose has actually been in normal range for 5 days with no insulin, even on pred. But her activity level has gone to almost zero - she gets up occasionally to eat or will eat if food is brought to her but then goes right back down. She does use the litter box. BM's are back to their "new normal" range of fairly well formed to diarrhea often in the same BM, but better than during the attempted pred taper. She had a B12 injection last week. She's not drinking excessively, or uncoordinated or disoriented. She completely alert,  just very lethargic. The vet is saying her blood chemistry in May was all normal (except blood glucose), not really pushing to do it all again, but said I could do that if I want but it's kind of my call. Any experiences with giving cat more than monthly B12 injections? I wonder if that would give her some energy. 

thank you

Not sure what to make of her lethargy. Do you think its the IBD? Or maybe her body adjusting to no insulin? 

Cat Pal said:

 
Any experiences with giving cat more than monthly B12 injections?

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The most recent change in Sebastian's regime was an increase in the frequency and dosage of B12 injections. He was getting them monthly and then every two weeks. We decided to go every week and also increase the dose to 0.50 ml versus the standard 0.25 ml. This has made a notable difference in both his appetite and nutrient absorption. He has had B12 every week before at the standard dose, but it seems doubling the dose has really been the kicker. The IBDKitties.net site talks about B12 dosage a bit.

Vivian went to visit the vet - again. Her chem panel was pretty normal with respect to organ function. She's slightly anemic, but has been presumably b/c of blood loss in BM's over time. There were indicators of urinary infection, so she got an antibiotic and some pain meds and hopefully she'll feel better when that clears up. Haven't actually given her the pain meds or the stuff to coat stomach/intestinal ulceration yet. Seeing how she handles the antibiotic. If you get too caught up in reading about the stuff, EVERY thing is controversial, from the type or technique of testing to the safety of the med - God! It's crazy - don't give your cat this or that med or she will die!! She's still very much alive, resting as usual but she ate and was up and about for a bit. Sweet girl. I asked the vet about increasing frequency of B12 and she said she wouldn't bother. But I might anyway just to see how she reacts - that would be after I know the antibiotic and the pain med and the stomach med don't kill her. Jeesh

Poor Vivian! Can't she catch a break!?    When Caesar had a UTI, he was very lethargic...asymptomatic otherwise. I know what you mean about reading all the bad stuff.

FWIW, my vet also felt that more B12 "wasn't necessary." But I pushed and made a case for it not causing harm. She finally said, "Fine, do whatever you want." 

Unfortunately all medications have potential side effects, it's a benefits vs risk thing.  The manufacturer is obligated to list all possible side effects.  I think it is the kitties that experience the side effects that get well represented on the internet.  We don't hear or read about all the kitties that take a medication with no ill effects.