dexamethasone and diabetic cat

A few years ago, 18 pound indoor tabby developed a "rasberry" on
his chin, perhaps from rubbing on the edge of the fridge door
expecting the roast chicken bits to appear. He gets his usual
Science Diet weight control wet and dry food.

Off to the vet, they tried antibiotics, didn't improve so they gave
him a series of steroids.

Urine output went through the roof and we discovered the world of
permanent steroid induced diabetes, vet had no clue about this.

He responded well to two units of Humulin insulin a day for years.

Many months ago he developed what might have been colitis and we
almost lost him, they couldn't really track down what the problem
was and we spent a fortune with them more or less turning up no
definite problem. But he recovered with a lot of care and looked
like he was back to normal.

A month ago it looked like ear mites, "coffee ground black grit"
in one ear. Off to the vet, he did a swab, said it didn't look
like mites to him, especially since he was indoor only, well he
does get onto the enclosed balcony and neighbor cats do get in there
where they growl at each other from opposite sides of the screen
door, but they are never in contact with each other after one
confrontation years ago. But, vet gave me a bottle of stuff that
he said would deal with it if it was mites and would deal with it
if it was anything else.

I put drops in each ear for a week. At the end of that his urine
output went through the ceiling, new record levels! So I asked the
vet if the drops could possibly be the cause, nothing else had
changed or been done. He said no. I searched the web for the
contents, one antibiotic, one something else and dexamethasone, a
potent steroid. Dexamethasone can induce whole body insulin
resistance, even when applied topically, one vet pharmacutical web
site says "do not give this to diabetic animals unless there are
life threatening reasons to do so." But doesn't give any more
information than that or give any idea what the consequences will
be. Again ask vet. Again he said this couldn't be it but he would
check. Blood glucose test done and sugar isn't wildly high, but
he is drinking up to 4 cups of water a day. Then the vet changes
his mind and thinks the dexamethasone was the cause. And the cat
has bouts of diarrhea, something he has never had. Now the vet
doesn't know what it is but doubts the dexamethasone.

So, web searching for dexamethasone describes this inducing diabetes,
describes symptoms of diarrhea, possibly this is iatrogenic Cushing's.
Says that gradually weaning a cat off steroids is best, but the
drops stopped weeks ago before we even knew this was perhaps related.
Some claim that a month or two and the adrenals may recover. But
this has been more than a month now, he is drinking over 4 cups a
day, he is very slowly loosing weight, something he has never done,
even though he is being given a little more chicken in addition to
his usual food. He isn't grooming as well as usual. But he hasn't
developed "fragile skin" which is one symptom of severe adrenal
problems, although we are being much more careful about brushing now.

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

The dexamethasone and definately cause diabetes and aggravate it if it's
present already. At this point I'd be looking for another vet who is
willing to help get the diabetes under control before you loose your cat.

Celeste


"Don Taylor" wrote in message
...
A few years ago, 18 pound indoor tabby developed a "rasberry" on
his chin, perhaps from rubbing on the edge of the fridge door
expecting the roast chicken bits to appear. He gets his usual
Science Diet weight control wet and dry food.

Off to the vet, they tried antibiotics, didn't improve so they gave
him a series of steroids.

Urine output went through the roof and we discovered the world of
permanent steroid induced diabetes, vet had no clue about this.

He responded well to two units of Humulin insulin a day for years.

Many months ago he developed what might have been colitis and we
almost lost him, they couldn't really track down what the problem
was and we spent a fortune with them more or less turning up no
definite problem. But he recovered with a lot of care and looked
like he was back to normal.

A month ago it looked like ear mites, "coffee ground black grit"
in one ear. Off to the vet, he did a swab, said it didn't look
like mites to him, especially since he was indoor only, well he
does get onto the enclosed balcony and neighbor cats do get in there
where they growl at each other from opposite sides of the screen
door, but they are never in contact with each other after one
confrontation years ago. But, vet gave me a bottle of stuff that
he said would deal with it if it was mites and would deal with it
if it was anything else.

I put drops in each ear for a week. At the end of that his urine
output went through the ceiling, new record levels! So I asked the
vet if the drops could possibly be the cause, nothing else had
changed or been done. He said no. I searched the web for the
contents, one antibiotic, one something else and dexamethasone, a
potent steroid. Dexamethasone can induce whole body insulin
resistance, even when applied topically, one vet pharmacutical web
site says "do not give this to diabetic animals unless there are
life threatening reasons to do so." But doesn't give any more
information than that or give any idea what the consequences will
be. Again ask vet. Again he said this couldn't be it but he would
check. Blood glucose test done and sugar isn't wildly high, but
he is drinking up to 4 cups of water a day. Then the vet changes
his mind and thinks the dexamethasone was the cause. And the cat
has bouts of diarrhea, something he has never had. Now the vet
doesn't know what it is but doubts the dexamethasone.

So, web searching for dexamethasone describes this inducing diabetes,
describes symptoms of diarrhea, possibly this is iatrogenic Cushing's.
Says that gradually weaning a cat off steroids is best, but the
drops stopped weeks ago before we even knew this was perhaps related.
Some claim that a month or two and the adrenals may recover. But
this has been more than a month now, he is drinking over 4 cups a
day, he is very slowly loosing weight, something he has never done,
even though he is being given a little more chicken in addition to
his usual food. He isn't grooming as well as usual. But he hasn't
developed "fragile skin" which is one symptom of severe adrenal
problems, although we are being much more careful about brushing now.

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

"Spot" writes:
The dexamethasone and definately cause diabetes and aggravate it if it's
present already. At this point I'd be looking for another vet who is
willing to help get the diabetes under control before you loose your cat.

Celeste

Thank you for the suggestion.

Actually, we switched from the first vet, who had no idea about
steroids and diabetes to the second vet, who supposedly had
considerable experience with treating diabetic cats. Unfortunately,
he was the one who prescribed the ear drops with dexamethasone,
probably not even considering that they had steroids in this or
thinking that the amount was too small to be a risk using this,
which may or may not be the cause of this. He did the recent
all-day glucose level test which came back with blood sugar levels
being not far out of line. He had previously checked and reduced
the insulin dose, and after this last test only increased it
slightly, saying that blood sugar wasn't high enough to warrant
any more than a slight increase in dose. But we can't figure out
where all the other symptoms are coming from. Temperature normal,
so we don't seem to be fighting urinary tract infections. And he
is just stumped at this point, thus my asking for any ideas.

Thanks

"Don Taylor" wrote in message
...
A few years ago, 18 pound indoor tabby developed a "rasberry" on
his chin, perhaps from rubbing on the edge of the fridge door
expecting the roast chicken bits to appear. He gets his usual
Science Diet weight control wet and dry food.

Off to the vet, they tried antibiotics, didn't improve so they gave
him a series of steroids.

Urine output went through the roof and we discovered the world of
permanent steroid induced diabetes, vet had no clue about this.

He responded well to two units of Humulin insulin a day for years.

Many months ago he developed what might have been colitis and we
almost lost him, they couldn't really track down what the problem
was and we spent a fortune with them more or less turning up no
definite problem. But he recovered with a lot of care and looked
like he was back to normal.

A month ago it looked like ear mites, "coffee ground black grit"
in one ear. Off to the vet, he did a swab, said it didn't look
like mites to him, especially since he was indoor only, well he
does get onto the enclosed balcony and neighbor cats do get in there
where they growl at each other from opposite sides of the screen
door, but they are never in contact with each other after one
confrontation years ago. But, vet gave me a bottle of stuff that
he said would deal with it if it was mites and would deal with it
if it was anything else.

I put drops in each ear for a week. At the end of that his urine
output went through the ceiling, new record levels! So I asked the
vet if the drops could possibly be the cause, nothing else had
changed or been done. He said no. I searched the web for the
contents, one antibiotic, one something else and dexamethasone, a
potent steroid. Dexamethasone can induce whole body insulin
resistance, even when applied topically, one vet pharmacutical web
site says "do not give this to diabetic animals unless there are
life threatening reasons to do so." But doesn't give any more
information than that or give any idea what the consequences will
be. Again ask vet. Again he said this couldn't be it but he would
check. Blood glucose test done and sugar isn't wildly high, but
he is drinking up to 4 cups of water a day. Then the vet changes
his mind and thinks the dexamethasone was the cause. And the cat
has bouts of diarrhea, something he has never had. Now the vet
doesn't know what it is but doubts the dexamethasone.

So, web searching for dexamethasone describes this inducing diabetes,
describes symptoms of diarrhea, possibly this is iatrogenic Cushing's.
Says that gradually weaning a cat off steroids is best, but the
drops stopped weeks ago before we even knew this was perhaps related.
Some claim that a month or two and the adrenals may recover. But
this has been more than a month now, he is drinking over 4 cups a
day, he is very slowly loosing weight, something he has never done,
even though he is being given a little more chicken in addition to
his usual food. He isn't grooming as well as usual. But he hasn't
developed "fragile skin" which is one symptom of severe adrenal
problems, although we are being much more careful about brushing now.

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

Hi Don,

Sorry your kitty has gone through so much.

Our diabetic cat developed pancreatitus about 6 mos. after diagnosis
(diabetes was also steroid-induced.) His symptoms were diarrhea,
vomiting, lethargy, and no appetite. Is your cat still eating? The vet
said if a cat gets sick after eating, they blame their food. We went
through lots of brands and flavors.

The vet also said Bob could have IBD, which she said studies show a
prevalence in diabetic cats, in addition to the pancreatitus. We ended
up putting him on IVD food, which is for cats with food allergies. It
has one novel protein, and one starch.

You might want to take your cat to a diabetes specialist -- Bob went to
an internist vet. We could only get in with a referral from our regular vet.

Also ask your questions to the message board at www.felinediabetes.com.
They helped me immensely, there were lots of experienced people on that
board.

Good luck,

Rhonda

Don Taylor wrote:

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

Rhonda writes:
Hi Don,

Sorry your kitty has gone through so much.

Me too.

Our diabetic cat developed pancreatitus about 6 mos. after diagnosis
(diabetes was also steroid-induced.) His symptoms were diarrhea,
vomiting, lethargy, and no appetite. Is your cat still eating? The vet
said if a cat gets sick after eating, they blame their food. We went
through lots of brands and flavors.

He is still eating, Science Diet weight management wet and dry that
he has been on a long time with no changes. And he begs for one
particular brand and flavor bits of roast chicken, if the store
stops selling that with their continual hunting for new flavors to
sell I don't know what we well do, he has turned up his nose at
other brands/flavors of roast chicken.

The vet also said Bob could have IBD, which she said studies show a
prevalence in diabetic cats, in addition to the pancreatitus. We ended
up putting him on IVD food, which is for cats with food allergies. It
has one novel protein, and one starch.

I'll ask the vet about this. Prior to the ear drops he had been very
consistent, so I was focussing on that primarily, but I will try this.

You might want to take your cat to a diabetes specialist -- Bob went to
an internist vet. We could only get in with a referral from our regular vet.

I'll ask about this as a possibility

Also ask your questions to the message board at www.felinediabetes.com.
They helped me immensely, there were lots of experienced people on that
board.

Will do

Good luck,

Rhonda

Thank you
Don

Don Taylor wrote:

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

"Don Taylor" wrote in message
...
A few years ago, 18 pound indoor tabby developed a "rasberry" on
his chin, perhaps from rubbing on the edge of the fridge door
expecting the roast chicken bits to appear. He gets his usual
Science Diet weight control wet and dry food.

Off to the vet, they tried antibiotics, didn't improve so they gave
him a series of steroids.

Urine output went through the roof and we discovered the world of
permanent steroid induced diabetes, vet had no clue about this.

He responded well to two units of Humulin insulin a day for years.

Many months ago he developed what might have been colitis and we
almost lost him, they couldn't really track down what the problem
was and we spent a fortune with them more or less turning up no
definite problem. But he recovered with a lot of care and looked
like he was back to normal.

A month ago it looked like ear mites, "coffee ground black grit"
in one ear. Off to the vet, he did a swab, said it didn't look
like mites to him, especially since he was indoor only, well he
does get onto the enclosed balcony and neighbor cats do get in there
where they growl at each other from opposite sides of the screen
door, but they are never in contact with each other after one
confrontation years ago. But, vet gave me a bottle of stuff that
he said would deal with it if it was mites and would deal with it
if it was anything else.

I put drops in each ear for a week. At the end of that his urine
output went through the ceiling, new record levels! So I asked the
vet if the drops could possibly be the cause, nothing else had
changed or been done. He said no. I searched the web for the
contents, one antibiotic, one something else and dexamethasone, a
potent steroid. Dexamethasone can induce whole body insulin
resistance, even when applied topically, one vet pharmacutical web
site says "do not give this to diabetic animals unless there are
life threatening reasons to do so." But doesn't give any more
information than that or give any idea what the consequences will
be. Again ask vet. Again he said this couldn't be it but he would
check. Blood glucose test done and sugar isn't wildly high, but
he is drinking up to 4 cups of water a day. Then the vet changes
his mind and thinks the dexamethasone was the cause. And the cat
has bouts of diarrhea, something he has never had. Now the vet
doesn't know what it is but doubts the dexamethasone.

So, web searching for dexamethasone describes this inducing diabetes,
describes symptoms of diarrhea, possibly this is iatrogenic Cushing's.
Says that gradually weaning a cat off steroids is best, but the
drops stopped weeks ago before we even knew this was perhaps related.
Some claim that a month or two and the adrenals may recover. But
this has been more than a month now, he is drinking over 4 cups a
day, he is very slowly loosing weight, something he has never done,
even though he is being given a little more chicken in addition to
his usual food. He isn't grooming as well as usual. But he hasn't
developed "fragile skin" which is one symptom of severe adrenal
problems, although we are being much more careful about brushing now.

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

Dexamethasone is a potent steroid- ~30x more potent than cortisone and ~8x
more potent than prednisone. But the amount of dexamethasone in topical ear
preps is usually only about 0.1% and stays in the system for about 48 hrs.

PU/PD, diarrhea and cachexia are also symptoms of chronic renal failure.
Many diabetic cats also have concurrent CRF -- which is often misdiagnosed
as poorly regulated diabetes. You might want to have your cat's serum
chemistry checked- especially BUN, creatinine and protein levels.

A complete urine analysis- especially urine specific gravity- might be a
good idea, also. USG with a serum protein level provides a more accurate
assessment of renal function than either test alone.

Best of luck,

Phil

"Phil P." writes:
"Don Taylor" wrote in message
...
A few years ago, 18 pound indoor tabby developed a "rasberry" on
his chin, perhaps from rubbing on the edge of the fridge door
expecting the roast chicken bits to appear. He gets his usual
Science Diet weight control wet and dry food.

Off to the vet, they tried antibiotics, didn't improve so they gave
him a series of steroids.

Urine output went through the roof and we discovered the world of
permanent steroid induced diabetes, vet had no clue about this.

He responded well to two units of Humulin insulin a day for years.

Many months ago he developed what might have been colitis and we
almost lost him, they couldn't really track down what the problem
was and we spent a fortune with them more or less turning up no
definite problem. But he recovered with a lot of care and looked
like he was back to normal.

A month ago it looked like ear mites, "coffee ground black grit"
in one ear. Off to the vet, he did a swab, said it didn't look
like mites to him, especially since he was indoor only, well he
does get onto the enclosed balcony and neighbor cats do get in there
where they growl at each other from opposite sides of the screen
door, but they are never in contact with each other after one
confrontation years ago. But, vet gave me a bottle of stuff that
he said would deal with it if it was mites and would deal with it
if it was anything else.

I put drops in each ear for a week. At the end of that his urine
output went through the ceiling, new record levels! So I asked the
vet if the drops could possibly be the cause, nothing else had
changed or been done. He said no. I searched the web for the
contents, one antibiotic, one something else and dexamethasone, a
potent steroid. Dexamethasone can induce whole body insulin
resistance, even when applied topically, one vet pharmacutical web
site says "do not give this to diabetic animals unless there are
life threatening reasons to do so." But doesn't give any more
information than that or give any idea what the consequences will
be. Again ask vet. Again he said this couldn't be it but he would
check. Blood glucose test done and sugar isn't wildly high, but
he is drinking up to 4 cups of water a day. Then the vet changes
his mind and thinks the dexamethasone was the cause. And the cat
has bouts of diarrhea, something he has never had. Now the vet
doesn't know what it is but doubts the dexamethasone.

So, web searching for dexamethasone describes this inducing diabetes,
describes symptoms of diarrhea, possibly this is iatrogenic Cushing's.
Says that gradually weaning a cat off steroids is best, but the
drops stopped weeks ago before we even knew this was perhaps related.
Some claim that a month or two and the adrenals may recover. But
this has been more than a month now, he is drinking over 4 cups a
day, he is very slowly loosing weight, something he has never done,
even though he is being given a little more chicken in addition to
his usual food. He isn't grooming as well as usual. But he hasn't
developed "fragile skin" which is one symptom of severe adrenal
problems, although we are being much more careful about brushing now.

So, he appears to be slowly getting worse, rather than slowly
recovering from the dexamethasone. Vet just doesn't know what it
is. Anyone have any ideas? There are adrenal function tests but
they say they aren't really conclusive and they involve giving him
more dexamethasone, among other things.

Thanks

Dexamethasone is a potent steroid- ~30x more potent than cortisone and ~8x
more potent than prednisone. But the amount of dexamethasone in topical ear
preps is usually only about 0.1% and stays in the system for about 48 hrs.

That is about what I have found in my searches. The only item I might add
is that if the steroid induces Cushing's that it can take several months
for this to retreat after the steriods have been gradually removed. One
web page said up to 18 months but I haven't seen others confirming that.

PU/PD, diarrhea and cachexia are also symptoms of chronic renal failure.
Many diabetic cats also have concurrent CRF -- which is often misdiagnosed
as poorly regulated diabetes. You might want to have your cat's serum
chemistry checked- especially BUN, creatinine and protein levels.

A complete urine analysis- especially urine specific gravity- might be a
good idea, also. USG with a serum protein level provides a more accurate
assessment of renal function than either test alone.

I'll bring this up with the vet.

Best of luck,

Phil

Thanks

Don, you might want to switch him over to totally wet food, especially
if the diabetes is not controlled. The dry has a lot of carbs.

Rhonda

Don Taylor wrote:

He is still eating, Science Diet weight management wet and dry that
he has been on a long time with no changes. And he begs for one
particular brand and flavor bits of roast chicken, if the store
stops selling that with their continual hunting for new flavors to
sell I don't know what we well do, he has turned up his nose at
other brands/flavors of roast chicken.