Steroid side-effects--Skin tears & Diabetes

Fuzzer--8/1/02 after a 10 day hospitalization

case from the Feline Diabetes Message Board at
Feline Diabetes information compiled by owners can be found at

Fuzzer (~10 y/o female, 7.8 lbs 7/21/02) has a 8 yr. history of miserable itching and overgrooming leaving bare spots--cause not identified--which was treated at home with monthly Depo-Medrol shots.  At some point, the .25 cc dose was inadvertently doubled  to .50 cc when a larger size syringe was received from the pharmacy, then with interval stretching to ~6 wks, "extra" was given in the belief that "more is better".  A side-effect of long-term Glucocorticoids is that the skin can become thin and fragile, tearing very easily. Fuzzer first had a large patch of skin tear off around July 19, 2002, saw the vet and got a topical spray, Granulex V. A couple of days later Fuzzer declined and when she went back to the vet, diabetes (with skin infection) was diagnosed.  Fuzzer spent 10 days in the vet hospital, receiving IVs and starting insulin (Humulin NPH, apparently diluted to u-50). It is unclear if Fuzzer had ketones while hospitalized, and  "kidney problems" were mentioned but not explained. Fuzzer came home taking Zenequin antibiotic 1 pill/day and has had 2 additional large areas where skin has torn off on her sides, plus some tears on her neck and head. The open wounds and fragile skin would make Home Blood Glucose (BG) testing extra-difficult--these ears might be too delicate for ear prick technique, though a paw prick might work if Fuzzer cooperates.  The owner hasn't been ready to try it yet, though she has tested urine for ketones with Ketostix (at first thought she found some trace, then negative, then trace again).

Fuzzer spent Mon. 8/12/02 at the vet for a curve, though we don't know what the Blood Glucose values were. There was some white drainage from where a scab broke open and the plan was to continue the Zenequin antibiotic another 3 wks. The usual 12 hr bid shot schedule won't work because her owner works 12 hr shifts, a split of 14 hrs and 10 hrs is possible.  Fuzzer's  vet is considering a longer-acting insulin (a PZI or Lantus), but she hasn't changed from the u-50 diluted N yet. Unless the dose was raised after the 8/12/02 curve, Fuzzer has been receiving 1.5 actual units of  N for the longer 14 hr interval and a second shot of only .5 u actual units for the shorter 10 hr interval. Fuzzer had been eating more and acting as if she felt pretty good--purring and pestering for food/attention until Sat. 8/17 when the new sore opened, bled profusely and her appetite decreased. The tail was stuck to the new wound with dried blood and long fur had to be cut away to free it up.  Also, Fuzzer's owner had been feeding raw ground beef as a supplement this past week, which Fuzzer ate with gusto. As the long-term use of steroids weakens the immune system and it can take a year to recover the ability to fight infections, a raw diet is more dangerous for Fuzzer--cooked meat treats and cat food with complete nutrition were recommended in lieu of raw.

The owner was urged to contact her vet about the new open sore/blood loss/decreased appetite and to keep checking for ketones. Vet was out of town with no one covering for the weekend.  Tips on checking for dehydration and syringe-feeding foods/unflavored Pedialyte if gums were tacky and Fuzzer wasn't eating on her own were offered.  Owner is considering a change to Humulin Lente (L) insulin or Humulin Ultralente (U) rather than Humulin NPH (N), both have gentler onset and allow a more flexible feeding/shot schedule. N is more difficult to manage because of  its rapid, steep drops and short duration.  

Starting over with a low dose of a new insulin 1-1.5 u and letting the cat adjust to that dose for a week or so, and doing a curve to see how low the BG drops before considering an increase in dose is a conservative approach that has worked for many cats.  

8/20/02 new lesion on her L side top opened 8/17, bled a lot

8/20/02 original lesion opened on her R side ~7/19 is healing

8/29/02 asleep, but healing, a small new sore opened 8/26

8/29/02 Triumphant Fuzzer with the sack.  Unequal pupil size? Right appears 2x Left.

8/29/02 Home BG Testing with the LifeScan One Touch Ultra meter started
             on 14 hr night/10 hr day bid split due to work schedule (12 hr eve-night shifts, days vary)
             on Humulin N, diluted to u-50 by the vet since dx~7/21, plans to switch to Humulin U soon
             on Zenequin antibiotic sid since 8/1 return home from 10 day hospitalization

Thurs 8/29/02
  7 am  ~+14/pre-shot 368,  .75 u Humulin N insulin (eating well, playing, ketostix trace? ketones)
5 pm   +10/pre-shot  314, 1.5 u  Humulin N insulin
11 pm   +6                  307
2:30am +10.5             361
 5am     +12                361

Although this is the first few tests, it appears that the N is not giving much duration.  She was fed a high protein meal about 15 min. before the shot and allowed to snack.

Wed. 9/4/02
Pre shot:   4:30 pm        322,  fed high protein meal
                4:45 pm                 gave 1 1/2 u Humulin N (3 marks of diluted) 
         +2   6:45 pm       256 
         +4   8:45 pm       274 
         +5   9:45 pm       264 
         +6 10:45 pm       326 
    + 7.5  12:15 am       354
    ~+13    5:30 am       366  (14 hrs would be the next pre-shot/meal time)

Again, it appears that the N is not giving much duration, wearing off between 5-6 hrs.  Will switch to Humulin Ultralente soon.  The earlier skin sores are healing, with fur starting to grow on the new skin.  In the last week, a small  new lesion opened near the base of the tail.


last updated 9/5/02