There are additional papers coming to light on the complications caused by steroid use, further to the types of issues shown below at 7/14/09
One of these papers states as follows and you can access the complete paper through the hypertext:
Conclusion: The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.
and another paper as an example that our companion animals are as vulnerable to bone demineralization:This study verified that the alterations in the bone metabolism of the dogs submitted to the therapy with prednisone in a dosage of 2 mg/kg occur rapidly, which recommends a monitoring of the patients for the prevention of pathologic fractures.
One of my personal concerns has always been the risks of giving our slightly asthmatic fellow inhaled steroids. Steroid use in the following study group caused the conclusions quoted here:Results Blood levels of osteocalcin and protein intake were lower in patients with moderate to severe asthma than in those with mild asthma (P<.05). Significant correlations (P<.02) were observed between bone density and calcium intake (r=.40), phosphorus intake (r=.35), protein intake (r=.30), and serum alkaline phosphatase level (r=−.30). Bone density was not significantly different between the two groups of patients with asthma.
and on it goes.
First let me state clearly that I don't think steroids should be used if there are other options and am NOT promoting steroid use here. However, science is not meeting assumptions being made online and I hope to bring those views together.
The issue has come up that feline diabetes owners on Internet groups are passing around the fact that supposedly one single shot of a corticosteroid can trigger feline diabetes. When I see "one shot" as a trigger for a cat that has turned diabetic, my mind says, "I doubt it."
After doing some serious research I have come to realize that when one looks at general information online, there is no indication that steroids would alter the approach to treating feline diabetes if indeed steroids have triggered transient diabetes, unless one wants the cat to regress to a permanent insulin dependent state. This would be sad indeed as a large number of cats have no problem going into remission if therapy is appropriate.
In the studies I have researched, so far, even when dexamethozone is used, a second condition has to be applied to trigger a diabetic state in normal non diabetic cats. However, it isn't that simple, as cats never are. I do sincerely empathize with owners wanting a controllable explanation for why their cat has been struck with this disease, and while I see them making assumptions based upon rumour, I believe they should understand more in order to make assessments that can help them and their cats revert back out of the state of feline diabetes.
Information online repeatedly points out that cats are more resistant to problems with corticosteroids than other species.
For an example, while THIS study uses one of the most potent steroids, dexamethasone to convert healthy cats to a diabetic state for the sake of study, it takes other inducements such as growth hormones to facilitate the conversion to a diabetic state. Dexamethasone is the one steroid that I think might be capable of turning a cat diabetic if the dosage was powerful enough, but veterinarians are aware of the strength of the drugs they use in their profession, so hopefully they would use due care when administering, and would follow up the patient afterward to ensure diabetes did not become a permanent condition in the cat.
Cats have many diseases that may be helped by the use of steroids, rather than hindered, even if they are in a diabetic state, including ,facilitating healing in the pancreas, asthma, cancer protocol, IBD, adrenal insufficiency and the list goes on. THIS site lists a variety of uses for steroids, as does THIS one. However, the issue here is that veterinarians should be taking precautions to ensure that cats that are pre-diabetic, or genetically disposed to feline diabetes, are given good followup and appropriate insulin treatment to ensure that if diabetes does develop from a non diabetic state, it can be quickly dealt with in a way that reverts the cat back to a non diabetic state if the steroids were determined to be worth the risks involved.
The way for a veterinarian to determine whether a cat has had diabetes triggered by steroid use is described by someone with reasonable knowledge here: "There is a test called a serum fructosamine test that can tell whether the cat is truly diabetic or if he's hyperglycemic due to some other cause, like corticosteroid usage." It sometimes shocks me when I see veterinarians online insisting that fructosamines are a waste of time. Where are their heads and just exactly what training do they have in feline diabetes? To me, that attitude is negligent, and unfortunately it gets reflected back to veterinarians in our support system who are trying to do the best they can without such stupid interference. Another website that states fructosamines can distinguish between Type II diabetes and either epinephrine or corticosteroid triggered hyperglycemia is here: "Therefore, the single measured blood glucose value cannot differentiate a diabetic patient with transient epinephrine- or corticosteroid-related hyperglycemia from a patient with an inadequate insulin dosage. This can be a potential problem in any animal that is stressed or frightened, but is particularly noteworthy in fractious cats."
Therefore, the single measured blood glucose value cannot differentiate a diabetic patient with transient epinephrine- or corticosteroid-related hyperglycemia from a patient with an inadequate insulin dosage. This can be a potential problem in any animal that is stressed or frightened, but is particularly noteworthy in fractious cats.
The form of diabetes caused by steroid use is determined to be a "transient" form of diabetes that can usually be reversed within a number of weeks if beta cell function can return to normal, and this is what is so important about whether an assumption is made, or facts are determined. If insulin resistance can be corrected, the owner wants to do what is needed to facilitate healing, of course. What is necessary, if there is question of steroids being a trigger for a diabetic state in cats, is that it be determined by fructosamine and treated as quickly as possible. There is an article that points out that transient diabetes caused by treating another disease with steroids can be reversed as quickly as four to six weeks, and when I track it down I will add a link to that article on this blog. Appropriate timely treatment is important.
Part of the importance for owners here is that sometimes they shy away from the use of needles for recovery of pancreatic performance and this is one situation where glipizide will do more damage, rather than effect a cure because studies show a consistent increase in amyloid deposits because the glipizide is forcing the pancreas to work harder rather than rest and heal. In simple words, glipizide has most likely made the condition permanent.
If any readers have further information on this subject that they can also back with science, please feel free to comment. I look forward to reading more on this subject.: The TCG is an important factor especially during puberty for a bone demineralization in patients with 21-hydroxylase deficiency. The glucocorticoid treatment should be adapted particularly at this life period and preventive measures should be discussed in order to limit this effect.