Can't not responding to insulin/currently lantus

I posted this earlier this morning on the regular board and only got one response so I thought I would repost it over here.

Hello everyone. First of all, let me give you a little backstory about my cat Sassy. She was diagnosed last August as the result of me taking her to the vet with a terrible urinary tract infection. Her BG levels at the time were hovering very close to 500. The vet started her out on Vetsulin and we started with a small dose of 2 units twice a day. I also completely changed her diet. She was a kitty that I just left a bowl of whatever kind of dry food I had out all day and let her eat. She was also 18 pounds at the time. I spent a lot of time researching her food and began to give her Fancy Feast wet twice a day (the kind without gravy). I also bought her some Wellness Core because of the protein levels but she is not a big fan so she doesn't eat too much of it.

Anyway, her BG levels were still terrible so the vet slowly increased it until she was getting 6 units twice a day. She said she didn't think it would make a difference if I gave her 12 units a day so she switched her over to Lantus which is quite a bit more expensive but she said we would only use a small amount. Well, this has proven to be untrue as well because I had to rush her back to the vet Friday morning with another bad bladder infection. She was crying because she was in such pain and could not urinate at all, just bleed everywhere. She got a shot and some antibiotics to take and the vet said to start giving her 4 units of Lantus twice a day and gradually keep raising the number of units over the next few days. Keep raising it to what? She said that one cat that she was treating was currently doing 16 units twice a day and was resistant to it. She seems to think that is Sassy's problem as well. I really cannot keep buying huge amounts of insulin for over $100 a bottle. That is just too much of an expense considering the cost of test strips, food that I have never had to budget for in the past, needles, constant trips to the vet (which also causes quite a strain with my job--they can understand me having to come in late if my child needs to go to the doctor, but they aren't quite as understanding about a cat that I have to take to the vet twice in one week). I'm sorry to vent about the cost but it is really killing me. Two visits over the course of one week have cost me over $300 and sadly this has been going on since last summer. It is a constant thing.

If Sassy is insulin resistant, is there any need to give her insulin at all? Can I just expect to keep rushing her to the vet every other week because she has another infection? Obviously untreated diabetes will eventually kill her, but how quickly? Is she suffering because the insulin isn't working? Am I going to have to put her to sleep? I know that the answer is probably yes but I feel terrible about it and I guess I really want to delay it as long as possible. Unfortunately, the vet didn't seem too hopeful about the insulin ever working. Has anyone else ever dealt with this before? FYI, her BG levels are always around 350 or higher. The lowest that I have seen is 299.

Thank you for reading this long, long post. I have truly got to the point where it is really causing me to be quite depressed. I just don't know what to do.

 

Hi and welcome, and I'm glad you found this forum. I have been using this forum for about a year, and although my cat is not regulated, yet, I have seen A LOT of people come to this board frustrated and depressed and confused and misinformed. I have seen a lot of cats get better, a lot become regulated, and a lot go off of insulin. There are a lot of people that visit this board that can and will help you. This place is amazing. There is a lot of combined knowledge here. Much more than most vets know. Ask questions, keep posting, we will help you.

 

Many of us here have high dose cats. I have one at 29u BID Levemir. It's a big commitment, I won't lie to you. This is something you have to decide for yourself. To avoid excess vet costs, hometesting is very important. It may seem scary and costly up front but the money you save in not going to the vet is quite a bit and the peace of mind you get knowing you're treating your cat the best way you can is priceless. We really can't help you with your dosing without seeing some numbers, but if you would be willing to begin hometesting, we can show you how to save money on strips and insulin costs. As I said, it must be your decision. It seems you might be hometesting but I'm unclear on that. If not yet, there will be days you run 8-10 or more blood tests on your cat, but it's easy. Your cat will learn to like it quickly because of the extra attention and treats.

Insulin resistance is often caused by acromegaly, IAA or Cushings disease, but there are other causes for it, such as glucose toxicity which can be caused by a cat being overdosed for too long. All of these conditions can still lead to a happy life for your cat. They are treatable, but they do require a lot of care. If this is something you would be willing to entertain, we will very gladly help you. Quality of life for high dose cats can be just as good as for your healthy cats. That's my high doser in my avatar pic. His name is Leo and he's an exceptional cat.

Urinary tract infections. Is your vet running cystocentesis collection (needle thru abdominal wall) and culturing the urine (C&S) or doing external collections (waiting for her to pee)? It sounds as if it's possible the wrong antibiotic is being used or the wrong condition is being treated.

(((hugs))) There are many of us shooting large amounts of insulin here and we all wonder over and over again how much is too much. The truth is, the alternative to us is too dark. If that's how you feel, we'll be very glad to help you straighten your little girl out. If you feel you can not take it anymore, please don't simply stop giving her insulin. She would die.

 

Thank you very much for your responses. I do test her at home although I only do it before each shot. Like I mentioned, I have been doing this since August of last year so I am not really new to this. However, it doesn't seem to get any easier. In fact, it only seems to get more difficult. I was able to prick her ear one time and get blood, now I can't get blood from one ear at all, and it took 5 pricks to get blood this morning. It took 8 last night. So you can imagine my frustration when I need to test her 8-10 times a day at 8 pricks each time. It just seems like a lot of unnecessary pain that I continue to inflict upon her. And the idea of giving her treats doesn't help at all either.

I am just so frustrated that I want to scream! I really don't know how they got a urine sample at the vet's office. She took her into another room and I heard her yelp so I really don't know. The vet said that there was an infection present but there were no crystals in her urine. Someone on the other board said that I am probably overdosing my cat because I should have started her off at a half unit. Have I done irreversible damage to her by giving her too much insulin? I was simply following the advice of the vet. Should I start giving her a smaller dose and see what that does? Truthfully, I think that giving her one unti, or six units, or twelve units is going to produce the same results--BG levels of 350 or higher, because that is all that I ever get.

I decided that I would give her no dry food today, and I gave her one can of Fancy Feast this morning and for dinner last night I gave her a can of tuna instead of her FF. 331 was the number before her shot last night and it was 312 before her shot this morning. I am going to try and stick her again (numerous times of course) and see what I get.

 

Welcome to the Lantus board. You will get all the help you need here. First, I want to caution you against suddenly changing Sassy's diet while she is taking a relatively high dose of insulin. Without the dry food, her numbers could drop quite suddenly. It is best not to change the diet until you have lowered your dose, or verified that it is a correct dose. I know that others will stop by to advise you about changing your dose, if needed, and how to go about it. You have not done irreversible damage, so please don't worry about that. I have cats with recurrent UTI's, and they are managed on long term antibiotic doses. This may be something you can address in the future. I'm not saying that's what she needs, but I want to reassure you that you will not necessarily need to make repeat trips to the vet for these. Also, at some point, you will be getting control of the BG numbers, which will decrease the amount of sugar spilling into her urine, which is providing a rich environment for bacteria to grow in. I am throwing a lot of stuff in here, but the message is to not give up. You will have a lot to absorb in a short time here, but there is hope, and things will get better.

 

Ok, I just checked it again (only took 5 pricks to get some blood this time) and seven hours after her shot, there is a BG level of 339. I really am about to just throw my hands up in the air and say that I give up. The idea of giving her such a high dosage would mean that I would have to buy insulin what once or twice a month? It is just not something that I can do. I really do love this cat, she has been with me longer than my son for Pete's sakes but as a single mom with a low paying job, I just cannot afford it. There is nothing that I can possibly cut out of my budget to make up for the costs. There just isn't. It's not a matter of not wanting to spend the money--I don't have it to spend. It really bothers me but that is just the way that it is. I also feel pretty terrible about the idea of having to take a cat that isn't in terrible pain (except when she has an infection) to the vet and tell her that I need to put her down because I'm not going to be able to do this. I think that I just need to have a long cry.

 

It is overwhelming in the beginning. It's too soon for you to give up - this may be very manageable. You don't know yet if your kitty is legitimately a high dose kitty or not. Please start reading the info links at the top about Lantus, and wait for more people to stop in with suggestions.

 

A couple of thoughts to add to what the others have already said.

Lantus dosing is not based on pre-shot numbers. Dose decisions are based on the nadir, or the lowest point in the cycle. We test at pre-shot to make sure it is safe to give an injection but whether to raise or lower the dose is not based on the pre-shot number. The concept of this is very important because you can get the same high numbers at pre-shot if you are giving too little insulin or if you are giving too much. I realize that the latter is counterintuitive. However, if you are giving too much insulin and numbers drop at mid-cycle, you will get a rebound at the next pre-shot test. So, if you could start to get some spot checks throughout the cycle, it will help to begin to sort out what is going on with your cat's dose. It may also mean that once this infection is passed, you may need to lower the dose in order to figure this all out.

The presence of an infection will raise BG levels. Numbers in the 300s aren't horrible. From your initial post, I would have expected much higher numbers. Carolyn's questions about how the UTI was diagnosed are important. If a cytocentesis and C & S weren't done, you won't know whether the antibiotic that was prescribed is the one best targeted at the infection.

Once some of these issues are sorted out, you may want to opt for blood tests that can diagnose high dose conditions if that's what it looks like is going on. Let us know how we can help or what other questions you may have.

 

So, do you think that I should just keep her where she is until she is finished with the antibiotics? Then I should test her several times throughout the day? I guess that I am just super confused. I have just been testing her before each injection. I will have to test more often but I am not here for 10 hours out of the day, but I can always check her in the evening after her shot. I guess that my main question is does anyone think that I should lower the dose or should I just wait until she is doing with the antibiotics and then see where her BG levels are? If I do lower it, is is something that I should do gradually or do I just cut the units down? Basically anything that you guys tell me at all is going to be a big help because I need all the advice that I can possibly get. Thanks again to everyone.

 

(((pookiepura)))
I am a newbie, so I don't have advice to give.. but please don't give up on your furbaby :YMHUG:

This is doable & hopefully you will feel less frusturated as you get advice.

 

Take a deep breath, have a good cry and then try to find a couple of videos online to help you learn how to get blood for the BG test. Some tips I have is to use a fresh lancet frequently. Hold a flashlight behind the ear to see if you can get a good idea of where veining is on outside edge of the ear. Set the lancing device for a deeper lance possibly and remember it really isn't hurting the cat to test the BG. Once you do get the blood and test, press the test spot for 10 seconds and gently rub it. I have only been testing my cat for about 6 weeks but he now comes to me at mealtime because I always test before meals. He is hungry and wants to test so he can eat!
I also always give him special snack treat after testing. By testing you are saving him some suffering so look at it as a good deed.
I totally understand your money issues because I have that same problem but my cat was able to regulate without insulin from 431 to below 100 by just stopping dry food. But if you are using insulin I don't think you should do a total food change at the same time. You might try not using insulin and just feed your cat ONLY wet food for about a week and test his blood at least 3 times a day to see what happens with his BG's. Then start fresh with the insulin if it looks to be necessary. There are plenty of experienced people here that can walk you through the Lantus route step by step.
My cat use to get UTI's before as well and now I realize that much of his UTI problems were related to eating dry food too! You might clear up 75% of his problem just by feeding only canned foods.
BEST OF LUCK!

 

Many of the members of this Board work or are in school and aren't home for most of one cycle. You do your best to orient your schedule so you can get a test before you leave to go to work and, hopefully a test when you walk in the door. At night, try to get at least a before bed test. You will no doubt be able to fill in some of the gaps on weekends or days off. We all do what we can to work around our shot schedule.

Can you describe how the doses of Lantus were increased to the current level of 4.0 units? The dosing protocol that we use here, increases does in either 0.25 or 0.50 increments. Many vets will increase in whole units so it would be helpful to know how the dose increases were done. Also, do you have any records of the tests you have done?

 

What Sienne said. :smile:

You're doing fine You can help us help you by pulling any data that you have into one place. The google spreadsheet is very helpful for seeing trends over time.

Then, I would test at each shot time, like you already are, and then get in other tests when you can. A before bed test (which is just what it sounds like, a test right before you go to bed each night) can give us tons of information. Then you fill in with other tests on the weekends and other times when you're home.

It might be a good idea to spend the next few days just doing some data collection this way, and put them on a spreadsheet, so we can help by looking at the numbers. Your cat's dose may or may not be too high, but the data should help us see that. Changing the diet will almost definitely help the numbers, but if you do that then you NEED to get some tests between shot times just to be sure your kitty is staying safe.

I know this is overwhelming and there is a big learning curve right up front, but hopefully we can help break it down into manageable chunks for you. I would start with adding the bedtime test and creating a spreadsheet and posting your numbers here daily, and we'll go from there. Ok? ((((hugs))))

 

I guess I should add my thoughts in here.
First about the poking the ear difficulty you are having.

1. there are pictures which can show you the best spots on the ears, there is a vein which runs along the edges of the ears and you may even be able to see it. The ears really do 'learn' to bleed with time and I did find that the ears really DID seem to bleed better as time went on for me.

2. be sure to warm the ear before poking. I do find that a cold ear doesn't give up much blood.


3. check what setting you are using on your device. I use a One Touch Ultra meter and the device that came with it has a setting dial from 1 to 10. That 10 will poke a hole clear through the ear! and that 1 like won't even break the surface of the ear. Try to adjust the setting and see which works best for you. I normally have mine at 6 or 7; others may use a different setting.

Many on this site can help you with some great tips to get the testing down to something that is so quick and easy that even your kitty won't notice it.

Now, this insulin, Lantus, is doses differently, and others have already mentioned that dose is based on the nadir, or the lowest point in the curve. That means your 300 numbers that you get at the time just before you shoot the insulin don't really mean much. What number counts most is the one in the middle, the lowest one that may be around 6 hours after the shot.

OK, someone mentioned about maybe you are giving too much insulin and your kitty is bouncing. You can picture it like a bouncing ball.
If you just toss a ball underhand, lightly to the ground, there is not that much of a bounce off the ground, right?
OK now I want you to wind up good , and pound that ball overhand straight down onto the ground. What happens after it hits the ground?
YIKES! It shoots up way high into the air!

The first example is likely a good amount of insulin; the second example is way too much insulin.

It could well be that with some adjustments to your kitty's food, and then starting a spreadsheet to track your test numbers, and then maybe even reducing the insulin dose, you may find that your kitty levels off and you start to see a BIG improvement.

If you can set up a spreadsheet and post your test results, everyone can see the sheet and help you with what needs to be done for your kitty. Take a look at my ss and any of the others on this site to see the kind of info we put down.

There are so very many foods that cause the high numbers! There are some kitties who are diet controlled, meaning once they were fed foods that were LOW CARB, they got off insulin completely! Just imagine that! All you may have to do is change the food and that is that, after reducing the insulin doses to less and less eventually.
OK that is the best case scenario, or a really good one, but others are not so bad either.
On this site, you will see several kitties who are at various stages, and many who are on trials with no insulin at all!

Check out Binky's food list; try some of the low carb foods, and there are plenty that don't cost an arm and a leg either. See which ones you can get for your kitty and the food will go a long way to help with lower numbers. Dry is out if at all possible. I don't know about your kitty, but if my Shadoe eats any dry, her numbers go through the roof. She eats only wet now, and it's helped her numbers quite alot.

For the insulin, I first got the vial, a 10ml, which was so expensive and it did not last long enough for me to use it. After about a month, your Lantus may lose its punch.
Many people just get the cartridges. Now, I get a 5-pack of small cartridges which are each only 3ml. The other 4 vials that remain unopened in the frig will last till the expiry date on the package and only the one you are using will eventually fade.
See about getting the cartridges instead of the big vial.

OK what else? I mentioned the following:
testing device - check the setting
records - set up a spreadsheet to post your test results so others can help you
ears - warm them up and poke by the veins
food - get on the low carb bandwagon using binky's list to help with selection
insulin - get the pack of small cartridges instead of the big vial

OH yeah, I forgot the absolute most important thing!
Now you can get your kitty, and give some serious hugs and scratches and some serious cuddles.
Everyone here knows how you are feeling and how important your kitty is to you.
We all feel your frustrations.

To know the road ahead, ask the man coming back.
Stay strong.
Keep positive.
We CAN help you.

 

Thank you so much for all of that information. The only thing that I can tell you about the dosing increase is that it was what was recommended by my vet. Why she did it that way, I have no idea. I was simply following her directions. I do have records of the testing that I have done, but since I was only doing it twice a day, I don't know if it will help or not. Someone made a comment about how testing right before a shot doesn't mean too much, but a shot around six hours or so is a good indicator, well, I did test her today seven hours after her first shot and got a BG of 339. My kitty has had no dry food at all since yesterday afternoon and hers numbers haven't changed in the slightest. Does it maybe take some time to get out of her system? I am going to try and collect some more numbers so I can get some more advice about what to do.

Once again thanks to everyone for all the help. I have just been so overwhelmed today! I will get some more numbers and post again tomorrow with some more questions.

 

You've been given great advice so far, and I'll just add a couple more thoughts:

It's very possible that when the cat is tested at the vets - the BG's are artificially higher than when at home - this is due to many factors - but mainly stress on the cat.

So, the vet tests, while it can be helpful, it really can be misleading and causing the vet to dose increase based on false data. Hence another reason why it's important to home test and to test more than once or twice a day.

you don't need to go crazy with testing alot, but getting in random tests will help you to better understand what's going on.

It's also possible that the cat is on too high a dose of insulin. There are tests to determine if your cat truly is a high dose cat, but to assume she is based on the vet BG's tests, is not an accurate way of making that determination. There are very specific tests to test for acromology and cushings, etc.

It's also possible that you may have missed the ideal dose for you cat, by starting at 4 units. It's typically recommended to start at 1 unit or 1/2 unit and with home testing, to gradually increase or decrease the dose accordingly and when making dosing changes to do it in small 1/2 unit increments.

Also, you said you are feeding dry food. That alone can be causing the high BG's. And while we ALL recommend not to feed dry food, BEFORE removing these foods, please make sure of your insulin dose as it will most likely need to be reduced, so as to avoid a possible hypoglycemic situation due to the removal of the dry/high carb foods that will lower the BG’s and reduce the amount of insulin required. Again, another reason why home testing is important.

You mentioned problems with ear poking, here's some pics of how to hold the lancet/device and where to poke along the ear.



I found holding it at an upward angle and poking that way, I was more successful in drawing blood than poking downward or straight onto ear.



And to make a warming sock (in case you don't know):

take one sock
add 1/4 cup of rice, oatmeal or dry beans
knot the top
microwave about 30 seconds
if warm to touch, then place behind cat's ear and hold until ear is warm - you can also keep it there to use as a support when poking - so if you pierce, you won't pierce your fingers.

I hope this helps and please know that we will do what we can to help you.

 

Your thought about dry food is absolutely correct. Dry food will take more time than high carb canned food to raise BG and it will take a much longer time to work it's way out of the system -- a surprisingly long time.

I think at this point, any data that you have will be helpful. I know I was assuming you were following your vet's directions. Did your vet ask you to raise the dose by 1.0 unit each time you increased?

 

What size vial of insulin are you buying?

Most of us get the 5-pack of 3ml cartridges for use with the injection PEN. We do use syringes with the cartridges - NOT the pen.

The 5 pack lasts for 5+ months and costs about $185 in the US, and if you order from Canada - about $120 + $10 shipping.
www.canadadrugsonline.com

 

Hang in there...you have gotten great advice! Just remember...even high dose cats can get controlled...then have periods of needing less and less insulin...even off the juice times! High dose kitties don't always require high doses! Not meant to confuse you...just a little known fact.

 

Here are a few links to get you started.

Creating spreadsheets and attaching them to your signature
viewtopic.php?f=6&t=16

Help with signatures/links/images/avatars here
viewtopic.php?f=6&t=486

How to create profile in Google Docs
viewtopic.php?f=6&t=531

This one has most of what you need, including the above:
Lantus & Levemir: New to the group? Please read.
viewtopic.php?f=9&t=157

If you read over the Tilly protocol, you will have an explanation on the dosing rules followed. I am sure there are some very good vets, but many just don't understand FD and treatment with Lantus. I know my vet told me to give shots once a day and I already knew that was wrong so I did not follow what my vet said.
We basically have to know on our own first to ensure that our vet is not asking us to do something harmful to our kitty without knowing.

 

hello and welcome to the group!
i'm sorry you're feeling overwhelmed. whatever data you've collected as well as letting us know how the doses were increased will help to sort things out.
looking forward to hearing from you today...