Regular Insulin combined with Lantus - anyone?

Does anyone have experience with this? My vet has suggested it since we have been unsuccessful in getting Gus's blood sugar down, but it scares me and I read that even vets don't like to use regular insulin in combo with basil insulins.

I'm sure my vet will walk me through it if we go this route, I would just like to hear if anyone else has experience and if it did work for your kitty. Overcoming the fear for me is going to be difficult.

 

I use R sometimes. I find that with J.D., R drawn just to the zero line will bring him down by 100s of points sometimes, so you want to be very very very very careful with it. Don't let the vet tell you to give 1 unit of R. That would be scary.
You'll need to be home, with plenty of supplies, and test every hour at first.

We wouldn't be able to help you further until your spreadsheet is updated.

 

This is why I am scared to do it Just the thought of it is terrifying.

He just started metronizadole last Thursday, but the best number I got was a midpoint reading of 300 on Saturday. He bounced back up sky high in the upper 400s Sunday. Increasing insulin does nothing because his body just isn't utilizing the insulin. His tests are showing inflammation in his intestines. Our vet also suggested budesonide to settle down the inflammation, but I'm less than thrilled about steroids even though this is supposedly a better one.

I'm afraid all of this is my fault. I put him on Avoderm when he was no longer able to eat Instinct. I think the high content of Omega 6 caused insulin resistence. He also started making gulping sounds and having hiccups. The hiccups are gone and the gulping has lessened (but not disappeared) since I removed Avoderm from his diet about a month ago. It is so frustrating because his foods are so limited from the diabetes and the IBD. He cannot tolerate many of the low carb foods. The Avoderm seemed great in the beginning because his itchy ear problem cleared up and his fur turned so soft. It wasn't until almost a month of feeding him the Avoderm that he developed high numbers that wouldn't come down, but I didn't make the association to the food until I found an article on Omega 6 and insulin resistance. My vet isn't convinced because she treats cats with omega oils all the time, but I really feel this is what happened and it's my fault.

If the metronizodole doesn't work then I will have to decide between the budesonide or the Regular insulin.

 

Do you have an updated ss to post... the link you have in your signature shows the dose at 1u in October?
It's very hard to comment on the use of R without seeing numbers to look at the difficulties you are having.

The starting dose for R is 0.1u and you will want to be around to test every hour for the first 5 hours. to see how your cat reacts.... some cats are very sensitive to R.

If your vet is meaning to use N .... forget about it.
Regular insulin lasts maybe 8hrs in cats.

ETA:
Short acting insulins are usually designated by the letter R (Humalin R, Novalin R) they are never used alone, typically they are given as a bolus at Preshot to bring the BG down quickly in the first few hours of the cycle before the basal insulin (a long acting) begins to take effect. This is used by high dose cats with conditions like Acro or insulin resistant antibodies. It may also be used in an inpatient setting to manage a cat with ketoacidosis.

 

My vet means to use Regular insulin. But I am now leaning more towards budesonide since he is showing intestinal inflammation. It is a vicious cycle. I'm sure the high sugar contributes to the inflammation and the inflammation contributes to the high sugar. I'm trying to figure out the best way to approach this with the least amount of harm to Gus.

I do not want to get into posting my numbers because I am not looking for help with dosing. My vet is working with me on that because Gus has triad's disease and cannot be treated like a regular diabetic cat. I wanted to get feed back from other people who have had experience with Regular insulin and budesonide so I could make a more informed decision because more than likely, anyone using these drugs has a cat that is having inflammation/resistance and I wanted to see what their experience is.

 

I think you'd be surprised by the degree of expertise here. There are other cats here with triaditis. There are certainly cats here with IBD.

There are a number of people who have used Humulin R ("regular" insulin) in combination with other medications. The home use of R takes considerable diligence since it is potent and short acting. You need to curve R with every dose change. Typically, people start at a very low dose such as 0.1u and then test every hour for 4 hours. R has a very short duration. You also need to be sure you do not have the nadir of R and Lantus coinciding. R can be an excellent tool. You just need to be clear about what you're doing in order to keep Gus safe.

 

It would not be wise to use Regular insulin which is known often as N along with Lantus.
Regular and Lantus are both considered as basal insulins, and they are not usually combined.

If your vet is talking about using a basal with a bolus, that's different.
Ask your vet if her suggestion was to use two basal insulins or a basal with a bolus insulin.

ETA:
you could also join an ibd group to ask for additional suggestions and feedback.
http://pets.groups.yahoo.com/group/felineibd1/

 

Thank you all for the replies and information. It is greatly appreciated. I'm trying to make the best and most informed decision before taking any further steps which is why I'm gathering info about budesonide and about regular insulin. I will discuss the type of insulin she was talking about to make sure I am clear.

I am in the group for feline IBD, but thank you for mentioning it. What I really need is a group for triad's disease since Gus cannot have the foods a lot of IBD cats can have. Also, since he is diabetic I worry about steroid use, but a lot of IBD cats use it. It is very difficult to treat one without upsetting the other.

My vet suggested antioxidants which can help with inflammation. I ordered them and should be here on Wednesday - however I'm not expecting some vitamins to deliver a miracle.

I've debated taking Gus to Dr. Graves who has been researching omega oils in cats with diabetes. He has also done a lot of other research because he is with the University of Illinois, however, I'm not sure if he will have any alternative suggestions that my vet hasn't already made.

Thank you all again for your input and information about the shorter acting insulins and which one to use if we go that route.

 

Rachel --

You may have more success researching the term, "triaditis" or cholangiohepatitis rather than triad's disease. This link provides a readable overview of cholangiohepatitis.

 

My vet said she wants to try budesonide first for 10 days to see if there is any improvement and we will go from there.

Thanks for all of your help. This is frustrating and scary as I almost lost him last year. I'm hoping this gets things under control.

I made an appointment next week with a specialist who also does research on feline diabetes at the University of Illinois. I don't know if he can offer anything more or not. Gus has a lot going on, but I always feel like I'm searching for the key to fix all of his problems.

 

I did check with my vet about the insulin and she said she is talking about R insulin.

We just started budesonide last night. I've got two vets at the practice I'm going to and one wanted to start budesonide before doing the R insulin. So far I have only given Gus one dose of the budesonide and nothing has changed. If we do the R insulin then I will have to be home so it will have to be on the weekend and have plenty of test strips and supplies for an emergency in case he does go hypo. It does scare me to do this, but I'm feeling like we are running out of options.

We have also discussed giving him a shot of Covenia - which he has had twice in the past without side effects (I already know everyone's feelings here about that). There was one other time Gus ran high numbers and our past vet said she thought he had an underlying infection and gave him the Covenia and it worked. However, this time around, Gus is making a gulping/hiccup sound sometimes and that concerns me along with the increased folate which all points to inflammation - but is it inflammation from an infection? I don't know.

I'm taking Gus to a specialist as well on Monday to get his take on what's going on.

 

The issue that we have with Convenia is that if your cat has a reaction to the drug, given that it lasts 2 weeks, your cat can be in trouble. Since Gus has had this antibiotic in the past with no ill effects, it's likely that he'll be fine. I would point out, though, that it's indication is for skin infections. Vets like to use it for other infections since you don't have to keep giving your cat a pill.

 

I am concerned that the covenia won't address the problem. I feel like we are just playing guessing games which is why I am taking him to a specialist - although I don't know that he will have the answers I need either.

It makes me extremely scared to use the R insulin, but it makes me very scared that Gus has been so high no matter what dose we give him of Lantus. I wish my appointment with the specialist was sooner, but we couldn't get in until Monday morning.

 

I'm also wondering if switching to Prozinc would work - if maybe Gus is resistant to Lantus now. I tried Levemir and we did achieve some good numbers, but he looked like he didn't feel good. He has so many things going on all at once that it is really hard to figure out. This is so upsetting.

 

What was the highest dose you gave of Lantus?
I realized much better numbers and more gentle curves on Levemir for both of my cats.
I have not used Prozinc but would not likely use it as it's not as long lasting, and many people need to dose TID to get comparable coverage as with Lantus or Levemir.
My Oliver's highest dose was 37u BID and my Shadoe's highest dose was around 21u BID of Levemir.
The insulins work fine; you can get to regulation once you reach the good dose for your cat.
If you follow the protocol, increasing slowly and letting each dose settle, the numbers WILL come down. If you have an acromegalic cat, that good dose may be 37u, 50u, 78u or even over 100u, but you WILL reach the good dose, if you don't stop too soon.

Another owner kept stopping at 10u BID, then switched to another insulin. The owner switched 3 times. The insulin was not the problem; stopping the dose increases was the problem.

 

If you decide to start using R on the weekend, be sure to have backup set up. Will your vet be open or is there an ER close? It will at least give you some peace of mind about using it.

 

Thank you. I plan on making sure I have syrup and the ER is 15 minutes from my house.

I'm still trying to decide what to do. I think the budesonide is having some effect on his evening BG which concerns me.

I'm debating going back to Levemir as we were able to get good numbers, but Gus didn't seem to feel well on it. It might be because of the other issues he has going on with his stomach and intestines though. Its is so hard to figure out what is making him feel bad. The Zofran makes him feel great, but I am limited on how often I can give it because it causes him to have diarrhea (which my vet said isn't typical in cats, but the pharmacist said it is a side effect in humans). Obviously the fact that he perks up after the Zofran indicates he is having pain in his stomach/intestines.

We are going to a specialist on Monday - which can't arrive soon enough. The specialist has a lot of experience with insulins and endocrinology. I'm hoping he can figure out what is going on.

 

An alternative to Zofran may be Cernia (maropitant). Both are used for nausea/vomiting with pretty good success. It may be worth discussing this as an option.

R is a very reasonable tool if used cautiously. There are a number of people here who experienced with it's use. It's a matter of starting low and curving your dose along with other considerations (e.g., you don't want your basal insulin -- Lantus or Lev -- nadir to coincide with the nadir of the R).

 

Thanks Sienna

We've tried Cerenia and I do have a supply that I use, but Gus doesn't seem to feel well on it. I have a feeling it has an effect on the brain since it is used for motion sickness in dogs and whatever that effect is probably makes him feel bad. I did use it twice this week. It is incredibly disappointing about the Zofran because I can see the immediate difference 30 minutes after giving it. In addition - Gus has focal seizures/facial twitches and the Zofran makes them disappear because it is used to treat people with facial ticks as well. Well I have meds for diarrhea on hand so if I over do the Zofran I have something to give him although I would rather not cause the diarrhea to begin with.

Right now - the Lantus is onsetting kind of late around 7-8 hours so I guess that is good if I use the Regular. The vet will go over it with me if we go that route.

 

Are you giving him probiotic? That is usually very good for diarrhea. You can use Fortiflora or go to a health food store and get a live culture type which is better. And, it won't cause constipation. Probiotics replenish the necessary good bacteria in the gut that keeps thins moving through properly.

 

Yes - Gus gets a probiotic, but the Zofran is what was causing the diarrhea.

I don't want to jinx anything, but my vet seems to have found the magic combination - budesonide cleared up the diarrhea caused by the Zofran so he is now on both of them and feeling so much better. His appetite has returned.

We aren't going to do the regular insulin as he has been responding to the increase of Lantus. He is consistently coming down in his numbers by 30-40 points daily.

He still makes a weird gulping sound sometimes when he swallows and I'm going to talk to the specialist about that.

The other very good news - Gus has hunted his toy the past two nights - which he hasn't done since his teeth were removed in August. This makes me very happy to see familiar behaviors returning.

My vet said that Gus is a regular topic of conversation at the clinic because he is such a difficult and complicated case. She is very supportive of me taking him to the specialist on Monday because she welcomes any insight into his health issues. Gus has all kinds of food issues and ingredients like Sunflower oil cause his blood sugar to shoot up. The foods that all of you are able to feed your cats are foods that cause Gus's blood sugar to go through the roof. One example is Tiki Cat - which he loves, but every single time I give it to him his blood sugar shoots up. My best guess is that it is because of his IBD. He has seasonal allergies so he probably has food allergies as well which cause inflammation in an increase in glucose. He is not a straight forward case and it is a constant balancing act of keeping him held together, but he is definitely worth the effort.

 

It sounds like you've done a huge amount of research already but I thought I'd mention Dr. Lisa's website since she does discuss IBD and raw food. There have been several cats here with food allergies and IBD that have had a good response to a raw (or partially raw) diet.

It's good to hear that Gus is responding to your efforts. I hope you'll post feedback after you see the specialist. Is this the vet you mentioned at U of IL?

 

I fed Gus a raw diet briefly, but all of my vets went ballistic and I understand why. His immune system is already compromised and they have explained the risks involved. My holistic vet believes in raw food for certain cats, but said it isn't for Gus because his immune system just couldn't handle coming into contact with a parasite. Believe me - I have been back and forth about this and even found a place (Hare Today) that sells ground mouse - which is so gross, but probably the best diet for cats. I often wonder if we are asking cats to adjust to a diet that wasn't meant for them. One of my vets said the ideal diet is mice which have everything cats need to survive. However the vet also added that cats are susceptible to the parasites that mice carry so it is a Catch-22. I just wish we would have a cooked cat food made from mice instead of other sources available in cans at the pet food store.

Yes - the specialist is with the University of Illinois. He is also the director of a clinic here in Chicago so he divides his time between the two places. My experience with internist in the past has been negative, but I've read a lot of of the research this vet has done and communicated with him via email and have a better feeling about him and the work he does. I will definitely let you know what he says!

Thank you again for the support and suggestions. I personally just wish they could find something remotely close to a cure for these complicated diseases.

 

Well the specialist spent a ton of time with us and we got mostly favorable news.

He wants me to wean Gus off the other meds and see how he does. He doesn't believe Gus has IBD because he doesn't have the symptoms. The vet that did the ultrasound when Gus had hepatic lipsidosis is the one who said he had it, but this specialist disagrees and I think the specialist is right.

Gus is to be on one food only. I've been feeding a smorgasboard of foods as well as free feeding which is what has messed things up. Gus will be meal fed and eventually reduced to two meals a day when he gets insulin.

Gus's insulin is too be increased - which I've started doing and he is steadily improving.

The specialist said that ability to control Gus's diabetes will depend on his pancreatitis. I will never gain great control if he has constant attacks. I'm hoping the food reduction will help give his pancreas a rest so it isn't constantly working.

The specialist felt Gus overall is in good health and that he isn't a worst case scenario cat - which was good to hear! I will see how things go.

 

Good news! What one food have you settled on? A unique protein? Interesting on the 2 meals a day and giving the pancreas a rest. Most here feed several small meals so as to not overwhelm the pancreas with too heavy a load at one time.

 

One thing to discuss with the vet is that frequent smaller meals are often easier with respect to managing Gus' diabetes.

I'm curious who the vet is that you saw. I'm in Chicago, as well. I know the U of IL vet school has a relatively new clinic in the city in the South Loop. Is that where you took Gus?