Second insulin now and doesn't seem to be working

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Gina G

Gina G

Member Since 2017
Pinkie started off on 2 units 2x's a day of ProZinc and was on it for about two months before the vet switched him to Lantus. I did two curves on the ProZinc and his sugar was over 400 and never got below 393. His fructosamine test was 450.

Well, he's been on Lantus for a few weeks now (2 units twice a day) and the first week, I tested him a few times and it was still around the same. This morning, I just did a spot check and it was 532 about 2 hours after his dose/food. I don't know what is going on. Pinkie is a very hard to handle, almost feral/very fearful cat. I can't do regular curves or checks on him but it's clear something is off here. Can it really be that two insulins aren't working or is something else going on? He eats a very low carb raw diet and is fed at regular times with a snack once a day of his regular food. The only treats gives are a less-than pea-sized amount of Sheba so that I can give him his insulin or otherwise handle him. Does anyone have any thoughts? Thank you.
 
Gina G said:
Pinkie started off on 2 units 2x's a day of ProZinc and was on it for about two months before the vet switched him to Lantus. I did two curves on the ProZinc and his sugar was over 400 and never got below 393. His fructosamine test was 450.

Well, he's been on Lantus for a few weeks now (2 units twice a day) and the first week, I tested him a few times and it was still around the same. This morning, I just did a spot check and it was 532 about 2 hours after his dose/food. I don't know what is going on. Pinkie is a very hard to handle, almost feral/very fearful cat. I can't do regular curves or checks on him but it's clear something is off here. Can it really be that two insulins aren't working or is something else going on? He eats a very low carb raw diet and is fed at regular times with a snack once a day of his regular food. The only treats gives are a less-than pea-sized amount of Sheba so that I can give him his insulin or otherwise handle him. Does anyone have any thoughts? Thank you.
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you probably just haven't hit your breakthrough dose yet. I got all 300-450's until I got up to 3 units. shortly after hitting that breakthrough dose I was able to decrease.
 
Hi Gina.

I was unable to access your spreadsheet. Can you make it viewable by others, please?

Not being able to test much is definitely going to complicate matters, but it is not impossible. The problem is, in order to know if the dose is a good one, you need to be able to figure out how low it is taking the cat. Keeping in mind I can't see your SS yet, so I don't know what you are doing already, but since you have to keep test to a minimum, I'd recommend getting a test before shooting (to be sure it's safe to shoot), and aiming for one more test in the middle of the cycle somewhere (+4 to +7). Most cats nadir somewhere in that range, and it's the nadir that will tell us what the dose is doing. Don't be discouraged by the high numbers. Pinkie could be dropping lower and bouncing back up, and what you are catching is the bounce. If he isn't dropping much, once we figure that out, we can help you adjust the dose until he starts responding better.

Keep in mind that insulin isn't a drug - it's a hormone, and it doesn't behave like a drug - you don't give it and see a response immediately. There are a lot of factors at play. We tell people "this is a marathon, not a sprint" because it really does take some time to get a handle on things. Hang in there. We'll help you!
 
Hi there. I think I fixed the link to make it viewable to anyone with the link. There's nothing on it yet. I am trying to figure out how to use it/what all the fields mean. I came across an explanation of the spreadsheet fields days ago and now I can't find it. To be honest, I am kind of overwhelmed by all the info/how to's on here and figuring it all out. The nadir today would be about 1:30pm-ish. I will retest him then if he lets me.

I haven't been able to test him much since he started the Lantus. He is getting very reactive and upset by all the poking despite lures of treats and other efforts to comfort him. He was on amitriptyline for years as he is very anxious (rescued from a trailer park where he was taken away from kids throwing rocks at him). He has been so upset with me since Dec. when he is diagnosed. He is only relaxed when he's with his pal, Barley, but now, when he seems me coming, he runs which is really distressing.

Thanks so much for the reassurance. I am at my wit's end. 3 of my 4 cats, including Pinkie, have kidney disease (another one diagnosed this week) and between that and the diabetes I feel like it's all falling apart with these guys! Not sure if his kidney disease is having any effect on the diabetes either....
 
Gina, I'm so sorry you're dealing with so much. I had four cats with major illnesses as once (all with cancer, two diabetic, one blind, etc.), so I understand what you are going through. Just take it one day at a time. :bighug:

Yes, it's very overwhelming, even when you aren't already in over your head! Just keep reading and bits will sink in here and there. Keep asking questions. We don't mind answering them at all!

Here is a post we put together for new members that might help you with this site. It contains links to things like setting up and using the spreadsheet: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/.

Here is another link with ideas to help with testing: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/ One of the best tips I've seen is to just spend some time loving on your kitty and gently massaging his ears. Give him a treat every time he lets you do touch his ears, even if you haven't tested. That helps him associate the action with good things. Then you can progress to testing, and always give that treat, even if you don't get blood. Make sure you interact with him as much as you can at times when you aren't going to give a shot or test, so he doesn't think that's all you do. Try to keep your frustration level down as much as you can (easy to say), as they can sense that and will take their cue from you. Don't give up. You can do this!
 
This might be the link you are looking for on Understanding the Spreadsheet. After you look at it, please let us know if you have questions.

It's doubtful that the insulin is not working for him. Some insulins work better for cats than others but you do have to give it time. It doesn't happen quickly for some. It's possible, as Tricia said, you might not be testing enough to figure out what is going on. Once you fill in the SS with the data you have, we will be able to look at his patterns and give you some thoughts.
 
I am so sorry you also had all those issues going on at once. That is really hard. I so appreciate your gentleness and understanding with me.

I am sure my overwhelm and anxiety isn't helping the cats. The nutty irony here is that my hypoplasia kitty who is also blind is the one that seems most messed up to the untrained eye and yet little Clover is the only one with no major stuff going on right now!

Thanks so much for posting the spreadsheet set up link for me. I was digging around all over for it this morning to no avail. Thank you also for the testing tips and tricks link. I hadn't seen that one yet. I talked to the vet just a few mins. ago who agreed with JanetNJ that maybe we should bump up his dose to 3 units but I am thinking maybe I should go slow and do 2.5 first. What do you think? Thank you again. I am really, really grateful for the advice and support. I can't express that enough.
 
Hey Gina and Welcome to the forum, the best place you never wanted to be. You are a special bean to take on a feral cat and now a feral "sugar cat". Bless you and darn those children throwing rocks at him. What in the world makes someone mistreat an animal???? Don't get me started......

You have all ready been giving some good info from the others but I just wanted to add, have you ever tried Feliway spray to help him? It was very helpful when my civvie cats was peeing inappropriately. Also, there is rescue remedy that you can get from a health food store and put into the water bowl to help relax him.

I can see you SS but as you said, you haven't filled it in yet. It would be hard to give dose advice with out seeing the numbers and trends. I think what I would do would be stay where you are and get some data, pre-shot numbers and some mid-cycle numbers. If the mid cycle PM is in the middle of your sleep and you can't set an alarm to get that reading, then just get one as late as you can before you retire. Also, keep in mind, that you don't want to give any food within 2 hours of the test so that you have a more accurate number.

The best test to get beside pre- shot and mid cycles are the +2. If the number you get at +2 is the same or lower than the pre shot number then it could indicate it is going to be an active cycle and you would need to continue to test to makes sure he doesn't go too low.

Keep reading all the stickies and keep asking questions as that is how we all learned and we are here to help you. :)
 
Good job getting the spreadsheet set up. Do you have any of the numbers from the curves you said you ran? Any that the vet ran? If so, please add them to the sheet. Every bit of data helps us fill in the picture.

Bobbie's suggestions for testing are good ones, but we realize that might not be possible just yet because of Pinkie's feral wariness. Just do the best you can. As I mentioned, the MOST important times to test are before shooting and somewhere in the middle of the twelve hour cycle. We can worry about the other times as Pinkie gets used to this.

Gina G said:
I am thinking maybe I should go slow and do 2.5 first.
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Around here we recommend doing dose changes in .25 unit increments. That doesn't sound like much, but for a cat it is a lot. Do you have syringes with 1/2 unit markings? If not, I'd recommend you get some. Much easier to figure out the smaller doses. Right now, I'm with Bobbie,though - I think you should stick with the current dose and see if you can get some more data.

Did your vet talk about testing for ketones at all? With a feral cat, I don't know how feasible it is, but there are urine test strips you can buy in most pharmacies that work fine for cats. He probably won't let you stick it in his stream, but there are tricks you can do in the litter box to get a small puddle to test. Just ask us for the ideas.

You're in the Bay Area? I'm in what is considered the East Bay. Hi neighbor! :)

 
Howdy neighbor! You ARE pretty close to me! I am on the Peninsula :) I do have syringes with half unit markings but am struggling with those. The petsitter is coming today though to help me figure it out. I put in today's reading on the spreadsheet. Hopefully, I fixed the settings so people can see it. I am going to aim for at least a test a day with my goal being the nadir and/or right before he eats and gets his dose. It's really hard to handle him for much more and even that seems kind of ambitious but I am going to try! I don't think I can do ketones by sticking it in his stream and since all 4 share the boxes and if I approach while he's in there, he darts off, pee trailing behind him! I am open to puddle testing though once I catch him leaving the box if you have any tips.

I didn't add the numbers from the previous curves because they were when he was on ProZinc and I hadn't set the spreadsheet up yet. Same goes for the fructosamine test but if it doesn't matter that it was when he was on a different insulin, I can add those from the curve on 3/18/17.

Thanks also for your advice, Bobbie. I have done everything you can think of- even had an animal communicator "speak" to him. One thing that has gotten him to come out at least and not hide all day is a heated pad in the living room.

Pinkie has had a really tough history. After he came from that trailer park, a rescue had him in a cage before I took him and his littermates to foster (and then failed miserably at fostering and kept him because I thought he was too skittish for anyone to adopt). He degloved his arm there by getting it caught in the cage in his panic to escape so his early experiences with people touching him were first trapping him and then operating on him. During his life with me, he had a feeding tube for fatty liver disease for a while, meds for anxiety and hyper t then radioactive iodine as well as other negative experiences with being handled for medical reasons/pilling that I think have deepened his fear and distrust of people. In his old age, he had gotten to a point where I could pet his head and cheeks at least but the diabetes/pancreatitis diagnosis seems to have set him back years now with all the poking and tests both by me and the vet. It really disgusts me how horrible people can be to animals. I used to do a lot of rescue work and burned out from the things I saw. It can really make you dislike humanity.... Thank you for the tips on testing times and food. I hadn't been as mindful of that and will be now.
 
Gina, God bless you for taking him on and trying to help him. The poor little soul. No wonder he's so skittish! :( I, too, have periods where I hate people. I don't understand cruelty in any form, but especially to innocent animals.

Gina G said:
I didn't add the numbers from the previous curves because they were when he was on ProZinc and I hadn't set the spreadsheet up yet. Same goes for the fructosamine test but if it doesn't matter that it was when he was on a different insulin, I can add those from the curve on 3/18/17.
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The Fructosamine test doesn't need to be in the SS, but if you can put the other tests in, then put a dividing line of some sort, indicating where Lantus started, that would would be great. Yes, I can see the SS now.
Gina G said:
I am going to aim for at least a test a day with my goal being the nadir and/or right before he eats and gets his dose.
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That is a good start. The reasoning behind testing before shooting is in case they have dropped low and it would be dangerous to give insulin. I've already explained the reason for the mid-cycle test. :)
 
Hello and welcome from me too. Thank for taking on the special cases in rescue. :bighug: It sure can be it's own kind of reward.

One thing you will see here is ECID or each cat is different. It is so true. Some cats need more insulin than others, some less. We see cats regulated on 0.25 units and others than needed over 20 units to get into good numbers. ECID. The key is increasing safely to find a dose that works for your cat. I hope we can help you get Pinkie there.
 
Welcome, Gina.

Do you think Pinkie would allow you to test 4 times a day? (Tests at pre-shot times and once during the AM and PM cycle?) You wouldn't have to test more often unless you saw that numbers were dropping.

I suspect that some of your kitty's reaction is that he's not feeling great due to the high numbers. As his numbers improve, he may begin to associate testing (and treats) with feeling better. Or at least we can hope that's the case.

 
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