Insulin Resistance?

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sugar_rush

sugar_rush

Member Since 2017
So we have been treating and monitoring our cat Kiwi since October using Lantus. He is currently up to 10 units twice daily. We have done several curves at lower doses and are doing one today. In summary, he's almost never below 300 blood sugar, and can spike near 600.

We also confirmed his diagnosis of pancreatitis via blood work. His values were over twice the normal. This was in addition to the 25 panel complete blood work performed. The only other issue there was slight dehydration.

He is eating normally and the amount he drinks varies daily. He is still excessively urinating.

He is down to 15.4 pounds, but his rate of weight loss is decreasing. He was 17.6 pounds in July and 15.6 pounds in October (time of first diagnosis).

We are wondering if we should be changing insulins. Lantus seems to be ineffective.

Thank you!
 
sugar_rush said:
we have been treating and monitoring our cat Kiwi since October using Lantus. He is currently up to 10 units twice daily.
Click to expand...
Strewth!

It is true that there are some 'high-dose' conditions (e.g. IAA, acromegaly) but sometimes if a cat starts off on too high a dose - or if the dose is raised too quickly - they can end up getting far too much insulin and staying mostly in high numbers can sometimes be a sign of that (although the cat may also go dangerously low at times during the middle of a cycle and then 'bounce' sky high as the body's defences kick in to protect the kitty from hypoglycaemia. Home testing is the best way to get a fuller picture of what's going on so it's great that

It would help members responding to your posts to get a little more background:

1. What was Kiwi's starting dose of Lantus?

2. In what increments was the dose increased (0.25IU / 0.5IU / 1.oIU / other)? [Large dose increments often result in skipping over what would have been a 'good' dose.]

3. How long was each dose held before raising it?

Also, we use a really helpful spreadsheet here to track how kitties are responding to their insulin (see the links in members' post signatures). If you could set one up and plug your BG test results into it it will help members here to get a better idea of what to suggest to you that might help improve Kiwi's regulation. Here are links with the instructions and a guide to understanding the spreadsheet.

Spreadsheet setup instructions (if you need help, just holler and we'll get someone to assist you)

Understanding the spreadsheet


Mogs
.
 
I can follow the instruction provided there, but I have no clue what to actually enter as data. Help?
 
sugar_rush said:
So we have been treating and monitoring our cat Kiwi since October using Lantus.
Click to expand...
Hi,
Mogs has given you some great advice and suggestions in her post above.

I would also suggest that, at those high numbers, you routinely test your kitty's pee for ketones, especially since ketones were present at diagnosis.
Ketone test strips are available from pharmacies.
The test only involves dipping the end of the test strip in a tiny amount of pee, and then counting for a given number of seconds, and seeing if the little test square has changed colour. Anything above a 'trace' reading is a reason to contact your vet, ASAP.
Crumpling plastic food wrap loosely in the litter tray is often an easy way to get a pee sample, and you only need a couple of drops.
.
 
I think I did it. This is the most recent full "curve" I can find (we did our own spreadsheet... have to find other results to enter them there). Link should be in our signature.
 
Critter Mom said:
Strewth!

It is true that there are some 'high-dose' conditions (e.g. IAA, acromegaly) but sometimes if a cat starts off on too high a dose - or if the dose is raised too quickly - they can end up getting far too much insulin and staying mostly in high numbers can sometimes be a sign of that (although the cat may also go dangerously low at times during the middle of a cycle and then 'bounce' sky high as the body's defences kick in to protect the kitty from hypoglycaemia. Home testing is the best way to get a fuller picture of what's going on so it's great that

It would help members responding to your posts to get a little more background:

1. What was Kiwi's starting dose of Lantus?

2. In what increments was the dose increased (0.25IU / 0.5IU / 1.oIU / other)? [Large dose increments often result in skipping over what would have been a 'good' dose.]

3. How long was each dose held before raising it?

Also, we use a really helpful spreadsheet here to track how kitties are responding to their insulin (see the links in members' post signatures). If you could set one up and plug your BG test results into it it will help members here to get a better idea of what to suggest to you that might help improve Kiwi's regulation. Here are links with the instructions and a guide to understanding the spreadsheet.

Spreadsheet setup instructions (if you need help, just holler and we'll get someone to assist you)

Understanding the spreadsheet


Mogs
.
Click to expand...

Kiwi started at 1 unit, twice daily in October.

His increases were all at 1 unit increments.

We went at least 7 days before any raises in insulin dose.

Spreadsheet is up now. Will add more data later.

Thanks!
 
Elizabeth and Bertie said:
Hi,
Mogs has given you some great advice and suggestions in her post above.

I would also suggest that, at those high numbers, you routinely test your kitty's pee for ketones, especially since ketones were present at diagnosis.
Ketone test strips are available from pharmacies.
The test only involves dipping the end of the test strip in a tiny amount of pee, and then counting for a given number of seconds, and seeing if the little test square has changed colour. Anything above a 'trace' reading is a reason to contact your vet, ASAP.
Crumpling plastic food wrap loosely in the litter tray is often an easy way to get a pee sample, and you only need a couple of drops.
.
Click to expand...

Good idea with the ketone strips. At initial diagnosis in October, he had a value of 1 in the vets office. Was sent home without hospitalization and stabilized. We could smell them on his breath then. No odors since...
 
Super job getting your spreadsheet and signature up and running at supersonic speed! :D

Another thought: the Purina DM dry food will be partially contributing to the higher numbers. If at some stage you try to switch to food that's all low carb you need to monitor blood glucose levels closely at home as the insulin dose usually needs to be reduced. Here's a highly respected vet-authored site on the subject:

catinfo.org - Feline Diabetes page

Obviously with pancreatitis in the mix any diet change needs to be approached with extra caution. Ketone testing needs to be more vigilant, too (especially as Kiwi has a history of producing them; some kitties are more prone to produce ketones than others).



Mogs
.
 
Woodsywife said:
I only see one entry on the spreadsheet for 12/4. Is it public?
Click to expand...
Yes it is. Just created the spreadsheet today. That's the only curve I had saved data for, it seems. Doing another one today. So far, not good.

Edit: Just found info on his first curve at the vet. Added to spreadsheet.
 
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sugar_rush said:
Yes it is. Just created the spreadsheet today. That's the only curve I had saved data for, it seems. Doing another one today. So far, not good.

Edit: Just found info on his first curve at the vet. Added to spreadsheet.
Click to expand...
Do you ever test before you shoot, or other data besides the occasional curve? If you have any other readings it would be really helpful if you could enter everything you have.
 
As Mogs said there are some high dose conditions. My cat has one of them. If you can start testing a bit more often, it will help us determine if you should get Kiwi tested for them. Get a test before each shot that is not food influenced. Then try to get a test or two mid cycle when you can. If you work, try just before you leave and at night right before bed. Any tests will help us see what’s going on.
 
Sharon14 said:
As Mogs said there are some high dose conditions. My cat has one of them. If you can start testing a bit more often, it will help us determine if you should get Kiwi tested for them. Get a test before each shot that is not food influenced. Then try to get a test or two mid cycle when you can. If you work, try just before you leave and at night right before bed. Any tests will help us see what’s going on.
Click to expand...

I think the dry food might be part of the problem.
 
JanetNJ said:
Do you ever test before you shoot, or other data besides the occasional curve? If you have any other readings it would be really helpful if you could enter everything you have.
Click to expand...
Yes we do. We didn't have testing supplies prior to his first curve by the vet. The December 4th curve was a pre-shot reading. We are doing a curve today and will update when it's complete. With our work schedules, etc., we only get a chance to do a full curve once a week, if that. Otherwise it's just spot checks.
 
Another issue with Kiwi is his eating habits. He typically doesn't eat meals all at once, and has a tendency to graze.

We have a lot of spot checks that we have done, but at this point few are recorded. Is there a sheet or database we enter checks into or... how should we go about getting that information out there?

One check I absolutely recall is that we had left him on Christmas Day, and we returned 17 hours after his injection. His BG was 220!!! We were stunned it was that low.
 
sugar_rush said:
Yes we do. We didn't have testing supplies prior to his first curve by the vet. The December 4th curve was a pre-shot reading. We are doing a curve today and will update when it's complete. With our work schedules, etc., we only get a chance to do a full curve once a week, if that. Otherwise it's just spot checks.
Click to expand...
Most people only get spot checks. If you can get daily preshots and at least 1 mid cycle reading it would be really helpful. I work during the week so I can usually only get am and pm preshot and a +3 or 4 before bed. On the weekends or days off I test more.
 
Woodsywife said:
I think the dry food might be part of the problem.
Click to expand...
Trying to ween him off of it. He probably only consumes 1/4 cup of it now per day. It's hard because of his back story. He has major anxiety relating to food, as he wandered in as a stray and was under 8 pounds. If he doesn't have it available to him, he'll react badly. Some other humans had neglected him and he chose us to live with!
 
sugar_rush said:
Another issue with Kiwi is his eating habits. He typically doesn't eat meals all at once, and has a tendency to graze.

We have a lot of spot checks that we have done, but at this point few are recorded. Is there a sheet or database we enter checks into or... how should we go about getting that information out there?

One check I absolutely recall is that we had left him on Christmas Day, and we returned 17 hours after his injection. His BG was 220!!! We were stunned it was that low.
Click to expand...
Just put them in the spreadsheet with your curves. Look at various spreadsheets of people on the forum and you can see how we use the.


Most of us feed several small meals per day. It's better then two big meals. Just no food at least 2 hours prior to the preshot test so the number is not food influenced.
 
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So we've updated his spreadsheet in our profile. Sorry for the lack of data, it's what I could retrieve. Needed to give him Cerenia this morning, wasn't feeling well.

Any other input? There's no way he should be above 400 on 10 units!
 
sugar_rush said:
Another issue with Kiwi is his eating habits. He typically doesn't eat meals all at once, and has a tendency to graze.
Click to expand...

sugar_rush said:
He has major anxiety relating to food, as he wandered in as a stray and was under 8 pounds. If he doesn't have it available to him, he'll react badly.
Click to expand...

With Kiwi on Lantus, because it is long-lasting it's a good insulin for grazer kitties. Many Lantus users here feed mini-meals throughout the cycle. As mentioned above, the only time you need to restrict access to food is for the two hours prior to each preshot test so that you'll be able to gauge whether it's safe to give the next insulin dose.

With (presumably chronic) pancreatitis in the mix have you been supplementing with B12 injections? If not then it's worth having a chat with your vet about them. B12 is very helpful in general for cats with gastrointestinal/malabsorption issues plus it can help with appetite and it has some anti-inflammatory benefit. Here's a helpful doc:

IDEXX Pancreatitis Treatment Guidelines

Inflammatory processes in the body can also elevate BG levels.


Mogs
.
 
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The one day of BF (12/4) is, by my experience, representative of a high dose condition. That is you are getting a relatively good drop
sugar_rush said:
So we've updated his spreadsheet in our profile.
Click to expand...
To me, the SS shows that 10 units could be too high since BG goes up with time after the shot.
With 7 and 6 units the PS BG was high but you did get a 100 point drop or more.
My only concern would be if the insulin needs increased between the 5/6 unit time from and the 10 unit time.
My MurrFee had acromegaly but before that was diagnosed I tried reducing from maybe 10 units to 3 and got a curve like you got at 10 but worse since BG wold go up to the limits of my meter (600) and only display Hi mid cycle and ten go to maybe 400 or so before PM shot time. At the end MurrFee was on 50 units twice daily
 
I spoke with our vet today, who called an internal medicine vet for a consultation. Being that Kiwi is at 10 units of Lantus and has not had any consistent readings below 250, he is considered insulin resistant. The suggestions are: urine culture; blood test for acromegaly; blood test for Cushing's disease; abdominal ultrasound. This is a lot to digest! Our vet said that the urine culture would be a good first step. For now, he instructed us to raise Kiwi to 12 units of Lantus twice daily. He does not feel that we increased the dosage too quickly because we went up only 1 or 2 units each week since Kiwi's diagnosis. Additionally, he said that changing the insulin would not be helpful because the veterinary versions are now synthesized in a lab instead of being derived from animals.
 
@sugar_rush -

Useful tip: If Kiwi is a high-dose kitty it might be worth asking your vet about Levemir at some stage. At higher doses Lantus can sting a bit but Levemir, another long-acting depot insulin, does not so the latter may be more comfortable for the kitty.


Mogs
.
 
@Larry and Kitties - Our vet said that the acromegaly test is almost $200. Why is it showing $58 at MSU? Could our vet ship the samples to this lab? Any help would be much appreciated!
 
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I imagine the Vet quoted you the price including his drawing the blood and overnighting it to MSU along with the price of the test. You should consider getting the IAA test done as well. (Insulin AutoAntibodies)
 
Make sure you get the IAA or insulin autoantibodies test done as well, that's the one that Larry suggested. It's also done at MSU. You can get the blood draw done at the same time as the one for acromegaly and share the shipping costs. Both of those add to the cost from your vet. IAA is quite a bit cheaper at MSU. It's the only place in North America that does those tests.

Neko had both IAA and acromegaly. One in four diabetic cats has acromegaly. Cushings is less common and diagnosis starts with a urine test. Maybe do it later, unless you are seeing some skin conditions with Kiwi.

As Mogs suggested, you might want to have a conversation with your vet about the possibility of switching to Levemir. Many high dose kitties benefit from the change. For one thing, higher doses of Lantus can sting. For another, Lev may have better duration.
 
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