Insulin had no effect?

[scienceofcats]

Lola’s health never ceases to confuse me. Following up on my previous thread kind of. This morning she had her AMPS bG = 9.6 mmol/L (173 mg/dL), I gave 2.0 units, and her +4.5 bG = 11.1 mmol/L (200 mg/dL). So not only did the insulin have no effect, her sugar actually went up. What gives?

I know for sure it wasn’t a fur shot, and there’s no way she got any contraband (unless my other cat puked and she ate it while I was sleeping, which happens sometimes... it’s gross, I know). She does have free access to diabetic-friendly dry food (or at least as diabetic-friendly as dry food can be), but that’s no different from other days.

Also, I tested her blood ketones, which were 0.4 mmol/L (there’s a sheet in my SS for these). Not great.

I’ve seen this happen before when she was on 1.5 units, where the insulin would have no effect. What causes this?

 

[Deb & Wink]

1. Don't forget meter variance. Home glucometers are only required to be within a certain percentage of the lab values. 173 + 15% = 199, so those 2 numbers are basically the same.

• 95% of all measured blood glucose meter values must be within 15% of the true value (a lab measurement); and
• 99% of meter values must be within 20% of the true value.

This is the source of the above info:
https://diatribe.org/fda-publishes-final-recommendations-blood-glucose-meter-accuracy from 2016

Some meters, even though they have been "approved" by the FDA, are not as accurate as other meters. Meters that have been on the market for some time, do not have to meet the new accuracy standards. They are "grandfathered" in and the companies can continue to manufacturer those meters for as long as they want. Some meters that passed the FDA approvals, are not as accurate as the companies claimed, at least that is what was shown in independent testing. This is my source for that info that I said above:
https://diatribe.org/are-blood-glucose-meters-accurate-new-data-18-meters from 2017

2. Simple variations from day to day. You are looking for trends over time, not for specific numbers for a specific cycle. Except for low numbers during a cycle, when your cat may be heading towards hypoglycemia and you may want to monitor more closely, it's those trends you are looking for.

3. Cat more active, cat less active, cat eating a bit more, cat eating a bit less, cat being a cat.
Insulin was processed better in relationship to the food, or not. Lola ate more of the high carb dry food, she ate less of the high carb dry food. Too many variations to account for.

Look at the trends, when you look at the SS. Look for the waves of action.

Quite frankly, though you like the fact that Lola does not have much bouncing on the Prozinc, it doesn't seem to do her much good either. It's as if she is getting no insulin at all. Might be time to think about another insulin.

 

[scienceofcats]

Quite frankly, though you like the fact that Lola does not have much bouncing on the Prozinc, it doesn't seem to do her much good either. It's as if she is getting no insulin at all. Might be time to think about another insulin.

Yeah, I’ve been thinking about this for a while. I brought it up with my vet at one point, and she advised against it... mostly because she said there’s less ‘manufacturer support if something is wrong’ for other insulins because they’re off label. Honestly I didn’t really understand that argument, but I ended up staying with ProZinc at the time because her fructosamine was good. Still, even the vet admitted recently that because she saw ketones in the urine, maybe the fructosamine wasn’t the best measure for Lola.

So it becomes a question of what insulin to move to. I know Lantus and Levemir are the two people here use the most. I’ve also seen that some people use Tresiba, and that one is an ultra-long actor that’s once daily as I understand? (EDIT: I may have been wrong about this, not sure where I read that. Looks like people are using Tresiba bid on here from what I can tell.) That’s definitely attractive if that’s correct... that’d mean in the evening she’d just need a test but no needle, which she’d definitely appreciate. Although I do know there’s a user here that also adds Novolin as needed on top of the base amount of Tresiba. I need to do more reading on this, but what are your thoughts?

 

[Panic]

I brought it up with my vet at one point, and she advised against it... mostly because she said there’s less ‘manufacturer support if something is wrong’ for other insulins because they’re off label.

LOL sorry but I busted out laughing at this. Reminds me of when my vet didn't like the idea of me buying insulin from Canada because it was a "foreign country".

 

[Chris & China (GA)]

what are your thoughts?

I'd go with Lantus or Levemir over Treshiba….mainly because with Lantus, Basaglar (both are Glargine) and Levemir, there are decades of experience here to help you learn how to use them most effectively.

With Treshiba, most of the people who've tried it had to give it twice a day so most likely you'd end up having to shoot it twice a day too....and there is very limited experience using Treshiba in cats

 

[Elizabeth and Bertie]

This morning she had her AMPS bG = 9.6 mmol/L (173 mg/dL), I gave 2.0 units, and her +4.5 bG = 11.1 mmol/L (200 mg/dL). So not only did the insulin have no effect, her sugar actually went up. What gives?

Hi, well, on the face of it, I don't think those numbers are bad at all. (There are some folks here who would dearly love to see these kinds of numbers in their kitties, and would look with envy at your kitty's numbers...)
But the 'flat' numbers are something of a mystery.
...When did you last get a new vial of insulin...? Could it have lost potency...?

Something else that can sometimes mess up numbers in Prozinc kitties is rapid dose changes; and I see that there was a skipped shot on a PM cycle recently, and then a much reduced shot the following PM cycle. Some Prozinc kitties are very sensitive to even small dose changes, and it can take a few days at a given dose for things to settle out and to see the full effect of that dose. Some kitties have responded to rapid dose changes with high flat numbers; in your kitty's case though the numbers aren't high, just flat...

She does have free access to diabetic-friendly dry food (or at least as diabetic-friendly as dry food can be), but that’s no different from other days.

Which food is this...?

she said there’s less ‘manufacturer support if something is wrong’ for other insulins because they’re off label.

Your vet may be referring to the fact that, because human insulins aren't licensed for cats, there is no data collected (from their use in cats) with regard to efficacy or safety. (This is one of the things that gets mentioned here in the UK with regard to insulin choices for cats.) ...However, Lantus has been used successfully in cats for many years, and there is a great deal of experience of that on this forum.

 

[Deb & Wink]

Yeah, I’ve been thinking about this for a while. I brought it up with my vet at one point, and she advised against it... mostly because she said there’s less ‘manufacturer support if something is wrong’ for other insulins because they’re off label.

Sounds to me it's more likely the inexperience of your vet with using another insulin that is limiting her willingness to prescribe another insulin.

Lots of drugs are used off label in the vet industry. This sounds like a specious argument to me.

So it becomes a question of what insulin to move to. I know Lantus and Levemir are the two people here use the most. I’ve also seen that some people use Tresiba, and that one is an ultra-long actor that’s once daily as I understand?

There have been a handful of people on here that have used Tresiba. Very little experience here with people using that for their cats. You also need to be able to monitor much more with Tresiba, since it can have an 18 hour or longer cycle. Thought you had monitoring issues when you go back to work. There is 1 (one) person currently on this message board that is using Tresiba, and she tests in concert with her daughter, to make sure her cat is ok.

I'd go with the lantus or the levimir if it was my cat.

My other thought is that you need to take away that dry food ASAP. Yes, I know your other cat likes it, but it's not doing your diabetic cat Lola a bit of good.