not responding to increased insulin

[Paula and Sammy(GA)]

Hi guys. So, Sammy has been on 4 units of prozinc for a few days yet his numbers continue to be high, and no indication of Somogyi effect. Having been on depo for years, I am worried about iatrogenic Cushing's syndrome and I guess my next move is to have him tested. The poor guy can't get a break! I did a modified BG curve (which was quite difficult with black ears and a general difficulty acquiring a blood drop the jerk). I welcome any advice at this point as I'm approaching desperation with his multiplying health concerns! His spreadsheet should be visible now with his updated numbers. Thank you all!

 

[Larry and Kitties]

Without a preshot BG i can't really make a good recommendation. It could be that 3 and 4 units are too much.. Usual starting dose is 1 unit.
When did Sammy start insulin and what was the dose?
If dose was increased what was the increase based on?

 

[Diane Tyler's Mom GA]

Hi guys. So, Sammy has been on 4 units of prozinc for a few days yet his numbers continue to be high, and no indication of Somogyi effect. Having been on depo for years, I am worried about iatrogenic Cushing's syndrome and I guess my next move is to have him tested. The poor guy can't get a break! I did a modified BG curve (which was quite difficult with black ears and a general difficulty acquiring a blood drop the jerk). I welcome any advice at this point as I'm approaching desperation with his multiplying health concerns! His spreadsheet should be visible now with his updated numbers. Thank you all!

@Suzanne & Darcy

@FrostD

Suzanne I see you had answered her on another members post and asked her to start her own. Here it is Here was the post
https://felinediabetes.com/FDMB/thr...hange-or-any-other-ideas.272232/#post-3036133
Starting with post #11
@Suzanne & Darcy

 

[Diane Tyler's Mom GA]

I think you should set up your signature
Hi if you are having trouble setting it up this might make it easier for you
signature
click on your name up top above where it says sesrch and then tap on the word signature and add this information

• Add info we need to help you:
  • Caregiver & kitty's name
  • DX: Date
  • Name of Insulin (do not include dose or frequency)
  • Name of your meter
  • Diet: "LC wet" or "dry food" or "combo"
  • Dosing: TR or SLGS or Custom (if applicable)
  • DKA or other recent health issue (if applicable)
  • Acro, IAA, or Cushings (if applicable)
  • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
  • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.

Be sure to click the 'Save Changes' button at the bottom.

Do you see mine?
From some of your previous posts I see Sammy has asthma and takes meds for it
Please list any health issues and any meds he is on also

 

[Sienne and Gabby (GA)]

Paula -

I would not want to suggest doing anything except gathering more data. One of the concerns is that Henry may be seeing lower numbers during the PM cycle and then bouncing into higher numbers during the day. It can also take a few days for those bounces to clear. Bounces occur if your cat drops into lower numbers than he's used to or drops quickly. As a result, the liver and pancreas overreact and release a stored form of glucose along with counterregulatory hormones which cause BG numbers to rise. We need more information to know what's going on with your cat.

We encourage you to get a pre-shot test both in the AM and PM -- it's the only way to know if your cat is in safe numbers to give insulin. You also want to get at least one additional test during both the AM and PM cycles.

We increase doses by 0.25u. Increasing by 1.0u can cause you to speed past what would otherwise be an effective dose for your cat.

 

[Suzanne & Darcy]

Hi

Hi guys. So, Sammy has been on 4 units of prozinc for a few days yet his numbers continue to be high, and no indication of Somogyi effect. Having been on depo for years, I am worried about iatrogenic Cushing's syndrome and I guess my next move is to have him tested. The poor guy can't get a break! I did a modified BG curve (which was quite difficult with black ears and a general difficulty acquiring a blood drop the jerk). I welcome any advice at this point as I'm approaching desperation with his multiplying health concerns! His spreadsheet should be visible now with his updated numbers. Thank you all!

Hi Paula. I found you over here. I looked at the ProZinc forum several times today trying to find this new thread. But I pretty much already answered on the other thread. Just try to gather data and definitely try to get the preshot numbers (very important as I said in the other thread.). Keep trying with those black ears. Some people buy those head mounted lights to direct light onto the ears (if you have help they can hold a light for you.). Oftentimes as you go along you will find that the ears will bleed more easily. Also, warming the ear helps. I used a very small bottle filled with warm/hot water and held it against Darcy’s ear in the beginning. Other people warm some uncooked rice in a sock (in the microwave). It does get easier. Also, don’t use the smallest lancets until you get really good at it and his ears bleed more easily. After they do you can always go with smaller lancets. And try to prick the ear at a 45 degree angle. I think I may be repeating myself and, if so, forgive me. I also would not recommend increasing doses by whole units. I hope your vet will give you an Rx for Lantus or one of the cheaper generic options. But you will not start with a large dose and you will need completely different syringes. .

 

[Suzanne & Darcy]

Oh, and what is chest x-ray for? I am concerned for your baby.

 

[Paula and Sammy(GA)]

Hi

Hi Paula. I found you over here. I looked at the ProZinc forum several times today trying to find this new thread. But I pretty much already answered on the other thread. Just try to gather data and definitely try to get the preshot numbers (very important as I said in the other thread.). Keep trying with those black ears. Some people buy those head mounted lights to direct light onto the ears (if you have help they can hold a light for you.). Oftentimes as you go along you will find that the ears will bleed more easily. Also, warming the ear helps. I used a very small bottle filled with warm/hot water and held it against Darcy’s ear in the beginning. Other people warm some uncooked rice in a sock (in the microwave). It does get easier. Also, don’t use the smallest lancets until you get really good at it and his ears bleed more easily. After they do you can always go with smaller lancets. And try to prick the ear at a 45 degree angle. I think I may be repeating myself and, if so, forgive me. I also would not recommend increasing doses by whole units. I hope your vet will give you an Rx for Lantus or one of the cheaper generic options. But you will not start with a large dose and you will need completely different syringes. .

Thank you so much for the advice. I actually do most of the things mentioned above - and this isn't even my first black cat with DM! Sometimes I forget that I used to do this often! I realize the Lantus is the U100 vs the U40. I don't mind - I can always donate what I no longer use. I just want to find something that works! I'm fearful he does have Cushing which will further complicate the job.

 

[Paula and Sammy(GA)]

Paula -

I would not want to suggest doing anything except gathering more data. One of the concerns is that Henry may be seeing lower numbers during the PM cycle and then bouncing into higher numbers during the day. It can also take a few days for those bounces to clear. Bounces occur if your cat drops into lower numbers than he's used to or drops quickly. As a result, the liver and pancreas overreact and release a stored form of glucose along with counterregulatory hormones which cause BG numbers to rise. We need more information to know what's going on with your cat.

We encourage you to get a pre-shot test both in the AM and PM -- it's the only way to know if your cat is in safe numbers to give insulin. You also want to get at least one additional test during both the AM and PM cycles.

We increase doses by 0.25u. Increasing by 1.0u can cause you to speed past what would otherwise be an effective dose for your cat.

These are great points, thank you so much. This info I was not aware of about the pm cycle. I will strive to get the pre shot tests done. I do never dose until he has eaten a good meal. But data is important! This I know.

 

[Suzanne & Darcy]

Thank you so much for the advice. I actually do most of the things mentioned above - and this isn't even my first black cat with DM! Sometimes I forget that I used to do this often! I realize the Lantus is the U100 vs the U40. I don't mind - I can always donate what I no longer use. I just want to find something that works! I'm fearful he does have Cushing which will further complicate the job.

Oh, I hope not!

 

[Paula and Sammy(GA)]

Without a preshot BG i can't really make a good recommendation. It could be that 3 and 4 units are too much.. Usual starting dose is 1 unit.
When did Sammy start insulin and what was the dose?
If dose was increased what was the increase based on?

He was started back in November with 1 unit and raised to 2, then 3 of the vetsulin, then got prozinc and started at 2 but the lack of any drop into a comfortable zone at all is what makes me fear he has Cushings.

 

[Suzanne & Darcy]

He was started back in November with 1 unit and raised to 2, then 3 of the vetsulin, then got prozinc and started at 2 but the lack of any drop into a comfortable zone at all is what makes me fear he has Cushings.

Does he have other symptoms of Cushings?

 

[Sienne and Gabby (GA)]

We typically don't think about a higher dose condition until a cat is at 6.0u. With Cushings, you would likely be seeing very fragile skin (e.g., easy to tear skin).

With cats with black ears, have you tried poking on the inside surface vs the outside surface? Sometimes the inner side of the ear is lighter in color (less fur!).

 

[Paula and Sammy(GA)]

We typically don't think about a higher dose condition until a cat is at 6.0u. With Cushings, you would likely be seeing very fragile skin (e.g., easy to tear skin).

With cats with black ears, have you tried poking on the inside surface vs the outside surface? Sometimes the inner side of the ear is lighter in color (less fur!).

Thank you! I will give the inside a look! He has hair loss from years of steroids but the vet does not think it is Cushings. He responded to the insulin while there (I was there too) I added the values to his spreadsheet.

 

[Paula and Sammy(GA)]

Oh, and what is chest x-ray for? I am concerned for your baby.

Hi guys. So, Sammy has been on 4 units of prozinc for a few days yet his numbers continue to be high, and no indication of Somogyi effect. Having been on depo for years, I am worried about iatrogenic Cushing's syndrome and I guess my next move is to have him tested. The poor guy can't get a break! I did a modified BG curve (which was quite difficult with black ears and a general difficulty acquiring a blood drop the jerk). I welcome any advice at this point as I'm approaching desperation with his multiplying health concerns! His spreadsheet should be visible now with his updated numbers. Thank you all!

Hi guys. So, Sammy has been on 4 units of prozinc for a few days yet his numbers continue to be high, and no indication of Somogyi effect. Having been on depo for years, I am worried about iatrogenic Cushing's syndrome and I guess my next move is to have him tested. The poor guy can't get a break! I did a modified BG curve (which was quite difficult with black ears and a general difficulty acquiring a blood drop the jerk). I welcome any advice at this point as I'm approaching desperation with his multiplying health concerns! His spreadsheet should be visible now with his updated numbers. Thank you all!

So, after possible food intake (available) from the night before and only a medium sized tuna breakfast, Sammy and I spent the morning at the vet - where he got xrays and BG levels with no more food intake. On the vet's machine his BG levels were 189 at +3.5, a whopping 87 at +5.5 and 94 at 7.5! With only access to water, is this all it takes? His xrays indicated slightly enlarged heart, and bronchial pattern in his lungs compatible with his history of chronic asthma. The vet does not think he is a Cushings prospect with this response. I shall continue testing at home, and trying to stick to meals twice a day to see if I can repeat these values! (And I got to work as a tech to reduce the bill! A win win!).

 

[April & Quincy]

So, after possible food intake (available) from the night before and only a medium sized tuna breakfast, Sammy and I spent the morning at the vet - where he got xrays and BG levels with no more food intake. On the vet's machine his BG levels were 189 at +3.5, a whopping 87 at +5.5 and 94 at 7.5! With only access to water, is this all it takes? His xrays indicated slightly enlarged heart, and bronchial pattern in his lungs compatible with his history of chronic asthma. The vet does not think he is a Cushings prospect with this response. I shall continue testing at home, and trying to stick to meals twice a day to see if I can repeat these values! (And I got to work as a tech to reduce the bill! A win win!).

I don't know if anyone mentioned but you should really feed your cat more than two meals a day. Apparently, this is old school thinking and it is easier on the pancreas for multiple smaller meals throughout the day. It is hard for me to do that so I have an automatic feeder. Maybe this would work for you?

 

[Diane Tyler's Mom GA]

April is right, you should be feeding your cat more than just 2 times a day

 

[Sienne and Gabby (GA)]

Just to clarify, this doesn't mean feed several big meals a day. Rather, you want to feed the same about of calories you've been feeding but breaking those meals into smaller amounts throughout the time until your cat reaches nadir (the lowest point in the cycle). The several smaller meals helps to keep the numbers a bit flatter vs big swings in blood glucose levels.

 

[Paula and Sammy(GA)]

I don't know if anyone mentioned but you should really feed your cat more than two meals a day. Apparently, this is old school thinking and it is easier on the pancreas for multiple smaller meals throughout the day. It is hard for me to do that so I have an automatic feeder. Maybe this would work for you?

Well, the veterinary specialist mentioned that he should be fed only twice a day. I have trouble with this because he doesn't eat well in the morning. On top of everything, his BG level with my Alpha Trak was back up in the 300's here at home. I went ahead and got another regular monitor and tested it on myself. There was 40 difference between the people monitor and the Alpha Trak monitor, although still nowhere near what the vet's numbers were yesterday. He also, being old school himself, took the blood from Sam's femoral vein (In the one back leg he has!). Could this make a difference? I don't know! I had incredible difficulty acquiring a blood drop from Sam's ear today. I am hitting the vein, but his ear veins are just so small plus I am doing this alone that it frustrates him and he wiggles. I can't even give him a treat if he needs to be kept without frequent meals raising his BG levels all day. I honestly don't know what to do right now other than try again tomorrow. I want to feed him more than twice daily but it it keeps his levels lower than it's worth it. But, I'm not even seeing using the "feline" monitor.

 

[Paula and Sammy(GA)]

Does he have other symptoms of Cushings?

not the fragile skin so much nor the curling ears, but his hair is spotty and hasn't grown back from his amputation surgery last July. The vet thinks he does not have Cushings but some of this was based on HIS numbers he got yesterday on his monitor, which were between 200 and 280 less than all the tests I've performed, although he did pull blood from his femoral vein as opposed to an ear prick.

 

[Suzanne & Darcy]

Wow. That’s odd - those greens at the vet. Many cats do go high at the vet, but some drop low. My Darcy did sometimes go quite low at the vet, but then he wasn’t getting the snacks that her normally would have at home. Let’s let the 3.5 dose settle in and see how it goes (as long as he doesn’t drop too low on it, of course.)