3/15 Taz, AMPS 553, PMPS 478 - Insulin Help

[Cat-Mom Amanda]

As I previously posted (03/07 Taz, AMPS 549, PMPS 524), "I found this forum in my endless search for answers/help. My 16-year-old cat, Taz, was diagnosed with diabetes this past September after being on prednisone for over 2 years due to small cell lymphoma cells biopsied in his colon, though he has not developed any cancer tumors yet. My frustration is that over the past 6 months Taz's gluocose reading keep popping high (300-600) despite increasing his insulin. We've increased from 1 unit to 5 units now, and it feels like his glucose levels increase as the units increase...." With continued high readings, the vet has now increased us to 6 units. I have put together a speadsheet, which I linked in my signature, with his 2022 and 2023 readings. Here are my questions:

1. Has anyone else had this happen... increasing insulin causing increased glucose readings?

2. Anyone ever been told their cat is "allergic" to a certain insulin, and that is why it does work? My vet was trying to tell me this, and I was wondering if it could be true? Is there a better insulin than glargine for cats?

3. Anyone knowledgable about "glucose intolerance"? I'm trying to figure out if this could be the issue.

4. Anyone know the phosphorus and carbs for Gerber Baby Food Chicken And Gravy?

5. Anyone know of a pate that is a bit more dry than most? The Weruva that I'm trying to hand-feed is too wet and drips off my fingers. Looking for something that would be good for his diabetes as well as his kidney disease. Was using Lotus turkey pate, but I think the carbs on it are too high.

6. Diabetic neuropathy is setting in quickly and badly for Taz. Anyone ever used Cyanocobalamin to try and reverse it? My vet thinks this is what I should use, but I've read online that Methylcobalamin should be used... so I'm confused. Plus, since we still can't get him in a normal glucose range, will it even help?

I've tried to follow all the instructions given to me on my initial post, so I think I have all the info in my signature, "About" section, and spreadsheet; however, if something isn't clear, please feel free to ask.

Thanks,
Amanda

 

[Bron and Sheba (GA)]

Here is your initial post
https://felinediabetes.com/FDMB/threads/03-07-taz-amps-549-pmps-524.275080/

Has anyone else had this happen... increasing insulin causing increased glucose readings?

It is possible you have increased and gone past the best dose.
We recommend increasing in 1/4 unit increments so you don't go past the best dose.

Anyone ever been told their cat is "allergic" to a certain insulin, and that is why it does work? My vet was trying to tell me this, and I was wondering if it could be true? Is there a better insulin than glargine for cats?

It is true that some insulins work better for some cats than others but glargine is a very good insulin for cats. I think it is more likely you have increased and gone past the best dose.

Anyone knowledgable about "glucose intolerance"? I'm trying to figure out if this could be the issue.

Its possible he has glucose toxicity. We would need to see more data to assess this. It is very possible he is dropping low and bouncing up high again. I can see some blue preshots so he is responding to the insulin. We need to see a lot more tests taken during the cycles. Cats often drop lower at night so get some in the pm cycles as well.
From the basics on the LBL page

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Anyone know the phosphorus and carbs for Gerber Baby Food Chicken And Gravy?

Sorry I dont know. Others may know.

Anyone know of a pate that is a bit more dry than most? The Weruva that I'm trying to hand-feed is too wet and drips off my fingers. Looking for something that would be good for his diabetes as well as his kidney disease. Was using Lotus turkey pate, but I think the carbs on it are too high.

Have a look at this list.
Food Chart it has the phosphorus levels of all the foods. Look for phosphorus 200-250mg/100kcals. Weruva also has a new range which is good for CRD cats

Diabetic neuropathy is setting in quickly and badly for Taz. Anyone ever used Cyanocobalamin to try and reverse it? My vet thinks this is what I should use, but I've read online that Methyl cobalamin should be used... so I'm confused. Plus, since we still can't get him in a normal glucose range, will it even help?

Cyanocobalamin will not do anything for diabetic neuropathy. You need the methly B12 (Methylcobalamin) which you can get from lifelink.com in the form of Zobaline. Also when the BGs become into the more normal range, things shouls get better. I would start using some methyl B 12.

If I were you I would start posting every day. I would test before every dose and again during every cycle because glargine dosing is based on the nadir not lowest point in the cycle, not the preshot BG.
It looks s if you are using a pen instead of a syringe, so you can only increase in 1 unit increments which is too much for cats. I would go out and buy a box of 100 syringes and start using them.
The syringes you need are U100, 3/10, 30 or 31 gauge, 6 or 8 mm insulin syringes with 1/2 unit markings.
You can buy them at Walmarts ..the ReliOn brand or look for BD brand which I like. There are also other brands.
Then you can use the pen cartridges to withdraw the insulin. I will post how to do that below.

 

[Bron and Sheba (GA)]

How to withdraw insulin from the pen

 

[Cat-Mom Amanda]

How to withdraw insulin from the pen
View attachment 66476

Thanks for chiming in with some answers to my questions. I'm really struggling with Taz and appreciate the help.

Regarding your comment that I have "gone past the best dose" causing these glucose readings to never improve, that is what I was thinking. Have you experienced this? Or anyone here experienced it? I need some solid advice on how to properly lower to fix this, if that is possible?

 

[Bron and Sheba (GA)]

Regarding your comment that I have "gone past the best dose" causing these glucose readings to never improve, that is what I was thinking. Have you experienced this? Or anyone here experienced it? I need some solid advice on how to properly lower to fix this, if that is possible?

I actually said it is possible you have gone past the best dose. For us to see if this is the case we need to see more testing during the cycles... am and pm cycles. It is not just the preshots but the tests during the cycles that give us lots of information. Also I would not go up in 1 unit increments, but 1/4 unit increments if necessary. I would also not increase to 6 units until we have seen more data.
It is very possible Taz is dropping low during the cycles and bouncing back up at preshot.
However I would not recommend reducing the dose back to a much lower dose until we see the data.