8/3 Maui AMPS 344 PMPS 354

[MauiDad]

Hi everyone, my name is Kurt and my kitty is Maui. This is our first post. Maui was diagnosed early this year after showing polyuria, polydipsia, and a decline in personal hygiene. She is about 7 or 8 years old as far as we can tell. She has been on Insulin Glargine (Lantus biosimilar) since then.

She started at 2 units once a day, slowly increasing to 4 units twice a day, then tapered down to 2.5 twice a day as we shifted her diet to low carb wet/dry combo. During this time, her preshot glucose measurement remained in the mid 400’s.

So after getting her low carb diet established at about 240 calories a day when she was about 14.5 pounds with the goal of slow weight loss, we very gradually increased her insulin to try to bring her preshot glucose down to below 300 on the Alphatrak2 meter we are using. However, we are currently at 10 units twice a day for the past couple of months and she still has averages about 350 preshot on the Alphatrak2.

Soon after starting on insulin, she became non-symptomatic and seems perfectly happy except that the restricted calories seem to leave her perpetually hungry, even right after eating. Her weight has decreased slightly to about 13.25 pounds, apparently as hoped due to the caloric restriction.

Last week my vet tested and found that Maui’s liver and kidney values are normal, but her blood sugar was confirmed at 346, and her fructosamine was 724. So per my vet, I’ve scheduled Maui for a visit with an internal medicine specialist and an abdominal ultrasound to see if they can find a reason why her glucose remembers are still so high, even at 10 units twice a day. However, her appointment isn’t until the end of September.

In the meantime, looking at the forum I’ve seen that every cat is different, but I didn’t see any doses in the double digits, but perhaps I missed them. Do some cats require 12 or 15 units twice a day? Is there such a thing as too much insulin glargine if needed to get her glucose numbers into the normal range?

Thanks for any insight you can provide on maximum dosing.

Kurt and Maui

 

[Wendy&Neko]

Hello and welcome Kurt and Maui. I've moved your post to Feline Health where we ask new people to post first. We like people to get their spreadsheet and signature set up first before posting on the insulin specific groups. Details on the information we need is in this post:
New? How You Can Help Us Help You!

Can you tell me exactly what food Maui is eating now?

Do some cats require 12 or 15 units twice a day? Is there such a thing as too much insulin glargine if needed to get her glucose numbers into the normal range?

When a cat gets up over 6 units a dose, and is eating low carb food, we usually suggest that they get the cat tested for some secondary endocrine conditions that can cause the cat to need higher doses. The most common two conditions are ones called acromegaly and IAA (insulin auto antibodies). My girl Neko had both and got up to 8.75 units, though I've seen cats on way higher doses, well past 15 units. Some cats with these conditions stay on low doses. ECID. Acromegaly is caused by a benign tumour on the pituitary gland that causes excess growth hormone to be secreted, which in turn causes the diabetes. Studies have shown about 1 in 4 diabetic cats has this condition. IAA is sort of like an allergy to the injected insulin - oversimplification, but the antibodies capture the insulin making it unavailable to the cells. Both conditions can be tested for, with a blood draw that is send to Michigan State University if you are in North America. There are treatments for acromegaly, IAA typically goes away over time. I might start with the blood tests first, cheaper than an ultrasound and likely will tell you more. Your regular vet can get those tests done.

Hunger could be because she is in high numbers all the time and can't properly process the food, though cats with acromegaly are also typically "starving" - thing growing teenagers and their appetites, caused by growth hormone spurts.

FYI - you don't have to use a pet meter. The strips are quite expensive, and the AT2 is being phased out with the test strips no longer available as of September. Most of us use human meters, which is also what our dosing methods were designed for.

 

[MauiDad]

Thank you Wendy! Current foods are Weruva canned food (Paw Licken Chicken, Tuna and Salmon Soulmates) and also Dr. Elsey’s Clean Protein Chicken Recipe dry food. All foods are about 3% carbs. Total calories per day are in the 220 to 240 range spread over 5 small feedings: 1/2 can morning and evening, 3 auto feeder dry food snacks in between. Total calories are 220 to 240 per day.

Thank you so much for the information. I'll check with my vet. I found a great post on the forum on how to get it done here: https://felinediabetes.com/FDMB/threads/msu-vdl-testing-instructions-for-igf-1-and-iaa.277084/

You mentioned some cats are above 15 units. In your experience, are double digit doses always due to an underlying condition? I guess I'm asking, is 10 or more units ever "just normal for a particular cat with diabetes"?

Thanks again for your reply!

 

[Hendrick Cuddleclaw]

Hi Kurt, welcome to the FDMB. Gorgeous kitty you got there, possibly a seal point? Some of my favorite cats of all time were seal or chocolates! I'm a big sucker for Siamese, we have four. Unfortunately they are one of the breeds that studies have shown may be more likely to get diabetes.

Some people have had great success with feeding a raw diet or freeze-dried raw, there was one member who's cat was getting I think 6 or 7 units a day, but after changing to a freeze-dried raw diet kitty needed a lot less insulin. Of course, any diet change needs to be coupled with lots of monitoring of the BG as you don't want to suddenly be giving way too much insulin. I believe they fed Stella and Chewy's freeze dried raw as well as Primal. Warning -- these options are pricey.

Another option (yes, also expensive) that some cats respond well to is making your own food using a product such as EZ Complete. I make a batch every night for our six civvies and Hendrick. (A civvie, aka a civilian, is a term used here for a regular non-diabetic feline)

As Wendy mentions you should be relieved to learn that you do not need to use an AlphaTrak device and the overpriced strips. When my kitty Hendrick was diagnosed my vet said to get the AT so we did, and that is what we started using in the beginning but after joining this group we switched to a human meter (Caresens N).

 

[Wendy&Neko]

You are feeding low carb food, though we have had some people notice their cat gets a little bit of a numbers bump from the Dr. Elsey's. However, not enough that it would mean a 10 unit dose. There is something else in play. We usually rule out other secondary conditions too, like hyperthyroidism, pancreatitis, needing a dental. But again, none of those except for high carb dry food lead to doses of 10 units or more. Mostly they make it harder to get regulation.

n your experience, are double digit doses always due to an underlying condition? I guess I'm asking, is 10 or more units ever "just normal for a particular cat with diabetes"?

There is almost always something else at play. We did have one member with a diabetic bobcat who got to higher doses, but he was also 34 lbs. Other than that, we've also had some members who didn't get the tests done when they got to higher doses, so we can't say for sure whether their cat had other condition. However, there were some physical symptoms of acromegaly in most of them. Cushings is another condition that can be present, but it's not as common. There are a couple reasons we push for testing. First, there are treatments that really help, but you have to know what you are dealing with first. Second, we approach dosing a bit differently if one of these conditions is present.

 

[MauiDad]

Thanks for the replies. I've sent a message to my vet to see about testing and she is looking into it.