still insulin resistant on 5 units :(

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pablo'smom

pablo'smom

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Hi everyone,

Here is the update on Pablo since its been a week or so. He tested negative for Cushings, his ketones have been the same, and we are making it no where with his sugar. He is on 5 units 2x a day and there isn't much changing. He is mainly sitting in the 300s. He also has been slightly dehydrated from all the peeing so I started giving him 3 hydra care packs a day and he has plenty of fresh water throughout the day and he is drinking water. Also he is now 12.6lbs meaning he is losing more weight. I have him eating 450 calories a day to help this but I think the biggest thing is getting his levels down in order to see drastic improvement. His vet basically told me that they have done everything they can and they are stumped so they referred me out to see a specialist. He has an appointment on 2/17 with an IM specialist at MedVet in Chicago who has experience with diabetes (I made sure to ask before even booking the appointment to avoid wasting time). Hopefully, she can figure it out. I asked his vet about switching insulin but she was very unsure about it and doesn't know much about Lantus. I'm hoping all it is is a quick insulin switch to fix this and nothing more serious. Other than that he is acting completely normal, energetic, cuddly, etc so I hope I can get him better soon.
 
pablo'smom said:
Hi everyone,

Here is the update on Pablo since its been a week or so. He tested negative for Cushings, his ketones have been the same, and we are making it no where with his sugar. He is on 5 units 2x a day and there isn't much changing. He is mainly sitting in the 300s. He also has been slightly dehydrated from all the peeing so I started giving him 3 hydra care packs a day and he has plenty of fresh water throughout the day and he is drinking water. Also he is now 12.6lbs meaning he is losing more weight. I have him eating 450 calories a day to help this but I think the biggest thing is getting his levels down in order to see drastic improvement. His vet basically told me that they have done everything they can and they are stumped so they referred me out to see a specialist. He has an appointment on 2/17 with an IM specialist at MedVet in Chicago who has experience with diabetes (I made sure to ask before even booking the appointment to avoid wasting time). Hopefully, she can figure it out. I asked his vet about switching insulin but she was very unsure about it and doesn't know much about Lantus. I'm hoping all it is is a quick insulin switch to fix this and nothing more serious. Other than that he is acting completely normal, energetic, cuddly, etc so I hope I can get him better soon.
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@Suzanne & Darcy

Previous post
https://felinediabetes.com/FDMB/threads/weight-loss-despite-insulin-increase.297754/#post-3241844
 
Your previous post had some discussion about sending blood to MSU for maybe testing for acromegaly (IGF-1)? Was this done? I would also test for insulin resistance (Insulin AutoAntibody (IAA)). I would also seriouslu consider changing insuin to likely glargine (Lantus is the brand name but the biosimilar ones may be less expensive).
What I have done in the past was to try a little R insulin in addition to the long lasting insulin to see if that does anything. YOu can get a 10 ml vial from Walmart for about $28 w/o a script.
 
I agree with Larry about getting Pablo tested for a high dose condition such as acromegaly and insulin resistance. If you've not already seen it, this thread has information on the testing at Michigan State University.

One observation may be reassuring. For cats that are insulin resistant (have high IAA values), it can take perseverance to get them to a dose that breaks through the resistance. Try to be patient. In the grand scheme of things, Pablo has been diagnosed for only two months. It's not that long of a time to be managing a cat's diabetes.

We do not recommend using R ("regular" insulin or Novolin R) unless you have an experienced member to guide/coach you through the process. R is very fast acting and there is a risk of blood glucose numbers plummeting as a result of how your cat responds or if there are overlapping nadirs between R and your usual insulin. While I understand the process, I've never used it myself.

I think you're fine using Prozinc. Most members with acro cats use Lantus/glargine. However, you don't know if Pablo has a high dose condition.
 
I talked to his primary vet about testing for acro and she didn't seem to know much about it, so I will bring it up to the specialist on Monday. I also would like to try switching insulins so I'll mentioned that to her as well. I'll keep you all updated on what happens and what the specialist thinks.
 
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