Virgil is having a difficult time getting regulated

ProfCat

ProfCat

Member Since 2026
Hi Everyone-- Our Virgil has been through so much. He's around 10 years old and has been really healthy until this year. He began having eye issues this summer. Lots of discharge etc. He had herpes virus, but his eyelids were also rolling inward. We learned that's called entropic eyes. So we took him to an eye specialist and he had surgery to correct it. He had bloodwork before and it was fine. It was a pretty brutal surgery with a difficult recovery. He just wasn't healing well and was losing weight. So we ran additional bloodwork and found out he was diabetic. Blood glucose was 400 at diagnosis.

We love our vet, but she definitely used the dog protocol when we started treating him. We've had a diabetic cat before like 20 years ago and had an easy time then with regulation and home testing. So we expected a similar experience. Our vet had us go up on the ProZinc too fast (1 unit at a time over a few weeks). Virgil was up to 5 units and not responding (numbers in the 300s and 400s). So we started from scratch with Lantus. He's now on 3.5 units and still not regulated. Every time we increase the dose, his numbers get all wonky again. Our vet wanted to do an ultrasound if he wasn't responding to 3 units, to see if there is something wrong with his pancreas.

The good news is that he is eating and feeling great. All our vet food is low- to no-carb, and we switched to Dr. Elsey's clean protein dry food so he can snack during the day. We're home testing as much as our schedules allow.

But yesterday I started googling anthropic eyes and acromegaly and got myself all freaked out thinking that this is what's going on. It turns out entropy can be caused by the excess growth hormone. We would be devastated if this is the case, so I haven't even told my wife I googled it (and I hope she doesn't, although she's already worried about acromegaly).

Our plan is to slowly increase Lantus to 5 or 6 and see if he starts responding. But our vet isn't even on board with that plan, so I have to talk with her this week and hope she agrees. Has anyone had it take this long to regulate? Is there still hope it's not acromegaly? Here's his sugar chart.
 
Welcome to FDMB.

The first thing I'd encourage you to consider is that there is no exact timeline for how long it takes for a cat to get regulated let alone reach remission. For some cats, the process can be quick. When I joined FDMB, for one of the members who joined at roughly the same time it took about 2 years for her cat to go into remission. My cat was reasonably well regulated but never reached remission. There are some members whose cats are not tightly regulated despite their best efforts. If you think about it in human terms, it's very similar. There's no way to know if the lack of regulation is due to a highly sensitive response to carbohydrates, how stressed your cat gets, or other factors.

The other factor may be if there is an inflammation or infection present. Any source of illness is a stress on your cat's system. The stress causes a rise in blood glucose levels.

There are ways to test for both acromegaly and for insulin resistance, the latter may also be a condition that may be having an effect on your cat's blood glucose numbers. The veterinary lab at Michigan State runs these tests. There's information in this post on getting the tests. We do encourage members to wait and see what numbers look like should your cat's dose reach 5 - 6u.

I'm tagging one of our members who has considerable expertise with high dose cats. @Wendy&Neko
 
Sienne and Gabby (GA) said:
Welcome to FDMB.

The first thing I'd encourage you to consider is that there is no exact timeline for how long it takes for a cat to get regulated let alone reach remission. For some cats, the process can be quick. When I joined FDMB, for one of the members who joined at roughly the same time it took about 2 years for her cat to go into remission. My cat was reasonably well regulated but never reached remission. There are some members whose cats are not tightly regulated despite their best efforts. If you think about it in human terms, it's very similar. There's no way to know if the lack of regulation is due to a highly sensitive response to carbohydrates, how stressed your cat gets, or other factors.

The other factor may be if there is an inflammation or infection present. Any source of illness is a stress on your cat's system. The stress causes a rise in blood glucose levels.

There are ways to test for both acromegaly and for insulin resistance, the latter may also be a condition that may be having an effect on your cat's blood glucose numbers. The veterinary lab at Michigan State runs these tests. There's information in this post on getting the tests. We do encourage members to wait and see what numbers look like should your cat's dose reach 5 - 6u.

I'm tagging one of our members who has considerable expertise with high dose cats. @Wendy&Neko
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Thanks for this info! I know it can take some cats longer. We had 2 diabetic cats in the past (15-20 years ago) and never had this issue getting them regulated, so I did not expect it.

I looked at the acromegaly info and he has always been a BIG cat. He has long toes, big paws, and a large nose. He was 16+ pounds before the surgery and went down to 12 pounds since the surgery and the diabetes. I guess weight loss is less common in acromegaly, so that's some good news. He was a bit "chubby" before and looks good now. He's very solid muscle, but his paws look larger because he's lost weight. He has always been a loud breather, though, and that's a sign. Along with the entropic eyes. Sigh.

As for other factors, he is definitely a chill cat, not stressed. He's been playing like a kitten lately! Surgery was stressful, though, and occasionally the herpes virus in his eye flares up. But it hasn't been bad lately, and we keep in touch with the eye doctor about it. All the food he eats is basically no-carb wet food, with some of the Dr. Elsey's dry.

I'll discuss with the vet this week keeping him on this insulin until he's up to 5-6 units, and then doing the bloodwork.
 
Hello and welcome.

First, I'd try not to look for physical symptoms of acromegaly. Other than far too eager an appetite, my Neko had no symptoms of acromegaly. I did find out later her sometimes teary eye could have been from soft tissue growth in her tear duct. In the latest 2025 iCatCare consensus guidelines on the diagnosis and management of diabetes mellitus in cats is the following statement
Most cats with HST (75%) have no phenotypic changes that can be identified through a physical examination that distinguish them from regular diabetic cats
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HST or hypersomatotropism is the more proper name of acromegaly, but way too long! Not all cats with HST have high doses. If it would give you some comfort, you can get the IGF-1 test (for acromegaly) and also the IAA (insulin auto antibodies) test done. They are blood tests send to MSU. If positive, there are treatments for acromegaly that can help.

Playing like a kitten is a good sign, lethargy is a common sign of acromegaly.

I'd encourage you to not hold doses overly long. Any chance you can get rid of the dry food? Without dry, you can increase the dose more quickly. Starting over from scratch with Lantus was a mistake - I made the same one based on advice from my vet. It's like he's got some glucose toxicity setting in and might need an even higher Lantus dose to break through.

ProfCat said:
All our vet food is low- to no-carb
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What is the name of it? Most vet food is higher in carb. You also don't need vet food for diabetes. There are plenty of low carb wet food and raw options commercially available. If you want food available during the day and night, most of us use automatic pet feeders.

One final thing, this post has information on what we like to see in your signature, besides the spreadsheet. Great job getting that set up. New? How You Can Help Us Help You!
 
Oh, I didn't mean "vet" food! That was a typo-- I meant "wet" food! We feed all Merrick bistro duck or rabbit (7.4% and 4.7%). And Weruva Cats in the Kitchen or Grandma's Chicken Stew, which is lower -- 1.4 and 3.6% carbs. And tiki cat sardines are 0% carbs.

It's going to be hard to stop the dry food bc we have other cats who get snacks throughout the day (2 elderly cats and one who has urinary issues and gets prescription food he can't eat). Instead of shoving him in the bathroom with no food, at least he knows he can go in there and have a little bit of a snack. We don't let him free-feed, but he does get a small pile of the dry food a few times a day.

You're right, we probably should have started with a higher dose of Lantus. Our vet didn't know, and I thought it was like a do-over for the whole process. I feel so stupid now. Maybe he has some toxicity, and if we get up to the right dose, we can "break" it.

Thanks for the info! The entropic eyes worry me, but I'll try not to look for physical signs. As I said, he's always been a big cat!
 
ProfCat said:
Grandma's Chicken Stew
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If that is Grandma's Chicken Soup - that is 21% carbs. If found it sent Neko soaring high and had to move to a lower %carb HC. I presume you are feeding the Cats in the Kitchen cans, not pouches. Most of the pouches are medium or high carb.

We've seen big cats on small doses and small cats on large doses. My Neko had some Maine Coon heritage so naturally larger.
 
Wendy&Neko said:
If that is Grandma's Chicken Soup - that is 21% carbs. If found it sent Neko soaring high and had to move to a lower %carb HC. I presume you are feeding the Cats in the Kitchen cans, not pouches. Most of the pouches are medium or high carb.

We've seen big cats on small doses and small cats on large doses. My Neko had some Maine Coon heritage so naturally larger.
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Oh jeez, where are you seeing this info about Weruva Grandma's Chicken Soup? What I see online is here. I checked all his food and we've avoided the ones closer to 10% carbs (like the Merrick Bistro Beef). Maybe I am getting the wrong info?


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Thanks for the info! I'm checking now and I am mortified. We are SO discouraged because we've been feeding him horrible food! Here's what he has been eating and he can't anymore:

Grandma’s Chicken Stews
Limited Ingredient Chicken
Meal or No Deal
Press Your Dinner
Merrick Kitten
Merrick beef
Merrick Duck
Merrick rabbit

How much has this been messing up his numbers!? Basically, all we have left to feed him is Funk in Trunk and Tiki Cat Sardines. What else? Is there a good list that includes Merrick and Weruva foods?
 
You know, most members use Fancy Feats pates between 0-10% most feed up to 5% carbs they have an amazing selection of flavors it is US made so it’s regulated and no waste goes into the food also many feed Friskies
 
CORKY said:
Here's a link to an approved Drs food list, the third column contains the carb content

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
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I'm totally confused again because I ran the calculator on the Merrick Purrfeck Bistro and came up with wildly different numbers than the carbs in this chart. Merrick Duck, for example, is 34.5% with the calculator, but it's listed here as 5%?

But I do have a list of weruva flavors that will work.

And we have fancy feast so it's good to know there are flavors of that that will work!
 
ProfCat said:
I'm totally confused again because I ran the calculator on the Merrick Purrfeck Bistro and came up with wildly different numbers than the carbs in this chart. Merrick Duck, for example, is 34.5% with the calculator, but it's listed here as 5%?

But I do have a list of weruva flavors that will work.

And we have fancy feast so it's good to know there are flavors of that that will work!
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I would go by what the calculator indicates, FF also has some Flake and chunky food that your cay might like, like Fish & Shrimp Flake 0%, Chicken Chunky 4%, Trout 4% to get an idea what, when, and how much food as an example, I feed Corky check his SS, scroll to the left till you get to remarks ;)
 
CORKY said:
Here's a carb calculator we are using

Carb Calculator - Felinediabetes.com
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That calculator is NOT what we are using for accuracy, just an estimate. It is an approximation because it uses the guaranteed analysis numbers, which are not accurate. The catinfo food chart shows 21% carbs for the Grandma's chicken soup. As it says in the beginning of that food chart,
The data used to calculate the values on this chart are fromTypical Nutrient Analysis (TNA) data -not the Guaranteed Analysis (GA) data which is listed on the product’s package (can/pouch/bag). GA values are reported as minimums and maximums and are, by definition, inaccurate since there is no ceiling or floor, respectively.
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For the Merrick Duck, I think you are seeing an example of the calculator being wrong if using GA values. Bottom line, go by the food chart, not the calculator. A lot more of what you were feeding can still be fed.

If you see that the manufacturer has come up with newer formulas than are in the food chart, there are ways you can get the data yourself. First is to see if someone else has done the leg work, and this thread contains a spreadsheet with some of the newer products
Second method is more complicated, but it starts with contacting the manufacturers of the particular food and getting the tyical nutrient analysis numbers and doing the calculations from there. Which is what the catinfo food chart has done several years ago. The Mady&Egon's food chart post has more details on how to do that, as does this post: Calculating % Calories from Carbohydrates
 
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