11/27/22 New Member - No insulin for 4 days now and on the low side.

[LeoTheLion]

Hi everyone. I have a wonderful 12 year old purebred Maine Coon kitty named Leo who was diagnosed with diabetes in September. He had all of the classic symptoms of peeing, drinking, and eating excessively, as well as neuropathy in his hind legs. His BG was high 500s on diagnosis.

His vet started him off on 2u of prozinc 2x a day, and he slowly made his way up to 6u 2x a day after multiple in office curves with not much improvement (BG 350-high 500's during curves). All of the sudden around Nov 18th, his BG started coming down, and he had a reading of 70 while at the vet. At this point we started taking home readings with an alphatrak meter. She decided to bump him back down to 2u 2x a day, and told us not to shoot if his preshot number was under 150.

He had his last dose of insulin this past Wednesday morning 11/23. He was very sleepy all Wednesday and didnt eat much. He became sick Thursday morning 11/24 with vomiting, diarrhea, and was not super responsive/wouldnt really open his eyes. His BG wasn't hypo at 158, but yet he was having hypo symptoms. We gave him a little Karo syrup and he perked up a bit but was still sick so we brought him to the emergency vet. His BG was 85 at the vet so they admitted him. He spent 2 days there where they gave him antibiotics, iv dextrose, and did some blood work and ultrasounds. They said his pancreas looks normal, but they did find abnormal levels of growth hormone in his blood which suggests a pituitary tumor/acromegaly. We have him home with us now and will be following up with his normal vet tomorrow. He's still really on the low side but not having hypo symptoms anymore.

I'm pretty confused on what is going on with him being on the low side with no insulin for 4 days now, after 2 months of high BG on a higher dose of insulin. Would love some insight if anyone had a similar experience.

I will work on a spreadsheet when I can, but his readings from the past week are as follows:
11/20 - 9:30a 185 (2u) 7:00p 182 (no insulin)
11/21 - 5:00a 372 (2u) 5:00p 142 (2u)
11/22 - 6:30a 221 (2u) 6:00p 125 (no insulin)
11/23 - 7:30a 205 (2u) 6:30 171 (no insulin)
11/24 - 6:30a 158 (no insulin). At ER around 11:00a 85
11/25 - At ER all day
11/26 - Discharged from ER at 12:00p 135
11/27 - 6:30a 89 9:30a 57 5:00p 127 9:00p 246

 

[Ale & Bobo & Minnie (GA)]

I’m not a prozync expert but 2 units is a high dose to start off and clearly too much. Didn’t the er vet suggest going down to 1 unit? Normal range is 80-120 so he still needs insulin but not that much. My guess is he will probably end up at .5 or 1 unit. Tagging a prozync expert @FrostD

 

[LeoTheLion]

I’m not a prozync expert but 2 units is a high dose to start off and clearly too much. Didn’t the er vet suggest going down to 1 unit? Normal range is 80-120 so he still needs insulin but not that much. My guess is he will probably end up at .5 or 1 unit. Tagging a prozync expert @FrostD

He's a big boy at 23lbs so I'm thinking that could be why she started him at 2 units. Either way, the 2 units was not enough for him initially as it didn't even touch his BG on the curves the vet took.

The ER vet said to give 1 unit only if he goes above 300, but otherwise refrain the rest of the weekend until we can consult with our regular vet tomorrow.

 

[apollonia-artemisia]

Starting dose (depending on diet) for prozinc is supposed to be 0.5-1.0U, which is why the vet I see started cadmium on 1, what the heck!! Average dose for diabetic cats is usually 2-4U, depending on how insulin dependent they are. Your vet started him at 2?? Did she think that your cat would be like other cats, or was it based on his levels at dx?? I would think that by the 6U mark, there would be a blood panel done, because that seems like a clear sign of “maybe the original assessment was off” to me, and I’m very new to the world of feline diabetes… (This is directed at your vet, not you btw!!) I have never heard of a case being so severe that they need that much per dose.

Growth hormone levels abnormalities is definitely a cause for hypoglycemia, and in fact is one of the more common causes of pediatric non-diabetic hypoglycemia in humans. Wouldn’t surprise me if its the same in cats, but I don’t know for sure. My suggestion is to monitor, give food/snacks depending on how his levels are, and make sure you have a hypo toolkit and know all the signs of symptomatic hypoglycemia. Someone more experienced can provide you with resources that have more specifics. Checking levels somewhat frequently can help catch any episodes of hypoglycemia unawareness, which is asymptomatic. Thats why some cats (and humans) have a continuous glucose monitor like the Freestyle Libre. Just know that the sensor has a 10-15 min delay, so you might need to double check it with a blood glucose test.

 

[Red & Rover (GA)]

Tagging @Wendy&Neko regarding pituitary tumour/acro.

Leo is beyond gorgeous!

 

[Wendy&Neko]

Hello and welcome to you and your plus sized, possibly sweet kitty.

they did find abnormal levels of growth hormone in his blood which suggests a pituitary tumor/acromegaly.

The blood test is called the IGF-1 test and the blood is sent to Michigan State University. I'm curious what the IGF-1 value was. My girl also had acromegaly.

Acromegaly is a condition that results from a benign pituitary tumour (hypersomatropism). We call it acromegaly cause it's so much easier to say. The benign pituitary tumour sends out excess growth hormone, which can cause diabetes and hyperglycemia. (not hypoglycemia @apollonia-artemisia ). Recent research shows that around one in four diabetic cats has it. The tumour can pulse the amount of growth hormone it sends out up and down, which can mean different doses needed, though not usually as drastic as your kitty's case.

If you weren't home testing at the beginning, and he was only getting tests at the vet, it's possible that he was just overdosed. He may have been lucky to be an acrocat and able to tolerate the overdose more. Side story - a locum vet told me about a kitty patient of his who was getting 20 units instead of 2, because his now former vet tech showed the caregivers the wrong dose. That cat also had acromegaly and survived the accidental overdosing. However, there are cats with acromegaly that need much larger doses - some for whom 20 units is too little.

I see that you are feeding Fancy Feast and high protein dry. Can you tell me which dry food? Have you changed how much of it you are feeding? Most dry foods are very high carb, and reducing the amount fed can also mean a drop in amount of insulin needed.

 

[apollonia-artemisia]

The benign pituitary tumour sends out excess growth hormone, which can cause diabetes and hyperglycemia. (not hypoglycemia @apollonia-artemisia ).

Yep, was reading more into it! Excess growth hormone causes hyperglycemia, however a deficiency can cause hypoglycemia. Wonder if that's what caused me to develop it as a child, or if its straight up idiopathic non diabetic hypoglycemia, lol. There's also a thing that can happen with certain tumors that causes hyperinsulin right? The ways a body can do weird stuff is fascinating and sometimes terrifying. Medical papers would be easier for me to understand if I didnt likely have dyslexia on top of everything else!

 

[LeoTheLion]

Hello and welcome to you and your plus sized, possibly sweet kitty.

The blood test is called the IGF-1 test and the blood is sent to Michigan State University. I'm curious what the IGF-1 value was. My girl also had acromegaly.

Acromegaly is a condition that results from a benign pituitary tumour (hypersomatropism). We call it acromegaly cause it's so much easier to say. The benign pituitary tumour sends out excess growth hormone, which can cause diabetes and hyperglycemia. (not hypoglycemia @apollonia-artemisia ). Recent research shows that around one in four diabetic cats has it. The tumour can pulse the amount of growth hormone it sends out up and down, which can mean different doses needed, though not usually as drastic as your kitty's case.

If you weren't home testing at the beginning, and he was only getting tests at the vet, it's possible that he was just overdosed. He may have been lucky to be an acrocat and able to tolerate the overdose more. Side story - a locum vet told me about a kitty patient of his who was getting 20 units instead of 2, because his now former vet tech showed the caregivers the wrong dose. That cat also had acromegaly and survived the accidental overdosing. However, there are cats with acromegaly that need much larger doses - some for whom 20 units is too little.

I see that you are feeding Fancy Feast and high protein dry. Can you tell me which dry food? Have you changed how much of it you are feeding? Most dry foods are very high carb, and reducing the amount fed can also mean a drop in amount of insulin needed.

Thank you! We were not told what his IGF-1 value was but the ER faxed that information over to his regular vet so hopefully i'll be finding out today.

We just started home testing recently when he dropped low one day at the vet and she said to reduce 6u to 2u, so definitely a possibility he was being overdosed all along. Now it's even seeming like 2u is too much for him as well. His BG has been creeping up again since last night, so will be starting insulin again at a more appropriate dose once I speak with his vet. 20u!!! That's an insane dosage. Even 6u felt like a huge amount to give Leo so I can't even imagine.

The dry food is Purina One high protein. He doesn't get it often anymore, just a tiny bit per day especially if he's not eating much of his wet. Over the past couple of weeks he's transitioned to mostly all wet food but can sometimes be a picky eater.

 

[Wendy&Neko]

The Putina One dry is not an appropriate one for a diabetic cat. It is too high on carbs. Pea starch is the third ingredient. I can tell stories of sudden changes in a cat’s insulin needs by removing dry from the picture. Scooter was one. His caregiver thought he couldn’t jump up to where other cats were eating dry. He was on six units of insulin per shot. She removed dry from the house and two scary days later he was off of insulin.

If your kitty must have some dry, there are a couple options that are low carb, Dr.Elsey’s as an example.

 

[Virginie & Chewie (GA)]

Scooter was one. His caregiver thought he couldn’t jump up to where other cats were eating dry. He was on six units of insulin per shot. She removed dry from the house and two scary days later he was off of insulin.

Just goes to show... never underestimate a cat's determination to eat what's bad for them!

 

[FrostD]

Wendy just about covered everything. Also curious what the IGF-1 was one, very interesting that they tested it, most don't (assuming that's the test they did).

The numbers on the 27th - were those with or without insulin ? Did they give a long acting insulin at the vet, like Lantus?

What are yesterday and today's numbers?

He definitely needs a reduced dose it's just a little hard for me to pinpoint what that is without a little more information.

 

[LeoTheLion]

The Putina One dry is not an appropriate one for a diabetic cat. It is too high on carbs. Pea starch is the third ingredient. I can tell stories of sudden changes in a cat’s insulin needs by removing dry from the picture. Scooter was one. His caregiver thought he couldn’t jump up to where other cats were eating dry. He was on six units of insulin per shot. She removed dry from the house and two scary days later he was off of insulin.

If your kitty must have some dry, there are a couple options that are low carb, Dr.Elsey’s as an example.

Thank you for the information! Do you know if the Hills prescription diabetic dry is low carb as well?

 

[LeoTheLion]

I thought they tested it, but now I'm not entirely sure since I never saw any of the test reports. The ER vet just gave me an information sheet on Acromegaly, and faxed all of the testing over to Leo's regular vet. I talked to her on the phone yesterday and she said Acro is a possibility but she's not certain, she wants us to go see an internal medicine specialist to figure things out.

#'s on the 27th were without insulin. The ER vet didn't give him any insulin at all, they were actually giving him IV dextrose the 2 days he was there.

He hasn't had any insulin at all in close to 7 days. I have an appointment at his regular vet on Friday and we're going to decide what his insulin needs are based on this weeks numbers. Am I right in suspecting he might only need 0.5u or 1u? I did notice over the past 2 days that Leo is acting more like himself than he has in a long long time. He's been really alert, he greeted me at the door like he used to, purring again, and even went out on his catio today which he hasn't done since this past summer.

Numbers from the past 2 days are:
11/28
4:00a 390
9:30a 280

11/29
7:30a 257
12:45p 316
9:00p 272

Wasn't able to get many readings the past few days due to a family emergency.

 

[Wendy&Neko]

Do you know if the Hills prescription diabetic dry is low carb as well?

Not low enough carbs for a diabetic, one of the reasons Hills had to change the name from diabetic dry to dietetic dry.

His more recent numbers are looking more like he needs some insulin.

Any vet, even your regular vet, could get sent blood sent to Michigan State University to test the IGF-1. You don't need an IM vet to "figure it out". If you paid for the acro/IGF-1 test, it should be on your bill, and you own the test results. You should be able to get the ER doc's office to give you a copy too.

 

[apollonia-artemisia]

Any vet, even your regular vet, could get sent blood sent to Michigan State University to test the IGF-1. You don't need an IM vet to "figure it out". If you paid for the acro/IGF-1 test, it should be on your bill, and you own the test results. You should be able to get the ER doc's office to give you a copy too.

^This. You always have a right to have access to copies of records, even if something silly like you misplaced the ones you initially had- know that from experience! The only time an acceptable reason to not be given records that you own is if the clinic is required to purge old records after a certain age, or the originals got completely destroyed (including digitized versions.) Sure it helps to have someone explain stuff to understand it, but you dont need to have someone do that in order to have access. This is crucial for transfer of care

 

[FrostD]

I thought they tested it, but now I'm not entirely sure since I never saw any of the test reports. The ER vet just gave me an information sheet on Acromegaly, and faxed all of the testing over to Leo's regular vet. I talked to her on the phone yesterday and she said Acro is a possibility but she's not certain, she wants us to go see an internal medicine specialist to figure things out.

#'s on the 27th were without insulin. The ER vet didn't give him any insulin at all, they were actually giving him IV dextrose the 2 days he was there.

He hasn't had any insulin at all in close to 7 days. I have an appointment at his regular vet on Friday and we're going to decide what his insulin needs are based on this weeks numbers. Am I right in suspecting he might only need 0.5u or 1u? I did notice over the past 2 days that Leo is acting more like himself than he has in a long long time. He's been really alert, he greeted me at the door like he used to, purring again, and even went out on his catio today which he hasn't done since this past summer.

Numbers from the past 2 days are:
11/28
4:00a 390
9:30a 280

11/29
7:30a 257
12:45p 316
9:00p 272

Wasn't able to get many readings the past few days due to a family emergency.

I would try 1U, if you can test during the cycle and have a hypo kit. 0.5U would also be fine, but given his numbers at 2U might be too much of a reduction...the concern with that is the possibility of ketones forming and DKA.

It's what you are comfortable with...but if you are going to completely remove dry then I would go 0.5U.

 

[LeoTheLion]

I would try 1U, if you can test during the cycle and have a hypo kit. 0.5U would also be fine, but given his numbers at 2U might be too much of a reduction...the concern with that is the possibility of ketones forming and DKA.

It's what you are comfortable with...but if you are going to completely remove dry then I would go 0.5U.

Thank you. I don’t think I’ll be able to completely eliminate dry food yet (but will be looking for a healthier choice).. so will probably go with 1u and see what the vet thinks on Friday morning. We’re planning to restart insulin at that point.

Todays numbers so far:
9:00a 259
1:00p 233
6:00p 218

 

[Ale & Bobo & Minnie (GA)]

Thank you. I don’t think I’ll be able to completely eliminate dry food yet (but will be looking for a healthier choice).. so will probably go with 1u and see what the vet thinks on Friday morning. We’re planning to restart insulin at that point.

Todays numbers so far:
9:00a 259
1:00p 233
6:00p 218

these numbers require insulin. You should restart at 1 unit as others have mentioned

 

[Bron and Sheba (GA)]

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