3/18 Taz - Last Post For Help...

Hi, all... I'm going to post my inquiry one last time, but I don't think anyone here has experienced what I am experiencing. Folks here are worried about 2 or 3 units, and I’m up to 6 units on Taz with BG still in the 400s. Each increase in insulin brings no change… seems the BG just gets a bit higher.

Taz was just diagnosed with diabetes 5 months ago in October, and, though the first few months "seemed" to be working with insulin, towards the end of December, it all changed. I was told in a previous post that Taz could both be past the appropriate dose and experiencing a “bounce”, but all the 2-hour glucose curves I’ve done over the last few months (see spreadsheet) show no significant drop in BG (if any drop at all). His food is the Weruva Wx and Gerber Baby Food to control carbs and phosphorus, thyroid tested fine, his IBS/SCL has not progressed, his congestive heart a has not progressed, his kidney issues have not progressed, no UTI, white blood cell count normal, and he has had xrays and ultrasounds that have shown nothing unnormal… yet the diabetes progresses. My questions are:


1. Has anyone had a cat on this high (6 units) of a dose? And did things ever get better? If so, what did you do?


2. Has anyone ever had a cat not respond to an insulin… but, when changed to a different insulin, did have success? This is what I’m considering to do next.


Taz has had BG of 300s, 400s, and 500s for the last few months, and diabetic neuropathy has set in. I can’t figure out how to help him, and the internet doesn’t have any cases or experiences like mine. I thought I’d try once more to see if anyone out there has been threw this, too… here are my two previous posts, if needed:


https://www.felinediabetes.com/FDMB/threads/03-07-taz-amps-549-pmps-524.275080/#post-3053175


https://www.felinediabetes.com/FDMB...53-pmps-478-insulin-help.275325/#post-3055772


Thanks,

Amanda

 

Tagging a few people familiar with high dosing.
@Wendy&Neko
@Suzanne & Darcy
@FrostD

 

Hello and welcome. My girl got up to 8.75 units in dose, lots of BG numbers in the 400's and even 500's along the way.

When a cat gets up to 6 units in total dose, when increases are done safely, and there are no other medical conditions that can cause the need for higher doses, we suggest that they get the kitty tested for acromegaly (IGF-1 test) and insulin auto antibodies (IAA). Both of those can mean kitty needs higher doses. My girl had both of them. Acromegaly is caused by a benign tumour on the pituitary gland that causes excess growth hormone to be produced, which in turn causes the diabetes. Recent research has shown one in four diabetic cats has it, though not all need higher doses. Amongst other side effects of acromegaly and that growth hormone are growth in organs, which can lead to things like HCM (and possibly congestive heart failure), kidney disease, and GI issues such as thickened bowels. There are treatments for acromegaly, so it's good to get that test done to see if you can start treatment. By the way, prednisolone by itself can cause a cat to need more insulin, though usually not as high as you are seeing.

You will notice that in my first sentence of the previous paragraph, I used the phrase "increases done safely". I'm afraid that it's hard to say if that was done by looking at your spreadsheet. Our Start Low Go Slow methods mean getting a test before each and every shot, not just on curve days. Plus doing that curve every 7 days to try to see how low the dose is taking your cat. Increases at lower doses are by 0.25 units at a time, so you don't shoot past a good dose. I see Bron mentioned that possibility in your previous post. Have you got any other test data, for say the last couple weeks? That can help us help you with dosing.

Taz's numbers do seem to be getting worse with increases, as shown with the data in your spreadsheet. There are a couple possible explanations for that. One is too high a dose, the other is that he has some condition causing insulin resistance and the resistance is climbing.

Diabetic neuropathy is treatable. Post about it here: Feline Diabetic Neuropathy Getting him better regulated will also help.

And lastly, if Taz does have one of the other endocrine conditions (acromegaly and/or IAA), you may find that a switch to Levemir insulin will help. We've seen a number of higher doses cats do better on it.

 

I have much to say, but first and very importantly, please stick around and continue posting here. Your situation is complex but definitely not unique. There is a lot to unpack but I do believe we can help you. We will certainly try.

There is a tremendous amount of collective knowledge and wisdom on this board, as well as real-life experience “in the trenches” of feline diabetes and other concurrent diseases. I encourage you to keep asking questions and leverage the info that is offered. It might be a lot to absorb, but keep at it. We might not be able to guarantee success, but we can help stack the deck in your kitty’s favor and perhaps help you feel more enlightened.

I too have had complex kitties. Sometimes we need clear steps to follow. So first thing I would suggest to get a pre-shot test before every insulin injection as well as try to get at least one test between injections. Then put those values in the spreadsheet so we can see it. Those data points can help answer your dosing question and perhaps sort out the puzzle of what’s happening..

The reason that we need multiple days’ worth of data is that not every “cycle” (the 12-hour window between shots) is identical. For example, low numbers or rapid BG changes can trigger high numbers (and in some cats those high numbers can last several days). If you only happen to test on a day when the BG is running high from one of those events, you might mistakenly think an increase in dose is warranted. In reality, the opposite might be true. I can’t emphasize enough how important it is to test.

And yes, too much insulin can look like too little.

A vet who used to frequent the site equated administering insulin without BG testing to be like driving a car with a paper bag over your head. Just as you watch the road every time you drive, you really need to monitor BG every time you inject insulin.

Is there a reason you can’t test more frequently? If so, let us know and we can try to find a solution.

Looking forward to your responses. You seem to care very much for you kitty and hopefully we can help you get on track.

 

Wendy, you are a god-send! All this specific info to Taz’s current issue is SOOOOO helpful. I was beginning to think no one else had this issue, so I was scared I was never going to find a way to help Taz. I know you said, “My girl got up to 8.75 units in dose, lots of BG numbers in the 400's and even 500's along the way.” Can I ask if she ever reduce down the units and/or the BG numbers? Or did she stay that high due to the acromegaly/IAA? And, if you did reduce, how did you do it—changed insulin, decreased insulin units slowly, or a large drop down in insulin dose all at once?

My vet has mentioned in our last meeting about possibly testing for acromegaly next, but I’ll also mention testing for insulin auto antibodies (IAA), though I’ll have to research what that is.

And for my information, you said, “Increases at lower doses are by 0.25 units at a time”. This is the second time I’ve heard this… how is that done? All the insulin needles I can find are half-units at the least, so I’m not sure how a person would administer a quarter unit. Is there a special needle out there?

You asked, “Have you got any other test data, for say the last couple weeks?” I grabbed my glucose monitor, and I’ve updated my spreadsheet. I don’t get time to get on the computer often, and when I do I’m usually searching for answers, so I had only put some of the curves and major readings on the spreadsheet… but I put all the readings I had from the last couple weeks on it now, as I test Taz twice daily before insulin.

“Taz's numbers do seem to be getting worse with increases, as shown with the data in your spreadsheet. There are a couple possible explanations for that. One is too high a dose….” I’d like to explore that by reducing his insulin, but, as I mentioned above, I need to know the right way to do this safely, if you have any advice?

I’ve purchased some methyl-B12 that will arrive Monday to try on him for his neuropathy, and I will talk to my vet about possibly switching him to Levemir insulin. If I may ask one additional thing… did you kitty ever experience noisy breathing at times? This has just started over the last few months. It’s not constant… just occasional. Almost sounds like he’s congested, but no nose drainage (vet has had me administering decongestant and saline drops to see if it helps clear it up, but it hasn’t so far). No drainage, sneezing, or coughing to indicate a upper respiratory infection, and vet says his lungs sound clear. He’s started snoring on occasion, too. Just trying to figure out if this is a problem, too, or just old age.

Sorry for all the additional questions, but I’m just so happy to have someone who’s been there to talk to about this. Thanks again!

Warm regards,
Amanda

 

Thanks for the info, JL... I really appreciate the positivity, as it is easy to feel like I'm doing this all wrong. I almost always test twice daily before each injection... I just don't often have the time to get on the computer to record it, as I am caring for a couple of other cats with issues and a disabled family member. I did take some time tonight to load a couple of the most recent week's BG numbers onto Taz's spreadsheet, so hopefully this extra info will help.

Thank you,
Amanda

 

Noisy breathing is common in cats with acromegaly. Tubby had acro and noisy/raspy breathing was one of the signs (caused by overgrowth of tissue).

For what it’s worth, Tubby went up to 12.5u of insulin and also saw lots of numbers in the 400s and 500s at times.

Heart and kidney issues are also common in acro cats, as are a pot belly, clubbed feet, and a host of other issues.

I believe the guideline is to be on insulin for at least 72 (?) days before testing for acromegaly. @Wendy&Neko can you confirm? The blood needs to be sent to Michigan State University; The test for IAA can be done at the same time.

I suspected Tubby had acro based on his large size (26 lbs), pot-bellied appearance, flat head, noisy breathing, and eventually the large insulin dose. I had the benefit of being aware of acro in advance so was quick to inquire about it and push for testing. He went from needing very little insulin to large doses seemingly quite quickly. He also had a significant problem with constipation/obstipation that bordered on mega colon.

I’m not saying Taz has acro, but it’s a possibility. Just knowing there might be an explanation out there for what one is seeing can be a huge relief. Check out the “Sticky” notes on the Acromegaly forum of this board if you want to read a bit about acro; I know I had a few “aha” moments the first time I read them.

 

According to a study at the Royal Vet Clinic, 1/3 of cats tested false negative for acromegaly if tested before 73 days on insulin. Taz has been over 5 months, so he's OK to be tested now.

Neko's symptoms weren't as obvious. She had a very aggressive appetite (think growing teenagers), and a higher than average dose. Later on I found out one teary eye was probably due to soft tissue growth in her tear duct. Many years later she got a slightly wispy breath, but not the breathing/snoring some acros get. One side effect was arthritis, which got quite bad. Towards the end, she had issues with kidneys, heart and small cell lymphoma. The symptoms seen by cats can vary from cat to cat.

I had Neko treated for acromegaly, by stereotactic radiation therapy, or SRT. There are newer treatments available since then. She did reverse course on the dose and at her lowest was on less than a unit of insulin. More important, she had a better quality of life as a lot of the acro symptoms diminished. The dose reductions didn't happen all at once, but off and on, some rather quickly. I followed the Tight Regulation protocol for dosing and managed to stay on top of the changes.

The other two people that Red tagged in post#2 also had acrocats, both on Prozinc at one point. You are definitely not alone.

We eyeball the 0.25 units on syringes with 0.5 unit markings. Once the dose gets over 5 units, we generally move to 0.5 unit changes at a time.

Before you do this, I'd like to see if you can do an experiment. If a cat is on too high a dose, there will be times when he/she will go lower. Is it at all possible for to get a second test each cycle for a few days? At night that could be a before bed test if you are up at least 2-3 hours after the shot. The same in the AM or if you are home from work a couple hours before the PM shot would also work. Those data points can be clues of lower numbers happening in the middle of the cycle. I've seen cats with really high preshots dive down, earn a reduction by going too low, then zoom back up again. Neko's first reduction was earned when she started in the high 400's. Without testing mid cycle, I would have missed it.

The reason for the experiment is what if he does need a higher dose? You'd be set backwards and possible opening up for a scenario with ketones.

 

Hello! You certainly are not alone. You've gotten great advice thus far. Like Wendy said, the first step is to verify the dose isn't too high. Then you cross each bridge as it comes.

If the dose is too high, we help you find a safe one. If the dose is ok/not enough, then there's the blood testing. If it's acro, we can help you understand treatments and pros/cons/risks. If it's IAA there is no treatment but to wait until it resolves (within about a year) and possibly handle dosing a little differently.

 

Wow, JL... your post just gave me an "aha" moment! Your comments on "noisy/raspy breathing" and going "from needing very little insulin to large doses seemingly quite quickly", Taz's recent larger stomach (couldn't figure out how he was getting chubby/pot-bellied on the same diet/calorie intake), and his issues lately with constipation all really seemed to suddenly connect some dots for me. I'm going to push to have him tested this week, if possible, and I'll be checking into those sticky notes for more info. Thanks for all these amazing tidbits!

Yes, Wendy, I will try that experiment. Taz has actually been at 6 units for a week, so I'm going to do a curve on him tomorrow per the vet. This will give a lot of data points to check out, and then I'll follow that with a couple of days doing mid-day and before-bed tests to confirm. Plus, I'll start checking into SRT to begin educating myself, in case it is needed. Thanks!

And I appreciate your chiming in, FrostB! Knowing there are a few folks out there that have had this experience and walked this path before finally gives me some hope that Taz can be helped. I was getting such a desperate feeling that I was all alone in this journey because Taz was some kind of unique, rare case. I'm so sorry your kitties had this situation, too, but I'm so glad such helpful people are around to share their experiences and advice. You are all MUCH appreciated! I'll post back to this thread Taz's numbers when I get them entered on Thursday. Thanks, everyone!!!

 

SRT was the only treatment available at the time Neko got her diagnosis. There are a couple other options now. One is a medication called cabergoline, the other is surgical removal of the pituitary gland. We've had members here that have done one or the other. Cabergoline is by far the cheapest and is something you can do at home. Melissa's Mr. Kitty went off of insulin on it, though most just need lower doses. Surgery isn't available many places, but Washington State University does it. SRT is available in more locations. Lots of trade offs.