An Interesting Development...

Giomax

Giomax

Member Since 2018
Not sure if this is the right place to post this?

I had a long discussion with my vet about WHY Max's condition is only worsening and he suspects that MAYBE Max wasn't diabetic to begin with and we've been giving him insulin he doesn't need! To be honest, I think that's very possible. He started to deteriorate almost immediately after we started him on the Lantus. Symptoms he didn't even have before he started to develop.

I'm supposed to take him to a specialty animal hospital next week to get him fitted for a continuous glucose monitor. Apparently that should tell us if he was actually diabetic when we started or if we've caused the Somogyi effect. The reason the vet diagnosed him with diabetes back in October is because his BG showed as 450 on the test results after they drew blood for his annual wellness profile, and glucose was present in his urine. Even for a nervous cat, 450 is really high for a non-diabetic.

If we find he really has had diabetes all along, we'll start to test for other reasons he's not responding properly to the insulin: Cushing's disease, acromegaly, wrong kind of insulin, etc. Or maybe we just haven't found the right dose for him yet. All we know is that he's been on a steady decline for the last three months and we need to figure out why as soon as possible.
 
I disagree. These numbers are clearly diabetic and he's got insulin resistance from being in high numbers a long time. I think a second opinion at a different vet is a good idea though. In the meantime have you decided which dosing protocol you're going to try?
 
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You can definitely continue to figure out what’s going on with Max. Are you and your vet doing anything to help treat Max’s symptoms? Finding an answer is good but also treating symptoms is good too.

For now, I’d continue what you’re doing with Max’s insulin. He might just have built up a lot of glucose toxicity. It took Ming 10 units of PZI to break his glucose toxicity when he was hospitalized. The way it was done would probably not be advised and I would not do it again but it helped break it.
 
Max was diagnosed in October. When did he start getting insulin? No matter how high his BG was, he should not have been started on 3 units. Lantus is a slow acting insulin & is started at 1 unit for at least 1 week. If no results are seen the dose is increased by .25 units. I don't give dosing advice but I've read everything I can find about Lantus insulin. A lot of vets are not informed & start with way too high a dose & too high increases. I talked to my vet about that just the other day & he was shocked that some of the cats have been started at such a high dose.

Max has all the signs of Diabetes. Neuropathy(,the most common complication in cats that are chronically hyperglycemic is diabetic neuropathy—about 10 percent of cats are affected. The progression to this condition may take several months, and, if properly treated, it can resolve within six to 12 months). excessive drinking water & peeing.And remember Stress raises a cats BG. When the vet checks him his bg will be higher than if he's at home & calm.

You mentioned ,No more dry food. Could he be getting into dry food some how? It will definitely raise his BG. I've seen cats go into remission in a few months when dry food is removed completely.
Have you read all the information in the Yellow sticky notes. The more informed you are the better.

Max's SS doesn't look worse. He's had some yellow & blue that he didn't have before, and less black #'s. Wendy has a lot of experience, she can help you if you just trust that she has MORE experience dealing with Diabetes & insulin than most vets.

If Max had glucose in his urine & a high BG why would you doubt he has diabetes? All these tests & dr's will just stress him out more. ( Ok this is all just my opinion, I get frustrated just like you do.)
Everyone here wants to help you & your kitty Max. The advisors like Wendy donate their time to Help you. Unlike vets that make a LOT of money doing all these tests on your cat.

We have all been in your situation. Anxious for results & stressed out. We come on this forum to get help. It takes time a an enormous amount of patience ( I'm still working on that for a year now) Your kitty's body needs time to adjust to the insulin there isn't any way to rush that.
The insulin must be gradually increased until the correct dose is reached.

I wish you the best outcome with Max.We all really do want to Help.
 
He was started on 1 unit, not 3.

Max wasn't showing any signs of diabetes until we started him on the insulin. As soon as we started, he just went straight downhill. That's why I'm considering it as a possibility. I'm not changing anything with his insulin until we get some more answers.

There is no dry food in my house anymore.

How can we treat the sumptoms? I've ordered the B vitamins for his legs, just waiting on it to arrive. Can't wait to see how it works!
 
Not sure how to treat his symptoms since I don’t have experience with those. But you can certainly change your title and see if other members can weigh in with some suggestions. But yes, I remember reading that B12 injections help with neuropathy but don’t quote me on that!
 
Crista & Ming said:
. But yes, I remember reading that B12 injections help with neuropathy but don’t quote me on that!
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The injectable B-12 is a different type.....it's good for some things (like it can help with energy, appetite, etc.) but it's not very effective for neuropathy.

The form of B-12 that's most effective for neuropathy is the methylcobalamin and it's oral (like in Zobaline for cats)

The injectable form is Cyanocobalamin
 
When Max was diagnosed by the vet, did the vet only test his BG numbers in the office only? Most vets will also send out or do a set of labs that contain a fructosamine test. The fructosamine test is similar to a Hemoglobin A1c in humans -- it gives an average of BG levels over the course of several weeks. It's very helpful at diagnosis since it avoids the issue of a cat being unduly stressed at the vet's office which causes a higher than expected BG number.

It's hard to know if the 1.0u increases are influencing the picture of what's going on with Max's numbers. The TR Protocol which was based on published research, emphasizes dose changes that are in either 0.25 or 0.50u increments. The rationale is that if you are increasing the dose by too large of an amount, you may miss what is a good dose for your kitty.

The other issue you need to factor in is that Max has likely gotten used to being in higher numbers (i.e., glucose toxicity). Whenever his numbers drop below the 300s, you're seeing a bounce back into higher ranges. This "bounce" is a result of his body reacting to the lower range numbers as though they are dangerous and, as a result, a stored form of glucose and counterregulatory hormones are released which causes numbers to spike back up. It usually takes about 3 days for a bounce to clear.

High dose conditions can be another possibility. The more prevalent of these conditions are acromegaly and insulin resistance. Cushings is less common and there is a likelihood you'd see skin tears since they are a symptom of Cushings. We generally begin to think about getting a cat tested for insulin resistance (IAA test) and acromegaly (IGF-1 test) once the dose is in the 5 - 6u range. The tests are only done at the vet lab at Michigan State. There is information on the High Dose board about diagnosis and testing. Lantus has had a very good track record with cats. Both Lantus and Prozinc are the two types of insulin which are recommended by the American Animal Hospital Assn. There are some cats that do better on Levemir, which is very similar to Lantus although it's pharmacology is a bit different. Personally, I'd be more concerned about the type of insulin if your kitty had been prescribed a shorter acting insulin like Vetsulin or Humulin N/Novolin.

I also want to caution you about Somogyi. This is a concept that was introduced in 1938 by an MD based on a small number of human observations. The original study data could never be replicated. In other words, it is at best, very dated and likely poor research. Further, it's not been replicated in cats and certainly not been replicated in cats that have been prescribed Lantus or any other long acting insulin. Roomp & Rand published a study not all that long ago that disputed the presence of Somogyi in cats using Lantus. Despite the research literature, and frankly, much to my amazement, there are vets who seem to be wed to a concept that is more urban legend than backed up by science.

 
He's had regular fructosamine testing, yes. It's what the vet was basing our plan of action on (raise dose, lower dose) before I started home testing.
 
The issue with the regular fructosamine level is you are picking up the "old" levels for several weeks. How long have you been testing at home?

If Max had been fighting somme sort of infection or inflammation around the time of his diagnosis, between the stress of being at the vet and something medical, it could have inflated his numbers. Do you happen to know if he needs any dental work? Anything dental can raise a cat's BG numbers and we've had a number of cats drop out of remission due to a dental issue (e.g., plaque/gingivitis).
 
Your spreadsheet notes that the 17th of this month was his first day on an all-canned diet. What was he eating prior to that?
 
Giomax said:
He was started on 1 unit, not 3.

Max wasn't showing any signs of diabetes until we started him on the insulin. As soon as we started, he just went straight downhill. That's why I'm considering it as a possibility. I'm not changing anything with his insulin until we get some more answers.

There is no dry food in my house anymore.

How can we treat the sumptoms? I've ordered the B vitamins for his legs, just waiting on it to arrive. Can't wait to see how it works!
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Maybe the type of insulin doesn't agree with him. Perhaps try something else like ProZinc.... But he definitly needs insulin.
 
I think Max is diabetic. Even with the dose he is at now, you are not seeing any numbers close to normal to a non-diabetic cat or anything low enough to cause a "consistent bounce" situation.

I am happy to see with switch to low carb wet food. What food did you settle on? With that switch you should see a drop in insulin need - which may take up to a week!! That said, there are high dose conditions that are more common then thought before.

I hope your visit to the specialist helps clarify some issues with Max. A second opinion is never a bad thing. While there I would discuss the high dose conditions that can occur. Wendy has been guiding you and she is very knowledgeable about these conditions as well if you have questions.
 
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