I'm posting this on the main feline health forum in case anyone else has had this problem. For those who have followed Xuxu's situation since December 2012, you know that he has wild swings in BG, and I've tried all of the long acting insulins and various doses in trying to control it. Neither have we been successful in identifying a problem which might be primary and causing the DM as secondary. He seems to have stumped everyone.
I've often found that an unsuccessful internet search is often because you haven't found the right search term to use. I stumbled across the term "Brittle Diabetic",, defined as major uncontrolled swings in blood glucose resulting in recurring episodes of either hypoglycemia or hyperglycemia (diabetic ketoacidosis). Unfortunately over the years, the medical establishment has come to define it as usually happening in young overweight girls and women, and that it's based on unstable emotional responses, and is often a self sabotage. (Gee, blaming it on female hormones again!) I don't think that's the case with Xuxu as he's an elderly cat who has no control over his insulin injections. I did find a few references where they didn't think the patient was self sabotaging, but since they felt a majority of the case studies were, they apparently stopped the hunt for the cause of the instability of the lone patient. Most of the references to Brittle Diabetes was in the 1980-1990's and it seems like the term has fallen out of favor.
The causes they gave for instability are:
poor diabetes control (high sugar diet, missing doses of diabetes medication) not anymore, he's on canned, and I'm giving his shots as regular and accurately as I can
gastrointestinal absorption problems has good stools, no sign of IBS
poor insulin absorption yes with lantus, but when he's swinging from 750 to 100, you assume it's absorbed
thyroid problems (hypothyroidism) tests were negative
adrenal gland problems tests were neg, but because of EOS, he was called cushingoid
drug and alcohol interactions not unless he's managed to get a key to the liquor cabinet and likes peach schnapps
hormonal imbalances well, who knows, nothing in test results.
stress yeah, but it's because not the cause
depression well, he acts happy when bg is in good range
So I'm continuing to do internet search. It seems to me that he has high insulin sensitivity, (since he swings so low with very little insulin) combined with a high metabolism that just seems to "eat up" the insulin. Since he goes up to 750, you'd think that his pancreas must not be making any insulin at all, but on ultrasound, there isn't any further indication of damage that would result in loss of capability.
So, I still don't have any answers, but at least I have a term which, while having no biological basis, at least is descriptive.
I've often found that an unsuccessful internet search is often because you haven't found the right search term to use. I stumbled across the term "Brittle Diabetic",, defined as major uncontrolled swings in blood glucose resulting in recurring episodes of either hypoglycemia or hyperglycemia (diabetic ketoacidosis). Unfortunately over the years, the medical establishment has come to define it as usually happening in young overweight girls and women, and that it's based on unstable emotional responses, and is often a self sabotage. (Gee, blaming it on female hormones again!) I don't think that's the case with Xuxu as he's an elderly cat who has no control over his insulin injections. I did find a few references where they didn't think the patient was self sabotaging, but since they felt a majority of the case studies were, they apparently stopped the hunt for the cause of the instability of the lone patient. Most of the references to Brittle Diabetes was in the 1980-1990's and it seems like the term has fallen out of favor.
The causes they gave for instability are:
poor diabetes control (high sugar diet, missing doses of diabetes medication) not anymore, he's on canned, and I'm giving his shots as regular and accurately as I can
gastrointestinal absorption problems has good stools, no sign of IBS
poor insulin absorption yes with lantus, but when he's swinging from 750 to 100, you assume it's absorbed
thyroid problems (hypothyroidism) tests were negative
adrenal gland problems tests were neg, but because of EOS, he was called cushingoid
drug and alcohol interactions not unless he's managed to get a key to the liquor cabinet and likes peach schnapps
hormonal imbalances well, who knows, nothing in test results.
stress yeah, but it's because not the cause
depression well, he acts happy when bg is in good range
So I'm continuing to do internet search. It seems to me that he has high insulin sensitivity, (since he swings so low with very little insulin) combined with a high metabolism that just seems to "eat up" the insulin. Since he goes up to 750, you'd think that his pancreas must not be making any insulin at all, but on ultrasound, there isn't any further indication of damage that would result in loss of capability.
So, I still don't have any answers, but at least I have a term which, while having no biological basis, at least is descriptive.
