Can't get cat regulated, high dose condition. Need Advice!

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Nic~n~Tom

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Hello, I'm hoping someone can help me out. After several months, my poor cat's diabetes is still not regulated and his quality of life has gotten really poor. He is 9 years old, 15 pounds with a large frame. We started him on glargine (sp?) a few months ago and it didn't help his symptoms at all. He drinks massive amounts of water all the time and always has a huge bladder because of it. We started at 2 units of glargine, moved to 3 and then 4 a few weeks later and had no improvement. We then switched to Prozinc. We started at 2 and now we are at 6. We started doing home glucose curves a couple weeks ago and his numbers have never been below 525. It's usually around 600-700. It seems like the insulin doesn't do anything! A few other things to note... He has had urinalysis and urine cultures with nothing found. He had a test for pancreatitis which came back inconclusive, right between normal and too high (420 if I remember correctly). At one point, we bought a brand new vial of insulin,thinking that possibly there was something wrong with it. We've had several fructosamin tests done and they are always way high. He has developed neuropathy really bad and barely walks around anymore. He had an x-ray a couple days ago and nothing abnormal was found other than a huge bladder (most likely because he drinks so much and doesn't want to go to the litterbox). He always seems hungry and still eats well but he's slowly losing a little weight. I'm so frustrated and sad and just hope there is someone out there that may have some advice. Please let me know if you have any ideas of what we can do or what could be the cause of what seems to be a resistance to insulin. Thanks!
 
Re: Can't get my cat regulated. Need advice!!!!

You might read over the stickies in the Acromegaly forum to see if you think acromegaly, insulin autoantibodies, or Cushings could be possibilities. Maybe change the title of this post to add "High Dose Condition???"

Acromegaly-- The Basics

Acromegaly and Other High Dose Conditions: What We Know

Also, we need some blood glucose test data we can review, to help us see any patterns which may be occuring. Instructions on creating a spreadsheet are here

Xobaline may help some with the neuropathy.
 
Re: Can't get my cat regulated. Need advice!!!!

I'm in the same boat- my Sneakers is a high dose kitty and still pees a lot. I'm getting the two tests done to see if she has either acro or IAA. She has started slowing down on her food intake and no longer drinks too much water from her bowl (I give her plenty with her food).

The reason we need numbers is it helps to figure out if you jumped too high with the initial dosing and your poor cat might just be in constant rebound. Sometimes the numbers for too much insulin is the same for those for too little insulin. Although I don't know about the symptoms continuing. Someone on the board could look at the numbers and give advice on dropping the dose if that might be the case.

Also, do you check for ketones? If you start to lower the dose that is a necessity to make sure he doesn't go into DKA territory.

Good luck!
 
Re: Can't get my cat regulated. Need advice!!!!

Nic~n~Tom said:
Hello, I'm hoping someone can help me out. After several months, my poor cat's diabetes is still not regulated and his quality of life has gotten really poor. He is 9 years old, 15 pounds with a large frame. We started him on glargine (sp?) a few months ago and it didn't help his symptoms at all. He drinks massive amounts of water all the time and always has a huge bladder because of it. We started at 2 units of glargine, moved to 3 and then 4 a few weeks later and had no improvement. We then switched to Prozinc. We started at 2 and now we are at 6. We started doing home glucose curves a couple weeks ago and his numbers have never been below 525. It's usually around 600-700. It seems like the insulin doesn't do anything! A few other things to note... He has had urinalysis and urine cultures with nothing found. He had a test for pancreatitis which came back inconclusive, right between normal and too high (420 if I remember correctly). At one point, we bought a brand new vial of insulin,thinking that possibly there was something wrong with it. We've had several fructosamin tests done and they are always way high. He has developed neuropathy really bad and barely walks around anymore. He had an x-ray a couple days ago and nothing abnormal was found other than a huge bladder (most likely because he drinks so much and doesn't want to go to the litterbox). He always seems hungry and still eats well but he's slowly losing a little weight. I'm so frustrated and sad and just hope there is someone out there that may have some advice. Please let me know if you have any ideas of what we can do or what could be the cause of what seems to be a resistance to insulin. Thanks!

Well, you have come to the right place.... man, your story sounds familiar; I've heard it before a few times.

OK first thing is diet.
What are you feeding? Low carb wet food or raw is the way to help keep the BG numbers down.
Here are some links with info on foods. There are more links, but it's a start.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

Some cats are very carb sensitive and I have seen cats at high doses, but they were being fed all dry food, and once the diet was changed, down came their insulin needs. One of my own cats, Shadoe, if she got ahold of just a mouthful of dry food, her BG numbers could jump 100points or more.
So food's kind of important.

Next, is home testing. You are going to save yourself lots of money by testing at home and know exactly how your cat is doing. Numbers at the vet are often colored by stress so they're not of much use.
The fructosamine tests can be eliminated because it's just an average of your cat's BG over the last few weeks, and if you are home testing, you can get that average from your own meter.
If you are in the US, just pick up a Relion meter at the pharmacy as these meters have the most inexpensive test strips.
While you are getting a meter and test strips, that's if you are not already home testing, also pick up some KETOSTIX so you can test your cat's urine for ketones. I am thinking if you have not had any issues so far, with months of high BG numbers, your cat may likely not be ketone prone, but better safe than sorry and do the testing at home.
Testing on cat’s ear

Now, you were given some links on conditions for insulin resistance.
I have seen some people give their cat insulin up to a certain dose, then the owner and vet 'think' it's not working, so they switch to another insulin, and get the same problem..... one person tried 4 different insulins, and had the same problem.
The problem is that they just had not reached the good dose for their cat! Work your way up to say 6u and then switch to another insulin and start over lower .... well, what if your cat's good dose was 9units? You got close but stopped too soon!

YES, you can get your cat regulated, so don't worry about that.
Once you have confirmed the diet is low carb, and you start home testing and have numbers to show how your cat is doing, you can dig in and start to work towards the good dose for your cat.

Regarding insulins, I would suggest you try Levemir. I know that Lantus is a good insulin, and for some cats, PZI is also a good insulin, but PZI is more of an intermediate insulin with no overlap, and Lantus has been known to sting at higher doses (as per human diabetics), so if you do find that your cat is a high dose cat, you will find that Levemir is most suitable.
I have had 2 high dose cats, and one did much better on Levemir than Lantus, so I have seen the difference between the two insulins at high doses.

If you are already feeding raw or low carb wet, and you are home testing, then you talk it over with your vet about having two tests done for insulin resistance. Be sure to have both tests done because many cats have one or the other or both.
One of mine has just acromegaly, the other, Oliver tested positive for both acromegaly and IAA.
IAA Test
IGF-1 (Acro) Test

You can get plenty of help on this site to sort out your cat's issues.
most people keep track of their blood glucose test numbers in a Google spreadsheet as it's free and you can set up access for others to view the numbers and they can give you a hand, some suggestions where to go on the dosing.
Create your Spreadsheet

Now, whatever you do, if you don't need to change the food much, don't let people tell you that you must start over at 1unit am and pm; you have already done that a few times, so once you are testing and have some numbers, and then decide on what insulin you will use, you can get yourself on the road to the good dose for your cat.

You mentioned that you are doing some curves; if you are doing these at home, maybe you can post the numbers in here and also set up a spreadsheet.

Any questions you have, ask away. Someone will be able to help you get answers here.
 
Re: Can't get my cat regulated. Need advice!!!!

Nic~n~Tom said:
It seems like the insulin doesn't do anything!

I read your post several times, but you didn't state if you are injecting once or twice a day.

Some vets seem to think that injecting huge doses of insulin once a day is correct, but that is wrong due to how the insulins work.

Please let everyone know if you are injecting once or twice a day, and hopefully they will be able to help you help your kitty. :)

Suze
 
Re: Can't get my cat regulated. Need advice!!!!

if you are giving PZI, I don't see any way there would be rebound because there is no overlap as this insulin does not last 12hrs, and there is no shed so don't worry about a rebound issue.
 
Re: Can't get my cat regulated. Need advice!!!!

Actually rebounds can happen with any type of insulin and is caused by either blood glucose going too low or falling to quickly. This causes the body to react and try to avoid an emergency by dumping glycogen (sugar) from the liver into the bloodstream. With too high insulin doses the cat can end up in a constant state of rebound ending up with consistently high blood sugars.

This happened to Mary and her first update includes her history which is similar to your cat ?Tom's. She was up to 4.5u twice a day and her last fructosamine was 481. She liked wet food but had been fed mainly dry. Ond week later shd is on 0.5 units Lantus twice a day and eating Fancy Feast and running at about 250.

Can you post the town you live in? Hopefully there is someone on this message board near you that could recommend a good vet that knows about feline diabetes that you can work with.

Lisa
 
Re: Can't get my cat regulated. Need advice!!!!

Rebound can happen with Prozinc too. It's duration is from 10-14 hours, unlike the old "PZI" which was more of an 8-10 hour insulin. Plenty of people currently posting in PZI, using Prozinc, have experienced cycles that last longer than 12 hours on occasion, which can (and usually does) indicate that the dose is too high. Other people with cats on Prozinc are shooting TID because they routinely have short (less than 12 hour) cycles. And shooting every 8 hours is causing them overlap of doses routinely.

Please let us know how often per day you have been giving insulin (both with glargine (Lantus) and Prozinc. And let us know what you are feeding, how often, and how much.

Your kitty could either be a "high-dose" cat, or it could be that he's been in constant rebound due to excessive amounts of insulin. Diet could also be a cause of the high numbers.

Carl
 
Re: Can't get my cat regulated. Need advice!!!!

Can you post the results of BG curves you and the vet have performed? make sure you provide the insulin and does for the curves.
 
Re: Can't get my cat regulated. Need advice!!!!

It's possible that your vet increased the insulin dose for Lantus and then Prozinc too fast. How long was your cat on 2 units of Lantus for before the dose was changed to 3 units? What about the doses on ProZinc? Changing the insulin dose too fast before the body has a chance to adjust to the insulin won't do anything for the diabetes symptoms and blood glucose levels.

I agree with testing your cat for Acromegaly and other high dose conditions first. If those come back negative, then you need to look at the insulin and diet for your cat. Lantus works great for cats but there are a few things to know about how that insulin works for cats. Some vets are not familiar with how Lantus works in cats. You can read the stickies at the top of the Lantus group for all the info and show them to your vet: http://felinediabetes.com/FDMB/viewforum.php?f=9

ProZinc is another good insulin choice. There might be some info on how that insulin works here: http://felinediabetes.com/FDMB/viewforum.php?f=24

Diet is important, just like it is for Human diabetics. For cats, a low carb canned food or raw diet is best. Dry food, even the supposedly great prescription stuff vets sell, are the equivalent of ice cream and cookies for a diabetic cat. There are many good brands of commercial canned foods you can feed your cat, from inexpensive Fancy Feast to the higher end brands like Merrick and Nature's Variety Instinct. We can help you with diet.
 
Re: Can't get cat regulated, high dose condition. Need Advic

Thanks SO much to all of you for your really helpful information!

I plan to spend some time today looking into acromegaly, insulin autoantibodies, and Cushings. I’m surprised my vet hasn’t mentioned any of those. The only thing she said was potentially cancer or something like that that would cause the insulin resistance. Does anyone know an approximate cost to test for those 3 conditions?

Here’s some additional info about Tom as requested:

Insulin dosing: we have always given him insulin twice a day 7am/7pm each day when he eats. There have been a few occasions where we haven’t been able to dose at the exact time. I’ve wondered if it’s better to give the insulin earlier or later in those rare occasions. How important is it to give the insulin at exactly the same time each day? As far as increasing the dosage of insulin, we’ve increased 1 unit at a time about every 2 or sometime 3 weeks. I will say that the last time we increased we went from 5 to 6 after 1 week because his bg curve numbers showed that they were barely budging at all. And another question, what is the best way to do the bg curve? Our vet told us to check every two hours but I was curious if that is often enough.

Diet: He has always preferred dry food so he has been free fed on Wellness Indoor cat formula dry food for years. When we found out about the diabetes we switched him to the veterinary DM canned diet and only gave him a portion twice a day at shot time. He didn’t like the wet food so after 2 days we switched to just give him the DM dry food. He’s been on the DM dry food exclusively for a few months. I read that switching to just canned food could help so yesterday I went and got a few cans of Wellness grain free canned food (it has just meat and/or fish) and he is actually eating it! So no dry food for him since Sunday morning. I also just checked out the Binky’s food list link and see that the Wellness canned food I got has a good amount of protein and only 4 or 5% of cals from carbs so my fingers are crossed that he will keep eating it!!

Ketones: We have the Ketostix and have used them a lot to test but they have always just shown high bg every time. The vet has also checked for ketones and says there are no issues.

Home bg testing: We are new to home testing and have only done 1 full day glucose curve at this point. (the vet has done a few at her office). We’ve also done a few random checks for a few hours after his shot to see if it’s gone down at all. I setup a Google account and will start a spreadsheet. Once I get that setup, I will post what we’ve documented so far. We are using the AlphaTrak 2 monitor (recommended by our vet) and just had to order more test strips and WOW… I wish I had read up on different monitors before purchasing it because the strips and lancets are really pricey!!

Also, we live in Thousand Oaks, CA. We’ve been going to our vet hospital with all our animals for many years now and really like them but if there is anyone that knows of a vet close by that treats feline diabetes as a specialty or anything like that, I would appreciate the info.

Thanks again for ALL the great info, it’s given me some hope when I was starting to think there was none! I’m off to do more reading…
 
Re: Can't get cat regulated, high dose condition. Need Advic

Your biggest issue is probably the dry food. When we switched Oliver from dry to wet, he dropped 100 points overnight. It makes a huge difference in blood glucose levels. We try to feed in or under 8-10% carbs. Some dry foods are 35% carbs. It's like feeding human diabetics donuts for every meal and giving them insulin at the same time.

Lots of people have struggled with diet change and we all have tips that helped. Some of mine are warming the wet food until nice and stinky, adding warm water to it to make a gravy, dressing it with Parmesan cheese or tuna juice. This vet has great ideas on her website also: www.catinfo.org

If you could get him eating wet food, that should make the numbers come down. BUT DON'T CHANGE TO ALL WET LOW CARB UNTIL YOU ARE CONSISTENTLY HOME TESTING. As I said, Oliver's numbers changed overnight. If we hadn't tested the next morning and gave him our usual dose, he would have hypoed.
 
Re: Can't get cat regulated, high dose condition. Need Advic

Nic~n~Tom said:
... He’s been on the DM dry food exclusively for a few months. I read that switching to just canned food could help so yesterday I went and got a few cans of Wellness grain free canned food (it has just meat and/or fish) and he is actually eating it!
So no dry food for him since Sunday morning. ...

ALERT: Some cats have dropped 100 points from a change from dry food to canned, low carb food If you are not testing, you run the risk of a hypoglycemic event!!!

Please read and print How to treat HYPOS - THEY CAN KILL! Print this Out!! NOW.

using an Alphatrak, he should not go lower than about 80, when he is 5-7 hours after his insulin shot. And it can take 3 days for that to happen after changing the food.
 
Re: Can't get cat regulated, high dose condition. Need Advic

Nic~n~Tom said:
Thanks SO much to all of you for your really helpful information!

I plan to spend some time today looking into acromegaly, insulin autoantibodies, and Cushings. I’m surprised my vet hasn’t mentioned any of those. The only thing she said was potentially cancer or something like that that would cause the insulin resistance. Does anyone know an approximate cost to test for those 3 conditions?

Here’s some additional info about Tom as requested:

Insulin dosing: we have always given him insulin twice a day 7am/7pm each day when he eats. There have been a few occasions where we haven’t been able to dose at the exact time. I’ve wondered if it’s better to give the insulin earlier or later in those rare occasions. How important is it to give the insulin at exactly the same time each day? As far as increasing the dosage of insulin, we’ve increased 1 unit at a time about every 2 or sometime 3 weeks. I will say that the last time we increased we went from 5 to 6 after 1 week because his bg curve numbers showed that they were barely budging at all. And another question, what is the best way to do the bg curve? Our vet told us to check every two hours but I was curious if that is often enough.

Diet: He has always preferred dry food so he has been free fed on Wellness Indoor cat formula dry food for years. When we found out about the diabetes we switched him to the veterinary DM canned diet and only gave him a portion twice a day at shot time. He didn’t like the wet food so after 2 days we switched to just give him the DM dry food. He’s been on the DM dry food exclusively for a few months. I read that switching to just canned food could help so yesterday I went and got a few cans of Wellness grain free canned food (it has just meat and/or fish) and he is actually eating it! So no dry food for him since Sunday morning. I also just checked out the Binky’s food list link and see that the Wellness canned food I got has a good amount of protein and only 4 or 5% of cals from carbs so my fingers are crossed that he will keep eating it!!

Ketones: We have the Ketostix and have used them a lot to test but they have always just shown high bg every time. The vet has also checked for ketones and says there are no issues.

Home bg testing: We are new to home testing and have only done 1 full day glucose curve at this point. (the vet has done a few at her office). We’ve also done a few random checks for a few hours after his shot to see if it’s gone down at all. I setup a Google account and will start a spreadsheet. Once I get that setup, I will post what we’ve documented so far. We are using the AlphaTrak 2 monitor (recommended by our vet) and just had to order more test strips and WOW… I wish I had read up on different monitors before purchasing it because the strips and lancets are really pricey!!

Also, we live in Thousand Oaks, CA. We’ve been going to our vet hospital with all our animals for many years now and really like them but if there is anyone that knows of a vet close by that treats feline diabetes as a specialty or anything like that, I would appreciate the info.

Thanks again for ALL the great info, it’s given me some hope when I was starting to think there was none! I’m off to do more reading…


For the insulin resistance tests, hold off because you want to make sure that ALL the dry food is out of the system.... dry food is a nitemare to diabetic cats' BG numbers, and lots of cats are diet controlled after switching.

I plan to spend some time today looking into acromegaly, insulin autoantibodies, and Cushings. I’m surprised my vet hasn’t mentioned any of those. The only thing she said was potentially cancer or something like that that would cause the insulin resistance. Does anyone know an approximate cost to test for those 3 conditions?
You can't well blame your vet as very very few would think of testing, and probably don't know anything about the tests, or where to send them, etc.
Here are the links for the 2 you should get done if the diet change does not show big drops in insulin needs and improved BG numbers.... forget about Cushings as the tests can be done but the results are not firm positive, plus Cushings is most suspected if you have a cat whose skin tears easily, is very thin. I've added some info on Cushings for you.
IAA Test
IGF-1 (Acro) Test
Cushings Info

Now, you are at a very high dose... be sure that you are home testing frequently because changing from dry to wet food could result in BIG drops in the BG numbers at a dose of 5u or 6u BID. Please put your testing numbers in the spreadsheet, as well as post here, so that people can help you avoid any possible hypo incident. You may even want to drop the dose a bit during the change.

List of Hypo symptoms
How to treat HYPOS-They can kill! Print this out!
Jojo’s HYPO TOOLKIT

As for that meter, I guess you can stick to the Alphtrak but strips are so pricey! I think I'd want to pick up a Relion meter and strips, saving yourself a big bundle of cash. Relion is not available outside of US; I most like the Bayer contour meters, and a few others, but be sure that you AVOID the FreeStyle meters with their butterfly strips as they give false readings... much lower than the cats are truly having. The meters with TRUE in the names are lousy as well. Just because you have the Alphatrak doesn't mean you have to use it!

I don't think you will find a vet that's all about diabetes, but you don't really need one. Neither of my vets were experts, and the first one knew nothing about acromegaly or the tests. You need a vet for dentals, and vaccines, and mending bones, as well as running tests, and writing prescriptions. Otherwise, if you like your vet and the vet is willing to work with you, and learn with you, then no point in changing. A good and caring vet is wonderful to have, and if your animals like the vet, why upset them with a switch?

If you have any questions at all, or help with your spreadsheet, or even need info to give to your vet, be sure to ask.
 
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