Cat came out of remission and BG is much harder to control

[eleutherium]

Hi everyone! New poster, long time lurker, obligatory thank you’s to you all for contributing to such an awesome resource. Truly would have been lost without it.

My 11 year old Siamese (Beans) was diagnosed with diabetes early last year. Naturally I freaked out for a few weeks like everyone else, convinced there was no way my stubborn very typical meeze would let me do all this to him. Welp turns out he doesn’t really mind any of it at all and thinks his ear pricks are just a bit of pain and a bunch of ear rubs. His initial BG readings were around 500 but I noticed the peeing and the drinking before he had a crisis. He was put on 1 unit of Vetsulin twice a day, he was put on low carb wet food (Fancy Feast at first), and he went into remission within a month.

He stayed in remission until late summer when his BG started creeping up again. He then decided he was over Fancy Feast so I switched him to Primal Freeze Dried, which he loved ravenously for a few months but I swear they change their formula around a lot and he went off it. Now I have a combo of low carb foods including Weruva, Fancy Feast, and Merrick that seems to keep him happy. I’ve carefully monitored his BG, even doing curves every week, and there was never a clear connection between any of the food and his BG. I sure was hoping it was a food issue. Once he got to 175, I took him to the vet and we put him back on Vetsulin. This was in August, I believe.

Problem is he’s WAY harder to regulate now than before his remission. He was very regular with very little Vetsulin and he got the full twelve hours out of it, but now I give him between 1.5 and 2 units twice a day and he’s still 250-350 most of the time when I test him before meals. He gets about ten hours of control out of it. If I give him more than 2 units, he gets too low. I’ve tried doing small meals midday but anything more than a freeze dried chicken breast treat just seems to bounce his BG around more. I’ve considered switching to Lantus but my vet didn’t think it was likely to make enough difference to justify the cost. Prozinc seems a bit more affordable, but it’s twice the price of Vetsulin and all of this is really adding up. I’m disabled, I only work part time, and will be a grad student later this year so if I’m going to spend even more on this, it’s got to make a significant difference for him. I’m barely making this work as it is.

The good news is he’s doing awesome even if his BG is erratic. He pees and drinks a bit more than before the diabetes, but not like when it first came on and the vet said he’s always going to drink and pee more than an average cat now. No neuropathy, still quite active, no issues losing or gaining a bit of weight if he needs to go up or down, and still just as screamy and bossy as ever. I’m just wondering if this whole “regulated before remission/everything is on fire after remission” is common and what else I can do, if anything, to better regulate him. He can still vary anywhere from 100-400 before meals. My vet said that lots of cats live long lives with imperfectly regulated diabetes, and not to worry too much. Would folks generally agree with her? I’m open to ProZinc, I’d just love some reassurance from people that it was worth it for you. Any tips or feedback are greatly appreciated. Thanks so much!

 

[Elizabeth and Bertie]

Hi, and welcome, 'long time lurker'.

It is often the case that it is much harder to get a cat into remission the second time around. And it can take a concerted effort to get the kitty into remission again.
Do you know if he might have any dental issues? Just wondering if there is a 'reason' for him coming out of remission that you could address? But quite often there isn't an obvious reason. I think I read just the other day that (according to recent research) around 30% of cats may come out of remission.

Kitties have a higher chance of going into remission if the blood glucose is kept well controlled for as much of the time as possible. The 'difficulty' with Vetsulin is that it typically has a short duration, often falling far short of 12 hours. This means that there may be a number of hours out of each day when the cat has no insulin in it's system. (There are cats who get better duration out of it, but they are few and far between.)

To get longer duration some people have actually given Vetsulin three times a day (starting with the day's total amount split into three rather than two doses). But this needs to be done with great care, and is a difficult schedule for the caregiver to maintain, especially given that regular blood glucose tests need to be done as well as the shots themselves in order to keep the cat safe from hypo.
The other option is a longer lasting insulin. And Prozinc does typically have a longer duration than Vetsulin. Research at the RVC in London found that cats switched from Vetsulin/Caninsulin to Prozinc had better glycemic control, better clinical signs, and higher chance of remission. ...And although Prozinc costs more than Vetsulin per vial its shelf life may be a bit longer, so, depending on the dose it may not cost you a whole lot more.

Recent remission research (again at the RVC in London) found that Prozinc and Lantus had similar results in terms of glycemic control and remission rates. However, much depends on how the individual cat responds to any given insulin. An insulin that works well for one cat may not work so well for another.

Lantus is a popular insulin on this forum, and many have had success with it. I think some US folks actually buy it online from Canada because it's cheaper that way.
Levemir is another good insulin, and is also popular here. It can sometimes produce longer flatter curves than other insulins.
Lantus and Levemir are 'depot' insulins and form a little store in the body (depot) that releases over time. For that reason it can take a few days to see the full results of any dose.
Prozinc isn't a depot insulin and the results are more 'immediate', though the curves may be more up and down than might be the case on a depot insulin.
Unfortunately there is no way of knowing in advance which insulin will work best for our cat...

My own cat had very erratic blood glucose levels for years, and was often in high numbers. He coped OK with no apparent ill effects (he's been diabetic for 12 years and is now a rather doddery 20 year old, but still pretty content). Other cats don't cope so well with high numbers. Again, it's an 'every cat is different' thing. Ultimately, we just do the best we can. There are some things in our control, and some that aren't.

Eliz

 

[eleutherium]

Hi Elizabeth (and Bertie!),

Thank you so much for such a thorough reply, that really tied all the disparate things I’d been reading together in a way I can understand. I realize no one can predict whether ProZinc will be worthwhile until we try, but your explanation gave me exactly the details I was looking for to feel confident in giving it a try. My vet made it sound like it wasn’t likely to matter, but as great as she is, the people who actually take care of their sugar cats every day know the nuances better. I’m actually not expecting a second remission for him since his was so brief, but I think we should give the ProZinc a try and see if we can’t get his BG more tightly controlled. I hate to see it bounce around, and even if it won’t kill him, it can’t be fun to be extra thirsty and hungry!

Thank you again for the clarity, I was overwhelmed by all the clinical info. It’s not easy to apply broad strokes advice to individual cases so thank the cat gods we have the forum

 

[Amina&M'row]

Many folks get lantus from Mark's Marine Pharmacy by mail/online. Much cheaper, as they're in Canada. I read you can also buy lantus cheaply in Mexico.