cat does not respond to insulin

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teacher56

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Hi, I am new to this board. My 8 year old cat was diagnosed with chronic pancreatitis (from toxoplasmosis) last June and it developed into diabetes. He was on Lantus from June until early December when he was switched to ProZinc. His BG level stayed around 325-365 on Lantus, and remains the same on ProZinc. I do not check his BG at home, but have weekly BG tests at our vet. My cat's dosage was increased up to 5 units twice daily on Lantus with no real BG improvement and he had gradual but steady weight loss. (He is large, but was not obese to begin with). So the veterinanrian changed him to ProZinc. So far, his BG is the same range (checked twice) but I now notice that he is drinking a ton of water, urinating a lot, and is constantly starved for food. I guess he is not properly breaking his food into nourishment. He is eatling close to three cans each day with no weight gain. He has been on canned food for several years. I would really appreciate your advice: should I give the ProZinc more time and more gradual increases like I did with the Lantus to see if it works better than Lantus? Do I try a new vet? Could there be some other cause? I don't know what to do but feel so bad for my kitty.
 
I'd suggest you do a lot of reading on this site. We have a very successful plan of home testing, diet and careful dosing that has helped hundreds of cats.Here's some info on how ProZinc is dosed:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

We would strongly urge you to test at home. Sometimes, cats get caught in a dose merry go round. They have higher numbers at the vet because they are stressed and stress raises bg levels. The dose is raised based on those numbers. When they get home and relax, it may be too much insulin. Then they can experience rebound.

Rebound is explained on this page (along with lots of other things that make regulation difficult)

http://petdiabetes.wikia.com/wiki/Obstacles_to_regulation

I think I would start again. First, home test. Then check out his diet. Are you staying under 10% carbs? Www.catinfo.org. Once you get some numbers at home, you can see how exactly how the insulin is working and what you can do to adjust.
 
Thank you for the advice. There is an abundance of wonderful info on this site and I will continue to peruse it. I will try to track the amount of carbs my cat is ingesting a bit better. Several months ago I wrote Purina and they sent me a packet of nutritional info/breakdown on each of their canned cat foods. Using that as a guide, I have been limiting my cat to the lower carb cans. He has not been fond of the DM food my vet sells. However, I am not sure he is under 10 carbs a day and will adjust that if necessary. I will also talk to my vet this week about home testing (must admit this is not something I really wish to do, but will do whatever is best for my kitty Pumpkin.). He did have a whole day BG curve done early this month and the BG was nearly the same all day - before and after insulin injections as well. Thanks again.
 
teacher56 said:
Thank you for the advice. There is an abundance of wonderful info on this site and I will continue to peruse it. I will try to track the amount of carbs my cat is ingesting a bit better. Several months ago I wrote Purina and they sent me a packet of nutritional info/breakdown on each of their canned cat foods. Using that as a guide, I have been limiting my cat to the lower carb cans. He has not been fond of the DM food my vet sells. However, I am not sure he is under 10 carbs a day and will adjust that if necessary. I will also talk to my vet this week about home testing (must admit this is not something I really wish to do, but will do whatever is best for my kitty Pumpkin.). He did have a whole day BG curve done early this month and the BG was nearly the same all day - before and after insulin injections as well. Thanks again.
Click to expand...

The best thing you can do is to home test. You will save money by eliminating the testing at the vet office, and you will eliminate the cat's stress which likely gives false readings at the vet office, meaning you are dosing based on stress influenced numbers.

I have 2 diabetics and one tests higher at the vet office, but the other tests lower than normal.

My cats would not eat DM; they tried to cover it up, so that tells you what mine thought of that crappy food.
Find some in Binky's list.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

One thing to keep in mind is that until the cat is regulated, you may have a hungry cat because the body is not able to process the food well enough to extract what is needed, so feed some extra.

As for the Lantus not working, I don't think that's the case at all. Lantus is a longer lasting insulin than prozinc, so I'd suggest to switch back and home test to find out how it works.For all you know, you may have just needed to increase the dose.


What were the numbers from the last curve at the vets? What was the dose given at that time. Also what doses were you giving on Lantus in the past and what were the numbers from the Lantus curves and how was it decided that Lantus was not working?
 
Home test, home test, home test!
You really can't tell what's going on with Pumpkin unless you do - as evidenced by one bean thinking you may be giving too much insulin and one thinking maybe you should have increased the lantus further before giving up on that.
I felt like I was going to throw up the first time I tested Vyktor but we both got used to it in no time and within a week he was purring through his tests in expectation of the treat to come, and this is a cat I can't pill!
Start by rubbing Pumpkins ears everytime you think of it for a day or three until she gets used to that. Then start clicking the lancing device near her ear so she gets used to the noise. Vyktor wasn't fussed by the noise so we tested the first day we clicked. Most importantly be calm and matter of fact about it while you're doing it and don't forget a low carb treat when you're done - whether you've been successful or not.
There are plenty of videos floating around the web that show you exactly how to do it. Good luck, I'm sure you'll be an expert tester in no time.
 
What dose of Lantus did you originally start at? 5 units is a very high dose unless there are other health issues going on. It is possible that you may have started at too high of a dose and missed your optimal dose. There is a condition called Somogyi effect or rebound that causes the BG levels to be high when too much insulin is given. In order to protect itself from hypoglycemia, the cat's body releases extra glucose when too much insulin is given. Therefore, you get high BG readings.

Once you are hometesting, you should consider starting over with your dose. Start over at 1 unit and give at least one week before increasing it. Then only increase by 1/4 - 1/2 unit and keep the same dose for at least another week before adjusting it again. You probably will find that you only may need to give 1 to 2 units to keep the BG levels under control.
 
Thank you all for your responses. I will ask my vet to demo home testing tomorrow when I take Pumpkin in for BG testing.In response to your query, he did start on a very low dose of Lantus when all this began (first of July), about 1/2 unit twice daily and was slowly increased every 7 - 14 days by another half unit. At the end of November, he was up to 5 units twice daily with no significant improvement. I actually believe the full day BG curve that was done on him at the end of Nov was likely skewed. I fed him before taking him to the vet and they administered his insulin. They ran out of the right strips or whatever they used to measure the BG and substituted human ones. The technician said it didn't matter, but his BG shot up to 400's when that happened and had never in 5 months been that high (or since). Before the substitution the BG was level at 320. Perhaps there has been the possibilty of overdosing with insulin and rebound effect. I will see what the vet says about that. While on Lantus, Pumkin's BG did not fall to normal levels and he did seem to feel bad after getting his shots (sitting hunched over for a half hour or more and occasionally throwing up liquid). However, I do not like some of the symptoms I am seeing him exhibit on ProZinc. He is soooo constantly hungry, even though I have increaased his food. This is not a problem because he has lost so much weight. He is listless and not very loving anymore.. He rarely wants to be in the same room as me. :( I know that must be because he does not feel well. Maybe the ProZinc just needs to be increased again......?
 
I think they did check his thyroid early on. He tested postivie for toxoplasmosis and they gave him the pancreatitis test which was positive. Good questions and I will follow up with the vet. My cat has always been considered large - very long and tall. He did get overweight at one point, though he did not look obese. At his highest point he got up to almost 18 pounds. While the vet acknowledged he was overweight, they were not too concerned about it due to his overall size. He now weighs 12.2 and is quite bony. The vet said he is now burning muscle mass.
 
What treatment was done for pancreatitis, and what was the test result number. A positive is anything above 3.5 so ask the vet for the result number.
Treatment is usually to give fluids at home, pepcid for nausea, and pain meds such a buprenex. Pancreatitis is very painful so you should have been advised of this treatment.

have you had recent bloodwork done and what were the values? Can you get a copy of the numbers?

If you are at a dose of 5u and still getting numbers in the 300s, you likely need to raise the dose but you want to be home testing to be sure he has high curves even when tested at home.

it's worrisome to hear he is big, bony at 12.2 lbs. What are you feeding currently?
 
Just wondering, how was the toxoplasmosis treated? There are meds to treat, and I can't find where it's connected to pancreatitis and then leading to diabetes.

http://www.vet.cornell.edu/fhc/brochures/toxo.html

toxoplasmosis - Can toxoplasmosis be treated?

Most cats that have toxoplasmosis can recover with treatment. Treatment usually involves a course of an antibiotic called Clindamycin. Other drugs that are used include pyrimethamine and sulfadiazine, which act together to inhibit T. gondii reproduction. Treatment must be started as soon as possible after diagnosis and continued for several days after signs have disappeared. In acute illness, treatment is sometimes started on the basis of a high antibody titer in the first test. If clinical improvement is not seen within two to three days, the diagnosis of toxoplasmosis should be questioned.

And pancreatitis needs to be treated with pepcid, fluids, and pain medication

To hear the cat has lost weight, from 18lb down to 12.2 is concerning.
 
Gayle, my cat had the treatment you refer to for Pancreatitis - fluids, pepcid, anti-nausea medication and appetite stimulant. He had a CBC and thyroid test, as well as the test for pancreatitis that was positive. He was also tested for toxo and that was determined to be a likely cause of the pancreatitis. I do not know the numbers.
At his BG check yesterday, he had a reading of 322, not bad considering it was a stressful visit with a long wait - most untypical at my vet's office. He was increased on Prozinc from 2 units am and 1 unit pm. to 2 units am and pm, and after the holiday weekend, I am to increase him to 3 am and 2 pm. His BG was down a bit at this visit. However, I sure do hate the new symtoms. My cat is hungry non stop - even right after eating and is very irritable. He does not even want to be petted. He just lays in the kitchen (near the food). And drinks a ton of water which he did not do on Lantus. I think if he is not better by next Wed, I am telling the vet I want to go back to Lantus and look for other causes of his high blood glucose. I am tired of my kitty feeling sick. My vet and I discussed this yeserday, and he does not seem to show signs of thyroid problems or acromegaly. I am wondering if anyone has had a similar experience with ProZinc and if it goes away??
 
teacher56 said:
Gayle, my cat had the treatment you refer to for Pancreatitis - fluids, pepcid, anti-nausea medication and appetite stimulant. He had a CBC and thyroid test, as well as the test for pancreatitis that was positive. He was also tested for toxo and that was determined to be a likely cause of the pancreatitis. I do not know the numbers.
At his BG check yesterday, he had a reading of 322, not bad considering it was a stressful visit with a long wait - most untypical at my vet's office. He was increased on Prozinc from 2 units am and 1 unit pm. to 2 units am and pm, and after the holiday weekend, I am to increase him to 3 am and 2 pm. His BG was down a bit at this visit. However, I sure do hate the new symtoms. My cat is hungry non stop - even right after eating and is very irritable. He does not even want to be petted. He just lays in the kitchen (near the food). And drinks a ton of water which he did not do on Lantus. I think if he is not better by next Wed, I am telling the vet I want to go back to Lantus and look for other causes of his high blood glucose. I am tired of my kitty feeling sick. My vet and I discussed this yeserday, and he does not seem to show signs of thyroid problems or acromegaly. I am wondering if anyone has had a similar experience with ProZinc and if it goes away??
Click to expand...

I am wondering what acromegaly signs you are expecting to see.
One of my acros was a small finely featured female DSH cat. I have not used Prozinc but her dose kept rising and her numbers were not improving. My vet at the time said she is female and has no acro signs. I said her dose is high and I want her tested.
She tested positive and the vet was shocked.

If your cat is hungry non-stop, feed your cat. One of my cats was eating around 30oz of food a day and the other acro was eating close to 24oz a day. As they became regulated, their hunger diminished and they are now around 10oz and 6oz a day, if that much.

I am also wondering if you are getting BG numbers over 240, why are you not increasing the dose?
I would suggest that you go back on Lantus, and try the protocol followed in the Lantus forum. Get your cat established on Lantus and raise the dose slowly, per protocol, until you are getting better BG numbers.
Lantus and Levemir work very well. You just have to work up to the dose your cat needs to get to decent BG numbers under 240
 
Thanks Gayle, I will ask my vet to check Pumpkin for the acro next week. I also appreciate the info on amt of food. Pumpkin has been eating about 15 ounces of food per day. In the past 3 weeks, his weight has stablized and he has stopped losing weight. I had started feeding him more. I was worried about feeding him too much but now I won't worry so much. And to clariy - his doses have been regularly increased every one to two weeks. After he was taken off Lantus and switched to ProZinc, he was dropped to a low dose again to see how that affected him. The vet did not want to chance hypo. He is being gradually increased once again. Thus the increase from 2 units morning/one at night to 3/2 beginning next Monday. Question - what was done for your cats with acromegaly? **I really appreciate your suggestions, many thanks.
 
I tend to give more aggressive dosing advice than many PZI/prozinc users, but that's a huge increase at one time. Your kitty was on 2 and 1, and is going to 3 and 2? That's a 67% increase in daily insulin intake all at once.
First, your vet should not have had you dosing unequal amounts day and night. Prozinc, like Lantus, should be evenly dosed 12 hours apart, unless you've gathered lots of data that shows a consistent reason for uneven doses day and night. Weeks of repeating-type data.
Can you give us more of the dosing numbers up to now? You said he was started on a low dose? And increased gradually to this point? I'm just having a hard time seeing going from 3u a day to 5u a day as "gradually". The "right dose" may very well be someplace in between 3 and 5 a day, and if you go up that quick, you may "miss it". It's a lot easier to go up in small increments than to miss the correct amount and have to work your way back down to find it. Safer for kitty too.

First thing I would try would be 2u am and 2u pm for a few cycles to see if that brings the numbers down some. When you do increase, any more than .5u at a time is too aggressive, IMO. Most people only kick it up .25u at a time.

Carl
 
I agree. PZI is adaptable but we try to increase slowly, testing so we can tell how the new dose is working. If you increase too fast, you run the risk of rebound: http://www.bd.com/us/diabetes/page.aspx?cat=7001&id=7434

Whether you stick with PZI longer or go back to Lantus, I would increase slowly - .25 units or .5 units - at a time over several cycles.

Here is a huge document on PZI. Too much to absorb at once, but it has great info on how it works and how it is dosed:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799
 
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