Hello,
My name is Ellen and my cat's name is Ceenka, aka Jungle-Kitty. Ceenka is a 5yo blue Aby dx'd with FD in March 2011. For the last year I have been treating her with Dr. Hodgkins's tight regulation protocol on the diabeticcathelp.com forum. I am happy with her treatment method, it is a good fit for her and me. However I have run into problems getting her regulated and am coming here to see if anyone has encountered a cat with the problems Ceenka has had.
Ceenka has been on four different insulins. She did best on ProZinc, her first insulin. For 5 months she did well on it, in her fifth month it looked like she was imminently going into remission. Her longest "run" was +105 hours on a dose of 0.4u. That month she had lots of runs in the +70s, +80s, +90s with shorter ones in between. Then in her sixth month, something went awry. She stayed in the lower 200s no matter what dose she was given, reductions or increases. It was like shooting water. It seemed like her numbers stayed the same no matter what dose I gave her.
In September I changed Ceenka to Lantus. I was seeing a lot of success with Lantus with other kitties on the board. Ceenka did great on Lantus at first. She seemed to go to +16-+24 runs very quickly. She would stay in double digit BGs, which we seek with our version of Tight Regulation, for hours and hours. As with the ProZinc, Ceenka seemed like the model kitty who was going to go into remission in short order. At the end of her third month on Lantus, Ceenka did an about face. Again overnight she was in BGs from 200 to 250. This time we tried for two months to regulate her. We tried doses from 0.25u to 2.5u. Her normal dose had been 1.0u. Again it didn't matter what her dose was, she stayed in the same numbers. Again like shooting water. I had extensive labs done, nothing was off significantly except her BG and cholesterol. After about 2 months in these numbers, Ceenka went into DKA. This was the second time, the first was when she was dx'd. My vet was astounded at her off-the-chart ketones--she had the highest level of ketones with dipsticks and blood tests. The vet said it couldn't be DKA, it had to be pancreatitis or a UTI. She tested for both, both came out negative.
So we changed Ceenka's insulin again, this time to BCP bovine PZI. We figured that perhaps Ceenka would tolerate the bovine insulin better than ProZinc or Lantus since it was only one amino acid away from a cat's insulin. Ceenka did SO well on the BCP--she was getting +27 runs after 8 or 9 days on it. And hours and hours in ideal numbers. Her doses were markedly larger than her doses on ProZinc. Since they are both PZI insulins I kind of expected that her doses would be similar in size, but this time Ceenka's doses averaged about 3.5-4.5u, as opposed to the 0.4u dose she was geting with ProZinc. And this time Ceenka's insulin honeymoon lasted only 6 weeks. Then back into the 200s. That was a little over two weeks ago. We tried adjusting her dose again, thought it might be going up from too much insulin. Tried reducing her doses. Nothing. Increasing, nothing. Same old, same old.
So then we decided to try ProZinc again. I started Ceenka's doses at the dose she had done well on, no effect. Started moving her up slowly. Within a couple of days she was still in the 200s. Since she was in the 200s again, I was testing for ketones. I managed to catch her a couple of times peeing. No ketones. Then I did a blood test--.01. Last Friday she stopped eating. I thought maybe a tummy problem, gave her pepsidAC. My husband caught her peeing in the late afternoon and she was at the next to highest color. He called me at work to tell me and I called my vet. When she heard that Ceenka had stopped eating and her ketones were so high, she prescribed Humulin-R which I went and picked up before going home. When I got home, Ceenka had that trance look that I had seen the previous two times, she was getting in the bathtub and staring at water but not drinking. Her blood ketone test registered 5.0. We shot her with both insulins.She looked better the next morning. But her numbers didn't come down for about 36 hours. She still wasn't eating, we gave her food and water with supplements by syringe. Added pinch of salt and half that amt of potassium chloride to add a bit of electrolytes in hopes of preventing dehydration. Saturday night I wondered if I might be losing her--her breathing seemed really labored and the trance-state continued. I took her to bed and tested every two hours. Fianlly during the night her numbers started to come down. Sunday morning she seemed alert and affectionate. Her ketones were down to 2.0. She stayed in ideal numbers all day, she didn't need to be dosed again for 19.5 hours. Go figure. (Because of the new insulin, R?) She had a couple of short runs after her long one. But she is coming down, not staying in the 200s.
So, here are my thoughts. It looks to me like it could be insulin resistance, that she stops responding to each insulin after awhile. But she doesn't fit the profile of IAA, acro or Cushings. She doesn't get huge doses. (But they ARE huge for her compared to the initial doses that seemed to work wonders for her.) She doesn't have the incessant hunger that the acro cats on my board exhibit, nor any enlargement of head or paws, though I know that acro doesn't always present this way, especially early on. She is on the thin side rather than pudgy. (She has lost at least a lb with the last 2 DKA's, with the Lantus down 1.5lbs over about 3 weeks, from 9.5 to 7.9lbs, with BCP down from 9.1 to 8.1lbs over a week. With her DKA at dx she was down to 6.9lbs). She doesn't have any skin tearing as they describe with Cushings. Sounds more like the IAA to me, but could it be any of these conditions with her relatively small doses of insulin?
So far my plan from here is to continue with the ProZinc, but to keep raising the doses to really big ones if necessary to see if she breaks through to a point where her BGs come down. I am keeping her on the R until her ketones are gone--she was still 2.2 on the meter this morning. Will taking the R away push her numbers back up?
The fact that Ceenka stops responding to the insulin after a honeymoon period, which pushes her numbers up, and that she goes into DKA at relatively low numbers, seems to me to be a deadly combination. It also seems to me that Jungle-Kitty's honeymoon period is growing shorter and shorter with each insulin, and that she is going into DKA in shorter and shorter periods of time in high numbers. Sadly, all of this does not seem to bode well for my kitty's longevity.
Any suggestions? Should I test Ceenka for the 3 insulin resistance conditions? What else should I do? Any other thoughts on what this might be? Has anybody seen similar experiences with DKA or with insulins? I would appreciate any feedback you may have for me.
Thanks,
Ellen and Ceenka
My name is Ellen and my cat's name is Ceenka, aka Jungle-Kitty. Ceenka is a 5yo blue Aby dx'd with FD in March 2011. For the last year I have been treating her with Dr. Hodgkins's tight regulation protocol on the diabeticcathelp.com forum. I am happy with her treatment method, it is a good fit for her and me. However I have run into problems getting her regulated and am coming here to see if anyone has encountered a cat with the problems Ceenka has had.
Ceenka has been on four different insulins. She did best on ProZinc, her first insulin. For 5 months she did well on it, in her fifth month it looked like she was imminently going into remission. Her longest "run" was +105 hours on a dose of 0.4u. That month she had lots of runs in the +70s, +80s, +90s with shorter ones in between. Then in her sixth month, something went awry. She stayed in the lower 200s no matter what dose she was given, reductions or increases. It was like shooting water. It seemed like her numbers stayed the same no matter what dose I gave her.
In September I changed Ceenka to Lantus. I was seeing a lot of success with Lantus with other kitties on the board. Ceenka did great on Lantus at first. She seemed to go to +16-+24 runs very quickly. She would stay in double digit BGs, which we seek with our version of Tight Regulation, for hours and hours. As with the ProZinc, Ceenka seemed like the model kitty who was going to go into remission in short order. At the end of her third month on Lantus, Ceenka did an about face. Again overnight she was in BGs from 200 to 250. This time we tried for two months to regulate her. We tried doses from 0.25u to 2.5u. Her normal dose had been 1.0u. Again it didn't matter what her dose was, she stayed in the same numbers. Again like shooting water. I had extensive labs done, nothing was off significantly except her BG and cholesterol. After about 2 months in these numbers, Ceenka went into DKA. This was the second time, the first was when she was dx'd. My vet was astounded at her off-the-chart ketones--she had the highest level of ketones with dipsticks and blood tests. The vet said it couldn't be DKA, it had to be pancreatitis or a UTI. She tested for both, both came out negative.
So we changed Ceenka's insulin again, this time to BCP bovine PZI. We figured that perhaps Ceenka would tolerate the bovine insulin better than ProZinc or Lantus since it was only one amino acid away from a cat's insulin. Ceenka did SO well on the BCP--she was getting +27 runs after 8 or 9 days on it. And hours and hours in ideal numbers. Her doses were markedly larger than her doses on ProZinc. Since they are both PZI insulins I kind of expected that her doses would be similar in size, but this time Ceenka's doses averaged about 3.5-4.5u, as opposed to the 0.4u dose she was geting with ProZinc. And this time Ceenka's insulin honeymoon lasted only 6 weeks. Then back into the 200s. That was a little over two weeks ago. We tried adjusting her dose again, thought it might be going up from too much insulin. Tried reducing her doses. Nothing. Increasing, nothing. Same old, same old.
So then we decided to try ProZinc again. I started Ceenka's doses at the dose she had done well on, no effect. Started moving her up slowly. Within a couple of days she was still in the 200s. Since she was in the 200s again, I was testing for ketones. I managed to catch her a couple of times peeing. No ketones. Then I did a blood test--.01. Last Friday she stopped eating. I thought maybe a tummy problem, gave her pepsidAC. My husband caught her peeing in the late afternoon and she was at the next to highest color. He called me at work to tell me and I called my vet. When she heard that Ceenka had stopped eating and her ketones were so high, she prescribed Humulin-R which I went and picked up before going home. When I got home, Ceenka had that trance look that I had seen the previous two times, she was getting in the bathtub and staring at water but not drinking. Her blood ketone test registered 5.0. We shot her with both insulins.She looked better the next morning. But her numbers didn't come down for about 36 hours. She still wasn't eating, we gave her food and water with supplements by syringe. Added pinch of salt and half that amt of potassium chloride to add a bit of electrolytes in hopes of preventing dehydration. Saturday night I wondered if I might be losing her--her breathing seemed really labored and the trance-state continued. I took her to bed and tested every two hours. Fianlly during the night her numbers started to come down. Sunday morning she seemed alert and affectionate. Her ketones were down to 2.0. She stayed in ideal numbers all day, she didn't need to be dosed again for 19.5 hours. Go figure. (Because of the new insulin, R?) She had a couple of short runs after her long one. But she is coming down, not staying in the 200s.
So, here are my thoughts. It looks to me like it could be insulin resistance, that she stops responding to each insulin after awhile. But she doesn't fit the profile of IAA, acro or Cushings. She doesn't get huge doses. (But they ARE huge for her compared to the initial doses that seemed to work wonders for her.) She doesn't have the incessant hunger that the acro cats on my board exhibit, nor any enlargement of head or paws, though I know that acro doesn't always present this way, especially early on. She is on the thin side rather than pudgy. (She has lost at least a lb with the last 2 DKA's, with the Lantus down 1.5lbs over about 3 weeks, from 9.5 to 7.9lbs, with BCP down from 9.1 to 8.1lbs over a week. With her DKA at dx she was down to 6.9lbs). She doesn't have any skin tearing as they describe with Cushings. Sounds more like the IAA to me, but could it be any of these conditions with her relatively small doses of insulin?
So far my plan from here is to continue with the ProZinc, but to keep raising the doses to really big ones if necessary to see if she breaks through to a point where her BGs come down. I am keeping her on the R until her ketones are gone--she was still 2.2 on the meter this morning. Will taking the R away push her numbers back up?
The fact that Ceenka stops responding to the insulin after a honeymoon period, which pushes her numbers up, and that she goes into DKA at relatively low numbers, seems to me to be a deadly combination. It also seems to me that Jungle-Kitty's honeymoon period is growing shorter and shorter with each insulin, and that she is going into DKA in shorter and shorter periods of time in high numbers. Sadly, all of this does not seem to bode well for my kitty's longevity.
Any suggestions? Should I test Ceenka for the 3 insulin resistance conditions? What else should I do? Any other thoughts on what this might be? Has anybody seen similar experiences with DKA or with insulins? I would appreciate any feedback you may have for me.
Thanks,
Ellen and Ceenka
