confused & need help in San Diego/hit a wall

[RobinParks]

All,

I'm a brand new member. I hope this is the right place to post my vexing problem.

Can anybody refer me to a good, FD-experienced vet in San Diego, to include the East County area?? I really need to get a 3rd opinion on something.

I'll save the whole long story for another post, but......after several months of mostly having my cat's FD under control (not in remission,not really regulated, just under control with 5u of Lantus usually 2x/day) he's spiked up to 450-550 levels, and the usual dose just won't bust the numbers down. My own vet is now recommending a slight increase in the dose, but another vet is totally & passionately convinced the problem is the Somogyi effect and that I should reduce or eliminate the insulin...and my cat is now caught in the middle. I am doing one experiment that's still ongoing and it may be that right now (Weds night) his numbers are dropping after 36 hrs of not having insulin and after some 5 days of having reduced doses (5u down to 2..5u). He still acts fine, eats fine, eliminates fine, and I see no noticeable increase in drinking.

I could really use some advice from someone who has been in this particular position.
Thank you
Robin Parks
San Diego, CA

 

[Sue and Oliver (GA)]

I think we have some people in San Diego. It is quiet tonight so be patient and come back and check.

You also might check out the Lantus support group. They have some great informational articles starred at the top of the page.

viewforum.php?f=9

 

[Carl & Polly & Bob (GA)]

Are those 400-500's numbers from tests at the vet, or are you seeing those at home? Also, are you checking regularly for ketones? With numbers that high, that is a definite possibility, and it doesn't take long to get from trace ketones to DKA.

There's a lot of controversy about whether somogyii rebound even exists, so understandable why one vet might think that and the other might not.

In the 1930s, Somogyi speculated that hypoglycemia induced by insulin could cause a counterregulatory hormone response that produces hyperglycemia, as in the image below. Unappreciated nocturnal hypoglycemia could lead to morning hyperglycemia; if the physician or patient increases the evening insulin, this could exacerbate the problem.[1] This phenomenon is actually less common than morning hyperglycemia due to hypoinsulinemia resulting from the dawn phenomenon.[2, 3] Debate continues in the scientific community as to the actual presence of this reaction to hypoglycemia. Shanik et al, for example, suggested that the hyperglycemia attributed to Somogyi phenomenon actually is caused by an insulin-induced insulin resistance.[4]

Here's a great page of info on it, though:
http://petdiabetes.wikia.com/wiki/Somogyi_rebound

An alternative might by "insulin resistance".
http://www.caninediabetes.org/insulinresistance.html (it's a site about canine diabetes, but same principle for cats)
Dr. Peirson's site discusses it also, and links it to "Glucose Toxicity" if the cause is chronic hyperglycemia
http://catinfo.org/?link=felinediabetes

Type 2 is characterized by two problems. The first, as in Type 1, is a diminished ability of the pancreas to secrete insulin. The second issue is one of insulin resistance. In other words, the receptors on the cell wall that would normally open the door to the cell to let the glucose in when insulin 'knocks', stop 'listening' to the insulin. The cells 'resist' the signal that the circulating insulin is sending and the glucose is not transferred to the inside of the cell, resulting in an elevated blood glucose (hyperglycemia) and cellular 'starvation'. The elevated blood glucose, in turn, sends a signal to the pancreas telling it to secrete more insulin. The elevated insulin may somewhat override the insulin resistance resulting in more glucose entering the cells, but eventually the pancreas can become exhausted or 'burned out'.

Glucose toxicity results from chronic hyperglycemia. Glucose toxicity wreaks havoc on the entire body - especially the pancreas and its insulin-producing cells. A vicious cycle then ensues as the insulin-producing cells are damaged resulting in less insulin being produced.

While you are doing this experiment, are you keeping a log or spreadsheet of how he's reacting to the lower doses, or since stopping insulin, what sort of numbers are you getting? If you test him, then feed him, and then test him a hour or two later, are his BG numbers falling on their own without insulin? If so, his pancreas is doing something. Maybe not enough, but you'd see a lowering effect if it's producing some insulin.

The other thing I wonder about is what type of food he's normally getting, and what sort of carb content does it have?

Carl

 

[concrete]

My cat went high in the 4-500 range with the same insulin for a couple weeks right before he went into remission. The vet recommended going from his 1u dosage to 2u and we started doing that for a while and he stayed in the same range. Suddenly he started going down to 150-200 in the mornings without insulin. I adjusted it to .5u and after a while it was less than 100 in he mornings. I stopped insulin and now he is usually around 80. There were some mornings in the past that I did not take his blood in the mornings and I got lucky because if he went down naturally and I didn't know, he could have went hypo because of too much insulin. I hope you have the same result. My cat sounds a lot like how your cat was, not regulated but under control, started going to the 400-500's

 

[Vicky & Gandalf (GA) & Murrlin]

Just wondering how the 5U dose was determined? Had your kitty ever been on low doses, such as 1U, twice daily?

Lantus works best using a step-up approach. Not starting low enough and/or raising dose too quickly or too much at each increase is counter-productive. And yes, the Somogyi effect could be happening, especially if you are seeing decreasing BGs with NO insulin, however I want to caution about that. He may still need very small amounts of insulin and withholding insulin from an unregulated cat can be a recipe for ketones/DKA. If you are testing his BGs, please report his values for us in terms of how many hours it's been since his shot and the BG level. We can help you determine how much insulin he needs.

Some vets are still new to using Lantus and may not realize that it needs managed differently than Prozinc, Humulin N or Vetsulin.