Failed reduction...bouncing...GGGRRRRRRR!!!

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Erin Lewis and Boops

Erin Lewis and Boops

Member Since 2015
Well, after a failed reduction previously, Boops' insulin was increased up to 1 unit, then .75, then .6, now .5. He got to a 48 on the .5 dose, but I'm assuming he is bouncing now? The vet stresses me out because she says he shouldn't be this hard to regulate. HELP
 
Perhaps Boops hasn't read the manual and that's why he's hard to regulate! ;) Or perhaps your vet hasn't seen too many diabetic cats and doesn't realize that this isn't unusual.

I think any certainty about the answer to your question really lies in the pm cycle. It's just very hard to figure out what might be going on without at least 1 test at night. Can you try to just get one test before you go to bed? That would make a huge difference in being able to answer about the dose and whether or not he's bouncing.

However, I can say that when I see both green and black numbers within a day of each other, I assume bouncing, because it's evident that the dose can get the cat into green numbers. But beyond that, I don't know. I certainly wouldn't increase his dose with a 48 on it day before yesterday.

Nice to see you, Erin!
 
For your cat to be droping from HI to low greens frequently from a very low dose of insulin is suspicious. I'd be concerned regarding adrenal insufficiency. Sometimes this can occur as a hormone imbalance, and sometimes it's due to the cat formerly being on steroids.

Have you had recent labs done that you could post?
 
Adrenal insufficiency (Addison's disease) without a history of steroid use is not well researched in cats, and believed to be pretty rare, but occurs more frequently with other endocrine disorders such as diabetes or thyroid disease. What happens is that without an adequate supply of natural cortisol, the body is unable to regulate blood sugars (ie. produce glucose when needed), and is unable to retain salt properly which is one of the body's mechanisms for maintaining blood pressure. These effects can be more severe in the presence of stressors.

In a cat with recent steroid use (topical, oral, and injected), the steroids suppress the ACTH from the pituitary. This prevents the natural release of cortisol and aldosterone in some amounts from the adrenal gland. When the steroid is withdrawn abruptly there can be insufficient endogenous cortisol for body functions as the pituitary takes some time to notice and respond to the low cortisol levels. In humans steroids are tapered to prevent these problems. In people sometimes it can take weeks to taper properly especially if the duration of use was long or dose was high.

I've personally seen a couple human diabetics that would respond to insulin very drastically - ie. go from >300 to <40 immediately post shot (regular insulin) and a very small amount of insulin and have a concurrent drop in blood pressure with a prolonged period of hypoglycemia. Glucagon is not as effective for treating these hypo's either. The diabetics I've seen with this presentation all had Addison's disease (one from an improper taper in the hospital).

As for symptoms, I'm having trouble finding studies where cats weren't extremely sick prior to the study, so I'm not sure what early symptoms might look like. You'd see a low sodium on chem panel likely. Maybe weight loss and lethargy. Maybe signs of fluid imbalance due to the diuresis.

Adrenal tumors are fairly common in cats, so this may be a factor in some cases.
 
Interesting - thanks for writing all of that out, Meya. Good information.

It's not uncommon for a cat to just be bouncy, no matter what the dose is - if their body has "forgotten" normal numbers, they react by bouncing. I'm thinking of JD, who made it to 20, and was diabetic for 9 years, I believe. He basically bounced every single day.

Erin, great job getting those pm cycle tests in. It helps. When I see a green number, like that 48, I look to see when it clears - should be in about 3 days or less. Three days would've been today's day cycle. I'd just make a habit of trying to catch how low he goes when he clears the bounce, so you know about dosing. Usually with a 48 you would reduce his dose to 0.25u.

How does he seem other than his blood sugar? Does he have his "5 P's?" Purring, playing, preening, pooping & peeing? Everything working ok?
 
Yes, he was in the 200s for his morning shot finally! He is very lovey as usual- purring and stretching out when he sleeps, wanting his belly rubbed. He loves to eat! I've been spending a lot of time brushing him because he loves it and it helps so much with hairballs! We have a check-up on Tuesday to recheck kidney values since we've been giving SUB-Q and I've started him on Kidney Support Gold.
 
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