Glucose Toxicity??

[Sarah Spickard]

Hello, I am brand new to the forum, so still reading instructions and trying to figure it out. It seems very complicated! I will ask my husband to help me with the spreadsheet instructions, as that has completely blown my mind.
One thing I have just read about is glucose toxicity. My cat, Lentil, was diagnosed with diabetes in July and was started on 1.5 units of Prozinc twice daily. Incidentally, he has been on a raw food diet since age 1, and he is now 8. So diet is apparently not the issue. Vet instructed to go by clinical signs (eating, drinking, weeing) to determine if more insulin was needed. We disagreed on home testing…I think it is a highly useful tool, she did not. Lentil seems to agree with the vet, and has been very difficult to test. He’s very fidgety and disagreeable with such things. I’ve had three Libres fitted, but none lasted more than three days. He’s generally in the low to mid 20’s mmol, and has never gone below 15. Back to the insulin dose, we increased it by half a unit every week if no improvement until reaching 4.5 units, which he’s been on for four weeks. Still drinking/weeing/eating like a fiend. Still high numbers when the last meter came off a week ago. I have another on the way,
Could my cat have glucose toxicity? How is this diagnosed and is there treatment? The vet is due to ring me today to discuss and I suspect they will want his dose increased to 5 units twice daily. I’ve asked about switching to Lantus (not sure what it’s called in the UK), but vet seemed clueless. My current bottle of Prozinc is getting low, so I need to either reorder or switch. What dose to start on if he switched? He weighs 11 pounds, 8 ounces (down from a high of 15 pounds a six months ago). He hardly sleeps anymore, just skulks about waiting for food. He’s fed multiple times a day, but not within the 2 hour window prior to the shot.
I’m confused how to proceed.
Thank you

 

[CORKY]

Hello, I am brand new to the forum, so still reading instructions and trying to figure it out. It seems very complicated! I will ask my husband to help me with the spreadsheet instructions, as that has completely blown my mind.
One thing I have just read about is glucose toxicity. My cat, Lentil, was diagnosed with diabetes in July and was started on 1.5 units of Prozinc twice daily. Incidentally, he has been on a raw food diet since age 1, and he is now 8. So diet is apparently not the issue. Vet instructed to go by clinical signs (eating, drinking, weeing) to determine if more insulin was needed. We disagreed on home testing…I think it is a highly useful tool, she did not. Lentil seems to agree with the vet, and has been very difficult to test. He’s very fidgety and disagreeable with such things. I’ve had three Libres fitted, but none lasted more than three days. He’s generally in the low to mid 20’s mmol, and has never gone below 15. Back to the insulin dose, we increased it by half a unit every week if no improvement until reaching 4.5 units, which he’s been on for four weeks. Still drinking/weeing/eating like a fiend. Still high numbers when the last meter came off a week ago. I have another on the way,
Could my cat have glucose toxicity? How is this diagnosed and is there treatment? The vet is due to ring me today to discuss and I suspect they will want his dose increased to 5 units twice daily. I’ve asked about switching to Lantus (not sure what it’s called in the UK), but vet seemed clueless. My current bottle of Prozinc is getting low, so I need to either reorder or switch. What dose to start on if he switched? He weighs 11 pounds, 8 ounces (down from a high of 15 pounds a six months ago). He hardly sleeps anymore, just skulks about waiting for food. He’s fed multiple times a day, but not within the 2 hour window prior to the shot.
I’m confused how to proceed.
Thank you

Welcome Sarah, you are in the right place, I know so much information all at once can be overwhelming, but it is not hard for starters you are way ahead than many of us we got here, our diabetic cat's diet is extremely important so you are a step ahead, if you have difficulty with the spreadsheet we can help you create it, it is the most special tool for you and us to be able to help you, we need a bit more about your cat, so below there is a link so you can create your signature, we are here to help you, one thing about home testing, is that the Libre as you have experienced, they tend to fall off and stop working way before the 14 days, and the sensors are expensive, and they are very inaccurate reading HIGH BGs and LOW BGs, it is important to home test especially before dosing, with ProZinc, which is what Corky uses, the protocol is test, feed, shoot, most of us here us the human ReliON Premier glucose monitor and strips, you can get an idea what the spreadsheet looks like by clicking below this post in blue 'Corky's Spreadsheet', let us know what we can help you with it is a lot of reading and information all at once, feel free to post any concerns, I will also tag a ProZinc expert to help you along with dosing in the meantime, do create your signature
P.S.
the ProZinc Vial once the seal is opened it is only good for 60 days, is sad to say that just yesterday, I had to throw away a bottle a little more that a 1/4 full, and start a new vial, it does have to remain in the refrigerator (cold) at all times at the same temperature as well. Corky gets a small dose, but if you your bottle is over 60 days, maybe that may be why the insulin is not working, but again I am a long time member, not an expert, so she will guide you best
@Suzanne & Darcy
@Bron and Sheba (GA)

https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

 

[Sarah Spickard]

Welcome Sarah, you are in the right place, I know so much information all at once can be overwhelming, but it is not hard for starters you are way ahead than many of us we got here, our diabetic cat's diet is extremely important so you are a step ahead, if you have difficulty with the spreadsheet we can help you create it, it is the most special tool for you and us to be able to help you, we need a bit more about your cat, so below there is a link so you can create your signature, we are here to help you, one thing about home testing, is that the Libre as you have experienced, they tend to fall off and stop working way before the 14 days, and the sensors are expensive, and they are very inaccurate reading HIGH BGs and LOW BGs, it is important to home test especially before dosing, with ProZinc, which is what Corky uses, the protocol is test, feed, shoot, most of us here us the human ReliON Premier glucose monitor and strips, you can get an idea what the spreadsheet looks like by clicking below this post in blue 'Corky's Spreadsheet', let us know what we can help you with it is a lot of reading and information all at once, feel free to post any concerns, I will also tag a ProZinc expert to help you along with dosing in the meantime, do create your signature
P.S.
the ProZinc Vial once the seal is opened it is only good for 60 days, is sad to say that just yesterday, I had to throw away a bottle a little more that a 1/4 full, and start a new vial, it does have to remain in the refrigerator (cold) at all times at the same temperature as well. Corky gets a small dose, but if you your bottle is over 60 days, maybe that may be why the insulin is not working, but again I am a long time member, not an expert, so she will guide you best
@Suzanne & Darcy
@Bron and Sheba (GA)

https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Thanks, Maria. My husband and I are stumped by the spreadsheet, but someone from the FB page has offered to help set it up. The insulin is definitely not old; he gets 4.5 units twice per day, so I'm going through it at a ridiculous rate. I am in awe of your spreadsheet. How are you able to test so frequently every single day? I have a full-time job along with a dog, a horse, and three other cats, so that is not possible for me. Plus Lentil is very difficult to test, so I am lucky to get 2 or 3 tests on a day, but certainly couldn't do that every day.

 

[CORKY]

Thanks, Maria. My husband and I are stumped by the spreadsheet, but someone from the FB page has offered to help set it up. The insulin is definitely not old; he gets 4.5 units twice per day, so I'm going through it at a ridiculous rate. I am in awe of your spreadsheet. How are you able to test so frequently every single day? I have a full-time job along with a dog, a horse, and three other cats, so that is not possible for me. Plus Lentil is very difficult to test, so I am lucky to get 2 or 3 tests on a day, but certainly couldn't do that every day.

Two or 3 tests a day is great especially before each dose you do not want to give insulin without checking hi BG , and about testing since the beginning I became a compulsive tester and I’m almost home 24/7 now I go out more frequently since I got use to seeing those amazing greens in his SS it wasnt Easy If his BG was in the mid 100s especially before shooting I became frantic, but now is a piece of cake, see, at these numbers his pancreas are healing, he is very healthy besides the diabetes, he is a very large cat weights 16.5 Not overweight when I took him to emergency on January 2 last year and he was diagnosed he had lost 8.5 lbs, I never noticed since he’s so big, I only saw the constant water sinking,,it’s been a long road for myself and him, but trusting these amazing experts, and following their instructions to the letter, I do not trust Vets with diabetes solutions, they are not that knowledgeable in the subject so they treat the cat as if were a dog with diabetes. And the cats is never regulated properly or dosed properly and the pockets get empty, and not worry once you referred to the link I send you and create your signature and the spreadsheet we will help you get you baby back to great health

 

[Sienne and Gabby (GA)]

Welcome to FDMB.

I'm removing the GA from your subject line. It means either "Gone Ahead" or "Guardian Angel" -- in other words, your cat has passed away.

I'm tagging one of our UK members who may have a better handle on resources on the other side of the Atlantic. @Elizabeth and Bertie

One of the things that can help with home testing is treats! There are low carbohydrate treats, typically a freeze dried protein, that most cats really like. Every time you test, regardless of whether the test is successful or not, Lentil gets a treat. Positive reinforcement, especially in a cat that is stalking his food bowl, really works. The Libre is a good option but aside from cats being very clever when it comes to removing the sensor, they tend to give a falsely low reading when numbers are under 100.

There are conditions that require higher doses of insulin. Insulin resistance or insulin auto-antibodies is one condition; acromegaly is another. One of the other moderators is very familiar with these conditions and also knows of a very well respected clinic in London (I think) that may be a resource for getting tests run to determine if Lentil has a high dose condition. @Wendy&Neko

With most types of insulin, you want to get a minimum of 4 tests per day. You want to test prior to each shot so you know its safe to give insulin. You also want to get at least one test during both the AM and PM cycles. It's important to know how low the dose you're giving is taking your cat's blood glucose numbers.

Maria is not entirely correct. Most of us use insulin for as long as it is viable. If you're still getting a good response at 60 days, the insulin is fine. While I didn't use Prozinc with my cat, the insulin I used according to the manufacturer was good for 30 days. I was typically getting around 90 days of use and that was using all of the insulin in the pen.

Given your cat's weight loss, hunger, and high numbers, I'd give him more food if he's not at an optimal weight.

If you want to do more reading about Prozinc, there are sticky notes at the top of the Prozinc forum. I'm also tagging one of our members who is a veteran Prozinc user: @Suzanne & Darcy

 

[Diane Tyler's Mom GA]

My husband and I are stumped by the spreadsheet, but someone from the FB page has offered to help set it up

@Bandit's Mom
Hi Bhooma can you help Sarah set up our SS ,vI know the FB one is different than ours

 

[Bandit's Mom]

@Bandit's Mom
Hi Bhooma can you help Sarah set up our SS ,vI know the FB one is different than ours

I see an SS in her signature that seems to be our format. Looks like @Chris & China (GA) or @Gus the Furminator helped her set it up.

 

[Diane Tyler's Mom GA]

I see an SS in her signature that seems to be our format. Looks like @Chris & China (GA) or @Gus the Furminator helped her set it up.

Sorry Bhooma I didn't see it
@Bandit's Mom

 

[Wendy&Neko]

To answer your question, we don't really diagnose glucose toxicity but can get an idea by looking at spreadsheets. Basically it means kitty gets used to higher numbers and you have to keep on increases to try to get enough insulin into him to get over it. With Lentil mostly above 16 for the last couple months, my guess is he's got glucose toxicity.

Would you call Lentil food very food focussed? My girl was practically a savage about food and I had to put all food on the kitchen counter into lockdown. She had both acronegaly and IAA and was on a raw food diet at the time of diagnosis. Acromegaly is a condition that about one in four diabetic cats as. It is the result of a benign pituitary tumour that sends out excess growth hormone, which eventually leads to diabetes, which is when most cats are diagnosed. The excess growth hormone also causes then to be extra food focussed. As Sienne said, one of the top research teams in acromegaly is at the Royal Vet Clinic. They also the place in the UK (and a lot of Europe) where blood would be sent to test for this condition. There are treatments, so it's good to know if that is what you are dealing with.

If you want to consider an insulin switch, Lantus (or generic glargine) is definitely a good option. Not sure if you can still get Levemir (determir) there, but it's also a great insulin for cats that need higher doses.

 

[Gus the Furminator]

I see an SS in her signature that seems to be our format. Looks like @Chris & China (GA) or @Gus the Furminator helped her set it up.

Yes, I went in to fix their sheet, for whatever reason the Unit column was acting like the data cells (on the US tab)… I’ve redone it (tabs all the way to the right) but was waiting on a confirmation that the data copied over fine before removing the old ones and moving the new ones to the left.

ETA: the original sheet was also for human meter, which I’ve changed to be pet meter sheet in the new since they’ve confirmed pet meter going forward.

@Sarah Spickard if you can have a look and let me know if all is good, i will make it right again ty

 

[Sarah Spickard]

To answer your question, we don't really diagnose glucose toxicity but can get an idea by looking at spreadsheets. Basically it means kitty gets used to higher numbers and you have to keep on increases to try to get enough insulin into him to get over it. With Lentil mostly above 16 for the last couple months, my guess is he's got glucose toxicity.

Would you call Lentil food very food focussed? My girl was practically a savage about food and I had to put all food on the kitchen counter into lockdown. She had both acronegaly and IAA and was on a raw food diet at the time of diagnosis. Acromegaly is a condition that about one in four diabetic cats as. It is the result of a benign pituitary tumour that sends out excess growth hormone, which eventually leads to diabetes, which is when most cats are diagnosed. The excess growth hormone also causes then to be extra food focussed. As Sienne said, one of the top research teams in acromegaly is at the Royal Vet Clinic. They also the place in the UK (and a lot of Europe) where blood would be sent to test for this condition. There are treatments, so it's good to know if that is what you are dealing with.

If you want to consider an insulin switch, Lantus (or generic glargine) is definitely a good option. Not sure if you can still get Levemir (determir) there, but it's also a great insulin for cats that need higher doses.

To answer your question, we don't really diagnose glucose toxicity but can get an idea by looking at spreadsheets. Basically it means kitty gets used to higher numbers and you have to keep on increases to try to get enough insulin into him to get over it. With Lentil mostly above 16 for the last couple months, my guess is he's got glucose toxicity.

Would you call Lentil food very food focussed? My girl was practically a savage about food and I had to put all food on the kitchen counter into lockdown. She had both acronegaly and IAA and was on a raw food diet at the time of diagnosis. Acromegaly is a condition that about one in four diabetic cats as. It is the result of a benign pituitary tumour that sends out excess growth hormone, which eventually leads to diabetes, which is when most cats are diagnosed. The excess growth hormone also causes then to be extra food focussed. As Sienne said, one of the top research teams in acromegaly is at the Royal Vet Clinic. They also the place in the UK (and a lot of Europe) where blood would be sent to test for this condition. There are treatments, so it's good to know if that is what you are dealing with.

If you want to consider an insulin switch, Lantus (or generic glargine) is definitely a good option. Not sure if you can still get Levemir (determir) there, but it's also a great insulin for cats that need higher doses.

Yes, Lentil acts like he is starving all the time since being diagnosed in July. Definitely a savage...will even dive into loaves of bread or potato chips if he can get away with it. No food was safe. He has always been a food-obsessed cat, which we attributed to his first year spend in a hoarder situation. I have been reading about feline acromegaly, and it does seems he has many of the symptoms. We have noticed his breathing is louder and more wheezy in the past year or so, and his brow seems a bit more prominent. Physically, nothing too obvious, though. I asked the vet about switching to Lnatus/glargine and he is working on the

 

[Sarah Spickard]

Yes, Lentil acts like he is starving all the time since being diagnosed in July. Definitely a savage...will even dive into loaves of bread or potato chips if he can get away with it. No food was safe. He has always been a food-obsessed cat, which we attributed to his first year spend in a hoarder situation. I have been reading about feline acromegaly, and it does seems he has many of the symptoms. We have noticed his breathing is louder and more wheezy in the past year or so, and his brow seems a bit more prominent. Physically, nothing too obvious, though. I asked the vet about switching to Lantus/glargine and he is working on the starting dose and what other tests we should try, including acromegaly.

 

[Elizabeth and Bertie]

Hi Sarah, waving to you from Surrey.

'IF' it turns out that Lentil is a high-dose cat for any reason, then it can certainly be cheaper to use human insulins in the UK such as Lantus and Levemir. These can be prescribed under the 'cascade system'. Some vets will prescribe them, others aren't so keen.
If you stay with Prozinc then it might be cheaper for you to buy online with a prescription from your vet. But, with Prozinc the best savings are to be had when the vet is willing to prescribe more than one vial on the same prescription. (The cost of buying from an online pharmacy will the the cost of the Prozinc + refrigerated postage + vet prescription).

My own experience of switching to human insulins was that I needed to do a bit more hometesting, especially at first. That's because they work a bit differently to the veterinary insulins which are 'usually' in and out within 12 hours of being given.
The human insulins have longer duration with a kind of overlap (referred to as the 'depot' because some of the insulin from the shot is stored in the body and released slowly over time). When I switched from veterinary U40 insulins to human U100 insulins I found that the longer duration meant two things for us. One was that my cat's pre-shot BG numbers got lower. The second was that the overall BG came down, and I needed to reduce the dose. This was just 'my own experience with my cat'. But I'd not have found these things out without hometesting.
I do totally understand that hometesting has not been easy for you at all, hence your trying the Libre.

Not every cat is easy to test... My second diabetic (adopted as a diabetic) was very challenging at first. (I cried!) And it took time and patience to get her used to the idea. But we got there. And mainly that was due to very gradually getting her used to the sounds and sensations involved in the test process, and rewarding her with treats (and brushing...) ...Once she got used to the idea, she'd actually jump up on her armchair (our 'testing spot') and wait for her test, bless her...

I have been reading about feline acromegaly, and it does seems he has many of the symptoms. We have noticed his breathing is louder and more wheezy in the past year or so, and his brow seems a bit more prominent.

Sarah, has the vet identified any other areas of concern? You also said Lentil wasn't sleeping much. Anything that needs treatment?
Have you considered getting a test for acromegaly?

Eliz

 

[Wendy&Neko]

will even dive into loaves of bread or potato chips if he can get away with it. No food was safe.

I'd definitely ask the vet for the IGF-1 test to be done at the Royal Vet Clinic. The Royal Vet Clinic are amongst the top researchers in the world on acromegaly. Not all acrocats show physical signs on diagnosis. My Neko's only signs were her dose size and ferocious hunger. She didn't get louder breathing until 4 years after diagnosis. But she loved her carb products too, our kitchen had to be on lockdown, except fruit.

Starting dose of Lantus would be 4.5 units. We take the existing dose into consideration when switching to one of the depot style insulins. My vet mistakenly had me start back at 1 unit Lantus (was on 5 units Caninsulin) and it took me months to get back to where we should have started.

 

[Sarah Spickard]

Hi Sarah, waving to you from Surrey.

'IF' it turns out that Lentil is a high-dose cat for any reason, then it can certainly be cheaper to use human insulins in the UK such as Lantus and Levemir. These can be prescribed under the 'cascade system'. Some vets will prescribe them, others aren't so keen.
If you stay with Prozinc then it might be cheaper for you to buy online with a prescription from your vet. But, with Prozinc the best savings are to be had when the vet is willing to prescribe more than one vial on the same prescription. (The cost of buying from an online pharmacy will the the cost of the Prozinc + refrigerated postage + vet prescription).

My own experience of switching to human insulins was that I needed to do a bit more hometesting, especially at first. That's because they work a bit differently to the veterinary insulins which are 'usually' in and out within 12 hours of being given.
The human insulins have longer duration with a kind of overlap (referred to as the 'depot' because some of the insulin from the shot is stored in the body and released slowly over time). When I switched from veterinary U40 insulins to human U100 insulins I found that the longer duration meant two things for us. One was that my cat's pre-shot BG numbers got lower. The second was that the overall BG came down, and I needed to reduce the dose. This was just 'my own experience with my cat'. But I'd not have found these things out without hometesting.
I do totally understand that hometesting has not been easy for you at all, hence your trying the Libre.

Not every cat is easy to test... My second diabetic (adopted as a diabetic) was very challenging at first. (I cried!) And it took time and patience to get her used to the idea. But we got there. And mainly that was due to very gradually getting her used to the sounds and sensations involved in the test process, and rewarding her with treats (and brushing...) ...Once she got used to the idea, she'd actually jump up on her armchair (our 'testing spot') and wait for her test, bless her...


Sarah, has the vet identified any other areas of concern? You also said Lentil wasn't sleeping much. Anything that needs treatment?
Have you considered getting a test for acromegaly?

Eliz

 

[Sarah Spickard]

Hi Liz,

The vet is going to prescribe Lantus for my cat, but he doesn't seem very confident in what he is doing. The clinic has apparently never prescribed it before, so it's not even in their system. When you switched from Prozinc to Lantus, did you go right back to a low dosage? The vet said to start on 2 units of Lantus; Lentil is currently on 4.5 units of Prozinc. Yes, I asked the vet about the acro test, IGF-1, and he said they could do it but he said to try the switch first rather than pay 300+ pounds for the test.

 

[Sarah Spickard]

I'd definitely ask the vet for the IGF-1 test to be done at the Royal Vet Clinic. The Royal Vet Clinic are amongst the top researchers in the world on acromegaly. Not all acrocats show physical signs on diagnosis. My Neko's only signs were her dose size and ferocious hunger. She didn't get louder breathing until 4 years after diagnosis. But she loved her carb products too, our kitchen had to be on lockdown, except fruit.

Starting dose of Lantus would be 4.5 units. We take the existing dose into consideration when switching to one of the depot style insulins. My vet mistakenly had me start back at 1 unit Lantus (was on 5 units Caninsulin) and it took me months to get back to where we should have started.

 

[Sarah Spickard]

Hi Wendy,

How much insulin was your cat on prior to testing for acro? Lentil is only on 4.5 units of Prozinc, but everyone on the diabetes forum and page seems to think this is a massive dose, so we haven't increased in more than a month. So, you think we should start on the Lantus at the same dose as the Prozinc? Also, vet said the pens wouldn't work, but I've seen people say on this forum and the diabetes forum that you can withdraw the dosages from the pen. Thank you.

 

[Sienne and Gabby (GA)]

We generally don't suggest testing for acro or other higher dose conditions until a cat is getting around 6u (at least over 5u).

The problem with the pens is that they dispense in 1.0u increments. We make dose changes in 0.25u amounts. However, as others have suggested, you can use the pen just like in vial of insulin. The pens have a rubber stopper at the top and you can insert a syringe into the pen and draw off the insulin you need. The majority of the members use pens for a variety of reasons. A big reason is that the pen is encased in plastic. If you drop a pen, there's only a small chance that the glass holding the insulin will shatter. If you drop a vial, your insulin is all over the floor.

You can start Lantus at 4.5u. Are you giving Prozinc twice a day? If so, I'm not sure what the numbers in the "U" column after your PMPS reading are.

 

[Wendy&Neko]

Although we don't suggest testing for acro until six units, that doesn't mean people have to wait until that size dose if they suspect acromegaly is present. We've seen plenty of acros on less than 6 units. The original RVC paper that found that one in 4 diabetic cats has acromegaly found the average dose was 7 unit, but found some on as low as 1 unit. Given that Lentil hasn't seen anything under 300 this month, I strongly suspect he'll need at least 6 units. Also, you are seeing other symptoms that sound like acromegaly (food obsession, noisy breathing), there is no need to wait.

If you look at this RVC page, the cheapest option that gets you the IGF-1 test is £198.00 + VAT.

Lantus, pens, or cartridges if available there, work just fine. You just don't buy the pen needles for injection. You used the pen/cartridge as a mini vial and still use syringes to extract, but you need U-100 syringes for Lantus.

How much insulin was your cat on prior to testing for acro?

She got to six+ units, but I had a strong suspicion she had something else before then. The RVC paper I mentioned came out in 2015, Neko was Dx'ed with acro in 2012, back in the days when people thought you needed to be on a really large dose to test. My vet talked to a local internal medicine vet who said you didn't need to test for acro until at 10 units, hence I had to practically beg my vet to get the tests done before 10 units. It took a few weeks, and a few dose increases before the blood draw was done. She never got to 10 units. And most of her diabetic life she was on 3 or less units - because I got treatment done.