Help! Best insulin for insulin resistance?

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Deb&Tiki

Deb&Tiki

Member Since 2022
Hi there,

My sweet Tux is really struggling right now. He is taking Budesonide for IBD and in the last week his insulin (Lantus) does not seem to be touching his glucose at all. He is currently at 3u for the past 5 doses and will do another increase but since he is remaining between 20 - 27 (mostly in the 24-25 range) even with insulin increases, is there a different insulin that might be recommended for cats with insulin resistance? I have lived through DKA 20 years ago and am so concerned about his glucose being too high for too long. Thanks for your advice!
Deb
 
Deb&Tiki said:
Hi there,

My sweet Tux is really struggling right now. He is taking Budesonide for IBD and in the last week his insulin (Lantus) does not seem to be touching his glucose at all. He is currently at 3u for the past 5 doses and will do another increase but since he is remaining between 20 - 27 (mostly in the 24-25 range) even with insulin increases, is there a different insulin that might be recommended for cats with insulin resistance? I have lived through DKA 20 years ago and am so concerned about his glucose being too high for too long. Thanks for your advice!
Deb
Click to expand...
Are you testing for ketones in the urine?
Do you have a spreadsheet you can share with us? It’s hard to give any dosing advice if we can’t see a spreadsheet. If you could get a spreadsheet set up and add the past couple of weeks BG numbers we could help you.
Lantus is a good insulin. Have you been following a dosing method?
How often are you testing the BGs?
 
Bron and Sheba (GA) said:
Are you testing for ketones in the urine?
Do you have a spreadsheet you can share with us? It’s hard to give any dosing advice if we can’t see a spreadsheet. If you could get a spreadsheet set up and add the past couple of weeks BG numbers we could help you.
Lantus is a good insulin. Have you been following a dosing method?
How often are you testing the BGs?
Click to expand...

I will try to figure out how to share his spreadsheet. I test several times/day (first half of curve) and hourly when making adjustments. I am trying to taper him off budesonide but I can't suddenly stop it so right now I am giving 1 mg every 36 hours and will start 1 mg every 48 hours in the next few days. I'm concerned that even Humulin R is not bringing him down a bit anymore. I have been giving .25-.5u R when his PS is above 22 as Lantus seems be to able to keep his bg down but not bring it down ever since starting steroids so R brings it down and then Lantus holds it there for a bit, if that makes sense but that isn't working anymore.
 
Deb&Tiki said:
I'm concerned that even Humulin R is not bringing him down a bit anymore. I have been giving .25-.5u R when his PS is above 22 as Lantus seems be to able to keep his bg down but not bring it down ever since starting steroids so R brings it down and then Lantus holds it there for a bit, if that makes sense but that isn't working anymore.
Click to expand...
Did the vet suggest using R? We normally only suggest that in a few cases and you need to be really careful giving R because you will end up with 2 nadirs in a cycle.
i can see the SS now
 
I’ve just looked at the SS. I can see you have been giving different doses of the Lantus all the time. This could be one of your problems. It is better to give the same dose am and pm cycles so the depot can stabilise and to follow a dosing method.
I would stay with 3 units am and pm for the moment. I am going to talk to a couple of other people and one of us will get back to you about the dose moving forward. what type of food are you feeding Tux at the moment?
With Lantus HERE are the two dosing methods you can follow.
Would you mind setting up your signature please with information about Tux so we can see. Thanks
I’m going to ask @Bandit's Mom to have a look at your SS as when I try and scroll down it goes all wonky
Here are your previous posts for continuity
https://www.felinediabetes.com/FDMB/threads/returning-new-member-april-7-2022.261723/#post-2935218
https://www.felinediabetes.com/FDMB...g-bg-due-to-prednisolone.286641/#post-3152969
 
A couple things: first, we need to get the SS fixed. This looks like a SS that one of the Fb groups pirated from us. The frozen columns make it rather difficult to see the picture correctly and the link is not the correct one for here because the SS can be edited by a smart hacker. Second, we need to get the SS into the signature block so you don’t have to keep reposting it.

Please be sure you post all numbers in the US format of mg/dL and not mmol/L as most of our members do not use the latter and would have to convert it. Since our SS auto converts, you can see what the BG is in mg/dL before posting it here.

I am happy to help you with the SS setup and I can move your data over for you if you send me a PM by clicking on “Marje and Gracie” to the left and then “start a conversation “.

Until I can see a SS with US values (because I don’t have time to convert all of yours on your current SS), I really can’t offer specific dosing advice but I do agree with Bron that you need to pick a dosing method and follow it and stick with a dose long enough to see what it does.

Just curious by why did you stop insulin the latter part of 2023?
 
A couple questions. How was he diagnosed with IBD? What food is he eating now?

There are times you reduced the dose, like the PM shot of 9/13. Can I ask why? That caused higher numbers in subsequent cycles.
 
Tux is currently eating canned Royal Canin Selected Protein. He was diagnosed based on ruling out other possibilities besides SC lymphoma (symptoms, blood work etc). The vet actually suspects triaditis due to Tux also having pancreatitis recently. He was first diagnosed with diabetes, then IBD (vomiting/no appetite only - he has never had diarrhea), then pancreatitis. Tux was only on insulin for a week when he was first diagnosed as a change in food seemed to be all he needed but once the vomiting started and later pancreatitis, he was started on prednisolone and his bg increased quickly. So he was not on insulin in December and most of January until prednisolone was needed.

My vet gave me dose reducing suggestions based on Tux's preshot numbers so I adjust accordingly. I use a pet meter and it tends to run about 2-3 higher than my husband's human meter. When I have not reduced Tux's dose in the past he has gone into the 3-4 range which is too low for comfort for me. Tux is my 3rd diabetic kitty and I've had experience using R since Jake (GA) struggled with ketones and DKA 20 years ago. This message board definitely saved him!
 
Pancreatits and triaditis are common with both SCL and IBD. Did you get an ultrasound? How is his weight trending? I've had over 10 years in a row experience with SCL and IBD, sigh!, 3 different kitties. All vomiters. :rolleyes: Neko took budesonide instead of prednisolone, and it didn't impact her blood sugar, though it does for a few cats.

We dose here based on nadirs, or how low the dose takes the cat. With the dosing methods we use, it just makes more sense given the depot style of Lantus. Less wonky numbers that dosing based on preshots give you.

Since Tux is eating high carb food (did you ever think of trying novel proteins), you don't want him going below 5.0 (90). Lots here on nutrition: https://www.ibdkitties.net/
 
We didn't get an ultrasound as the vet said that our treatment would be the same (steroids) and the cost of ultrasound is $1600, which is more than I can afford. I didn't realize that the canned RC Selected Protein would be high in carbs. I couldn't find a carb number for it but when I used an online carb calculator, I got 2.4% carb which I thought was good? The protein is duck and he had never had duck before. He hates wet food so we had a hard time finding any that he would consistently eat and he had been eating Hill's A/D for a couple of months as we tried to find something he would eat.
Given that his current nadir is quite high, I'm thinking that a .5u increase would make sense. I'm trying to taper his Budesonide so I do need to watch in case a reduction in steroids reduces his insulin needs.
Thanks so much for your advice!
 
RC Select Protein Duck is 16% carbs. He is on high carb food. I see you are following SLGS - that means waiting 7 days before you can increase, and increasing by 0.25 units.

Treatment is not the same for SCL and IBD. Both can have a steroid component. IBD steroids may be for life, SCL it is short term. SCL also needs a mild chemo, at least until kitty goes into remission. Not all cats go into remission, but a majority do. However, if the novel protein food is helping, that is a good hint that at least IBD is in the picture as food doesn't matter for SCL. They can have both IBD and SCL.
 
Wendy&Neko said:
RC Select Protein Duck is 16% carbs. He is on high carb food. I see you are following SLGS - that means waiting 7 days before you can increase, and increasing by 0.25 units.

Treatment is not the same for SCL and IBD. Both can have a steroid component. IBD steroids may be for life, SCL it is short term. SCL also needs a mild chemo, at least until kitty goes into remission. Not all cats go into remission, but a majority do. However, if the novel protein food is helping, that is a good hint that at least IBD is in the picture as food doesn't matter for SCL. They can have both IBD and SCL.
Click to expand...

16% is much higher than I thought but still lower than dry food. He really does not enjoy wet food. He didn't mind A/D but the vet said not to stay on that for too long. Not sure what to do about food as he is so picky and I want to keep a novel protein.
My vet had told me that if he had SCL, steroids would be used and only if steroids are not effective would chemo be used. I need to look into this further.
I do know that there is no way I can afford the biopsy required to confirm IBD or SCL. I wish I could but I can't.
 
The point of me telling you about the carbs is confirming that SLGS is the right dosing method for you. Have you tried freeze dried or air dried raw? It has crunch too and lots of protein options.

I've belonged to a SCL group for a while now. Someone described what is happening in an analogy that works for me. You can think of the SCL as a factory that produces excess lymphocytes, that causes the inflammation. The steroids mop the lymphocytes to a point, but the factory eventually outproduces what the steroid can do. Some cats can last a long time on just steroids. You do what you can do. :bighug: My current SCL (and IBD) kitty is about to have her 6th anniversary of SCL diagnosis (via endoscopy). But she was on chemo.
 
So happy to hear about Neko's anniversary! That is amazing!
I will look into dried raw food and see what I can find that's a novel protein.
If Tux's symptoms are being managed by steroids, does it make sense to use chemo?
Thanks so much for your advice and support!
 
Not Neko - she passed in 2016 - that's what GA in my signature means (gone ahead or guardian angel). It wasn't SCL that did her in. This one is third in a row with SCL. :banghead: First kitty (Neko was second) was also in remission but got pancreatic cancer. :(

Deb&Tiki said:
If Tux's symptoms are being managed by steroids, does it make sense to use chemo?
Click to expand...
The question is how long the steroids help. Or do you shut down the factory with chemo.
 
Sorry to hear about Neko. You've really had a lot to manage with your kitties!

My vet is suggesting to use Chlorambucil along with 0.5 mg Budesonide, hoping that the reduction in Budesonide will help with Tux's glucose levels. I have never used a chemo medication so I'm hesitant but I want Tux to feel well.
 
I wouldn't use a chemo unless it was confirmed to be cancer (small cell lymphoma). It is itself a carcinogen and can have side effects of nausea. Which I controlled with ondansetron.
 
That makes sense and the steroids seem to be working so far, just wish his glucose would settle down.
 
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