How can you tell if cat is insulin resistant?

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sulile

Member Since 2012
Here are some relavant facts:

Male Cat: Buddy, 16 years old
Diagnosed as diabetic: 2006
Insulin History: Vetsulin until it was discontinued, well controlled
Humulin 5 units, 2x a day for 2-3 years, well controlled
November 11,2012: Had a hypoglecemic episode out of the blue (BG down to 20) and was hospitalized

Since the hypo episode on November 11 of this year, the vets decreased his Humulin to 3 units, twice a day, but he crashed again. So they decided Humulin just isn't a good choice for him any more.

December 4, 2012: Started on Lantus, 1 unit twice a day
December 11, 2012: Increased Lantus to 1.5 Units, twice a day

I've been doing some glucose testing at home and his numbers remain so high. Seems like the get higher instead of lower.

I'm using Alpha Trak II and average reading since I started giving Lantus is 480....even after I increase to 1.5 units twice a day, the BG readings are sometimes in 500's.

This is torture; I;m a nervous wreck.....I hate doing the BG readings because each time it seems that they are higher. I'm having a 3rd Blood Glucose curve done today. My vet said she might also contact an internal medicine specialist at the vet school to see what they recommend.

She did tests for Cushings, ultrasound for tumors and they all came back negative.

He is lethargic, but is still eating pretty well.

It's so strange that he was well regulated for years and all of a sudden this happens.

I feel like his numbers would be the same whether I gave him the insulin or not.

Need encouragement.... :sad:

Susan
 
Hi Susan,

it is hard to see high numbers time after time. Lantus users can advise you on the dose/numbers (It is not the insulin I used). Can you post the date and numbers from your last curve and maybe the numbers from the last few days. Maybe Lantus users will be able to see some patterns that will help.

Is Buddy eating wet low carb? That can make a big difference in blood glucose numbers. We try to stay under the 8 - 10% carb range of wet food.
 
Susan:

1.5u of Lantus is not a lot of insulin. On the Lantus board, we don't start thinking about high dose conditions until a cat is over 6.0u of insulin at each shot. You've got a ways to go. I think part of the issue is that you are used to using much more potent insulin. Humulin will yank numbers down. Lantus is far more gentle and what you lose in potency, you gain in duration. How you use Lantus is very different than Humulin and will take a bit of a shift in your thinking. Dosing is based on the lowest point in the cycle -- the nadir -- not on your pre-shot value.

What I would suggest is that you read over the starred, sticky notes at the top of the Lantus board. In particular, the information on the dosing protocol. I suspect you may be holding your dose for too long which can result in glucose toxicity (the name sounds worse than it is). If this occurs, it makes it harder to get the numbers to come down. Generally, doses are increased every 3 days. You may need to be more aggressive with dose in order to see more movement in Buddy's numbers.

When people switch insulin, we take the previous insulin dose into consideration. I would be surprised to see Buddy be in really good numbers on his current dose of Lantus given that he was at one point doing well on 5.0u of Humulin. I suspect he will need to get closer to that 5u dose.

Hang in there. If you have questions, we're here to help.
 
Hi Susan,

I know things seem rough now, but we can certainly help you get things under control! Do you think you could set up a spreadsheet with whatever numbers you have now? Here is instructions on how to do it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207. If you need any help understanding it or setting it up, please ask!

I would cancel any curves scheduled to be done at the vet. Vet curves are very unreliable because stress raises blood glucose levels, often leading to inaccurate overdosing (as evidenced by the hypoglycemic incidents Buddy had on the Humulin N). If you are home testing, you can do your curve at home and it will be cheaper and much more accurate.

How many times per day are you testing? With Lantus, you want to test at least 3 times a day. Once before each shot to make sure it is safe to give insulin, and a test about 6 hours after either shot to show you how low he is dropping on the insulin. It is that third daily mid-cycle number that all dosing decisions should be made from, and dose adjustments are made in .25u-.5u increments depending on how high those mid-cycle numbers are trending. Unfortunately, many vets are not familiar with how to dose Lantus correctly, and so it's really common to have to deviate from your vet's dosing advice.

Unless you're getting mid-cycle tests at home, too high a dose will keep BG numbers just as high as too low a dose. That's because when a cat drops too low, his liver will release glucose into his bloodstream to counteract the low blood sugar. This can keep BG high for up to 72 hours. If you are not getting that third test daily, then you do not really know if the dose is too high or too low. Here is a link to the Lantus dosing protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf. I have also attached an article that explains the correct treatment with Lantus. I would print these out and give them to your vet, so that they understand why our dosing advice here is likely not matching what they are doing.

Are you feeding a low carb, canned diet? Dry food will inflate BG and cause problems with regulation. However, be aware that removing the dry food, even if the cat is only eating a small amount, can cause a 100-300 point drop in BG levels and drastically reduce the need for insulin. So make sure you are monitoring (with mid-cycle checks) and lowering the dose as needed if you are switching to a low carb, canned diet only. Given Buddy's age, I would recommend also feeding a premium canned food without byproducts, like Wellness Turkey (when it's bought in 12 oz cans, it's cheaper to feed than Fancy Feast). That's because most senior cats have some loss of kidney function, and foods with high quality protein sources help slow that loss. This is another reason why you need to feed a canned diet, as senior cats also need to be fed diets with a high moisture content for their kidney an urinary tract health.

Another thing that I would recommend is perhaps switching from the Alphatrak to a human glucometer. There's nothing wrong with using the Alphatrak, but the strips are expensive and only available at the vet. That's why most of us use human meters, where you can get cheap strips in stores and online. Some vets will tell people that they must use the Alphatrak because human meters are inaccurate (because their office makes money off of it, and that's what the Alphatrak reps tell them), but this is not true at all. It is true there is a slight difference (the blood glucose range is a little lower on human meters), but the dosing protocol for Lantus is written to compensate for that difference, so it doesn't matter. If money is not an issue, then the Alphatrak is fine, but is far more important that you are able to afford to test as frequently as needed (3 times a day, with a curve once a week), than that you use the animal meter. Two meters that are very popular on this web site are the Relion Confirm and the Relion Micro, because you can get strips online for $14 for a bottle of 50, or $20 in the store. Alphatrak strips are over $50 for a bottle of 50, if I remember correctly.

Hang in there. A lot of this stress will go away once you start getting those tests and understand how the insulin is actually affecting Buddy.
 

Attachments

How can you tell? Here is my opinion:

1. If you have fed your cat only a wet, low carb diet, including low carb treats, and
2. If you are testing the bg before every shot and hopefully 1 or 2 times in between, at say +5 and +7 and then next day at +6 and +8, and tracking the numbers so that you can see the patterns, and
3. If you are using a long acting insulin like Lantus or Levemir and have followed the protocol for increasing the dose (hold for minimum 3 days and increase by .5 or 1 unit, depending on the dose), and
4. You see a response to the insulin but not ever getting into normal numbers, and
5. The insulin dose is more than about 5 to 7 units bid, then

the cat is a candidate for testing for IAA and acromegaly.

I just want to point out that insulin resistant cats can be regulated, but their dose is often pretty high and may require a booster insulin to bring down the very high numbers until the long acting can take effect.

Others may wish to quibble with the top end dose, or the unit increase, but generally these are the points that I would consider indicative of a cat that needs further investigation.

There are few specialists who are well enough versed in feline diabetes and the ensuing complications to be worth the amount of money that it will cost for a consult. You might want to post your location and see if someone has seen a vet near you who has already been visited and is known to be knowledgeable.
 
Just-As-Appy said:
3. If you are using a long acting insulin like Lantus or Levemir and have followed the protocol for increasing the dose (hold for minimum 3 days and increase by .5 or 1 unit, depending on the dose), and
Click to expand...

The recommended protocol for Lantus calls for dose increases of .25u-.5u, not .5u and 1u. 1u is definitely too much to increase the insulin at once, and is not recommended for Lantus or Levemir. Perhaps this was a typo?
 
Thanks so much for the good information.

Some answers to questions posed:

1. Buddy eats the Purina DM dry food; he has always preferred this and I think it's too late to convert him to a wet food diet; I've tried with little success. Main thing is to keep him eating now.
Plus, isn't this a good food? I'm looking at the "Cat Food - Nutritional Composition" chart provided by Lisa A. Pierson at
http://www.catinfo.org/docs/Food%20Char ... -22-12.pdf
This is up to date as of September, 2012. On about page 27, she lists Purina DM as 3% Carbs.
Then I also found one at http://binkyspage.tripod.com/dryfood.html which lists Purina DM (CNM-DM) as 13%. Not sure which is correct.

2. I've only been checking his BG 2X a day, before each shot. It's difficult for me to go home mid-day as I work away from home, but I can to get some mid-day readings while I'm on Christmas vacation next week.

3. I live in Raleigh, North Carolina near North Carolina State University Veterinary School if anyone can recommend a knowledgeable vet.
 
Since your familiar with Dr. Pierson's website, you know how strong an advocate she is for a species appropriate, canned food diet. She also has a lot of information on how to transition a cat from dry to canned food. A lot of our cats were dry food junkies prior to their diagnosis. We were able to switch them over. Some switched with few problems. Other cats were a bit more stubborn. The difficulty is that you will have a great deal of trouble regulating your cat on a dry food diet. It may also be contributing to the high numbers.

For what it's worth, take a look at the ingredients in DM. There are far better quality foods that don't require a prescription and are much less expensive.
 
sulile said:
1. Buddy eats the Purina DM dry food; he has always preferred this and I think it's too late to convert him to a wet food diet; I've tried with little success. Main thing is to keep him eating now.
Plus, isn't this a good food? I'm looking at the "Cat Food - Nutritional Composition" chart provided by Lisa A. Pierson at
http://www.catinfo.org/docs/Food%20Char ... -22-12.pdf
This is up to date as of September, 2012. On about page 27, she lists Purina DM as 3% Carbs.
Then I also found one at http://binkyspage.tripod.com/dryfood.html which lists Purina DM (CNM-DM) as 13%. Not sure which is correct.
Click to expand...

As others have pointed out, the DM listed at 3% is the canned DM. There is no dry food that is appropriate for a diabetic cat. Dry food will continue to interfere with regulation and is likely the reason why you are not seeing better numbers with the Lantus. Did you see these? http://catinfo.org/#Transitioning_Dry_Food_Addicts_to_Canned_Food_. It's very important that you don't give up transitioning your cat, even if it's difficult at first. You don't want to starve your cat so if he refuses the food at first, you do want to feed him some dry. However, you need to keep at it and try different foods and tricks. The most common reason people have trouble transitioning is because they are free-feeding the dry food. The first step is to do scheduled, controlled portions of dry just like you would canned and not have it available 24/7, especially when the canned is down. Often times just getting the cat back to a natural hunger drive is all he needs to transition, but there are other tricks you can use on top of that.

Also, if you were only trying out the DM canned with him, many cats refuse to eat it because it contains a lot of liver. What canned foods did you try? I wouldn't recommend this long term because of his age, but a lot of cats LOVE Fancy Feast pates. If you could get him to Fancy Feast, from there you could get him on something a bit better once he's transitioned. Or perhaps it's the texture of pate foods he doesn't like? Did you try out something with more of a shredded meat consistency, like Merrick's Grammy's Pot Pie?

sulile said:
2. I've only been checking his BG 2X a day, before each shot. It's difficult for me to go home mid-day as I work away from home, but I can to get some mid-day readings while I'm on Christmas vacation next week.
Click to expand...

In order to dose Lantus safely and effectively, you need to get a daily mid-cycle check. Without those mid-cycle checks, you're not exactly dosing blind, but more like dosing with your hands in front of your eyes. In order to get a complete picture of how the dose is working and adjust it correctly, you need them. I was working two jobs (and my M-F job had an hour commute in either direction, so lunch hour testing was not possible) and going to grad school when Bandit was on insulin, so what I did weekdays was test before each shot (7am, 7pm), test again before bed (10-11pm) and then set an alarm to test 6 hrs after the shot and went right back to bed (1am). On the weekends when I was home during the day, I did a curve in the morning cycle. It seems like a lot of extra work to get that extra daily test, and I will admit it was a pain the first week or two while my body adjusted getting up and going back to bed, but new parents do it to a greater extent all the time with young children and they handle it ok. Trust me, putting that little extra effort in pays off big time in both your cat's safety and your own peace of mind. Think about how stressed you are now about his numbers without getting that test, and how much less stressed you'll be once you can stop guessing at the right dose and actually give him the right dose.

Another option is to teach someone else to test (partner, friend, family member, random student) and have them come over and do the test while you are at work.
 
Thanks so much Julia and others. This is great information.
I'm going to try your testing schedule Julia in hopes of getting a more complete BG picture.
And I'm also re-reading how to transition to soft food. Buddy has eaten Fancy Feast before, but most of the time he just sniffs it and walks away. Seems like it would smell much more tasty than the dry, but then I'm not a cat :) I also have some FortiFlora I'm going to use.

Will post more later when I have more information.

Thanks everyone!
 
Julia & Bandit said:
Just-As-Appy said:
3. If you are using a long acting insulin like Lantus or Levemir and have followed the protocol for increasing the dose (hold for minimum 3 days and increase by .5 or 1 unit, depending on the dose), and
Click to expand...

The recommended protocol for Lantus calls for dose increases of .25u-.5u, not .5u and 1u. 1u is definitely too much to increase the insulin at once, and is not recommended for Lantus or Levemir. Perhaps this was a typo?
Click to expand...

Please note that you missed the depending on the dose which means if your dose is 10u BID or 20u BID, you will not be bothering with .25u or even .5u unless you are fine tuning the dose.

So, no, it was not a typo.
 
Blue said:
Julia & Bandit said:
Just-As-Appy said:
3. If you are using a long acting insulin like Lantus or Levemir and have followed the protocol for increasing the dose (hold for minimum 3 days and increase by .5 or 1 unit, depending on the dose), and
Click to expand...

The recommended protocol for Lantus calls for dose increases of .25u-.5u, not .5u and 1u. 1u is definitely too much to increase the insulin at once, and is not recommended for Lantus or Levemir. Perhaps this was a typo?
Click to expand...

Please note that you missed the depending on the dose which means if your dose is 10u BID or 20u BID, you will not be bothering with .25u or even .5u unless you are fine tuning the dose.

So, no, it was not a typo.
Click to expand...

Buddy is currently at 1.5u, not 10u or 20u. Recommending .5u-1u increases at this stage is dangerous, and certainly not called for by the Rand protocol, which clearly states that dose increases should be made in .25u-.5u increases. I understand modifications to the protocol need to be made for high dose cats, but Buddy has only been on Lantus for about two weeks, which is way too soon to assume he's high dose (especially since he hypoed on 3u of N) or be modifying the protocol for him.
 
Buddy is currently at 1.5u, not 10u or 20u. Recommending .5u-1u increases at this stage is dangerous, and certainly not called for by the Rand protocol, which clearly states that dose increases should be made in .25u-.5u increases.
Click to expand...

I realize that you have no understanding of insulin resistance or how dosing for same is handled at different doses.
Clearly, a dose of 1.5u is not a situation of insulin resistance, so please do not pick out point 3. of a person's reply when it well connects to point 5. below in the same reply.

Cat was on humulin 5units BID for a long time then all of a sudden a drop to 20. That event could be a hint of resistance.
Cat switches to Lantus and gets to 1.5u BID but still at BGs in the 400s and higher? That also could be a hint of some resistance, but it's still early to suggest it.... until point 5. which mentions reaching a dose of 5 to 7u.

Being familiar with insulin resistance, I can state that cats having resistance issues, their doses rising and BG not going lower, DO need larger increases than a .25u or .5u, depending on the dose. Because this thread has a subject of How can you tell if cat is insulin resistant? it should be appropriate for one to post a short list of points relating to insulin resistance. If this thread was relating to Rand or Tilly, then a mention of dose increases .5u and 1u may not suit the thread.

Cats, with or without resistance, all reach a point where they will need to fine tune their dosing. The cat can be getting 20u BID or 50u BID, a time will come when dose adjustments of .25u or even less are needed to maintain good BG numbers, but on the road up to that range of good BG numbers, dose increases of .25u just don't cut it if you are at a higher dose.

The list in Just As Appy's post is correct, when taken as a group of related points. I see no place in the post where Buddy's owner was being advised to make dose adjustments of .5u and 1u. The majority of owners of cats having resistance issues may begin with 1u increases after passing 10u, and if still far from good BG numbers may even consider fast tracking and holding a dose for 5 cycles.

There was no typo, but rather only a misinterpretation by Julie.
 
Thanks Blue for this explanation. I guess we need to wait until I get to 5-7 units dosing twice a day before we can tell if he really is resistant.
This is so discouraging.
I am just so puzzled why he was doing so well for so long and all of a sudden had a hypo episode. My vet is puzzled as well....that's why she mentioned he could be insulin resistant, but there was no definitive test for that.

I will post the results of the glucose curve done yesterday in the vet's office when I get home.

Susan
 
I do not want to hijack Susan's thread with this (really pointless) argument, but the way the .5-1u increase was stated (before getting up to 5-7u in the list, and before being tested for a high dose condition), was misleading especially for Susan who is just learning how Lantus should be dosed, and is unaware that 1u is not a typical dose increase for most cats. My point was (and still is) that .5u-1u increases are not appropriate at this point in time for Buddy, where by no means has a high dose condition or insulin resistance been determined yet. Whether that was intended to be said to Susan or not, I am merely trying to clarify this for her now.

Please do not put the cart in front of the horse in this case, and let's check all egos at the door. There are many knowledgeable people here, and we all want to do the best to help Susan out without confusing her while she's trying to learn the basics.

sulile said:
Thanks Blue for this explanation. I guess we need to wait until I get to 5-7 units dosing twice a day before we can tell if he really is resistant.
This is so discouraging.
I am just so puzzled why he was doing so well for so long and all of a sudden had a hypo episode. My vet is puzzled as well....that's why she mentioned he could be insulin resistant, but there was no definitive test for that.

I will post the results of the glucose curve done yesterday in the vet's office when I get home.

Susan
Click to expand...

Susan, I am sorry if this disagreement is confusing for you. Do not be discouraged. You should not worry about insulin resistance or high doses yet, because you haven't eliminated the far more common problems with regulation (dry food/infrequent testing/increasing the dose too much too quickly). Focus on getting those mid-cycle checks, setting up/filling in your spreadsheet, and changing the diet, and then everything will be far more clear. No one can tell you exactly for sure what is going on right now by guessing or making assumptions--but once you collect those mid-cycle numberes and are hopefully more successful with the change of diet, things will be far more clear and you will be able to better determine what's going on and what the dose should be. There are very experienced Lantus users in the Lantus forum that can help you determine exactly what is going on with Buddy. It's far more likely this is just a diet/testing problem, and you likely will not need to get up to 5-7u of insulin.

It is far more likely that Buddy dropped to 20 on 5u of Humulin N because the dose was too high and he was being chronically overdosed. That happens all the time with Humulin N when the dose is raised in 1u increments without home testing. That he also hypoed on a smaller dose of 3u of Humulin N is further evidence that the dose was likely too high, which and this is by far the most common reason you see cats hypo on N. I have experience with two different cats that were on high doses (5u and 6u) of Humulin N, without home testing. In both cases, the cats were being chronically overdosed and the owners had no idea because they were not home testing. It's impossible to tell how your cat was doing on the Humulin N from observation and vet curves alone. Too high a dose can keep blood glucose levels just as high as too low a dose, and cats can be habitually overdosed for months before finally having a severe hypo incident. Numbers obtained with vet curves are inaccurate because stress inflates a cat's BG. Switching to Lantus and learning to home test are very good, positive things--Lantus works far better in cats and it's unlikely you will need a high dose if you can get the diet changed over to canned. Most cats on a low carb, canned diet and Lantus do not need much more than 1u of insulin.
 
No problem....the discussion is interesting. I probably didn't give the thread a good Subject line. I'm basically just really worried and stressed out. Thanks everyone for the information; it is all very useful. There seems to be no hard and fast answer.

Susan
 
sulile said:
No problem....the discussion is interesting. I probably didn't give the thread a good Subject line. I'm basically just really worried and stressed out. Thanks everyone for the information; it is all very useful. There seems to be no hard and fast answer.

Susan
Click to expand...

There is definitely a lot of information overload at first with Lantus--as you can, I would check out the stickies in the Lantus forum. There's wealth of valuable information there about the insulin you're using. Just get through them as you are able, there's a lot to absorb at first!
 
sulile said:
Thanks Blue for this explanation. I guess we need to wait until I get to 5-7 units dosing twice a day before we can tell if he really is resistant.
This is so discouraging.
I am just so puzzled why he was doing so well for so long and all of a sudden had a hypo episode. My vet is puzzled as well....that's why she mentioned he could be insulin resistant, but there was no definitive test for that.

I will post the results of the glucose curve done yesterday in the vet's office when I get home.

Susan
Click to expand...

Susan, your are most welcome. My reply addressed the subject you used, and most certainly not where you may end up..... the majority of cats will never need anywhere near 5u shots, but if you ever DO get to that dose and you are not seeing lower BG numbers, it's something to consider.

There is also a condition where a cat can be just fine on a dose, then all of a sudden, have a big drop in the BG. I am referring to a different type of resistance condition: IAA.

I think the best approach would be for you to be home testing before each shot, and recording the test numbers because it's about the only way to know for sure how well or poorly the insulin is working.

Many people hope that with a bit of a diet change and a short period on insulin, their cat's pancreas can heal and start to function 100% on its own and no longer need shots of insulin. The best way to know when this is happening is to home test..... imagine your cat heals well but you are not testing.... that could cause your cat to have a very low BG - by giving insulin when not needed.

Humulin is quite a poor insulin choice for cats and does not last the full 12 hrs, so you should have much better luck on Lantus, and with your home testing, you will see better numbers and a much happier cat.
 
I have some BG readings but haven't done a spreadsheet yet. Thought I would just get some quick feedback. First curve was done while Buddy was on 1 unit of Lantus 2x a day on 12/11; I give Lantus shot at 7:00 AM and 7:00 PM:

1 Unit Lantus/ 2X a day (Done in Vet's office)
----------------------------
7:00 AM 516
8:00 AM 387
10:00 AM 245
2:00 PM 376
5:00 PM 368
7:00 PM 534

Next curve was done on 12/18 while Buddy was on 1.5 Units Lantus 2x/day:

1.5 Units Lanuts 2X a day (Done in Vet's office)
-------------------------------

7:00 AM 507
8:00 AM 433
10:00 AM 364
12:00 PM 389
3:00 PM 422
4:00 PM 375
6:00 PM 464
7:00 PM 488

The next curve I did myself 12/20 at home:

7:00 AM 509
10:30 AM 491
12:30 PM 510
2:30 P M 496
7:00 PM 467

As you can see, he is stuck in the high 400's to low 500's. And it seems like his numbers increased after going from 1 to 1.5 units Lantus. These numbers make no sense to me. They seem totally random. Lately, I almost always get readings in the 400's. And the vet always seems to get lower numbers which is odd; thought he would be more stressed there.
My vet talked to the Vet School at North Carolina State University and she said they really weren't very helpful. Everything they suggested, we've already tried.
She did mention one other test we could do which is for "atypical Cushings" . Something about the sex hormones binding with the insulin? Anyone familiar with this?
Can't be done until after Christmas and it costs $300.00+ and must be sent to University of Tennessee??? And we have't tested for IAA (insulin auto antibody??). She didn't think this would be worth it since we know Buddy is not producing insulin.

Any thoughts are welcomed.

Thanks so much for the support.

Susan
 
I would increase the does and see what happens. My Tonis was a high dose kitty. Except for the first shot or two his BG acted like yours . I switched from Lantus to Levemir when I got up to four units. Performance on Levemir was essentially the same.I finely got very good response (under about 150) all the time with 8 units Levemir and 5 units N.
 
sulile said:
I have some BG readings but haven't done a spreadsheet yet. Thought I would just get some quick feedback. First curve was done while Buddy was on 1 unit of Lantus 2x a day on 12/11; I give Lantus shot at 7:00 AM and 7:00 PM:

1 Unit Lantus/ 2X a day (Done in Vet's office)
----------------------------
7:00 AM 516
8:00 AM 387
10:00 AM 245
2:00 PM 376
5:00 PM 368
7:00 PM 534

Next curve was done on 12/18 while Buddy was on 1.5 Units Lantus 2x/day:

1.5 Units Lanuts 2X a day (Done in Vet's office)
-------------------------------

7:00 AM 507
8:00 AM 433
10:00 AM 364
12:00 PM 389
3:00 PM 422
4:00 PM 375
6:00 PM 464
7:00 PM 488

The next curve I did myself 12/20 at home:

7:00 AM 509
10:30 AM 491
12:30 PM 510
2:30 P M 496
7:00 PM 467

As you can see, he is stuck in the high 400's to low 500's. And it seems like his numbers increased after going from 1 to 1.5 units Lantus. These numbers make no sense to me. They seem totally random. Lately, I almost always get readings in the 400's. And the vet always seems to get lower numbers which is odd; thought he would be more stressed there.
My vet talked to the Vet School at North Carolina State University and she said they really weren't very helpful. Everything they suggested, we've already tried.
She did mention one other test we could do which is for "atypical Cushings" . Something about the sex hormones binding with the insulin? Anyone familiar with this?
Can't be done until after Christmas and it costs $300.00+ and must be sent to University of Tennessee??? And we have't tested for IAA (insulin auto antibody??). She didn't think this would be worth it since we know Buddy is not producing insulin.

Any thoughts are welcomed.

Thanks so much for the support.

Susan
Click to expand...

Hi Susan,
I would not spend the money on IAA testing or Cushings yet .... the numbers you have been getting don't look like any IAA pattern and Cushings tests are really not definite.
If you want some info on Cushings:
Cushings Info
Cushings Info
Cushings Info

I will tell you about my cat, Shadoe, who did test positive for acromegaly, but she was also extremely carb sensitive. For the first 5 yrs of her life, she was fed only dry food, all kinds and she loved it. When she was diagnosed with diabetes, I of course freaked and tossed ALL the dry out, putting out fancy feast and friskies pates for my cats. Shadoe grumbled but she ate it; my other non-diabetic/feral cat refused and did not eat for 3 days. Now, Booboo is a tiny girl, but also vicious, and stubborn. I have a very time consuming job and could not spend the time to switch Booboo over to wet so here is what I did.
I let her eat the dry food, she eats ONLY fancy feast dry, when I was present and watching her. If I left the room, went out, or to work, the dry food was removed and put in the cupboard. She learned that when I came home, the first thing I would do would be to put out her bowl of dry food.
The reason I had to hide the dry was that Shadoe was an addict and she could smell that dry.... she would try to sneak in and steal a mouthful, then run off, drop the mouthful of dry pieces and start chomping on them. Her BG always jumped into the 400s when she stole even a few pieces, so I had to watch her like a hawk.
In the beginning of taking up the dry, I felt guilty about Booboo starving but then I stopped and thought there is no reason to feel bad because there was always wet low carb food available so if she was really hungry, she could eat the wet!

It is for the above that I say to hold off testing any more until you can get the one diabetic on wet only. My Shadoe was a sly little rascal and any chance she saw, she'd try for some dry, and when she was successful, I saw numbers like you are getting.

Now, if you can't do the food switch, that's no problem but you will just have to settle for giving more insulin. I wish I could believe that every single cat in the world could be switched to wet low carb, but I think there may be a couple stubborn ones who just won't switch, and those guys, if they are diabetic, will need more insulin.

Awhile back, there was one person who was giving their cat 20units of insulin twice a day.... whoa, that's a big dose, yes? Well, once that person switched to wet food, the dose dropped to about 1unit twice a day. The food really does make a difference but if you can't do it, then it may result in a bit more insulin needed and your boy may have some other health issues along the line.

I never tried it, but what if you added water to the dry food? I wonder if it was gradually more moist, would the cats try it?

Your Buddy may be like my Shadoe with carb sensitivity, so that's why I say hold off testing, unless Buddy has some of the signs for Cushings.

Last, the insulin could be switched. Shadoe had weird numbers and was 'tense' when on Lantus, but once I switched her to Levemir, she relaxed within days. That's another thing you could try... switch to Levemir.

We just need to keep trying, and eventually, something will work for each of our cats.
Keep at it, but hold on the tests for now.
 
Re: Last, the insulin could be switched. Shadoe had weird numbers and was 'tense' when on Lantus, but once I switched her to Levemir, she relaxed within days. That's another thing you could try... switch to Levemir.

Thanks so much Blue. I have started Buddy now on 2 units 2x a day. How is Levemir different from Lantus?
Susan
 
Larry and Kitties said:
I would increase the does and see what happens. My Tonis was a high dose kitty. Except for the first shot or two his BG acted like yours . I switched from Lantus to Levemir when I got up to four units. Performance on Levemir was essentially the same.I finely got very good response (under about 150) all the time with 8 units Levemir and 5 units N.
Click to expand...

Thanks so much Larry. It is good to hear from someone who has a high dose kitty. I have increased Buddy's dose to 2 units 2X a day now. Do you mean you give your kitty 8 units Levemir and 5 Units N (is that Humulin?) twice a day? How is Levemir different from Lantu.

Susan
 
Yes, Tonis got 8 units Levimir and 5 units N twice a day.
Levimir is similar to Lantus. Both are one a day insulins for humans. They work differently.
 
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