Increased Drinking When BG drops (to healthy levels)

[Chellie]

Hi! My cat was diagnosed earlier this year with steroid-induced diabetes, and the community here was very helpful in guiding me on insulin dosage. He went into remission after a few months, but is now diabetic again. We are doing okay, starting slow this time, making sure we do this right. He is currently at 1 unit twice a day. We are seeing decent progress, but not a ton of blue yet. He is generally staying below 250-280 though. He feels MUCH better here than 380 as you can imagine. Anyway, on days when the insulin seems to be more productive and he drops to the 150s-160s during the middle of his cycle I've noticed him drinking a lot of water again. Previously I only noticed this when his BG was high. Is this a normal reaction for a body that isn't quite used to numbers that low yet? Or is it a sign that something else is going on? Just want to make sure he's safe. For example, this morning is AMPS was 243 but he refused to eat (bad IBD day) and did start eating around an hour or so later so I gave him his full shot knowing it might hit him a bit harder today. Within a few hours he had much more of an appetite and then I started noticing the excessive drinking (it's definitely not as much as when his BG is high but it's noticeable). At +5 after a little lunch he's at 169, which is of course very safe but why does he react so strongly to this number? Thanks so much!

 

[Suzanne & Darcy]

Hi Chellie! I hope you’re well. Looking at Cash’s spreadsheet, the numbers I see there are not indicating that he was actually in remission when you discontinued insulin. When a cat is in remission, they will stay almost all in the green numbers below 100 for almost all of the time, with a very rare blue number under 120. I think the remission was rushed and he needed a little more time and a small amount of insulin support to help his pancreas finish healing. We have a protocol here that we use to try and ensure a strong and lasting remission. Unfortunately, I see vets quite often say that a cat is in remission and to discontinue insulin when the cat isn’t quite there yet. Let me post this and see about your other concerns.

 

[Suzanne & Darcy]

Is Cash currently on prednisolone or any other steroid? Your signature says IBD/Lymphoma. How was this diagnosed. Surgical biopsy? Ultrasound (which can tell if the intestinal layers are inflamed, but cannot diagnose SCL.)

 

[Suzanne & Darcy]

What exactly is he eating?

 

[Suzanne & Darcy]

Are you saying he drinks more water in the 100s than in the 300s? Or just that you would not expect to drink so much in the lower numbers.

 

[Suzanne & Darcy]

Now, looking at his spreadsheet again, this 1 unit dose has been held for too long (two weeks). He needs an increase to 1.25 as soon as possible. Holding doses for too long only allows the kitty to get cozy in the higher numbers and it makes it harder to shift them out of them (what is called glucose toxicity.) You have only been seeing mid-blue nadirs on 1 unit so you need to increase to start seeing better nadirs and hopefully lower preshots as well. We should hold the 1.25 unit dose for 7 days and then reevaluate for another increase (unless he earns a reduction.)

 

[Chellie]

Hi Suzanne, good to hear from you. I realize we did probably stop Cash's insulin treatment too early last time. Our vet was adamant that as long as he was staying until 180 on his own we could stop insulin. Cash is under care of an internist/specialist now, so hopefully he will be a bit more knowledgeable. Cash is no longer on any steroids. He was diagnosed with IBD/Lymphoma following an ultrasound which showed enlarged lymph nodes and thickened intestinal walls. At the time, he was quite weak so we decided not to do the invasive biopsy procedure to determine whether it was cancer or IBD. How Cash has reacted off steroids but with a novel protein diet does have the vets thinking IBD is more likely.

 

[Chellie]

He currently eats a mix of Raynes Kangaroo maintenance stew (14%) and Raynes Kangaroo dehydrated (6%). I would say it ends up being around 8-10% carbs.

 

[Chellie]

He does not drink more water in the 100s than 300s, but when in the 100s he drinks more than when he is in the 200s. My concern with the water was that I see him drinking a lot of course when his BG is high (usually over 300). However, on the occasions that he has dipped to 150-160, I see him start to drink more water as well, although not as much as when his BG is in the 300s. I was just wondering if this is his body reacting to lower BG levels that it's not used to. I see it often mentioned for symptoms of hypoglycemia so was just curious if I should be concerned.

 

[Chellie]

And yes, I realize he has been on 1 unit for a while. Part of that is because on September 2 I realized Cash had an abscess on his paw and he had to go to the vet to get an antibiotic shot. His BG numbers had started to creep back up in recent days before that and I was thinking that the infection might be affecting them. I just wanted to make sure everything was back to normal in his body before increasing the dose again, so that any insulin resistance caused by the infection might dissipate first. Additionally, as his BG levels have gotten lower and stayed lower for a while, he is starting to feel better and thus eating MORE. Which is great, because he wasn't eating enough before, but as he has increased his appetite, the 1 unit doesn't do quite as much. Of course, because of his IBD, he has days where he isn't eating so much too. So we are trying to balance all these things. I agree that it is probably time though to move to 1.25. Thank you for all your insight!