Info on Possible Help for Cats with High Fasting Glucose Levels

[Critter Mom]

Hi all,

Both when on insulin and when she first became a diet-controlled diabetic, Saoirse had an ongoing problem with impaired fasting glucose. This is where blood glucose starts to rise significantly the longer a cat fasts after a meal. I think it may only become more manifest when a cat is in - or close to - remission. They may stay in the normal range when fed regularly, but a longish fast and the liver will start dumping glucose into the bloodstream, leading to an anomalous spike in blood glucose levels. If the cat's pancreas has functioning beta cells, feeding the cat should trigger a pulse of insulin which will then lower the BG soon after the meal.

I had to make sure I fed Saoirse at least once every three hours when she was on insulin and then every two hours or so when she became diet-controlled in order to keep her BG numbers in the healthy range. A fast of four hours or more resulted in BG spikes of several points in magnitude (mmol/L).

Last year, I wanted to trial Saoirse on a SAMe/silybin supplement to support her liver and also to see whether the problem of impaired fasting glucose might be that there was still some residual insulin resistance in her liver (cf. her pancreas not secreting enough basal insulin between meals). I didn't get support from our vet for this at the time (he thought it was unnecessary and that it might not be palatable to Saoirse).

Saoirse had ultrasounds in March, and these revealed some liver abnormalities (no firm Dx at time of posting - vets think it's possibly a knock-on from her pancreatitis). I finally got support from our vets to give her the SAMe/sylibin supplement (initially Samylin, but then switched to Hepatosil 50 for cats).

After about 2 months of treating Saoirse with the liver supplement, there has been a significant improvement in her fasting blood glucose values. She can now go for hours and hours between meals with no BG 'fasting spikes'.

I recognise that this is anecdotal, but I've posted this in the hope that it may help other kitties with similar problems. If your cat has impaired fasting blood glucose levels maybe have a chat with your vet about whether some support for the liver might be of benefit.

Blessings to all beans and scritches to all kittehs.



Mogs & Saoirse

 

[Critter Mom]

 

[Brashworks]

She is so beautiful!! Just look at those eyes! Gorgeous.

Thank you for the thoughts on impaired fasting glucose - it's an interesting premise. I have long wondered about the interrelationship of pancreas and liver and food. So many factors to consider - your thread is well timed because I've been wondering whether or not I was feeding Genghis too often. She is thin but gaining weight so for now I may stay the course and continue to feed her as much as she will eat but in smaller portions throughout the day. Today I didn't feed her the moment I got home from work as I didn't want to "corrupt" her PMPS but I've noticed a more gentle curve when I've been home all day and given her mini meals every few hours when doing curves at home.

I am also strongly considering changing her to Lantus. Her BG reacted well to the 2.0u Caninsulin but it's a harrowing drop even if she showed no outward signs of hypo. I suppose I would need her labs and a clearer idea if fasting did indeed spike her BG levels and then approach the vet for additional liver support- need more data!!

Thank you again for this additional info to consider.

 

[Critter Mom]

Aw thanks, Melanie! You should have seen her this time last year. Half of her coat had fallen out (like poor Genghis) and she was spending most of her days flat out and immobile (severe pancreatitis flare). I really was scared I might lose her; she was so sick.

One can lose oneself in Saoirse's eyes. I'll be sure to pass on your compliments to my Bonnie.

Here's a link to the best resource I've been able to find about the blood sugar regulation system (took me several months to find it):

How Blood Sugar Control Works - And How It Stops Working

It is written from the human glucose regulation standpoint, but I found it an invaluable aid in better understanding exactly how the pancreas works and also the interplay and signalling between the organs involved. It confirmed that I was correct to infer from the data I had gathered for Saoirse that the anomalous BG spikes were caused by her going without food for too long (i.e. it was not just a mere correlation).

To give you an idea of how impaired fasting glucose looks numerically, have a look at Saoirse's 2014 data for the October / November period. The 'fasting spikes' stick out like a sore thumb (and they're annotated in the remarks column). Obviously it's the liver's job to release glucose between meals so that the body's cells have a steady supply of glucose for metabolism, but in the case of impaired fasting glucose it looks for all the world that the liver's 'Off' switch is banjaxed. That's what led me to the two hypotheses mentioned in my opening post about what might be causing the problem.

------

I think you're right to consider Lantus. Like Caninsulin, it has its tricky aspects (most notably managing a hypo when the depot is full) but it is much better suited to tightly regulating a cat. The Caninsulin is (usually) too crude a tool. Looking at Genghis' data, methinks she might be a fast metabolizer - a strong onset by +2 and the dose really starts petering out by +8 - in which case a longer-acting insulin should definitely be the way to fly.

 

[Brashworks]

This is a very interesting article, both for my cat and for me. My dad's side of the family are all Type II diabetic and I have been monitoring my BG along with Genghis. I currently suffer from post prandial hypoglycaemia - I have since a young age - but now I am finding some BG swings into >7.8 which have probably been brought on by my penchant for fast food, my lack of exercise and my increasingly broad beam.

One site encouraged home monitoring at both 1 and 2 hours post meal that contained at least 64 g of carbs - medical professionals often only test at +1. I never knew about the 2 waves of insulin, either, but this now makes so much more sense.

Interesting how the liver can get confused - healthy support for the liver makes so much sense!

PS. Thank you for taking a look at G's SS. I have the Lantus in my fridge - thanks Dad! I believe I may start her this weekend when I am home to monitor her properly.

 

[Critter Mom]

Insulin treatment didn't prevent the fasting spikes, so there was a stronger possibility of the liver insulin detection system being iffy in Saoirse's case. The liver supplement was very much a suck-it-and-see thing. I've never seen any reference to SAMe/sylibin support being helpful for impaired fasting glucose (or anything else being helpful, for that matter). It was the only thing I could think of to try. It was a punt. I'm delighted it seems to have done something to help - in Saoirse's case at least.

 

[Critter Mom]

I currently suffer from post prandial hypoglycaemia

I've not heard of that before, although I can see how it might work from having seen Saoirse's BG drop within 2 hours of eating sometimes. (You're right about the +2 tests, btw; very valuable!) What causes the hypoglycaemia? How low does the BG go?

 

[Brashworks]

I was poring over Saoirse's SS - dang, woman you take great notes! I can see the fasting spikes you spoke about. How is her nausea now - it seemed so problematic for her? Do you still take her readings? I'm glad that the SAMe/sylibin helped her - she's such a lovely girl. Her coat looks fantastic, so glossy! Hard to believe it wasn't always like that.

About the hypoglycaemia - there's no known cause and no known cure - I'm just told to keep carbs/glucose lozenges with me at all times. The odd thing is, it doesn't happen all the time. There is one place I get soup and a sandwich from and it's caused my BG to plummet within about 2 hours of eating it about 4 or 5 times - too many to be coincidence so I don't eat there any more!

My BG has fallen to 1.9 which feels really awful- I get a full-on panicky feeling that I understand is my brain saying GIVE ME SUGAR NOW!!! About 2.8 I get lightheaded, sweaty, jittery and very … cranky - I've learned not to let myself fall much below that but it can come on very suddenly. This is why I truly understand when they say a cat with hypo numbers can exhibit no symptoms, then plunge rapidly into full on hypo.

I thank you for the article again - you'd think I'd have researched a little more for myself but the "cure" seemed easy enough. Now with Genghis, it's so much more important. Somehow understanding it better I think, combined with good data, will help me make the right decisions for her.

 

[Critter Mom]

Glad that the fasting spikes are clear to you - they stick out like a sore thumb to me, but I'm the one that was doing the monitoring. I do still test Saoirse regularly (I use BG measurements as a diagnostic and treatment suitability aid as well as a check on her blood glucose levels) and I maintain a detailed journal for her. It's invaluable. She still has nausea problems because of the chronic pancreatitis and now also because of the early CKD. Thankfully, we're managing it well with the right supportive meds (ondansetron and famotidine). Re her coat, it's not always that good at the moment. Saoirse has thyroid issues (apparently a knock-on from the pancreatitis issues) so her coat condition has deteriorated since her Lantus treatment stopped last November. It looked and felt a-mazing at Christmas ...

Interesting. Was it always the same soup and sandwich that you ordered? I ask because the magnitude of the BG-lowering effect in Saoirse was very much correlated with the food she was eating.

I found your description of what it's actually like to experience a hypo enlightening and informative. My best friend is a type I diabetic and I always make sure I have a candy bar with me if I'm in his company. He has had mild hypos when I've been with him a couple of times (not a bad average for a quarter-century long friendship!) but, being a bloke ( ) he was never the greatest at describing to me what the experience was like subjectively or what symptoms to watch for objectively. If only there were a way we could get our kitties to grab the feline equivalent of a Snickers when they were dipping low.

I'm really glad you found the article valuable. I most certainly did.