Insulin Not Working Question

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catman31

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I am knew to this forum. My kitty was diagnosed with diabetes a month ago. He spent a week at the vets. He did go back for a glucose test curve and all seemed well. But his insulin dosage was increased. He was on PZI. He became very ill and from what I have read on line, I believe that he became "hypo". I took him back to the vet and he has been there 4 days now. The vet asked me if I had dropped the insulin or left it out of the frig. I assured the vet that I had not. The vet said that the insulin was not working. So they opened a new bottle of the same insulin and this morning called and says that it is not working. They are switching him to human insulin NPH. Does anyone know of cases where insulin stopped working?
 
Can you post this on the Health forum as well?
I have seen where a certain type of insulin for some reason stops being really effective, and people switch to a different type, but not like overnight. Hoping that someone has some feedback for you. You are most likely to get a lot more "eyes" on the thread in Health.
Please let us know if the Humulin starts working?
Carl
 
So, how can the vet say it isn't working? What is he basing this on? You can give too much insulin (you said the dose had been increased, but that it appeared to be working prior to that )and have blood glucose readings go up....which makes it appear like the insulin is not working, but in fact too much insulin is being dosed. You also can have a flat curve where there is no upward movement in blood glucose numbers, but flat readings...this can indicate too little insulin.

Unless, there are symptoms outside of BG readings, I would think it would be impossible to say the insulin is not working based on a curve. I would go back to the dose that appeared to be working and see if you can get any movement.

We had a cat named Risky that was getting decent curves on a dose, only to be increased by the vet ....eventually he got to 8 units twice a day. His numbers stayed Hi and he had terrible symptoms...he is now on 2.5 units and doing great. Too much insulin will make it appear that the insulin is not working. The body, ie liver, instinctly dumps sugar to protect the body from hypo. this is the body's natural defense.

Do you know what the vet is basing the statement on?
 
There are some conditions that cause insulin resistance. These conditions cause cats to need a "high" dose of insulin. A "high" dose is considered any dose above 1u insulin per pound of body weight per day. My cat Norton was at 13U BID at one point, and he had Acromegaly. So - he was getting 26u per day and he weighed 16 pounds.

IAA - Insulin Auto-immune Antibodies -- the body rejects the foreign insulin
Acromegaly - a pituitary tumor generates "insulin-like" growth factor which interferes with the normal insulin receptors and causes the diabetes.
Cushings (rare in cats, more common in dogs) - an adrenal tumor that causes the diabetes (I am less familiar with this)

There are two good tests conducted at the same lab for determining if IAA or Acromegaly is present. Since your vet fee for blood draw and shipping are the most expensive part of these two tests --- get BOTH done. The Acro test costs $49 US and the IAA test costs $15
Cushings is very had to diagnose until extreme stages when the skin is very fragile and tears easily.

More details, and links to the tests:
viewtopic.php?f=12&t=375
IGF-1 test:
http://www.animalhealth.msu.edu/Bin/Cat ... ne&Id=1401
IAA test
http://www.animalhealth.msu.edu/Bin/Cat ... ne&Id=1494

It would be great if you could try a more gentle, long-lasting insulin like Lantus or Levemir.


A few of the cats with Acromegaly need over 50 units BID to get healthy blood sugar levels. More commonly, acro-cats need a less scary dose, like 15u BID to 25u BID.

Do you test your kitty's blood sugar at home? That is the best way to understand how your kitty uses the insulin and how much your kitty needs.

What doses of PZI were tried (and how quickly were the doses changed?) and where are you with the Humulin N dosing?

We recommend a "start low and go slow" approach -- starting at 1U BID and holding the dose for several days or even a week before increasing.

Another possibility is that your kitty has been overdosed from Day One, and is in Somogyi Rebound. This is where the kitty's liver dumps extra sugar into the bloodstream to "soak up" the excess insulin. If the dose started out to high and increased from there --- blood sugar crashes from low to high.

Some cats only need a tiny dose -- my adopted diabetic cat, Tiggy, we use Levemir and he gets a tiny dose of 0.5u BID. (adopted him after we lost Norton to cancer).

Where are you located? (city/state) Maybe someone can show you how to test your cat's blood sugar at home. (saves money and the results are more accurate because cats are usually stressed out at the vet's office - causing increased blood sugar)
 
Without knowing the BG at various times after taking the insulin I can't really say much. Some kitties are on a relatively high dose. My Tonis is on 13 units twice daily.
 
Larry and Kitties said:
Without knowing the BG at various times after taking the insulin I can't really say much. Some kitties are on a relatively high dose. My Tonis is on 13 units twice daily.

And some kitties are on a low dose-Cass gets 0.2 units twice daily.
 
Someone on this forum suggested I post my same info on the Health Forum which I did.

My cat Sandy is not doing well at all. He was diagnosed with diabetes on Oct 18 and spent a week at the vet's hospital. I brought him home on the 24th and began giving him insulin. I was so unknowledgeable about everyting and was never told to feed him prior to injecting insulin. He seemed ok some days and then on others not. I took him back to the vet on Nov 4th for a glucose curve. The vet instructed me to up the dosage of PZI from 1 unit BID to l.5 units BID which I did. He started to deteriorate and I had to take him back to the vet's hospital on Nov 15th. The vet called me later in the afternoon and asked if I had dropped the insulin or left it out of the frig overnight as it was not working. Sandy was in bad shape. The vet said that Sandy was so weak that he couldn't make it to the water bowl. That hurt! As I carried him the water bowl or made sure it was next to him. Never once did he not use his litter pan either.

The vet kept Sandy from Nov 15th to Nov 18th. She called in the morning and said that he wasn't eating on his own and couldn't come home until he did. At 2PM she called again and said that the new insulin she was using Humulin was working and that Sandy was eating and I could come get him. I brought him home and drove 20 miles to get his new insulin and new size syringes. He was good that evening and the next day. But on the 20th, he had stopped eating and was going down hill quickly. I called the vet at home (she had given me permission to call her if he stopped eating). She said to up his dose of Humulin to 2 units BID which I did and she also said that the next morning might be a good time to euthanize him. I called her the next day and said that I would like to keep hand feeding him every two hours and give him a chance.

On the 23d I took Sandy back to the hospital and requested that my vet of 20 years take a look at Sandy. My original vet is ill and has been battling cancer. But he agreed to see us. He took one look at Sandy and said that Sandy hasn't been regulated on the insulin yet. Sandy is still at the hospital and this is his third hospitalization in just over a month. I spoke with my vet this morning and he said that Sandy's liver and kidneys readings were high and he would have some tests done. He said that we should consider other options. I am not sure what he meant by that.

Sandy is only 6 years old and I have had him since he was a tiny baby and I bottlefed him and was his Mom. He never resisted an injection of insulin and took it in his stride. I am sorry about not posting more quickly, but I have not been feeling like doing anything. My old vet told me that I had spent a lot of money and that he would take Sandy in and not charge me at all. Sandy is a strong kitty and if there is a chance, he will make it. For over a month, I feel that he wasn't receiving the proper care. On my own, I bought a glucometer and was able to do two tests on Sandy. The one reading I got which was just before his PM insulin read 225. The test I did 12 hours later in the morning before his insulin injection read 495.

Please keep good thoughts for Sandy as he is the most gentle kitty in the world. Again I am sorry for not having posted sooner and not having done more research that has been suggested. But this is a very difficult time for me also. And I apologize if posting the same comments on anothe forum is not correct. I am new to this forum and also to feline diabetes.
 
It sounds you and Sandy and really been through the mill! And without much help from your vet albeit at a lot of expense.

In general, we think cats are treated at home just like humans with diabetes. Unless they are complicating issues, which it sounds like Sandy may have had.

The first and biggest step is testing at home which you have accomplished. Fantastic and welcome to the vampire club!

First, are you using Humulin or PZI? It seems like you were using PZI when you first posted. That is a preferred insulin to Humulin as it lasts longer in the cat and is less harsh. Do you still have the PZI and can you use it?

The forums are confusing. I would suggest you find your other posts and read the replies. You got lots of helpful advice on each one. If you got to your profile here: http://felinediabetes.com/FDMB/memberli ... ile&u=5265 you can see that you have posted 4 times. Pick "search all posts" and you can easily read all your threads.

If you can come on a couple times a day and respond to our questions, we can get a dialogue going and hopefully help you help your kitty.
 
More people will see and respond to your post on Health - however there are many more posts, so it can get "lost" --- keep scrolling down to find it.

Since you have switched to Humulin N, the people here in PZI group may not be able to help much... there is a different insulin support group for Humulin N.
 
Phoebe, the Humulin board is inactive. The last post there was november 14th.

If you are using or can use ProZinc, we can help you on this forum. If you are on Humulin, I would agree with posting your next question on the Health Forum. I will be watching for you and reply over there. (I don't use Humulin - very few people here do - but I have helped others use it.)

Check your pms. In the upper part of this page "you have 1 message" If you want, we can talk on the phone and I can help you find your way around the board. It is very complicated at first. My first post was to a forum nobody uses......but someone helped me!
 
The first bottle of PZI was one that the vet said was not working. So they opened another bottle of PZI and the vet claimed it was not working also. That was on the morning of Nov 18th. Then at 2PM or so she called and said that she had switched him to Humulin and it was working and Sandy was eating. She said that I could come get him. He was great health wise -just like his old self Friday and all day Saturday. But Sunday he was in really bad shape. Our old vet who is caring for him now at the hospital, called this morning and said that Sandy's insulin dosage should be between 3 and 4 units and that he had not determined the exact amount yet. Sandy's kidney values are back to normal. But the liver isn't. The vet also said that he was not eating and mostly nonresponsive. I now feel that, if the vet who saw Sandy and cared for him for 4 weeks had established the correct dosage initially, he would be in a better situation than he is now. I don't think that I should post on the Humulin site right now as I am not sure if Sandy is going to make it. The vet will be calling me tomorrow and I hope and pray that there is a dramatic improvement in Sandy. I believe that PZI was trying to do the job but that the dosage was too small from when he started insulin on October 18th. I thank you for sending the site to check comments on my postings.

I volunteer at the County Animal Shelter and photograph all the cats and kittens and put them on the website. I have been doing this for 7 years and it is rewarding to know that it increased adoptions and reunites people with the lost friends. Being able to do this will help me, should I lose Sandy.

Thanks to everyone for all you help and shared knowledge.
 
Oh, I am so sorry that Sandy is not doing well. One of the issues is that if he is scared or stressed at the vet, stress raises bg levels. Then the dose is raised. That makes it really hard to regulate him at the vet.

Are they syringe feeding him or using a feeding tube? If they will let you visit, you might bring some favorite food from home and hand feed him- from your finger. Sometimes that gets them started again. The other thing is to bring a favorite toy and a "smelly" tshirt of yours he can sleep on.

Fingers and paws crossed that he improves and you can get him home.

No need to move to Humulin. As I mentioned, no one posts there because so few people use Humulin on this site.
 
Please do not worry about posting anywhere but in this forum for now. People know where to find your threads, and we want to help you and Sandy out.

The next time you talk to the vet, can you get some specific information as to what he thinks is wrong with Sandy's liver? No matter what is wrong with Sandy, please don't give up! Whatever is wrong with his liver or anything else, there will be someone here who has gone through the same problems with their kitty. If we know exactly what your vet thinks, we can help.

It doesn't make any logical sense that the PZI stopped working completely. Maybe your bottle, but not also a brand new bottle at the vets. If Humulin is working, then the PZI should too. Do you still have it at home? No matter really. If you can get Sandy improved enough to come home, no matter what kind of insulin you are using, somebody here can help you with it.

I saw above that you do have a human glucometer, and you have been able to get a couple of tests. Those numbers that you got are not too terrible really. When first diagnosed, most cats are up in the 400 and 500 numbers.

A part of the reason that Sandy's liver is in bad shape might be because he also is not eating. He might be suffering from "hepatic lipidosis" which can happen when they go any length of time without food. If it is not treated, Sandy could die from it, but it can be treated if this is what is wrong with him. It is absolutely critical that Sandy eat something. They can feed him using a syringe, or they can insert a feeding tube and feed him through it. Please ask the vet if hepatic lipidosis is what is going on with Sandy?

And please keep us updated. Don't give up!

Carl
 
I don't have much news about Sandy as the vet didn't call today. I did visit Sandy in the hospital the first two times he was there. But so far no visits this time. I know that my vet of 20 years who is sick himself, is coming in and caring for Sandy. He has been doing this for 5 days now. I did talk to him yesterday and Sandy is on a feeding tube for the first time. The vet placed him on one immediately. The other vet talked about doing that, but never did. I was hand feeding him here at home every two hours. When I took Sandy in for this third visit at the hospital my old vet smelled Sandy's breath immediately and looked at me. He said his insulin is not regulated. I read about taking in a piece of my clothing with my scent on it. Great advice. I have worn the same t-shirt for three days and will be take in for Sandy to have near him. I had no knowledge at all about feline diabetes, but I have learned so very much from the posts here. And I thank each and every one of you for all your help for me, for Sandy and for all the other people and kitties out there needing the shared knowledge, experiences and help from you wonderful people. I plan to talk to those who have offered their phone numbers. Sandy was in great shape on the 18th and 19th, but on the 20th he crashed. I had never seen anything like that. Now I believe that the first vet was inexperienced and not too up on feline diabetes. I googled her and saw that her experience was working with wild life before she came here. She may have worked some place else also. I would suggest, from what happened to Sandy and me, that anyone with a kitty having feline diabetes, should point blank ask the vet if they have experience in treating a feline diabetic cat. I'll keep everyone posted. And, again, thanks for all your help.
 
Thank you for the news about Sandy.
And the next time you post, please let us know your name? We're pretty much all on a first name basis here, and it helps to be able to say "HI fill in you name" when we say "HI"!

Happy to hear about the tube. Very important that Sandy get food, before other things develop from not eating.

You are absolutely correct about the first question people need to ask the vet if they tell us "Your kitty has diabetes". It should be "OK, how much experience do you have treating diabetes?". There's nothing wrong with a vet not being a diabetes expert. They can't know everything about everything. BUT, they SHOULD be upfront with the pet owner if they aren't all that skilled with something, whether it is diabetes, or any other illness.

PLEASE do keep us updated on Sandy, and how you are doing too. Now that you came here, you have a whole lot of people you don't know (yet) that are really concerned and want to do whatever we can do to help.

Hope for more good news soon!
Carl
 
My cat Sandy passed away last night at the vet's. This was his third trip in 6 weeks and he was hospitalized for a total of 16 days on three different times.

I cannot stress the importance of going to a vet who has experience with a diabetic cat. This last time I took him in on Nov 23d, my vet of 20 years (who is ill himself) took over from the quite young vet in his office. He smelled Sandy's breath and said that his insulin isn't regulated. I last spoke with him on Saturday the 26th and Sandy's kidney readings had gone back to normal and his insullin dosage would be somewhere between 3 and 4 units.

I called this morning and was put through to the young vet who said "Sandy died last night". She said that my vet of 20 years would be calling at 9:30am. I waited the entire day and no one called me. I didn't get a call yesterday about him either and I kep the phone with me at all times. I am heartbroken over Sandy and not knowing why he died is terrible.

Sandy came home from the vet from his second hospitalization and was his old self and that was on Nov 18 and 19.

I have spent over $2,200 for the first visit and glucose curve. I have yet to receive a bill for the second hospitalization of 4 days and this third one of 5 days. I am expecting that to be about $1,800 with the total to be about $4,000 and poor Sandy is gone. I paid the first bill and have enough to cover the second and third visits. But to me, it is heartless to use someone's beloved friend Sandy as a means to make money, and have Sandy die.

Again, I cannot stress the importance of having a vet that understands feline diabetes and how to treat it. I believe that if he had received the proper care in the first week,, he would be with me now. I only wish that I had found this group sooner.

I want thank the group for all the advice, knowledge and experience that you have shared.

My name is Frank and I was 80 years old this past May.
 
Oh my God, Frank! I can't even think of the right words to say. Just know that this literally just took my breath away like a punch in the stomach.
This makes no sense. And you still haven't heard from anyone about how/why this happened?

Poor Sandy, you were obviously so loved. Frank, you did all a person can do, and Sandy knew he was loved.
Fly free Sandy, and return to bless your bean's dreams to let him know all is okay for you now. Land softly at the bridge...

Frank, my thoughts and prayers will be for you tonight, that your heart can heal. Please, if and when you do hear from your vet, please let us know what he says?

Carl
 
Oh Frank, I am so so sorry to hear you lost Sandy. You tried so hard to get him the care he needed. I am sure you are devastated you didn't get the help you needed from the vets.

It was clear from your first post that he was a beloved kitty who had a wonderful life with you. There are so many cats in this world who are lonely and hungry tonight. But not Sandy - he was a very lucky cat. It sounds like you two had a great life together. And that he knew he was cherished.

They always leave us before we are ready.

You are right. Very few vets get much education in feline diabetes - maybe a workshop. It is too bad they won't acknowledge that up front so their patients can chose the best vet possible.

Please know that everyone on this site understands what a big spot kitties hold in our heart and what a hole they leave behind. We grieve with you.
 
Dear Frank,

So sorry for your loss of Sandy!!!
I wish that you remember the best times you had together, always, and that it brings you joy whenever you need it.

Thanks to sharing your experience, you might help my kitty and other people's too.
I am going to ask my vet the hard questions and dig into her experience more to see if she truly understands FD, in Sandy's honor.

With deepest sympathy,
Karen
 
I'm so sorry for your loss, Frank.
I had been following Sandy's thread on PZI group.
I know you loved Sandy very much and did the very best you could for him.
Its so hard to lose a beloved friend like Sandy, I will pray for you that you can heal and find comfort during this grief when you are missing Sandy so much.
And I just have to say I think its very shoddy that they did not call to inform you that Sandy had passed away and didn't call all day to talk to you. You and Sandy deserved better.
I will keep you in my thoughts and prayers.
Sandy is an angel now and he knows you loved him so much and would want you to remember all the good times you shared with him.
wings_cat wings_cat Fly free to the Rainbow Bridge, sweet Sandy.
 
Oh Frank, I'm so sorry for your loss. I've been following along, you did so much to save him.

My heart hurts for you. Fly free Sandy.

Please come back and let us know how you are doing. You are part of our family now.

((((Frank))))

Robin
 
Frank,
My heart is breaking for you
I know there are no words that could comfort you at a time like this
I am praying for the 2 of you
 
I really want to thank everyone for all the kind words, hugs, and condolences you have sent me in my loss of Sandy. Sandy passed away on the night of Nov 27th and the vet has not called me at all. I went to the vet hospital to pick up Sandy's carrier at 3PM yesterday. There were no owners with patients there and some of the staff were going home. The receptionist got Sandy's carrier and did say that she was sorry that I lost Sandy. I went from there to the library to return a book. My town is small - 14,000 people, and the library is where you run into people. I saw a friend Daniel and we had a short conversation in which he told me that he lost his two kitties. The first kitty he said had been diagnosed with Lyme's Disease. His kitties were indoor only. I googled Lyme's disease just now and found that it is very, very rare in cats. But then Daniel said his other kitty Abby had gotten sick and he had to give her injections twice a day. When I asked him the reason, he said that she had been diagnosed with diabetes. Daniel is developmentally challenged and living on disability income. He had asked me to write down the vaccinations dates of his kitties and to remind him each year when they were due. This is something that I did for Daniel. I am shocked to learn this as Daniel uses the same vet. I will talk further with Daniel about the vet treatment his two kitties received, but I will not upset him by letting him know that there may have been a problem with Abby's care. Daniel's girls were his life and were his friends and family. Yesterday I went to the County Animal Shelter where I volunteer as a photographer for the cats and kittens. I photo'd 33 cats and kittens and put their photos on the Pet Harbor website. This morning I put four photos and descriptions and animal ID numbers on Craigs List under the "Lost and Found" column hoping that owners may see their lost cats. This is helping me cope with the loss of my friend Sandy. I will continue to wait for the vet to call me. Thanks again for all your help and condolences. I do miss Sandy.

Frank
 
Hello Frank,

Good to hear from you. I am glad you have a place in your life where you can be around kitties and I hope they will help heal your heart.
 
Hello Frank,

Thank you so much for this update. It is tragic that your friend Daniel has also suffered such a terrible loss, and my thoughts and prayers go out to both of you.
Please keep us updated on if you here from that vet, and on what you find out about Daniels kitties? You said those pictures are on a website? Can you point us there? I would love to see them.

Carl
 
Carl and all,

I will put a web address at the bottom of this messge. But it will take you to the County Animal Shelter website. When you get there, on the left there is a place to click on "find an animal". Click here and then on the next page, click on the center where it says "cats in the shelter". Once you bring that up, if you click on the top on Animal ID #, that will arrange all the kitties by their ID number. The newest arrivals are at the very end and right now there are 9 pages of cats and kittens. I was in Wednesday evening and photo'd 33 cats. A bonus is that I get to name the cats and kittens after their 5-day hold is up. That's so that anyone looking for their cat or kitten, will not be misled by a name. I had some great names Wednesday - named one "Lollipop" and one "Maggie Mae". It gives the kitties an identity instead of just a number. I also put an ad on Craigs List under the "lost and found" section with photos of four cats who belong to someone for sure. One kitty had a microchip but it wasn't activated. The website is so important and there are kitties reunited with their families. The names that I give are in quotation marks. A couple of years ago, I was there when a little girl, about 5 or 6 years old, came in with her parents. They had printed a photo of one of the shelter kittens and I had named him "Jellybean". This little girl came up to me with her parents and held out his photo and said "I want to adopt Jellybean". And that she did. Moments like this are what keeps me going. (Still haven't heard a word from the vet about what happened to Sandy.) Here is the web address - don't know how to put a link in.

http://www.slocounty.ca.gov/aserv
 
What a wonderful thing you are doing for those cats, Frank. A cute picture is worth a thousand words. Thanks for sharing your story with us.
 
Bless you Frank, for caring and helping shelter kitties find a new home.
I am glad this is helping you through your loss. Sandy is looking down and smiling to know you are helping other kitties find a wonderful, loving home like he had when he was here on the earth plane.
 
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