Insulin Not Working?!

[Jeanette Morris]

Good morning,

Our little guy Simon's BG levels have been a rollercoaster recently. Since his numbers were so uncontrolled, we took him in to get his teeth checked out and to run a fructosamine test. He came back at 570. Per the vets suggestion, we went off insulin for a week with the intention of maybe starting him at .5 units. As you can see in the SS, when we went off insulin, his numbers around shot time were in the 200s and either stayed there or went in the 300s. He also was acting like he did before he was diagnosed (happy and hanging around us, meowing and trying to get attention, purring nonstop, running and playing). We then went back on insulin the last few days and his numbers went up and he started just lying around. We decided to stop again. It just didn't make sense to us to give him something that seemed to make him feel worse. His numbers were high this morning, but I assume he will go back down like he did the last time we stopped.

I'm so confused about what to do. Is the insulin possibly just not good for him? The vet suggested vetsulin for him if this didn't work, which I thought was not a good one to use for cats.

Any help would be greatly appreciated.

Thank you!

 

[SashaV]

I think it would be very interesting to see some tests during the cycles where you shot 0.5U.
Too much insulin can look like too little, so it's possible what you see is bouncing and not that he's not needing it.

I'll tag some Prozinc people for you.
@Deb & Wink
@JanetNJ

 

[Jeanette Morris]

I think it would be very interesting to see some tests during the cycles where you shot 0.5U.
Too much insulin can look like too little, so it's possible what you see is bouncing and not that he's not needing it.

I'll tag some Prozinc people for you.
@Deb & Wink
@JanetNJ

Thanks Sasha! I appreciate the info. I'll wait to see what Deb and Janet say on this also. They have been helping me throughout this journey on here.

I can definitely try and do curve on .5 units or just test a few times during a cycle. I don't know if this weekend would be too soon to do it since we skipped last night and this morning. So, even if he doesn't get to low numbers, he can still bounce? I thought they had to get to lower numbers (below 200) in order to trigger the bouncing. Although based on his last couple weeks, I guess the 200s could be low for him. He seems to be bouncing all the time.

If I need to start up the .5 units again, I definitely can. I just got concerned that his numbers were rising, even mid cycle around +5-+6 hrs.

Thanks!

 

[SashaV]

Thanks Sasha! I appreciate the info. I'll wait to see what Deb and Janet say on this also. They have been helping me throughout this journey on here.

I can definitely try and do curve on .5 units or just test a few times during a cycle. I don't know if this weekend would be too soon to do it since we skipped last night and this morning. So, even if he doesn't get to low numbers, he can still bounce? I thought they had to get to lower numbers (below 200) in order to trigger the bouncing. Although based on his last couple weeks, I guess the 200s could be low for him. He seems to be bouncing all the time.

If I need to start up the .5 units again, I definitely can. I just got concerned that his numbers were rising, even mid cycle around +5-+6 hrs.

Thanks!

Whenever a cat drops too fast or lower than they're used to they can bounce.
Really confusing and annoying..

 

[Deb & Wink]

I'm going to be very blunt here. What was your vet thinking, stopping the insulin. What was the reasoning?

With a fructosamine level in the high 500's, pre-shot tests sky high also, I'm totally flabbergasted that your vet told you to stop the insulin. Did they mention the need to test for ketones, and the risk of DKA (diabetic ketoacidosis)? Since a fructosamine is an average of the BG levels over a couple of weeks, it's no surprise the results came back high. (It's actually a different substance in the blood that the fructosamine measures, not the blood glucose.)

This thread has the reference ranges for the fructosamine test. Reference Ranges for Fructosamine Test. A fructosamine result of >500 shows that Simon's diabetes is poorly controlled.

Bottom line. Simon needs insulin. Probably somewhere between 0.5U and 1.25U. Please give Simon some insulin ASAP, before he ends up in DKA. Without insulin to help process his food, he is starving. Literally. It's going to take some time to get him regulated.

A cat that does not need insulin, would not be getting those pink and red BG numbers, without insulin. He should be in the green BG's, under 100 mg/dL. Consistently.

No, Vetsulin is not an insulin recommended for cats and lasts a much shorter time, 8-10 hours usually. So Simon would be high for a good portion of every 12 hours. Vetsulin,(aka Canisulin) was developed for canines (aka dogs). Cats are not small dogs and their insulin needs are very different than dogs. The (2018) AAHA Diabetes Management Guidelines for Dogs and Cats talks about the needs of cats vs dogs. You might want to pass this vet association article on to your vet.

You might try to spread Simon's meals out a bit during the 12 hour cycle. Bigger portion of the meal at pre-shot and then a meal around +3 or so, to slow that rapid drop that he gets. I looked back at your previous posts, and I do see that you are feeding Simon (and your other cat) 4 times a day. Would you put the times you are feeding him, in our + hour format, on your SS please? The Remarks column in the perfect spot for something like this.

I know that you must be overwhelmed, especially with taking care of your toddler, as well as 2 cats, one of them a diabetic. Try to do the best you can. Are you finding it any easier to do the testing all by yourself?

Have Simon's symptoms improved? Not his behavior, but his excess peeing, his water consumption, his weight loss, his appetite, his coat and skin and so forth?

 

[Jeanette Morris]

Hi Deb,

Thanks so much for responding. I will definitely look at those resources you posted on here. I've just been so confused with everything and pretty stressed out. My vet is saying one thing and I'm seeing everybody on here say other things. I think he was just trying to say we needed a fresh start to see where Simon is, but at the same time he told me we didn't need to test any time during the no insulin period. He just told me to go back up to .5 units, but again told me to not worry about testing. We obviously have kept up with his testing. Clearly my vet doesn't know much about diabetes, so maybe it is time for us to look into a different vet. I'm getting to the point where I don't trust his judgment on this. I am getting pretty good at testing Simon on my own now, so I have been trying my best to do it.

We did give Simon .5 units tonight. I dont feel like he has any symptoms. He has seemed to be peeing a little more, but I didn't notice the water bowl being any lower. We did not withhold food from him at all the last week knowing that he could possibly be more hungry. I did notice him clearing the bowl more quickly than before though.

Just so I understand, we currently feed them pre shot and then around mid cycle. So we should maybe pull that second meal back a few hours to avoid him going to low? That makes sense to me if that's what you're saying. So then what would be good times to test him during the cycle if we do that? I will update the spreadsheet with our current meal times as well.

Again, I really appreciate everything! I'm so glad I can come on here and ask for help. It is very overwhelming to try and get things under control, especially when the person you trust your fur babies with isn't that helpful in this area.

 

[JanetNJ]

I think he needs at least 1 unit. That being said, if you are going to switch to a different insulin, i'd try lantus rather than vetsulin.

 

[Jeanette Morris]

Thanks Janet!

He was at 202 today a little over +3 hrs. I fed him around that time like Deb suggested. We will test again pre shot obviously. We will try and slowly work our way up to 1 unit. The last time we did a big jump, his numbers went crazy, so I would like to avoid that by maybe increasing by .25 units every couple days. We will obviously be testing him as well.

Thank you so much!

 

[JanetNJ]

Thanks Janet!

He was at 202 today a little over +3 hrs. I fed him around that time like Deb suggested. We will test again pre shot obviously. We will try and slowly work our way up to 1 unit. The last time we did a big jump, his numbers went crazy, so I would like to avoid that by maybe increasing by .25 units every couple days. We will obviously be testing him as well.

Thank you so much!

sounds like a plan. I'm ok with getting there gradually.

 

[Deb & Wink]

sounds like a plan. I'm ok with getting there gradually.

Me too. Slow and steady wins the race on dose changes. Let's give Simon some time to settle into each dose before you increase again. At least 3 days, maybe more time. It depends on how his BG numbers are trending over a few cycles.

Just so I understand, we currently feed them pre shot and then around mid cycle. So we should maybe pull that second meal back a few hours to avoid him going to low? That makes sense to me if that's what you're saying. So then what would be good times to test him during the cycle if we do that?

Yes, a bit earlier in the cycle to feed would be good. Mid-cycle meal is too late to stop that rapid drop, to stop Simon dropping too fast, and/or too low. So that +3 time is a good one to feed Simon and test him right before you feed him. Thanks for the note on the SS about the feeding time. Every clue helps when we are trying to see what is going on in an insulin cycle.

If possible and Simon lets you test him by yourself, a test around the mid-cycle (+5 to +7) every day would be helpful. Mix it up. Do a +5 one day, a +7 another, throw in a +6 test now and then. You choose when in that time frame, the +5 to +7.

I realize that you are "chasing after" a toddler and you may be wanting to take a nap during the day when your little one is napping also, so that mid-cycle test may not be possible to do. Again, do what you can, which may be different every day. I know it can be exhausting to look after a young child, and try to help your diabetic cat Simon at the same time. Any tests after the pre-shot test, we expect to be food influenced. So don't worry about feeding Simon at the +3 or a bit later and having that impact the BG levels. Right now, I think we want that slightly earlier meal to slow down the action on the insulin.

I hope you are taking some time for yourself, with maybe some relaxing "me time" such as yoga or meditation or deep breathing exercises. We all need something to refresh our spirits.

One reason vets say not to test, or not to test so often is because they don't have the resources to answer questions from their clients about what is going on in a cycle. We do. Think of us as an adjunct to your vet, as a group of people that have that day to day experience with a diabetic cat and can throw out all sorts of suggestions of things to try. We aren't meant to replace your vet, but lend our assistance to you when you need it.

Another reason vets say not to test, is that their clients can get overwhelmed. You already are saying that "overwhelmed" feeling is happening to you. How can we help? Push back on us if we say something and you disagree or you simply can't do what is asked. We're not perfect, we're fallible and we know it. So let us know. OK?

 

[Jeanette Morris]

Me too. Slow and steady wins the race on dose changes. Let's give Simon some time to settle into each dose before you increase again. At least 3 days, maybe more time. It depends on how his BG numbers are trending over a few cycles.


Yes, a bit earlier in the cycle to feed would be good. Mid-cycle meal is too late to stop that rapid drop, to stop Simon dropping too fast, and/or too low. So that +3 time is a good one to feed Simon and test him right before you feed him. Thanks for the note on the SS about the feeding time. Every clue helps when we are trying to see what is going on in an insulin cycle.

If possible and Simon lets you test him by yourself, a test around the mid-cycle (+5 to +7) every day would be helpful. Mix it up. Do a +5 one day, a +7 another, throw in a +6 test now and then. You choose when in that time frame, the +5 to +7.

I realize that you are "chasing after" a toddler and you may be wanting to take a nap during the day when your little one is napping also, so that mid-cycle test may not be possible to do. Again, do what you can, which may be different every day. I know it can be exhausting to look after a young child, and try to help your diabetic cat Simon at the same time. Any tests after the pre-shot test, we expect to be food influenced. So don't worry about feeding Simon at the +3 or a bit later and having that impact the BG levels. Right now, I think we want that slightly earlier meal to slow down the action on the insulin.

I hope you are taking some time for yourself, with maybe some relaxing "me time" such as yoga or meditation or deep breathing exercises. We all need something to refresh our spirits.

One reason vets say not to test, or not to test so often is because they don't have the resources to answer questions from their clients about what is going on in a cycle. We do. Think of us as an adjunct to your vet, as a group of people that have that day to day experience with a diabetic cat and can throw out all sorts of suggestions of things to try. We aren't meant to replace your vet, but lend our assistance to you when you need it.

Another reason vets say not to test, is that their clients can get overwhelmed. You already are saying that "overwhelmed" feeling is happening to you. How can we help? Push back on us if we say something and you disagree or you simply can't do what is asked. We're not perfect, we're fallible and we know it. So let us know. OK?

Thanks so much Deb! For some reason I never got the notification for your post on Friday night. We have my parents in town, so we have been a bit distracted.

I am totally fine testing Simon now whenever we need to unless for some reason I am out of the house. We did increase to .75 earlier than suggested in your last post since we had him at .5 for a couple days and just stopped for two cycles before starting right back up again. We saw his mid cycle numbers start to get in the 200s, which was good. I think we are seeing some bouncing now that we are up to .75. It seems he is very sensitive to lower numbers than he is used to. He is scarfing his food right now pre shot time. We have been feeding at +3 and testing right before that meal, but I will try and get some tests mid cycle over the next few days between +5-+7 to see where he is. I will move it around. I do understand getting that +3 food in him before he drops. That makes sense to me. Sometimes he drops pretty fast once his dose gets higher up. Should we just hang out at .75 for a while until his numbers start going lower? What numbers do you think we should be looking for before going up to 1 unit?

Thankfully my toddler has started to understand that Mommy needs to test and give Simon his "medicine", so that has been pretty helpful. He is a bit wild and sometimes I think that stresses Simon out. I can usually squeeze in some tests while he is playing by himself.

I again just really appreciate your help. You have taken so much time to explain everything to me in a way that makes sense, and it has been so helpful. We are definitely still new to this. I had a feeling it was diabetes after doing research before Simon was diagnosed, and diabetes to me was the best outcome of the list of horrible things it could have been. Treatable and able to be controlled. I am ready to do whatever we need to do to help our little guy. He overall is a pretty tolerant and cuddly cat. He is starting to get used to the testing and seems to come over to me a remind me to give him his insulin after he is done eating.

I honestly don't like things sugar coated. I appreciate the straightforward answers and would like hear honest opinions. Getting him under control is a priority for us, and we just want to understand everything we can do to get there. I've been trying to relax and spend some time to myself. Unfortunately, my husband works a lot and we don't have family around since we moved for his job, but my toddler does nap a long time, so the midday breaks are great for me to do some self care or watch a movie. I also try and get out when my parents come to visit.

Thanks so much again for all your support and for taking the time to write these posts out! You have no idea how helpful they have been!

 

[Deb & Wink]

Thanks so much again for all your support and for taking the time to write these posts out! You have no idea how helpful they have been!

You are welcome. I'm actually pretty horrible at doing "short and sweet" replies.

Having your parents being able to visit must be so nice! It's been too long for many families, to feel that they can get together. Vaccinations have made that possible for so many folks.

I'm guessing, and this is only a guess, that Simon is dropping lower somewhere in the 12 hour dosing cycle, and you aren't catching it with a test. So for now, I'd keep Simon at that 0.75U dose, until you get a low number, say < 100 mg/dL that would say you need to decrease the dose.

I agree with you that Simon seems to be bouncing. So when is he dropping low, and how low is the question we need an answer to.

If the nadirs stay above 150 mg/dL, it's time to think about increasing the dose. BUT before you do that, some tests during that +5 to +7 hour time frame are critical. Because we have no idea how low Simon may be dropping during the middle of the cycle and he has dropped low before on a 1.5U and a 1.25U dose. So let's see how he is doing for about a week on this 0.75U dose.

A curve would be helpful. Testing every 2 hours, from one pre-shot to the next, or testing every 3 hours from one pre-shot to the middle of the following 12 hour cycle for a total of 18 hours of testing.

 

[Jeanette Morris]

You are welcome. I'm actually pretty horrible at doing "short and sweet" replies.

Having your parents being able to visit must be so nice! It's been too long for many families, to feel that they can get together. Vaccinations have made that possible for so many folks.

I'm guessing, and this is only a guess, that Simon is dropping lower somewhere in the 12 hour dosing cycle, and you aren't catching it with a test. So for now, I'd keep Simon at that 0.75U dose, until you get a low number, say < 100 mg/dL that would say you need to decrease the dose.

I agree with you that Simon seems to be bouncing. So when is he dropping low, and how low is the question we need an answer to.

If the nadirs stay above 150 mg/dL, it's time to think about increasing the dose. BUT before you do that, some tests during that +5 to +7 hour time frame are critical. Because we have no idea how low Simon may be dropping during the middle of the cycle and he has dropped low before on a 1.5U and a 1.25U dose. So let's see how he is doing for about a week on this 0.75U dose.

A curve would be helpful. Testing every 2 hours, from one pre-shot to the next, or testing every 3 hours from one pre-shot to the middle of the following 12 hour cycle for a total of 18 hours of testing.

Thanks so much! Those numbers to look out for are very helpful. We have just been kind of guessing as to when to increase or decrease, so having an idea of where he should be and certain times to test is great!

I think next weekend would be the best time to run a curve. That would be just over a week on .75 units. My husband and I will both be home, which makes the curve a lot easier for everybody.

It has been wonderful to be able to have my parents come and visit now. Everybody is vaccinated now, so we feel comfortable having them stay for several days at a time. It is a nice break for me as well to just have some help and be able to relax a little bit.

Thanks again so much! I will keep you posted on the curve and if anything is going on in between!

 

[Jeanette Morris]

You are welcome. I'm actually pretty horrible at doing "short and sweet" replies.

Having your parents being able to visit must be so nice! It's been too long for many families, to feel that they can get together. Vaccinations have made that possible for so many folks.

I'm guessing, and this is only a guess, that Simon is dropping lower somewhere in the 12 hour dosing cycle, and you aren't catching it with a test. So for now, I'd keep Simon at that 0.75U dose, until you get a low number, say < 100 mg/dL that would say you need to decrease the dose.

I agree with you that Simon seems to be bouncing. So when is he dropping low, and how low is the question we need an answer to.

If the nadirs stay above 150 mg/dL, it's time to think about increasing the dose. BUT before you do that, some tests during that +5 to +7 hour time frame are critical. Because we have no idea how low Simon may be dropping during the middle of the cycle and he has dropped low before on a 1.5U and a 1.25U dose. So let's see how he is doing for about a week on this 0.75U dose.

A curve would be helpful. Testing every 2 hours, from one pre-shot to the next, or testing every 3 hours from one pre-shot to the middle of the following 12 hour cycle for a total of 18 hours of testing.

Hi Deb,

We have kept Simon at .75 units for about a week. I've been testing different times and feeding at +3 hrs. I haven't gotten a single number below the 350s. We went ahead and increased to 1 unit just because he has been crying and scarfing his food when he's hungry and the litter box has been full. I figured a curve wouldn't really show us anything at this point. You can definitely let me know if you disagree.

We are going out of town in a week (moving in a few months so we are checking out our new city). Just thinking maybe putting him on .5 while we are gone.

Separate question...why would his numbers be higher on insulin than when he's not? Seems like the opposite of what I would think should happen.

Thanks so much!

 

[Deb & Wink]

Simon's BG numbers still weren't good on the 0.75U dose, so I'm glad to see you increased his dose.

Separate question...why would his numbers be higher on insulin than when he's not? Seems like the opposite of what I would think should happen.

Don't know. BUT even without insulin, Simon's BG numbers were never good.
BG numbers up in the yellows, pinks, reds and blacks are not good BG numbers.

When you stopped the insulin for nearly a week, that set any progress that Simon had made back too far, IMHO.

We are going out of town in a week (moving in a few months so we are checking out our new city). Just thinking maybe putting him on .5 while we are gone.

Although it is often recommended to reduce the dose when you go on vacation because the temporary caregiver can not or will not test, with Simon's BG numbers so high, I think a reduction to 0.5U would be risky. Instead, you might think about getting a vet tech to come in and test Simon. Or board him at a 24 hour facility that could test him.

 

[Jeanette Morris]

Simon's BG numbers still weren't good on the 0.75U dose, so I'm glad to see you increased his dose.


Don't know. BUT even without insulin, Simon's BG numbers were never good.
BG numbers up in the yellows, pinks, reds and blacks are not good BG numbers.

When you stopped the insulin for nearly a week, that set any progress that Simon had made back too far, IMHO.


Although it is often recommended to reduce the dose when you go on vacation because the temporary caregiver can not or will not test, with Simon's BG numbers so high, I think a reduction to 0.5U would be risky. Instead, you might think about getting a vet tech to come in and test Simon. Or board him at a 24 hour facility that could test him.

Thanks Deb. I do agree that taking him off was a setback, and I do feel like his symptoms worsened towards the end of the week with no insulin.

I don't think that the vet tech we have coming does testing at home. Simon has never had low numbers on 1 unit so I don't think he would get too low or anything on 1 unit and not reducing to .5 units.

He honestly gets very stressed out when we take him to the vet, to the point where he does not eat, and we have never been able to do a curve at the vet (not a big deal because either easier to do at home). I worry that he would get very stressed not being at home, and I think it would send his BG levels super high from from stress. I will double check with the vet tech though to see if she could at least test a few times throughout.

I will continue to test over the weekend and next week to see where we are. I appreciate that advice. I have thought about boarding our two guys several times, but they both get so stressed out leaving the house.

 

[Deb & Wink]

Home it is. Even cats at home can get stressed out with a different caregiver.

I've done cat sitting for a couple of friends, and did that a LOT, so their cats got used to me. But even still, one cat will run and hide every time I come over, and I've looked after Cassie for about 6-7 years. If there is any way your vet tech can come over a few times before you leave, that might help.

Once this pandemic is under control, and people have gotten their vaccines and are fully vaccinated, maybe you can invite a few friends over to get your cats accustomed to strangers.