insulin or not? That is the question!

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judy and squamee(GA)

judy and squamee(GA)

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To recap--Squamee was diabetic lat year for about 3 months induced by steroids. OTJ as of Aug 2009. Steroids were given again this month for a recurrence of the eating problem that now appears to be the result of probable brain tumor. Since the steroids, eating is now much better, and her BG runs in the mid to upper 200's. She had a seizure last week, and the vet has not put her on insulin since she is seizure prone and he believes low blood sugar makes this more likely. My quandry---is the quality of her life better with or without insulin? When she was on insulin she was not a happy cat, spent much of her time sleeping in hiding places. Now she also sleeps, but is not hiding. Is somewhat hungrier and thirstier, but not to a great extreme. Should I try to convince the vet that since I can test her at home and give small doses of insulin that we should try that? Or am I playing with fire (possible seizures) and is she better off without insulin unless she goes into the 300's (his parameter for giving her insulin)?

To anyone who is not familiar with her history---the vet has said that a cat scan and brain surgery would be the next step, but that will be a minimum of $5000 and I cannot do it. So now I am focused on giving her the best life possible at the moment.
 
judy i am sorry to hear of kitty's health issue's.
do i understand that you do home testing?
if your doing that, and i hope you would be, than keeping squamee's bg's down to at least 100 or so during the mid day would likely help her feel better and avoid her #'s getting even higher.
you can start with a very low dose.
what insulin have you used in the past?
lori
 
In my opinion -- having myself treated a kitty with a brain tumor -- Norton --

If you are willing to home test and give tiny doses of insulin as needed, that would perhaps be better than NOT treating the high blood sugar. Home testing before every shot and periodically at nadir will help you prevent seizures induced by hypoglycemia.

What insulin would you use?

For intermittent micro-dosing, I would suggest that your best bet would be to get BCP PZI in U40 strength from http://www.BCPvetpharm.com
PZI is the closest genetically to a cat's own insulin, so it should be the most gentle.

Develop a sliding scale -- if BG at test time is between 150 and 200, give dose A. If BG at test time is between 200 and 250, give dose B. If BG at test time is between 250 and 300, give dose C. The sliding scale is customized to the kitty based on the history (recent since Squamee has been OTJ) of blood sugar as documented in your spreadsheet.

Lantus and Levemir really need to have steady 12 hour dosing and it builds up in the body. Since Squamee is just borderline diabetic -- I would think it would be better to NOT have a shed of insulin hanging around for many hours.

It is important to also treat for pain if needed. Many of the acro-cats suffer from headaches from the brain tumor. A recent medication that is working wonders for the chronic pain associated with acromegaly is gabapentin

Norton was on Prednosolone every day (6mg) which helped reduce inflammation of the tissue in his brain -- he could walk in straight lines instead of circling and definitely felt better -- more interactive with his humans and tail up in the air instead of dragging low. He developed an aggressive intestinal cancer before his brain tumor got worse, and he crossed the bridge.
 
Thanks for your helpful responses. Last year Squamee was on PZI, which worked well for us. I recently asked my vet about the compounded PZI and he did not like the idea of using compounded insulin. Would Prozinc be basically the same? I do home test, and have been thinking about printing out my old spreadsheet to show him how I kept track of her BG and used tiny doses (as she was on her way to OTJ) the last time around. THe only reason I have not yet contacted him is because she just doesn't seem that uncomfortable---not really much hungrier than usual.

Phoebe, I am sorry to hear about Norton. But it is very encouraging to me to hear that you were able to successfully treat him for the tumor while also treating the diabetes. In what form was the pregnosolone? Was it hard to administer?
After Squamee had a tooth extraction in early Sept she was on Buprenex for pain, which did not seem to have much of an effect on her. How do you tell if the brain tumor is causing a headache?
 
judy my thought is why wait for symptoms? by that time your cat is uncomfortable. if you catch it low, you'll probably only need token doses maybe even once a day...i'd hate to see her move high enough that you'd have trouble regulating her and she was symptomatic.
 
I used the PZI made by BCP with very good results. It is not the same as the "local" compounding companies -- BCP does significant business with the insulin as well as other medicines.

The Prednosolone that we used was compounded in a tuna-flavored liquid that we squirted into his mouth every day. This was messy and Norton didn't like it much but it did make him feel better.

BCP has a chewy treat for Pred that we were going to try but Norton left us before we got to order any. The chewy treats come in 5 mg doses.


when our acrocats have a headache -- they sit "meatloaf" style with their head down - eyes squinched shut (not comfy sleepy but squinched/squeezed)
sometimes they hide under furniture or go in strange places -- Norton would go into the small space between the washer and dryer
they act like the light is too bright, and noises are too loud, and may cringe when petted

When it was time for food / shot, Norton would slowly circle his way over to the kitchen with his head and his tail nearly dragging. When he was on the Pred and feeling better, he walked straighter with his head up and his tail high like a flag.

We used a golf club or cane next to his neck to help him walk straight (just giving light pressure like he was rubbing against a wall).

We set up a very big low sided litter box for him that he could walk in from any direction when we discovered that he could not climb up the steps / ramp to the litterboxes (elevated to help me clean them since I have a bad back)
Even with the Pred, he sometimes still walked in a circle (a symptom of a brain tumor that affects the motor skills -- may be applicable since Squamee has had seizures - might be in a similar area of the brain)
 
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