Insulin Resistance or Bad Batch of Insulin?

W

Wmichielssen

Member
Hi there, first-time poster, long-time diabetes mom! Thank you for all of your help over the years- I've usually been able to log on and find answers and I've really apprecaited it. I am seeking an answer I couldn't find today.

Recently, my 16-year-old, Bodhi is having trouble with his insulin. He is on Prozinc and we test every morning and night before giving him his dose of insulin to ensure accuracy. Recently, he has begun to drink and pee A LOT more and I chatted with a friend who is a vet who suggested an insulin curve to rule out the early stages of renal failure. Sure enough, the Prozinc isn't lowering his numbers at all. Now, I've had a bad batch of insulin before. However, he's been on this bottle for at least a month and since that bad batch, I stopped buying from Chewy and only pick it up directly from the vet.

So my question is this: is there a way to tell if he is becoming insulin-resistant or if I have a bad batch of insulin without repurchasing another $150 bottle? AND if he is becoming insulin-resistant, would switching to another type of insulin solve the problem? Thanks for your advice!
 
I’m so sorry to hear you are going through this with your boy. It’s concerning.

Well even a single day curve cannot be completely accurate because he could be bouncing from a lower number (if he’s inclined to be bouncy.) Without any data on a spreadsheet and some mid-cycle testing we can have no idea of what is really going on with him. I would recommend getting at least a +6 today and a +5 the next day and a +7 the next day — unless you have been running regular curves on other days?

Tell me what numbers you got on the day you ran the curve.

It’s never a good idea to shoot insulin without knowing how low the dose is taking your cat (nadir.) You certainly can’t know that from preshot tests. The main purpose of a preshot test with ProZinc is to see if it’s lower than expected and to decide (based on data you have gathered from mid-cycle testing) whether a one-cycle reduced dose should be shot. More on insulin resistance…
 
There are many causes for insulin resistance in a cat and they can include (1) holding doses too long and letting glucose toxicity set in (2) urinary tract infection or any other infection or inflammation (3) tooth problems (4) constipation. Some lesser known causes for insulin resistance are insulin autoantibodies and acromegaly (which require blood testing at University of Michigan Veterinary Laboratory.
I occasionally see people with ProZinc that has gone bad before it’s time. In fact, another member I help recently had that happen and once she got a new vial the cat returned to his normal numbers. The ProZinc had been stored in the refrigerator. It didn’t have any visible floating particles either. Of course, she had first taken him to the vet for bloodwork and a urinalysis. But in this case, it was simply the insulin.
 
On the other hand, another member I help, whose cat normally stays in the normal blood glucose numbers of 50-120, suddenly had terrible numbers (200-300) — much higher than his normal blood glucose. In this kitty’s case, he was taken to the vet and found to have an infected anal gland. Once it was treated, he returned to the 50-120 range.
 
Thanks for your reply! I just started the curve today, so I'm definitely still in the information gathering state. 8am: 380 (gave 1.75 units and he ate a little bit of his fancy feast), 10am: 486, 12pm: 433. Will continue testing every 2 hours today and see what happens.

Other factors: he has megacolon, so he's basically chronically constipated. However, he finally pooped this morning (!!), so maybe that's contributing. Originally, I thought it was another UTI (he's had many in the past). However, the vet is doubting that becuase there's no blood this time and he's passing large amounts of urine when he goes. Hoping that's the case! Only 6 teeth left, so would be surprised if it's tooth related, but I suppose it's possible! Thank you again for the reply! This is helpful!
 
So if your boy is staying in really high numbers like 300s, it’s not surprising that he’s drinking more. Poor boy. Although it is hard on a cat’s kidneys to have blood glucose consistently higher than the low to mid, 200s, the way to screen for kidney disease is to het bloodwork done that checks the kidney values and also (very important) a urinalysis to check the specific gravity of the urine (USG).
 
Wmichielssen said:
Thanks for your reply! I just started the curve today, so I'm definitely still in the information gathering state. 8am: 380 (gave 1.75 units and he ate a little bit of his fancy feast), 10am: 486, 12pm: 433. Will continue testing every 2 hours today and see what happens.

Other factors: he has megacolon, so he's basically chronically constipated. However, he finally pooped this morning (!!), so maybe that's contributing. Originally, I thought it was another UTI (he's had many in the past). However, the vet is doubting that becuase there's no blood this time and he's passing large amounts of urine when he goes. Hoping that's the case! Only 6 teeth left, so would be surprised if it's tooth related, but I suppose it's possible! Thank you again for the reply! This is helpful!
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Oh wow. Those numbers are not looking good at all. I am sorry. What kind of numbers do you normally get on him? Preshot numbers? Any curves? I’m trying to understand how much higher he is now than his normal? Does he always start out from the 300s?
 
Suzanne & Darcy said:
And regarding this, I would think that finding the cause of his insulin resistance (and if the PZ has gone bad) would be the first step. He’s probably not just resistant to ProZinc insulin.
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he's always around 400-450 preshot...usually give 2 units and he ultimately ends up around 200. This is pretty normal for him...but he usually comes down and doesn't stay so high for so long. The ProZinc is only about a month and a half old, so the vet thinks that the insulin is probably okay and suggested increasing the dose. Just tested again at 2pm and he's 460 (hasn't snacked).
 
Wmichielssen said:
he's always around 400-450 preshot...usually give 2 units and he ultimately ends up around 200. This is pretty normal for him...but he usually comes down and doesn't stay so high for so long. The ProZinc is only about a month and a half old, so the vet thinks that the insulin is probably okay and suggested increasing the dose. Just tested again at 2pm and he's 460 (hasn't snacked).
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You definitely can do better than nadirs of 200. He’s spending too much of his time in high numbers. The vet is probably thinking that, since you only test preshot most of the time, it would be safer to only let him drop into 200s Why did you only shoot 1.75 today if his usual dose is 2 units? If I were working with you and had some data, I would also advise increasing the dose and getting mid cycle test around nadir time (~+6 or six hours after the shot.) Getting his nadirs down will also allow him to spend more time during each two hour cycle in somewhat healthier numbers and also should help get those preshot numbers down (they’re too high — normally I see that only in recently diagnosed kitties.)
 
I understand and agree he should be spending most of his day lower than what he is currently. I gave 1.75 today becuase he woke up around 380 and he usually goes down 100 per unit, so I was expecting him to be around 200 after the shot. However, when that didn't happen, and I tested every 2 hours today, I learned the insulin isn't doing what it's supposed to do. So the question remains, is it the insulin, or is he resistant for some reason. We didn't discuss dosing, but I would probably increase the dose by .5 in this case, to target a 150 number and see if that worked. He doesn't have a standard dose becuase we test every single time we issue insulin. I was trying to keep him around 200 becuase I had a very scary experience when I first got him and almost lost him, when I was only fostering him and they told me to give him 3 units if he ate. Well, that was too much once he ended up in a low-stress, happy home. I'm now seeing I should target 150 and maybe that'll get us where we need to be. I just picked up a new bottle of insulin and made a vet appt for tomorrow. I'm going to switch bottles tonight for his 8pm dose and wake up every 2 hours for a curve tonight. Hopefully it works and I can cancel the appt at noon.
 
Oh, I do hope that is all it is (the PZ) and your baby will be back to normal. Let me know how it goes!

If you followed our Start Low Go Slow Method, target nadirs would be 90-150. That’s very reasonable for a cat where there may be some difficulty getting tests or you are extremely fearful of a hypoglycemic event (defined as the cat’s blood glucose dropping below 50 on a human meter and also accompanied by clinical signs of a hypo.)

In my experience, consistent dosing of ProZinc is best. Too frequent dose changes (daily?) is not a good way to go (I am not talking about this morning because you already said why you did the reduced dose.) Sometimes you see an unexpectedly low preshot and, hopefully, you have data recorded to tell you how low a certain dose will take him with a certain preshot level — that helps you to decide if a lower dose is needed and if so how much lower. Generally speaking, the goal is shooting lower preshots over time — as data is gathered. Skipping shots is also generally not beneficial to the cat. I am not saying you are doing any of this, of course.

Right now, you have your hands very full trying to figure everything out. I sincerely hope it was just a fluke of bad insulin (although I am sorry you had to spend the money on a new bottle.) :bighug:
 
Thank you from us both!
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He is one handsome guy. What a sweet face!

What glucose meter are you using? The target/normal numbers are a bit different depending on whether it’s a human or pet meter. Either way, the numbers you have so far are high so I’d monitor for ketones regularly.

I agree with Suzanne that collecting midcycle data is critical to understanding what is going on. One of my diabetics could go from 400s to 40s and back up again on a tiny dose of insulin — if I hadn’t been checking throughout the cycle, I’d never had known and we’d have likely increased the dose rather than what he needed, which was a lower dose. It’s sort of like bungee jumping … it’s not just how high you start, but very importantly how low you go. Don’t want to crash into the rocks, if you know what I mean.

I also had a diabetic with constipation and probable megacolon. I could definitely see it in his BG numbers when he was getting backed up.

Have you had Bodhi’s blood pressure checked recently?
 
JL and Chip said:
He is one handsome guy. What a sweet face!

What glucose meter are you using? The target/normal numbers are a bit different depending on whether it’s a human or pet meter. Either way, the numbers you have so far are high so I’d monitor for ketones regularly.

I agree with Suzanne that collecting midcycle data is critical to understanding what is going on. One of my diabetics could go from 400s to 40s and back up again on a tiny dose of insulin — if I hadn’t been checking throughout the cycle, I’d never had known and we’d have likely increased the dose rather than what he needed, which was a lower dose. It’s sort of like bungee jumping … it’s not just how high you start, but very importantly how low you go. Don’t want to crash into the rocks, if you know what I mean.

I also had a diabetic with constipation and probable megacolon. I could definitely see it in his BG numbers when he was getting backed up.

Have you had Bodhi’s blood pressure checked recently?
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Hi there, thanks for your reply! I haven't had the blood pressure checked recently, but would love to know more on your thougths on that! I was using the alpha track 3, but just bought the relion human meter becuase if I'm going to be testing mid cycle for a bit, I needed something a bit more affordable. It arrives today. Any info you have on target numbers for the human meter, I would appreciate!

I used the new bottle of insulin last night and was able to get him down to about 300, approx 6 hours after giving it to him, so I think I just need to increase the insulin dosage. I think he likes to feel higher because he was mad that I picked up his food last night to see how low we were getting without his midnight snackies! He's acting great today, so my plan is to cancel our noon appt (it's not with our regular doc anyway), monitor over the weekend, and revisit with the regular doc if needed on Monday.
 
Suzanne & Darcy said:
Oh, I want to kiss that sweet face! He’s adorable!
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Good morning, here's my update. He was 489 at 8pm last night, so I issued 3.5 units of the new bottle and he eventually went down to about 300 around 2am. He was angry I picked up his snacks, so I offered him his DM hard food at that time and he ate, so when he woke, he was around 400 (gave 3 units). I was glad to see the 3.5 units at 8pm brought him down. I am looking forward to testing 6 hours after dosing, as you suggested for the next few days and adjusting insulin as needed. I just bought a human meter to make this more affordable for me. It will arrive today. Any info you have on target numbers for a human meter, I would really appreciate! Thank you!!
 
Wmichielssen said:
Good morning, here's my update. He was 489 at 8pm last night, so I issued 3.5 units of the new bottle and he eventually went down to about 300 around 2am. He was angry I picked up his snacks, so I offered him his DM hard food at that time and he ate, so when he woke, he was around 400 (gave 3 units). I was glad to see the 3.5 units at 8pm brought him down. I am looking forward to testing 6 hours after dosing, as you suggested for the next few days and adjusting insulin as needed. I just bought a human meter to make this more affordable for me. It will arrive today. Any info you have on target numbers for a human meter, I would really appreciate! Thank you!!
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How is it going?
 
Suzanne & Darcy said:
If you followed our Start Low Go Slow Method, target nadirs would be 90-150. That’s very reasonable for a cat where there may be some difficulty getting tests or you are extremely fearful of a hypoglycemic event (defined as the cat’s blood glucose dropping below 50 on a human meter and also accompanied by clinical signs of a hypo.)
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See this (above) the target nadirs I used were for a human meter for a cat following the SLGS dosing protocol. They are lower for the Modified ProZinc method, of course.
 
Suzanne & Darcy said:
How is it going?
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He's okay- Honestly, he's acting just fine, he's just peeing a lot and he's not getting low enough with the insulin. I can get him down to about 300, but then he just wants food...I think he likes to run a little high. At age 16, I'm feeling like I should just let him do his thing and stop worrying about it so much....of course, monitoring for any infection or such and continuing to try to get him lower with the Prozinc so he's spending more time below 240.
 
Suzanne & Darcy said:
ER 4 on the ReliOn meter means not enough blood. I guess it requires more than your AT meter?
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Thank you! Today’s update is that I’m pretty sure he’s having some gingivitis. I was finally able to see into his mouth. Super sad because he’s too old to be put under for a cleaning so I’m hoping for a miracle treatment. Will bring him in on Monday. Ugh…

Note on the relion meter: the instructions on the Er4 error say not enough blood or blood too thick. I’ve gotten quite a bit of blood both times so I’m suspecting the later, but at this point, doesn’t matter. I’m pretty sure we are dealing with a teeth issue.
 
If his kidneys are in good condition (BUN, Creatinine and USG within normal limits) and he doesn’t have heart disease, then he would probably be able to have anesthesia. Extra kidney protecting precautions can be taken as well during anesthesia. Other options are pulsed dosing of antibiotics (preferably Clindamycin) as it’s specific to oral bacteria) and different probiotics. There’s a probiotic called Entero that is specific for oral issues and there’s a very good supplement called 1-TDC. that you should look into.

I had a quite aged cat with kidney disease who could not undergo anesthesia and she did quite well with the pulsed dosing of clindamycin (one week on and three weeks off) for a long time.
 
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