Insulin resistance

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Tina & Sammy

Tina & Sammy

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My cat was diagnosed back at the beginning of September. She was on vetsulin for 3 weeks, then we found she no longer needed it. When she started the vetsulin she was also started on an anitbiotic, so the vet thought it was an infection that caused the diabetes.

Then about a month after going off the vetsulin her glucose was back up and has been very high (300's - 400's, with a few spike into the 500's and 600's) since then. After a month of insulin (human grade) she was still quite high, so we put her on another dose of antibiotic thinking that maybe the infection wasn't totally cleared up.

But now after a full month on the antibiotic she is still high, and doesn't seem to have any consistance with her levels and the amount of insulin given.

Has anyone else experienced anything like this. I am so frustrated at this point.

Please help.

Thanks,
Tina
 
Hi Tina,

Welcome to FDMB. Would you mind if I asked a few more questions:

When you say you're kitty is resistant to the insulin - can you tell us what dose of Vetsulin she is on? And are these blood glucose levels done at the vet's office?

Also what kind of food are you feeding your cat?

And just because I'm curious - what is your kitty's name and how old is she?

There are several things we have found here that greatly influence a cat's blood glucose (BG). The food they eat, having their blood tested at the vet and yes an infection.

Eating dry food can GREATLY elevate a BG. It is best to feed canned lo carbohydrate food. Here is a link to all our diet and nutrition information that we talk about alot here:
viewtopic.php?f=14&t=115

And testing a cat's BG at the vet alone can be very stressful for the cat and can cause an increase in BG. I have a cat who is NOT diabetic. HOwever @ the vet her BG is in the 300's. At home she is perfectly normal. We also encourage home testing with a human glucometer when our cats are on insulin in order to get a better feeling for how your cat is doing when they are on insulin. Do you hometest by chance?

I am just throwing a couple things at you initially to get you started. There ARE TRUE cases of "insulin resistance" for sure - but I feel that there are some things here we first need to address with your kitty before we can even think about resistance.
 
Are you using Vetsulin? There have been some alerts on Vetsulin - that batches are inconsistent. Here is a website with the info: http://www.fda.gov/AnimalVeterinary/new ... 188752.htm It could be that you got a bad batch?

You also say a human grade insulin. Is it Lantus or Levemir? What dose did you start with? Sometimes you can start with a higher dose ( we suggest .5 to 1 unit twice a day, 12 hours apart) and be over the ideal dose. Then you get into a pattern of rebound.
 
Hi Patti,

Here are the answers to your questions:

When you say you're kitty is resistant to the insulin - can you tell us what dose of Vetsulin she is on? And are these blood glucose levels done at the vet's office?

Sami is on a human grade insulin not vetsulin, she was on vetsulin in September but when she had to go back on the insulin the vet recommended a human grade insulin instead. We first had her on 1 unit in the morning and at night then we increased to two units and within a few doses she actually had a hypoglycemic reaction and was down to 61. Since then I have been gun shy with the dosage, and try to base the number of units on what her BG is when her insulin is due. I am testing at home.

Here is an example of the inconsistance:

600+ BG - 1 unit given - dropped to a low of 321 before starting to rise, she went up to 443 before her next dose of 1 unit. After that unit she dropped to 374 before rising up to 442. Abother unit was given and she droped to 279 before rising back up to 521. At 521 she was given 2 units, and her BG was 464 at her next dose time. 12 hours between each dose.

By the way I have some very detailed readings over the last few days because I have been testing her about every 2 hours because she has been fluctuating so much.[/i]

Also what kind of food are you feeding your cat?

I am feeding her dry food, but am attempting to get her switched to wet food. In the past, she totally turns her nose up at the wet food, and goes as far as wanting to cover it up like it was poop.

Hope that helps. I have a full spread sheet with her BG levels and what dose was given so I could analyze what is going on and over the last two months there is just no consistancy.

I hope someone is able to help.

Thanks again.
 
If you are using Lantus, it is not recommended to change the doses based on preshots. Take a minute to go over to the Insulin Support Group for Lantus (or Levemir, if that is what you are on) and read the stickies. They have great info on how these insulins work and how to use them to your best advantage.

You could be seeing rebound also: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

Also, the dry food can raise bg levels. When we changed Oliver over from dry to wet, his bg levels went down 100 points overnight. Have you seen this website written by a vet: http://www.catinfo.org? It explains why wet lo carb food is better for all cats, but especially diabetics. And she has good ideas about changing over resistant eaters.
 
Yeah, what you're seeing is likely *not* insulin resistance, since you saw a good response the first day. It's most likely a combination of insulin overdose and too much carbohydrate from the dry food.

The high-carbohydrate food raises blood sugar dramatically, but only for a short time (an hour or two), then it plunges.

The insulin, if not a long-lasting one like Levemir or Lantus (what brand is yours?), probably does the exact same thing in reverse, plunging blood sugar dangerously, but only for 4-6 hours.

A very low blood sugar (hypo) incident, if it doesn't kill your cat, is likely to cause its liver to dump huge amounts of stored sugar into the bloodstream (see the "somogyi rebound" links posted above), making his blood sugar look high even when he's getting too much insulin.

And remember blood sugar can easily go between way too high and way too low over a period of a few hours, so a test every few days at the vet's, even if accurate, won't really tell you anything. (And they're seldom accurate because of stress).

So, three things to iron all this out:

1. Test blood sugar at home, 3 times a day at first, reducing to two when you know what's happening. It's easy and not expensive, here's the video http://www.youtube.com/watch?v=_zE12-4fVn8

2. Since you're already using human-type insulin (good idea these days), use a long-acting one: Levemir or Lantus. If you're using another brand, please try to use one of these, and be sure to buy the 5-pack of pen cartridges rather than the vial, to save money. (That way when a vial goes bad, you throw away much less).

3. Use the techniques at http://www.catinfo.org to get your cat off dry food and onto canned as soon as possible. Dry food is just oil on the flames for a diabetic. It's like asking a human diabetic to subsist on Twinkies.

This sounds like a lot but it's really just three things, and it usually works.

Breathe and read up all you can (see the links in my signature) and you'll get a good feel for this stuff. It's not rocket science but many vets are not up on it.

Best regards,
Steve

P.S. Dosage can be adjusted with a protocol like this one: http://tillydiabetes.net/en_6_protocol2.htm this is excellent and well-researched. Show your vet.
 
Sue and Oliver said:
If you are using Lantus, it is not recommended to change the doses based on preshots. Take a minute to go over to the Insulin Support Group for Lantus (or Levemir, if that is what you are on) and read the stickies. They have great info on how these insulins work and how to use them to your best advantage.
Click to expand...


Sami is on Lantus, so I will definitely check out the fourm for information on how to use them to my best advantage.

I did switch Sami to wet food last night and then took up the rest of the food before I went to bed. I allowed her a little dry food because that is what she really prefers and she wouldn't eat all the wet food. Plus, understand that I have 4 other cats that are very demanding and it is difficult to remove all traces of food for the night when they are use to having it available. Four of the 5, Sami included, were by my bedside a few times during the night asking for food. I have kept food by my bed for this exact reason and I despensed out a little snack for all of them.

I am also happy to say that after giving the wet food, only allowing a little dry food, and two units of Lantus, Sami dropped from 442 (last nights reading) to 189 (this mornings reading). I am very happy with this. I don't know if it was a combination of the things that I did or just some fluke. I will see how it goes today and hopefully it will become the norm.

Thanks again for all the help I am still planning to read up more on the insulin and recommended diet because 2 months of high sugar have take its toll on me and I am sure it hasn't been healthy for Sami either.

Tina
 
Steve & Jock said:
2. Since you're already using human-type insulin (good idea these days), use a long-acting one: Levemir or Lantus. If you're using another brand, please try to use one of these, and be sure to buy the 5-pack of pen cartridges rather than the vial, to save money. (That way when a vial goes bad, you throw away much less).
Click to expand...

What is the 5 pack of pen cartridges? I got a vial, and it has 1000 units in it, according to my friend who is a pharmacist. She did mention that it should be fine for a longer period than what the vet told me, which was a few months, as long as it isn't left out of the refrigerator. She said I could keep using it up to a year.

As for the wet food, I gave her some last night and she really only ate a half a can of the Fancy Feast. This morning I noticed that she was mostly licking the juices off rather than actually eating it. She did eat some in the process, but still only about half a can. And at 12 lbs, I am sure she needs a lot more food than that. Any suggestions on what type of canned food is best. I did read the the section about Fancy Feast without the wheat and gluten and I am going to try that variety. Any other suggestions?

Thanks for all the helpful advance.

Tina
 
Sue and Oliver said:
You could be seeing rebound also: http://petdiabetes.wikia.com/wiki/Somogyi_rebound
Click to expand...

I don't think we are seeing rebound, but I can't be 100% sure. If the sugar can drop too low and then spike back up within a 2 hour period then it is possible. Although, for the last few days, I have been testing same every 2 hours, except only a few times during the night, to try to get a accurate account of what her blood sugar is doing.

Understand that before last night, I was leaving out dry food all the time, so she could have eaten any time throughout the day. I didn't always see when.

My vet has told me from the start that it is best to only feed just before the insulin is given, but for awhile there, when Sami wasn't feel all that great she wasn't eating all the time, and only providing a 30 minute to 1 hour span for her to eat wasn't working, so I left the food out. Now that she seems to have her appetite back I will probably try the twice a day feeding instead.
 
Hello Tina, I saw your post over on the Lantus board and then saw this one. A couple of things to note...a non-regulated diabetic cat is usually always hungry and you should not withhold food from them except for the 2 hours before the shot time (kinda like a fasting blood test). It is very difficult to switch a carb-addicted (dry food) kitty to wet when there is ANY of the dry in the house (we call the dry kitty crack! :lol: ) You might want to think about switching all your kitties to wet or, if there is a holdout, feed that cat in a different place. One member here feeds her civvie (non-diabetic) up on the counter where the diabetic one can't jump up to and keeps the dish covered when the civvie isn't being fed. Also, most of us add a bit of water and mix it with the canned food...it seems to be a consistency that the kitties prefer plus it adds that much-needed water to their diet. In addition, mini meals throughout the day rather than a twice-a-day feeding routine helps to even out the BGs. I feed 1/4 can of food about every 1 for the first 4 hours after AM shot and then every 2 hours for the rest of the day up til PM shot. I even feed right before I go to bed about 1/2 can and he usually gets me up at PM shot plus 8 hours, which is his nadir that I like to test anyway so I feed him.

Your best bet is to post to a daily thread (called a condo) over on the Lantus board...there are very experienced users over there that can help you get your Sami to a safer dose and BG and possibly even into remission....there are something like 100 cats so far that are OTJ (off the juice) on the Lantus board.

Look forward to seeing you there.
 
Hi Tina,
So glad to see you posted back. You've gotten some more great advice from everyone. I'll only address the food question you asked.

There are many more foods you can feed besides the Fancy Feast (FF). We use some Friskies right now - again a lo carb one. Here is a link to Janet and Binky's food charts - which are also in the nutrition links I gave you:
http://binkyspage.tripod.com/CanFoodNew.html
It takes a while to get used to finding your way around the site but eventually you'll know where everything is! ;-) You want to feed foods that have a carb count <10%. In the beginning many of us have carried a copy of these charts around with us when we go shopping for food! :shock: Some of the food you can find in your local grocery stores - some you may have to go to a more premium pet food store. You may have to play around a little to find one your Sami likes best.

I hope this helps you a little. Best of lucky to you. I know they'll be a great help to you over in Lantus land with your dosing questions.
 
Brenda and Morris said:
A couple of things to note...a non-regulated diabetic cat is usually always hungry and you should not withhold food from them except for the 2 hours before the shot time (kinda like a fasting blood test).

It is very difficult to switch a carb-addicted (dry food) kitty to wet when there is ANY of the dry in the house (we call the dry kitty crack! :lol: ) You might want to think about switching all your kitties to wet or, if there is a holdout, feed that cat in a different place.

Also, most of us add a bit of water and mix it with the canned food...it seems to be a consistency that the kitties prefer plus it adds that much-needed water to their diet. In addition, mini meals throughout the day rather than a twice-a-day feeding routine helps to even out the BGs.
Click to expand...

Thanks Brenda, this feeding schedule is very good to know. My vet is the one who suggested limiting the feedings to twice a day. I am finding that more and more what my vet has recommended hasn't been totally good for regulation. I will keep some wet food out for her all the time and try to feed her more often, although it is difficult during the week since I work. Sami will like that much better.

As for switching all the cats to wet food, I am not sure how that will work, because we have one cat who seems to have intestinal problems and tends to have the runs if we switch the food. Although we have had him on a diet, and he has dropped 5 lbs (29 lbs at his highest), and he seems to be doing a little better now. I will attempt to convert all cats to wet, but I might have to keep the dry for at least the one cat and maybe for a little treat on the side.

I will also try the water in the food, as Sami tends to just lick up the juices rather than eat it. Maybe if it is a little wetter she will get more of the food with each lick.

Thanks again for all the help. I am learning so much from everyone.

Tina
 
One way to leave food out, Tina, when you are at work is to freeze the wet food. I have a Smartware (plastic) cupcake pan. This spot fits one can of Fancy Feast. I freeze it and then take it out and put it into a plastic bag and refreeze. Whenever I need to feed him and will be gone, I take out a cupcake of food. It thaws in a couple hours.
 
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