Insulin Resistance

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Dragonnns

Dragonnns

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Hi All,

Cindy has been on Lantus since June and moved up to 7 units with no change. So we started using ProZinc on the 10th. Using the SLGS process, I started her off at 1 unit and am now up to 3 units BID. While I have seen lower numbers than ever before, they aren't signifiantly lower. At this rate, I'll probably move her up to 4 units next week (but want to run the numbers past my vet first).

In reading through the posts in here, it seems that many cats react much stronger to smaller doses than I'm seeing with Cindy. I'm concerned that she is insulin resistant. Does anyone know if there is there an upper limit to how much insulin you can give before jumping to the conclusion that a kitty just isn't able to create or use it?

Thanks for any thoughts on this...
 
No firm number when it comes to insulin resistance.
Some cats can get up to 7u then go OTJ, and others could just remain at a high amount but not be resistant.

I can't really say much without seeing any BG numbers, but there are tests that can be done for Acromegaly, IAA, and Cushings.

IAA Test
IGF-1 (Acro) Test
Cushings Info

I have 2 high dose insulin resistant cats; you can look at our ss to see how their numbers were, the doses given and at what point I had them tested for resistance.
 
I went back to read your first post, the introduction and noticed Cindy's got alot of other health issues, so if you could put a profile together and link it into your signature, you would get some more suitable responses.

OK I took a look at your ss with the Lantus numbers, and while you had only the pre-shot BG numbers, it sure looks like you have some resistance happening so you may want to print out the sheets for the links I posted earlier and have Cindy tested for acro and IAA.

If the tests come back positive, you may want to consider switching to Levemir - I know nothing about PZI insulins so can't really help with the dosing etc, and most high dose kitties are on Lantus or Levemir.

The tests are done at MSU, so your vet will need to arrange for delivery via Fedex to the MSU lab

If you have any questions, please ask.
I did not see your ss when I first replied, sorry.
 
I believe there actually is a number (dose), based on weight, that doctors will consider insulin resistance. It came up regarding Charlie in one of his recent threads. Let me go find it...I'll add it to this post. I believe that acro information I've read said that most vets don't ask owners to test for it until the dose closes in on 20u. Of course, you could request the test at any point before then. From what I've learned here, full unit increases are not generally recommended since you can easily miss a dose that may have been her "good" dose and then send kitty into rebound. Brb with that quote...

"Insulin resistance is defined as persistent high bg readings throughout the day when 3 units of insulin per 4 pounds of body weight are used. OR: A unit or more of insulin per pound of body weight us needed to achieve regulation." quoted from Marvistavet.com, Topic:the hard to regulate pet.
 
Several things are to put together a profile and SS...which is underway i suspect.

The other is you might want to cross post over in Lantus too. Lots are really great advisers!

Lantus has a definate protocol you would want to work through first. Jumping up on lantus by more than 0.25u or .05u could cause you to miss the proper dose. Whole unit doses are definitely not encouraged.

Tilly Protocol for Lantus:
http://www.tillydiabetes.net/en_6_protocol2.htm
 
Thanks all for the advice and suggestions!

I do have her spreadsheet in my signature. I'll see about creating a profile for her as someone may have some thoughts on her other issues as well.

The dose increases have all been under advisement of the veterinarians involved in her care. I have done curves on her with Lantus and more with ProZinc since it seems to be a faster acting insulin than Lantus.

The numbers in June are pretty much the same numbers today which I'm finding rather depressing.

Based on the formula, I have 4.5 units more leeway so that is good. Hopefully I'll see some changes soon.
 
Based on that formula, my Oliver is not insulin resistant yet because he weighs 23.6lb, but his dose tonite was only 20.5u. The same goes for my Shadoe - she weighs just under 14lb, but her dose tonite was only 10.5u Lev and .75u R.

No, I would not hold to that formula.

If you look at your numbers on Lantus, there was no drop in numbers at all - the curves were all high and flat meaning more insulin needed. Since the change to another insulin, there has also been no difference.

I think you may want to be testing for ketones daily and talk to your vet about the IGF-1 and IAA tests. You may want to consider using a fast acting insulin at some point to help in bringing down the constant high numbers.

The tests, if positive, will let you know that Cindy has a functional pancreas, unlike other feline diabetics, and you will have a reason for the high dose. You will also want to avoid any BG below 100.

At 9u, I had Shadoe tested. The vet said she did not look acro and did not want to have the testing done. I harassed them for weeks, finally had her tested. Results: Positive acromegaly. The vets were shocked.

At 12u, I had Oliver tested, but we already knew the results, and the vet agreed, mostly because he looked acro. Results: Positive Acromegaly as well as IAA.

I'd suggest you discuss it with your vet and get prepared. You won't do much different, but you will understand what is going on and will be able to treat more aggressively.
 
debby here's my thought fwiw.
there was never enough testing during the lantus time to decipher anything.
there was no way to know if dose increases were appropriate or not as you know that lantus shoots on the nadar.

now looking at your pzi sheet i don't see a time when she has come down more than 40 or so points at mid cycle. barely a curve.

if it were me i suppose i would raise small amounts at a time as her system is adjusting to the different insulin (or has that ship sailed?)
but still, raise i would have to do...small .2 or .4 at a time every 3 cycles. it's hard to watch her in the highs i know but we still have so much to learn about this cat.
 
Dragonnns said:
Thanks all for the advice and suggestions!

I do have her spreadsheet in my signature. I'll see about creating a profile for her as someone may have some thoughts on her other issues as well.

The dose increases have all been under advisement of the veterinarians involved in her care. I have done curves on her with Lantus and more with ProZinc since it seems to be a faster acting insulin than Lantus.

The numbers in June are pretty much the same numbers today which I'm finding rather depressing.

Based on the formula, I have 4.5 units more leeway so that is good. Hopefully I'll see some changes soon.
Click to expand...

Hi there.. I will go off the deep end here and say.. while there were few early spot checks on Cindy's cycles on Lantus, I like the increases. I'm concerned about a couple things:

1. Lantus has a short open shelf life. Commonly discussed as 28 days, it's alleged it can last longer with proper treatment, which I will dispute :D It's possible your vial(s) went bad at about a month. I like Lantus, but I like Levemir better as far as the L insulins. It's gentler in behavior, yet every bit as powerful. ***edited to add*** Lantus ROCKS as an insulin, but I like Levemir better for the high dose cats

2. Cindy's ss, even without spotchecks, is a classic example of an acromegalic spreadsheet. I would highly recommend you look into that testing. If in fact Cindy is an acromegalic, there are some things you'll need to know. As well, if it turns out she is, you can increase far more dramatically. Acromegaly causes such severe insulin resistance that it becomes a toxicity. You must shoot far more insulin than you will ultimately need. For instance, very resistant cats can reach doses of 40u BID and more before the toxicity "breaks". With proper increases, done rapidly and in large increments, once that resistance is broken, an acromegalic cat could come down from an extremely high dose to only a sort of high dose. As a reference, I have an acro who went to 40u BID. The reason we went so high is because (in hindsight) we increased too slowly and could not overcome the resistance.

3. Spotchecks. You'll need some, with any insulin. It's crucial to know when the cat nadirs, however... no need to test so much every cycle, your meter may explode. :mrgreen:

If you would like more information on high dose cats, or you'd like to know more high dose moms, please feel free to find me on facebook, there are a ton of us FDMB hd moms there and it's super nice to have a place to vent. My email is wnstnbabe at gmail dot com and that'll take you right to me. I'll gladly introduce you to the high dose family on there, we have acrocats, a cushings cat, an IAA cat and a couple of undiagnosed high dose cats. No matter what happens with your dosing of Cindy, I want you to always know this: Do not feel bad that your cat needs more insulin than all the other cats you see posting here. It's not a competition, you just do what the cat needs. Besides, you'll never beat Lorna and Girlcat at 62u BID ;-)

It's a pleasure to meet you :)
 
Hi - I had a high dose case, Norton, who passed away from cancer two years ago.

One study I read at the time said 1 unit per 1 pound of cat PER DAY is considered "High Dose" or Insulin resistant.

So... add the two shots per day together...

At one point, Norton was up to 13u BID and he weighed 15 lbs. After changing to low carb canned food, he needed 15u per day - at that point, we were shooting TID instead of BID. (5u in three shots)

phoebe
 
Formulas are fine if all factors are constant... but as soon as one of the factors is a cat, you can forget about formulas for the most part.

It may be a good idea for you to look into having the tests done for insulin resistance.

I had Shadoe tested when she reached 9u BID but that's only because I was not fully aware of the possibilities, plus my vet office did not think the tests were needed. I had to keep pushing my vet and harassing them and even had to take down the sheets for the tests and tell them to call and make arrangements.
And yes, they were shocked when we got a positive result.

I had Oliver tested around 12u BID, but really just as a formality as he even has the look of acro and it was a forgone conclusion that he'd be positive.
And he was. For both acro AND IAA.

Changing from one insulin to another and then another will not make any difference. If the cat has a resistance issue, the dose will be higher than others. It's kind of important to know if you are dealing with a functioning pancreas or not, because if the pancreas is working just fine, you do NOT want to be aiming for numbers below 100.

Deja vu .... "Hopefully I'll see some changes soon."

Man, if I have even HALF a penny for every single time I thought that, said that, or posted that, I'd be a gazillionaire!


I know, I know, I have repeated much of what I have said earlier but it's important.
I get ZERO directions for dosing from my vet office for my two cats because they have absolutely no knowledge on acromegaly. I take a copy of their spreadsheets with me on every visit so that they can learn from my handling of the dose and numbers.

And scrap the formula thing; I don't know who thunk that up, but it does not fit either of my two high dose cats nor does it fit many others. If positive, you can see fluctuations in needs - Shadoe has been as low as 2.75u BID and up to 14u BID. Oliver has been up to 26u BID, down to 13u, and is back at 22u now. You could be seeing a low that will rise ... think of a wave and that is what you may see.

It may be an idea to speak with your vet about having the 2 tests done eventually, plus ask your vet what experience he/she has with insulin resistance issues. Nothing wrong with being prepared.
 
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