Insulin Resistant Cat- 6 months and still not regulated

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veverich222

Member Since 2014
Hello to all!
Long time reader, first time poster here :smile:
I was hoping I could post just to see if anyone else on this board has had a similar experience as us, and perhaps can offer any support or insight.

First, I would like to just mention that our cat is under the care of a small animal internist, who specializes in feline diabetes. We live in a large city, and she came highly recommended as the "guru of feline diabetes" to go to. My point in mentioning this is that we really do trust our vet so that is not an issue.

Our cat Puma was first diagnosed by our family vet in March with diabetes. She was started on Lantus, and despite several dose increases, her readings were not becoming regulated. Because of this, and the suspicion that she had occult pancreatitis, we were referred to the internist that we are seeing now.

An ultrasound confirmed that Puma had what our vet calls "sub-clinical or occult" pancreatitis. Her pancreas was inflamed, but thank goodness she shows no clinical signs of the disease - no abdominal pain, no vomiting, no lethargy, no loss of appetite. The only signs that she does show are those of the insulin resistance/ unregulated blood sugar and all of the symptoms that come along with that - she does have a ravenous appetite and increased water intake/frequent urination.

Onto the treatment:

Diet First: Puma is on Purina DM 1/2 and 1 oz of tuna twice a day. To curb her ravenous appetite, we just got the ok from the vet to include up to 2 tablespoons of oat bran with each meal, as well as allow her to lightly snack on broccoli and green beans (per vet these are low glycemic foods that should not spike the sugar).

Puma recently started also getting 1/4 teaspoon of Miralax and 2.5 mg of Ciaspride twice a day to help with mild constipation and hairballs (ok, I lied- this may be one symptom of the pancreatitis). It has helped her to be more "regular" and the quality of her bowel movements are normal- no longer dry and hard. Our vet also recommended 1/4 tab of 10 mg Zyrtec once per day, as Puma has seasonal allergies, and she believes reducing any inflammation (including that caused by allergies) would do good. We also keep our home cool, as we were told hot weather will flare up the pancreatitis as well.

She was switched to Levemir a couple of months ago, aka "the big guns" as our vet called it. I won't list the entire dosing guide, but generally, she is up to 6 units for anything between 250-299, 7 units for 300-374, and 8 units for 375-449. Of course, these doses are a result of a very slow increase over time. We home check Puma's sugar twice a day prior to feeding and injecting her insulin based on her BG reading. We report the readings once a week to the vet, and Puma is seen every 2-4 weeks usually for a re-check.

If you are still reading, THANK YOU!!!! Because here is my actual question/concern:

Has anyone had a similar experience and still no real regulation of BG readings?

Puma's are anywhere from 200-500 with spikes and drops that seem to have no rhyme or reason (per vet, pancreatitis waxes and wanes throughout day and this is what makes it so hard to regulate)

I know we can (and probably still will) go higher with the insulin dosing. We had done one blood sugar curve in the past on the Lantus, which showed the insulin was not really ever bringing the BG level down. According to the vet we see now, it is not worth it to do another until Puma's readings are more regulated. It is troubling to both us and the vet that despite the increased Levemir dosing, and the actual average of Puma's BG readings decreasing, her fructosamine levels keep increasing. About a month ago it was 432, now it is over 600 :(

Are we missing anything? Does anyone have any tips on anything we could be trying differently? Again, we really trust and respect our vet, but are just putting it out there, as I know there are hundreds of stories and experiences on this board that could offer some new insight. I am aware there is also a feline pancreatitis board and support group that may be more appropriate, but after reading posts on both those boards and this one, this one just seemed the better fit.

Thanks again for taking the time to read this and hoping our story can also offer others new info/tips as well!
 
Can you post recent BG values with times they were taken with respect to shot time and the dose of insulin given?
You should talk to your vet about and other conditions that can cause a high dose. See:
viewtopic.php?f=12&t=375

My MurrFee is doing OK with 16 units of Levemir twice daily. His preshots are generally low 300s with lows in the upper 10 or above.
 
Oh wow, it is comforting to know we still have room to go up in the Levemir dosage and are not the only ones on higher doses.

We have discussed Cushing's Disease with the vet, which was pretty much ruled out as Puma's adrenal glands looked normal on the ultrasound and all of her blood work is normal. All thyroid blood work is normal as well.

Acromegaly has not really been discussed, but it is something I will definitely bring up next time we are at the vet. The vet seems pretty convinced that it is the pancreatitis that is truly causing the insulin resistance. To note, Puma's weight has stayed the same throughout this entire process, she is female, and all of her organs were of normal size on the ultrasound, which may be other factors that the vet is considering before testing any further. But again, will definitely bring up the subject.

Here is how the blood glucose readings are going so far this month:


Date Time Blood Glucose Insulin (units)

8/1/2014 6:30 AM 227 5
8/1/2014 6:30 PM 389 7
8/2/2014 6:30 AM 468 7.5
8/2/2014 6:30 PM 381 7
8/3/2014 6:30 AM 468 7.5
8/3/2014 6:30 PM 376 7
8/4/2014 6:30 AM 298 5.5
8/4/2014 6:30 PM 376 7
8/5/2014 6:30 AM 332 6
8/5/2014 6:30 PM 443 7
8/6/2014 6:30 AM 273 5.5
8/6/2014 6:30 PM 266 5.5
8/7/2014 6:00 AM 365 6
8/7/2014 5:30 PM 256 5.5
Dosing Increased
8/8/2014 6:30 AM 414 7
8/8/2014 6:00 PM 367 6
8/9/2014 6:48 AM 419 7.5
8/9/2014 5:19 PM 399 7
8/10/2014 6:18 AM 212 5.5
8/10/2014 6:00 PM 342 6.5
8/11/2014 6:00 AM 332 6.5
8/11/2014 6:00 PM 439 7.5
8/12/2014 6:30 AM 316 6.5
8/12/2014 6:00 PM 227 5.5
8/13/2014 6:20 AM 377 7.5
8/13/2014 6:00 PM 428 7.5
Dosing Increased
8/14/14 6:45 AM 215 5.5
8/14/14 6:20 PM 397 8
8/15/14 6:15 AM 358 7
8/15/14 6:15 PM 442 8
8/16/14 6:16 AM 371 7
8/16/14 5:00 PM 433 8
8/17/14 6:03 AM 431 8
8/17/14 5:40 PM 300 7
8/18/14 6:00 AM 409 8
 
I apologize the BG readings above are so hard to read...it didn't look that way while I was typing it. Everything was more spaced out. Guess I should have hit "Preview" nailbite_smile
 
Hello and welcome to you and Puma. My Neko has both IAA (insulin auto antibodies) and acromegaly which are two high dose conditions. She got as high as 8.75 units and is now around 1 unit. Both IAA and acromegaly are seen a lot more around here than Cushings. Cushing's is more common in dogs. As a rule of thumb, we suggest that cats on low carb wet food diet needing over 6 units a dose be tested for IAA and acromegaly. BTW, Neko didn't have any visible signs of acromegaly and her CT scan showed normal size organs. The main symptom she showed was an insatiable hunger as well as the higher doses. We've seen some acromegalic cats with doses much higher, even up to 50U. Recent research has shown that acromegaly is a lot more common than originally thought. My vet was more surprised than me at the test results but has since identified another acrocat in her practice.

Here is an article on Insulin Resistance in Cats. Pancreatitis can cause resistance, but not usually to such high doses. We do have one cat here with chronic pancreatitis and IAA that got to around 8 units.

Have you take a look at the website http://www.catinfo.org? Cats are obligate carnivores and an off the shelf low carb wet food or raw food is best. The website has a chart showing most commercially available cat foods and their carb %. You want something under 10% carbs. Cats are obligate carnivores, oat bran is not a natural food for them. It's also not necessary to feed expensive veterinary food.

Larry asked about mid cycle tests. We dose Levemir and Lantus based on the low point in the cycle, not the preshot values. The low point can vary based on insulin and the cat. With Neko on Levemir her low point is often around 9 hours after shot time. Levemir (and Lantus) are depot insulins. That also means it's best to use a consistent dose instead of changing it up cycle to cycle. A second reason for testing mid-cycle is that there can be a huge variability within a cycle. When Neko earned her first dose reduction (by going under 50), she started out that cycle at 430. :shock: It's not unusual for cats to start and end the cycle high and get very low in the middle. For safety it's best to get periodic mid cycle tests.
 
Thanks for all of the info everyone!

Larry and kitties, I actually took it upon myself to do a curve today, as I had the day off from work. Her BG stayed high all day

6:00 AM pre-feeding/insulin injection: 409 8 units of insulin given
8:00 AM 453
10:00 AM 374
12:00 PM 375
2:00 PM 377
4:00 PM (Had to run out for one work related thing!)
6:00 PM 322 7 units of insulin given

I am going to give this info to my vet when I report Puma's weekly readings on Wednesday.

For those mentioning Acromegaly, would the standard initial test be the IGF-1 level blood test? Again, something I will mention to the vet.

And thank you Wendy&Neko for the nutritional information. I know there is a wealth of info out there on the benefits of feeding a more natural diet, which we will hopefully move towards in time.
 
Thanks for doing the curve - sorry she was mostly high and flat today. I find it's often better to do spot checks at various times instead of the curve, although a curve can be useful when you are trying to identify when the onset and nadir are. Hard to tell from today's curve though.

And yes, the IGF-1 is the test currently used as an indicator of acromegaly. Both it and the IAA test require blood samples be send to Michigan State University.
 
Just an update: Talked to the vet about acromegaly, but she is 100% sure we are moving toward regulation and it is just the pancreatitis. Upped the insulin dose by 1 unit (8-9 units on average now) and Puma's readings have been better - in the low 300s. Her appetite has not decreased, but it's only been a few days. Hoping this positive path continues.
 
I'd still push the vet to try the tests for acromegaly and IAA. My vet thought you didn't need to test for that until you got over 10 units so I asked her to humor me. We never got to 10 units. Most vets were taught that it's a rare condition, but recent research has shown that's not true. The reason we suggest testing is that the excess growth hormone put out by the acromegaly tumor (benign tumor) can cause some other issues which it's good to know about.

Puma will likely still remain hungry until she's spending more time in the 100's.
 
Thanks. We have an appointment the second week of September so I will talk to her then. Unfortunately when I called, I did not get to talk to the actual vet, but the rather had the message relayed through the vet tech after she talked to the vet.
 
The IGF-1 test costs about $45 and the IAA is done at the same lab for about $15. The biggest cost is your vet visit for blood draw and shipping (cold /overnight -- MSU has a special shipper available that your vet can get -- so print and take the info about the test at MSU)
This is the only lab in North America that does the IGF-1 test. Have your vet contact them directly.

My first diabetic cat, Norton, had acromegaly. At one point, he was up to 13U BID.

Levemir is like Lantus, and works best when you have consistent dosing. It is NOT like PZI which does respond well to using a BG-related dosing scale.

I used PZI insulin for Norton for his last few months, and a dosing scale for TID -- ranging from ~3.5-5.5U TID (every 8 hours).

Now, I use Levemir for adopted Tiggy and really like it.

Many High Dose kitties and their people hang out on Facebook. If you search for Feline Acromegaly, the group page will pop up and you can request to join.
 
There are also a number of high dose kitties who hang out on the Lantus Tight Regulation Forum here - even those that are using Levemir. Be prepared if you ask for the tests that some vets add extra charges on top of the blood draw. We've had a couple of members have that happen recently.
 
Hi -

Your numbers look like Grayson's back when we were on ProZinc - with a very minimal range. After 3 months he was tested (IGF-1 and IAA - both positive). At 5 months we switched to Levemir. He climbed the dosing ladder, to the scary high doses, had SRT, then started dropping. Slowly, but now at 1u. :mrgreen:

I would encourage you to have the tests run so you know what you're dealing with... makes it much easier to work with high doses and dose aggressively. [keep in mind, the IGF-1 isn't a "slam-dunk" diagnosis, but it's a very good indicator]. Home testing, including the mid-cycle tests help give you a good picture of how effective their body is processing the insulin. Great info/files in the Acro/High dose/Cushings ISG here, as well as on FB when you want to read more. I strongly recommend that you read at a reasonable pace - too much can make you feel completely overwhelmed and over-loaded. And ask LOTS of questions. Many of us have been where you are right now.

Lu-Ann
 
Thank you all again for all of the information and support. Puma is finally scheduled to have blood work done this Thursday, hopefully including both IGF-1 and IAA. It has been a real struggle to get the specialist to agree to order the tests, but I am bringing Puma to her regular vet on Thursday along with all of the information regarding those two tests. I will keep you up to date!
 
veverich222 said:
Thank you all again for all of the information and support. Puma is finally scheduled to have blood work done this Thursday, hopefully including both IGF-1 and IAA. It has been a real struggle to get the specialist to agree to order the tests, but I am bringing Puma to her regular vet on Thursday along with all of the information regarding those two tests. I will keep you up to date!

How did Puma's IGF-1 and IAA test results turn out?
If her tests were positive, you are most welcome to join the Feline Acromegaly group on Facebook which has 145members who have high dose cats, and can help you with Puma's care and dosing. Phoebe and Lu are both longtime members, and have already posted here to you.
 
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