Introducing Perry & Sooty and need your help!

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Perry and Sooty

Perry and Sooty

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Hi I'm Perry, in Atlanta GA and Sooty (NM, Black DSH, 15 lbs not obese!) was diagnosed late June.
Since then he's been (on Vet's orders) on steadily increasing doses of Lantus (glargine) starting at 2IU BID (8AM and 8PM) increasing after 1 or 2 weeks in 0.5 increments, ending up at 5.5 IU early September - and we are geting absolutely nowhere. After we reached 5.5 units BID and were still getting 260s to 300s and him spending ALL DAY crying for food (in spite of eating normally all day!!) we went to a referral specialists and all they could do was tell us to go back and do the same thing all over again. He seems to be very insulin reistant so I asked the specialist "could he then, maybe have Type 2 Diabetes?" and he replied "There is no such thing as Feline Type 1 and 2 diabetes. That is only for humans. there is only Feline Diabetes Mellitus and the only treatment is Insulin" - he now wants us to (again!) increase the dose every 3 days or so by 1 Unit at a time until his BG numbers change! But we have been there and done that and after 2 months we never did see any significant downward trend in his BG levels. We are keeping him at 4.5IU BID while we try and understand where we can go from here. Last Saturday I did a full Curve on him and here are the numbers:
AMPS: 331
+2: 335
+4: 278
+6: 286
+8: 300
+10: 340
+12: 282
Can anyone give us any advice please?
 
HI Perry!

Welcome! When you start above a beginning dose of 1/2 to one unit twice a day, you run the risk of starting over his ideal dose. It's called rebound: http://petdiabetes.wikia.com/wiki/Somogyi_rebound Hard to get your head around, but the idea is that if he is getting more insulin than he needs, his body produces more glucose and his numbers continue to be high. This might be the problem.

I'd suggest that you go over to the Lantus Insulin Support group page and read the stickies at the top. They will give you great information on how it works and how to best use it. viewforum.php?f=9

It sounds like you are hometesting - That's wonderful!
 
Hi, thanks for the reply. Yes we're home testing and I have read the stickies... I understand about Somgyi rebound even if some websites disagree as to whether it really happens..(!) Anyhow he's a big cat and the initial does per the protocols is said to be .25 to .5 IU per Kg so 2 IUs start dose seemed to be reasonable...??
Anyhow I shall go to the Lantus section and see how we do there..!
 
Sounds like you have done your research. Yes, I would go on the Support group site and ask what they think about your dose, etc. They all use your insulin and have seen lots of different scenarios. We often see cats here in rebound; on this site at least, it is not uncommon.
 
Thanks! I thought for rebound to occur you'd ned to see some point when the BG was low (like 50s or 60s)? So unless that might be happening overnight (I haven;t done any overnight curves but have done snapshots at 2AM after 8PM shot - and seen 250s)... So is there such a thing as a 'permanent' rebound state?
 
What type of food is Sooty eating?

There are conditions that cause a need for a high dose of insulin, but first, may I ask, were you hometesting from the beginning or start recently? If from the beginning have the numbers ever come down? If just recently, what was the dose at when you started hometesting?

Could be rebound or it could be a high dose condition that you can get some tests for. You can read about those conditions here: viewtopic.php?f=12&t=375
 
Welcome to the site.

So, first is YAY that you are home testing; testing at home is the best way to know how well the insulin is working.

It would be a great idea if you can set up a spreadsheet as it will help you to keep track of all progress, and it will also allow others to see how things are going and to offer you some help, advice, and suggestions.

One thing you can consider, maybe later on, is that there were IS a resistance, and there are tests that can be done.
Both of my cats are resistant and tested positive for acromegaly, with Oliver also testing positive for IAA.
The links for you, in case you want to look into it:
IAA Test
IGF-1 (Acro) Test

Please know that there have been some cats with doses higher than where you are right now, and I know of one who did go OTJ, you may just have a thirsty fella!

Another very important part of the picture is food. By changing from dry foods to wet, and only low carb, some cats have gone OTJ or drastically reduced their insulin needs.
One VERY IMPORTANT point to keep in mind is that you need to be careful with dose when making food changes.
Some food links - one is a list of foods to see if you are feeding low carb, and the other has a great deal of good info on nutrition:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

If you have been testing regularly and have seen fairly high and flat numbers, and are feeding low carb, you may just need to give more insulin.

Be sure to ask all questions you have, and feel free to have a look at my spreadsheets for my two cats, to see what I record for them.
 
perry please tell us the diet you have him on...wet canned or dry kibble. this can make a big difference.
 
you know the numbers are not terrible, they are just not so good. it may be that he will end up being on a big dose. the curve is nice and smooth... for a cat that's been on lantus for a while.. has he continued with these #'s or are the #'s lower now then on the lower dose?
 
tuckers mom said:
What type of food is Sooty eating?

There are conditions that cause a need for a high dose of insulin, but first, may I ask, were you hometesting from the beginning or start recently? If from the beginning have the numbers ever come down? If just recently, what was the dose at when you started hometesting?

Could be rebound or it could be a high dose condition that you can get some tests for. You can read about those conditions here: http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375
Click to expand...
Thanks - he's been on low carb Fancy Feast / Friskies wet food, since the beginning of July. Used to feed him demand dry food and have to conclude that this may have played a part in his becoming diabetic. You live and learn... and since this I am rather losing respect for the petfood companies!
We've been home testing ever sine the beginning of July also... when diagnosed initially, the Vet had a reading of 485.

HTH!
 
lori and tom said:
you know the numbers are not terrible, they are just not so good. it may be that he will end up being on a big dose. the curve is nice and smooth... for a cat that's been on lantus for a while.. has he continued with these #'s or are the #'s lower now then on the lower dose?
Click to expand...
The numbers have shown precious litle change whatever dose he's been on. That's what is mostly puzzling us! We reduced him from 5.5BID to 3.5BID over a week and nothing changed... as far as we can see...
 
perry there are a couple of cats here, they're called 'big gulpers' and they take 7U's or so.
could be sooty will be one of those types of cats. try not to be too discouraged.
posting here everyday on lantus insulin support group may teach you certain trends to follow either up or down.
have you been testing prior to every dose? silly question maybe but have to ask.
 
Great that you changed the food and are hometesting for so long. I'd still suggest reading the link to the high dose kitties and see what you think about that. And definitely ask questions.

My next question :) Is your Lantus still good?

It's a great insulin, a favorite here on FDMB, but it needs to be treated well to maintain it's potency. The insulin does not need mixing, we don't roll or shake the vial, don't store on the door of the fridge, no injecting air into the vial. I'm not really an expert on Lantus, others can help or you can check out this link on proper handling/storage: viewtopic.php?f=9&t=151
 
Gayle and Shadoe said:
Welcome to the site.

So, first is YAY that you are home testing; testing at home is the best way to know how well the insulin is working.

It would be a great idea if you can set up a spreadsheet as it will help you to keep track of all progress, and it will also allow others to see how things are going and to offer you some help, advice, and suggestions.

One thing you can consider, maybe later on, is that there were IS a resistance, and there are tests that can be done.
Both of my cats are resistant and tested positive for acromegaly, with Oliver also testing positive for IAA.
The links for you, in case you want to look into it:
IAA Test
IGF-1 (Acro) Test

Please know that there have been some cats with doses higher than where you are right now, and I know of one who did go OTJ, you may just have a thirsty fella!

Another very important part of the picture is food. By changing from dry foods to wet, and only low carb, some cats have gone OTJ or drastically reduced their insulin needs.
One VERY IMPORTANT point to keep in mind is that you need to be careful with dose when making food changes.
Some food links - one is a list of foods to see if you are feeding low carb, and the other has a great deal of good info on nutrition:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

If you have been testing regularly and have seen fairly high and flat numbers, and are feeding low carb, you may just need to give more insulin.

Be sure to ask all questions you have, and feel free to have a look at my spreadsheets for my two cats, to see what I record for them.
Click to expand...
The referral Vet practice were quoting about $400 for the Acromegaly blood test...!! Shows where their motives lie perhaps???
Will try and check out the spreadsheet thing... thanks again!
 
tuckers mom said:
Great that you changed the food and are hometesting for so long. I'd still suggest reading the link to the high dose kitties and see what you think about that. And definitely ask questions.

My next question :) Is your Lantus still good?

It's a great insulin, a favorite here on FDMB, but it needs to be treated well to maintain it's potency. The insulin does not need mixing, we don't roll or shake the vial, don't store on the door of the fridge, no injecting air into the vial. I'm not really an expert on Lantus, others can help or you can check out this link on proper handling/storage: viewtopic.php?f=9&t=151
Click to expand...
Good question, I have wondered that myself. It looks fine.... I did used to roll the vial because my Vet taught us to (!). I also used to inject air nto the vial because that is what the BD Websote tutorial said to do (!) again! I only found out that you shouldn't do either of these, for Lantus, when I arrived here (yesterday)... !
But it does LOOK OK - there is no cloudiness, no floaties, it's completely clear. Are there any other ways to tell if it's good or bad?
I guess also that I am just a bit loth to throw yet another variable into things, because to change to a new vial now, to see if it made any diffeence, I'd have to keep him on the same dose for a few days, right?
But I know too that without getting a new prescription and a new vial, I guess there is no other way to tell if the one were using is still good...
 
well 3 things come to mind, the insulin has been rolled, been injected with air and from what i know a vial of insulin has a very short shelf life once opened, 1 month.
has it been refrigerated?
it truly might be the insulin.
 
I was helping someone over the weekend and the Lantus vial she had been given with her new kitty looked clear but it had an odor to it. A fishy, sort of lobster smell to it. It was easy to tell that vial had gone bad.

So, any smell to your vial? The folks on the Lantus ISG could probably help you determine if there is another way to tell if the insulin is bad.
 
Starting over is a decent way to do things, although there are some folks who would disagree with it. Take a look at Eeyore's ss (in my signature), and you'll see we started over, went super high on the numbers, and then something clicked - dunno what - and we're way back down to close to nuttin' now...0.5U on a "high" day, which for him is about 130-140.

Somogyi is a contentious topic, but I believe it exists. One thing to realize about somogyi is that you don't need to see actual low numbers...just a fast enough drop (whatever that means; each cat has a different opinion, it seems) to trigger the liver into putting out some stored glucose, and voila, you have high numbers with a relatively minimal drop in there. It can very easily be mistaken for a dose which is simply not working.

Unfortunately, the only way to test is to see if the reductions help. And it will take several days on each reduction to see if there is movement in the numbers, too...because Lantus is a "storage" insulin.

Further, if you've changed the diet and seen no significant change (although it seems you have - went from kibble and 485 to wet food and mid200's at nadir; about 100 points is a good diet change number, I've seen), I would consider the somogyi as being the culprit.

If you want to test for Somogyi, let me know; I've been there, done that, and there are some issues that come with the testing. I've managed to figure out how to get "around" them, and have some guidelines if you'd like them, that have worked for me and Eeyore.

As you said, it's difficult to throw away any "good' insulin, but...it also may be that. Hard to tell, without getting a new vial.

So, your options are (in no particular, recommended order):
1. Test for somogyi
2. Get a new rx and a new vial of insulin
3. Test for acromegaly
4. Do nothing

I'm super glad to hear you're testing at home. That takes a ton of guesswork out of things, and will make monitoring for somogyi much easier (you can't really do that without testing...).

Be happy to help, just say the word!

Best-
Michele
 
Hi Perry.

Like others have said, it's hard to tell whether the insulin has gone south without getting new insulin. I think it's worth a shot based on what you've told us you did with the insulin. However, if you get new Lantus, ask for an RX for the lantus pens rather than the vial. They're a little more expensive up front, but over the long run they save you money because the vial can lose its strength early and the pens will last you longer. You can read about them in the lantus stickies. You can also call various pharmacies to price them. Some folks have gotten good prices.
 
How old is Sooty?

I assume the vet did complete bloodwork and urinalysis when he was diagnosed with diabetes?

You said he cries a lot for food. That could be the unregulated diabetes or he could also have a thyroid condition (Hyperthyroidism). Has he ever had a dental - maybe his teeth need cleaning? Any other health problems? Just a couple of things to consider for his 'possible' insulin resistance.
 
tuckers mom said:
I was helping someone over the weekend and the Lantus vial she had been given with her new kitty looked clear but it had an odor to it. A fishy, sort of lobster smell to it. It was easy to tell that vial had gone bad.

So, any smell to your vial? The folks on the Lantus ISG could probably help you determine if there is another way to tell if the insulin is bad.
Click to expand...
I just tried squirting a bit onto some kitchen paper and there is an odd smell to it. Very hard to describe, Should there be no odor at all?
 
gingerand((calliope))(GA) said:
Hi Perry.

Like others have said, it's hard to tell whether the insulin has gone south without getting new insulin. I think it's worth a shot based on what you've told us you did with the insulin. However, if you get new Lantus, ask for an RX for the lantus pens rather than the vial. They're a little more expensive up front, but over the long run they save you money because the vial can lose its strength early and the pens will last you longer. You can read about them in the lantus stickies. You can also call various pharmacies to price them. Some folks have gotten good prices.
Click to expand...
Thanks much will get a new Rx tomorrow and see if we can get the pens. Darned misinformation from people who are supposed to know (we were doing what we thought was right! Grrrrrr!!!
 
That's why I thank my lucky stars all the time that I found this place to help me do the best for Calliope. My vet suggested I put her to sleep. I had another good year and a half with her because I came here. The kidneys took her, finally, not the FD!
 
pamela and tigger said:
How old is Sooty?

I assume the vet did complete bloodwork and urinalysis when he was diagnosed with diabetes?

You said he cries a lot for food. That could be the unregulated diabetes or he could also have a thyroid condition (Hyperthyroidism). Has he ever had a dental - maybe his teeth need cleaning? Any other health problems? Just a couple of things to consider for his 'possible' insulin resistance.
Click to expand...
He's 7 and a 1/2. Has had thorough Vet eval moore than once and although since Dx he has had one Urinary tract Infection and one Upperr Respiratory infection, those were brief and successfully treated. As far as we know he has no other condditions now other than the FD. Thanks so much for the followup!!
 
awwww, sooty's just a teenager! :-D
the smelly insulin may just be your problem..
you never handled it correctly (vet's fault not yours) cuz you always rolled it.
was it refrigerated?
i am feeling really good actually about the fact that your vet has no idea how to use lantusbecuase that means there is alot of hope to have sooty regulated....maybe even off the juice!
 
lori and tom said:
awwww, sooty's just a teenager! :-D
the smelly insulin may just be your problem..
you never handled it correctly (vet's fault not yours) cuz you always rolled it.
was it refrigerated?
i am feeling really good actually about the fact that your vet has no idea how to use lantusbecuase that means there is alot of hope to have sooty regulated....maybe even off the juice!
Click to expand...
So here's a dilemma. Suppose we have bad Lantus. We will get a new vial tomorrow but - we are currently at 4.0U BID. If we continue at this dose, with fresh Lantus, do we have a risk of dropping him into Hypo, or will it take a few days to kick in? What testing frequency would be recommended to avoid such a complication? Or should we drop the dose lower just in case? Oh dear I am feeling a bit lost here...
 
ok, breath... i would start at half that dose so you can monitor any changes on the safe side if indeed the problem is bad insulin.
that' what i would do.
 
Thanks Lori that seems very sound advice.

I am definitely leaning towards starting over, with a fresh bottle of Lantus and 1.5U BID (his ideal weight being 6.8Kg). Seems like the safest and most 'likely to succeed' way to go.
 
lori and tom said:
you know the numbers are not terrible, they are just not so good. it may be that he will end up being on a big dose. the curve is nice and smooth... for a cat that's been on lantus for a while.. has he continued with these #'s or are the #'s lower now then on the lower dose?
Click to expand...
Sorry for the slow reply, I just realized I hadn't yet!
To answer your Q yes he continued with similar numbers there was never a noticable drop despite steadily increasing doses.
Anyhow today we are starting completely afresh - back to 1.5 BID and will only increase by small amounts... a case of "back to the drawing board", basically!
 
I think a cautious starting over in your case isn't a bad idea. BUT please ensure you watch his clinical signs (pee/poop/water intake/hair condition/etc) and test his urine for ketones on a daily basis just in case he really does need more insulin.
 
Perry and Sooty said:
Thanks much will get a new Rx tomorrow and see if we can get the pens. Darned misinformation from people who are supposed to know (we were doing what we thought was right! Grrrrrr!!!
Click to expand...
Your vet is like a GP, trying to know everything about everything. The fact they prescribed Lantus is great. Did they get you started on low carb food and hometesting? That's great, too. And Lantus is a human insulin, so they may not know as much about the handling, which isn't great, but it's also not awful either. So please give your vet a little slack.
 
Michele and Esse said:
Starting over is a decent way to do things, although there are some folks who would disagree with it. Take a look at Eeyore's ss (in my signature), and you'll see we started over, went super high on the numbers, and then something clicked - dunno what - and we're way back down to close to nuttin' now...0.5U on a "high" day, which for him is about 130-140.

Somogyi is a contentious topic, but I believe it exists. One thing to realize about somogyi is that you don't need to see actual low numbers...just a fast enough drop (whatever that means; each cat has a different opinion, it seems) to trigger the liver into putting out some stored glucose, and voila, you have high numbers with a relatively minimal drop in there. It can very easily be mistaken for a dose which is simply not working.

Unfortunately, the only way to test is to see if the reductions help. And it will take several days on each reduction to see if there is movement in the numbers, too...because Lantus is a "storage" insulin.

Further, if you've changed the diet and seen no significant change (although it seems you have - went from kibble and 485 to wet food and mid200's at nadir; about 100 points is a good diet change number, I've seen), I would consider the somogyi as being the culprit.

If you want to test for Somogyi, let me know; I've been there, done that, and there are some issues that come with the testing. I've managed to figure out how to get "around" them, and have some guidelines if you'd like them, that have worked for me and Eeyore.

As you said, it's difficult to throw away any "good' insulin, but...it also may be that. Hard to tell, without getting a new vial.

So, your options are (in no particular, recommended order):
1. Test for somogyi
2. Get a new rx and a new vial of insulin
3. Test for acromegaly
4. Do nothing

I'm super glad to hear you're testing at home. That takes a ton of guesswork out of things, and will make monitoring for somogyi much easier (you can't really do that without testing...).

Be happy to help, just say the word!

Best-
Michele
Click to expand...
Michele, sorry for not responding sooner, been a bit overwhelming...!
As you might have seen in our other condos since, have decided to go right back to step 1 - and do a complete do-over, respecting the "SLGS' principle properly this time (together with much more - daily! - testing. Thanks for the offer to explain how to test for Somogyi I would still be interested in hearing about that...
Thanks so much for your brilliant reply - I am getting soooo much really terrific advice and REAL help here! :-D
 
Maggies Mom Debby said:
Perry and Sooty said:
Thanks much will get a new Rx tomorrow and see if we can get the pens. Darned misinformation from people who are supposed to know (we were doing what we thought was right! Grrrrrr!!!
Click to expand...
Your vet is like a GP, trying to know everything about everything. The fact they prescribed Lantus is great. Did they get you started on low carb food and hometesting? That's great, too. And Lantus is a human insulin, so they may not know as much about the handling, which isn't great, but it's also not awful either. So please give your vet a little slack.
Click to expand...
OK - fair comment! Slack duly cut for the Vet (please don't get me wrong she really is VERY nice and very caring! Just not quite so keen on the referral practice we tried - mega $$$). Oh and the advice / training video on drawing a shot of insulin by first shooting air into the vial and then shooting any bubbles back into the vial & redrawing, was on the BD syringes website.
We figured out to get him off the dry food and switch him to LC wet food on our own, vets generaly seem to want to sell you the high-price prescription brands it seems... (but ok I know they have to make a living too! ;-) )
 
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