Introduction and question about rebound effect

  • Thread starter Thread starter Anonymous
  • Start date Start date
Status
Not open for further replies.
A

Anonymous

Guest
My cat was diagnosed with diabetes in early November, just four days after I had to euthanize my other cat after a five-month period of intensive nursing after that cat was diagnosed with oral cancer. At the same time, my elderly mother had just undergone open-heart surgery, and her recovery was very slow and required much care from me and my siblings and a lot of running back and forth between where I live and where my mother lives. I was shell-shocked to say the least when I found out what feline diabetes management meant, in terms of cost and effort. And to think that I had hoped the symptoms meant diabetes, because the alternative was renal failure, and i had already been through that with a previous cat. Turns out diabetes is much harder to deal with. Blessings on you who find it easy. I do not.

My vet warned me that it would be expensive but most of the cost would be up front. And without any energy to do otherwise, I jumped on the treadmill. Between the two cats, my vet bills for November and December were over $2,000, which I can not easily afford. I crossed my fingers, hoping to get thing stabilized soon. I figured I would give it six months and see whether this is something I can sustain. It has now been six months, and I'm ready to bail, except for having to watch him deteriorate, which I can't face yet.

January and February, he seemed to be getting more stable as I worked on finding a very low-carb diet and we got used to the shot routine. In March, very high BG at vet, so vet raised dose from 2 units of ProZinc to 2.5. Then up to 3 a few weeks later because the symptoms seemed to be getting worse--much increased urination, increased drinking, some increased eating. Things have continued this way through two more dose increases--now up to 4 units and he's peeing more than ever. I had him to the vet again in late March but not since then. The vet is not convenient (the vets who are convenient are not worth going to--a whole other story), and I cannot afford to continue so many office visits or tests. I've spent easily another $1,200 in vet bills in 2011 so far, not to mention insulin, needles, and Keto-Diastix. I'm going to have to spend less over the next six months, not more.

I know there is a heavy emphasis here on home BG testing, so let me say right up front that I am not going to be home testing. I have a lot of other stresses going on right now. For six months, I've been struggling to keep up with urine testing for sugars and ketones and shots twice a day and feeding. I simply do not have the mental energy to take on the task of getting hold of testing supplies, learning to do the tests and then doing them several times a day. I KNOW it is the best way to treat, but it's not going to happen in the next few months. Maybe when the rest of my life settles down. But not before. So please don't waste your time trying to talk me into it. I KNOW the benefits. It's not that. Until I get some mental and emotional space, it is just something I can't do. I am burned out. I cannot add another task to my day. So please, if that's going to be your advice, just skip my posts and don't distress yourself with my approach. I'm not going to engage in a debate about home BG testing, no matter how important you believe it might be that I give it a try. I hope to give home testing a try at some point, but right now, I can't. I also am not someone who feels that my pets are like family members and their illnesses should be treated as much as I would treat a child's. I understand that many people do feel that way about their pets, and I'm not knocking it. Just saying that my philosophy is different. I have a responsibility toward my pets, but a different one than I would have toward a child. And a responsibility to myself not to overextend financially or put the cat's health ahead of my own. I am just barely holding it together in a very stressful time. I am hoping to be able to keep him reasonably healthy, but "reasonably" is a gray area.

I do test his urine every time he pees, which is around six times in 24 hours. We had been getting some 0.5% and 1% urine glucose readings in January and February, but in the last six weeks or so, it's been 2% all the way, with three 1% exceptions. I understand that urine glucose testing is not at all precise and not to be used as a sole indicator of his condition, but it seems to me that this trend might have some meaning.

So given my limitations (I can't afford frequent vet visits and I am unable to deal with home BG testing for the foreseeable future), I'm groping in the dark to a large extent. I know that's not ideal, but it's how it is. What I'm trying to figure out is whether he might be experiencing a rebound effect. The doses are going up and the symptoms are not getting any better. Things were pretty good in Feb. and early March but have deteriorated since then. If it is a rebound effect from overdosing, would there be any symptoms that I'm not seeing? We haven't had any hypo episodes. His behavior has been normal all along and continues to be so (aside from the excessive urination (over 16 oz/24 hours) and increased drinking and eating. I will be talking to my vet this week. In the past, he didn't seem to think it was a rebound effect, and he is a very experienced vet. So before we speak again, I am hoping to have a little more knowledge about the rebound effect.

If home BG testing is such an integral part of the culture of this board that I won't fit in unless I am willing to do it, I'll have to agree to disagree and look elsewhere for what information I might find. But I hope you good people might be able to meet me where I am and offer any info. you have.
 
Vet stress can raise the BG quite a bit so the vet increases the dose. Catch-22 situation if not home testing. To check for rebound you need to look at the numbers and then either cut the dose in 1/2 and test for a few days, at least one whole day, or start over at 1 unit again and see what the numbers will be.

In the time it took you to write your whole post, you could have tested, fed and shot in less time.
 
Thank you for your input. I will talk with the vet about possibly reducing the dose for a few days and seeing what happens.

Couldn't help yourself, could you? ;-)
 
Well I'm going to be very up front about this, you would greatly reduce your costs if you were open to home testing.

I adopted my own diabetic cat from this very board back in October, to date my vet hasn't seen him, except the one time that I took him in to show THEM how to home test. The reason for this is because there has been absolutely no reason to...He was already neutered, he was up to date on UTD on his vacinations, and I knew exactly what his BGs were at a moment's notice and was able to make partner with my vet over email to make the decisions on dosage changes, without the numbers being inflated by vet stress.

There is a very good chance that your cat is getting too much insulin if the dosage is being based on tests done at the vets. But frankly there is no way for you or us to know with out testing him at home.

Since you have already but him on a low carb (I'm assuming canned ) diet, you are testing for keytones, and giving insulin I'm not exactly sure what else you would like us to do. We coul help you learn to home test which would be a lot less frequent (min. 2xday) then testing every time he pees. We could help you work out a dosage that is correct for him, but we can't do that without having numbers from you testing at home...We are cat lovers and we have or have had our own diabetic cats that we are successfully treating but as far as I know none of us are mind readers so we can't tell you the best thing to do for your cat to help regulate him with out some kind of data.

I do know that when I adopted my Maxwell from this board that by testing him at home and working with the wonder folks here and following their proven protocol, within 2 weeks my guy went from 485 to the non-diabetic ranges and he has been in normal ranges for the last 7 months. But if I hadn't been testing him at home, I would have killed him with an overdose of insulin. All I'm going to ask is consider this...If this was a human child...would you consider giving insulin without testing before every shot?

Mel, Max & The Fur Gang
 
I'm sorry I wasn't clear. I'm wondering whether there are symptoms of the rebound effect that I should be seeing if that's what's going on. IOW, would he be having hypo episodes or something. I'm not asking you to diagnose or tell me what I should do. Looking for info about rebound effect, mostly.
 
First, welcome! Second, take a deep breath and exhale. Has the vet given you any BG numbers?
Are you totally switched to wet food? There are plenty of cheap low carb wet foods - i.e. all the fancy feast classics, lots of the friskies....
Can you add simple home cooked chicken (any parts)?
Dry food really keeps the BG numbers high.
Maisey was on ProZinc and did very well with low doses. And with the help of everyone here was only on insulin for a month - she's 12 years old. I was very stressed out when we first started, but by the end of the first week things improved a lot. You can get a newbie kit for FREE! And it would have everything in it for testing. I know you don't want to and can certainly understand how rough your life is now. The year I had major surgery and missed 6 months of work, my mother was on round 4 of cancer (last one was brain) and it was very draining.
Perhaps if you think of testing as a way to end vet bills and perhaps even ending the diabetes, it wouldn't look so bad to you. It really only takes and additional two minutes twice a day and maybe 3-4 times once a week for a curve. And it's kitty petting and loving times, which should help you catch your breath.
HUGS, HUGS, and MORE HUGS.
 
A hypo will definitely tell you the dose is too high but not if it is rebound. Nope, couldn't help myself :mrgreen: because I am one that will go back at any vet that puts home testing down in front of me. I adopted 3 more diabetics because I could home test. Without that testing there is no way I would do it blind again. You could save on glucose urine strips also besides saving on vet tests. FWIW, hypos are not pleasant to see happen.....especially when the cat is in a full blown hypo and seizing and foaming.
 
That is just it, too much insulin and too little insulin look exactly the same when you are looking at a cat....Basically with too much the body tries to protect itself by dumping stored sugar..so he could still be spiking BGs but without data there is no way of knowing. Until of course the body runs out of stored sugar and he either goes hypo, goes into seizures or dies. Plain and simple.

Can I ask....Exactly what do you have against learning to test him at home? If you can give insulin twice a day, and catch urine 6 times a day, what do you have against testing? Just curious on my part.

Mel, Max & The Fur Gang
 
I don't have anything against testing him at home. It's the learning curve I can't handle just yet. The learning curve for giving shots was tough. I can't go through that again right now. I'm sure once we both get used to BG testing it, it will go fine. And as I said, when my life settles down, I hope to do just that. It's the "getting used to" part that is the problem. Right now, I don't have the energy to learn a new thing and try to fit it into the routine. I'm still finding the shot routine somewhat stressful, though I do it faithfully every day. I need to leave it at that until I have more energy. As it is, I have tried several times to figure out what's a good glucometer, and I am completely stymied by what I find out. That says more about me and my ability to deal with new information that has a lot of difference pieces than it does about the glucometers. Obviously, you all managed to pick one and find the supplies and whatnot. I have found that it just puts my brain in a fog. I said I was burned out. I wasn't kidding.
 
Kathyh said:
First, welcome! Second, take a deep breath and exhale. Has the vet given you any BG numbers?
Are you totally switched to wet food? There are plenty of cheap low carb wet foods - i.e. all the fancy feast classics, lots of the friskies....
Can you add simple home cooked chicken (any parts)?
Dry food really keeps the BG numbers high.
Maisey was on ProZinc and did very well with low doses. And with the help of everyone here was only on insulin for a month - she's 12 years old. I was very stressed out when we first started, but by the end of the first week things improved a lot. You can get a newbie kit for FREE! And it would have everything in it for testing. I know you don't want to and can certainly understand how rough your life is now. The year I had major surgery and missed 6 months of work, my mother was on round 4 of cancer (last one was brain) and it was very draining.
Perhaps if you think of testing as a way to end vet bills and perhaps even ending the diabetes, it wouldn't look so bad to you. It really only takes and additional two minutes twice a day and maybe 3-4 times once a week for a curve. And it's kitty petting and loving times, which should help you catch your breath.
HUGS, HUGS, and MORE HUGS.
Thought I'd answered this, but I can't find my reply. If it's there, I apologize. Brain fog strikes again.

Totally switched to wet food in November. He's currently eating Fancy Feast Classic. I tried EVO (he didn't like it) and Wellness (liked it at first, then quit eating it). I had hoped that the change in diet alone might manage the diabetes, but that didn't happen. I don't remember the latest BG numbers at the vet. The last one I watched him do was very high (500+), but I don't remember exactly. I'm sure they were high at least partly due to stress. Last couple of times, they kept him all day and did several tests.
 
I can help you out with the meter and all the rest of the testing supplies....We have free newbie kits right here http://www.kitsforcats.webs.com/ It will have everything you need meter, test strips, lancets and even a catnip toy for your furry friend. Lori who runs the kits asks that if you can, to pay the shipping, which is like $6 but if not she is still happy to just send it out to you.

If you would like to post your general location..nearest major city and state, there is a very good chance that we have a member somewhere close that would be more than happy to come over and give you some hands on help with the testing.

I know you said you had him a low carb diet, but what exactly are you feeding? Also how old is the insulin you are using? Just trying to get a good picture about what is going on and see if I can find was to help you tweak it so that you aren't so overwhelmed and stressed out.

I completely understand brain death...lol Right now I'm a full time college student (Veterinary Technology), Wife, Mother, Grandmother, and I can for 11 ( 1 diabetic, 6 former abuse cases, 2 with heart problems) and a very large dog (also a former abuse case) and I volunteer at a local animal shelter, and care for my elderly parents, and help my eldely father in law with this rental properties ..So I get stressed out.

So lets see if we can figure this out together to help you help your kitty...(Btw ..names would be nice).

Mel, Max & The Fur Gang
 
BRW said:
I don't have anything against testing him at home. It's the learning curve I can't handle just yet. The learning curve for giving shots was tough. I can't go through that again right now. I'm sure once we both get used to BG testing it, it will go fine. And as I said, when my life settles down, I hope to do just that. It's the "getting used to" part that is the problem. Right now, I don't have the energy to learn a new thing and try to fit it into the routine. I'm still finding the shot routine somewhat stressful, though I do it faithfully every day. I need to leave it at that until I have more energy. As it is, I have tried several times to figure out what's a good glucometer, and I am completely stymied by what I find out. That says more about me and my ability to deal with new information that has a lot of difference pieces than it does about the glucometers. Obviously, you all managed to pick one and find the supplies and whatnot. I have found that it just puts my brain in a fog. I said I was burned out. I wasn't kidding.

We understand. Hometesting is not difficult, but it does sometimes take a little effort be become comforatable with it. If you are willing to post your location (city & state), we may have a member that lives near you who can show you how easy it is to test. As for meters, you can use any brand of glucometer, including store brands. Many of us use Walmart Relion brand meters and are very happy with them.

There is a lot of information about feline diabetes available on this site and other sites and it is very easy to become overwhelmed with it and experience information overload. If you could concentrate on diet, hypoglycemia and hometesting first, that will help reduce the load. Also, feel free to ask any questions you may have. We are not here to judge you, we only want to help you learn to care for your cat in the best way that works for you.
 
Here's the info you need on rebound: http://petdiabetes.wikia.com/wiki/Rebound

http://www.vetsulin.com/vet/Cats_Monitoring_Somogyi.aspx

If the dose is too high, you may see a rebound effect which results in flat, high blood glucoses.

As a previous PZI user whose cat's dose was raised steadily until 6U, I saw the same symptoms as you are - a steady decline, increased urination, increased hunger. That's because rebound leaves them in hyperglycemia almost constantly. Their body is trying to protect itself.

And I'm sorry, but I can't help myself either - if you are urine testing up to 6 times a day no wonder you feel that you can't learn to hometest. Hometesting only needs twice per day before you give the shot and several times one day a week to get it every couple of hours so you see how the dose is working. There are videos online to see how it's done and we have lots of tips that make it easier.

Many of us have hectic, active lives, work long hours, have health crisis (ask how many members have suffered from breast cancer), children and other family members who depend on us, besides our pets. If we can do this, so can you.

You have found the best online resource, probably the best resource period, for feline diabetes. Open your mind to the possibility that you are capable of more than you believe and with our help, because many people and their cats benefit greatly from our collective knowledge even when they are their own worst roadblock, and you will find that treating your cat's diabetes properly is much much easier than you have convinced yourself it is.
 
I'm grateful for the time you all are taking with me.

Diet: Fancy Feast Classic. I've quit giving him any flavors that include fish, since those are said to be harder on the kidneys. He's eating about five 3-oz cans per day, up from 3 cans/day in early March and 4 cans/day earlier this month. Over the winter, I tried him on EVO and Wellness, but he quit eating them.

Insulin: ProZinc. This bottle I bought in either mid-Feb or early March.
 
I look forward to working with you all on home testing at the point when I can contemplate it. That time is not now. I'm sorry to have to keep repeating this, but it's not going to happen in the near future. I'm hoping sometime over the summer. I have talked this over with people--cat lovers--who are close to me and know my situation. I do know what I can and can't handle right now. I'll get back to you on the home testing when I'm ready.

Thank you all for the information and the concern. I know you have the cat's best interests at heart.
 
Actually, we have your best interests at heart also because if you should lose him to a hypo, you will go back at yourself with the "what if's". Right now you could test just before shooting, that's only twice (b.i.d.) a day. He may not have the time left to wait till summer and I would rather stick the ear than wait for one of mine to pee ;-)
 
I think my original question was answered by several of you. Thank you all for your concern. :smile:
 
I'd consider lantus over prozinc first of all.

Second, I have no idea how you manage to test urine 6 times a day! I found once hard enough.

Jen
 
Jen & Squeak said:
I'd consider lantus over prozinc first of all.

Second, I have no idea how you manage to test urine 6 times a day! I found once hard enough.

Jen
I was able to test from the stream pretty often in the early weeks--it surprised me that he let me, but he did. Luckily, I don't have to try to do that since I got a Smart Cat Box:

http://www.smartcatbox.com/

It has also been a huge help in letting me accurately measure the amount of urine. I love that box. I would use it even for a non-diabetic cat.

ProZinc is what my vet prescribed.
 
I understand prozinc was prescribed, I'm simply saying that another insulin might be better for your cat. It would appear that lantus and levemir are much easier to use and have better success than prozinc (altho some do well with prozinc). This becomes even more important if you aren't testing blood glucose levels.
 
Jen & Squeak said:
I understand prozinc was prescribed, I'm simply saying that another insulin might be better for your cat. It would appear that lantus and levemir are much easier to use and have better success than prozinc (altho some do well with prozinc). This becomes even more important if you aren't testing blood glucose levels.
Any documentation you know of would help (i.e., studies that show comparison data). I would need something for my vet. "These well-informed and experienced people on an Internet forum said so" isn't likely to cut it. *I'm* not doubting you, just trying to figure out how to present it to the vet. :-D
 
There is a lot of information on Lantus, but looking just quickly there's this on tight regulation with Lantus.
http://www.ncbi.nlm.nih.gov/pubmed/19592286
Dosing protocal
http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

http://www.uq.edu.au/ccah/index.html?page=43599&pid=0

Tell your vet to research Dr. Rand's work, he or she will find a lot information on VIN. Many vets presribe Lantus. I would highly recommend a switch from Lantus, I haven't seem much from ProZinc that I like.
 
Rand also posts a protocol for those who are not doing home testing on the general diabetes page
http://www.uq.edu.au/ccah/index.html?page=41544

"Cats: Information on Use of Glargine (Lantus) and Detemir (Levemir) in Diabetic Cats with insulin dosage adjustments based on monitoring blood glucose concentration once a week (preferred) or every two weeks with serial measurements every 3-4 hours over 12 hours."Link to article. (I think they mean at the vet)
 
BRW, first let me say I totally appreciate your honesty and your feelings.
I really do.
I do want to send you a kit with everything you will ever need to test your cat if and when you feel the urge to do so.
It may never happen...and that's ok.
It may happen the minute you get the kit....and that's ok.
what you do with the numbers is your business...you can tell us or not.
It might excite you to know them.
This is not a special favor to you...it's called Newbie Kits and it's what I do.
Well actually it's what the board allows me to do by constantly contributing all the items I need.
Please take advantage of this offer.
there is a toy or two in the deal for the kitties if nothing else.
I will also throw in some pee stix just for your benefit.
Lori
and tomtom
newbie kits link below.
 
I think I would echo what the others are saying...if you won't hometest then switching to a gentler insulin like Lantus would be less dangerous, and keep the cat on a low dose. Most cats end up needing somewhere around 1u. As for his current dose of ProZinc, there's simply no way to know if it's rebound without hometesting. Too much and too little insulin look exactly the same in a fructosamine or urine strips, and a curve at the vet is going to have elevated BG.

Your mind seems to be made up already about hometesting, but you say "I'm going to have to spend less over the next six months, not more" as a reason why you don't want to take on hometesting. Spending $30 a month on testing strips is much cheaper than taking your cat to vet for regular testing. And you won't have to pay for the large emergency vet bills because the cat either hypos or has complications because its blood sugar is too high. Bandit was on insulin a year before becoming diet controlled, and my total costs for that year including vet visits, test strips, and insulin were $614 (I kept a spreadsheet to keep track of the added diabetic costs to work into my very tight budget).

I'm not trying beat a dead horse, here. It just seems that you're viewing testing as an added burden, when it actually helps relieves your burdens with a diabetic cat and makes things so much easier. You seem very stressed out, and that's the biggest advice I can give to help with that.

I would really urge you to consider posting what town or city you live in, because if there is someone here in your area (myself included), they would be happy to come show you how to test to help with that learning stress.
 
Thanks, BJ. I will talk to the vet about the insulin. He is very good at explaining why he makes the recommendations he does make, so I will ask why he chose the ProZinc and see what he says about Lantus.
 
BRW said:
Thanks, BJ. I will talk to the vet about the insulin. He is very good at explaining why he makes the recommendations he does make, so I will ask why he chose the ProZinc and see what he says about Lantus.

He may not be terribly familiar with contemporary diabetes management in felines; we have found that many vets are not.

Additionally, ProZinc is only available from the vet, so you can't shop for the best price; its whatever the vet decides to charge you (he gets to determine his markup) whereas Lantus and Levemir are available from most pharmacies.

If you decide to try Lantus, get the disposable pens and use regular 0.3 mL (30 unit) insulin syringes to draw out the insulin - that works out the cheapest. I've found single pens available from places like Sam's Club in Columbus, OH for around $47 and a 5-pack may be available from most pharmacies starting around $120. Keep in mind 1 vial or pen may last more than a month, depending on how well it is stored and what dose you use, so the upfront cost gives you sticker shock, but it is actually spread out over more than a month.
 
Hi BRW,

I'm a relative newbie to the site myself, and I also ended up here because I had a question about rebound. The short answer is that yes, you could be seeing a rebound effect due to the insulin dose being too high. It is interesting that you started seeing higher urine glucose measurements after the dose was raised and raised again. In my cat Argyle's case, the Lantus dose kept going up (slowly, 0.5 unit at a time, maintained for a couple of weeks before the next change). When we got up to 3.5 units, there was no change in her continuous drinking/peeing, but after four days, she had a really bad hypoglycemic episode (BG=24, completely limp). At the time it was totally unexpected, but when I looked back, I realized that Argyle's urine glucose data were pointing toward hypoglycemia and I just didn't know how to interpret it at the time.

As you noted, many people consider urine testing to be only a rough estimator of the cat's condition. I happen to think that there is quite a lot of valuable information there, especially if you are able to monitor him for glucose and ketones every time he pees. In Argyle's case, when we got up to 3.5 units twice a day, her urinary glucose would change significantly between the times that she peed. I was using the test strips that you sprinkle in the litterbox. I would find clumps with purple or red strips,meaning lots of glucose, and clumps with white or pale orange strips, meaning not much glucose. Right after I starting seeing these different urine glucoses, she had the hypoglycemic episode. I later read that serial changes in urine glucose concentration can be evidence of a hypoglycemic event because it indicates big changes in BG were happening over those times.

If you are monitoring urinary glucose and ketones, you are in a good position to work on finding the right dose for your cat. The motto here at FDMB, and best advice you will ever get, is "start low, go slow". Many vets seem to do the opposite, so it is really easy to get into the wrong sort of feedback loop. You could restart at a very low dose and work your way up (in 0.5 units). The only thing you would have to keep a close eye on would be the ketones. My cat ended up in the hospital a couple of times with DKA. I wasn't able to keep that up ($$$$$), but the vet helped me us the 'regular' Humulin insulin at home. This is the short-acting insulin that the hospital uses for cats in DKA. It is hard to handle ketones with the longer-acting insulins like ProZinc or Lantus. The idea is to get rid of any ketones, and then work on finding the right dose of the ProZinc. I was never able to get Argyle regulated on Lantus - there is so much variability in how long it takes to start working and it can overlap the next shot. ProZinc seemes more predictable.

It seems like you would be able to make a lot of progress toward finding the right insulin regimen using the urine tests you already do. You might have to add the shorter-acting insulin to control ketones, but you are already familiar with giving shots. You will probably feel a lot of relief when you feel like you have gotten things to a more stable place, even if you cat isn't completely under control.

As you've already found out, there are many very caring people who would love to help you reach the 'gold standard' of blood testing. You know best how much you are able to handle at a given point in your journey. My advice would be to accept the Newbie Kit so that when/if you decide to look into it, you already have the supplies and everything. You can practice on yourself! This site has so much information it can be intimidating - but everyone is caring and concerned. We've all been in that overwhelmed place - just know that we are here to help as you work your way through it at your own pace.

Wishing you and your kitty success!
Jackie
 
Status
Not open for further replies.
Back
Top