? Lantus question for Pooper's

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rbrumbaugh82

Hey guys, I'm back again asking for solutions. I joined a feline diabetes message group on Facebook and we was discussing Pooper's and ways to get his numbers down. Someone mentioned that I could be giving him too much insulin and that too much insulin can cause a cat to stay high and barely drop to healthy values. So most of you know from looking at my SS that he is getting atleast 5 units 2 times a day. I know before when I got Lantus and was starting out at 3 units that it wasn't doing much either to get his numbers down into 100s. Someone suggested that maybe I should either switch to Levemir from Lantus since others didn't have any luck with Lantus like they do with Levemir or start all over with his dosing since he could be getting too much insulin and to give it time to readjust. Lastly, while I have been giving Pooper's YAZC I just can't imagine it being a culprit to his high numbers despite it being dry food. So I did take away the dry food bowl and replaced it with an additional bowl of wet FF Turkey and Giblets. I will experiment on that to see if the dry was the problem which I'm sure it won't be. So right now the stress continues and I don't know what else to do. I know its a broken record you keep hearing me complain but I am just so determined to help Pooper's get to healthy numbers and it kills me that he stays high most of the time.
 
While I'm not familiar with the idea of too much insulin making numbers high, unless it causes crazy bouncing maybe... I do recall reading, however, that you should be extra vigilant when switching foods because a high insulin dose on dry food (not sure if YAZC counts) could become super, super high on a low carb wet food.
 
Well I wanted to add that I don't believe in reducing units or that Pooper's could be getting too much insulin. He may not be getting enough for his weight. I know that he gets bouncing of numbers each day. Some days he'll start in the 400s and then within a few hours will drop into the 200s and end up leveling off in low 200s before going right back up by evening. Other days he won't budge at all on the same dose and shot schedule. A few days given by his SS he will drop into the 100s but it doesn't last. :(
 
rbrumbaugh82 said:
Well I wanted to add that I don't believe in reducing units or that Pooper's could be getting too much insulin
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Oh good :) I wasn't sure of the concept myself but it sounded odd. I've seen and read around here about people who have given 7 units BID for their kitties before there is a breakthrough. Hang in there, I'm sure he'll get there soon. Hopefully someone more knowledgable with this can reassure you as well.

And always ask questions! At the very least, you have people like me stalking your condo to see what the answers are as well ;)
 
The information you received is correct -- too much insulin can look pretty much the same as too little. However, you've been seeing some intermittent blues with Lantus.

I'm not a big fan of telling people to switch insulin after roughly 6 weeks. That makes absolutely no sense to me.

What I'm seeing is the potential for Poopers to be a "high dose" kitty. My knee jerk suspicion is IAA -- insulin auto-antibodies. Basically, this is insulin resistance. It's almost like how an allergy develops -- you have to be exposed to the thing you're allergic to and then antibodies develop. Instead of breaking out in hives, your cat become resistant to the effect of the insulin. When you raise the dose you may see some response but then the numbers go back up. You can get your cat tested for IAA through the vet lab at Michigan State University. We typically suggest that once a cat is at 6.0u, you get labs for IAA and acromegaly run. There's info on these conditions and the link to the lab in this post.
 
my vet seems convinced that is what is happening to Oren; when i passed 6.25 I took him to vet to ask for IAA and Acro tests. She completely flipped out about his dose, me using human glucometer and said he'd been going far too low (50s-60s), and was hypo, and overdosed. I explained with citations from the Roomp-Rand protocol about systematic increases, info. on human vs. alphatrack glucometers etc. and was offered the chance to pay 42$ for her to discuss all the info. I provided. And she dropped his dose, convinced he's getting too much. 7 days into the reduction, he's as high and higher. I asked her via email this a.m, "how long do you need to prove overdose" and as yet, have not heard back. Seems a damn risky, unhealthy experiment to me. I'm limping along until a follow up to recheck after treatment of a mild pancreatitis diagnosis in a week or so, but most likely will be looking for another vet after that.

@Sienne and Gabby , (or anyone else with experience) have any knowledge/suggestions about how to know if it's overdose vs. the other conditions (w/o getting those tests)? Or how long a reduction should be held before being convinced it's not due to overdose (other than what the protocol says). I think she is freaked about the short time frame. She keeps harping on "his body needs time to adjust to the dose" , but won't say how much time that is.
 
As a person with a cat with both IAA and acromegaly, I agree with Sienne that it's time to test Poopers for high dose conditions. When kitties get to 6 units after increasing safely (holding each dose at per the dosing method or protocol and getting appropriate tests to see if he's going low), then there is a good chance the cat has one or more high dose conditions. The latest research from the Royal Veterinary College in England who is testing every cat going into their Diabetic Remission Clinic is that 24.8% of all diabetic cats have acromegaly. He does also have the look of the insulin auto-antibodies (IAA). Poopers numbers are not high and flat, he has seen some blue and even a green so is getting some downward movement in his cycles which suggests this is not too high a dose.

I am glad you increased to 6 units. If you don't see green after your next curve in a week, I'd increase again by .5U. There is a dose out there where Poopers will start getting better numbers, but if you wait too long or reduce, you may introduce glucose toxicity, meaning even more insulin will be required to get into lower numbers. If the test comes back positive for IAA, then you will have to stay on top of the increases to beat the antibodies.

If you reduce you have to test for ketones at last twice a day and you'll likely end up with much higher numbers. @Megan & Oren - like any reduction, you can tell if it's failed when the numbers start to trend upwards. You would have a pretty good idea after 4 cycles and after 6 cycles the larger depot will be gone and you can tell exactly what that dose is doing. Early last year I was worried about being overdose (after SRT changes aren't always gradual), but I only reduced for two cycles before I saw the numbers were drifting up and returned to the higher dose and in fact kept increasing to try to get regulation back.

At this point I also wouldn't suggest an insulin change, unless Poopers is starting to react to the dose of Lantus. Some kitties (not Neko) start flinching and seem to feel a sting at the higher doses. We've had kitties on much higher doses of Lantus.
 
"Even a small overdose can trigger a rebound effect (A typical case is increasing bidaily dosage from 1 unit to 2, passing a correct dose of 1.5 units.)"

this quote from Wikipedia page on feline diabetes (this line not specifically sourced, but the Tight regulation protocol and even felinediabetes.com are cited on this page) in the section discussing too high a dose causing higher BG.
I bring it up just because it makes me wonder if I went off the rails all the way back at the beginning, because my first vet did exactly that. Started him immediately at 1 unit, then increased from 1 to 2 units after just about 10 days. Perhaps he started too high and then zoomed past the proper dose right away? Hindsight is 20/20, but have i been fighting 'chronic overdose' since then, thinking it's something else? Short of getting those IAA/Acro tests, is it ever done to just try and start all over? I'm grasping at straws here, but just need some perspective? After that first dose increase it was still a few weeks before i learned to home test and tried to get going on the TR.
 
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Perhaps your vet increased too rapidly. You can start over (which I wouldn't recommend at this point) which, if Pooper's is indeed a high dose cat is a total waste of time and way to hard on your cat's body. Ultimately, if the dose is too high, the numbers will break. However, if what we're seeing is IAA, you could have the same result.

@Megan & Oren
The info from Pet Wiki was written by a member of FDMB. I don't always agree with what he has to say. I'd suggest looking at the date of the posting. I don't think anything there has been updates in quite some time.
 
Wendy&Neko said:
As a person with a cat with both IAA and acromegaly, I agree with Sienne that it's time to test Poopers for high dose conditions. When kitties get to 6 units after increasing safely (holding each dose at per the dosing method or protocol and getting appropriate tests to see if he's going low), then there is a good chance the cat has one or more high dose conditions. The latest research from the Royal Veterinary College in England who is testing every cat going into their Diabetic Remission Clinic is that 24.8% of all diabetic cats have acromegaly. He does also have the look of the insulin auto-antibodies (IAA). Poopers numbers are not high and flat, he has seen some blue and even a green so is getting some downward movement in his cycles which suggests this is not too high a dose.

I am glad you increased to 6 units. If you don't see green after your next curve in a week, I'd increase again by .5U. There is a dose out there where Poopers will start getting better numbers, but if you wait too long or reduce, you may introduce glucose toxicity, meaning even more insulin will be required to get into lower numbers. If the test comes back positive for IAA, then you will have to stay on top of the increases to beat the antibodies.

If you reduce you have to test for ketones at last twice a day and you'll likely end up with much higher numbers. @Megan & Oren - like any reduction, you can tell if it's failed when the numbers start to trend upwards. You would have a pretty good idea after 4 cycles and after 6 cycles the larger depot will be gone and you can tell exactly what that dose is doing. Early last year I was worried about being overdose (after SRT changes aren't always gradual), but I only reduced for two cycles before I saw the numbers were drifting up and returned to the higher dose and in fact kept increasing to try to get regulation back.

At this point I also wouldn't suggest an insulin change, unless Poopers is starting to react to the dose of Lantus. Some kitties (not Neko) start flinching and seem to feel a sting at the higher doses. We've had kitties on much higher doses of Lantus.
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Yes Pooper's flinches and stuff with the higher dose.
 
If Pooper is flinching from the acidity of the Lantus, then you might consider switching to Lev when you run out of Lantus and need more insulin. Personally, I'd finish up the Lantus first, but it's up to you.

If you get him tested for acro/iaa then you'll know for certain if he is a high dose kitty or not. I suspect he is as well.
 
Well unfortunately I don't have the funds to order these tests in addition to what the Vet would charge for their fees. Given that he has had to have increased insulin to me and struggling with insulin intake I would think he has some form of insulin resistance. I just hate the idea of changing insulins again because what makes me think Levemir is going to work any different then N, Lantus and a more cat suitable insulin of BCP Bovine? I acknowledge that every cat is different and what is working for most cats on here isn't working for mine.
 
If Pooper is insulin resistant, you'll find the same response regardless of the insulin. It's a matter of increasing the dose until you break through the antibodies.

The value of Lev if Pooper is flicking is that it isn't acidic the way Lantus is. You don't have to change insulin.
 
I am believing he is insulin resistant to a certain extent but he does get some breakthroughs here and there that allow him to dip into the blue numbers.
 
I had someone else mention Levemir and even a pharmacist suggested it when I was talking to them about Lantus and the usefulness of it.
 
I'm not suggesting that you switch to Lev. The benefit would be that it doesn't sting. Also, like human medications, some meds work better for some cats. Another thing with Lev is that your starting dose would be around 70% of your Lantus dose.

For example, Cobb was at 31u of Lantus when we switched to Lev. We switched, not because of the sting, but because he had been on Lantus for a full 6 months and wasn't showing much progress. I felt his resistance was to the Lantus specifically. And I had a vet that was willing to try Lev instead.

We started him at 21 or 22u. Coincidence perhaps, but that is when his dose started shrinking. His IAA may have broken around the same time.

We saw other changes with the switch as well...behavior changes, no peeing outside of the litter box, no more matted coat. He just did better on Lev than on Lantus.

So yes, what works for one cat might not work for another. But there are only so many insulins out there. I would give the Lantus a little more time to work, unless you really feel like it is hurting Poopers when he gets his shot.

I think the breakthroughs you are seeing are classic signs of IAA. The dose is good, until the antibodies grab hold and renders that dose ineffective.

For what it is worth, Cobb was on Prozinc, then Lantus and then Levemir. We finally found an insulin that worked.

I would ask the vet if they would just charge what Michigan State charges for the tests. There's no real reason for them to mark the tests up. Maybe charge for the blood draw and visit, but that's really it.
 
I will have to consider that insulin. I seen cost about the same as Lantus
 
spend the money on the test.... as I recall, it's not that expensive.
If you find out he has a high dose condition, you won't need to switch insulins , especially when you can't afford it.
 
The amount a person ends up paying really varies, depending on the vet. In addition to the test cost charged by MSU, you have to pay to mail it and for a blood draw. Some vets will double those amounts for the total. Some will charge exactly what the costs are and nothing extra. I've seen people get the comment from the vet that the extra is for "interpreting" the results. There is no interpretation needed - but the results will go to the vet, not to you. We can help you move ahead with the results.

Ask in advance so you aren't shocked.
 
Lurking here as I may be in the same boat at some point. I too fear the diagnosis , as I couldn't afford the SRT treatment either. And 41 units of insulin? Or more? That's not going to be cheap either if it's the only option. IAA seems temporary, at some pt it breaks and hopefully dose needs go down, but untreated acro? Not very encouraging at all.:(
 
Not all acro cats need those kind of high doses. Toby likely has acro and he is in the teens. Tommy's highest dose was less than 20u and most of the time he was 10ish, i believe.

You don't need to anticipate that happening, @Megan & Oren.
 
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