New diabetic too sensitive to Lantus and PZI

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Lisamstephan

Member Since 2012
Hello. My 14 year old soul kitty was diagnosed with diabetes in June. When he was initially diagnosed he was on steroids and we weaned him off of them once we realized he was a diabetic. I am wondering if anyone else has had an issue with a kitty who is too sensitive to insulin? My guy is now on a low carb and low fat diet and off steroids. He is still diabetic (not a full honeymooner). He is lingering in the mid to high 200s blood glucose. Some days ge is showing clinical signs, some days he is not. Here is the issue, although he is in the mid to high 200s, if he has even 1/2 unit of Lantus or PZI, he drops into hypo range (below 50) within 4 hrs then shoots high (somogyi effect). I cannot give him less than 1/2 unit and I am reluctant to try a third insulin as he has been hospitalized twice in two months because of the insulin sensitivity. How do you treat a diabetic without insulin? He has only been on this current low carb, low fat diet for a week and a half. Any thoughts?

Lisa and Snuggy
 
Hi Lisa,

Please let us know which insulin you've been using most recently, and if you still have some of both Lantus and Prozinc.

Many, many people here routinely shoot doses lower than .5u, and we can definitely help you understand how to do that. Some cats need literally drops of insulin to get from where you are at to where you want to be. That could do the trick for Snuggy.

Carl
 
He was on Lantus for six weeks. We didn't catch the somogyi effect at first and kept upping his dose.NC State did not lile how he was responding to Lantus and suggested we try PZI. I tried 1/2 unit one time and he was hypo...

How do you measure less than 1/2 unit?
 
Jake was also very sensitive to insulin. When (the old) PZI sent him into hypo with subsequent Somogyi effect with only 1/2U we switched to Lantus. He reacted to Lantus the same way. I don't know how most handle this, but I was down to 1/4 units or less and not even every day. He became regulated and started into his 14 days trial remission all in one week. His last insulin was April 29, 2010 two days before his 18th birthday. Today he is 20+.

Judy
 
Lisa,
Some questions...
You said he's been hospitalized 2x for insulin sensitivity. Were those clinical hypo episodes?
What meter are you using?
When he went lower than 50 on the pzi, do you know what the preshot numbers were?
Have the sub-50 numbers happened since the diet change and removal of steroids? Or did you see them both before and after?
When you refer to somogyi, are you just talking about bouncing due to low numbers, or are the numbers staying that high for several cycles? How high did he go after the lows?

Carl
 
You can give less than .5U of insulin. You need to measure the insulin in drops. Here's how:

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

You also want to test before each and every shot and you will get to a point where that value will mean you give a shot or it's too low to give the shot, so you skip the shot. How to determine that value is done through checking mid cycle to see how low the dose takes him from the particular preshot value, that level is called the peak or nadir. 50 is the minimum you want for nadir so he doesn't get in to trouble. A preshot value at 150 is probably where you would want to closely monitor during the cycle after you give the shot. Below 150, you might skip the shot and see how long it takes for him to get to a shootable level, say over 200. The key is making that period longer and longer until he can eventually hold his own below 150 without insulin.

With the drop method, you might try .1U and see what reaction he has. I highly recommend Lantus, not ProZinc for this method. Lantus has a better remission rate.
 
Lisamstephan said:
The PZI I have was actually formulated for the U-100 syringes already...yes, I am sure
:)
Click to expand...

Do you have half unit marked U100 insulin syringes? If not, you'll need to get some so you can measure less than 0.5 units. Wal Mart's Relion brand of insulin syringes are available with half unit markings. There are other brands with half unit marked insulin syringes, like Monoject and BD. Many people buy their insulin syringes online at AmericanDiabetesWholesale.com, except for the Relion brand which is sold only at Wal Mart stores.

Here are some close up pictures of how to micro-dose: http://steverapaport.com/jock/SyringeFineGradations/
 
Many cats need microdosing (less than .5u of insulin) to fully reach remission. It sounds to me like he's on the verge. :smile:

Do you have u-100 syringes with half unit markings? These are very important in measure doses less than .5u.

Also, what food are you feeding? Do you know the percentage of carbs? If it's in the higher range (8-10%), you might be able to get his BG down by switching to something less than 8%.
 
You also might see positive results by adjusting meal times. What is your feeding schedule? Do you feed multiple small meals throughout the day/night?

Carl
 
Sorry I didn't respond promptly. I have a baby and a young child with significant special needs and sometimes I have trouble getting to a computer! I do have 1/2 unit marking syringes. I have attempted to give Snuggy 1/4 unit doses when he has tested high the last two days. I do not feel super confident about consistency yet. A friend who is a vet said maybe I could get pediatric U-100 syringes. Anyone try those?

Snuggy also had chronic pancreatitis. An acute flare is why he was in the hospital this last time when they noticed the somogyi effect because they monitored glucose every 2 hrs for 4 days. I am doing a low fat (for the pancreatitis) and low carb for the diabetes. He gets hills m/d, fancy feast elegant med shredded tuna and shredded chicken. His carbs are around 11%. I had him lower on carbs but that made the fat higher and caused the pancreatitis flare.

I have to move him 180 miles to our new home in two weeks. I am terrified he is going to have a set back from stress!
 
Is your cat on any meds for the pancreatitis?

Here's an old post with info on treating diabetic cats with pancreatitis:


****CHRONIC PANCREATITIS****
(or does my cat have a pepcid deficiency?)

things are going great. diabetic fluffy is nicely regulated. and then one day...just seems "off". BG numbers are higher. not eating much. maybe vomits later that night. hunched up in the 'meatloaf' position. lethargic. what is going on? you listen to the freely dispensed pepcid advice off board and after a couple of days fluffy seems to snap out of it. pepcid rocks! and recommend it to the next person on board that posts about their diabetic cat being "off".
however a few weeks/months later fluffy goes through the same episode. and again. and again. some of the episodes are worse than others. that last attack was bad and you got scared and fluffy was hauled off to vet for some basic blood work. yet nothing really abnormal on the results. is this just a normal part of being a diabetic cat? does your cat have a basic pepcid deficiency??? no.

it is estimated that <b>AT LEAST 40% of all diabetic cats</b> have what is known as Chronic Pancreatitis (CP). makes sense, the pancreas is the weak link with diabetics, in fact CP could be the causative factor on why fluffy became diabetic in the first place. simply put the pancreas has 2 types of basic functions~ the production of metabolic hormones (like the one everyone knows about, insulin) and the production of digestive enzymes. with pancreatitis it is the production of those digestive enzymes that is out of whack. when the pancreas 'misfires' and activates those digestive enzymes too early, the pancreas actually starts to digest itself and then the surrounding tissue and nearby organs, and systemic inflammation and toxin production ensues. there is a close link between CP with IBD and Cholangiohepatitis, (all three together collectively known as Triaditis).
so what now?

the best diagnostic test available is the fPLI (feline pancreatic lipase immunoreactivity ) http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml not perfect but far better than the options we had in the recent past.
it is far better to have a diagnosis (always) because then you and your vet can form a plan better than just pepcid. SQ fluids and pain management top the list. CP flare ups ARE painful...look carefully at how your cat is acting, it is not easy to tell when a cat is in pain, they hide it well. it is not just nausea that is keeping fluffy hunkered down under the chair, it is pain.
possible tools your vet might have you use:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category)
~appitite stimulant (new med called mirtazapine (remeron) works well for cats)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed

can all be used to help the cat through the flare up. your vet can work up a treatment plan for managing your cat's CP flare up attacks.

the veterinary community is still undecided on the issue of fat content of food and whether or not it is something to be considered in feline CP. it is very much an issue in human or canine CP, however felines are very unique in how they utilize the fats (and protein) in their diets. anecdotally, some owners find that lowering the fat content (to about 35% or less) of their CP diabetic cat's diet even though it means they have to raise the carbs helps. ECID, you would have to experiment on that yourself. just a reminder on the topic of food..as a CP flare up begins cats will eat less in the days leading up to it and often not eat at all when the attack is in full force, know that it does not take many days of reduced calorie intake to make hepatic lipadosis possibly rear its ugly head, especially in a liver already compromised.

cats that are simply diabetic with no other condition going on should not need pepcid ever...if you are reaching for the pepcid again, maybe reach for the phone and call your vet instead and discuss the possibility that your diabetic cat might be one in that 40%.

links for those that wish to read about CP further:

http://books.google.com/books?id=to...onepage&q=feline chronic pancreatitis&f=false

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6623&Category=1004&O=Generic

here's a CP treatment update from Indexx: http://www.idexx.com/pubwebresource...pec-fpl-treatment-for-feline-pancreatitis.pdf
 
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