I am new to this board. I have a cat that was diagnosed as diabetic in December. Despite starting him on insulin (Lantus), we have not seen his BG come down. Accordingly he has continued to loose weight, crave water, and urinate constantly. The vet has us measuring his BG prior to food and his morning shot. He was started on .5u twice daily and is now up to 5u twice daily and there is absolutely no change in his numbers they still are in the 225-285 range. He is obviously not feeling well i.e. more lethargic, more vocal (in a pitiful way) than normal. The vet ran blood work though and said everything else looked okay. She did put him on an antibiotic just in case there was an infection. The vet is begining to be concerned that he might have insulin resistance, but wants to keep increasing his dose every two weeks if we don't see a change until he's up to like 7.5 u twice a day. My vet hasn't mentioned the possibility of a rebound issue, but from what I've read here and on a few other websites I think it might be more likely a rebound issue instead of resistance. I just think its odd that his BG would be the same at .5u twice a day that it is at 5u twice a day. My vet is nice, and I'm in contact with her weekly, but I'm getting frustrated because it doesn't seem that anything is helping. Perhaps I'm not asking the right questions or being patient enough, just don't like to see my cat suffering. Any advice or suggestions would be appreciated it. Thanks, Carissa
New to board - question about rebound vs resistance
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Kelly & Oscar
Very Active Member
First question - How often was the dose raised and by how much each time?
Second - what food are you feeding him and is there any possibility he could get into something he shouldn't?
It isn't out of the question that your baby may have insulin resistance or acro, but other factors need to be ruled out first.
Second - what food are you feeding him and is there any possibility he could get into something he shouldn't?
It isn't out of the question that your baby may have insulin resistance or acro, but other factors need to be ruled out first.
Food is important, you need to be feeding low carb wet food. Please advise what food you are feeding and how much. There are some cats who are diet controlled once their diet is adjusted.
A list of good low carb foods:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
Health issues including teeth need to be addressed. Please ensure that a dental is not needed as a bad tooth can make a big difference.
With Lantus, dosing is best based on nadir, the lowest point in cycle. Info on Lantus:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Home testing is important to track your cat's BG numbers. Without knowing what's happening in the hours between shots makes it pretty much impossible to say what is going on.
If you can set up a spreadsheet, you can track the BG from testing and others can help you understand if you have too high of a dose or a possible insulin resistance issue.
A list of good low carb foods:
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
Health issues including teeth need to be addressed. Please ensure that a dental is not needed as a bad tooth can make a big difference.
With Lantus, dosing is best based on nadir, the lowest point in cycle. Info on Lantus:
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers
Home testing is important to track your cat's BG numbers. Without knowing what's happening in the hours between shots makes it pretty much impossible to say what is going on.
If you can set up a spreadsheet, you can track the BG from testing and others can help you understand if you have too high of a dose or a possible insulin resistance issue.
Julia & Bandit (GA)
Very Active Member
From what I understand, you're only testing once a day before his morning shot? It's possible that you might have skipped over his ideal dose. Lantus is dosed not by the pre-shot test, but by the nadir (6 hours after the shot is given, when the insulin peaks).
It is possible that he might have a condition making him resistant to insulin, but more often it's because the dose is too high. Would it be possible for you to do some more testing at home? At the very least, you should be testing before both shots, and at the nadir, but you will be able to make better decisions if you collect some more numbers on top of those.
It is possible that he might have a condition making him resistant to insulin, but more often it's because the dose is too high. Would it be possible for you to do some more testing at home? At the very least, you should be testing before both shots, and at the nadir, but you will be able to make better decisions if you collect some more numbers on top of those.
Thanks for all of the quick replies.
One quick note I should have put on my original post is my cat has asthma and is on steroids for it (has been for 6 years)
Insulin Dose:
His dose has been increased in .5 to 1u increments about every two weeks (sometimes 1 week, sometimes longer than 2 weeks). If no improvement in another 2 weeks vet wants us to call back and will increase to 6u twice a day. Its been over a 4 month period so far overall.
Food:
He was on 1/4 cup twice a day of of EVO weight management food. I know that is low but it was under vet's guidance to curb a problem with continually gaining weight (was almost 20lbs at one point). He's a big cat though and vet says his weight should be around 16-17 lbs. Due to his current weight loss (he's under 15 lbs and dropping), vet has us doubling his food to 1/2 cut twice a day (he never eats all that though), and mixing the regular EVO dry which is very low carb but high cal, with the weight management. Eventually we were going to go just to the regular EVO if the weight keeps dropping. He has no interest in wet food.
BG measuring:
I was just following what the vet said, but thanks to some of the stuff I've read now realize more frequent checking is required more than just pre morning shot (and I need to do more reading). Vet never mentioned this, just said check before morning shot. Of course I had to suggest the idea of home testing to the vet in the first place. Testing before both shots is doable. However, testing 6hrs after shot is going to be difficult as I work during the day (except weekends), but I could set an alarm and do it in the middle of the night I guess. Do you need to check 6hrs after every day or just to get an initial curve?
Other Health:
The vet recently did bloodwork/urine sample, said it looked good other than signs of diabetes. Since he was acting so oddly though, she did however put on antibiotics just in case of infection.
In response to the reply on dental health, the vet said his teeth looked okay. He can't have a dental cleaning (very serious adverse reaction to anesthia).
He was on Lantus briefly (less than a month) in Dec 2009 after an immune reaction, requiring massive doses of steriods, caused his glucose to get really out of whack. In less than a month (max dose 1u twice per day and then tappered down), his BG was back to normal. We continued daily BG testing for 2 months, then weekly testing for a month, then monthly spot checking. After 6 months though of normal we stopped testing. This past November we notice excessive drinking/urnination and realized he had lost weight (2lbs), so we called the vet and started checking again. His BG was reading in the 225-285 range (one 300 reading) before we started him in insulin. Now at 5u twice a day he is having the same readings as before we started insulin.
I'm in contact with the vet every week, but she just says to be patient. So my question is what do immediately, should I call the vet about dropping the dose, or do the testing and wait and see. Would hate to think this is a rebound issue and I am causing my cat to feel so bad by giving him these high insulin doses.
One quick note I should have put on my original post is my cat has asthma and is on steroids for it (has been for 6 years)
Insulin Dose:
His dose has been increased in .5 to 1u increments about every two weeks (sometimes 1 week, sometimes longer than 2 weeks). If no improvement in another 2 weeks vet wants us to call back and will increase to 6u twice a day. Its been over a 4 month period so far overall.
Food:
He was on 1/4 cup twice a day of of EVO weight management food. I know that is low but it was under vet's guidance to curb a problem with continually gaining weight (was almost 20lbs at one point). He's a big cat though and vet says his weight should be around 16-17 lbs. Due to his current weight loss (he's under 15 lbs and dropping), vet has us doubling his food to 1/2 cut twice a day (he never eats all that though), and mixing the regular EVO dry which is very low carb but high cal, with the weight management. Eventually we were going to go just to the regular EVO if the weight keeps dropping. He has no interest in wet food.
BG measuring:
I was just following what the vet said, but thanks to some of the stuff I've read now realize more frequent checking is required more than just pre morning shot (and I need to do more reading). Vet never mentioned this, just said check before morning shot. Of course I had to suggest the idea of home testing to the vet in the first place. Testing before both shots is doable. However, testing 6hrs after shot is going to be difficult as I work during the day (except weekends), but I could set an alarm and do it in the middle of the night I guess. Do you need to check 6hrs after every day or just to get an initial curve?
Other Health:
The vet recently did bloodwork/urine sample, said it looked good other than signs of diabetes. Since he was acting so oddly though, she did however put on antibiotics just in case of infection.
In response to the reply on dental health, the vet said his teeth looked okay. He can't have a dental cleaning (very serious adverse reaction to anesthia).
He was on Lantus briefly (less than a month) in Dec 2009 after an immune reaction, requiring massive doses of steriods, caused his glucose to get really out of whack. In less than a month (max dose 1u twice per day and then tappered down), his BG was back to normal. We continued daily BG testing for 2 months, then weekly testing for a month, then monthly spot checking. After 6 months though of normal we stopped testing. This past November we notice excessive drinking/urnination and realized he had lost weight (2lbs), so we called the vet and started checking again. His BG was reading in the 225-285 range (one 300 reading) before we started him in insulin. Now at 5u twice a day he is having the same readings as before we started insulin.
I'm in contact with the vet every week, but she just says to be patient. So my question is what do immediately, should I call the vet about dropping the dose, or do the testing and wait and see. Would hate to think this is a rebound issue and I am causing my cat to feel so bad by giving him these high insulin doses.
BJM
Very Active Member
You mentioned he was gaining weight at one point. Does he seem to have a large build - large feet, head, skeleton?
And since he doesn't do well with anesthesia, you may want to start doing home dental care with a pet safe toothbrush and paste to prevent buildup and infection.
And since he doesn't do well with anesthesia, you may want to start doing home dental care with a pet safe toothbrush and paste to prevent buildup and infection.
Julia & Bandit (GA)
Very Active Member
My guess is that the dry food is keeping his BG high.There isn't a dry food that is low carb enough for a diabetic cat. Weight Loss dry foods are the worst because because of the very high grain content. Here's a helpful link transitioning your cat to wet food: http://catinfo.org/#Transitioning_Dry_F ... nned_Food_
It's also possible that in one of the 1u dose increases the right dose was skipped over. It's recommended that dose is increased by only .25u to .5u at a time. Here's a link to the Lantus dosing protocol that we use: viewtopic.php?f=9&t=1581
Sometimes it's just a matter of finding the right food to get a cat off the dry. One highly palatable low carb wet food that I've seen cats transition on that wouldn't eat any other kind is Merrick's Cowboy Cookout. You can also try tricks like adding tuna juice to the food, or fortiflora. Will your cat eat anything other than dry cat food? (Turkey, Chicken, Tuna, etc.)
This is very important, though...when transitioning a diabetic cat to wet food, their blood sugar levels are likely to drop dramatically. This can mean that their dose of insulin can suddenly be too much and send them into a hypoglycemic episode. Do not switch diets without first lowering insulin.
I know it seems like a lot of work at first to get all those numbers, but pretty soon it gets to be routine. I work two jobs and I'm in grad school, so I had very busy days. Here's when I tested during the week: AM Pre-shot, (Then I'm at work all day), PM Pre-shot, 4 hours after the PM shot and 6 hours after the PM shot. I would set an alarm for the latest shot and go right back to bed. On the weekends when I was home all day I would do a curve, which is testing every 2 hours from one shot to the next. This way you have enough data to figure out what your cat's dose should be.
It's also possible that in one of the 1u dose increases the right dose was skipped over. It's recommended that dose is increased by only .25u to .5u at a time. Here's a link to the Lantus dosing protocol that we use: viewtopic.php?f=9&t=1581
Sometimes it's just a matter of finding the right food to get a cat off the dry. One highly palatable low carb wet food that I've seen cats transition on that wouldn't eat any other kind is Merrick's Cowboy Cookout. You can also try tricks like adding tuna juice to the food, or fortiflora. Will your cat eat anything other than dry cat food? (Turkey, Chicken, Tuna, etc.)
This is very important, though...when transitioning a diabetic cat to wet food, their blood sugar levels are likely to drop dramatically. This can mean that their dose of insulin can suddenly be too much and send them into a hypoglycemic episode. Do not switch diets without first lowering insulin.
I know it seems like a lot of work at first to get all those numbers, but pretty soon it gets to be routine. I work two jobs and I'm in grad school, so I had very busy days. Here's when I tested during the week: AM Pre-shot, (Then I'm at work all day), PM Pre-shot, 4 hours after the PM shot and 6 hours after the PM shot. I would set an alarm for the latest shot and go right back to bed. On the weekends when I was home all day I would do a curve, which is testing every 2 hours from one shot to the next. This way you have enough data to figure out what your cat's dose should be.
Carissa,
One of my fosters, Ivan, came from a shelter who had him on 6 unit of Lantus twice a day. He was free feeding dry food. We picked him up on a Saturday afternoon about 3 pm. His head was in a big bowl of dry food just before we left the shelter.
That night, the woman who picked him up for me presented him a bowl of wet canned food. He sniffed and walked away. She did not give his Lantus shot that evening. Good thing, because his morning BG was 106. He hasn't had any insulin since that Sunday morning last summer.
He was extremely difficult to switch to canned food once he got to my house. He's a very long, lean active cat and needed more food than he was willing to eat. Finally, he has adjusted to wet food (Cowboy Cookout and Friskies). He gets 1/2 a can of each twice a day. He doesn't think it is enough, but he looks good and the vet said he's healthy.
To tell you how much he wants dry food, I'll share a funny story. I recently contacted an Animal Communicator and wanted to know why he insists on leading with his right paw when interacting with my other cats. There was discussion of rehoming this foster. He said he would prefer to stay with me. If he has to move, he wants a home that will feed him dry food. Guess I have a permanent cat.
So, you can switch your guy to wet food. Do it gradually, test as often as you can, and you will be rewarded with a regulated cat who feels and looks good. Patience and as we remind everyone - Breathe, breathe.
Good luck,
Claudia
One of my fosters, Ivan, came from a shelter who had him on 6 unit of Lantus twice a day. He was free feeding dry food. We picked him up on a Saturday afternoon about 3 pm. His head was in a big bowl of dry food just before we left the shelter.
That night, the woman who picked him up for me presented him a bowl of wet canned food. He sniffed and walked away. She did not give his Lantus shot that evening. Good thing, because his morning BG was 106. He hasn't had any insulin since that Sunday morning last summer.
He was extremely difficult to switch to canned food once he got to my house. He's a very long, lean active cat and needed more food than he was willing to eat. Finally, he has adjusted to wet food (Cowboy Cookout and Friskies). He gets 1/2 a can of each twice a day. He doesn't think it is enough, but he looks good and the vet said he's healthy.
To tell you how much he wants dry food, I'll share a funny story. I recently contacted an Animal Communicator and wanted to know why he insists on leading with his right paw when interacting with my other cats. There was discussion of rehoming this foster. He said he would prefer to stay with me. If he has to move, he wants a home that will feed him dry food. Guess I have a permanent cat.
So, you can switch your guy to wet food. Do it gradually, test as often as you can, and you will be rewarded with a regulated cat who feels and looks good. Patience and as we remind everyone - Breathe, breathe.
Good luck,
Claudia
There have been several cats turn out to be diet controlled - take away their dry food ( I call it kitty crack ) and they have no need for insulin. I bet if you had a choice, you would switch over to a wet low carb food, and not need insulin or need a very small dose.
There was once a cat on the board who was getting something like 20u of insulin BID. After they switched from dry foods to wet, that cat's insulin need dropped like a stone to something like 1u. You need to be very careful with the food transition, so it's very important to be home testing. There are a few test times that are vital: a test before each shot, and a before-bed test. many cats drop low at nite so it's good to test just before you are heading to bed.
Many people work and are away from home, so they can't test, but on weekends and evenings, more testing can be done.
There was once a cat on the board who was getting something like 20u of insulin BID. After they switched from dry foods to wet, that cat's insulin need dropped like a stone to something like 1u. You need to be very careful with the food transition, so it's very important to be home testing. There are a few test times that are vital: a test before each shot, and a before-bed test. many cats drop low at nite so it's good to test just before you are heading to bed.
Many people work and are away from home, so they can't test, but on weekends and evenings, more testing can be done.
Larry and Kitties
Very Active Member
What kind of steroid is your cat on, what is the dose and frequency? Steroids tend to increase insulin needs.
For the first question, it's a possible sign of acromegaly. Not all acros have these signs, and there are others, such as weight gain and pot belly.
I have two acros; one is quite large and looks the part, but the other had no visible signs before, but does have a pot belly and has gained weight since dx.
I have two acros; one is quite large and looks the part, but the other had no visible signs before, but does have a pot belly and has gained weight since dx.
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