No nadir with Lantus: should we try Caninsulin again?

[Dasha and Kabosu]

Hi all,

Kabosu's BG has been flat and high for a while now.

I remember when he was back on just 2 units of Caninsulin (and dry food!) I was seeing numbers below 300 in the middle of the day quite consistently. Now, on 7.5 units of Lantus he is usually around 400 all the time.
I understand that Lantus is a much much better insulin than Caninsulin, and it is just that Kabosu probably has another serious condition that causes his insulin resistance to get worse and worse, but I just keep wondering: what if I try giving him Caninsulin again? What if Lantus is just not OK for him?

Has anyone tried switching back to Caninsulin? Or maybe combining the two?

I know this sounds crazy but I just don't know what to do anymore...

Thank you!

 

[tiffmaxee]

Looks like you haven’t hit a breakthrough dose yet. Has he been tested for IAA and Acro?

 

[Dasha and Kabosu]

Has he been tested for IAA and Acro?

No, our vet suggested we should first test him for EPI (exocrine pancreatic insufficiency), which is more common, and cheaper to test. We are hoping to get that test next week.

 

[Wendy&Neko]

o, our vet suggested we should first test him for EPI (exocrine pancreatic insufficiency), which is more common, and cheaper to test.

Umm, one in four diabetic cats in the UK has acromegaly. It think that's waaaaay more common than EPI. I've only seen a small hand full of EPI kitties on my time on the board. I think testing for EPI is a waste of your money - unless his poo is runny/semi formed, stinky and yellow/tan coloured. His dose and flatness tells me he just needs more insulin and is a good candidate for testing for acromegaly. Many vets are unfortunately really lacking knowledge of acromegaly. I had to practically beg my vet to get the test done, finally had to ask her to humour me.

And no, do not switch back to Caninsulin. He might benefit from a switch to Levemir instead. Lantus has an acid base that can sting at higher doses. The nature of conditions that cause insulin resistance (like acromegaly, insulin auto anti bodies), is that the resistance can grow and increasingly more insulin is needed. Though you do eventually get to a dose that gives them better numbers.

Here is the link to your last post here, for continuity.

 

[FrostD]

I wouldn't switch back. His BG on Caninsulin still wasn't good, needed to go much lower. Looks like glucose toxicity over time, so like Elise said you're chasing a breakthrough dose.

But given the way Caninsulin works, he'd be dropping very hard and very fast at these high doses...so really something like Lantus or Levemir is better. Caninsulin tends to sting above 5U, beyond which many people move to ProZinc.

Look at my sheet last year - we had good numbers on Caninsulin, until we didn't. After too much messing around Im just now starting to see some movement in BG, so I'm hoping for a breakthrough dose somewhere between 5U to 7U.

I think you just have to be patient and keep going, and get the tests for IAA/acro.

 

[Dasha and Kabosu]

Umm, one in four diabetic cats in the UK has acromegaly. It think that's waaaaay more common than EPI.

I understand... My vet consulted with an internal medicine vet specialist though, and both of them decided EPI is more likely. I believe it is because Kabosu's stools are indeed pale and soft and his pancreatitis test came back positive several times. He has had a few episodes of inappetence, but mostly he has extreme polyphagia instead.
Basically, they believe there is definitely something wrong with his pancreas, once this is somewhat sorted, we'll look into acro tests.

Also, I've been told that acro treatments are all extremely expensive, and even the IGF1 test is almost 400 euros (that's a lot, the ultrasounds costed below 200)! They believe that there may be no point in doing the test if we can't afford the treatment.

 

[Wendy&Neko]

It's also possible he has both. Your vet is quoting too high a price for IGF-1. From this page, this is what it costs at Royal Vet Clinic:

• Diabetic Cat Profile - ‘limited’
  - includes: fructosamine, IGF-1 £105.00 + VA

 

[Dasha and Kabosu]

From this page, this is what it costs at Royal Vet Clinic:

• Diabetic Cat Profile - ‘limited’
  - includes: fructosamine, IGF-1 £105.00 + VA

Oh, this would be amazing! Unfortunately vet prices in Ireland are MUCH higher than in UK. My neighbours who have had dozens of cats told me they sometimes would drive to Northern Ireland (which is part of UK) to get a vet treatment there, because it was cheaper that way, even with many hours of driving! We can't do it now though (Brexit and lockdown).

 

[Dasha and Kabosu]

It's also possible he has both.

Yeah, my gut feeling is that he has acro :/ and something else as well...

 

[Wendy&Neko]

There are 3 test packages you can get from RVC that include IGF-1, I quoted the cheapest. Your cost should include the RVC test cost, the cost to take bloodwork, the cost for the vet to mail the serum to London, and any profit. Even factoring in the cost to convert to pounds, that's one heck of a profit if charging over 400. There are two places in the world that do the test. I am on the west coast of Canada, so thousands of miles away from Michigan which is the other place that does this cost. It also means I had a decent shipping cost but total not near what your vet is charging. Maybe you can mention you've seen the test cost on the RVC website. Unfortunately Michigan State University is the only places that tests for IAA (insulin auto antibodies), so you won't be getting that test done.w

I do agree that if he does have EPI, it would be good to know that and have it treated. Poor boy.

 

[Dasha and Kabosu]

There are 3 test packages you can get from RVC that include IGF-1, I quoted the cheapest. Your cost should include the RVC test cost, the cost to take bloodwork, the cost for the vet to mail the serum to London, and any profit.

I believe sending anything to UK is very problematic due to recent Brexit... Also, we're in complete lockdown which complicates the things really badly. I will ask my vet though! She called the lab here, and the price was 350 euros if I remember correctly, for just IGF-1 and nothing else.

Poor boy.

My heart breaks every day... The only good thing is that he does not seem too sick despite his BG being in 400s, he jumps a lot (to steal food) and he even brought a mouse home yesterday... Although he still sleeps on the bathroom floor.

 

[Wendy&Neko]

I believe sending anything to UK is very problematic due to recent Brexit

Mail/courier should still work. In Canada we still send and receive packages from the US even though the border is closed to all but essential travel. The quote I gave you was direct from the RVC diagnostic labs page. They do have higher costs tests that include IGF-1, blood work and urinalysis, which you don't need.