Peeka insulin resistant

[Peter (Boo) (Peeka GA)]

Hey everyone,

There may be some who remember us and our journey with Peeka and our other diabetic cat Boo. A lot of changes since the last update, but the major one I’m needing help with is Peeka and her recent insulin resistance. I would check before shooting and a few hours based on the nadir and around Christmas time we noticed her going back to her water bowl more frequently. We’re currently up to 9u or Prozinc now and not entirely sure how to proceed here. Neuropathy is still an issue with her, though there have been some major improvements.

Any and all feedback would be appreciated.

https://docs.google.com/spreadsheets/d/1KG7ASFTbbdngRwiHbQwlgy-d4z-soLuiJ5tTsMiJCgs/edit

There is the most recent spreadsheet since I went back to recording numbers again.

 

[FrostD]

Welcome back!

Have you had her tested for IAA and acromegaly? Thyroid recently? IAA is antibodies attacking the insulin and causing resistance; there's no treatment, just adjusting insulin as needed and waiting for it to resolve (usually within a year). It helps to know the diagnosis because the insulin needs can crash when the IAA resolves, so rapid/large reductions. Acro is a pituitary tumor, the hormone it secretes blocks the insulin from getting to cells. there are a few treatments (medication, radiation, surgery, or just managing with insulin) but we'd cross that bridge if we get there. My cat had/has both. At this dose it's unfortunately pretty much guaranteed she has an underlying condition causing it. Cushing's is another possibility, if she has any of those symptoms.

Unfortunately the only thing you can do is keep increasing methodically. Between 5-10U you can increase by 0.5U. above 10U can increase by whole units (basically consider increases as 10% of the dose - so 1.5U above 15, etc).

She seems to be doing ok on ProZinc for now, but usually high dose cats do better on Levemir (Lantus tends to sting at higher doses). So just keep that in the back of your mind, if her number start to get too bouncy/wonky/unpredictable may need to change.

 

[Peter (Boo) (Peeka GA)]

Have you had her tested for IAA and acromegaly? Thyroid recently?

I have not, our most recent vet visit was for a UTI a month ago, other than that, things have been fairly normal. We got down to 285 today which is lower than we’ve been in some time. I think I may continue with daily curves until I can figure something out. I appreciate the response!

 

[FrostD]

I wouldn't worry about daily curves, 1-2x a week is fine!

Just stay on top of increases. 0.5U increases (1U above 10 units) every 6 cycles (3 days) til she starts seeing blue. Have to break through these numbers and get her below renal threshold

 

[Peter (Boo) (Peeka GA)]

I wouldn't worry about daily curves, 1-2x a week is fine!

Just stay on top of increases. 0.5U increases (1U above 10 units) every 6 cycles (3 days) til she starts seeing blue. Have to break through these numbers and get her below renal threshold

Fair enough. Will keep an eye for it! 9u feels like a lot, we had good success earlier in with 4-4.5u.

 

[Christie & Maverick]

Hi Peter, nice to see you. If I could make a suggestion - I see you have Peeka on Prozinc now, would you be able to get some night time tests in regularly? At the moment, your SS info is quite sparce, so it is hard to say what is happening but I wonder whether Peeka is going lower at night and bouncing during the day.

 

[Peter (Boo) (Peeka GA)]

Hi Peter, nice to see you. If I could make a suggestion - I see you have Peeka on Prozinc now, would you be able to get some night time tests in regularly? At the moment, your SS info is quite sparce, so it is hard to say what is happening but I wonder whether Peeka is going lower at night and bouncing during the day.

I can! I admittedly got a little relaxed about it because she was making significant improvements and her numbers were good. But now we seem to be slipping up, I’ll be more rigorous in my data keeping.

 

[Bron and Sheba (GA)]

How long has she been on Prozinc? If it has been several months I would look at swapping over to Levemir to see if you get a better response. I also agree with Christie that getting some data in the pm cycles would be helpful. Even getting a before bed test in every night would give good data.
@Wendy&Neko

 

[Peter (Boo) (Peeka GA)]

How long has she been on Prozinc? If it has been several months I would look at swapping over to Levemir to see if you get a better response. I also agree with Christie that getting some data in the pm cycles would be helpful. Even getting a before bed test in every night would give good data.
@Wendy&Neko

She just started back with Prozinc. We switched back to Vetsulin for a short period due to lack of availability. We were on that for a few months before switching back to Prozinc last week.

 

[Wendy&Neko]

When a cat gets up to 6 units of insulin, chances are good there is a secondary condition causing a need for higher doses. I'd talk to the vet about getting bloodwork done to be sent to Michigan State University for acromegaly (IGF-1 test) and IAA (insulin auto antibodies). The most recent research shows around 1 in 4 diabetic cats has acromegaly.

As others have said, often higher dose cats do better on Levemir, seems to give longer duration. However, with only a couple days of data to look at, it's hard to say anything about dose.