Possible Insulin Resistance

[LokiL]

Hello all!


My little old man, Loki, was diagnosed with diabetes the week before Christmas, We've been trying, unsuccessfully, to get him regulated. I'll try to give as much detail as possible.

When I initially took him in, it was because he had a nagging respiratory issue he couldn't seem to clear that his previous vet thought was no big issue- he thought it was likely allergies after multiple visits. Once winter rolled in and it kept going, I took him to a new vet for a second opinion. She agreed that the respiratory issues didn't seem like a big issue, and assumed there was something else happening suppressing his immune system since he couldn't shake it. We did bloodwork, and he was diagnosed with diabetes (his kidney levels were also mildly elevated, but not to a point where the vet had concerns).

At his initial diagnosis, he was reading in the 400s. We started him on Prozinc at 2 units, 2 times daily. After a couple days of this, he seemed rather lethargic and no longer interested in his food. This is extremely unlike him- Loki has always been a bit of glutton. After this, the vet thought maybe we started him a bit high and scaled us back. Once we scaled back, he returned to most of his usual behavior, with the exceptions being he refused the food he was eating initially (Merrick Limited Ingredient wet food), and will spend most of his time lying on the hard floor rather than any soft places like he typically would.

We did half a unit for a week and rechecked- still high
1 unit for a week and rechecked- still high (high 400s)
2 units for a week and rechecked- still high (600s)
3 units for a week and rechecked- results were too high to even read. At this point, he was beginning to exhibit signs of neuropathy. Between that and the off the charts reading, we hospitalized him over the weekend.
After being there since Saturday, she rechecked and he is back in the 500s (still high, I know...but not nearly as frightening to me as "it isn't even readable". Her thinking is this is either insulin resistance or something is happening with his pancreas- and she recommended a MRI as a next step if an insulin change didn't help. Where we sit now is he is still there for her to get a curve while trying out a new insulin (the insulin name escapes me) and if he still isn't responding well, the MRI was her recommendation.

We also haven't tried a diet change yet.

That's all I can think of off the top of my head...any insight would be so appreciated.

 

[majandra]

Are you checking him at home? That will give you the most accurate readings, and is the number one tool to keep your cat safe while on insulin.
It is possible, depending on how he reacts to the vet, that he was getting more stressed with each visit, and that was part of the problem.
It is also possible that he dropped dangerously low during his cycles, and his liver is pumping out more sugar to counteract it.

Experienced members will be replying here soon. In the meantime, if you could create a spreadsheet and put in what data you have, and also create a signature with pertinent info, it will help those who are helping you, and save you repeating things frequently

ETA: I would highly recommend you don't change his food until you are testing at home. Changes to food can cause drastic changes to insulin requirements

ETA2: Testing at home will also save you tonnes of money, as opposed to having him hospitalized for curves. And you may even find he doesn't need an MRI (but it's still possible)

 

[LokiL]

Hi, thanks so much for the fast response!

No, I haven't begun at home testing yet, but am looking down that road now. I had brought up the stress factor with the vet and she agreed it could contribute, but didn't think it would be taking him this far out of line. I'll do a bit more reading here in a bit and see if I can gather a shopping list for at home testing and will request the readings the vet has taken to this point when I get him back (either tonight or tomorrow, depending on how his curve goes).

 

[JanetNJ]

Hi, thanks so much for the fast response!

No, I haven't begun at home testing yet, but am looking down that road now. I had brought up the stress factor with the vet and she agreed it could contribute, but didn't think it would be taking him this far out of line. I'll do a bit more reading here in a bit and see if I can gather a shopping list for at home testing and will request the readings the vet has taken to this point when I get him back (either tonight or tomorrow, depending on how his curve goes).

The Crazy thing is sometimes too much insulin can look like not enough. Esp if these changes are being made based on random scattered readings. Your vet started him too high and is raising in whole units very quickly.

Definitly start testing at home then we can help you.

I have a video in my signature showing how I test my cat CC at home

 

[Lisa and Witn (GA)]

I agree that the doses may be too high and you should start home testing. My suggestion is start back at 1 unit and test before feeding and giving insulin. By testing at home you are eliminating the vet stress that could be raising the BG levels. If after a week or two at the lower dose you think an increase is needed, only raise it by 1/2 unit. By raising in smaller increments, you have a better chance of finding the optimal dose. Wait at least a week before increasing it again to give his body time to adjust to the new dose.

What can happen if a dose is too high the body produces extra glucose to prevent hypoglycemia. That looks like what may have been happening. It is called Somogyi effect or bouncing. So as the dose increases so does the glucose levels raise.

For home testing you do not need to buy a "pet" meter. Most people use a human glucose meter. The pet meter and the test strips for it are expensive and very limited for where you buy additional test strips. With a human meter you can get additional test strips at your pharmacy. This is important especially if you need them quickly.

 

[LokiL]

Thank you for the replies- that's actually very enlightening and makes perfect sense hearing it explained that way. I don't have my little guy back just yet- the vet wanted to keep him another day. The information I did have was that she switched him over to Vetsulin and that his curve hovered in the high 300s yesterday (still high, but it's the lowest measurement we've seen since diagnosis). Is it *possible* that he didn't respond to Prozinc for some reason but actually may respond well to Vetsulin?

As far as at home testing, are there any recommended devices? Or, rather, any devices to avoid? I'm definitely in the "buy it for life" type of camp, so higher up-front cost for something that is a bit better or more reliable isn't a concern.

Another question- should I look into a food change immediately as well once I get him back? I'm mildly concerned to change too much all at once. He was previously on Merrick Limited Ingredient (alternating Turkey and Duck) which I saw was on the list of low carb foods. But, he began refusing that food for a while- then we eat it but would stop mid meal and grind his teeth. A change to a different food (which unfortunately isn't on the list) cleared up most of the grinding and seemed to help with his intermittent constipation. My assumption would be "let's find something on the low-carb list, and just use Miralax to aide in the constipation."

Sorry if that's a lot of questions...just a concerned cat parent trying to get his feet under him

 

[majandra]

The ltd ingredient duck is quite high carb. 15% iirc.

For a meter, you want something with a small sample size and decent priced strips. I really like my Freestyle Lite. It also reads slightly low compared to other meters, which is great when you want to avoid hypoglycemia. It should also come with some lancets. You will also want to pick up a small tube of antibiotic ointment with pain relief- the ointment helps blood bead up when testing.

Make sure when you get syringes that they have half unit markings, and the smallest volume possible. I don't know if you have to buy from vet or not initially, but make sure to get the half units asap- it will make your life a LOT easier.

Eta: if there is a meter to avoid, my opinion would be to avoid anything that is large and bulky- I saw one that looked like a nightmare to use. Can't remember the name though. The strips should also self wick.

 

[LokiL]

I did initially receive syringes from the vet- so I will probably finish those off and will look into ones with half unit markings.

You're right on the Limited Ingredient Duck- I misread the spreadsheet and was looking at a different line! Looking at the food he began eating after refusing any Merrick whatsoever- it's even worse; so a diet change would seem to be absolutely needed here. The question I guess would be what carb level to start at. I know you mentioned wanting to wait on a diet switch until we're testing at home, so my thought would be to check what the vet has been feeding him during his stay and continue there for a while before making a full switch? I'll bring this up with the vet as well, but just wanted to bounce that thought here as well and see if it seemed logical.

Thank you again, Majandra!

 

[flyingduster]

For my girl, she was in the 500s when she came home from the vets. I went whole-hog and switched her food immediately and totally.

My reasoning was; she was already on a different diet at the vets for four days compared to the diet she had at home prior to then, so it was gonna be changing about in her system to go back to the old food anyway. And that at those high levels she was at, even a significant drop caused by food was unlikely to actually bring her down to a dangerous level so I felt like it was “safe” if I kept a close eye on her.

Although in hindsight we know that the abrupt diet change and the dosage she was on did end up causing some bouncing to go on which is taking a bit to settle down again, so be prepared for that!

It is generally recommended to go gradually though, so you can monitor and change the dosage as needed as well. It also may depend on what your cat likes to eat!!!

 

[majandra]

Regardless of what he is being fed, do make sure to have a hypo kit ready, just in case, and for peace of mind.
Also, you can post in the Vetsulin area of the forum for advice specific to your insulin. That is one thing I can't help on!