Question of the Day: Neuropathy in overdosed cats?

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Carolyn and Spot

Carolyn and Spot

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I am kitty sitting jmflake's Milo and we've been going back and forth all week on whether or not this cat is overdosed. Currently at 5.5u Lantus after runs from 1u up to 9u (yes, nine) on both Vetsulin and PZI since DX this past Sept. We both think he is not overdosed due to diabetic symptoms present including PU/PD, heavy appetite, weight loss and severe neuropathy. There HAS been dry food present though he receives a good bit of canned food as his primary food source. He will not be getting dry food while in my home so it's my hope that we can stabilize those symptoms a little while he's here. He has been started on methylcobalamin.

She plans to get him tested for IAA and Acromegaly, which we are both leaning towards. He does have some of the characteristics of an acro, but I am reluctant to yell Eureka! quite yet without a positive IGF-1. He's got the "acro breathing", a broad head, broad nose and pot belly. He's not a large cat, and his paws and jaw are not out of line.. not quite the definitive characteristics one would hope for, but still there are acro's who show no physical signs. The other idea is IAA, which as far as I know is impossible to identify without the blood test.

3 of my 4 diabetics have had neuropathy, and I can clearly see it is neuropathy and not something else. He has neuropathy in all 4 legs, is on his hocks in the rear and wrists in the front.

So my question is, do we have any board cases of neuropathy in overdosed cats? It was my thinking that neuropathy would not be present in a cat on too high a dose, but I really want to be sure. Her vet says she doesn't think there is "any evidence the cat is insulin resistant". :shock:
 
Congratulations and kudos for taking on this special Milo winter vacation project. Hope you can make him more comfortable and resolve some questions that will help improve his quality of life.

Can't help with the neuropathy question - neither of my diabetics have had it.

ETA: agree with Venita -- I've never heard here on FDMB of a cat with Neuropathy that was at a higher dose -- only recently diagnosed / haven't reached their dose cats.

From the symptoms, it does sound to me like he is not getting enough insulin for whatever reason (acro or IAA)
 
So, Karen, would you agree that Milo appears to not get enough insulin?

People have apparently questioned whether or not he is a "high dose" cat, but he has severe neuropathy and a moderately high dose of insulin.
 
Karen & Angus said:
Since diabetic neuropathy is caused by high blood sugar levels, I wouldn't think it would matter why the BG was high.
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Karen,
That is exactly where I was going with this.. if in fact he IS overdosed, we have a cat with neuropathy in 4 limbs from too much insulin. A curious situation, in my mind.

And Phoebe, my brain is working overtime on this, but I have that suspicion in the back of my mind that says "hey don't rule out that something else could be going on that's undiagnosed".. like for instance CRF which causes a lot of these symptoms. Pancreatitis flareups. Or even a combination of more than one illness like say.. hyper t, crf AND diabetes.. Now in my mind, this is pretty unlikely because the owner has had a battery of blood work done to the tune of several thousand dollars, but we all know that if you don't have the right lab, or the right test, that stuff can be missed or disregarded as fluke.
 
Phoebe_Tiggy_Norton said:
So, Karen, would you agree that Milo appears to not get enough insulin?

People have apparently questioned whether or not he is a "high dose" cat, but he has severe neuropathy and a moderately high dose of insulin.
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I have not seen his spreadsheet, so I couldn't say. Does he ever reach normal numbers?
 
She *just* started testing last week and was gone for the weekend so no tests from there either. There's a pattern developing and it's all high and flat.. which can mean both over and underdose. Lowest number to date was this morning at 293 after cutting dry food yesterday. I've got access to his SS but I don''t have the URL to the published version yet so you can see it too. Only she can give me that, but when I have it, I'll post it here.
 
You are right, high and flat. I think the neuropathy is simply the result of high and flat and does not tell you whether the dose is too high or too low. However, the weight loss and hunger would point to too low. Have you checked his urine for ketones? The presence of ketones would definitely indicate too low.

Edited to add: I have never used Lantus. Are you going to post in the Lantus forum? They may be better able to advise you on dose.
 
I'm ok with the dosing, just curious about the neuropathy and if it can be brought on by overdose, glucose toxicity or anything other than too low a dose. Thankfully he's ketone free, she's been testing him for that and I'll be ketone testing him every day while he's here too.
 
Misty's neuropathy didn't go away until she was regulated.

She was being treated for over a year by Claire75 from the old board before she gave her up. When I got Misty she was getting 1 full unit AM and 1/2 unit PM of PZI. Misty was never a big gulp kitty, but she needed less insulin than she was getting. We ended up at .5U BID.

I also don't know how long Misty had neuropathy (rear leg only) before I got her.

I'm just guessing here and only have the limited experience with Misty, but I'd think too much or too little insulin wouldn't matter, either way BGs are not under control yet.
 
Very interesting Jenn... I would be very excited to see if this kitty just has been pushed past the dose he needs and that he really isn't insulin resistant.
 
Hi Carolyn

I've been following this thread today and wasn't sure if our case would be anything to do with your questions, but I'll try anyway.
I know most don't consider 2u as a high dose, but in the end I felt anything higher than 1u was not agreeing with Luna.

Which makes me wonder if maybe some kitties develop neuropathy after starting insulin on a dose too high without knowing what a smaller could of done and/or prevented.

Before Luna was DX'd he had no signs of neuropathy. It's very heartbreaking to see, and if he had it I would of seen it. It's not something you forget.
Vet began him on Caninsulin 2u, and soon after, he began with the back legs symptoms.
I began giving him B12 within the first month.

Two full months on Caninsulin, he was still showing those signs, even after lowering that dose, maybe it was too late anyway, maybe it was the Caninsulin.
I don't know for certain, all I know is that he did not have neuropathy before Caninsulin. He had the classic signs of diabetes for a few months before the DX but nothing compared to what he showed after.

Finally switched to Lantus. My reasoning with the 3rd and last vet was sensitivity to anything higher than 1u
I began him on .75u and he spent a short time on 1u before making his way back down.

It wasn't until late in the 2nd month on Lantus that he began to show improvement with the back legs, gradually it began to get better after being on Lantus and as the dose got smaller. Regulation? Lantus a better insulin than Caninsulin? Sensitivity to higher dose? I don't know, maybe a combination.

Early December it was completely gone and he no longer had neuropathy signs on the back legs.
 
The reason I mentioned weight is that in humans (I am diabetic), too high a dose usually results in weight gain even when the BG is too high. Too little insulin usually results in weight loss, ketones, or both.
 
Hi Carolyn

The short answer to your questions is: the cure for diabetic neuropathy is regulation. If he's not regulated (either from rebound/too much insulin or too little insulin), his neuropathy will not resolve. Also it is likely to take months for this to resolve *after* his DM is regulated and that is a long time for him to hyperflex his carpi (the carpus is the forelimb "wrist", and it's supposed to bend towards the body, like ours do). My next at-work day is Sunday, and I will ask the orthopedists I work with if something should be done about that (if I don't post back to you within the next few days, don't hesitate to remind me). Besides that, the poor cat has to be in severe pain. Diabetic neuropathy alone is painful, according to humans, and walking with your wrists bent the wrong way by itself has to be painful. This is a case where gabapentin might do a world of good. Milo's caretaker should have a talk with the vet about this asap, and if she is not receptive I'd find another vet to talk to, honestly. The neuropathy may take months to resolve and that's a long time to be in pain :sad:

I don't know his full history but assume that full chemistry/cbc/thyroid/urinalysis has been run recently. I'd also consider Cushing's.
 
Jess & Earl said:
Hi Carolyn

The short answer to your questions is: the cure for diabetic neuropathy is regulation. If he's not regulated (either from rebound/too much insulin or too little insulin), his neuropathy will not resolve. Also it is likely to take months for this to resolve *after* his DM is regulated and that is a long time for him to hyperflex his carpi (the carpus is the forelimb "wrist", and it's supposed to bend towards the body, like ours do). My next at-work day is Sunday, and I will ask the orthopedists I work with if something should be done about that (if I don't post back to you within the next few days, don't hesitate to remind me). Besides that, the poor cat has to be in severe pain. Diabetic neuropathy alone is painful, according to humans, and walking with your wrists bent the wrong way by itself has to be painful. This is a case where gabapentin might do a world of good. Milo's caretaker should have a talk with the vet about this asap, and if she is not receptive I'd find another vet to talk to, honestly. The neuropathy may take months to resolve and that's a long time to be in pain :sad:

I don't know his full history but assume that full chemistry/cbc/thyroid/urinalysis has been run recently. I'd also consider Cushing's.
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Thanks Jess, that's a load of info that I greatly appreciate. Jen is on vacation but she knows this thread is up and she's very curious to see what comes out of it. IMO I think she needs a new vet, and I think she would agree with me on that LOL I will look forward to what the ortho's have to say about this!
 
Jess & Earl said:
Hi Carolyn

The short answer to your questions is: the cure for diabetic neuropathy is regulation. If he's not regulated (either from rebound/too much insulin or too little insulin), his neuropathy will not resolve. Also it is likely to take months for this to resolve *after* his DM is regulated and that is a long time for him to hyperflex his carpi (the carpus is the forelimb "wrist", and it's supposed to bend towards the body, like ours do). My next at-work day is Sunday, and I will ask the orthopedists I work with if something should be done about that (if I don't post back to you within the next few days, don't hesitate to remind me). Besides that, the poor cat has to be in severe pain. Diabetic neuropathy alone is painful, according to humans, and walking with your wrists bent the wrong way by itself has to be painful. This is a case where gabapentin might do a world of good. Milo's caretaker should have a talk with the vet about this asap, and if she is not receptive I'd find another vet to talk to, honestly. The neuropathy may take months to resolve and that's a long time to be in pain :sad:

I don't know his full history but assume that full chemistry/cbc/thyroid/urinalysis has been run recently. I'd also consider Cushing's.
Click to expand...

WOW!!, Great feedback from eveyone!! Yes, I have watched his neuropathy go from bad to worse. I am insane, but i refuse to disconnect completely even while away on vacation. I had always been asking if the neuropathy had been causing him pain or not. The vet said she didnt think so. I do know that it is painful in humans, but havent found any evidence of that being true for kitties.

Being a persistant engineer myself, I cant for the life of me understand why there is no pattern of any sort in his readings thus far. Unfortunately, the testing began very close to my going away. I trusted the vets to no avail, and spend ungodly amounts of money on testing. I asked about Cushings and Acromegly, but the dosing wasn't "high enough" for them to consider him insulin resistant. I had no other opinions to go on, so I followed along and kept testing for pancreas issues, etc. The next step was a ultrasound, but I had to stop mystery diagnostics, because during all of this he was suffering with high sugar and doing horrbile. I truly believe in the all WET food diet beecause the proof is in his numbers. I am completely blown away. So, he will not have access to dry food ever again.

I will be following the threads as much as possible, and of course, I am bugging the hell out of my boy's caretaker, Carolyn..lol :-D
 
I would agree with the ultrasound, actually, since it never hurts to have a look in the belly when you have wonky numbers. Has he had a negative urine culture, too? The acro and IAA tests are simple blood tests and there is no good reason not to do them (except $!). Cushings brings with it some other symptoms so if any of those are present, I'd take a look at that too. If your regular vet won't cooperate you can take him to an internal med specialist who would be glad to do a complete workup.
 
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