Slow insulin response

AlexH

AlexH

Member
Hello - just posting a bit of an update and to get peoples thoughts on Ziggy's progress on Prozinc

Ziggy seems to be barely responding to insulin day to day, we have gradually been increasing his doses as per the guidance on here to try and get his numbers in the blues, particularly after we had the DKA scare this has become a big priority. But no matter what we do he hits about 12 - 13mmol (210 - 230mg) and then rises again.

Wondering if anybody had experienced this before? We're on 5u now which seems high to me

He's a very big cat (not in terms of weight, but generally large as he is a male Bengal) and I was wondering if this could be some explanation, and that maybe he needs a bit more than a typical cat to kick into his system? My other worry is the insulin has lost some effectiveness?

really welcome your thoughts and experience!
 
Just an update - this seems to have continued and now the vet has asked us to hold at 5u, they are concerned he has a resistance to insulin for whatever reason, perhaps acromegaly, as his numbers are the same on 2u as they are on 5u :(

@JanetNJ you’ve helped a lot previously, do you have any experience of this? Thank you!
 
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AlexH said:
Just an update - this seems to have continued and now the vet has asked us to hold at 5u, they are concerned he has a resistance to insulin for whatever reason, perhaps acromegaly, as his numbers are the same on 2u as they are on 5u :(

@JanetNJ you’ve helped a lot previously, do you have any experience of this? Thank you!
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Acro is a possibility. We usually recommend they get tested once you hit 6 units. My cat was acro. Regardless of the reason, they need what they need. My cat was up to 13 u at her most before it came down.

You've held at this 5u dose a long time. If it's not enough don't hold it more than a week. Time for an increase. If it does wind up being acro I'd get more aggressive with dosing... Raising every few cycles.
 
I would have him tested for IAA and acro, but in the meantime please do continue to increase the dose as needed! Neither of those conditions would warrant delaying increases in the BG range you're seeing.
 
Thanks both that’s very helpful - we were a little worried that the vet said not to increase beyond 5 (she actually seemed a bit shocked we’d gone up that much) - he is due a fresh vial of insulin tomorrow so going to see how his numbers are on that, then do a curve, then start putting him up again.

As you both say, treatment for something like acro is increased insulin therapy anyway, there does not seem much point prolonging that until tested. Especially since his hunger levels have got so bad because of unmanaged glucose levels, we can barely cope with his shouting and breaking into things for food. (Even though he’s now on about 1.5 / 2 times his recommended daily amount of food)
 
AlexH said:
Thanks both that’s very helpful - we were a little worried that the vet said not to increase beyond 5 (she actually seemed a bit shocked we’d gone up that much) - he is due a fresh vial of insulin tomorrow so going to see how his numbers are on that, then do a curve, then start putting him up again.

As you both say, treatment for something like acro is increased insulin therapy anyway, there does not seem much point prolonging that until tested. Especially since his hunger levels have got so bad because of unmanaged glucose levels, we can barely cope with his shouting and breaking into things for food. (Even though he’s now on about 1.5 / 2 times his recommended daily amount of food)
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How many calories a day is he eating? What is his weight?

I would raise to 5.5 starting today.
 
Probably
JanetNJ said:
How many calories a day is he eating? What is his weight?

I would raise to 5.5 starting today.
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Probably on 400ish calories per day, although this is a rough figure. The real figure is likely more because his shouting for food really wears us down, coupled with excessive urination out of his litter if he does not get his own way. His weight is 6kg - he's always been around here, he looks slim for his size really, as I say he's a big cat!
 
AlexH said:
Probably


Probably on 400ish calories per day, although this is a rough figure. The real figure is likely more because his shouting for food really wears us down, coupled with excessive urination out of his litter if he does not get his own way. His weight is 6kg - he's always been around here, he looks slim for his size really, as I say he's a big cat!
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Do you know what his ideal weight is?

I personally wouldn't withhold food if he isn't overweight; unregulated diabetic cats do not utilize food as well as regulated or even non diabetic cats. I free fed my cat so he could maintain his weight. At his worst we were probably going through about 4-5.5 oz cans a day, his ideal weight is about 5.5kg
 
FrostD said:
Do you know what his ideal weight is?

I personally wouldn't withhold food if he isn't overweight; unregulated diabetic cats do not utilize food as well as regulated or even non diabetic cats. I free fed my cat so he could maintain his weight. At his worst we were probably going through about 4-5.5 oz cans a day, his ideal weight is about 5.5kg
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Hi sorry I have been a bit busy with work - ideal weight is 5.5 / 6kg. To be honest recently he has had as much food as he has wanted but he is piling on weight and still shouts for more.

Since I last posted we've taken the decision to just work through dose increases (with appropriate testing) to get a response from his insulin. We're feeling really stressed as poor ziggy is clearly unhappy. He cries and cries no matter how much food he has (he recently broke into his food cupboard and tore open five packets, and then shouted for more) he grabs things in his mouth from the fridge when we open it and howls if you try to take it away, he steals the dogs food...etc. We really feel completely stumped by his lack of response to the insulin and an appetite that literally cannot be satisfied.

As a result of insulin increases however we have seen a few blues in his spreadsheet which is the first time in months, just hoping this can stick and we can level him out.
 
Ok if he's putting on the weight then be sure not to overfeed.

We do recommend only increasing by 0.5U at a time once over 5U.

He's completely low carb wet/raw food right? No dry, including treats? Have you considered tbe modified dosing method which allows for faster increases? It just requires more testing,which it seems you do most days. At minimum the preshots and one other test, ideally around nadir

I'd say it's time to have him tested for IAA and acromegaly. There's nothing to be done for IAA except wait it out and continue to increase insulin as needed, but when it does finally break it's important to know he has IAA because they often come down fast and need to be safe. There are a few treatments for acromegaly, but we can cross that bridge when test results come back
 
Thank you that's great advice!

Diet is almost totally raw supplemented with a wet food with a very low level of carbs, no dry and no treats, although policing him 24/7 with his current hunger levels is difficult with another animal! Though we've found when there has been obvious accidents and he breaks into the dogs kibble his numbers do shoot right up to unusually high levels

Will definitely take a look at the alternative dosing method this sounds very helpful.

We have a vets appointment booked in which will hopefully help us work out if it is IAA and a Fructosamine test - Acro is apparently a costly test in the UK and frustratingly his DKA wiped out his insurance cover, but apparently the vet said that there are lots of other tests they can do that basically rule out everything else that all but confirms Acro? If not we'll just have to get saving!
 
AlexH said:
Thank you that's great advice!

Diet is almost totally raw supplemented with a wet food with a very low level of carbs, no dry and no treats, although policing him 24/7 with his current hunger levels is difficult with another animal! Though we've found when there has been obvious accidents and he breaks into the dogs kibble his numbers do shoot right up to unusually high levels

Will definitely take a look at the alternative dosing method this sounds very helpful.

We have a vets appointment booked in which will hopefully help us work out if it is IAA and a Fructosamine test - Acro is apparently a costly test in the UK and frustratingly his DKA wiped out his insurance cover, but apparently the vet said that there are lots of other tests they can do that basically rule out everything else that all but confirms Acro? If not we'll just have to get saving!
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I would save your money on the fructosamine since you already test enough at home.

Both IAA and acro are blood tests...I don't really see how they can be officially diagnosed either way. I personally would not feel comfortable treating my cat for acro without confirmation - in fact two of the options I'm sure require it (surgery and radiation).

@Wendy&Neko thoughts?
 
Hello, it has been some time since posting but we have been having a few tests and managing with Ziggy's diabetes as best we can - unfortunately not been filling in his FD spreadsheet but still doing very regular testing with mixed results.

Today Ziggy was finally diagnosed with Acromegaly and we are feeling a bit heartbroken about it to be honest - treatment is not common in the UK, if at all, and our vet has advised simply increasing his Insulin doses to at least treat his Diabetes.

@FrostD it would be great to get your experience on this, from what I have read the long term prognosis for Ziggy looks pretty poor possibly even less than a year without treatment :(
 
Would you mind posting this over in the acro forum? There are a lot of people over there who can help! I'm not 100% clear on the options and costs in the UK but there will be someone who knows or can help. Lot of info on that forum.

I know Royal Veterinary Clinic has done a lot of work with acros but in my opinion they are behind the curve with respect to cabergoline (or at least they were).

So it is by no means a death sentence. I'd say most of us end up losing them to something else entirely (kidneys, cancer, etc).

Option 1 is just treat with insulin as your vet said. That does not do anything to the tumor itself though, it will still be sending out the growth hormone which causes other issues (enlarged organs, etc)

Option 2 is cabergoline (you may see pasireotide but it is cost prohibitive, 1000s per month). I don't know cost or availability in UK, but I pay about $35 USD for a 5 month supply (every other day dosing). It primarily works to suppress the growth hormone, and there is some limited evidence it may shrink the tumor. This is the treatment I elected to do, I figured why not because it was cheapest and least invasive to start with.

Option 3: SRT (radiation). Fairly costly, in the US at least 3000-8000 USD ish. No guarantee they can get the whole thing, it can regrow. Risk with anesthesia.

Option 4: Hypophysectomy (surgery). Most costly. Here, 10000+. No guarantee they can remove whole tumor, can regrow, and there is always the risk with anesthesia, surgery in/near the brain.

It sounds overly simplified and cold, but you kind of have to weigh what you can afford vs how much life he has left vs ultimate goal (remove tumor, just manage it, etc). He's a fairly young cat. If he's otherwise healthy, he may still have a lot of life left in him. If he were 15+ I'd say maybe just do something less invasive or more palliative.

We had considered radiation, but then due to other financial issues that cropped up we couldn't swing it anymore.
 
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