Sugar is not budging despite 3 units--what's wrong?

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Nancy and Pasha

Nancy and Pasha

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Hello everyone. First, a HUGE apology for not coming back to THANK everyone for the tips you shared so generously last month when I first tried home testing my Pasha:

viewtopic.php?f=28&t=16797

I tried everything--I really did--warm sock, ear w/ flashlight, etc.--and Pasha was angelically patient, but I simply could not squeeze any blood out of that turnip-cat--he just doesn't bleed, either in his ear or his paw. I became very frustrated, feeling extremely bad about poking the cat (hard) 15 times to get only 3 results on glucose-curve day. And when I came home from work at lunch few days later, trying to get just one mid-afternoon reading for the vet after she upped his insulin, I tried 5 times and got nothing. I gave up in utter frustration.

I didn't mind the time spent, etc., but I felt like I was torturing this poor cat endlessly--and all for no results. So, I gave up and have been taking him to the vet for his glucose curves.

My problem now: he's already up to 3 units of Lantus glargine and his sugar is just not budging. On 2 units, it came down into the low 400s and high 300s. She raised him to 2.5 units, but on his next curve he was back into all 400s. Now he's at 3 units, and I just got a blood sample from him (hallelujah! with only two pokes!!) 5 1/2 hours after his shot and it's still 433!!

It's as if the insulin is having virtually no effect!

And the vet was scared to raise it even to 3 units--said she'd never had a cat higher than that, had to consult with her colleagues before she raised it that high, etc. She had me get the urine dipsticks to get a rough idea of whether he was shedding sugar OK and those things always turned dark brown immediately (the highest level), within like 5 seconds. And now this--a 433 reading even on three units.

Does anyone know why the insulin doesn't seem to be working!? Is it possible we got a bad batch? Do some cats just not respond to insulin?

He is still drinking excessively and still losing a little weight.

I will schedule another curve and consult with the vet next week, but wondering if anyone has any clues for me before then...

Thanks so much...

Nancy
 
What may be happening is that your cat is experiencing a Somogyi effect also known as rebound. What happens is that the insulin dose is actually too high and in order to prevent the body from becoming hypoglycemic, your cat's body is producing extra glucose. Eventually, the body will quit producing the extra glucose and your cat will become hypoglycemic.

The problem with only getting glucose readings at the vet is that stress will raise the glucose levels. And most cats do become stressed at the vets.

Hometesting is the best way to determine the optimal insulin dose and regulate your cat. Once your cat's BG levels are stablized, you will see a lot of the symptoms are reduced or disappear.

Can you tell us where you are located? City and state only. There is a good chance we may have someone on this board that lives near you that can help you learn to hometest. Or you can also ask either your vet or one of the vet techs to show you how.
 
I agree with Lisa - it could be rebound. It would be great if you could get some tests at home or in a less stressful environment than the vets office.

I know you've tried -- do please post your city / state and consider meeting someone to get a home testing demo.
(e.g. once my hubby met a girl ~17yo and her father in a Petsmart parking lot, and tested both our cat Tiggy and her cat sitting in the back seat of the car to show her how to test her kitty. They sat talking awhile until the kitties were calm.)

There are also some "high dose" conditions that cause resistance to insulin. With such limited blood sugar data, it is impossible to determine if your kitty has one of these conditions -- Acromegaly, IAA (insulin antibodies), Cushings.

Two can be diagnosed by blood tests -- Acromegaly is dx'd with IGF-1 test and IAA is dx'd with IAA test

Both these tests are conducted by the vet lab at Michigan State University (the ONLY location in North America to run these tests). If interested, have your vet contact them directly -- to send to any other lab will rack up extra shipping and middle-man costs.

Information about these conditions and the links for the tests (print and give to your vet) are in the Acromegaly/IAA/Cushings Cats Insulin Support Group.

By the way -- one article suggests that "High Dose" is when DAILY insulin needs exceed the weight of the cat in pounds.

So... my Norton (GA) just barely met that at 15 units total per day for a 14 pound cat. He did test positive for Acromegaly on the IGF-1 test.

Read the information in LANTUS Insulin Support Group, and either print for your vet or send them here to FDMB. If you follow the dosing and testing protocol, you keep on increasing very gradually to find the right dose.

A few of the High Dose Acrocats have needed more than 30 units per SHOT twice a day.
A caution though -- the insulin needs of a High Dose cat can fluctuate a lot and so home-testing is very important to keep the kitty safe.
 
Lisa--thank you so much--I read something briefly about the Somagyi effect; I put a call in to the vet and am awaiting a call back to see what she thinks about the situation. We did increase it only slowly--by half a unit every 2-3 weeks.

Pasha does not appear too stressed at the vet's; he's a calm cat generally and they say he is affectionate while there, but of course he could be more stressed than he looks on the outside. However, he sure wasn't stressed when I tested him today.

I am in Portland, Oregon (SE part of the city). I felt rather encouraged today when I put away my previous utter frustration/anxiety with the testing and managed to get a nice drop today with only two sticks. (Stabbing him freehand seems to work better than even the pen on the highest setting! and he's easygoing about his paws.) Maybe I will be able to do at least some home testing, even if not six tests a day for a full glucose curve. If I get frustrated again, I will certainly welcome some help from someone more experienced. Thanks much for the suggestion. I'll see how it goes from here...

Phoebe--thanks so much for all the info. I will check it out while I'm waiting for my vet to call back.

Newbie question--what does "GA" mean?

Thanks again!!

Nancy
 
Couple of things I forgot to mention--not sure whether they're relevant. Pasha has FIV but has seemed healthy except that his mouth was in terrible shape when we got him two years ago. We got his mouth all cleaned up right away, with many extractions, and he's been fine.

The vet did a TON of bloodwork on him when we initially took him in for the excessive drinking at the end of May--not only blood sugar but all kinds of other tests of his internal organs and I don't remember what all. Everything was great except for the diabetes.

He has back-leg weakness and muscle wasting which became apparent/pronounced about a year and a half ago, long before his diabetes symptoms showed up. He limps slightly at times, and the weakness and limping appear to have gotten a bit worse lately, as well as his apparent need to sit down frequently and suddenly when walking.

The very experienced vet that we had at the time the leg problems began said it was highly unlikely we'd find out what was causing it. When he was under for another extraction a year ago we did an x-ray anyway, and of course it showed nothing. Now I wonder if it's the diabetes after all.

Anyway... I haven't seen anything that indicates diabetes management and insulin dosing is different in FIV cats--is that correct?
 
Nancy T said:
I am in Portland, Oregon (SE part of the city). I felt rather encouraged today when I put away my previous utter frustration/anxiety with the testing and managed to get a nice drop today with only two sticks. (Stabbing him freehand seems to work better than even the pen on the highest setting! and he's easygoing about his paws.)
Click to expand...

Nancy,

Many of us, including me, find it easier to use the lancet freehand instead of using the pen. Two sticks is great. It won't be long before the ear learns to bleed and you will be able to get a drop on the first try. If you warm the ear a little or massage it before testing, that also helps the blood flow.
 
I haven't seen anything about changing the treatment for FIV+ diabetics.

They may be even MORE prone to infections, etc, than a "regular" diabetic. Great that you got his mouth healed up - that can definitely aggravate blood sugar.

Definitely start your sweetie on Methyl B12 vitamin. (not "regular B12)

This will SLOWLY help the hind leg weakness -- most crush up one vitamin per day and mix it in the food. And plan on giving it for many weeks / even months.

It is possible to get injectable Methyl B12, but I'm not sure where or how much to give.
 
Thank you everyone--I consulted with the vet and we are increasing to 3.5 units. I will test him at home--I know I can do it!!--and if no results I will ask her about the other possibilities.

Thank you all VERY much for all the good information.

nancy
 
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