Sustained high BS levels, advice please.

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Emily & Mr. Howell

Emily & Mr. Howell

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Hi, a little background about myself and Mr. H. I'm a recent college grad, adopted Mr. H. from the humane society about 3 years ago, they told me he was probably 7. The first few months I had him he was fine, later I went on vacation and when I returned he had been flung into diabetes through stress. I treated him with insulin (Lantus) for about a year when he honeymooned. Back in April I noticed he was urinating a lot so I purchased a BG machine and he was spiked at 450. I started him back on two units of insulin twice daily (what he was on before he honeymooned) and put him back on his old diabetic food diet.
Since about June I noticed he was urinating a lot, and his BG fluctuates between 220-550, mostly in the 300-400 range. I know that is ridiculously high. I increased his insulin (SLOWLY, over a few days) to 4 units twice daily, and he is still not getting below 444. I am beginning to suspect insulin resistance. I have a few different vials of Lantus, so I know at least one of the insulins has to be good. I just bought ketone strips to test his urine but haven't had success getting a sample yet. He is acting as normal as ever, which is to say he sleeps a lot but he is still on his normal schedule (i.e. scratches at the door in the morning, eats the same amount, still able to jump onto the high bar stools in the kitchen). I am paranoid that he is 'wobbly' when he gets up but he could just be waddling because he's fat.
I did some of the tests to see if he is dehydrated, and despite the fact he is peeing a lot, he is not obsessive about water like he was when he was first diagnosed.
Needless to say, if I could have taken him to the vet months ago I would have. I already have this guilt riding on my shoulders, but I lost my job and don't know what else to say, other than please help with some advice.
 
How old is the insulin you are using? If you haven't been back to the vet - did you get them to call in a new rx?

If your insulin is the same you used before Mr. H's honeymoon then the insulin just isn't good anymore. Lantus has a very short shelf life.

Best,
Pam & Lala
 
I have a few different vials of Lantus, so I know at least one of the insulins has to be good.
Click to expand...

Did you start a fresh vial of Lantus, and what is the expiry date on that vial?
Do you have a spreadsheet with your BG numbers? It would be helpful if you could confirm that the vial was freshly started and if you could do a curve for a few cycles to show how the insulin is working.
The dose of 4u is higher than many but many factors could cause the dose.

Health issues such as dental problems could cause high BG and the need for a higher dose. One of my cats dropped from about 14u BID down to 2.5u BID after her dental.
When was last b/w done, and is there a history of other health issues?

Food can also result in more insulin being needed. Please confirm that you are feeding low carb wet food.
 
I am absolutely NOT using the same insulin, I should have clarified.
The one I was using before just switching to a new vial last week had a shelf life till 7/2012, the one I am using now is 08/2013. My mother is a physician and gets new samples of Lantus regularly.
I don't have a spreadsheet with his numbers, I have been checking his BG 4-6 hours after his shot and before I give him his new one. Here are some levels and times:
7/21: 440 @ 7:30 p.m. (checked it and decided I needed to give insulin early, I am on a 9 a.m./9 p.m. schedule usually)
7/22: 280 @ 9:40 a.m.
7/22: 417 @ 2 p.m.
7/22: 513 @ 7:15 p.m.
7/22: 444 @ 10:47 p.m.
7/23: 361 @ 9:45 a.m.
7/23: 347 @ 8 p.m.
7/24: 444 @ 10:15 p.m.

His last BW panel was done in January and he was scheduled for a teeth cleaning. Literally a blizzard came up and I never got him to the appointment (my parents were in town and going to help me pay for it, then left me hanging).
Before he was first diagnosed by my vet, I brought him in on two separate occasions and both times they told me he had a bladdar infection. After trying to 'treat it' for months and he was getting worse, they admitted their mistake and said he had diabetes and they didn't catch it ???.
He is on Science Diet DM diabetic dry cat food, prescribed by his vet. He will not eat wet food.
 
My guess is that you started him on too high a dose. If this were my cat, I would start over at 1 unit twice a day. You see, giving too much insulin can cause high, flat numbers. It's called somogy effect or rebound. When blood sugar levels drop too far or too fast, the animal will defensively dump stored glucose from the liver into their bloodstream, resulting in high blood sugar.

Other possible factors could be an infection (like a UTI or bad teeth) or some other health issue. Feeling ill can raise their BG levels.

The dry food doesn't help, but I understand having a dry food addict - my Maggie wouldn't eat wet food either.
 
Can you present your BG is terms of when you gave the insulin shot. Like:
AMPS (BG at AM before you gave a shot), + (number of hours after shot you obtained aBG) then the BG value
PMPS (BG at PM before you gave a shot)
 
I was not aware to check his BS before he ate, I have always checked it afterwards. And to save my face I am doing what my (I am beginning to think) incompetent vet has told me.
My other reply got deleted so here goes again:

He does not act ill. If I wasn't checking his BS I would not think he was sick at all.
It's almost time for me to buy new food and I am wondering if I should try wet cat food. He has never liked this diabetic food and eats it begrudgingly. It's Science Diet DM diabetic dry food, and is stupidly expensive.
Before he was first diagnosed they kept sending me home with UTI antibiotics and he continued to be sick. It wasn't until after the third time I brought him to this vet (the most reputable in the town, I thought), when he was hours away from death that they told me he had diabetes. I still don't think he ever had a UTI, just diabetes.
 
- Yes, I would switch to canned commercial food such as Friskies or Fancy Feast. It is lower in carbs and thus will probably lower the insulin needs.
- The only way to determine the insulin dose is to measure the GB before a shot and then at various times after the shot. You only need to do the between-shot BGs periodically but should do a pres-shot BG before every shot. You do not want to shoot a full dose if too low.
- I think a lot of times the vet tries to minimise a client doing too much testing since some client will just give up and euthanize the cat.
 
That is so terrible but I have had many family/friends ask me why I continue to deal with this cat. They will never understand!! He is my precious baby and I love him and want to see him healthy and happy.
Do you have any further advice on food? Such as what 'flavor' or what ingredients I should look for/avoid?
I will start checking his BS before his food and will do so after. I'll keep posting here to follow his progress. You guys have already been so much more supportive and helpful than my vet, who tends to brush me off as irresponsible or too young to handle this (I was 19 when he was first diagnosed, you find me any other 19 year old that will love and care for a diabetic cat in a college town).
Thanks everyone for your support.
 
Here is a pic of my lovely fatty manx, Mr. Howell. He is posing in front of some of my business cards to show the scale.
 

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OK good, I am glad the insulin is fresh and that's confirmed by the good drop from the 440 to 280.
Now I am betting alot of your higher numbers are coming from the dry food. My Shadoe gets a few pieces of dry food, and her BG jumps into the 400s. If you have a cat that is carb sensitive, you will need the higher dose to offset it.
If you switchover to low carb wet food, you may find that your cat can be diet controlled and not need insulin.

Aside from food, the infections and dental can have a big effect on BG / dose needs. When Shadoe had her dental, her dose dropped from 14u down to 2.5u, so dental can definitely contribute to high numbers and dose.

For Lantus, you want to stick as close as you can to the 12/12 schedule, so if you shoot early at 730am, you won't get good results by shooting the next shot late at 900pm. You may need to work your way ahead to your reg shot time by half hour intervals at most.

If you could do a curve to find nadir, you will know better how much to increase the dose. Until the health issues and the food issues are addressed, you may be stuck with the higher doses.

If you look at the below links, maybe you can find some food help.

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition
 
Very handsome!!

I transitioned my dry food addicted cats to wet slowly over several months.

First -- I switched to Wilderness by Blue Buffalo -- it is 18% carbs and lower than most dry foods (also providing the low carb flavors of Fancy Feast wet)

Then we switched to EVO Cat & Kitten which is 8% carbs (also providing the low carb flavors of Fancy Feast wet)

Now my kitties eat BG (before grain) with a little Fancy Feast (all wet food)

For more details on carbohydrate content of cat foods -- google Janet & Binky's Food Charts. there are charts for dry and canned (new & old because it is such a long list). Choose flavors that are below 10% carbs for best results.
The bottom line is avoid all grains and starch like potato. Also -- the food manufacturers change the formula sometimes -- I no longer feed Wellness canned because they seem to have added more potato -- it made Tiggy's blood sugar go up a lot.

I agree that starting at 2u may have been too much. After the honeymoon, you should really start over at 1u.

My current diabetic, Tiggy, is well regulated on only 0.5u BID.


Also -- the teeth needing a dental can cause high BGs.

If you change to low carb food and get the dental done, you may find Mr. H going on honeymoon again.
 
Any canned with carbs below 10% is fine except you only want to feed fish a couple of times a week. This post says where you can vind the carb content of canned food
viewtopic.php?f=14&t=115
 
You say he won't eat wet food, but you are willing to try. Here's a link on tips for transitioning. I have heard others suggest using FortiFlora sprinkled on wet food to help cats be more interested in it. If you do make the transition, I wish you the best! I'm not sure the carb count in science DM, but if low-carb wet food will work for your kitty, I know it's cheaper than prescription!
 
Switching to wet food may help his BG drastically. I would recommend starting over at 1u if you're switching to a low carb canned diet. Most cats' BG will drop 100-200 points automatically once the dry is removed.

As for type of foods, take a look at this chart, and pick something under 10% carbs. Ideally, though, I would pick something under 6% carbs if you can. Many cats are very carb senstive (like my Bandit), and even 8-10% carbs can shoot his BG up by 100 points. http://binkyspage.tripod.com/canfood.html

Bandit currently eats the grain free versions of Fancy Feast: http://felinediabetes.com/glutenfree.htm I've also fed EVO 95%, Grain free Wellness, and Merricks with great results if you're looking for a higher end food without byproducts.

Just a another thought to add that might possibly be giving you trouble with regulation--Lantus works best when shot on a 12/12 schedule, at the same time every day. When you move around the shot by more than 15-30 minute increments, it can do wonky things.

I would also urge you to check out the Lantus forum, which has a wealth of knowledge about the insulin you're using. This is a great thread to start you out: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139. There were little things I didn't realize I was doing wrong (like shooting insulin back into the vial) that the forum helped me out alot with. Also, if you can get a spreadsheet going you can post there for dosing advice: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207&start=0. The people there are incredibly experienced with this insulin and have helped hundreds of cats into remission. There's been a bit of technical difficulties saving the spreadsheet lately, so if you have trouble just post back and I can give you the workaround.
 
Here's a link to the spreadsheet workaround in case the other link doesn't work: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=46476

I second trying the fortiflora with wet food. It contains the same flavoring that manufacturers put in dry food to get cats to eat it, so it's a great place to start. It's also a probiotic, so it will help prevent any upset stomach/loose stool problems that can sometimes temporarily occur with a food change.
 
Thanks again everyone. He is currently on Purina DM (I always get that and Science Diet confused), which I just noticed is 18% carb. which is probably making a huge difference!!
He didn't like the canned food I tried him on before but that was a few years ago before he had diabetes. He always comes running when I get the can opener out but is then disappointed when it isn't what he thought ?? making me believe he use to be on a wet food he enjoyed at least.
I'm going to buy some wet food and drop him back to 1u tonight. I am rescheduling a teeth cleaning as soon as I can find a job! :(
Thank you, thank you, thank you!
 
Here's a link to the dosing protocol for Lantus: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

It's the same one cited in the study I provided for you. Dosing increases are done in .25-.5u increments, usually on the .25u side unless the cat is really high, and once the dry food is removed and dental or infection problems are resolved, most cats don't need that big an increase because they usually don't need more than 1-2u at most.

Get that spreadsheet up and then come get advice in the Lantus forum! http://www.felinediabetes.com/FDMB/viewforum.php?f=9 It is a wonderful resource and it's great to have someplace to ask questions until you can absorb all the information.
 
Hey all, I'm at +3.5 hrs from Mr. Howell's last 4units. He was at 283 and is down to 223 now. I'm going to start him on a 1/2 wet/dry mix tonight at his usual time and do the BG test before and let you all know how it goes.
 
Hey everyone again. I am +9 hrs from Mr. Howell's last shot (4u 9:45 a.m.) and he is creeping back up to 315. I'm wondering if I should give him 3.5u early tonight since I assume he's just going to keep going up until his next shot around 9:30. This is where I get messed up, because he goes up and down all over the place.
I was planning on starting a new post tomorrow morning on the Lantus thread, I just thought since my info was here from today I'd post again.
 
Lantus works best if the dose is consistent.... jumping from dose to dose will cause ripples, NDW, new dose wonkiness, so if you change the dose, you can expect to see a bit of odd numbers as the dose settles.

As you cut out the dry foods and increase the wet, you may find that you need to lower the dose.
How often are you feeding? You may also find more level numbers with more frequent, smaller meals.
 
I am learning that the 12/12 frame is much more precise than I originally thought -- again I was going off of what my vet said, and he said there could be a TWO HOUR leeway in either direction (from 8-14 hours after the first shot)
From now on he's getting it at 9 a.m. and 9 p.m., no exceptions.
I feed him twice daily when he gets his shots, 1/4c twice daily. He usually does not eat it all at one time and prefers to snack during the day, so I can see how that might mess up his levels.
Just got back from the store with Fancy Feast Classics (the >10% carb/gluten free) to mix with his current dry Purina DM tonight. And I will wait until 9 for the shot for the sake of consistency.
 
Okay gang. He's doing better already (I hope!)
1/2 hour before I gave him his 3.5u he was at 388; after a delicious meal of 1/2 wet/dry mix (which he LOVED, I was surprised! he sat down on the floor afterwards and just purred!). It's been +2 since his last shot and he is down to 287. Down 100 in 2 hours, I am so thrilled!
Thanks to everyone for their support and advice. I will start a new post tomorrow on the Lantus thread. I am so glad I found this forum, my stress level has already deflated!
 
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