? Teddy's insulin requirement is still going up

Sher (Teddy)

Sher (Teddy)

Member Since 2021
Since my last post at the beginning of December 2021, Teddy was diagnosed with a dental infection and treated with a Convenia injection. He was also transitioned to a homemade cooked poultry diet supplemented with Alnutrin. Clinically he is doing well, with good activity and much less vomiting than when he was on low carb Friskies pate canned food. However, his insulin requirement continues to climb. The vet wonders if his increased weight is playing a role. Teddy is at baseline a 14-15 pound cat. When he was diagnosed with DM, his weight had dropped to 12 pounds. He regained the weight he lost after starting insulin glargine but has overshot and ranges 16-17 pounds now. His sodium/potassium balance is normal, thus decreasing the concern for hyperadrenocorticism. Thyroid was normal last year. His kidney function is normal. He has not been evaluated for acromegaly but lacks the clinical features. His cholesterol, triglycerides, and pancreatic enzymes are a bit elevated. My questions:
1. Does he have chronic rebound hyperglycemia? Is his current insulin dose actually too high?
2. Does he need a different type of long-acting insulin? He is now at 4U twice a day, whereas last year he was averaging 2U twice a day.
 
Hi. Your dosing makes no sense. When the BG is in the 50’s it means getting too much insulin. You need to decrease and see how he does for more than a cycle or day. Have you read out dosing methods? Please read them and I will be back in a few minutes. I’m on my phone now and need to finish drying my hair.
 
When he goes hypo, yes, I decrease the dose. Then he rebounds for several cycles, necessitating an increase again. I usually split the difference between the dose that caused the hypo and the prior reduction. But if you look at his SS, he then requires more insulin. This is why I am wondering if I am chasing chronic rebound hyperglycemia.
 
When I clicked on the spreadsheet it went to 2021. When you are able would you switch that is the 2022 is the first to the left. I was on my phone and didn't catch that. Now I see the correct one. With TR you need to increase every 6 cycles now that you have seen blue and green. You actually are holding the dose too long. Actually the opposite of what I wrote is happening. On 2/4 you reduced which was the right thing to do but once thence cleared you should have gone back up sooner. With TR tif a reduction fails, you go right back to the last good dose. You just saw your first green since then and he is bouncing because I think there is some insulin resistance going on from being too high too long. I would have increased on 2/8 because you were not seeing any green. I would increased to 4.25 tomorrow unless you see green or low blue tonight.
 
Looks like when I click on the SS link in my signature it still shows 2021 to the left of 2022, although in my goggle docs it shows the reverse. Not sure what to do with that.
 
No, he has not had a dental cleaning. At last visit vet treated his dental infection but wasn't pushing for a cleaning since the rest of the teeth looked good. I plan to bring Teddy in for a visit to check his teeth and talk about a cleaning.
 
Needing a dental is one of the leading causes of a cat being hard to regulate.

When I look at your spreadsheet, I see a low of tests at +6. Is there a reason you are always testing then? Nadirs can and do change around. Getting an earlier test, like a +2 or +3, can give you a clue of what the cycle will look like, and whether you need more testing that cycle. I'm a little worried that if you wait until +6 to test, you could be missing lows earlier, such as might have been the case on Feb 4th.
Sher (Teddy) said:
He has not been evaluated for acromegaly but lacks the clinical features.
Click to expand...
So did my girl. In fact, only about 35% of cats show clinical signs on diagnosis of acromegaly. Neko's only signs were her dose, crazy hunger, and one tearing eye that we later clued in was due to soft tissue growth in her tear duct. I'm not saying you need to test your cat for acromegaly at this point, we usually don't suggest it until kitty gets to 6 units, or if a caregiver has a reason to suspect it earlier. IAA (insulin auto antibodies) is another secondary endocrine condition that can cause a need for higher doses.
 
I feel like something is amiss given that Teddy is requiring double the amount of insulin he did a year ago. Vet is young and eager to learn. He's been very supportive of everything I have wanted to try to get Teddy regulated. I am lucky to have a good partnership with my vet. I will scramble up the sugar checks and make an appt with vet.
 
A cat's insulin needs can change over time. An mouth infection is a common reason. So are many other secondary conditions, so keeping up on senior blood work is a good idea.
 
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