Uncontrolled 11 yo male cat on Lantus and Novolin

Status
Not open for further replies.
C

catgirl2013

Member Since 2012
I have an 11 y.o. male neutered Abby with high glucose numbers (off the AlphaTrax 2 meter) on 2 units Novolin and 3 units Lantus 2x day. He was ADK and hospitalized for 9 days. He had a UTI but has
cleared up. He has no pancreatitis and ab. ultrasound and chest x ray was ok. He is eating and drinking and grooming but glucose is over 600 in a.m. before he eats and has his insulin. We are consulting a DVM board certified internist with lots of experience with this matter and have consulted with Dr. Feldman who is an expert in the US with animal endocrinology and he is stumped. Supposedly my cat was building up anti-biodies to insulin. He started on PZI and then went to Levemere. The vet switched to Novolin and Lantus because the PZI and Levemere were not working When the 12 hr glucose curve was done on Dec. 24, the numbers were in the 200s but have shot up again. He is eating DM wet food and some KD dry food (1/2 c or less per day). Any one else had experience with insulin resistant felines? Am I right to be upset? It has been 2 months and seems like a roller coaster ride. Thanks.
 
1) ditch the dry food - it is a water-depleted diet that puts a strain on the kidneys and except for about 4 varieties, has over 10% calories from carbohydrates.

2) aim for a low carb, over the counter, diet - see Cat Info for a food list

3) Is your vet familiar with AAHA Guidelines?

4) there are certain high-dose conditions - acromegaly, IAA, and Cushings - and we have a forum for these

What schedule are you using to dose the insulins?
 
There are a couple of tests that can be run for high dose conditions, but 3 units of Levemir bid is not actually that high. I'm a little confused by your insulin regime - perhaps others are familiar with this protocol.

DM wet food is not the best for a diabetic cat, and the dry food definitely will be too high in carbohydrates and contributing to the high numbers. If you read through the nutrition section on catinfo.org you will find a wealth of information about the types of food that cats need and a comprehensive list of wet cat foods available in North America. Choose any of the foods that are less than 10% carbs - and lower is better.

If you wish to ask the specialist about the tests, one is called IAA (insulin autoimmune antibodies) and the other is IGF-1 which is a test for acromegaly. Frankly, I don't see the need for these at the moment. If you have only been treating for 2 months, it may just be a matter of settling into a routine with the right food and insulin dose.

And good for you for testing at home. This is the most important thing (besides insulin) that you can do for your cat.

Are you able to share your curve numbers, and other pre-shot numbers? This will help others to give you suggestions.
 
Three different insulins in 2 months? None have them have really gotten a fair trial by switching so often. Considering that he is eating some dry food, his insulin needs may be higher than some cats. The Novolin is probably the worst choice of those 3.

It takes time and patience to work out the right dose. It rarely happens in a couple of months. I would suggest going back to either Lantus or Levemir and starting all over again.
 
I agree with ditching the dry food! Definetly check out the cat food list, we feed strictly fancy feast low carb and the cats love it. I don't understand the use of novolin and lantus at the same time? I would be confused too. Are you home testing?
 
So your vet has never tried one insulin on its own, he's always had you using 2 insulins at once? What is the reasoning? Because I've never seen that except for very experienced people who have been treating their cat for a while using a short acting along with a long acting. Using 2 long or a long and a medium seems odd and I can't understand where your vet would have come up with this. It seems like the logical conclusion would be that the cat would build up antibodies because its getting such a weird coctail of crap thrown at it, it doesn't know which insulin to use so it fights them both. It sounds to me like you have a couple of high-credentialed people experimenting on your cat with unproven methods. I would start over using 1 long lasting insulin and get rid of the dry food.
 
Could you tell us a little more about how the dosing was done when your cat was on Levemir and PZI? What dose was your cat started at and in what amounts were doses raised? Do you have any test data, especially home testing data that you can share with us.

I'm most familiar with Lantus and Lev. With these two long-acting types of insulin, doses should be raised by no more than 0.5u. The dosing protocol for Lantus and Lev take a very systematic approach to dosing so you do not end up giving too much insulin.

Depending on whether you've been home testing and especially if you've not been home testing, it's entirely possible that you have a high number, give a dose of insulin, numbers drop (which, if you're not getting any spot checks you don't see the drop), and by the next time you're ready to give another injection, numbers have spiked back up. This isn't a matter of insulin resistance. It's your cat's liver and pancreas kicking in and dumping a stored form of glucose into his system along with counterregulatory hormones.

With Lantus and Lev, consistency is also important. You need to be giving the same amount of insulin at your AM and PM shots and you need to be giving an injection as close to every 12-hours as possible. Frequent changes in dose and in shot time can yield wonky numbers.

For cats experiencing high numbers, a basal insulin (e.g., Lev, PZI, Lantus) coupled with a shorter-acting bolus insulin (usually Novolin R or "Regular" insulin or Humulin R -- they are all the same) is not that uncommon. It's just another tool that some vets use and some members here use, as well. If you are using R, I really hope you're home testing. It's a very potent insulin. 2u of Novolin is a huge amount. It's entirely possible that the amount of this short-acting insulin is what's contributing to the problem. However, it would be very helpful if you had home test data that you could share with us so we have a better sense of what's going on.
 
Thanks for the info about the dry food. I agree -- cats are carnivores! My Abby was hospitalized because he did not respond to PZI at all and became AKD. When he was receiving insulin IV, his numbers were in the 200 - 400 range. When he was tried on Levamere, via injections, his numbers soared into 500- 700 range. The DVMs we are using see hundreds of DM cats a year so they have plenty of experience. My cat is now getting 2 units Novolin and 4 units Lantusx 2x day because his numbers are now off the glucose reader and the DVM suggested these doses after 2 months of tinkering. We test at 6 a.m. and 6 p.m. everyday, but the poor cat's ear veins are getting stripped out. We do not want to hurt our cat but we want to get the readings, too. The cat was first tried on PZI and did not respond at all. We then tried Levamere with the same results. On Dec 22 my cat developed UTI which can surely mess up glucose readings. He took an antibiotic for 10 days and looks and seems much better but readings still too high. We will get another glucose curve tomorrow and report back. The short term and long term insulin were recommend by his DVM DIVM upon hospital release. My cat has seemed to have confounded 4 top specialists and his two human owners. BTW- he gets his food and insulin at the same time each day 6am and 6pm and the insulin is injected IM.
 
Its pretty unusual to inject the insulin intramuscularly rather than subcutaneously.
 
I agree with ditching the dry food. No acromegaly or Cushings found. No pancreatitis. Will ask about IAA - good idea. Dosing of insulin is consistent 6a.m. and 6 p.m.
 
catgirl2013 said:
Why is Novolin a bad choice for shorter acting insulin?
Click to expand...

Typically, only 1 insulin is used at a time in the absence of other medical problems.

The N (Neutral Protein Hagedorn) insulins last about 6-8 hours, drop the glucose fast (which may trigger the liver to produce compensatory hormones and release glycogen which pops the glucose level back up), and when it wears off, it tends to do so suddenly. It is seldom used with Lantus concurrently as that isn't regular veterinary practice.

A concern when you are giving the N is if the low point in the N cycle overlaps the low point of the Lantus cycle; you run the risk of a hypo.

If lack of duration is part of the problem, you may want to read up on Levemir, which can last up to 14 hours in a cat.
 
Injecting into muscle may be your problem... some quick Google searches on it say that it can cause the insulin to wear off very fast... but I would not try injecting under the skin at that high dose, especially not with 2 insulins. Maybe you could try a subq injection of something like .5u or 1u of just Lantus for a few cycles and see what happens.
 
Subcu injections were NOT making a difference for my cat -- that's why we were instructed to do IM injections with the Lantus and Novolin. He does well when the meds are given IV but when they are given subcu, he does not absorb them very well. This is according to a Internal Medicine Diplomate DVM who has had yrs. of experience with DM cats. She states that my Abby is in the 10% of her toughest cases since she's been practicing. Levemer didn't work well for my cat and neither did PZI. He had another blood glucose curve yesterda y : High, 650, 450, 325, 200 and 125 when it was done yesterday.
 
I agree that IM is unusual but my cat never responded to subcu injections. In fact, my primary vet accused my husband (who is an expert in needle placement and an MD not DVM) of not injecting properly.
The problem is not too low blood glucose numbers but too high -- hence the suggestion by a DVM Dr. Feldman (he is an expert in animal endocrinology at one of the big CA state univs) to do IM injections. The DVMs do not think he is developing an immunity to the insulin now but rather there is a problem with absorption of the insulin. Apparently, cat's case is quite unusual and quite frustrating. According to his IM DVM yesterday, we are three quarters out of the woods. Hopefully, this trend will continue.
 
catgirl2013 said:
I agree that IM is unusual but my cat never responded to subcu injections. In fact, my primary vet accused my husband (who is an expert in needle placement and an MD not DVM) of not injecting properly.
The problem is not too low blood glucose numbers but too high -- hence the suggestion by a DVM Dr. Feldman (he is an expert in animal endocrinology at one of the big CA state univs) to do IM injections. The DVMs do not think he is developing an immunity to the insulin now but rather there is a problem with absorption of the insulin. Apparently, cat's case is quite unusual and quite frustrating. According to his IM DVM yesterday, we are three quarters out of the woods. Hopefully, this trend will continue.
Click to expand...

Maybe your cat just never got to his 'good dose'.

Both of my cats tested positive for acromegaly and one was also positive for IAA.
The first got up to a dose of 21u Lev twice a day and the other got to 37u Lev twice a day.
Acromegalic cats are not unusual.

Are you home testing? If yes, can you please post the BG numbers you have, and if not, it would be a good idea to start home testing.

Talk to your vet about having your cat tested for acromegaly and IAA. Once you have those results, you will know a bit more.

Yes, Levemir can be used with a fast acting insulin to pull down the cat's numbers so that the Levemir works better.... that's not a problem at all. Just the IM shots are completely unnecessary.... why hurt the cat?

here are the links to the tests you can have done
IAA Test
IGF-1 (Acro) Test
 
catgirl2013 said:
Subcu injections were NOT making a difference for my cat -- that's why we were instructed to do IM injections with the Lantus and Novolin. He does well when the meds are given IV but when they are given subcu, he does not absorb them very well. This is according to a Internal Medicine Diplomate DVM who has had yrs. of experience with DM cats. She states that my Abby is in the 10% of her toughest cases since she's been practicing. Levemer didn't work well for my cat and neither did PZI. He had another blood glucose curve yesterda y : High, 650, 450, 325, 200 and 125 when it was done yesterday.
Click to expand...

Why do you say that Levemir didn't work well for your cat? What was the highest dose you reached on that insulin? What was the highest dose you reached on PZI?

If a vet is accusing you of poorly treating your cat, maybe it's time to look around for a more compassionate vet office. Years of experience does not make one good at something.
Did you do the curve yourself at home or was it done at the vet office?
I am asking because one of my cats always tested much higher at the vet office but then she came right down at home.
If that curve was done at home, can you add what times those numbers were taken in relation to the insulin shot, and what was the dose given..... the numbers look like they fall straight down, so maybe it's just too much insulin being given and your cat is bouncing right back up high again. A typical curve, between 2 shots should look more like a U or like a valley with numbers dropping till about mid point or 6hrs after the shot and then slowly rise again to the next shot time. Your curve numbers look skewed like too much insulin, or maybe some fast acting insulin was given when it wasn't needed?
 
Your dose is actually pretty low for having jumped insulins so much and went to something like injecting the insulin improperly before trying things like raising the dose checking to see if your cat is a acro or high-dose cat and just needed more insulin. I don't really care what credentials a vet has unless they've tested your cat for these very common reasons for not responding to insulin and taken your cat up to the higher doses of insulin (at least 1U per pound of weight) before trying unusual/untried methods, I still say it sounds like they are just experimenting on your cat. There are tried, tested, and proven methods of treatment they have not tried with your cat. Why?
 
Status
Not open for further replies.
Back
Top