Update on Diabetic Cat

Hi all, it has certainly been a while since my last posting! Life has definitely been a maelstrom. I posted a while back with questions about my diabetic cat. It's been a while, but I've returned!

I continued to go to the vet, who expressed a differing opinion about how much insulin my feline friend should be getting. They advise I give up to 13U of vetsulin per day.

Do you think this is safe? I told them that his numbers didn't seem to go down even after a while, so I was worried about insulin resistance. The previous vet I talked to before mentioned that my cat may have another endocrinal condition (on top of his hyperthyroidism) that is characterized by such a feature (and other things he happens to uncannily check the list off of). I am worried that he may have this condition-- I don't mean to sound that I am trying to self-diagnose my cat either please do not misunderstand-- Rudy's thyroid levels have not been getting better either, and he has the physical characteristics and even with the increase in insulin I have never seen his numbers reach below 260's.

Sorry-- I haven't been on the computer lately, I usually write the numbers down in my notepad. I finished my conversation with the good doctor and just thought of the community that has helped me! I appreciate your thoughts. Does anyone else have a cat with hyperthryoidism or the like? They are telling me to increase with the following:

less than 75 stop insulin (karo syrup)
101-150 decrease by one unit
151-225 maintain dose
226-325 one unit increase twice daily
326-425 two unit increase twice daily

 

Without any BG data to go on, it is impossible to give any advice.

Are you testing before every dose of insulin? And do you test during the cycles to see how low the dose is taking the BG?
Are you still using Vetsulin?
I would swap to a more suitable insulin such as Lantus. Vetsulin is not recommended for cats.

Personally I would not use the scale of increases the vet has given you. Doing increases of 2 units twice a day is huge.
The condition your vet mentioned may have been Acromegaly. I will tag @Wendy&Neko as she has a lot of experience with Acro.
But we will need to see BG data to be able to help you.

 

At 13 units on a low carb diet, I would strongly suggest getting him tested for acromegaly. Extreme hunger is one of the common symptoms. There are treatments should he be tested positive for this condition. The test is a blood test sent to Michigan State University. The second thing I'd suggest is getting him on an insulin suitable for cats, which Vetsulin is not. At that size dose, Levemir is probably the best option.

 

Hi everyone, I hope it is appropriate to bump this thread despite such a long period of inactivity! I would like to update you on my situation. Unfortunately, after another unsuccessful visit at my vet, I have made the decision to find a new place to treat my boy. I asked about testing for acromegaly, as he has hyperthyroid issues, but they only told me to increase the dosage on his felimazole (he gets generic 5mg every day for his hyperthyroidism) and that he should be able to get 1U/1LB for insulin dosage and his numbers should drop... but they seem to drop for a little bit and then rise right back up!

I will test him before his insulin shot, 2-3 hrs afterwards, then before his next meal (usually at the 4.5-5th hour) to see where it goes from there... but it will go from high, lower a little, then high again! His appetite is voracious and if I don't feed him every 4-5 hours he starts to cry.

I am unable to get a vet appointment with the newest doctors until late into next month. I'm worried, as I still have Vetsulin, and the many second opinions I have received all seem to fall in the consensus that Vetsulin isn't very effective for diabetes. I tried to ask that maybe my cat could have acromegaly because I read that there is a characteristic of insulin resistance and it is a thyroid condition after all, so I asked it several times... and they told me that his thyroid levels increased.

Do you think if I contact this vet about my situation, they would be able to prescribe insulin? I usually get mine through the prescription service in Chewy and approved by the vet, but they believe Vetsulin is the best choice.

Thanks for all your help.
I've been reading more into it, and I appreciate all of the insight.

 

You do not have any recent BG in your SS. The latest is in 2021.
Please update you SS with recent BGs.

What was the last thyroid blood value and the corresponding range?

Acromegaly is due to a tumor on the pituitary gland when hyperthyroidism is due to problem with thyroid gland. The two are not related and are in different part s of the body

image from:https://catexpert.blogspot.com/2016/12/the-feline-adrenal-glands.html

 

It took a lot of convincing for me to get my vet to run the test for acromegaly. She also was a fan of Caninsulin/Vetsulin. I finally asked her to humour me, and even found the information she needed to get the tests run. Remember, you are the client asking them for services. You don't need their permission to spend money the way you want to. I found it help to give scientific articles to my vet. Maybe give your vet his one showing how common the condition is: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127794

There is some relation between the pituitary and the thyroid. One of the many hormones that the pituitary controls is the thyroid-stimulating hormone (TSH). A benign pituitary tumour can mean excess growth hormone, and that's what causes the acromegaly and diabetes. Like growing teenage boys, these cats are very hungry.

Unfortunately that's old thinking. We start a cat on a dose based on his weight, but what turns out to be a good dose for a cat has little to do with his size. I've seen large cats on small doses and tiny cats on big doses. What dose are you giving now?

 

Thanks for the information! Appreciate it. I will update my chart accordingly. Sorry for the delay!
Regarding his thyroid blood value and range... I do not know this information, they just told me his numbers were higher than usual and to increase his dosage for felimazole to a full pill twice a day with insulin shots.

His appetite is unlike anything I've ever seen before!

Like I said before, I will update my test results, but I've decreased from the larger 5U down to 3Ubecause when I went up to 5U and tested afterwards, my cat's blood levels were at a scary 59. He wasn't uncoordinated or showing any signs of distress, but I gave karo syrup and fed him just in case, and soon after, his numbers went to 197. I felt apprehensive about the vet's 1U/1LB advice, considering my pet lost weight from 12.5 lbs to 11lbs... 5U is a lot ...

Nowadays, his pre-testing numbers seem to be at the high 300's-400's every pre-insulin test, and then 2-3 hours after testing I barely see a dent in the numbers.

 

If you have the time, could you update your spreadsheet with the data from the last couple weeks? We might be able to help you with dosing. My girl, about 14lbs (part Maine Coon) had a dose that varied from a high of 8.75 units Lantus down to about 0.75 units then up to 7 and back down to 0.25 units. Her weight didn't change that much, but her body's insulin needs did over time.

 

Hi there, Thanks for the replies. I will update the chart.

Please forgive me for any holes in the data, as I will be adding more today. Here are his numbers as of recently... I can't understand how his numbers have gone up and stayed up this high despite given insulin. If anyone has any pointers please let me know!

I have been giving him 3U. Here has been his numbers as of the past few days... this has basically been the pattern for a while.
04/28/2022:
11A 334, fed
1P 343, given insulin shot 3U

4/29/2022
1:30P 439 3U
3P 467
5P 350

4/30/2022:
1A 468 given insulin shot 3U
5A 303
1P 346
3PM 344

05/01/2022
528 12P

He usually gets his insulin at 1P/1A and I try to test him throughout the day, but I sometimes wonder if I'm fudging it up somehow. Thank you so much for taking the time to read this; I've never seen his numbers so high before his test and he has been running around behaving like fine so I'm not sure what this could mean.

 

It'll be really helpful to us if you could get the data for the last couple weeks in the spreadsheet. How to Use the Spreadsheet

 

Okay, sorry for the delay, I will add the rest of the numbers I have in my document. I apologize for the inconvenience, but I'm having a little difficulty getting the spreadsheet readjusted to the current date. Additionally, I'm recording the information directly from my device.

In the future, I will be more diligent about using the spreadsheet. Please don't be too harsh for the sporadic testing - juggling work, academics, and a diabetic elderly cat has not been an easy feat. His numbers have always been within this range of the 300's, and after receiving the blood test when his result was 59, I slowly dialed back the dosing and asked for a second opinion because I was scared he would get sick. the 127 blood test is after I gave him some karo syrup and fed him a meal -- he didn't seem to have any symptoms and ate the food and syrup very quickly. I decreased from 5 to 3 in small intervals . He has been high ever since then ...

Spoiler: test results

03/18/2022
12P

03/19/2022
11A 320

03/20/2022
12P 284

03/23/2022
11A 320

03/22/2022
12P 340

03/24/2022
12P 387
03/27/2022
12A 333

04/07/2022
12P 319

04/08/2022
1P 280

04/09/2022
1P 331

04/10/2022
1:30P 294
** this is when I decreased from the higher 4.5-5 units down to 3 after the following shot and his blood level went too low
4:30P 59
6P 127

04/11
1A 346
4A 270
3P 474

04/12/2022
12P 438

04/15/2022
12P 515

04/17/2022
12P 170
3P 451

04/18/2022
12P 314

04/20/2022
1P 473

4/21/2022
1A 386
2P 431

04/26/2022
1A 397
1P 498

04/27/2022
1P 447

04/28/2022:
11A 334, fed
1P 343, given insulin shot 3U

4/29/2022
1:30P 439 3U
3P 467
5P 350

4/30/2022:
1A 468 given insulin shot 3U
5A 303
1P 346
3PM 344

05/01/2022
528 12P

I haven't been missing any shots, and I've been good on making sure that he eats his pill with his meal and insulin every time... Am I just not giving enough or is there a problem with how much I'm feeding him? I'm so sorry for all of the confusion. I feel like I'm ripping my hair out at all of this confusion. Thank you for your patience and understanding. What dose should I give him if I've been giving him 3U ?

 

I'm going to reiterate what Wendy asked. Please use our spreadsheet and enter Rudy's numbers there. For those of us to read spreadsheets on every cat we offer comments about, we need the spreadsheet data.

 

Also the last 3 numbers you have on your spreadsheet have no dates

 

In the process of adding the data from my Alpha trak device to the google doc. Using the spreadsheet is a little confusing still. Please bear with me. Thank you for your patience. For recent information as of the following days, I have it posted in my previous message .. currently reading your messages and feeling a little confused and overwhelmed with the amount of things I've been learning in the past few days -

should I just follow the vet's advice and increase again?

In the process of adding my dates sorry in advance. At the date where you see the lowest bg of 59 is when I was still following the instructions of the vet and maintaining the dose. I believe around that time he was doing 4.5U... at that point I noticed how low he was going and by then I began decreasing it from the 5U (I didn't want to go higher than 5U even though the vet said 1U per 1LB; I bought a scale and weighed him and he was at 11LB so I didn't think it was a good thing to keep increasing.)

for reference this is the numbers i was told to follow:

less than 75 stop insulin (karo syrup)
101-150 decrease by one unit
151-225 maintain dose
226-325 one unit increase twice daily
326-425 two unit increase twice daily

Sorry for the shifty numbers. I usually write the numbers and dates on papers and the whiteboard on the fridge, so I can coordinate his eating. He acts like he's hungry whenever someone comes into the room so we have a whiteboard to use to make sure someone fed him. I usually feed him a half can every 4-5 hours, and then we give the small chicken treats. Purina Friskies pates, fancy feast classic pates... and wellness core turkey + duck pates and those little packaged chicken filets as snacks when we test him and in between meals.

I have updated the list for more context, but I will continue to add more dates when I come back. Thanks for taking the time to look over it.
edit: the spreadsheet is still unfinished. i will have to add more dates when I come back online. thank you : )

 

Hi looking at your spreadsheet you should start with the date that is 12-17-21 that should be the first date on your spreadsheet then work your way down to 5-2-22
It's confusing to look at it the way you have it.
If you can't re do it let me know and I can tag one of our members to help you out

 

4 units is too much insulin, it got him down to a 59 on that AT which is way too low. That was a month ago, but I'd still worry with the amount of testing you are doing that you would be missing lows if you went up to 4 units again. We strongly recommend that you get a test before every shot, AM and PM, so you know it's safe to give insulin. Tests throughout the cycle will tell you how low the dose is taking your cat, and whether it's too much or too little (or just right) dose of insulin. We have a dosing method for people on Vetsulin which will explain our logic for dosing. You might want to read the following documents:

INTRODUCTION TO CANNISULIN/VETSULIN & N/NPH and
BEGINNER'S GUIDE TO CANINSULIN/VETSULIN

As Diane mentioned, we start with the oldest data first, going down to the newest data.

 

I'm so sorry for messing up the chart. I will fix it. When I come back from work I will be able to redo the chart going downwards.

Hi there, I've been more diligent with my testing so I hope to not have the testing issues in the future - sorry for the confusion going on in my chart, I will fix it. Currently reading the Vetsulin forum post- he is on a low carb diet so he should've started off with .25U and worked from the following guideline:

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
• HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.

Just tested him for the first shot of the day, and he was still in the 400's before giving him his snack. Could this be he's bouncing back from the high dosage?

Going to fix it when I come back from work. ..again
Thanks again for all of your help, it's been a treasure trove of knowledge!

 

Hey guys, sorry to double post. Just got back and thought it was important to share that from midnight today I have tested him a total of three times - before I gave insulin and fed him, then an hour or so afte. r his insulin, and then I had to go. I just got back from work and tested him and his number was at 290. I am currently in the process of revising the spreadsheet but he has dropped lower again. He still has a bit till his insulin test, but his blood sugar number as of now is 290. Before his shot this morning he was given 3U and his level was at 407.

I am hoping to finish revising it promptly
Thank you