Weight loss despite insulin increase

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pablo'smom

pablo'smom

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Hi everyone, sorry I have been gone for a bit but I just updated everything on Pablo’s sheet. It’s been a very up and down journey but 4 units of Prozinc isn’t doing much. I’m going to start 4.25 units tonight but I feel like I’m getting no where and the dosage seems higher than most cats which makes me nervous that we won’t find a dose that works. Also, I think he has lost a bit of weight. It is difficult to tell and he isn’t underweight but he lost more weight when he shouldn’t have which makes me nervous since he was a healthy weight. I know it’s because his diabetes isn’t controlled yet but it’s been a month and a half now and I feel like I’m getting no where.
 
pablo'smom said:
Hi everyone, sorry I have been gone for a bit but I just updated everything on Pablo’s sheet. It’s been a very up and down journey but 4 units of Prozinc isn’t doing much. I’m going to start 4.25 units tonight but I feel like I’m getting no where and the dosage seems higher than most cats which makes me nervous that we won’t find a dose that works. Also, I think he has lost a bit of weight. It is difficult to tell and he isn’t underweight but he lost more weight when he shouldn’t have which makes me nervous since he was a healthy weight. I know it’s because his diabetes isn’t controlled yet but it’s been a month and a half now and I feel like I’m getting no where.
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Until he gets into more normal numbers he probably won’t put on weight because he can’t absorb all the nutrients in the food.
How is his appetite? Are you giving plenty of snacks as well as the two main meals.?
You will find a dose that works for him. You just haven’t reached it yet.
 
First, breathe :bighug: Managing diabetes isn't going to be quick or easy. A few lucky cats may go into remission within weeks of diagnosis. Some cats may take months to become regulated, even to achieve remission. Other cats may never become quite regulated but it's not because you're doing something wrong. You can do everything FDMB recommends and still have a lemon of a cat. That was my first diabetic and now I'm on my second :facepalm: As long as the cat is otherwise happy and healthy, that's all that really matters :) Just take things one day at a time. If ProZinc doesn't seem to be working well for your cat and your vet has ruled out acromegaly or Cushings as the reason why the insulin dose is high with little effect on blood glucose levels, you may want to discuss using a different insulin with the vet. My first diabetic was on 3 different insulins before one finally worked to get blood glucose levels in a relatively good range.
 
Looking at your SS it appears you were getting lower BG at lower dose. However, it is not unusual for cats to change their insulin needs with time so maybe a higher dose is required. WHen increasing dose now with the BGs you are seeing and your specific BG results I would say increase via 0.5 units. Also, I would discuss w/your vert changing to another insulin like Glargine (Lantus is the brand name but generis/biosimilars are less expensive.

pablo'smom said:
I know it’s because his diabetes isn’t controlled yet but it’s been a month and a half now and I feel like I’m getting no where.
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It can take a lot of time to get goood BG number. For some of my past cats it has taken years. I adopted my Buddy in September and he is still not well controlled.
 
Bron and Sheba (GA) said:
Until he gets into more normal numbers he probably won’t put on weight because he can’t absorb all the nutrients in the food.
How is his appetite? Are you giving plenty of snacks as well as the two main meals.?
You will find a dose that works for him. You just haven’t reached it yet.
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He is eating a ton and is constantly hungry and tries eating human food now but I have him at 400 calories a day so he definitely is getting a ton of calories in. I’m just frustrated with how hard it is to control. I feel bad because he’s always hungry and begging for food even though he eats plenty and he’s so bony now.
 
Has his thyroid levels been checked? It could be that he also has high T4 levels, driving him to be constantly hungry while losing weight, and being more insulin resistant.
 
Do you know how much he weighs now and what weight he should be? Your vets office should be able to look at his chart and tell you what weight he was before diabetes and if that is a good weight for him or if he needs to be a different weight. If he’s losing and is thin I echo strongly that he needs more food, regardless of what calorie count is that you are feeding him because he apparently isn’t getting what he needs from it. Inadequate calories contributes to his ketone issue that I know you’ve been battling. Triple check the calories of what you are feeding. A cat losing weight when he’s thin needs more calories no matter what the calorie count may be

I have great empathy—my boy has an adrenal tumor so regulation is aspirational at best, ketones are a constant struggle, and I’m constantly trying to fatten him up (unfortunately he only has an appetite when his BG is blue which is rare). And btw it took a long time to see the occasional blue. I cried for the first two months solid.

I agree with those who said to test his thyroid if not done (I’d like to think it was during his hospitalization): hyperthyroidism gives cats a ravenous appetite, causing weight loss and making it very difficult to control his diabetes. It’s very common in cats. Also check his kidney function—it can cause insulin resistance and is also very common in cats. Not uncommon in diabetic cats is acromegaly and very uncommon in cats is Cushing’s, both of which can cause insulin resistance. I’m not experienced enough to say whether a change in insulin is warranted, or testing for acromegaly or Cushing’s but I’d say ask your vet.

finally, and this is in no way a criticism, I noticed the first few days out of the hospital were his best BG days. Perhaps triple check your storage and handling and administration of insulin. I don’t use prozinc (I may have used the experimental form of it long ago)—I think it should be gently rolled but not shaken right? Check the expiration date also. Make sure you’re using the correct syringes ( I think prozinc uses the less common U40 right?) and drawing to the correct line.

as one cat mom of a diabetic ketotic cat to another —good luck!
 
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I know they did a ton of lab work and I’ll double check with the vet but I believe his thyroid levels were normal. I know his kidney and pancreas were great. I looked into acromegaly but he isn’t getting bigger, just smaller so I’m not sure if it’s that. Also the reason his levels were so great right out of the hospital is because he wasn’t eating for days and just kept getting fluids so he had nothing in his system to spike his glucose. Once he started eating regular again the numbers went right back up. I have triple checked on date, storage, syringes etc. the only thing I can think up is maybe he has scar tissue that’s preventing the effectiveness. I rotate spots between right, middle and left side to avoid scar tissue and I pinch the skin to make sure it’s subcutaneous and I do the pat and smell test to make sure nothing leaked out. But for some reason his levels seem to be getting worse now. I’m going to give him more food at feedings to help with the weight loss. He is a big framed cat and was healthy around 14 pounds according to both his vet and the ER. He now is ~12.5lbs with muscle wasting.
 
Do we think he could be at a too high of a dose and it’s causing rebound? I’m trying to think of reasons his levels are worse at a higher dose.

Also, other than drinking and peeing a lot along with a crazy appetite, he is acting completely normal. Playing, energetic, affectionate and very vocal per usual so that’s good. I’m currently giving him 4 cans of FF pate a day with snacks in between feedings so I’m thinking of giving him 2.5 cans in the morning and then 2.5 cans in the evening to give more calories.
 
pablo'smom said:
looked into acromegaly but he isn’t getting bigger, just smaller so I’m not sure if it’s that.
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I've seen a research paper that said on 35% of cats diagnosed with acromegaly had clinical signs at the time of diagnosis. Neko didn't, just her dose size and one teary eye which the vet dismissed, but I later realized it was probably a blocked tear duct due to excessive soft tissue growth. She had crazy appetite too because acromegaly is a benign pituitary tumour causing excess growth hormone to be produced. Think teenage boys! Recent (well 10 years ago now), shows 1 in 10 diabetic cats has acromegaly. Not saying that, but excessive hunger in spite of eating enough is usually a sign of hyperthyroidism, unregulated diabetes or acromegaly, or a GI condition such as IBD or small cell lymphoma that means they can't absorbing the nutrition in their food. GI conditions should also be ruled out.

For food, the other thing you can look at is a food with higher fat content, but still low carb. Some kitten foods might fit that description.
 
I’m hoping it’s just unregulated diabetes but how do they test for acromegaly? He doesn’t have issues with diarrhea. He actually has had ongoing constipation issues that have been fixed with Miralax and have been a lot better recently.

also if it is acromegaly how do they treat it? Is it just monitoring since it’s benign?
 
GI issues can be vomiting, constipation, and even no visible sign other than weight loss. A full GI panel blood test is a good start to test for it, but will also need an ultrasound. Acromegaly testing is a blood test for something called IGF-1 (insulin growth factor). The blood is sent to Michigan State University, the only place in America that tests for it.
 
He has had numerous GI X-rays for constipation but no ultrasounds and I’m not sure all the blood work he’s had done because it’s been a lot but the only thing ever abnormal is his glucose. He never throws up (except when he was DKA) and he’s never experienced weight loss until his diabetes has gotten bad. He actually lost weight right around being diagnosed then put back on weight then recently lost it again. I can talk to his vet about it to see if she wants to do blood testing or wait until we try another type of insulin. I just don’t want to put him through a bunch of testing unless necessary because it stresses him out. If I do take him in though I’ll probably just have them take all his labs so this way he’s not having to go back and forth. Do regular vets send the blood to Michigan state for you?
 
A GI panel, such as the Texas A&M GI panel is not part of usual bloodwork. It can tell you such things as whether he's absorbing B12 (cobalamin) properly. GI x-rays don't have enough detail to tell you if there is thickening in the bowel walls.

pablo'smom said:
Do regular vets send the blood to Michigan state for you?
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Some do, some don't. Some rely on Idexx to do the sending, but then it adds a LOT to your bill.
 
I’ll talk to his vet and see. He is about 1.5 months into this journey so I think seeing what we can do with insulin first before ordering additional testing is the plan for now. I’m hoping we figure everything out soon.
 
I'd keep going on the insulin increases as per the dosing method. It's not a good idea to test for acromegaly until kitty has been on insulin at least 73 days. Otherwise about 1/3 of acrocats get a false negative on the IGF-1 test. And there are other reasons cats might not be regulated when under about 6 units.

Good luck!
 
Update: we ended up going to vet this morning because they wanted to run labs to just double check everything and to test for Cushings. He was a little dehydrated so they gave fluids. We get all the lab results back tomorrow so prayers it’s not Cushings and all his levels are good.
 
Does he have a pot belly? Any skin conditions or losing hair anywhere? Good luck with the blood work results.
 
I haven't noticed a pot belly or any skin/fur issues. Also, I accidently just gave a fur shot so now I feel really bad. They don't happen often but I was trying to avoid injecting near the where they gave fluids since he had a fluid lump today and I think I had a weird angle. Hopefully, it doesn't impact his numbers too much.
 
Good idea to avoid where they got fluids. That can impact the cycle and make it more active - not that it's a bad thing right now.
 
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