Diabetic cat question

[dbtoo]

I have a 14 year old cat who has been on insulin for 6 years. After the first couple of months of insulin which helped tremendously he had a history of having higher blood sugars but eating, peeing, drinking, acting normally. We finally go the numbers down to the mid to upper 200’s in the Fall by putting him on Lantas.

I took him in for his glucose curve this week. His first two readings before his morning injection were mid-400’s, he got his shot and next several readings showed that the blood sugar only came down to lower 400’s so it seems like the insulin was having no effect at all. Admittedly it was the very bottom of the bottle, but the bottle was only 3 months old.

What do you think is going on? Has the strength of the insulin weakened over the past couple of weeks? IS the cat is getting resistant to it? The vet is a little stumped.

I got a new bottle of Lantas and the vet wants me to increase the dosage by one unit per shot (he gets them twice daily). Do you think that is the answer or is something else going on?

The cat looks great, happy, good weight, shiny coat, eating, drinking, and peeing the same.

Ideas?

[anel]

How much insulin does your cat get? Insulin resistance is defined as over 1.5 to 2 units per Kg of body weight. He would have to be getting a significant amount of insulin before I would say we are resistant. If he is getting over this amount, work up for reasons for inadequate control would be recommended.

Lantus is only approved for one month after it is opened. Due to the cost people will use it for longer periods of time. Most of the time this is fine if it is refrigerated. Trying a new bottle is probably a good idea.

Any type of concurrent illness can cause a relative insulin resistance. If the new bottle does not help and if you cat is on a resonable dose of insulin it is often worthwhile checking for a urinary tract infection, hyperthyroid etc.

I am glad that you cat is othewise doing well. Most likely the dose just needs to be adjusted. Cats often need curved every two weeks for a few months to get maximum control.

Hope this helps

[HenryisBlaisin]

Are you home testing his glucose? If you are not (and many vets don’t encourage it), you really need to be. Stress raises blood glucose; in some cats, it raises it a LOT (and for a small number of cats,it can lower it). A curve done at the vet’s is not particularly accurate for this reason, and dosing based on a curve done at the vet’s is not a particularly great thing based on this. It may be that your cat is getting too much insulin, which can result in a high blood glucose as the body tries to compensate for the overdose. (Research Somogyi rebound) You can use a human meter (Walmart’s Relion brand is reliable and has the cheapest test strips. It’s what I use; you do NOT need the expensive monitors that vets try to sell you!) With Lantus, it’s extra important to home test as it’s the low point int he cycle, or nadir, that determines the correct dose, and Lantus kitties seem to not show signs of hypoglycemia until it’s very severe and a huge emergency.

Also, what are you feeding your cat? Studies show that a low-carb, all-wet food diet is by fat the best for diabetic cats. However, if you switch to this type of diet, you will likely need an immediate reduction in insulin as it will dranmatically reduce blood glucose levels. My cat went from a BG of around 400 to around 200-250 JUST from the change in diet. So if you do switch, and you should, you need to talk to your vet about dosing. This site provides excellent information about controlling diabetes with diet, and also has a link to a chart that has the actual carb values for many canned and dry foods (the guaranteed analysis does not give adequate info about the actual % of calories from carbs).

The most recent studies indicate that the Rand/Roomp protocol for Lantus dosing is the most effective method. You can print it out and give it to your vet.

This Website Has been a HUGE help to me since my cat was diagnosed. There is a wealth of information from both people with years of experience with multiple diabetic cats, and also some vets who post. It is a Godsend for me!

Here is a link to the Rand/Roomp Protocol. There are other sites that describe it in layman’s terms, but this one is easy to follow and can be given to your vet.

Many general vets are not particularly versed on the latest information about feline diabetes, and by doing all the research you can and insisting that your vet work with you on home testing and diet (remember that many vet school nutrition seminars are sponsored by pet food manufacturers-of COURSE they’re going to tell vets that their RX foods are best, when they often are not). If I had blindly followed my vet on dosing, my cat might not have survived as he drops to dangerously low numbers on even a quarter unit. If I had not been testing at home, I would not have caught these until he started showing symptoms. He is doing great on a tenth of a unit. My vet couldn’t believe it took such a small dose.

ETA: Lantus should last 3-6 months if kept refrigerated, but if you notice that it’s not working when it was before, it’s best to replace it. The 28 days is a very conservative estimate and is for unrefrigerated insulin.

[JB]

I knew you’d get some really interesting and helpful replies

If you decide to go all wet and low starch, Wellness (all wet is grain free) is quite nice

[Horsegal984]

Go to the lantus pens! Much more effective dosing, and they do not have to be treated as gingerly or refridgerated. And in the long run they usually wind up being just a little cheaper too!

If your kitty gets stressed at the vet (and who doesn’t!!) check a fructosamine as well, because that will show an average control over 2 weeks as opposed to a single(stressed) day.

Katherine
Vet Tech

[HenryisBlaisin]

Agreed on the pens; I plan to switch to them, but, they still are only supposed to be good for 28 days if unrefrigerated. They will last longer refrigerated-usually you can use them until they run out.

Also, everyone I know who uses them still uses a syringe to draw and inject because the dosing is less accurate with the pen needle, and you can’t microdose unless you use a syringe; you can only dose whole units.

If you home test regularly, a fructosamine test is an unnecessary expense as you will have that data already. I don’t take my cat to the vet unless it’s absolutely necessary because it stresses him to the point of neurologic symptoms. I run daily spot checks of BG and weekly curves and email the spreadsheet to my vet. It saves the stress and the cost of the visit, and she’ll tell me if she needs to see him in person.

[Horsegal984]

Henry-

the pens last 30 days from the time each pen is opened, and since there is less volume in each pen, most of our owners are going through a pen a month. And at least here, 3 pens is equal in cost and volume to vials on lantus.

There must be some differing opinions on the accuracy, as the specialists here are recommending the pens for being MORE accurate than needles and syringes. However the micro dosing is a legitimate concern, although we have found that the few animals we have on the pens currently(2 cats one dog) are all well controlled by whole units, although we could just have been lucky with that small of a “test group.”

And yes, you’re very correct about testing at home vs fructosamine. If you’re comfortable doing home testing it is more informational, but for owners who are not we have been recommending fructosamine more now for cats, because they skew their curve results.

Katherine
Vet Tech

[HenryisBlaisin]

True, but the pens can last much longer if refrigerated. For me, a 3ml pen would last a long time. My cat, for example, is regulated at .1 unit…a full unit would send him into severe hypo. Most people I’ve heard from think the pens are less accurate, but love them for their smaller size. I plan to switch, especially if i can find a pharmacy who will split a box as they would expire before I could use them all.

Also, the Rand/Roomp protocol (see the above link), which has an 84% remission rate, requires being able to microdose, as it recommends increases of no more than half a unit at a time, and that much only in rare circumstances. As recent studies have shown this protocol to be the most effective, it’s what many vets and owners choose to go by. IMO, a full unit increase could be very dangerous for some cats. If you haven’t checked out the protocol, it’s an interesting concept, and IMO, well worth introducing to your vets if you haven’t. I showed it to my vet along with the other research I did, and it’s been amazing for my cat, though his hypersensitivity to insulin may mean we never achieve that tight regulation ourselves.

[anel]

A fructosamine is a good test but should be reserved for cats that are generally well controlled. It is probably not the best test for a cat such as the one the that was initially asked about. The problem with the fructosamine is that it can read high (indicating not enough insulin) in a cat that is actually getting overdosed. This happens becaues of the somogyi effect mentioned above in another post. If, for instance, your cat is getting too much insulin and the glucose drops to 40 (or less) the body is going to overcompensate and cause the glucose to rebound to a very high level. This will likely happen daily. When the fructosamine is checked it is basically an average of the previous few weeks. The fructosamine, in this case, will often be high because of the somogyi effect. As a result the insulin is increased by the veterinarian. This results in an even greater overdose. Eventually the overdose will be severe enough to cause symptoms and your cat could end up in the emergency room.

I am not saying that a fructosamine is not a good test. It is a good test in the correct situation but should not be used to replace the curve. Home curves are a good idea to reduce the problem of stress.

lots of good information from several posters!!

[dbtoo]

Thanks everyone. Those are some great ideas. I wll discuss the rebound idea with the vet.

The cat is going back to the vet tonight because of some digestive problems he’s has ever since the last visit. Could they be related to the insulin?Maybe he picked up a bug while there all day?

He sometimes gets cooked chicken because of the high protein content. I microwave it for 8 minutes so it is well cooked. The past week the meat was just slightly pink in parts. Could he have gotten Salmonella from that?

[tarynls]

In our clinic, we would put hard-to-regulate cats on PZI insulin with great results. Here’s some info:

http://felinediabetes.com/pzi.htm