Cat (named Cooper) is insulin resistant?

New to forum, which I discovered researching my issue. My cat is a 5-6 year old male (orange-white mix breed), which we adopted from a local shelter. Cooper is a house cat and has been on a diet of Blue Wilderness High protein dry food with 1/2 can of wet cat food daily. He began showing signs of trouble about a month ago and a trip to the Vet verified he has severe diabetes. Cooper had weighed 15 lbs two months ago, but is now at 13 1/2 lbs.

Vet put Cooper on 2 units of NOVOLIN U100, but there was no change in Glucose level when tested a week later...Vet increase dose to 3 units, then 4 units a week later when glucose was still high at 520.

The Vet then had me put Cooper on ProZinc U40 starting at 4 units using the U40 syringes...I have seen no change in the amount of urine in his sandbox, which I clean at the same time each day. his activity remains low and sleeps most of the day.

I have been very careful to follow all the procedures in giving Cooper his shot every 12 hours and after his has eaten. I am scheduled to take him back for a Glucose spot-test in two days, but know what the results will be based on what I see at home.

Upon reading post here on the forum, I am thinking he may be getting too much insulin or the diet should be change to 100% wet protein diet understanding that this has to be done gradually.

I am thinking about going to Walmart and getting a test kit to do Cooper's test myself as I am losing confidence in the vet resolving Cooper's problem unless he is really insulin resistant and there is no hope.

Any advise would be appreciated.

 

Welcome, Jerry and Cooper. You will definitely want to start home testing. Getting a random reading once a week is not enough to tell you what is going on. It could be that the dose is way too high and that his BG level is going very low then shooting up very high ('bouncing'). It is recommended that you always do a pre-shot test, being sure to take up any food two hours before the test. Then, get mid-cycle tests as you can to see what impact the insulin is having. To me, it sounds a bit aggressive to have gone up in dose three times and changed to a different insulin all within one month. Is your current ProZinc dose 4 units twice a day or 4 units total in a day (2 units twice a day)? ProZinc is normally started at 1 unit twice a day and increased in .25 or .50 increments as needed.

A 100% wet food diet is best, and as low carb as possible. The cat food database is a great resource for finding food options.

You can get a lot of assistance here, but even more so if you can take some time to set up a signature with some basic info in it (so we do not ask you the same things over and over) and a spreadsheet for tracking Cooper's BG levels and doses once you start home testing..

 

Welcome Jerry and Cooper! I like your plan to start testing Cooper at home. It will be the best tool you have to keep Cooper safe and to get him regulated.

Diet can have an amazing effect on BG and in some very fortunate cases, cats have been known to go into remission from diet change alone. That said, because a change to a wet diet can be so effective at lowering BG, it is really important to be testing before making the diet change as it will result in Cooper needing less insulin and the change in dose needed may be substantial.

Your vet started Cooper on a larger dose of insulin than we would recommend (usually about 1 unit to You've obviously been doing some reading and understand that too little and too much insulin can look exactly the same.

The other problem is that most cats get stressed out at the vet's office and that alone can cause elevated BG by as much as 100 points (based on US BG measures) and occasionally even more which leads the vet to think the cat needs more insulin than they really require.

If you are in the US, many folks on this forum use the Relion Micro or Confirm meters available at Walmart. There is also a Prime meter which is fine but does require a larger sample of blood which can be problematic for some cats and caregivers and sometimes causes wasted strips due to the inability to get a large enough sample.

 

Thanks for fast response... To answer your question, the Vet said 4 units twice a day of ProZinc, which I can only assume was because that is the amount Cooper was getting before with U100 insulin... Should I start over with 1 unit twice a day now?

 

Thanks so much for your quick response..I will go with your recommendation on Relion Micro and will get up to speed on how to use tomorrow.

 

That does is a super high. I am not a vet nor have I been at this long enough to feel comfortable telling someone what to do, however, I will say that it if was me, yes, I would absolutely start over with 1 unit twice a day and do home testing. The American Association of Animal Hospitals says, "The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat's lean body weight. This equates to 1 U q 12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours." They say to decrease/increase dose by .5 units based on BG testing results. I see most people here recommend dose increases in .25 units, and I am finding for myself that just that small of an increase can make a difference.

 

This makes sense to me...if anything he will just have higher glucose until I can find the right amount by slow increases...I am not looking forward to the getting blood from the ear that often a day, but understand why it needs to be down.. Again, thanks for your input and I have my fingers crossed with this.

 

If you've been giving 4U twice a day so far, I wouldn't drop all the way back to 1U and start over unless you find out that he's dropping too low when you test

We don't usually recommend going all the way back down to the normal "starting dose" when a cat has already been given a higher dose because it can just end up taking longer to get back up to a dose that will work

I'd suggest dropping back down to 3U and testing to see what kind of numbers you're getting before reducing any further, BUT, if you get a Pre-shot test that's under 200, stall, don't feed and post for help

We use 200 as a starting place....as you get more familiar with how he responds to both food and insulin, that number can come down

 

Chris has been at this much longer than I have been, so her advice should get more weight. I think the most important thing is to start testing ASAP so you can see what the dose is doing - then, it should become clear whether adjustment is needed.

 

Trying to start testing this morning and spent an hour reading all the meter and lancer instructions, then could never get any blood from Cooper's ear.. poked him 5 times and stopped...did the ear warming, set the adjustable depth to 3 as suggested on a video in forums and using a 28 gauge lancer as recommended...

Gave Cooper just 1U this morning at 7am ... He is really is just laying around and sleeping, so need to get this testing figured out soon.... very frustrated at this point.. Will do some more reading on test sampling technique.

 

OK.. finally a blood sample from Cooper and he has been very patient with me...reading was 334 at 71/2 hrs since morning shot.... I will test again before the PM shot to see reading, which I suspect will be high and will boost dose to 1.5U unless you think I should do something different.

 

Congratulations and welcome to the Vampire Club! As you test more, Cooper's ears will grow more capillaries and it will get easier to get a sample. I think taking the dose up to 1.5u tonight is a good idea.

 

I had already started the 1u dose when I saw your post and did not have my home test kit then..On the 2nd cycle of 1u dose,Cooper had a 370 meter reading before PM feeding, so I did go with 1.5u dose...should I up dose if no change in AM test or go with the 1.5u for a few more cycles?

 

Will you be able to get a test somewhere during the cycle like somewhere between +4 and +6? That is how you see the impact of the dose you gave. Pre-shot alone does not show you that. For example, Mia had a AMPS of 365 the other day, and her PMPS that day was 355. Looks the same, but since I did mid-cycle testing, I know that she actually went down to 92 during the cycle.

 

Without more data, there's really no way to answer this 100%

If he's still eating the Blue Buffalo dry food and his AMPS is over 300, I think you could try 3U and get some testing in to see how it goes but you need to get rid of the high carb dry as soon as possible

Just getting the dry out of the picture will probably cause his dose to be reduced a lot sooner!

Now that you're starting to gather data by home testing, if he's getting too much insulin, we should see it fairly quickly

If possible, get at least a couple of tests on the AM cycle and at least a "before bed" test on the PM cycle.....that will make the decision on dose a lot easier

 

Cooper' reading was 9/13 AM was 358 and I increased dose from 1.5 to 2u before I checked my messages today...Will see what PM will bring....About he diet, I assumed the Blue 'Buffalo' Wilderness dry was high protien as that is how they advertise it...I dive him a can 3oz of Fancy feast with the dry, but will go out today and get a recommended can food , which should not be a problem for Cooper as he is a good eater.

Again, thanks for your feedback and help

 

Going to test the midpoints a few days as well..thanks for your input again

 

It is the carb content that is the issue. I think their dry is over 20% carbs. You want as low carb a diet as your cat will eat. Also, dry food is not the best option for them for other reasons, too. CatInfo.org will tell you all about it.

 

Have had some internet issues, so just got my spreadsheet updated...Cooper is on an all wet diet now and I just have get some chicken can food included in the seafood cans I am now giving him...The midpoint glucose readings today are encouraging from earlier test, but you can see how they climb up near end of cycle...Increase dose to 3u at PM shot 9/14 and will test him tonight at +3 PM ..His activity is better, but urination volume is about the same.

Question...What is the average dose of Insulin for a big cat to control diabetes? There must be a practical limit to where you assume the cat is insulin resistant? I assume when the insulin is working, the mid-range glucose samples should fall below 100?

 

The 100s sure look better than the 300s, 400s or 500s! Congrats on getting some movement. It is normal it to go up near the end of the cycle. It should be highest at pre-shot then head down until reaching the lowest point, usually somewhere around mid-cycle, then head back up. That is the 'curve' you want to see. Be careful about jumping up in whole units on the dosing. What you do not want to do is cause him to have too extreme of a drop. If that happens, you could trigger a bounce and send his numbers even higher. Once you have a bounce it can take a few cycles to clear. If you do not have pre-shot tests and mid-cycle tests, you will not realize that is happening and you may think his dose is too low because you just happen to catch a test when the number is high. Did you get a pre-shot test this evening?

It can take a few cycles for them to adjust to a dose, so you may need to be patient and give it a little while.

 

There's really no "average dose"....it takes what it takes, but generally, if you've started at a reasonable starting dose and gone up slowly, we'll suggest testing for acromegaly and insulin resistance when they're over 6U twice a day.

It will take time before you get anything resembling regulation, but eventually, yes, what we'd like to see is a Pre-shot below 200 and a nadir in the 50-80 range (on a human meter)

With him getting into blues today on the 2U, I'd make sure you get a "before bed" test in tonight, especially if you didn't get a PMPS

That 2U dose dropped him into pretty good numbers.....we don't want him dropping too far! Most cats go lower at night than they do during the day so that "before bed" test is really important all the time.

Getting a Pre-shot test before every shot is vital....it's the only way to know if they're high enough to give insulin at all....and then at least mid-cycle test on the AM cycle and a "before bed" test on the PM cycle will help tell us what's going on with Cooper

Could we get you to add some information to your signature? It's helpful to us so we don't have to go back and read all the other comments or ask the same questions over and over again. We like to have:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food currently being fed, any other health issues? and a general location

Then you add the link to your spreadsheet and "save"

 

Preshot test have become impossible for my because Cooper will not be still enough to draw blood.. His focus is getting food ASAP...I am running a 'curve' today at 2-hour intervals and the +2AM reading was 191...

 

You need those pre-shot tests though. Can you try not putting food out until after you test? (Assuming you are getting the food ready first, and he goes bonkers because he sees/smells it.) Or, if you have to, could you grab a quick test just as he first starts to eat? If he just started taking his first bite or two, you should be able to get a test without the food really factoring into the results.

Don't forget to keep your spreadsheet updated with your tests and doses.

 

By the way, you have to have a pre-shot test result to do a true curve. That is your starting point. Without it, you do not know what the full impact of the dose was. Your +2 was 191 but is that a drop? How much of a drop? You cannot know without a pre-shot test.

 

I give my cat a small amount of food 0.2 oz mixed with water and test him as he snacks. I have never been able to test him without distracting him with food.

 

I think you could start the testing process by giving a teaspoon or so of his food. That'll take the edge off and if you get a test in right away the food will not have affected the BG yet. It takes 15-20 minutes to hit the bloodstream.

 

Thanks for the advice on pre-shot testing.. I will try that at PM shot time.. Will have a towel rap and wife holding as backup, but she hates seeing Cooper get stuck

 

Aim for the least amount of restraint possible. Cats like to think everything is their idea!

 

I just saw your AM + 6 for today, 48. Yikes!

 

Yes that +6 today is a tad too low! How long ago did you take that test? If 20 minutes or more, i'd suggest you test again to ensure Cooper is not still dropping. You increased the dose by 1 full unit (50%) and we generally recommend increases/decreases of 0.25u at time to not bypass the best dose. And right now, it looks like the best dose for Cooper is between 2 and 3 units. Please let us know what his reading is now. We get concerned when kitties get that low!

 

If BG is still low, give Cooper some LC food and retest again 20 minutes later. You want to get his BG up to a minimum of 50 and preferably a bit higher (60 -70).

 

Think about what must have been going on with the poor baby when the vet had him on 4 units twice a day!! I bet he has bounced all over the place. (And, a bounce is probably coming after the 48 today.)

 

I don't want to think about what the 4units was doing to poor Cooper! Makes me angry when I see stuff like that but in all fairness I think sometimes vets get overzealous dosing so hopefully the caregiver will see some results.

I hope Cooper is OK!

 

I know! No spreadsheet updates yet. I hope Jerry checks in soon.

 

Updated spreadsheet...last two readings were 143 +8AM and 161 +10AM... I assumed about a 50 readings was ideal for the mid-point? ...So GREEN is bad ? .. should I not cut back to 2.5?? This is all very confusing now.

 

Lime green is too low. Dark green is ideal. If a lime green pops up it time to decrease the dose by 0.25 units. That would be 2.75 u for the next dose.

 

Is this still good advise? "It will take time before you get anything resembling regulation, but eventually, yes, what we'd like to see is a Pre-shot below 200 and a nadir in the 50-80 range (on a human meter)" Will be taking Pre Shot test here in an hour, so what should I do if BG is below 200u? should I go back to 2.0u again or 2.5u or skip a shot?

 

Thanks for feedback...I can guess at 2.75, but estimating already with this 40u syringe which only grades in whole units...

 

Make your best estimate of 2.75 u with coloured water in a reference syringe and use it as a guide. Consistency is more important than absolute accuracy.

 

Got BG preshot tested by giving Cooper a little food and ran the test 5-10minutes after he ate... Test results were 160u which is same as +10AM reading??? Read that under 200 at +12 cycle was good, but not sure this is good for Cooper yet.. Should I go ahead and give shot of reduce dose talked about or wait with shot?

 

No reply, so going with the 2.75u shot now...

 

This is from the Protocol for Prozinc on this site:
"The general recommendation for new diabetics is not to shoot a preshot under 200, but to wait 20 minutes (without feeding as food raises blood glucose levels) and retest. If the number is rising and above 200, then a shot can be given with perhaps a little less insulin given."

 

Too late, I fed him already, but have not given the shot.. Had to give him something in order to get him still to take the test and feed him rest after BG test.. So now what?

 

If you have plenty of supplies and can test tonight as long as necessary, I think you could give the 2.75, but if you're concerned, you could drop the dose back a little to 2.5

either way, you'll want to get a +1 and +2 tonight to see how he responds when you shoot a lower number

It's easier to intervene early (if you need to) than to chase the numbers when they're too low

 

I would probably test again (I think it has been over 30 mins since your test) just to make sure the number is rising.

I do not want to add to your confusion, but if it was me, I would drop to 2.5 instead of just 2.75. That was a HUGE drop for him this cycle. You really did not stay on 2 units long enough to get enough data to know what that dose would have done, and this cycle has shown that 3 is definitely too much. I would try 2.5 for awhile.

 

Oh, and it might be a good idea to read up on how to handle a hypo just in case he gets too low.
HOW TO TREAT A HYPO

 

and it's fine to let him start eating so you can get a test in....you might want to see if he'll eat something like baked chicken though so IF you get a lower than expected Preshot test, you can stall, don't feed him his regular food and test again in 20-30 minutes

A pure protein "snack" shouldn't raise his BG much .....what we're concerned about is getting a Pre-shot that's not influenced by food

Even if you feed him cat food, it still takes about 20 minutes for it to break down and get into the bloodstream, so a quick bite or two right as you test isn't terrible....but if you can find a pure protein he likes, that's even better

 

OK.. Thanks much for the advice... well see how it goes tonight...

 

I think this would be fine too

You'll see that even those of us that have been here a long time may differ in our opinions, so it's important to remember that it's always your decision in the end.

Do what makes you the most comfortable.....as you gather more data on him, it'll make decisions easier and easier to make going forward

 

Took a Preshot BG test an hour after he had eaten and his normal PM shot time.. BG was 361 so I gave him his shot with a dose of 2.5u ....

Question.. When you delay a shot, do you have to start a new 12hr cycle between shots? I could see where this could creep up over time to where one was having to give shots late after midnight if the answer is yes.

 

No. You have a little wiggle room with ProZinc. I believe that as long as the shot is within the hour you are fine.

I have had to adjust things by half an hour here and there to get back on track myself.

 

Because I have a very 'bouncy' kitty, I have to warn you that having gone so low, Cooper may bounce. You may see his numbers go up pretty high and possibly stay 'flat' for a period of time. That is a very confusing thing to see if you do not know what it is. It can take a couple/few cycles to work itself out. Just stick with your dose for awhile (unless, as discussed, you have a really low pre-shot test) and see what happens.

By the way, when do we get to see a picture of Cooper?

 

Sorry to post yet again, but I wanted to mention that you will want to put the 361 as the PMPS on your spreadsheet. You can put in the notes that it was 160 before you fed him and waited and so on. Otherwise, it looks like you gave the shot when he was at 160, and he then rose to 361 afterwards. Trust me.. that kind of stuff will get confusing.

 

another option is to work your way back to your chosen shot times.....by moving the next few shots 15 minutes per cycle or 30 minutes per day, you can get that time back in a few days

You should try not to feed him for the 2 hours immediately before Preshot times so you get a number that's not influenced by food....we usually expect them to be higher an hour after food (we call it a "food bump") and it's useful information to know in the future....knowing how much of a "food bump" to expect can help you when making a decision to shoot a lower PS number (like if you know he usually bumps up 80-100 points after food, that can make a difference if you're PS number is 150)

If you absolutely can't test without giving him something, try baked chicken or a little piece of tuna (or other pure protein) to distract him while you're testing

 

I only feed him twice a day, so he is really hungry at pre-shot time.. I took the suggestion to feed Cooper a small amount of pure-protein wet food (1 oz) and then BG test within 15 minutes of feeding..Tried to feed while trying to get a blood sample off a moving head is too hard for me.. After test, I give him the rest of his meal.

 

The little owl has flown away and a pictured of Cooper is here

 

Yay! Hello, little man.

 

He's very cute and looks like @Marvin's Mom - Nat kitty, the famous (seriously!) Marvin.

 

Cooper had a good Mid-point and I think the BG bouncing has settled down...Will keep him at current dose of 2.5u for now and let him settle in with the new diet and more active lifestyle.. He is laying on my keyboard right now watching me try to type...Thanks again for all the help you'al have given me, which my Vet would have billed about $10,000 for him time

 

I'm so happy for you and Cooper! It is looking good.

 

Looks good!

 

Nice numbers, love orange kitties

 

Did you know that Orange cats have their origins from the Vikings, who brought the breed back from trading trips up the Volga river in Russia and considered them good omens.

 

Need advice... Cooper's PM readings at +12 were low BG 119 and tested 30min later were 92, so I have delayed shot... Nothing had changed in dose, food or activity.. So not sure what is going on?? ...If BG goes up in a few hours, should I give Cooper his normal 2.5u dose or reduced about or just skipped this one?

 

Since you're using Novolin, you don't want to shoot anything under 200 because of the harsh nature of that insulin

Generally, if you're getting Preshots that are too low to shoot, it's a good indication that the dose is too high, so I'd probably skip tonight and if he's high enough in the morning, go with 2U and see how he does

Could you please add some information to your signature like:

Your name/cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health problems? and a general location

Having to go back and read the entire thread to remind ourselves of what's going on and this basic information takes a lot of time....and in a crisis, it's time we might not have.

 

Cooper is on ProZinc as of 9/12 .. will add that general information to Sig. ..Thanks for quick response.