Diabetic Again?

My male 10 year old was diagnosed in March 2009 with a reading of 23mmol/414mg. He had been on dry food up till then. That day I put him on canned-only and in 5 days he went to 13mmol/234mg. He needed the juice (Glargine) for only one month, at which point he stayed between 4.1mmol/74mg and 5mmol/90mg on diet alone.

The vet told me in the fall not to test him anymore (I had been still testing him weekly for the past 6 months at that point), so I stopped testing him.

In around January, I did something really stupid. I had some dry food left over and got into the habit of giving him a teaspoon a nite as a treat.

Last week I went to test him again and noticed that he is at 12.7mmol/228mg. I stopped giving him any dry bits and figured I would wait a couple of days and test him, expecting to see lower numbers.

48 hours later, he was at 13.7mmol/247mg. I gave him 1 unit. The next day the reading was the same, gave another. Today, he is up to 14.2mmol/255mg.

What doesn't make sense is that he isn't responding to the juice like he once did.

I am thinking that giving him even a little amount of dry (teaspoon at max) could have caused him to go back to being diabetic? Or could there be another explanation that is causing him to not respond - like infection?

(* he has no outwartdly visible signs, no real PU/PD etc.. and he is going to clinic tmmrw)

 

I am sorry to hear that your kitty is needing insulin again. Diabetic kitties go into remission when they no longer need insulin. This means that they are not cured and will always need a special diet. It is very possible that the little bit of dry food caused the higher numbers, but I wouldn't rule out infection either. I would definitely cut out all dry food/high carb food to start with. Also remember that Lantus (gargline) needs a few days for the shed under the skin to fill up. This has to happen before any of the insulin can be used by the rest of the body. It is likely that with Lantus you will not see a number change until around day 4 or 5. If you still see absolutely no change at that point, a trip to the vet may be in order to check his white blood cell count to rule out infection.

Are you giving insulin every 12 hours or once a day? If his numbers are remaining in the 200's, you really need to give insulin both in the morning and evening for it to work properly. Make sure to also check the expiration date on your vial (if it has not been used before now) and to check for any floaties or milky-ness.

 

just thought i'd let you know the exact same thing happened with me and tomtom. 30 day on the juice, then 2.5 years remission. i got stupid and gave him some hard kibble 'treats' almost everyday, just 15 or so.
we've been back on the juice for 6 months now. and it is a whole different dance this time around. he's very insulin sensitive and i have to give much smaller doses, plus he tends to carry it far past 12 hours. he's only high (230) in the amps really.
bummer
pass it on.

 

It looks like you are only testing once every 24-48 hours? I would recommend testing more frequently. Lantus is a 12hr insulin in cats so if you are not testing for 24 hours you aren't really getting to see what the juice is doing for him.

If you are only giving a shot once a day instead of b.i.d. I would suspect shed fill would be adversely affected too.

I'd recommend getting a spreadsheet set up, get some good spot checks throughout the day and get a condo set up in the Lantus support forum to get dosing advise from them.

 

That was a grave error I made, thinking that "just giving him a little", like 15 pieces or so wouldn't affect him. I still don't know if it did, as he hasn't had any for one week and his numbers still aren't going down. The first time (last year) when I made a change from dry to canned overnight, his numbers went down overnight - from 23mmol/414mg to 13mmol/234mg in 5 days.

Tomorrow I take him in for a workup, I think there has to be a reason he isnt responding. I've been only testing him every 24 hours as that's what I did last year, and then with the same numbers as now, he responded in 4-5 days on just .5 unit glargine. Now, its like 1 unit every 24 hrs isn't doing anything but bringing him up. I am going to test him every 12 hrs and maybe get them to run a new BG curve.

Kelly & Oscar: I got the Glargine March 09 and its exp date is May 2011. Its been in the fridge door and doesn't seem to have any thing visibly wrong with it - no crystals or murkiness etc.. And it still has that unmistakable smell too.

lori and tom: why is it that it is a "different dance this time around" for some cats in and out of remission? I wonder if there are any easy answers for this?

 

Melanie and Smokey: what does "I would suspect shed fill would be adversely affected too" mean?

 

well as far as the dance being different this time around and also about you not seeing changes when you dropped the kibble.
first i think when i 'reactivated' tom's diabetes by putting pressure on his pancrease like that i damaged it some. it all seems so innocent and un-dangerous huh? so now he has a sputtering damaged pancrease that requires smaller doses of insulin and yet can't pull itself together enough to be done with it. i've tried all different kinds of experiments with his dosing becuase i noticed he'd have basically the same #'s whether i shot him or not. (very wierd) i switched bottles, new strips...
if you happen to look at our SS the time he was really high during i think late feb was stress induced becuase of a stray cat that kept beating him up. horror story. good ending tho. so i never count those as 'real #'s' but it does show how much stress will raise the bg's.
good luck in LL

 

I agree that you'll want to give the insulin twice a day, to let the shed fill up and the insulin have time to take effect. You may want to re-read the sticky at the top of the Lantus forum to refresh yourself on how the storage shed works.

Also, while I'm not a Lantus user, my understanding is that the vial or cartridge can still 'poop out', even if it's still within the expiration date. If you don't see a response to twice-a-day dosing in the next few days and you have an unopened pen on hand, you might try switching to that.

 

I am testing and giving him dosages 2x/day now. I am still waiting on his lab results today, but the vet said that BG around 12-14 isnt too bad and she said its debatable whether or not he needs insulin. (I am guessing she doesn't believe in TR ) I mentioned to her that I had him at 77-80 before on average, and she said its too close to hypo.

I am going to set up a SS and keep to the sliding scale and TR for what its worth.

 

Given you opened that insulin 18 months ago, I would suggest that it might be toast and you should get another.

 

I am in a similar situation, Goodie was OTJ for 2 years then earlier this year she was back on it. I know some of the reason the numbers went back up was diet related, but in the past whenever she ate something she shouldn't have she always came back down in a couple of weeks. This time that didn't happen so we started insulin again. It has been 3 months and it wasn't until 1 month ago that we saw actual results! I was getting impatient and frustated. Her last Fructosamine (last week) came back in the normal range and now we are at low numbers that are to close to shoot insulin but not low enough as they were before. I am actually posting a new post in that regard shortly.
I would say give it some time with the insulin and keep a close eye as Lantus starts working all of the sudden and then we can get in our kitties in trouble...