diet

18 mos.since DXD and not any improvement with my Spanky. We have stayed with Lantus. Going from 1u. X2 daily to 6u. Xdaily. First had him on the canned Hills R/D. It was expensive and he didn't like it much. (consistency of baby food and gave him diarreha) Switched to low carb canned foods (he loves) only eats two cans a day. NO SNACKS. The vet keeps telling me I need him back on Hills cause it's low in fat. I told him I have done my homework and know its hi carbs. His BG is never below 250. He seems healthy, 12 yrs old. I am so frustrated and thinking I will just have to keep increasing the juice. What am I doing wrong????

 

Six miscellaneous thoughts:

1. Am I reading correctly that you switched from 1u twice daily to 6u once daily? 'Cause pretty much all insulins work best with twice-a-day dosing in cats, including Lantus. If you're dosing once a day, you might stop by the Lantus forum and re-read the stickies at the top of the forum. If you *are* dosing 6u once a day, I'd like to see you get some BG numbers for the Lantus folks, and I'd seriously recommend switching back to 1u twice a day and working your way up from there.

2. When did you open your current vial / pen /cartridge of Lantus? Some types of insulin can lose their effectiveness, and it's possible that the vial you're currently using is no longer effective. In which case, you'd want to start with a new vial. There's a sticky near the top of the Lantus forum on care and handling, to extend the life of your Lantus most effectively.

3. When did you switch to low-carb food? And, when you switched to low-carb food, what dose were you on, were you testing BG levels, and did you lower the dose? Do you have any recent numbers, and hopefully a recent curve? One possibility is that the change to a lower-carb diet reduced the need for insulin. But if you didn't catch the need to reduce the insulin, it's possible that Spanky is still getting too much insulin. I know it sounds odd, but too much insulin can cause high numbers; that's called rebound.

4. Does Spanky have any medical conditions other than diabetes? Some cats have problems that can cause pain, infection or inflammation, each of which can raise BG levels. If your cat has even a minor medical problem -- even something as minor as tartar build-up on his teeth, which can cause inflammation -- then that can increase BG levels and make it harder to get the diabetes under control.

5. Similarly, is Spanky is on any medications besides the insulin? There are some medications that can affect BG numbers and make it harder to control the diabetes. (The classic example would be some steroids.)

6. Finally, some cats have medical problems such as acromegaly or Cushing's disease that require large doses of insulin to bring their diabetes under control. While it's possible that Spanky may such a problem, those conditions are pretty rare; I think you should eliminate the other possibilies first, and only then consider whether Spanky might be a high-dose kitty.

 

Thanks for the input. I have had him on lo carb for the entire 18 mos. (-5.5 cans twice a day)
I DO dose him twice a day (6u.each)
I did replace the old vial last week just in case (no change)
I will check out the forum on Lantus. Could be he is rebounding like you said. I don't have a resent curve. That I should do soon. He is NOT taking any other medication or signs of any other illnesses. I am very strict with his diet. I am just at my wits end. I feel like I am failing him as his caretaker. But, I will keep my chin up and do more research!!

 

Hi,

Just to make sure, you didn't go directly from 1 unit to 6 units, did you? How long did you stay at each dose?

Odiesmom

 

I did the increase gradually over the 18 months. Is there a big diffeence in where I give him the shot? I usually do the nape of the neck. But, recently started the tummy. I don't think I am feeding him too much food. (2 cans daily) sometimes for a treat, I give half can of tuna. My vet is insisting that I switch back to the Hills canned. But, the list of carbs show there is 33% in each can! I just won't do it. BEsides, he doesn't like it. Today we are still shooting 6u. til I decide what to do.

 

Just as important as diet is hometesting. Have you been getting blood sugar readings at home or have these increases been done due to curves at the vet's office?

I feed two cans a day, but we break it out into four feedings. Feeding more often seems to keep my cats' blood sugar down better. Don't bother with script food, it's a waste of money. You'll do fine with food like Wellness canned, Fancy Feast canned (gourmet feast varieties) or even some friskies or 9-lives, depending on your budget. Most of my cats eat FF (Fancy Feast), one likes raw food also.

There can be a difference in where you shoot. I believe the absorption is slower in the scruff of the neck, which may be better for Lantus, but it would be best to ask that question over on the Lantus ISG (insulin support group). viewforum.php?f=9
While there, check out the stickies on how to store lantus, about the shed, all kinds of amazing information.

 

I do home testing, usually twice a day. They are always higher at the vets, but not alot more than home. I know stressing him out there will raise his BG levels. I will go to the Lantus forum and get some info there. I am careful to store the Lantus in fridge. I also thought it might be better to divide the cans into four meals. That's an option I will try!! Thanks!!

 

Hi -
There are some conditions that cause Insulin Resistance. Details are posted in the "High Dose" Insulin Support Group stickies (posts at the top of the list).

My Norton had a condition called Acromegaly that caused his diabetes. It is somewhat rare [ETA: when you consider the entire cat population], so we usually only test for it if the kitty is up to 5 or 6 units BID and still needs more insulin. One study in the UK found that 17% of diabetic cats had Acromegaly -- nearly 1 in 5.

Acromegaly and IAA (Insulin autoimmune antibodies) are diagnosed with blood tests - blood is drawn and sent to Michigan State Univ vet lab.
The Acro test costs $44 and the IAA test costs $14 or so. Your vet will charge for office visit / blood draw and cold overnight shipping.
Here is the link for the Acro test:
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401

phoebe

 

Hi Jennie,

It sounds like you are pretty much on top of things, and I am glad you are not listening to your vet on the food. Good job!

I would recommend you do post on the Lantus forum since you are testing. There is a sticky for how to set up a spreadsheet which might seem useless to you right now, but it WILL come in handy. It's much easier for us to point out things if we can see all the numbers at the same time. I do not mean that you need to go back and get all your past numbers, but the past few days would be a good start. Also we're gonna want to see any spot checks you can get, and it might seem kind of pushy at first, but it's how we can tell what's going on.

It's quite possible you do have a high dose condition going on. Here's why I say this: I do not hear you mentioning lethargy or other symptoms of overdose. Can you tell us a little about him physically? Is he heavy, skinny, medium weight? Did he lose a lot of weight since the diagnosis, or has he maintained? Is there anything unusual about him in comparison to other cats? Does he have any skin conditions? Breathing issues? Does he have any concurrent illnesses such as hyper thyroid? If in fact he has been overdosed to 6u, a condition may have occurred called "glucose toxicity" which would require more insulin to break the cycle. We can help you with that.

Without seeing any numbers, we can not recommend you either increase or decrease the dose just yet because it would be unsafe. I just wanted to let you know that there are plenty of high dose cats on this board, and there are several conditions which could cause it. Don't feel alone!

..Carolyn

PS: I see it mentioned that acromegaly is rare, it is not. We have had multiple cats dx with it over the last several months on the Lantus ISG, and it is thought that upwards of 1 in 3 diabetic cats could actually be an undiagnosed acromegalic.

 

Hi Jennie,

I'm another one with a "high-dose" cat. I think the absolute best thing to do at this point is to get the IGF-1 and IAA tests done. Positive or negative, they will help you know how to proceed. If you get the blood drawn and over-nighted on a Monday, you'll have your answer by Friday.

 

Hi Guys,
Thanks for the info. To answer some questions: He was 18# when he was DXd in 2/09, (but he was too heavy) dropped to 12.5 over a few months and maintained that weight for about 1 yr. No skin condition, eyes are clear, seems to hear and see well, has had a flea problem this summer (but with meds have that under control), stress free environment, only thing is sometimes he will "yap" alot after he's been fed. No vomiting or runny stool. So, I guess I will take him and get those blood tests done. You guys are just awesome for your help and concern. I will definitely get going on that spreadsheet.
Example for today: Fed him 5.5 oz. of Friskies at 6AM, shot 6 units at 7am, test BG at noon (279). Will feed again at 6PM, test at 7PM and shoot soon after that.

 

Jennie, question for you....when raising your dose, did you test more often than just preshots and the occassional test inbetween? DId you do any curves? I'm just wondering how you based your dose increases...

Jen

 

You're doing great, I hope see pictures soon too

One question for you, did you get a blood test this morning before the shot? I see the noon reading, but it's important to get readings at shot time as well as some spot checks and the curves.

I have a kitty named Lilly Grace who yells at me all the time after she eats. I mean she yells at me!!! She seems to be mad that she had to eat, but I'm guessing yours isn't yelling at you each time :lol:

 

This advice to raise his insulin to 6u. was the advice of my vet after a couple stays with him. But, I always do alot of testing. I have been careful to do preshot testing cause of the hi dose and controlled carbs. This has been a gradual increase. I have done only two curves. I think tomorrow I will do a curve and monitor the results on the spreadsheet. How do I get a spreadsheet again???

 

Here's the link for the spreadsheet.

viewtopic.php?f=6&t=16

You're doing a fantastic job, your kitty is very lucky. I was asking about the preshot number because I didn't see it noted. That's just me being curious.

 

Sorry, no AM preshot ##. I usually do that, but running late this am. It's usually around 250. I know I shouldn't shoot w/o testing. But, it's a sure bet it's gonna be high. Thanks for the link.