great control but continued excessive urintion

hi all! im new here, and am desperate for any advice. my 11 year old cat was diagnosed just under a year ago with diabetes, and while all of his curves show he is very well controlled, he still is urinating (outside his box quite often!) very frequently. i have multiple boxes in the house, clean them every day, monitor his sugar, feed an all grain free, organic, canned/raw diet. he is constantly ravenous, and is still drinking a lot of water. we ave adjusted his insulin amounts over his course of treatment going up to as much as 16 units a day (8am and 8pm), and his curves are always good (ranging anywhere from a low of 70 to a high of 115, a low of 125 to a high of 160), but his behavior does not change. he is on Lantus. when his diabetes was first diagnosed, his sugar was over 600, but we were able to get his numbers down pretty quickly using a slightly conservative treatment (waiting at least 3 to 4 weeks in between insulin increases). any info or advice anyone could offer would be greatly appreciated! thanks so much!!

 

hi there and welcome.

first, 'cause i know a lot of people's eyes are gonna pop at mention of 16 units of insulin being given , does your kitty have any other illness like acromegaly or cushings or something of that nature that has caused a need for that much insulin? or what does kitty eat, since diet plays such a role in insulin needs?

then, as i read your post my next thought was when was the last time kidney function, thyroid, etc....was checked? my late Kitty pee'd up a storm and turned out it was 'cause her kidneys were getting tired so she was drinking more, thus pee'ing more. so perhaps if full bloodwork hasn't been done recently, i'd start there.

 

:shock: yep mine popped !
I just want to add to the great advice offered by cindy that if your kitty hasn't been evaluated for the illnesses she asked about ( any other illness like acromegaly or cushings) it would be a good idea to ask your vet about that when you get those other things checked out.

welcome to the board

 

The others are right; seeing the 16 units got my attention immediately.
No regular diabetic cat needs that much insulin. I have seen some around 7u or so but certainly not 16. Something's up with your kitty.

If you are giving 16units of Lantus twice a day and you cat is living through it with decent numbers, I think you are overdue to test your sweetie for acro, IAA and maybe cushings if the others test negative.

There is no reason for such a high dose that I have heard unless your kitty has some sort of condition with resistance.

Here are the links to the tests you ought to get done; you can print them out and take them to your vet.

IAA Test
IGF-1 (Acro) Test

Now I had to push my vet to get my Shadoe tested because the vet did not think that Shadoe 'looked' acro. Her test was positive and the vet was shocked.

It is important to have the tests because positive results could let you know that your kitty's pancreas is fine, and not like other diabetic kitties who have a pancreas that is not working well.

Depending on the results, you may change your approach to treatment.
Both of my diabetic cats tested positive for acro. Shadoe gets 9u BID Lev and Oliver gets 23u. He tested positive for both acro and IAA.

As for the urine outside the box, my Shadoe has always been one to intermittently piddle outside the front of the box, but that is just her, and it started shortly before her dx with diabetes. I lay down paper and pee pads to protect the floor. Some kitties are just like that.

Please let us know how it goes with the tests; there are plenty of others with acro kitties on this site.

 

I definitely agree with getting the IAA and Acromegaly (IGF-1) tests done.

Another condition that causes PU/PD (increased drinking & urination) is Hyperthyroid. It is diagnosed with a blood test called T4/Free T4. In older cats, the thyroid number on the general bloodwork can be in the normal range and yet still the detailed test will show positive -- so it was with my Buster. After exhibiting symptoms for over a year and having two normal blood panels, I insisted on the T4/Free T4 test and now Buster is doing much better on medication for Hyperthyroid.

 

thanks everyone for your posts! to clarify...my guy was up to 16 units per day, given a 8u in the am and 8u in the pm, not 16 at once. we have done a full scope of all the normal blood work on him twice in the past 6 months, because myself and 2 different vets (a traditional and a natural), are mystified. the only other condition he has is asthma (which he has had for most of his life), which he takes 1-7 puffs (depending on the season) of Flovent for, and IBS (showed up at about the same time as the diabetes) and food allergies. we believe he needs a higher than normal insulin dose due to the steroids from the Flovent. he eats a grain free diet of organic wet food, along with organic raw meats. he has eaten this diet for the last 6-7 years. before his diag, he never urinated outside of his box. while i do believe he has been tested for all of the things that were suggested, i'm not positive on a few so i will confirm with my vet. thansk again to you all, and keep sending the suggestions if you have them!

 

16u per day is still a lot.

One acromegaly publication indicates that the dividing line for "High Dose" is when the dose equals or exceeds 1u per pound of cat per day

My cat Norton (now gone ahead) was at one point getting 13u BID and tested positive for Acromegaly. After we changed to low carb food, we were able to reduce to 8u BID, which was still slightly higher than 1u per pound per day (Norton weighed approx 14 pounds)

Steroids can cause an increase in blood sugar but not always.

Norton got steroids every day for his last two months to alleviate pain/inflammation from a brain tumor. We were monitoring closely to increase his dose as needed, and he did not need any increase in insulin after starting the steroids.

 

Please ask your vet if you have had the tests for acro (IGF-1) and IAA.
My Shadoe is currently at 9u BID today, but she has been up to 14u BID and down as low as 2.5u BID.
There are some low dose acro cats, and even some who have gone off insulin for a time when there must be no GH output.

Oliver's Xrays showed he also has asthma, but I have yet to question the vet to confirm it.

One thing I have done for my cats is to keep copies of all tests and the results so I can look back to see the changes. You could do the same and then know for sure how things are going. I don't take everything my vets say as correct; I have provided them with info that they did not know before and have questioned their findings.

The weight calculation is a decent indicator - how does your guy measure up - my Oliver weighs 23lb and gets 23u twice a day so he's way over LOL. My Shadoe is 14lb and is getting 9u twice a day so she is a bit over that 1u per lb.

How's it going with the asthma and Flovent? I have not yet started on any, so I am sure you will have lots of tips in that area!

Anyways, ask about those 2 tests because they will give you info on your guy's pancreas.

 

We are going to have a consult with an internal medicine vet this week on the recommendation of my vet to see about testing for acro and Cushings.

My cat fluctuates between 13 and 15 pounds, so 16 units a day isn't too over the top for him.

I've been using the Flovent for over 7 years now, and it helped tremendously! He was having attacks a few times a week right before he was diagnosed, and after a short run of prednisone to get things under control, he started on the puffer once a day. after about 6 months, I learned his signs pretty well, and now, depending on the season, he gets 1 puff of Flovent anywhere from 1 to 7+ times a week.

 

Cats are not dosed by their actual weight, only dogs are. My Oliver was 16 pounds at diagnosis. We started way too high per our vet's advice at 4 units twice a day. By hometesting, we realized we needed to rapidly get down to one unit a day. We have large cats on here daily who start at one unit twice a day. And we urge people to increase insulin in small dosages, usually 1/2 unit per day or less.

It is easy to go over a cat's ideal dose and cause rebounding: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

If your cat does not test as having a high dose condition,(viewforum.php?f=12) I hope we can talk you into starting over at a lower dose.

 

I understand cats are not doses by weight, I was just clarifying for the people wondering his weight, as it seems to be the general concensus that more than one unit per pound is excessive.

When we started on insulin, it was at a dose of 1 unit twice a day. We waited an average of 3 to 4 weeks between increases, doing curves all along the way.

Somogyi was considered, but was not the case.

When we were at 8 units twice a day, a flare up of Kitty's IBD caused us to cease insulin for a few days due to not eating, we started over with a very low dose and slowly worked our way up again. We just made it back to 5 and 5 from 1 and 1 with no clinical improvement.

We are having a consultation with an internist next week who hopefully can find something out.

Cushings and/or acromegaly don't seem quite right, as his BG shows him to be well regulated, even at the lower doses. It his clinical signs (the excessive overeating/urinating/drinking) that show something else is going on.

I'll update on what we discover!

 

Being well regulated has absolutely nothing to do with testing positive for acromegaly. When I get blood work done on my two, they BOTH have results indicating that they are very well regulated.

So how to explain that I am giving Oliver 26units twice a day?
He had a fructosamine test included in a bunch of others, and he registered as good, close to excellent as far as being regulated. The vet is very pleased that he is so well regulated, no matter what dose it takes to get there.

Oliver tested positive for acromegaly and also IAA. He has had Xrays which confirm organ enlargement. This morning, I delayed his am shot because he was 112, a pretty fine number for BG, but just a bit low to shoot 26 units. His weight is around 23lb.

Shadoe tested positive for acromegaly as well, but she is a lower dose kitty, despite testing positive. Right now her dose is 10units twice a day but she is not feeling well, is on a/b, and has pancreatitis so her numbers are high lately. Normally, she was getting closer to the 8units region with a bit of fluctuation. Her weight is around 13lb.

Oliver 'looks' acro; Shadoe does not. Home testing has become critical now because there have been times that I have had to skip shots, because their need for insulin changed

It may be an idea to have the acro & IAA tests done because a positive will tell you that you have a functioning pancreas, unlike other FD kitties.
It's very important to know about the pancreas because it will have to be factored into how you are dosing. You may want to know about a positive acro condition so that you can look into issues that accompany acromegaly such as heart problems and organ enlargements and soft tissue growth.

Remember: well regulated does not rule out acromegaly or IAA, so a dose of 8u BID could indicate something is going on other than just diabetes.
Better safe than sorry.

 

I understand cats are not doses by weight, I was just clarifying for the people wondering his weight, as it seems to be the general consensus that more than one unit per pound is excessive.

When we started on insulin, it was at a dose of 1 unit twice a day. We waited an average of 3 to 4 weeks between increases, doing curves all along the way.

Somogyi was considered, but was not the case.

When we were at 8 units twice a day, a flare up of Kitty's IBD caused us to cease insulin for a few days due to not eating, we started over with a very low dose and slowly worked our way up again. We just made it back to 5 and 5 from 1 and 1 with no clinical improvement.

We are having a consultation with an internist next week who hopefully can find something out.

Cushings and/or acromegaly don't seem quite right, as his BG shows him to be well regulated, even at the lower doses. It his clinical signs (the excessive overeating/urinating/drinking) that show something else is going on.

I'll update on what we discover!

 

Reading through all of this I have an impression that these numbers you got were from the vet's office which makes them inaccurate at best and dangerous at worst. Are you home testing? Are you testing before every shot and doing spot checks?
Can uyou give us your numbers for the last 4 or 5 days?

 

I'm not sure which #'s you;re talking about (his insulin amount?), but in addition to anything my vet tells me, I research all information on my own.

I check his BG before each shot, as well as 12-16 hour curves every 2 weeks at least.

His #'s from the last 5 days are as follows:

Sat am 156/ pm 152
Sun am 162/ pm 195
Mon am 170/ pm 186
Tues am 162/ pm 162
Wed am 192/ pm 156

 

Hi Melissa,

Great job getting him well regulated, and it sounds like your journey there was well thought out.

It is very possible for cats with these high dose conditions to be well-regulated -- it is merely a question of finding the right dose. Norton had decent numbers when he was getting 8u BID or 5u TID (we experimented with dosing every 8 hours). One acro-cat even went off insulin several times over a 3 year period -- it completely depends on the output of the tumor which blocks the natural insulin.

That said -- it is still a lot of insulin for a "traditional" diabetic. Most cats with doses that high have another condition - either Acromegaly or Insulin Autoimmune Antibodies or Cushings.

We're just suggesting that you look into these conditions and have the testing done at least for Acromegaly and IAA (these are relatively inexpensive blood tests done by the same lab in Michigan).

My vet also thought Norton did not "look" like he had acromegaly -- even after a neurologist confirmed the presence of a brain tumor. The IGF-1 test proved the point that he DID have it.

Knowing if your cat has one of these conditions will affect treatment --- for example - Acro-cats have a functioning pancreas - so the treatment for HYPOglycemia is different. It will also let you know what other symptoms to watch for, which may develop in the future. Also, if caught early enough, radiation treatment of the tumor can kill it off before any permanent damage is done to organs etc.

There are several kitties here who have gone to Colorado State Univ and had stereotactic radiation to kill the Acro-tumor. At least two are now off insulin

 

He is definitely going to be tested for all of the conditions that were suggested (we were planning on it anyway), he just doesn't really seem to fit very well into any one category so I was hoping for some additional theories. I do think he needs a higher dose of insulin due to the inhaled steroids he gets for his asthma.

His appt is next Thursday and we will be testing for pretty much everything so I'll be sure to post the results!

 

Melissa,

If you are going to have the acromegaly test done, check out the high dose board under the insulin forum. The tests for acro and for insulin antibodies is only done at one lab in the US. All the information is in the forum. Will save your vets some research time. Also, you will know the cost upfront.

I just recently tested one of my diabetics that was creeping up kind of high.

Good luck with your boy.

Claudia

 

Gayle posted the links for the tests up higher in the thread

 

I should add that some vets are a tough sell when you ask for the acro and IAA tests.
I have to say that my vet office knew absolutely nothing about the tests, so I had to print out the two test info sheets and take them to my vet office and said here, make arrangements for these tests. I want them done.

I had to keep pushing them to make the arrangements because I needed to know that the tests blood draws would be shipped correctly and I also needed to know when to bring in Shadoe for the blood draws because she has a problem with lipemia and I have to fast her before some tests.

The tests are done only on certain days of the week so the shipping has to be coordinated and needs to be shipped directly to the lab and by FEDEX.

If you have any questions about the tests or any related issues, what to do next if negative, be sure to ask as many here can help.

 

First off, I just want to thank everyone for their advice.

Secondly, it seems so many of you have not so great relationships with your vets! I see so many comments about having to "convince" and "push" vets to run certain tests and I find that appalling! I just wonder if this is an issue many of you seem to have? I have such a great working relationship with my vet, I rely on her for her training and expertise, and she relies on me for my at home observations and opinions. She takes everything I say seriously and never once has tried to deter me from something I wanted done to try to provide care for my pets. I've always been thankful for my doc, but reading some of the posts on here, I'm realizing that I'm even luckier than I thought!

I'm someone who has worked with animals in various capacities throughout my life, and had many animals in my care, from lifelong pets to fosters, and just would like to say please find a vet who respects you and is willing to work with you and your pet!