911 HELP! BG #'s Still high

Walker is on 3 units of Novelin in the morning and 4 at night. His nadir numbers hover around 384 - 440. His before meal BG#s are in the 500s - 600s. No sign of going hypo or even close. In fact vet keeps bringing up insulin resistance and he is concerned that may be the case with Walker. I refuse to go there. Walker is still loving, and purring. I can tell he has added weight so he is getting some nutrients. (Last weighed at 10.5lbs, a little skinny for him) In fact his fur is starting to feel like his old luxurious coat. But he lies around a lot and is not so much interested in playing. The last two mornings he didn't look so great, kind of weak like. He was tested at the vet last Saturday for ketones and he did not have any.

I have removed all dry food (was on Royal Canin SO to prevent UTIs as he has had them before) and last night got him transitioned from FF grilled over to DM. He loves DM. In fact I got my other cat transitioned to Friskies Pates so if Walker eats his food, he is getting low carb food.

Do cats take awhile to adjust and respond or should they be responding asap? I appreciate your help so much!!

 

I'm sorry, I don't know much about Novolin. I'll tag some people who might know more. @BJM, @Cat Ma

If Walker seems weak and unwell, I'd find another vet to take him to for a second opinion. He might do better on a different insulin.

 

How long on 3 units? I consider an increase is called for I would go to 4 units inf you on 3 units for at least three days.
I would also consider changing insulins. Discuss that with your vet.
Some cats are high does. My MurrFee is on 25 units Levemir twic daily.. My Badger on 7 units ProZinc twice daily.

 

Diabetes regulation is a process, not an event. You are using an insulin known to last much less than 12 hours in the cat, so control will be poor with it, unless you can manage testing and shooting every 8 hours.
I strongly recommend you switch to either BCP PZI or ProZinc, both in and out insulins which work similarly to NPH, and last about 12 hours.
I also strongly recommend you get the teeth cleaned asap, even if he is not perfectly regulated as dental infection raises glucose levels.
We really, really need you to get a spreadsheet going so we can see a visual display of the test data. It will give your vet and us some clues.

 

My vet wants to give Novelin enough of a chance to work before he will consider changing. I plan to take him to the vet on Saturday to review his numbers and where to go next. If he is not willing to consider other options after giving Novelin a chance, I will get a second opinion.

 

He has been on 3 units for four days and actually I did give him four units this morning after being advised by the vet to do so. So now I am at four units 2x a day. By the time I see the vet on Saturday he will have been on it this new plan four days so that should be plenty of time to have given this insulin a fair shot. Did your kitties have issues with other insulins before getting on Levemir and ProZinc? How long did it take for you to determine which insulin was best for each kitty? I feel like I am playing beat the clock. Thanks so much!

 

Thank you for the insulin recommendations as I will bring that up with my vet on Saturday. By then we should have given Novelin enough of a chance to work. BTW, per my vets instructions I started giving him 4 units in the morning as well as at night.

RE: getting teeth cleaned, I totally understand the need for getting his teeth cleaned. My concern is that he is already under duress and a teeth cleaning would be too much, expose his little system to bacteria his body is not ready to fight. Me personally, I have to take an antibiotic before I get my teeth cleaned as it could infect my heart. Just didn't want to put him at risk before stabilized. But I don't know. Just so afraid I will make a wrong decision and kill my cat. I appreciate your recommendation and will discuss with vet.

 

"I have removed all dry food (was on Royal Canin SO to prevent UTIs as he has had them before) and last night got him transitioned from FF grilled over to DM. He loves DM. In fact I got my other cat transitioned to Friskies Pates so if Walker eats his food, he is getting low carb food. "

I would be very careful. Changing from high carb to low carb can cause levels to suddenly lower. Also, do you have any numbers in the 3-5 hour window after the shot. That is when N usually is lowest. It's possible that he is dropping low then and bouncing back up for your pre shots. (Bouncing is when a cat perceives a lower number than usual or than is safe and releases extra glucose, causing the number to rise quickly.) Adding more insulin can make this worse.

It would be ideal to get another insulin. Lantus, Levemir and ProZinc all are milder, usually nadir later and last longer. If you Can't get the vet to do that yet, I would get more data mid cycle and see what is really happening during the cycle. Also, it would be helpful if you'd track your numbers on our color coded spreadsheet. Not only is it valuable for you and your vet (it will give him a good picture of how the insulin isn't working well) but it is needed for us when you need dosing advice, so we can quickly see the levels and doses. The instructions are here :

http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

 

Even if you keep upping the dose, I strongly doubt you're going to see much of any improvement with Novolin unless you give it every 8 hours. The simple fact is that Novolin doesn't stay in the body long enough to be effective.

I would talk to your vet now about changing insulins. If he is resistant to considering other insulins, then clearly another opinion is needed. But you'll get excellent guidance here once your spreadsheet is set up. Many of us use our vets for non-diabetes related issues and use FDMB for insulin guidance and dosing. But it is always helpful if you're able to find a good vet who is also knowledgeable about feline diabetes. The reality is that many are not.

 

Thank you for all your responses. I feel worn out. Was up late last night getting Walker's nadir. I don't like this not being in control. It is a very helpless feeling. I'm used to managing things so they work out. Always have a plan B and a Plan C. Don't like it when the vet suggests possible insulin resistance which means there is no back up plan.

I just keep praying and moving forward. Y'alls love and commitment to your animals and your giving hearts that want to help others who share similar struggles is so appreciated. So glad I found this message board.

 

I appreciate your experience and plan to see my vet on Saturday and discuss changing insulins then. By that time we will have given Novolin a fair chance. I'm just concerned none will work on him. If that is the case, what can I do?

 

You have only tried one insulin, the one very few of us give, one that is too short acting to have an impact. We have many cats here doing well on the other insulins Larry, BJM and Sue mentioned.

 

Is Walker still on a combination of high and low carbs? How long has he been on this?

 

The only reason I changed his food is because there was no sign of his blood sugars dropping too low. Even at the 3-4 hour window, he was only dropping between 384 - 440. I'm hoping to have a spreadsheet soon so I can share numbers with you guys. Changing him to a new insulin is my goal if things don't change between now and when I see the vet on Saturday. Thank you for your advice.

 

Are you testing for ketones at home? I would do that while his #'s are still high.

 

So Walker is on low carbs only now? If so, please update the info in your signature line.

 

I got him transitioned yesterday to just DM canned. He seems to love it much more than FF. I even gave him some of my baked chicken as he was acting like he was starving. Last night I stayed up late to check his nadir and it was 440 even with his low carb meal and snack.

 

The starving part tells us he is not regulated, typical with Novolin. I really think you're going to see improvements with another insulin.

Canned DM is a low carb but there is no need for an expensive prescription diet. Take another look at the Cat Food Nutritional Chart in my signature line for some other low carb options.

Make sure not to feed Walker any baked chicken with any seasoning, garlic or onions. Garlic and onions are toxic to cats.

 

Oh, thank you for telling me about that as I forgot garlic and onions are bad. I just gave him straight chicken no skin which had the seasoning on it.

RE: DM, I'm hoping at some point to switch him to Frisky's Pates which my other cat is on and seems to love. Waaaay cheaper! Just thrilled I found a low carb food Walker loves for right now. Had tried FF Classics before but both kitties seemed to have issues with it.

 

I can understand the concern. You don't want to end up waiting till your cat is drooling, unable to eat and in pain. All of my cats have had dentals. CJ has had two consecutive dentals and in a few weeks it will be her third year in a row. None have ever had complications afterwards. I think an antibiotic is given during the cleaning. If extractions are needed, antibiotics and pain meds are given. Your vet will need to do a current exam and blood work. There are always risks with anesthesia but the risks of not doing a dental are far greater.

 

@Walker's Mom , I emailed you the spreadsheet. Please let me know when you get it, and if you have any issues.