Help! Cat doesn't respond to insulin

Hello everyone. First of all, let me give you a little backstory about my cat Sassy. She was diagnosed last August as the result of me taking her to the vet with a terrible urinary tract infection. Her BG levels at the time were hovering very close to 500. The vet started her out on Vetsulin and we started with a small dose of 2 units twice a day. I also completely changed her diet. She was a kitty that I just left a bowl of whatever kind of dry food I had out all day and let her eat. She was also 18 pounds at the time. I spent a lot of time researching her food and began to give her Fancy Feast wet twice a day (the kind without gravy). I also bought her some Wellness Core because of the protein levels but she is not a big fan so she doesn't eat too much of it.

Anyway, her BG levels were still terrible so the vet slowly increased it until she was getting 6 units twice a day. She said she didn't think it would make a difference if I gave her 12 units a day so she switched her over to Lantus which is quite a bit more expensive but she said we would only use a small amount. Well, this has proven to be untrue as well because I had to rush her back to the vet Friday morning with another bad bladder infection. She was crying because she was in such pain and could not urinate at all, just bleed everywhere. She got a shot and some antibiotics to take and the vet said to start giving her 4 units of Lantus twice a day and gradually keep raising the number of units over the next few days. Keep raising it to what? She said that one cat that she was treating was currently doing 16 units twice a day and was resistant to it. She seems to think that is Sassy's problem as well. I really cannot keep buying huge amounts of insulin for over $100 a bottle. That is just too much of an expense considering the cost of test strips, food that I have never had to budget for in the past, needles, constant trips to the vet (which also causes quite a strain with my job--they can understand me having to come in late if my child needs to go to the doctor, but they aren't quite as understanding about a cat that I have to take to the vet twice in one week). I'm sorry to vent about the cost but it is really killing me. Two visits over the course of one week have cost me over $300 and sadly this has been going on since last summer. It is a constant thing.

If Sassy is insulin resistant, is there any need to give her insulin at all? Can I just expect to keep rushing her to the vet every other week because she has another infection? Obviously untreated diabetes will eventually kill her, but how quickly? Is she suffering because the insulin isn't working? Am I going to have to put her to sleep? I know that the answer is probably yes but I feel terrible about it and I guess I really want to delay it as long as possible. Unfortunately, the vet didn't seem too hopeful about the insulin ever working. Has anyone else ever dealt with this before? FYI, her BG levels are always around 350 or higher. The lowest that I have seen is 299.

Thank you for reading this long, long post. I have truly got to the point where it is really causing me to be quite depressed. I just don't know what to do.

 

There are several things in your post that I find very upsetting. Let me ask a few questions.

Regarding Sassy's UTIs--how were they diagnosed? I ask because unless a c & s (culture and sensitivity) was done to identify the exact bacteria involved she might not have had an infection at all. A sample for a c & s is taken directly from the bladder by extracting it with a needle--was this done? The symptoms Sassy had could have been cystitis, which doesn't respond to antibiotics. It is painful, there is blood and it goes away by itself, the proper treatment is pain medications.

You are doing everything right with Sassy's diet, you could quit the dry food, but that's a minor issue just now. Biggest question, are you blood testing at home? If so, please share the numbers with us. If not, it's time to start.

As for insulin, the proper starting dose is half a unit to 1 unit, by starting at two units you have probably missed Sassy's ideal dose and sent her into rebound. The manner in which increases were made is adding to my conviction that this is what's happpening.

When too much insulin is given the body protects itself by dumping stored glucagon into the system, When this happens it looks as if glucose is increasing, but it isn't. I know this is counterintuitive but too much insulin can produce higher and higher numbers until the cat crashes in a serious hypoglycemic episode. There is more information on this in our FAQs, look at Somogyi rebound there and in the pet diabetes wiki.

Please go to the Lantus group in the Insulin Support Groups forum for advice on how Lantus works in this situation.

I doubt Sassy is insulin resistant. You can do a rebound test (ask Jojo or Jill in Lantus Land for supervision) to determine this for sure. You are not near the end of your rope, honest. There are answers here,

Gia & Quirk (GA)

Guilt trips are a detour from life

 

I really don't know how the UTI's were diagnosed. I know that the first time that I took her, the vet said that I would have to leave her until they got a urine sample and they got one about as soon as I returned home. This time, the vet (different vet in the same office) took her to the back and I heard her cry out and she got a sample. She told me that it was an infection and that there were no crystals present. So, I really don't know how they got the sample and arrived at that diagnosis.

Yes, I test her at home on a daily basis. I haven't done a true curve in some time. I am not here during the day for the most part, so I will usually just test her before each meal. I am running into some problems testing her right now, because it is getting very difficult for me to get blood. It makes me feel so terrible to have to stick her 7 or 8 times before I get any blood--makes me really not want to do it at all.

I guess I don't really understand what you are saying about the units of insulin. Let's say that I decided to cut her down to one unit. Is it too late for that to work? Have I already done too much damage? How long would it take for me to see if one unit is really working or not? A couple of days? A week?

Maybe I should try to repost in the Lantus thread to see what I am doing wrong. I am just following the advice of the vet and it really doesn't seem to be working.

 

The only way you are going to know about the urine test is to ask. There is a terrible epidemic of vets overprescribing antibiotics, just like the human docs overprescribing antibiotics, so don't feel I'm criticizing your vet, I ask everyone this.

As for doing a rebound check YES go to the Lantus group and specifically ask for Jojo and/or Jill to look things over for you. Jojo is a vet tech whose diabetic cat lived for 14 years, we all trust her and Jill is her backup person, also very skilled.

I am a very old timer here, 10 years, so I know how to spot a problem but I'm not up to date on how to solve one involving a specific insulin.

I'm so glad you checked back! It isn't too late, but I want to be sure you have the best advisors while you get Sassy back on the right track. Please let us on this board know how it goes.

 

I checked the bill from the vet and it just said urinalysis (multistix/sediment) so I am going to assume that they didn't stick her with a needle to get a sample. I have posted on the Lantus board and am getting some responses although I am as confused as ever. However, I will be on the lookout for the members that you specified to see if I can get a few more answers. Thanks again to everyone for all your help.

 

Annie started at 1 unit of lantus...within months I had to REDUCE her dosage...and I did after getting high preshot numbers...

I agree with everything Gia has said...

Very glad you found us and are posting on the Lantus board.