JeffJ from Austin - Leoberry kitty

Hi all,

I'm usually a lurker. Anyhow...
Leo is a beautiful 10 year old black tabby male, inside cat, who we had since a kitten. He is playful and still quite the lap cat.

He has had diabetes for ~1 year....and had had 2 shots a day since then.

I don't know all the forum lingo. But Leo is now unresponsive to Lantus. He was up to 8.5 units twice a day, with a shallow nadir. So he now considers Lantus as water! Typical readings from 280-420 in the last 2 months. But his hind legs are having worse issues (neuropathy). I've read tons of literature.

My vet just switched him to PZI yesterday, starting at 1.0 unit/shot twice a day. His readings are now 500...but it's just the first day.

He is on vet Overweight Management (OM) with some cooked chicken sprinkles. And his weight is good, with not too much fat. He has typical non-treated symptoms:
- starving all the time
- pees all the time (in the box), maybe a quart a day
- and now the obvious neuropathy in the hind legs

We are hopeful the PZI will be effective. We will ramp slowly. He has not had a single hypo-glycemic incident since diabetes onset, but I'm ready in case it happens.

Besides the clinical discussion above, we love him dearly. He gets brushed on and loved on all the time.

cheers,
JeffJ

 

A warm welcome to you & Leo. Sorry to hear the Lantus has not worked out for Leo.
Hope the PZI works !!!!

 

Thanks DebG.

 

When a cat gets up to 6 units of insulin while eating low carb food, we suggest reading up on insulin resistance and maybe getting the cat tested for acromegaly and insulin auto-antibodies.

 

Thanks BJM. He was evaluated for acromegaly, and he definitely does not have it. I'll read up about the insulin auto antibodies. Thanks for the suggestion and links.

 

What were the results of the IGF-1 test?

 

Hi Jeff welcome to you and Leo. Hope the PZI works for Leo. Since you decreased his dose significantly, you should make sure to test him for ketones. You can pick up test strips at any pharmacy. When you say Leo was evaluated for Acro, did he have the blood test from MSU?

 

Also, wait at least a week between dose increases and only increase by 1/4 to 1/2 units. It sometimes takes that long before a cat's body adjusts to the dose. By increasing in small increments, you have a better chance of determining the optimal dose. Too much insulin can also cause glucose levels to be high. It is called Somogyi rebound. If too much insulin is given, the body tries to protect itself from becoming hypoglycemic by producing extra glucose. That may have been the issue with the Lantus.

Also, with the Lantus, were you using a vial or pens? If a vial, depending on how long you have been using it, it is possible that it was no longer effective. The pens are smaller containers which are used like mini vials, but you are able to use almost every drop before the insulin stops working.

 

Thank you everyone for welcome, suggestions, and questions.

Leo did not get an IGF-1 test, or antibodies test, or the blood test from MSU. But if he is unresponsive to PZI, i'll get that done. His face has not changed at all - since incredibly cute kitten-hood.

I read about the Somogyi effect a couple months ago. With Lantus we increased him slowly to his high values.

For Lantus - it was vials. They didn't last long because of the amount he was receiving. I carefully refrigerated after each dose.

Recent values:
Lantus
7/4 - 7/8/2015
7/3 9pm - Lantus
7/4 9:05a 297 - this was his typical low and nadir as well.
7/4 9:08a Lantus injection
7/4 12:15noon 436
7/4 4:20pm 417
7/5 9:00am Lantus 8.0 units 2x daily
7/6 Lantus 8.0 units BID

7/7 - PZI started, Lantus stopped
7/7 8:30am PZI 1.0 unit
7/7 12:30pm 531
7/7 8:35p 503
7/7 8:36p PZI 1.0 unit
7/8 8:06a 454
7/8 8:07a PZI 1.0 unit

7/8 Doing a 12 hour curve, 2 hour increments today (7/8/2016))
Since he is on new insulin I'll get ketone test strips today. He was only positive for that during initial diabetes onset.

Per our vet recommendations dosage has been increased to 2.0units PZI BID starting 8pm. He doesn't mind the injections. Getting blood is like trying to test a wriggling worm. Getting purrs from him is easy

thank you,
Jeff

 

Purina Pro Plan makes the cat food you mentioned - Overweight Management. Is it the canned or the dry?
Take a look at Cat Info and the food list in the right hand column. If the vet food is a high fiber diet, chances are good the percent of calories from carbohydrate could be too high.
It is possible to feed a diabetic cat low carb, over the counter canned food such as Friskies pates for less money than the Rx stuff (which doesn't have anything inIit that is actually prescription!).
Changing to lower carb food may reduce the glucose 100-200 mg/dL and may drop insulin dose 1-2 units in some cats.

 

Until and if you get a spreadsheet setup it is easier for caretakers here to review your BGs if you present them is this format. I used your data from 7/4 to 7/8
7/4 AMPS 297 - AMPS means the bg before AM shot) ? unists Lantus
+3 436 (the +3 means 3 hour after shot)
+7 417
7/5 9:00am Lantus 8.0 units 2x daily
7/6 Lantus 8.0 units BID

7/7 - PZI started, Lantus stopped
no AM PS PZI 1.0 unit
+4 531
PMPS 8:35p 503 PZI 1.0 unit
7/8 AMPS 454 PZI 1.0 unit

 

Hello and welcome Jeff and sweet Leo. My kitty Neko also did not show the classical signs of acromegaly until a couple of years after she tested postitive with the IGF-1 test. I later found out that her eye tearing was from soft tissue growth blocking the eye ducts. She also had a slight sensitivity to light. That plus a voracious hunger and higher dose were the only symptoms. We do recommend that kitties receiving over 6 units of Lantus get the tests done (IAA and IGF-1). Neko was positive for both. The latest studies have shown that one in four diabetic cats has acromegaly, some on much lower doses than 6 units. Only about 35% of cats with acromegaly show obvious face changes at time of diagnosis. What I figure is at least 5 years after the start of acromegaly, Neko's face doesn't look much different than she did when much younger.

I hope the Prozinc works out for you, but if it doesn't, the majority of higher dose cats end up on Levemir and post in the Lantus/Levemir forums. The long lasting insulins are best for cats with high dose conditions, and some cats feel a sting with higher doses of Lantus. While you are on a much lower dose of Prozinc and in much higher blood sugar numbers, please test daily for ketones. We usually switch between Prozinc and Lantus or Levemir at much closer to the same dose of insulin.

Here is a post on acromegaly, including links ot some of the latest research. By the way, my vet didn't think Neko had acromegaly and that we didn't need to test for it until we got over 10 units. We never got that high. Unless your vet is young, most vets were taught it's a rare disease.

I also second what others have said. Low carb wet or raw food is best. Several small meals throughout the day and night will help hold off the hunger. I also got an automatic feeder and Neko then focussed on it instead of bugging me for food!

 

I did not think my MurrFee's face/head looked like acromegaly. However, after he was positive for it via the IGF-1 I visited an internist she pointed out MurrFee's facial feature that pointed to acromegaly. The IGF-1 results were greater that the max MSU could measure.

 

On Dr Lisa's food chart, OM dry is 22% carbs. The first five ingredients are various kinds of meal - cornmeal, chicken meal etc. We suggest staying in the 8-10% range and feeding wet low carb.

If you are feeding the dry OM, you might consider changing the diet. It can make a big difference.

 

Changing the diet now would be ideal, while you are starting over with a new insulin, as you likely have some high numbers with the much lowered dose, so there is room for the diet change without as much risk of hypoglycemia.

 

Thanks everybody for the additional info and help. It is encouraging. I appreciate the advice.

I read more about Acromegaly. And it is good to see the survival cases.

Leo has had multiple diets in the past year, all canned food, attempting to resolve issues while providing high protein. We also have Fancy Feast and then Petsmart is only 1 mile away. Leo also gets baked chicken. We can't auto-feed, since the other indoor cat Chinus (siamese) will eat it.

I agree the "prescription diet" has no prescription content. I might take it back. His weight is now just above average with a little fat layer for the tough times. So there is no current weight issue.

If the ProZinc doesn't produce some results we will switch to Levemir. The high BG is taking its toll. Leo's numbers today (7/8/2016):
8am test then 2 hour intervals, 8:01am PZI
454
509
359
432
461

Scoobs:
We were recently traumatized on July 1 when Scooby, our 8 year old tabby developed vomiting, then bloody vomit. Then 1.5 days later (July 1) he went to emergency surgery and almost all of his intestines were necrotized. There was no blockage or foreign matter, and no twisted intestine. He went to the Rainbow Bridge during surgery. There were no symptoms even 1 day earlier. Two experienced vets did the surgery. They think it was cancer or he ate a bird/rat with poison. We still can't believe our sweetie is gone. Scoobs was the best cat ever. He was a good boy. Oh my Scoobs. :-(

 

So sorry for your loss. Fly free sweet Scooby

 

Im so sorry for your sudden loss of Scoobs.
Prayers and thoughts for you and family!

 

Requiem aeternum, Scoobs.
{{hugs}}

 

Hi all - Thanks for the condolences.