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[J-Roc]

J-Roc was diagnosed with diabetes in October 2013 at age 10.5 years. We started him on Lantus but struggled to get his BG under control. Then we managed to get him to change his diet to low-carb canned food only in December (he was a dry food addict before this - refused to even lick wet food off his fur if it got smeared there - so this was a HUGE accomplishment). After this, his insulin needs plummeted to half a unit of Lantus once per day. Stayed like this between January and April of 2014. We thought he was getting close to remission. Suddenly in April his BG started rising again, despite no change in diet. We increased his Lantus steadily since then. Now on 4 units twice per day. He was well-controlled at this level for awhile, but now the BG levels are becoming erratic again. For example, he was at 6.9 last night. This morning he was at 21.3. He received his regular 4 units of Lantus at 8 this morning. I'm doing a curve today and thus far it's been as follows:

8:00 a.m. - 21.3
10:00 a.m. - 19.2
12:00 p.m. - 18.3
2:00 p.m. - 18.1 (just now)

His diet is 6 to 6.5 ounces of canned food per day, fed across 3 meals, same as our other two cats. Food is mixed with water as one of our other cats had urinary blockage last year and that's the only way we can keep their water intake up. Naturally, he does not think this is enough food and often will start crying several hours before the next feeding. The other two are fine on this amount. I do not want to give him more food because I think that would just increase his insulin needs even more. I am hoping to get his sugar better regulated and hopefully the crying will dissipate. He has no other symptoms right now, no excessive drinking & urinating, not sluggish (in fact he became far more active after his diagnosis and getting onto the canned food diet, despite the reduced calories).

Now, it could be that his Lantus has gone stale, it's a little over 4 months old, refridgerated the whole time. There's not much left in this vial, so I will be getting him another one today. However, given that his BG was an acceptable (though not ideal) 6.9 last night, I don't think the Lantus is bad.

 

[dirtybirdsoaps]

Have all other medical issues been ruled out? Teeth, infection, etc. Any added stress in the house?

 

[Larry and Kitties]

Could be the because of "old" Lantus but I doubt it.
Has J-Roc been to the vent recently? Maybe another health problem is responsible.
Could be that the disease is progressing and he needs more insulin.
Could have given a fur shot last night and may be this morning?
I would try the new insulin.

Most of use here purchase the 5 pack of 3 ml pens and use a syring to draw the insulin out of the pen. Usually you can use up a 3 ml pen before it goes bad compared to the 10 ml vial.

 

[J-Roc]

Have all other medical issues been ruled out? Teeth, infection, etc. Any added stress in the house?

No added stress in the house. Has no other symptoms of anything, but has not been to the vet since late 2013.

We spent $2400 on an emergency hospital stay and follow-up care for Houdi last December - January due to a urinary blockage, and then Albert required $1000 worth of dental work, so our vet budget was kind of destroyed for a while. J-Roc is next on the list for a return to the vet, but from my experience, they just end up recommending increasing the insulin. I can do that myself. I'm not crazy about spending another $500 on a full blood work up and check up. But if I can't get his BG down he'll be going back in for sure.

 

[J-Roc]

Could be the because of "old" Lantus but I doubt it.
Has J-Roc been to the vent recently? Maybe another health problem is responsible.
Could be that the disease is progressing and he needs more insulin.
Could have given a fur shot last night and may be this morning?
I would try the new insulin.

Most of use here purchase the 5 pack of 3 ml pens and use a syring to draw the insulin out of the pen. Usually you can use up a 3 ml pen before it goes bad compared to the 10 ml vial.

I've blown shots before, and don't think that was the issue. Insulin stinks, and I always scratch the spot where the needle went and then smell my hand - the shots, to my knowledge, were good.

I believe there is a chance the insulin went stale, and will be using a new vial tonight. If that does not help, I'll increase it in a few days.

 

[BJM]

You don't restrict food to control glucose levels; you adjust the insulin to the appropriate food level. You might break feeding into more mini-meals.

If he is losing weight, and is getting too thin, you need to up the food intake.

 

[J-Roc]

You don't restrict food to control glucose levels; you adjust the insulin to the appropriate food level. You might break feeding into more mini-meals.

If he is losing weight, and is getting too thin, you need to up the food intake.

He's not losing weight; his weight has been stable for a good 8 months now, same with the other two cats on the same diet. I can't just allow him to eat as much as he wants - he's a glutton and that's how he became diabetic to begin with. I don't mind increasing his food slightly if that's what I need to do (I gave him a cooked egg tonight for a treat - he likes eggs and the others don't) but I will not let him eat himself sick again. Restricting his diet is the only reason he is alive right now.

 

[BJM]

Just wanted to clarify that.

If he wasn't producing enough insulin, it is possible he was eating more to get at least some calories to convert to glucose. A diabetic cat can be starving, even when binging.

It can help with the appetite control to slow him down or increase volume without increasing calories. Options include splitting food into mini-meals so he never eats too much at one time, smearing the food over a wide plate so he has to work harder to eat it all, adding some water (1-2 tablespoons) to increase volume without calories, even adding a pinch of plain psyllium powder to provide some bulk. (You'll note that reducing foods often add fiber to keep the volume high enough, but they forget cats are carnivores, and put in too many carbs!)

 

[J-Roc]

Just wanted to clarify that.

If he wasn't producing enough insulin, it is possible he was eating more to get at least some calories to convert to glucose. A diabetic cat can be starving, even when binging.

It can help with the appetite control to slow him down or increase volume without increasing calories. Options include splitting food into mini-meals so he never eats too much at one time, smearing the food over a wide plate so he has to work harder to eat it all, adding some water (1-2 tablespoons) to increase volume without calories, even adding a pinch of plain psyllium powder to provide some bulk. (You'll note that reducing foods often add fiber to keep the volume high enough, but they forget cats are carnivores, and put in too many carbs!)

He certainly acts like he's starving. But if anything, he is stable-to-gaining weight. He's not as fat as he was pre-diabetes, but he's nothing like the gaunt skeleton he was at the time of diagnoses. I ended up feeding him 2 cooked eggs last night - one between meals and one with his final meal of the day (11 pm). I also increased his insulin by half a unit to 4.5 units per injection starting last night. He still woke us up crying for food at 6:00 this morning. (Thank god for the clock change, and 6 was really 7.) We already add 2 tablespoons of water to each of their 3 meals, since another one of our boys had a urinary blockage last year.

I'm reluctant to add any bulking fibre since that is likely to raise his BG levels even more; I'm really trying to keep his carbs down to below 10% of his diet. I'm also reluctant to do more than 3 meals per day, since that won't work with our work schedule, and also when we go on vacation, a petsitter comes in twice per day, so he already has an adjustment from 3 meals to 2 larger meals when we're on vacation. I don't want the adjustment to be an even bigger shock for him, and it's too difficult (and too expensive) to have a petsitter more than twice per day. My giving him the snack last night felt almost like waving the white flag, like I'm just going to let him eat himself to an early grave rather than have him drive us nuts with his constant crying. 2 eggs is a significant snack even for me. He's always been a vocal cat who always lets you know when he's dissatisfied with something, but he's been unbearable these last few months.

My one hope is that if I can get him regulated tightly enough, he'll stop being so hungry. He wasn't nearly this bad back when he was almost in remission, on half a unit of Lantus once per day, with BG levels between 2 and 5 (at that time, I got several readings as low as 1.9 - he showed no ill effects or hypo symptoms at that level, but it was kind of scary to see it that low). Now he's on 4.5 units twice per day - I'm not sure how high we can push that. Another trip to the vet is probably on order soon. Grrrr.

Anyway, thanks for the replies everyone. If anyone else has any ideas or insight, I'd love to hear it.

 

[BJM]

Just a thought, since you say he is big - have you read about acromegaly? It is caused by a pituitary tumor that may fluctuate in its effects. It results in enlargement of many parts of the cat's body. Check our sub-forum for high dose conditions.

Also, the PetSafe 5 timed feeder might be very helpful if feeding mini-meals. The per sitter can just refill it, with some of the later feedings being frozen so they thaw and are fresh when it opens - no need for extra visits. If you purchase through the shopping link above and go to Amazon, it'll help support the message board, too. By separating you from the feeding, you may get pestered less and allowed to sleep!

 

[J-Roc]

Just a thought, since you say he is big - have you read about acromegaly? It is caused by a pituitary tumor that may fluctuate in its effects. It results in enlargement of many parts of the cat's body. Check our sub-forum for high dose conditions.

Also, the PetSafe 5 timed feeder might be very helpful if feeding mini-meals. The per sitter can just refill it, with some of the later feedings being frozen so they thaw and are fresh when it opens - no need for extra visits. If you purchase through the shopping link above and go to Amazon, it'll help support the message board, too. By separating you from the feeding, you may get pestered less and allowed to sleep!

Thanks for the suggestions. I will look into both acromegaly and the PetSafe5 feeder. I just weighed him this morning and he's 13 pounds. So he's not overweight at all; I probably don't need to fear feeding him a little more. He's a long, tall, lanky cat but very fine boned (skinny little legs and tiny paws - smaller paws than cats much smaller than himeslf). He was at least 16 lbs when he was obese, before his weight crashed and he became diabetic.

 

[BJM]

Here's the link to Acromegaly and Other High Dose Conditions: What We Know

 

[J-Roc]

Update on the situation: Took J-Roc to the vet about a month ago. Spent over $500 on various screenings and tests (blood, urine, etc.). Nothing came up except for his persistent high BG levels. He was getting Lantus 8 units twice daily. The vet said to try Prozinc. Now he's on Prozinc - started at 1 unit (u-40) twice daily, and we're up to 2.8 units twice daily. His BG seldom drops below 15 mmol/L (I did get one pre-shot reading of 10.8 about a week ago). Last week's curve (at 2.5 units u-40 twice daily) was 21.3, 19.9, 18.1, 16.2, 15.4, 15.1, 16.4. It looked like progress, although the opening number was still high.

Doing another curve today, after upping the Prozinc dose to 2.8 units twice daily since Thursday morning. Thus far I've got 20.8, 19.8, 21.0... Will update when the curve is complete.

I do not understand why he is so damned insulin resistant. Currently eating Wellness Grain Free and Merrick (the lower carb flavours). Wellness has about 4%-6% of its calories coming from carbs, while the Merrick (which he gets less of) ranges from 5% to 10%. So his overall diet is almost certainly not more than 5% or 5.5% carbs.

The vets are, as always, extremely reluctant to be more aggressive with insulin dosing. I'm urged to hold it at the same level for more than a week before each increase. Since NONE of his levels are scary low, I think this is utter bunk. Even though his vets are feline specialists (including one of just 4 board certified feline specialists in Canada), I am thinking of once again ignoring their advice towards excessive caution, and pushing his dose up (in a controlled, methodical manner of course). They never wanted me to go as high as 8 units of Lantus either, and had I not done that, I'm sure he'd be dead by now. If anything, maybe I should have tried to push the Lantus dose even higher before trying the Prozinc.

I think 3 days is plenty at one dose before moving up to the next increment, and I don't think I'm wrong in being more aggressive here. Thoughts? I'm not looking for endorsement or validation, so if anyone thinks I'm wrong, please say so. But J-Roc's blood glucose has been consistently high for most of the past 2 years (and much longer prior to diagnosis in October 2013) and his kidneys are not going to last forever unless we get it down. Not sure what else I can do at this point.

 

[Larry and Kitties]

Many of us here record our reading and other info in a spreadsheet. See:http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/
That allow others to better see what is going on long-term.
Your present dose is not alarming but yo are not getting a good response. I would increase the does but not too fast. If it get over 5-7 units twice daily I would get the blood test done for acromegaly.
My MurFee has acromegaly and is on 47 units twice daily but not getting that good of BGs.

 

[MrWorfMen's Mom]

Hi from a fellow Canuck with a cat whose readings are also consistently high despite large doses of insulin. I had tests done for acromegaly and insulin auto antibodies and my girl is insulin resistant. Most vets do not want to entertain any high dose conditions until the cat is receiving 6 to 7u twice per day so from the dose of Lantus J-Roc was on, it sounds like getting the testing done could potentially shed some light on why you are having such a hard time getting J-Roc regulated. I had a specialist suggest I could increase my girl's dose every 3 to 4 days but I have always held a dose for 7 days to ensure I knew where the dose was taking her. That said, when I switched from Lantus to Levemir (due to painful shots from the Lantus) I increased every 3 or 4 days without any issues whatsoever despite my vet wanting to be far more conservative. I think ProZinc is sometimes used on a sliding scale so I'd think as long as you make small increases at a time (0.25 to 0.5u) and monitor with mid cycle tests you should be fine but I have little experience with ProZinc and would recommend you post your question on the ProZinc board to get benefit of the vast experience there.

 

[J-Roc]

This is his curve from last week.

 

[J-Roc]

Thanks for the replies. From what I understand about acromegaly, the treatment would be the same whether I know he has it or not. That is, I would treat the high BG ratings with higher doses of insulin. Testing for acromegaly, while enlightening as to his condition, wouldn't necessarily change how we'd respond to it. I'm not sure what else could be done for him even if we confirmed that he had it, other than to increase the dose.

If I am going to go aggressive with the dosing, I'm wondering if I shouldn't switch him back to Lantus. I feel a little more comfortable going with high doses of lantus than Prozinc, as there seems to be more literature and experience on higher doses and tight regulation with lantus than with prozinc. Mind you, I've almost given up an tight regulation now. Certainly if he stays on Prozinc I'll be happy to keep him under 10 for part of the day.

 

[Sharon14]

Hi I too have a high dose cat. We are up to 8.5 u Levemir BID. Wednesday we are getting tested for Acro, and IAA. I recently switched from ProZinc to Levemir. I chose Lev over Lantus because I was told that at high doses Lantus may cause stinging/burning. Since you've used Lantus before, it may not be a problem with your cat though. Good luck.

 

[MrWorfMen's Mom]

There are treatments for acromegaly albeit very expensive and not without some risks, that can potentially put a cat into remission or at least lower the insulin requirement. For me with a 5 yr. old, I would have seriously considered treatment if she'd been positive and it was deemed to have a reasonable hope of success. For an older cat of 12 yrs. old (I'm guessing at J-Roc's age now), I'd tend to agree that treatment might not be in the cat's best interests and it would only serve to solve the mystery.

While Lantus has a good reputation of getting cats into remission using Tight Regulation and there does seem to be more literature on it's use, I'm of the opinion that any cat that is going to go into remission might very well do so no matter what insulin is being used. One insulin may work better than another for your cat, so I would compare any data you have from using Lantus vs. ProZinc as a gauge of which is working better for J-Roc and then go that route. If, like my girl, J-Roc seems to be sitting about the same numbers no matter dose or insulin type, chances are there may be something else involved and no matter what insulin you use, he is still going to need high doses and may not ever be tightly regulated.

If you could plot a couple of months of readings onto the spreadsheet (link above in Larry and Kitties post) we use here, there are a lot of folks with an immense amount of knowledge with both Lantus and ProZinc who could offer you their opinions on how to proceed.

What type of glucometer are you using? Pet or Human? All the reference material here is based on human meter readings which are lower than those obtained using a pet meter so it's important for anyone giving you advice to know what meter you are using. There are people here experienced with both types.

 

[Larry and Kitties]

You are getting pretty good decrease in BG. I would continue to increase does and see what happens.

 

[J-Roc]

He did show some mild improvement in his "diabetic behaviour" when we got the prozinc up above 2.0 units per shot. By diabetic behaviour, I mean the excessive drinking and constant hunger (i.e. crying for food most of the day). This crying for food was constant even at 8 units of Lantus. However, this behaviour modified somewhat once he got going on prozinc, even if his numbers aren't great. It left us hopeful, but every time there is an improvement with a higher dose, he relapses back to his old patterns of constant thirst and hunger after a few days. Today is actually a better day. I guess I've got nothing to lose with gradually pushing the prozinc up higher and seeing what happens.

 

[J-Roc]

You are getting pretty good decrease in BG. I would continue to increase does and see what happens.

The weird thing is, most of his curves follow different shapes. Here's another:

Today's, when I'm finished, is going to show a zig zag pattern. I suppose it's typical of hard-t0-regulate cats to have different shapes on each curve, given the poor response to the insulin. The frustrating thing is he doesn't really improve with higher doses, at least not so far.

 

[J-Roc]

What type of glucometer are you using? Pet or Human? All the reference material here is based on human meter readings which are lower than those obtained using a pet meter so it's important for anyone giving you advice to know what meter you are using. There are people here experienced with both types.

I'm using a human glucometer - Contour is the brand.

 

[MrWorfMen's Mom]

You are not alone in your frustration. I feel it first hand daily too. While the nadir each day can and does move, it's often within the same few hours timespan each cycle. You appear to be seeing a nadir even if it is a moving target. I can't even find a nadir most days.....I get a straight line with a minimal little wobble in it sometimes and other times she actually goes up for hours after her insulin shot! The fact that my girl is a die hard kibble addict is not helping matters but I'd expect to see some movement in the right direction given the amount of insulin she is on. So I share/understand your frustration and concern. My girl needs some dental work done (booked for January) and I am hoping once that is done, I will see some improvement.

 

[J-Roc]

You are not alone in your frustration. I feel it first hand daily too. While the nadir each day can and does move, it's often within the same few hours timespan each cycle. You appear to be seeing a nadir even if it is a moving target. I can't even find a nadir most days.....I get a straight line with a minimal little wobble in it sometimes and other times she actually goes up for hours after her insulin shot! The fact that my girl is a die hard kibble addict is not helping matters but I'd expect to see some movement in the right direction given the amount of insulin she is on. So I share/understand your frustration and concern. My girl needs some dental work done (booked for January) and I am hoping once that is done, I will see some improvement.

J-Roc needs some dental work too, but they don't want to put him under until his BG is better controlled, which I understand.

J-Roc used to be a kibble addict. In fact, we did briefly get remission when we first got him to switch over to wet food. We were so optimistic at that point! His insulin requirements dropped to zero. Then after a few weeks, his BG started creeping up again, but we were able to control it for 4 full months with just 1/2 unit of Lantus per day if I remember correctly. Then his BG numbers exploded, and we chased them all the way up, until we were giving him 8 units of Lantus per day, and he still very poorly regulated. That's been our situation for 1.5 years now. Prozinc was not available in Canada for a long time, but became available recently, so the vet had me switch over.

As for switching over to wet food, don't give up. J-Roc used to refuse to eat his kibble if the dish smelled like wet food. He'd scream at us if he thought his kibble had been contaminated with even the scent of wet food. Finally I buried his kibble under some wet food, then locked him in the bathroom with it so we didn't have to listen to his crying. Half hour later, he had taken most of the wet food out and spit it out on the floor to get at his kibble. But at least he had to get some in his mouth. Next feeding, he seemed to consume a bit more wet food and hadn't spit as much out. Finally, after a few days, he was actually consuming the wet food along with his kibble. After that, just we just eliminated the kibble. He's been eating wet ever since.

We went through the entire list of tricks on catinfo.org, and none of them worked. But locking him in the bathroom with his beloved kibble buried under a layer of wet food finally did the trick. I think locking him in the bathroom was important as it shut out all other distractions, and left him to figure out how to get at his food all by himself. Otherwise, he'd just cry after us.

 

[MrWorfMen's Mom]

My vet, while quite capable of dealing with Menace's dental needs, felt it safer to have it done by a dental specialist at the Emergency Hospital in Toronto so there will be an internist to monitor her BG and keep her safe. That however meant a 2 month wait to get an appt. Dental issues can and do raise BG levels so I'm surprised to hear your vet wants the BG under better control before doing the dental work as that could be the key to better regulation for J-Roc.

J-Roc sounds so much like Menace with the kibble addiction....she even tries to bury the canned food I put out for my two boys and won't eat her kibble if it's within a few feet of the canned food. I managed to get my 17 year old off kibble which I thought would never happen....but not Menace. Like you I have tried every trick and tip I could find. I have been trying to get her to acknowledge that soft stuff is food since she was 10 weeks old. I have not closed her in another room with canned food on top of her kibble and wish I had tried that when she was little or at least before the diabetes diagnosis. At this point, I continue to have standoffs with her but she has to eat with all the insulin she is getting so I can only holdout so long before I have to give in. I will have to try segregating her when she is really hungry and see if I can "crack" her resistance. I fear however that she will hold out until I decide she has to eat leaving me no choice but to give her pure untainted kibble! I'll have to go buy some ear plugs first though as Menace has some Siamese blood in her and her voice is definitely characteristic of that breed! Thanks for the idea!

 

[J-Roc]

My vet, while quite capable of dealing with Menace's dental needs, felt it safer to have it done by a dental specialist at the Emergency Hospital in Toronto so there will be an internist to monitor her BG and keep her safe. That however meant a 2 month wait to get an appt. Dental issues can and do raise BG levels so I'm surprised to hear your vet wants the BG under better control before doing the dental work as that could be the key to better regulation for J-Roc.

J-Roc sounds so much like Menace with the kibble addiction....she even tries to bury the canned food I put out for my two boys and won't eat her kibble if it's within a few feet of the canned food. I managed to get my 17 year old off kibble which I thought would never happen....but not Menace. Like you I have tried every trick and tip I could find. I have been trying to get her to acknowledge that soft stuff is food since she was 10 weeks old. I have not closed her in another room with canned food on top of her kibble and wish I had tried that when she was little or at least before the diabetes diagnosis. At this point, I continue to have standoffs with her but she has to eat with all the insulin she is getting so I can only holdout so long before I have to give in. I will have to try segregating her when she is really hungry and see if I can "crack" her resistance. I fear however that she will hold out until I decide she has to eat leaving me no choice but to give her pure untainted kibble! I'll have to go buy some ear plugs first though as Menace has some Siamese blood in her and her voice is definitely characteristic of that breed! Thanks for the idea!

Just be careful with the insulin dose if she does switch. She will likely see an IMMEDIATE reduction in her insulin needs.

 

[MrWorfMen's Mom]

Oh not to worry! I will be monitoring her like a hawk. The one and only time Menace flung a couple of great numbers (not overly low numbers) at me, I was totally flummoxed and on the board looking for some hand holding! It's one thing to be helping others but when you get unexpected stuff yourself, a little support is priceless and the folks on this board are indeed just that...priceless!