Still Nothing

I have increased the dosage twice in the past 2 days and getting no reaction. I know these are not fur shots as I am injecting into bare skin. I am at a total loss as to what is going on since out of nowhere the numbers began climbing and remain high regardless.

Are there any other suggestions? Spreadsheet is current as of pm 4/23 +10.

 

How old is your bottle of insulin? Are you varying the injection site?

 

I just rechecked the spreadsheet and had noted on the 19th of April that I started a new bottle of insulin that morning. I am rotating left to right on the sides in various areas, however the area is now getting to be troublesome due to the spreading skin condition. It is becoming so bad, that I have been causing blood from the injection site(s). Small amount, but this wasn't happening so often in the past.

 

It seems that the insulin isn't the issue. I wonder if her skin issue is affecting its absorption - just guessing. I'm assuming that tests for high dose conditions like acromegaly or anti insulin antibodies aren't available where you are. I'm grasping at straws. She's on a lot of meds and has several other medical issues that might well be complicating things.

 

That (skin issue affecting its absorption) may be the answer - Thank You...I will speak to the vet today when I take her in. I will ask about tests for acromegaly or anti insulin antibodies. Not hopeful in that regard, but who knows, they may surprise me...

 

I would also recommend trying a different insulin. Goma seems like she might be a good candidate for Levemir since her dose is getting a bit higher and she isn't responding much to the Prozinc. Levemir is a human insulin, so it should be available, though it would be a matter of finding out if a vet can prescribe it there, or if it could be purchased over the counter.

 

You assumed correctly in that neither test is available here or, according to the vet, anywhere in Japan. Stated that the test would have to go to the U. S. I did not bother with asking the cost. Really at a loss as to what to do. Appreciate your suggestions and support.

 

I have been considering changing to another insulin. Have asked the vet about Lantus which they can obtain. I have to plead total ignorance here. I see a forum for Lantus(Glargine)/Levemir(Detemir) and haven't a clue what to ask for. Thought I should be giving current insulin type six months. Not sure yet. With all that is going on with her now feel perhaps haven't given it a fair shot and changing now may not work out either until the skin and other problems are resolved. Really feel stuck and pretty darned dumb at the moment.

 

Lantus has a good track record with kitties. It's action is quite different from PoZinc's. I suggest you go to that forum and read the yellow stickies to learn about it - might help you decide.

 

It may be helpful to read the "sticky" threads at the top of the L/L forum. Lantus and Levemir are both long acting insulin. Whereas Prozinc typically lasts 10-14 hours, L/L last 12-24 hours (rarely as long as 24 in a cat). So you end up with greater overlap from one dose to the next. Levemir seems to last longer than Lantus with some cats hitting nadir right around the next PS time. So you can end up shooting a full dose on a green number and be perfectly safe. You end up with cycles where the numbers are flatter instead of the up and down of Prozinc. Levemir is recommended for higher dose cats as it stings less at the injection site than Lantus does. Most cats at lower dose aren't bothered by Lantus, but a few are. Because of the potential stinging and Goma's sensitivity, I would lean toward Levemir if you can get it, but either insulin may do better for her than Prozinc is doing.

While I agree that her concurrent conditions are probably making it difficult for her body to regulate and heal, I still think that a longer-acting insulin may at least give better results, even if still not good results.

It is typically recommended to stay on one insulin for six months, but Goma is getting really close to that - she'll be at five months in a week or so, won't she? So you can take a little time to read through the L/L protocol, talk with the vet, start to read some of the threads over there and get a sense of how they do things (it's quite different than over here in Prozinc-land), maybe post there with any questions you have as you read -- she'll likely be between 5-6 months before everything is ready to switch.

 

I had Bob on Lantus after original insulin (Caninsulin) proved useless. It was starting to work well with him until he got an infection and our new vet put him onto ProZinc, as she doesn't like Lantus (it's a French vet thing). PZ is proving to be a slow starter, as Bob's BGs are back up in the red and black number zones with no change of food regime. No doubt about it, managing FD is a game of trial and error!

 

Thank you for the candid response. Not sure what to do anymore.

 

Not sure what to do anymore. Appreciate the information and time you spent. I may just turn the process completely over to the vet since I am being told here by them via my spouse that I don't know the little points and didn't go to vet school.

 

Dont be discouraged by your vet. You take great care of all of your cats and you have to do what you feel is best. Don’t give up!

 

No other vet in your area? You’ve probably already addressed this but that’s not nice! I’m sure you know more about diabetes than he does. Will he do a switch to Lantus or Levemir? I agree that maybe this is what he needs... I’m sorry you’re having these problems & hope things can right themselves. You do so much & try so hard for him... lucky boy!

 

Please take this observation with a grain of salt but when looking at her spreadsheet, back in January she was getting 2.25 and 2.5 units - there were many more blues and fewer blacks. Have you thought about the possibility that her current dose is too high? I know she's on a lot of different meds and I don't know her history, but I just wanted to point it out since you are trying to figure out what to do.

Also, it sounds like the vet feels that you are stepping on their toes and I wouldn't let it bother you. It's important to hear what they say but ultimately, this is your cat and you seem very knowledgeable about the condition. Trust yourself.

 

Thank you so much for that observation. I have a lot to remember but I think I was raising doses as she was bouncing and then getting stuck in higher numbers and to preclude glucose toxicity I was increasing dosage. in all honesty I never thought about moving back down afterwards at that time. Recently I have been wondering the same thing but figured I was just grasping at straws looking for a solution. You are more than likely right about the vet but I have them and others teaming up now and I’ve become tired of the arguments. Her loss of hair and skin condition worsening leads them to now think of Cushings. They want to test for that. Can too much insulin cause her current condition? Would like to hear your thoughts on that and dose decreases.

@Kris & Teasel , @Djamila , @Rachel , would like to hear your thoughts and anyone else that wants to share as well if your time permits.

 

Cushings is worth testing for. It can make regulation much more difficult:
https://www.vin.com/apputil/project...atId=102903&id=4952021&ind=787&objTypeID=1007

 

Thank you. Would you or anyone else also please review the spreadsheet. Has the Somogyi Overswing come into play here at any time? Does she have to go below 65 before this is a factor or can just a rapid drop cause this?

 

Our view of bouncing is that BG doesn't have to drop low to get it going. Bg merely has to drop at a faster rate than usual or into numbers that, although still high, are lower than recent numbers. Vets get caught up in the notion of Somogyi rebound but many caretakers here have SS data that supports a broader definition.

As the article says, Cushingoid cats become insulin resistant. If Goma has Cushing's and that's the root cause of her refusal to regulate I don't think a lower dose trial is going to help. Having said that, you could try it out for a few days to see what happens and test diligently for ketones while you do.

 

I was just reading about Cushings today - skin conditions are part of it. Being difficult to regulate bg. Did they do any cortisol testing on your past bw? It might be worth a try.
Baby still eat & drinks all day & her belly is bloated- pot belly. Her coat is just always disheveled looking. That is why I was reading about it.. thought of you when I saw the skin condition description.

 

I agree with Kris. I think a test for Cushings is in order. If you know that's an issue, it can help you make decisions about how to treat in the future. It'll be tough, but you can do it!

 

I had already decided to have the test performed however the test they are doing is 50/50 at best. My understanding in the past in regards to Cushing’s is that if creatinine levels are normal it is not Cushing’s but I’m probably wrong about that also. Every blood test performed in the past has shown her right about middle or thereabouts. I have also read that this can be caused by a tumor or steroid overuse. I suspect her diabetes is from steroids and this would now follow. Can’t discuss with anyone here as they take everything as an attack or interference. Thanks for the thoughts, means a lot.

 

There is a group for Cushings on here: http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/

You could post with your questions and hopefully those with some knowledge of it can help you out. It doesn't get a lot of traffic b/c most of those cats are on either Lantus or Levemir and post in that forum, but it might be a good place to at least get acquainted with folks who are familiar with cushings. They may be able to answer your creatinine question too.

I'm so sorry the vets are giving you a hard time. You are really doing so great with all of this and don't deserve that! It can be very hard for people in positions of authority or expertise to deal with the democratization of information caused by the internet. (or at least that's what my millennial co-workers tell me ). Hopefully the blood test will reveal something helpful. Please let us know when you get the results.

 

We haven’t had many with Cushings. One member is @Tuxedo Mom maybe she can give you some insight

 

Thank you. I’m still gathering my thoughts as I just don’t even know where to begin.

 

From looking at your spreadsheet at would appear that there may be other factors at work besides the diabetes. You mentioned that you were going to have the IAA and IGF-1 tests run which is a good idea.

I had a Cushing's kitty who passed away last year after 2 1/2 years with diabetes. He was PDH which is caused by a tumour on the pituitary gland. Cushing's can also be caused by a tumour on the adrenal gland (ADH) or iatrogenic which is caused from steroid use. My Tuxie's numbers were extremely volatile and could go from extreme highs to extreme lows all within the same cycle. He eventually got up to 6 units twice a day but was never even close to being regulated.

Cyshing's kitties often will have thin skin,prone to easy tearing, fur loss, and a pot-bellied appearance ( my Tuxie always looked like he was pregnant). The easiset test is the UCCR (urine cortisol creatinine ratio). This is done by collecting a urine sample AT HOME so there is no stress involved and having your vet send to an outside lab such as IDEXX for testing. There are IDEXX labs in Japan so this shouldn't be a problem. If the test comes back positive or borderline then other tests are necessary to determine which type of Cushing's it is.

Iatrogenic Cushing's (caused by steroid use) often can reverse itself once steroids are removed. PDH (pituuitary based) Cushing's has been treated with some success with trilostane (vetoryl). Kitties on this drug must be tested regularly, especially at the beginning, to make sure the dose is not too high. Too high a dose can cause Addison's syndrome which can be life tjreatening. ADH (afrenal based) can be treated by removing the tumour or adrenak gland although the surgery has higher risks.

Since you are having the IAA and acro tests done it wouldn't hurt to also do the UCCR test to rule out Cushing's. Current veterinarina literature says that Cushing's is rar in kitties. However it is my opinion that Cushing's in more prevalent than believed and is under diagnosed. If you need more information on Cushing's I will try to help you.




ETA Another useful test is an ultrasound done by a board certified technician. Cushing's kitties will often showing an enlarged pancreas, liver and adrenals. If both adrenals are enlarged then Cushing's is usually the PDH (pituitary) type. Of only one adrenal is enlarged then it is most likely ADH.


ETA I am including links to Tuxie's early spreadsheets. They were done in sections originally but these are the early ones after he was diagnosed with diabetes. I was using the AT2 pet meter.

https://docs.google.com/spreadsheets/d/1zjLCy1Y3LgvEsa3TU22TfmUUru9Ekr55QBrfBUpRO1Q/edit#gid=5

https://docs.google.com/spreadsheets/d/1eL-wdSvWyV5Z4ZIeSYbEP0WupKTcb4NuvahUQdVUcS8/edit#gid=5

 

First and foremost - I am sincerely and deeply sorry for your loss. Though much time has gone by, we will never forget. I have lost 20 felines over the past 12 years and each one breaks my heart a little more.

I thank you so much for the information that I can most certainly use. The vet here states they do not have the IAA or IGF-1 tests in Japan. Given your information in regards to IDEXX it appears to me perhaps they can, so I will pose this to a different vet who is working with another cat of mine. The only test they would do is a short version ACTH which was done last Friday and results not expected for quite some time due to the "Golden Week" holidays the majority of this week. They wanted to hold off doing that until after the holidays but I insisted this process get started NOW and the results could be back Tuesday or Wednesday hopefully. If not it would not be until May 7. They wanted to wait until May 7 to perform the test. Any way, done and water under the bridge...

I also appreciate the information in regards to the drug Trilostane as they were suggesting something else that has side effects that would do more harm then good in my novice opinion for a diabetic cat. I have begun reading different papers (with my limited access) and it seems trilostane has shown some very positive results. I would really like to be back in school so I could gain access to all the journals out there. I'm sure you already are well aware of everything involved and the different courses of action. I am working with what I refer to as "non starters" over here. I have to push, poke, prod, whatever to get things done outside of their (what I perceive to be) very limited comfort zone. I am certain they have never treated Cushing's.

I apologize for the delay in responding. I'm getting overwhelmed again and just getting used to the diabetes diagnosis and treatment.

Any suggestions for treating the hair loss and skin condition? Local professionals at a total loss....

Thank you again for your willingness to share your thoughts, experience, and knowledge. You are truly kind.

 

@Greg and Goma & Friends

Unfortunately IDEXX does not do the IGF-1 or IAA test. In North America the only place I found that did these tests was MSU (Michigan State University) I don't know if there are any labs in Japan that will do these tests.

The ACTH stimulation test is useful, but has some restrictions and is best as a diagnostic tool for which type of Cushing;s is present if any.There is another test that can be done using urine sampling with dexamethosone, but this test is better for determination of which type of Cushing's it is. The UCCR test is probably the easiest and cheapest of all the test for feline Cushing's, although they usually will use the lab result spread for canines, since there is so little specific test results for felines. I originally had the ultrasound done and then the UCCR when the U/S results were indicative of Cushing's. Because Cushing's in kitties does not have a range of specific test results most labs use the normal ranges as shown for canines.


With my Tuxie bloodwork showed high liver enzymes and pancreatitis (which is not unusual with FD kittties). Cushing's causes high excesses of natural cortisol which is normally produced as a necessary element for the body. HOweber with Cushing's kitties the usual normal 'control' mechanisms do not work and cortisol is being constantly produced. This causes higher glucose numbers and extra strain on the liver, pancreas and adrenals which is why Cushing's kitties will tend to have the pot-bellied appearance.

Unfortunately the diagnosis of Cushing's is not generally a quick yes or no, unless you get bad a definite negative with the UCCR test. When my Tuxie was diagnosed I had to research the tests that could be done and the interpretation f the tests since my vet had never had a Cushing's kitty...she had dealt with a number of Cushing's dogs, but never a kitty. Between the U/S (done twice within 1 year), the UCCR test and the HDDS test the results all came back as early Cushing's. I never tried the vetoryl( Trilostane) because the regular ACTH testing would have stressed Tuxie out far too much. Vet visits were so stressful for him and tended to aggravate his chronic pancreatitis A few members on here have tried this drug with varying results.

Just some background....Tuxie was 14 when diagnosed with FD. He had NEVER eaten dry food, was not overweight and for 10 years I had been making my own food. Statistically, there was no "reason" for him to become diabetic. His sister Maxie ended up becoming diabetic about 1 year after and again there was no finger to point at why this happened. She is also proving hard to regulate, but not near as bad as Tuxie was. Whether genetics has a role ...I don't know.

Anyway sorry for the ramble. I am sending many ((HUGS)) and positive energy for your Goma.

 

Greg, I don't know the first thing about Cushings, but I just wanted to pop in and send you a word of encouragement. I know you have a lot going on with all of your fur babies and the ongoing struggles with the vet. You've done such a wonderful job caring for Goma through all of this. I hope you are able to get some rest and peace and just take one step at a time. There often aren't easy answers to all of these health problems, but your kitties couldn't be in better care or surrounded with more love. You are a wonderful caregiver. Sending healing vines to Goma and peace to you!

 

Ditto to what Djamila said! I have no experience with Cushings so I'm glad Mary Ann was able to weigh in. Know that we're here for you and sending tons of healing vines for you!