Unregulated Diabetes

My cat Riley was diagnosed with diabetes in October of '09. He is about 10 years old and very sweet. His diabetes has been very difficult to regulate. He started out at 2 units of Lantus insulin and seemed okay in the very beginning, then we gradually had to increase the dose to eventually, 4 1/2 units. Then, about a month ago Riley got very sick and we took him to the hospital. He was hospitalized twice. It was concluded that he had a infection of some sort and many tests were sent out. They were not able to figure out what the infection was, but it was treated with medicine and the almost dangerously high fever disappeared. He is much better now (now that the infection is gone). We concluded that maybe the infection, that we think he could have had for a while, caused him to need such a high dose of insulin, so we started again at 2 units of Lantus insulin. Gradually after lots of monitoring, BG curves and vet check-ups, we got up to 5 1/2 units of insulin with readings still in the 400's. They upped his insulin to 6 units which he has been on for the past few days and he will be going in for another check on Tuesday. Another issue is his food. Riley has been eating wet Hills MD since he was first diagnosed and recently he has been eating wet DM. We have been feeding him whenever he asks, which can get up to 8 or 10 times a day, normally eating 2-3 cans daily. He also has a dry mix of MD and WD with TD mixed in that is sitting out all the time for him to eat, though we know that wet food is the best for him. Recently, a vet has suggested not giving him food whenever he eats because for human diabetics, eating a lot causes the need for a higher dose of insulin. I am writing to see if anybody has any information that would be helpful to getting Riley better regulated. A thank you, from Riley as well!

 

Sounds like you guys have gone through a roller coaster here. First things first - wet food is best, but not just any wet food. Diabetic kitties optimally need 10% or less carb content. Many of us feed 5% or less foods. The higher carb foods alone could cause that high of a dose. Second, once you switch your food over to completely low carb food you will probably need to lower your kitty's insulin dose due to less carbs in his system. Hometesting Riley's blood glucose will give you a better idea of how he is responding to the insulin than taking him into the vet every other week for glucose curves. The vet trip adds a lot of stress, which can make blood glucose levels sky rocket, giving you a falsely high value to be basing dosing decision on.

Once you have switched completely to a low carb food and are hometesting, then you can increase the insulin dosage with more knowledge of when it really is appropriate. If you still get to such a high dose of insulin, then you need to consider getting Riley tested for Insulin Resistance or Acromegaly. (Two conditions that inhibit the proper function of insulin in the body).

 

I would recommend that you get your kitty tested for insulin resistance (IGF-1 and IAA). It's a simple test - your vet draws some blood and sends it off to MSU. You can get more information here: viewtopic.php?f=12&t=375

You've spent so much time trying to get Riley regulated, that it's best at this point to see if there is a good reason for your trouble. Hopefully, he comes back negative; if it's positive, there are quite a few "high-dose" moms around here that can help you.

 

My first question is are you home testing? If not, you can save yourself alot of expense and stress on Riley by testing his BG at home. You can get any human meter at the pharmacy that diabetics use to test their BG before giving themselves their insulin shots. Many people here can help you if needed. If you have been home testing, would you be able to post some numbers of one of Riley's recent curves?

The testing for insulin resistance may be a good idea, just to rule out some reasons for the high dose.

As Riley is eating wet food, you should consider removing ALL dry foods and treats as they are all high carb and contribute to high BG numbers. My Shadoe cannot eat any dry food or her BG numbers go into the 400s, so your Riley could be affected the same.
The vet prescribed foods are not the best in ingredients, and you can get much better quality and for less cost and much less carbs.
A list to use to select some better foods:
Binky’s Food Lists

A great deal of important info on feeding:
Feeding Your Cat: Know The Basics of Feline Nutrition

Another thought is dental - quite often, dental problems can contribute to high numbers. If Riley has any bad teeth, gum issues or the like, you could make sure there is no problem in this area.
My Shadoe had a dental with one molar bad and being pulled; her BG dropped and she needed much less insulin afterwards for awhile.

The links to the tests you can request via your vet:
IAA Test
IGF-1 (Acro) Test
You can print them out and take them to your vet if you like.

My cats both tested positive for acro and Oliver also is positive for IAA

 

Thank you all so much for replying. Riley's most recent update is that he was taken to the vet/ animal hospital on Monday and the doctor thinks that there may be some other problem, complicating his diabetes. She sent out some blood to be tested, but we haven't gotten the results back yet. As of last night, the doctor told us to increase his insulin from 6 units of Lantus to 7 units, which we will begin tonight.

Also, in response to your comments about home-testing glucose, we do have the equipment and have tried a couple times, but it has proven very challenging. Given the information you have posted, we will try again on home-testing.

Also, as for food, the food situation is very difficult. Riley has a brother, Cookie (also a cat) who wasn't treated well in his home before. He often did not get enough to eat so the vet recommended that we keep dry food out all the time. Unfortunately Cookie gets very nervous when the food bowls aren't there, even when we are just cleaning them,he will go and sit right by them. He just likes the reassurance that it's there. Anyway, Cookie was underweight in his old home and now he is overweight! The problem is the Riley needs to gain weight, in June of '09 he was at 15lbs and now he is currently at 11.4lbs, and Cookie needs to lose weight, so the food that we're feeding Riley (very high calorie food) is terrible for Cookie (in terms of the weight issue), so we are hoping that once we get Riley stabilized, we will start on Cookie's food plan.

 

When Riley is getting enough insulin, he will gain weight even on low carb high protein food -- he does not need high calorie "Twinkies"

As far as the blood tests -- specifically request the IGF-1 and IAA tests -- they are ONLY done at the vet lab at Michigan State University (only place in North America).

These tests screen for the two most common "High Dose" conditions.

 

As a problem that could complicate Riley's diabetes, the vet had mentioned cushings disease. I know that there are plenty of websites where we could learn about cushings disease, but i was wondering if anyone had any information or first hand knowledge of cushings disease that would be helpful. Thanks!

 

i think cushings is more rare but definitely recommend getting the IAA and IGF-1 tests for insulin resistance (insulin auto antibodies) and acromegaly. any time we start talking higher doses and still unregulated kitties it is very worthwhile to do the tests. if they test positive, it gives us a heads up to give more and more insulin without worrying as much about hypo. if they test negative it tells us we might need less, not more, insulin, and maybe a change somewhere else like diet, infection, meds, shot timing, etc.

have you looked on the lantus forum at the stickies at top? the tilly protocol linked there, also linked in my signature line, shows a very good way of moving up in dose to get to the optimum dose. we use very small increments. if your cat tests negative for acromegaly/resistance, you might then want to start all over at 1u every 12 hrs and follow tilly. it's helped hundreds of cats and is an excellent protocol.

 

Arnold lost several pounds before he got his dx. He's still slightly over ideal, but just getting him on a good diet has helped regulate his weight. Humans do the same thing. Once things are working well in the insulin department, weight takes care of itself whether that's gaining or losing. How much does the vet say Riley should weigh? Arnold is fairly big boned and the vet told us 12# would be good so if it's around there, it's not like you're far off from the ideal. We had to take a lot of time retraining Arnold w/ his meals. We always free fed dry food. Arnold liked eating when his bowl was full and overflowing. We started by going 1/2 dry and 1/2 wet w/ set feeding times and amounts. Then all wet 3x a day. I still feed him off his schedule if he's really meowing up a storm and acting starving, no point in torturing him (or me having to listen to him!). He now eats one small 3-3.5oz wet can of food 3x a day. I hope you can get it figured out!

 

Thanks for replying! I will suggest both the IAA test and the IGF1 tests to the vet. I have already asked about the insulin resistance test and the vet is considering doing it. Also about Riley's weight, he was at 15lbs before and then, he was a little overweight, but not to be concerned about, now he is 11lbs 8oz and so he should ideally be about 12-14lbs. Also, his most recent vet appointment, on Saturday showed that at 7 units of Lantus, his mid-day BG check was in the 470's which means that it hasn't improved much since being on 6 units of Lantus, so we are hoping they will find out what seems to be the problem.

 

Unfortunately, the vet is thinking Riley's problem may be a tumor in his pituitary gland or Acromegaly. He is going in for an MRI tomorrow. We are just taking one step at a time. I was wondering if anybody had any information on Acromegaly. Thanks.

 

There is a support group on this website for acromegaly. It will give you information -check the stickies out at the top of the page: viewforum.php?f=12 I don't know how busy that page is, but there are several members here with that issue. Good luck!

 

There are several people with cats having acromegaly, including both of mine.
I don't know how much an MRI costs but you can test as has already been suggested, just a blood draw sent to msu for IGF-1 and IAA.

 

An MRI is kind of unnecessary, and would have to be done again if you decide to treat. Please get the IGF-1 test first. If positive, and if you want to treat, Colorado State University does the best treatment in North America. However, you are required to get a CT scan AT the university because it feeds into the radiation machine.