We're back...need advice, please! Insulin resistant?

Hi All!

Prince and I have had so much going on and took a leave from FDMB. For a while, his BG really seemed to getting better (around the beginning of June). Then, towards the end of June, his #'s seemed to shoot back up. I feel like I have tried everything-a fresh bottle of Lantus, restricted food (made sure he wasn't snacking)...

I can't figure it out and it is really upsetting. I have been increasing his dose slowly as his numbers have risen. He is now up to 3.0U.

The only thing that happened around this time is that when his numbers started getting really low in the beginning of June, I reduced his dose (lowest was 1.5U). That is when the numbers started getting whacky and rising, even when I increased his dose again. His BG never came back down! I have decreased/increased his dose carefully, only decreasing by .25U, although there were a few times I increased by as much as .5U.

Is this possibly a case of insulin resistance? Should I try switching to a new insulin, continue increasing his dose, or get him tested for either IAA or IGF-1, which I don't really understand but read on here that they are 2 conditions that may be responsible for insulin resistance?

The vet really hasn't been much help. If anyone could take a look at his SS and provide some insight/tips, I would be so, so grateful. Prince is my baby and I feel so helpless right now. He was diagnosed in January of this year, and I thought we were FINALLY on the way to regulation and was so happy, but it's not the case :cry:

Thank you so much!

 

Re: We're back...need advice, please!!!

have you had any medical tests done, emily? like investigating teeth or bladder infections? infections are notorious for causing increasing blood sugar, even to the point that they can bring an OTJ cat out of remission.

but i'm not sure you can be certain this dose isn't bringing about some low numbers. Take a look at June 16th. His amps was 203 and his pmps was 211. Looks like an all-yellow day, except that you got a mid-cycle test that caught a 39. That tells you that sweet prince can go from 200-39-200 without blinking, and it could be happening from the 300's today. Just no way to know.

My best suggestion would be to get a minimum of 1 mid-cycle test in the day cycle and one in the pm cycle for the next 4 days. More is better. Then revisit this question again - you're going to have a better idea of how low the dose is getting him and we're going to be able to see the picture better as well. With only preshot numbers, there just isn't much to go on.

If the data shows that he really isn't getting into low numbers, then I would get lab tests done to check for a bladder infection, get his teeth looked at, and get a general blood test done to see if he's got increased white blood cells, or anything else obvious going on.

That's what I'd do if he were mine - how does that sound to you? You must be worried about him! How are his 5 P's? Sometimes that can tell a lot if something is bothering him.

 

i just saw your questions about acro and iaa - we don't suspect a high dose condition until a cat is about at 6u per shot. i wouldn't worry about that at this point.

 

Hi Emily,

Welcome back. I was looking at your spreadsheet. For a three or four weeks, you didn't have any midcycle tests so it was hard to tell if the doses of 2 units and 2.5 were good for Prince with only the preshots. I also need to test my cat more often as well so I can get a better picture of what is happening. It seems like Prince had a lot of pink preshots in later June and July, but we don't know his nadir or lowest number in the cycle. He may have been bouncing from lower numbers midcycle or maybe just needed more insulin. Many kitties have their lowest number midcycle sometime from hours 5-7. We usually dose change based on the lowest number in the cycle not on the preshots alone.

I am not sure if I would have moved up to 3 units without more testing with the 2.5 dose. I am sure others who have more experience can give you more advice as well.
Don't worry FD can be tricky. He will get back on track.

 

Thank you so much for your reply! What are the 5 P's? So you recommend doing a +6 in the daytime and evening for about the next 4 days? I can definitely do that! I am so worried about him because I cannot figure out what could be bringing his numbers up all of a sudden. He had been doing so well!

I don't have a ton of faith in my vet because he didn't catch the diabetes and hasn't been much help. What kind of tests should I ask for? I just found a site that said that insulin resistance can be due to:

Drug administration (progestagens/corticosteroids)
Infection (urinary tract/oral cavity/sepsis)
Hyperthyroidism
Acromegaly
Pancreatitis
Renal disease
Hepatic disease
Cardiac insufficiency
Hyperlipidemia
Neoplasia
Severe obesity
Exocrine pancreatic insufficiency
Hyperadrenocorticism
Pheochromocytoma

ARGH! Would I ask for some sort of general test for infections? Does that exist? Thank you!!!

 

Also side note: I stopped testing mid-cycle because the vet laughed and said I was testing way too much. Now I feel terrible for listening to him! My poor Prince! I will definitely start testing mid-cycle again!

 

i'd go one step at a time. it's too soon to worry about him having one of those high dose issues. Catherine is right, it's possible that his high numbers are being CAUSED by too much insulin and bouncing.

Nadirs aren't always at +6. Even if they are sometimes in a cat, they can move around. It's far more useful to sprinkle your midcycle tests around through the cycle. I wrote this for someone a while ago and it could apply to Prince and you as well:

I wasn't sure why you haven't been getting mid-cycle tests, but that's your first step. It's going to tell us a lot. hang in there - we'll help you get to the bottom of it!

 

Emily --

You live in Boston? If Angell Memorial is anywhere nearby, I'd seriously encourage you to go there. Dr. B is a wonderful vet. One of the members here who was way before your time used him for her diabetic cat (and a non-diabetic cat) and he was my sister's kitty's vet and her cat had a number of health problems. Just let him know that you've been following TR here and hopefully he'll remember that Cynthia and Cosmo were members.

I agree with what the others are suggesting -- getting more spot checks. Also, just an FYI...nadir isn't always at +6. My cat's nadir is at around +3 or +4 except for cycles when it's not. The nadir can move around. Getting tests when you can -- definitely before bed every night, when you leave the house, when you come home, etc. -- getting tests at random times will will in the white spaces on your SS. I'd also suggest that you don't increase the dose by more than 0.25u unless you have 6 cycles where the nadir is over 300. I don't think you had enough data to be quite so aggressive with your dosing. A cat that's getting too much insulin can have high numbers.

There's a saying in medicine, if you hear hoofbeats, think horses not zebras. Rule out the most common problems before you start looking for illnesses that are rare. If you think there is some underlying medical condition, what are the symptoms you're seeing? Fishing expeditions are very expensive. If Prince hasn't had his annual vet visit, routine blood work can be helpful. Also, have a vet check Prince's teeth. Dental problems can raise BG numbers.

The 5 Ps: peeing, pooping, purring, playing, and I can't remember #5.

 

In addition to all the great info you've gotten so far...how old is Prince's insulin? Could it possibly be toast?

The 5th is is "preening" :smile: !

 

As for tests, I would want a full blood panel, CBC and Chem 25 plus urinalysis. However, I wouldn't rush to do that until you get more data and see if the issue is too much insulin. In addition to having nadirs at different times, my Max often has his lowest numbers in the pm cycle, often after a number in the high 200's at +2 or +3. So I'd gather my data before spending money on tests you hopefully won't need.

 

We replaced the insulin and it made no difference, so that's out. I will definitely start getting some more numbers mid cycle. Thanks everyone! I will post in a few days with the information, and then we go from there? He is not due for his annual visit for a while, so should I still make an appointment, or just wait? He was also there a few months ago with a bad ear infection that luckily healed quickly.

He is eating normally (voracious appetite!), purring, cleaning, pooping all normal, too. I also weigh my cats every month (or more frequently) and his weight has been stable, which is good.

How terrible are these numbers in the 300's? Is it okay to wait a bit longer or is it doing a lot of damage to him?

 

in many infections, the white blood cell count increases. those are the body's army against infections. i think there are some infections where that might not occur, but i'm not certain about it.