When to worry about insulin resistance?

Discussion in 'Lantus / Levemir / Biosimilars' started by billy, Aug 1, 2012.

Thread Status:
Not open for further replies.
  1. billy

    billy New Member

    Joined:
    Jul 21, 2012
    Hi guys! Smudge's spreadsheet is in my signature. Wanted to get some input on his numbers and whether we should be worried.

    Going forward I'm trying to get a lot more readings, more curves, to keep an eye on his nadir and where his nadir is. I've read that the pre-shot numbers aren't nearly as good as know his curve and/or nadir. So that's one thing I'm trying to improve, getting more BG readings.

    From his spreadsheet it looks like the only times the shot had much of an impact was the first shot ever (12 hours), when we went to 2.0 (for 12 hours) and 3.0 (for 12 hours) then things returned to normal. Is he building up a resistance that quickly? Is it just a matter of increasing the dosage enough to break through that resistance? At this point a 3.50 shot is barely putting a dent in his BG levels. Is it too early to start worrying about the type of insulin or other underlying causes? Should we get a new bottle of lantus? I'm worried about him staying at 350-450 BG for such an extended period of time. I know it's harder to tell without more readings, which I'm going to work on, but if anyone has some insight or suggestions that would be great. =)
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The first thing I would consider if whether the Wellness Core is too high in carbs. It's 8%. If Smudge is carb sensitive, that may be contributing to higher numbers. That said, his numbers weren't much different on Fancy Feast.

    I wouldn't be concerned about the dose. We don't look at doses at entering the "higher" range until they are over 6.0u. I am concerned about the ketone readings and the high numbers. When you took Smudge to the vet, was any lab work done to rule out infection? How are his teeth? In many cases, ketones result from infection, not enough food (usually a cat that's sick doesn't want to eat) and not enough insulin. With ketones present, I'm more concerned about infection/illness than insulin resistance.

    I think you are going to need to be more aggressive about dose. With ketones in this range, I'd be raising the dose every 4 cycles. Once you see some shift in the numbers, you can slow down the pace of the increases.
     
  3. billy

    billy New Member

    Joined:
    Jul 21, 2012
    For some reason I thought the Wellness Core was lower in carbs than 8% (we are giving him only Wellness core chicken/turkey/chicken liver canned cat food).

    When we took Smudge to the emergency vet, they took a urine sample to check for a UTI but we have not gotten the results for that yet.They also scheduled us to come back for an ultrasound for pancreatitis - to check his organs. I haven't done it yet because he gets so stressed and that makes his bg go up and it is already high. He has a great appetite so I wasn't sure if pancreatitis is even his problem. Should I get that done ASAP or wait until he is more regulated?

    I actually had him in to get his teeth cleaned when they found out he had diabetes with the senior blood work they did on him, so he didn't get his teeth done. I have since talked to the vet and she said I could go ahead and get his teeth cleaned even though he ins't regulated and that it is safe. He definitely has some tarter build up (he is 8 never had his teeth cleaned,) but I dont think they are terrible. Again, I am worried about stressing him out and was going to wait till his bg was more under control. Should I go ahead and get this done?

    So you are saying the fact that he has any blood ketones, even though he is unregulated, may mean he has an infection?
     
  4. Melissa and Celle

    Melissa and Celle Member

    Joined:
    Jun 11, 2011
    I really don't feel qualified to give any advice, but you might want to look at Celle's spreadsheet to see a similar pattern at similar doses. Celle has tested positive for pancreatitis even though she doesn't have any obvious symptoms.
     
  5. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Yes, that's exactly what I'm saying. Ordinarily, a cat should not have any ketones, even an unregulated cat. If you look at your first ketone tests, they were negative. We consider ketone levels problematic once they are above trace. Smudge is sitting right at the border of above trace. Ketones are more likely to develop if an infection is present.

    I would be calling the ER vet to get the results from the urinalysis. If they did a sterile draw using a needle, it takes around 2 - 3 days for them to culture the sample to see if bacteria are present.

    With teeth, it's really impossible to tell how bad the teeth are until a cat is anesthetized. When Gabby was diagnosed, the vet said she had moderate tartar. Once they got into her mouth, it was a different story. I would take one thing at a time, though. Find out if there is a UTI. If not, then discuss the ketone levels with your vet and maybe more blood work will tell you if there's an infection.
     
  6. billy

    billy New Member

    Joined:
    Jul 21, 2012
    Just called the vet and she said Smudge does not have a UTI. She said his teeth were not that bad, but like you said sometimes there is stuff hidden under the gums. I will get him the pancreatitis ultrasound then ASAP and his teeth cleaned but I will wait a little bit after the ultrasound to do that since he will be stressed. What else could cause infection? You say more blood work could show an infection. He had blood work when he went into the vet and everything was normal (except his bg of course). The reason I ask is because sometimes the vets don't do a thorough job and I just like to know what to ask for.

    Melissa, Celle's numbers do look similar to Smudge's. When you treated the pancreatitis did his numbers go down? That's what it kind of looks like in the last few weeks after he was diagnosed. How did you treat the pancreatits?
     
  7. miso00

    miso00 Well-Known Member

    Joined:
    Nov 13, 2011
    I don't know what exactly got Mikey OTJ the first time...but in November when we first got him the vet said "from what I can see his teeth are not bad"...in Feb. I got his teeth cleaned (3 removed, they were a little worse than the vet thought) and his numbers went down from there. I also changed his food from regular Friskies at 11% carb to Friskies special diet at 4% carb and I thought that was a big difference in his BG's. I've also read in other posts that even the flavor can increase/decrease BG's. I tried it the other day switching from turkey to beef and I did see a bigger spike.

    He was sick a few weeks ago (again with a tooth issue that didn't seem "too bad" and he had rotten roots and more removals) and his BG's went up for 2 tests and then once he started on the prednisone I had to put him back on insulin.

    Tidus I gave a bactaquin pill to and his BG shot up the highest it's ever been.

    It seems like there are so many things that can effect BG's.

    In my opinion I would stay away from liver based food. The liver is what filter all the toxins out of your body so in essence when you eat liver you are eating toxins. It also store glucose (glycogen) not sure if that has an effect??? But like others said more importantly I think you need to watch for serious issues like ketones and pancreatitis. Maybe the vet can do the ultrasound and the teeth on the same day?
     
  8. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    You don't need an ultrasound to diagnose pancreatitis. Pancreatitis can be diagnosed by a spec fPLI. It's a blood test available through IDEXX. The blood test is way less expensive than an ultrasound.

    A CBC will tell you if Smudge's white count is elevated. That's one way to determine if there's an infection.

    Overall, I would discuss the ketone issue with your vet. If you're going to get a blood draw for pancreatitis, what I'd suggest is that you see if the vet can also do a blood ketone level. One other possibility is your meter is off. I'd want to compare your ketone readings with the vet's before you go to the expense of more tests or work-ups. Another way to cross check is to get some Ketostix and do a urine ketone test at home. If you are seeing less than trace, it may be your meter.
     
  9. Melissa and Celle

    Melissa and Celle Member

    Joined:
    Jun 11, 2011
    We didn't do anything for the pancreatitis. Our vet recommended metronidazole, which we haven't been able to give her and a special diet, which she wouldn't eat. So we're just happy that she's doing better now as far as the BG is concerned. I think it must be the higher dose that did it. Since we had periods of control before on much lower doses, we were reluctant to go so high, but clearly that's what she has needed. As for whether she still has pancreatitis, we haven't done another blood test, and she never had any symptoms (other than uncontrolled BG), so we can't really say.
     
  10. Grayson & Lu

    Grayson & Lu Well-Known Member

    Joined:
    Jan 9, 2012
    I just glanced at your spreadsheet... it's still kinda early in the dance, so it may just be that you haven't found the right dose, or that his body is still getting acclimated to insulin. Sometimes, even with aggressive dosing, you still can't get them to break the 300 threshold. Grayson "swam in a sea of pinks" until I got him tested - and once I learned he was resistant (no big surprise), I then got aggressive w/ dosing. Perhaps it's worth having the blood drawn and sent to MSU (Michigan State does both the IGF-1 for Acromegaly and the IAA for insulin resistance). Let me know if you need more info about that - or you can do a search.

    Lu-Ann
     
Thread Status:
Not open for further replies.

Share This Page