Advice needed for cat being given 18u daily!

Hello all,

I am hoping you wonderful folks can guide me with this situation. My friend has a diabetic kitty who is in need of some help, she asked for my advice since I had such success with regulating Lucy's diabetes, the problem is I am not really sure where to start.....here is what I know so far:

Louie is a 14 year old female diagnosed in Sept 2010. She started at 1u of Lantus twice a day and has increased to a whopping 9u BID. She has been on that dose for the last 9 months. Currently feeding a mix of dry (not sure what kind) and DM wet. I am being told that bloodwork from the vet shows no other conditions / disease other than diabetes.

My friend is not currently testing at home, they tried to but the 'clicking' of the lancing device was too much for Louie! I have no idea how the vet has decided to increase the insulin with such little info.

I am going over to check things out on Thursday, hopefully will get at least a test done and see what kind of numbers we are dealing with. My friend is willing to test at home, as long as I can teach her how to do it without Louie freaking out. We have talked about cutting out the dry food, and feeding only low carb wet.

I don't really know where to begin - I know the testing and the food change are probably enough for now, but would love some advice. I have never had experience with such a high dose of insulin! It scares me to shoot such a high dose - what kind of numbers would I be seeing to warrant that?

Any ideas would be more than welcome....also any other information that I should be asking Louie's bean? She is very willing to change and be assertive with treatment.

Thanks a bunch!
Val & Lucy (on behalf of Louie)

Holy Smokes! That is a lot of insulin without home testing!

Before you change the diet and remove the dry food - make sure the testing is in place and DROP the dose to 1 unit or less and start the process over!

It is possible that the cat could be an acro cat or one that is insulin resistant, but without proper testing for this - viewtopic.php?f=12&t=373

If you go to the Acro board, you will get lots of information on the conditions and tests needed to determine if this is the case. viewforum.php?f=12

Chances are that this cat is just being mishandled by the vet and doesn't need this kind of dose, but if he does, then get the necessary tests done in order to determine what is really needed.

When you test, do you free hand or use the device? If the cat doesn't like the noise from the device, then teach your friend how to free hand test. Personally, I find it much easier than figuring out the device.

And remember - DON'T CHANGE the food until you are home testing and reduce the dose to 1 unit!

Also, please test for ketones!

When I tested Lucy, I free handed - the device made me super frustrated, I found it awkward and a pain in the butt! I am planning to teach her how to test free hand too!

I won't change the food - can we increase the wet food though? My friend is concerned that Louie is always hungry

Thanks for the links to the Acro board, I will check it out! The vet just keeps saying that Louie is 'insulin resistant' but no real definition or explanation etc.

Will the major reduction be harmful at all? It seems like such a drastic move - although it was my gut instinct to do so as well. My friend works all day, so there won't be anyone home with Louie in case of emergency.

A major reduction in insulin can result in DKA - Diabetic Ketoacidosis - a very painful and serious condition requiring ER / hospitalization for several days.

Get Ketosticks for testing urine for Ketones BEFORE any major changes, and be ready to quickly go back to the 9u dose if that is found to be the right dose.

The Acro-beans are most active on Facebook these days - you and your friend would be welcome to join there and ask questions / advice there. It is a private group so that no public see the doses that some of the acrocats need (over 50 u per shot - YES they need it!!! Really!!!) Send me a PM here and I'll send you a link etc.

When I first came to FDMB in 2007, my Norton was at 13u BID (26u per day) and everyone freaked out. A dose reduction test resulted in 500 to HIGH, so we went back to our dose (Humulin N in those days) very quickly.

If the 9U BID dose was reached gradually over time - it is probably the right dose. Granted the dry food does contribute.

When I got my cats over to low carb canned food -- Norton went from 13u BID down to 8u BID.

If that dose has not harmed the cat so far, a reduction is ridiculous.

Your first step is to start home testing; once you know what the BG are for this cat, you can then plan your food changes..... it could well be that the cat is very carb sensitive, and that dose of 9u BID is needed mostly because of the food. You won't know until you are testing at home.
I personally prefer to use the lancet device for testing because cats will get used to the sound, but will remain jumpy if it's never known how deep the lancet will hit with the free hand method. When you dial to a setting on the lancet device, you have a consistent depth, each and every time you poke the ear. Both of my cats usually slept through pokes with the lancet device, so it's not scary, loud, or hurting.

To get a cat up to the high of a dose without testing is dangerous. How did the vet decide on dose increases; can you ask your friend for any numbers on tests from the vet? I would guess the vet must be doing curves or something? What tests were done by the vet?

Once your are home testing, a food change could be tried by introducing some low carb wet food and minimizing the dry... it takes a few days to get out of the system, but you don't know how quickly the BG will drop when the dry is removed, so you want to be sure that Louie's being home tested first.

When you are there on Thursday, would you be able to stay a bit and get a few numbers? Also, can you help your friend to set up a spreadsheet for keeping track of Louie's numbers? The google spreadsheet will be very helpful to assist your friend.

While I am there on Thursday I will get as many tests as I can. I will bring over Lucy's spreadsheet and hopefully get one set up for Louie! I have mentioned FDMB to my friend, but she isn't a frequent computer user - hence why I am asking all of the questions for her!

I am hoping that my friend will have more info for me on Thursday regarding what tests were done at the vet, she just said "blood tests" when I asked her. Apparently there is nothing else to be concerned about other than the diabetes according to her vet?!?

I too hope that the vet has done some sort of curve or testing before increasing the dose - again I will get more info and report back. From what I gather, the vet has essentially said that Louie is just a cat that requires a high dose of insulin and my friend accepted that and followed vet advice.

It sounds like home testing and getting background info is where we will be starting. I will report back on Friday and let you all know how it goes!

Thanks to all who have given advice so far

Tell your friend that there is no need to be an active and frequent poster online, but if she has her test results entered into Louie's spreadsheet, then you can help her by keeping an eye on the numbers. Also, if she joins the board, then she will know where to come to ask questions when she has some.
While you are there, maybe you can get her joined up or at least know where to go to get help.

Have your friend see about getting copies of the tests done by the vet, and you can help her with the numbers. She can also ask about a fructosamine test.

If the vet said the cat needs a high dose of insulin, then have your friend ask about tests for insulin resistance. No cat needs that much insulin if not insulin resistant. I don't even think dry food would cause such a high need of Lantus... Caninsulin maybe, but not Lantus. The vet can draw blood for IGF-1 and IAA tests to be done at MSU.

I got my cat used to the clicking of the lancing device by clicking it and then giving him a small treat. Then I'd click it near his ear and give him a treat. He soon got to associate that sound with treat giving, and now comes running when he hears it!!!

She may find it helpful to have a printout of notes on Secondary Monitoring Tools to help keep track of ketones, behavior, etc, while she is getting used to the gold standard of blood testing.

And I don't think I'd drop down to 1 unit from that high of a dose. I'd be inclined to make a small food change while blood testing and monitoring for ketones/glucose to see what happens. Like maybe try reducing the dry food calories 25% and replacing them with low carb wet or raw food calories (not volume or weight), testing/monitoring for effects, adjusting dose based on guidelines, monitor for safety, rinse and repeat until all dry is gone.

And if the diet alteration isn't helping reduce the insulin dose, definitely get the Acro/IAAA tests done.

I have a high dose cat- currently 23u BID but she has acromelegy (but not IAA) and BOTH of those tests require blood being sent to a university (info on acro forum) for testing as they are the ONLY place in the US that tests for it. If she doesn't remember paying $15 for IAA and $49 for Acro plus S/H and it isn't listed on ANY receipt or paper work it was not tested for.

A few questions to ask her- is he still loosing weight? What does his fur feel/look like (bad/dandruff/dull)? How is his pee/how often? You know the signs of an unregulated FD and some you will notice right off.

Now- I would teach her how to test- my guess, since he is still hungry as she says, he is as unregulated as the she found out about it but not reduce OR change food for a few days to get her/him used to the testing before you change anything and to test for ketones. Increasing the canned food is a GREAT idea- just don't decrease the dry (although he might switch on his own, so be aware of this and be prepared to move quicker.) Three days should be good- not overlong unless she doesn't get the hang of the testing.

ONCE she has testing down and you know what numbers you have I would then change the food and drop the dose. Depending on how the numbers come up every 3 days reduce again until she gets him down into good numbers consistently.

I would not DROP to 1u- for a cat that has been slowly moved up to 9u BID that could lead to ketones and DKA quickly. Dropping BY 1u increments would be okay or even two units as it is 22% drop, but then go to 1u drop when get to 6u or 5u from then on.

As always- test for ketones daily while doing this- even twice a day if she can catch him at it.

First and most important thing is what you're putting in kitty's mouth!!! There is a lot of prejudice for moist foods and against dry foods. But the bottom line is % of calories from digestible carbs. My own tuxedo cat went from 6.5 units/day on a 50-50 mix of Hill's A/D with baby food (moist & the only thing he would eat for a while after he got sick) to 2 units/day (pureed moist fancy feast classic chicken) to off insulin altogether on "young again zero carb" dry food alone. My kitty was an acute diabetic, iatrogenic from a series of prednisone injections, but he's all better now. At least in his case, diet made all the difference.

If you can afford it, I'd go to zero carb food if at all possible (it seems expensive, but they eat less, so compared with 4 cans / day of fancy feast it's competitive). It eliminates one variable. Beyond that, you need to get your cat's blood sugars tightly controlled for a period of time. I have strong disagreements with the management over at Elizabeth Hodgkins' board (yourdiabeticcat.com) because of the gestapo moderators who will ban you for merely advocating a zero carb dry food. Nevertheless, there's some useful information over there on insulin types and a sliding scale for protamine zinc insulin, I found useful for a brief time before getting my cat in remission with zero carb dry food. Sounds like you won't get your kitty off right away with diet alone, so that may be even more useful to you. The Hodgkins moist food gestapo are right about one thing, however. What you put in kitty's mouth is first and foremost and should be mentioned front & center before your insulin dosing. On that much I agree, though I have profound disagreements with the moist food gestapo.

You absolutely MUST learn to test at home. Go out & buy yourself a meter (ultra mini gets good reviews), and get in the habit of testing 4 times / day & follow the sliding scale. Get your kitty under control. But the first and last thing is getting your cat on a proper diet. 18.5 units/day without testing is flying blind into the storm (JMHO). My cat is off insulin & I'm still testing him twice a day (may reduce this in a week if he continues under control).