Cat not responding to insulin (Norway)

Hello. I'm a newbie in this forum and also a newbie on the subject of feline diabetes, and I'm hoping you can help me. My 7 year old cat, Pelle was diagnosed with diabetes about two months ago. We were very in doubt about what to do. We have a 2-year old and a baby due in May, we lead a busy life, and we like to travel. But we love Pelle and didn't want to give him up. So we decided to start him up on insulin. He was hospitalized, they quicky got his levels stable, and we were able to bring him home the next day. We started up with one unit Caninsulin morning and evening and have since then been increasing. We just started giving him 3 units morning and evening, but he is not responding very much to the insulin. We have been measuring his blood sugar with home testing. I don't know if you are using the same measuring system as in Norway, but the last time I measured (when he was receiving 2,5 units morning and evening), we measured 29,7 before insulin and 22,7 after 5 and a half hours. He weighs about 5 kilos. The vet suspects that he might have cushings or acromegaly and sais that it's okay if we want to let him go. I'm so unsure of what to do, I cry every day because I think it's so frustrating. I can't bear the thought of putting him to sleep, but I don't want him to suffer either. We don't have very much money and Pelle does not have insurance. Any advice for me?

 

I forgot to add, Pelle is on Hills M/D dry food. I've tried giving him canned food, but he hardly touches it.

 

Dear Marianne,
so very sorry to hear about your cat's diagnosis.
In order to help your cat you need a lot of time and commitment and it can be very costly when you don't have insurance but it can be done.
If you have time please read all the information here about FD and other diseases which can be primary cause of diabetes like acromegaly and Cushing's.
You said that Pelle was stabilised in hospital. What dose has he been stabilised on and how often do you increase the dose? What type of meter are you using? What type of food you're giving
There are people here who could help you although Caninsulin is not the best insulin for cats. Saying that my cat went into remission twice on this insulin so it did work for him. Unfortunately third time it did not work well and I had to try Hypurin Pro Zinc.
I do understand your frustration. I've been doing diabetic dance for almost 2 years and I'm struggling with other issues in my life as well. You seem to be very busy with a young child and another one arriving soon. You need to do it with your partner so you're both support and help each other.
I think you would get more help if you post in Feline Health - Main Forum.
My advise to you is try to relax, read the information provided on this forum and give yourself time to think about it.
Let us know how it's going.
Best regards,
Marlena

 

Dear Marlena. Thank you so much for your response. You're saying that you had to try Hypurin Pro Zinc. What happened then? Did your cat get better? Did it help? I actually just sent an email to my vet, asking if it would be a good idea to change insulin, but I haven't received a response yet. I don't know what dose he was stabilized on in the hospital, when I asked my vet about it, she said that he received the insulin intravenously in the hospital and that it could not be compared to giving it at home. We have been increasing the dose with one unit per day every two weeks. I'm giving him Hills m/d dry food, he doesn't want canned food. The meter I'm using is called Wellion GLUCO CALEA. I'm doing this with my partner, but he's not the worrying kind so I feel that the burden is on me. Thanks so much for your understanding.

Best Regards,
Marianne

 

Marianne,
I really feel for you. As long as your partner is helping you by giving injections and testing and going along with your commitment regarding feeding etc it is good. You can't expect them to worry about the issue in the same way as you - they think differently! I have learnt to accept that.
You could try to think about better food for your kitty, there is a lot information on this website how to make your cat eat different food like homemade or commercially prepared very low carbohydrate wet food. There is now a lot of choices when it comes to choosing good quality food for your pet and one of most important thing is to avoid dry food and food with carbohydrate like wheat, corn, sugars and vegetable byproducts.
You might want to do a Google research in your country for the ideas where to find good quality cat food (low carbohydrate, real meat, no fish). There are ways to encourage your cat to eat wet food like putting various toppings like nutritional yeast, bonito flakes etc.
As I said this Forum is full of information, I'm sorry but I have no time at the moment to direct you to relevant pages.
Marianne, hold on in here and we will help you.
Regarding my cat - he has been on Hypurin (it's for humans made from beef and long lasting) since January and I haven't regulated him yet, I'm struggling. But I think he is getting better.
There is only 3 people here (2 with experience and I) who are familiar with that insulin. Another option is Lantus (glargine) or Levemir (detemir). There is lots of very knowledgeable people here to guide you if you choose one of these options. In UK where I live the vet must try a cat on Vetsulin (Caninsulin) first and if it's not working very well they are allowed to prescribe a human insulin under CASCADE SCHEME. Vetsulin is a good insulin for dogs but for cats it is not best choice as it is too harsh (producing very low nadirs - risk of hypo and then leaving the system too quickly and giving a cat high blood sugar before next shot). But I have to mention that some cats did well on it as it WAS the case with Rocky.
Please read as much as you can here (all the yellow circles called "sticky") and hopefully somebody who is allowed to give recommendations will see your post.
In the meantime try to approach this very upsetting DX (diagnosis) with calmness as it will test your patience and sanity but I'm happy to give you moral support. I have received a lot of it here so you are in the right place.
In the meantime please post your questions and good luck with the vet.
Lots of hugs
Marlena & Rocky

 

Hi Marianne, welcome to FDMB. Lets start getting you set up to help others give you some feedback.

It is absolutely terrific you are home testing! The insulin dose is based on how LOW the glucose goes, with some consideration of the pre-shot levels as a safety check. We use a grid to record the glucose tests that automatically color codes the test values to let you see patterns of response. Instructions are here. Since you're in Norway, you'll likely want the World version of the grid (spreadsheet)

Another thing which will help folks give you feedback and ideas is your signature - the notes at the bottom of one's post. Here are instructions to editing your signature.

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 

Thank you! =)

 

Perfect!
If there are any prior tests with date + time since insulin, go ahead and enter what you can.
I will note that this is not the most active forum, so for anything urgent or emergent, post in the Feline Health section. You may find you'll get more responses in that section if you post there regularly. I always check this forum but am not on much during the work week.

 

Hei Marianne jeg har også en diabetiker her på snart 9 år. Vi sliter også med å stabilisere blodsukkeret hans. Han får 4 enheter morgen og 3,5 kveld, men fortsatt for høy etter 4-5 timer. Han slet med matlysten inntil jeg kjøpte bløtmaten til royal canin diabetic. Prøv det å se om det hjelper på matlysten

 

Hei Hanne! Så hyggelig å se flere norske her inne Og godt å se at vi er i samme båt..Vi har nå prøvd å bytte insulin til Lantus, han får 3 enheter morgen og kveld, men ligger fortsatt på 23,8 på det laveste. Fortsetter du å øke doseringen jevnlig eller hva har du tenkt til å gjøre videre? Pelle har fått tilbake litt matlyst, spiser Hills m/d tørrfor og boksemat, det er det eneste han vil ha.

 

Hei vi måler jevnlig fruktisamin hos dyrlege , men disse verdiene er ikke bra. Vi skal trappe opp til 4 enheter på kvelden så får vi se hva som blir gjort videre:-/ min kom ikke under 20 i BS før vi kom opp i 3,5E så det skal tydeligvis litt til før de responderer. Dyrlege sa at det kunne ta minimum en uke fra insulinøkning til den skikkelige virkningen inntraff han har akkurat vært å tatt prøver av veksthormonet som i mange tilfeller kan gjøre at man ikke responderer på insulinen. Hvor i landet bor du? På dyrehospitalet vi bruker er de dyktige, og de legger nå opp en videre plan hva som skal skje Videre Crash spiser også m/d fóret, men sper på litt ren kyllingfilét innimellom han har blitt så tynn stakkar:-/ har begynt å bestille fór på nett, er ikke mange ørene per boks man sparer, men alt hjelper i det lange løp;-)

 

Vi bor i Østfold, har gått til behandling på Fredrikstad Dyrehospital, men har ingen tiltro til den dyrlegen vi har der. De prøvene dere har tatt, er de for å teste om Crash har akromegali eller cushings, har dyrlegen nevnt noe om det?

 

Just ran the page through Google Translate, so please forgive me if I've misunderstood anything from the posts in Norwegian above.

The dose for both Caninsulin and Lantus are adjusted based on the nadir, the lowest glucose post shot.
The lowest glucose for Caninsulin/Vetsulin is around +3 to +4 hours post-shot.
The lowest glucose for Lantus is around +5 to +7 hour post-shot.
The nadir should be above 50 mg/dL (2.8 mmol/L) on a human meter and above 68 mg/dL (3.8 mmol/L) on a pet meter.
When we do dose increases here, based on the home tests, we make small increases at a time, trying to measure 0.25 units by eye or by using calipers. Increasing by whole units may pass over the best dose.

Very important: too much insulin may look like not enough insulin. This is because the body releases stored glucose (glycogen) to fight off too much insulin. It cannot do this forever and the cat may crash into hypoglycemia if there is no more stored glucose.
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Bare løp siden via Google Translate, så tilgi meg hvis jeg har misforstått noe fra innleggene i norsk ovenfor. Dosen for både Caninsulin og Lantus er justert basert på nadir, det laveste glukose innlegget skudd. Den laveste glukose for Caninsulin / Vetsulin er rundt tre til fire timer etter skudd. Den laveste glukose for Lantus er rundt 5-7 timer etter skudd. Nadir bør være over 50 mg / dL (2,8 mmol / L) på et menneske meter og over 68 mg / dL (3,8 mmol / L) på et kjæledyr meter. Når vi gjør doseøkning her, basert på hjemmetester, gjør vi små økninger om gangen, prøver å måle 0,25 enheter ved øyet eller ved hjelp av målepunktene. En økning på hele enheter kan passere over den beste dosen.

Svært viktig: for mye insulin kan se ut som ikke er nok insulin. Dette er fordi kroppen utgivelser lagret glukose (glykogen) for å bekjempe for mye insulin. Det kan ikke gjøre dette for alltid, og katten kan krasje inn hypoglykemi hvis det ikke er mer lagret glukose.

 

The part about too much insulin and increasing 0.25 units at a time, have you learned this from experience? I have been following the instructions from my vet, who is also a specialist in cat diseases, and I find it very strange that she is not aware of this. How can you tell if you are giving too much insulin? Shouldn't that show in the measurements? Because we have been measuring his BGs for every dosage, and his numbers have never been below red in the spreadsheet.

 

Vi går også på Fredrikstad dyreh

vi bruker det samme stedet. Han ble testet for å finne ut av veksthormonet for å utelukke akromegali. Å da fikk jeg bare svaret; det er ikke alle katter som kan bli godt regulert.. Men jeg spør jevnlig; har katten min det vondt? Det er det som betyr noe for meg, da jeg er opptatt av hans livskvalitet. Dette spørsmålet får jeg ikke svar på, og vi har holdt på med dette siden september:-/

 

The members of FDMB have found that making small changes is generally safer than making large increases and you are less likely to pass over the best insulin dose. Insulin is a potent hormone and small changes can be very effective. Staying up all night feeding carbs and testing glucose to keep your cat safe or having to take your cat to an emergency vet because of overdose is very stressful. Plus it risks your cat's life - an insulin overdose can kill - we had a fairly recent member lose her cat because the vet was incompetent.
Consider that folks here have time to focus on just feline diabetes while a vet is expected to know or be able to find resources to handle any disease in the species they treat. It is impossible for a vet to be up to date at all times on all diseases.
When the body exhausts its glycogen reserves due to too high of a dose, the glucose level will make a sharp drop and possibly go into hypoglycemia and death. Until then, the way to check is by lowering the dose and monitoring both glucose and ketones. Careful small adjustments based on how the specific insulin is metabolized minimize the risk of this. If you post a question on this in the Lantus or ProZinc areas, you'll get responses from some who have experienced this personally.
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Medlemmene av FDMB har funnet ut at å gjøre små endringer er generelt tryggere enn å gjøre store økninger, og du er mindre sannsynlig å passere over den beste insulindosen. Insulin er et hormon som potent og mindre endringer kan være meget effektiv. Sitte oppe hele natten fôring karbohydrater og testing glukose for å holde katten din trygg eller å måtte ta med katten til en nødsituasjon veterinær på grunn av overdose er svært stressende. Pluss det risikerer kattens liv - en overdose med insulin kan drepe - vi hadde en ganske nylig medlem miste henne katten fordi veterinæren var inhabil.Tenk at folk her har tid til å fokusere på bare feline diabetes mens en veterinær er forventet å vite eller være i stand til å finne ressurser til å håndtere noen sykdom i de artene de behandler. Det er umulig for en veterinær for å være oppdatert til enhver tid på alle sykdommer.Når kroppen bruker opp sine glykogen reserver på grunn av for høy for en dose, vil glukose nivå gjør et kraftig fall, og muligens gå inn hypoglykemi og død. Inntil da, måten å sjekke er ved å senke dosen og overvåking både glukose og ketoner. Forsiktig små justeringer basert på hvordan den spesifikke insulin metaboliseres minimere risikoen ohis. Hvis du legger inn et spørsmål om dette i Lantus eller ProZinc områder, vil du få svar fra noen som har opplevd dette personlig.

 

One of the important characteristics of FDMB is peer-review, where other members can read your post and give feedback. It would be really helpful if you would either provide an English translation in addition to the Norwegian text, or to post in English only, as the majority of members here both speak and write English.
Most folks won't likely go to the trouble of getting a rough translation with Google Translate, because it can be time-consuming and may not be exactly what you intended.
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En av de viktigste egenskapene til FDMB er peer-review, hvor andre medlemmer kan lese innlegget ditt og gi tilbakemelding. Det ville være veldig nyttig hvis du enten vil gi en engelsk oversettelse i tillegg til den norske teksten, eller å legge på engelsk, som de fleste av medlemmene her både snakke og skrive engelsk.
De fleste folk vil sannsynligvis ikke gå til problemer med å få en grov oversettelse med Google Translate , fordi det kan være tidkrevende og kan ikke være akkurat det du hadde tenkt.

 

I understand. Sorry about that.

 

I am sorry to hear your cat doesn't like wet food. My 13 yr old cat was diagnosed diabetic earlier this year. He was immediately started on 2 units of Vetsulin..which is the same thing as Caninsulin. He is now up to 5 units twice/day. But the big change in his numbers came when I switched him to low carb canned food. From my research on this matter, it seems none of the dry foods...even the ones labeled for diabetic cats...are low enough in carbs. A diabetic cat should have wet food only and it should be food that has 10 carbs or less. There are actually quite a few brands out there that are low carb. A quick internet search came up with a list of low carb wet foods. 9 Lives and Fancy Feast, the lower cost foods, actually have a few that are low carb. My cat won't touch the 9 Lives, but he does like the fancy feast and the more expensive brands. After switching him to a strict low carb diet, his glucose numbers dropped from 485 to 140.