New Member Feb 1st, Insulin not working?

Hello, I'm a fairly new member and this is my second post. I received a lot of help on my first post from this group and it was amazing! I have created a spreadsheet for my sweet boy Oscar and things seemed to be going well. The last couple of days his sugar check at +4 hours is not as low as it was 3 or 4 days ago. From my chart you can see we started at 0.5 units, then 1 unit for a dose, went up to 1.5 units and his sugar was beginning to drop into a good range. I have had a little trouble with the shots the last few days - he screams a bit as I'm injecting - is it possible I'm not getting the insulin under the skin? Is it normal for the insulin to be effective then not so much?

Any help or advice would be greatly appreciated. I am considering increasing the dose again up to 2 units this time but I don't want to if it's too early or if the reason is that I'm not injecting properly.

Thanks in advance!!

 

Hi Carolyn! I can't help with Caninsulin but this post will bump you back to the top

I see @Critter Mom helped you in your previous thread:
Feb 1, New Member, Need help with Triaditis cat in pancreatic flare and newly diagnosed diabetic

 

Thankyou!!

 

Hi Carolyn,

It's a bit tricky to work out what's going on without before bed/mid-cycle tests in the PM cycle, plus you've got GI issues going on with Oscar at the moment.

Would you be able to run a full curve for the current dose on tomorrow's AM cycle (AMPS as usual, then do normal feeding schedule but test every two hours right the way through to PMPS), and then get a PM+2 or PM+3 on tomorrow's evening cycle. That might help fill out the picture of Oscar's current response and give a better foundation for review of the current dose and any decision about adjusting it.


Mogs
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Thankyou for your reply Mogs! I will absolutely do his sugar every 2 hours today and create a more complete cycle into the evening as well. Evenings this week have been tough as i am getting up at 4 am with my son to get him off to school everyday. The other thing i forgot to mention is a couple of days ago i started adding enzymes to oscar’s food (Aurion Digest 7) as the vet asked. His diahrrea stopped and his poop volume has decreased and they are larger in diameter and less like soft serve icecream or diahrrea. Could the enzymes be helping with his absorption and putting more sugar into his system? I’m not sure if that even makes sense. I’ll keep updating his chart throughout the day. Thankyou for the help! ❤️

 

Goodmorning! I took oscars sugar throughout the day yesterday and i thought we ended in a good spot. This morning his sugar went up after dosing but the vet asked to add some purina hydra-care to his food starting today so i gave it to him this morning - i think it might be why his sugar went up this morning. I’m going to go back to just adding plain water to his food and stay with that until i get him regulated. I backed off slightly from the 2 units this morning as i have to go to toronto today for the day and my son will be watching oscar. I wont be home until late afternoon and i didnt want him to end up hypoglycemic. Although i dont think i needed to worry about that based on his +2 that was going up. I’m going to see if i can get my daughter to do his sugar at +4 or +5. Thanks for watching and helping!

 

Nice job catching the 162 last night, Carolyn. It'll be a great help to you if your daughter can act as a second for BG testing.


Mogs
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Instead of the enzymes, if diarrhea is an issue, you might want to try a probiotic. Many of us use S. boulardii which is very effective for treating poop problems. Unless there's a major issue, using about 1/3 of a capsule in canned food twice a day should help.

 

Hi Mogs thankyou! My daughter has been a great help doing B12 shots for Oscar 2 times per week and helping me with insulin shots. She did take his sugar this morning and it was lower so I’m glad it didnt continue going up. I’m home now and it’s close to his suppertime and insulin shot so I’ll add that info shortly.

 

Hello Sienne, thankyou for your comments! We did try a probiotic (Fera) and it seemed to make his diahrrea worse so we stopped. I then tried S Boulardii and it worked great for about a week but he still had the ocassional bout of diahrrea. Thats when the vet suggested enzymes. They seem to have stopped the diahrrea but boy oh boy do his poops stink! My husband says he could knock a buzzard off a sh*t wagon for sure lolol. But his diahrrea seems to be gone for now and we keep S Boulardii on hand just in case as it has been helpful in the past. There are just so many things going on with Oscar and I don’t think my vet is good at managing them all together - pancreatitis, IBD (actually triaditis) and now diabetes! Honestly I feel like at times I’m not managing it well either ☹️ I would be totally lost without groups like this.

 

Goodmorning Mogs, sorry to bother you with more questions. We had a bad couple of days recently (I updated Oscar's spreadsheet) and I had to skip insulin doses for two reasons - number one being Oscar got into some kibble a couple of nights ago when one of my other 3 cats knocked the food bowl off the piano bench they are fed on. We use the piano bench because Oscar doesn't jump or climb and he can't reach the food. He gorged off the floor and had a completely watery diarrhea mess in the litter box and all over his hind end. I had a lot of cleanup to do and Oscar didn't seem too interested in his canned food so I opted to skip. He was off all day and slept a lot - ate only small amounts but I gave him an evening dose. The following morning his sugar was sooo low and I don't understand why. I rechecked 20 minutes and it was virtually the same and he was soooooo hungry I couldn't wait any longer. I opted to skip - then I skipped the evening dose under pressure from my husband (who doesn't believe in all this insulin stuff even though he is diabetic). Today we are back on track but I backed off the insulin dose this morning just in case - I gave 1.5 units instead of 2.0. My husband thinks as long as Oscar is below 20 he is fine. I know otherwise so I'm going to try to get back on track starting today. Should I stay at the 1.5 units for a few days up to a week? Or should I up it to 1.75 based on this morning sugar still going up? Last question... Oscar eats a large amount of canned food in the morning (1 to 1.5 cans fancy feast turkey and giblets) - he is super hungry - can I give him a larger dose of insulin in the am and a smaller dose in the pm? Is that ok/normal? I appreciate your time and advice immensely. Thanks!

New info: Oscars +2 went up slightly from AMPS this morning but his +4 is all the way down to 8 (I'm so glad I backed off on the dose this morning)... is that too dramatic and/or too quick of a drop? Why did it go up first? and not much seemed to be happening with the insulin at the +2? Thanks for all advice and guidance you can give me...

 

Thankyou Shelley! She did!!

 

Hi Carolyn,

Sorry to hear that Oscar's poor system got such an upset from the contraband. (((Oscar))) Glad to read on his spreadsheet that he seems to have got back to normal in that department.

Here's a helpful guide as to what may be considered good control in cats from the 'What is Regulation?' info post in the FAQs:

There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum":

• Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
• Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
• Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
• Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
• Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
• Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin

There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a glucometer calibrated for humans. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.​

Poorly regulated cats are more at risk for nerve and organ damage (similar holds for human diabetics).

I'm really glad Oscar has you in his corner, Carolyn.

If it was me in this situation, I'd be inclined to hold the 1.5IU dose for a few days - morning and evening - to see how Oscar does on that, largely because of that blue preshot from out of nowhere and because things have been in flux for a bit. I'd then suggest a review and, if an increase seems to be indicated, to try 1.75IU BID, hold that for a few days and review again.

I would not recommend using different sized doses AM and PM. Cats often run in different ranges on AM and PM cycles (e.g. many cats run in a lower range on the PM cycle, others run higher at night). It's safer to keep the two doses the same, and should make it somewhat more straightforward to interpret how Oscar is responding to his insulin. It's still early days and it may take a while to get a feel for his 'style' of response to treatment.


Mogs
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THANKYOU MOGS!! Your advice and guidance is very comforting in a stressful time! I’ll keep with the current dose and feeding schedule. I’ll continue to update Oscar’s sheet and reach out when I have more data to share or more questions. I am so grateful that I was referred here for help ❤️❤️ My vet is very impressed with the spreadsheet and data and frankly so am I!! ❤️❤️

 

Me again... I have a question about Oscar's insulin peaks... his daytime peak (at PMPS) always seems to rebound higher than his AMPS... is that an issue? How do I prevent this? Is there anything I can do to reduce that peak or is this normal?

 

Hi Carolyn,

It's not uncommon for AMPS and PMPS to be in different ranges. Sometimes it's the other way round, higher average AMPS and lower PMPS. Most cats usually run lower in one cycle or the other and that can feed into the preshot BGs you see. Caninsulin's mode of action isn't a great help in that department because it typically produces bucket-shaped BG curves and the duration isn't great in most cats so by about 2/3 of the way through the cycle the dose pretty much peters out and there's nothing to hold BG levels down. Looking at Oscar's AM cycles yesterday and today you can see this style of response quite clearly.

I see from Oscar's spreadsheet notes that you're still having difficulty helping Oscar to gain weight. I understand it's tricky with the triaditis in play. Are you currently feeding him extra? Do you think he might eat more if you gave it to him? How long is it now that he's been on the digestive enzymes?

With the weight concerns, it might be worth having a chat with your vet sooner rather than later about switching Oscar to a longer-acting insulin (Lantus or Prozinc). Lantus typically produces the shallowest BG curves - wide smiles, not buckets! - and, with adequate testing, it's possible to gradually lower the no-shoot preshot limit and keep a kitty in better numbers for longer each day.


Mogs
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So Oscar has been back on the digestive enzymes for about 1 week (8 days). About 6 or 8 weeks ago Oscar was increasing weight steadily from his all time low of 5.25 lbs... he was just under 8 lbs then took a turn. He was losing weight and got down to 6.25 lbs despite consuming about 300 calories (280 to 350) daily. His fur was looking bad and so i made an appointment for blood workup. The vet suspected his IBD had maybe progressed to cancer but after seeing his high sugar levels she said he has diabetes and that was the reason for his weight loss and scruffy appearance. They tested for EPI and said it came back negative but he had pancreatitis which she believes is what has led to the diabetes. I was hoping that by getting his sugar into the proper zone for parts of the day that he would begin putting on weight. It wasn't until I decided to add the digestive enzymes that he seemed to start looking and acting better - his diahrrea is gone for the most part too since starting enzymes. I know it’s only been a week for the enzymes and a few weeks at trying to control his blood sugar but I wish I could somehow get the weight gain faster - he is so bony - he does have a small frame so his highest weight was around 9 or 10 lbs and he was chunky then. If I could feed him kibble he would gain faster but it flares his IBD and now it will drive his sugar up. I’m just so overwhelmed by the mix of issues and how do I treat it all when the solutions for each individually contradicts the other. I have shared Oscar BG data with the vet and they said they are fine with swings up to 15/16 from hopefully values as low as 6 to 8 with the help of insulin. I just wonder if swings that large are hard on him. Are they normal? If so then we will just keep plugging away. I don’t think I can get more food into him he eats 3 to 3.5 cans of FF - i could add more by feeding at night with a timed feeder perhaps as he is soooo starving in the morning. He eats around 10 pm before I go to bed then at 5:30/6:00 am when I get up. His food does cause his sugar to go up and because he eats so often it’s hard to keep his sugar down. Let me know your thoughts ❤️

 

On this insulin, very much so. Here's a graph showing an example of an 'ideal' curve for a cat on Caninsulin:





See what I mean about bucket-shaped curves?!

In answer to your other question, yes, some cats who experience big swings in BG like this can find it hard on their systems. For example, Saoirse had a really hard time on Caninsulin, so much so that she started hiding when her injections were due in the most inaccessible place she could find in an effort to avoid them. She became really lethargic after the dose went in and withdrew behind a curtain for most of the time. She'd then perk up and be more herself for the last two hours or so of the cycle when the dose had petered out, only for it all to repeat again as soon as the next dose was delivered. As I noted in her spreadsheet at the time, it was like having two different cats. When she was switched to Lantus I got my cat back - full time! It suited her far better and she was a much happier cat for the change. (((Saoirse)))

That might be a factor in his lower AMPS values. It might be an idea to try feeding a bit more at night. He needs to get the weight back on - healthier all round.

Part of the problem with Caninsulin and the bucket-shaped curves is that very often a cat gets to the point where the nadir gets as low as it's safe to go but the preshots are still quite high and the duration is still poor. Trying to increase the dose then starts taking the nadir too low for safety and yet the cat may remain in quite a high range at preshot and in the later hours of each cycle, hence recommendations from the likes of the AAHA to treat feline diabetics with gentler-acting, longer-lasting insulins (Lantus, Levemir, Prozinc).

There certainly seems to be a significant improvement in Oscar's clinical signs since addition of the enzymes to his regimen. The diarrhoea would have been interfering with proper absorption of nutrients from the gut, so its resolution should help Oscar get more benefit from his grub. As you note, he is spending part of the day in fairly good numbers for a newly diagnosed cat. Between the two, hopefully he might start to regain a bit of weight.

I do think that it's worth considering a switch to a longer-acting insulin sooner rather than later, specifically because spending longer in a better range might help Oscar to get back to ideal weight sooner. In terms of discussions with your vet, if you can show that the Caninsulin doesn't have long enough duration that might be the best way to oil the wheels if negotiating a change of insulin. If you can regularly grab tests around nadir time (usually somewhere between +3 and +6, but it can move around) to show how low the dose is taking Oscar, and also around the +8 mark to shed light on dose duration (or lack thereof) it would provide you with the evidence to take to your vet to support a request for a different insulin.


Mogs
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Wow! I totally see what you mean!! You are so knowledgeable and I love that you explain things so well. I have good graphs from the data I already have that will totally support the need to move to a longer acting insulin and I’m going to contact the vet tomorrow. My insulin will need to be refilled shortly anyways. I’ll let her know he hasn’t gained anything and ask her to look at other insulin options as he isn’t spending enough time in the lower range to make it easier for him to gain weight. Something he really needs to do. Thankyou thankyou thankyou ❤️❤️

 

If she's resistant to the idea, slap her upside the head with the AAHA guidelines!




Mogs
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I surely will!!! LOL...

 

Just a side note, Carolyn. If you go with Lantus it can be expensive but you can get it at a pretty good price through Mark's Marine in Canada. There is a link, somewhere on this site, that will direct you to their website. Hopefully, someone can find it and send you the information you need. You will want the Solostar Pens not the vial. I just got five pens and am switching from Vetsulin to Lantus next week. If you do get approval from your vet to switch make sure you read all the "Sticky" notes at the beginning of the Lantus,/Basaglar and Levemir Forum. It is a lot to absorb so I am making a list of questions to ask this group and will present that list to the group in the next couple of days. You're doing a great job with the testing and Oscar's Spreadsheet looks similar to mine. I'm going to the Lantus with the hopes of better control, more consistency and an easier acting insulin for my Susie. Good luck. You are definitely getting the best help here with the diabetes.

 

As requested:

Buying insulin from Canada


Mogs
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Thanks, Mogs.

 

Hello! Thankyou so much for your message. My vet is looking into insulin options but she thinks oscar is doing great. I don’t like all the pink and yellow and occasional blues along with the large swings. I looked at your chart and lantus looks like it was a good switch! The preshot numbers seem much better and with slowly increasing dose I think Susie will reach that well managed state - soo happy for her!! ❤️ I am going to push my vet harder - I sent her another email just yesterday with oscars numbers to show her what we are struggling with. Hopefully we now get the go ahead for lantus

 

Thanks Mogs! I’m hoping to get the go ahead for lantus this week. I’ve researched it a lot and read some great articles on it. I do have a question about the monitor we are using - should I switch to a pet monitor or keep using a human one? Does the human one read higher or lower than actual? Thanks for your help!!

 

I am not an expert but I think they will say not to compare apples to oranges with the meters. My opinion, and just mine, I thought the pet meter I used (AlphaTrac 2) did read higher than the ReliOn Prime but others may disagree. If you look at the Sticky Note, at the beginning of the Lantus, Basaglar and Levemire site entitled "Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) it states that "The use of pet-specific meters is discouraged because the dosing methods used on the FDMB were created with meters calibrated for Humans. All referenced numbers correspond with meters for humans, not pet meters". I would stick with a human meter but I will let the experts comment on your question. The other thing is if you switch to the AlphaTrac Pet Meter you are going to pay over $50 for 50 strips. It was super expensive. My ReliOn Prime test strips cost me around $17.00 for 100 strips.

 

Carolyn, is Oscar still on Prednisone? Isn't Prednisone discouraged for a cat with diabetes @Critter Mom?