very high blood glucose, despite regular insulin doses

Please help! I am panicking big-time!!!
My cat Einstein was recently diagnosed with diabetes. We started him on 2u mornings and evenings of Caninsulin (that's what we have here in SA). For the past few weeks I have been feeding him only protein food, and have been testing him with a glucometer I purchased. But his blood sugar readings are all over the place!!!
We upped him to 2.5 units twice a day, and when I did his 5 hour test (which should have shown his sugar-low for the day), it read 25!!! (450)!!!!!!!! I cannot understand how this is possible! I am always very good about rubbing his injection spot, to relieve discomfort, but also to check that I didn't miss and give him a "fur-shot".
Should I give him another shot of insulin, even though it is now 4 hours until his next shot?
Also: he hates chicken, but really loves chicken liver. So I give him tinned tuna or pilchards, mixed with a bit of chicken. and as a treat, I give him some chicken liver. I have heard that, because it is high in fat, it is bad for a cat's blood sugar. Is this true!!
Please help! I'm so lost and don't know what to do. I called the vet TWO hours ago, and haven't had a reply yet... So I'm asking for advice online..

 

I don't know your insulin so can't help with why his bloodsugar is all over the place, i could be a couple of things, including that he is getting too much insulin which is causing his body to dump stored sugar. At least if he was on Lantus that is one of the things that I would be suspect of, but that is because Lantus works off a shed or build up in their bodies. You might want to add something in you title about which insulin you are using to get the right eyes.

What I do know is regardless of how high he is right now you don't want to give more insulin right now.

Mel, Maxwell, Musette & The Fur Gang

 

Do not give more insulin.

Read here, about 'rebound". Could be you are giving too much insulin, not too little.

http://www.indulgedfurries.com/petdiabetes/somogyi.htm

I hope your are feeding a commercial cat diet that is complete nutrition. You cannot
just feed tuna, or chicken liver. Alone, these do not contain all the nutrients needed.
Find a good low-carb commercial canned cat food.


Cats need/tolerate a higher fat diet than people. Extreme
high fat is not good for the liver, but has no effect on BG that I know of.

You need to do a complete BG curve to see what the insulin is really doing.
Pre-shot number, shot, then BG readings every 2 hours: +2, +4, +6 (nadir ?) +8, +10, next pre-shot number.

 

Hard to say, but here are some ideas. The canninsulin may just not last as long in your kitty. Some get 5-6 hours of duration. Some get less. More numbers would give you this answer. Get a number (btw, fantastic you are testing!) at +2 and +3 to see what is happening with the insulin.

You may have started over his ideal dose and he could be rebounding. We suggest starting at one unit because you can always increase as the numbers indicate. It would be scary to try the lower amount for a cycle or two, but it is an option. If you try that, you want to be testing for ketones (you should be anyway with high numbers), be monitoring carefully and be ready to go back up.

The food sounds okay. Were you able to find any carb counts for South African foods on our food list?

Are there any other options for insulin? We use human insulins with success here including Lantus and Levemir. Any chance your vet might be willing to try them? Lantus particularly has a vet written protocol that he could follow. Read the starred info on this page:

I am not a vet - just someone with a little experience with diabetic cats. If I were you, I would research rebound and the lantus information and discuss it with my vet.

 

Lantus information (starred topics at the top) Lantus forum

Rebound: Rebound

Ketone testing: ketones

Canninsulin info: viewtopic.php?f=19&t=302

Food list: http://binkyspage.tripod.com/nonusfd.html

One other idea. Is there any chance he has an infection or terrible teeth? Those things can play havoc with the bg levels.

 

It might be that it will take longer than most cats to find a dose that will keep him regulated. Or it might be that there is another underlying issue (but it's too soon to look for that unless he's showing other symtoms). The main thing is not to panic. A high reading is just a high reading. It doesn't mean you have to do anything differently right now today. Keep a list or chart of the numbers to give the vet next time you call or go in, and try to relax.

My cat is on 8 units of ProZinc and still not regulated. I've researched, I've taken the dose down lower in case of rebound, and his numbers are all over the place and have been for months. Not to scare you, because this is apparently very rare. But this is a complicated illness, each cat is different, and until you find the right dose, you're probably going to see all kinds of numbers, and one high or low number isn't a call to action (unless the number is very low and you need to watch for hypoglycemia). The main thing is that you're doing all you can: Feed him a low-carb canned cat food, give those shots at the prescribed time, keep testing his BG, and stay in touch with the vet. But think of it as a long distance race, not a sprint. Stability comes slowly sometimes.

 

My cat is also on caninsulin,

He was diagnosed at the end of May. You really need to do a curve (blood testing every 2 hours for a 12 hour period) to see how the insulin is afecting your cat. Like stated above, apparently some cats sugar dropps fast with caninsulin (though i've never seen an example of it.. only people saying it on here), and then starts to climb again with a full cycle happening in less then 12 hours....

My cat hists nadir at +6 hours and is back up to high numbers by the 12th hour... i don't see his sugar dropping fast like some suggest - but i had to do a curve to figure that out.

My cat still has pretty high numbers... mostly in the low 20's... occasionally he'll be at 10 -12 (he was at 12.4 before his shot last night), this morning he's back to 22.3.

But as we go along, we're seeing more and more lower numbers overall

**EDIT** for what it's worth, he started on 2 units twice daily, and it was raised to 4 units in the morning and 3 at night.

 

That's a pretty high dose of insulin, even though I am not familiar with that particular insulin.
If you have ruled out health issues and dental issues, have you considered testing your cat for an insulin resistance condition?
You can test for acromegaly and also IAA; it's more common than many may think.

 

I believe that you should be able to get Lantus for your cat; there have been others posting I thought in SA who were able to start using Lantus.

Caninsulin may be good for dogs, but it's not great for cats. I started one of my cats on Caninsulin and had the same terrible results... all highs - over 22's to 27's and the lowest numbers were around her 3hr test (call it +3) around 20s.
You could try testing sooner after the shots - test just before the shot, then test each hour after that shot and you will see how well the caninsulin is working, or you will see the length of time it takes to start working, how well it works, and then when it wears off.

I used Caninsulin for only one month, then switched Shadoe onto Lantus, and we started to see changes in her numbers and also how she was acting better within the first week.

If you can do the tests, and then take the numbers to your vet and say that you want to try using Lantus, it may be better for you.

ETA: I would not give a diff dose am and pm; most people will say to give the same dose for each shot.

 

I don't want to hijack this person's thread but will answer briefly. I don't know what IAA is. I have researched possible co-occurring illnesses, acromegaly being one of them. I plan to talk to my vet about whether there is any point remaining on such a high dose when it's not doing any more than the lower doses did, and about possibly trying a different insulin. Testing--that depends. I can't afford much in the way of testing, and the cat is not showing symptoms of these other conditions, aside from insulin resistance and polyuria/polydipsia, and I absolutely can't afford a "fishing expedition." We ruled out certain things via recent full blood panel, fecal, and urinalysis, and that's scraped the bottom of the budget for the next couple of months. If I spend any $$ at all on testing, it's going to have to be for something it seems likely the cat has, based on positive symptoms, and it will have to be testing I can afford (no CAT scans or MRIs, for instance, and that's what I keep finding on sites with info about acromegaly), and the target condition would have to be something that's affordably treatable or would in some way affect how we're treating the diabetes.

But this doesn't really pertain to the OP's concerns. But thank you for the suggestions.

 

I believe IAA is Insulin Auto-Antibodies.

The body has an immune response to the insulin, attacks it, & breaks it down, so it can't work. External insulin, in high doses, may be needed to manage the cat's diabetes.

 

Gayle, thank you for your PM. I wasn't upset at all, just wanted to explain without getting too far off topic. I tried to reply to your PM but you seem to have PMs disabled? Thanks again. I'll tiptoe on out of this thread now. :smile:

 

Hi there,

my Max was on caninsulin for about 6 weeks before switching to lantus. We had a similar experience to higgs with the caninsulin. After 6 weeks we had worked up to 3u twice a day and were only just starting to see regular good numbers. Max was mostly in the low 20's and high teens (350-420) at nadir regardless of the dose he was getting for the first 4 weeks. After a week-ish on 3u he got an occasional nadir around 10 (180). Then the longer he was on 3u the more good numbers he got. In the 6th week he got 5 days straight in good numbers and then threw a few high numbers again. Just seems to take more time with some kitties...

I have now switched to lantus and am getting the same thing - very little movement in numbers despite the dose increases with an occasional lower number thrown in for good measure. We're now up to 2.5u and going to hold tight at this dose for a little longer to see if we can get any good numbers. I treat the occasional lower number as a "true" number of what is achievable on that dose and if that looks ok then hold the dose for a couple of weeks or so to see if more of the occasional lower numbers start showing up.

I read something on this forum about glucose toxicity (sorry don't have a link handy). From what I recall it talked about the cat being used to its high BG numbers and using the livers stored glucose to combat the insulin given and maintain the high numbers they have been used to. Just need a heap of patience so the cat can get used to lower numbers and stop fighting them and let the insulin do its job. Someone correct me if I am wrong here!

It's definitely worth doing a couple of curves to see what is going on. On the caninsulin we would get a cycle with high flat numbers (23's/414) immediately following a cycle with a nadir of 10 (180). These high flat cycles gradually lessened and the lower numbers got more frequent over a few weeks on the 3u 2xdaily.

I hope your kitty settles down soon. Despite all the high numbers Max's condition did improve dramatically once he was getting insulin, it just took some time for the BG to improve also.

I'd send you some patience but I've pretty much exhausted my supplies :lol:

Amy & Max

 

Thanks everyone.
Your posts are invaluable; and give me hope that eventually I will get it right... If I can't stabilize Einstein on caninsulin, I will try to move him to another insulin. Its just not that easily available here in SA; and my vet knows caninsulin well, she says.
Ironically, the vet also seems to be somewhat in the dark regarding the BG highs, so its try, try, try at this stage.
I have done some BG curves in the past; the first one where my poor kitty started the day (before insulin) on 26.6 (470)!! The 2 units brought it down to 20 within 3 hours, and it remained there at +6 hours. Unfortunately, he HATED the ear-pricking so much that he ran away and didn't eat for the rest of the day, until we found him hiding in the garden at 7pm (+12 hours). His blood glucose was then 16 (288).
The test showed me that he needed more insulin (I think). Just one thing that worries me tho'. His glucose fasting blood sugar test (tested at the vet) was 18 (this was before he began his insulin treatment.) Isn't it odd that on the mornings when I DO test him, his BG is a lot HIGHER than 18? That is the one thing that worries me - maybe he is getting too much insulin and that's rebounding by pushing up his blood sugar in the mornings... What do you think?
I'm thinking I should take him down and then increase slowly, depending on the curves I get. (If the cat will allow..)

PS. The tuna and pilchards I give my cat are especially made for cats. I have also called in to the factories and checked that there is no added cereal etc, so they are all low-carb/high-protein.