Blood glucose levels not responding to treatment

My baby Karsten was diagnosed with diabetes this summer, and he's been on insulin for close to half a year now. Only problem is, his prescribed dose has been increased multiple times and his blood sugar isn't under control. It's still much too high but he's already on an abnormally high dose for a cat. My boyfriend says his dry food is low carb but the wet food isn't anything particularly fancy. Does anyone know of any other health conditions that could be impacting this? I've tried to do some online research but haven't found much. He's the sweetest of our three cats and he's been such a trooper, it's hard to know he's struggling like this.

Has the vet switched insulin brands or just dosage on the same insulin?

No, the brand has stayed the same. It's Lantus.

Dry food is loaded with carbs. Can you get him off dry food completely and I'm a grain and carageenen free or raw diet? I've read of cats reversing diabetes when fed a raw diet.

This article may help you. It was written by a vet.
http://catinfo.org/feline-diabetes/

We may be able to get rid of dry food once we move into our own place, but right now I don't think it's possible. Right now he and two of our cats are living with his parents, and since they insist on feeding their own cat dry food it's impossible to keep Karsten from eating it. This added to the fact that his high insulin dosage and the price of insulin in the US means right now my boyfriend barely has enough money to feed himself, let alone buy enough wet food for three cats. 

I recommend that you also post for additional advice on the FelineDiabetes.com board. The members there are really helpful. Diabetes isn't discussed much here on TCS in any detail but you are welcome to post here

Lantus is a great insulin to use. There's a particular dosing protocol for it which you'll find on the FelineDiabetes.com board.

What "low carb dry food" are you feeding? Some diabetic cats are super sensitive to carbs. Ideally no dry food should be fed.

How long as the bottle or pen of Lantus been in use? The bottle tends to lose effectiveness after a month or so while the pen can last almost to the last drop.

There are some conditions that can cause high doses of insulin. Acromegaly and Cushing's disease are two. Your vet would have to run blood work to determine if your cat has it or not. I'm not familiar with either and how one would manage it and diabetes at the same time but the members of the FDMB can provide more info on that.

My kitty was switched from Lantus to prozinc and began responding well after about 2 weeks. I thought insulin is insulin but apparently not. Also as with Humans this takes some time to figure out the right dose. Have you had a fructosime test done to see the glucose history on your kitty?

You didn't mention this so it may not apply, but steroids --like Prednisolone, or Flovent for asthma treatment-- can cause high blood sugar too.

I don't know the brand... I'll try to find out. He's been using a bottle, and a big one, since it's cheaper than buying the small vials that only last a week. Is the pen expensive?

Kitty's not on steroids, up until he was diagnosed with diabetes he had no health problems. He's only 4 years old. 

He had a stay with the vet a few months ago where he had his glucose measured every hour, and yesterday my boyfriend plotted out a curve of his glucose over the course of the day, but I'm not sure about a fructosime test. 

That test spans days and is a better indicator of how controlled he is. The vet always starts on the minimal dose and goes up from there. Again it does take a few months to get it right. So the glucose has not improved one bit?

It's pretty consistently over 500. My boyfriend just sent me this document of measurements he and the vet took: 

 
looking at www.vetsulin.com/vet/Cats_Monitoring_About.aspx it doesn't seem to match anything except maybe insulin resistance but measurements are very high even for resistance

moonbrie said:

 
I don't know the brand... I'll try to find out. He's been using a bottle, and a big one, since it's cheaper than buying the small vials that only last a week. Is the pen expensive?

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Lantus is only available as a 10 ml bottle or as a 3ml pen which comes in a box of five. Where did you buy the Lantus?

I don't know the current cost of Lantus. When I bought it several years ago, the 10 ml bottle was around $100 and the box of pens was around $150. The box of pens is basically a 5 month supply of insulin so it's cheaper to buy the pens instead of the 10 ml bottle which you have to toss nearly monthly since it loses effectiveness pretty quickly. You should ask on the FelineDiabetes.com board for the current cost of Lantus.

12 units of insulin is a lot The dry food certainly isn't helping. Stress from being at the vet's office elevates blood glucose levels so any curve done at the vet's is inaccurate. You can test your cat's blood glucose levels at home and just email or call the vet with the results of a curve.

Sometimes too much insulin causes the body to panic and dump extra sugar into the blood. That can be one reason why your cat's blood glucose levels are too high. What dose of insulin did your cat start at and how long was he on that dose before the vet increased it?

How did the vet diagnose your cat with diabetes without a fructosamine test? A simple blood glucose test, which is often included with regular blood work, will often show a high level because of stress. Was your cat showing unusual behavior or signs of sickness which prompted you to take him to the vet?

I found the insulin advise on human as very informative with respect to the biochemical impacts. In fact, insulin use is not just "insulin decreases the blood gucosys" , there is a more complex biochemical chain. I remember that I found something about the "kick-back" effect of the insulin injection on cat (some temporary small increase in glucosys and a reglatory cycle involved), but I do not remember now where I read about this. 

These are very high but it's only one day. I would get a fructomine test to assure this is not just stress from being on the vet office. If that is still high for the days it tests I would probably ask the vet about the other insulins that can be tried. My cat needed to switch from Lantus to Prozinc. I'm not sure what the difference is other than Prozinc is labeled for use in Cats. What prompted the diagnosis?

Yes, there are other insulins that can be used in cats Lantus is great but may not work for every cat. Other insulins to try are Levemir (an insulin for Humans), ProZinc, BCP PZI, and Vetsulin. There are pros and cons to using each of these. There are stickies on the FelineDiabetes.com that go into detail about each insulin and typical dosing protocols.

It's rare for a 4 year old cat to have diabetes that is not steroid induced. I hope the OP can provide some more details about what led to the diagnosis of diabetes last summer and what the initial insulin dose was and how much it was increased and how often. If the OP doesn't feel the vet has a good handle on managing the cat's diabetes at 12 units of insulin twice a day, a second vet opinion would be helpful.

@moonbrie just out of curiosity, are you using the correct insulin syringes? Lantus is a U100 insulin and requires the use of U100 insulin syringes. If you use U40 insulin syringes instead, your cat is not getting the correct amount of insulin which may be why the high dose of insulin has no effect. Your box of syringes and each individual syringe will have the U number printed on it. Can you double check?

Sorry if I fail to be as informative as I should be on some counts - I'm actually living abroad right now and my boyfriend is the main caretaker of this cat, so I don't know/remember the specifics of everything.

From what he told me, at first he was buying vials that cost about $50 and lasted a week, and then moved up to a vial that cost nearly $300 but should have lasted 3 months. He may have switched to Lantus after that though because it seems he's been able to handle the cost of the insulin on his own. All I know about the syringes is that he gets them from the human pharmacy (insulin too). 

Karsten has been fat basically all his life - we just figured it was his weight/overeating. Before he was diagnosed he weighed 20 pounds, but he's lost a few pounds since his diagnosis.

He was diagnosed because for almost a year he kept peeing in inappropriate places - bafflingly, often right next to the litter box. Around the time he got diagnosed, he was also drinking a lot of water, generally acting sick, and wasn't eating as much (given how much he loves food, also cause for concern). The inappropriate peeing was also getting worse, and more often nowhere near a litter box - just in the middle of the floor. 

Also, the second set of readings in my previous post were taken by my boyfriend at home (he was carefully monitored to make sure he didn't eat any dry food that day too) . Only the first set was taken by the vet. If a fructosamine test is the typical way of diagnosing diabetes, the vet must have done one a while ago, but I don't know if it's been repeated. 

moonbrie said:

 
From what he told me, at first he was buying vials that cost about $50 and lasted a week, and then moved up to a vial that cost nearly $300 but should have lasted 3 months. He may have switched to Lantus after that though because it seems he's been able to handle the cost of the insulin on his own. All I know about the syringes is that he gets them from the human pharmacy (insulin too). 
 

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It sounds like the cat was started on a different insulin and then moved to Lantus which is what he is currently using. It sounds like your cat was started on Humulin N first. Humulin N is cheap and it lasts at least a month. I don't know why your boyfriend had to buy a vial every week. All insulin should be kept in the fridge and handled very gently. Improper storage can result in the insulin going bad very quickly. If he's getting the insulin from the Human pharmacy then he is getting the correct insulin syringes. Store pharmacies don't sell U40 insulin or syringes.

Is your boyfriend measuring the insulin correctly? You wouldn't happen to know if he is buying the 30 unit syringes or the 50 unit syringes would you? If he's using 30 unit syringes, the line markings are for every unit. If he's using 50 unit syringes or even 100 unit syringes, each line represents 2 units.

moonbrie said:

 
He was diagnosed because for almost a year he kept peeing in inappropriate places - bafflingly, often right next to the litter box. Around the time he got diagnosed, he was also drinking a lot of water, generally acting sick, and wasn't eating as much (given how much he loves food, also cause for concern). The inappropriate peeing was also getting worse, and more often nowhere near a litter box - just in the middle of the floor.

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When your cat did use the litter box to pee, were the pee clumps huge and very very sticky and sugary smelling? Even if he peed outside of the box, you would notice the sugary smell.

It wouldn't hurt to ask your boyfriend to take the cat to a different vet for another opinion. Some vets just aren't very kowledgable about diabees. You and / or your boyfriend should definitely check out FelineDiabetes.com for more info and tips on how to manage a diabetic cat at home. There are some diabetic cat owners here on TCS but I don't know if anyone would be able to really go into details and provide specific help and tips and analyze blood glucose trends, all of which you should double check with your vet.

moonbrie said:

 
Also, the second set of readings in my previous post were taken by my boyfriend at home (he was carefully monitored to make sure he didn't eat any dry food that day too) . Only the first set was taken by the vet. If a fructosamine test is the typical way of diagnosing diabetes, the vet must have done one a while ago, but I don't know if it's been repeated. 

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It takes a day or two for the dry food carbs to work their way out of the body. Thse second set of numbers are likely still influenced by dry food carbs. Stopping dry food cold turkey though can result in a drastic drop in blood glucose levels in some cats so it's important to test frequently during a diet change. A few times a day is ideal epsecially right before insulin is given.

If the cat's blood glucose levels are taken at home daily and a log of the numbers are kept, additional fructosmine tests aren't necessary. If you can track the numbers on a spreadsheet (there's a great template for a Google-based one on FelineDiabetes.com), you can just email the vet the spreadsheet to review as needed.

I think technically they were lasting 10 days, but in my head I stored that as "about a week." His starting dose was 1 unit twice per day, and he was on that for a week, and it's been steadily going up since that.

From what I remember when I was back home, all I noticed about his pee was that it didn't smell very strongly of pee - maybe due to sugar? 

I'll try making a post there - wish I could convince my boyfriend to, since he has all the info, but he has a somewhat typical masculine habit of never asking for help until something is a dire emergency   

When I go back to the US (in about a month) I'll be living with Karsten again so I'll learn all this stuff and can make more informative posts, I'm just so worried in the meantime because he was our first baby and our only cat who we raised from a kitten. 

Has the vet recommended increasing the insulin yet?