Trouble regulating numbers

[AnnaKilljoy25]

Hello everyone,
Im new here! My cat wheezy(10yr/15lbs was diagnosed as diabetic a couple months ago. I initially took him to the vet due to him losing weight and walking on his haunches, struggling to jump and drinking excessive amounts of water. His glucose was above 400 (I dont remember the exact number). There were no keytones in urine but vet decided insulin injections would have a better chance of regulating over oral. He had dropped down to 12lbs by this time.
Its been about 3 months and 5 curves and we just upped the does to 2.5 units 2xs a day and a libra 3+ monitor. I've noticed that his insulin injections take about 2 hours to kick in enough to cause a decrease (other than these drops the meter just reads HIGH) and wears off after 2 hours in which he jumps back to an unreadable range. I feel bad because some days he can hardly walk. I'm using zobaline for the 2nd month and it doesn't seem to be having an effect so I would like to try and get his numbers regulated. Any thoughts on how I could better regulate? Hes been eating fancy feast pates on the approved list for over a montb and we are doing injections at 7am and 7pm.i attached a screenshot of his libre readings.

 

[Sienne & Gabby (GA)]

I'm so glad to see you made it over here! We'll do our best to help.

One quick question -- which insulin are you using? There are different types of insulin and they work a bit differently so it's important to know what your vet prescribed.

We suggest that members use a spreadsheet since not everyone uses a Libre. We're wed to the spreadsheet since it's a method that we've used here for well over a decade. The information and template for the spreadsheet is in this post on helping us to help you. The spreadsheet makes it easy for you to track your Wheezy's progress and we can follow along and offer feedback. The linked post also contains information on setting up your signature. The signature contains basic information about your cat so we don't keep asking you the same questions. There's also additional information that is useful as you're getting started here.

One possible explanation for what you're seeing is that Wheezy is doing what we refer to as "bouncing." We rarely know how long a cat has been diabetic prior to their being diagnosed. As a result, the cat's body may have become accustomed to sitting in higher than normal blood glucose levels. If insulin drops numbers into a low range, if numbers drop fast, or if numbers drop into a range that your cat is now not used to, the liver and pancreas release a stored form of glucose along with counterregulatory hormones. This causes the numbers to spike back upward. The bounce isn't harmful -- in fact, it's a protective response. However, it's truly annoying for caregivers since we want to see our kitty spend time in better numbers.

Please let us know if you have questions. We're here to help.

 

[AnnaKilljoy25]

Thank you! We're currently on novolin. Its the only one I've tried so far. I'll take a look at setting up the signature and spreadsheet!
I think having the libre is making me paranoid in regards to his numbers because I check it constantly and want it to be in the green zone. However, my main focus is getting his neuropathy under control since he is still eating and drinking normal amounts. I feel like its the neuropathy that's limiting his activity so its difficult to tell if he's less active or lethargic than normal

 

[Sienne & Gabby (GA)]

Anna -
The only positive that I can think of regarding Novolin is that it's inexpensive. It's a very old school choice of insulin. I'd urge you to take a look at our information on the use of Novolin. One important factor is your cat MUST eat before you inject Novolin. In fact, the sequence is test, feed, wait 60 minutes, and shoot. The reason is that Novolin is fast acting and if food isn't on board, numbers can drop hard. The other issue is that it does not have an adequate duration given a cat's fast metabolism. In other words, it doesn't last the entire 12-hour cycle. In fact, depending on the cat, Novolin may last only 8 hours.

The American Animal Hospital Association has published guidelines for the treatment of diabetes. I linked the guidelines which were originally published in 2018 and updated in 2022. The two insulins they recommend for treating cats are either Prozinc which is formulated for animals or Lantus (glargine) which is a human insulin, widely available, and has an impressive track record for treating feline diabetes. Both Prozinc and Lantus have a longer duration so it may help to reduce the swings in numbers that you noted. They are both much gentler insulins than Novolin.

I'd encourage you to have a discussion with your vet about switching Wheezy to either Prozinc or Lantus. Lantus used to be prohibitively expensive but is now available in a generic/biosimilar and is much more affordable. The only downside to Prozinc is that unless your vet stocks it, you need to order online since it's not carried in pharmacies. Lantus, on the other hand, is available pretty much anywhere and there are GoodRx coupons for it.

The headache with neuropathy is that it takes a while for methylcobalamin (Zobaline) to work. In addition, it tends to work best if your cat is in decent numbers.

 

[AnnaKilljoy25]

Hello again! I've updated my spreadsheet tracking Wheezy's numbers that pull in from his Libre sensor and I'm noticing that at first the 3 units would drop him significantly, but now, his numbers are hardly moving, and if they are, it's only for a few hours. I'm calling the vet tomorrow to see about swapping his insulin. He is currently eating at the same time as the injection but I would think we would still see a decrease since he's on a diabetic approved food. Any thoughts now that you can see his recent numbers?

 

[Wendy&Neko]

Can you tell us what brand/make food he specifically is on? Some vendors claim food is good for diabetics, but it isn't really.

Since you saw a 64 on 7/3 on 2.5 units of insulin, I would not have increased the dose, but rather decreased it. Right now he's dropping really hard and fast and doing what we call bouncing, which is causing those high numbers. Which is very common, even more so with newly diagnosed cats. Here is the definition:

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Good idea to call the vet and ask for a better insulin for cats. It'll make regulation much easier.

 

[AnnaKilljoy25]

He's eating the Friskies pates. (Salmon dinner, Mariners catch, sea captains choice and ocean whitefish and tuna dinner).
The vet suggested I increase to 3 but we dialed it back to 2.5 after his 2 low drops into the 50s and 60s but it seemed as if it had stopped helping. I can decrease back to 2. My sensor caps out at 350 so im not sure what the actual ranges are after it hits that mark.
If I hold him at 2.5, would he eventually stop bouncing and start to see lower numbers?