insulin resistant cat help !!!

Re: insulin resistant cat help !!!

Rachael Winder — Tue, 31 Jul 2012 21:14:58 GMT

Speak To Stijn Niessen at RVC- really helpful guy. I got a cat I was treating MRI scanned there as part of a trial and they are offering medical tx as part of a trial as well as surgical options.

Re: insulin resistant cat help !!!

Andrew Mellor — Tue, 31 Jul 2012 19:10:02 GMT

the curve I discussed was with the cat hospitalised I injected and we monitored every hour, www.vetsurgeon.org/.../6204.8.docx

these are the readings we got. I am going to reduce his insulin tonight and start as suggested on 0.25iu/g and see if over the next week things stabilise .

If he is acromegalic what would we do ? all other body systems have been checked and at no point over the last 12 months has he really changed weight or habits , drinking seems to fluctuate up and down again seemingly unrelated to readings.

Re: insulin resistant cat help !!!

Martin Atkinson — Tue, 31 Jul 2012 15:08:23 GMT

[quote user="Christopher Saul"]

[quote user="Martin Atkinson"]you can probably rule out somogyi effect [/quote]

agreed, it's not probable but it is possible, somogyis can be hard to detect.

[/quote] Equally true but that is why I do one hour glucose tests rather than the standard 2hrs because you can miss that dip and recovery which give it away and try to get the owner to do a 24hr home curve if they can both to get the second 12 hrs and to rule out surgery stress effect..

Re: insulin resistant cat help !!!

Christopher Saul — Tue, 31 Jul 2012 12:52:36 GMT

[quote user="Martin Atkinson"]you can probably rule out somogyi effect [/quote]

agreed, it's not probable but it is possible, somogyis can be hard to detect.

Re: insulin resistant cat help !!!

Martin Atkinson — Tue, 31 Jul 2012 12:41:15 GMT

I would think with a flat curve hovering between 18 and 24 with no sudden dips and rises you can probably rule out somogyi effect and you would probably have killed it by now over the period of time you indicate if it was one, but before you embark on a load of expensive tests for the other things suggested on here, if you haven't done so already, get the client to demonstrate their injection technique if front of you - you'd be amazed the length clients can go to to confound you with this. Maybe even get the cat in first thing and give it the insulin dose yourself then do a 12 hour curve testing every hour. One other thing, remember that you will get a flatter curve with glargine but admittedly it is still a hefty dose.

Re: insulin resistant cat help !!!

Nicola Lawlor — Tue, 31 Jul 2012 11:40:10 GMT

Another vote for checking for acromegaly. I have seen a few positive cats now, including my own who initially tested negative for it but on a repeat test a month later was well into their acromegaly ranges.

Re: insulin resistant cat help !!!

Christopher Saul — Tue, 31 Jul 2012 11:07:36 GMT

Hi Andrew, I'm sorry for the brief reply as I'm in a bit of a hurry. I'll try and reply in more detail later.

there are a number of reasons why a diabetic cat may be apparently insulin resistant. These may including intercurrant dieases e.g. endocrine disorders such as acromegaly, cushing's, and hyperthyroidism; inflammatory disesaes e.g. chronic pancreatitis or occult infectious foci such as persistent UTIs.

You could also be looking at insulin overdose and resultant somorgyi overswing here... counter-regulatory hormones can persist in circulation for some time and as a result an overswinging individual may actually only go hypoglycaemic every 2 or 3 days or so and for a short period of time. Therefore overswings can be hard to detect.

I would :

*start with a fresh full physical exam looking for any signs of other diseases at all - oral /ear infections? pyoderma? obesity?

*send urine from a cysto sample to for culture and sens. Measure TT4 and GH/IGF as Raj has suggested.

*If you cannot find evidence of intercurrant disease, I'd strongly consider cutting your dose right down to a starting dose and starting again. e.g. 0.25IU/Kg BID.

Hope this helps,

Chris

Re: insulin resistant cat help !!!

Rajat — Tue, 31 Jul 2012 10:55:36 GMT

amongst other causes of persistent insulin resistance, I'd include Feline Acromegaly and suggest checking a growth hormone and IGF-1 levels via the RVC :

http://www.rvc.ac.uk/cic/documents/DiabetesandacromegaliccatsV2jul09kj.pdf

It is free and you get a fructosamine as well

Obviously other things important to evaluate in this setting such as injection technique of owners, insulin viability(storage and so on) concurrent disease/infections and so on.

Best

Raj