Diabetic curves

Re: Diabetic curves

ilanit — Tue, 06 Aug 2013 16:19:57 GMT

[quote user="Martin Atkinson"]

This cat almost certainly has concurrent pancreatitis which is probably causing bouts of insulin 'resistance' but it is unlikely a cat that was stable on 1 unit bid will suddenly require 4-6 units in the longer term. The first curve looks OK until you realise that the nadir is 8 hours after the start (it should be 4-6 hrs) and as pointed out has not risen back to anywhere near its start point so another 6 units at that point would certainly overdose. The second curve is too short to be sure if this is a Somogyi effect or underdosage. I would go with your instinct, stop for few days then re-start on 1 iu bid as that was the last stable dose and work up. Test for pancreatitis and treat accordingly, For what its worth I don't think fructosamine is of any value in cats under treatment it is only of use for initial diagnosis. You could consider a switch to Lantus glargine.

[/quote]

Thanks! I think I will do just that. Start again from 1 unit and see what happens.

I have checked fPLI previously when he was having insulin resistance and it was negative, but I will repeat it.

Re: Diabetic curves

Busybee — Tue, 06 Aug 2013 11:15:28 GMT

[quote user="ilanit"]

That sounds like a good idea. I am not in the UK though, so I am not sure if we have that service available.

Can I find those forms somewhere online?

[/quote]

Hmmm, not sure if they're online, we can request them from our MSD rep.

Re: Diabetic curves

Martin Atkinson — Tue, 06 Aug 2013 09:56:10 GMT

Re: Diabetic curves

ilanit — Tue, 06 Aug 2013 04:48:56 GMT

[quote user="Busybee"]

Have you spoken to MSD? I have found their vets and Caninsulin feedback forms very useful for frustrating diabetic cases. Either phone to speak to them directly, or fax a brief history along with a feedback form and any relevant curves and they will be in contact within a few hours.

[/quote]

That sounds like a good idea. I am not in the UK though, so I am not sure if we have that service available.

Can I find those forms somewhere online?

Thanks

Re: Diabetic curves

ilanit — Tue, 06 Aug 2013 04:42:05 GMT

Yes I agree that we don't know what happens after the nadir (which IMO is too low) so we haven't at such documented a rebound hyperglycemia. Morning glucose is 25 though and a drop of around 21 mol is too much. The glucose is still only around 6 two hours before next injection, so if you give again 6 units I would imagine glucose will drop too low.
There are no signs of hypo but cats tend to show little signs until it drops really low.
I have recorded values of 2 mmol in this cat with no symptoms.
I just cannot understand why on 4 units I got a reading of 9 an couple of days ago and today it didn't,t go below 20. There's quite a difference there.

Re: Diabetic curves

ilanit — Tue, 06 Aug 2013 04:39:15 GMT

I haven't checked for pancreatitis recently to be honest. He seems very well in himself. The diarrhea lasted only a couple of days and now all is back to normal. But you are right, it might be worth it to rule it out.

The cat is 8kg and I never managed to get him to loose weight, which is more of an owner compliance issue than anything else. The owner is a lovely old lady and follows instructions very well, with the exception of feeding. All her cats are obese! So the obesity in itself might play a part in erratic control.

Re: Diabetic curves

Rob Loxley — Mon, 05 Aug 2013 23:31:49 GMT

[quote user="ilanit"]bouts of suspected insulin resistance (with all flat curves) in the past where I had to go up to 7 units to get control and than could eventually lower again. He was again on 1 unit BID when he had some gastrointestinal signs about 2 months ago, which passed after a couple of days symptomatic treatment[/quote]

pancreatitis?

Re: Diabetic curves

Busybee — Mon, 05 Aug 2013 23:05:03 GMT

Re: Diabetic curves

James Laidlaw — Mon, 05 Aug 2013 20:35:20 GMT

Have you done fructosamine levels at all?

Re: Diabetic curves

Nicola Lawlor — Mon, 05 Aug 2013 20:13:42 GMT

I would be pretty happy with the 6units curve you have posted - not sure why you consider that a somoygi effect as there is not enough curve to see what happens after the nadir. How does the cat seem clinically on the higher doses, any reason to believe it shows signs of hypos? I would maybe consider trying 5 units if you are wanting to play it cautiously and repeat the curve in a week or so and if need to increase could always go up by just half a unit if not to fiddly for the owner? Also worth considering putting onto a dose for a while (unless signs of concern meantime) and around 3-4 weeks later look at a fructosamine as this will give you a better idea on the average control. Some vets are not always so keen on fructosamine levels but personally I have had good experience in using these to help interpret levels of control.