Brutus is Diabetic - Insulin question

[Traci]

So, he's up to 13 units once a day now?

How often, in the last year and a half, has it been attempted to decrease the insulin? Ever?

What is the median range of blood glucose he's been at in the last year, and how many blood glucose checks have been done in the last year?

Has there ever been any signs of hypoglycemia within the last year? What about now?

[Carol Teitler]

The insulin has never been decreased. As far as the blood glucose checks, I can't say for sure how many were done since we were with a different vet when Brutus developed the problem. I do know that we did do several blood tests, also including several fructosamine. Brutus does not display any symptoms of hypoglycemia but it seems that he is also not showing any signs of improvement....and he seems to be drinking even more, urinating a lot, and eating as usual (not really more). It still seems that as soon as he eats a little, he drinks; he eats, he drinks; we are really stumped what do try. According to the vet, Brutus needed MORE insulin. We had discussed the possibility of reducing the dose but that was before the blood glucose checks. As bad as the possibility is, we are considering taking him to a large animal hospital in the area for a 2nd opinion. We just don't know what else to do. I'd like to believe that the vet is right in his decisions based on the tests, but I am starting to really worry what the problem really is.

[Traci]

If you have the option, then definately get a second opinion, right away.

If you don't know how many blood glucose checks have been done within the last year, then it doesn't sound like your vet is really talking to you, nor encouraging you to keep a log/schedule/record of regulating his insulin. This is so extremely important so that you can go back and see where things changed or were significantly different regarding BG's, increases in insulin, and how each increase affected the BG as well as Brutus' overall health.

I would encourage the second opinion, right away. And, I'd ask the second vet about the insulin type, and make sure he has ALL Brutus' records since the initial diagnosis (copies from your current vet, they can be faxed or the new vet can set that up by requesting from the current vet). Explain that it doesn't seem that Brutus is regulating insulin properly, rule out secondary conditions that may be affecting insulin absorption, and talk about possibly changing the insulin type, talk about maybe using glargine insulin instead.

When there is excessive drinking and urination, this needs to be addressed immediately, and consistently, whether this is because he needs more insulin or not remains to be determined with a more specific testing schedule....and/or ruling out secondary conditions like renal disease, etc. (causes for dehydration, etc). It could also be that the insulin type isn't working for him, and that a different insulin may be considered.

[Carol Teitler]

Thanks, again. Renal disease can be ruled out since he just had a complete physical, including blood, and all his values were in normal range. It just seems to me that he's drinking MORE since we increased the insulin, not less. I will get copies of his records and keep you posted.

[Carol Teitler]

Hi! Just a quick update and question....We took all Brutus' records and went to an internist at the Red Bank Veterinary Hospital. She did not do any blood work but rather had us begin DECREASING the amount of insulin Brutus is getting and changing the dosage from once to twice a day. She wants to wait until after the 1st of the year to see how he does. Right now, we are at 8 units total. He is acting fine...playful and normal but he is still drinking more than usual (for him). He is not eating excessively, nor is he urinating excessively (about 4-5 times during a 24-hour period). Without doing bloods, can you give us an educated guess as to what is going on? All his tests, including liver, kidney, thyroid, etc. were normal. Could it be that his diabetes has gotten "better?"

[Traci]

Carol, the only way to tell is described earlier. Blood glucose curves in the clinic, then two-three weeks later, a fructosamine level. Might want to do another urinalysis to be safe.

It isn't unusual for diabetic cats to drink more than normal, even during insulin regulation and even after being regulated for a certain amount of time, this can be different for every cat. However, you do NOT want water consumption to be increased on a regular occurance Again, it doesn't sound like he had good insulin control, and still may not.

I can't fathom why the second vet wouldn't do a blood glucose check, or a curve. Decreasing insulin without blood glucose curves is a risky approach. I assume you've decreased a unit each week or so, but nothing more drastic??? You did NOT directly decrease from 13 units to 8 units iin one day, right???

Ideally it is sometimes better to decrease insulin as opposed to an increase, but I worry something fierce about doing this without a blood glucose check a few days after the decrease of insulin. You don't know what the glucose is doing, and how it's affecting his system.

What was her reasoning for this?

[Carol Teitler]

When the insulin was first increased, his symptoms got progressively worse. When the insulin was decreased, he began to act more normally. No, it wasn't decreased rapidly. Right now, he seems much more comfortable. I'm thinking he might need to be reduced even more, but we will be taking him in for a blood glucose curve after the 1st of the year. I have been constantly checking his urine (better than nothing) and most readings throughout the day (at different times) show negative. The most I'm getting, occasionally, is about a 10% trace. We'll keep a close monitor on him until we know more. Thanks and have a great Holiday!