by Brenda
Brenda, a nurse from Florida, owned a diabetic dog named Cody.
Question
Our problem is that no
matter what we do, we can't get his BGs under 400. When he first
started PZI, he would
go as low as 190's, but after 3 or 4 days, all readings would be
400-500+.
(Same with all other
insulins we tried, but PZI has been the best, numbers were even higher
on the others).
The last two weeks we've had nothing under 400(I test every 3 hrs. at home
and vet does also).
We went form 11U to 13U last Friday night, and it didn't do anything.
Increased to 15U today,
still nothing under 400.........suggestions?????
Brenda's Answer
There really is so many
possibilities here and none of us can diagnose what is going on.
Resistant does seem a possibility
for sure as that is a large dose for a 9 pound cat.
1. It could be that
he is not getting enough insulin and you still need to go higher.
2. It could be that
he is getting way too much insulin and is having rebound hyperglycemia
and the resistance that goes along with that and therefore you need to
go much lower
with the dose.
3. It could be that
he is fine at home and having stress hyperglycemia at the vets.
4. It could be your
technique.
5. It could be something
wrong with the insulin.(wrong type, bad batch, diluted, outdated,
overheated, mixed by shaking, etc.)
6. There could be
another illness or infection somewhere else in the body which is causing
problems(Infection, hyperadrenocorticsim, exocrine pancreatic insufficiency,
acromegaly,
hypothyroidism in the dog, hyperthyroidism in the cat, renal, cardiac or
liver insufficiency,
chronic pancreatitis).
7. Absorption problems
(giving a shot subcutaneously does not guarantee that it will get
absorbed.
8. Insulin antibodies
(this is rare that antibody formation causes clinically significant resistance.
So as you can see there is
a lot that can be going on-----any advice from us is really just
random guess work on our
part and none of us have the advantage your vet or the specialist
has of a hands on examination
and knowing how to interpret that exam. The easiest thing
to do is rule out problems
with the insulin itself (try a new bottle) and to have your vet
actually watch you give
an injection (from the start---drawing up). Once that is done then
usually the most common
causes of resistance is infections or inflammation processes.
Hypoglycemia induced hyperglycemia
(somogyi phenonomen) is ruled out or diagnosed
by decreasing the insulin
dose and monitoring for 3 days (the resistance caused by this
event can last 72 hours)
and see if you have a decrease in glucose levels. But you say
your vet has been in contact
with specialists so I would certainly think they are well aware
of all of the above.
You might consider having a referral to the specialist for a hands on
examination.
It is people like Brenda
that make email groups such a success. The rainbow
group tries to answer
questions and tell what their vets have tried. In no way,
does this group try to
replace the vet in charge. Always take your diabetic pet
to the vet because diabetes
mellitus is a serious disease but is not a death
sentence. Do not
adjust insulin dose without consulting the vet in charge.
Remember two shots of
insulin a day will keep high blood glucose away. Judy