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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 26928
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My cat who is 15 is not responding to her insulin. Her

Customer Question

My cat who is 15 is not responding to her insulin. Her levels are way too high and increasing her insulin is not h3elsping. she is eating and drinking so much that she is frustrated and crying for me to help her, my vet has givem her pain killers and anti
anxiety cream but she still crys help Her levels are at 20 to 25
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. Michael Salkin replied 1 year ago.

My initial thought was Cleocatra is also hyperthyroid. Blood sugars between 20 and 25 are certainly increased but not to the point that my patient is constantly crying. Hyperthyroidism is common in 15 year old cats and will cause the same symptoms that we see with diabetes - increased hunger, thirst, and weight loss in spite of overeating. Hyperthyroid cats are also agitated, act younger than their age, vocalize, and may show signs of gastrointestinal distress - vomiting and/or diarrhea. Whenever a cat appears to require such high doses of insulin (greater than 1.5 units/kg/0.7 units/lb twice daily) we look for a concomitant disorder such as hyperthyroidism and Cushing's disease (which also causes increased hunger and thirst but isn't as common as hyperthyroidism), and the various other causes of insulin resistance which you can review here:

From Feldman E, Nelson R: Canine and feline endocrinology and reproduction, ed 3, St. Louis, 2004, Saunders.

Recognized Causes of Insulin Ineffectiveness or insulin resistance in Diabetic Dogs and Cats

Caused by Insulin Therapy

  1. Inactive insulin
  2. Diluted insulin
  3. Improper administration technique
  4. Inadequate dose
  5. Somogyi effect
  6. Inadequate frequency of insulin administration
  7. Impaired insulin absorption, especially Ultralente insulin
  8. Antiinsulin antibody excess

Caused by Concurrent Disorder

  1. Diabetogenic drugs
  2. Hyperadrenocorticism
  3. Diestrus (bitch)
  4. Acromegaly (cat)
  5. Infection, especially of oral cavity and urinary tract
  6. Hypothyroidism (dog)
  7. Hyperthyroidism (cat)
  8. Chronic kidney disease
  9. Hepatobiliary disease
  10. Chronic congestive heart failure
  11. Glucagonoma (dog)
  12. Pheochromocytoma
  13. Chronic inflammation, especially pancreatitis
  14. Pancreatic exocrine insufficiency
  15. Severe obesity
  16. Hyperlipidemia
  17. Neoplasia

Please respond with additional information and further questions or concerns if you wish.

Customer: replied 1 year ago.
Cleocatra does vomit fluids sometimes but \I though it was because of the excess drinking. What tests should my vest be doing?
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the additional information. A senior/geriatric diagnostic panel which includes a T4 (total thyroid) and fT4 (free thyroid) is your most cost effective manner in which to get to the bottom of this. It's important that her vet understand that although the normal range of T4 is usually quoted as 1.0-4.0 ug/dL, 2.0 ug/dL or higher suggests hyperthyroidism in a 15 year old cat. (To convert from ug/dL to nmol/L, multiply by 12.87. I don't know which units are used by Cleocatra's vet's lab.) I would be pleased to review the test results for you.

Please continue our conversation if you wish.

Customer: replied 1 year ago.
Thank you I will get back to you after I talked with my vet. in the meanwhile is there anything I can give her without a prescription to help her be calm so I can sleep
Expert:  Dr. Michael Salkin replied 1 year ago.

We have to be very careful what we give a 15 year old cat in the way of tranquilizers. A benzodiazepine such as diazepam or clorazepate might be considered. Some cats will become sedate after being dosed with diphenhydramine (Benadryl in the United States, not always the case outside the United States) at a dose of 2 mg/kg/1 mg/lb. You're quite welcome. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.

Customer: replied 1 year ago.
You have been extremely helpful. My vet is coming over tomorrow to do more testing and will call in an expert. She said she is not hyperthyroidism because she has done the test. Thank you so much for your helpp
Expert:  Dr. Michael Salkin replied 1 year ago.

You're quite welcome. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.