? Dosing Advice?

[Izzy2017]

***Cross posting here .. also posted in main health!

I'll try to keep this short and to the point!

Izzy has been consistently in the upper 300s to low 400s for a while now. He is on cerenia every three days and metronidazole twice a day. He was having issues with loose and rank smelling stool and consistent vomiting so I am afraid to take him off any of the medicine ( I believe I finally got the house to not smell like a pile of poo....) We have slowly been trying to up his dose and his numbers are not moving.

A little over 3 weeks ago he started barfing and not eating and lost a few pounds. Since then we have been consistently keeping him on the above pills. We have not been pulling food for AMPS or PMPS since we do not want to put him off his food.

We are at 3.5u for a day now (not long enough to tell anything) but when we were at 3u and asked our vet if we should increase she said, "I rarely have to go above 3" and did not recommend upping his dosage.

He is a happy kitty and is running around with only mild neuropathy in his legs. He looks a lot better than he did 3 weeks ago and is at a normal weight. Externally he looks great! Internally I'm afraid of the damage that consistently being around 400 is doing. He is eating mostly wet food with some YAZ.

I did test my meter against our civvie (much to his dismay) and my meter gave a normal number. I'm just looking for pointers on what our course of action going forward should be?

-Kayla

 

[Wendy&Neko]

Hi Kayla, and welcome to you and sweet Izzy. Sorry about the smelly poo situation. Is there any reason you are just doing Cerenia onee every three days? It can be given once every 24 hours if needed. I really hope that resolves soon. Now let's talk dose.

First, a cat needs as much insulin as they need at any given point in time. That can change over time, and also go over 3 units. My Neko topped out at 8.75 units, and got as low as 0.25 units being the right dose for her at that time. She also had two high dose conditions, acromegaly and insulin auto antibodies or IAA. Acromegaly is quite common, one in four diabetic cats has it. It can often mean larger doses are required. But most vet's over a certain age were taught it is very rare, so you vet may be uncomfortable suggesting higher doses. Plus we have cats without high dose conditions above three units. Keep at it, and you will find the dose that moves Izzy.

How do we know what is a good dose? By home testing. I am glad you are doing some testing, but it may not be enough. We strongly recommend testing before each and every shot, so we know it's safe to shoot. There were times I went to bed with Neko in the pink and woke up to a number in the 40's, which wouldn't have been safe to shoot. We also determine the Lantus dose by how low it takes the cat, which is somewhere in the middle of the cycle. You are getting some daytime mid cycles tests, which is good, but I see a blank slate at night. There is a reason our spreadsheets show cells for both AM and PM cycles. Many cats go lower at night. Neko often went lower at night and higher during the day. Without me spot checking the nights, I would have thought she needed more insulin, not less. Getting a test in before bed is a good habit to get into.

You are right that high numbers for a long period of time are not good. We can help you help Izzy get to a point where his numbers are in a much safer range. First step is to read our dosing methods here (Tight Regulation and Start Slow Go Slow) and figure out which you'd like to follow. If dry food remains in the picture, it'll be SLGS.

And keep asking questions. We all remember what it was like to be new and like to help.

 

[Gill & George]

Hello and welcome Sue, Kayla and Izzy,

I hope that together we will be able to help you get Izzy into a better BG range.

So sorry about the poop issues, glad it's settled down for now.

Wendy has already covered the salient points that should start to get you into a better position for dosing.

There are many kitties here on more than 3u, they need what they need at the end of the day.

I agree with Wendy and Angela, a little more midcycle testing, and always getting a test at amps and pmps will be helpful when you come to try to figure out dosing. The just before bed test is really important, George also often had his low numbers in the pm cycle.
Are both you and your mum sharing the care? Can you both test/shoot understand Izzy's needs.
Having two people that can share the responsibilities can be really helpful.

For now, I would stick with the 3.5u and gather a little more data.

Once you've taken a look at the dosing methods please ask any questions that you may have, we look forward to being able to help you and Izzy.

 

[Izzy2017]

With him consistently being in the 400's / upper 300s I'm not sure why testing at night is an issue right now? Since he had such rapid weight loss he has had free access to food and eats throughout the day / night.

Don't shoot me down for saying that I am just genuinely unsure why we should wake up in the middle of the night when he is always in high 300s and mid 400s ?

 

[Stacy & Asia]

Hope others with more experience chime in, but unfortunately too high of a dose can also look like too low of a dose, there is also a bounce from low numbers the cat isn't used to: AMPS could be red and there could be a sudden drop to blue or green and then a "bounce" back up to pink or red by PMPS, etc. The only way to be more sure is to do small increases that are properly timed and get tests in between cycles (both am & pm) to fill in some of the blanks. You could have skipped over a good dose without realizing it since you did not know what was happening at the peak (nadir) of each cycle. Lantus doses are based on how low the cat goes (nadir, moves around, but supposed to be somewhere in the middle of the cycle), it is not dosed based on preshot numbers. Additionally, many cats have much lower cycles in the pm, and the am and pm cycles can look very different from each other. Look at some other people's SS around here, check out the cycles in am vs pm, cover up all the middle tests and just look at amps & pmps, then reveal what's between them, you'll see what I mean. I don't think you need to be testing every other hour or anything, but just to get one mid cycle test, in each cycle, move around +4 one day, +5 the next, +6 another time, etc. to start filling in some of the gaps, especially at night. It sucks to wake up in the middle of the night, but it's quick enough to do and you'll have much better data to work with.

I hope the GI issues get sorted out and there are so many knowledagble people here for you, I was so relieved to find this board and I'm sure you will be too.

 

[Gill & George]

With him consistently being in the 400's / upper 300s I'm not sure why testing at night is an issue right now? Since he had such rapid weight loss he has had free access to food and eats throughout the day / night.

Don't shoot me down for saying that I am just genuinely unsure why we should wake up in the middle of the night when he is always in high 300s and mid 400s ?

I don't think it's necessary at the moment to wake up in the middle of the night, but getting a test just before you head to bed would be a good place to start. I gave George his shots at 7am/7pm as I went to bed at 11pm-midnight I was alwaysys able to get at least a +4/+5 without having to disrupt my sleep. If that just before bed test indicated the need to then I would set an alarm and test again.

Some cats can start of in red/pink drop quite low in the first half of the cycle and then come right back up to pink/red by next shot the only way you will catch that is by getting spot checks in at different points in the cycle as and when you can. That way when you come to make an increase in dose you can be sure that its the right action to take.

At the moment when we look at the data, there is a lot of 'holes' and we can't be sure of what is going on. That's why we are recommending getting some spot checks in whenever you can.

 

[Izzy2017]

I understand the theory behind getting a shot before bed but most days Sue is in bed by 8:30.

We will work on getting some during the day shots when we are home /able to!

 

[Izzy2017]

Hi Kayla, and welcome to you and sweet Izzy. Sorry about the smelly poo situation. Is there any reason you are just doing Cerenia onee every three days? It can be given once every 24 hours if needed. I really hope that resolves soon. Now let's talk dose.

First, a cat needs as much insulin as they need at any given point in time. That can change over time, and also go over 3 units. My Neko topped out at 8.75 units, and got as low as 0.25 units being the right dose for her at that time. She also had two high dose conditions, acromegaly and insulin auto antibodies or IAA. Acromegaly is quite common, one in four diabetic cats has it. It can often mean larger doses are required. But most vet's over a certain age were taught it is very rare, so you vet may be uncomfortable suggesting higher doses. Plus we have cats without high dose conditions above three units. Keep at it, and you will find the dose that moves Izzy.

How do we know what is a good dose? By home testing. I am glad you are doing some testing, but it may not be enough. We strongly recommend testing before each and every shot, so we know it's safe to shoot. There were times I went to bed with Neko in the pink and woke up to a number in the 40's, which wouldn't have been safe to shoot. We also determine the Lantus dose by how low it takes the cat, which is somewhere in the middle of the cycle. You are getting some daytime mid cycles tests, which is good, but I see a blank slate at night. There is a reason our spreadsheets show cells for both AM and PM cycles. Many cats go lower at night. Neko often went lower at night and higher during the day. Without me spot checking the nights, I would have thought she needed more insulin, not less. Getting a test in before bed is a good habit to get into.

You are right that high numbers for a long period of time are not good. We can help you help Izzy get to a point where his numbers are in a much safer range. First step is to read our dosing methods here (Tight Regulation and Start Slow Go Slow) and figure out which you'd like to follow. If dry food remains in the picture, it'll be SLGS.

And keep asking questions. We all remember what it was like to be new and like to help.

We have gotten him down to only needing the pill once every 3 days with no issues. Thankfully the stinky poops have gone away and he has his appetite back and isn't vomiting.

Although he is getting sour towards taking pills. We have tried to disguise them in treats with no luck

 

[Gill & George]

I understand the theory behind getting a shot before bed but most days Sue is in bed by 8:30.

Looks like you shoot at 7am/7pm getting a +1 can be useful, a +1 that is lower than amps/pmps can indicate an active cycle in some cats.


Is Sue an early riser? Getting a test in at +9 can also help fill in some blanks, it's unwise to completely ignore the pm cycle.