Better numbers at lower doses

JanetNJ

JanetNJ

Very Active Member
Im up to 8.25. Seems CC had better numbers at 7.5 and 7.75. Or maybe her insulin resistance is worse?

Nothing I try seems to help.
 
I'm not sure what's going on Janet. Just kind of running my eyes over the numbers and seeing colors rather than numbers, it all looks about the same to me. Yeah, you got some crazy lime greens a few times on lower doses, but I really think you're still dealing with insulin resistance. To me, it looks like things aren't changing much.
 
Rachel said:
I'm not sure what's going on Janet. Just kind of running my eyes over the numbers and seeing colors rather than numbers, it all looks about the same to me. Yeah, you got some crazy lime greens a few times on lower doses, but I really think you're still dealing with insulin resistance. To me, it looks like things aren't changing much.
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Very true. She had more energy before hitting 8 units though. She's been just laying around this week. I am thinking this is just her new normal now. She's getting old I guess. Although I was happy to find her in her cat tree this morning. She hadn't gone up there all week.
 
I'm so sorry CC's having a hard time. If you're going to back up and lower the dose, make sure to test for ketones daily. With the inflammation she has, those are always a concern. She's been in these numbers for awhile now, so her lack of energy concerns me a little, although if I'm remembering correctly, it hasn't been long since her last vet visit. Is she on B12? I've read that can help with energy.
 
Djamila said:
I'm so sorry CC's having a hard time. If you're going to back up and lower the dose, make sure to test for ketones daily. With the inflammation she has, those are always a concern. She's been in these numbers for awhile now, so her lack of energy concerns me a little, although if I'm remembering correctly, it hasn't been long since her last vet visit. Is she on B12? I've read that can help with energy.
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Yes she takes b 12. I give a zobaline everyday... Half in the morning half in the evening. I checked ketones a week ago with a blood meter and it didn't detect any at all. Thankfully. She's sweet and purrs often and happily joins us on the bed at night (with some help from pet steps). So she still enjoying life which is of course my main test of how she's doing.

Her one elbow bows out when she walks poor thing... And she's stiff but usually doesn't limp since starting Gabapentin. The gabapintin may be adding to the lethargy too I suppose. I miss seeing her play.

Her last vet visit was mid August.
 
I want to say something about bouncing but obviously you know about this Janet. For anyone else, it can be hard grasping the idea of throwing less water on a fire that's getting bigger but it can work. Read the stickie (where is it anyone?) and it should make sense. Noah's numbers used to climb and climb (Caninsulin) until I finally got up the nerve to reduce his dose. He's still unregulated but the days of 6 units are long gone.
Best wishes for C.C., I know she's in good hands.
 
Noah & me (GA) said:
I want to say something about bouncing but obviously you know about this Janet. For anyone else, it can be hard grasping the idea of throwing less water on a fire that's getting bigger but it can work. Read the stickie (where is it anyone?) and it should make sense. Noah's numbers used to climb and climb (Caninsulin) until I finally got up the nerve to reduce his dose. He's still unregulated but the days of 6 units are long gone.
Best wishes for C.C., I know she's in good hands.
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Yeah I am hoping the slightly lowered dose helps. Worth a try anyway but it’s all so disappointing. I really thought after the dental we would be under 5 units.
 
Noah & me (GA) said:
I want to say something about bouncing but obviously you know about this Janet. For anyone else, it can be hard grasping the idea of throwing less water on a fire that's getting bigger but it can work. Read the stickie (where is it anyone?) and it should make sense. Noah's numbers used to climb and climb (Caninsulin) until I finally got up the nerve to reduce his dose. He's still unregulated but the days of 6 units are long gone.
Best wishes for C.C., I know she's in good hands.
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What insulin do you use?
 
Wow decent numbers yesterday but huge bounce up this morning! Take your springy shoes off, CC
 
She's giving you a run for your money for sure, Janet! Maybe stash the idea of trying a depot insulin in the back of your mind for future consideration. Yes, there are stricter rules about their use but you'll figure out how you can bend them to suit CC - and you. I had to do that with my guy.
 
JanetNJ said:
I asked about levemir and she wasn't open to it.
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Why?? My vet had never even heard of it, but she was able to do some quick research while we were in her office to verify that it IS being used in cats and with success. So, she felt comfortable giving me what I had asked for.

JanetNJ said:
I'm not convinced to results would be much different
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Maybe not, but only one way to tell. It works so differently that maybe it would surprise you.
 
Janet, just a caution that Lantus often starts to sting somewhere around 5-6 units and I was not refrigerating it because I was going through it fast enough. Stings worse cold. I switched Menace to Levemir because her shots suddenly became obviously uncomfortable for her. I too had a vet who had never heard of Levemir but she researched and gave me the green light. There is a paper HERE that might help you convince your vet to give you a script for Levemir if you choose to go that route. To me Levemir is definitely a whole different insulin to work with in that it doesn't take as long to see effects of dose changes (a bit more like ProZinc etc for example) but it also has a later onset, longer duration, and carryover than Lantus and an extremely flat curve once optimal dosing is attained.

I'm still in catch up mode so forgive me for asking, but have you done or are you considering testing for acro and IAA?
 
MrWorfMen's Mom said:
Janet, just a caution that Lantus often starts to sting somewhere around 5-6 units and I was not refrigerating it because I was going through it fast enough. Stings worse cold. I switched Menace to Levemir because her shots suddenly became obviously uncomfortable for her. I too had a vet who had never heard of Levemir but she researched and gave me the green light. There is a paper HERE that might help you convince your vet to give you a script for Levemir if you choose to go that route. To me Levemir is definitely a whole different insulin to work with in that it doesn't take as long to see effects of dose changes (a bit more like ProZinc etc for example) but it also has a later onset, longer duration, and carryover than Lantus and an extremely flat curve once optimal dosing is attained.

I'm still in catch up mode so forgive me for asking, but have you done or are you considering testing for acro and IAA?
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I am not planning on trying it any time soon. I have not tested her for acro or iaa. Arethose things that can develop suddenly? Because up until June she responded to insulin normally.
 
I think Doodles of Karen and Doodles, developed IAA after either being in remission or at least well regulated. IAA could develop anytime. I assume the same is possible with acro given that it's caused by a tumour which could start to grow/become active at anytime in the cat's life. Just a thought. The tests themselves are not particularly expensive...its the blood draw and sending to Michigan that costs a bit. Cost me $179.00 Cdn. all in except taxes. For me, just knowing what I was dealing with made it so much easier to cope with the frustrations of seeing no improvement no matter what I did. Interestingly, like you, in my early days with Menace, I would back up her dose thinking she'd had better numbers on less insulin only to find my theory was full of holes.
 
MrWorfMen's Mom said:
I think Doodles of Karen and Doodles, developed IAA after either being in remission or at least well regulated. IAA could develop anytime. I assume the same is possible with acro given that it's caused by a tumour which could start to grow/become active at anytime in the cat's life. Just a thought. The tests themselves are not particularly expensive...its the blood draw and sending to Michigan that costs a bit. Cost me $179.00 Cdn. all in except taxes. For me, just knowing what I was dealing with made it so much easier to cope with the frustrations of seeing no improvement no matter what I did. Interestingly, like you, in my early days with Menace, I would back up her dose thinking she'd had better numbers on less insulin only to find my theory was full of holes.
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Yeah didn’t really work. I am grasping at straws. I hate to talk to my vet about it though. Last time I did she wanted to micro manage the dose and cc started developing ketones.
 
Always amazes me how a vet thinks they can adequately manage a diabetic from afar but alas that's more often the case than not. While my vet was pro testing (although there was the suggestion I tested too much on occasion) and actually provided me with some basic reference material off this site, she was not familiar with the dosing methods etc. here. She also thought hi dose conditions were so rare that testing was not needed.

So when I first started making noise about the testing, my vet decided to get some so called specialist in Texas to look at Menace's records. His big issue was her diet (she was still a kibble addict then) but she was eating EVO which was only 8% carbs. :rolleyes:He also suggested changing her over to PZI if she exceeded 8u twice daily. At that point I started considering importing insulin from the UK to get the manufactured PZI that most closely resembles cat insulin but decided to pursue high dose testing before I started jumping through hoops. This time my vet agreed to test for Acro and Cushings but still tried to dissuade me on the IAA. I told her to humour me and test IAA and Acro but declined testing for Cushings given there were no symptoms of Cushings other than the impossible to control BG. When I got the results back, I felt so vindicated and my vet was absolutely amazed but of course had no clue what the next steps should be. If not for FDMB, goodness knows Menace would probably either still be in high numbers or worse.

Obviously Idon't know your vet but I'd certainly try to reason with her even if you have to use the "I'm pulling my hair out so humour me" card.
 
AAAAND Laura gave in to CC'S puppy dog eyes and sitting up begging routine and gave her chicken that had been marinated. Grrr. I am like STOP WHAT ARE YOU DOING???? LOL." But she's begging! ","I don't care! Lol" so two hours later she's at 459. Greeeeat.
 
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So decided to try "starting over" from 8 down to 5. So far I've seen a decent response. She's down to 300 from a preshot of 400 at +3.5. Let's see what happens.
 
Took a peek at your SS. She seems to be doing about the same on 5u as on 8. How long do you plan on staying at 5? She sure is a tough one to figure!
 
I think I read here on FDMB that anti insulin antibodies can develop at any time. I wonder if that's what's going on with CC?
 
Kris is right. IAA can develop at any time.

I have been peeling over CC's data. I have to admit that she has me flummoxed however, I think part of that is that with insulins like Vetsulin and ProZinc, you don't worry as much about holding a dose and that, for me at least, muddies the picture. All the dose changes make it difficult to discern if there really is a pattern of doses going stale which is a hallmark of IAA. That said, there is something about CC's numbers and patterns that makes me wonder if that might be the problem.

My suggestion would be to up CC to 5.5u (At that dose 0.5u increases are reasonable), hold for a minimum of 4 cycles, max of 6 cycles barring any pre-shots too low to shoot) and see if you see improvement day 1 or 2 and then a drop off of the insulin action back to pre increase numbers. Since you already reduced CC's insulin from 8u it may take a few increases to see if this phenomenon is occurring.

Janet, the good news is that if it is IAA, then it will break eventually but it may take more than 8u of insulin to get to that point. My Menace was on 16u twice daily before her antibodies finally started to be beaten back. Remember a cat needs as much insulin as they need.
 
MrWorfMen's Mom said:
Kris is right. IAA can develop at any time.

I have been peeling over CC's data. I have to admit that she has me flummoxed however, I think part of that is that with insulins like Vetsulin and ProZinc, you don't worry as much about holding a dose and that, for me at least, muddies the picture. All the dose changes make it difficult to discern if there really is a pattern of doses going stale which is a hallmark of IAA. That said, there is something about CC's numbers and patterns that makes me wonder if that might be the problem.

My suggestion would be to up CC to 5.5u (At that dose 0.5u increases are reasonable), hold for a minimum of 4 cycles, max of 6 cycles barring any pre-shots too low to shoot) and see if you see improvement day 1 or 2 and then a drop off of the insulin action back to pre increase numbers. Since you already reduced CC's insulin from 8u it may take a few increases to see if this phenomenon is occurring.

Janet, the good news is that if it is IAA, then it will break eventually but it may take more than 8u of insulin to get to that point. My Menace was on 16u twice daily before her antibodies finally started to be beaten back. Remember a cat needs as much insulin as they need.
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Omg 16 units I can't imagine. Is there a test spe cifically for IAA
 
Yes there is and it's cost is super cheap. What costs is the blood draw and sending it to University of Michigan. I got both IAA and Acro testing done for $179.00 Cdn so if you want to get testing done, might be worth testing for ACRO too just to cover all bases. UMC is the only place in North America that does the IAA test to my knowledge.
 
Janet, IAA is an auto immune disease. It causes the body to develop antibodies so the insulin cannot be utilized as it normally would/should be. Lots is not all cats have them to some degree but in some of our kitties they get totally out of control. The only treatment is to basically overwhelm the antibodies until the body can once again use the insulin it produces or we add exogenously.
 
MrWorfMen's Mom said:
Janet, IAA is an auto immune disease. It causes the body to develop antibodies so the insulin cannot be utilized as it normally would/should be. Lots is not all cats have them to some degree but in some of our kitties they get totally out of control. The only treatment is to basically overwhelm the antibodies until the body can once again use the insulin it produces or we add exogenously.
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Ty for the info.


She is responding somewhat. I mean she’s down about 200 points since the preshots 5 hours ago right now. So it’s not like she’s not responding at all.
 
High and flat this morning. She's not feeling well. Didn't eat much, threw up foam and had diarrhea last night and this morning. She is still drinking. I checked ketones with the blood meter and it was only 0.4, so pretty much nothing so it's not that. If she's not better by tomorrow I'll contact the vet. Could be a stomach bug, pancratitis (I hope not... She never had it before)... Maybe constipation? I know she had the squirts but my cat Zimmy used to get that when he was constipated. Maybe hairball bothering her? :(
 
Poor C.C. :( I too hope it's not pancreatitis. Diarrhea could be sign of constipation. My geriatric guy has always looks like death warmed over when he is about to produce a hairball. He'll drink copious amounts of water and projectile vomits clear fluid a few times before the hairball is expelled. Fingers crossed C.C. perks up!
 
MrWorfMen's Mom said:
Poor C.C. :( I too hope it's not pancreatitis. Diarrhea could be sign of constipation. My geriatric guy has always looks like death warmed over when he is about to produce a hairball. He'll drink copious amounts of water and projectile vomits clear fluid a few times before the hairball is expelled. Fingers crossed C.C. perks up!
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Yeah I'm wondering if it's a hairball too. Some of the foamy puke had a little hair in it. I'll pick up pumkin later too. I thought I had some but must have used it up.
 
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