10/23 Gryphon AMPS 265 Dose Advice Please

[Cindie]

I'm wondering about increasing Gryphon's insulin to 7 units, and would really appreciate another opinion.
He has been on 6 units consistently for over a week now. Prior to that, he had been on 8 units for approximately 6 weeks, and his BG was consistently high and very unpredictable. His Prednisolone was discontinued as of Oct. 2, and I stopped feeding kibble as of Oct. 15. I reduced the insulin dose to 6 units because I was nervous about some relatively low BGs and decided to reduce the insulin until things stabilized with the medication and diet adjustment.

Here is the link to the previous thread:
10/13 Gryphon AMPS 358 & PMPS 122!.

I also have questions about food & BG testing. I do take up the food 2 hours prior, but I give a treat before & after testing. The treats are freeze-dried protein, 2 calories each & 0 carbs. So, if I decide to stall for a while & retest before giving insulin, how much will those treats influence the second test result?

 

[Chris & China (GA)]

Here's the link to your previous thread (not sure why but the one you posted doesn't work)

I wouldn't go up by a whole unit.....after they go above 5U, we do suggest .5 unit increases though so how about 6.5U?

I know in your intro you said you were started at 2U and went up gradually, but can you tell us how increases were done before you came here? Did you go from 2 to 3 to 4.....etc?

 

[Cindie]

Here's the link to your previous thread (not sure why but the one you posted doesn't work)

I wouldn't go up by a whole unit.....after they go above 5U, we do suggest .5 unit increases though so how about 6.5U?

I know in your intro you said you were started at 2U and went up gradually, but can you tell us how increases were done before you came here? Did you go from 2 to 3 to 4.....etc?

Yes, I could do an increase to 6.5. The dose was increased every 1-2 weeks by 1 unit each time until we got to 6 units. Our vet recommended a jump from 6 to 8 units.

 

[Sienne and Gabby (GA)]

I was just typing out a question regarding how Gryphon's dose was increased and you answered it before I could finish typing!

We generally suggest increasing doses by 0.25u or 0.5u depending on which dosing approach you're using and where the numbers are.

Given that you've made several adjustments (prednisolone and diet), I agree with Chris about being conservative with the dose increase. With cats on a higher dose of insulin, usually more than 6.0u, we often recommend increasing by a larger amount.

You may want to discuss getting Gryphon tested for a high dose condition. It may be a bit premature given that I'm not sure how long it takes for the pred to completely clear out of your cat's system. The tests for acromegaly (IGF) and insulin resistance (IAA) are done only at Michigan State University. There is information on this in this link. I'm also tagging @Wendy&Neko who is our guru on high dose conditions.

 

[Chris & China (GA)]

The dose was increased every 1-2 weeks by 1 unit each time until we got to 6 units.

Were you home testing during this time? While it's entirely possible that he's got a high dose condition, I also have to wonder if he's just getting too much insulin.

Tiny dose changes can make a big difference so going from 1 to 2 to 3, etc...you may have bypassed a "good dose"

Let's see what others have to say

 

[Wendy&Neko]

In Cindie's initial post here, she mentions that she sees some possible acro symptoms and her vet suspects it as well.

I don't see a dose entry on the spreadsheet for the PM cycle of 10/20, but am assuming it was also 6.0 units. On those days where you deliberately (or accidentally) skip the dose, could you write Skip or NS (no shot) in the units column. That lets us know you skipped instead of just forgetting to enter the value.

I agree with the increase to 6.5 units. Good luck with the new dose.

 

[Cindie]

I was just typing out a question regarding how Gryphon's dose was increased and you answered it before I could finish typing!

We generally suggest increasing doses by 0.25u or 0.5u depending on which dosing approach you're using and where the numbers are.

Given that you've made several adjustments (prednisolone and diet), I agree with Chris about being conservative with the dose increase. With cats on a higher dose of insulin, usually more than 6.0u, we often recommend increasing by a larger amount.

You may want to discuss getting Gryphon tested for a high dose condition. It may be a bit premature given that I'm not sure how long it takes for the pred to completely clear out of your cat's system. The tests for acromegaly (IGF) and insulin resistance (IAA) are done only at Michigan State University. There is information on this in this link. I'm also tagging @Wendy&Neko who is our guru on high dose conditions.

Thanks for this! Yes, he is going to be tested for Acromegaly and Cushings. I should have mentioned that.

 

[Cindie]

Were you home testing during this time? While it's entirely possible that he's got a high dose condition, I also have to wonder if he's just getting too much insulin.

Tiny dose changes can make a big difference so going from 1 to 2 to 3, etc...you may have bypassed a "good dose"

Let's see what others have to say

For the first few dose changes, I wasn't home testing. I was taking Gryphon to the vet weekly for a mid-day BG test. After I started home testing, I mostly did mid-day tests and not every day. My vet recommended dose changes based on those results. Also, I didn't realize that I should pick up the food 2 hours prior to testing until I joined the forum and started reading the information here. So, the BG numbers I was recording back then might not have been very relevant.

 

[Cindie]

In Cindie's initial post here, she mentions that she sees some possible acro symptoms and her vet suspects it as well.

I don't see a dose entry on the spreadsheet for the PM cycle of 10/20, but am assuming it was also 6.0 units. On those days where you deliberately (or accidentally) skip the dose, could you write Skip or NS (no shot) in the units column. That lets us know you skipped instead of just forgetting to enter the value.

I agree with the increase to 6.5 units. Good luck with the new dose.

Thank you! I will make those corrections on the spreadsheet. The dose was 6.0 units on 10/20. There were other days when I deliberately skipped doses because of my nervousness about the low pre-shot numbers. Yes, I should have mentioned that Gryphon will be tested for Cushings and Acromegaly. I did also ask about the test for IAA, but my vet said it is very rare and not likely an issue for Gryphon.

 

[Wendy&Neko]

IAA is more common that Cushings. The blood goes to the same place as the acromegaly test. Try pushing for it or ask your vet to humour you, which is what I had to do. You are the customer. It can make a difference in dosing strategies. And yes, most vets think it's rare. Why does your vet think it's not an issue if he/she does not have experience with it? My vet thought acromegaly was rare too (it's not). For example, here is Lou's SS. He has just IAA.

 

[Chris & China (GA)]

I did also ask about the test for IAA, but my vet said it is very rare and not likely an issue for Gryphon.

I disagree with your vet....we see a lot of cats here with both Acromegaly and IAA and some with just one or the other.

As long as you're pulling blood, it makes sense to me to just cover all the bases

 

[Cindie]

IAA is more common that Cushings. The blood goes to the same place as the acromegaly test. Try pushing for it or ask your vet to humour you, which is what I had to do. You are the customer. It can make a difference in dosing strategies. And yes, most vets think it's rare. Why does your vet think it's not an issue if he/she does not have experience with it? My vet thought acromegaly was rare too (it's not). For example, here is Lou's SS. He has just IAA.

Good points! Thanks! I'll talk to my vet again.

 

[Cindie]

For the first few dose changes, I wasn't home testing. I was taking Gryphon to the vet weekly for a mid-day BG test. After I started home testing, I mostly did mid-day tests and not every day. My vet recommended dose changes based on those results. Also, I didn't realize that I should pick up the food 2 hours prior to testing until I joined the forum and started reading the information here. So, the BG numbers I was recording back then might not have been very relevant.

Were you home testing during this time? While it's entirely possible that he's got a high dose condition, I also have to wonder if he's just getting too much insulin.

Tiny dose changes can make a big difference so going from 1 to 2 to 3, etc...you may have bypassed a "good dose"

Let's see what others have to say

How would we know if we had bypassed a good dose and Gryphon is getting too much insulin? I'm guessing we would we have to start again at a very low dose and increase the doses more gradually?

 

[Wendy&Neko]

Starting back at the beginning can be a bad idea if Gryphon really does need a higher dose. It would set him back a lot. The best way to know if the dose is too high is to keep testing. Try to get at least one other test each cycle, in addition to the preshots. Getting a before bed test at night is really important as many cats go lower at night. If +2 or +3 is your before bed test and you see a really big drop compared to the preshot number, I would set an alarm for a couple hours later if you can.

If he is on too much insulin, you will see some lower numbers. So far I'm not seeing that. I would stick with 6.5 units and get some tests in, and evaluate the dose after a few days.

 

[Cindie]

Starting back at the beginning can be a bad idea if Gryphon really does need a higher dose. It would set him back a lot. The best way to know if the dose is too high is to keep testing. Try to get at least one other test each cycle, in addition to the preshots. Getting a before bed test at night is really important as many cats go lower at night. If +2 or +3 is your before bed test and you see a really big drop compared to the preshot number, I would set an alarm for a couple hours later if you can.

If he is on too much insulin, you will see some lower numbers. So far I'm not seeing that. I would stick with 6.5 units and get some tests in, and evaluate the dose after a few days.

Ok. Thank you!