Need advice before switching to Levemir (from ProZinc)

[Karen&Rocket]

My poor little acro kitty Rocket's spreadsheet. We've been trying dosage increases (maybe too slowly?) in order to get his numbers under control and nothing has been working. I know this is a problem with acro, but, we're switching to Levemir this week, and I don't know where to start. I'll be posting on the Levemir forum later today to get some ideas on switching safely, but I thought I'd ask here first in case anything stands out to anyone.

My problem is this... the way his spreadsheet looks, I can't tell if his dosage is too low, or too high. I just don't know what amount to shoot anymore. He hits low blues on rare occasions. Could he be bouncing? I know most acro kitties are on high doses, but if we start giving him (eventually) 8, 9, 12 units, won't the lows he hits be even more drastic? How do we settle on a "correct" dose? He hit 694 last night.

Sorry if I sound like a total confused newbie... I guess I still am.

 

[Sharon14]

Before and even after Colin was diagnosed, I was like you, confused. He’d have a day or two in nice numbers and I’d breathe a sigh of relief thinking I had finally found the dose, only for him to go right back up into the reds and blacks. I even tried lowering his dose to 1u and going back up more slowly to see if I had missed the magic dose, but I hadn’t. Colin ended up at 18u BID at his highest, but though he hadn’t been tested for IAA, he may have had it because one night he hypo’d and after that his dose went down in half and stayed there.


From the sticky http://www.felinediabetes.com/FDMB/threads/acromegaly-the-basics.373/

The Pituitary Gland naturally fluctuates the amount of hormones it gives out hour to hour, day to day, week to week. This is a normal process which sometimes can influence the tumour cells. This means that in some cats the tumour cells do not give out a constant flow of GH. The tumour cells are not so sensitive as the proper Pituitary Cells so the changes in the amount of unwanted GH are not necessarily obvious or predictable. However, it does mean that just how 'diabetic' an acrocat is on any given day can change. Several acrocats can go for several days (or weeks in some cases) with normal BGs because the amount of GH coming from the tumour has dropped, which drops the IGF-1 levels. Lower IGF-1 levels means the cat's own insulin 'keys' are sufficient to cope with the blood glucose levels (they're not being out numbered by too many IGF-1 keys in the insulin locks). That means the amount of insulin we need to give to help out is reduced.

And yes, Rocket can also be bouncing, Colin sure did, but bounces generally clear within 6 cycles or so. Have you read the L&L stickies on DOSING METHODS? You’ll need to choose one. I started with SLGS because I was scared of the switch and the high doses, but once I was comfortable I changed to TR, and then I developed my own regiment.

Wendy was my go to for all questions acro. She knows her stuff and is a great teacher. She will be able to help you get a grip on Rockets dose. I’m sure she’ll be along eventually and will be better able to explain things. I just wanted to give you my experience and remind you that you’re not alone in this.

 

[Karen&Rocket]

Before and even after Colin was diagnosed, I was like you, confused. He’d have a day or two in nice numbers and I’d breathe a sigh of relief thinking I had finally found the dose, only for him to go right back up into the reds and blacks. I even tried lowering his dose to 1u and going back up more slowly to see if I had missed the magic dose, but I hadn’t. Colin ended up at 18u BID at his highest, but though he hadn’t been tested for IAA, he may have had it because one night he hypo’d and after that his dose went down in half and stayed there.


From the sticky http://www.felinediabetes.com/FDMB/threads/acromegaly-the-basics.373/

The Pituitary Gland naturally fluctuates the amount of hormones it gives out hour to hour, day to day, week to week. This is a normal process which sometimes can influence the tumour cells. This means that in some cats the tumour cells do not give out a constant flow of GH. The tumour cells are not so sensitive as the proper Pituitary Cells so the changes in the amount of unwanted GH are not necessarily obvious or predictable. However, it does mean that just how 'diabetic' an acrocat is on any given day can change. Several acrocats can go for several days (or weeks in some cases) with normal BGs because the amount of GH coming from the tumour has dropped, which drops the IGF-1 levels. Lower IGF-1 levels means the cat's own insulin 'keys' are sufficient to cope with the blood glucose levels (they're not being out numbered by too many IGF-1 keys in the insulin locks). That means the amount of insulin we need to give to help out is reduced.

And yes, Rocket can also be bouncing, Colin sure did, but bounces generally clear within 6 cycles or so. Have you read the L&L stickies on DOSING METHODS? You’ll need to choose one. I started with SLGS because I was scared of the switch and the high doses, but once I was comfortable I changed to TR, and then I developed my own regiment.

Wendy was my go to for all questions acro. She knows her stuff and is a great teacher. She will be able to help you get a grip on Rockets dose. I’m sure she’ll be along eventually and will be better able to explain things. I just wanted to give you my experience and remind you that you’re not alone in this.

Thank you SO much. This disease is so heartbreaking and crazy-making. So much to learn too. I've read the protocols, but I definitely need to re-read them. We're probably going to start with SLGS too, since unfortunately I have surgery coming up in about 10 days and I want to start conservatively. Or, we might have to wait to switch until after my surgery, but I'm not sure our current bottle of PZ will last long enough. Anyway, I'm writing my Levemir forum post right now, and that's one of the things I'm asking about.

You have no idea (actually I guess you do ) how much I appreciate help from you and the others on this board. I'm so afraid of asking too many questions and being a pain. And I'm so touched by people like you whose kitties are no longer with us, but you're helping us. Ok, now I'm crying again. Geez, this has been an emotional week.

 

[Sharon14]

I'm so afraid of asking too many questions and being a pain.

Never be afraid to ask questions around here! We like to help when we can.

 

[MrWorfMen's Mom]

@Keskat&Rocket There are a number of us here who understand the ups and downs of having a kitty whose diabetic journey is not "by the book". There are a number of us who understand how overwhelming this is and all I can tell you is just take it one day at a time and use this board as your sounding board when you need it. My girl had IAA and while it's not the same as acro and is self limiting eventually, it too involves higher doses and can be confounding and overwhelming.

I think we all tend to hang on each and every reading we take and I found once I got past that, realizing each BG test was just one moment in time, it got a bit easier. You'll have all the support you want or need here so never be afraid to ask any questions, have an emotional outburst or just let off some steam.

So curiosity, is your name Kes? If not, what would you like your family here to call you?

 

[Karen&Rocket]

@Keskat&Rocket There are a number of us here who understand the ups and downs of having a kitty whose diabetic journey is not "by the book". There are a number of us who understand how overwhelming this is and all I can tell you is just take it one day at a time and use this board as your sounding board when you need it. My girl had IAA and while it's not the same as acro and is self limiting eventually, it too involves higher doses and can be confounding and overwhelming.

I think we all tend to hang on each and every reading we take and I found once I got past that, realizing each BG test was just one moment in time, it got a bit easier. You'll have all the support you want or need here so never be afraid to ask any questions, have an emotional outburst or just let off some steam.

So curiosity, is your name Kes? If not, what would you like your family here to call you?

Thank you... I think I'm definitely letting myself get too scared by the numbers. My husband is always saying "But how is he feeling? He looks ok!" Two opposite ends of the spectrum. I think I'll feel a lot better after this hospital stay I have coming up.

My name is Karen Keskat was a name I've used before for other online things, and it wasn't 'til I was here for a little while that I noticed you all pretty much use your real names. I added "&Rocket," but when I tried to change it again it said I could only do it once every 90 days. I'll add it to my sig. Thanks again, and nice to finally officially "meet" you, Linda. You've helped me a ton these past few weeks. to you too!!!!!!!

 

[MrWorfMen's Mom]

Nice to officially meet you too Karen. Having a civvie named "Worf" I initially wondered if the your "Kes" had any Star Trek association! LOL! Always loved that character's name!

You've got far too much on your mind right now between the upcoming surgery and Rocket. While hubby may be reluctant to learn how to test Rocket, he is quite right that you need to pay attention to how Rocket is feeling just as much if not more so than the numbers. Their bodies have become used to the high numbers and they have to adjust to the insulin we add into the mix. If he is feeling better that means you are moving in the right direction.

 

[Karen&Rocket]

Nice to officially meet you too Karen. Having a civvie named "Worf" I initially wondered if the your "Kes" had any Star Trek association! LOL! Always loved that character's name!

You've got far too much on your mind right now between the upcoming surgery and Rocket. While hubby may be reluctant to learn how to test Rocket, he is quite right that you need to pay attention to how Rocket is feeling just as much if not more so than the numbers. Their bodies have become used to the high numbers and they have to adjust to the insulin we add into the mix. If he is feeling better that means you are moving in the right direction.

Hehe... my hubby and I both love Star Trek, but I wouldn't go so far as to call ourselves Trekkies. Kes was a cool character, but the nickname was just a coincidence. I love the name Worf by the way!!!

Thanks for the encouragement. At this point I just can't wait to get the hospital stay over with so I can get back home! It'll all be over before I know it. Time has a way of just marching on.