10March2020/Maxi/AMPS353/Update & Approval Request

I'm a newbie, but I personally would increase as you are planning. Others may have differing opinions :) My only suggestion would be to try to get more mid-cycle tests, to really understand where his nadirs are falling. Easier said than done, I know.

Best of luck with Maxi!
 
SnowKat said:
I'm a newbie, but I personally would increase as you are planning. Others may have differing opinions :) My only suggestion would be to try to get more mid-cycle tests, to really understand where his nadirs are falling. Easier said than done, I know.

Best of luck with Maxi!
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Thank you, Kat.

By mid-cycle, do you mean +5, +6, +7? I kind of stopped doing that since I discovered that Maxi's nadirs seem to be later in the cycle.
Do you think I'm making a mistake by not testing mid-cycle? (Also, there will be many days when I can test mid-cycle only at night.)
 
Susan & Claudio said:
I can't offer any suggestions as I'm basically new also.
But I feel your frustration. I'm in the same boat.
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Thanks, Susan. I peeked at Claudio's spreadsheet and saw that he is up to 3.75 too. But at least it looks like the insulin is actually lowering his glucose. Good! I wish the same could be said for Maxi.
 
bambinaki said:
By mid-cycle, do you mean +5, +6, +7? I kind of stopped doing that since I discovered that Maxi's nadirs seem to be later in the cycle. Do you think I'm making a mistake by not testing mid-cycle? (Also, there will be many days when I can test mid-cycle only at night.)
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Yup, that's what I meant. But, as the saying goes... KNOW THY CAT! If you are confident in the timing of Maxi's nadirs, then extra testing probably isn't necessary.
 
Sandy and Black Kitty said:
Yes, unless you see blue or green this cycle a .25u increase next cycle is in order.
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Thank you, Sandy.

I noticed "HIGH doses required" below your name, and as I'm worried about Maxi's dose getting higher and higher, I looked at BK's spreadsheet, and to my shock I saw that BK was up to 13.5 units. But then I saw that BK went into remission. Right? (I still don't know what OTJ means, and it's not in the glossary.) And I saw that Black Kitty passed away. I'm very sorry. From what I can understand from BKs story, he gives me hop for Maxi. I'm glad Black Kitty had a really good home with you.
 
bambinaki said:
I noticed "HIGH doses required" below your name, and as I'm worried about Maxi's dose getting higher and higher
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Sandy and Black Kitty had IAA - that means Insulin Auto Antibodies. There is a blood test for that, but it's usually not recommended until the cat gets to 6 U per 12 hour dosing cycle.

IAA can develop when there is an underlying condition.
Here is one thread that talks about IAA. http://www.felinediabetes.com/FDMB/threads/what-is-iaa.188200/

Being overweight might be a factor in insulin resistance. So getting your cat down to a normal weight can be important in controlling the diabetes.

But a study in human children found "excess body weight and insulin resistance do not influence autoantibody frequency."

Glucose toxicity can develop when the dose is held at a low level for too long.
 
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@Deb & Wink

FYI --

IAA = insulin auto-antibodies or what is commonly referred to at insulin resistance. IAA can be assessed via a blood test.

Glucose toxicity results when a dose is held for longer than in necessary and your cat starts to treat the higher numbers as the new "normal." It can make it harder to get numbers to come down and there's often a fair amount of bouncing that occurs.
 
bambinaki said:
Do you think I'm making a mistake by not testing mid-cycle?
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Yes. 2 reasons why I say that.
1. Because those nadirs can change from cycle to cycle. They don't stay static, not the same all the time.
2. Also, if you are not testing in the middle of the cycle,or around the time when your cat nadirs, you don't know how low the increased dose is taking your cat Maxi.

We realize that people work. So you won't be able to get a mid-cycle test on those days you are working.
But there are other opportunities to do testing.

bambinaki said:
By mid-cycle, do you mean +5, +6, +7? I kind of stopped doing that since I discovered that Maxi's nadirs seem to be later in the cycle
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So, when do you think Maxi's nadirs usually occur?
 
Good luck with the increase. One thing to keep in mind is that insulin is a hormone, not a drug. It's not like you add a bit more and you see a little bit more numbers. You just have to keep increasing (safely, and knowing how low the dose is taking the cat), until you hit a fitting dose. As far as testing goes, try to get a before bed test each and every night. Cats often go lower at night, so that's the time to catch those lows.

In the mean time, try not to worry about the dose. A cat needs however much he needs. Maxi's spreadsheet does not look unusual at this point of his FD journey.

Piling onto something said above, cause my Neko also had IAA, some cats have insulin auto antibodies at lower doses. Loudogg got tested and found positive at around 3.5 units. There isn't much research in this area, but I've seen two studies on small numbers of cats. One said it's common, the other uncommon. :rolleyes: The treatment is as much insulin as they need, until the antibodies break. So, nothing different than what you are doing now.

In a previous post, you asked me why three different insulins for Neko. There was actually 4. :p First one Caninsulin, just isnt a good insulin for most cats - Neko got little duration out of it. But it was the insulin my vet knew, so that's why we started there. I moved to Lantus when a locum vet recommended it, and told me to start coming to FDMB. :) Later Neko was diagnosed with two secondary endocrine conditions (which some people call high dose conditions as some cats with them require higher doses). She did get to a high of 8.75 units of Lantus. Anyway, at higher doses, Lantus can sting some cats because of it's acid base. I switched to Levemir after a couple years, which also had even better duration. Neko at that time was on less than 1.5 units, but her dose did later increase a second time back up to 7 units, so I was glad I had switched to Levemir. The fourth insulin was Humulin R, which was used as a bolus insulin. It's a short duration in and out insulin, that can help lower temporary rises in numbers. It's a tool used by some people whose cats have IAA or acromegaly, and some with ketone prone cats.
 
Deb & Wink said:
Yes. 2 reasons why I say that.
1. Because those nadirs can change from cycle to cycle. They don't stay static, not the same all the time.
2. Also, if you are not testing in the middle of the cycle,or around the time when your cat nadirs, you don't know how low the increased dose is taking your cat Maxi.

We realize that people work. So you won't be able to get a mid-cycle test on those days you are working.
But there are other opportunities to do testing.


So, when do you think Maxi's nadirs usually occur?
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+7 - +10 but sporadic
 
Deb & Wink said:
Sandy and Black Kitty had IAA - that means Insulin Auto Antibodies. There is a blood test for that, but it's usually not recommended until the cat gets to 6 U per 12 hour dosing cycle.

IAA can develop when there is an underlying condition.
Here is one thread that talks about IAA. http://www.felinediabetes.com/FDMB/threads/what-is-iaa.188200/

Being overweight might be a factor in insulin resistance. So getting your cat down to a normal weight can be important in controlling the diabetes.

But a study in human children found "excess body weight and insulin resistance do not influence autoantibody frequency."

Glucose toxicity can develop when the dose is held at a low level for too long.
Click to expand...

Maxi is a tiny bit chubby, but he's hungry all the time and gets only about 6 ounces of canned food per day. He weighs about 13.5 pounds. Do you think he's overweight enough to be concerned about insulin resistance?
 

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As far as testing goes, try to get a before bed test each and every night. Cats often go lower at night, so that's the time to catch those lows.

Because of my work schedule, Maxi's shot time is 9:30. You can see on his ss that he does get lots of +2, 3, 4 PM tests.

Maxi's spreadsheet does not look unusual at this point of his FD journey.

This is probably the most reassuring thing I've been told.

Thank you!

So, because in about an hour he'll get his first shot at 4 units, I'll be up often testing him tonight.
 
bambinaki said:
Maxi is a tiny bit chubby, but he's hungry all the time and gets only about 6 ounces of canned food per day. He weighs about 13.5 pounds. Do you think he's overweight enough to be concerned about insulin resistance?
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NO. He'll probably lose a bit of that weight as you try to get his diabetes regulated, under control.

15-20 calories per pound of a cat's weight is usually about right. But unregulated diabetic cats need more food.
13.5 lb times 15 =202 calories 13.5 lb times 20 = 270 calories
So a Weruva 3 oz can averages 55 to 70 calories each. So that seems like too little food. It should be more like 3 of those 3 oz cans. Maybe a bit more.

There is a bigger 5.5 oz can. Do you feed him those? or the pouches?

https://weruva.com/nutrition-landing/pates-ni/ Nutritional info from the Weruva website.

Do you ever weigh him at home? If you are like many women, you have a bathroom scale at home. Hold him in your arms, step on your bathroom scale, note the weight, let him down, note your weight alone. Subtract 2nd number from the first to get a rough idea of Maxi's weight.

6 ounces does not sound like a lot of food. Wink was eating 11-12 ounces when he first came to me as a foster cat. It took time for him to like the canned food and he lost too much weight at the beginning. Once he decided canned food was edible, he got better and needed less insulin and less food.
 
It's normal. No intervention with food needed.
You simply keep monitoring to gather more test data tonight.

It's the low numbers, under 50 that you need to pay close attention to.
Then you would need to steer and guide the blood glucose levels with some food.

So you go ahead and give Maxi the 4U.
 
Deb & Wink said:
NO. He'll probably lose a bit of that weight as you try to get his diabetes regulated, under control.

15-20 calories per pound of a cat's weight is usually about right. But unregulated diabetic cats need more food.
13.5 lb times 15 =202 calories 13.5 lb times 20 = 270 calories
So a Weruva 3 oz can averages 55 to 70 calories each. So that seems like too little food. It should be more like 3 of those 3 oz cans. Maybe a bit more.

There is a bigger 5.5 oz can. Do you feed him those? or the pouches?

https://weruva.com/nutrition-landing/pates-ni/ Nutritional info from the Weruva website.

Do you ever weigh him at home? If you are like many women, you have a bathroom scale at home. Hold him in your arms, step on your bathroom scale, note the weight, let him down, note your weight alone. Subtract 2nd number from the first to get a rough idea of Maxi's weight.

6 ounces does not sound like a lot of food. Wink was eating 11-12 ounces when he first came to me as a foster cat. It took time for him to like the canned food and he lost too much weight at the beginning. Once he decided canned food was edible, he got better and needed less insulin and less food.
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Oh no! I've been giving Maxi too little food! Poor Maxi!

Thank you, Deb. You've given me important info.

I feed him some 3 oz cans and some 5.5 oz, but I've been giving him 1/2 of the 5.5 oz cans. I will increase the amount I feed him.
Maxi has already lost weight.
I'll start weighing him.
 
bambinaki said:
I looked at BK's spreadsheet, and to my shock I saw that BK was up to 13.5 unit
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I was also using Humulin R (“R” for short) along with Lantus. At one point his daily total insulin (AM +PM) was 45u.
The deck seemed to be stacked against him; FIV+, diabetic, 2 episodes of DKA..and then IAA-which no one at the time knew anything about (BK was the first FDMB kitty to test for it). He was the last cat anyone imagined would get regulated much less go into remission. After 21 months he did just that. He remained dirt controlled the rest of his life (6.5 years). There’s always hope.

He was a character and kept us entertained with his antics which can be seen in my tribute video.

Regarding IAA- it is idiopathic. It arises spontaneously and without cause.
 
bambinaki said:
Maxi is a tiny bit chubby, but he's hungry all the time
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With diabetes, the lack of insulin means that food ingested is not properly converted into usable energy the body needs to function so a kitty always running in high numbers often seeks food in an attempt to fulfill energy requirements.
 
Sandy and Black Kitty said:
I was also using Humulin R (“R” for short) along with Lantus. At one point his daily total insulin (AM +PM) was 45u.
The deck seemed to be stacked against him; FIV+, diabetic, 2 episodes of DKA..and then IAA-which no one at the time knew anything about (BK was the first FDMB kitty to test for it). He was the last cat anyone imagined would get regulated much less go into remission. After 21 months he did just that. He remained dirt controlled the rest of his life (6.5 years). There’s always hope.

He was a character and kept us entertained with his antics which can be seen in my tribute video.

Regarding IAA- it is idiopathic. It arises spontaneously and without cause.
Click to expand...

Thank you, Sandy.

Black Kitty was a very cute boy. I'm glad I got to see him cutely tearing up paper and hear him purring.
 
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