? 9/30 Willow AMPS 289 / +3: 287 / +6: 380

cabreu

cabreu

Member Since 2020
Willow is making some progress on high doses, like spending more time in the 200s. But she's getting close to the 6-unit mark.

We are planning to take her to a new vet. On the phone, the vet said their usual procedure was to have patients test at home, and increase about 0.5 units about every week if BG doesn't go down enough. Then if you get to 6 units and BG is still high, they switch to a different type of insulin.

This was way better than a previous vet who told me not to go past 2 units, but I'm still concerned that switching insulins won't be the right step yet. Should I insist on testing for acro/Cushings/insulin resistance? Any tips appreciated!

And another question: is there a reason why some people say not to shoot insulin in the lower back? Willow is ticklish on her stomach and sides, and she's gotten more and more angry about shots that aren't near her spine. In order to rotate locations along the spine, I would have to go to the lower portion of the back.
 
I'm not sure I've seen anything here regarding shooting lower back, there is a pic here that shows some of the possible injection sites, which includes the flank. https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Sorry, I'm on my IPad so I can't just pull the photo.

Changing the insulin wouldn't really make a lot of sense. You likely just haven't found the right dose yet. You may also have some particular underlying conditions going on ...IAA (insulin autoantibodies) or acromegaly which can be tested for to rule out or determine if they are relevant.
I'll let @Wendy&Neko talk to you more about these and dosing, as that's not in my wheelhouse.
 
Christie & Maverick said:
I'm not sure I've seen anything here regarding shooting lower back, there is a pic here that shows some of the possible injection sites, which includes the flank. https://www.felinediabetes.com/FDMB...info-proper-handling-drawing-fine-dosing.151/

Sorry, I'm on my IPad so I can't just pull the photo.

Changing the insulin wouldn't really make a lot of sense. You likely just haven't found the right dose yet. You may also have some particular underlying conditions going on ...IAA (insulin autoantibodies) or acromegaly which can be tested for to rule out or determine if they are relevant.
I'll let @Wendy&Neko talk to you more about these and dosing, as that's not in my wheelhouse.
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Thanks, yes I've seen this photo and am wondering if the lower portion of the back near the spine is ok.

Are the tests for acro/Cushings/IAA easy and affordable? Are vets familiar with them?
 
Not sure about the cost of those tests, it may depend on your area somewhat? As for all vets being familiar, I'd hope so, but not sure. As for the location of insulin shots, I've seen my vet give vaccines in that area, so I'd say as long as you can get a pocket/pinch up the skin, it's fine. I could never get enough there, but it's my technique, that's off. I like to do a small pinch up, my guy doesn't like getting his fur pulled in a roll motion.
 
cabreu said:
Are the tests for acro/Cushings/IAA easy and affordable? Are vets familiar with them?
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Don't start with Cushings - vets know less about that in cats, cause it's less common. How much your vet knows about acromegaly and IAA really depends how current they are. Vets used to be taught "this is acromegaly, you'll never see it". Recent research (2015) has show one in four diabetic cats has it. Cost depends partly where you live. Since you are in the US, cost is a a blood draw, then cost of the tests at Michigan State University, and shipping to get the blood there. Insist on both IAA and acromegaly. Some cats have one or the other, or both like my girl. My vet thought I was wasting my money, I had to ask her to humour me. She thought I had to get to 10 units before testing, we never got there. That 2015 study showed cats from as little as 1 unit to up to 30, and an average of 7 units for the acromegalic cats. We've seen a few odd cases over 30 units. This post has links to the MSU test database with prices. It quotes $65 for the MSU portion of the IGF-1 test (the test used for acromegaly) and $20 for the IAA test. So add blood draw + shipping.

From doses of 5-10 units, we suggest increases by 0.5 units at a time, unless you are tweaking an already good dose with some green in it. As long as you are only seeing nadirs above 200 and following TR, increase every 3 days.
 
Wendy&Neko said:
Don't start with Cushings - vets know less about that in cats, cause it's less common. How much your vet knows about acromegaly and IAA really depends how current they are. Vets used to be taught "this is acromegaly, you'll never see it". Recent research (2015) has show one in four diabetic cats has it. Cost depends partly where you live. Since you are in the US, cost is a a blood draw, then cost of the tests at Michigan State University, and shipping to get the blood there. Insist on both IAA and acromegaly. Some cats have one or the other, or both like my girl. My vet thought I was wasting my money, I had to ask her to humour me. She thought I had to get to 10 units before testing, we never got there. That 2015 study showed cats from as little as 1 unit to up to 30, and an average of 7 units for the acromegalic cats. We've seen a few odd cases over 30 units. This post has links to the MSU test database with prices. It quotes $65 for the MSU portion of the IGF-1 test (the test used for acromegaly) and $20 for the IAA test. So add blood draw + shipping.

From doses of 5-10 units, we suggest increases by 0.5 units at a time, unless you are tweaking an already good dose with some green in it. As long as you are only seeing nadirs above 200 and following TR, increase every 3 days.
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Thanks for these tips. Good to know about not doing 0.25 increases anymore.

What is your opinion of switching insulins? I have a feeling the vet will suggest it.
 
At Willow's size of dose, I might consider a switch to Levemir. For some cats, it can give better duration. But most important, because of Lantus's acid base, it can sting at higher doses whereas Levemir does not. I would not consider Prozinc, and we don't have much data for any of the other longer lasting insulins like Tresiba.
 
Wendy&Neko said:
At Willow's size of dose, I might consider a switch to Levemir. For some cats, it can give better duration. But most important, because of Lantus's acid base, it can sting at higher doses whereas Levemir does not. I would not consider Prozinc, and we don't have much data for any of the other longer lasting insulins like Tresiba.
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Thanks- why not Prozinc? That is the insulin that the new vet prefers.
 
Ask your new vet how many cats with higher doses he/she has seen. Willow is at the point in dose that I strongly suspect there is a secondary endocrine condition causing insulin resistance. In my time here (over 8 years) I have seen exactly one cat with higher doses stay on Prozinc. I've lost track of how many more who started on Prozinc and switched to Levemir. Here is CC's spreadsheet, she's on Prozinc. Here are some example spreadsheet of cats on Levemir. Amethyst

This post contains links to spreadsheets of people who have switched from Prozinc to Levemir. And this second post ones who switched from Lantus to Levemir.

Levemir seems to have longer duration than Prozinc, you see flatter cycles. Flatter cycles and a depot means it's easier to get more insulin into the cat and keep then from nose doving. To sum up, all the cats with insulin resistance conditions that I've seen switch to Levemir do better on it. I have yet to see someone switch back after trying Levemir for a while, unless it was a cost or availability issue. And then they switched back to Lev when they could.
 
Wendy&Neko said:
Ask your new vet how many cats with higher doses he/she has seen. Willow is at the point in dose that I strongly suspect there is a secondary endocrine condition causing insulin resistance. In my time here (over 8 years) I have seen exactly one cat with higher doses stay on Prozinc. I've lost track of how many more who started on Prozinc and switched to Levemir. Here is CC's spreadsheet, she's on Prozinc. Here are some example spreadsheet of cats on Levemir. Amethyst

This post contains links to spreadsheets of people who have switched from Prozinc to Levemir. And this second post ones who switched from Lantus to Levemir.

Levemir seems to have longer duration than Prozinc, you see flatter cycles. Flatter cycles and a depot means it's easier to get more insulin into the cat and keep then from nose doving. To sum up, all the cats with insulin resistance conditions that I've seen switch to Levemir do better on it. I have yet to see someone switch back after trying Levemir for a while, unless it was a cost or availability issue. And then they switched back to Lev when they could.
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Thanks so much for these links! I will try to convince an older know-it-all vet to prescribe Levemir. He is all about prozinc.

When it comes to high-dose issues, is acro almost always to blame? Or do you see IAA alone very much? It would be nice if it weren't cancer.
 
Acromegaly is not cancer, it is a benign tumour on the pituitary that causes excess growth hormone to be output. One in four diabetic cats has acromegaly, so it is reasonably common. IAA possible less so, though also there is very little research on it. I have seen two papers on it, one saying it is common, one the opposite conclusion. Both studies done on a small handful of cats not large enough to be a significant sample size. We do see IAA alone, but less commonly.
 
Wendy&Neko said:
Acromegaly is not cancer, it is a benign tumour on the pituitary that causes excess growth hormone to be output. One in four diabetic cats has acromegaly, so it is reasonably common. IAA possible less so, though also there is very little research on it. I have seen two papers on it, one saying it is common, one the opposite conclusion. Both studies done on a small handful of cats not large enough to be a significant sample size. We do see IAA alone, but less commonly.
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I see. What is the prognosis/number of years a cat can live without radiation or surgery? Can't find this online. Thanks.
 
cabreu said:
Or do you see IAA alone very much?
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Take a look over at Oberon, he was diagnosed with just IAA this week, and negative for acromegaly. Without tests done, all we can do is guess.
cabreu said:
What is the prognosis/number of years a cat can live without radiation or surgery? Can't find this online.
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Because there is no on answer fits all acrocats. I've seen some cats not much longer than a year, some up to 5 years. And some die of other things like cancer as they do tend to be older cats and get the same diseases as any other cat too. There is a new medication treatment called cabergoline that can help reduce some of the effects of excess growth hormone, including lowering the dose. We've had three cats go off of insulin because of it.
 
Wendy&Neko said:
Take a look over at Oberon, he was diagnosed with just IAA this week, and negative for acromegaly. Without tests done, all we can do is guess.

Because there is no on answer fits all acrocats. I've seen some cats not much longer than a year, some up to 5 years. And some die of other things like cancer as they do tend to be older cats and get the same diseases as any other cat too. There is a new medication treatment called cabergoline that can help reduce some of the effects of excess growth hormone, including lowering the dose. We've had three cats go off of insulin because of it.
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I see. Hopefully I'll get the tests at the new vet appointment next week.

Do high-dose cats use Humulin R effectively? I've noticed that come up a lot. I've also noticed that even the IAA cats have dips in BG. Willow has never gone below the mid-200s. :(
 
This post is getting a little old. If you have more questions, time to start a new one.

Not all people with high dose cats use Humulin R, some do. It's situation dependent. And each higher dose cat is really different. With Oberon, there is a concern about high ketones, so the R was a way to get more insuiin in quickly. Hopefully you are testing fairly regularly for ketones since Willow is spending time in high numbers. If you do ketones tests, it's good to put the results on the spreadsheet, I did it in the Remarks column.
 
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