12/17 Marvin Advice & Opinions at 6 units Please

Kwyn

Kwyn

Member
Hi,

We have increased to 6 units of Lantus and I am hoping to get some advice or opinions on his numbers please.

Back story: Marvin was diagnosed Sept 2021 and was diet controlled from April 2022 until Oct 2024. Started Lantus Oct 4th 2024. Following TR. No other medical issues so far. Probably needs his teeth cleaned but the vet doesn't seem to think it is bad enough to affect his BG. He eats Friskies and FF pates. Has put the weight he lost back on and is back to his normal self.

In looking at his spreadsheet, I was advised in the FB group that I held 4.5 units too long so started to increase every 3 days again. I am wondering when I went from 5 to 5.5 units did I maybe miss his optimal dose since his numbers haven't really come down since then and he is now receiving too much insulin. Or is it time to test for Acromegaly and IAA since we have hit 6 units. He isn't showing any outward signs of being an Acro cat but I know it is possible to still have it.

I appreciate your time!

Kwyn and Marvin
 
Hello and welcome. I didn't stop in on your last post here.

A couple things about dosing. First, when you get over 5 units total dose, change to increases of 0.5 units unless tweaking a dose that's already showing you some green. He's isn't seeing green, much less low blues. You test enough, therefore he's not overdose. Second, Marvin's spreadsheet does look like something is causing insulin resistance. One in four diabetic cats has acromegaly and it's something we suggest when people get to 6 units, along with IAA testing. Some cats have both, like mine did, some have one or the other. Testing both is a good idea cause the blood goes to the same place for testing and makes a cheaper add on. We've also had cats with acromegaly and/or IAA on less than 6 units.

It is possible there is something else at play, and I'd encourage you to see about that dental if possible. And by a vet who does dental x-rays. Neko did have one dental by a dental vet specialist, and even he couldn't see an issue that only showed up in the x-rays. Infection/inflammation from needed dental definitely can cause insulin resistance. As can holding a dose too long, when you can get glucose toxicity.

You can hold a dose that is seeing greens for 10 cycles, and also longer than 6 cycles if low blues - to see if he comes back to those nadirs when the bounce is over.

Did you have any idea why he came out of remission in October?

Are you really testing almost every two hours? We can give you some tips so you don't have to test as much.
 
Wendy&Neko said:
Hello and welcome. I didn't stop in on your last post here.

A couple things about dosing. First, when you get over 5 units total dose, change to increases of 0.5 units unless tweaking a dose that's already showing you some green. He's isn't seeing green, much less low blues. You test enough, therefore he's not overdose. Second, Marvin's spreadsheet does look like something is causing insulin resistance. One in four diabetic cats has acromegaly and it's something we suggest when people get to 6 units, along with IAA testing. Some cats have both, like mine did, some have one or the other. Testing both is a good idea cause the blood goes to the same place for testing and makes a cheaper add on. We've also had cats with acromegaly and/or IAA on less than 6 units.

It is possible there is something else at play, and I'd encourage you to see about that dental if possible. And by a vet who does dental x-rays. Neko did have one dental by a dental vet specialist, and even he couldn't see an issue that only showed up in the x-rays. Infection/inflammation from needed dental definitely can cause insulin resistance. As can holding a dose too long, when you can get glucose toxicity.

You can hold a dose that is seeing greens for 10 cycles, and also longer than 6 cycles if low blues - to see if he comes back to those nadirs when the bounce is over.

Did you have any idea why he came out of remission in October?

Are you really testing almost every two hours? We can give you some tips so you don't have to test as much.
Click to expand...

Thank you so much for your reply!

I test often because I work from home and I like to see the data. Probably also hoping that the next numbers will be lower. :) I lucked out and have a very chill cat who also loves freeze dried chicken so he is really good about testing.

My assumption is that the few pieces of dry food that I was giving him here and there when I fed my outdoor cats is what brought him out of remission but I am not entirely sure. I will make a vet appointment to have him tested for Acromegaly and IAA as well as see about a dental appointment.

I think what is confusing me is that we had lower numbers at 4.5 units and now that I have increased his dose we are high again. I will change to 0.5 unit increases going forward.

Thank you!
 
Kwyn said:
I think what is confusing me is that we had lower numbers at 4.5 units and now that I have increased his dose we are high again.
Click to expand...
That is the nature of insulin resistance, whatever kind there is. That plus there is something we call New Dose Wonkiness, or NDW. It's a phenomenon in the first few cycles of the increase, where numbers are higher. We aren't sure why, maybe something to do with depot rebalancing? It doesn't happen always, and today looks like it could be that.

Have you tested for ketones lately? If so, please put the result in the Remarks column, or we'll keep asking. :) Especially since the signature says ketones trace.

A tip for testing, if the +2 and/or +3 is higher than the preshot - it'll be a quieter cycle. Save those tests for when you really will need them. You could have stopped testing at +4 today. This tip will allow you to get more sleep. Time will come when you need to test more often.
 
Wendy&Neko said:
That is the nature of insulin resistance, whatever kind there is. That plus there is something we call New Dose Wonkiness, or NDW. It's a phenomenon in the first few cycles of the increase, where numbers are higher. We aren't sure why, maybe something to do with depot rebalancing? It doesn't happen always, and today looks like it could be that.

Have you tested for ketones lately? If so, please put the result in the Remarks column, or we'll keep asking. :) Especially since the signature says ketones trace.

A tip for testing, if the +2 and/or +3 is higher than the preshot - it'll be a quieter cycle. Save those tests for when you really will need them. You could have stopped testing at +4 today. This tip will allow you to get more sleep. Time will come when you need to test more often.
Click to expand...

Thank you so much for all your help!

I will do a ketone test on our next BG test, I haven't tested for that in a while.

I will cool it on testing so much for a while :D. He only lets me test on one ear so it could probably use a break.

Thanks again!!
 
Pass on some scritches to the sweet boy. Hope you get him into a range with better numbers soon.

I was reading back your quite older posts. What is the status with the kidney disease?
 
Wendy&Neko said:
Pass on some scritches to the sweet boy. Hope you get him into a range with better numbers soon.

I was reading back your quite older posts. What is the status with the kidney disease?
Click to expand...

It turned out that he had an acute kidney injury and not CKD. His numbers and urine specific gravity are all back within normal range.

Just did a ketone test with my blood meter and he is 0.3 granted the test strips are from 2022. I opened a new bottle so I am not sure if the "use in 3 months" rules applies. Need to order new strips.
 
Wendy&Neko said:
That is the nature of insulin resistance, whatever kind there is. That plus there is something we call New Dose Wonkiness, or NDW. It's a phenomenon in the first few cycles of the increase, where numbers are higher. We aren't sure why, maybe something to do with depot rebalancing? It doesn't happen always, and today looks like it could be that.
Click to expand...

Hi Wendy,

I just have a question regarding NDW. Is it possible for it to last 6 cycles and did I jump the gun this morning by increasing Marvin's dose 0.5 units after he came down in the 200s in last nights PM cycle. We are back in the 300-400s in his AM cycle today.

Also had blood work done yesterday to test for IGF-1 and IAA. It will be nice to have some answers regarding those.

Thank you again for all your help!
 
NDW, if it happens, is over by cycle three.

When following TR, and if seeing nothing under 200, you increase after six cycles. Good luck with the new dose. He’s probably bouncing from that nice long stretch of yellow.

Keeping paws crossed for answers from the blood work. Something causing insulin resistance, would be good to know what. With the holidays, will likely be a couple weeks until you hear answers, but maybe not. For me, this wait was the longest wait of all!
 
Wendy&Neko said:
NDW, if it happens, is over by cycle three.

When following TR, and if seeing nothing under 200, you increase after six cycles. Good luck with the new dose. He’s probably bouncing from that nice long stretch of yellow.

Keeping paws crossed for answers from the blood work. Something causing insulin resistance, would be good to know what. With the holidays, will likely be a couple weeks until you hear answers, but maybe not. For me, this wait was the longest wait of all!
Click to expand...

Thank you!
 
When following TR, and if seeing nothing under 200, you increase after six cycles. Good luck with the new dose. He’s probably bouncing from that nice long stretch of yellow.

Hi Wendy,

Hope you had a wonderful holiday!

Today (Friday) is day 3 at 8.5 units and in cycle 5 we have dropped below 200. Tomorrow (Saturday) I would normally increase his dose but what should I do now? Continue with 8.5 units or increase as normal? I guess it may depend on what happens in cycle 6.

Still waiting on our lab results. Also please let me know if it is ok that I continue posting on this thread or if I should start a new one.

Thank you for your help and your time!
 
Hi Kwyn, hope you and Marvin had a good holiday too. Next time you post, start a new thread, with a link to this one. That avoids the threads getting too long and older threads tend not to get read as much as the current ones.

As for those blues - wahoo! More than just a quick touch down too. :cool: With TR, we hold doses with blue nadirs for 6-10 cycles. I held towards the longer end if mid to low blues. I'd be tempted to go another day on this dose, to see where he's going with it. Of course, if he goes under 100, you definitely hold longer.
 
Wendy&Neko said:
Hi Kwyn, hope you and Marvin had a good holiday too. Next time you post, start a new thread, with a link to this one. That avoids the threads getting too long and older threads tend not to get read as much as the current ones.

As for those blues - wahoo! More than just a quick touch down too. :cool: With TR, we hold doses with blue nadirs for 6-10 cycles. I held towards the longer end if mid to low blues. I'd be tempted to go another day on this dose, to see where he's going with it. Of course, if he goes under 100, you definitely hold longer.
Click to expand...

Thank you so much!
 
You must log in or register to reply here.
Back
Top