my questions are that it was my understanding that Lantus dosing takes awhile to settle. So moving every couple of days may be too fast. What can you share about that? Also, when I look at his numbers, I think maybe his body liked 2.5. That's when I got yellow and lowered his ketones. Well, the latest news is he has severe and chronic pancreatitis so that is definitely making it difficult to manage. But back to dosing, if I increase every four cycles, what about the way Lantus works and builds up in body, how do you know it's not too much if the dosing settles in past four cycles? Thanks!
When we have a cat who is throwing ketones and is above 300, we have
very much experience in raising the dose 0.5u after four cycles. We can do this twice in a row if the BG stays above 300 but then we slow down and raise the dose 0.5u for six cycles. I promise we know what we are doing and I’ve just been doing it with a couple other cats and they are so much better and are now below 300, normal ketones, and are back doing the TR protocol as written.
So how do we know? Well, we’ve been doing this a very long time, as I mentioned, and we have you monitor so we can catch the yellows because that’s when we stop fast-tracking. That means you will need to get tests during the a.m. cycle as you were doing and if he’s still on a Libre, that means you just need to pop some of the numbers into his SS especially the lower ones. If he’s gotten into yellow today, for example, we won’t fast-track him. Also since you have a Libre, it’s important for us to know what is going on in the PM cycle since cats often go low there. We know the trends to look for to stop the fast-tracking and, as I mentioned, we only do it twice before we let the depot catch up. However, that’s all for info and if you have the data for the last couple cycles that show he’s gotten below 300, we will just do normal TR.
The 2.75u wasn’t even close to what he needs to be at. Our goal here is to get each cat tightly regulated which means the majority of the time the BG is between 50-120. So he has a long, long way to go. We do it very gradually so you don’t have to worry about that but we do need to get him into better numbers. We would really like to know what dose you shot the evening of 5/6. There is no data there at all.
I’m sorry he has so much going on. You might want to read this post on
Pancreatitis as it will help you know the treatments we recommend and have been successful in helping them get through it.
If you have any labs, if you can post them on the lab tab of his SS and let us know, we are also good at looking at labs and can give you some additional info.
Staci is very correct on the cerenia and I, personally, would also be giving ondansetron (zofran) even if he is eating. My CKD kitty was getting both of these and I would get the smaller ondansetron (4 mg each) by Aurobindo manufacturer (Walgreens would order these for me) and I could put them in a #3 empty gel cap (buy on Amazon) and once a day, I could put the cerenia and the ondansetron in one #3 gel cap. It makes it SOOOOO much better. I could wrap the capsules in my boy’s raw food and he never even knew he was getting them. But, I always gave him a little water first, then the food/capsule, then another bite of food, and then a little more water to be sure nothing got stuck in his esophagus.
I would also be giving pain meds. I’m not a fan of gabapentin (neither is my vet) and we use buprenorphine. There has been a shortage of the injectable which you actually don’t inject, you just use a needleless syringe and squirt on the gums. Because of the shortage, my vet called a prescription into our compounding pharmacy and I had it compounded with a little flavor and then syringed it. I hope they gave him some pain meds as pancreatitis is very painful.
I mentioned feeding a/d or Recovery for higher calories. A/D is higher carbs but Royal Canin Recovery is LC so if you can get that, you can give him a lower carb/higher calorie food. At this point, I would say you need to feed him whatever and as much as he will eat.
For acro testing, the Royal Vet Clinic which is an expert on acro, states cats should be on insulin at least 73 days to avoid a false negative test. But I would hope after 90 days on insulin, you might be able to test and get a realistic test IF you really believe he’s showing signs of acromegaly. Be sure you also have him tested for IAA. It’s cheaper to do both together and sometimes it’s no acro but just IAA.
I hope he feels better really soon. The supportive care.....the anti-emetics and anti-nausea, the pain meds, the fluids, and the food really go a long way to helping.
but the large diameter means the fluids get into the cat faster than a thinner needle.
