? 03/01 Mowgli AMPS 425, +3 351, +5 387

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Thanks for all the help thus far!

Update: Mowgli says he's not impressed with 7 units BID . I tend to agree haha

Will be increasing to 7.5 tonight...

Question: I know that Levemir is the preferred insulin for high dose kitties because it's long-acting yet doesn't sting. However, I think the later onset would make testing problematic for my mom and sister during the night. Right now we are shooting at 8 am/pm and therefore I am able to drive to their house at 1-2 am (+5 to +6) to test Mowgli if it's needed, but wouldn't be able to do that as often if his nadir is consistently later than that. So I feel very inclined to make Lantus work for us. So my question is this: Would it be advisable for us to add a Humulin/Novolin N or R insulin at some point (conceivably at an L dose where we notice stinging)? The way I see it that would allow us to continue increasing his insulin as needed. The potential cost savings of using some Novolin N or R from Walmart is icing on the cake.

Lastly, at which point would it be advisable to get Mowgli's IGF-1 levels tested? We started insulin on January 9th.

 

Hi There!

I don't know much about high dose kitties, so I am just bumping this to get someone else's eyes.

I think @JanetNJ has experience with high dose? Sorry if I am thinking about the wrong person....

 

Hi! We usually say once they pass 6 units without much progress it's time to get tested. I'd say it's time to send out for a test. If the high dose seems to be stinging him and you don't want to use Levemir, Prozinc is another option that doesn't sting at high units. At her most my cat took 13 unts and it didn't sting her.

 

Wait 73 days after starting insulin before getting the tests done. There have been some studies that 1/3 of acrocats show false negative if tested before then. Looks like you are at day 52 now. Otherwise, as long as you are feeding only low carb wet or raw, and he has no other major issues like needing a dental, then over six units is when we suggest getting the tests done.

As for Lantus vs Levemir, let Mowgli's reaction to Lantus be your judge. I've seen some cats on 20+ units of Lantus and not react to the shot. Neko's nadir on Levemir was often very close to +12. Since that was preshot time, it was a very convenient time!

Using R with L insulins needs quite a bit of monitoring at first. Until you learn what works. Since it's ECID on how a cat reacts to R and how much they need, we strongly recommend getting someone experienced with R to help you out the first few times. There are some guidelines to learn about when to use R, and most important, when not to.

 

@Wendy&Neko @JanetNJ
Thank you for the advice! It's truly very much appreciated.

I'm looking at your SS and can see what you are saying about the nadir on Levemir being close to shot time. Depending on the time of shot that might actually be advantageous. Maybe something to consider. Regardless I don't think I could switch any time soon considering that I had to convince the vet that diagnosed Mowgli to prescribe Lantus and she refused to prescribe us a Freestyle Libre. She ultimately said that she is not very experienced with diabetes and would rather us see a specialist for continued treatment.

After initially hoping that we could get Mowgli into remission with treatment I am realizing that it might not be a real possibility. Therefore, my first priority has turned to getting him to safe BG numbers ASAP (I'll even be happy to see mostly yellows at this point). This is the reason why I bring up the idea of using an R insulin. I realize that it would be more work for us. But if it means being able to get Mowgli to better numbers soon as opposed to waiting for the L depots to do that at some future date, then I am all for it. I have been known to go above and beyond for my pets (I paid $8k for a disc surgery on my current little mutt dog that I took from the streets! And what a rehab that was...), so I am dedicated to preventing Mowgli from having permanent damage from these prolonged reds and pinks. I took him off the streets when he was a kitten and I was in high school and I have maintained my sense of responsibility over him and his brother Junior even after I moved out of the house and left them in my mother's care.

Knowing all this, do you think an R insulin can help us get Mowgli to better BG numbers? If so, can you point me to the guidelines that need to be followed when using R?

As far as the testing for acromegaly and IAA goes. I am hesitant to have him tested yet if it means that we might not get a correct diagnosis... We notice Mowgli makes a weird sound when he breathes hard as he waits for his food. Is that a symptom of acro? He doesn't display any physical signs apart from that.

 

There is a symptom called stridor, check it out on Youtube to see if that's what you are hearing. It's caused by soft tissue growth in the throat. Neko didn't show stridor until over 4 years after diagnosis, and it was very mild. ECID very much on acro symptoms seen.

As for R, there is no set of guidelines to point to. We've had people go off on their own without guidance and make things worse with R, not better. Which is the main reason we set you up with an experienced person to learn what works for Mowgli. If you decide to go that way, we'd try to find an experienced R user who can be around for your shot time, and the 4 hours afterwards. So have to be compatible time zone/preshot time. Initially you start with a small dose shot at preshot time, and test every hour for 4 hours afterwards. That amount of testing slows down when you learn the R onset and nadir/duration.

My vet joked that Neko was worth a new car. Worth much more than that to me!

 

Thanks again for the help!

In your experience would you say that we could benefit from the addition of R?

I have heard mention of R scales. Do you mind explaining that concept?

 

R scales mean you give different amounts of R at different preshot values. See an example on Black Kitty's SS. Note, this example only is for Black Kitty, everyone would create a scale that works for their cat. The goal with giving R is to bring the numbers down but no more than 100 points over the length of time R is in the system. Any more than that, and you can create a bounce from a fast drop, which causes numbers to be even higher. So you want a gentle hand with R, nudge the numbers down so that the L has some better numbers to work with, but not so fast that you get into a vicious cycle of bouncing.

The other advantage of R is that it can help you when you do a furshot. Or Suzanne used it with Darcy on the weekend when she ran out of Lantus and had to go to longer Lantus cycles.

Remind me again of the special circumstances with Mowgli? I know he doesn't live with you.

 

That's right. When I moved out for college I left him in the family home under the care of my mom. By the time I had a good job and stable home life I decided it was not a good idea to uproot Mowgli and his doggie brother Junior since they were already middle aged by then.

The main caregiver for Mowgli is my mom. She gives 90% of shots and she tests him during the day. Since she works as a property manager she has more leeway and doesn't have to leave the house often. She tests past the PM shot but not much after PMPS +3 due to her sleep schedule.

My younger sister who still lives at home works nearly full time outside the home, but she is available to test on evenings after work or on her days off.

Lastly, I volunteered to drive to their house at night (shots are 8am/pm) if it looks like we will have an active nighttime cycle. I live about 20 minutes away. Also, since I work from home, I am available to cover for my mom if she has to be somewhere or needs a break.

 

OK, so communications would have to be with your mother if she was the one giving R. Or to you and then onto her. Could she handle testing every hour for 4 hours after an R shot?

 

I was thinking that we could begin using R on a weekend so that I could be there myself to make communication simpler. Otherwise, I typically pass on any communications through phone daily.

She can definitely handle testing every hour for 4 hrs after the R shot as we develop our R scales. As I understand it if for whatever reason no one is available to test in the hours after an R shot we can simply cancel the R shot and go with the L shot only right?

 

Yes, R is completely optional. Can you tell me your time zone and PS time. So I can see if there is someone able to help.

 

Time zone is PST and PS time is 8 am/pm