04/05 Eddie AMPS 383 +2.5 275 3.5 149 4.75 106 +6.5 151 PMPS 470 +2.5 319 +338( increase dose )

Good morning,
Here's yesterday's story:

https://felinediabetes.com/FDMB/threads/04-04-eddie-amps-436-pmps-376-2-5-416-worried.261570/

Increased dose today to 8.5u and already it seems to have made a difference.

I will be around all day with the exception of +4 to +5.

 

Yellow, yes!

I meant to ask yesterday if you've looked at other spreadsheets of cats with IAA. Here is Oberon's SS, he is just IAA so it's easy to see the effects without any other conditions. Right now Lisa is threatening an increase, as it looks like the "dose is going stale" as I used to call it. What used to look like a good dose has stopped being one. Lots of dancing up and down around a dose. Not unlike what Eddie looks like lately, though Lisa uses a human meter so the numbers aren't as high. Similar results with Minnie's SS. Liz held the 5 units dose a little too long and had to crank up the dose to see greens again. Minnie is also IAA only.

Sorry to sound like a broken record with the follow on CT's. I just want to make sure that spending the dollars and travel time would be worth it for you and safe for Eddie. I always ask myself when a vet suggests a test "what would this tell me and would I do anything any differently with the answer". More than once I've seen members here have vets say they must get a CT done once they have a positive IGF-1, when the caregiver isn't planning on doing treatment. In that case, the answer is that they would do nothing differently but would get to spend money for nothing. In addition to my own issues with Neko, a friend with an acro had it pass during a "routine dental" anaesthesia due to heart issues. So I'm cautious that way.

 

@FrostD @Wendy&Neko

@3.5 149. I come into the kitchen and Eddie is hissing at me as if I'm a great threat. He then vomits and runs off to try and use the cat box. Nothing happens. He comes back into kitchen, vomits again, yowling and hissing. One back leg seems weak. I quickly test: 149 so dropping fast from AMPS.

Called vet: get put on hold. Tech comes back say to email numbers as the internist is with a client. Seeing numbers in an email "better than [her] scribble". I wonder What are you there for?

20 minutes: still waiting. Will test Eddie again. I was able to interest him in a tsp of LC 20 mins ago.

 

Hmm that's odd. Constipated? Did he get into anything he shouldn't have?

The leg is curious, not sure if he has arthritis or anything. I know Mr Kitty is a bit stiff/waddle-y when he first gets up

 

What type of vomit? Food, foamy, bile? They mean different things.

The leg is odd. Other than arthritis, low potassium can be a cause. I don't see any lab values on the spreadsheet so don't know how he's trending with that. Or he could have hit himself on something? I had a clumsy civvie who banged into things when in toy chase mode.

Of course Eddie would plummet down just as you are headed out. Not sure seeing the numbers will be useful for the vet. I'd go more by symptoms.

 

It was really weird. It happened after he projectile vomitted and exited the room yowling. I thought at first HYPO but then he was at 149. I just tested again +4.75 106.

What a wild day.

I got a call from the vet finally. who really didn't tell me anything I haven't already thought. He settled on perhaps the insulin isn't lasting long enough. He told me it would be a good idea to feed him frequently throughout the day.

We finally settled on the possibility the tumour is reactive and creating insulin resistance. OR it's not and Eddie has another secondary condition.

I've stayed home from my meeting and have given him LC twice. Just now with the 149 @ +4.75 so I'll monitor.

He's not limping anymore and not hissing or yowling either. He now seems totally normal.

 

Hi Wendy,
as below, I said, he's neither limping nor yowling nor vomitting. He has eaten a little LC after the last test +4.75 106 (and earlier as well). Maybe he did twist his leg or something because he's totally himself again.

The vomit was mostly liquid with the mousse of the Tiki Cat (but only a little of his breakfast).

I decided not to go to my meeting. See below for the vet call. Oh, well...

 

Maybe this dose increase was a kick-starter.

Now what is equally weird is that I turned around and he was nowhere to be seen. Thought he might be hiding but instead he went outside into the catio, which he has not done in months. He was just sitting out there enjoying the spring air and came in only when he saw me looking at him incredulously.

 

One of the reasons Levemir might be a good option. But you'd end up with later onsets and nadirs so that might not work for you.

Cats and their timing! A little food to try to convince him to surf a little longer at this range is a good idea.

Could be, could also be enough extra juice to side step the antibodies for now.

 

These cats, I can feel the gray hairs popping out of my head! One has Eddie's name on it.

Since I can't find recent labs, did the vet have any idea as to "secondary conditions"? The only other major ones I can think of are like thyroid, Cushing's (minus the usual infections, dentals, anemia, etc that can make things a little wonky).

Are you typically "off" for the summer? Semester end around early May? I know you just bought all that Lantus, but I assume the expiration date is still a year+ away? I'd give a single pen of Levemir a try

 

LOL. It's true about the hairs but sometimes I just feel like my hair is on fire!!
The vet's "secondary conditions" were quite vague, TBH. I think he just doesn't know what to say. Eddie does take thryoid medication but if anything he'd be hypothyroid as he's gained quite a lot of weight from his pre-diagnosis ninja days. Eddie's dentals are an issue but the point is he really cannot be anesthetized for the long surgical hours dental work takes. It's a double find there.

I appreciate how you put "off" in quotation marks! usually summer is our research intensive time but I'm teaching a summer session course starting in mid-May and lasting six weeks. It's quite intense and involves teaching 3x week on one course. The good part is it's over quickly. The hard part is that because it's over quickly one has to pack a lot into a course that ordinarily would be full term. Pedagogically, I liken it to running down a burning hallway carrying a tray of ice cubes that you need at the end.

Where can I post Eddie's labs? I think I posted them here in a thread once but is there another place for them?? I could upload that.

I did buy all that Lantus. The thing about Levemir is that I'd have to get another prescription for it and this vet is soooooo conservative. He's the one who doesn't want to look at the SS because there are "too many colours".

 

There is a labs tab on the spreadsheet, best place for those sorts of things. You will have to modify the reference ranges from the examples that are in there.

BTW, you do NOT need a prescription for Levemir in BC. If the vet wants less colours, that's another vote for using a human meter.

 

In that sense I was fortunate to teach STEM...pretty concrete stuff, so once the initial creation of the courses were done, it was pretty smooth sailing. And doubly fortunate that things like homework and take home projects/papers weren't really possible/relevant given software/material. Triply fortunate to not have to teach summer classes!

Thyroid is one of those funky ones from what I've been reading lately. Hyperthyroid usually means metabolizes insulin too fast and BG goes up. But hypothyroid can break other mechanisms and also cause BG to go up...yet sometimes down. I am not looking forward to all these trips for thyroid labs for Mr Kitty, that's for sure.

 

Oh, boy, I hear you. I have a hypothesis about acromegaly and the pituitary: that it has something to do with mercury in seafood. I'd be very interested to see what humans who have acromegaly have been eating... Long story there and there's a bit of paper in it.

 

SO, a ferocious bounce: PMPS 470 and @ 2.5 319.

Hmmmm. Gave TBSPs LC