07/13, Lilly, AMPS 596, advice needed

[catman13]

Hi all,

Update this week, Lilly went to a very low carb dry food < 5% and she’s mainly on wet food between 2-8% carbs.

I maintained the 2u shots for about a weeks because of the food change. However I’m still seeing higher numbers and this morning BG was 596 which is devistating . I had increased her dose to 2.5u last night, not sure if that’s the reason.

I’m doing to start increasing every 5-6 cycles since I’m not seeing much of a change in BG levels.

Random question: what’s the highest dosage a cat can be on? In other words is there a limit?

 

[Catacular]

I am not an expert, and a few FDMB folks have commented that I'm moving too fast with my dosecreases... However, based on Lilly's numbers (reds and blacks), I don't think 2.5U seems unreasonable. Some cats are quite a bit higher, although some of those have underlying problems.

**Please note protocol numbers below are with human glucometers. Interpret accordingly.**

Roomp & Rand protocol (2008) recommends an initial dosage of "0.25 IU/kg of ideal weight BID." So, let's say you have a 12 lb. cat, the initial dosing recommendation in this protocol is 12 lb. converted to 5.44 kg * .25 = 1.4U (rounding up). A 16 lb. cat would be 7.25kg so 1.8U. However, Roomp & Rand's later 2013 Management of Diabetic Cats with Long-acting Insulin indicates "Begin with 0.5 IU/kg [BID] if the blood glucose is >360 mg/dL (>20 mmol/L)." So, a 16 lb. cat would be at a dose of 3.6U in that case (7.25kg * .5).

NOTE: The 2008 Roomp & Rand protocol also recommends "Cats with a history of developing ketones that remain >300 mg/dL (17 mmol/L) after 24-48 hours . . . Increase by 0.5 IU." That's quite aggressive, and it seems most on the board disagree with this published recommendation.

I am not saying you should start your cat's dosage using the R&R recommendations. Most folks on here seem to start at 1U after DX, which is what we did, but this might help you to understand how your current dose compares to an initial dose recommendation based on what worked for "the average cat." Yes, ECID, so that's why I think starting at 1U and working your way up slowly seems best.

 

[catman13]

That’s really helpful. Thanks for the info.

I did start Lilly at 1u Lantus which seemed to be low and she was previously at 2.5u novolin N.

I’m now at 2.5u lantus which seems to be reasonable for her 4.5kg weight (10lbs). I’m planning to increase dosage every 5-6 cycles (3 days) I just wasn’t sure how high I can go without the dose being considered ridiculously high.

She went down from 596 BG this morning to 475 now (3h later) so I’m assuming her BG went high because of the dose increase last night (I read it’s a reaction sometimes to dose increases)

Hoping to get this baby regulated sooner than later. She’s had high glucose now for few months and switching to lantus have us high hopes from what I read, just haven’t seen real results.

 

[Wendy&Neko]

Here is the link to your last post on this forum.http://www.felinediabetes.com/FDMB/threads/07-07-lilly-amps-603-can-i-give-lantus-and-novolin.198013/#post-221608 We include those links so people can easily go back and see the history.

Are you planning on following Tight Regulation for dosing? If so, it'll help us help you if you put TR in your signature. And if you do follow TR, and it's suggestions for larger increases, you will need to make sure you get a second test in each and every cycle. I see a couple of nights with no test beyond the preshot test. The night of the 11th didn't even have a preshot test. TR is aggressive, but with following the testing guidelines, it will be safe. And I would not increase any faster than every 6 cycles, unless an experienced member suggests otherwise.

@Catacular you are indeed increasing by too large an amount.. We determine dose based on nadirs and blue nadirs means slowing down both the rate and size of increase.

Try to ignore the high preshots. In the beginning, it's quite common for kitties to be bouncy. Neko's first reduction (nadir below 50), came in a day she started at 430. That high a preshot does not mean increase, rather the below 50 meant decrease the dose.

You also asked about maximum dose. There is no such thing. A cat needs however much insulin they need. Each cat is truly different. My girl Neko had two high dose conditions and at different points in her diabetes journey, the right dose ranged from 8.75 units to a low of 0.25 units. We have had cats here on over 80 units per shot, though that's uncommon.

I had previously mentioned to you that starting back at one unit was too low. What can then happen, besides higher numbers, is that glucose toxicity can set in, where the cat's body gets used to higher numbers. The result is you need to go to a slightly higher dose to get over the toxicity. Keep following the guidelines in TR protocol, and you will find a dose that works for Lilly.

 

[catman13]

I started at 1U because I was following SLGS method and didn’t want to bounce around too much but im going to follow TR now with continuous monitoring. I read about insulting toxicity after you mentioned and I think this is exactly what happened.

Lilly has had high BG for a couple of months before the lantus..
hopefully we can break through that with the TR method and go back to lower dosage.

Thanks for the help again!

 

[catman13]

I’m also reading about insulin resistance .. is this something that will go away after we find the right dosage?

In other words does it break through after high insulin doage and I’ll be able to reduce the dose slowly once Lilly is regulated?

 

[Sienne and Gabby (GA)]

I want to encourage you to eliminate the dry food. With TR, a dry food is not an option -- your only options are a canned or raw food diet . Also, what dry food are you using? Frankly, I don't know of any dry food that is below 5% carb. If you stick with any dry food, you will need to use SLGS as your dosing method.

Re. insulin resistance - It depends on what you mean by this term. Technically, insulin resistance is a high dose condition whereby the cats IAA (insulin auto-antibodies) are elevated. You have to aggressively work the dose up in order to overcome the the action that the antibodies exert in response to insulin. Ultimately, insulin resistance is a time limited situation.

Insulin resistance may be a misnomer for a cat that hasn't reached a "good dose" yet. At this point, we don't know what the situation is with Lilly. If she is at a point where her dose is 6.0u or more an her numbers are still less than lovely, we can discuss getting her tested for high dose conditions.

 

[catman13]

Ok thanks for the response. I will keep with the TR until I start seeing a difference in numbers.

The dry food she’s on now is Dr elsey’s clean protein chicken formula, it has 6.8% carbs on a dry matter basis (im attaching the nutrition info above).
Lilly’s mainly on wet food diet with 2-8% carbs, I try to limit her access to dry food anyway.

I tried taking the dry food away but my other cat, Tango, does not go near wet food and all he did was cry for 2 days and not eat. he got so excited when I put the dry food out again.

 

[Phoebes (GA)]

If you look at our ss you will see Phoebe went up to 24 units twice a day. She now is at .75 units. Once we switched her to levemir her numbers came down. I have not had her tested, financial issues, but the treatment we gave her was the same. I believe there was some insulin resistance going on.( She was on a low dose for awhile before I found this site and learned better ways to treat her.) Good luck with your girl.