? 1/21 Kokkinoulis AMPS 536, +2 378 +4 330 Dose advise

Kokkinoulis

Kokkinoulis

Member
Previous post:
https://www.felinediabetes.com/FDMB...-again-123-please-advise.285804/#post-3145088

Dear
@Bandit's Mom , @Marje and Gracie , @Wendy&Neko , @tiffmaxee , @Chris & China (GA), @Ale & Bobo & Minnie (GA), @Sienne and Gabby (GA)

My cat starts to have BGs at blue in the last days with dose 5.5 iu. Today it seems that he is bouncing.
Could you please take a look at his spreadsheet and advise me about the next steps and dosing? Kokkinoulis had the previous 5 days some nadir BGs <200 mg/dL but peaks were >200 mg/dL.

I did not know what to do in the morning today and I increased the dose by 0.25 but maybe it was not the correct action.

Yesterday Kokkinoulis had low pre-shot BG numbers and although I stalled the shot for 1 hour the BG numbers were remained the same so I was afraid and I made the mistake to not shoot 5.5 iu or at least 5.0 iu and instead of this I shot 4.0 iu. So, after that all day had high BG numbers and also something like bounce.
 
Yes, the higher numbers you are seeing are a combination of a bounce from the 120s you saw yesterday as well as the token dose.

However, you have held the 5.5u dose for 9 cycles before yesterday's token dose, so he's due for an increase.

Dose increases and reductions between 5u and 10u are in multiples of 0.5u and not 0.25u, so the next increase after 5.5u would be 6u.
 
Bandit's Mom said:
Dose increases and reductions between 5u and 10u are in multiples of 0.5u and not 0.25u, so the next increase after 5.5u would be 6u.
Click to expand...
Τhanks Bhooma.

Kokkinoulis will have an ultrasound on Tuesday and the new vet told me to not increase the dose till we found what happen with the cat as he has very high total protein and albumin levels (you can see his labs in spreadsheet). Ιt seems that there is an underlying disease. Ι am not sure what to do with the insulin dose.
The new vet agrees with the administration of Lantus but I understood that she has no experience with it and she is not used to this high dose.
 
Kokkinoulis said:
Kokkinoulis will have an ultrasound on Tuesday and the new vet told me to not increase the dose till we found what happen with the cat as he has very high total protein and albumin levels (you can see his labs in spreadsheet). Ιt seems that there is an underlying disease. Ι am not sure what to do with the insulin dose.
The new vet agrees with the administration of Lantus but I understood that she has no experience with it and she is not used to this high dose.
Click to expand...
He has just broken through into good numbers and you don't want to lose momentum and risk glucose toxicity setting in. You can always reduce his dose if treating any other health issues improves his blood sugar.
 
Bandit's Mom said:
He has just broken through into good numbers and you don't want to lose momentum and risk glucose toxicity setting in. You can always reduce his dose if treating any other health issues improves his blood sugar.
Click to expand...
I know...and I dont want to lose the momentum as you said but I am afraid to take alone the responsibility of his life. It is a crucial moment for all of us. I think to keep the dose between 5.5, 5.75 or 6 till Tuesday according to his BG today. But then I will wait for his final exams.
 
Bandit's Mom said:
However, you have held the 5.5u dose for 9 cycles before yesterday's token dose, so he's due for an increase.

Dose increases and reductions between 5u and 10u are in multiples of 0.5u and not 0.25u, so the next increase after 5.5u would be 6u.
Click to expand...

Till which BG numbers (nadir or peak) we increase the dose? Till it is within 50–200 mg/dL throughout the day.
 
Kokkinoulis said:
I know...and I dont want to lose the momentum as you said but I am afraid to take alone the responsibility of his life. It is a crucial moment for all of us. I think to keep the dose between 5.5, 5.75 or 6 till Tuesday according to his BG today. But then I will wait for his final exams.
Click to expand...
You are testing enough to keep him safe. He will also feel better in lower numbers and they are also good for his kidneys. And you would hold the increase at least 6 cycles and if he sees low blue nadirs then would you hold the dose 10 cycles.
 
Last edited:
Now that you have shot 5.75 for two cycles, I would hold that dose for a total of 6 cycles, then evaluate what to do next based on the nadirs you are seeing.

I too had a cat that nadired late. I had to learn to shoot lower numbers, just like you will have to do. Yesterday gave you some really good data. You can see that at the end of the PM cycle before then, he was essentially flat when you started stalling. Once they are flat like that, they aren't going to start heading down again, as long as you get food into them. You also got a +1 which gives you an idea how much of a numbers increase he gets from food. I know shooting lower numbers is scary, but if there is a day when you are home and can monitor and you see lower numbers, it's a perfect opportunity to see what happens when you shoot low. Shooting lower preshots usually means flatter cycles.

From what I've read, dehydration can cause higher albumin and total protein. Which can happen with diabetes. Did the vet say what part of him they are going to look at with an ultrasound?
 
Wendy&Neko said:
From what I've read, dehydration can cause higher albumin and total protein. Which can happen with diabetes. Did the vet say what part of him they are going to look at with an ultrasound?
Click to expand...
I put a little water in his canned food in every main meal. They will perform upper and lower abdomen ultrasound. Althought his condition his mood is better than before and he started to play again in the last weeks. Let's hope that he has not have something serious.
 
Some cats with acromegaly nadir late, some early. I think it's more common in cats with insulin auto antibodies (IAA), but I've also seen counter examples. In other words, Each Cat is Different. I can't remember the details now, but I do remember reading something about why nadirs might be late. When a cat bounces, then clears the bounce, that bounce clearing cycle is often late. That happens in all types of cats.

Neko had hardly any characteristics due to acromegaly when she was diagnosed to it. She was "starving" all the time due to the excess growth hormone, and needed a higher dose. Later after diagnosis I found that her one teary eye was probably due to soft tissue growth in her tear duct. But it was only there when her numbers were higher. I've seen a paper that said something like only 35% of cats with acromegaly had any clinical or physical signs at the time of diagnosis. The rest did not.

The ultrasound may or may not show enlarged organs, one symptom of acromegaly. Neko did not have those either.
 
You must log in or register to reply here.
Back
Top