1/27/21 Chicamonkey AMPS 447 dose increased last night to 3.5 U lantus/ PMPS 347/+3 275

Suzi and Chicamonkey

Suzi and Chicamonkey

Member Since 2020
Good morning!
Lots of good info yesterday! Thank you so much to all who shared!
I found a vet 10 miles from my home that works with diabetic cats , a Dr Norrell, she uses AAFP regulations for tight regulation working towards remission. I emailed her about my concerns and she seems willing to work with us. I’ve posted the aafp link below
https://catvets.com/public/PDFs/Toolkit/Diabetes/AAFP-DiabetesToolkit-Full.pdf
So I’m going to email my current vet today , tell him about monkeys dose increase again and her 300-400 range, my concerns for acro.... etc and we will see what he says.... I will keep you posted!
Yesterday:
https://felinediabetes.com/FDMB/thr...-5u-lantus-igf-questions.242102/#post-2727843
 
Best of luck with the increase!
Interesting link; thanks for sharing.

There were a couple of interesting sections in the AAFP info that jumped out at me (I added the bold):
Intensive
This protocol may be considered in a patient with a good likelihood of diabetic remission. The owner must be willing to monitor the cat closely and be able to follow directions.
• BG is checked at home three times a day
• Before each insulin injection
• 6-10 hours after the morning dose
• Insulin dose is adjusted as necessary
■ Goal is to keep BG between 80 mg/dl (4.4 mmol/L) and 220 mg/dl (12.3 mmol/L)
■ Clear, written guidelines regarding dose adjustment must be provided to the owner
• Adjustments are usually made in 0.5 U increments
• Insulin dose should not be increased more frequently than q3 days
• Insulin dose must be decreased if hypoglycemia is identified (see References list – Roomp 2009)​

:eek: to only checking three times a day and making possibly up to 0.5U adjustments based on three daily BG checks. At least they're saying to test before shooting, though.
I'd be interested to know what Dr. Norrell says if you share your spreadsheet with her and she sees all of those tests:). I found a vet for Butters in November who turned out to be fine with me doing TR for her after I showed him her spreadsheet. He became pretty hands off from a dosing perspective once he saw how much monitoring I do:), and said that the important thing is getting her numbers down and keeping her safe. I ended up increasing her all the way up to 4.25u (from 1u) in a relatively quick amount of time by following the TR protocol instructions in the dosing sticky. That's what got her numbers down. Anytime I've hesitated with increases, her numbers bobble back up.

I also find it interesting that they have a section on Somogyi Effect...love that they have a "troubleshooting" section. lol. It's like I'm reading the manual to figure out why my blender won't work....or in this case, why my cat isn't having the expected response to insulin (I added the bold):
Somogyi Effect
• Rebound hyperglycemia as a counter regulatory response to low blood sugar
• Mediated by effects of adrenaline, cortisol, growth hormone, and glucagon
• Observed as a BG <70 mg/dL (3.8 mmol/L), followed by a steep rise exceeding 400 mg/dl (22 mmol/L)
• Documented cases are rare but if suspicions are present, 18 to 24 hour BG curves may be needed to identify

The observation of the steep rise in BG sounds very much like a bounce. I've had two vets look at Butters' bounces and tell me she was experiencing Somogyi. Both wanted me to drastically reduce her insulin. I listened, once, and she got stuck in high numbers for weeks and weeks. I thought I'd seen somewhere that there are next to no documented cases of Somogyi in cats but I can't remember where I read this so someone can tell me I'm wrong and correct me if they want to.
 
Butters & Lyla said:
Best of luck with the increase!
Interesting link; thanks for sharing.

There were a couple of interesting sections in the AAFP info that jumped out at me (I added the bold):
Intensive
This protocol may be considered in a patient with a good likelihood of diabetic remission. The owner must be willing to monitor the cat closely and be able to follow directions.
• BG is checked at home three times a day
• Before each insulin injection
• 6-10 hours after the morning dose
• Insulin dose is adjusted as necessary
■ Goal is to keep BG between 80 mg/dl (4.4 mmol/L) and 220 mg/dl (12.3 mmol/L)
■ Clear, written guidelines regarding dose adjustment must be provided to the owner
• Adjustments are usually made in 0.5 U increments
• Insulin dose should not be increased more frequently than q3 days
• Insulin dose must be decreased if hypoglycemia is identified (see References list – Roomp 2009)​

:eek: to only checking three times a day and making possibly up to 0.5U adjustments based on three daily BG checks. At least they're saying to test before shooting, though.
I'd be interested to know what Dr. Norrell says if you share your spreadsheet with her and she sees all of those tests:). I found a vet for Butters in November who turned out to be fine with me doing TR for her after I showed him her spreadsheet. He became pretty hands off from a dosing perspective once he saw how much monitoring I do:), and said that the important thing is getting her numbers down and keeping her safe. I ended up increasing her all the way up to 4.25u (from 1u) in a relatively quick amount of time by following the TR protocol instructions in the dosing sticky. That's what got her numbers down. Anytime I've hesitated with increases, her numbers bobble back up.

I also find it interesting that they have a section on Somogyi Effect...love that they have a "troubleshooting" section. lol. It's like I'm reading the manual to figure out why my blender won't work....or in this case, why my cat isn't having the expected response to insulin (I added the bold):
Somogyi Effect
• Rebound hyperglycemia as a counter regulatory response to low blood sugar
• Mediated by effects of adrenaline, cortisol, growth hormone, and glucagon
• Observed as a BG <70 mg/dL (3.8 mmol/L), followed by a steep rise exceeding 400 mg/dl (22 mmol/L)
• Documented cases are rare but if suspicions are present, 18 to 24 hour BG curves may be needed to identify

The observation of the steep rise in BG sounds very much like a bounce. I've had two vets look at Butters' bounces and tell me she was experiencing Somogyi. Both wanted me to drastically reduce her insulin. I listened, once, and she got stuck in high numbers for weeks and weeks. I thought I'd seen somewhere that there are next to no documented cases of Somogyi in cats but I can't remember where I read this so someone can tell me I'm wrong and correct me if they want to.
Click to expand...
I wish there was a love button!
Sorry it takes me so long to respond.
I wish I could take you all with me for her appt.
Apparently Dr Norrell has a respiratory issues so she is not allowing pet parents at this time .... she will allow me to Skype for the appt though and I will share everything I receive!
 
Last edited:
This post contains a link to a paper discussing that real "Symogyi" is very rare in cats following TR.

A few errors in that link in the acromegaly section:
Test: Serum IGF-1 concentration > 1000 ng/mL supports this diagnosis. Note: IGF-1 results may be unreliable inuntreated diabetics; testing after 6 weeks of exogenous insulin is recommended. (see References list – Niessen 2007)•Cats with hypersomatotropism will require insulin dosages in excessively high ranges (2-70 U daily)
- The US doesn't measure IGF-1 units in ng/mL, so positive is above 92 when blood is sent to MSU. There is a video on the Royal Veterinary College FB pace that suggests waiting 73 days (not 6 weeks) after starting exogenous insulin. We just had a cat here tested the first time at about 3 months after starting insulin (negative) to now very much positive.
- The insulin doses isn't right either. Neko got down to 0.25 units for a while, I've seen cats on doses up to 100 units. :eek: And that was per cycle, not daily.:eek::eek: The quote on doses was from a research study that found cats in the range of 1 to 35 units per shot.

However, given all that, the new vet does sound more open minded and knowledgeable than a lot I've heard about.

I like where Chicamonkey is going on this dose so far tonight. :)
 
Wendy&Neko said:
This post contains a link to a paper discussing that real "Symogyi" is very rare in cats following TR.

A few errors in that link in the acromegaly section:
Test: Serum IGF-1 concentration > 1000 ng/mL supports this diagnosis. Note: IGF-1 results may be unreliable inuntreated diabetics; testing after 6 weeks of exogenous insulin is recommended. (see References list – Niessen 2007)•Cats with hypersomatotropism will require insulin dosages in excessively high ranges (2-70 U daily)
- The US doesn't measure IGF-1 units in ng/mL, so positive is above 92 when blood is sent to MSU. There is a video on the Royal Veterinary College FB pace that suggests waiting 73 days (not 6 weeks) after starting exogenous insulin. We just had a cat here tested the first time at about 3 months after starting insulin (negative) to now very much positive.
- The insulin doses isn't right either. Neko got down to 0.25 units for a while, I've seen cats on doses up to 100 units. :eek: And that was per cycle, not daily.:eek::eek: The quote on doses was from a research study that found cats in the range of 1 to 35 units per shot.

However, given all that, the new vet does sound more open minded and knowledgeable than a lot I've heard about.

I like where Chicamonkey is going on this dose so far tonight. :)
Click to expand...
I woke up to an amps of 215! Omg ! Now what ...
Should I. Be ready for the perpetual bounce ......gosh I wish I had that magic dose!!!
 
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