1/3 Klinger 1u

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Marcy & Klinger (GA)

Marcy & Klinger (GA)

Member Since 2010
Hi all,
Klinger started on Lev this morning.
AMPS 478, 1 u
PMPS 532, 1u
+1 559

He's eating, sleeping, and I haven't been home long enough to catch him peeing or pooping, sleeping in the bedroom - didn't come out to greet me when I got home from work.
I'll keep testing for a few hours tonight.
 
A couple of things - has anyone mentioned the use of a bolus insulin, such as R? It is very fast acting, usually clears the system within 3-4 hours. It can be helpful when used with a longer acting insulin to bring the blood glucose down to a more manageable level for the basal insulin, which would be Levemir in this case.

That method is used most often for acromegaly cats because it takes such a large amount of basal insulin to bring their blood glucose down. Which leads to my next question - have you considered having him tested for acromegaly? We have a high dose section/ISG with some very knowledgeable members who understand the necessary test and also how to determine an acrocat's dose, if indeed he is acro, and how to use a bolus insulin with a basal insulin.

I mention this because I noticed he had a good response to as much as 7.5U of Prozinc.

I don't know any details about that test, IAA I think it's called. It would be a great idea to ask over in the High Dose/Acro ISG about it. I would hate to see him running so high as you work your way through lower doses if he indeed is an acrocat. I see why the vet suggested starting at 2U. My apologizes for not looking over the whole spreadsheet previously.
 
Hi Vicky,
I have been in close communication with an Acro-mom. At this point, I need to pay off his dental extraction bill :o before I can get him tested.
I also think that he was being overdosed on insulin...the day when he dropped from 500s to 100s in a very short time, vomit, etc. So, I cut back to 2.6 as a mini rebound test.

How long should I keep him on 1u? Can I increase tomorrow night or wait until Wednesday morning to increase?

Thanks all~
 
mars72 said:
Hi Vicky,
I have been in close communication with an Acro-mom. At this point, I need to pay off his dental extraction bill :o before I can get him tested.
I also think that he was being overdosed on insulin...the day when he dropped from 500s to 100s in a very short time, vomit, etc. So, I cut back to 2.6 as a mini rebound test.

How long should I keep him on 1u? Can I increase tomorrow night or wait until Wednesday morning to increase?

Thanks all~
Click to expand...

With numbers this high, I think you could go up tomorrow night. If he's still in the 400s, maybe even to 1.5U. The Tilly recommendation says increase by .5U if their nadir is over 300.

" Phase 2: Increasing the dose

Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations."

Thought I'd paste that in so you understood what I meant.

Glad you know about acromegaly and that someone else is keeping an eye on this for you, although I'm not sure if you saw Rebecca's (site owner) sticky about "off-board' advising or not. Doing things behind the scenes isn't a great idea, as the board operates on a peer review system to help keep kitties safe. Someone who is able to advise you should be willing to do it on the board.
 
No, she was actually responding to my posts on PZI ISG throughout Klingers time on ProZinc. No behind the scene posts. Sorry if I gave you that impression.

+4 543
Thanks for copying that information from the Tilly Protocol. I really don't want him to be in these high numbers unnecessarily for too long.
 
I hope his numbers continue to improve as the lev builds up in his system. You won't be able to get mid cycle numbers (+6 to +9 or 10) until the weekend, right? I wish we could see a mid cycle to see if he is starting to go down midday or not.
 
Marci,

Do you know the total cost of the test for your vet?

I understand there is one test for ACRO then something Vicky mentioned about IAA, then shipping and the vet's fee, too, right?

Do you know the total you'd need?
 
Shelia - I won't be able to get those +6, +9, +10 tests in until Friday.

Melissa - I have to look back and find the total cost, but the tests themselves weren't that expensive...it was the cost to overnight the samples and the blood draw from the vet that was the most costly.

1/5/11 - AMPS 460
 
not to throw a monkey wrench into things but adding R requires a number of pieces of data before using as well as knowing cat and how Lev affects the cat without the R.one needs alot of data and know they cat before embarking on its use
 
mars72 said:
Melissa - I have to look back and find the total cost, but the tests themselves weren't that expensive...it was the cost to overnight the samples and the blood draw from the vet that was the most costly.
Click to expand...

Hi Marcy, (sorry for spelling Marci in previous response)

I'd be very interested in knowing the total cost that your vet charges, including the shipping, if you don't mind. You can PM it to me if you'd prefer.

Maybe just give them a quick call to ask the total again?

Appreciate it, thanks.
 
I'd be very interested in knowing the total cost that your vet charges, including the shipping, if you don't mind. You can PM it to me if you'd prefer.

Maybe just give them a quick call to ask the total again?
Click to expand...
I'll let you know when I hear back from them.

not to throw a monkey wrench into things but adding R requires a number of pieces of data before using as well as knowing cat and how Lev affects the cat without the R.one needs alot of data and know they cat before embarking on its use
Click to expand...
I agree. Without being home to test would make me very uncomfortable.

1/5
AMPS 460 1.5u
+1 450
PMPS 512 1.5u
+1 417 - hmm a 100 point drop in the first hour. I'll keep testing him.
+2 341
 
mars72 said:
I'd be very interested in knowing the total cost that your vet charges, including the shipping, if you don't mind. You can PM it to me if you'd prefer.

Maybe just give them a quick call to ask the total again?
Click to expand...
I'll let you know when I hear back from them.

not to throw a monkey wrench into things but adding R requires a number of pieces of data before using as well as knowing cat and how Lev affects the cat without the R.one needs alot of data and know they cat before embarking on its use
Click to expand...
I agree. Without being home to test would make me very uncomfortable.

1/5
AMPS 460 1.5u
+1 450
PMPS 512 1.5u
+1 417 - hmm a 100 point drop in the first hour. I'll keep testing him.
Click to expand...

The high dose ISG group has the costs of the tests, but I wonder like Melissa what the shipping, etc. would be.

Also, agree about the Regular insulin. I believe Vicky was just bringing it up for something to maybe consider at some point down the road. There are a few on the high dose group that use it who could guide you, but again you would have to be there to monitor. Doesn't have to be a daily thing though (weekends), just something to try and break through some of the glucose toxicity to help the Lev work better.

I myself have never had to use Regular, but it was used pretty routinely a few years ago by a number of people on the old Tight Regulation forum. It even prompted Steve (Jock) to post for peer review his start low, go fast approach on the Think Tank forum. A lot of people just used a very small bolus dose to overcome pesky food spikes along with a longer acting insulin like Lev or Lantus as the basal insulin just like people do.

BTW, the use of Regular was never encouraged back on the old forum without a lot of data and knowledge of how your insulin works in your cat. Just like with TID dosing which was also routinely done with the PZI insulins on the old Tight Regulation forum, people were encouraged to gather a lot of data first on how the insulin worked with their cat first.

Sorry to run on about this subject, I just wanted to clarify that it wasn't suggested here in a cavalier way, but thank Lorna for bringing it up. :)
 
Also Marcy, can you add this to your profile that you posted here in the beginning of December. It is very helpful information. Thanks!

"Where to start...there is a lot that's happened...

Klinger was dx in Feb 2010 with a number of 570, he was eating FF grilled varieties and the vet switched him to FF kitten canned turkey. He was put on Lantus 3 u BID. Vet had us test him on the weekends only. I think she was trying not to overwhelm us. When the vial was done, he had gotten up to 6u BID without improvement (only based on weekend testing ohmygod_smile ). We switched to ProZinc, which he has been on since 5/22. Again with only testing on the weekends he got up to 7.5 u's BID. That is when I found this wonderful website and started testing him before each shot and here and there throughout the day. It was also recommended that starting him out at 3 u's and increasing by a full 1 u - I could have missed his dose. So, we started over at 1 u BID. We switched his food to FF Classic varieties. Klinger would through me a blue here and there or a low pre shot number. Vet would tell me that it could be his teeth are in bad shape, but she was reluctant to do the dental fearing that he wouldn't come out of the anethesia. I finally had enough of fighting a losing battle of trying to regulate him while his teeth were so bad and got her to schedule the dental. On 10/23 Klinger had eight teeth extracted and since then he has been solidly in the blacks, reds, and pinks. Of course today he gave me a yellow AMPS.
On 11/15 introduced Nature's Variety Frozen Raw into his diet and some days still give FF Classic Chicken. Currently at 3.8 u's BID. I give him pepcid for chronic p'titis.

Anyway, it's been suggested that Levemir might be a better fit for Klinger, since he bounces a lot and usually zooms up after +10. Right now I shoot a 12/12 schedule - I test between 3:50 a.m. and 4:00 a.m., feed, and shoot at 4:30 a.m., DH does the same for the pm shot. The problem is, we both work and won't be able to get a lot of tests in during the day. I am home on Friday - Sunday and can get as many tests in as I can on those days....
I should also mention that Klinger MIGHT (he has not been tested) be a high dose kitty and Lev apparently doesn't sting as much in higher doses and it would cost less.
I guess I'm wondering if Lev would work for my schedule with not being able to test other than pre shots and up until +4 at night Mon-Thur; and then as often as I can Fri-Sun?"
 
mars72 said:
On 10/23 Klinger had eight teeth extracted and since then he has been solidly in the blacks, reds, and pinks.
Click to expand...

I'm just wondering about the dental procedure.... why were 8 teeth removed? Did/does he have stomatitis (resorptive lesions)? Is it possible that he has a tooth root fragment still stuck in his jaw - or that they fractured his jaw removing teeth? I have read up on dental complications and there are a lot of things that can go wrong if the surgeon is not extremely careful with these delicate teeth/structures. Too often post-operative xrays are not taken to make sure all the infected root parts are extracted properly.

I do think that you may be dealing with a possible insulin resistance/glucose toxicity situation with the too high doses over a prolonged period and perhaps with slow, incremental increases in the lev you can "break through" that resistance and his numbers will start to come down. However, it is still possible that he has a dental infection from a poor extraction that is driving up his BG and keeping it there. Worth looking into. Unfortunately, that would mean questioning the vet about the procedure and/or money for xrays.
 
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