? 1/4 Kokkinoulis AMPS 414, +2 398, +5 432, +8 404 increased doses & increased BGs

Kokkinoulis

Kokkinoulis

Member
Previous post:
https://felinediabetes.com/FDMB/thr...-high-bg-and-blood-issue.285232/#post-3139192

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

I am trying to follow TR protocol. Today in the morning I increased the previous Lantus dose by 0.5 unit from 3.5 to 4.0 units.
The pattern of BG numbers is strange as even as the insulin dose is increased the glucose curve remains flat with no nadirs. In addition, with each increase in the dose of Lantus the BG numbers also increase or remain stable instead of decreasing (at least at some hours without nadirs).

At first when the cat was given caninsulin I saw some reduction in BG numbers. Now except for some low BGs 3 days ago, all others BGs are high, like the insulin is not act at all.
What is your opinion?
Have you noticed anything similar in other cats?
I am afraid thay my cat may has some other co-morbidity and this is the reason why the insulin is not acting despite receiving this dose.
Is it possible that this high insulin resistance and poor glycemic control is related to Anti-Insulin Antibodies? Are you aware of this or by your experience do you have seen it in other cat cases?

Should I keep this dose longer than 3 days this time to see how the cat's body reacts as it may need time to adjust to the insulin?
 
Kokkinoulis said:
Previous post:
https://felinediabetes.com/FDMB/thr...-high-bg-and-blood-issue.285232/#post-3139192

Dear Administrators,
@Bandit's Mom , @Wendy&Neko , @tiffmaxee , @Chris & China (GA), @Ale & Bobo & Minnie (GA), @Sienne and Gabby (GA)[/USER
[B]
Should I keep this dose longer than 3 days this time to see how the cat's body reacts as it may need time to adjust to the insulin?[/B]
Click to expand...


No. Lantus works differently. You won’t see how well a dose works often until given 6 cycles You have not hit the breakthrough dose yet. Once that happens you will see results faster most likely. My guess is there is some glucose toxicity and the way to break through it is to follow TR and keep increasing until that happens. Holding doses longer will not work and lead to a need for more insulin.
 
Ale & Bobo & Minnie (GA) said:
I agree with Elise. Keep upping the dose every 3 days until you get to the breakthrough dose but you need to make the adjustments by 1/4 units not 1/2
Click to expand...
With nadirs as high as this the increases are .50. Once you see blue or green the increases will be ,25 and held longer.

from the dosing sticky.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:
 
Kokkinoulis said:
I am afraid thay my cat may has some other co-morbidity and this is the reason why the insulin is not acting despite receiving this dose.
Is it possible that this high insulin resistance and poor glycemic control is related to Anti-Insulin Antibodies? Are you aware of this or by your experience do you have seen it in other cat cases?
Click to expand...
It is too early to worry about secondary conditions like Acromegaly and IAA. Kokki has not been on insulin long enough and like Elise said, he's possibly seeing some glucose toxicity (which is a temporary form of insulin resistance) that he needs to break through. Of hand, I can only remember Gumung who went to 5U before he started seeing blues and went all the way to 6U before turning around and going into remission. Here is his SS.
https://docs.google.com/spreadsheet...iZPzcYph7SlVOxU7zR744aV5E/edit#gid=1182885903


Kokkinoulis said:
Should I keep this dose longer than 3 days this time to see how the cat's body reacts as it may need time to adjust to the insulin?
Click to expand...
If you are not seeing any better numbers (less than 300) in 3 days, it is unlikely that you will see them by holding the dose longer. It is better you follow TR and get to a good dose sooner. You are testing enough to know how he is doing at each dose.

I know it's scary and frustrating to see no improvement but just keep at it. :bighug::bighug::bighug:
 
tiffmaxee said:
With nadirs as high as this the increases are .50. Once you see blue or green the increases will be ,25 and held longer.

from the dosing sticky.
  • Increase by 0.25 unit after 3 days (6 consecutive cycles) if nadirs are greater than 200, but less than 300.
  • Increase by 0.5 unit after 3 days (6 consecutive cycles) if nadirs are greater than 300.
Reducing the dose:
Click to expand...
Hi Elise,
Thanks a lot for the prompt reply. I will follow your advice.
 
Bandit's Mom said:
It is too early to worry about secondary conditions like Acromegaly and IAA. Kokki has not been on insulin long enough and like Elise said, he's possibly seeing some glucose toxicity (which is a temporary form of insulin resistance) that he needs to break through. Of hand, I can only remember Gumung who went to 5U before he started seeing blues and went all the way to 6U before turning around and going into remission. Here is his SS.
https://docs.google.com/spreadsheet...iZPzcYph7SlVOxU7zR744aV5E/edit#gid=1182885903



If you are not seeing any better numbers (less than 300) in 3 days, it is unlikely that you will see them by holding the dose longer. It is better you follow TR and get to a good dose sooner. You are testing enough to know how he is doing at each dose.

I know it's scary and frustrating to see no improvement but just keep at it. :bighug::bighug::bighug:
Click to expand...
Bandit's Mom said:
It is too early to worry about secondary conditions like Acromegaly and IAA. Kokki has not been on insulin long enough and like Elise said, he's possibly seeing some glucose toxicity (which is a temporary form of insulin resistance) that he needs to break through. Of hand, I can only remember Gumung who went to 5U before he started seeing blues and went all the way to 6U before turning around and going into remission. Here is his SS.
https://docs.google.com/spreadsheet...iZPzcYph7SlVOxU7zR744aV5E/edit#gid=1182885903



If you are not seeing any better numbers (less than 300) in 3 days, it is unlikely that you will see them by holding the dose longer. It is better you follow TR and get to a good dose sooner. You are testing enough to know how he is doing at each dose.

I know it's scary and frustrating to see no improvement but just keep at it. :bighug::bighug::bighug:
Click to expand...

Hi Bhooma,

Thanks a lot for your advice and your kind words that engourage me. I can see many similarities in Gumung SS and I am glad that he was in remission for some time.
It's a tough road because on the one hand it's scary and frustrating to see no improvement and on the other hand it's scary when the numbers are low even if they're close to normal.
In addition, next week I have to go back to work (luckily, some days I can work remotely from home) but because of my job as a Clinical Research Associate, I also have to travel. I live alone with many indoor and outdoor cats (more than 20 and all of them are stray cats as Kokkinoulis) and my neighbors who help me when I'm away will be gone for 2-3 months so, I'm very stressed about what to do in the next few months with Kokkinoulis. I'm thinking of buying an automatic wet food feeder from Amazon, but in terms of home monitoring it won't be that easy.
I was hoping that I could have found the right dose of insulin for Kokkinoulis in the 2 weeks I was on vacation and now I'm disappointed that I don't see the numbers going down
At least I found all of you who understand us, help us and encourage us!
Let's hope everything goes well.
 
Sienne and Gabby (GA) said:
I agree with what the others have said. What you learned using Caninsulin does not apply to Lantus. It's a very different insulin with a very different pharmacology.
Click to expand...
Hi Sienne,
Thanks for your reply. I agree with you. However, I read an article about IAA with Lantus and for this reason I was thinking if this could be a reason for these high BG numbers.
I have dealt with diabetes for many years while working at the Novonordisk company, but I never expected that I would not be able to manage the situation with a kitten
 
cecile & bella said:
It is so discouraging at first. Bella went all the way to 5.25 units before she starting showing blues and greens. @Bandit's Mom helped me not feeling discouraged and be patient. Look at Bella's SS, in February and then finally for good in March 2022 she started to finally show better numbers: https://docs.google.com/spreadsheet...xsPm45JB4H0KMDN6kEFa0jMIM/edit#gid=1183721521
Good luck and keep posting, you are doing great :bighug:
Click to expand...

Hi Cecile,

Bella is such a beauty!!! What an encouraged SS! What do you think? Will she ever go to remission? Has she been long-term diabetics e.g., >6 months?
I don't know how long Kokkinoulis has had diabetes, although the diagnosis was made at the end of November.
 
Kokkinoulis said:
Hi Cecile,

Bella is such a beauty!!! What an encouraged SS! What do you think? Will she ever go to remission? Has she been long-term diabetics e.g., >6 months?
I don't know how long Kokkinoulis has had diabetes, although the diagnosis was made at the end of November.
Click to expand...
Bella was diagnosed over 2 years ago, in October 2021. I found this forum while looking online to find a way to test her, I could not get it right and was getting so frustrated. I don;t know if she will ever get into remission. @Diane Tyler's Mom Diane's Tyler went into remission after several years, so everything seems possible. I managed to have her loose weight, which seemed impossible for years, so who knows what's in the cards for her!
Like you, I thought I understood diabetes and insulin (I'm a M.D.) until I started dealing with feline diabetes. That's interesting and humbling to see how things work in cats. Try to take it one day at a time and be patient, he will get there. That is so great of you to take care of those lost cats :bighug:
 
My girl had both IAA (insulin auto antibodies) and acromegaly. There is very limited research on IAA in cats. In two very small studies, it was shown to be either quite common, or not common at all. All I can go by is looking at the spreadsheets of cats that have been diagnosed with this condition. I've seen some on as low a dose as 3 units, and much higher. However, looking at Kokki's spreadsheet, there isn't enough data there that looks like IAA yet. To me it just looks like a combination of glucose toxicity and not reaching the right dose yet.

It helps to remember than insulin is a hormone, not a drug. It's not like you add a bit more and the numbers get correspondingly better. You just have to keep increasing until you reach that amount of insulin that moves his numbers into a better range. Every cat has a dose that moves them into better numbers.

Don't hold the dose longer. TR works if you follow it as written. Since you have a limited time to get his numbers into a better range, use the time you can monitor to get him to a better dose as quickly as it is safe to do.

Bandit's Mom said:
It is too early to worry about secondary conditions like Acromegaly and IAA.
Click to expand...
And to refute that phrase - it is not too early to worry about secondary conditions. We've seen cats on less than 6 units with IAA, acromegaly, and Cushings (less common condition). It's just that once a cat gets to 6 units, we strongly recommend testing for one of those conditions as it's much more likely at that point. It does not mean that a cat on less insulin cannot have it. The large Royal Vet Clinic study that showed one in four diabetic cats has acromegaly, found the average dose was 7 units, but they found cats on as low as 1 unit. We've seen both Cushings and IAA on 3 ish units.

The question is should you worry about these conditions at this point with Kokki. Unless you see some physical symptoms of those secondary conditions, I wouldn't worry about it yet. JL has a great phrase, when you hear hoof beats, think horses, not zebras. Look at the more likely causes of higher numbers which is glucose toxicity and not high enough dose yet.

Kokkinoulis said:
I read an article about IAA with Lantus
Click to expand...
Can you post the link to that? I'm always trying to improve my knowledge of IAA.
 
Wendy&Neko said:
Don't hold the dose longer. TR works if you follow it as written. Since you have a limited time to get his numbers into a better range, use the time you can monitor to get him to a better dose as quickly as it is safe to do.
Click to expand...
I will follow the TR protocol as your advices!

Wendy&Neko said:
Can you post the link to that? I'm always trying to improve my knowledge of IAA.
Click to expand...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111345/

J Vet Med Sci. 2021 Apr; 83(4): 661–665.
Published online 2021 Mar 5. doi: 10.1292/jvms.20-0345
PMCID: PMC8111345
PMID: 33840723
Relationship between anti-insulin antibody production and severe insulin resistance in a diabetic cat
 
Thanks for that link. I have seen that particular paper but it is fairly new. It was a case of treatment of one cat, so not much to be taken from it. Basically is says IAA exists in some cats, but we knew that from experience here and earlier papers studying more cats - though still not large enough numbers to be significant.
 
cecile & bella said:
@Diane Tyler's Mom Diane's Tyler went into remission after several years, so everything seems possible
Click to expand...
@Kokkinoulis
Hi Gabriella , it took me 2 years and 4 months to get Tyler in remission with the advice I took from the experienced members. So don't give up hope .
I don't want to jinx it but on 1-24-24 it will be 3 years in remission .:bighug::bighug::bighug::cat:
By the way Kokkinoulis is gorgeous :cat:
 
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