1/4 Wally AMPS 463, +6 507 ...dose increase not approved by vet

Wally & Stefano

Wally & Stefano

Member Since 2018
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http://www.felinediabetes.com/FDMB/threads/1-3-wally-amps-484-6-401-pmps-452-tomorrow-shot.208949/

I met my vet today for the vomit episodes. She blamed me because we raised insulin too much and too fast... she's asking to lower now. I'm very confused on what I should do.

I told her we raised because ketones were too high, and wally needed more insuline.... but seems like we had to wait instead because wally is new to lantus and we should not rush...

Aside from being confused, I can't understand if its normal to have a BG increase with just a little dose increase

Please give your feedback
 
With DKA you always want to be vigilant to ensure they are eating, there is no uncontrolled inflammation/infection and they are getting enough insulin. I am not expert but those numbers are really high and you have gotten a lot of testing in lately to know he isn't going too low and bouncing.

Some kitties are big gulpers and need a lot of insulin.

I see Wendy has given you advice on dosage and she is very knowledgeable about high dose conditions and giving dose advise.


I would keep to the dose suggested @ 4.5 units and hold for the 4 cycles that Wendy indicated.

With diabetes, sometimes you need to go with your gut. The results are what important. The vomitting doesn't have to do with the insulin but I would say more to do with an acidic tummy. Have you tried spacing out meals for Wally? Keep a little bit of food more often may help. I am sure the high BG makes him feel a little unwell just like we feel when we have eaten too much sugar.
 
Stefano said:
I met my vet today for the vomit episodes. She blamed me because we raised insulin too much and too fast... she's asking to lower now.
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You are on the correct dosing path. The BG numbers indicate your kitty needs more insulin. With a recent history of DKA, reducing insulin would be unwise.

You see the way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown it’s own fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.

A kitty battling ketones needs plenty of insulin as well as plenty of calories- aim for 1.5x the calories required for maintaining normal weight. Hydration is also very important - mix as much water as he will tolerate into his food.

How and when did you discover Wally was diabetic?
 
Here is the link to Tilley's page I referred to yesterday: http://www.tillydiabetes.net/en_6_protocol2.htm That is where the TR protocol started. You may wish to forward this link to your vet, so she knows what protocol you are following. Specifically the section on increasing the dose "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."

As for increased numbers today, there is a phenomenon that we call New Dose Wonkiness that happens shortly after an increase as the depot adjusts. Again from Tilley's page "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."

Wally is new to Lantus, but not new to insulin. He was still seeing ugly numbers on a higher dose of Caninsulin. Thankfully his ketones are goind down as the insulin dose is being increased.

Vets have a lot of conditions with a lot of species they have to learn about. Typically they get less than a day in training on diabetes, usually in combination with dog diabetes. They also don't usually have a lot of diabetic clients, because sadly many caregivers don't care enough to give treatment like you do. We have a lot of experience with feline diabetes collectively here, including with cats that need more insulin than most. We will help you get to a good dose safely.
 
Thank you all for your support.

Wally was diagnosed with diabetes on 11/14/2018 when he was hospitalized for 10 days - The first day on hospital he had 490BG and 7.9 ketones

Syntoms were: dehydratation, weight loss (he went from 5.7 to 4.2 in few days), lack of appetite, and increase in urination

He was cured with fluid therapy and antibiotic. He was treated with humulin insulin during hospital and sent back home with regular BG level on 11/24/18 with prescription of caninsulin in case of raise of BG.

These days i confirm he is having about 330kcal , while vet prescribed 240kcal for his current weight (4.5kg). Also his food is mixed with alot of water.

We behaves like a healty cat especially today... eats well and is awake all the time looking for attentions
 
Tracey&Jones said:
The vomitting doesn't have to do with the insulin but I would say more to do with an acidic tummy. Have you tried spacing out meals for Wally? Keep a little bit of food more often may help. I am sure the high BG makes him feel a little unwell just like we feel when we have eaten too much sugar.
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Yes, we are feeding 5/6 time during the day. About the night we are waiting for a feeder with timer so we he can have some food ....

Thank you
 
Stefano said:
We behaves like a healty cat especially today... eats well and is awake all the time looking for attentions
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Beautiful!

How long did the antibiotic therapy last?

Along with not enough calories and not enough insulin the 3rd ingredient that makes a kitty vulnerable to developing ketones is the presence of an infection, inflammation or some other systemic stress. Pancreatitis or gingivitis are often responsible. Does he have any other health issues that you are aware of?
 
Sandy and Black Kitty said:
How long did the antibiotic therapy last?
Pancreatitis or gingivitis are often responsible. Does he have any other health issues that you are aware of?
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Antibiotic for 10 days at the hospital and 10 more days when back home

In that occasion we did all sort of exams and found nothing!

We also did a blood test 2 weeks ago and found nothing!

No health issue that i'm aware of
 
You are on the right track with the dose. Vets cannot be experts in everything, and they often have a very conservative approach to treating diabetes, to the point of putting the cat at risk. You have enough tests on your spreadsheet to guarantee that you are not missing a hypo (low numbers) which would send Wally up in the black in reaction. Ketones are down, you're seeing pink, keep at it. Yellow is around the corner, probably with the next dose increase. This forum has a TON of experience with Lantus, and though they are not professionals, the people who hang out on this board have probably "followed" more diabetic kitties than most vets. The TR protocol linked above is solid and has served as the basis for a publication in a peer-reviewed journal -- your vet might be interested in seeing the article.

Hold on tight, I know how hard it is when board and vet disagree!
 
Hello Stephanie... did you see today's Wally improvements? I'm pretty happy of the AMPS value until +6 !

My vet is working together with his colleague endocrinologist... they are worried we are missing the right dose if we go too fast.

I think this could be true in theory.... but TR allow both increase and decrease, so for what i understand we should be able to recognize when it's too much insuline from a low and then a bounce. correct?

Thaks
 
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