Re: 10/16 Toby's PMS=352
Hi Peg! Some of us are talking about strategies for Toby. In the meantime . . . here's a couple of thoughts:
- are you open to getting blood drawn tomorrow to send to Michigan State Univ to test for acro and iaa?
- if you're going to talk to your vet about dose, which I think is a good idea, print out your spreadsheet and the link to the Tight Regulation Protocol - I think I would print out the version that is on the
Tilly's Diabetes Homepage because it specifically gives the guideline for increasing as often as 2 days when the nadirs are constantly high. That supports what you have been doing. I would emphasize that this protocol has been published in a professional veterinary journal. You could also print out the PDF on "Management of Diabetic Cats Using Long-Lasting Insulins" that is on our TR Protocol yellow starred sticky page (about 5 paragraphs down from the top - you have to download it.)
Be confident that you have followed the protocol guidelines to a T. You've evaluated the nadirs on each dose and increased in accordance with the published guidelines in order to try to get control of his blood sugar. We do see high blood sugar caused by overdosing a cat sometimes, but for a cat like Toby that started on an appropriate dose and had his dose increased methodically, per the protocol guidelines, there is little chance of that being the cause of his high blood sugar. I'm mentioning this just in case the vet thinks that he is overdosed and that is the cause of his high blood sugar.
Toby gives indications of having a high-dose condition. Acromegaly is the most common of the 3 conditions. Insulin auto-antibodies is the next most common (some think iaa to be very rare, but we see it here fairly regularly and currently have 3 cats daily posting with iaa in the mix - Polly, Neko and Cobb), and Cushing's appears to be the least common, however we see cats with all 3 of those conditions. Some cats have a combination of 2 of these conditions. Your vet is very likely to not have seen these conditions - most have not. There are vets that refer people to FDMB when their cats are diagnosed with diabetes. If I were guessing, I would guess Toby's got iaa as the dominant condition - my guess is based upon the way he will respond to a dose with lower numbers, then his body gets accustomed to that dose very quickly and he immediately goes into higher blood sugar ranges again. Acromegaly doesn't typically show an initial good response to a dose that subsequently goes away like that. Cushing's includes very fragile skin as a dominant symptom.
Hyperthyroid and Pancreatitis are two other conditions that can make it difficult to get control of a cat's blood sugar. Usually we suspect one of the 3 conditions in the previous paragraph when a cat exceeds about 6u per shot. Hyper T and Pancreatitis alone don't typically result in doses over 6u.
- i'm wondering if it's time for you to consider adding R into your toolbox. You can get Humulin R (R stands for Regular) or Novolin R at any pharmacy without a prescription. This is a faster acting insulin that can be used in addition to the long-lasting Lev/Lantus insulins. That would give you a tool to use when you're trying to safely increase the L dose and he's having high numbers. It's very inexpensive. I've heard people say they've gotten it at Walmart Pharmacy for maybe $25-35ish. Mine cost $65ish in 2011. It lasts for a very long time. I only bought one vial and gave a large amount away after punkin passed away.
What do you think about trying R? If you want to, we'd want to choose a time that someone experienced can stay with you, and you can test once an hour for 4-5 hours straight after the shot. You would initially start with a small dose to see his response to it. One benefit of using R is that you have the flexibility to address high blood sugar immediately with a larger dose of R, and not use it at all if the blood sugar is low. It just allows more immediacy in the response, unlike the way a depot insulin works.
As far as tomorrow goes, I would go ahead and increase his dose in the morning. If you want to get back on the line, you could just go up to 9.5u. It might/might not change the blood sugar numbers, but most people would rather be on the 0.5u or even unit markings in dose if at all possible.
Do you need links to any of the things I've mentioned above? the iaa/acro tests, protocol guidelines, etc.?
Hang in there - you're not the first person to be dealing with this. You're not alone. If you're not following Suzanne's Cobb, Marilyn's Polly or Ellie's Charlie, they would be good condos for you to read on a daily basis. You'll learn a lot reading their posts. :YMHUG:
