10/31 Big Kitty AMPS 314; numbers won't budge

[evakot]

Previous condo: viewtopic.php?f=9&t=27727

Happy Halloween to all beans and kitties!

Big Kitty is definetly ready for the trick-or-treaters. He LOVES to sit by the door when they come and receive compliments from the children about what a pretty cat he is... :lol:

Now onto more serious matters...We've been doing shots for 6 weeks now, and despite more than tripling his initial dose of 1 unit
(he is on 3.25u BID now), he still remains in the pinks for most of the day, every day. I know that Lantus requires patience, etc., but wouldn't he have some response to insuline by now, if he was a "regular diabetic?" Because of his persistently flat response I am beginning to suspect that there is something else going on with him.

I am also beginning to see the early stages of diabetic neuropathy setting in. He is still walking on his paws, not on the hocks, but he walks slowly and sits down to rest a lot. He used to run up and down the stairs with a speed of light (especially as it came to hearing cans of food being open) but now he takes a long time to ponder if he should even bother to go downstairs and when he does, he takes one step at the time. It breaks my heart...

I will be calling his vet tomorrow to discuss the plan of action. I wanted to ask what options should I inquire about with my vet? Should I ask to have him tested for acromegaly? What other tests would you request? (He had regular bloodwork and urinalysis done before going on insuline and everything came back fine, except for high BG.) I am planning to press my vet on getting a dental done or at least a more thorough dental exam (he never had dental x-rays done), although she did not agree to a dental in the past saying that teeth are unlikely factor and they don't want to anesthetize unregulated diabetics.

In general- what else should I consider doing to help bring my big guy's numbers down?

All input is much appreciated,

Eva

 

[Perry and Sooty]

I can empathise as we've been on Lantus since Dx in June and still, you'd think we were shooting water. His numbers now are really no different than when he was not getting any Lantus at all... but you (we!) still have to go through this - or you would never know, right?

I won't presume to offer advice but will be most interested to see what feedback you get.

Acromegaly is always a possibility it would seem - and we are right now, waiting for the results of that very test.

OR - for both of us, it may simply be, that neither of us has yet reached that magic dose...! Grrrr!! It sure can be very frustrating!

Good luck - do let us know, whatever you decide?

 

[Sienne and Gabby (GA)]

The best way to bring numbers down is more insulin. (Sorry, I know that's obvious!) Given that you're getting nadirs in the 300s, you can increase by 0.5u (vs. 0.25u). Sometimes, it can take a fair amount of insulin before you hit the dose that starts numbers coming down. Generally, I don't start thinking about high dose conditions until you are in the neighborhood of 6.0u.

Making sure that there aren't any dental issues makes good sense. You can ask your vet to check on acro or IAA. This involved blood being sent to Michigan State where they can run the tests.

 

[evakot]

I can empathise as we've been on Lantus since Dx in June and still, you'd think we were shooting water. His numbers now are really no different than when he was not getting any Lantus at all... but you (we!) still have to go through this - or you would never know, right?

I won't presume to offer advice but will be most interested to see what feedback you get.

Acromegaly is always a possibility it would seem - and we are right now, waiting for the results of that very test.

OR - for both of us, it may simply be, that neither of us has yet reached that magic dose...! Grrrr!! It sure can be very frustrating!

Good luck - do let us know, whatever you decide?

Hi Perry,

I've been actually reading your posts, because of what I see as a similar situation! I can't even tell you how many times my DH and I have said: "it's as if we were shooting water!!!" I also had an impression for some time that insuline shots actually elevated my cat's numbers. Prior to starting Lantus he "hanged out" in 200s most of the day, after we started shooting he is "glued" to 300s. But, this may only be an illusion.

Anyway, i am curious to see what your vet says about Sooty's tests.

And- I am also from Georgia (Augusta), so maybe it's a "southern curse"- huh, huh- just kidding!

Have a great Candy Day,

Eva

 

[Jill & Alex (GA)]

just a few thoughts...

like sienne suggested, when nadirs are greater than 300 you can increase the dose every 2-3 days by 0.5 unit versus increasing in increments of 0.25 unit. if big kitty were my cat, i would only hold a dose for 2 days (4 cycles) before increasing by 0.5u if nadirs continued to be over 300... until i saw some better movement.

diabetic neuropathy: if you're not giving METHYLCOBALAMIN, i'd get some.
here's a link with all you'd ever want to know about treating neuropathy: Jasper The Big Orange Goodness.

if big kitty's blood work is good, having a thorough dental exam has merit. i disagree with your vet. bad teeth is definitely a factor in regulating a diabetic. my own cat was OTJ for almost three years before gingivitis knocked her out of remission! a dental (no extractions) and a short stint on insulin put her back in remission. unfortunately, liver and kidney disease put her back on insulin this year.

if you're looking to rule out other possible factors, having the IGF-1 test for acromegaly and the Insulin Auto Antibodies (IAA) tests done isn't a bad idea. normally, we don't suggest them until kitty has been on a higher dose of insulin without achieving the desired results. however, having them done may give you some peace of mind. you can read all about them here: Acromegaly and Other High Dose Conditions: What We Know.

hope this helps...

 

[evakot]

just a few thoughts...

like sienne suggested, when nadirs are greater than 300 you can increase the dose every 2-3 days by 0.5 unit versus increasing in increments of 0.25 unit. if big kitty were my cat, i would only hold a dose for 2 days (4 cycles) before increasing by 0.5u if nadirs continued to be over 300... until i saw some better movement.

diabetic neuropathy: if you're not giving METHYLCOBALAMIN, i'd get some.
here's a link with all you'd ever want to know about treating neuropathy: Jasper The Big Orange Goodness.

if big kitty's blood work is good, having a thorough dental exam has merit. i disagree with your vet. bad teeth is definitely a factor in regulating a diabetic. my own cat was OTJ for almost three years before gingivitis knocked her out of remission! a dental (no extractions) and a short stint on insulin put her back in remission. unfortunately, liver and kidney disease put her back on insulin this year.

if you're looking to rule out other possible factors, having the IGF-1 test for acromegaly and the Insulin Auto Antibodies (IAA) tests done isn't a bad idea. normally, we don't suggest them until kitty has been on a higher dose of insulin without achieving the desired results. however, having them done may give you some peace of mind. you can read all about them here: Acromegaly and Other High Dose Conditions: What We Know.

hope this helps...

Very helpful- thank you!

I ordered Xobaline tablets from LifeLink and am awaiting their arrival- probably tomorrow or Tuesday.

So it sounds like the experts say to be more aggressive- i.e. hold the dose for 2 days only and increase by 0.5 units. Will do!

If the "high dose markers" start at 6 units, I still have almost 3 units to get there...So, maybe I should hold off with Acro/ IAA tests just a little longer, but stick to my guns about the dental...?

Thank you again,
Eva

 

[evakot]

Generally, I don't start thinking about high dose conditions until you are in the neighborhood of 6.0u. .

Thank you for the guideline. I always wondered what was considered a "high dose." So, it looks like I am not there yet with the 3.25u. Will be increasing every second day now, and by 0.5 u, if everything stays the same.

Thank you again,

Eva

 

[Jill & Alex (GA)]

I ordered Xobaline tablets from LifeLink and am awaiting their arrival- probably tomorrow or Tuesday.

fantastic!

So it sounds like the experts say to be more aggresive- i.e. hold the dose for 2 days only and increase by 0.5 units. Will do!

yes, as long as nadirs are greater than 300. once you start seeing some movement, you'll want to go back to following the protocol more closely.

If the "high dose markers" start at 6 units, I still have almost 3 units to get there...So, maybe I should hold off with Acro/ IAA tests just a little longer, but stick to my guns about the dental...?

it's entirely up to you. if you can afford to have the tests run, i would go ahead and do it. i *think* they'll run you somewhere in the vicinity of $100.
"IF" big kitty does have a high dose condition it would be good to know.

 

[Ele & Blackie (GA)]

Good luck with the dosecrease, Eva. I hope you get to see some lower numbers soon. If you look at Blackie's spreadsheet you'll see that we had to go up to 3.5 units to see yellow and 4 units to see green. Blackie has other issues too, but I hope you find that better dose soon.

 

[mybuddybinks]

can't help with info, but maybe a costume make big kitty feel a lil better...
binks

 

[evakot]

can't help with info, but maybe a costume make big kitty feel a lil better...
binks

Soooo cute! Thank you. Big Kitty probably sees this as a tasty chicken/rabbit treat...he thinks himself to be a mighty hunter, in theory... :lol: In practice, he is an indoor cat whose only attempt at hunting is an occassional dazed lizzard who visits our screened-in porch. Big K was once bitten (yes- bitten!!!!!!!!!!) by a lizzard who attached himself to his paw and wouldn't let go. Let me tell you- my boy was shrieking and crying and rolling on the ground, shaking his paw frantically until "mommy" came to the rescue. What an embarrassement. :lol:

 

[Ann & Tess GA]

I keep telling Tess not to take those little lizards for granted. :lol:

 

[Perry and Sooty]

Eva, seems you've had some wonderful feedback here! I do see the similarity (not just the locale!!) - but then the big difference for you is that Big Kitty's BGs are much higher throughout the cycle than Sooty's are and are all in the 300s. We're stuck in the 200s and can't really risk to go up in .5 increments... but since you can, I really hope you'll soon see SOME effect from the Lantus - at least, sooner than you would have done otherwise.

We've occasionally gotten the impression that the shots have actually elevated his numbers; this may be illusory or if you're an optimist, you might take it as a sign that there is at least, SOME reaction to the insluin (if only of the 'bounce' variety!). The big picture though, is that we have to stay focused on the NADIRS, wherever you can see one. With Lantus it is the lows that really dictate what we do...

I liked the advice to go ahead and get the IGF-1 and the IAA tests done (yes, do both if you have the $$!)... I agree it is just as well to know, for sure, either way. I really believe that you can't have too much information. As long as you can afford to get it done I'd go for it if I were you...

Good luck ! I know you'll let us all know what you decide....!