10/4 Xena AMPS 260, +4 247 / PMPS 276, +4 264

[Don & Xena]

At 28 units now, seems crazy.
Am I supposed to just keep increasing? Thought she was seeing improvement at 22 but here we are again.
Is it possible that she is just not going to respond to insulin? I have’t seen too many, if any examples of cats with doses this high.
Stressed… I know my situation is not an easy one to give advice on, because I’m currently under such a financial strain. I can’t be taking the cat to the vet every couple weeks for bloodwork, changing insulins etc. I don’t even know what a vet would say now in the situation, since none of them follow this type of protocol anyway.
Any insight would be helpful.

 

[Staci & Ivy]

Hi Don, you must be so stressed. I’m sorry it’s been so tough going. Maybe tag some of the administrators to have them review Xena’s situation?
Sending you a big hug of support

 

[Wendy&Neko]

If. you want, I could give you spreadsheet examples of cats on much higher doses. But it doesn't really matter, Xena needs however much insulin she needs. And yes, even those cats on much higher doses do eventually find a dose that fits them.

Unfortunately the nature of insulin resistance (whatever she has but I have my suspicions at this size of dose), is that it can look like a moving target until you get closer to that fitting dose. And then that may need to be tweaked too, but the same as with other diabetics. I'm not suggesting taking the cat to the vet every couple of weeks. Just once. Get the IAA and IGF-1 tests done and talk to the vet about the possibility of cabergoline should the IGF-1 test prove positive. If she's reacting to the Lantus, I'd discuss going to Levemir as well. If not, leave her on Lantus. I guess what the vet says will depend on their experience with higher dose cats. They may try to get you to go to an IM vet, which would be a second visit. I told my vet we could be a team, and that worked for us.

If going to the vet is not possible, and I get that your situation is tricky, then your choice is just to keep following the protocol for increases/decreases. FWIW, my vet didn't follow TR (though had heard of the protocol), and didn't even have experience in Lantus. We got started on Caninsulin cause that's what they did.

 

[Don & Xena]

Thank you Wendy
If you could link some spreadsheets for cats on very high doses I would appreciate it.

my comment about going to the vet every two weeks alluded to what my previous vet wanted in order to keep prescribing insulin. The only reason I’ve had enough insulin to get this far is because I was able to buy some from someone who didn’t need it anymore because they moved to pens.

… also, I assume I am supposed to start increasing by 3 units soon?

 

[Wendy&Neko]

Note, a lot of people delete their spreadsheets when their cat passes on, so it's hard for me to find all the ones I'd like to point to. Some of the ones that stick out in my mind (that I could find) are:

Crystal (spreadsheet here) was on both Levemir and R insulins. Her caregiver decided to max out at 60 units of Levemir and compensated with R for the rest. Lived in France where not much available in the way of treatment.

Lily (spreadsheet here) though unfortunately missing the tabs for the climb in 2017, hit a high of about 55 ish and eventually went OTJ - no treatment but insulin.

Howie (spreadsheet here) , got to mid 50's and I see he's currently around 11 units. Howie's on cabergoline.

Pig (spreadsheet here) got to 59 units before having SRT then going down.

I have heard of other cats going higher, but it was before my time. And spreadsheet more than likely gone by now.

Think of dose increases as 10-15% of the total dose. Lower end if seeing some good numbers, higher if high and flat.

 

[Don & Xena]

Note, a lot of people delete their spreadsheets when their cat passes on, so it's hard for me to find all the ones I'd like to point to. Some of the ones that stick out in my mind (that I could find) are:

Crystal (spreadsheet here) was on both Levemir and R insulins. Her caregiver decided to max out at 60 units of Levemir and compensated with R for the rest. Lived in France where not much available in the way of treatment.

Lily (spreadsheet here) though unfortunately missing the tabs for the climb in 2017, hit a high of about 55 ish and eventually went OTJ - no treatment but insulin.

Howie (spreadsheet here) , got to mid 50's and I see he's currently around 11 units. Howie's on cabergoline.

Pig (spreadsheet here) got to 59 units before having SRT then going down.

I have heard of other cats going higher, but it was before my time. And spreadsheet more than likely gone by now.

Think of dose increases as 10-15% of the total dose. Lower end if seeing some good numbers, higher if high and flat.

Thank you… So Crystal was on levemir and a short acting insulin together?