? 11/1 Lincoln AMPS 380, +4 340, +6 344, +9 394, PMPS 410, +4 351

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Could the shorter needle be the cause of this? The new needles with the half units are only 5/16ths inch long compared to the old ones being 1/2 inch long. I shoot in the sides. I haven't had fur shots for a long time. Is the shorter needle long enough to deposit the depot properly? The numbers keep going up and i am starting to worry that i am making this worse and not better at all. Thoughts on his numbers?
 
Often times, right after we increase, the numbers are temporarily worse. We call the effect New Dose Wonkiness or NDW. Because Lantus is a depot insulin, some of the injected insulin goes to the depot and some to be used that cycle. After we increase, the depot has to stabilize and you can get higher numbers for a couple of cycles. Don't worry, the numbers should start heading down more as the depot stabilizes.

The needle length shouldn't make a difference, as long as you are getting it under the skin.
 
Back in the red.... :(
I could understand a bounce if he had gone down low... i could understand NDW if it was 2-3 days into a new dose. But its 6 days since i took him 3.75 and this morning went 4. And its lasted yesterday and today now these higher numbers. I have been watching what he eats. So i guess my question is how long after a dose increase do you say its not NDW but something else? Still concerned about how i am injecting with the new needles. It is going into skin but far enough i don't know. Going over everything i do for him and trying to figure out what i did wrong. Its not been a good day.. this post really reflects that im sorry. Other cats have conditions... but i feel like i had time to get into the groove with them and figure them out. And with Lincoln and this i feel if i don't get it he is going to pass and either end of the scale is bad. Just a bad day sorry for the ramble
 
Sorry it's been one of those days - I think we all can relate. :bighug: Managing FD is hard. But you are doing a great job getting tests in.

NDW usually happens within the first few cycles, not days. The other thing that can happen if cats are seeing higher numbers, is glucose toxicity. The name sounds worse than it is, but basically their bodies get used to higher numbers. And just means you have to keep increasing (according to the SLGS method guidelines) until you overcome the glucose toxicity.

Any chance you have any of the old needles around to try? Personally I prefer the longer needles myself too, though I have used to short ones occasionally.
 
Yes i have the old needles -- i stocked them up lol. I already set one up for the morning. Since i am pulling 4.0 they will work. But they only do whole units so won't be helpful when i have to increase again. Still something to cross off whats happening. Took weeks to find the needles with half units marked... looks like i am still on the search for them but with a longer needle. Thank you for helping
 
I use the BD Ultrafine II syringes. If you check out this web page, it's the purple and yellow box lower down. They are called the original sizes, or 8mm length.
 
That is what i changed over too. But before my needles was 1/2" long. This was seems so short compared to that!
 
How is Lincoln feeling? You would think his numbers would start trending down. Are you feeding wet canned or raw food or any dry? Could Lincoln have teeth issues or any other health issue causing the numbers to be higher?
 
He is acting normal. When he gets too low BG he hides under my bed and when it hits too high he hides under the table and hisses at me when i come near him. Right now he is happy, cuddly, comes when i ask him too for meds, testing and food. Feeding low carb wet. All dry is away and has been for a couple weeks now. His teeth look good when i open his mouth and check. I just have been going over and over what is going on.
 
That is half the 8mm ones i think is short! When i first started shooting 1/2" seemed too long but once i got good with it there were no fur shots. Now i feel like i have to learn all over again with the shorter needle. And maybe that isn't even the problem. Thats the most frustrating part. Dissecting everything i have been doing not knowing if those are even the factors effecting him.
 
Just to check some routine things - did you buy his insulin from a regular pharmacy? Are you using u-100 syringes?

As Chris said, some cats need more than others. You've got plenty of data to show that he needs more insulin rather than less. I think I would just stick with the guidelines for SLGS for now, increasing every week. When a kitty gets up to 6u we suggest that s/he is tested for the 2 most common high dose conditions, acromegaly and insulin auto-antibodies. Punkin had acro and got up to 15.5u per shot before we had it treated and his dose started to go down. The most recent research is that 1 in 4 diabetic cats has acromegaly. It's a benign tumor in the pituitary gland. Insulin auto-antibodies is less common, but we see it pretty regularly here. It means that the cat's body has begun making antibodies against the insulin that's being injected. The antibodies bind to the insulin and keep it from being usable by the body for a period of time.

I'm not saying that Lincoln has a high dose condition. I'm just saying that it isn't uncommon for us to see kitties that aren't responding to the usual dose and that need to go up in dose. There is nothing here to say that he is overdosed. From what I can see on his spreadsheet, I don't think he is. I think that it's a matter of going up in dose until his blood sugar levels improves. Every cat has a dose that will move him - it's just a matter of getting to it.

Hang in there Amber. It's hard having a kitty that isn't responding like you'd like them to.

Ah, I'm seeing you have another thread (condo) going for today. I'm going to put a link to that thread here and let's keep the conversation to just one thread. That helps all of us.

Everyone please post here: http://www.felinediabetes.com/FDMB/...340-6-344-9-394-pmps-410.167567/#post-1814674
 
I just posted on your other thread for today and am directing everyone to post here. We encourage people to edit their subject line all day long to reflect any questions and to update with test results.

Here's what I put on your other thread:

Just to check some routine things - did you buy his insulin from a regular pharmacy? Are you using u-100 syringes?

As Chris said, some cats need more than others. You've got plenty of data to show that he needs more insulin rather than less. I think I would just stick with the guidelines for SLGS for now, increasing every week. When a kitty gets up to 6u we suggest that s/he is tested for the 2 most common high dose conditions, acromegaly and insulin auto-antibodies. Punkin had acro and got up to 15.5u per shot before we had it treated and his dose started to go down. The most recent research is that 1 in 4 diabetic cats has acromegaly. It's a benign tumor in the pituitary gland. Insulin auto-antibodies is less common, but we see it pretty regularly here. It means that the cat's body has begun making antibodies against the insulin that's being injected. The antibodies bind to the insulin and keep it from being usable by the body for a period of time.

I'm not saying that Lincoln has a high dose condition. I'm just saying that it isn't uncommon for us to see kitties that aren't responding to the usual dose and that need to go up in dose. There is nothing here to say that he is overdosed. From what I can see on his spreadsheet, I don't think he is. I think that it's a matter of going up in dose until his blood sugar levels improves. Every cat has a dose that will move him - it's just a matter of getting to it.

Hang in there Amber. It's hard having a kitty that isn't responding like you'd like them to.
 
He was at 6u once and then i decided to change diet and drop back to 3u. I was concerned about Acro. One of my vets knew about it one didn't. If i want to get him tested for it what are they supposed to be testing / looking for? Name of test? Just hate seeing the red numbers. Would be happy to just see more yellow at this point. Appreciate all the information and support.
 
This link, "Acromegaly, The Basics, Hope you will Read and Like" is in the last section of the "Basics: New to the Group?" sticky in the collection of single topic posts. The top of the second post in that thread has the links for testing.

I would strongly encourage testing of both acromegaly and iaa. Most of the cost is in the blood draw and shipping. We've had many vets suggest not testing for iaa because they think it's very rare. It's common enough that we see it regularly. Both Neko and Karen's Doodle have iaa. Neko also has acro. There are differences in how we suggest dosing strategies, depending on what the kitty has going on, so it does make a difference if you know.

The third high dose condition is called Cushing's - it's a tumor on the adrenal gland. Acro's tumor is on the pituitary gland. We don't see Cushing's as often, but Tuxedo Mom's (Mary Ann), Tuxie has Cushing's.

If you don't have it, you might want to bookmark the "Where Can I Find?" thread. It can help you find helpful information that is lurking about the site and elsewhere.
 
Oh one more - hyperthyroid can cause some insulin resistance too. So if he hasn't had his thyroid tested, that would be a good test to run.

In that same section of the "New to the Group?" sticky there are other links that might be helpful. I like this one for explaining insulin resistance.

2014 ~ 39th Congress of the World Small Animal Veterinary Association (WSAVA)
  • Which Insulin in Cats - p 156
  • Management and Monitoring of the Diabetic Cat - p 160
  • Feline Diabetes - p 229
  • Diabetes Mellitus and Quality of Life - p 730
  • Acromegaly in Cats – p 733
  • Insulin Resistance – p 737 (description of mechanisms of resistance on p 738 under heading Pet)
  • Medical and Nutritional Management of Diabetes Mellitus – p 739 (description on p 741 of glucose toxicity and lipotoxicity)
 
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