11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261 +5/325

[miso00]

was given 4.5u last night thinking we were going to follow Lantus/Lev. protocol/ISG but have decided to follow Lev. ISG and gave him 1u this morning.

Our shot time is late 11a/11p. I work from home and am able to monitor him pretty well.

Please let me know anything else I may need to be aware of with switching

 

[Venita]

Re: 11/10 Tidus AMPS 252

I think we are all sitting here with baited breath and waiting for the other shoe to drop.

When I switched Ennis from BCP PZI to Levemir in 2006, I took the "start low, go fast" approach. Ennis had responded to BCP PZI, but then suddenly "froze" in highish numbers despite getting him up to about 4.5U BID. I restarted him on Levemir at 1U, but ramped up fairly quickly. (This was before the whole Lantus/Levemir "protocol" was in place so at the time I wasn't breaking any "rules." Steve and Jock had written about a "start low, go fast" approach that appealed to me.)

Within a few weeks I had Ennis back up to 4.5U BID on the Levemir, and it was shortly after that he "broke" and came tumbling down to 1U or less for the rest of the 4+ years he was on Levemir.

This is going to be a scary few weeks for you. I know that. My best advice is to breathe. Keep an eye on his clinical symptoms and test his blood and urine ketones when you are able. He's been on 0 U insulin for a few days, and he's not done anything differently than when he was on 6.75U BID Lantus. Same mid-to-high 200 BG numbers. Same negative ketones. Tidus seems to be a durable diabetic.

You and he will be fine, wherever this path takes you.

 

[Sheila & Beau GA & Jeddie GA]

Re: 11/10 Tidus AMPS 252

Good luck Jenn and Tidus! You are doing what you need to do. The second or third shot seems to be where they will have a dramatic response - if they are going to do that. You can see it on Cami and Beau's SS.

Venita, love the term "durable diabetic". Paws crossed that Tidus continues with that characterization for the very long haul. And thanks for clearing up the meter "LO" reading on the other thread (equaling zero). It does seem like a meter measuring such a critical thing would have a "zero" setting... wouldn't you think?

 

[Laura and Harley (GA)]

Re: 11/10 Tidus AMPS 252

Hi Jenn,

Looks like you are off to a good start. Wishing you and Tidus good luck and :YMHUG: cat_pet_icon ! We're here for you day or night if you need support. Pity I can't pass chocolate through my wireless connection, but when I figure that one out I'll let you know.

Thank you Venita for clarifying the starting dose and the ketone issue and offering words of encouragement and wisdom born of experience.

 

[miso00]

Re: 11/10 Tidus AMPS 252 +6/300

+6 could be due to food. He ate about 4pm and his +6 was 5pm. I was trying to hold off feeding him but he wasn't having it.

 

[hmjohnston]

Re: 11/10 Tidus AMPS 252 +6/300

+6 could be due to food. He ate about 4pm and his +6 was 5pm. I was trying to hold off feeding him but he wasn't having it.

Jenn- please, PLEASE tell me- have you ever been successful on holding off on feeding? Sneakers always told me, under no terms, she was ALWAYS starving if I held off on the food :lol:

First day on Lev- going well. I believe Sneakers was red and black most of the time with a little pink thrown in so Tidus is off to a great start.

 

[Blue]

Re: 11/10 Tidus AMPS 252 +6/300

+6 could be due to food. He ate about 4pm and his +6 was 5pm. I was trying to hold off feeding him but he wasn't having it.

Until regulated, you will see the need to feed more. Oliver went from around 30oz/day down to maybe 6-10oz/day once he was regulated.

My Shadoe had a pot belly as well and went from 7lb up to 17lb; she was all belly, acro belly.
My Oliver was all around big. He arrived very gaunt and you could feel every rib, but he was 15lb; he rose to 33.8lb and now that he is an OTJ acro, he is down to a handsome 20lb.

Large, fairly fast weight gains and pot bellies, plus a refusal to respond to insulin, regardless of dose, are signs for insulin resistance.

I am not quite sure why someone would advise to give no insulin because serious problems could happen. Also, doing a reboot of dose can be dangerous as well.

By starting over at 1u, you run the risk of ketones and a sick cat, so I hope that you are testing for ketones often.

I do not know the definition of a durable diabetic, but the numbers on the ss look like a cat that could use more insulin than 6.75u as nothing you have given him has caused any movement in the downward direction. Switching to Lev usually results in a smoother, flatter curve, but you already had that on Lantus.

 

[miso00]

Re: 11/10 Tidus AMPS 252 +6/300

I feed him around these times (give or take a hour before or later)
5am
11am
4pm
7-8pm
11pm

For those that don't know I have 17 cats including Tidus in a very small place so the feeding times are a little harder to control for just him. They used to free feed so getting it down to 5 times per day is miraculous :lol:

 

[Blue]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277

I did not limit food for Shadoe or Oliver; they ate as they needed and once regulated, quite often, food would just sit till they felt the need to eat...

17 cats?

 

[miso00]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277

Tidus has already stopped eating as much as when he first got here. Initially he was eating about 2.5 cans of Friskies (which are bigger than FF, I think 5.5oz) at each meal. He's now eating 1/2 can of FF 5 times per day mixed with some Raw.

yes, 17 cats. Prior to moving to NY I was very involved with my local shelter and had a big house in FL. When I moved they came with me. It's really not as difficult (for me) as most people think. I do everything around them and luckily it just works.

 

[Marje and Gracie]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

I just want to reiterate that a very plausible reason for him not going up while Jenn was giving him no insulin is the large depot he had with a 6.75u dose of insulin. Some cats, even on small doses, will see the effects of a previous dose affecting six or more subsequent cycles.

You could see him stay around these numbers for a bit and then increase.

"Start low, go fast" is not a science-based protocol. Only the TR protocol is based on science and it would not have someone starting a new insulin dose on 1u from 6.75u.

 

[Venita]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

"Start low, go fast" is not a science-based protocol.

You are absolutely right. It is not. Never claimed it was. I understand that some disagree with any dosing that is not within a science-based protocol.

Can someone please link me to the 70% rule? This is a new concept to me and I would like to look at the science behind it. Thanks!

 

[Venita]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

"Start low, go fast" is not a science-based protocol.

You are absolutely right. It is not. Never claimed it was.

Actually I may be a bit wrong on SLGF not being science based. I am assuming the Roomp-Rand study is the science we are talking about.

In the section on initial dose in Table 3A, that study says that "Cats with a history of developing ketones that remain >300 mg/dL (17 mmol/L) after 24-48 hours" should get an increase of .5U. (That would be on top of a weight-based starting dose of .25U/Kg of ideal weight. Tidus was 10 pounds in June, and I am guessing he is maybe 13 pounds now. 13 pounds is almost 6kg, so the ideal starting dose according to Roomp-Rand would have been 1.5U.) (In the starting dose section of that table it also says "If the cat received another insulin previously, increase or reduce the starting dose taking this information into account." However, no further information is given in the table about applying that exception. Perhaps the full study does, but I have no access to the full study. Perhaps that is where the 70% rule comes from. Maybe someone can post a link to the full study or email me a copy at Venita@dcin.info.)

That same rule is stated slightly differently on the Tilly's Diabetes page, which I assume is an acceptable restatement of the science given it is linked from the Lantus sticky on TR Protocol. (However, Tilly's rule differs from the original Roomp-Rand study table rule because it uses an "or" qualifier, not an "and" qualifier.)

"Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours)."

However, I see nothing similar about this "go fast" exception in the Lantus sticky on TR Protocol. Don't know why.

 

[Carl & Polly & Bob (GA)]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

I think the initial dose is 4.75u is probably going to skew the numbers for a bit also.

How long is it okay for Tidus to hang out in numbers above the renal threshold? It's just going to cause more glucose toxicity.

Hi Jenn, how's Tidus doing? How about a WCR?

Carl

 

[Venita]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

How long is it okay for Tidus to hang out in numbers above the renal threshold? It's just going to cause more glucose toxicity.

It's not "okay" at all. I know you didn't mean to suggest, Carl, that I think highish BGs are an "okay" thing just because I recommend a conservative starting dose.

I don't want Tidus DKA and I don't want him above renal threshold. I want him healthy, happy, well regulated, and possibly OTJ. I want that for all the diabetic kitties.

 

[Carl & Polly & Bob (GA)]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

Venita,
Of course I know that I wasn't trying to imply otherwise. It was a question to the group, wondering how long to put up with what might be wonkiness from prior doses before saying "increase".

FWIW - I don't think the "70%" rule is written in stone anywhere. I believe it is based on data and experiences that have been noted over the course of time by members of FDMB? It seems to be what has worked well collectively.

Also, I don't have an issue with people veering from "protocol" - any protocol. Hell, there isn't even a protocol for Prozinc/PZI unless you count the Hodgkins one that nobody here uses. As long as things fit the primary directive in the Advice for Advice Givers sticky that whatever is advised "does no harm".

I am just hoping that whatever Jenn does, it works quickly. What I am trying to put a finger on is with SLGF, how fast is "fast"?

Carl

 

[Jill & Alex (GA)]

Re: 11/10 Tidus AMPS 252 +6/300

Large, fairly fast weight gains and pot bellies, plus a refusal to respond to insulin, regardless of dose, are signs for insulin resistance.

I am not quite sure why someone would advise to give no insulin because serious problems could happen. Also, doing a reboot of dose can be dangerous as well.

By starting over at 1u, you run the risk of ketones and a sick cat, so I hope that you are testing for ketones often.

I do not know the definition of a durable diabetic, but the numbers on the ss look like a cat that could use more insulin than 6.75u as nothing you have given him has caused any movement in the downward direction. Switching to Lev usually results in a smoother, flatter curve, but you already had that on Lantus.

i've highlighted key remarks in gayle's post so they don't get lost in the shuffle because they're very important.

jenn has brought tidus up the dosing scale "honestly"... with little to no response.

instead of endless discussion, semantics, and nit-picking over rules and protocols, there's a simple solution here:

HAVE TIDUS TESTED FOR ACROMEGALY and IAA.

results of these two tests will provide the insight necessary to make educated decisions with dosing and treatment.

i don't know if he's a High Dose kitty (no one does for sure), but the indicators are there and have been for awhile now. for his sake, they shouldn't be denied or ignored.

it'll probably be the best $100 (approximately) DCIN spends for this cat.



and that's all i have to say on this subject...

 

[Venita]

Re: 11/10 Tidus AMPS 252 +6/300

Large, fairly fast weight gains and pot bellies, plus a refusal to respond to insulin, regardless of dose, are signs for insulin resistance.

I am not quite sure why someone would advise to give no insulin because serious problems could happen. Also, doing a reboot of dose can be dangerous as well.

By starting over at 1u, you run the risk of ketones and a sick cat, so I hope that you are testing for ketones often.

I do not know the definition of a durable diabetic, but the numbers on the ss look like a cat that could use more insulin than 6.75u as nothing you have given him has caused any movement in the downward direction. Switching to Lev usually results in a smoother, flatter curve, but you already had that on Lantus.

i've highlighted key remarks in gayle's post so they don't get lost in the shuffle because they're very important.

jenn has brought tidus up the dosing scale "honestly"... with little to no response.

instead of endless discussion, semantics, and nit-picking over rules and protocols, there's a simple solution here:

HAVE TIDUS TESTED FOR ACROMEGALY and IAA.

results of these two tests will provide the insight necessary to make educated decisions with dosing and treatment.

i don't know if he's a High Dose kitty (no one does for sure), but the indicators are there and have been for awhile now. for his sake, they shouldn't be denied or ignored.

it'll probably be the best $100 (approximately) DCIN spends for this cat.



and that's all i have to say on this subject...

Thanks so much for your guidance, Jill.

 

[Laura and Harley (GA)]

Re: 11/10 Tidus AMPS 252 +6/300 +8/277 PMPS 261

Venita,
What I am trying to put a finger on is with SLGF, how fast is "fast"?
Carl

Hi Carl,

You know, just as we say ECID, every cat is different, well EBID, every bean is different. One person's fast is another person's slow. :lol: But since I first mentioned fast-tracking dose increases in Tidus's introduction thread, I will put on my flame-proof suit and at least explain my definition of "fast."

In the section on initial dose in Table 3A, that study says that "Cats with a history of developing ketones that remain >300 mg/dL (17 mmol/L) after 24-48 hours" should get an increase of .5U.

That same rule is stated slightly differently on the Tilly's Diabetes page, which I assume is an acceptable restatement of the science given it is linked from the Lantus sticky on TR Protocol. (However, Tilly's rule differs from the original Roomp-Rand study table rule because it uses an "or" qualifier, not an "and" qualifier.)

"Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours)."

Since Tidus is a "proven" diabetic with a history of flat 200's at all Lantus doses tried to date and was up to almost 7u, and was starting over at a lower Lev dose, it was not a far leap to figure that he was going to end up needing dose increases. Especially since the no insulin trial did not show a reduction in his BGs. Since he'd already spent months "earning" his dose increases the "honest" way, so long as his BG's merited it, I surmised he could he could go up the dosing ladder in half the time - every 3 cycles. While I didn't know the provisos above existed when I first posted, I'm grateful to Venita for pointing them out as it offers some scientific support. Both provisos state that doses can be raised as early as 2 cycles or as late as 4 cycles - my suggestion of 3 cycles fit right in the middle. Combine this with the question of whether or not Tidus was showing ketones at the time of my posting, suggesting faster increases seemed the most prudent. [As of the time of this writing, the ketone issue has been resolved, Tidus in not showing ketones.]

From the level of outcry following my posting, I think we can safely deduce that increases after 3 cycles can be classified according to the group mores as "too fast." ;-)

bcatrun_gif

 

[Carl & Polly & Bob (GA)]

From the level of outcry following my posting, I think we can safely deduce that increases after 3 cycles can be classified according to the group mores as "too fast."

Laura,
I must be in the minority then. In Jenn's latest condo, I just told her that in my opinion, increasing after this cycle (his 3rd on 1u) was a good idea. nailbite_smile

CArl

 

[Laura and Harley (GA)]

From the level of outcry following my posting, I think we can safely deduce that increases after 3 cycles can be classified according to the group mores as "too fast."

Laura,
I must be in the minority then. In Jenn's latest condo, I just told her that in my opinion, increasing after this cycle (his 3rd on 1u) was a good idea. nailbite_smile

CArl

:lol: We'll we're together then because I agreed with you!