11/11 Smokey haven't been here in ages,but we need some help

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Melanie and Smokey

Melanie and Smokey

Member Since 2010
Smokey is thowing around some really wonky numbers lately and I am at a loss for how to handle them. We are way off schedule and have too low of numbers for me to feel comfortable giving her a full dose of 10.5U again now. I know we've switched to Lev, but hoping some of our old Latus peeps can help out. Here is the post I just put in Health with a link to the original problem day prior.

viewtopic.php?f=28&t=82966

Normally I am not hesitant to dose her because I know she is going up. She is not following any normal patterns these days. :roll:

Any advise, help, hand holding would be greatly appreciated. I'm not sure how we go forward with her insulin at this point. I am quite certain we have something else at play here. My gut is sinking that it is the horrible 'c' finally catching up with us.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

If no one else is around to advise and you don't want to be off schedule anymore than you already are, then maybe just give her a BCS dose that you are comfortable with giving and monitor her carefully. You'll be around, and have all the supplies?
Test before you give the shot, and maybe she'll be well up into the 100s by now.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Thanks Dyana.

She's decided Friskies tasted really good and she's been snacking well in the last hour again so she was moving up pretty fast (the 94 to 123 on the chart is 45min apart) so I gave her 8.5 units. That's a 20% decrease in the insulin. We'll see how that works.

I've got to go out and pick up some more of the kidney healthy food she likes and some more high carb foods in stock, we've worked through our supply of those pretty good lately. Though she thinks the can of cool whip works just fine :razz:

Just got a new shipment of strips in thankfully and a niece that knows how to test if I need backup while I am out of the house.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Hey, Melanie!! Good to hear from you.

The first thing that strikes me is that with the exception of the last few days, Smokey''s numbers are flat yellow. With that kind of pattern and at your current dose, I really want to encourage you to get Smokey tested for a high dose condition. With insulin resistance, once you break through the resistance, you can see some wonky numbers. I do, however, think it's worth getting Smokey tested for both insulin autoantibodies (IAA or insulin resistance) and acro. (IGF-1). The cost for both tests will probably cost arount $100 plus shipping.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Good, I'm glad you have someone who can test and watch her, while you're gone.

Are you more off schedule now?

You know, we don't normally feed them within 2 hours of shot time, so the PS number isn't influenced by food?
I'm glad you're supplied with strips. Please let us know how she's doing.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Hi Sienne!

We did discuss those tests in great length with our vet and the specialists/surgeon at the UofMN when we had her pancreatic biopsy done. With the biopsy they felt that the tests wouldn't tell us anything further than what we already knew from the biospy - her pancreas isn't going to ever work right again. She has pancreatic nodular hyperplasia with a large dark green mass growing on her pancrease that is attaching it to her intestines and many other smaller growths on it. The internist we got at the UofMN I wouldn't give a D- to in diabetes and I pretty much walked out of that consult, but I highly respect the surgeon we dealt with and his said he'd order the tests if we really wanted them, but in the end we would still be left with a cat that needed high doses of insulin beause her pancreas didn't work anymore and nothing was going to fix that because the large mass couldn't be removed the way it was attached to the intestines.

At this point, I doubt we would get the tests out of my vet and they probably would be pointless. We likely don't have much time left with Smokey. Her heart disease, hypertrophic cardiomyopathy, has advanced to severe and developed signs of CHF, and a new mass has been spotted in her lungs on xray. Because of her heart, we can't do the CT to find anything more on the mass but my vet is fairly certain we are looking at metastatic cancer. We have pretty much entered the palative care stage in Smokey's life containing her conditions as best we can and keep her happy and comfortable. I love the thought that we've broke through an insulin resistance rather than cancer consuming the sugars though. Makes these last few days seem more worthwhile rather than heartbreaking.

Dyane - I am just right back were I was with the first skip. I suspect this trend is going to continue so I guess being off, or more off isn't going to matter. We free feed Smokey. She can't afford to lose weight and needs to gain some back. We've looked at putting her back on schedule and the gain in the numbers (because we do see a drop whenever she doesn't eat) has just not been worth the risk on her not eating. Usually she isn't snacking too close to shots since it isn't fresh, but we don't pick up the food preshot, their main meal is after shot.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

What you're saying makes sense about the tests.

If, in fact cancer is part of the picture, cancer can lower BG, like you noted. That may be a factor with what you're seeing. There may also be some intermittent pancreatic function which then drops Smokey's numbers. Unfortunately, there are just a lot of unknowns and you may need to play it by ear. To be honest, this is not unlike what the caregivers of acro cats have to deal with when the tumor revs up or down. The cat needs less, sometimes dramatically less, insulin or the dose needs to be raised.

With CHF in the picture, I would try to be attentive to the sodium content in food. From what I can tell though, cat food labels or on-line info doesn't require that the sodium content be listed.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Hi Melanie!

I looked at your spreadsheet first, before reading any comments in this thread or on the spreadsheet. My first thought was "great! Smokey finally found a dose she likes!" It's a pretty typical response with Lantus/Lev to see nothing but a whole lot of flatness, then all of a sudden a breakthrough that gives green everywhere. So this looks like a typical response to me, even though it is a relatively high dose.

That said, with her other health concerns and just not knowing for sure where the numbers are coming from, I can understand your concern. You are right to be conservative. Diabetes is probably the least of Smokey's concerns now, so you are (I assume) not gunning for OTJ but rather trying to keep her safe and comfortable. She doesn't need to run in the 50s, so a reduction makes sense.

In acro and IAA kitties, as well as cancer kitties, sometimes cats will need very large reductions, or else a quick series of smaller reductions. I wouldn't necessarily say that the cycles these past few days are indicative of acro/IAA/cancer, they are just nice numbers, but if you find yourself doing reduction after reduction or doing big reductions and she still goes low, then there could be something else at play. Be cautious, just in case. This is the time to become familiar with Smokey's response to carbs, so you will know exactly what is needed to bring up her numbers (and that will let you know how low is too low to let her run).

Speaking from my experience with Jazzy, who was acro AND I believe may have had cancer, sometimes it feels like a big game of hide and seek. At times I did reductions that were pretty big, and I skipped shots liberally if something didn't feel right or if I felt like I needed to get ahead of her huge insulin depot. If I did a big reduction and her numbers went higher than I liked, I increased again pretty quickly. I did find myself going back to the protocol for guidance, not following it to the letter but because its guidelines are built to help you really understand the way the insulin works in your cat. I felt like it gave me power because I understood WHY I needed to make certain changes or why something did or did not work the way I expected. JMHO.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Thank you Libby. Your post reminds me that even though we are treating the big picture, sometimes I need to focus back down on things and treat the diabetes just for the diabetes. Since we can't know more about the cancer situation, I need to treat what I have in front of me and I have the tools to treat. Smokey was always such a flat cat that I've never been afraid to dose, this hide and seek game is new to me!

Is there something on the boards that gives some guidelines on dose adjustments for the high dose kitties? I've read around in the IAA/Acro ISG and most of what I can find is on acro kitties and talks about normal adjustments of .5 or 1.0U. I just can't see a .5U adjustment doing much on a 10U cat when they are in the green at shot time, is that really what we do? An adjusted dose seems much more effective that constantly delaying/moving my dose if she continues this pattern of the last few days.

The 8.5U today seems to be holding pretty good. A decent top - no yellow or reds!, a steady down with 4 hours left to go before the next shot. The problem will come with the night cycle where it seems like we get overlap. She is eating good today. Back to Friskies. I'd switched her over to kidney friendly foods when we jumped her lasix up 5X the old dose, which she LOVED the new foods, but nothing was exciting until the ol' Friskies that is neither heart nor kidney friendly came back out.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

I don't know of any written guidelines for higher doses. I played around with the size of reductions. I did 1u reductions sometimes for Jazzy. Also remember that the bigger the dose, the bigger the insulin depot. It can take DAYS for a big depot to clear after a reduction, so sometimes it might make sense to reduce by 1-2 units for a couple of days, let the depot clear out, then increase again to some dose in between.

Jazzy was acro so it's not quite the same thing, but if you want to study Jazzy's spreadsheet when she was earning reductions, I tried to write my thoughts in the Comments section when I could. I did it both for myself, and so it might help somebody else in the future. I went through a lot of trial and error.
 
Re: 11/11 Smokey haven't been here in ages,but we need some

Best wishes to you and Smokey! ((Hugs)) to you and scritches to Miss Smokey from me and Shasta!
 
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