11/23 Eddie AMPS 196 +5 376 PMPS 448

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Member Since 2021
Good morning,

Here is yesterday when I managed to get in a few tests beyond the regular:

https://felinediabetes.com/FDMB/threads/11-22-eddie-amps-358-5-5-268-8-194-pmps-191-5-157.271081/

I'll be having a Zoom meeting with the IM vet today and we are discussing insulin requirements, SRT and the endocrine system in this context:

"One particular challenge with SRS and SRT for feline acromegaly is that the time to onset of an endocrinologic response is highly variable and often quite long. Although Wormhoudt et al8 reported that the median time to lowest insulin dose was 9.5 months for cats that underwent SRT, at least 1 cat in their case series had a documented response within a month of irradiation. Similarly, Mayer et al7 reported that insulin requirements began decreasing within the first 2 months after full-course radiotherapy in 2 of 6 diabetic cats. In a case report, Littler et al30 reported a hypoglycemic episode in a cat 2 months after a hypofractioned course of radiotherapy, which necessitated a decrease in the exogenous insulin dose" ("Endocrine response and outcome in 14 cats with insulin resistance and acromegaly treated with stereotactic radiosurgery (17 Gy) https://avmajournals.avma.org/view/journals/ajvr/83/1/ajvr.21.08.0122.xml , emphasis mine).

Eddie has already had a decrease in insulin from end of October (27u) to now (15u). Although I know ECID I'm wondering if Eddie is following in Blue's pawsteps after his SRT. Blue started needing lower and lower doses about 4 weeks following his SRT in
 
Neko responded within a week of SRT, though it could have also been a combo on glucose toxicity and/or IAA breaking. I had to lower her dose for the ride home, she held the reduction. The people at CSU (where Wormhouldt got her degree) said typically can take at least two weeks to start seeing a reaction. Note, Eddie also has glucose toxicity and IAA in the picture. That means it'll be really hard to pin down what you are seeing, at least in the short term.
It's way too early to guess what Eddie will do.

The statement about hypos in the above quote just tells me what I already knew - home testing BG is essential. Just follow the dosing method with the BG data you have. I like that he's getting some solid blue time on this dose.

Neko's lowest dose post SRT #1 was 70 weeks after SRT complete. Having a response is not the same as lowest insulin dose. After 72 weeks, her dose started creeping up again. ECID.

The Wormhouldt paper is a study of a lot more animals than the one you quoted.
 
Wendy&Neko said:
Neko responded within a week of SRT, though it could have also been a combo on glucose toxicity and/or IAA breaking. I had to lower her dose for the ride home, she held the reduction. The people at CSU (where Wormhouldt got her degree) said typically can take at least two weeks to start seeing a reaction. Note, Eddie also has glucose toxicity and IAA in the picture. That means it'll be really hard to pin down what you are seeing, at least in the short term.
It's way too early to guess what Eddie will do.

The statement about hypos in the above quote just tells me what I already knew - home testing BG is essential. Just follow the dosing method with the BG data you have. I like that he's getting some solid blue time on this dose.

Neko's lowest dose post SRT #1 was 70 weeks after SRT complete. Having a response is not the same as lowest insulin dose. After 72 weeks, her dose started creeping up again. ECID.

The Wormhouldt paper is a study of a lot more animals than the one you quoted.
Click to expand...

I know Eddie has IAA but I didn't know anything about glucose toxicity, at least not officially, if you know what I mean, unless it has to do with Prednisolone...Anyway, I'm thinking that we are seeing some SRT reaction, regardless. What I'm seeing in the short term is to go slow and to expect rebound or "bounce", which may be linked to going low. The IM vet also said that the 95 Eddie hit the other day might well be his going up rather than his going down. He emphasized ECID and particular to Eddie. I was able in a Zoom meeting to share screen and the spreadsheet which was helpful in discussion.

I include the quotation above not to limit it to that but because it succinctly described what is going on; not that no one know this but it's a good baseline for discussion. I included it the paper in the discussion with the vet for that reason.

The whole point seems to be: we are dealing with unknowns because what's happening with Eddie post SRT is manifest as numbers that are highly variable and that the variability unfolds over time. As the vet said, with the rebound/bounce idea, the tendency is to want to increase insulin when in fact the opposite--a decrease--might be in order. He did not say to do this but it is a matter of consideration if only because Eddie is not strictly speaking a cat with DM but DM is part of a more complex issue/condition.

Anyway, all i know is, we go on.
 
Jodey&Eddie&Blue said:
As the vet said, with the rebound/bounce idea, the tendency is to want to increase insulin when in fact the opposite--a decrease--might be in order.
Click to expand...
Exactly, that's why I suggested you get a night time test on the 19th. I had suspected some lows were hiding in there somewhere. Patience and knowing how low the dose is taking Eddie is key.
Jodey&Eddie&Blue said:
because Eddie is not strictly speaking a cat with DM but DM is part of a more complex issue/condition.
Click to expand...
But he's not alone in that. We have many examples of acrocats here, some with or without IAA, examples of IAA only cats, examples of cats who have had SRT. Almost all of them are safely following TR for dosing. The data and the dosing method will guide you in what to do. Since you have a period of time where you cannot tests as much as needed for TR, the SLGS dosing method is a good fallback to help keep Eddie safe. We also have cats with glucose toxicity, meaning cats whose body is used to higher numbers. Regardless of why they have DM.

It is interesting to see that Eddie's numbers now are looking a lot like they did in September, before he had SRT.
 
Wendy&Neko said:
Exactly, that's why I suggested you get a night time test on the 19th. I had suspected some lows were hiding in there somewhere. Patience and knowing how low the dose is taking Eddie is key.

It's very strange because the issue of decrease seems so counterintuitive, yet the choreography makes sense.

But he's not alone in that. We have many examples of acrocats here, some with or without IAA, examples of IAA only cats, examples of cats who have had SRT. Almost all of them are safely following TR for dosing. The data and the dosing method will guide you in what to do. Since you have a period of time where you cannot tests as much as needed for TR, the SLGS dosing method is a good fallback to help keep Eddie safe. We also have cats with glucose toxicity, meaning cats whose body is used to higher numbers. Regardless of why they have DM.

No, I hear you that he's not alone. But he is in his own body/system. I'm kind of glad to have this anomalous period of time because it gives me another perspective on Eddie without compromising his safety. The only weakness in the system is me: I can set alarms and get up a couple of times. I just can't usually get back to sleep and it was playing havoc with my well-being. So, right now, I do set alarm and get up and I can feed him without being too awake and can get back to sleep more easily.

It is interesting to see that Eddie's numbers now are looking a lot like they did in September, before he had SRT.
Click to expand...
yes, when he was on 17u, not 27!
 
He was a lot less bouncy and flatter on 27 units. Not saying he needs that dose now, but if you were following TR you would probably increase to flatten him out and get rid of those higher numbers.
 
Jodey&Eddie&Blue said:
you were talking about a reduction or at least not needing an increase because of the green???
Click to expand...
There is a different reduction point between TR and SLGS. With SLGS, you reduce if you see them go under 90, which he did not on the 20th so I did not suggest you do a reduction that day. I suggested holding the dose that day.
Wendy&Neko said:
but if you were following TR you would probably increase
Click to expand...
That's what I said above - IF you were following TR, which you are not, you would increase. But since you are following SLGS, you would hold the dose. Nothing has changed in what I am suggesting.
 
You must log in or register to reply here.
Back
Top