11/29 Ozy update AMPS-294

Status
Not open for further replies.
donaleen and Ozy

donaleen and Ozy

Member Since 2013
We raised Ozy's dose to 6.5 units today.

As I look at his SS, what I see is that when the insulin brings him down to green, he bounces up and never comes down again until his dose goes up. To me that says that some mechanism in his body is actively fighting the insulin. It wouldn't seem that acromegaly would behave that way. Isn't the insulin resistance just a side effect of the growth hormone? Wouldn't his glucose be more erratic from that?

Ozy's neck has been swollen and I think those lumps are swollen lymph nodes. The swelling comes and goes, and can change radically in twelve hours. We are taking him to the vet this morning to check his teeth more carefully and talk about options. The vet said on the phone we could try switching to Levemir and see if that makes a difference.

Our plan at this point is to try and rule out an infection (in his teeth or sinuses or throat) because his breath is bad. Then to try Levemir and see if it works better. No other ideas.

I've tried some food changes and those have not been successful. I think he reacted badly to the rabbit (meatloafing). I think changes are hard on his digestive system for whatever reason.

Any ideas?

thanks
donaleen
 
I found Tiggy was the same way until I got more aggressive in dosing. Now I wait three days and if I don't see enough green we go up. I don't wait till insulin resistance sets in. Send a PM to dale and chip. He has been so helpful with Tiggy and might be able to explain more.
 
That's funny I was just looking at Ozy. Acro or IAA doesn't jump out at me but the tests aren't all that expensive to eliminate those. If you can rule out infection and dental problems, it might be a case of getting him more accustomed to normal numbers by getting him there and keeping him there longer until his liver is trained.

Levemir may help smooth things out. Might be as simple as typical temporary resistance or other (minor?) issues but I'd definitely look into the swollen lymph nodes.
 
Hi Donaleen, sorry to hear that Ozy's not feeling so well. I hope you got some answers at the vet today. Ruling out any sort of infection or dental issues is important as that can impact dose. However, once infection is ruled out, when kitties get to 6U is when we suggest getting tests for acromegaly IGF-1 test or IAA.

Neko has both of these conditions. Getting the tests done can help determine a strategy going forward. With cats with IAA, you can be a bit more aggressive with the dosing. It looks like you are already doing a good job going up the dosing ladder with Ozy. Neko's reaction to dose increases was similar. She would get some greens and then the dose would do what I thought of as "going stale". It would stop working or wouldn't work as well. Sometimes she would get into greens a second time, but that would be it. Take a look at her 2012 SS. The most important thing you can do for an acrocat, should Ozy be one, is to try to keep his blood sugar in good numbers.

There is another important reason for finding out if a cat has acromegaly. The growth hormones can also impact internal organs, especially the heart and liver. Enlarged hearts can mean a type of hypertrophic cardiomyopathy (HCM). This means enlarged heart and can lead to strokes. But it is something that can be treated with medication if you know about it. It's also something Maine Coon cats can get. I lost a cat two years ago to HCM, 2 days before his follow up heart ultrasound was scheduled. :sad: My Neko has a heart murmur, so we got an echocardiogram (heart ultrasound). Her heart is just .1mm outside of spec, but she is a largish cat (14lbs) and the cardio vet thought she was fine. One more thing - acrocats have working pancreases. This means that food can trigger the pancreas to work. I have to be careful when Neko is low to only give high carb food. I have experimented with low carb and higher low carb food, and had her blood sugar take a dive at the wrong time.

I September I switched from Lantus to Levemir. Some people switch because Lantus at high doses could sting, it's acidic. However, it never bothered Neko (we got to 8.75U) and it didn't seem to bother Pepper (who got to 26U). ECID - I think Marje said Gracie noticed it at quite small amounts. I switched to try and change Neko's night time diving habits - it didn't impact that. :roll: I do find Neko is flatter on Levemir, but again, not all cats react the same. It's worth trying however, if you can live with a schedule that is a later onset and nadir.

Some kitties (not just acrocats) have IBD, and do seem sensitive to food changes and particular proteins. I believe Ozy's on Wellness Chicken and Turkey now? If rabbit isn't working, you could try lamb or venison to see if he handles that better.
 
Dale 'n' Chip said:
That's funny I was just looking at Ozy. Acro or IAA doesn't jump out at me but the tests aren't all that expensive to eliminate those. If you can rule out infection and dental problems, it might be a case of getting him more accustomed to normal numbers by getting him there and keeping him there longer until his liver is trained.
Click to expand...

Hi Dale... how do I get him there and keep him there longer?

Wendy... Ozy's lymph nodes are fine today. We did schedule a dental. And he is taking a course of Clavomax, both because his breath smells like an infection and because they give a course of antibiotics before a dental.

Ozy eats Wellness grain free turkey and salmon, which also has chicken and whitefish listed on the label. He has been eating it for about a year. It was suggested to me that too much of the same thing was bad and could cause a food allergy which could raise his glucose. So I tried rabbit but I don't think it agreed with him.

Thanks for the information. Acromegaly seems pretty scary.
 
Good on scheduling the dental. I've just done the same thing with Neko. I've seen dentals make quite a difference. Sienne did a post on dentals which is a good read.

Acromegaly originally seemed scary to me too, but once I found out, then I knew what I was dealing with and how to approach it. It gave me answers whereas before hand I wasn't sure what to do.
 
Looks like you are *close* already with what you are doing. I tend to shoot low(er) to stay low(er) but of course I am using Levemir with Chip and I have plenty of data to support it. At this point I don't suspect Chip is acro. I don't have much patience with reductions that may be failing.

Ozy seems to get so close at times and you are certainly getting lots of data and plenty of testing.

You might want to get IGF-1 and IAA tests since the results may impact the approach if he might be acro with a possibly functioning pancreas.
 
Now that his dose is so high, it seems the Lantus is really starting to sting and Ozy is really unhappy with his injections. I guess that's reason enough to switch to Levemir.
 
If you do decide to switch, we start the new insulin dose at 70% of the old insulin. At his current dose, that would be 4.5U Levemir. Some cats have a strong response to the new insulin at first. And some cats need a lower dose and some a higher dose when they switch. You just have to be ready to up the dose if he's high and flat.
 
i think that is a good enough reason to make the switch. you're doing a great job with him, donaleen. it's challenging when you have a kitty that doesn't read the protocol and make things easy for you! ;-)

i'll be anxious to see what the dental does for him!
 
Sorry to just get to your post donaleen but you've gotten good info.

Gracie did get a bit of a sting at about 1.25u of Lantus which is a small dose but she was never at that dose long so that's not why I switched her.

Levemir is a great insulin. It does help some cats get a little flatter.

Please let us know when you switch. You'll want to just shoot the Lantus one cycle and then the lev the next but as Wendy said, we generally drop the lev dose back by 30%. Even still, some cats may have a very measured and active response to the change so you will need to be really on your toes the first cycle or two in case he becomes very active.
 
Thanks Julie and Marje. The vet wants to wait until after his dental and after the antibiotic to do the switch. So in the meantime, we aren't raising his dose above 6. He does medium well with that dose... not as much flinching and biting and crying and hissing and fighting and hiding. It is soooo hard to give him a dose that hurts him.

He bounced so hard on the 6.5. He got his highest reading ever. He hardly ever goes over 400 and he got a 438.

His pre dental bloodwork is scheduled for Friday and his dental for the following Wednesday. I am more than a little scared of the dental. I read a terrible story about a cat getting a trachea tear during a dental.

How long does it take for the dental cleaning to have an effect on his BG, assuming there is an infection and it goes away?

Five months today since his diagnosis. His body seems pretty determined to keep his BG numbers high.
 
Have you seen Sienne's post on Dental Procedures? It's excellent.

In terms of how long it takes to see BG come down if the issue was dental, it's one of those ECID issues. You should see some change in his BG as soon as any infection is resolved.

Sending many prayers for a good and safe dental.

On the lev....that's reasonable. Just let us know and we'll help you, if you like. :-D
 
hi donaleen - i'm going to just keep posting on here since there isn't a newer condo. hope that's not too confusing.

punkin saw better numbers beginning within a few days. with Ozy already on AB's, i'm not sure what the response might be. punkin got ABs after the dental.

he's a bit flat yellow today - his bounces are so interesting.
 
Status
Not open for further replies.
Back
Top