julie & punkin (ga)
Member Since 2011
yesterday
punkin was downright obnoxious about getting tested this morning. he acted like he was starving and was trying to get away from me before i even poked him. his wiggliness knocked over the lancet device and the little button you push to release the lancet popped off. fortunately we were able to get it back on. I'd have believed the "I'm starving" story more except that he got an extra 1/2 can last night that anya left. snarf boy.
last night after i got offline, liz asked about why we've dropped his dose in half a couple of times to let his shed drain. Was it because he has acromegaly or because his dose is large?
the answer is yes to both, Liz. acromegaly is caused by a tumor in the brain that puts out a hormone that prevents your body's insulin from getting into the cells. The simplest treatment for that is to increase the dose of insulin so that enough insulin gets in to keep the BG in non-organ-damaging numbers. Hence, sometimes astonishingly large doses - Sooty was getting 90ish units twice a day at one point. One vial gives you about 900 usable units - so one vial every 5 days. Most acrocats seem to need up to around 14u, but i think there's not really any standard. Punkin was at 15.5u per dose in Sept.
With Lantus, a shed builds up inside the body where you've shot it that corresponds in size to the size of the dose. The shed is formed of micro-crystalline precipitate that dissolves and releases over time. If you have a small dose, you have a small shed. The bigger dose of Lantus means that the shed contains a lot of insulin in precipitate form (as Sandy says "they have a shed the size of Lake Michigan") which can release a lot of insulin over a long time period. How long - I don't know. But I know i've skipped doses with punkin and seen almost no change in the numbers of the next cycle.
The second factor is the tumor is called "pulsative" meaning that it pulses in its secretions. Think of a light dimmer switch - on and off, or slight up and down. The SRT (Stereotactic Radiation Therapy) that punkin had done at Colorado State University in September causes the cells in the tumor to not be able to replicate themselves. That means that the cells that were alive and secreting on September 20th would live out their lifespan, but they would not be replaced by more secreting cells. These secretions by the tumor are what's causing him to be diabetic. It's like type 2 diabetes in humans - it's caused not by the pancreas malfunctioning as happens in type 1, but it's caused by this tumor. Most of our cats here are type 2 as well - their diabetes is caused by steroids, obesity, inactivity, excessive stress - that's why we have so many go OTJ. The cause gets resolved and the insulin receptors work again.
The potential for the tumor to turn down/off combined with the size of the shed that will keep on giving is the reason many of the people with acro cats use Regular insulin in combination with Lantus or Levemir. R can knock down the higher numbers without building up the shed, so you're decreasing the risk from the giant shed.
So . . . the potential problem that i'm seeing that causes me to drop the dose: at any point, any cat with acromegaly could have the tumor shut off production and the cat's shed would continue giving insulin that would now be dramatically more than a cat could ever need, potentially causing a hypoglycemic event that would be extremely difficult to counteract. Combine that with punkin's apparent lessening need for insulin from the SRT. If he's had a run in the under 100's that tells me he's needing less insulin, I drop the dose in half to let the shed drain some, then return to a slightly reduced dose. I hold it there til he seems to need less again, and repeat.
This tactic seems to be working for punkin. I don't know how others have done it. There have only been a handful of kitties have the SRT - it's only been available for a couple of years. The gravest danger for any of these cats is for them to get too low and you not to be able to pull them up. I want to avoid that. This is the main reason that cats with high doses avoid the green numbers - it gives a safety margin for our little ones. if his tumor is killed he *shouldn't* need insulin. Unless, of course, his beta cells have been too damaged by high numbers to become functioning again - in his case i doubt that's happened because his numbers haven't been sky high for any sustained length of time.
Probably more than you wanted to know, but I keep documenting in case someone in the future needs the information.
My quilting group is coming today so i'll check condos this evening. in the meantime, punkin is holding down the coffee table for me and anya is holding down the ottoman. *whew* won't have to worry about levitating furniture today!
Hope you all have a good day too.
edited to add today's numbers:
amps 207
+3 150
+5 124
pmps 200
+3 122
punkin was downright obnoxious about getting tested this morning. he acted like he was starving and was trying to get away from me before i even poked him. his wiggliness knocked over the lancet device and the little button you push to release the lancet popped off. fortunately we were able to get it back on. I'd have believed the "I'm starving" story more except that he got an extra 1/2 can last night that anya left. snarf boy.
last night after i got offline, liz asked about why we've dropped his dose in half a couple of times to let his shed drain. Was it because he has acromegaly or because his dose is large?
the answer is yes to both, Liz. acromegaly is caused by a tumor in the brain that puts out a hormone that prevents your body's insulin from getting into the cells. The simplest treatment for that is to increase the dose of insulin so that enough insulin gets in to keep the BG in non-organ-damaging numbers. Hence, sometimes astonishingly large doses - Sooty was getting 90ish units twice a day at one point. One vial gives you about 900 usable units - so one vial every 5 days. Most acrocats seem to need up to around 14u, but i think there's not really any standard. Punkin was at 15.5u per dose in Sept.
With Lantus, a shed builds up inside the body where you've shot it that corresponds in size to the size of the dose. The shed is formed of micro-crystalline precipitate that dissolves and releases over time. If you have a small dose, you have a small shed. The bigger dose of Lantus means that the shed contains a lot of insulin in precipitate form (as Sandy says "they have a shed the size of Lake Michigan") which can release a lot of insulin over a long time period. How long - I don't know. But I know i've skipped doses with punkin and seen almost no change in the numbers of the next cycle.
The second factor is the tumor is called "pulsative" meaning that it pulses in its secretions. Think of a light dimmer switch - on and off, or slight up and down. The SRT (Stereotactic Radiation Therapy) that punkin had done at Colorado State University in September causes the cells in the tumor to not be able to replicate themselves. That means that the cells that were alive and secreting on September 20th would live out their lifespan, but they would not be replaced by more secreting cells. These secretions by the tumor are what's causing him to be diabetic. It's like type 2 diabetes in humans - it's caused not by the pancreas malfunctioning as happens in type 1, but it's caused by this tumor. Most of our cats here are type 2 as well - their diabetes is caused by steroids, obesity, inactivity, excessive stress - that's why we have so many go OTJ. The cause gets resolved and the insulin receptors work again.
The potential for the tumor to turn down/off combined with the size of the shed that will keep on giving is the reason many of the people with acro cats use Regular insulin in combination with Lantus or Levemir. R can knock down the higher numbers without building up the shed, so you're decreasing the risk from the giant shed.
So . . . the potential problem that i'm seeing that causes me to drop the dose: at any point, any cat with acromegaly could have the tumor shut off production and the cat's shed would continue giving insulin that would now be dramatically more than a cat could ever need, potentially causing a hypoglycemic event that would be extremely difficult to counteract. Combine that with punkin's apparent lessening need for insulin from the SRT. If he's had a run in the under 100's that tells me he's needing less insulin, I drop the dose in half to let the shed drain some, then return to a slightly reduced dose. I hold it there til he seems to need less again, and repeat.
This tactic seems to be working for punkin. I don't know how others have done it. There have only been a handful of kitties have the SRT - it's only been available for a couple of years. The gravest danger for any of these cats is for them to get too low and you not to be able to pull them up. I want to avoid that. This is the main reason that cats with high doses avoid the green numbers - it gives a safety margin for our little ones. if his tumor is killed he *shouldn't* need insulin. Unless, of course, his beta cells have been too damaged by high numbers to become functioning again - in his case i doubt that's happened because his numbers haven't been sky high for any sustained length of time.
Probably more than you wanted to know, but I keep documenting in case someone in the future needs the information.
My quilting group is coming today so i'll check condos this evening. in the meantime, punkin is holding down the coffee table for me and anya is holding down the ottoman. *whew* won't have to worry about levitating furniture today!
Hope you all have a good day too.
edited to add today's numbers:
amps 207
+3 150
+5 124
pmps 200
+3 122
Thank you!