12/06 Pepper AMPS 417, +6 282 -new ? about hi-dose cats
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KPassa
Member Since 2012
Re: 12/06 Pepper AMPS 417 - Dose Advice?
Since his nadirs are greater than 300, according to the TR Protocol, you would increase by .5u:
Even still, since you said you're opening a new vial of Lantus, does that mean you've been using this vial for a while and it's lost some of its potency? In that case, +.25u might be a safe call until you can see how the new vial affects him. Hopefully, someone more experienced will come along and they'll be able to tell you for sure.
Just as a general inquiry, you're not "rolling" your Lantus bottle, by any chance? I was doing this for the first few weeks, per the vet's instructions, before I found out that you don't need to do this as it can greatly reduce the potency of the insulin over time.
Since his nadirs are greater than 300, according to the TR Protocol, you would increase by .5u:
Even still, since you said you're opening a new vial of Lantus, does that mean you've been using this vial for a while and it's lost some of its potency? In that case, +.25u might be a safe call until you can see how the new vial affects him. Hopefully, someone more experienced will come along and they'll be able to tell you for sure.
Just as a general inquiry, you're not "rolling" your Lantus bottle, by any chance? I was doing this for the first few weeks, per the vet's instructions, before I found out that you don't need to do this as it can greatly reduce the potency of the insulin over time.
Re: 12/06 Pepper AMPS 417 - Dose Advice?
Nancy
I probably would have increased by .5u. But for now, I'd just leave it alone, start your new vial, and give him six cycles to see where he is....unless he comes down into green and then we'll rethink it
Nancy
I probably would have increased by .5u. But for now, I'd just leave it alone, start your new vial, and give him six cycles to see where he is....unless he comes down into green and then we'll rethink it
Nancy&Pepper (GA)
Member Since 2012
Re: 12/06 Pepper AMPS 417 - Dose Advice?
Would it screw things up to give him .5 u more tonight instead of .25 u? I was being a big chicken.
Would it screw things up to give him .5 u more tonight instead of .25 u? I was being a big chicken.
KPassa
Member Since 2012
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
I think you made the right decision this morning; it's better to be safe than sorry! :thumbup And, for me personally, I'd stick with the .25 increase for a little bit longer at first with the new vial in case your old vial actually lost a lot more potency than you may have realized.
I think you made the right decision this morning; it's better to be safe than sorry! :thumbup And, for me personally, I'd stick with the .25 increase for a little bit longer at first with the new vial in case your old vial actually lost a lot more potency than you may have realized.
Nancy&Pepper (GA)
Member Since 2012
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
Hi Kpassa. I'm such a chicken. I'm still afraid to make increases without the experts' stamp of approval. The vial of Lantus is 5 weeks old. I know not to roll it but I'm not sure how long a vial really lasts even if you're careful with it.
Hi Kpassa. I'm such a chicken. I'm still afraid to make increases without the experts' stamp of approval. The vial of Lantus is 5 weeks old. I know not to roll it but I'm not sure how long a vial really lasts even if you're careful with it.
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
I agree with Marje -- hold the dose at 6.25u. Depending on what the numbers are looking like, you could increase after 4 cycles.
I doubt there's a problem with your Lantus losing potency. Unless you mishandled the insulin or you see "floaties," it's probably fine. I've never really seen a big change in numbers as a result of starting new insulin.
I agree with Marje -- hold the dose at 6.25u. Depending on what the numbers are looking like, you could increase after 4 cycles.
I doubt there's a problem with your Lantus losing potency. Unless you mishandled the insulin or you see "floaties," it's probably fine. I've never really seen a big change in numbers as a result of starting new insulin.
Nancy&Pepper (GA)
Member Since 2012
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
Thanks, Sienne. I appreciate your advice.
Thanks, Sienne. I appreciate your advice.
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
Nancy --
I want to make a suggestion. I've been looking at Pepper's SS and I asked several of the people who are very experienced with reading spreadsheets to take a look, as well. Given how consistently flat in the pinks and reds Pepper's numbers have been, coupled with how systematic you've been with your dosing, I think it's worth getting Pepper tested for a high dose condition. Once we see a cat over 6.0u, it's helpful to know if either insulin resistance (Insulin Auto Antibodies; IAA) or acromegaly are the explanation for the numbers. Those conditions may not be present but regardless of whether or not they are, I think it's helpful to know what you're dealing with. That knowledge will help you to make decisions about dosing. There is information about these conditions and how to get testing in this link. Basically, there are 2 blood tests - one for IAA and the other for IGF-1, which is a test for growth hormone which is what causes acromegaly. Your vet would draw the amount of blood needed for the tests and then the sample is sent to the vet lab at Michigan State University. The tests themselves are not terribly expensive -- under $100 for both if I'm remembering correctly. There are people here (e.g., Tracy/Leo) who have acro cats or cats with IAA (Lisa/Do Lou). They can give you first hand information.
Nancy --
I want to make a suggestion. I've been looking at Pepper's SS and I asked several of the people who are very experienced with reading spreadsheets to take a look, as well. Given how consistently flat in the pinks and reds Pepper's numbers have been, coupled with how systematic you've been with your dosing, I think it's worth getting Pepper tested for a high dose condition. Once we see a cat over 6.0u, it's helpful to know if either insulin resistance (Insulin Auto Antibodies; IAA) or acromegaly are the explanation for the numbers. Those conditions may not be present but regardless of whether or not they are, I think it's helpful to know what you're dealing with. That knowledge will help you to make decisions about dosing. There is information about these conditions and how to get testing in this link. Basically, there are 2 blood tests - one for IAA and the other for IGF-1, which is a test for growth hormone which is what causes acromegaly. Your vet would draw the amount of blood needed for the tests and then the sample is sent to the vet lab at Michigan State University. The tests themselves are not terribly expensive -- under $100 for both if I'm remembering correctly. There are people here (e.g., Tracy/Leo) who have acro cats or cats with IAA (Lisa/Do Lou). They can give you first hand information.
Nancy&Pepper (GA)
Member Since 2012
Re: 12/06 Pepper AMPS 417, +3 425, +6 282 - Dose Advice?
I looked at the link. I can't say that I think he sounds like an acro-cat. I'm assuming you think I should discuss this with Pepper's vet? I recently got a copy of Pepper's chart from when he was first diagnosed from the vet. This was September 2011 before I knew anything about home testing - the vet did a curve at the office and Pepper went down to 185 on 1 unit of Novolin N. His numbers weren't as bad when he was first diagnosed. I do think he'd be a lot better today if he had started on Lantus instead of Novolin, because the Novolin did a terrible job of controlling his diabetes. I don't know if that makes any difference to your view of Pepper's possible condition, I just thought I'd mention it. Do they do anything for these cats except increase their dose until it's very high? (I was afraid someone was going to bring this up)
I looked at the link. I can't say that I think he sounds like an acro-cat. I'm assuming you think I should discuss this with Pepper's vet? I recently got a copy of Pepper's chart from when he was first diagnosed from the vet. This was September 2011 before I knew anything about home testing - the vet did a curve at the office and Pepper went down to 185 on 1 unit of Novolin N. His numbers weren't as bad when he was first diagnosed. I do think he'd be a lot better today if he had started on Lantus instead of Novolin, because the Novolin did a terrible job of controlling his diabetes. I don't know if that makes any difference to your view of Pepper's possible condition, I just thought I'd mention it. Do they do anything for these cats except increase their dose until it's very high? (I was afraid someone was going to bring this up)
Pepper may not be an acro kitty. He may be insulin resistant. We don't know if he's is or isn't. There are different issues related to dosing depending on the diagnosis. However, you're right -- you do raise the dose until there's a break through. With acro, the cause of the need for insulin is a pituitary tumor that revs up and down with regard to whether growth hormone is released. Acro cats have a functioning pancreas and are not diabetic in regard to the beta cells of the pancreas not working they way they should. With IAA, you need to get ahead of the antibodies in order for the insulin to begin to bring numbers down. With either of these conditions, numbers can rise or fall either because the tumor is not releasing growth hormone or because you have "squished" the antibodies. FWIW, Gayle (aka "Blue") has an acro cat that's OTJ.
There is a treatment for acro. Julie/Punkin or Tracy/Leo can fill you in on the details.
There is a treatment for acro. Julie/Punkin or Tracy/Leo can fill you in on the details.
Nancy&Pepper (GA)
Member Since 2012
Thanks for the information. I read some of the acro cat stories. I guess I just don't want it to be true. Maybe I'll talk with the vet about the tests.
Hi Nancy, Neko tested positive for both IAA and acromegaly. She has had the stereotactic radiation therapy (SRT) that both Leo (Tracy) and Punkin (Julie) had. The SRT is currently offered at Colorado State University and Yonkers. It's a 4 day process, and SRT neuters the (benign) tumor cells so it eventually dies off. A subset of acro kitties have had SRT because of the time commitment and $$ involved. Not everyone can do it. There are untreated acro kitties that have continued on for a number of years without treatment, but there are some things about acromegaly and how it affects kitties that are important to know. As an example, there can be soft tissue growth in the larynx, so acrocats who have to go under anesthesia should have kitten sized breathing tubes. The most important thing for acrocats is to try to get their blood sugar under control. As Sienne mentioned, there have been OTJ acro cats, or even ones who end up on lower doses once they reach their breakthrough dose. IAA is supposed to be self limiting over time, and as the IM vet at CSU said to me "acromegaly trumps IAA".
But that's getting ahead of things for Pepper. The first step is to get the tests done. Normally your vet will be involved, because they do the blood draw for the sample that is sent to MSU. Be prepared for the vet to be skeptical as they are taught these are very rare conditions. Mine was just humoring me by doing the tests and was probably more surprised than me at the results. My vet has since recognized that Neko isn't the only acrocat in her practice. If Pepper tests positive for one or the other, you might end up changing your dosing strategy a bit. And not all high dose cats have one of these conditions. We were on Caninsulin for a couple of months which didn't help things either.
Feel free to PM me if you have other questions. There is also a ton of information on the high dose calendar. I just got mine and I'm finding the pictures and info quite useful.
But that's getting ahead of things for Pepper. The first step is to get the tests done. Normally your vet will be involved, because they do the blood draw for the sample that is sent to MSU. Be prepared for the vet to be skeptical as they are taught these are very rare conditions. Mine was just humoring me by doing the tests and was probably more surprised than me at the results. My vet has since recognized that Neko isn't the only acrocat in her practice. If Pepper tests positive for one or the other, you might end up changing your dosing strategy a bit. And not all high dose cats have one of these conditions. We were on Caninsulin for a couple of months which didn't help things either.
Feel free to PM me if you have other questions. There is also a ton of information on the high dose calendar. I just got mine and I'm finding the pictures and info quite useful.
Tracy & Leo
Member Since 2011
Hi Nancy and Pepper!
I've never stopped by your condo before but my eye caught the question about hi-dose kitties. Sienne mentioned me and my kitty Leo, I had Leo tested for acromegaly after he got up over 6 units a day, I listened to the wise people of Lantus-Land When i told our vet i wanted him tested her response was "but i only recommend testing for acromegaly on cats who are over 20 units of insulin" if i had listened to her i still wouldn't know Leo was an acro-cat!! I had Leo tested for just the IGF-1 and not IAA because at the time for me to get both tests done it would have cost me well over $500 
(i'm in Canada). But as Wendy said, acromegaly trumps IAA. Just think of it this way, if you get the test done then at least you'll know, Pepper will still be the same kitty whether he is acro, IAA or not.
I am here for you if you have more questions!
Hugs to both you and Pepper.
PS take a look at Leo's SS, he wasn't the typical pink and red acro-cat.
I've never stopped by your condo before but my eye caught the question about hi-dose kitties. Sienne mentioned me and my kitty Leo, I had Leo tested for acromegaly after he got up over 6 units a day, I listened to the wise people of Lantus-Land
When i told our vet i wanted him tested her response was "but i only recommend testing for acromegaly on cats who are over 20 units of insulin" if i had listened to her i still wouldn't know Leo was an acro-cat!! I had Leo tested for just the IGF-1 and not IAA because at the time for me to get both tests done it would have cost me well over $500 (i'm in Canada). But as Wendy said, acromegaly trumps IAA. Just think of it this way, if you get the test done then at least you'll know, Pepper will still be the same kitty whether he is acro, IAA or not.I am here for you if you have more questions!
Hugs to both you and Pepper.
PS take a look at Leo's SS, he wasn't the typical pink and red acro-cat.
Wendy&Tiggy(GA)
Member Since 2011
I found this document on insulin resistance http://www.2ndchance.info/diabetescat-insulinresistance.pdf It says insulin resistance is suspected at >6IU per dose or >1.5IU per kg. Given Pepper is a big boy at 15lbs (6.8Kg) he isnt yet at the 10IU that would fall into this category... yet.. But this paper is worth a read and its worth keeping in mind.
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