? 12/26 MICIO: AMPS 265 / 156@ +3 / 186@ +5.5 / 246@ +9.75 / PMPS 246 /

MISSY + Simone&MICIO (GA)

MISSY + Simone&MICIO (GA)

Member Since 2021
Yesterday: AMPS 232 / 184@ +3 / 209@ +5.5 / 276@ +9.5 / PMPS 260 / 213@ +5.5
Ended another 6th cycle @ 3.75u and it looks like I'll have to increase again and go up to 4u!
As I was looking through comments and files about insulin resistance, dosage and Acromegaly, I run across some old comments about 4u of Lantus considered a "massive dose" and that most cats won't need over 3u to get better BG numbers... , @Chris & China (GA) Karen Nicholson, if you find the time, could I also get your input on Micio's diabetes situation? (I have been promptly and gratefully helped about dosage anytime I needed by other knowledgeable members, I'm just looking for a second opinion especially after reading some concerning dosing comments...)

I think Micio is doing a bit better as his numbers are lower since we started insulin on this November 1st, but getting concerned over the amount of insulin; could this be symptoms of Acromegaly? Where do I find Acromegaly files/discussions in FDMB?
I am taking Micio to the vet on Friday for his first check up since diagnosis and trying to get prepared for possible questions to the Dr.
Any help will be greatly appreciated, tnx
 
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First, 4.0u is not by any means a "massive dose." I'm not sure who would have said that other than someone with limited experience. (As a reference point, we've had a cat with acromegaly whose dose was 60u -- and I do mean sixty, not six. That large of a dose is also an anomaly.) As a general rule, we don't even consider suggesting a cat get tested unless the dose is above 5.0u. And if so, if the numbers are running high with very little variation.

In Micio's case, you're seeing a response to Lantus. His numbers are systematically moving from the 300 - 400 range to 100 - 200. This is good progress. He was also diagnosed in October (I'm assuming of 2021 since it's not clear in your signature.) It likely took a while for Micio's diabetes to develop. It's going to take time and patience for his numbers to get regulated.
 
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Your SS show improving (lower) BGs for preshot and between shots. Thus, I would keep slowing increasing dose like you are doing.
Depending upon BG and dose, you might consider getting blood test for acromegaly and IAA.
 
Sienne and Gabby (GA) said:
First, 4.0u is not by any means a "massive dose." I'm not sure who would have said that other than someone with limited experience. (As a reference point, we've had a cat with acromegaly whose dose was 60u -- and is do mean sixty, not six. That large of a dose is also an anomaly.) As a general rule, we don't even consider suggesting a cat get tested unless the dose is above 5.0u. And if so, if the numbers are running high with very little variation.

In Micio's case, you're seeing a response to Lantus. His numbers are systematically moving from the 300 - 400 range to 100 - 200. This is good progress. He was also diagnosed in October (I'm assuming of 2021 since it's not clear in your signature.) It likely took a while for Micio's diabetes to develop. It's going to take time and patience for his numbers to get regulated.
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Thank you for looking into this, I'm trying to gather as much info as I can and, because I came across some old comments ( from well experienced people) about 4u being a high dose, I started getting concerned and look for more info that eventually led me to acromegaly and so on, but hopefully it's not Micio's case. I'll try to find those comments and re-read those once again
Larry and Kitties said:
Your SS show improving (lower) BGs for preshot and between shots. Thus, I would keep slowing increasing dose like you are doing.
Depending upon BG and dose, you might consider getting blood test for acromegaly and IAA.
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What's IAA? Tnx
 
IAA = insulin auto-antibodies. There is a means of testing for insulin resistance that assesses for the presence of these antibodies. It refers to what can be a self-limiting higher dose condition whereby there are antibodies present with interfere with the effectiveness of insulin. You have to keep increasing the dose in order to get ahead of the antibodies. At some, the cat stops producing antibodies and insulin needs drop. Acro and IAA can co-occur and we often suggest that if getting a cat tested, you test for both.
 
Sienne and Gabby (GA) said:
First, 4.0u is not by any means a "massive dose." I'm not sure who would have said that other than someone with limited experience. (As a reference point, we've had a cat with acromegaly whose dose was 60u -- and is do mean sixty, not six. That large of a dose is also an anomaly.) As a general rule, we don't even consider suggesting a cat get tested unless the dose is above 5.0u. And if so, if the numbers are running high with very little variation.

In Micio's case, you're seeing a response to Lantus. His numbers are systematically moving from the 300 - 400 range to 100 - 200. This is good progress. He was also diagnosed in October (I'm assuming of 2021 since it's not clear in your signature.) It likely took a while for Micio's diabetes to develop. It's going to take time and patience for his numbers to get regulated.
Click to expand...

Thank you for looking into this. As I was looking into insulin resistance and dosage, I came across that "4u insulin is massive dose" and few other comments (but hopefully they were referring to "newly diagnosed "cats that were started on high dosage insulin) and that prompted me to research even further and freak out more about possible undergoing issues like acromegaly and others...
I'm also trying to gather as much info as I can cause I'm taking Micio to the vet this Friday for the first time since diagnosed with diabetes and I already know the Dr. will just fire me after she'll know how much insulin I'm giving him...Dr. wasn't there when the whole diabetes ordeal started and left me on my own but luckily I found you guys and no matter what she says, I'll stick with this group. Just having a hard time finding another vet right now though...
 
As Sienne said "4.0 unit is a massive dose" could only have been said by someone with little experience. I'll do her one better and see we've seen cats on over 80 units, though only a couple I can remember in my time here. Both those cats had acromegaly and IAA (one couldn't be tested, so it was a guess). My girl had both conditions and maxed out at 8.75 units and at some points was on a dose less than 1 unit. We do have one cat with acromegaly here, Walter, who is trying to decide if 1.75 or 2.0 units is his dose. So what does all this mean? First - a cat needs however much insulin they need. The important numbers are the blood sugars, not the size of dose. And second - a diagnosis of acromegaly does not mean a high dose needed. A recent study has shown that one in four diabetic cats has acromegaly.

This forum has information on those conditions: Acromegaly / IAA / Cushings Cats and we have a couple links in the bottom of the New to the Group Sticky Note that have some information on acromegaly. One thing to keep in mind, I read that only about 35% of cats with acromegaly have physical signs of it on diagnosis. Neko's only symptoms were a ravenous appetite (growth hormone excess, sort of like growing teenager appetite), her dose, and one tearing eye. The latter from soft tissue growth in her tear duct. Her vet did not think she had acromegaly, until I insisted we test for it.

The above is all for your information, not because I think he has acromegaly. It's always good to learn about different conditions and will allow you to have a decent chat with the vet. By the way, the vet shouldn't fire you for the dose you are giving. Show her the spreadsheet, his numbers are getting better as you go up in dose. You could also print off the paper with the TR protocol in it so she knows you are following a researched dosing method. That's what I did. Treatment of the diabetes was my turf, I followed everything else she said about Neko's other conditions. Micio has a lot going on. One other thought, you could ask the vet for a referral to an internal medicine doctor. I found Neko's IM really good at balancing multiple conditions. And he called Neko's diabetes "well managed". So I liked him.

Is Micio still on budesonide? Although it didn't impact Neko's blood sugar, I have seen it do so for some. Micio also has a couple of other conditions that can cause insulin resistance, IBD or inflammation and CKD. Insulin resistance means a higher dose may be needed.
 
Wendy&Neko said:
As Sienne said "4.0 unit is a massive dose" could only have been said by someone with little experience. I'll do her one better and see we've seen cats on over 80 units, though only a couple I can remember in my time here. Both those cats had acromegaly and IAA (one couldn't be tested, so it was a guess). My girl had both conditions and maxed out at 8.75 units and at some points was on a dose less than 1 unit. We do have one cat with acromegaly here, Walter, who is trying to decide if 1.75 or 2.0 units is his dose. So what does all this mean? First - a cat needs however much insulin they need. The important numbers are the blood sugars, not the size of dose. And second - a diagnosis of acromegaly does not mean a high dose needed. A recent study has shown that one in four diabetic cats has acromegaly.

This forum has information on those conditions: Acromegaly / IAA / Cushings Cats and we have a couple links in the bottom of the New to the Group Sticky Note that have some information on acromegaly. One thing to keep in mind, I read that only about 35% of cats with acromegaly have physical signs of it on diagnosis. Neko's only symptoms were a ravenous appetite (growth hormone excess, sort of like growing teenager appetite), her dose, and one tearing eye. The latter from soft tissue growth in her tear duct. Her vet did not think she had acromegaly, until I insisted we test for it.

The above is all for your information, not because I think he has acromegaly. It's always good to learn about different conditions and will allow you to have a decent chat with the vet. By the way, the vet shouldn't fire you for the dose you are giving. Show her the spreadsheet, his numbers are getting better as you go up in dose. You could also print off the paper with the TR protocol in it so she knows you are following a researched dosing method. That's what I did. Treatment of the diabetes was my turf, I followed everything else she said about Neko's other conditions. Micio has a lot going on. One other thought, you could ask the vet for a referral to an internal medicine doctor. I found Neko's IM really good at balancing multiple conditions. And he called Neko's diabetes "well managed". So I liked him.

Is Micio still on budesonide? Although it didn't impact Neko's blood sugar, I have seen it do so for some. Micio also has a couple of other conditions that can cause insulin resistance, IBD or inflammation and CKD. Insulin resistance means a higher dose may be needed.
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Micio stopped Budesonide on 9 December this month after a few years he was on a 0.3ml every other day and in the last 3 months I tapered down to 0ml. Micio always had great appetite but lately it's even greater. he's been having a tearing eye for the last couple of years but always thought he's allergic to fish, vet never had a clue. But, for the last year he has a "cyst" on his left cheek that is filled with liquid (clear stuff with a smidge of blood) that can get as big as a walnut overtime, so we poke it to let the liquid out but it'll fill back again, vet always said is benign. I also noticed he has several smaller bumps around his body (almost like skin tags) and some bumps on his spine (vet calls that arthritis.... I don't know if any of this could be symptoms of those disease mentioned above.
THANK YOU for the suggestions. I did make an appointment with the IM just in case (it's on Jan 4th) and we'll see how it goes with the regular vet. I'll print out some stuff to bring at the appointment and go from there.
 
The teary eye isn't a common trait of acromegaly, but I have seen one or two other caregivers of acros reference it as well. The bony and soft tissue growths that come with the excess growth hormone caused by acromegaly seem to differ by cat. Neko also has some soft tissue growth in her gums, and a bony growth on her jaw. She also has arthritis, and even I could feel it, though it took a couple years to manifest. But arthritis is not uncommon for older cats in general. Snoring or breathy sounds, pot belly, jaw changes are more common. I'd make a list of everything you are seeing in Micio and tell the IM vet about it.
 
MissyKat said:
"4u insulin is massive dose" and few other comments (but hopefully they were referring to "newly diagnosed "cats that were started on high dosage insulin)
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Bingo! For awhile (maybe 5-6 months a couple of years ago), for some reason a lot of newly diagnosed cats were all being started at 4U...like they were all going to the same mis-informed vet! We still see it too much in the Facebook group but not like we were during that one time period. My own vet that diagnosed China told me to start her at 4U and when I said I wasn't comfortable with that (she weighed less than 7lbs at the time) he said I could start where I wanted but he was sure she'd end up needed a lot more than even the 4U! I thank the Lord every day that when I Googled "feline diabetes" that almost every search result led to the FDMB.

As long as you started at a reasonable dose and increases were done in appropriate amounts, 4U isn't "massive" at all. You're doing great and Micio's numbers prove it! Lots more blue and no more pink or red!

Keep up the awesome job you're doing and remember, ECID! (Every Cat is Different)
 
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