2/14 Oscar amps 297 +6 275 - update and acro questions

[Kelly & Oscar]

Previous condo: viewtopic.php?f=9&t=34534&p=361597

An over due update for us. I am in my last semester of doctoral work and taking way too many credit hours this semester! I barely have time to breathe :dizcat

Oscar's blue/green trend ended several weeks ago and we are back to bouncing around between nice and beautiful blue/greens and up to yellows, sometimes for no possible discernible reason. He acts fine - even on days like today. Sleeps in the sunshine, begs for food, still drinks from the water bowl every day, and romps with Yoda.

The more and more I go through this with him, the more and more I am thinking he is showing signs of acro (even though he isn't a high dose kitty). He is a big kitty, but the only physical sign I can see is large paws. What mostly concerns me is the continued drinking, and his fur is still not back to being fluffy like it was pre-diabetes. (though it is healthy, shiny, and soft). Nothing has shown up on blood work (except slightly low lymphocytes). If anyone wants to take a look - here is a link to the blood work that has been run in the last year: https://spreadsheets.google.com/pub?key ... utput=html

Am I just driving myself crazy thinking that Oscar will ever get nicely regulated? Am I looking for something when nothing is wrong? I have almost given up on OTJ hopes for him.

 

[Carolyn and Spot]

Hi Kelly,
I don't see "acro numbers" but I do have a suggestion: Levemir may help flatten those curves for you. Lantus has a little more of a "kick" and some kitties feel it loud and clear. I see you're using carts and vials.. for a cat at this dose, I would stick with carts or pens only. (Canada is cheap!) Vials just don't seem to last well with doses this small. If he was acro, I expect he would have hypo'd at least once in those greens. Earlier on in your SS you commented everyone was getting a can less and that was 3 cans in one cycle and 4 cans in the other.. if that's fancy feast, at 3oz per can, your cats are getting 21oz a day of food? That is too much food, so I hope I misunderstood. Are you feeding the equivalent in raw? A normal healthy cat should eat 6-8oz a day. If he's getting too much, that could be interfering with your regulation. I also see he's been at pretty low numbers and not earned reductions. I'd hazard a guess his dose is a little high as the yellows appear to possibly be a bit of bouncing. Overall, *most* of the time, he is below the renal threshold and I'd say you're doing well! My number one recommendation is a switch to levemir though. IMO you will be surprised at the difference an insulin switch can make, and since the two insulins are so close, you wouldn't have to start over. You can knock about 1/3 of his dose off when starting to Levemir and adjust from there. Hope this helps!

 

[Sienne and Gabby (GA)]

I like Carolyn's suggestion re. the Lev. While Lantus and Lev are similar in the way that they act (i.e., they are both long-acting, depot-type drugs), they are chemically different. Oscar's system may do better on Lev. Functionally, the biggest difference is that Lev has a later nadir. It's worth a try if you're getting frustrated.

 

[Kelly & Oscar]

I have been toying with the idea of switching to levemir. Let me answer a few questions though. When noted that we are using a vial, it is because we are using donated insulin from a human diabetic. We didn't have to buy it. Also, the food amounts are for 3 kitties and not just Oscar. On the raw food he gets 3 large tablespoons per cycle. For dose reductions we can't reduce if he goes below 50 only once. He has to go below at least 3 times before I can reduce and have the reduction hold. At least this is what I have experienced so far with him.

 

[Libby and Lucy]

I don't see acro either, not that it can't be (we haven't tested cats at this low a dose and this well regulated very often). I do see a cat that most people would call nicely regulated. I know what you mean, though, about wanting to see something different. I notice a big difference in Jazzy when she is under 200 vs. when she is over 200, and I want to aim for the numbers that keep her where she is happy and comfortable and not drinking and peeing too much. That's not too much to ask.

I think Levemir is definitely worth a try, if you can get it. It's hard to give up free insulin, though, so that's not an easy decision. If you stay with Lantus, remember that it's not unusual for cats to occasionally need a bump up in dose for a cycle or two to help them get their momentum back. You don't have a ton of room because he has had some 40s on this dose, but you could increase the dose on a cycle when you'll be able to monitor for a few days and see where it takes him. He would probably earn a reduction back to this dose fairly quickly, but then he would have some momentum behind it and might hold the dose better.

You can also try food manipulation. It's more work, but would involve experimenting with the timing of his meals to try to flatten the curve. Then once the curve is flatter, you might be able to raise his insulin dose just a little bit to help him bring down the higher numbers.

 

[Kelly & Oscar]

Well, I am lucky on many levels. My mother-in-law is diabetic and had switched insulins a few months ago. Over Christmas she gave me her stock pile of Levemir pens, so I have 4 Levemir pens in the fridge in addition to another 3 Lantus pens that were donated to us. I was previously planning on waiting until the Lantus ran out to switch to Levemir, which would have been about 4-5 months from now. I'll stay on Lantus through this vial though, which should last maybe another month. Maybe I will see if anyone here or on my local Craigslist wants to swap my Lantus for their Levemir :mrgreen:

The several consecutive yellow cycles make me want to up the dose, but it is those drastic drops into the 40s that have been keeping me at bay. With Oscar it is all or nothing sometimes and he can respond to a dose just out of the blue. We'll see where he is at by this Friday - I will be home most of the weekend if I want to bump it up then.

Thank you everyone for taking a look at his numbers. Its great to have another set of eyes! :YMHUG: