2/6 Smokey AMPS 264 + 3 251 Just nothin' happenin'

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Melanie and Smokey

Melanie and Smokey

Member Since 2010
Haven't posted in a while, just nothing progressing with her while I have been getting busier at work with tax season getting into full swing.

We held her at 5U for a while, while we did the AB, got fresh insulin, did all the shuffling around trying to see what else might be causing the insulin to not do anything. We almost never see a blue number anymore :YMSIGH: and even though she seemed to be getting better after the start of the AB - gaining weight, fluffier, silkier coat - she's slid back into the rattier look and bony butt again.

Today we went in and drew blood for a thyroid check and a full CBC, plus a urine draw for culturing (last one they apparently didn't culture). We are still talking a trip to the UofMN, but trying to cover all the bases that they'd want to see anyway before going to that amount of stress on her. Its just so dang frustrating to see no progress in the numbers. :?





last condo viewtopic.php?f=9&t=61962&p=670040&hilit=Smokey#p670040
 
hi melanie!!! nice to see you and smokey!

i'm sure it is frustrating to not be seeing any progress. it sounds like you've ruled out a lot of the easier things - the insulin is new, no infections - i think if i were you i would be a little more aggressive in following the protocol dose increases. someone told me it's not about the size of the dose, it's all about the BG numbers you want to be seeing. so try to not worry about the size and press on with the goal of better numbers. here's the part of the protocol that you could use:

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...

smokey's got the past 13 days of nadirs in the 200's. you could increase every 6 cycles by .25u and see if you can get on top of this. when you stay at a dose that's not enough it increases their insulin resistance and makes it harder to get to that breakthrough dose. you're doing lots of testing so i think it would be safe for you to be more aggressive.

i'd probably also send a blood sample in to test for iaa or acro before taking her to a new vet. even at 5.25 u that's not necessarily a high dose condition - could just be some resistance from staying too high too long. if you want to read some on it, i posted yesterday with a bunch of articles/links on Glucose Toxicity.
 
I agree with Julie. If you're going to be thorough and rule everything out you possibly can, sending blood to Michigan State for IAA (insulin resistance) and IGF (acromegaly) testing may be a good next step. In the meantime, I would evaluate the dose every 3 days.
 
i'll jump on the bandwagon with my two friends, Julie and Sienne. There is some thought that acromegaly in cats is really underdiagnosed and that a higher percentage have it than we realize. Wouldn't hurt to rule it out or find out what you are dealing with.
 
Does acro just pop up like this? One month diet controlled just fine, the next acrocat? I did question my vet about running the IAA test (she doesn't really present like an acro to me) and my vet said that insulin resistant cats are usually in the 300s consistently, not the 200s so she didn't think it was a real possible diagnosis. I would guess that these are tests the U would opt to do if we went there unless their workup told them it wasn't a possibility. I will go look at the high dose kitties and see if any have charts that look like ours.

It just seems like once we cleared about 4.5 we've just gotten less and less reaction, but really have made no progress at all in her numbers.

As far as adjusting her dose more often, that's a catch.Due to increased work hours I won't be getting tests between AM+2 or 3 and PMPS and then PMPS +3 or 4 until AMPS, except on weekends or rare days here and there for the next couple of months, so not many nadirs will be caught. Dosing adjusts on nadirs, and I won't have them. I've tried to get my husband to get them at night, he just doesn't wake up. If he does, its like a bull in a china shop and every one and everything in the house is awake defeating the purpose of him doing it instead of me. I am under drs orders to NOT be waking up at night once I am asleep, so I am only testing her if I naturally wake up.
 
mmm, that is a conundrum. what are you doing right now that's different? i mean i'm seeing a lot of testing in there - would you be able to do that much still or would it be less? yesterday you had a total of 5 tests, and that *should* be enough.

acro is caused by a tumor in the pituitary gland - that tumor is benign, but it puts out a hormone that prevents the cat's own insulin from being able to get into the cells. think of it as though the cell has a padlock on it, and the insulin is key-shaped. the hormones distort the shape of the padlock so the insulin can't get in.

the speculation is that as many as 30% of cats who get high doses (again, i'm not sure 5.25u is high enough to be considered "high dose" but it's getting closer) have acromegaly. some seem to have a more "active" tumor than others. the tumor hormone production can go up and down, on and off. there have been cats (Linda's Guinness is the first that comes to my mind) that were diabetic, went OTJ, then became diabetic again from the tumor ramping back up.

symptoms - usually male, average age 12, usually larger bodies - but then there's libby's jazzy - petite little girl and gayle's shadoe, another petite girl. so, you can't just "know" by looking at them.

the first sign i saw on punkin after the dose being above 7u was that his tongue seemed really big. his feet enlarged, after a few months i began hearing a sound that's called "stridor" kind of a noisy breathing that's not quite snoring.

the fact that smokey went OTJ and back on - that *looks* more acro. but she could have some insulin resistance.

the total of the blood tests was around $200 - you have to send the blood cold. if you want to have the tests run, Michigan is the only place that does those 2 tests. the tests themselves aren't that much, it was the shipping that was the larger costs.

i gotta go pick up the husband from work - so i may have more but have to stop now. bbl.
 
mm, that is a conundrum. what are you doing right now that's different? i mean i'm seeing a lot of testing in there - would you be able to do that much still or would it be less? yesterday you had a total of 5 tests, and that *should* be enough.
Click to expand...

The change is I pretty much didn't really work on a schedule during this summer and fall, stayed home and tended to the cats and home stuff during the day and went to work late in the day, just a few hours before hubby got home. I am a CPA and it is tax season now so I need to work every waking minute I can. Yesterday was Sunday and weekends we can adjust our schedules a little more so one of us is home to run tests more. Weekdays I just can't stay home to get as many tests as I have been and the tests we can get are going to be early and late in the cycle, not the middle. We are still working on ironing out the shift in schedules.
 
ok, i get it.

any chance of shifting the shot time so you can catch the evening cycle nadir? do your husband and you work exactly the same shift or could your work times be staggered to get better coverage of smokey?

do you have a timed feeder? we've only just gotten one and i'm thinking i should've done it months ago. it's insurance and peace of mind!

what are your thoughts on it?
 
I had shifted my work to do that, during tax season I can't. Silly clients expect me to work normal hours :shock: My husband's job entails a lot of meetings, he can't really be outside of the office between AMPS and + 8. Since we can't work shift schedules enough to hit the +6 test, I don't think we could shift the shot time enough to help the situation.

After the 17th I can possibly go back to trying to catch the nighttime nadir. I just need to be careful. The lack of sleep in really making me sick. If I don't show improvement when I go back to the doctor, he may attempt to admit me into a sleep study or something just to get me out of the house at nights. He blames my cats for my condition.

We have timed feeders. We used them the first time. With the change in our feline lineup and Smokey's liver hepatitis and need to gain weight, they just didn't work this time. Mittens is a pig and Smokey gets sick if she can't eat frequently.

Since Smokey is a flat cat, its doubtful that she's showing PS of 270s, +2s of 250s and then hitting 30s at nadir so we can see if we can find a pattern and dose from there. We'll see what the vet has to say on the thyroid and urine cultures in the next couple of days and talk to her about more aggressively adjusting while we decide about going to the U for ultrasounds, possibly a biopsy. Her blood work never shows us anything, we always have to peek inside to figure anything out on this girl.
 
that seems like a reasonable solution - to combine the nadir checks when you can (weekends?), with other mid-cycle checks like the +2, add in what you know about how smokey works, and do the best you can. it might be a patchwork of data, but sometimes you have to make the best solution you can. there are other people who can't get night checks because of health reasons too.

punkin is fairly predictable and much of the time, not 100%, but a lot, i can tell where he's going to be at nadir by what i see at preshot. for sure a +2/+3 tells me where he's going.

that's why it's so important to know how your own cat "works." in your case, you may want to accept a higher range of BGs for safety.

i think, however, given what you're saying, that if i were you i'd probably get the iaa/acro tests, just to rule them out. information is power and if one/both of them is positive then you know the direction you need to go.
 
Melanie,

I feel your frustration because I experience the same thing with Sid except that he either over responds or underresponds. Very frustrating. Good luck and I'd like to know how the tests turn out.
 
What do we do differently if the acro or IAA tests are positive? Other than the possible radiation?

Sorry you are dealing with a bouncy Sid, Lydia. I do prefer my flat cat in that case, though she does tend to bounce off of any blue number, at least she doesn't dive and then bounce.
 
the tactic with both acro and iaa is to get on top of the numbers - to get more aggressive to keep their numbers in control. of course, as you know, you're still confronting the testing issue.

there are slightly different things to watch for with each of those issues and it would definitely be helpful, although not absolutely necessary, to know.
 
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