3/8 Penny AMPS 291 +6 242 +8 308 PMPS 308

[Robyn and Penny]

Hi everybody! I'm beyond frustrated! I haven't had time to find my older condos tonight but I'm wondering at what point do I have to start thinking about taking Penny to the vet to look at insulin resistance? There is a concurrent dx of spinal arthritis, but beings that she's been running up and down the stairs chasing raw chicken (her daily exercise now lol), jumping to the top of 5' cat condos, chasing bugs and eating them and chasing her sister, I'd say the Adequan injections and her 2lb weight loss so far has really been helping, so she is not on any pain medication at the moment.

I still want to blame gabapentin for her relapse, especially since Mel (who used to be on this bd) had an issue with her cat Autumn's BGs while on gabapentin, but Penny has been off for 2 weeks and no improvement in her numbers. Even though I have slowed down her dose increases (I was increasing per TR till I saw Lantus-y curves and she's on Levemir), so I increase by fattening up the dose rather than going up a full .25u, which has resulted in much flatter curves, which is more Levemir-y, but I still can't get any consistent control. She had a beautiful blue couple of days on a fat 1.25u but has been going higher and higher since.

Her Lev pen was opened 2.11.15 and is kept in the back of the fridge. Before deciding to restart insulin last December, she had been evaluated by 3 different vets at 2 different practices and infection and dental problems had been ruled out. Urine culture was done on free catch (nobody would aspirate straight from the bladder). Soft/loose BMs have been a problem with Penny since I adopted her from the rescue in 2012, well before her original diabetes dx.

But I'm concerned that for a cat who only needed to get .5u twice per day to get into remission and now I can't get one green # on 1.5u on relapse, could I be looking at insulin resistance or is it too early to panic? And what really has me confused is the very quick nadir she's been having at +6, a rapid increase by +8, then a 4-hour surf?

Please help!! SS in signature and TIA!!

 

[Robyn and Penny]

The only other thing I did notice is she burps sometimes and smacks her lips after her raw chicken snack, and this morning she coughed a little after she burped but normal activity and appetite today.

 

[Chris/China (GA)/Garfield]

You're still at a fairly low dose ...we don't start thinking about insulin resistance or acromegaly until they're over 5U per shot

If there's nothing going on with her teeth, and there's no sign of infection or inflammation anywhere else, you're just going to have to increase according to the protocol you're on.

Since insulin is a hormone, the way it works can vary from one time to the next so you can never say that because they only needed "X" before, they shouldn't need "Y" now.

I think I'd try increasing in .25 unit increments for now until you start to get her "dialed in" instead of just fattening the dose.

When she's getting better nadir's, then you can think more about adding a drop or two (or reducing a drop or two) to get her where you want her

 

[Wendy&Neko]

We don't consider testing for high dose conditions causing insulin resistance until the foes gets to 6 units. Kitties coming back from remission usually need higher doses than the first time on insulin. As Chris said, kitties respond better to full .25U increases. I'd stick to that unless you are tweaking a mostly green dose. Good luck with the next increase.

 

[Robyn and Penny]

Okay...thanks everybody...I had stopped increasing .25u because I was having some extreme curves, like AMPS 400 and nadir in low 100s or greens, which is more like PZI or Lantus than Lev, so Mel (and the fur gang) had suggested slowing down the increases by fattening up and holding til the numbers go flatter again and then fatten up again. It did serve its purpose to keep her numbers flatter and keep her more level. I just didn't know at what point should I take her to the vet and start spending buckoo bucks for more testing again. I'd like to get my own dental done before I have to spend more money on her! lol!!

I am happy that other than the diabetes symptoms, she's doing so well, but I'm anxious to get her under renal threshold more of the time. I did notice that since being off the gabapentin that her numbers are flatter and more predictable, too, so maybe I can try increasing normally again. I believe the gaba was playing a part in the extreme fluctuations she was having. I'll wait till the 7th cycle and try 1.75u and see what happens. I'm home most of the week to monitor...