4/13 Pumpkin AMPS 313 +2 359 PMPS 356 +2 296

[Jacques and Pumpkin]

Yesterday

My wife is still figuring out the testing, so we don't have as many mid-day tests as I'd like.

I'm going to hold off on the next increase for just a little. The new vet wants to see how far down she gets if we give her a bit more time for the bounce from the dose increase to work its way out. I'm pretty sure it won't be a dramatic change, but she's working with me on a bunch of other stuff so I'll meet her halfway on this, for a couple days at least.

Meanwhile, the IGF-1 sample got lost. They did it through IDEXX. I know IDEXX just reships it to MSU, but I didn't have the energy to get into it while dealing with Pumpkin's sprain. Turns out IDEXX lost that sample. I've asked them to figure out how to ship directly to MSU given that IDEXX is providing negative value for their hefty markup.

 

[Bandit's Mom]

At the levels that Pumpkin's BG is at, the amount of testing you're doing is fine. I can understand your wanting to not upset your vet. Just for your own information, you needn't worry about bypassing a good dose when you're increasing by 0.5u and getting tests to see how low a dose is taking Pumpkin.

@Wendy&Neko

 

[Jacques and Pumpkin]

At the levels that Pumpkin's BG is at, the amount of testing you're doing is fine. I can understand your wanting to not upset your vet. Just for your own information, you needn't worry about bypassing a good dose when you're increasing by 0.5u and getting tests to see how low a dose is taking Pumpkin.

Im just going to wait a couple days. It does feel like she’s often in the middle of a bounce/new dose wonkiness at cycle 6. Either that or something that’s counter-regulating catches up to the increase by the 5th or 6th cycle. So I’m a bit interest myself to see if she’ll go lower with a slightly slower rate of increase.

 

[Wendy&Neko]

Turns out IDEXX lost that sample. I've asked them to figure out how to ship directly to MSU given that IDEXX is providing negative value for their hefty markup.

Sigh! I hope Idexx gives a refund. Information here, or the vet can contact MSU directly.
https://vdl.msu.edu/Bin/Catalog/Catalog.exe
Search for code 20005 and code 20031 for the IAA test. You do want to get both. Some cats have both (like my girl), some have just one or the other. If you are going to pay for blood collection and shipping, might as well get both tests at once. We do slightly different dosing strategies if IAA is present.

It does feel like she’s often in the middle of a bounce/new dose wonkiness at cycle 6.

NDW is gone by cycle 3. I don't think she's bouncing all that much. She just needs a dose increase. Some vets need the additional data from a longer hold on a dose as they aren't that familiar with TR, so it's OK to do just once. But the nature of insulin resistance is that it can get worse if you hold doses too long. You also have some glucose toxicity to deal with. The longer in higher numbers, the wore it gets. The good news is that she is seeing a bit more yellow, so there is some progress.

 

[Jacques and Pumpkin]

Sigh! I hope Idexx gives a refund. Information here, or the vet can contact MSU directly.
https://vdl.msu.edu/Bin/Catalog/Catalog.exe
Search for code 20005 and code 20031 for the IAA test. You do want to get both.

The vet is going to refund me. Then it’s up to them to fight with IDEXX. She was familiar with MSU’s lab, but didn’t know IDEXX just shops these tests out. We’re doing both tests.

NDW is gone by cycle 3. I don't think she's bouncing all that much. She just needs a dose increase. Some vets need the additional data from a longer hold on a dose as they aren't that familiar with TR, so it's OK to do just once. But the nature of insulin resistance is that it can get worse if you hold doses too long. You also have some glucose toxicity to deal with. The longer in higher numbers, the wore it gets. The good news is that she is seeing a bit more yellow, so there is some progress.

That’s basically my thinking. The vet is really motivated to learn about this stuff. I think Pumpkin is her most complicated diabetes patient yet, certainly the first one with this set of complications. She’s been doing a bunch of reading up and consulting with colleagues. And she listens when I tell her what I’ve learned. Frankly I’m a little curious myself to see how things settle out with just a couple days of delay, but I’m not planning on slowing down in general. We finally started getting somewhere when I stopped with SLGS and started cranking up the dose, and I don’t want to lose that momentum.