4/20 MR Grey AMPS 116;+3 93 +10 176 PMPS 134 +3 120

[Rick & Mr. Grey]

Hello it's been a while since my last post mainly to do with having Mr Grey's BGL under control lately. I am tempted to raise his dose in the morning to 3.5u to try and get the PMPS BG level to stay below 100 is this a necessary approach ? Also how long do we proceed giving this around 3-3.5u dose. If Mr Grey continues to heal at this does range could we expect his BG to drop low eventually to signal a dose reduction ?

 

[Blue]

Re: 4/20 Eyes On Mr Grey dose advice How's his SS looking ?

Hello it's been a while since my last post mainly to do with having Mr Grey's BGL under control lately. I am tempted to raise his dose in the morning to 3.5u to try and get the PMPS BG level to stay below 100 is this a necessary approach ? Also how long do we proceed giving this around 3-3.5u dose. If Mr Grey continues to heal at this does range could we expect his BG to drop low eventually to signal a dose reduction ?

Rick,
Mr. Grey is not healing; he just needs less insulin. Mr. Grey is not a diabetic; he likely has diabetes because he's acromegalic. If the pituitary tumor stops secreting excess growth hormone, then you need to give him less insulin.

He's got great numbers and it could be that you could completely stop giving him insulin.
Oliver's last shot was 3u on Jan7/12.

The problem is this: what's Mr. Grey's normal non-diabetic range? You don't know and nobody knows because who is testing their cats before they are diabetic? Just about nobody!

Oliver's numbers now are around 70 to 110, and that's on no insulin. He's here and there and if I get a number like 140, I just feed him and then test again a couple hours later.... sure enough, his number is lower.

Mr. Grey has some very nice numbers. What would you like to try? Why not cut the dose back and see what happens? What if you cut it to 2u and you kept getting the same decent numbers? They are all non-diabetic in range, and you do not need to push for numbers under 100.

Here are the links to the two tests normally done for insulin resistant cats.
Print them out and take them to your vet to say you want the tests done.... then see how the vet reacts. If the vet refuses, find another vet.
It's important that you have a vet who will work with you and not against you.
IAA Test
IGF-1 (Acro) Test

 

[Marje and Gracie]

Re: 4/20 Eyes On Mr Grey dose advice How's his SS looking ?

Mr. Grey is not healing; he just needs less insulin. Mr. Grey is not a diabetic; he likely has diabetes because he's acromegalic. If the pituitary tumor stops secreting excess growth hormone, then you need to give him less insulin.

I'm sorry but I just don't think we need to make such statements without tests to prove it. Perhaps he looks acro or IAA but until the tests are done, I think it's best to not draw such assumptions that he is not diabetic. If he just tests positive for IAA, then he is diabetic....Rick has just managed to get to the dose that broke the resistance. But no one knows that without the tests.

Rick...I think his numbers look really good. Any numbers between 50-120 are healing numbers for his pancreas. IMHO I wouldn't chase preshots below 100. At this point, I'd let this increase to 3.25u have some time and give him a chance to settle in....the numbers will come to you and they are already looking great.

Sometimes it takes more than ten cycles to see what a dose increase will do. If you see a general trend up cycle after cycle (not just one cycle but one after the other), then you can think about an increase.

You might also find that the next reduction he earns is by being in normal numbers for a full week instead of by dropping below 50.

You're doing a great job!

 

[Libby and Lucy]

Re: 4/20 Eyes On Mr Grey dose advice How's his SS looking ?

Mr. Grey is not a diabetic; he likely has diabetes because he's acromegalic.

This is a pretty big assumption... There are other reasons for cats needing higher doses (and 9.5u really isn't THAT high). Acromegaly is one, IAA is another, or Mr. Grey might have simply needed a higher dose to break through because he started on a high dose to begin with. Who knows, he might have been over dose the whole time and just had some glucose toxicity to break through. Rick played things very conservatively on the way down the dosing scale, just to be safe in case there was acro or IAA at play, and it paid off nicely. :smile:

What I see right now is the spreadsheet of a well regulated cat. I don't see any notations of needing high carb food in a while, which is good. Do you feel like you're in control of his numbers right now?

In Tight Regulation, we usually aim for them to be stable under 120 pretty much all the time. Mr. Grey is there - even after a skipped shot he was just 130. He doesn't seem to be diving and bouncing, he's just surfing all the time.

I wouldn't increase the dose, just because you have had a skipped shot and a slightly reduced shot in the recent past and he is still holding these numbers. If you're following the tight regulation protocol, where you would go next would be to give him at least a week on a consistent dose, and if he is still maintaining under 120 then try a reduction.

You can try a larger reduction if you want, or do it sooner. It might hold, as the rest of his reductions did. The difference in my mind is that before, you were doing bigger reductions because you were trying to get control over Mr. Grey's numbers. Now you have control. So you can do slower/smaller reductions and you know you'll keep control, or you can do a large reduction and see if you can keep control. If you do lose control, you should be able to get it back, as long as you are willing to increase again quickly if the numbers start to falter.

I think I might have shared this when we were going through the fast reductions, but the whole time I was thinking "if he is acro or IAA, then the reductions might hold, if not then they probably won't." They did hold, so yes, there's a good chance he has/had one of those conditions that is changing. But he might not, so IMHO we deal with what we see in front of us.

 

[Rick & Mr. Grey]

Re: 4/20 AMPS 116; +3 93 reduced dose to 2u

Thanks for all the concern and helpful advice. Today I tried an experiment and lowered Mr Grey's dose to 2u to see if it would stick. Looking good so far at +3 93 :mrgreen:

 

[Marje and Gracie]

Re: 4/20 Eyes On Mr Grey dose advice How's his SS looking ?

Rick

Remember that a higher dose can affect up to six subsequent cycles. If you lowered his dose this morning, and he's in green, it's "possible" that it is the depot from the higher dose. The only way to know for sure is to hold the reduction for at least six cycles and see where he goes......of course, unless he starts going way up. If his numbers trend up, don't sit on that dose too long.

 

[Rick & Mr. Grey]

Re: 4/20 MR Grey AMPS 116;+3 93 +10 176

Thanks Marje I understand what you are saying. I'll see what happens with this lowered dose of 2u over the next 2 cycles.

 

[Blue]

Re: 4/20 Eyes On Mr Grey dose advice How's his SS looking ?

Mr. Grey is not a diabetic; he likely has diabetes because he's acromegalic.

This is a pretty big assumption... There are other reasons for cats needing higher doses (and 9.5u really isn't THAT high). Acromegaly is one, IAA is another, or Mr. Grey might have simply needed a higher dose to break through because he started on a high dose to begin with. Who knows, he might have been over dose the whole time and just had some glucose toxicity to break through. Rick played things very conservatively on the way down the dosing scale, just to be safe in case there was acro or IAA at play, and it paid off nicely. :smile:

What I see right now is the spreadsheet of a well regulated cat. I don't see any notations of needing high carb food in a while, which is good. Do you feel like you're in control of his numbers right now?

In Tight Regulation, we usually aim for them to be stable under 120 pretty much all the time. Mr. Grey is there - even after a skipped shot he was just 130. He doesn't seem to be diving and bouncing, he's just surfing all the time.

I wouldn't increase the dose, just because you have had a skipped shot and a slightly reduced shot in the recent past and he is still holding these numbers. If you're following the tight regulation protocol, where you would go next would be to give him at least a week on a consistent dose, and if he is still maintaining under 120 then try a reduction.

You can try a larger reduction if you want, or do it sooner. It might hold, as the rest of his reductions did. The difference in my mind is that before, you were doing bigger reductions because you were trying to get control over Mr. Grey's numbers. Now you have control. So you can do slower/smaller reductions and you know you'll keep control, or you can do a large reduction and see if you can keep control. If you do lose control, you should be able to get it back, as long as you are willing to increase again quickly if the numbers start to falter.

I think I might have shared this when we were going through the fast reductions, but the whole time I was thinking "if he is acro or IAA, then the reductions might hold, if not then they probably won't." They did hold, so yes, there's a good chance he has/had one of those conditions that is changing. But he might not, so IMHO we deal with what we see in front of us.

Neither IAA or acro cats are diabetic.
I was not aware that a dose of 9.5u was not really THAT high. Really? Please state what is currently being considered as a high dose and not due to glucose toxicity.
Cats with IAA show entirely different patterns than cats with acromegaly.
The latest catch phrase of glucose toxicity would not present itself as you are seeing on this ss.
I don't believe my statement was a big assumption.

 

[Grayson & Lu]

Re: 4/20 MR Grey AMPS 116;+3 93 +10 176

Hello to another gray boy!

Not to split hairs, but I feel the need to share this: As was pointed out to me, both before and after Grayson was tested for IAA and IGF-1 (Acro indicator), "the test results are not a slamdunk diagnosis of Acromegaly." FD and insulin-resistant diabetes can be symptoms of Acromegaly. We also had an ultrasound done at NC State Vet School which showed enlarged organs. STILL not a slamdunk. It wasn't until the CT scan at Colorado State Univ. when the tumor was visible that we had an "official" diagnosis of Acromegaly.

Meanwhile, Grayson climbed to 6u TID of ProZinc at his max before we switched to Levemir. Most people (at least on PZI) see more than 3u BID as a "high dose" for a normal diabetic kitty, since most kitties respond to .5u - 2.0u. "High dose" for an insulin resistant acro kitty is sometimes more than 30u. That being said, I would say that 9.5u IS a high dose - regardless of whether you've had the tests or not.

Since Grayson barely moved on high doses, the insulin resistance was no surprise. The Acro dx, however, was a lot more difficult to swallow. He was still anorexic-looking, down to 12# from 22. I read everything I could, and looked for other characteristics to help convince me. Fortunately, I have several cats, so I was able to get a good study group. The size and position of his jaw; and most convincing for me, was the separation of his canines (fang teeth). All the other "test subjects'" teeth were pretty snug. Grayson's were separated almost 1/8". Grayson & I also had the benefit of meeting with Dr. Kathy Lunn (formerly of CSU; presently at NCSU) - the person who's probably had her hands on more Acro's than anyone else. As I said before, the results, including the US, were good "indicators", and are fairly reliable; but not definitive. But for those that have had SRT @ CSU, I believe they said that every one that had the test results that they treated, did in fact have a pituitary tumor.

So, I encourage you to have the testing done when you can - the sooner the better. Treating any condition, when you have a good sense that that IS the condition, is much more effective.

Feel free to ask questions of those of us with Acros and IAA kitties - there are a few of us from here whose kitties have this condition.

Lu-Ann

 

[Rick & Mr. Grey]

Hello Lu, thank you for taking the time and effort to reply in this condo. It seems both our Grey's have been getting treatments since December 2012. It seems you have quite a battle going on with BG levels. Something happened with my boy cat and he just broke free of his insulin resistance around Easter 2013. I have been on a completely different journey with Mr Grey since then. I will work on getting Mr Grey those two tests to start. Initially after DX vet ramped the dose too high too soon without any great results.Within 10 days Mr G looked and acted like he was getting sick from the insulin ? which prompted me to get an education and second opinion via the internet and so I immediately found and read all the information on FDB by Lisa A. Pierson, DVM which in turn led me HERE
I started home testing on day 12 post DX and that's when I re boot Mr Grey by reducing dose down from 6u - 2u and begin the tight protocol.His appearance and health steadily rose and his desire to drink allot of water started normalizing as well as his over peeing symptoms gradually went away.
I'm a little puzzled as to what's next for Mr Grey now that he's achieved steady blues and greens on his SS :mrgreen:
Looking back on the SS data might suggest that doses between 3.0-3.5u was and still might need to be his dose range again for several cycles, I'm not liking this 2u experiment so far. Any comments greatly appreciated. :smile:

 

[Wendy&Neko]

Hi Rick, this is an interesting experiment with Mr. Grey. Marje suggested:

hold the reduction for at least six cycles and see where he goes......of course, unless he starts going way up

Some kitties take a while to settle into a new dose, especially with a larger reduction, although Mr. Grey went down faster when he first started going down. But as a percentage of his old dose, going to 2U was a large reduction. The blues are still a nice range to be in, it's likely below the renal threshold. If he started getting into lots of yellows, then I'd start to worry earlier.

Going down the scale really seems to be an Every Cat is Different Thing. For Neko, we zoomed down from 8.75 to 3-3.5 units fairly quickly, where we hung out for several months before sneaking down again and seem to be fairly stable again around 2. For us, it's been either quickly changing or hurry up and wait, completely unpredictable. I've been using the guidelines above. When I do a reduction, I wait 6-8 cycles, and if I don't see enough green in the new dose, up we go. I'm reducing in much smaller increments now. I also know she still needs insulin because she zooms up if I do fur shots.