? 4/23 Tennessee AMPS 338, +1 346, +9 330 Are we ready for another increase?

Status
Not open for further replies.
Andrea&Tennessee (GA)

Andrea&Tennessee (GA)

Member Since 2014
Hi everybody!
Tennessee has been seeing more frequent blue numbers recently, and some bounces to go with them.
He has had a full 8 cycles at 7 units Bid.
Is he ready for another increase?
We still have not seen any greens, although we have been close.

He seems to be on a bounce today from last nights blue numbers.
Is it OK to increase while he is bouncing or should I wait for him to clear it before I increase?

Thanks for your help.
 
You wouldn't want to increase just yet....since he's bouncing off last night's numbers, if he were to clear the bounce on the same cycle you increased, you could send him too low

Bounces can take up to 3 days to clear, so for now, I'd just hold the 7U dose

If at all possible, I would have gotten another test in last night....when they drop at +2, that can act like an "early warning system" that they could be having a very active cycle. It's very possible he dropped into green last night
 
Thanks Chris
So as soon as I see this bounce break should I bring him up if I don't see a green before then ?
Or should I wait a couple of cycles to see if we can get to green on this dose?
 
I think you could go either way. I see Chris' point that it's possible he could've gotten to green last night, although it also looks like he typically nadirs fairly early in the cycle, about +2-+4 most of the time. I think it would be ok to wait 2 more cycles (total of 10) in case he can work his way into greens, but I'm thinking he's going to need an increase to get solidly into greens. When you do increase, I'd go up by 0.5u because he is on a larger dose.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • 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.
Andrea, have we talked about having him tested for a high dose condition?
 
I presume you are using the TR protocol? Since there are now people also using SLGS in this forum, we've been asking people to put TR or SLGS in their signatures so we can tell at a glance what they are using for dosing methods.

I'm going to offer a different opinion on the increase. I think you are fine for another .5u increase. Take a look at this post on TR Protocol: Myths Debunked. Libby talks about increasing during a bounce. There is nothing wrong with increasing during a bounce, you just don't want to increase on a cycle where they break the bounce, because there is already downward momentum from the breaking bounce and adding an increase can make an exciting cycle.

Another reason for not holding the dose is it looks like Tennessee might have some type of resistance happening. If so, you want to stay ahead of the resistance. If you are certain Tennie's not getting into dry food, and he's been checked by the vet for hyperthyroidism or signs of inflammation/infection such as needing a dental, then it's time to consider that he might have a high dose condition. We usually suggest that people get their cats tested for acromegaly and IAA once they get to 6 units. The latest research shows that 20-25% of all diabetic cats have acromegaly. Blood work has to be taken by your vet and sent to MSU (Michigan State University) for cats in North America. Neko has both those high dose conditions. The tests are the IGF-1 test and the IAA test.

We have a number of cats here with these conditions and high doses.:bighug:
 
Yes Wendy,
I am thinking that we will need to test for high dose conditions sometime soon. The vet had wanted to have an ultrasound done, but for some reason it never got scheduled.
Do you think that my money would be better spent on the high dose tests or an ultrasound?
 
An ultrasound will see if there are changes to organs, which may or may not be useful. Acromegaly can cause enlarged liver and heart, so it is good to know if that is occurring, especially with a heart murmur, which Neko also has. But the U/S won't tell you for sure about the high dose conditions. What was the vets reason for wanting the ultrasound? The blood tests are not that expensive, though there are shipping charges (much higher in Canada :rolleyes:). The definitive test for acromegaly is actually a CT scan, but that is way more expensive - most people do the IGF-1 blood test.
 
The vet wanted to check all the organs out because he seemed to have to keep increasing after his pancreatitis issue. Befor that we had pretty good control with only 2 units. But that is was before I was on the forum and knew that I could shoot when he went below 200. The vet had said not to shoot below 200
 
Well now things are all messed up. The boyfriend asked me to run a "quick" errand with him that has now turned in to a couple hours. Tennies shot time will now be off by at least an hour late. I think that I am just going to keep his same dose tonight. Then maybe I can go for the increase tomorrow night
 
I think that's fine to shoot late - life happens.

And if he's high tomorrow, you may be able to shoot an hour early to get back on schedule. I wouldn't increase the dose and shoot early in the same cycle, though. One or the other.

I'd get the blood test done first so you know what you are dealing with. It helps with dosing strategies to know the reason for the high dose. I'd make certain that both the IGF-1 and IAA tests are done. Sometimes vets aren't that familiar with iaa and they think it's extraordinarily rare - it doesn't seem to be. We seem to be seeing a fair number of cats with either/both. Punkin only had acro.
 
Thanks for the shooting advice Julie.
I know that my vet has no experience with acro kitties- she said that Tennie may be her first.
I will make sure to have both done when I get my act together and get it scheduled.

I'm interested to see how the acro or IAA diagnosis change dosing strategies- any advice where I can read more about it?
 
we can tell you - nothing is written down.

Well, that's not completely true. Look on the New to the Group sticky, at the bottom in the single topic posts, for info about acro and iaa.

The thing about iaa is that it is self-limiting, meaning that at some point the cat's body will stop having iaa. I think I've heard about a year. When the iaa "breaks" the cat suddenly become receptive to the insulin and the cat can often come fast down the dosing scale. the goal with iaa is to keep the cat's blood sugar in normal numbers because that seems to be what works.

With acromegaly, there is a tumor in the pituitary gland that puts out a hormone that blocks the insulin from being able to get into the cells. That tumor's production can wax and wane, so doses can go up and down. An acro cat can go off of insulin into remission if the tumor shuts down. Most people with acro cats who haven't had them treated with SRT choose to run their cat a little bit higher so if the tumor's production wanes, they have a little safety margin.

Personally, I have mixed feelings about that, although I did it, because it seems that running a cat higher can contribute to climbing to higher doses. Glucose Toxicity is just as real for a high dose cat as for a "regular" diabetic cat. When you get control of a cat's blood sugar, it often stops the ever-increasing dose. If you do that early it seems like the dose stays down. When we have a cat with constant high blood sugar we often fast-track them by increasing every 4 cycles - doing that can help get "on top" of the blood sugar and then a person can hold them flat.

But maybe that's more than you wanted to know - those are just my opinions about the topic.
 
julie & punkin (ga) said:
Most people with acro cats who haven't had them treated with SRT choose to run their cat a little bit higher so if the tumor's production wanes, they have a little safety margin.
Click to expand...
Neko has acromegaly and had IAA. and got to 8.75U. Her IAA broke probably around the same time as she had her SRT or stereostatic radiation therapy, about 9 months after her diabetes diagnosis. She started going down scale very fast, sometimes one unit a week. At the time I was first posting here there weren't many acrocats - just Julie who saved my sanity. I decided to keep Neko with green nadirs as I discovered that she bounced less if her nadirs were in the 70's. And with experimentation, I discovered how she reacted to high carb food and knew that I could get her up if I needed to. We've since had a number of acrocats here following TR and aiming for green nadirs, including those who didn't have SRT.

There is also some information in the Acro/IAA/Cushings forum here. It's not an active forum, mostly information posts but some are old. Ive been collecting some articles that I've been meaning to add to the posts Julie referenced above. There isn't much on IAA, but this article is one of the better newer ones on acromegaly. The second half of the article is on Cushings, and you probably don't need to read that.
 
Yes, my vet is pretty convinced that we can rule out cushings, she has never mentioned IAA to me, but she did mention the possibility of acro when Tennie was first diagnosed.
I will do some reading and plan to get in contact with my vet about getting both the acro and IAA tests done.

Thanks for all the info.
 
IAA is not something most vets know about. There is research that says it fairly common in diabetic cats, and other research that says it's rare. :rolleyes: Both were small studies. It's not often referred to in veterinary journal articles of insulin resistance or high dose conditions. We've also seen vets dismiss it's importance, but it does impact dosing strategies. Neko and Polly are two cats active here that have tested positive for IAA. We suspect Crystal may also have it, but there is no test for it in Europe.
 
Status
Not open for further replies.
Back
Top