5/22 Meadow AMPS 392 PMPS 471 Curve

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Amber & Meadow

Amber & Meadow

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Planning on getting more spot checks after PMPS. Also, tomorrow I will try to get spots checks between mowing the yard & planting flowers. When I took Meadow to the vet to be tested for the UTI, she said Meadow didn't fit the acromogaly profile, but she was wondering if she was insulin resistant. I don't understand why her BG's were in the 100's on Vetsulin, but now so high on Lantus.
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oh gosh I hate seeing such high numbers!
Honestly I know nothing about Vetsulin... or why your numbers were better.
What dose were you giving?
It's weird that on 3/19 and 3/21 you got a blue number... but not since then.
were you using vetsulin up until the moment you switched to Lantus?
How old is your Lantus?
Sorry for all the questions .
 
Hi Amber

Good work on the curve!
you started Lantus April 24th right? (according to ss)
I also see you give some food at +11 (11th hour), has anyone mentioned that feeding between +10 and shot time can give you a food influenced preshot number?
The +9 feed is good, many of us do that one too.

I'm glad to see you're still checking ketones. Good!
Other than that - it is interesting that you had blues while on vetsulin.
 
Just as an FYI, not all cats who have acromegaly have the physical features that are associated with the condition. It's actually been found to be more common than what was originally thought. The best way to rule it out is by getting the testing done if you are thinking it's a possibility. Generally, the people here are at about 7.0u before they think about getting the tests done.

It may be that Meadow is experiencing some insulin resistant/glucose toxicity. If you have a chance, take a look at Randi/Max's SS or Connor's SS. Their numbers weren't so great until they found the right dose. Not every cat needs 2.0u in order to start moving down the dose ladder.

Did your vet happen to check Meadow's teeth? Do you know if a dental is needed?
 
Ok, I'm going to try and answer all the questions. Vetsulin was started on 11/09/09. I was shooting 3 units when they BG's were in the 100's. Some days I didn't give her insulin because the BG's were too low. Then in late January, the BG's went up into the hi 200's to 300's. Took her to a different vet who put her on Humilin on 1/30/10. Stayed in the hi 200 to 300 range. Took her to the specialist on 3/18/10 and started her on Lantus that day. BG's constantly hi. On 4/19/10, vet said to go back to Humulin to see if we could get BG's down. It didn't work. I found this website and started Lantus again on 4/24/10. As far as checking her teeth, all the vets looked in her mouth and at her gums. The specialist did the x-rays, ultrasound, & EKG. She said her heart was enlarged on the left side, and there appeared to be small masses or growths somewhere in her abdomen, and her kidneys were enlarged. Then she said she really didn't know what any of that meant, which I found amazing since she is supposed to be a specialist and charged me $1200. So, I googled acromegaly & it states the only way to cure it is to do radiation treatments. And if it is Cushing's, she needs to have her adrenal glands removed. I've decided that insulin it the last resort. I cannot afford to have anymore tests done, and if I did and found out Meadow had either acromegaly or Cushing's, I would have her put to sleep. She has been through way too much already, and is too weak to live through either one of those treatments. So...Lantus needs to work. I've been wondering over the last couple of weeks if I made the right decision by keeping her alive this long. Oh, and the Lantus was bought on 3/18/10, so that would make it 2 months old. I hope I didn't forget anything.
 
Amber, I know this is overwhelming... It all seems so crazy until we can start to see some leveling out.
Of course I can't know for sure what is going on but I can give you my opinion of what MIGHT be.

First, I have to tell you, if you opened the insulin on 3/18/10, it is quite possibly toast by now.
Some people get more than a month out of a vial/cartridge... but many people find that it just stops working after a month or so. I know it s expensive... but many people buy insulin in cartridges rather than vials to lower monthly costs (the initial cost is more but the overall cost is less)

Second, here's what I'm seeing on your SS. ( keeping in mind that it is speculation and extrapolation since we have no PM data to work with)
On 3/19 ( the 2nd day of Lantus) you got a blue number, which caused a bit of rebound that lasted thru 3/20 - breaking that evening and giving you another blue preshot on the 3/21 -- she probably dropped low enough or fast enough to cause yet more rebound that lasted and broke on 3/22. You have no tests for that day but I'm assuming she droopped again that day.
Then you have missing days and an increase in dose that corresponds to higher numbers - which suggests to me too much insulin.
It looks like by the time you got back to using Lantus consistently at the same 2units that you started with, it was 5/1/2010 - about a month and a half after the insulin was first opened... This makes me wonder if at that point you were working with a wonky insulin...

ETA - if you can get a new vial or cart of insulin and try 2.0 again - you might find that the numbers come down again. fwiw, I'd try that for a few days before going the route of testing for other things.

Of course, this is only me thinking "out loud" so to speak -- I can't know for sure...
but I always found it helpful to know what others were thinking and seeing on my cats SS in the beginning.
Sending good wishes to Meadow!
 
I honestly don't know where to start!

OK I have two acro cats and Oliver also tested positive for IAA. I cannot afford any fancy expensive tests or treatment, but I don't need to! Negative or positive, you treat with insulin. OK it's maybe alot more insulin per shot for some but you need to know that some acro cats CAN go OTJ because they have a functioning pancreas, unlike the other regular diabetic cats.
You certainly don't have to get the tests but it does help you to know the reason for the high insulin doses, the resistance. I don't understand a specialist saying that problems are observed but don't know what they mean. I would get the copies of the tests and Xrays and u/s and then tell them I was going to a REAL specialist who actually knew how to read and interpret test results.
How can a vet say a cat is insulin resistant but not fit the acro mold? If you look at pictures of my 2 cats, one looks the part and the other, nope, cute as a button. OK pot belly but that's just one thing.

Let me tell you a story about my Shadoe and Randi's Max.

We both were new to the board and FD and all that goes with it, but we started low, went slow, followed the protocol and both Shadoe and Max moved up the dosing ladder. Increase by increase, up the two of us went. Then one day, something changed; Max broke through and it all started to work for him, and down he came, down that dosing ladder. We were up by 7u BID when that happened. And where is Max now? Well our Max is OTJ and doing just fine!

I did not have Shadoe tested till we got up to 9u BID, but we pretty much knew by then that something was going on, so the tests were just a formality.We still were doing the same thing for her, testing and giving her insulin. The thing about the tests being positive was that we knew what was going on; we knew that she had a functioning pancreas so it was not the problem; it was the IGF-1 hormone secretion. It also told me that we would not be trying to get down to green numbers, we needed to stay mostly in the 100-200 range. Otherwise, it was just another day for us.

If you have been using Lantus vial for more than 30 days, you could very likely be using expired insulin so it's no wonder there is no drop in numbers. Stick with the 30days guideline and if you get more time out of it, great. But if you see your numbers creeping up and up or just stopping and staying high, and you are past the 30day mark, it may be time to crack open a new cartridge of insulin.

You can look at Shadoe's ss; we also started on Caninsulin, then moved to Lantus for obvious reasons, and finally to Levemir for high dose reasons.
You will see that I reduced her dose today, down to 6.75, and she is getting GREEN BG numbers! She's an acro cat, and is doing just fine! I have a feeling that I may be reducing her dose again in the near future too!

Now to comment on the value of home testing and the results of bouncing.
Take a rubber ball and pound it into the ground as had as you can - what happens to that ball? It bounces SKY HIGH. Then depending on how hard it comes down, up it goes again! Bounces apparently can take up to 72hrs to clear for some kitties, but there are ways to deal with them.
Now, if there are only test results at ps time and very little or no other tests done, you will never see the bounce; all you will see is the highs at ps times. When you test a couple times between shots, you can get an idea of what's going on - all high and flat likely means give me more insulin, but high at ps then really low in between and the back up high at the next ps means something entirely different. You need to know your cat's nadir, and no 2 cats are alike.
If you looked at my 2, you would see Shadoe has nadir close to +4 or +5 but Oliver is more like +10 or +11! I have to look at each in a completely different approach but without the tests in the middle there is no way I would know a thing.

there is no need to arrange for the tests now if you don't want.
You can still take care of your kitty and the diabetes, so stick around and there are plenty of people here who can help you and guide you.

To know the road ahead, ask the man coming back.
 
I'm glad Gayle stopped by. Many people here have acro cats. Only a handful have taken their kitties for the sterotactic surgery; most treat the high BG that is a side effect of the acro the way Gayle is. No one here would ever tell you that the situation is hopeless or untreatable or that your only recourse is PTS. And it may not be that Meadow is an acro cat. Meadow may be more like Max. It's a matter of figuring out what is going on.

I guess the one question that no one actually asked was how old the insulin you're using is. I thought you started Lantus at the end of April. Gabby is very sensitive to the age of her Lantus and I do swap out the cartridge every 28 days. Others here do get longer use out of a cartridge. When I've tried to go longer, her numbers get wonky. If your insulin is older than 28 days, try a new cartridge and see what happens.
 
When I first started on Lantus, I didn`t know a thing about this 28day thing!
I am going along and going along and the numbers are just getting worse it seemed.
Someone said how old is your Lantus and I went HUH?
I went out and got fresh 5-cartridge pack and Shadoe's numbers improved on the very first shot out of the new cart! So I am one.
Seriously. Look at Shadoe's ss on Dec27/09. I had been using the same vial of |Lantus since Nov20/09, so I was not all that much past the 28days, but look at the results after the switch to fresh insulin! WOW she took off.
 
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