6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221

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linda and guinness

linda and guinness

Member Since 2009
Good Morning Lantus Land,

Hope everyone is doing well this fine June morning. Guinness is again very loving this am and also very vocal and hungry.

I spoke with my vet yesterday about Guinness and she feels he's not insulin resistant if he is responding to insulin whether it's Lantus or the Humulin R. I'm trying to move forward with having three tests done (PLI for pancreatitis, IAA for resistance and the Acro test for Acromagely). She doesn't seem all that concerned about any of these, but said I could move forward with the tests. My only problem is time to take him down for the draw. My days off are Wednesdays and Saturdays and there is no one there on Wednesdays to draw (they don't take appointments on Wednesdays) and we can't do it on a Saturday, because the blood has to be frozen and shipped overnight. So I'm trying to find a day where I can take off work and go. It's frustrating.

Question for Libby or Sienne: Should I move forward with another dose increase tonight of the Lantus or should I hold this dose for a few more cycles? I feel like we have some momentum and don't necessarily want to lose it, but am freaking out a little by the continued climb of his dose as his numbers are starting to drop. Thoughts?

Have a great day all. Hopefully, I will have time to visit some other condos, I've been really bad about keeping up with you all. Sorry :sad:
 
Re: 6/1 Guinness APS 317(.1uR) Dose Increase ?

Good morning Linda & Guinness! I have no advice but just wanted to let you know we were thinking about you. Hope you are able to get the tests done and get some answers!
 
Re: 6/1 Guinness APS 317(.1uR) Dose Increase ?

Hi guys .. I sure do hope you can find a day to take off work so you can get those tests done .. I know they are very important to you .. I'm sure Sienne will be around soon to help with the dosing question .. have a great day guys!
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienna or Lib

Hoping to get some advice before 4:30pm Pacific time. Thanks so much!

Question for Libby or Sienne: Should I move forward with another dose increase tonight of the Lantus or should I hold this dose for a few more cycles? I feel like we have some momentum and don't necessarily want to lose it, but am freaking out a little by the continued climb of his dose as his numbers are starting to drop. Thoughts?
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

While your vet may not be operating under the assumption that Guinness is IAA, I am. A cat can be insulin resistant and respond to insulin and even go OTJ. That said, I'd increase the dose. With insulin resistance, you metaphorically need to smash through the antibodies that create the resistance. You have to get ahead of the production of antibodies in order to get the numbers to come down.
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

Sienne,

So are you saying he just doesn't "switch" off being insulin resistant and the anti bodies are continually fighting to resist the insulin? Do you recommend me increasing the R to try and stay a head of them? I've been being conservative with the R (usually only giving .1u unless I'm here to test). Maybe Libby is the one to ask the R question of.

What causes a cat to become insulin resistant in the first place? Any ideas why their bodies produce the antibodies? Just wondering. Thanks so much for the advice...I will keep increasing.
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

linda, i'll offer a slightly different opinion. i'd hold this dose for the full 6 cycles.

my reasoning is the dose was prematurely increased from 8u to 8.5 units. on 5/30 (AM cycle) guinness dropped to a nice mid-blue number. one would expect him to bounce and he did. unfortunately, the dose was increased the very next cycle which didn't allow any time for the bounce to clear. this afternoon is only 48 hours after that blue and we're talking about yet another dose increase. i'd hold the current dose to let his body catch up.

edited to add: i don't know whether guiness has IAAs or not, but increasing the dose too quickly can result in a kitty being over dose... which *can* mimic the pattern of an IAA kitty.


just my thoughts...
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

I'd probably listen to Jill. She's more experienced than I am and I'm always happy to defer to her expertise.
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

Hi Linda!! Because of the debate about dosing, I took a look at Guinness' spreadsheet. I'm truly amazed at how much he has improved. For a cat who was forever pink, he now only makes an occasional trip to the pink floor and then keeps it in the lower pink number for just one BG check before sliding on down to yellow. You can definitely see the improvement he's making. :-D
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

i'm not sure you have correct info on the testing. i called the michigan lab and they said because of the weather being basically cool, we didn't even need to have it sent refrigerated.

punkin's was drawn and then it had to settle 30 minutes to be spun, i think, to separate the serum. then they took it to federal express to send it out. the lab person said that the USPS has been unreliable in getting samples there, so they only recommend Fed Ex.

also, the iaa test only costs $15, compared to all the rest of the kitty costs, that's almost nothing. well worth doing, in my view.

edited to correct info.
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

Here's info from the lab for the acro test:
Shipping Requirements

May be shipped via regular mail. We recommend using one of the DCPAH USPS single mailers. See product order form for mailer numbers #99120, 99121, or 99122. However, during hot months, we recommend using one of the DCPAH FedEx single mailers. See product order form for mailer numbers #99020, 99021, or 99022.
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Here's the quote on the IAA test:
Shipping Requirements

Refrigerate or freeze prior to shipment. Ship serum samples in a leakproof tube with an ice pack. We recommend using the DCPAH Insulated Mailer with Fed/Ex (99001).
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so surely it doesn't need to be frozen. unless it's the PLI test.
 
Re: 6/1 Guinness APS 317(.1uR)|+2.5 281|+6 262 Sienne or Lib

Jill, thank you for the input. I have felt like I've wanted to hold the dose, especially that round when he hit the blues, but I didn't want to lose any momentum that we may have been gaining. It's such a balancing act. It's taken him so long to surf in the yellow that I don't want to lose ground and head back up to the pinks and red.

edited to add: i don't know whether Guiness has IAAs or not, but increasing the dose too quickly can result in a kitty being over dose... which *can* mimic the pattern of an IAA kitty.
Click to expand...

Another question is he's suspected of being IAA because he hasn't responded at all to most increases, whether back at the beginning when I was sticking it out for 6 cycles and not increasing too much or when I was only holding a dose for 4 cycles and increasing by .5 units. The only time he seems to respond is when the R is added to his cycle. I understand what you are saying about a cat mimicking the pattern of an IAA kitty, but would you look at his spreadsheet in the beginning and think he might be mimicking an IAA kitty, or looking at it do you think he might actually be IAA? I know I really need to get this test done, but I'm having trouble finding a good time to get down to my vet when she can make the draw. Just looking for thoughts.

What are your thoughts regarding his R doses? Right now I am using a sliding scale that Libby suggested:

AMPS/PMPS
>350 .25u
>250 .1uR
<250 No R

After Nadir (around +6 or +7)
>300 .25uR
>200 .1uR
<200 No R

If I've recently increased his Lantus dose or I'm not going to be around to test, or if it just doesn't feel right to me at the time, I will skip the R altogether.
Thank you gain for your thoughts, it's really helping to get all the input I can at this point!
 
Re: 6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221 CONFUSED!

I've got one vote to increase and one vote to hold the dose..anyone with a third, tie-breaking vote? I see Sienne, you have deferred to Jill, which is fine, I'm hoping for some more clarification if anyone could help.

From what I understand from Jill's post, Guinness might be mimicking Insulin Resistance because I've been increasing his dose too quickly. I don't understand if he's mimicking insulin resistance now, was he mimicking it earlier when I wasn't raising his dose so quickly and by so much when his bgs were stuck in the upper 300's? Also, I'm confused by the "clearing the bounce" statement. Isn't a bounce to a high number a bad thing? Shouldn't I be doing what I can to prevent a bounce, like giving the R to skip the bounce? Why would I want him to "clear a bounce?"

Sorry to be so dense, any further explanations here on "mimicking insulin resistance" or "clearing the bounce" would be greatly appreciated.

I plan to hold his dose this next cycle, but am also now unsure of how I should be handling his "r" doses if I'm creating some sort of insulin resistant monster. Thanks so much for helping out!
 
Re: 6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221 CONFUSED!

linda, i'm in the middle of making dinner and can't look at his spreadsheet now.

From what I understand from Jill's post, Guinness might be mimicking Insulin Resistance because I've been increasing his dose too quickly.
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no. i did not say that. you're reading way too much into what i said.

will be back later to explain...
 
Re: 6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221 CONFUSED!

Ok, Jill, get back to me when you can. No worries. Sorry if I misunderstood or took your post wrong. It's hard to understand some of the responses sometimes when they are quick and "drive-by" of nature, I have no explanation and sometimes only have my interpretation to lean on. Hence my rambling long posts looking for clarification. I can wait for a response, I've decided to hold the dose as you suggested and not shoot the R tonight (which you didn't suggest, but I am not sure how to move forward with). I know you have your own busy life, and I truly appreciate any time you can take to clarify things for me.
 
Re: 6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221 CONFUSED!

first off, in Internet-speak using the caps lock is the equivalent of shouting. unless there's an emergency (which this is not) please refrain from shouting for attention, k?

secondly, i didn't think my post nor sienne's was quick or drive-by in nature because we both offered explanations of why we thought you should increase/hold the dose. i'm sorry you felt differently.

now, on to your other questions...

Another question is he's suspected of being IAA because he hasn't responded at all to most increases, whether back at the beginning when I was sticking it out for 6 cycles and not increasing too much or when I was only holding a dose for 4 cycles and increasing by .5 units. The only time he seems to respond is when the R is added to his cycle. I understand what you are saying about a cat mimicking the pattern of an IAA kitty, but would you look at his spreadsheet in the beginning and think he might be mimicking an IAA kitty, or looking at it do you think he might actually be IAA? I know I really need to get this test done, but I'm having trouble finding a good time to get down to my vet when she can make the draw.
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i've never said i suspected guinness of being an IAA kitty. something is going on with him... whether it's IAAs or some other underlying health condition, i don't know. that's where your vet comes in. your vet has to run diagnostic tests to figure out what the problem is.

your impatience had you veering from the protocol used here pretty much from the start by increasing in half units rather than quarter units and possibly compounding the problem by increasing after only four cycles. could that have set this in motion? it could have. otoh, guinness may have an underlying condition which is yet to be discovered.

i've looked at guiness' spreadsheet many times. there's no way i could/would say if he's an IAA kitty. there are too many other variables involved. even if there weren't... no one can call a disease and be correct 100% of the time. no one. that's why there are diagnostic tests to determine what ails our kitties.

what do i suspect? i suspect what's going on with guinness could be related to any one of the things mentioned above. i give equal weight to him being an IAA kitty, being over dose, or having some other underlying condition.

What are your thoughts regarding his R doses? Right now I am using a sliding scale that Libby suggested:

AMPS/PMPS
>350 .25u
>250 .1uR
<250 No R

After Nadir (around +6 or +7)
>300 .25uR
>200 .1uR
<200 No R
Click to expand...
i am not comfortable offering advice on an insulin which acts so differently than the two insulins i have experience with. R can be dangerous if not used properly. there's not much room for error. even those who have used R themselves don't always offer the best advice. so in the interest of your cat, i leave R scales and dosing of R to those who really understand it's use.

I've got one vote to increase and one vote to hold the dose..anyone with a third, tie-breaking vote? I see Sienne, you have deferred to Jill, which is fine, I'm hoping for some more clarification if anyone could help.
Click to expand...
yes, you received conflicting advice. not at all unusual on a message board. all one can do is weigh the advice and do your own research. none of us are infallible. ultimately, the decisions are yours to make.

From what I understand from Jill's post, Guinness might be mimicking Insulin Resistance because I've been increasing his dose too quickly. I don't understand if he's mimicking insulin resistance now, was he mimicking it earlier when I wasn't raising his dose so quickly and by so much when his bgs were stuck in the upper 300's?
Click to expand...
what i said was, "i don't know whether guiness has IAAs or not, but increasing the dose too quickly can result in a kitty being over dose... which *can* mimic the pattern of an IAA kitty.". what i meant by that is the spreadsheets can often look similar. lots of highs and sometimes occasional dips into lower numbers, but not always.

Also, I'm confused by the "clearing the bounce" statement. Isn't a bounce to a high number a bad thing? Shouldn't I be doing what I can to prevent a bounce, like giving the R to skip the bounce? Why would I want him to "clear a bounce?"
Click to expand...
no, bouncing is not a bad thing. all it means is the liver is doing it's job. when a kitty drops lower than what it's body is used to the liver panics and releases counterregulatory hormones into the body. these counterregulatory hormones cause the numbers to rise. guinness' liver is working... and that's a good thing.

you want him to "clear the bounce" before increasing the dose. when you're evaluating what a specific dose can do you cannot count the cycles where kitty is bouncing. we wait for the bounce to clear before adding any more insulin into the mix so as not to cause kitty to become over dose. this can take up to 72 hours (3 days)! the stickies have lots of links to all sorts of information like this to help caregivers learn about the action of the insulin they're using.



hope this helps...
 
Re: 6/1 Guinness +2.5 281|+6 262|+8(+2.5R) 221 CONFUSED!

Hi Linda. It sounds as if you've really got your plate full of dosing choices and approaches. It is frustrating when a bounce occurs, but the most difficult part of the bounce is to not fix it. Patience pays off with a natural settling of the numbers and then you can get a real idea of how to dose. Try to hang in there and just look at Gus' SS if you want to feel better. He's got a bounce or two recorded!!
 
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