? 6/14 TUXIE AMPS-428. +2.5-373; +5-263; PMPS-373; +3-349; +5-292 ; +6-254 Thinking of reducing back

[Tuxedo Mom]

ALPHA TRAK 2 PET METER Reads higher than human meter


Yesterday:
http://www.felinediabetes.com/FDMB/...82-3-290-6-130-pmps-391-5-270-6-5-329.139384/

RECAP:

AMPS-382; +3-290; +6-130
PMPS-391; +5-270' +6.5-329

Tuxie's numbers are still not good. Since the last two dose increases from 6 units to 6.25 units and now at 6.5 units his drinking and urine seem to have increased. I understand about NDW and bouncing and all, but when the clinical signs are getting worse with dose increases then something is just not working.

I am considering cutting back his dose to 6 units for a couple of days and see how it goes. I know this goes against protocol, but at the worst it is no different than a furshot. Any thoughts and reasons would be appreciated.

 

[Sienne and Gabby (GA)]

I think you're seeing bouncing. The drop of 300 points the evening of the 11th no doubt triggered the latest bounce. It helps to remember that it can take 3 days/6 cycles for a bounce to clear. Give this dose a little bit longer before making a change to see if once the counterregulatory hormones clear out, Tuxie's number look better.

 

[Bron and Sheba (GA)]

I agree with Sienne. I don't think you have managed to get the fast drops under control yet and because of this you are seeing the bounces that follow. When Sheba was really bad with the fast drops and then bounces, I took her bsl every half hour from +3 til about +5.5 to catch the drop and then hourly if she was still dropping. It was only when I did that, that it all started to change. I did it day after day, every cycle, and it eventually paid off. I wasn't always successful in catching her, because she could do a big drop in half an hour but little by little we got there. She still bounces but she gets over them much quicker now. And we are getting much better numbers. So if Tuxie was my cat, that is what I would do. It is frustrating but you will get there if you persist.

 

[Tuxedo Mom]

I think you're seeing bouncing. The drop of 300 points the evening of the 11th no doubt triggered the latest bounce. It helps to remember that it can take 3 days/6 cycles for a bounce to clear. Give this dose a little bit longer before making a change to see if once the counterregulatory hormones clear out, Tuxie's number look better.

Thank you for the responses. With Tuxie it seems that it can take 5-7 days to totally clear a bounce, especially if it was a big bounce. Tuxie's clinical symptoms of water intake and urine output were much better from June 3-10 than they are now. I am thinking that maybe I did not allow enough time for him to clear the bounces from earlier and I should have waited longer, since he takes his own sweet time adjusting.

I will give this dose a couple more days and re-evaluate then. There is just something that says to me that I might have upped his dose too quick, regardless of what the protocol calls for. I am inclined to think that if a certain dose causes such rapid or large drops then maybe it is too much too quickly.

I took her bsl every half hour from +3 til about +5.5 to catch the drop and then hourly

Bron...I am testing as much as I can right now. Unfortunately I have to take naps and go out and do errands sometimes and that would end up being the time Tuxie gets an active cycle going. Besides that I am missing the summer, which is short enough to begin with. Also with the cost of the strips (I use the FS Lite strips with the AT2 and they work fine) it is getting to be very cost prohibitive, and any "budget" I once had is shot, with testing 10-15 times a day. I just don't think I could test any more than I already am. I love my Tuxie, but I have had no social life for 7 months and no sleep either.

 

[julie & punkin (ga)]

I agree with Sienne & Bron. I'd give Tuxie a total of 8-10 cycles on this dose and then, based upon the LOW points, not the high numbers, I think you'll likely need to increase the dose. He hasn't gotten below 99 yet on this dose - that says that it's probably not quite enough insulin, but I'd still give it a little longer to see if he can get lower.

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.

One thing to consider as well - Tuxie has something going on that's causing a need for a higher dose. Once a kitty passes 6u per dose, we can assume that there is either acromegaly, insulin auto-antibodies (iaa) or Cushing's disease going on. Acromegaly is by far the most common - the most recent research is that 25% of diabetic cats have a benign acro tumor. Iaa seems to be fairly common as well. Cushing's is the least common and usually easy to spot because there is typically skin involvement, ie, rashes and easily torn skin.

Are you interested in having him tested to see if he's got acro or iaa or both? There's info on acromegaly & getting a cat tested here.

With high dose kitties, the answer to high numbers is usually that they need more insulin. Bouncing improves when the dose gets the nadirs in a better range.

 

[Tuxedo Mom]

I agree with Sienne & Bron. I'd give Tuxie a total of 8-10 cycles on this dose and then, based upon the LOW points, not the high numbers, I think you'll likely need to increase the dose. He hasn't gotten below 99 yet on this dose - that says that it's probably not quite enough insulin, but I'd still give it a little longer to see if he can get lower.

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.

One thing to consider as well - Tuxie has something going on that's causing a need for a higher dose. Once a kitty passes 6u per dose, we can assume that there is either acromegaly, insulin auto-antibodies (iaa) or Cushing's disease going on. Acromegaly is by far the most common - the most recent research is that 25% of diabetic cats have a benign acro tumor. Iaa seems to be fairly common as well. Cushing's is the least common and usually easy to spot because there is typically skin involvement, ie, rashes and easily torn skin.

Are you interested in having him tested to see if he's got acro or iaa or both? There's info on acromegaly & getting a cat tested here.

With high dose kitties, the answer to high numbers is usually that they need more insulin. Bouncing improves when the dose gets the nadirs in a better range.

I had Tuxie tested for Cushing's , acro and IAA at the beginning of the year after he had been on insulin for about 8 weeks. Unless I had him tested too early then he should be Ok for those high dose problems.

My target range with the AT2 meter is to keep him between 80-162 as much of the time as possible

 

[julie & punkin (ga)]

ohmygosh - i'm sorry - as soon as I read your reply i know you've told me twice before and somehow it keeps falling out of my brain.

But there is something going on - and those are the 3 possibilities - so it may be that it was too soon when he was tested.

 

[Tuxedo Mom]

ohmygosh - i'm sorry - as soon as I read your reply i know you've told me twice before and somehow it keeps falling out of my brain.

But there is something going on - and those are the 3 possibilities - so it may be that it was too soon when he was tested.

I have wondered about that. But from reading I did it said to wait at least 1 month after starting insulin therapy before testing for these 3 things. I waited about 2 months. I had him tested because he was having almost no response to Lantus in the beginning even with regular dose increases. Although I had only gone to 3.5 units at that time, he was consistently running blacks and reds with very little drops . I wanted to know if there was something going on and even my new vet said it looked like he was not even on insulin...Tuxie was on my home-made food same as he is now (no dry..ever),I tried a fresh insulin..different injection sites, etc and my vet watched me inject so there was no "owner" error involved.

 

[Tuxedo Mom]

and those are the 3 possibilities - so it may be that it was too soon when he was tested.

Actually, I just checked and it was actually Feb 26/15 which is 3 months after starting insulin I had the IAA and IGF-1 tests run so that should have been well within a time range for getting proper results. I had the UCCR and UCCR with dex testing done January 22/15 after he had an U/S done and the vet who did the U/S said his subjective opinion was pituitary based Cushing's because of the organomegaly.

 

[julie & punkin (ga)]

With iaa, a hallmark "look" is that when the dose is first increased, the blood sugar responds by dropping, but then it's as though the dose "goes stale" as Wendy describes it. Then that dose doesn't bring the cat's blood sugar back into normal numbers again, and to get them there you have to increase the dose again. There are a few times that I've seen that in Tuxie, but sometimes he can get back into good numbers after a few cycles on a dose. So . . . just not sure about that one.

With acro, the tumor's hormone production can wax and wane, so you're just chasing numbers and responding to the blood sugar tests as best as you can. Might need to go up, might need to go down. Punkin only went up in dose until I had his tumor radiated, then he went up and down both.

Do you see any of the "symptoms" of acro in Tuxie? Wendy has said she could look back and see physical changes from before Neko became diabetic. I couldn't see them, but punkin did have a gigantic tongue, very large clubbed feet, the respiratory stridor (like snoring), and a large potbelly. He developed arthritis from the acro as well.

 

[julie & punkin (ga)]

oh - so the doctor thinks he has Cushings . . . that would explain his dose.

 

[Tuxedo Mom]

With iaa, a hallmark "look" is that when the dose is first increased, the blood sugar responds by dropping, but then it's as though the dose "goes stale" as Wendy describes it. Then that dose doesn't bring the cat's blood sugar back into normal numbers again, and to get them there you have to increase the dose again. There are a few times that I've seen that in Tuxie, but sometimes he can get back into good numbers after a few cycles on a dose. So . . . just not sure about that one.

With acro, the tumor's hormone production can wax and wane, so you're just chasing numbers and responding to the blood sugar tests as best as you can. Might need to go up, might need to go down. Punkin only went up in dose until I had his tumor radiated, then he went up and down both.

Do you see any of the "symptoms" of acro in Tuxie? Wendy has said she could look back and see physical changes from before Neko became diabetic. I couldn't see them, but punkin did have a gigantic tongue, very large clubbed feet, the respiratory stridor (like snoring), and a large potbelly. He developed arthritis from the acro as well.

Tuxie's main physical symptom that matches Acro is the weight gain and pot belly. His pot belly is not as pronounced now as it was a few months ago. He does not have any of the other well-recognized symptoms...protruding forehead, clubbed feet, enlarged tongue etc. I asked the vet to check the teeth positioning when he had his dental done a few months back since that is another sign, but he did not have that either. His reading from MSU was 68 with a reference range of 12-92 nmol/L.

 

[Tuxedo Mom]

oh - so the doctor thinks he has Cushings . . . that would explain his dose.

The vet who did the U/S offered a subjective opinion of pituitary based Cushing's back the begining of January. That was based on the fact that Tuxie had enlargement of the liver, pancreas and adrenal gland. That was the only time that vet saw Tuxie was just for the U/S. I had the UCCR test done and then the HDDS UCCR test done and according the IDEXX the readings are well within the reference range used...albeit for dogs...but that is what they go by for cats as well. The reference rang was that anything >35 was indicative of Cushing's and Tuxie ran 10 and 14, with total suppression using the dex.


EDITED TO ADD:

Tuxie does not have the thinning skin and usually with Cushing's there is more likely to be a weight loss...which Tuxie does NOT have. His hair is slow to grow in from the shaving of the U/S and IV line from dental, but others have said that is not unusual with diabetic cats.

 

[julie & punkin (ga)]

Well, in the absence of certainty on the "why," you just carry on with dosing per his numbers. You do a good job with him, Mary Ann.

 

[Meya14]

If there is some Cushings issue, hormones in this case will wax and wane as well. This can lead to high dose and still fluctuation in BS levels. Something to watch out for, however, is it's common for Cushings cats to be chugging along on a very high dose, and suddenly out of the blue, the hormone production takes a break for a day and blood sugars can go low.

I'm still thinking your patterns of BS with twice a day highs would correspond to the typical times of cortisol release.

Maybe at some point it's worth getting him retested?

 

[Tuxedo Mom]

If there is some Cushings issue, hormones in this case will wax and wane as well. This can lead to high dose and still fluctuation in BS levels. Something to watch out for, however, is it's common for Cushings cats to be chugging along on a very high dose, and suddenly out of the blue, the hormone production takes a break for a day and blood sugars can go low.

I'm still thinking your patterns of BS with twice a day highs would correspond to the typical times of cortisol release.

Maybe at some point it's worth getting him retested?

The test I had done is a yes or no result. The only variable is whether the UCCR range they use is the same for cats as it is for dogs. Since there are very few studies on cats the range of >35 is what is commonly accepted as the definite range for cats as well. I can not afford the MRI or CT pituitary scan to see if there is a tumour, and there is no where close by that does it There is an ACTH suppression test but that is done at the vets over I believe a 4 or 6 hour period and stress definitely affects the results of both tests. Same thing with the 8 hour LDDS test. Since Tuxie is high stress both the vet and myself did not feel either of these tests would be a good indicator. Since the HDDS test showed that there is no adrenal problems the only thing I could do is try a minimal dose of trilostane to see if that helps. HOWEVER if Tuxie does not have Cushing's then it could actually cause Addison's, which could be very serious.

Tuxie was tested with UCCR and HDDS UCCR January 22, which was 2 months after diagnosis. He was responding very poorly to insulin at that time. Since the tests ruled out Cushing's (according to the reference range IDEXX uses) then it would be unlikely that Cushing's would develop afterwards, since his resistance to insulin was already a concern at the time the testing was done. Since then I have switched to Levemir and been doing regular increases. Tuxie does not show the tell-tale signs of Cushing's such as thinning, fragile skin, lethargy or muscle wasting. Unfortunately if I run the test again and the results are the same then either the reference range used is not accurate for cats or Tuxie does not have Cushing's.


FELINE CUSHING'S DISEASE TESTING

The testing situation is somewhat different in cats.

The Urine Cortisol/Creatinine Ratio While this test is of limited value in dogs, it is the preferred test in cats. The owner should bring urine samples collected first thing in the morning on three consecutive mornings. Having the sample collected at home removes the possibility of interference from vet visit-induced stress. The first two samples are used to determine if the cat has Cushing's disease and the ratios are averaged. On the second day, after the second sample is brought in, dexamethasone pills are given to the cat at home and the sample from the third day is used to determine the type of Cushing's disease the cat has.


This test is sensitive in both dogs and cats, which means that a negative test can be considered a confirmed negative.

http://www.veterinarypartner.com/Content.plx?A=636&

 

[Meya14]

Yeah, so there is probably not too much value in retesting. Also, when sugars are elevated for a prolonged period the cortisol increases from the stress and inflammation this places on the body, which further increases resistance. That may explain a low level result without cushings as well, maybe even false positives.

Max got up pretty high too with his insulin resistance. We've been working our way back down and are now at 1.5U twice a day. He was at 7U in Dec/Jan. I was feeling really hopeless because he really wasn't responding at all the whole way up (like 6 months) and almost dying from DKA. But the way down was much quicker. Hoping that your kitty breaks through.

If you did try the trilostane at a very low dose, it might help to beat down his compensatory mechanisms, and you can gauge the activity by the blood sugars. However, you still would not know for sure if it's cushings or if the med is just overwhelming the compensatory mechanisms, and addisonian crisis can happen very quickly if he were to get an infection or co-current illness. Also, if you were to stop, there may be a rebound period. Not an ideal way to rule it out. Also, if it were cushings, you would see abnormalities in electrolytes, sodium is increased and potassium decreased as cortisol has some overlap with aldosterone in the kidneys and I think you had mentioned everything is ok with electrolytes.

 

[mariko]

Just sending some calming and positive vines to you.
I understand how frustrating it can be, when we can't make sense of our sugar cat's BG numbers.
I had the same dilemma of "do I go up or do I go down" often, and it's not fun!
I think you do wonderfully taking care of your boy.
Tuxie is lucky to have such a caring bean!

 

[Tuxedo Mom]

Yeah, so there is probably not too much value in retesting. Also, when sugars are elevated for a prolonged period the cortisol increases from the stress and inflammation this places on the body, which further increases resistance. That may explain a low level result without cushings as well, maybe even false positives.

Max got up pretty high too with his insulin resistance. We've been working our way back down and are now at 1.5U twice a day. He was at 7U in Dec/Jan. I was feeling really hopeless because he really wasn't responding at all the whole way up (like 6 months) and almost dying from DKA. But the way down was much quicker. Hoping that your kitty breaks through.

If you did try the trilostane at a very low dose, it might help to beat down his compensatory mechanisms, and you can gauge the activity by the blood sugars. However, you still would not know for sure if it's cushings or if the med is just overwhelming the compensatory mechanisms, and addisonian crisis can happen very quickly if he were to get an infection or co-current illness. Also, if you were to stop, there may be a rebound period. Not an ideal way to rule it out. Also, if it were cushings, you would see abnormalities in electrolytes, sodium is increased and potassium decreased as cortisol has some overlap with aldosterone in the kidneys and I think you had mentioned everything is ok with electrolytes.

I always have a bit of a ?? in the back of my mind about Cushing's since there is no definite established cat specific reference range for the UCCR. I had even spoken to an endocrinologist at MSU trying to get a reference range specific to cats and he said there is really no accurate studies but using the >35 is pretty well a definite yes for cats. But what if a 14 is early signs??? I could drive myself crazy (or already have). Trying trilostane is a crap shoot at best and there is too much of a chance of it back-firing. The endocrine system is such a complex feature...mess with one little thing and everything gets thrown out of wack. It is actually very amazing at the inter-relationship between all the organs and how they all work in harmony...until something goes out of line...then BAMM!!!

Tuxie's electrolytes were all good, but I think I will have another full blood panel done in about a month. His last panel was done at the end of January so it is about time for a new one.

The one thing (anti-jinx) I haven't had to deal with is DKA. Even with numbers up into the 600s on a regular basis in the beginning, the worst Tuxie ever had was a trace for 2 days about 5 months ago. I actually had hoped that Tuxie tested positive for IAA, since that can be dealt with by using higher doses until the break-through dose is found. In the meantime I keep plugging along trying to rationalize what is happening. You would think I would know better than that by now but I still keep doing it and Tuxie keeps doing his own thing.

 

[Tuxedo Mom]

Just sending some calming and positive vines to you.
I understand how frustrating it can be, when we can't make sense of our sugar cat's BG numbers.
I had the same dilemma of "do I go up or do I go down" often, and it's not fun!
I think you do wonderfully taking care of your boy.
Tuxie is lucky to have such a caring bean!

Thank you for the vines...I will tie them to the patience pants I should be wearing Frustration has just become another part of my daily routine, along with sleep deprivation and being broke. I have actually dropped a few friends along the way, since they think I shouldn't be spending the time or money on "just a cat" who will be "gone in a few years anyway". In the meantime I have a kitty who absolutely LOVES being tested..every time I pass his "test mat" he runs over to it and sits down..."are you going to poke my ear now??" I am so blessed to have a kitty with very strong food motivation and an appetite that won't quit.

 

[Meya14]

Max is the same way with the tests. He tries to jump on the bed and into my lap of I sit in our "test spot". He purrs the whole time, and will watch the meter too until it beeps. Then he gets attention. He's cuddle motivated.

Doesn't so much like the shots, he thinks its a game where he runs and we chase. Maybe I should have trained him better with those, but the 6U of lantus before I switched used to really bother him.

 

[Tuxedo Mom]

Max is the same way with the tests. He tries to jump on the bed and into my lap of I sit in our "test spot". He purrs the whole time, and will watch the meter too until it beeps. Then he gets attention. He's cuddle motivated.

Doesn't so much like the shots, he thinks its a game where he runs and we chase. Maybe I should have trained him better with those, but the 6U of lantus before I switched used to really bother him.

Our kitties are so funny aren't they??

7 months ago if someone told me Tuxie would be "asking" for his ear pokes and purring while I do it...I would have told them they were totally crazy!!! Your Max likes his cuddles and my Tuxie likes his food. Tuxie has also learned that he can't shake his ears until after the meter beep....well most of the time.

Tuxie gives me 10 seconds to do his shot. He scarfs down his food then comes over to the mat for his belly pokey. I have 10 seconds or less to get it done then he is back at his plate for the remainder of his meal. Luckily he still has bare spots from his U/S so I can get the shot done quick.

 

[Bron and Sheba (GA)]

Thank you for the responses.
Bron...I am testing as much as I can right now. Unfortunately I have to take naps and go out and do errands sometimes and that would end up being the time Tuxie gets an active cycle going. Besides that I am missing the summer, which is short enough to begin with. Also with the cost of the strips (I use the FS Lite strips with the AT2 and they work fine) it is getting to be very cost prohibitive, and any "budget" I once had is shot, with testing 10-15 times a day. I just don't think I could test any more than I already am. I love my Tuxie, but I have had no social life for 7 months and no sleep either.

Mary Ann I totally understand about how much the strips cost and the time involved. It is very frustrating and costly in terms of money and time. And when friends/family don't understand it makes it harder.
All any of us can do is our best and you are doing that and more! You are doing a wonderful job looking after Tuxie.
And we all need to make sure we are getting on with our lives as well.......I think we are all guilty of forgetting about ourselves. Take care of yourself and give Tuxie a big hug from me

 

[Megan & Oren]

Mary Ann;
just a note of support and empathy, as I'm in similar situation w/ my guy Oren. He had gotten up to 6.25 units w/ little bits of progress then sliding back and I had been fast tracking him sometimes, every 3 days. The vet freaked out about his dose when i went in asking for IAA and/or Acro tests once he got past 6, and was convinced it had been raised too fast. She pushed hard to drop it to 4 units (based also on starting a new vial of Lantus) and I thought, well this is a chance to see if perhaps he HAD been raised too much, too fast. However, I only went down to 4.5. At that time she also did bloodwork and said he tested positive on the snap Fpl test for pancreatitis. He still eats like a champ and hasn't really displayed any symptoms from it. She had me curve at 2 wks, and wanted to raise his dose by a full unit to 5 (which of course, was only .5 since I'd only gone to 4.5). He got some blues on that dose. Another 2 wks, and she raised him another .5 to 5.5. He's been 6 days on that and numbers have slipped from where they were at 5. He still hasn't been tested for IAA/Acro. I suspect he needs more, but am so turned around by the protocol guidelines, the ISFM Consensus Guidelines, the vets input that I just don't know what's right anymore as to amounts and timing of increases. I want to raise him again after just 1 wk., instead of her two wks, but i just feel overwhelmed and don't seem to have confidence because nothing seems to work.

I totally understand about the costs in time, money and friends etc. also. His recent vet visits alone totaled nearly 800$, on top of a new vial of Lantus and everything else.
You're doing your best under what are daunting circumstances, and as Bron said, that's all we can do. It is just frustrating and perplexing and defeating when nothing seems to work, no matter which course you follow. I am keeping you and Tuxie in my thoughts and hoping for better days for both of you.

 

[Tuxedo Mom]

I suspect he needs more, but am so turned around by the protocol guidelines, the ISFM Consensus Guidelines, the vets input that I just don't know what's right anymore as to amounts and timing of increases. I want to raise him again after just 1 wk., instead of her two wks, but i just feel overwhelmed and don't seem to have confidence because nothing seems to work.

Thank you for your support Megan. It is so hard to make the RIGHT decision on dosing. There are protocols and guidelines and vet accepted practises and when nothing seems to be making a good step in the right direction, you do feel at a loss. I think in the end it comes down to the set protocols AND knowing your own cat. ECID and I am sure none of our kitties have read up on the correct procedures. They each do things their own way and in their own time. I know all of the petparents here doing their best, because we all care so much about our furkids.

Sending you and Megan lots of positive vines to find the right road to travel in your treatment plan.

All any of us can do is our best and you are doing that and more!

Bron..you are the shining example of a bean who does all she can and more for your Sheba. When I look at Sheba's S/S I wonder if you EVER sleep. Your dedication to Sheba is amazing and I don't think I could keep up with the intense monitoring you do. You are amazing!

Trying to find the right balance in taking care of our fur-kids and actually having a life is difficult. Thank you for your on-going support and I am sending positive vines for Sheba as she continues to (anti-jinx) show more improvement with her numbers.

 

[Bron and Sheba (GA)]

Bron..you are the shining example of a bean who does all she can and more for your Sheba. When I look at Sheba's S/S I wonder if you EVER sleep. Your dedication to Sheba is amazing and I don't think I could keep up with the intense monitoring you do. You are amazing!

Trying to find the right balance in taking care of our fur-kids and actually having a life is difficult. Thank you for your on-going support and I am sending positive vines for Sheba as she continues to (anti-jinx) show more improvement with her numbers.

Mary Ann, I was quite startled when you called me a shining example of a bean....etc. I am just an ordinary person who got so jolly sick of the bounces, I decided to dig in and beat the wretched thing if I could. So for a few weeks I did test intensely to try and manage the drops. Now that we have sort of tamed the beast (anti jinx) I am not testing nearly as much. I couldn't have kept up that pace with time or financially. If I test more now, it is when she drops low and I have to monitor that.
I am not sure of your situation, but I am at home a lot of the time, except for school pick ups, shopping, visiting friends, appts etc which makes it relatively easy to choose when I test. I look after 7 grandchildren after school and 5 eat dinner here during the week and one is a preschooler so is here during the day, so I am busy. During the school holidays they are all here.
I am trying really hard to have a life as well.....I know exactly what you mean. I think it is really important we do find time for ourselves, otherwise we will be no good for anyone in the end. I know I feel so much better mentally when I get a break from it all.
Just remember you are doing a great job with Tuxie. Some cats are harder to regulate than others.....you and I drew the straws with the harder cats to regulate
Take care

 

[Tuxedo Mom]

I look after 7 grandchildren after school and 5 eat dinner here during the week and one is a preschooler so is here during the day, so I am busy. During the school holidays they are all here.

Now I feel even more humbled. You are doing an amazing job of grandparenting as well as all the monitoring and treatment of your Sheba kitty. There is absolutely NO way I could keep up the sort of pace you do....if you have a magic elexir that gives you the energy to do all that please tell me!!

 

[Bron and Sheba (GA)]

Now I feel even more humbled. You are doing an amazing job of grandparenting as well as all the monitoring and treatment of your Sheba kitty. There is absolutely NO way I could keep up the sort of pace you do....if you have a magic elexir that gives you the energy to do all that please tell me!!

Mary Ann.........!!! We all do things....this just happens to be what I do at the moment.....I actually have lots of fun with them so it is not hard work.....just time. And my DH helps as well so it is not just me. He plays sport with them every afternoon which I would find tiring but he loves it.

 

[Wendy&Neko]

Wendy has said she could look back and see physical changes from before Neko became diabetic.

At the time of Neko's acro diagnosis, the main symptoms were incredible appetite, including for inappropriate things like muffins and banana bread, and her dose. She did show some shying away from bright light too. I identified the "dose going stale" early on. She first saw green under 4 units, but it would go away and she never went under 50 until almost 9 units. Some research I did last year on acro humans told me that her teary eyes 6 months before her diabetes diagnosis, was an early sign of acromegaly (blocked tear ducts), but that's not anything a vet would state is acromegaly. In fact, research from the Royal Veterinary College showed that it's very difficult to identify an acrocat by sight. Neko's face still doesn't look acro. I've also seen it said you should wait until after 8 weeks on insulin to test for IGF-1, because of the false negatives you can get from unregulated cats at the beginning of their insulin treatment.

But regardless of why Tuxie needs more juice, the most important thing you can do is try to get him to spend as much time as possible under renal threshold. I'm trying to remember if I've ever seen a cat on too much insulin, if they have been increasing via the protocol and testing as much as you do Mary Ann. I am also wondering if there is a way for you to do less testing, but still keep Tuxie safe. That not only makes things cheaper for you, but perhaps gives you more time to do things for you. For example, looking at his SS, if he's pink at +5, I think you can stop testing the rest of the cycle. I'm sure there might be a few other rules like this. I'm big on figuring out when I need to test and when I don't.

 

[Tuxedo Mom]

At the time of Neko's acro diagnosis, the main symptoms were incredible appetite, including for inappropriate things like muffins and banana bread, and her dose. She did show some shying away from bright light too. I identified the "dose going stale" early on. She first saw green under 4 units, but it would go away and she never went under 50 until almost 9 units. Some research I did last year on acro humans told me that her teary eyes 6 months before her diabetes diagnosis, was an early sign of acromegaly (blocked tear ducts), but that's not anything a vet would state is acromegaly. In fact, research from the Royal Veterinary College showed that it's very difficult to identify an acrocat by sight. Neko's face still doesn't look acro. I've also seen it said you should wait until after 8 weeks on insulin to test for IGF-1, because of the false negatives you can get from unregulated cats at the beginning of their insulin treatment.

But regardless of why Tuxie needs more juice, the most important thing you can do is try to get him to spend as much time as possible under renal threshold. I'm trying to remember if I've ever seen a cat on too much insulin, if they have been increasing via the protocol and testing as much as you do Mary Ann. I am also wondering if there is a way for you to do less testing, but still keep Tuxie safe. That not only makes things cheaper for you, but perhaps gives you more time to do things for you. For example, looking at his SS, if he's pink at +5, I think you can stop testing the rest of the cycle. I'm sure there might be a few other rules like this. I'm big on figuring out when I need to test and when I don't.

Thank you for your information. I did argue with my vet for the acro test, since she said Tuxie did not have the physical appearance. I was aware and informed her that not all acros show the signs and many do not show it until much later in the progression. It was 3 months after staring insulin that I had him tested so the time frame should be acceptable to avoid false negatives. HOWEVER, since the reference range is merely an averaging and Tuxie was in the upper middle normal, there is always a chance that it may still be a consideration. I am planning on having a full blood panel done in about a month so I may consider having another IGF-1 done again at that time. Tuxie did have teary eyes and light sensitivity at one point, but he also had an URI at that time. Since then the teary eyes and light sensitivity does not seem to be a problem. The one thing he does have is intermittent periods of sneezing...almost like an allergy.... no stuffed or runny nose, just every now and then he will do 5 or 6 sneezes in a row.

I DO overdo the testing, but Tuxie has every now and then has a later lower nadir, although usually that would be when he is running blue during the cycle. So I think you are right that if he is running pink around +5 or +6, then I can back off on the testing. I think I have enough data to have a pretty good handle on what his curve looks like. I am a lot like you where I study the S/S looking for trends and patterns, but Tuxie likes to throw a curve in there every now and then.

I think the best approach for my sanity and Tuxie's safety is to allow longer time frames in between dose increases(more like 6-7 days), since he can take 5 or 6 days to settle into a dose. At this point I do not hold out a lot of hope for a remission, rather I am aiming for safe number that will cause as little damage to the organs as possible.