6/28 Meadow DOSE???

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Amber & Meadow

Amber & Meadow

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Ok, before you look at the SS & freak out, let me explain. I took Meadow to the vet this morning (old vet moved). I explained everything to him since the previous vet barely had anything written in her chart. He made the comment that other people would have had this cat put to sleep a long time ago. I started crying and he said "I wasn't saying that's what you should do. You tell me what you want & we'll do it." So he drew the blood for the IAA & IGF-1, but I had to ship it myself. That was fine, because they gave me the cooler and ice. Anyway, he said the cats that he's seen that do not respond to high doses either (a) are having a rebound effect, or (b) cannot be regulated for some unknown reason and get put to sleep. He said he had no problem with having her tested for IAA & IGF-1, BUT he's leaning toward rebound. SOOOO, since I had to take her early this morning & hadn't given her her AM shot yet, he said to skip it to see if the BG went lower by itself. He insisted that this would not harm her (since she is so high anyway and she wouldn't go into ketoacidosis). So I didn't give her the shot this morning and when I tested her after work, it is lower. Now what?? Do I give her the scheduled dose tonight still for the increased 13 units? I'm afraid something's going to kick in, and she'll go hypo. Is that possible? Also, he mentioned that there is a new insulin just for cats on the market. He hasn't used it yet, but if we can't get Lantus to work, then he'd like to try the new one. At least he's trying compared to other vets I've dealt with. Could someone please let me know what I should do about the evening dose? I have to take my Nursing boards tomorrow, so I need to go to bed early. Thanks!!!
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Sounds like you've got a great new vet :) I can't help with the dosing but just wanted to wish you luck with your Boards tomorrow!!! I hope you, vetty bean, and the lovely here at FDMB can get your Meadow into some purdy numbahs!!!!
 
Hi there! I also can not give you any advise on dosing for your lovely Meadow. I'll put a shout out on FB to see if any of the high dose peeps can drop by. Would that be ok?
 
It does sound like this vet might be a good one! I don't agree with all he said, but his attitude and willingness to work with you are great signs.

About rebound, we don't see that here when we follow our protocol and work up to doses methodically. There are even studies that say Somogyi doesn't exist in cats. You've done everything right. Rebound would occur if Meadow was dropping low and bouncing to high numbers. Sometimes after a while, they get "stuck" in those high numbers and don't necessarily need low numbers to bounce from. I don't see any indications on Meadow's spreadsheet that rebound is happening. Have you looked at Gayle/Oliver's spreadsheet? http://spreadsheets.google.com/pub?key= ... utput=html It probably looks pretty familiar to you.

I had a long talk with my vet on Friday (as I mentioned before, I had Jazzy in for testing too). My vet said that the most common reasons for insulin resistance are 1) infection, like a urinary infection or a dental infection; 2) pancreatitis, 3) Cushings, 4) other conditions like acro and IAA. Keeping in mind that I am not a vet person at all and I only know what I have seen here, I would probably rearrange the order of those items a little bit, but overall she is on the right track.

I'm long-winded, but what I'm saying is that I would at least hold the current dose. She does need an increase, but if it will make you feel better to slow down, that is fine.

Oh, and ketoacidosis IS possible, I'm not sure why he would say otherwise. Withholding insulin when it is needed can be very dangerous. If you are going to withhold insulin or reduce the dose significantly, please test for ketones daily.
 
Good luck with Boards tomorrow. Sorry you have this additional bit of stress.

I agree with everything Libby said. You've systematically worked the dose up and if there was any chance of rebound, we'd have pointed that out. With rebound, the numbers form a V - high at pre-shot and low in the middle. Meadow's numbers are flat. When you noted that her mid-cycle test was lower, in actual numbers it is a little lower -- and probably a lot lower than what you thought it would be given that you didn't give a shot. However, there is a certain margin of error (technically, measurement error) that's inherent in any glucometer. There's about 10 - 20% variance with any test. The higher the result of the test, the bigger the range. In addition, at this point Meadow has a pretty sizable shed. That shed is carrying over the effects of the insulin. That's why Meadow's numbers didn't skyrocket. It's one of the strengths of Lantus -- the overlap between doses makes it a less harsh insulin than the short acting types of insulin where her numbers would have been in the black after skipping a shot.

As far as ketoacidosis, it's often the lack of insulin over a period of time that causes the condition. There may be other factors present but insufficient insulin is a key factor in the development of ketones.

If you decide to stick with this vet, you might want to print out the Rand protocol for him. It's written by a vet (Jacqui Rand, DVM) who is at the University of Queensland and her research on Lantus has been published in veterinary journals. The reference for the article is in the protocol link.
 
Hi there Amber,

Like the others, I don't believe in the rebound theory. However, since you had the blood drawn and you shipped today (right?), you should have your answer on Friday (call your vet and make him call MSU). I would recommend you just keep on shooting until you have results.

Also, with the dose you're shooting, skipping a day (or more), won't appear at first. Meadow has a HUGE shed. All you did was drain it a bit.

Good luck with your boards!
 
Thanks for the response. So, am I getting this right? I should give her 12 units tonight? And then tomorrow morning increase to the 13 units? The vet did say something about how a dental infection could have some bearing on this and he looked at her teeth but didn't say he thought that was what it was. I didn't have them test for cushing''s because he said she'd have to be there all day long to obtain the blood for that. We decided to wait and see what the other tests revealed. I shipped the blood today - overnight to MU.
 
Any sort of inflammation or infection can raise BG levels. For example, look at Kasha's SS when she was in the midst of a nasty urinary track infection - lots of blacks and reds. Right now, Spot, who was OTJ is having some significant dental problems and is back on insulin. Tartar can cause gingivitis which is an inflammations and can raise BG levels. The vet was good to point that out.

I just want to remind you that most vets think acro and IAA are rare conditions. The reality is that the conditions are more prevalent than was previously thought. If a vet isn't thinking to test for acro, all he's going to see is a cat that needs a high dose of insulin and feel as frustrated as the cat's bean over dose issue and dismiss the situation as a cat that can't be regulated. I suspect the vet you saw today has never had a cat tested. Gayle encountered the same thing with her vet and I suspect that many of the acro moms will tell you a similar story. If this vet is as willing to work with you as it seems, he may be very willing to learn along with you and find out that these kitties can be treated.
 
Actually Sienne, when I started talking about acro today, the vet had this weird look on his face. I said, "Oh, I know, she doesn't have the clinical signs right?" And he said, " I don't know what you're talking about. I've never heard of acromegaly." Well I guess if she tests positive, he'll have to learn about it. Well, the PMPS was 334 and I gave 12 units. Tomorrow AM I'll increase to 13. I'm off to bed now. Cross my fingers for tomorrow.
 
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