6/8-Tip-AMPS-431...PMPS-392...+6-203

[Cindy & Pets]

6/6 condo

Yesterday's numbers
AMPS-283
+2-300
+4-238
+6-211
+9-309
PMPS-384
+2-339
+6-266

Today's numbers
AMPS-431
+6-289
PMPS-392
+2-286
+4-211
+6-203

Talked to the vet yesterday about Tips numbers and what might be wrong. Given her weight, the vet is thinking that's the problem, just that she's gotten too overweight. I wish I knew how to get her to exercise more. I know fluids made her feel better, but I'm not sure if I should ask the vet if I could have another bag for home just to give her some relief until I can get her weight down. Would that help or make the situation worse? The vet isn't open again until monday, so I have time to decide. But it's just I'm not sure if that'd be a good way to go, make the problem worse, or what.

 

[Marje and Gracie]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

Cindy

Has her weight changed that much in ten days? Has she been sick?

I think part of the problem might be that you are taking too small of increases for a high dose cat.

From Tillys website on the TR protocol:

Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.

Sometimes they just need the dose to go up. If she has been well and no signs of any infection, she likely just needs more insulin.

 

[Cindy & Pets]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

She's gone up 5oz or so in 10 days. I'm not sure if that's a large amount or what. She's been acting lethargic, but since the last vet visit, her abdomen isn't sensitive to the touch anymore, she's eating fine, breathing sounds normal to me, no temp, no ketones, but she has been a little dehydrated even though she's drinking normal.

I was already thinking about increasing her insulin, guess it should be by .5 then. But she would still probably do better losing weight since she's overweight, but when she's so lethargic(sometimes sleeping in the same spot for half of the day) it's difficult to get her moving.

 

[Marje and Gracie]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

Is she retaining any fluid?

As far as giving fluids, assuming it is directed by your vet, it may slightly lower BG but not substantially.

She doesn't have any interactive toys she likes?

 

[Cindy & Pets]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

I don't think so. How would I be able to tell? Or is that something only a vet would be able to find out?

There's her feather wand, but that's it and she'll only play with it for a few minutes a couple of times a day, I've at most gotten her to play 15 minutes in one day.

 

[Marje and Gracie]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

Wendy/Neko told me about a post Julie (Punkin) made on Tiggys condo regarding high dose kitties.

I looked at the link to your previous condo on 3/7 and the discussion about dosing. the only thing i would add for you to consider is that it's helpful to make decisions on size of dose increases by taking into account how tiggy reacts to them. the general wisdom is that you want to increase by the percent that is roughly the same as with a 1.0 unit dose to 1.25u dose. That's the "normal" increase that the protocol was based upon, right? you're adding on 25%. So with a 5.0u dose, in theory, you could increase by 1.25u, or 25%. with a 10u dose, you could increase by 2.5u . . . most people wouldn't do that however. Most people (generalizing) with higher dose cats think in terms of 10%, and then round it to an easy to shoot number. Punkin's highest dose was around 15u and i think the largest dose increase i made was 1u. i do use R to knock the top off the bounces and now that i'm comfortable with it, understand when to use it and can anticipate how punkin will respond to it, i really like having it in my toolbox.

The thing that's important however, is how each cat responds to dose adjustments. at the beginning, i increased punkin's dose a few times by 1.0u, following that 10% guideline, but when i realized that he still responded to a small increase, i changed back to .25u and .5u increases. even at 15u i could see that .5u made a difference in his numbers. i think the closer you are to an "ideal" dose (and good BGs) the smaller your dose changes. anytime i felt like his numbers were rising out of control, I also have done the dose increases every 4 shots until you're seeing good numbers - like a nadir in lower blues. then shift to holding the dose longer and making the dose changes in smaller increments.

It's also important to have a strategy for decreasing doses. the tactic i have used if i thought he needed a dose decrease is to drop the dose significantly for one dose to allow the shed to drain some, then return to a slightly decreased dose with the subsequent shot. So if he was at 10u and hitting too low, I would give the next shot at 7u and the following shot come back up to 9 or 9.5, something like that. my husband and i have laughingly named this strategy "Dialing for Doses" because sometimes you are just making the best decision you can make. it is very important to understand the shed action of the lantus/lev insulins. when you decrease the dose you can still see effects from the original dose for several cycles after the decrease. it seemed to us that doing a significant reduction on that first reduced dose helped to keep the next cycle from dropping too low. In my previous example, if he was getting 10u dose in the morning and hit a 30, and i decreased to 9.5u that evening, i would almost guarantee i'd see a 30 again that pm cycle. that's not enough of a reduction to prevent it.

I hope that helps....it actually better refines the suggestions I made.

Any thought yet to having her tested for acro/IAA?

 

[Cindy & Pets]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

That's got me a little confused...that means the max I can increase Tips dose by currently would be roughly 1u? Or is that not what I should be getting from it?

Yeah, I'll be talking to the vet about it on monday to get in that week to do them when I give them Tips weekend numbers.

 

[Marje and Gracie]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

No...this is the part I wanted to draw to your attention:

The thing that's important however, is how each cat responds to dose adjustments. at the beginning, i increased punkin's dose a few times by 1.0u, following that 10% guideline, but when i realized that he still responded to a small increase, i changed back to .25u and .5u increases. even at 15u i could see that .5u made a difference in his numbers. i think the closer you are to an "ideal" dose (and good BGs) the smaller your dose changes. anytime i felt like his numbers were rising out of control, I also have done the dose increases every 4 shots until you're seeing good numbers - like a nadir in lower blues. then shift to holding the dose longer and making the dose changes in smaller increments.

I bolded what I see as very important.

 

[Cindy & Pets]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

Alright. I'm pretty sure I get it now. Should I stick with increasing by .5u tomorrow then? Or should I go with a different increase?

 

[Wendy&Neko]

Re: 6/8-Tip-AMPS-431...PMPS-392...+6-203 ??

Cindy, the post from Julie suggests that you could increase by up to 1U when you are at 10U, but what you actually increase depends on how your cat reacts to increases and how close you are to the ideal dose. I think a .5U increase given Tips numbers is a good idea. She hasn't seen much blue lately.

I'm glad you are thinking of getting the IGF-1/IAA tests, as the answer to those tests can help us make suggestions. For example, cats with acromegaly have extra growth hormone secreted by the pituitary. As a result, there is growth in soft tissue and even the organs. This can cause cats to gain weight, even cats who aren't as well controlled as Tip usually is. That would mean that weight gain is not unexpected. The other thing you mention is lethargy. My Neko is not as active as she used to be. Acrocats can get a form of arthritis which slows them down a bit. Adding glucosamine (for example Cosequin) can help with that. Non acrocats get arthritis too, if you talk to your vet about lethargy it might be something to ask about.