? 7/6 Charlie AMPS 362 Need to go back on insulin, how start again?

Status
Not open for further replies.
Kiki's Charlie

Kiki's Charlie

Member Since 2014
My little kittie Charlie was on insulin for about eight months and then off insulin for eight months and managed to balance her number beautifully on her own. Since about three weeks now, I noticed that her numbers started to creep up again. I have changed diet, feeding scheme, tested for UTI and checked teeth (which was all fine)... I think I just have to surrender now and go back on insulin : ((( I know I should probably start low (1 unit?) and go slow, but looking at her old spreadsheet, are there any learnings I can take forward? Ie, I think 1 unit will be too low, maybe start with 1,5 unit or is that too much, too sudden?? Any advice appreciated! PS - She's on a pet meter = numbers showing higher than human meter!!
 
Hi Kiki.

It will probably be a while before there are many people online to answer your questions, but I do have one suggestion. Can you find a day when you can do a curve (test every two hour for a complete 12 hour cycle)? That will tell you if Charlie's pancreas is working. I recently did one with my civvie, Harvey, at my vet's instructions, and even though his PMBG was high, he came down to the low 100s at mid cycle, which means it was not diabetes. BGs can go up for a variety of reasons, including undiagnosed illnesses, pain, stress, etc. You want to be sure, before starting insulin, that Charlie really needs it. That said, we'll see who else chimes in.
 
Your max dose last time was 1.5u. I would not start with that high of a dose. You may end up going beyond that dose (which is not unusual with a cat that's fallen out of remission) but I would not start that high since you have no idea how much insulin Charlie will need. If it were me, I'd start at 0.5u. You'll want to be aggressive with regard to dose, though, and make sure to evaluate the dose every 3 days beyond the first 5 - 7 days when the depot is forming.

 
Thanks, good point. Maybe best to start with 0,5... The other thing I forgot to mention is that we have had a terrible heatwave here the last week (very unusual for The Netherlands) so maybe the high numbers are also a reaction to that?
 
I agree with Sienne. I think starting with 0.5 sounds reasonable. Good luck.
 
While starting with a low dose is never a bad idea, I've yet to see a kitty returning from the Falls who doesn't end up surpassing the highest dose they've ever received prior to falling out of remission.

However, getting kitty back to normal numbers as quickly as safely possible is key to success. Please check out the 2009 tab on Alex's spreadsheet. You'll notice I also re-started insulin at 0.5u BID, but realized it wasn't enough insulin within the first 4 cycles. Over the next 10 days I became aggressive by rapidly taking her up close to the dose I probably should have started her at to begin with when following the guidelines in the weight-based formula of the TR protocol (1.375 units).

Obviously ECID, but here's an example (from Alex's 2009 spreadsheet):
Highest dose the last time on insulin = 1 unit
Re-started insulin = 0.5 unit
Starting dose following TR guidelines (0.25u x per kg of cat's ideal weight) should have been = 1.375 units
Breakthrough dose = 1.5 units
Dose which flattened her out in greens overall = 1.6 units

You're an experienced caregiver. If your schedule permits careful monitoring to ensure safety, become as aggressive as safely possible. The longer kitty remains in higher than normal numbers the less chance of another remission.

BTW, don't get scared off by the amount of testing you see on Alex's 2009 spreadsheet. I tested her more than usual because I wanted to create a document that would illustrate what happens when shooting full doses on lower preshot numbers.


Good luck! Hope Charlie returns to the Falls sooner than later! :)
 
Thanks Jill for the advice. The highest dose Charlie got last time (after a roller coaster start, I don't count that), was 1,5 u. If I read your advice and also base the dose on the TR guidelines, she would get 0,25 u x 4 kg = 1 u. This was also the dose my gut feeling told me to start her with... I think I will try that. The first two weeks I can monitor her closely, then I'm away for two weeks and my partner needs to do the job. He can shoot, but not blood test, so not ideal. I'll deal with that when I get there! Her curve today was very high (for her) the whole day, so I really need to take action asap. I've ordered new Lantus from the vet and will pick it up and start on Wednesday.
 
Kiki's Charlie said:
If I read your advice and also base the dose on the TR guidelines, she would get 0,25 u x 4 kg = 1 u. This was also the dose my gut feeling told me to start her with... I think I will try that.
Click to expand...
Correct.

However, start with a dose you're comfortable with. I just like to urge experienced caregivers who can monitor often to become aggressive with dosing when the current dose isn't doing enough. In other words, don't hang on to an inadequate dose for more than 4 - 6 cycles before increasing the dose.

Kiki's Charlie said:
The first two weeks I can monitor her closely, then I'm away for two weeks and my partner needs to do the job. He can shoot, but not blood test, so not ideal. I'll deal with that when I get there!
Click to expand...
Given the circumstances and for the sake of safety, you may find it necessary to reduce the dose while you're gone, but like you say... deal with it when you get there!
 
Status
Not open for further replies.
Back
Top