7/8 Oscar AMBG 122 Should I lower dose again?

josette

josette

Member Since 2022
The hospital lowered Oscar’s dose from 9u to 7U. His PMPS number looks good to give the 7U but the morning AMPS keeps getting lower each morning. Yesterday I gave 3 U in the morning but this morning it was lower and I skipped because I got nervous. Didn’t know if I should have given 1U as afraid the 3U might have been too much.

so the question should I reduce the evening dose?
 
josette said:
The hospital lowered Oscar’s dose from 9u to 7U. His PMPS number looks good to give the 7U but the morning AMPS keeps getting lower each morning. Yesterday I gave 3 U in the morning but this morning it was lower and I skipped because I got nervous. Didn’t know if I should have given 1U as afraid the 3U might have been too much.

so the question should I reduce the evening dose?
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To be honest, this is not TR. But to answer your question, he was on 9u bid in the hospital and got to 47. The dose should have been lowered to 8.75u under TR. However, you don’t have much data so I would at least be shooting 7u since he’s seen some blue BGs there and I would be testing much more to try and catch the nadir so you can see what he’s doing A higher dose, such as 9u, could be affecting the depot for up to six subsequent cycles so the lower numbers since they dropped the dose, could have, at first, been the depot from 9u.

I would be very remiss if I didn’t tell you that the management of his diabetes could be drastically better if you were following TR or at least SLGS. If you are not able to get mid cycle daytime or any test after PMPS in the evening, you should probably be doing SLGS. There is no way we would have ever suggested you hold a 9u dose for so long with the BGs you are showing.

Have you had him tested for IAA or acro? He really should be at the dose he’s getting. I’d also like to encourage you to post every day and let us help you get him sorted out and his BG looking much better.

Finally, could you please put the subject line in the correct format which would be: “7/8 Oscar AMBG 122 Should I lower dose”.

Thank you.
 
He has been tested for those and all negative. Are you saying I should i should increased the dose why back when? They want an endoscopy since ultrasound showed thinking abdomen lining and enlarged pancreas to rull out small cell lymphoma or irritable bowel disease. He just came out of the hospital.

What dose should I have given this morning?
 
josette said:
He has been tested for those and all negative.
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Can you remind me again what the results were for the IGF-1 and IAA tests? It's very unusual to see a cat over 6 units be negative for both, so I'm curious about this. Also, what date were the tests done?
 
Wendy&Neko said:
If you could have gotten any testing in today, I would have given his normal dose. As you saw on the 7/5 AM cycle that 7 units "mistake" was fine. Dose changes at his size of dose are by 0.5 units at a time.

How is Oscar's appetite now?

Here's the link to your last post here from last week: https://felinediabetes.com/FDMB/threads/oscar-in-hospital.279230/
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Thanks for reminding me about those larger dose changes with over 5U bid cats. I was too focused on how long that 9u was held :p

I’m not sure what Wendy means by “his normal dose” but since he earned a reduction while he was in the hospital, she might mean 8.5u which you would have shot as soon as you got him home. I was thinking 7u because he saw some blue on it past the 9u depot and I felt you might be a bit more comfortable with it. I’ll confer with Wendy to be sure we are on the same page and one of us will get back to you this evening.
 
Wendy&Neko said:
Can you remind me again what the results were for the IGF-1 and IAA tests? It's very unusual to see a cat over 6 units be negative for both, so I'm curious about this. Also, what date were the tests done?
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April 12 Oscar had a GI panel, insulin like growth factor-1 MSU, Cortisol Serial 3 Dex, Dexamethasine-sp 4 mg/ml, complete blood count with Retic count.

I will have to look thru their notes on line to see exactly what she said but basically she said he didn’t have either.
 
Wendy&Neko said:
If you could have gotten any testing in today, I would have given his normal dose. As you saw on the 7/5 AM cycle that 7 units "mistake" was fine. Dose changes at his size of dose are by 0.5 units at a time.

How is Oscar's appetite now?

Here's the link to your last post here from last week: https://felinediabetes.com/FDMB/threads/oscar-in-hospital.279230/[/QUOTE

where I write mistake is where the tech in the hospital took it upon herself to give him 7 U without the doctor approval when his number was so low. Tech was reported to staff and management and I hope fired! So he could not go home that day because he had to be monitored closely.
His appetite is very very good! Of course he is taking Cerenia, budesonide for anti inflammatory, and Prilosec for acid reflex.
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Wendy&Neko said:
Can you remind me again what the results were for the IGF-1 and IAA tests? It's very unusual to see a cat over 6 units be negative for both, so I'm curious about this. Also, what date were the tests done?
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From the internist:
Antech CBC: Hct 28%, WBC 5.1k, platelet count 430k
2. MSU IGF-1: 401 (high)
3. TAMU GI Panel (cobalamin/folate/fPLI/TLI): TLI 68.6, fPLI 14.7, cobalamin 885, folate 34

4. Low dose dexamethasone suppression test: does NOT support Cushing's Disease
baseline cortisol: 3.0
4hr post cortisol: 0.4
8hr post cortisol: <0.2

Oscar's LDDST test was not supportive for Cushing's Disease. While his IGF-1 levels are mildly high, diabetic patients often have mildly elevated levels naturally without evidence of acromegaly (growth hormone tumor). Patients with acromegaly tend to have significantly increased IGF-1 levels (greater than 1000), so the chances of Oscar having acromegaly are very low.
 
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josette said:
From the internist:
Antech CBC: Hct 28%, WBC 5.1k, platelet count 430k
2. MSU IGF-1: 401 (high)
3. TAMU GI Panel (cobalamin/folate/fPLI/TLI): TLI 68.6, fPLI 14.7, cobalamin 885, folate 34

4. Low dose dexamethasone suppression test: does NOT support Cushing's Disease
baseline cortisol: 3.0
4hr post cortisol: 0.4
8hr post cortisol: <0.2

Oscar's LDDST test was not supportive for Cushing's Disease. While his IGF-1 levels are mildly high, diabetic patients often have mildly elevated levels naturally without evidence of acromegaly (growth hormone tumor). Patients with acromegaly tend to have significantly increased IGF-1 levels (greater than 1000), so the chances of Oscar having acromegaly are very low.
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According to this previous post from Wendy, it seems Oscar does have acro with a level of 400:

- The US doesn't measure IGF-1 units in ng/mL, so positive is above 92 when blood is sent to MSU.
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Those test results also indicate pancreatitis and potentially small intestine bacterial overgrowth (high folate). Did the vet mention these?

I haven’t been able to touch base with Wendy so I would continue the 7u dose for now. I’d like her to address the IGF-1. And they didn’t test him for IAA?
 
Marje and Gracie said:
According to this previous post from Wendy, it seems Oscar does have acro with a level of 400:



Those test results also indicate pancreatitis and potentially small intestine bacterial overgrowth (high folate). Did the vet mention these?

I haven’t been able to touch base with Wendy so I would continue the 7u dose for now. I’d like her to address the IGF-1. And they didn’t test him for IAA?
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internist says greater than 1000 was acro. He was given Veraflox (pradofloxacin) for treatment of Mycoplasma for 2 weeks.

yes he has chronic pancreatitis . Mild gallbladder sludge, urinary bladder mass, mild hepatomegaly with myelolipomas

what is IAA?
 
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josette said:
internist says greater than 1000 was acro. He was given Veraflox (pradofloxacin) for treatment of Mycoplasma for 2 weeks.
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Wendy is our acro expert but from what I understand, the “greater than 1000” is based on tests from the Royal Veterinary College. Tests through MSU are different so anything above 92 is positive for acro.
 
Marje and Gracie said:
Wendy is our acro expert but from what I understand, the “greater than 1000” is based on tests from the Royal Veterinary College. Tests through MSU are different so anything above 92 is positive for acro.
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I do see that on the report from MSU that I just found in an email attachment and I will definitely bring that to her attention. So basically what does that mean?
 
josette said:
internist says greater than 1000 was acro.
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It does if you are sending the blood to the Royal Vet Clinic in the UK, where they use a different measurement system. Sort of like we have two versions of our BG spreadsheet, one for the US and another for the rest of the world. In the US, anything above 92 is positive for acromegaly.

This result means that Oscar has acromegaly. You should definitely talk to vet about that and see if you want to discuss possible treatments. If cost or availability to travel is an issue, then the medication cabergoline is probably your best choice. Not everyone does treatment for the condition, and mostly just try to manage the blood sugar with appropriate levels of insulin. Note that acromegaly means an excess of growth hormone in the body. You can see side effects from that, though different acrocats seem to present with different symptoms. My girl's first symptoms (other than savage humger and needing a higher dose) was arthritis, due to growth hormone causing bony growths. Later on she got kidney disease and heart disease that was probably caused by it as well. Acros can get organ growth. Hepatomegaly means larger liver. Another common condition is thickened bowels, such as Oscar is dealing with now, and my girl also had. This was over a period of a number of years. I did get her treated with radiation therapy, and it slowed but didn't stop the disease. Cabergoline was not available as a treatment in my time.

IAA is insulin auto antibodies. You can think of it as sort of like the cat's body reacting to injected insulin as a foreign body and trying to trap it in antibodies. Cats can it by itself, or in common with acromegaly, like Neko did. Not all vets think to test for it too. At this point, it's probably not too important to test. It's good to do at the same time as the IGF-1 test, as it's a cheap add on at the time.

When I said "shoot normal dose" above, I meant, not a reduced dose or a skip. I wasn't being specific about a size of dose.
 

He was in the hospital the 3rd, 4th and 5th . They lowered the dose they gave him. And I still do not understand how they got such low numbers when they feed 26 carb prescriptions food. Also they only feed at shot times! They said cats are not humans. Makes me mad.
 
josette said:
He was in the hospital the 3rd, 4th and 5th . They lowered the dose they gave him. And I still do not understand how they got such low numbers when they feed 26 carb prescriptions food. Also they only feed at shot times! They said cats are not humans. Makes me mad.
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I can certainly understand that. When Gracie was in the hospital, they acted like they knew so much more about FD than I did and it was a fight to get them to test her when I told them to. I hope he will start feeling better but you’ll need to test him a bit more at home to give us an idea of how low he’s going so we can ensure the correct dose,
 
Marje and Gracie said:
I can certainly understand that. When Gracie was in the hospital, they acted like they knew so much more about FD than I did and it was a fight to get them to test her when I told them to. I hope he will start feeling better but you’ll need to test him a bit more at home to give us an idea of how low he’s going so we can ensure the correct dose,
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He had on a continuous glucose monitor at the hospital.
 
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