? Coco is up to 8.5 units on TR..need advice as to dose tomorrow

[Anna123]

Coco has gotten some blue on her 8.5 dose...we held the dose for the 3 days...Not sure if I raise to 9 tomorrow, or 8.75..or even to hold the dose. We are getting pretty high on the dosing..YIKES!! .Can anyone see any progress? I have an appt. with a specialty vet in a week ($$$) ...I will have them check her teeth and ask about her dosing & whatever else I can think of!

 

[Wendy&Neko]

That was a great stretch of blue there. I would hold the dose one more day (total of 8 cycles) to see if she can see even more improvement. If not, then I'd go up to 9 units. I like seeing the improvement in her spreadsheet. You are seeing more yellow preshots and more frequent blues.

When you talk to the vet next week, I'd highly recommend you get them to test her for high dose conditions. The IAA test is for insulin auto antibodies and the IGF-1 test is for acromegaly. The blood is sent to Michigan State University, the only place in North America that does those tests. We have a number of kitties with one or other or both of those conditions here. Usually when kitties are on low carb wet food or raw, and have been increased methodically (as you have done), then there is usually a high dose condition present. FWIW - I didn't bother seeing a specialist, I got my own vet to run the tests. Seeing an internal medicine specialist once you have those test results might be more productive.

 

[Anna123]

That was a great stretch of blue there. I would hold the dose one more day (total of 8 cycles) to see if she can see even more improvement. If not, then I'd go up to 9 units. I like seeing the improvement in her spreadsheet. You are seeing more yellow preshots and more frequent blues.

When you talk to the vet next week, I'd highly recommend you get them to test her for high dose conditions. The IAA test is for insulin auto antibodies and the IGF-1 test is for acromegaly. The blood is sent to Michigan State University, the only place in North America that does those tests. We have a number of kitties with one or other or both of those conditions here. Usually when kitties are on low carb wet food or raw, and have been increased methodically (as you have done), then there is usually a high dose condition present. FWIW - I didn't bother seeing a specialist, I got my own vet to run the tests. Seeing an internal medicine specialist once you have those test results might be more productive.

That's exactly what the specialist is that I have the appt. with~ an internal medicine specialist. Curious, why don't you think I could just get them to run those tests? My own vet is relatively clueless, so I thought I'd ask the specialist to do everything in one shot & not have to make appointments at 2 places...

 

[Chris/China (GA)/Garfield]

Curious, why don't you think I could just get them to run those tests?

The only place in North America that does the specific testing for acromegaly and IAA is Michigan State University.....any vet can pull the blood and send it to MSU for the testing....it doesn't have to be a specialist

I think Wendy was suggesting you wait to see an internal medicine specialist until after you get the special tests run because IF Coco is positive for acromegaly or IAA, there are certain things that are specific to acromegaly and IAA that an internal medicine doctor would want to keep an eye on

Of course the IM vet should also be able to pull the blood, but to get the testing, they have to send it to MSU too.....I think she was just trying to save you the money of seeing a specialist twice (since if she's positive, the IM vet will want to keep an eye on those special things)

 

[Anna123]

The only place in North America that does the specific testing for acromegaly and IAA is Michigan State University.....any vet can pull the blood and send it to MSU for the testing....it doesn't have to be a specialist

I think Wendy was suggesting you wait to see an internal medicine specialist until after you get the special tests run because IF Coco is positive for acromegaly or IAA, there are certain things that are specific to acromegaly and IAA that an internal medicine doctor would want to keep an eye on

Of course the IM vet should also be able to pull the blood, but to get the testing, they have to send it to MSU too.....I think she was just trying to save you the money of seeing a specialist twice (since if she's positive, the IM vet will want to keep an eye on those special things)

ok, got it! Thank you...it's funny, I just automatically think my regular vet will have no clue how to do basic things like that specific bloodwork..The only vet that I liked at that practice I was just told is no longer there. I'll call tomorrow & see if they can do those tests there..

 

[Wendy&Neko]

Curious, why don't you think I could just get them to run those tests? My own vet is relatively clueless, so I thought I'd ask the specialist to do everything in one shot & not have to make appointments at 2 places...

My reasoning is that you'll probably need to have two visits with the IM specialist. The first for the blood draw and the second once the results come back. Just thought it would be a little cheaper to go into the IM vet visit with all information in hand. My vet hadn't run the tests before either but I showed her where things had to go and she got it done.

You could go ahead and get the IM vet to run the tests. I found that the IM vet consults weren't that much more expensive than the regular vet. And bonus, he was great at responding to questions via email so I got more information out of my IM vet.

 

[Anna123]

That was a great stretch of blue there. I would hold the dose one more day (total of 8 cycles) to see if she can see even more improvement. If not, then I'd go up to 9 units. I like seeing the improvement in her spreadsheet. You are seeing more yellow preshots and more frequent blues.

When you talk to the vet next week, I'd highly recommend you get them to test her for high dose conditions. The IAA test is for insulin auto antibodies and the IGF-1 test is for acromegaly. The blood is sent to Michigan State University, the only place in North America that does those tests. We have a number of kitties with one or other or both of those conditions here. Usually when kitties are on low carb wet food or raw, and have been increased methodically (as you have done), then there is usually a high dose condition present. FWIW - I didn't bother seeing a specialist, I got my own vet to run the tests. Seeing an internal medicine specialist once you have those test results might be more productive.

I also forgot to ask.. what exactly WOULD an improvement be, when I wouldn't have to adjust the units of insulin? I am adding the additional day for the 8.5 unit dose..but when would I NOT move up in dose...or just go up 1/4 of a unit? I'm a little confused on that. Thnx

 

[Wendy&Neko]

Your goal would be to try to find a dose where she is under renal threshold the majority of time. That number varies by cat. For Neko it was in the low 200's, for some cats it's in the upper 100's. But once you reach that dose, it may not remain static for long period of time. Due to many reasons, cat's insulin needs can move up and down over time.

If you see a number below 100, then hold the dose longer, otherwise increase again. At the size of dose Coco is on, most changes would be by 0.5 units, unless you were trying to fine tune a dose because it is almost the right dose.

 

[Anna123]

Your goal would be to try to find a dose where she is under renal threshold the majority of time. That number varies by cat. For Neko it was in the low 200's, for some cats it's in the upper 100's. But once you reach that dose, it may not remain static for long period of time. Due to many reasons, cat's insulin needs can move up and down over time.

If you see a number below 100, then hold the dose longer, otherwise increase again. At the size of dose Coco is on, most changes would be by 0.5 units, unless you were trying to fine tune a dose because it is almost the right dose.

ok, thanks...she hit the lower 100's at her nadir today again...although her numbers have definitely come down a lot, she always goes back up to the 300's at her AMPS & PMPS. Should I hold the dose again for tomorrow or increase .5?

 

[Wendy&Neko]

Sorry, I don't see the numbers on her spreadsheet.

 

[Anna123]

Sorry, I don't see the numbers on her spreadsheet.

I always wait until the end of the day to enter them on the computer, when I'm done with all the testing (transferred from notes during the day)... but her nadir was in the lower 100's...check back later lol

 

[Wendy&Neko]

OK, but not having the data just makes it a little harder to day what to do. I think I would still increase tomorrow if you don't see green tonight.

 

[Anna123]

J

OK, but not having the data just makes it a little harder to day what to do. I think I would still increase tomorrow if you don't see green tonight.

Just updated her spreadsheet for the day. I hope a .5 increase isn't too much, but I may do that tomorrow