Darcy's spreadsheet. Will someone with a high-dose kitty please look at it

Suzanne & Darcy

Suzanne & Darcy

Member Since 2020
Hello. My sugar boy Darcy is just not doing well at all. He is always high and flat. We have been through Vetsulin (back when he was first diagnosed in June 2020) then ProZinc, then November 14 we started Lantus. I keep trying new insulins with high hopes and it looks like we start out with a little improvement and then things just get worse. Darcy is also prone to producing ketones. He was hospitalized for DKA and hepatic lipidosis (he had some kind of infection and very high fever when he was admitted) back in October. He had a bad tooth, which we removed after he had recovered from the DKA and hepatic lipidosis enough that we could anesthetize him safely. He really doesn't have many teeth left. At one point the told me he had stomatitis (a few years back) and his mouth was very red and inflamed. He had many of his teeth removed at that time and didn't have it recur -- even with his recent bad tooth, the whole mouth was not inflamed... it was localized to the tooth. Well, that's a little background on my boy. I am a member of the Sugarcat Support Group on Facebook (and I know that quite a few people from that group are on this board as well). They are wonderful and so helpful and I love them! I just thought that maybe somebody here who has a high-dose kitty could comment. Thanks! https://docs.google.com/spreadsheets/d/144_vB3dOH64wmL5bf19K2YJ1ionuPmTd_SbV0inmXrI/edit?usp=sharing
 
Chances are you do have a high dose condition, however there’s also a possibility of a nasty case of glucose toxicity from holding doses that aren’t working for too long. It didn’t do him any favours starting Lantus back at 1U either. The solution for either is the same, follow TR and keep increasing every three days until you start seeing some movement. You may also want to consider getting Darcy tested for acromegaly and IAA at this point. If it’s IAA it will be self limiting within a year but you need to treat very aggressively to beat it down. You are generally testing enough for TR with just a few exceptions so I would highly recommend that, especially with the ketone issues. A cat needs as much insulin as it needs, there’s no such thing as giving a cat too much insulin if that’s what’s needed. Purrdy (Cushings) got up to 16U, the link to his spreadsheet is at the top of Vyktor’s first linked spreadsheet in my signature. I have seen other kitties need over 20U. If you do find yourself needing to give very high doses you may also consider switching to levemir, not because it will work any better but because lantus can sting at high doses whereas levemir does not.

Would you mind putting a solid line across Darcy’s spreadsheet with started lantus written in when you did that so it’s easier to see.
 
Hello and welcome. You've been through a lot with your boy. :bighug: I have a few comments on your SS, but have to move from iPad to computer.

OK, I'm back. The reason I had to move was your spreadsheet. Unfortunately a certain FB group (which you are familiar with) took the spreadsheet template from here, made some edits, and unfortunately introduced some problems with those edits that cause the spreadsheet to die on tablets. If you are interested in advice longer term here, it'll be helpful if you can use our template instead and copy the data over. We have people who can help if this is too much for you. FDMB Spreadsheet Instructions: At the same time, we can help you get set up to have a second spreadsheet tab for 2021, just makes is so we don't have to scroll down so much to see the most recent data.

We also have some conventions in our signatures that help us help you faster: New? How You Can Help Us Help You! If Darcy has any other medical conditions or medications, it helps to list them there, as some can impact blood sugar numbers. Knowing about the DKA and ketones at a glance impacts our dosing suggestions.

Now the formalities are over, some comments on Darcy. First off, big mistake going back to 1 unit when you switched from Prozinc to Lantus. I know some other groups suggest that. We take the dose of the previous insulin in mind when switching. I confess I made the same mistake when switching from Caninsulin and it took months to get back to where I should have been. In the mean time, glucose toxicity set in and Neko was firmly entrenched and comfy in higher numbers. It turns out she had two secondary conditions that sometimes mean cats need higher doses (acromegaly and insulin auto antibodies). But dosing in the past is the past and I think we can help you going forward.

What type of food is Darcy eating? It would really help Darcy if you can use the Tight Regulation protocol as a dosing method. It allows you to increase again as soon as after 3 days, depending on the numbers you are seeing. With recent ketones, it'll allow you to get past that quicker. And help get over whatever insulin resistance seems to be present.

Other than the ketones and teeth, how is Darcy otherwise. His litter box habits, is he grooming or playing or purring? Cats are so much more than their numbers.
 
I have a high dose kittie who has IAA (diagnosed Sept. 30). I follow TR and he is up to 32 units twice/day of Levemir. The insulin bill is not fun! I had him tested for IAA and Acromegaly after he hit 6 units twice/day of Prozinc and didn’t see that he was going anywhere down the scale so made the switch to Levemir when his diagnosis came in. So I would definitely consider getting your kittie tested for both if you can. Howie lives in yellows and pinks but has hit a nice blue streak lately. @Wendy&Neko and @Sandy and Black Kitty are angels with high dose kitties who have these types of conditions.
 
Wendy&Neko said:
Hello and welcome. You've been through a lot with your boy. :bighug: I have a few comments on your SS, but have to move from iPad to computer.

OK, I'm back. The reason I had to move was your spreadsheet. Unfortunately a certain FB group (which you are familiar with) took the spreadsheet template from here, made some edits, and unfortunately introduced some problems with those edits that cause the spreadsheet to die on tablets. If you are interested in advice longer term here, it'll be helpful if you can use our template instead and copy the data over. We have people who can help if this is too much for you. FDMB Spreadsheet Instructions: At the same time, we can help you get set up to have a second spreadsheet tab for 2021, just makes is so we don't have to scroll down so much to see the most recent data.

We also have some conventions in our signatures that help us help you faster: New? How You Can Help Us Help You! If Darcy has any other medical conditions or medications, it helps to list them there, as some can impact blood sugar numbers. Knowing about the DKA and ketones at a glance impacts our dosing suggestions.

Now the formalities are over, some comments on Darcy. First off, big mistake going back to 1 unit when you switched from Prozinc to Lantus. I know some other groups suggest that. We take the dose of the previous insulin in mind when switching. I confess I made the same mistake when switching from Caninsulin and it took months to get back to where I should have been. In the mean time, glucose toxicity set in and Neko was firmly entrenched and comfy in higher numbers. It turns out she had two secondary conditions that sometimes mean cats need higher doses (acromegaly and insulin auto antibodies). But dosing in the past is the past and I think we can help you going forward.

What type of food is Darcy eating? It would really help Darcy if you can use the Tight Regulation protocol as a dosing method. It allows you to increase again as soon as after 3 days, depending on the numbers you are seeing. With recent ketones, it'll allow you to get past that quicker. And help get over whatever insulin resistance seems to be present.

Other than the ketones and teeth, how is Darcy otherwise. His litter box habits, is he grooming or playing or purring? Cats are so much more than their numbers.
Click to expand...
Wendy&Neko said:
Hello and welcome. You've been through a lot with your boy. :bighug: I have a few comments on your SS, but have to move from iPad to computer.

OK, I'm back. The reason I had to move was your spreadsheet. Unfortunately a certain FB group (which you are familiar with) took the spreadsheet template from here, made some edits, and unfortunately introduced some problems with those edits that cause the spreadsheet to die on tablets. If you are interested in advice longer term here, it'll be helpful if you can use our template instead and copy the data over. We have people who can help if this is too much for you. FDMB Spreadsheet Instructions: At the same time, we can help you get set up to have a second spreadsheet tab for 2021, just makes is so we don't have to scroll down so much to see the most recent data.

We also have some conventions in our signatures that help us help you faster: New? How You Can Help Us Help You! If Darcy has any other medical conditions or medications, it helps to list them there, as some can impact blood sugar numbers. Knowing about the DKA and ketones at a glance impacts our dosing suggestions.

Now the formalities are over, some comments on Darcy. First off, big mistake going back to 1 unit when you switched from Prozinc to Lantus. I know some other groups suggest that. We take the dose of the previous insulin in mind when switching. I confess I made the same mistake when switching from Caninsulin and it took months to get back to where I should have been. In the mean time, glucose toxicity set in and Neko was firmly entrenched and comfy in higher numbers. It turns out she had two secondary conditions that sometimes mean cats need higher doses (acromegaly and insulin auto antibodies). But dosing in the past is the past and I think we can help you going forward.

What type of food is Darcy eating? It would really help Darcy if you can use the Tight Regulation protocol as a dosing method. It allows you to increase again as soon as after 3 days, depending on the numbers you are seeing. With recent ketones, it'll allow you to get past that quicker. And help get over whatever insulin resistance seems to be present.

Other than the ketones and teeth, how is Darcy otherwise. His litter box habits, is he grooming or playing or purring? Cats are so much more than their numbers.
Click to expand...
 
Vyktors Mum said:
Chances are you do have a high dose condition, however there’s also a possibility of a nasty case of glucose toxicity from holding doses that aren’t working for too long. It didn’t do him any favours starting Lantus back at 1U either. The solution for either is the same, follow TR and keep increasing every three days until you start seeing some movement. You may also want to consider getting Darcy tested for acromegaly and IAA at this point. If it’s IAA it will be self limiting within a year but you need to treat very aggressively to beat it down. You are generally testing enough for TR with just a few exceptions so I would highly recommend that, especially with the ketone issues. A cat needs as much insulin as it needs, there’s no such thing as giving a cat too much insulin if that’s what’s needed. Purrdy (Cushings) got up to 16U, the link to his spreadsheet is at the top of Vyktor’s first linked spreadsheet in my signature. I have seen other kitties need over 20U. If you do find yourself needing to give very high doses you may also consider switching to levemir, not because it will work any better but because lantus can sting at high doses whereas levemir does not.

Would you mind putting a solid line across Darcy’s spreadsheet with started lantus written in when you did that so it’s easier to see.
Click to expand...
--------------------------

Okay. I'm not sure I'm posting my replies correctly at all. I appreciate your response. I have already downloaded and printed the information on the IAA and Acro test information for the University of Michigan. They are not that expensive, fortunately, and I am planning to ask Mr. Darcy's vet to run those tests this week and do general blood work. We have had him re-ultrasounded not long ago to make sure there was nothing bad going on with his liver, since he had suspicious areas on there during his first ultrasound performed when he was hospitalized that whole week. We did a FNA on his liver that week. It was mostly indicative of hepatic lipidosis. The vet still says that there are hyperechoic spots on his liver, but there was little to no change. Darcy is being given Denamarin daily. I hope it will help his liver after the hepatic lipidosis.

I have been worried about the Lantus starting to sting at higher doses. So far, Darcy doesn't seem to care a bit. He is a real sweetheart though and is a favorite at the vet. But we are only at five units so far.

I'm not sure how to make the line across the spreadsheet for when I started Lantus. I will try to figure it out. More later! Lots more to fill in and I suppose I can add a lot to my signature that would help. Thanks.
 
Darcy eats Dave's Naturally Healthy Grain Free Turkey and Giblets cat food (wet). He has been eating this food for a long time -- long before he ever became diabetic. He only gets a small amount of dry food and it is Dr. Elsey's Clean Protein chicken flavor dry food and he only gets this as a food topper in small amounts. It does not seem to affect his BG numbers.

I test using a ReliOn Premiere. More to come!
 
I have been through a lot trying to convince my vet that a cat can have high ketones even when he's in the 200s. She doesn't believe in the accuracy of my Nova Max ketone meter. I will do the dose increases every three days. I only waited on some of the doses because I wanted to make sure it wasn['t a bounce (which as you all say can last 72 hours). Darcy seems to go higher and higher with every dose increase. I have noticed, however, that every time I switch to different insulin, we start well and then things go south. I think it's antibodies.
 
Howiesmom said:
I have a high dose kittie who has IAA (diagnosed Sept. 30). I follow TR and he is up to 32 units twice/day of Levemir. The insulin bill is not fun! I had him tested for IAA and Acromegaly after he hit 6 units twice/day of Prozinc and didn’t see that he was going anywhere down the scale so made the switch to Levemir when his diagnosis came in. So I would definitely consider getting your kittie tested for both if you can. Howie lives in yellows and pinks but has hit a nice blue streak lately. @Wendy&Neko and @Sandy and Black Kitty are angels with high dose kitties who have these types of conditions.
Click to expand...
?
 
Good to hear you are planning to ask for the IGF-1 (acromegaly) and IAA tests. Be prepared some vets aren't as current with how common these conditions are with diabetic cats - you may have to ask the vet to humour you, like I did.

A couple reasons numbers go higher as the dose goes higher. One, the higher insulin dose is bringing more lower numbers than he is used to, so he's bouncing more. When I finally started getting numbers over 500 :rolleyes:, I knew the insulin was finally working to bring Neko down. Holding doses too long, especially in presence of secondary conditions causing insulin resistance - brings both glucose toxicity and lets the antibodies have a field day. If there is acromegaly, the tumour can ramp up - see Neko 2015, mid July when it really took off. I'd increase to catch up and the tumour kept on racing ahead of me.

Ketones can indeed happen in yellows. Check out Bubba's SS. He switched to Lantus 12.1.15 and started seeing ketones a few days later, mostly in yellows at the time. Check out Howie's SS (in post 7 above) and he was seeing ketones end of October. That boy loves the yellows. And his caregiver is also using the Nova Max. Above 2.6 ketones is concerning.

TR really requires all low carb wet food or raw. How much dry per day does he get? Even with TR, I'd only increase every 3 days if you have at least two tests per each cycle that day, so we know you aren't missing any lows.

For the Lantus sting, it really is ECID (each cat is different). It is more common at higher doses, but we've seen some cats react at lower doses, and I've also seen cats on north of 20 units do fine on Lantus. Just keep an eye on it. Look for his skin to quiver around the shot location, walking away from the shot, personality changes.
 
You’ve received some great advice already. Freckles was Dx with acromegaly and IAA February of 2020. She was up to 11 u twice/day and is now at 5.5 u 2x/day and Stays primarily in the blue zone. We had to switch from Lantus to Levemir because of the stinging. TR is the way to go for sure!
 
Yes, I've heard about some really bad reactions to Lantus from the stinging, Luckily we haven't seen any of that yet. I'll be on the alert for it. I am sure it will take my vet some convincing about the testing, but I plan to ask her to humor me and run the tests. I'll bring the paper with the tests that I want run. I was planning to do it this week, but now I most likely will not. Another of my cats, Julius, a civvie had to be taken to the Emergency Vet today with pneumonia. He's there now spending the night on oxygen, antibiotics, etc. It's always something with these guys. I've updated my spreadsheet with a new tab for 2021. I'm not sure how to make a line for when we started the Lantus (November 14). I am also not sure how to modify to use your sheet so that you can access it on the tablet. Can I just copy and paste all my numbers into one of your sheets?

My plan is to increase Darcy by another half unit after six cycles. I've actually had two yellows since I increased him to 5 units, but today his ketones hit 5.0 (yikes.) He still is sweet and loving... not as energetic as he used to be but mostly seems fine and loves eating a lot of food with no vomiting. I'm getting ready to go give him some sub-q fluids right now. It usually seems to help with the ketones... although today the 5.0 really freaked me out. Thanks very much for all of the support and helpful information! Here is the latest sheet, updated just now. I'll test again before bed, as usual.

https://docs.google.com/spreadsheets/d/144_vB3dOH64wmL5bf19K2YJ1ionuPmTd_SbV0inmXrI/edit?usp=sharing
 
Judy and Freckles said:
You’ve received some great advice already. Freckles was Dx with acromegaly and IAA February of 2020. She was up to 11 u twice/day and is now at 5.5 u 2x/day and Stays primarily in the blue zone. We had to switch from Lantus to Levemir because of the stinging. TR is the way to go for sure!
Click to expand...

This is so great to know that your kitty has acro and IAA and you still have been able to reduce the dose and keep in the blue zone! This gives me great hope! I would not be able to afford the stereotactic radiation therapy ... I'm still paying on my Darcy's DKA and hepatic lipidosis hospitalization on my Care Credit card... then my cat Julius got pneumonia and is in the ER now... I've already paid them $1200! Yikes.
 
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