Re: Desperately need help my baby is fading away MEDICAL MYS
hi ellie!
there are medical conditions that cause a need for higher doses of insulin. Charlie isn't to a dose yet that we would even consider that, but looking at his spreadsheet for the past 2 days it looks like he needs more insulin. Do you have any testing data from 8/10-27 that could be added to the spreadsheet?
My cat punkin, had acromegaly, which is a benign tumor on the pituitary gland that puts out growth hormones, which cause the cat to become diabetic. they need more than average amounts of insulin, the most significant characteristic is that they have an uncontrollable appetite (which is true of high blood sugar for any cat), often they gain weight upon diagnosis rather than losing weight (i know Charlie has lost weight), they show signs of growth, ie, the feet get big, the face can broaden, the tongue & colon both can enlarge, so you might see a child-sized tongue and stools. Often a cat with acromegaly has a particular sound when they breathe, called stridor. the excess growth of soft tissue in their throat and airway will cause a sort of "snoring" sound, that most people just find cute. The vocal chords can grow and the cat's voice can change - punkin sounded like a pack-a-day smoker. I don't know that Charlie has this, but it can strike at any age. Males get it more often than females, although females also get it. I'm just brainstorming, not saying that he has it. Many vets don't know much about acromegaly, but it isn't uncommon in diabetic cats. Here are a couple of posts that have more information on this
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=45324 and
http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=45324. Some of the links are on both posts, but it might be helpful if you look at these and see if you think it applies to Charlie. It's possible this is the source of the mystery that you are exploring. Typically, we don't suspect a high dose condition until a cat gets to 6u per shot, and as i said, you're nowhere near there yet. He might just need a little more insulin and not be to a good dose yet.
Can you explain how the dose has been arrived at? I'd really like to see his dose being adjusted every 6-8 cycles to get these blood sugar numbers down. I think with 2 days of good testing in, you would be ok to increase by 0.5u.
From our guidelines from the
Tight Regulation Protocol
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
The same Tight Regulation Protocol is interpreted slightly differently on another site:
http://www.tillydiabetes.net/en_6_protocol2.htm and it suggests increasing every 2 days, or 4 cycles if the cat is constantly high:
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.
It's going to be very helpful if you can continue getting more tests in - a minimum of preshot and at the very least, one other per am cycle and one other per pm cycle. I'd love to see a test about every 3-4 hours while you're awake if it's at all possible. The reason for the frequent testing when it appears that he is just high, is that we know some cats will dive down, barely touch a lower range, say a 150, and then zoom immediately back up. Because Lantus dosing is based upon how LOW a dose causes a cat's BGs to go, catching any low numbers is extremely important. Especially so because it appears that Charlie needs more insulin fairly quickly, so we don't have the luxury of waiting several days and just hoping to catch any lows that appear.
If he were mine, I'd increase to 3.5u Lantus tonight, and test every 3 or so hours. I'd also post every day so we can see what he's doing and help you with his dosing. As long as you have enough test data in to show that he really is constantly high, not bouncing, then we would help you evaluate if he needed his dose increased every 4 cycles. We need to get enough insulin into him to help deal with the ketones. You also need to make sure he's eating enough and is getting enough water. You can add water to his food, as much as he will tolerate it.
I am taking him to Dr Weigand. She is an internal med specialist in Deerfield. She is the guru of endocrine diseases around here. I am more than willing to take him to Tufts as well. Heck, I'd take him cross country for some answers! 
