determining dose

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RobbiesMom

RobbiesMom

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I realize the method used most successfully and safely is "low and slow" but I'm still wondering what something like this means:
How Much Insulin is Too Much?

The Cornell University Feline Health Center has addressed the topic of high insulin doses in cats. Excessively high insulin doses are those greater than one to two units of insulin per pound per day. Felines who use more insulin than this should be evaluated more intensively. Other diseases may be underlying or complicating the diabetes mellitus and as a result, necessitate high insulin dosages. Problems with insulin injection, poor absorption or too rapid metabolism of insulin, or even insulin overdose are potential causes of an apparently excessive insulin requirement.

I mean that would indicate that a 20 lb cat could be using up to 40 units a day? No, right? I'm reading this wrong - plus dose isn't determined by weight right? I have to admit the more I try to learn about all this the more I am confused - but I will continue to sort it all out - just looking for some thoughts on this.
 
I think some will use the weight to calculate a starting dose for a cat, but dose is definitely not based on weight.
 
Upon FD diagnosis in Dec. 2011, my vet put my kitty (weight 18 lbs) on 4 units bid or 8 in 24 hours. I blindly followed his advice for days without blood glucose testing. I didn't kill my cat and the 3 day hospital stay didn't kill him, but I believe that was only because my cat was and is immensely strong plus he was on dry high carb food. And we were just plain lucky! I flipped out when I finally noticed that the hospital injected 4 units when my kitty had blood glucose of 71 and no food for several hours - that's all part of my kitty's hospital records. There is a lot of ignorance about FD among vets and general public. I'm much less ignorant these days! Eventually, I lowered the dose to 1.2 and started testing BG. Then, I found this board and will be forever grateful for the wonderful people, tremendous knowledge and support I have found here. Cornell does not impress me nor does Harvard nor Columbia. There are intelligent, but ignorant people in every profession and location.
 
Gayle,
Did you have, or do you have, an "acro" cat? If so, what's a "normal" dose for an acro kitty? I know it's high, but not as high as that, right? I know there are conditions that require big doses, but that's crazy high, isn't it?

Carl
 
I read that to mean the cat should be evaluated for Acromegaly. They just don't say that's what they mean by
"evaluated more intensively."

Yes, Acro-cats can need very high doses.
 
carlinsc said:
Gayle,
Did you have, or do you have, an "acro" cat? If so, what's a "normal" dose for an acro kitty? I know it's high, but not as high as that, right? I know there are conditions that require big doses, but that's crazy high, isn't it?

Carl
Click to expand...

Carl,
Yes I have.... TWO "acro" cats at the same time and they were different as night and day.

And there is no "normal" dose for an acro cat; that's like saying what's a "normal" dose for a diabetic cat.
There are acro cats who have an extremely high dose, you can get past 100u BID, but some cats with IAA resistance condition can be at a very low dose, even 3u BID. My Shadoe at the start of this year had some doses around 2u.

If a vet were to start a cat on an insulin dose of 4u BID, I would know 100% that the vet knows nothing about cats and feline diabetes.

Quite often, you see vets starting cats at a 1u or 2u BID dose, but 4u is irresponsible.
Reaching a dose around 40u BID is possible as it does happen.

Sophie is right about high dose and high carb dry food; quite often, you see people whose cats are at a high dose, have been for some time, and are not displaying any hypo issues. I would ask/confirm that the cat is eating lots of high carb dry food, and if not, I would ask if home testing, and if not, help them to start because they may well have an undx acro or a cat with other health issues.

If you have a cat that is approaching 5u BID and BG is not showing improvement, you may want to file the acro possibility a little bit closer to the front of your mind.

Robbiesmom, do you have any of the links to places that show the calculations for dosing? I would be interested to see the Cornell one for sure!
 
Gayle Shadoe & Oliver said:
Robbiesmom, do you have any of the links to places that show the calculations for dosing? I would be interested to see the Cornell one for sure!
Click to expand...

I have a friend in the vet school at Cornell and I know that they use the AAHA guidelines when determining the starting dose at the animal hospital. Recommended diet is Purina DM canned, and recommended insulin is either Prozinc or Lantus, depending on the vet's preference. The large majority of the time it's Lantus.
 
Thanks Julia,

Here's the section on initial dose setting:

Most cats are well regulated on insulin at 0.5 U/kg q 12 hours, with a range of 0.2 to 0.8 U/kg.
The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight. This equates to 1 U q
12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2 U per cat q 12 hours
Click to expand...

Carl
 
I got that info off this site so thought some of you here would have clarification on what the intent of that section was. Cornell is a highly respected Vet school but certainly not the end all be all of anything. I just found that reading all the literature that's so amazingly available thru this fabulous forum.
 
Well, how much does Robbie weigh? According to that formula, the starting dose for a nine pound cat should be 1unit bid, and 2u bid for an 18 pounder. Which is not what we would consider extraordinarily "high". Above that, we would for sure.
Carl
 
The original info you posted, I don't believe, applies to starting dose, but to extreme cases of high doses. If a cat gets to the 2u per pounds per day level, they're saying "hey, we need to reevaluate because something bad is going on". Like severe insulin resistance, or acro for example.
Carl
 
Ok I've re-read the entire paper and I still find it confusing - Robbie is 20.5 lbs. I'm not basing decisions on any one paper or comment or anything - I just found that particular info to be contradictory to a lot of the other information on here and was wondering if others did too.
 
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