Dose change for Colin?

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Sharon14

Sharon14

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Hi all, I'm just wondering about Colin's numbers(what else is new?!). In an earlier post, Sue, you told me to lower his dose. I haven't done that because it's been a crazy few days and I wanted to monitor him a bit more with a change. Given the high numbers, do you still think I should do this? If so, to clarify, should I lower to 1unit, or by 1unit to 1.5? He's still constipated but is on the Miralax now, also I was an hour late this AM with the routine. Otherwise, he's acting pretty good. Wanting to go out(I watch him), sleeping with me at least part of the night(nice cuz it's been awhile since he's done that!), and eating like a horse. Will get a weight and ketone test today. Thanks
 
This is a hard call, Sharon. One, I am not sure how much the constipation is affecting his numbers. It can raise them significantly. So I am not sure whether this reduction helped. The yellow on 9/2 was encouraging and then he was constipated... Two, you are "down in the vicinity" anyway. If you are ever going to try to reduce, this is the time. He isn't showing any bad effects (hanging out in the water bowl, more urination, lethargic). It sounds like he seems to feel a little better. His numbers aren't any worse than on 5 units.

It would be best if he'd have a BM. Hope the Miralax will work. If not and it has been a couple days, I'd go to the vet. It is possible that he is impacted and can't go. There likely would be other symptoms like lethargy, but it is a dangerous possibility.

IF the constipation clears, I think I'd try it. You need to get ketone tests, daily if possible, when you reduce. If you are going to be around this weekend, maybe this is the time. I think I'd go down to 1.5, watch behaviors and get ketone tests. Stay there 2-3 cycles. If you see no improvement, then we need to look in other directions - high dose conditions, another insulin.

Please remember I am no vet. I have helped people for years with PZI, ProZinc. Sometimes the answer has been the cat was getting too much insulin. But often, not. Don't do anything that doesn't sit well with your gut. I write this post with trepidation as I know it could make things worse, not better. And I never want to hurt anyone's cat.
 
Thanks Sue. As for the constipation, he has had bowel movements, it's just that he strains and it takes several trips to the box to accomplish. I also know he needs to go in to check his teeth. I haven't done that because I don't really have a vet to trust. It's a small town, don't have much to choose from. Will try to get my courage up and call someone next week. Maybe that'll help.
 
If you're vet shopping, have a look at my signature link Vet Interview Topics for some things to discuss with candidate vets.
 
Thank you for that info. Problem is I live in a very small town. There are 4 vets here. one, I absolutely do not trust, second is the one I've been going to and am not happy with, third is my horse vet who used to work with #2, so probably follows the same protocol(I will check though), and four is the one that diagnosed Colin and sent me to #2. These vets also serve the surrounding towns. I would have to drive an hour one way to get to the next town, and that may not be possible. I plan to call the vet that diagnosed Colin Tues to set up an appointment to look at him and see if she thinks he needs a dental. I don't know what else to do.
 
Hi Sharon,

Took a peek at Colin's spreadsheet. Is his constipation better? I think I'd make a decision either way - less insulin or another insulin. It isn't good for him to sit in those pinks. Today's cycle could be a clue. Sometimes if the nadir is higher than the preshot, it means too much insulin. I just wish it was a bigger difference. It could also just be a flat cycle as it isn't a huge difference number wise.
 
Thanks for looking. I was about to ask someone too.(got busy reading about the history of BJM's basement kitties!). What do you think I should do? If I go up, do I go in small increments? He's never been lower than mid 200's since I've been testing. That was at 5 units. We went to 5.5 and he seemed worse, now down to 1.5 and worse. As far as changing insulins, I can ask vets, but I don't know if they'll accommodate me. They'll want him in for a curve at the least. I feel so lost.
 
It is just like you are shooting water. How old is your insulin? Does it have any floaties in it?

It's up to you. If your vet isn't willing to change insulin a (Lantus or Levemir are the only two I would consider) then you can either find another vet who will (I understand your choices are limited) or go back up. I would go right back up to 5.5, wait 3 cycles and start increasing by 0.5 (assuming the numbers stay high and flat). Even if it is not an ideal insulin for him and even if he is a high dose cat, there should be a point at which he hits a wall and drops some. It is just once they are at 5 units, we start looking at different choices - insulin or high dose conditions.

You checked out the high dose thread, right? And none of the symptoms sounded right?

I am sorry. It is certainly discouraging and you have done everything right. This scenario just isn't something we see often, unless it is worth a high dose condition.
 
I bought a new bottle, not too long ago, in case that was a problem, so I think it's ok. You think I should go from 1.5 to 5.5 all at once? I will try to get him in this week and have a vet look at his teeth and I'll ask about blood work to check for some of the high dose conditions.
 
I think it'd be okay. But I understand your hesitation. Maybe a rapid rise - go back up to 2.5 and then increase every third cycle by 0.5, monitoring carefully.
 
Ok thanks. I think I feel better doing it that way. Will give 2.5 tonight, and I'll call the vet Tuesday
 
I'm sorry Sharon. I know how frustrated you are and I don't blame you. It's really possible that you just need to try a different insulin. Remember, ECID. Some cats do better on other types of insulin for whatever reason. I know the vet may not go for it, but I've heard good things about Levemir for higher dose kitties. Has your vet seen your spreadsheet? I can't remember. You might tell the vet you'd love to have a curve done, but to ensure that stress doesn't factor in, you'd like to do it at home and then share it with the vet. See if that helps? They might go for it...I just can't remember your history with the vet.
 
It is frustrating! He was really flat today. Does that mean anything? I gave the 2.5 this evening and will check him at +5 and again later if I see a reason to. I will call and talk to the vet this week. I hope it doesn't come to a change in insulins, I was reading about Levimer and Lantus-whew! And I though ProZinc was confusing!
 
Sharon14 said:
It is frustrating! He was really flat today. Does that mean anything? I gave the 2.5 this evening and will check him at +5 and again later if I see a reason to. I will call and talk to the vet this week. I hope it doesn't come to a change in insulins, I was reading about Levimer and Lantus-whew! And I though ProZinc was confusing!
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Hang in there Sharon, see what your newest dose change does for him. Fingers and Paws crossed.
 
Sharon14 said:
It is frustrating! He was really flat today. Does that mean anything? I gave the 2.5 this evening and will check him at +5 and again later if I see a reason to. I will call and talk to the vet this week. I hope it doesn't come to a change in insulins, I was reading about Levimer and Lantus-whew! And I though ProZinc was confusing!
Click to expand...

I wouldn't expect to see any change till you get back to the 5.5+ and maybe not then, Shannon. For whatever reason, the insulin is just not doing anything.

Levemir is the preferred insulin for high dose kitties because sometimes Lantus is thought to sting at high doses. There is no separate forum for Levemir so you post on Lantus. (They work and are dosed the same) It does seem overwhelming at first - there is a firm protocol. "If you get this number, do this." That can be easier than ProZinc as you don't have to rely on past data so much. But it is dosed completely differently. Your increases are based almost solely on nadirs only, not nadirs and preshots like ProZinc. You shoot much lower preshots because they are depot insulins. They last longer and have flatter cycles.

It will be like relearning how to work with the insulin. The forum is very supportive and people are very knowledgable. it is a much bigger forum than ProZinc. To get attention when you need immediate help, you have to use a Subject line that draws attention and doesn't get lost in the other daily posts. There are a number of people there who have higher dose kitties. Once you get their attention, rely on them for help. I'll see if @Grayson & Lu are around and will give you some help. Grayson started on ProZinc, had a high dose condition and went to Levemir. Lu lost her sweet Grayson some time ago but is still around the forum. She may know the other people with high dose kitties still active. @Suzanne & Cobb(GA) are you still around too?
 
Hi Sharon,

I saw a post of yours in the Main Health area and saw you mention you had a high dose cat, so thought I'd take a look at your situation. I'm not fluent in ProZinc, but Punkin had acromegaly and I am familiar with high dose kitties and conditions. I wonder if I can give you a hand?

When I look at his spreadsheet, Colin looked better at 5u than he has since you reduced his dose. If he were mine, I'd go back to the 5u and increase as needed from there. He had a lot more yellow on 5u - he wasn't into normal numbers yet, but the overall look was a lot better than it looks now. Sometimes people get the idea that a cat "ought" to only need a unit or so of insulin - and most do - but there are many, many kitties that need more than the typical doses of insulin. If you need to stay on ProZinc, I'd think in terms of increasing until you're getting better numbers than you are right now.

You do have to make a mind-shift when you switch from another insulin to Lantus or Levemir, but they last longer in the body and can really improve blood sugar control. The difference is that dosing is based upon how LOW the dose gets the cat, not on the preshot numbers. But we teach people all the time how to use those insulins with their cats. It looks like Colin needs a change of some sort as soon as possible.

Please let me know if I can give you a hand. It's hard having a cat that doesn't fit right into the mold, but there are actually many kitties on the Lantus/Lev group that have doses that are more than 5u. Probably at least 10-15. You're not alone with your higher-than-average-dose kitty.:bighug:
 
Thanks Julie. I am working my way back up to the 5 units and will go from there as suggested. Will also talk to my vet about insulin change and tests for high dose conditions. The odd thing is(actually this whole thing is odd to me!) he seemed to feel better on the 2.5-3u dose even though the BG was higher. Maybe that's just my wishful thinking though. I will keep better notes on how he feels as we go up in dose to see if that sheds any light at all. I think he may be constipated. I haven't seen him have a bowel movement in a couple days. He's on Miralax 2x/day and is eating good with no going to the LB straining or anything. It's possible he used another box, once and awhile he does, since I have so many cats I may have missed it. I'll keep a closer watch on that. Any ideas you have are welcome!
 
Hi Sharon -

Sorry, I can't access FDMB on my phone, so just seeing this. Colin's SS looks like Graysons in early 2012. I barely got out of the pinks until we were getting closer to the dose, which for him was extreme - and not until about October 2012.

Looks like you're doing everything right, just have a kitty that isn't following the rule book - moreso than a normal diabetic. Your food is good, you're testing frequently... and he's still not responding much to higher doses of insulin. I would agree testing is in order.

Definitely have your vet contact MSU and request their mailer for the blood samples. It is much cheaper than FED EXing it yourself. I gave the info sheets to my vet, told them what I needed/wanted, and scheduled the blood draw AFTER the mailer arrived. At that time, some of the tests were ONLY done on Wednesday, so we drew on a Monday, shipped overnight Monday afternoon, and had results Thursday afternoon and Friday afternoon. (IGF-1 and IAA).

If the tests come back positive, and if you are considering treatments, here's some basic info.

I am in NC, about an hour from NC State vet school. After we got the test results, we went to NCSU for an ultrasound. This confirmed organmegaly (enlarged organs), though as they told me, not a slam-dunk diagnosis. But the elevated IGF, combined with correct diet, not responding to high doses of insulin, and enlarged (but not diseased) organs, was a good indication. We opted for treatment at Colorado State - at that time, it was pretty much the center of the universe in the states for SRT. It is now available many other places, though probably not the volume they've done at CSU. Some members of our Facebook Acro group have had the surgery - both at the Royal Veterinary College in London, and at Washington State University. Others have had cyber-knife SRT at Yonkers, NY. And some in Europe, where SRT and surgery are not an option, are using Pasireotide, which another member used successfully in a drug trial at RVC. All have achieved favorable results. Meanwhile, much of the early info I read about untreated Acromegaly life expectancy, has been disproven by other members - some have had as much as 3 yrs or more without treatment. Of course each one is different.

Please let me how I can help you, or provide additional info. I know this is a LOT to absorb. But, just like diabetes, there are many kitties living fruitful lives with the condition, no matter what path you might choose.

Lu-Ann
 
Hi Lu! Thanks for jumping in and helping! Sharon, Lu is one of the few people on the forum that I have actually met. When she came with Grayson to Colorado, we ate out on the patio of a restaurant in Denver with another member I hadn't met. I was so amazed that he had been such a great traveler -on the plane, in the car and even eating out!
 
Hi Sharon,
I'm so sorry that you're going through this with your boy! I can't speak specifically to dosing advise, but you have plenty of solid support there. I will say that I have struggled with William and it seemed like he was the only guy who didn't start showing signs of improvement quickly like so many cats on the forum, though I realized that there are all sorts of patterns (and non-patterns) represented here.
William has struggled with constipation for the better part of a year, but especially since the diabetes came on. It can be severely dehydrating and can stop things from moving through easily. Not to mention, there can be some impairment in the nerves in the bowel that move everything along. He has really high numbers whenever it gets too slow in there. I have found that giving him Sub Q fluids ( however much he'll tolerate - sometimes it's only 1/3 the recommended amount) helps immensely. I don't give it often, but when it seems more acute, I try to get a few in a week, if both of us can handle it. Maybe you can check with your vet about that. They can administer them or you can do it at home. I do use Miralax as well, but I've found that about a 1/4 tsp Slippery Elm Bark in some water (I put it in a syringe and give it to him orally- he doesn't mind) works a bit better for him. When I do these things, he has BMs that are easier and a bit more frequent and his numbers always lower when he's a little more regular. There's a lot of information about Slippery Elm Bark for cats out there, and VCA hospitals has info about it, too, just so you know it's not all herbalists and alternative vets! Even if these things don't magically bring his numbers down, they are at least good for addressing one of his issues and they're both gentle on the system.
Of course, the first thing would be doing the necessary test to see if he's got other sources of inflammation or a blockage or one of the other issues that can accompany FD. When William was first diagnosed and I started reading and researching, I was shocked to find out how many things big and small can effect a cats BG (and people thought I was nuts when I told them), and I've had experience with quite a few, from pancreatitis to the plumber coming into the house, so keep hope you'll find the source and be able to move from there even if it takes a while! Good luck to you and Colin!
Vanessa
 
Grayson got 1/4 tsp Miralax at shot time. I just sprinkled it over his food and then added 1 can of water. As long as he ate, everything moved well. If I missed, he would sometimes get backed up. 2 misses in a row and we were at the vet for an enema. But it would be amazing when you'd seen them struggling to go, numbers are high, then VOILA! Poop, Magical Poop! And suddenly you're back to good numbers! :)
 
Thanks Vanessa. I have some SubQ fluids I can give him and I'm interested in the slippery elm bark. Where do I get that and do you give it every day, or just as needed? Yes I'm going to call the vet for a check up. I'm just afraid of what he'll say:(
 
Sue - it was so good to meet you and Marcy in CO! I've met a few others since. Heather (Sneakers) and several acro peeps. I even got to meet Brent's Tigger in person when I went to my nephew's graduation a few months back!

Though Grayson is no longer with me, he was a very good traveler - planes, trains & automobiles! Last year, he even let Spartacus share the front seat with him, coming back from Illinois! They were great passengers. Now Spartacus is getting ready to go to a conference with me! If only my dogs were as well-behaved as the cats are in the car! :)
 
Thanks Lu. I've been fearing the acro Dx I can not afford any surgery or expensive treatments I guess that's why I put off going in for the tests. I will call the vet though and talk to him. Thanks again.
 
I have the loose powder from the health food store near me but it's also available online through Amazon or The Vitamine Shoppe, etc in capsule form, but it's, of course, very important to get any herbal supplement from a reputable company since they're not regulated. Natures Way is widely available and reputable. Here are a few links (and of course there are so many more!) that I pulled from to treat William. Much that you'll find about it relates to diarrhea, but it, like pumpkin, works for both and it also helps with hairballs and urinary inflammation and general GI upset.
I have made the "soup" from the Holvet website, though I cannot put much of anything to Williams food and get away with it. It's very simple to mix the powder with a bit of water and make it as I go, though, so I just mix 1/8 to 1/4 tsp adding about 1 tbsp cold water to get the thicker (kinda slimy) consistency I prefer to syringe. It has very little taste and he almost seems to like it!? I have given it daily for periods of time. I always try to wean him off of things to see if he's gone back to normal, but I usually find I have to start them up again. Anyway, I started very slowly and I still have mostly stuck to about one dose a day, twice if he seems particularly bad. It's all a bit of an experiment to find what's right for the both of you. It coats the insides, so it can interfere with absorption of medicines and could also interfere with the way nutrients are absorbed in the bowel (another reason why I take him off of it) so I try to give it between any meds and food. Also, I specifically looked up slippery elm and diabetes and there is nothing I could find that said that it raises BG, and found an article on humans where it's said to possibly lower BG, and my personal experience is that there is no negative effect on him in any way. There are other people who use it on the forum so you could search here for other experiences, too.

http://www.vcahospitals.com/main/pet-health-information/article/animal-health/slippery-elm/570
http://www.felinecrf.org/holistic_treatments.htm
http://www.holvet.net/slippery_soup.html
 
Thanks for the info Vanessa. I think I'll try it, for Colin and myself, this
diabetes thing has my gut in an uproar too!
 
It may be that when you think he's feeling better at the lower dose, it's because he's in higher numbers and that's what his body is used to. Cat's bodies seem to "forget" quickly that normal is pretty low - 50-120 on a human glucometer - and once they've spent some time in higher numbers, it becomes their norm. Then that's what feels good.

I think of it like caffeine. My normal state is uncaffeinated, but I'm so used to it that when I'm without, i feel yucky and draggy. I've heard many people report that their cat seems to feel tired and lethargic when they first get into normal numbers, but if they continue to stay there, the body gets used to it and then they start acting perky before too long.
 
Regardless of an ability to go for surgery, drugs or radiation (not all cats are even candidates, and I don't know too many of us who won the lottery to treat them!), knowledge is power. It will help you know the demon you're fighting. It changes the rules up a little with dosing, increases & their frequency, etc. It is a slightly different road if you have the dx. And it helps us understand why we aren't seeing the same responses, improvements and numbers that other kitties are.

Like I said, there are many kitties who did not go for treatment, and have been well-managed for years. If you know what they're fighting, you can defend them against the common conditions that most acros experience, that are different from true diabetic kitties. It will also help us help you better.

To me, not knowing is the hardest challenge. Knowing what is going on, learning how to defend them, and helping them do the best they can, makes life much more manageable.

I like Julie's assessment of caffeine... really spells it out. Grayson "swam in a sea of pinks (& reds) " for months. Once we knew he really did need more juice, it made it okay to give it to him. Prior to that, I was afraid to give him so much.

I used to think the vets had dollars in their eyes when they suggested doing bloodwork or x-rays. Now I ask - and want the full panel - so I can see the whole picture. I was the one that asked for the x-ray that saved Grayson's life a year ago. Had we not done it, he probably would have died within a day or two. My perspective of things has changed dramatically, as a result. But we also have to live within our limits. Only we can choose what we do for our pets. People here can advise us. Friends/family will tell us we're crazy (nothing new there!). But whatever you chose will be the right thing for you and your situation. And we're here to help if you need us.
 
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