Help please - To go up or go down? So confused!

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My cat, Redd, is unregulated after 5 months of low & slow increases and I need advice. He is up to 6.5 units of Lantus and his number are still high, mostly in the 300's. His vet thinks he is a high dose cat and will be testing for cushings, IAA, and acromegaly in the coming weeks. In the meantime, she wants me to keep increasing the dose more frequently. I am glad we are going faster now than in the past but frustrated that it doesn't seem to be helping. It is making me wonder if his correct does was lower. We were starting to get some good number back around 2.5 but then he had a pancreatitis attack and they shot up. He is currently going through a flare up again which complicates things.

My questions:

1) Can you be at too high a dose even if you do not have rebound happen?
2) If I try a reduction, how low do I go to start and what should I watch out for?

If he is a high dose cat, I don't want to harm him or delay getting to the correct dose by trying a reduction but I also don't want to keep overloading him if he is on too high a dose.

Thanks in advance for any advice you can give me!
Ellen & Redd

Basics - Redd is 15 y.o., weighs 13 pounds, has a bunch of other health issues, eats canned wellness core, I test at home as often as I am able - please see SS below.
 
Hi Ellen,
I just linked this thread into the Lantus forum for some of them to take a look at. I'm way too new to answer these questions! But if you can hold on few minutes, there should be some experienced lantus users along to help you out.

Carl in SC
 
Hi Ellen,
I'm way too new to offer advice as well but I can sure understand your frustration with the high numbers. It's very distressing when they don't feel good! Have you found the Lantus Support Group http://www.felinediabetes.com/FDMB/viewforum.php?f=9? There is a ton of information and dosing experts to help you. Plus lots of support and encouragement from everyone else.
Liz, Bean-in-Charge this week
 
Welcome, Ellen.

Could you provide a bit more information? What are the other health issues and what medications, if any, are you giving Redd? If Redd on any meds for the pancreatitis?

To respond to your questions, a cat can be on too high of a dose without bouncing. A bounce isn't necessarily related to the dose. A bounce is the result of how the liver reacts to lower numbers.

I'd like to have some other experienced Lantus users take a look at Redd's spreadsheet. It will help if you could begin to reliably get pre-shot tests and at least one test during the PM cycle.
 
Hi Ellen and Welcome.

I have a (former) High Dose kitty, who is now off the juice. He tested high positive for IAA

6.5u is a lot of insulin. I need to say you must not shoot without testing first (blind).
Also, you need to test more often between shots. Lantus dosing is based on the nadir , the lowest BG of the cycle. Without that data it's not possible to make appropriate/safe dosing decisions.

You should find out if he is a high dose kitty as soon as possible - not in the coming weeks. His vet should submit both the IAA and Acro tests at the same time. Once you have those results, you will know how to proceed.
In the mean time you need to get a better picture of what is going on between shots.

There are plenty of folks that will help you with your kittys journey on the Lantus board.
 
Carl - Thank you for the cross post!

I am aware of the Lantus board and appreciate the help from anyone willing to look at my spreadsheet. I posted numbers there once but, while everyone was really nice and helpful, I felt a little intimidated by the testing regimen everyone seems to be able to do. I was not testing very often for the first months as I was following my vet's instructions to only spot test. For the past month however, I have been testing pre-shots regularly and I do at least 1 mid cycle test too. While I did miss a series of days/tests due to two trips and a personal health issue this month, I am doing the best I can. Even with my past month's increased efforts, several posters have told me I need to test more often. What is the ideal - pre shot, +3, +6, & +9? I am just not going to be able to do that every day, so I now feel like I'm wasting people's time or am not worthy of helping if I can't get 30 straight days of perfect tests.

Health Issues - Redd has/takes: high blood pressure/amlodopine, cardiomyopathy/atenolol (complicates regulation), IBD/ metronizadole or cerenia if needed, pancreatitis/denosyl daily & buprenex during flare ups, Spondylosis (arthritic spine)/cold laser as needed & glucosamine chondrotin supplement. It's a lot and complicates regulation when you aren't sure what is causing what. Is it neuropathy or arthritis when he walks funny? Is it the pancreatitis or high BG that makes him cranky or lethargic? When he is hungry all the time is it the diabetes or an IBD flare up? Basically, he's old and falling apart little by little but has not yet crossed the quality of life line. To clarify, when I said my vet would be testing for acro, IAA, etc. in the "coming weeks", I meant I have an appointment next week and should have results the following week.

Food - It was pointed out to me on a past post that his food is 8% carbs and should be under 5%. I thought under 10% was the target. Has that changed? Here I was all proud that I did a ton of calculations and research to find a wet, grain free low carb food that didn't trigger his ibd, but I guess I need to keep looking. I'll have to think about whether the 3% is worth risking a possible IBD flare up if I switch foods.

I don't mean to sound so defeated or negative but it is a lot to handle and I haven't seen too many other cats here with such a high dose and such bad numbers, especially on the Lantus board. It seems like even the cats there that are having problems have better numbers than my guy. Maybe I should only read the high dose board.

Sad & frustrating. Thanks for "listening". - Ellen
 
Hang in there. They say every cat is different (ECID), so there's no magical solution. You just do the best you can and never give up on your kitty.

I can't advise on dosing or lantus, but I've done the overwhelmed bit.

If you can get a good curve in one cycle (say, over a weekend), you can pinpoint the lowest point in Redd's cycle. That's where you need to spot.check as much as you can. Most of us don't have perfect 30 day tests either.
 
Hi Ellen,

I have a cat with acromegaly. It sounds like you have a pretty good vet and it sounds like if you've been doing "low and slow" for 5 months that the IAA & Acromegaly tests are the appropriate next step. Don't bother with "rebound tests" or trying to lower the dose...get the test results. If you overnight them on Tuesday, you may have the results on Friday (I think they set up on Wednesday and run the tests on Thursday). If the results are positive, the high-dose people will appear to help.

Heather/Boo
 
Ellen:

On the Lantus board, we're pretty adamant about asking that you get a minimum of 4 tests per day -- your 2 pre-shot tests and one additional test per cycle. That said, most of us either work or are in school. I have some flex in the mornings but many people do not so getting anything beyond the pre-shot test is difficult. If that's the case, try to get more tests in the PM cycle and on weekends/holidays to help fill in the info. Sometimes, you have to remind us that you need to have a way to pay for insulin and strips! (Some people even put a note to that effect in their signature.) In addition, many vets are not big advocates of home testing whereas the people on FDMB are huge advocates since it is the best way to keep your cat safe and for you to have an understanding of how Redd is responding to insulin.

A mini-curve (testing every 3-hours) is great if you can get that in. More test data is always helpful especially if there's some question about what's going on. Getting a mini-curve on a daily basis is not what most of the people who post on the Lantus Board do. When you have a chance, visit there and look at a range of the spreadsheets. There are some people who are home (or work from home) and can test a lot. That's not everyone, though.

It does sound like some of the meds may be effecting regulation. Jessica/Boo Radley just replied to a post on this Board about glucosamine and diabetes. If you think there's neuropathy, methyl-B12 may be helpful and there are products that are diabetes friendly (e.g., Zobaline is formulated for cats). Also, have you ruled out a pancreatitis flare? That can raise numbers, as I'm sure you know. I'd also want to be sure that Redd is feeling OK. Anything that is causing discomfort, inflammation or infection can keep BG levels elevated. Is there any chance that there are dental issues?

Low carb is typically considered less than 10%. However, there are plenty of good foods around that are lower than 5% carb. Sometimes it takes some experimenting to know how carb sensitive your cat is. Some cats here will get a sizable bump in their BG from a piece of poached chicken breast others can eat 9% carb food and it doesn't seem to have any effect. For a while, I was feeding a homemade raw diet which was about 1% carb. I tried my guys on a 4% canned food with no appreciable change in BG response. Needless to say, I saved a lot of time by going back to canned food. Since you are wondering about dose, I'd suggest trying a lower carb food and seeing what happens with Rudd's BG levels. Since you're testing, you'll know if what you're currently feeding is causing more of a rise in BG than a lower carb food.

As for other cats with high numbers or high doses on the Lantus board, you haven't been there enough to see the broad range of SSs. Certainly, some of the members who post there have acro and/or IAA cats. We work just as hard with them to help them get their cats into healthier numbers. There are also other cats who haven't as yet found that dose that starts them back down the dose ladder. Until there's either a diagnosis of a high dose condition or you find that "good" dose, it can be hugely frustrating. We've seen several cats who are up to the dose Redd is at and all of a sudden start responding. If anything, Lantus teaches you patience and a higher tolerance for frustration!
 
Hi Ellen,
Welcome. My Harley is IAA positive (high dose) and has IBD. I do understand where you are coming from. My vet also told me only to spot check. She said that AM & PM was all that I needed. Being a dietitian, I know that with a human diabetic, testing is important to know what is going on. On a good day, I can get in lots of test (4-6). On a very busy day, I might be able to get in AM, noon, PM. As I have been told here, everything helps in building information about your cat.

Harley has IBD and I stick with food that is 5% or less in carbs, and yes, it is 10% or less is touted. Harley seems to have higher bs with the higher carb foods (6-10%). So you need to see what is best for you. When Harley has an IBD flare up, he does not eat, so the hunger might be coming from the diabetes. Once that is in check, the hunger will suside.

I post over on LL. At one point, Harley was up to 10u of lantus, so there are higher dose kitties there. Once you get the results back from the tests, you will be able to get a plan of action.

Don’t feel intimidated (easier said than done). At one point I felt that way also. Hang in there, you are doing a good job for you kittie. The experts here are wonderful and will supply tons of help.

Pattie
 
Hi Ellen & Redd,

You're doing well - hang in there! With so much other "stuff" going on, it is very possible that Redd has Acromegaly - which can lead to a lot of seemingly unconnected health issues. (cardiomyopathy, IBD, arthritis, hungry ALL THE TIME!!!)

How much does Redd want to eat? Some of the acrocats eat up to 30 oz of food per day before their magic insulin dose is reached. Once you get to the right dose, the hunger goes back to normal - like 10-12 oz per day.

Most days, we only test Tiggy (a traditional diabetic cat that we adopted in 2009) before his shots (2 tests per day). That said - we don't post on the Lantus board. We've been treating Tiggy for 2.5 years and before that Norton for 2 years. We do a curve on a weekend, and may do a spot check at bed time once in a while.

Have you read the sticky about Acromegaly? My Norton (our first diabetic cat) was an Acro-cat (died of cancer in 2008). Post on the Acro/IAA/Cushings page or here on Health. We (acro-beans) will be happy to help you out and answer any questions that you have. We have a "sister" site www.catacromegaly.com (has a separate registration/log in) that is good but currently being updated.

Regarding the tests -- there is only one lab in North America that runs the Acromegaly IGF-1 test, and for $14 more, they will run the IAA test also. It is at Michigan state university.

Cushings doesn't have any one test -- it is very hard to diagnose -- you can have lots of tests run and the answer will still be Maybe / Maybe not. At least with the Acro and IAA tests, you get a definite yes or no answer.

The really "telling" symptom to confirm Cushings is fragile skin -- literally the skin will tear if you have to hold the kitty firmly while they squirm around. This is a really difficult and heartbreaking condition to deal with -- where do you inject insulin if the skin tears when you tent it up? This condition is rare in cats and more common in dogs. Definitely do Acro and IAA tests first.

Some cats are more sensitive to carbs than others -- we use canned food that is 0-3% carbs (Merrick's Before Grain and Fancy Feast Classic pates)
 
Thank you all so much for your feedback and support! Hopefully our next tests will bring some answers.

We''ll be back soon! Thanks again.
Ellen & Redd
 
(((((ellen))))

it is discouraging to feel like you're not getting anywhere. i think getting your testing done for acro/iaa and getting the results back will tell you the direction to go. it's easier to cope with anything when you know what it is that you're dealing with.

i also have an acro kitty - diagnosed with acro in june, with diabetes last december. he's doing very well now, but we didn't have the concurrent medical issues that you're describing and we just tromped up the dosing scale following the protocol. at the moment he's laying on the floor purring so loud you could hear him next door - and he's been doing it for about 20 minutes since his last test and a piece of chicken. life is good in punkinland! he's on a dose of 14ish units twice a day. the important thing is that they get what their body needs, not how much the syringe measures. his BG today started at 247 and was 159 at the nadir. that's not too bad.

you can only do what you can do with the testing. what i've learned is that the test results give me so much information that i continue to do it all the time - i'm a bit hooked on it more than i need to be. if you get the minimum tests in that sienne is talking about - one midcycle and one before each shot, even that will tell you a ton when you learn how to read it. patterns emerge that teach us how the kitty's body is responding to the insulin - or if Redd has insulin resistance or acro - to those conditions.

i know no one would have intended to discourage you on the Lantus forum. sometimes i think we tell people what we know about how lantus works, but it doesn't seem do-able, and it probably is discouraging to hear. i hope you'll continue the conversation so we can help you figure out what is do-able for you and your life. there are ways to work around nearly every obstacle.

hang in there!
 
I don't mean to sound so defeated or negative but it is a lot to handle and I haven't seen too many other cats here with such a high dose and such bad numbers, especially on the Lantus board. It seems like even the cats there that are having problems have better numbers than my guy. Maybe I should only read the high dose board.

btw, ellen, i just wanted to address this. i suspect you just aren't seeing things that scream HIGH DOSE KITTY on the Lantus support group forum, only because most of those cats are under control now. Their numbers look just like the other cat's numbers. Some of the kitties on there that have acro include me and punkin, Bev & Gus, Linda & Guinness, Squirrel & Tommy, Susan & Lanky, Brent & Tigger (also iaa), Libby & Jazzy - the iaa kitties include Lisa & DoLou, Pattie & Harley, Sandy & Black Kitty (who sandy managed so well that she was able to get him off of insulin!). There are a number of others who post occasionally to offer support also.

There are a number of conditions that seem to go along with feline diabetes - hyperthryoid is one, pancreatitis is another, diabetic ketoacidosis is also seen from too high of BG. There are people who have experience with just about all of it who will come and help with whatever comes up.

Not everyone posts every day - once you get your kitty regulated you don't necessarily need the daily support, but if there is someone who needs help with a high dose kitty or one of the other conditions that goes with diabetes, the help emerges just by asking for it.

maybe it would encourage you to take a look at some of the spreadsheets of these cats - every single one had to go through the process of getting regulated, just the same as if they hadn't had a high dose condition. You'll get Redd there - and we'll all be glad to help you.
 
Eizenson said:
Carl - Thank you for the cross post!

I am aware of the Lantus board and appreciate the help from anyone willing to look at my spreadsheet. I posted numbers there once but, while everyone was really nice and helpful, I felt a little intimidated by the testing regimen everyone seems to be able to do. I was not testing very often for the first months as I was following my vet's instructions to only spot test. For the past month however, I have been testing pre-shots regularly and I do at least 1 mid cycle test too. While I did miss a series of days/tests due to two trips and a personal health issue this month, I am doing the best I can. Even with my past month's increased efforts, several posters have told me I need to test more often. What is the ideal - pre shot, +3, +6, & +9? I am just not going to be able to do that every day, so I now feel like I'm wasting people's time or am not worthy of helping if I can't get 30 straight days of perfect tests.

Health Issues - Redd has/takes: high blood pressure/amlodopine, cardiomyopathy/atenolol (complicates regulation), IBD/ metronizadole or cerenia if needed, pancreatitis/denosyl daily & buprenex during flare ups, Spondylosis (arthritic spine)/cold laser as needed & glucosamine chondrotin supplement. It's a lot and complicates regulation when you aren't sure what is causing what. Is it neuropathy or arthritis when he walks funny? Is it the pancreatitis or high BG that makes him cranky or lethargic? When he is hungry all the time is it the diabetes or an IBD flare up? Basically, he's old and falling apart little by little but has not yet crossed the quality of life line. To clarify, when I said my vet would be testing for acro, IAA, etc. in the "coming weeks", I meant I have an appointment next week and should have results the following week.

Food - It was pointed out to me on a past post that his food is 8% carbs and should be under 5%. I thought under 10% was the target. Has that changed? Here I was all proud that I did a ton of calculations and research to find a wet, grain free low carb food that didn't trigger his ibd, but I guess I need to keep looking. I'll have to think about whether the 3% is worth risking a possible IBD flare up if I switch foods.

I don't mean to sound so defeated or negative but it is a lot to handle and I haven't seen too many other cats here with such a high dose and such bad numbers, especially on the Lantus board. It seems like even the cats there that are having problems have better numbers than my guy. Maybe I should only read the high dose board.

Sad & frustrating. Thanks for "listening". - Ellen

Hi Ellen,
Please know that your frustrations sound so familiar to me and to others.
I have two acro cats and know that it's rough, but I don't have all the health issues to balance.

First, as for the food, I think you are doing perfectly fine by going with 8%, and balancing with IBD needs to be considered by those who are saying you need to change the diet. I would say to listen to those who are dealing with IBD over others.

I am glad to hear you are having the acro/IAA tests done because it will give you more info. If the tests are positive, then you know you are dealing with a functional pancreas and that you will be better able to handle Redd's numbers.

When it comes to testing, I think that there are at least 3 tests most important: before each shot and before you go to sleep.
Now, testing before a shot is pretty important because what if Redd's to low to get a shot? You could have a serious hypo on your hands if Redd's already low, and you give more insulin. If Redd does test positive, you will see some fluctuation where you may need to skip some shots. If you test before the shot and Redd's at a safe number, you can give the shot.
The 3rd test, before bed, is a good one because some cats drop lower at nite, so it's a good idea to see how low Redd is before you go to sleep and so you don't wake to a sick kitty.

I know that many people press for lots and lots of testing but I think if you get those 3 tests in each day and then maybe do a curve on a weekend day or one day you are around to test every 2 or 3 hours on a cycle, that should be plenty.
Sure there are lots of people who test much more but lots have the time and can afford the expense of many strips, but once you know how Redd reacts to insulin and know Redd's nadir, there are plenty of times that you don't need to bother testing.
Expecting people to test frequently every day is completely unrealistic... when people work Mon to Fri and 9-5 or something, there are not around to test, and they do what they can. Don't worry about being told to test often; do what you can by testing before each shot, before bed for sure and then aim for maybe an extra test in the evenings and a curve on a weekend cycle.

I have one acro with nadir around mid-cycle, so if she is low at ps, I will delay her shot or maybe even skip it.
Her curve is like a valley.
I have another acro with nadir almost at the end of the cycle, so if he is low at ps, I will test again in 15min and if he is rising, I am OK to give his shot because he will rise higher for at least 4 or 5 hours.
His curve is like a mountain.
I know the above because I did a fair amount of testing long ago - now I know when I don't need to bother testing.

Man, you sure have a truckload of health issues, so do what you can for them and get the tests done when able.
I can't say much about any as mine are young and have pancreatitis issues with Shadoe. I just make sure I have fluids at home and lots of pepcid. I give both weekly B12 injections and our daily pain med of choice is gabapentin orally.
I have seen an amazing improvement in both my acros after starting gabapentin - both walk better and seem much more alert.
It might be an idea if you can talk to your vet about trying a maintenance pain med, and you may have a less grouchy Redd!
I had been giving Shadoe bupe for her pancreatitis issues and even tried giving small doses BID, but she is better on the gabapentin.

Now cheer up; I know that you are doing a great job caring for Redd, and I am sure Redd knows too.
Best of luck on the tests and the results. In the meantime, keep doing what you are doing, and know you have support whenever you need it.
 
Hi Ellen and of course dear Redd

I too was mom to a hi dose kitty Merlin and he had acromegaly. We've come quite a ways in learning more about hi dose cats and there are many more people to help support you should your kitty come back with such a diagnosis. Everyone has already given you great advice so mainly I just came to introduce myself and give some emotional support. I so remember how frustrating, scary, and frightening it is to try and figure out what is going on. Especially when you are trying to do everything everyone is telling you.

I'm one of the "old" acromoms. I don't want to worry you but I agree with the others to get the acro/Iaa tests ASAP. What concerns me are some of the things you mentioned in your posts:

Redd is Male, 15yrs old, using significant amounts of insulin with little change in his numbers and he eats canned <10% carb foods. He has cardiomyopathy and spondylosis. All of these can be a part of acro I'm afraid. And as I always say - I hope I'm wrong. yet what helps many moms/dads is being able to get a diagnosis as that can help move forward in being able to know what to do next.

Redd is very lucky to have you as his mom - we are all here for you. Neither of you are alone now and you can post for help anytime. Just let us know what we can do for you and your boy!
xxx
patti
 
hello Ellen and Redd!

I'm an acromom, too! My Charlie was dx'd with diabetes one year ago, and had some of the classic signs of acro. He was a large male. He snored. He had a slight heart murmur. I wasn't financially able to test for high dose conditions until march of 2011, so I treated him as though he had acro. I avoided numbers below 100 like the plague :lol: That is important for acros, since they have a working pancreas. Well, it turned out that he tested positive for both acro and IAA. He is on levemir, mostly because human diabetics report that it doesn't sting at high doses like lantus can. Otherwise, they are both good insulins for a high-doser. I also understand time constraints with testing. I have a baby and a toddler that I chase around, plus 2 kitties. Most days I get 3 tests in, good days I get 4-5. Some days I only manage to get my pre-shot tests. I'm at peace with that because I am a cautious doser. I don't increase a dose until I have enough information to know that it's time. I don't jump up in large increments like other high-dosers can (they test more than me and have way more guts than me). So I guess I just wanted to be the voice from the other side of the tracks. If you treat him as though he has acro, you will be safe until you can do the test. If acro isn't the issue (say it's IAA instead), though, you won't be able to beat it down until you know for sure, then you will follow a much more aggressive dosing strategy. Scritches to Redd!
 
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