Help with Lucy's recent numbers. Better, but confusing. 10U 2x per day :(

[hellolucy]

When I first re-appeared last month (10/3/17), Lucy was having all sorts of problems. Ketones, ER visits, etc. She's gotten better since then. No ketones since that point. I wasn't great about getting her shots in when I first joined a long time ago when she was initially diagnosed, because it was pretty difficult - she wanted absolutely nothing to do with it and I'd get pretty emotional (just sad/frustrated) when I wasn't able to get a reading from her because I wanted to help her so much. I know now that's not an excuse and things got a lot easier the more I learned. I've gotten a lot better at taking tests and so has she! I'm amazed at how far I've come. All of the advice I've received from test timing to blood droplet size on this forum has been incredibly helpful.

Anyway, I have more readings in my spreadsheet. Her readings have been lower the past few days - some a LOT lower than normal for her. However, she has still had a few higher numbers thrown in here or there. What could be causing this? I am so confused. She seems perfectly fine - even happier. She has been playing like crazy the past few days and not drinking as much water. She sleeps pretty dang comfortably (see picture below for proof ). She eats one 5.5oz can of Wellness Turkey & Duck at each meal as of the last few days - twice per day - yes, you heard me correctly...one 5.5 oz can per meal, gone. She devours it. So, obviously she's still hungry. She's also a larger cat in general. 10U 2x also seems like a lot to me though- I'm concerned with her numbers being randomly low and then high again and giving her so much insulin (which is why a pre-shot is always done of course).

Any comments or ideas on her recent readings and a way forward?

 

[Tricia Cinco(GA) & Harvey]

Hi.

Here is a link to your most recent post: http://www.felinediabetes.com/FDMB/...-sample-size-affects-bgs.185824/#post-2063909.

I am unfamiliar with Lucy's history, and you don't have much info in your signature block. Has Lucy been tested for any of the high dose conditions - IAA, Acromegaly, etc.? We usually recommend testing when a kitty goes above 6 units (although it is possible to be an acrocat and be on a lower dose).

Her numbers are starting to look slightly better - blues, even! So you may be approaching a good dose. I'd like to tag some of our members that are more experienced with high doses to see if they can give you some feedback. Being a holiday, it might take a while, but let's see if @Wendy&Neko, @Sandy and Black Kitty and/or @julie & punkin (ga) have some thoughts for you.

 

[Wendy&Neko]

Hello there, and welcome, from someone who's girl cat also used to like showing off her tummy. My Neko had two high dose conditions, acromegaly and IAA (insulin auto antibodies). Her dose got as high as 8.75 units. One in four diabetic cats has acromegaly, which is caused by a benign tumour on the pituitary gland. Since you've reached 10 units, I would strongly suggest testing for acromegaly and IAA. The links point to the blood tests required to determine if those conditions are present. Your vet will draw the blood and send it to Michigan State University where the tests are done. The results of the blood tests may change our recommendations for dosing.

From what data you have on your spreadsheet, it looks like Lucy is starting to get to a better dose. The fact that she's feeling good is also a good indication. Cats can still have very colourful spreadsheets, even if they are starting to get to a good dose. Since her body is not used to lower numbers, she is probably bouncing. It's perfectly normal. From the New to the Group Sticky:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

I see on your signature that you are following Tight Regulation, but I also see increases where half the cycles didn't have any mid cycle data. TR is an aggressive but safe protocol. The only way we can make sure our kitties are safe is to get as many mid cycle tests as possible. I would strongly encourage you try to get a mid cycle test (somewhere from +4 to +7 ish) when you can. I understand you work during the day, but you should be able to get a "before bed" test every night. The post on Doing TR with a Full Time job may give you some hints that will help. Keeping on following the protocol will help you get Lucy into even better numbers.

 

[hellolucy]

I'd like to tag some of our members that are more experienced with high doses to see if they can give you some feedback

Thank you!

Has Lucy been tested for any of the high dose conditions - IAA, Acromegaly, etc.?

Since you've reached 10 units, I would strongly suggest testing for acromegaly and IAA.

Lucy has not been tested for either of these. I will be bringing her back in to the vet in the next 2 weeks or so to have her tested for both. I knew about acromegaly but haven't heard of IAA. Are there specific tests I should be asking for with both of these? I just want to make sure I know exactly what to ask the vet for and what they should be charging me for.

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low".

I had read this sticky post a few weeks ago, but forgot about it and more had a "confusion freak out" moment when her numbers dropped below 200 and went back up above 300, instead of remembering this. This makes sense!

 

[Chris & China (GA)]

Are there specific tests I should be asking for with both of these? I just want to make sure I know exactly what to ask the vet for and what they should be charging me for.

Your vet just needs to draw the blood and send it to MSU. Some vets charge for this, some don't. You can either get the mailer from MSU or make your own arrangement for shipping.

Details HERE ----for Acromegaly, put 20005 in the "Name/Code" box, for IAA put 20031

After you enter the number (and "feline" in the species box) the test name will come up on the left....click on it to get exact details of how much blood, etc.

There's lots of information on Acromegaly and IAA in the Acromegaly and Other High Dose Conditions: What We Know post

 

[Wendy&Neko]

My post above had links to the two test forms. The highlighted blue for IAA (insulin auto antibodies) and IGF-1 or insulin growth factor, are the two tests. You can print them off and take them to your vet if they have not done this before. Mine hadn't, I had to show her the tests.

 

[hellolucy]

Details HERE ----for Acromegaly, put 20005 in the "Name/Code" box, for IAA put 20031

My post above had links to the two test forms.

Thank you both! I was so in to the details of the post that didn't even realize those were links The tests are way less expensive (minus the blood draw, if they do end up charging for that) than I thought they'd be. I have had her tested for Cushing's and her vet said the numbers were way too low to indicate she had it. May get her tested again just to be completely sure. Will keep everyone posted as to her results!

 

[Wendy&Neko]

Why test for Cushing? Any history of steroid use or other signs? One in four diabetic cats cats acromegaly, it's much more common. There will also be a shipping fee for the tests, so that's why it's best to do both at once.

 

[hellolucy]

Why test for Cushing? Any history of steroid use or other signs?

Her vet had recommended it and a few other folks had brought it up on an earlier post I made on this board, so I went for it just to rule it out. In this case then, I'll just go forward with the IAA and acromegaly tests as her Cushing's test was pretty recent, within the past year. She took steroid pills years ago when she was diagnosed with asthma, but only for a short period of time. I am definitely interested in the results.

 

[AZJenks]

She looks so comfy in that chair! I don't know if I could resist belly scratches long enough to take a picture. It's great to see a couple surprise blues in the spreadsheet. Hopefully that means you're close to the breakthrough dose where things will start to settle down!

 

[hellolucy]

Since you've reached 10 units, I would strongly suggest testing for acromegaly and IAA

So I heard back from the vet and would be interested in your opinion as you seem familiar with these tests. They said the costs for the blood tests are $44.90 for IAA and $120.91 for IGF-1 + $40 for shipping to Michigan State University. Does that sound right? I confirmed with her that those costs are just for the blood draw and do not include the actual tests, which MSU will run. It seems high to me.