? High Dose (IAA+) suddenly nose diving - Expert Counsel Needed

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MrWorfMen's Mom

MrWorfMen's Mom

Member Since 2015
Menace tested positive for Insulin Resistance, negative for Acro (I know this is not a definitive negative!). Up till now it I have been gradually increasing Menace's dose. She topped out at 16u of Levemir twice daily before I started seeing the odd "better" number.

I went away for a week at the beginning of March and just before I left, Menace shot me a few lower numbers which I shot through without incidence trying to get her more used to being in somewhat better numbers. While I was away, I backed up her dose slightly to ensure my sitter would not be dealing with any emergencies and admittedly her dose was not consistent but I wasn't taking any chances.

Upon my return, I increased Menace's dose back to the 16u over the course of a few days and WHAM we now seem to be on a roller coaster ride of highs and lows with shots being skipped due to low pre shot readings and dose adjustments every couple of days.

It looks to me like she is nadiring into the next cycle or depot buildup which I presumed meant I needed to decrease her dose. I backed her up again to 10u from 16u. Needless to say she ran high so I took her up to 12u, then 14u and finally back to 13u and again today, she was too low to shoot this morning.

She has had food and a teensy bit of HC gravy this morning and is now at 3.4 on a human meter and 5.1 on her pet meter and I hate to miss a shot yet again. Do I lower the dose to 12 or 12.5u (or lower) and shoot now with food on board? I still have time to keep to a 12 hour schedule.

Other important facts
1. Menace is a kibble addict so numbers so close to hypo are extremely concerning. She has refused soft food since 10 weeks old despite every trick in the book!
2. Trying to get any HC gravy or karo into Menace's mouth is like a fight to the "death" and if she gets away (she's a big cat and hard to hold) she will hide so I want decent numbers but am not aiming to ride the hypo line.
3. Current diet is about 18% carb (NV Ultimate Protein). No better choice she will eat here in Canada.

I dual test with both a human and pet meter so there are two separate spreadsheets with US conversions already done.

Any and all opinions/suggestions appreciated!
 
Oh Karen! I just peeked at Doodles SS. How disheartening for you! I was planning on starting to try some "R" with Menace when I got back from my trip and I think she overheard me and had visions of more shots dancing in her head! LOL! Let me tell you, I have spent more time with my heart in my mouth lately with my reticent little one than I'd like but dang those low numbers do look good! :bighug:
 
Darn google docs will not load Menace's SS correctly...grrr. From what I understand about IAA it can break at anytime and their insulin needs change dramatically. The lower numbers are good but understand the heart in mouth...ugh. Hopefully someone will jump in soon with good advise for you.

Doodles is a kibble addict too. I had him mostly on wet for a short time but he is now free-fed dry with wet 4 times a day. Sometimes he eats it good (maybe 1 oz at a time). With the HCM, congested heart failure and IBD....he needs to be happy.
 
Hi Linda - looks like you are now starting the "fun" part of the dance. I see it's been a little over a year since Menace was diagnosed. IAA is supposed to be self limiting, around the one year mark. Can you remind me what Menace's IGF-1 number was and when that test was done?

First I'll answer your question about what to do now, then reply with more later. How about a one time 1/2 dose (6.5 units) to drain the depot and going back to the regular reduced dose tonight.

More later.
 
Yeah. I had a feeling the little darling was finally starting to "break" and thank goodness she waited till I got home. I'll give her 6.5u now and go from there. Her IAA number was 67 done mid Nov/15. Thanks for your help. I'm flummoxed at this point!
 
@Doodles & Karen, it's a real problem when you have a kibble addict. I have never been able to get Menace to eat anything soft except for a few nibbles of a peanut butter sandwich and some covert chewing on Mom's grilled cheese and bacon sandwich another day. Too bad soft food doesn't come in those flavours! :banghead:. You are battling additional demons on top of the diabetes and IAA. I agree with you that keeping them happy is most important. I'm sure Menace isn't too happy with me today, using her as a pin cushion and trying to get some gravy into her mouth (what a mess we had to clean up!) but we do what we have to do to keep them safe too!
 
Neko's had her high numbers break a couple of times. The first started late August of 2012 after her first SRT treatment and the second in December 2015 after her second SRT. I was following TR both times, but the first time I modified it so that I used a reduction point of 70 instead of 50 (I'll talk human meters) to give me a little safety margin. Second time I had a better idea of what to expect. But you definitely feel like you are doing the quick step a lot! With Menace on dry food, think about whether you want to stick with 90 as your reduction point or maybe raise it a bit. I haven't seen kitties on SLGS with resistance breaking so not sure what to suggest there.

It is indeed possible that Menace nadirs after +12. Neko's nadir is highly variable, but I've seen it as late as +15 on Levemir. Do you have a good idea when her onset is?

OK, more tips and tricks when heading down dose at a rapid pace. First, be conservative with dosing. It's perfectly fine to take bigger reductions and work your way back up if you need to. Especially if you need a break or can't monitor as well for a while. It's amazing how many times Neko's "temporary" reductions became permanent. Over time you'll get a feel for what is a good size reduction. I would go with at least 1.0 units at the current level of dosing. Think of reduction in the range of 10-15% of the dose. With Neko, we never got above 10 units, but a 0.5U reduction worked until we got down to 3.0 units. I once tried a .25U reduction in December last year and got slapped with a BG in the 20's. :banghead:

The BCS or big chicken sh*t can be your friend to help reduce the depot. After a reduction is earned, it can help you get ahead of things if you do a one time reduced dose the following cycle. Hence the suggestion for that 1/2 dose today. A skip is also OK, especially if you aren't around to monitor. The first time round, I didn't do the BCS much, because Neko was such a bouncer then I was pretty much guaranteed she'd sky rocket. Not so much this time round so I used the BCS a few times.

When the IAA breaks, it's not all at a consistent rate. You may have periods of time you hang around a particular dose or go back up a bit before it starts again. Conversely, sometimes back to back reductions work.

A couple of other spreadsheets for you to look at to see what happens when resistance breaks are Toby (started breaking late 2015) and Cobb (after the switch to Levemir in August 2014).

And finally, post if you need help. If it is indeed the IAA breaking, it can be a scary, though thrilling ride - sort of like the down part of the roller coaster. A second pair of eyes on the dose can help.

Are there any high carb trests that Menace likes? We have people use anything from Temptations to SeaFlex treats (has honey in it) to HC hairball gel. Or can you put syrup or honey on a crunchie?
`
 
Wendy, thank you so much for the synopsis and helpful suggestions. It is indeed scary but also rewarding to finally see some decrease in Menace's numbers. While I wish the hills weren't so steep (I hate roller coasters of all types and this one has become emotional too!), to see multiple blue and some green start showing up has been enough to make me do some happy dances and have a cry of joy several time lately. But those low pre-shot numbers have also had me terrified and sleep has been somewhat lacking. Your tips give me a way to make a plan so I can keep Menace safe without losing my sanity.

And thank you for reminding me about the Temptations! I have some in my hypo kit but did I even see them when I grabbed the kit this morning?.....NOOOOO! Just grabbed a can of HC and ran. DAHH! You'd think I'd have known better and had a better plan in mind given Menace's dietary nuances but I never imagined I'd be dealing with a potential hypo situation until very recently.

I will no doubt be continuing to need some guidance as we stroll down this new path but at least now I can formulate a plan of attack and I know I'm not alone. :bighug::bighug::bighug:
 
Wendy, sorry I gave you the IAA number and you asked for her IGF-1 although I'm guessing you meant the IAA. Anyway if it makes any difference her IGF-1 was 57 done at the same time as the IAA.
 
Thanks - I haven't seen a lot of results of what non acro kitties test for IGF-1, so it was mostly curiosity. Also good to know the IAA, as that's higher than Neko (52%).

I was just looking at the SS, and didn't realize it was three hours later for shot time. That reminds me of another technique you can used to help reduce the depot some, and that's two 18 hour cycles in a row. So instead of three 12 hour cycles in 36 hours, you do two 18 hour cycles. Since Menace likes to give her lows around preshot time, this technique may be one for you to tuck away. It would give you 6 more hours for her numbers to come up, then a bit of a break as the next shot isn't for 18 hours after that. It's great if you get a low morning like today, but harder to implement if you get a low PMPS, cause it means being up 6 hours later.
 
Just want to say hello Linda and good luck! FD is a roller coaster by itself and now you're on an upside-down looping roller coaster with IAA thrown in. And the fact that she's a kibble addict doesn't help, I know. :nailbiting: Hang in there. It's good to see Menace is coming down the dosing ladder a bit!
 
Hi Linda -

Grayson was Acro/IAA, but as was noted above, when their insulin needs drop, it can do so very suddenly. You did well with the 6.5u. I found that I could either reduce or shoot late. Skipping didn't work for G... just set the roller coaster in motion. Although I was very aggressive with his climb, the descent was much more conservative. The first few times I'd seen a blue (it was very foreign to me), and then later greens, I would drop to 25% or 50% of his regular dose. I watched a lot of other Acros & IAA kitties, and found that their reductions were often just 5-10% of their regulars. Depending on your availability, and that of the food, and of course, kitty's appetite... (Grayson never missed a meal!) I would factor all of these in when deciding what to shoot. Sometimes they will nadir at shot time. Though your numbers were low enough to shock you, it's good to test through it a couple of times and see when they start to climb again. I know not all of us can stay up to do this, but it's very helpful to see where they are in 1, 2, 3 and 4 hrs. That way you'll see if/when they start to climb again, and when you can get to a "shootable" dose. Or, if you should just reduce.

The whole dance involves a LOT of trial & error. What works for one cat may never work for another, so it's important that you gather all the info you can from your kitty.

Grayson got up to 50u Lev and 3uR. We FINALLY started seeing movement out of the pinks and into greens/blues in October 2012. He did a bit of the cha cha - 3 steps forward, one step back. So don't be surprised if your guy does the same.
 
Yes those 18 hour cycles have come in handy at least twice lately although since I am fairly flexible time wise, I have done 15/16 to get back on a schedule we could manage without having to be a total night owl. The 3 hour delay today is fine because I had routinely been shooting around 11pm previously so another hour is neither here nor there although I had just recently moved her back to 9am to make it easier to get night cycle tests in and she pulled this morning's stunt. Darn I wish she's read the manual and pay attention to the schedule!:p My alarm clock is definitely one of my best friends these days! :woot:

I just thank my lucky stars she didn't start any major slide until I got back from my trip. She must have a guardian angel! I wonder now though, just how low she might have been going while I was gone when mid night cycle tests were not happening. The thought just sends chills through me!
granadilla said:
you're on an upside-down looping roller coaster
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That's a great description of how I am feeling right now but man do those blues and greens look good!


Grayson & Lu said:
Grayson got up to 50u Lev and 3uR.
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I can't imagine giving 50u but then I never imagined giving 16 either. Funny how you just keep increasing and get used to giving high doses. I was planning on starting to use some "R" on my return. Menace apparently overheard me planning and decided to take things into her own paws!:cat:
 
I was lucky to have seen him respond when we got there - other acro/iaa kitties have been over 100u BID! Sooty was at 104, and has been OTJ for 4 yrs now. One in the UK, and one in California had the surgery. Barrington is OTJ; Ben ended up having SRT on top of the surgery, as they were unable to get the whole tumor. So when I think of their insulin costs, I'm grateful I only had ONE house payment in Grayson! I just couldn't stand the thought of 2 pokes each shot time, or larger syringes!
 
Hi there

With BK being the first kitty here to test for IAA there was no ones sleeve to tug on or ss to look at for any sort of guidance. We basically stumbled and tumbled our way through, flying by the seat of our pants.

I was fortunate that his highest Lantus dose was 13.5u and I used a lot of R. It was October of 2008 when I noticed insulin sensitivity returning. The first thing I did was stop the R which was a 10u or so bid instant dose reduction. No depot, no HC, no PJ parties. No drama.
It was just dumb luck but brilliant.

He had his first dental in early Dec 2008 and once he finished the post dental antibiotics momentum started building.
It was time to fasten our seat belts. Free fall had commenced.
He had his first taste of HC the first week of Jan 2009. The next 6 weeks or so were exhausting as we tried to navigate our way from 13.5u to 3u.
This was just before the 18hour cycle option had been derived.

I learned to trust my instincts in terms of when to shoot a BCS or when to skip. Since we were in uncharted territory I played it safe. The occasional red number didn't rattle me and rather than try to shoot it down with R most times I would just let it ride.

Once insulin sensitivity returns what came before quickly becomes obsolete.
 
I'm late to your party, but just wanted to say you've gotten some great advice here from experienced people. I used the one-time 50% reduction a lot after Punkin had his SRT for acromegaly. My husband and I would stand there with the insulin vial and syringe and do what we called "Dialing for Doses" on his way down the dosing scale. It's a bit hairy and it's helped that now people have figured out percentages to help at least somewhat guide those decisions.

Every high dose cat is a little bit different, but it does help to see what other people have done that worked with their cats.

Glad to see that Menace did just fine today.
 
Sandy and Black Kitty said:
He had his first dental in early Dec 2008 and once he finished the post dental antibiotics momentum started building.
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Menace had a dental done early January and when I look back it was shortly thereafter I started to see some blues periodically. I assumed it had helped a tad but not as much as I had hoped. Now I wonder if it really helped or if we were actually seeing the start of a break in her resistance.

Sandy and Black Kitty said:
Since we were in uncharted territory I played it safe.
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I'm so grateful that I have you "pioneers" to guide me although sounds like Menace is the first kibble addict with IAA (and ECID) so using the guidelines here, we will chart our own path. I have always tended toward the conservative side as well but there are times when I think I have been too conservative. It's hard to find that middle of the road.

julie & punkin (ga) said:
My husband and I would stand there with the insulin vial and syringe and do what we called "Dialing for Doses"
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My routine has always been to draw up Menace's insulin, test, feed and shoot while she is eating. Having now dumped out a few syringes due to skipped shots, and forgetting I had one drawn up yesterday that I could have just adjusted to the BCS dose, I'm gonna have to re-think my routine while I play "Dialing for Doses!" I'm wearing a path in my carpet from pacing and mumbling to myself about what to do lately while the cats look at me as if to say "Mom's lost it!":woot:

Hope Menace behaves today. I've got to go pick up more test strips. Gotta make sure I am extremely well stocked for this adventure! Thanks to everyone for chiming in. I feel much better just knowing your support is here for us!:bighug::bighug::bighug:
 
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