High Dose?

[Shelly and Spaceman]

Just thinking.
What do you guys consider high dose?
And if you are high dose, How long did it take you to get there?
Is there a high incidence of rebound on Lantus?
At what point do you consider that maybe there is something more going on? (acro, insulin resistance)

 

[Caryl & Sebastian & Alex (GA)]

Morning Shelly,
How is Feeburt today?

I am no expert on high dose that's for sure and it may be different for each cat but I think that if a cat gets to the point of 5U or more bid, keeps getting dose increases and is not responding in any positive way (ie staying in the 300-400 range) then it is probably time to "consider" that this could be an issue.
Like I said, I am no expert, my cat is not high dose, but if you look at Jan and Buddy's ss for example you'll see an example of a cat that was recently diagnosed IAA.

Yes, I'd say there is a pretty high incidence of rebound with Lantus, until the cat has gone through Liver Training School (LTS) and becomes regulated. Unfortunately, Alex still hasn't passed that stage. Have you read the Tilly Protocol? It's in the stickies http://www.tillydiabetes.net/en_6_protocol2.htm
If you look at many of the charts you'll see that after a cycle of very low numbers, a lot of the unregulated cats will then have relatively high numbers the next day. Their livers have not yet been trained to accept that these low numbers are good and reacts by spilling glucose into the body..hence the high numbers. that's why everything(increases and decreases) is done in such small increments...so the body can adjust and accept and hopefully regulate.
All cats will have some rebound..that is not high-dose specific

Like I said, I am not an expert but I hope this helps

 

[Carolyn and Spot]

It all depends on the cat, and the treatment of the cat. If the cat was has been diabetic for a long time and not been managed properly, then 5u might not be a high dose, but if the cat is sustained flatlining in very high numbers (300 and up) without relief, at a good methodical dosing history, such as the protocol followed here, that cat would be considered *heading for* high dose.

Mostly it is decided when a cat reaches the maintenance dose, which is the dose that puts the cat in good numbers without radical swinging.

I don't mean to harp on this, but you would be amazed at the effect of dry food on a cat's numbers. Lantus is really not good at overcoming numbers that high on low doses, so Feeburt may ultimately end up needing a very large amount of insulin to overcome the dry food, making him not technically a high dose cat. I'd keep bumping him 1/2u every 7th dose until you see a break.

 

[Sienne and Gabby (GA)]

Carolyn has considerable experience with high dose kitties so there's not much I can say. There are certain physical characteristics associated with acromegaly, in addition to dose issues. If you want to see a SS where the dosing has been worked up, take a look at Shadoe's SS. Gayle is waiting on the "official" diagnosis based on lab work.

I doubt that there is much difference between Lantus and any other insulin when it comes to bouncing. It's a natural response of the liver to lower numbers. In many ways it's a protective mechanism. Because most of our cats have been diabetic for a while prior to their being diagnosed, their body has become somewhat accustomed to being in higher BG ranges. As insulin, or a cat's pancrease producing endogenous insulin, drops those levels, sometimes abruptly (and other insulins are much harsher in that regard), their liver, which stores glucose, panics and dumps glucose into their system to "protect" it from the lower numbers.

A few weeks ago, Jojo commented that the bouncing is actually a good thing. Given that a diabetic cat may have some functioning beta cells in their pancreas, if at the early stages of treatment, the numbers were staying low all the time, it would be putting undue pressure on those functioning cells. As a result, whatever functionality was there would cause them to burn out. So, in effect, the bounce takes that pressure off.