High Dose?

[Shelly and Spaceman]

I'm Moving this from Lantus. Feeburt has only been on insulin for 2 weeks so I am really looking for some insight for moving forward.

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)

 

[Phoebe_TiggyGA_NortonGA]

One of the Acro articles that is linked mentions "High Dose" has being greater than 1 unit per pound body weight per day.

So - Norton was 14 pounds and got 8 units BID (16 units per day). His IGF-1 was 331 (insulin-like growth factor).

We started insulin (Humulin N) at 1 unit BID and held the dose for a week at a time. "Start low and go slow"

once per week, we went to the vet for a blood sugar test at nadir (+6 or +7 after injection for Norton on N)
(this was before we found FDMB and started home testing)

The vet would have us increase his dose if his nadir reading was above 200. When we reached 11 units BID, his BG at nadir was below 200 for the first time (125 at +7) (he was still on high carb Science Diet crunchy food at the time).

It took 12 weeks to reach the 11 units BID dose.

This is a graph of Norton's blood sugar at nadir, his dose and his weight while on Humulin N.
http://www.devilkitty.org/graphics/nort ... umulin.jpg

Initially, the data points are every week - later every 2 or 3 weeks.

I did not find FDMB until September 2007. Norton had a severe infection in June 2007, and afterwards, he was walking in circles. He had crashed (hypo'd) at the vet's office under anesthesia when she was cleaning/treating the abscess in his jaw. I was trying to find information about why he would walk in circles etc. He also seemed stiff and his neck seemed to hurt increasingly. We tried different things and ended up at a neurologist in March, who confirmed a brain tumor.

Anyway, when I arrived at FDMB, we were at 9 units BID, and most flipped out at the dose when I first posted. I did a brief rebound test and satisfied myself that he needed the dose that we were giving. I ended up lurking to avoid criticism while learning -- and found the High Dose group, who helped a LOT!!

We determined that he fit the profile of an acrocat - big feet, muscular - gained 4 pounds while diabetic, round head, brain tumor (usually acro tumor is tiny, but it grew and caused him to walk in circles), needed a "high" dose of insulin to get reasonable BGs.

My vet did not think Norton had Acromegaly. I asked and eventually insisted that she send off the blood for the IGF-1 test. She was surprised by the positive result.

 

[OptOut]

Hi Shelly,

Boo started insulin last January; we did the IGF-1 testing in early April. Her curves were high and "flat" - her numbers just didn't move much. I think the best thing to do is to follow the protocol used in Lantus for now; if you hit 5-6 u w/o getting nice numbers, you might want to consider the IGF-1 and IAA tests. For now though, just be patient...look at spreadsheets. In particular, you might look at Libby/Lucy, Kathy/Kitty, Jan/Buddy, Gayle/Shadoe, Holly/Pablo...see if you notice anything in those.

I know it's hard; it's probably super hard since this is your second one. However, just relax and be patient and try to be a part of the community so you don't feel alone.

 

[Blue]

Hi Shelley,
I looked at your ss, and my first thought was Hey that looks familiar!
I was told that those flat highs likely mean you need a higher dose, but it's important to follow the protocol, so Shadoe and I crawled up with never an increase sooner than 6 cycles.
Our increases started at .25u every 6 cycles, then once we got to 6u BID, our increases went to .5u every 6 cycles. Now, tonite will be our first increase by a full 1u, from 10u to 11u.
Shadoe weighs usually between 11 and 12 lbs, so she is now getting double that guideline Phoebe mentioned: 1unit per lb per day.

I think there are some cats that are just slower at getting with the program; some may take till that 6th cycle before you see them respond to a new dose while others, react sooner.
Over time, you will start to see better how YOUR kitty is responding as you gather more and more numbers on your ss.

I have found that the numbers are not nearly as important as how your kitty is acting.
You can tell if Feeburt is looking happier, lighter on the paws, eating more or less, urinating more or less, playing and purring, that sort of thing. Be sure that you look to these details first, and try to add a note of any changes you observe onto your ss so others can see and suggest. I am positive that you will see a HUGE improvement with these details way before you see something of note in Feeburt's numbers.

Even if you don't think it's time to ask about having Feeburt tested, it is already past time to talk to your vet about the tests. I don't know about your vet but where I go, they had no clue about the tests or how to go about testing or where to send them and how! Seriously!

DO talk to your vet and ask IAA and IGF-1 tests, just to get a feel for your vet's opin and also your vet's knowledge on the process. If you decide on getting the tests done, DO ask your vet for an estimate so that you know the cost of the labs, the shipping, and your vet's charges for the draw and packaging. It's not cheap, and some vets charged some beans crazy amounts. Ask for the values separate too, so you know how much is Fedex, how much is MSU and how much is your vet's portion.
Do NOT let your vet say that your kitty does not need the tests; it is YOUR decision to have the tests done, NOT the vet's. There have been others who have been told by their vet that their kitty likely did not have those conditions, but pushing for the tests proved the vets to be WRONG.
I had to take printouts of the two sheets with details on the 2 tests from the MSU site to my vet, and said CALL THEM AND GET WITH THE PLAN.
Even after my first mention, they were still dragging their feet and I had to get pretty angry with them (they are learning that I can get pretty angry and annoying). My vet then called and got the info on what needed to be done, when and also arranged for the shipping with Fedex. Unfortunately, they never bothered to followup to get the results on Friday, so I screamed at them many times, and will now have to wait till tomorrow morn when the lab opens at 730am. Watch your vet closely.

Because Shadoe always has a positive lipemia value on her bloodwork, we had to fast (well, she did, not me :lol: ) because one test could be disrupted by lipemia. She did not like the fast, but I did take a small container of food with us when we went to the vets (it was some of a HC that she likes. I figured she would already be stressed from the vet and starving, so a treat was in order to let her know that fasting has a good ending!)

Shadoe may be getting more insulin than many other kitties, but she is one happy happy kitty most days, despite her high numbers. Eventually, we will find the right dose for her and she will be a happy happy kitty with low numbers!

So talk to your vet about the tests and spend some quality time with Feeburt.