HighDoseCatQ's

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Holly4Richard

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Sorry I couldn't find the high dose forum, this new site messed me up.
I'm giving my 14lb 9.5year old male tabby 6units of lantus, u100 in a u100 needle. his pre shots are between mid and high 300's. We started low and went slow with vetsulin in fall 08 when he was diagnosed, he had diabetic ketoacidosis nov 08, we quadrupled the dose to 8 units vetsulin.(he was on 1.5 units every 12hrs and she gave him 2 units of regular insulin IM every two hours for 8 hours) The vetsulin was eventually increased to 8units. A year later we started pzi, he eventually got up to 11units pzi with preshots in the mid 300's, never getting below 250 with the two hour curves we did.. now started lantus at 5 units per vet, his preshots are still mid three hundreds (althought i'm giving half the units in lantus as i did in pzi) We went to 5.5 units lantus and this week to 6units lantus. The cat is not getting anywhere near 100mg/dl. this cat is also extremely polyphagic, he wakes me up if he hasn't eaten in 5hours, he screams and stares at me, follows me around until i feed him. if i don't feed him constantly he lashes out and eats the loaf of bread through the bag, eats hamburger buns through the plastic, mauled a jelly donut through cellophane, eats potatoe skins, anything consumable. He exhibits polyuria to a somewhat lesser degree than previously but is still creating large clumps in the litter. He only eats fancy feast classic varieties and i try to give him a 3ounce can with each 12hour injection but he readily demands twice that in food. This cat also seems to 'use up' each type of insulin in 8hrs, not 12. He seems vibrant and excitable but very unregulated. would testing for high dose causes be beneficial? would it help if i knew why he was high dose? also, should i keep increasing this lantus glargine by a half unit every 2weeks till he gets near an acceptable range. i want him to be under 200 for 22 of 24hrs a day. this cat is at 300+ 24/7 please respond with lots of advice and if you need any clarification please ask, i have waited to long to regulate him. is it possible that he is unable to be regulated? Can i use two insulins at once???
This cat is my best friend and I want to help him!!!!-He's also driving me crazy, i'm pumping him full of insulin and he's begging for food like he hasn't eaten!!!
 
I would really recommend that you get him tested for insulin resistance. You've tried large doses of many insulins and don't seem to be getting anywhere. The information about testing for IGF-1 and IAA are buried here: http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

The tests are fairly cheap ($44 & $14? + whatever your vets tacks on). Turn-around is about one week. By doing these two tests, you'll be able to see if there is an underlying reason for the resistance and then dose accordingly. Some cats simply need more (but the only way to safely determine that is by getting the tests). My cat needed 15 u (Lantus + R) at one point. We have several cats that need 20 u Lantus/Levemir.

Do you have a spreadsheet you can link?
Does your kitty snore? Is he particularly big (or are parts of him big)?

Also, the people in the Lantus forum are very good with high-dose cats. However, you'll need a spreadsheet and profile before heading over there. I would really, really recommend that you have your vet draw blood for those tests on Monday - you'd have your answer by Friday.
 
Jen, they went from 11 units PZI to 5 units Lantus in a cat with a history of DKA. While it would be desirable to start over at 1u BID - the risk of DKA?

Definitely get the IGF-1 and IAA tests done as soon as possible.

Also -- do allow your kitty to eat as much as he wants. High blood sugar / unregulated is uncomfortable and until he is getting enough insulin -- he is starving. Also -- if your kitty does have acromegaly (positive IGF-1 test), then he may have excess growth hormone causing big hungries (think growing teenage boy)

The High Dose forum has been pretty quiet lately -- it is fine to post here in Health for now. Heather & Boo and I both have/had acro-cats. Some of the other acro-moms post in Lantus regularly.

What area do you live in? The two tests are run at a lab in Michigan -- so shipping cost is a big part of the expense.
Make sure your vet contacts MSU directly -- if going through the "regular" local lab, extra handling costs will be added by everyone that touches the package of blood.

The MSU lab is the ONLY lab in North America that runs these tests.


One benefit of KNOWING whether or not these conditions are present -- you know that your kitty really Needs a lot of insulin and can be more aggressive in treatment.

For example -- instead of waiting two weeks for a dose increase, 3 days (6 shots) if you follow the protocol defined in the LANTUS Insulin Support Group.
 
Hi,
Your story sounds VERY familiar ( I have someone staring me down for food as I type :lol: ) and it turned out Cody has Acromegaly. Thanks to the dear angels on this board, I had him tested and it explained years of frustration. PLEASE check out the stickies in the high dose forum for links about how to get the test, etc. They run the test on Wednesdays, so you need to get the blood draw probably on Monday, and then send it cold storage or frozen overnight by Fed EX so it gets taken directly to the MSU lab (michigan) by Tuesday , so its there for the Wed set up.

Your vet may have doubts- almost all do. Heres a link that you /she WILL find helpful -its a Jan 2010 Feline Med/Surg veterinary jounal article about Acromegaly (open it as a PDF):

http://www.sciencedirect.com/science?_o ... 58b97d9ea5
 
Hi,

hope you have now found the high dose forum.
It's heartening to read how hard your trying with what sounds like a troublesome cheeky kitty :lol:

Think someone has mentioned it, but if your kitty is staying in te 300's s/he is still going to be constantly hungry as unable to process the food properly.Free feeding until you get some answers may be a way forward (avoiding the 2 hours before shots if you hometest so you can see what their levels are like)

Bread won't be doing kitty any favours as it's high in carbs-might need to buy a lot of tupperware!

From your story it does sound like highdose is a probability, especially if you cut from 11u to 5u despite the previous DKA.

The test will give you answers and also if positive will allow you to dose more aggressively to try and attain those lower bg's whilst knowing your not hurting kitty.

Good luck :-D
 
As I was reading your post, I recognized all that you were saying.

I echo the others. Set up a spreadsheet so that you can track all your test results, and so that others can help you understand the numbers.

About the foods - your cat is not able to get the nutrients it needs from the food being eaten now so you cat may eat a great deal more until things settle down. My two both went through a great deal of food - Shadoe once was eating 20oz or more a day, but now she does not eat more than maybe 6oz. For Oliver, he is eating easily 30oz or more, plus some raw chicken, but once he is more settled, he will also likely eat much less. Both are high dose kitties that tested positive on the IGF1 test. Just let your cat eat, but please put all other foods away where kitty can't get, even if it's in the frig. Those other foods are causing higher numbers.

Did someone suggest starting back at 1u BID with Lantus? NOT a good idea, you can look at Oliver's ss and see that his numbers were horrible when his dose was decreased down to 1u BID.

You can post in the Lantus group as there are several other high dose cats over there.
Just add the links to your spreadsheet and your profile in your signature.
some links to info for you:
Spreadsheet Template and Instructions
Profile Creation
New to the Group

I agree that you should get the tests done so that you know the reason for the high dose or rule out two possibilities. And apparently, it's best to get the tests done before you are that high up in dose as it will affect the IAA results.
 
I never said start at 1; I simply cautioned ....obviously the dka history has to be kept in mind, its just not clear whether the previous high doses were reached properly. if your read the op, the dose of vetsulin was quadrupled after dka! and there is no indication of how 11 units pzi was reached. there is not nearly enough info to know whether this is truly a high dose cat.
 
The proof for high dose cat and its needs for that dose and higher may well come from the two tests for acro and IAA.
All it takes is a simple blood draw which is packed up and shipped via Fedex to msu. Inside a week, you will know the IGF-1 level if out of range 12-92, and the IAA % if >20.

I can't see any reason not to have the tests done, based on the insulin that's been given.
I did recently find out that the IAA may come back high because it can't differentiate between the different autobodies. If receiving a very high dose, the body creates more of the antibodies thereby increasing the odds of throwing off the result you get. Oliver is a perfect example of that statement. He was getting 12uLev BID and 4uR QID when his blood draw was done for the tests, so his result of 60% may likely be skewed by the amount of insulin he was receiving at the time. Yes, he very well could be positive, but we can't tell his true value. It's just like feeding a low number then retesting. Did it go up on its own or are you seeing a food rise? His high dose is needed due to his acro condition which had a result of 325.

Test when the resistance is being observed but the dose has not yet reached the nosebleed section. You will then have a better chance of getting a more true IAA result.

I did start Shadoe on Caninsulin and after 6weeks getting to 4u, we switched to 1u Lantus and observed no real change at all. Different insulins; same resistance. Shadoe was at 9uLantus BID and seldom any R and her IAA came back 7 which is a negative, but her acro result was positive at 120.

The two tests are simple, and will buy you some peace of mind. You will either know the reason for the high dose, or you will have eliminated 2 possible reasons.
 
Hi Jen,
I know it sounds very haphazard on the dosing, and you're right, it is. I won't comment further on the dosing because I think we can all agree, it was not done as properly as we would like. The IM injections to even consider are scary, particularly as often as they were done.

That said, there is so much in what Holly has written that stands out as being a cat with a high dose condition. The appetite alone is a dead giveaway, followed by the fact that the cat is actually 14lbs. A true diabetic who is THAT hungry would weigh far less. This cat is exhibiting something we have all seen: inappropriate food consumption. Nancy is the proud owner of a chocolate cake eater. :-D I own a green bean eater. :mrgreen:

The doses given, particularly the IM doses, did not harm the cat. The cat has been diabetic a long time. Over the course of this disease treatment, those substantial doses should have resulted in hypoglycemia multiple times, and I find it unlikely that she would be here posting today if in fact the cat was overdosed, because I can not see how he would have survived all this time with too much insulin on board.

I know it often seems crazy when we all jump on these threads, but I swear to you, we would never endanger a cat. If it were not for what we read, we would say the same as you: "cut the dose" - but we recognize what we are reading. (((Hugs))) to you, you are a true savior on this board, and I hope you will always know that. :smile:

Hi Holly!
I would recommend to you that you post on the Lantus board. There are many there with Lantus and Levemir acrocats and one there with an IAA cat. They are well versed in dosing, and can get you on track with your increases. You will need to set up a spreadsheet, and there are instrux there for that, but once you're on the road with the SS and posting, you will quickly see improvement in the starvation level of Richard. I promise :) More than likely you will be increasing your doses every 8 cycles, aka every 4 days, at first. Ultimately we may suggest you increase faster, and at a higher increment. Here is the forum: http://felinediabetes.com/FDMB/viewforum.php?f=9

I do think you should get the testing done, recommend you have both IAA and Acro done, as they are both at the same lab and will require overnight shipping which is costly, so def get them both done at the same time so you don't have to have two shipments. It cost me just over $100 to get both mine, with shipping included. It is a relief when the tests come back because you will know why the cat is like he is, if the tests are positive. If they are negative, you will have narrowed down the possibilities. :)

(((hugs))) Glad to meet you, and look forward to seeing more from you! My acrocat, Leo, is the one pictured in my avatar, and he gets 20u BID Levemir. He was once at 40u. :lol:
..C

PS: Forgot to mention Leo's food intake.. once at 24oz per day. Leo is now a far more affordable 12oz a day kitty! He lost his ravenous behavior at about 10u, so there is hope for you and your human food LOL
 
Thank you, as always Carolyn, for helping me understand! My concern stems from the lack of dosing logic; not having a high dose kitty, the other symptoms don't stand out the same way to me. And even with Squeak, he was ravenous and ate chinese food including baby corns, prior to DX and he's not an acro cat. But slowly I will learn!

Jen
 
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