Need Dosing Help-Possible High Dose Cat

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Nancy and Scotty

Member Since 2014
I have been lurking around this board for several months and have finally decided I have to ask for help, my 11 year old male beige tabby cats was diagnosed the first week in January, thanks to a month of one of my females being diabetic 6 years ago all my cats were already on wet food and I knew about testing, my female Katie's diabetes were caused by steroids for allergies and her numbers came down so fast that the whole month I was scared too death she would hypo and was prepared for this to start all over again with Scotty, little did I know.

The vet started Scotty on 1 unit of PZI insulin, he dropped into the low 300's and started feeling better for a couple weeks and then climbed back into the high 400's and low 500's-we raised his insulin 1/2 unit and he dropped back to the 300's for a couple weeks and then back up-this went on and on, even though he had never used it my vet suggested Lantus but because I worked 13 hours a day and had no one to test for me while I was gone I was reluctant to try but finally in June when we were at 14 units of PZI twice a day and the neuropathy was so bad I decided that I had to do something or he would die of Hyperglacemia, I got my work to set up a 12 hour schedule for me and worked it out where I can go home and test at +6. I decided after reading everything I could that I would rather have Levemir and though the vet had never heard of it, he read up on it and wrote me a prescription.

We started at 2 units and I had slowly raised him up to 2.75, I had kept his blood sugar between 65 and 130 for 2 weeks, he was actually started to play and his legs were betting better then on Saturday morning last week he jerked as I was giving him the shot and lost about half of the insulin, the next day he was at 329 and he stayed between 300 and 330, I use a Relion Confirm but have an Alpha Trak my vet insisted on, since the numbers were so flat I check against the Alpha Trak a couple times and got 360 on it so pretty much 330 on a human meter, on Thursday I could tell he was starting to feel bad so I gave him 3 units for his evening shot and then 3 units Friday morning, I really did not know if this was the best thing to do but my internet connection at home was so slow I could not ask this board for help and my vet was off, on Friday morning, AMPS was 329 but by +3 he was at 86 and stayed in the 80's the rest of the night, I was a little concerned about the fast drop but went ahead and gave him the 3 units on his evening shot and watched the numbers until around 0400, then when I did his AMPS test I could not believe it but I got 343, is this a bounce? I really need some dosing help and apologize because I have not been able to do a spreadsheet, I have kept a notebook since starting the Levemir and can give you numbers, I realize that maybe no one is around to help me this weekend or everyone is busy but if anyone can help today, Monday anytime I will appreciate it, I am starting to feel like my baby will never get better and it is all my fault. Thank you.
 
Re: Need Dosing Help

I am not a Lantus user but, until one comes along, I'll try to help. Here is the Lantus protocol:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. Notice they hold the dose for a few days and then increase by less than one unit. And they base any increases on the nadir, or lowest point in the cycle.

I can help you with a spreadsheet. If you want me to, just reply.

And most importantly, IT IS NOT YOUR FAULT! This stuff is really difficult to learn and the learning curve is incredibly steep at first. Keep posting and asking questions and listen to the Lantus advice. We can help you figure this out.
 
Re: Need Dosing Help

What you are describing suggests insulin auto-antibodies (IAA) - dose increases with some effect, then becoming less effective, and the high dose you have increased to (14 units of PZI twice a day). Please read up on this here.

I strongly suggest printing that out and discussing it with your vet, plus arranging for testing.

Maybe edit your first post to include "Possible High-Dose cat"
 
Re: Need Dosing Help

I just went home to do my +6 test and he was at 143, I am afraid that he is showing resistance to the Levemir also but still would like to know if anyone has any advice on dosing, I had hoped the resistance was just to the PZI but it looks like maybe not, still all I know to do is keeping trying to increase slowly and get through it.
 
If you just switched to the Lev, you have to give it a good 5-7 days to get stable at the dose.
 
He has been on Lev for 5 weeks and I thought I was getting him regulated, everything was all blues and greens for 2 weeks until he jerked during a shot and lost about half of the dose of 2.75, then from Saturday to Thursday it was 300-330 until I finally raised the dose to 3 units, then it was 80s for 24 hours until a 343 this morning pre-shot but when I went home to test at +6 it had come back down to 143, was the 343 a bounce, I am really afraid he is developing resistance to the Lev and after 6 months of just going up, up, up on PZI I really do not understand what constitutes a bounce and am unsure if I just need to hold the 3 units or for how long.
 
Read all the way to the bottom, please :smile:

This is how we enter data on the spreadsheet:

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

For now, if you could report the last couple days in a list as
AMPS, dose
+# for any mid-cycle test(s)
PMPS, dose

We can work with that to give you feedback.
 
Without seeing a spreadsheet or any numbers other than these, I'll answer your question as best I can. Yes, this is probably a bounce.

Bouncing happens when the insulin takes their blood glucose lower than their body has gotten used to. Since your kitty has been diabetic for awhile, his body has gotten used to high numbers and now thinks they're normal. The insulin brought him down into REAL normal numbers (50-120) and the liver released sugars and hormones to bring them back up quickly.

The more time they spend in normal numbers, the less your kitty should bounce, but it's important for you to continue testing and keep track of the numbers on our spreadsheet. Once set up, it's very easy to use...you just enter the numbers as you get them.

He may need to increase or he may not...if 3 units got him into the 80's, I'm thinking that is a pretty great number so I'd suggest you just continue with the same dose unless he drops below 50, and test and record the results for the next several days and let's see what it looks like then.

Hope that helps! Keep posting here and we can help you learn what you need to know and get him better controlled!
 
Thanks to everyone who answered, from Saturday night through Thursday no matter what time I tested him he was between 300 and 330, his numbers on Friday and Saturday are :

AMPS 330
+6 86
+8 80
PMPS 130
+6 84
AMPS 343
+6 143
PMPS 183
+6 130
AMPS this morning 203

so maybe it was a bounce and he is coming out of it, I just hope he is not building resistance to the Levemir. I am going to stick with the 3 units for 3 or 4 days and see how he does, he seemed to feel pretty good this morning. I know we are not supposed to have favorites but he has always been my biggest baby, everyone at the vet loves
him, he is just such a big sweet boy. He is in good health besides the diabetes, he has been on wet food only for 6 years and has never been overweight so this was a big shock.
 
Hi Nancy (and Scotty!),

I'm not seeing any insulin resistance in the numbers you've quoted above. Actually that looks like a pretty nice response to me, especially for this 'stage of the game'.
It may be though that there has been some bouncing going on. It's hard to say without more data.

Do shout out if you need some help setting up your SS. There are some smart techy folks here who can help you (sadly I'm not one of them... ;-) )

Eliz
 
Thanks Elizabeth, it makes me feel much better that you do not see any resistance to the Levemir, after my 6 month nightmare on PZI I worry about it constantly, as everyone can see I am not tech savvy at all, I don't do facebook and this is the first time in my life I have posted to a message board but when my vet told me last week that I had done everything I possibly could for Scotty I realized that no there was one more thing I could do and that was bite the bullet and ask this board for help, luckily a girl I work with is an ex Geek Squad member so next week she is getting drafted to set up my spreadsheet, signature etc.
 
Nancy...it really is easy to set up your signature!

Look in the upper left side of the page..Find "User Control Panel" and click there

Find "Profile" and click....then "Edit Signature"...a new little box will pop up and all you have to do is enter what you want to put there! We usually suggest

Your name/cats name
Date of dx (diagnosis)
Type of insulin
Type of meter
Food
Other health problems?

Then you just hit "submit" and you're done! We can set up a spreadsheet for you too. It's important that you use the one we use because we're so used to dealing with it instead of the vast number of other spreadsheet programs that are out there. It's very easy to use too. Once set up, you just enter the numbers as you get them into the right place!

If you'd like our help in getting your spreadsheet set up, just ask!
 
Hello Nancy and Scotty and welcome. My kitty Neko has two high dose conditions, IAA (insulin auto-antibodies) and acromegaly and she is currently on Levemir, although now down around 1U. If you manage to get a spreadsheet set up, that will greatly help those of us who are familiar with these conditions see if we think Scotty might have a high dose condition. The fact that he was on 14U of PZI twice a day, and still alive is interesting. However, we do dose Levemir based on the nadir (low point), and those 80's are looking pretty good. :-D
 
Wendy just wanted to let you know that Scotty was not on 14 units the whole 6 months, the vet started him at 1 unit, he would drop to around 350 for a couple weeks then back up to 500, it really looked like he had a resistance to the PZI but even though I used 3 different vials trying to see if I had a bad vial or something sometimes I wonder about my vets PZI supplier, I feed so bad that I did not switch him to another insulin sooner but I was afraid of using a depot insulin with my work schedule, I had held Scotty at between 70 and 150 on the Levemir for 2 weeks then he jumped up to 300-330 for a week until I upped his dose from 2.75 to 3.00, before that I was thinking of a reduction, when he jumped into the 300's and I could not get him down I was so scared he was developing resistance to the Levemir but Wednesday morning he acted like he felt bad and his appetite was down (appetite down is a big deal for him) so I took him to the vet, he had a fever and the vet thought maybe my mean kitten had bitten him, he started him on an antibiotic and after one day on it his numbers have really dropped, he had a 61 preshot and at +6 was at 78, I dropped back down to 2.75 this morning and if his preshot is still low I am going to drop to 2.5 tonight and try that for 3 days, I was afraid with his long time in high numbers there was no chance of OTJ but I am starting to have a little hope. My vet had not seen Scotty since the day we started him on Levemir and could not believe how great he looked, he had gained 1 1/2 lbs. We have had a pretty big shake up at my work this week and I have had to work 13 hours a day so I have not even tried to work on the spread sheet but I will be off the next couple days so I hope to get it done so I can ask everyone for advice, my vet is really nice but he has no experience with Lantus or Levemir and once I had a prescription he just pretty much said call if you need me but you seem to know what you are doing, everyone else says seems to think it would just be better to have him put down so I really feel alone with this a and sometimes lose confidence in my ability to get him through this so thank you for answering me and I guess as much as anything I just need to know that I am not the only person out here that thinks if a cat is sick you have it put down and just go get another one.
 
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