new cats who arrive here with larger than average doses

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julie & punkin (ga)

julie & punkin (ga)

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i just want to ask for people to not fixate on it when cats arrive here and they are getting a larger than average dose. i had it happen to me when we came with punkin and i have to say, it freaked me out. he was getting 3units at the time and now with acro he's getting 14. i know that's not a lot of cases, but there are some, and nearly every time i look at the main health forum i see someone comment on a new cat's large dose of insulin.

the area to focus on is the hometesting, from my perspective. if the cat is getting too much it will become obvious immediately in the testing.

i think it's a really questionable practice to advise people to reduce their cat's dosage before they are testing. all the factors that might need to be addressed, switching to canned food, getting hometesting and the dosage, all can be juggled at once, but i guess my plea is to all advice givers to not go OHMYGOSH THAT'S A BIG DOSE OF INSULIN! when someone arrives here at FDMB.

thank you thank you thank you!
 
i think it's a really questionable practice to advise people to reduce their cat's dosage before they are testing.
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Not everyone jumps on the hometesting bandwagon and until they do, we are just trying to keep them from a possible hypo. Yes, hometesting will tell all including whether a cat needs to be tested for acro but until then ,when a newbie comes on with a new kitty and a high starting dose, I doubt many will not ask them to reduce that dose and go buy a meter.
 
It can depend on the insulin type as well as how long the cat has been at the high dose.

If they come on Humulin N at a high dose I would probably ask for a reduction quickly because of my experience with N.

If they come on one of the Ls, Lantus or Lev, and have been giving a high dose for over a few months without complication, then I might suggest hometesting before lowering dose.

If on an L insulin for a long time and having complications, then I would probably mention dose reduction quickly.

If PZI high dose I'd probably treat similar to N but ProZinc, not so much.

I think you have a great point and I know that with Acro we're dealing with something very different, but the majority of cats I've seen are not Acro and are on too high of a dose to start with. Even some I've adopted were on high doses of harsh insulins and when they came to my home didn't need any insulin at all. Mr. Darcy and Sweet Potato, Darcy was on Vetsulin, SP on ProZinc, neither needed insulin at all. It was by sheer luck that they didn't hypo. Kiki was on 4U Lantus shot blind, she takes only 1.5U at my home. Kiki did hypo at least twice that I heard about at the shelter.

Perhaps the "OHMYGOSH THAT'S A BIG DOSE OF INSULIN!" is a bit harsh and can be toned down a bit, but for the number of years I've been treating FDs, more often it's too high of a dose.
 
if they've been on the dose for a while, it might not be too much, especially if they've worked up to that dose. i understand wanting to be cautious - perhaps it's the level of reaction that's my concern.

actually, yes, it's the level of reaction that i find upsetting.

if people advising on the main board could keep in mind that there are medical reasons why a cat might need more insulin. There's not only acromegaly, which my cat has, but there's insulin resistance and cushing's syndrome as well. i don't think these are as rare as people might think.

i'm just begging for some sensitivity around the issue and not just blanket statements that the cat is getting too much insulin. without testing the cat, no one knows if it's getting too much insulin or if it's the amount the cat needs. if the cat's been on a higher dose for a while, it very likely IS the right dose for the cat.
 
One of my vets at the hospital, in 2007 when Simba didn't respond to any dosage, thought Simba had Cushings, and when I came here January 18th 2008, I was already home testing and Simba was on 5-6 U and had also been prescribed Acarbose to reduce his bgs. No one here commented on the high insulin dosage, but luckily for me both vet tech Jojo and vet Dr Lisa was here and both responded, and also others, about the Acarbose saying it was a totally unlogical and unnecessary medication to give if one got rid of all the carbs in Simba's high carb dry food. So I did the food changes, and tested tested tested tested tested, and as soon as I've done the food changes Simba's bgs dropped and he hadn't Cushings at all ---- but, I had a really hard time explaining this to that vet that Simba didn't have Cushing.


I've asked other newbies coming here with high doses (the highest newbie doses I've seen have been 7 U bid) if they possibly have acro or cushing cats, but that is also difficult when someone is new and never heard of any of those diseases before and their relation to diabetes.


I don't think 3 is a very very high dose, that is what my vets at our animal hospital want to give Simba every time he has been admitted. They always start high, at 3, then lower to 2 and then lower to 1. Sort of the opposite of start low go slow :-)


Sorry you're experience as new here wasn't the best.
 
The large, large majority of cats that show up here on a very large dose is not because of insulin resistance or acromegaly. It's because the cat was started on too high a dose by the vet, and/or raised to quickly, and/or on a dry diet. I think everyone does use caution in advising lowering the dose if ketones are present or there appear to be other medical conditions, but keeping a cat in extended rebound to me is dangerous--because you're not only dealing with a hypo, you're dealing with high numbers from rebound as well. And if someone is changing the diet and they show up on a high dose, the resulting BG drop could cause a serious hypo (possibly deadly) incident if the dose is not lowered.

Home testing is always the first recommendation because the best decisions are made with data, but sometimes it takes a while for people to get into it doing it daily and to collect the right numbers in the cycle, and they may already be in the midst of a diet change. If the cat did not arrive at the high dose safely, and has not been tested for insulin resistance or acromegaly, and is in a food transition, then I think the advice to immediately lower the dose is sound. I've seen cats that were doing fine on 7 or 8u go down to 1u once the diet was changed. And that can happen overnight. Even if you're testing, you have to use caution and lower the dose with a diet change because shooting 7u in that situation could put the cat low enough where they can't get back up, even if you catch the low number in a test.
 
it was absolutely awesome as far as support and welcoming. this board is fabulous - the patience is wonderful, the instant help is beyond wonderful. i'm not meaning to be as critical as i think i might be sounding. it's just the comments on the dosage that i found upsetting - i had already read the Rand/Roomp protocol and knew that cats using lantus in that protocol were on doses up to 10u.

i understand there might be a need for some cats to lower the doses, especially if they are on crunchies. i'm just asking for some awareness/sensitivity that the dose might be ok. you wouldn't want to send a cat into ketones without being thoughtful in the approach.

btw we've had 6 cats diagnosed with acro on the lantus board in the past 2 months - i really don't think it's as uncommon as we've been told - i think it's likely just underdiagnosed.
 
The discussion also gets more complicated when the cat is getting a high dose and dry food. Newbies transitioning a cat on a high dose to wet food need to be extra careful about the sudden drops in BG that often occur. No one was saying to just drop the dose , but to consider it if also switching to wet food.

Of course home testing is stressed as a first step, and no changes were suggested until that was started.
 
Your caution is warranted, in my opinion. There ARE too many people who issue blanket statements without understanding all the basic facts.

There are many reasons why a cat may be on a high dose but there are been tons of cats who show up here who have been overdosed and so its a hard line to tread when giving advice....so..people need to ask questions, point out options and be cautious...
 
julie1220 said:
if people advising on the main board could keep in mind that there are medical reasons why a cat might need more insulin. There's not only acromegaly, which my cat has, but there's insulin resistance and cushing's syndrome as well. i don't think these are as rare as people might think.

i'm just begging for some sensitivity around the issue and not just blanket statements that the cat is getting too much insulin. without testing the cat, no one knows if it's getting too much insulin or if it's the amount the cat needs. if the cat's been on a higher dose for a while, it very likely IS the right dose for the cat.
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Based on my personal experience with Spooky(GA) and what I have seen/read here for over 10 years (gosh, how did that happen?!) insulin resistance is frequently caused by excessive amounts of insulin.

One of the best tests for resistance is to cut the dose in half and monitor for a couple of days. In most resistance cases, the reduced dose will actually reduce the sugar levels in the blood.

And, just because the cat has been on a high dose for a while, it does not mean that it is the correct dose. Case in point, my Spooky was, at one point, on over 10 units twice a day. Eventually, his body just couldn't take that massive dose and longer and he had a severe hypoglycemic event that landed him in vet care for almost a week, crashing twice more on them without even receiving any more insulin.

Just my thoughts on resistance,

Lisa and Spooky (GA)
 
I consider that one has to give advice based on the information presented. There is no one-size-fits-all advise. I the caretaker is not home testing, it makes it harder to figure out what advice to give. Remember that each cat is different. I have had eleven insulin-dependent diabetic cats and they are really different. my Tonis does great on 6 units Bid and lightning on 0.4 BID.
 
julie1220: I'm wondering if you can think of a more acceptable way to ask the poster how long the cat has been on insulin, how the dose was raised, and what the cat eats that doesn't come across as an unreasonable 'level of reaction'. I have pretty much quit responding to those posts b/c it breaks my heart that often these cats suffer unnecessary hypos and sometimes don't survive.
 
i think it's an entirely appropriate topic - the dry food, the dose (why do vets increase by whole units anyway?), the lack of hometesting - all of that is perfectly appropriate. you have to discuss the whole package of what people are doing and how the cat is.

what i find distressing is the response to "my cat's getting 3 units" of an automatic "that's too high" or "that's an unusually high dose." it may be entirely appropriate to drop the dose and restart, but maybe not.

i must not be explaining very well. it's the level of response to the question, not the question itself. asking additional questions about how they got to that dose might give the answer as to how to proceed. i don't think anyone arriving here for the first time would know about iaa, cushings or acro because those things arise after the diabetes has been going on - but just being aware that all newbie cats have the potential for a high-dose condition in the response would be helpful.

just-as-appy - heehee i like your name - i think just asking without then responding with exclamation marks is fine. i think it's ok to say "most cats do well on 1unit, but there are medical reasons why some cats need higher doses - let's look at the rest of what's going on with your cat" is great.

that's different than "that's a really high dose!"

maybe that sounds nit-picky, but i do know that it would've made a difference to me.

lisa, with your spooky - the cure for insulin resistance is more insulin - i would wonder if spooky got up to 10u if he was insulin resistant and you hit the magic point that knocked it out. i have no idea, but that's what i would think of.

i appreciate you all even talking to me about it. i do HUGELY respect what you're doing on this forum with all the new people coming in being in crisis and feeling desperate. you were there for me too. it's just this one little thing - so i don't want to say any more about it because overall - YOU'RE SO AWESOME! really. i mean that - so i don't want to belabor the point. you're like the paramedic first line responders - and it's a tough job. i recognize that.

so thanks! i do appreciate you all. :YMHUG:
 
I wonder if we could post the "suggestions to advice givers" on a regular basis, like how the "new and confused" or crf or hypo threads get posted.
 
there are also symptoms to look for that could signal a need to get tested for a high-dose condition, although the high dose itself is the first "symptom."

with acro - a big body including big feet, forehead, muzzle and tongue go with it as the excessive growth hormone actually makes them grow; also acro cats develop a breathing sound like wheezing or snoring because the soft tissues have grown and now rattle when they breathe. with cushing's they have fragile skin that might not heal or might "tear." i'm not sure if there are other symptoms that go with insulin resistance other than needing increasingly high doses. the definitive thing is a lab test done only in Lansing, Michigan. but when i see a large cat, most often male, who is getting a higher dose - i would immediately wonder about acro.

for whatever reason, i suppose because vets have to know a lot about many animals and conditions, vets just don't seem to know much about these other conditions that can go with diabetes. my own vet, who's in his 50's and been practicing all his life, had never heard of acromegaly. he has a partner who's been out of vet school 3 years - she said she recognized the word but didn't know anything about it. i've had to educate myself and then send them info on it. but now being here and seeing how many of our kitties on Lantus have been diagnosed with it, i really have to wonder if it's more common than previously thought.

other conditions that go with feline diabetes include hyperthyroidism & pancreatitis - seems like there's one more common one but it's escaping me.
 
I hear what you are saying, however, some additional things that need to be taken into consideration include that several people (and yes I can name, names) came onto this board with high starting doses. Why, because it is what the vet told them to do.

Kathy & Kitty are one prime example. She was told by the vet to dose 5 or was it 10 units Bid and the vet even wanted to raise the dose. Kathy came onto this board, scared, skeptical and not wanting to trust the advice of strangers. Well, long story short, she home tested, learned to trust us and reduced Kitty's dose to 1 unit. I can't recall how high the dose got after that, but it was never 5 or 10 units.

And this is a cat who is now OTJ.

Yes, there are other things that cause a cat to need what we typically consider a high dose. The thing to understand is that we want to prevent hypos, DKA and all other nasty things that can happen. So, if we come on a little too strongly and recommend starting at 1 unit, there is a reason for that. And if the person can't or won't home test, then 1 unit is the safest amount to give when shooting blindly.

I've seen some big gulpers getting as much as 17 units and while for us 1 unit peeps, seeing those kinds of numbers can be scary. But the people get there because they've been testing and had other tests done to determine the IAA, cushings, etc.

Just my two cents and now that I talked about Kathy & Kitty, I will ask her to chime in.
 
julie1220 said:
lisa, with your spooky - the cure for insulin resistance is more insulin - i would wonder if spooky got up to 10u if he was insulin resistant and you hit the magic point that knocked it out. i have no idea, but that's what i would think of.

:YMHUG:
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I'm sorry, but I must strongly disagree with this statement. Unless the resistance is caused by an underlying condition, i.e., acromegaly, then the resistance is frequently an attempt by the cat's body to counter the massive doses that it is receiving.

The following is my very poor attempt at explaining what I actually understand far better than it will sound (how's that for an opening statement?)

Anyway, kitty is getting too much insulin so kitty's body dumps extra glucose into the bloodstream to counter the dose. So, glucose readings either fluctuate from very low to very high, or in our particular case, remain a constant high. Appearances based on testing indicate that insulin isn't working, so increase the dose.

This cycle continues until kitty has no extra sugar reserves left -- massive hypo.

As I stated earlier, the test for too much insulin, and hence the resistance, is to actually cut the dose and monitor the results for a couple of days.

In my particular case, after the hypo Spooky initially went on honeymoon. When the remission ended, back to insulin (humulin U at the time) increasing to 8 units. At that time I started doing internet research, learned about the effects of overdose and resistance and also about more species appropriate insulin (i.e., BCP Pharmacy PZI). I switched insulins, and started at 8 units of PZI as that was his Humulin U dose. Nothing. I finally listened to some wiser than me people on this board, reduced the dose, and saw improvements.

Spooky finally settled at his ideal dose of 2.5 units per shot of BCP until he was taken by cancer several years later.

Lisa and Spooky(GA)
 
We used to post the high dose info on Health once a week -- maybe we need to start doing that again.

My first diabetic cat Norton was an acrocat too. And I made a post just like this a few years ago.
 
How about we all just become more aware of 'piling on'
It is overkill at best when we all jump in shouting the same thing.
If you see it has been stated...move on to the next indicated question.
Food, Testing, Why the high dose?,
How 'bout,
can you give us more information about how you arrived at this dose?

We can be a little overwhelming folks.
 
To follow up on Hillary & Maui's mention of us, she has it right.

The large, large majority of cats that show up here on a very large dose is not because of insulin resistance or acromegaly. It's because the cat was started on too high a dose by the vet, and/or raised to quickly, and/or on a dry diet.
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This was us. Kitty was badly misdosed - that is, I misdosed him on the direction of a vet, who kept raising the dose, because Kitty's BG wouldn't stay low. In retrospect, I KNOW that Kitty was being overdosed, and I nearly lost him. I came here when Kitty's dose had been raised to 10 units twice daily. How he survived, I don't know.

It was hard for me to admit that a vet was wrong, so I was very frightened when I came here. The chorus of "that's a really high dose" that I got did help convince me. I could see people here were knowledgeable, and I was getting a lot of the same advice.

(FYI: We consulted with an out-of-state vet, reduced to 5 units twice daily, then 5 units once daily, then started over at 1 or 2 units daily. We worked up to his breakthrough dose of 5.25, and then down to OTJ. :-D Kitty was on insulin 15 months.)

Hillary was the one who reached out to me and took my hand over the internet. I knew she was on my side, and that people were being caring, not yelling at me. So it may be a lot about how the message is delivered, as much as the content of the message.

EBIN - every bean is different! But as long as the caring comes through, calling attention to potential problems is, I think, good. At least, it was for us.
 
lori and tom said:
How about we all just become more aware of 'piling on'
It is overkill at best when we all jump in shouting the same thing.
If you see it has been stated...move on to the next indicated question.
Food, Testing, Why the high dose?,
How 'bout,
can you give us more information about how you arrived at this dose?

We can be a little overwhelming folks.
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perfect.

Kathy and Kitty said:
EBIN - every bean is different! But as long as the caring comes through, calling attention to potential problems is, I think, good. At least, it was for us.
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equally perfect.

clearly there are times that cats are overdosed. equally clearly there are also times that a cat has a high dose need. seeking more information, showing caring, not jumping on a bandwagon - those are all super solutions that will help get to the bottom of the question without overwhelming the newbie.

thanks to all of you!!! i know this is a passionate issue, obviously near and dear to many from personal experience. i appreciate you letting me raise it and for everyone sharing their experiences about it.

you're the best! i'm grateful to be part of this community. it's all about the cat! :YMHUG:
 
julie1220 said:
being here and seeing how many of our kitties on Lantus have been diagnosed with it, i really have to wonder if it's more common than previously thought
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I have thought about this a lot recently. I think that for the cats that tend to stay around on the board on ever increasing doses of insulin it is reasonable and perhaps probable to suspect an underlying medical condition. However, I think that our view may be slightly skewed b/c the transient or diet controlled cats come and go from here very quickly. Some members stay around and help other newbies, and I really applaud them for doing that. (I think that it makes a big difference when a relative new member can tell a brand new member that 3 weeks ago she/he was in exactly the same spot - and equally valuable when they say that their cat is still diet controlled a year later.) However, many cats become diet controlled and the beans move on with their lives.

I remember that medical school students were told 'if you are in North America and hear hoof beats, think "horse" not 'zebra'. I guess my point is that if a person comes to the board with a new diagnosis and on 5 units, my first thought would still be 'high dose' and not acro. However, being that I am not very diplomatic, I shall leave those posts to others unless it is a dire emergency and I'm the only one on late at night on the west coast.
 
Just-As-Appy said:
I remember that medical school students were told 'if you are in North America and hear hoof beats, think "horse" not 'zebra'. I guess my point is that if a person comes to the board with a new diagnosis and on 5 units, my first thought would still be 'high dose' and not acro.
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I agree 100%. Since most likely the too high dose isn't warranted, which can be very dangerous, I don't see the point of treating it like it could be acro right off the bat. There's a far, far greater risk that a kitty will hypo on a high dose they don't need than an acro kitty will develop ketones by lowering the dose until the owner is testing. I don't agree that if a cat arrives on a high dose and seems fine it's because the dose is probably correct--the cat can be rebounding like crazy on that high dose and not be showing severe hypo symptoms that the owner recognizes. A cat in rebound like that is also at risk for ketones.

I understand that for someone who does arrive with an undiagnosed acro kitty that advice can be frustrating since you're in that minority that has to go against the conventional wisdom. But until the newbie is home testing and has enough data to figure out what's going on with the dose (which can take weeks), then I think the conventional wisdom is what's needed because that is what is most likely to help the cat and keep it safe.

I do like to emphasize that a high dose is a high dose, because many newbies don't realize that 3u or 5u is a high dose and could be dangerous. If a newbie shows up with a cat on a low carb diet and home testing with data to look at, then of course I'm going to suggest the possibility of Cushings or Acro. But even a cat that has acro and arrived at the high dose without testing or on a dry diet will need the dose lowered some, diet changed, and the dose re-raised correctly in order to determine that acro is a possibility.

*sigh* In my perfect world, the conventional wisdom would be reversed because the majority of vets would send newly dx'd kitties home on a canned diet, home-testing, and with a copy of the dosing protocol, so that most high dose kitties that showed up here did need the high doses they were given. Maybe someday, I hope!
 
Based on my personal experience with Spooky(GA) and what I have seen/read here for over 10 years (gosh, how did that happen?!) insulin resistance is frequently caused by excessive amounts of insulin.

One of the best tests for resistance is to cut the dose in half and monitor for a couple of days. In most resistance cases, the reduced dose will actually reduce the sugar levels in the blood.
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I would not say the best test for resistance is to cut the dose. I think you could be asking for trouble taking that route.
I do agree with asking the important questions like home testing and of course diet. There have been several cats who end up diet controlled, and after high doses, so home testing first, then adjusting diet, must be handled first. You will then have a better picture of what's going on. I think it would be a relief to the new person if told that hey let's just get you testing and then off the high carb foods because there have been tons of cats who are diet controlled and never even need insulin! It's excellent to try before starting insulin, but more tricky if insulin already started. It can be done though.
Once the testing and food issues are put in place, you can then look to adjusting the dose.

I was driven to try the 'drop back to 1u BID from 4u BID, he's getting too much insulin' when I adopted Ollie, and that approach was painful to see. Even with a proper diet and extreme home testing showing all 400s, still I was told that I was overdosing him. I can tell you first hand that such an approach hurts the cat and the owner.

I was not new to feline diabetes as Shadoe had just been formally dx as having acromegaly. She had absolutely zero physical features - she was small, petite, fine featured face, small paws and no belly - and had not been on insulin long - she began on Caninsulin Oct/09 but quickly switched to Lantus Nov/09 on finding this board. I was helped by great people on this site - jojo, Carolyn/Spot, and Lorna/GC as well as others. I followed the protocol to the letter and her dose kept rising. We pretty much knew testing would be positive for Acro and it was, in March/10. She was not on too high a dose and built a resistance.

When I adopted Oliver, he had been on insulin barely a month, since Feb08/10. He arrived mid-March17/10 and tested positive for both acromegaly and IAA April11/10. Surely not enough time there to build up a resistance to reach over 300 for acro and 60% for IAA in 2 months.

I would say that the resistance comes before and causes the diabetes because there is nothing wrong with the acro cat's pancreas. The tumor hormone secretion is the issue with insulin resistant cats.

It is important to keep in mind that there are some cats who really do need a higher dose and a perfect example is Randi/Max. Max and Shadoe were neck to neck, both with doses rising. Max got up to 6u or 6.75u I think and then he broke through, I guess pancreas was healed and able to take over. And now he is OTJ. You could suspect maybe he had some IAA and fought it back but no, his numbers did not support that theory. Max just needed a bit more insulin and when he was able, he came off insulin.

I think a few prelim questions about type of insulin and diet, plus how the dose was reached are a perfect start, along with home testing. A weekly post or sticky would be a great idea.
 
Gayle and Shadoe said:
Once the testing and food issues are put in place, you can then look to adjusting the dose.
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I think it's dangerous to change the diet without lowering the dose in most high-dose cases. Many cats will show huge drops in BG overnight once the dry is removed. I think a reduction should be made when changing the diet, even if it's only temporarily, and especially if little or no data has been collected yet.

Gayle and Shadoe said:
I was driven to try the 'drop back to 1u BID from 4u BID, he's getting too much insulin' when I adopted Ollie, and that approach was painful to see. Even with a proper diet and extreme home testing showing all 400s, still I was told that I was overdosing him. I can tell you first hand that such an approach hurts the cat and the owner.
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If a cat is on a proper diet and the data supports the high dose, then I do agree people shouldn't be badgering someone about lowering the dose. All of the information provided needs to be taken into account. I don't think that's the majority of cases that show up on Health, though.
 
the basic premise of what i was asking for in my initial post is to control the urge to shout "that's too high a dose" when newbies come. it's the reaction that i'm asking to have tempered, and an increased awareness of high dose conditions, more than anything else.

i think all of the things that have been suggested are great - we all know that the diet & insulin dosage have to be managed and changed carefully.

i think we're all on the same page & wanting the same goals - we want to help the new person get settled quickly and be able to get their cat controlled as quickly and safely as possible. keeping everyone calm in their responses is probably the best thing we can all offer to a newbie!
 
I think it's dangerous to change the diet without lowering the dose in most high-dose cases. Many cats will show huge drops in BG overnight once the dry is removed. I think a reduction should be made when changing the diet, even if it's only temporarily, and especially if little or no data has been collected yet.
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At a higher dose, something is keeping the cat OK and it's likely the HC food, so the first thing needed would be to get the testing going. Since the cat's likely been at the high dose for awhile and if there have been no problems, a day or two wait to get some tests done will let you know what's going on. It would be great to have some guidelines on how to do what, the sequence of change.
For example, if the cat is resistant to change in food, what will an immediate drop of dose do but put the cat into higher BG levels. I would never say switch dry for LC wet right away and leave dose as is, but some sort of combination would be preferable. If the cat is eating wet and dry, then it could be simpler by reducing dry and increasing LC wet, at the same time be testing and gradually reduce the dose. Dry food takes a few days to get out of the system, so you have some leeway when making the dose changes.
You could well find the cat is in the 400s and eating dry food, so you can remove dry gradually while introducing wet and monitor the numbers. You are not going to see an immediate drop so you really need to play it by ear. The testing is the most crucial though.

Not too many new people know alot about DM, so it's best to hold back dose comments until you can gather info on the cat's situation.
 
Gayle and Shadoe said:
At a higher dose, something is keeping the cat OK and it's likely the HC food, so the first thing needed would be to get the testing going. Since the cat's likely been at the high dose for awhile and if there have been no problems, a day or two wait to get some tests done will let you know what's going on. It would be great to have some guidelines on how to do what, the sequence of change.
For example, if the cat is resistant to change in food, what will an immediate drop of dose do but put the cat into higher BG levels. I would never say switch dry for LC wet right away and leave dose as is, but some sort of combination would be preferable. If the cat is eating wet and dry, then it could be simpler by reducing dry and increasing LC wet, at the same time be testing and gradually reduce the dose. Dry food takes a few days to get out of the system, so you have some leeway when making the dose changes.
You could well find the cat is in the 400s and eating dry food, so you can remove dry gradually while introducing wet and monitor the numbers. You are not going to see an immediate drop so you really need to play it by ear. The testing is the most crucial though.

Not too many new people know alot about DM, so it's best to hold back dose comments until you can gather info on the cat's situation.
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It'd be great if things always went in that order, but it often doesn't. Some newbies want to run out and get a meter and test right away, some want to immediately change the diet, some want to do both at once, and some want to do neither, so advice needs to be tailored to the situation at hand. It'd be great if they all changed the diet gradually while collecting enough data to adjust the dose, but it's uncommon that they do everything in the right order. One very common thing that happens is that people come to the boards, find the diet info and start the switch before they even post the first time--I think because it's a less scary/easier sounding step to them than home-testing.

I agree that you should always try and get as much information as you can, but it can take many new people a while to not only start home-testing, but to also test frequently enough to get the numbers they need to make informed dose adjustments. I think it's dangerous to let a cat hang out on a high dose it likely doesn't need in some situations, especially if the owner is in the middle of changing the diet. Even changing to a lower carb dry food could cause a hypo incident.

I think we are arguing two sides of the same coin, but I just don't want someone to feel like they shouldn't say "please lower the dose!" if the newbie considering a diet change before hometesting.
 
First off, thanks to everyone who has posted in this thread so far. I've absorbed a lot of good advice for "how to welcoming newbies", which I've been doing lots of (and not as well as I could have been after reading this).
I don't personally tend to express an opinion regarding initial dosing for a couple reasons, and when I do, I think I more or less parrot what I've seen others doing ("well, from what I've read here, that sounds like a high dose"). #1, I don't know what a "usual" starting dose is for the different types of insulins. Generally, it seems that 1u BID is the usual starting dose? And that's what Bob's was. What has always amazed me is when I read someone debating to go with like "do I go with .4 or should I raise it to .6?" because I never experienced that small a "tweek" until I started doing micro-adjustments near the time where Bob was ready to come off the juice. Also, Bob went as high as 4u BID until he really started to improve, so if I see someone saying they are shooting 3 or 4 units, it doesn't shock me. I had been testing and treating at home for a month before I posted here the first time, and Bob was in the 6-7-8 units a day range by that time. The really "high" ones like 6 or 7 sort of make me pause, but what I keep reminding myself is ECID. They have different sensitivity to insulin, to carbs, etc.
The other thing I have learned is that there needs to be a step-by-step order to this madness that we call the sugardance, especially with new members. Home testing first. Then we can talk about changes to diet. But not without considering changes in dosage at the same time (just in case there's a really positive response from kitty to the low-carb diet change). And maybe there are other medical reasons and things going on with kitty that are compounding the problems that are at first thought to be "just" diabetes. I'm a "numbers" person. Love 'em, love working with them. I'm a big fan of "constants", so that at least you know that some part of the equation is not changing while others might be. There's a few really important things that newbies (who aren't home testing when they come here) need to do, but you can't do them all at the same time, and then expect people to figure out what exactly is working well or not working well.
And I also have to keep in mind that EBID like someone already said. Some people are willing to change whatever needs to change in order to make kitty better as quickly as possible. Others are reluctant, or unable, to do that. Could be scheduling issues, could be financial restraints, could be just plain fear of turning the lives of their sugarcats over to a group of people that they really don't know anything about (and accepting the fact that maybe their vet IS wrong, or lacks the knowledge needed to really help). There's also a big fear that they (the newbie) will screw up and end up hurting their dear kitties. I had that fear. I'm sure lots of people do. I always try to keep in mind that I don't want what I say to someone to be the reason they run screaming from FDMB and never come back.
When giving advice, I try to be calming and honest. Tell the newbie that they are doing good, that it gets easier every day, and then if I don't know the answer, try to contact someone who does and let them advise. Try to remember to include "this is what worked for me, or for my kitty" with any advice, and stress that ECID. Tell them that we were all once in their shoes.

I am one of the most fortunate beans here. I had an almost dead kitty that went from 2 paws on the bridge to OTJ in about 10 weeks. Of course, in my perfect world, everyone who joins FDMB would get the same results. I also know that isn't going to happen. There are people here who have been dancing this dance for years, and every day still wake up to dance some more. You people just flat out amaze me! You will never "quit" trying and you will give your sugarcats the best life they could ever possibly have until the day that either your kitty, or you, can no longer dance.
OK, I've hogged enough bandwidth.

Julie, thank you for starting this discussion, and thanks again to everyone who's posted in it and shared your wisdom.
Carl and Bob in SC
 
I like this thread! I arrived at charlie's high dose slowly, but was advised on a couple occasions to drop back and start over. I did, hoping beyond hope that he wasn't acro. When I finally got to test him, he was both acro and has IAA. Double whammy. I have no bad feelings for the beans who encouraged me to drop back, but I've always felt it was better to be safe than sorry, and he isn't ketone-prone. I didn't get a lot of "yelling" until I switched insulins right before his acro dx and refused to start over at 1u. But I know that the beans are so well intentioned and they just wanted Charlie to be safe. I agree, though, if it looks like an acro and it smells like an acro, well- it just may be an acro. But you also have to be sensitive when suggesting that. Testing is expensive, especially outside of the US. I was deep in denial, too. Acro is scary. His DM dx was scary, but as soon as I got a handle On it, people were suspecting acro. That was horrifying because it is quite likely that it will eventually be what takes him. DM is treated, acro is just managed. That's a scary thought for a new bean.
 
i appreciate all the comments. i'm a numbers person too, carl - and i like organized information. i kinda wondered why there wasn't a post that said do A, B, C when you arrive here - you have to look all over the whole site for info. but i've realized that giving individual attention is one of the things that FDMB does best. having someone hold your hand through your first experience when your cat hits 32 is priceless - i had the printouts but a human with me (ok through the computer, but with me) and telling me exactly what to do is so much better.

everyone here is here because they are passionately committed to their own cat, and all of those who give advice are passionately committed to helping the next scared person. we should pat each other on the back for it! :lol:

but seriously, it's a great place to be and it serves an essential need. i adore my vet but freely admit that he had everything wrong about diabetes in my cat. i've thought that punkin's acro is actually what allowed punkin to survive the vet's mistakes. when he switched punkin from prozinc (a u-40 insulin) to lantus (a u-100 insulin) he didn't tell us to change syringes - so punkin's supposed 3units of lantus dose in the wrong syringes was actually 7.5 units . . .

asking all of those questions of newbies is a SUPER thing!
 
i don't think so jen, but it's been a while and by now i've looked at everything everywhere, so i'm not sure. i joined the end of february. the doc that i found probably most helpful is the post that's on the lantus ISG forum that says "newcomers start here." it goes over most everything.
 
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