New Vengeance thread

[Ummlee and Vengeance]

@Suzanne & Darcy hey hope all is well thoughts on venges numbers last few days??? and if I can get into the vet this week what tests should I ask for..

also was going to ask about a reset ... I have been reading about doing a reset of dose where you start back and a lower starting dose and work back forward and sometimes that you have went too fast or too slow which causes the Somogyi overswing which then can cause you to over shoot what would be the correct dose or that different???

Thanks

 

[Suzanne & Darcy]

@Marje and Gracie can you help here about resets? I haven’t had time to respond. Sick cats, sick husband. Bad day.

As for resets, I had very bad experiences with them when a facebook group recommended them to me. I lost a lot of valuable time and hurt my cat with “resets.” He had acromegaly and he needed more insulin and not less. It wasn’t until I came here that I started getting real help for Darcy’s dosing.

You have definitely not increased too quickly or skipped any doses.

I will come back tomorrow with more of my take on everything.

As for Symogi, here’s a link to an informational sticky note. Marje actually authored this.

Info - Chronic Somogyi Rebound: Myths and Facts

 

[Suzanne & Darcy]

As for the dose, Now that you are at 5 units, dose increases are done in half unit increments. So Vengi’s new dose if you increase would be 5.5 units. Think of it as an increase of 10% of the dose. When cats reach 10 units, the dose increases are done 1 unit at a time (again ten percent of the dose.) Smaller increases and decreases can be made when you are getting really close to an ideal dose and you are just fine-tuning the dose.

 

[Suzanne & Darcy]

I would ask about the Acromegaly and IAA testing for Vengi. It’s the Insulin Like Growth Factor-1 and the Insulin Autoantibody tests done at MSU.

 

[Marje and Gracie]

@Suzanne & Darcy hey hope all is well thoughts on venges numbers last few days??? and if I can get into the vet this week what tests should I ask for..

also was going to ask about a reset ... I have been reading about doing a reset of dose where you start back and a lower starting dose and work back forward and sometimes that you have went too fast or too slow which causes the Somogyi overswing which then can cause you to over shoot what would be the correct dose or that different???

Thanks

What you are referencing are rebound checks. First, it has been shown that Somogyi doesn’t occur in cats. In fact, it hasn’t actually been scientifically documented in humans.

When you slowly and systematically increase the dose as you have been doing, you haven’t been going too fast or slow. In all the years I’ve been here, I’ve seen only two Lantus cats where we did rebound checks and that’s because the vet was raising the dose by 2u every few days in one cat and the other one had similar large increases.

I think Vengeance’s dose has gone up and down in small enough increments that he’s never been overdosed and there is no reason to do a rebound check. In 99% of cases, a rebound check sets a cat back substantially.

We usually do the IAA and acro tests at 6u.

IMHO, I think you should continue as we’ve been doing and, if the dose gets to 6u bid, have him tested.

@Marje and Gracie can you help here about resets? I haven’t had time to respond. Sick cats, sick husband. Bad day.

As for resets, I had very bad experiences with them when a facebook group recommended them to me. I lost a lot of valuable time and hurt my cat with “resets.” He had acromegaly and he needed more insulin and not less. It wasn’t until I came here that I started getting real help for Darcy’s dosing.

You have definitely not increased too quickly or skipped any doses.

I will come back tomorrow with more of my take on everything.

As for Symogi, here’s a link to an informational sticky note. Marje actually authored this.

Info - Chronic Somogyi Rebound: Myths and Facts

I hope your husband and kitties will be better soon, Suzanne. I’m sorry they are ill.

 

[Ummlee and Vengeance]

@Marje and Gracie can you help here about resets? I haven’t had time to respond. Sick cats, sick husband. Bad day.

As for resets, I had very bad experiences with them when a facebook group recommended them to me. I lost a lot of valuable time and hurt my cat with “resets.” He had acromegaly and he needed more insulin and not less. It wasn’t until I came here that I started getting real help for Darcy’s dosing.

You have definitely not increased too quickly or skipped any doses.

I will come back tomorrow with more of my take on everything.

As for Symogi, here’s a link to an informational sticky note. Marje actually authored this.

Info - Chronic Somogyi Rebound: Myths and Facts

@Suzanne & Darcy sorry you have sicky cats and hubby... hopefully you stay ok and hopefully they all get better soon... @Marje and Gracie gotcha on the resets I was reading a vets posting on her blog about it all when I had looked up agromeglia online and she had mentioned doing it etc and the smogyi so figured I would ask.. the whole anxiety that he might have agro or cushings really has me freaking out because I have read about the life limits etc.. I know hes 13 but I had hoped hed be around another 7 or so years at least.. ( I have had 3 friends whoses cats reached 25+ ) I upped him to 5.25 tonight and he has had good numbers so far... should I up it to the 5.5 or leave as is for a few cycles? thanks to both of you I appreciate it ...

 

[Marje and Gracie]

@Suzanne & Darcy sorry you have sicky cats and hubby... hopefully you stay ok and hopefully they all get better soon... @Marje and Gracie gotcha on the resets I was reading a vets posting on her blog about it all when I had looked up agromeglia online and she had mentioned doing it etc and the smogyi so figured I would ask.. the whole anxiety that he might have agro or cushings really has me freaking out because I have read about the life limits etc.. I know hes 13 but I had hoped hed be around another 7 or so years at least.. ( I have had 3 friends whoses cats reached 25+ ) I upped him to 5.25 tonight and he has had good numbers so far... should I up it to the 5.5 or leave as is for a few cycles? thanks to both of you I appreciate it ...

Under MPM, you would hold the dose six cycles, unless he drops below 50 for a reduction, and then reassess.

Don’t borrow trouble . In other words, don’t worry about something that hasn’t happened. It could be he just has IAA which is self-limiting after a year if you do nothing. Or his insulin needs could just be more right now. I have seen cats at higher doses who were not acro, IAA, etc and the dose eventually came down.

 

[Ummlee and Vengeance]

@Marje and Gracie @Suzanne & Darcy so hes had a great night and day so far I dropped him to 4.75 at amps being he was at 58 ... as of right now hes at 167 ... 4 hrs till dose what dose should I give him in what range being he did great so far today on the 4.75 but the 5.25 made his amps very low... thanks

 

[Marje and Gracie]

@Marje and Gracie @Suzanne & Darcy so hes had a great night and day so far I dropped him to 4.75 at amps being he was at 58 ... as of right now hes at 167 ... 4 hrs till dose what dose should I give him in what range being he did great so far today on the 4.75 but the 5.25 made his amps very low... thanks

Honestly, I would have shot 5.25u this morning. He wasn’t doing much even on 5u so I’m not sure why you would want to go back to 4.75u?

 

[Suzanne & Darcy]

have seen cats at higher doses who were not acro, IAA, etc and the dose eventually came down.

This is true. I have seen this as well.

 

[Ummlee and Vengeance]

Honestly, I would have shot 5.25u this morning. He wasn’t doing much even on 5u so I’m not sure why you would want to go back to 4.75u?

he was at 58 so I was worried a full dose would push him into hypo I was going by the guide that says

How to handle a low pre-shot number:

• Sometimes your kitty will surprise you with a lower than normal PS number (but above 50). When that happens you have four choices:
  • Skip the dose: If the number is below 200, and your kitty is newly diagnosed (less than three months), your best option is to skip unless your kitty has ketones or is post-DKA (see below) and you should post here or in the Health Forum for help.
  • As you gain more experience and data, your goal is to gradually learn to shoot lower and lower numbers (never below 50). You can use other options below as you are learning to shoot below 200. Ultimately, with data, experience, and knowing your cat, you should be able to shoot PSs above 50 provided you are available and able to monitor.
    • If your cat has been diabetic for awhile and the PS is much lower than normal, you may still need to skip if you have to leave the house for many hours and can’t monitor, but in general we don’t recommend skipping if your cat has a good body of data, so see the other options.
  • Stall: Do not feed your kitty but wait 30 minutes and test again. (Note: we generally stall without feeding because food will falsely cause the BG to rise. It’s important to not shoot a food spike
  • If after stalling the number is rising into safer ranges, you can then give the full-dose shot. You can stall as long as you need to (in 30 minute increments), but keep in mind that the next shot needs to be 12 hours later, so be mindful of your new shot time. If it’s getting too late, try the next option.
  • Reduce the dose: How much to reduce can be a tough decision. Some of it will depend on how well you know your cat, how confident you are in testing, if you’ll be around to monitor, etc. This is a good time to ask for advice. If no one is around and it’s your first time, reduce the dose by 50%. If you have been at this awhile and know your cat’s reactions well, you can do a smaller reduction. If your cat is below 150, do not give a dose at all unless you can get regular BG tests throughout the cycle.
  • Give the regular dose: this is recommended if you are able to monitor closely and/or if your cat is a long-term diabetic (more than a year) and you have a lot of data to know it’s safe. Long-term diabetics with solid data can often safely shoot below 150 (and should if possible to do so safely).
• I stalled 30 minutes being he was at 63 then after the 30 minutes he had dropped to 58 so instead of skipping shot I chose to reduce the dose??? so took a .5 unit drop was this not the correct thing to do when hes that close to 50?

 

[Marje and Gracie]

he was at 58 so I was worried a full dose would push him into hypo I was going by the guide that says

How to handle a low pre-shot number:

• Sometimes your kitty will surprise you with a lower than normal PS number (but above 50). When that happens you have four choices:
  • Skip the dose: If the number is below 200, and your kitty is newly diagnosed (less than three months), your best option is to skip unless your kitty has ketones or is post-DKA (see below) and you should post here or in the Health Forum for help.
  • As you gain more experience and data, your goal is to gradually learn to shoot lower and lower numbers (never below 50). You can use other options below as you are learning to shoot below 200. Ultimately, with data, experience, and knowing your cat, you should be able to shoot PSs above 50 provided you are available and able to monitor.
    • If your cat has been diabetic for awhile and the PS is much lower than normal, you may still need to skip if you have to leave the house for many hours and can’t monitor, but in general we don’t recommend skipping if your cat has a good body of data, so see the other options.
  • Stall: Do not feed your kitty but wait 30 minutes and test again. (Note: we generally stall without feeding because food will falsely cause the BG to rise. It’s important to not shoot a food spike
  • If after stalling the number is rising into safer ranges, you can then give the full-dose shot. You can stall as long as you need to (in 30 minute increments), but keep in mind that the next shot needs to be 12 hours later, so be mindful of your new shot time. If it’s getting too late, try the next option.
  • Reduce the dose: How much to reduce can be a tough decision. Some of it will depend on how well you know your cat, how confident you are in testing, if you’ll be around to monitor, etc. This is a good time to ask for advice. If no one is around and it’s your first time, reduce the dose by 50%. If you have been at this awhile and know your cat’s reactions well, you can do a smaller reduction. If your cat is below 150, do not give a dose at all unless you can get regular BG tests throughout the cycle.
  • Give the regular dose: this is recommended if you are able to monitor closely and/or if your cat is a long-term diabetic (more than a year) and you have a lot of data to know it’s safe. Long-term diabetics with solid data can often safely shoot below 150 (and should if possible to do so safely).
• I stalled 30 minutes being he was at 63 then after the 30 minutes he had dropped to 58 so instead of skipping shot I chose to reduce the dose??? so took a .5 unit drop was this not the correct thing to do when hes that close to 50?

You are an experienced CG. Under the first dark bunker, look at the second light one. At this point, unless you can’t monitor, you should be able to shoot every BG above 50 and then manage it with food.

 

[Ummlee and Vengeance]

You are an experienced CG. Under the first dark bunker, look at the second light one. At this point, unless you can’t monitor, you should be able to shoot every BG above 50 and then manage it with food.

the issue was I didnt know if I was going to be able to monitor this morning but I cancelled my plans and did of course... so always shoot full dose over 50? if I can keep an eye on?

 

[Suzanne & Darcy]

Hey Lee. How have the numbers been today?

 

[Marje and Gracie]

the issue was I didnt know if I was going to be able to monitor this morning but I cancelled my plans and did of course... so always shoot full dose over 50? if I can keep an eye on?

If you are there to monitor and have supplies to manage the lower numbers, the best way to get him regulated again, barring any high dose conditions, is to shoot the full dose for anything above 50 per MPM.

If you have doubts, stall without feeding, and post and if one of us is available, we can walk you through it.

 

[Ummlee and Vengeance]

Hey Lee. How have the numbers been today?

yesterday wasnt bad no pinks kept in yellows and blues and it was the very last doses of the vial.... started new vial today and been great so far... how are your kitties and hubby

 

[Suzanne & Darcy]

Good about today's numbers. Let’s go for more green, Venge!

Kitties are holding their own. One will be starting chemotherapy infusions tomorrow. I have never done this before— I only have experience with oral chemotherapy for small cell lymphoma in the past. After talking to my vet yesterday and getting her real world experience instead of me just reading scary papers on it, I have decided to go ahead with it. It’s not a cure, since there is no cure for feline mammary cancer, but she had surgery and the chemo will hopefully buy her some more quality time before it reappears somewhere else.

My husband is all right, all things considered. It’s hard getting men to take care of themselves!