? One skipped shot results in total insulin drain?

[Susan G & Jimmy G]

I was not able to give Jimmy his shot Sunday night and now I feel as if I've set him back weeks. I'm also at a .75 mark where I find it difficult to be consistent. But I'm doing my best with that. Since the skipped shot - do I need to wait a full 3 days/6 cycles to increase from the pt after the missed shot - or can I consider that part of the total attempt at the 4.75 dose?

 

[Kris & Teasel]

The 4.75 u depot is large enough that one skipped shot won't drain it all. I doubt you can say with certainty what % was drained but the higher the dose, the larger the depot. Why not finish up today with the 4.75 u dose and increase to 5 u tomorrow AM? Let's see if the pros agree.

 

[Susan G & Jimmy G]

The 4.75 u depot is large enough that one skipped shot won't drain it all. I doubt you can say with certainty what % was drained but the higher the dose, the larger the depot. Why not finish up today with the 4.75 u dose and increase to 5 u tomorrow AM? Let's see if the pros agree.

I'd love to! At least the 5 is a whole unit I can easily see and give a consistent dose with (I am using half unit syringe with a magnifying glass but still.) He was doing so well up until that missed shot. Was just teetering at 200.

 

[Marje and Gracie]

I would agree that you likely did not drain his depot with one skipped shot. His numbers are pretty consistent before and after the skipped shot.

I also agree you should keep the 4.75u for tonight but the reason is because when you skip a shot,shoot a reduced dose, or stall, it starts the cycle count over again. This is well explained in this post on Counting Cycles. Since tonight will make six cycles on 4.75u since you skipped, then under TR protocol, you can increase the dose to 5u.

Have you considered using Calipers for dosing? It makes it soooo much easier.

 

[saltycat]

The depot does not fully drain with just one skip. It can take up to 6 cycles for the depot to adjust. This is why we generally recommend holding a dose for 6 cycles to let the depot stabilize. They can recover quickly from a skip. I would think in a day or two he will be right back where he was number wise.

Even if you are a little off of exactly .75, consistency is more important then an exact dose. For those inbetween's and finer doses some people use calipers (micrometer) to give a consistent dose every time.

Generally, you would want to wait 6 cycles after a skip to let the depot stabilize before making dosing decisions.
You are already on cycle 5 since the skip, and with Jimmy's numbers still pretty high, I think you could safely increase tonight or tomorrow.

 

[Susan G & Jimmy G]

Thanks - I think tonight I'll let this be the 6th cycle at this dose (continue to test to get an idea of his happenings) and increase to 5 u tomorrow morning. He has one more full until we get in to the "next steps" category with the vet. Ugh. Hoping between now and then he responds! I'm just starting to check out the ACRO forum and those kitteh SS as well. Praying he's not going down that route. Paws crossed. Thanks for the clarification about the cycles.

 

[Cherryl & Mouzer]

I dont mean to be nosy but after just reading about the depot, I went to see what to read next but found myself scrolling down, to see what others have going on with their kitties. I saw your topic or headline - whatever it is called - and thought this might have something to do with the depot and wanted to check it out, so to learn.

And I thought you were giving your kitty .75u -- But I am reading and it is 4.75u? And said to move to 5u?
Am I understanding correctly? And if so, may I ask why your kitty would get such a high dose?
And I call it high because I was told it is not often a kitty even gets up to 3u. So, that is why for my question.

 

[Susan G & Jimmy G]

Is your question "why a high dose?" If so, because he hasn't been responding to the prior amounts. I am following TR and am increasing at .25 increments. Jimmy is also a big cat (20.5 lbs) so using the formula he would have started around 2.25 or so units. I actually screwed up and started him off at 4 units - so when you look at the SS his beginning numbers looked great and then I dropped down to which I thought were 2 units. It was a rough start. It's been a slow and safe progression to get back to that 4 units. Prior to the skip he was beating his own records...lowest AMPS, lowest nadir, etc. however they are still quite high. I'm praying 5 u is his safe breakthrough number. Jimmy is an unusual case in my opinion...

Here's another example of EDIC...when I read that cats switch from dry to wet and over a short amount of time go in to remission or get great low numbers I am amazed. Because Jimmy hasn't had dry food in nearly 5 years. And within the last six months we switched him from Fancy Feast to Natures Instinct a few carbs higher, still under 10% but better quality IMO. His coat had improved, less dander, and I feel good with the increased protein. Paws crossed we're close to a break through.

 

[Cherryl & Mouzer]

Is your question "why a high dose?" If so, because he hasn't been responding to the prior amounts. I am following TR and am increasing at .25 increments. Jimmy is also a big cat (20.5 lbs) so using the formula he would have started around 2.25 or so units. I actually screwed up and started him off at 4 units - so when you look at the SS his beginning numbers looked great and then I dropped down to which I thought were 2 units. It was a rough start. It's been a slow and safe progression to get back to that 4 units. Prior to the skip he was beating his own records...lowest AMPS, lowest nadir, etc. however they are still quite high. I'm praying 5 u is his safe breakthrough number. Jimmy is an unusual case in my opinion...

Here's another example of EDIC...when I read that cats switch from dry to wet and over a short amount of time go in to remission or get great low numbers I am amazed. Because Jimmy hasn't had dry food in nearly 5 years. And within the last six months we switched him from Fancy Feast to Natures Instinct a few carbs higher, still under 10% but better quality IMO. His coat had improved, less dander, and I feel good with the increased protein. Paws crossed we're close to a break through.

Thank you for explaining and yes that was my question - why the high dose. Mouzer was a bit heavier than he is now but I am in hopes he will gain his weight back.
I did have a 16 pound kitty, that just passed away on April 29th - just dropped dead, great surprise and sadness. I thought he was so big and I was so happy to have him.
20lbs heehee Big Kitty! That is what I used to always say to my Sunny Bunny. And I wish you and your Big Kitty the very best!!

 

[saltycat]

Am I understanding correctly? And if so, may I ask why your kitty would get such a high dose?
And I call it high because I was told it is not often a kitty even gets up to 3u. So, that is why for my question.

The general wisdom is regardless of the underlying issue, a cat needs as much insulin as they need to stay in good numbers.

A lot of vets are under-educated about diabetes, they have a lot of different diseases to learn. Acromegaly used to be considered a rare condition, but more recent studies report the number being closer to 1 in 4 diabetic cats have Acromegaly. My vet thought no cat needed more then 5u per day, Jack hit the mid 30u's before coming down some. I know of 2 cats that were/are over 50u per shot.


A lot of cats respond well to insulin, and if their pancreas starts healing, they can go into remission. Other cats need higher doses of insulin. Two common causes of cats needing higher doses of insulin are acromegaly and IAA(Insulin Autoimmune Antibodies). Acromegaly(a tumor on the pituitary gland) releases excess amounts of a hormone that fits the same receptors in the cells that insulin does. This means you have to give more insulin to out-compete the acromegaly growth hormone to get the insulin into the cells where it is needed. The IAA means the cats immune system perceives the insulin as a foreign body and tries to destroy it, just like when you have a cold. This leads to some of the injected insulin getting captured by the antibodies and never making it to the cells.

I'm just starting to check out the ACRO forum

The Acro forum is pretty quiet these days, most of the acro/high dose cats just post here in the Lantus\Lev forums. I hope you don't have to travel down that road as well. If you do, there are a number of us "high-dosers" here who can share our experience. The IGF-1 and IAA tests from MSU would be the best way to check for Acro or IAA. It cost me about $225 for the vet to do the blood draw and ship the samples to MSU.

 

[Marje and Gracie]

We do normally wait until the dose gets to 6u bid before recommending testing for high dose kitties. We've had some kitties that just needed 5 or 5.5u before they hit a good dose and then came down the dosing ladder.

 

[Susan G & Jimmy G]

We do normally wait until the dose gets to 6u bid before recommending testing for high dose kitties. We've had some kitties that just needed 5 or 5.5u before they hit a good dose and then came down the dosing ladder.

That is what we're hoping for! Esp since at the beginning my mistake of 4 BID actually gave us some good results. I keep telling myself...marathon.... marathon...marathon. Today is def not a good day for him. High number right now. One hour until I give him insulin. I know he's not feeling well either- he gets aggressive toward his sister when he hits this threshold. Starting a new pen tonight too.