Overmedicated, undermedicated, Acro - over 1 year on Lantus/Levemir and still not close to regulated

[sbluhrs]

OK, guys, I need some serious handholding/help with my Sophie. I adopted her last year and it seemed that she was going well on Lantus, but bouncing constantly. I switched her to Levemir and continued issues.

I can't seem to get her below the 300s low 200s now for anything. Am I over-medicating? She just had a dental, a little gingivitis, but no real change in her numbers. She's a big girl, around 11 pounds, continues to be food seeking so much so that we dare not have anything left on the counter, and has been peeing outside the box for months now. We use peepads to deal with the pee problem, but that is getting really old, too, and expensive.

She has been on Tiki cat chicken Puka Puka luau and the related chicken and egg Tiki cat, has dehydrated chicken necks as treats, but no dry since we got her. Even a little food with carbs seems to make her worse.

Any suggestions.

Here is her spreadsheet. https://docs.google.com/spreadsheet...CbDiiPwyo-v3tzox_Ek5T5eBQ/edit#gid=2110605851

Sue

 

[Janine & Floyd (GA)]

Welcome to the club of long-term unregulated acrocats. I get your frustration! Floyd passed his 1 year anniversary of FD diagnosis last month.

Have you seen the Using Lantus/Levemir With an Acrocat sticky? My opinion (until someone better educated than I comes along to help you) is that Sophie needs more insulin. I think you should increase after 6 cycles unless you start seeing lower nadirs.

 

[Wendy&Neko]

Hello and welcome. My girl took her sweet time getting regulated too. Give the amount you seem to be able to test, and that you have a stubborn cat, I would suggest reading the Sticky Note on the Tight Regulation Protocol, and start following it. With kitties with a known secondary condition causing insulin resistance, you do have to be a bit more aggressive on the dosing, though still safe. The TR protocol gives you some good guidelines to follow and will allow you to make dosing decision. Of course, feel free to post here and ask if you have questions. OK, my first question, what was Sophie's IGF-1 number?

First some comments on what I see. Janine is right, Sophie needs more insulin. (love her black and white face by the way). As per the TR protocol, if the dose isn't giving you numbers you want, you keep increasing. If all you are seeing for the lows or nadirs is yellows, increase every 6 cycles. Below 5 units you would typically increase by 0.25 units at once, over 5 units you go to 0.5 unit dose changes. Acrocats need as much insulin as they need. There is no one size fits all. We have seen acros here from 2.25 units to over 60 units. So don't hold doses as long as you have been. There is also the phenomenon of glucose toxicity that can happen, where their little bodies get used to higher numbers, and it can takes some increases to break through.

I would also mix up the timing of your tests a bit. Although the "typical" Lev onset is +4 and nadir is +8, not all cats are typical. My girl liked to onset at +5 and nadired anywhere from +5 to +15, though typically +9 to +12 when on Lev. We make dosing decision based on how low the dose takes the cat, so finding those low points is key.

 

[sbluhrs]

OK, I haven't had her tested yet for Acro, but her numbers and the fact that she is BIG for a girl and is still no where near regulated lead me to believe this. I'll contact my vet this week about getting her tested.

 

[Wendy&Neko]

My girl was 14 lbs, but she had some Maine Coon heritage.

If you have a positive diagnosis, we may be able to help you decide if you want to pursue treatment. Getting her in better numbers should help the litter box and food seeking issues. I got really good at locking away food too.

 

[Wendy&Neko]

One more thing, if you are getting a blood draw for acromegaly, I would tack on the IAA (or insulin auto antibodies) test. It's a low price add on and the test is done at the same place. Some number of cats have that condition as well (like my girl).

 

[sbluhrs]

Sophie doesn't look like she has one Iota of Maine Coon in her. She is just regular ole Domestic Shorthair, but she even looks a little thin to me at 11 lbs. She could carry 12 and not be fat. Definitely not a normal sized girl.

I'll definitely get the IAA test, too.

BTW, when I got her, she had been on Vetsulin for several months, and was getting 4 units at the time of adoption. Her BG at that point had been in the 400s, so not even close to regulated with that stuff.

 

[JeffJ]

Hi and welcome. As others said above, Sophie needs more insulin. She is not regulated, and that will cause some side effects including possible neuropathy. I would increase her as suggested above until you start to get some 100-150 nadirs.

My Leo had Acro, and I treated him with SRT in Sept 2016. Now his insulin requirement is down from 18.0 units/dose to 3.0-4.0 units/dose. And he is regulated.

As listed above, Leo is on Levemir. His typical nadirs are at +8 to +12. This makes it very challenging to dose him.