Scooters multiple endocrine issues

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Critter Mom said:
Hi Jeff,

There are a few posts from Linda and myself at the end of Scooter's previous thread which I strongly recommend you read before seeing the vet today to discuss Scooter's insulin.

Here's a link to the first of them:

http://www.felinediabetes.com/FDMB/threads/introducing-scooter.169382/#post-1843545


Mogs
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Good news is that Scooters thyroid levels are back under control at 2.7 and he has also gained .10 lb from 7.3 to 7.4. Woohoo!

Brought all documentation to the vet to plead my case with no luck. The reasoning is that no clinical studies have shown that human insulin or any l insulin benefits animals and it's tougher to control.

She said don't look at the levels but more the clinical signs of treatment. She also said some felines responded better to prozinc than vetsulin. Might try that because she said it has shown longer afternoon durations.

At +4 today he was at 140 and at +6 at 170 and he had a fancy feast classic flaked fish and shrimp snack at +4 for being good at the vet. All protein and no carb.

Guess I'll be researching and changing vets after the Christmas Holidays.

Thanks Mogs and Linda y'all have been an awesome asset for Scooter.

Jeff
 
Anyone have experience with Dr Hodgkins approach to feline diabetes remission? Using a vetsulin or prozinc type insulin that peaks at 6-8 hours and dosing 3 times a day.
The study has an 80% remission rate and the key is keeping blood sugar in the 80-150 range as long as possible during the day. This allows the pancreas to heal and relieve the stress placed on it with high blood sugar. Over time less and less insulin is required and eventually none.

Thinking of trying this.
 
Hi Jeff. Your vet is obviously not up on the latest research regarding feline diabetes. Lantus and Levemir have an excellent track record and a good number of kitties have gone into remission on them.

Some folks may be able to manage a TID (three times per day) schedule of insulin but most can't. So while I have no experience with the Dr. Hodgkins protocol, and it may work for some cats, I think the idea of TID dosing makes it more difficult and constraining from a caregiver perspective. ProZInc works great for some cats but in some it will produce dramatic drops....not quite as dramatic as Vetsulin....but nevertheless it can be a bit of a rollercoaster. With HyperT in the picture I still think a gentler, longer acting insulin is the way to go. Many folks use ProZinc on a 12 hour cycle and get good results so if that's what your vet is willing to prescribe, so be it. If you are up for doing an 8 hour shot schedule, then it's worth a shot to see if that helps Scooter. The principle is sound but the actual doing is another story altogether.

I agree that clinical signs are very important but I have a kitty who can be very active while her BG levels are giving me panic attacks and quiet when her BG is where it should be. Clinical signs are part of the equation but not only can they be misleading but they only give you part of the picture.

Not sure if anyone gave you these documents but they clearly indicate that Lantus/Levemir are excellent and even optimal choices of insulin for cats. Perhaps giving your vet some reading material will persuade her.
 

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MrWorfMen's Mom said:
Hi Jeff. Your vet is obviously not up on the latest research regarding feline diabetes. Lantus and Levemir have an excellent track record and a good number of kitties have gone into remission on them.

Some folks may be able to manage a TID (three times per day) schedule of insulin but most can't. So while I have no experience with the Dr. Hodgkins protocol, and it may work for some cats, I think the idea of TID dosing makes it more difficult and constraining from a caregiver perspective. ProZInc works great for some cats but in some it will produce dramatic drops....not quite as dramatic as Vetsulin....but nevertheless it can be a bit of a rollercoaster. With HyperT in the picture I still think a gentler, longer acting insulin is the way to go. Many folks use ProZinc on a 12 hour cycle and get good results so if that's what your vet is willing to prescribe, so be it. If you are up for doing an 8 hour shot schedule, then it's worth a shot to see if that helps Scooter. The principle is sound but the actual doing is another story altogether.

I agree that clinical signs are very important but I have a kitty who can be very active while her BG levels are giving me panic attacks and quiet when her BG is where it should be. Clinical signs are part of the equation but not only can they be misleading but they only give you part of the picture.

Not sure if anyone gave you these documents but they clearly indicate that Lantus/Levemir are excellent and even optimal choices of insulin for cats. Perhaps giving your vet some reading material will persuade her.
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My original vet has limited experience with diabetes and the second vet is no better. She is a part of Rehm clinics that have multiple offices throughout two counties. (A big operation)

I printed and took the studies of the longer lasting insulin but she didn't read them and said no studies show a benefit over insulin specifically for cats like prozinc or vetsulin for dogs and cats.

I have maybe two more options for vets but they are also part of a big network of vets in the area.

I agree cause Frisky had diabetes in the 2000's and was on a humilin insulin and eventually went into remission.

I am somewhat lucky that I have flexibility with my profession and live close enough to go home for lunch everyday so a three time dose is not a big deal.

6am and he peaks at +5 so a 12pm and then a 6pm and if he needs it a 11-12pm.

There is a sliding scale of dose amount at each level that has been used for ten years and even though cats are different the scale is lower units at the middle dose. Just a boost to reduce the spike back to 600 everyday.

Scooter has a perfect bell curve now but 600+ are the highs and 130 are lows but only like an hour to 1.5 hours below 200 in general. Under 300 for maybe 5 hours than a climb back to 600. Not a spike like before on 4.5 units so 3.5 is good for him but he needs a booster at +6.

Thanks for watching my thread Linda. A bunch of kitties need human assistance and advice on the health section.

Jeff and Scooter
 
Jeff Phillips said:
I printed and took the studies of the longer lasting insulin but she didn't read them and said no studies show a benefit over insulin specifically for cats like prozinc or vetsulin for dogs and cats.
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Priceless. :banghead:

Methinks you really need a new vet, Jeff; it makes such a difference if you can find a vet who's collaborative, not dismissive.

Sorry I've not had a chance to visit your thread over the last number of days, Jeff. Not forgetting the two of you; the board has just been very busy recently.

Link to Scooter's spreadsheet:

https://docs.google.com/spreadsheets/d/1sWDKEa-WUHSFnvLA3y9fdl0_FtegaVtOUJzwf6ZPZHk/pubhtml

When you get a moment it would be great if you could add Scoot's latest BG data to the sheet so we can have a gander, too. :)

Re the Hodgkins protocol, I did look at that when Saoirse was first diagnosed but I thought the approach was far too aggressive and unnecessarily risky. (I disagree vehemently with Hodgkins' recommendation not to intervene with sugars if a cat dips into the hypoglycaemic range; I consider that dangerous and would never follow such advice when treating a cat of mine.)

I still think you should give consideration to using an L insulin and following the Tight Regulation Protocol, Jeff. The remission rates for newly diagnosed cats receiving Lantus or Levemir and following the Tight Regulation Protocol are equally as high as the rates quoted for those following the Hodgkins' protocol - without what I consider to be putting cats at unnecessary risk and with only twice-a-day dosing.

Bearing in mind that Scooter has the hyperT issue, I would speculate that the smoother one could keep blood glucose levels over the course of the whole day the better it might be for the functioning of the endocrine system as a whole; a bit more resemblant of normal homeostasis in a completely healthy animal.

Prozinc and PZI typically produce wider swings in BG than Lantus or Levemir (especially in cats who are running in high number ranges). It might interest you to see a real-world example of a cat treated with different insulins so I'm introducing Romulus. He received treatment with both Vetsulin (aka Caninsulin in the UK) and Prozinc but he has just been switched to Lantus insulin. Rom's BG levels are already showing great improvement after only a few days on this new insulin - and he is feeling and acting like a much happier cat! (A great example of BG data and clinical signs dovetailing for the benefit of the kitty!) It might be helpful to you to bookmark his spreadsheet so you can follow his progress. (His human is member Sue484 and she usually includes 'Romulus' or 'Rom' in her thread titles should you wish to do a forum search to read more about Romulus' diabetic journey.) Here's a link to his spreadsheet:

https://docs.google.com/spreadsheets/d/1JI_2ANvHbmb8rcGNKreaxTQ6mHE9mSw35QR8KUdAeUw/edit#gid=0

FYI, Sue uses an Alphatrak meter so the BG numbers are approximately equivalent to lab values, i.e. the same normal reference range as the one cited by the Hodgkins protocol. (Note: human meters require use of a lower normal BG reference range - 50-120mg/dL - when used for measurement of feline blood glucose levels.)

Romulus' data for Caninsulin and Prozinc insulins is like a rainbow but, despite some bouncing at the moment (AM cycle pinks) you can see how he's already levelling out, spending more time in blues and greens - particularly in the PM cycles. Rom has already earned two dose reductions since starting on Lantus. :)


Mogs
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Jeff Phillips said:
Scooter has a perfect bell curve now but 600+ are the highs and 130 are lows
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Jeff this is precisely why the longer acting insulins are now considered more effective for cats than those that are "in and out" like Vetsulin and ProZinc. Scooter goes from very high down to an almost normal BG in a cycle but he's not staying in an optimal range as long as he needs to. A longer acting insulin would extend the period of lower readings and stop what is likely a lot of bouncing and bring the pre-shot numbers down too. While the pre-shot reading tells you if it's safe to give insulin, it is the lowest BG reached on a particular dose that dictates what dose should be given. Sliding scales work for some cats where you have lots of data and kitty is somewhat regulated and predictable but in the early days and if kitty is the least bit unpredictable which many cats are, they can be very dangerous. Scooter has HyperT as well which increases chances that he's not always going to be predictable. Another member is dealing with HyperT with her cat who is on Vetsulin and a dose change of his thyroid meds recently had us all scratching our heads as to what was going on. A sliding scale in that case could have been catastrophic.

Jeff Phillips said:
I printed and took the studies of the longer lasting insulin but she didn't read them and said no studies show a benefit over insulin specifically for cats like prozinc or vetsulin for dogs and cats.
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That is one arrogant and dangerous attitude on the part of the vet IMHO. How can she dis studies she hasn't even read? It suggests to me they are only in the practice for the money rather than the good of their clients. I realize your vet choices may be limited and many may be prone to "toe the party line" policies but medicine isn't a one size fits all proposition and you'd be far better off with someone who is willing to work with you as opposed to expecting you to kowtow to a seriously outdated dictatorship. It might be worth calling the other clinics and asking about their feline diabetic care practices/policies like what insulins they usually use/have experience with, support of home testing, etc. as well as their knowledge of HyperT. You might just find one that is more open minded and willing to work with you and Scooter to find the optimal treatment regime for him.

Frisky may have gone into remission on Humulin. There is no doubt some cats do go into remission using the faster acting insulins but that doesn't guarantee Scooter will be as lucky even on a TID shot schedule.

Obviously, it's your choice what you do Jeff, but you have a special kitty whose treatment will not necessarily be as simple as most because of his HyperT and I really feel it's in your and Scooter's best interest to at least find a vet who isn't expecting Scooter to be as simple as the majority of their diabetic patients and is willing to consider ALL options to help Scooter the best way possible.
 
Jeff Phillips said:
She said don't look at the levels but more the clinical signs of treatment.
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I disagree with this vet (and many others like her): both clinical signs and BG levels are of equal importance when assessing the level of success of an animal's insulin treatment. (Example: a cat may be running around like a kitten one moment only to collapse seconds later with a severe hypo. If the cat had been regularly checked, the low BG trend would have been caught, carbs given, and the hypo averted. Clinical signs alone are not a reliable means of assessing whether a cat's BG is in a safe range. Conversely, good BG levels may not necessarily mean the cat's as well as it could be: even at good numbers a particular insulin may disagree with a particular cat, and the only way of determining this is through monitoring of clinical signs.)

Your current vet's attitude is, sadly, far from uncommon. Many caregivers don't test BG at all so a lot of vets are only used to working with information about clinical signs, water consumption, occasional BG checks in the surgery and fructosamine tests. NONE of these metrics are sufficient to determine dose safety and efficacy. Many vets never see much BG data for their patients and consequently don't tend to realise just how valuable real-time data gathered in the cat's home home is for informing treatment decisions and optimising a cat's regulation.

I would lay money on there being a lot of cats in the world who could have achieved remission had their guardians been home testing and refining dosage based on that data but who instead remain insulin-dependent for the rest of their lives - solely because their vets didn't offer better education or treatment options. Indeed, for some vets it seems to be a default position to consider insulin therapy to be completely successful if the cat's BG levels remain hyperglycaemic but below the renal threshold, justifying this purely on grounds of minimising risk of hypoglycaemia. They would sooner see the cat unnecessarily high (and sustaining all the nerve and organ damage which goes hand in hand with time spent in a hyperglycaemic state) than consider an an alternative treatment method; hardly an ambitious approach for their patients! While such a level of regulation may be more than acceptable to many caregivers who, for any number of reasons, are not able to test home BG routinely I don't think it right the way that some members of the veterinary profession appear to limit their feline diabetes treatment recommendations to this lowest common denominator approach.

I think caregivers should be given the opportunity to choose from a range of FD treatment options so that they can set goals for treatment according to the level of involvement they can manage in providing their cats' day-to-day care. It would certainly create more opportunities for those caregivers willing and able to monitor more closely to strive for safe, tighter regulation, to help improve their cats' overall health, protect them from the ravages of hyperglycaemia, and increase their cats' chances of achieving diabetic remission.

Of course if one is dealing with a vet who is closed to the latest developments in feline diabetes treatment it makes it much more difficult to get the best results for Scooter. We need vets who are collaborators, Jeff, not dictators. It is my fond wish for the New Year that you will be successful in finding a new vet to partner you in caring for your beloved boy.


Mogs
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MrWorfMen's Mom said:
Sliding scales work for some cats where you have lots of data and kitty is somewhat regulated and predictable but in the early days and if kitty is the least bit unpredictable which many cats are, they can be very dangerous.
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I could not agree more strongly with this statement. Here's why:

Saoirse's Caninsulin Data - All readings on Alphatrak (same as Hodgkins reference range)

upload_2016-12-22_14-22-40.png


Identical dose of 0.50 units produced the following drops between AMPS and nadir on consecutive days:

21.07.14 - 252 points (!)
22.07.14 - 119 points.
23.07.14 - 34 points.
24.07.14 - 161 points.
25.07.14 - 94 points.
26.07.14 - 126 points (and a dose reduction was given on the following PM cycle).

Saoirse's environment and feeding schedules had little or no variation day-to-day so activity/feeding variances are not a significant influence on these numbers.

Looking at the effect a 0.50IU dose had on BG levels, had I been using a sliding scale dosing method and increased the dose based on a 407 AMPS on 21.07.14 I don't like to think about what might have happened to my cat.

It is not uncommon to see Vetsulin/Caninsulin yanking down unexpectedly high preshot BG levels on a dose which would normally produce a smaller BG drop between PS and nadir; hardly a recommendation for use with a sliding scale dosing method (IMHO).

I trust consistency. I trust nadirs.

ETA:

In fairness to Hodgkins her protocol is based on use of PZI insulin but I still wouldn't feel comfortable using it. A starting dose for a newly-diagnosed cat of up to five - FIVE!!! - units??? Most cats on Lantus or Lev following TRP start on one unit! (Starting doses are based on body weight.) As I said in an earlier post, Hodgkins' method is far too aggressive for my comfort.


Mogs
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https://docs.google.com/spreadsheets/d/1sWDKEa-WUHSFnvLA3y9fdl0_FtegaVtOUJzwf6ZPZHk/pubhtml

I agree with you both :) I appreciate the knowledge yall contribute tremendously. Until find a vet that will work with Scooter I have to do what is best for him. His T4 is under control and while it is my concentration is now focused on his diabetes. This is the same vet that said he is old and will never be the same when I made the statement of, I wish he was under control like he was. (when he only had thyroid issues)

Anyway since he was diagnosed diabetic I have kept pretty good records. What I notice is he peaks at +5 or +6 and then spikes back up to 600.

I did the extra 1 unit last night at his peak and you can see by the spreadsheet that the one unit didn't really drop his level as much as it helped the spike back to 600.

This morning he was at 500 and gave him 3.5 units and will assess his levels at peak today and for the next two weeks (I'm off for Christmas holidays) and track progress. If he is lower for longer and his pancreas starts catching up I wont administer the 3rd or 4th small unit dose at peak.

I am still looking for a vet but in the meantime I need to keep Scooter as low as possible without hypo. He is pretty predictable so far so time will tell. This is the best time to try since his thyroid is under control so we aren't fighting two issues now.


Mogs, no worries about following up:) I see how busy this wonderful forum is and more furbabies need yours and Linda's expertise more than we do right now. Im not worried a bit cause the first post in about a week was responded by you both within hours. This is pure awesome because I cant get a response from a vet in days. I feel Scoot and I are being watched by guardian furbaby parents and are in good hands. :) cant find the emoji for hugs but that's what Scoot just gave yall.

his levels are staying blue longer since I followed your advice over my vets and we really, really appreciate it. That's the only thing my vet did agree to was the advice yall gave on reducing the dose. ROFL

Jeff
 
Jeff, just had a quick peak at Scooter's SS and I'd keep a really close eye on him today and by that I mean I'd be checking his BG at least every hour until you find the nadir. That is one major drop from 500 to 139 in 3 hours and while it would be great to think nadir would be the same time every day, its often not. Many cats hit nadir on Vetsulin at around about +4 so don't get lulled into thinking it won't be till later every day. And as Mogs said before, a kitty can be just fine one minute and collapsed the next so please be careful. It could be that the insulin is trying to take him down even lower and his defense systems are kicking in to keep his numbers up thus making it look like the extra shot didn't do much. This is a very complex puzzle to deal with and the more variables you throw at it the more complicated/frustrating it gets along with increasing the possibility of a hypo.
 
Thanks Linda

His level at 10am was 108 so it's now leveling off and won't be dropping anymore. I can see this on my graphed curve sheet that time increased with little drop in level. I check levels every hour and if and when it ever drops below 120 I check every 5minutes. He doesn't mind the pricks at all.

I also give him a snack at + 2 and +5 every day. A small pure protein snack of maybe 1-1.5 oz.

I will update his sheet daily and y'all let me know if u see something funky.

Jeff
 
I'm glad to hear you are checking levels hourly. :)

Jeff Phillips said:
won't be dropping anymore
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That's a pretty strong statement to make for any diabetic cat and especially one on Vetsulin. Expect the unexpected is my motto because I've been monumentally surprised by my girl more times than I care to count on long acting insulin. Cats don't follow a straight or consistent path, every day is a new day, and things aren't always going to go as you expect they should. Just saying! ;)
 
Jeff,

For safety FDMB advocates not letting Vetsulin cats' nadir BG numbers go under 100 on a human meter (higher on a pet meter - I personally would not want to see a nadir for my cat lower than about 130-135 on an Alphatrak). That's on a 12/12 cycle. You need that sort of safety buffer.

Please be extremely careful with what you're attempting here.


Mogs
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MrWorfMen's Mom said:
I'm glad to hear you are checking levels hourly. :)


That's a pretty strong statement to make for any diabetic cat and especially one on Vetsulin. Expect the unexpected is my motto because I've been monumentally surprised by my girl more times than I care to count on long acting insulin. Cats don't follow a straight or consistent path, every day is a new day, and things aren't always going to go as you expect they should. Just saying! ;)
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You definitely have more experience than I do on this but im using the past curves from October, November and part of December that when he gets to his nadir around +4 to +5 it levels and doesn't drop anymore. At least not in the past months. Checked it sgain at 10:30 and it was 109. its also predictable that it rises to 600 after +6 to + 7.

What is not predictable is that if he eats his 3-4oz of fancy feast classic and then eats some of Rooteys and I give him the same 3.5 units it varies in nadir from 250-200 and never goes lower. As long as I regulate food and don't sllow grazing it's pretty predictable if I keep the food and amount consistent.

Jeff
 
Critter Mom said:
Jeff,

For safety FDMB advocates not letting Vetsulin cats' nadir BG numbers go under 100 on a human meter (higher on a pet meter - I personally would not want to see a nadir for my cat lower than about 130-135 on an Alphatrak). That's on a 12/12 cycle. You need that sort of safety buffer.

Please be extremely careful with what you're attempting here.


Mogs
.
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Thanks Mogs, I do like to keep a buffer and I also don't agree with not giving them honey if they drop below 70. If Scoot drops farther in level than he does in duration (time) I feed him extra pre nadir.

What I'm looking for is that when stress is relived from his pancreas with the constant higher levels, I will see changes in duration of the insulin working with his system.

His level when he was first diagnosed was 412. Since the vets poor regulation his fasting blood sugar is now 600+, not sure how high above 600 it actually goes cause my meter only reads 600.

That's because she kept him on one unit and i kept telling her it never dropped below 300 and she continued to tell me he had to be on that dose for at least a month to stabilize. Thats when I went to the 2nd vet concerned about his dehydration noticed while giving him injections. He had to be given fluids every 2 days for a week to rehydrate.

Now he is happy again and hopefully some recovery repair will begin on his pancreas.


Jeff and Scooter
 
Jeff Phillips said:
What I'm looking for is that when stress is relived from his pancreas with the constant higher levels, I will see changes in duration of the insulin working with his system.
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It's unlikely that you'd see any change in duration of dose, Jeff. In the majority of cats treated with it Vetsulin does not last long enough (and that's for "uncomplicated" diabetes - no additional issues with hyperT metabolic rate impacts). If numbers stay lower for longer on a 12/12 dosing schedule then it will more likely be pancreatic insulin keeping levels down in the latter part of a cycle, not Vetsulin. You can see this even in very well regulated cats like Elmo:

https://docs.google.com/spreadsheets/d/1ZAoPctvtyhkyKhyx_vJh8ffy8ZTl_Ac1AqiCovCd_70/pubhtml

FYI Elmo is also a hyperT kitty. As you can see from his data he's spending a lot of time in the healing range but his Vetsulin is still pooping out around +8. He had his hyperT med dose adjusted a couple of days ago and you'll be able to see how it's impacting his BG levels at the moment.

What can be worrying is if a healing pancreas decides to sputter unexpectedly in the middle of a cycle. Should such a thing happen when a cat is already at nadir and in lower BG numbers the burst of pancreatic insulin could see numbers going lower. (Safety Note: As the pancreas recovers more function BG numbers may actually go down in the hours following a meal, not up.) The safety buffer is vital.


Mogs
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Critter Mom said:
It's unlikely that you'd see any change in duration of dose, Jeff. In the majority of cats treated with it Vetsulin does not last long enough (and that's for "uncomplicated" diabetes - no additional issues with hyperT metabolic rate impacts). If numbers stay lower for longer on a 12/12 dosing schedule then it will more likely be pancreatic insulin keeping levels down in the latter part of a cycle, not Vetsulin. You can see this even in very well regulated cats like Elmo:

https://docs.google.com/spreadsheets/d/1ZAoPctvtyhkyKhyx_vJh8ffy8ZTl_Ac1AqiCovCd_70/pubhtml

FYI Elmo is also a hyperT kitty. As you can see from his data he's spending a lot of time in the healing range but his Vetsulin is still pooping out around +8. He had his hyperT med dose adjusted a couple of days ago and you'll be able to see how it's impacting his BG levels at the moment.

What can be worrying is if a healing pancreas decides to sputter unexpectedly in the middle of a cycle. Should such a thing happen when a cat is already at nadir and in lower BG numbers the burst of pancreatic insulin could see numbers going lower. (Safety Note: As the pancreas recovers more function BG numbers may actually go down in the hours following a meal, not up.) The safety buffer is vital.


Mogs
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I stand corrected Mogs, thanks.
I knew what I was saying just not sure how to say it. By longer duration I did mean that the pancreas was starting to function some. Right now Scooters doesn't function much if any at all.

Wow!,,, woohoo for Elmo. He is doing excellent compared to Scoots pmps and amps. I have Scooter on .85ml of methamazole twice a day. 17mg is a big jump from him being controlled on 5mg a day since 2012. I check T4 levels every 4weeks just in case some other part of his system starts working more efficiently. Hypo for diabetes is a concern but hypoT is a severe issue that could shut his kidneys down pretty quickly.

With hypo diabetes at least an emergency vehicle would be that his liver would release glucose.

The only thing im not following on hodgekins is allowing him to go below 100. He stabilized today at +4 to +5 and started his gradual rise to 118 from 109and at +6 was 170.

Thanks Mogs :)
 
https://docs.google.com/spreadsheets/d/1sWDKEa-WUHSFnvLA3y9fdl0_FtegaVtOUJzwf6ZPZHk/pubhtml

Scooters updated levels

He really is feeling much better. Not sure what it feels like in the past when his levels were 600+ for 12+ hours per day but this has to be better for healing. His blood stayed toxic.

His scabbing has healed, gaining more weight and growing hair over the scab locations. He got high on catnip last night and this morning and played.

Im going to reduce his am and pm dose to 3 units beginning tonight in lieu of 3.5 units.

what do yall think so far?

Im guessing his pancreas will begin to heal and will need to adjust dosing accordingly.

Jeff and Scooter
 
I like the idea of a dose reduction. He dropped quite low today after very high AMPS. I know that Mogs has been discussing the idea of a longer acting, gentler insulin with you.
 
More: that 70 mid cycle today is near hypo. Are you giving him a little higher carb snack? There's no buffer for him, Jeff. I know that Mogs advised not letting him get below 100+. I apologize if I seem nosy but I'm concerned.
 
His am and pm levels are finally coming down below 600 now. My goal is to reduce his dosage in relation with his level and gradually bring the high am/pm levels down. Hopefully around 300-400. Right now the drops from high levels to low is all that can be done. If I decrease his dose his level won't drop below 300 and defeats the purpose.the vet didn't regulate him from the beginning and threw him out of sync.

I did find a vet that will use long lasting insulin but they wanted to wait till after the holidays.
 
Jeff Phillips said:
Im going to reduce his am and pm dose to 3 units beginning tonight in lieu of 3.5 units.
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I've no experience with the dosing method you're using here, Jeff, but if I saw the numbers you've seen with the green background if it were my cat on a 12/12 schedule I would definitely reduce the dose.

The only guidance I can suggest is that the FDMB Vetsulin Guide recommends not letting BG go below 100mg/dL at nadir for cats on Vetsulin on a 12/12 dosing schedule.

I am glad that Scooter is feeling better and that his clinical signs are really improving. Please be very careful and test very frequently.


Mogs
.
 
I guess I'm confused about what you mean by AM and PM levels. The PSs I see on your SS are all blacks. Are you referring to the BGs in the +1 and +2 time frame after his AM and PM shot? Basically, I'm focusing on AM/PMPS (blacks) and what the nadir is and when it occurs. Lowering the dose might well keep the nadir a little higher and reduce the rate of descent of BG but you still have the issue of a very large delta BG with Caninsulin. The goal is to have PSs is decent numbers and a small delta BG between PS and nadir.
 
Peak is +5 for Scooter. No carb but he always gets a protein snack of 1.5oz at +5 to +6.

No you're not nosey and I appreciate all advice to add to my knowledge base. Im not too worried about his levels below 100 if he is at peak. I just know to reduce dose tonight. My main gosl is to eventually get his amps and pmps lower for a flatter curve. My vet started him on the wrong dose in October this year and jacked his levels to 600+ probably closer to 800 by the time 2-3 hours for it to drop below 600.

We have been together for 17 years going on 18 so I'm the last person to let something happen to him. I also understand that his pancreas is not working but will eventually start to produce his own insulin eventually. (Hopefully) as much as I test him I will notice levels and adjust accordingly.

Thanks

Jeff and Scoot
 
Kris & Teasel said:
I guess I'm confused about what you mean by AM and PM levels. The PSs I see on your SS are all blacks. Are you referring to the BGs in the +1 and +2 time frame after his AM and PM shot? Basically, I'm focusing on AM/PMPS (blacks) and what the nadir is and when it occurs. Lowering the dose might well keep the nadir a little higher and reduce the rate of descent of BG but you still have the issue of a very large delta BG with Caninsulin. The goal is to have PSs is decent numbers and a small delta BG between PS and nadir.
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His amps and pmps were way aboce 600. My meter doesn't read above 600 but on multiple occasions it took 2-3 hours to regester below 600.
 
Jeff Phillips said:
Peak is +5 for Scooter.
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Jeff,

Vetsulin is made of TWO fractions - amorphous and crystalline:

- The amorphous fraction is stronger and has a peak effect in cats anywhere from +2 to +5ish (though this can move around).

- The crystalline fraction kicks in after +6 and has its strongest period of effect in cats is between +7 and +10 (and this can move around, too).

With the numbers you're seeing today be very careful to test right the way through the cycle. I would worry that you might see another dip in the second half of the cycle when the crystalline fraction kicks in.


Mogs
.
 
Critter Mom said:
I've no experience with the dosing method you're using here, Jeff, but if I saw the numbers you've seen with the green background if it were my cat on a 12/12 schedule I would definitely reduce the dose.

The only guidance I can suggest is that the FDMB Vetsulin Guide recommends not letting BG go below 100mg/dL at nadir for cats on Vetsulin on a 12/12 dosing schedule.

I am glad that Scooter is feeling better and that his clinical signs are really improving. Please be very careful and test very frequently.


Mogs
.
Click to expand...
Hes not on 12/12. He's on 6/6
Critter Mom said:
Jeff,

Vetsulin is made of TWO fractions - amorphous and crystalline:

- The amorphous fraction is stronger and has a peak effect in cats anywhere from +2 to +5ish (though this can move around).

- The crystalline fraction kicks in after +6 and has its strongest period of effect in cats is between +7 and +10 (and this can move around, too).

With the numbers you're seeing today be very careful to test right the way through the cycle. I would worry that you might see another dip in the second half of the cycle when the crystalline fraction kicks in.


Mogs
.
Click to expand...
Mogs I never have seen the 2nd kick with Scooter ever since the end of September when diagnosed. I have been to the vetsulin site and have read that also. He hits peak and then shoots up after +6 normally. On the new dosing he stays below 200 for most of the time now. Today he doesn't require the +6 to + 8 (.50-1 unit) on the hodgekin approach the goal is to keep them low without the spikes. Gradually getting there and eventually bringing his level to a flatter curve back to a 12/12 dosing. Now just want his levels down to heal so we can change insulin in January to a longer lasting one. Scooter has seen + 600 levels most of a 24 hour period from October till the middle of December. Been dehydrated and tremendous weight loss over that time. I can tell he feels better by his activity level and him jumping on the kitchen table and bed.

Hopefully the longer lasting insulin will be better with his thyroid issue.

Jeff and Scoot
 
Your great Mogs! :)
I appreciate everything you have done to help. Scooter would still be on too high a dose if it wasn't for your help. He no longer bounces like he used too.


I have not seen this type of dose routine on this forum. Scooter is our family's heart. We have other cats but not like Scooter.
I have looked through the forum and seen the struggle to regulate. I don't want to just regulate. (Will if needed) i want remission. This approach has a greater than 80% chance of remission. Im thinking that when Scooters t4 levels went haywire it triggered hyperglycemia.

This approach only works on newly diagnosed hyperG and has less chance if any at all on longer regulated felines.

If it works, it can be passed on to other furbabies parents. Not sure if it will but worth a try for Scooter and Scoot and I don't mind the frequent testing and a bonus he feels better.

Still meeting with the vet in January but why not try this now. Anyway it hurts me and I can't sleep good knowing his levels shot above 600 after +6.

Now they don't and a have a large bell curve albeit from high pmps and amps levels but those have come down considerably and run 500 instead of 600+

Jeff n Scooter
 
I believe the Hodgkins TR protocol was originally written for PZI type insulins. ProZinc is one of those. They're similar to Vetsulin in how they work but have longer duration and generally a less sharp drop to nadir. I'm sure there are people out there who have tried this protocol with Vetsulin/Caninsulin. This protocol isn't popular on FDMB for a number of reasons so you don't see posts about it. Your Diabetic Cat is another forum where (I believe) there are people who do this.
 
Kris & Teasel said:
I believe the Hodgkins TR protocol was originally written for PZI type insulins. ProZinc is one of those. They're similar to Vetsulin in how they work but have longer duration and generally a less sharp drop to nadir. I'm sure there are people out there who have tried this protocol with Vetsulin/Caninsulin. This protocol isn't popular on FDMB for a number of reasons so you don't see posts about it. Your Diabetic Cat is another forum where (I believe) there are people who do this.
Click to expand...
My main objective and the goal of this site is to help my cat. Ive been having issues with 2 different vets. You can see from Scooters spreadsheet that his pmps and amps have been off the chart. His +1 and +2 were still black for months.
I searched remission from diabetes when T4 levels are controlled and found the hodgekins protocol. Since my luck with 2 vets has failed to put him on a longer lasting human insulin I searched other options to help him. Nothing like watching your cat exhibit signs of PU and PD while battling an out of control thyroid after being controlled for 4+ years. His increased dose of methamazole to 17mg a day taxes his kidneys. This combined with the losd placed on his liver, kidneys and pancreas and the toxic nature of his blood changed my thought process.

I was referred to this site by a moderator over st the hyperT site and thankfully found Mogs and Linda pretty quickly. They helped put Scooter on the right path and recommended longer lasting insulin. I meet with the vet in January.

Since vetsulin is similar (I did research before starting this) to pzi, decided to try. Vetsulin peak with Scooter is +5 to +6

Hopefully Scooter will have a little pancreas repair before January. The path he was on was not ideal with mostly black, red and pink levels peaking at yellow.
 
Jeff Phillips said:
My main objective and the goal of this site is to help my cat. Ive been having issues with 2 different vets. You can see from Scooters spreadsheet that his pmps and amps have been off the chart. His +1 and +2 were still black for months.
I searched remission from diabetes when T4 levels are controlled and found the hodgekins protocol. Since my luck with 2 vets has failed to put him on a longer lasting human insulin I searched other options to help him. Nothing like watching your cat exhibit signs of PU and PD while battling an out of control thyroid after being controlled for 4+ years. His increased dose of methamazole to 17mg a day taxes his kidneys. This combined with the losd placed on his liver, kidneys and pancreas and the toxic nature of his blood changed my thought process.

I was referred to this site by a moderator over st the hyperT site and thankfully found Mogs and Linda pretty quickly. They helped put Scooter on the right path and recommended longer lasting insulin. I meet with the vet in January.

Since vetsulin is similar (I did research before starting this) to pzi, decided to try. Vetsulin peak with Scooter is +5 to +6

Hopefully Scooter will have a little pancreas repair before January. The path he was on was not ideal with mostly black, red and pink levels peaking at yellow.
Click to expand...
You certainly have a lot on your plate with Scooter, Jeff. It's obvious that you care about him a lot and it's unfortunate that you're having a hard time finding a helpful vet. As I said above there aren't many, if any, people who post here frequently that use the Hodgkins protocol so it will be difficult to get guidance on FDMB.

Linda and Mogs are extremely knowledgeable and I'm glad they've been able to give you a lot of helpful information. They both have recommended the L insulins (lantus or levemir) to you. I hope you're able to get a prescription for one of them from your vet in January. If Scooter responds well, his BGs will come down nicely and stay relatively flat for much of the dose cycle. That would be really beneficial for him. Those insulins are very expensive in the US and many American users order from a Canadian Pharmacy, Marks Marine Pharmacy.
 
Kris & Teasel said:
You certainly have a lot on your plate with Scooter, Jeff. It's obvious that you care about him a lot and it's unfortunate that you're having a hard time finding a helpful vet. As I said above there aren't many, if any, people who post here frequently that use the Hodgkins protocol so it will be difficult to get guidance on FDMB.

Linda and Mogs are extremely knowledgeable and I'm glad they've been able to give you a lot of helpful information. They both have recommended the L insulins (lantus or levemir) to you. I hope you're able to get a prescription for one of them from your vet in January. If Scooter responds well, his BGs will come down nicely and stay relatively flat for much of the dose cycle. That would be really beneficial for him. Those insulins are very expensive in the US and many American users order from a Canadian Pharmacy, Marks Marine Pharmacy.
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Thank Kris, for whatever reason I called several vets in our area and one was willing to talk about L Insulin.
I had a diabetic cat go into remission on L insulin back in the early 2000's.
When Scooter was diagnosed I asked about that type and they said it's not used anymore. Crazy since it worked on Frisky. Frisky ended up going to the rainbow bridge from old age and not diabetes.

I think the vets must get incentives for prescribing certain types.

Jeff n Scooter
 
Jeff Phillips said:
Thank Kris, for whatever reason I called several vets in our area and one was willing to talk about L Insulin.
I had a diabetic cat go into remission on L insulin back in the early 2000's.
When Scooter was diagnosed I asked about that type and they said it's not used anymore. Crazy since it worked on Frisky. Frisky ended up going to the rainbow bridge from old age and not diabetes.

I think the vets must get incentives for prescribing certain types.

Jeff n Scooter
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That's strange. Lantus is the insulin of choice for most vets because of the Roomp & Rand research although ProZinc is promoted as being an insulin specifically for cats. That's marketing though - it's a human recombinant insulin like lantus. My vet here is part of a large practice and lantus is their go to for FD kitties. My guy is the only one there on ProZinc.
 
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Kris & Teasel said:
That's strange. Lantus is the insulin of choice for most vets because of the Roomp & Rand research although ProZinc is promoted as being an insulin specifically for cats. That's marketing though - it's a human recombinant insulin like lantus. My vet here is part of a large practice and lantus is their go to for FD kitties. My guy is the only one there on ProZinc.
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Prozinc was the only other insulin my current vet would recommend over vetsulin. Not sure why but most of the other vets I called named prozinc as the best choice.
 
Jeff, I'm betting that the reason some vets don't recommend Lantus is because it's marketed as a human insulin so no rep is visiting their clinic selling the goods and most vets can't or just don't read all the research on all ailments so they stick with what they know no matter how long ago they learned it. In the average vet practice, their number of diabetic cats is likely very small so it's not a subject they feel they need to stay current on. ProZinc being marketed as a veterinary insulin has probably "sold" the vet practice the goods so that's what they use exclusively. It's a good insulin and works great for some cats but medicine is not a one size fits all proposition and that kind of thinking is pretty closed minded and not in the best interest of their clients. It's the same thing with prescription foods vet's prescribe. They get "sold" the goods and most Rx diets are not optimal at all!
 
Kris & Teasel said:
That's marketing though - it's a human recombinant insulin like lantus.
Click to expand...
Not really. ProZinc is human R (human recombinant insulin) insulin with protamine zinc additive to extend it duration.
Lantus and Levemir too are called insulin analogues since they are not really human insulin made by the recombinant process. They act like insulin but are not real human insulin.
The prescribing information
http://products.sanofi.us/lantus/lantus.html#section-16
for Lantus includes
"LANTUS (insulin glargine injection) is a sterile solution of insulin glargine for subcutaneous use. Insulin glargine is a recombinant human insulin analog that is a long-acting, parenteral blood-glucose-lowering agent [see Clinical Pharmacology (12)]."

ProZinc's predecessor was PZI VET which was 90% bovine insulin and 10% porcine insulin with a protamine zinc additive. PZI VET was the same formulation used by EI Lilly for use in humans before human recombinant insulin was developed.
 
Ok guys I have a good news update on Scooter.
Being on the hodgekins protocol for about a week now.the amps and pmps has dropped to the 350-400 range.
We have reduced his am and pm dose to 2.5 units from 3.5 units and have been able to delete his +6 1 unit dose. His curve is now gentler and flatter than it ever has been and no longer starts at 600+. I will update the spreadsheet soon but wanted to collect more data and make sure this was not a temporary drop.
I seriously think that dosing 4 times a day was able to take stress off his pancreas and that now he is producing some insulin of his own. He still eats protein snacks at +6 and with no insulin dose does not spike like he used too.

Very happy now and Scooter feels way better.

Jeff and Scooter
 
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