Should I reduce and/or start over or hold the course?

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Maresydotes

Maresydotes

Member Since 2011
I have posted once or twice on this board and I am struggling a little with a decision. My cat Missy was dx'd in March 2011 with FD. She was also grossly obese. My vet, whom I trust very much ( saw our last kitty through cardiomyopathy with compassion and excellent care.) got us started on home testing right away (although it took ME some time to get on board) told us to get her on a low carb wet diet, sent us to Binky's page for information on food and told me about this site, so she is quite 'progressive' compared to some stories I have read in the General Forum.

Missy went in to remission very quickly...April of this year and remained in remission until August, when I noticed she was starting to ask for more food. I tested her 8/10 and she was at 225. A visit to the vet showed no UTI, but sugar in her urine. Otherwise in good health, less chin acne we have been battling for some time.

I bought a scale and have been weighing her more or less weekly and she continues to lose weight, steadily, but safely. She is down not quite 5 pounds since March. We cannot figure the cause of the relapse, as nothing has changed....routines, food,etc. She is now down to 22 lb 2 oz. with more to go.

I did not do a real good job of getting mid-cycle readings this go around, due to various reasons I won't go in to here. I did get some, however. Several times she was at normal levels and I did not inject her, with a resultant bounce to higher numbers. I spoke with my vet about it and she had me reduce the dose, but inject on days she was low, as long as I was around to monitor her.

So she had been hanging around in numbers higher than I would like to see, so I bumped up her dose by .25 and watched for 5 days and finally was able to do a curve. (10/5) Her numbers were pretty flat throughout the day, not much of a curve...(my vet wanted me to go to 4.5, I opted to go to 4.25 then 4.5).

So on 10/7 I thought it was time to bump her up another .25 to 4.5 units. I did that for her AM dose and watched her. She seemed fine, alert, engaged, no obvious signs of hypoglycemia....I checked her at +5 and she was 64 on the AlphaTrak. Checked again a couple minutes later and she was 74. Fed her a bit and checked at +7 and she was 77. At plus 10 she was 142 and PPMS 234. I gave her a fat 4 units that night.

So, I have heard from some people that I should consider dropping her down to 2.50 and start over using the 'low and slow' dosing. That she is on too high a dose and it is inflating her numbers. I spoke with my vet about it and she still contends that because of Missy's weight and numbers 4.5 is an appropriate dose for her, with careful monitoring. I am not totally opposed to dropping her down and starting over, but I am wary of dropping her from her current dose to 2.5 all at once. That is counter to the protocol, I am concerned that it will wreak havoc on her body and I am having a little trouble with the idea that a high dose is causing her to have high numbers when increasing her to 4.5 brought her into low, but normal numbers.

I have dropped her down a bit (4 or skinny 4.25) since 10/7 while pondering what I want to do. The person I have been discussing this with (from this forum) suggested I might want to post here and get some other input.

I admit I do not have a lot of data, but I am working at getting it, now that I am able.
Do any of you have any input on this scenario? I would really welcome other thoughts, as mine are one way one minute and another the next :roll: Any input would be appreciated.
Thank you
Mares and Miss

PS starting her out at 3 units in August was the dose suggested by my vet, as it was the dose she was on prior to her achieving remission in April.
 
Re: Help with dosing

i am not a fan of starting over, mares. i have a high dose cat with acromegaly and when we arrived here (not knowing that he had acro) he was on what we thought was 3units BID. people suggested starting over, but i didn't do it. i think if the dose was too high, you would see it by the numbers and then you would reduce, just as you have been doing. if you drop the dose and start over your missy could spend a significant amount of time in high numbers.

i think the time it's appropriate to drop the dose and start over is when you're within a short time of starting lantus (say 3 weeks) and your vet had you increase weekly in 1 unit increments, or a similar situation. that isn't your situation, however.

that's my 2 cents worth on that.

the best thing you can do is get consistent tests before every shot and midcycle. there are a number of concurrent problems that can cause a need for a high dose - not every cat thrives on 1unit. if i were you, i would stay the course. i want to again encourage you to post here on the lantus forum daily so we can help you along the way. we all understand lantus and how it works, and you would in a short time as well.

i think you'd find it more satisfying than posting irregularly and having to go over the story each time.

here's your previous post: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=53800&p=581870#p581870
 
Re: Help with dosing

I am not a dosing helper but have been here a long while--It does happen that some cats have higher numbers on higher doses, and looking at your ss, it seems like there is a lot of high bounces.
Lantus needs consistancy & patience--that means holding a dose for at least 3-5 days...I am assuming you know about NDW & bouncing.. As I wrote to some one the other day, my cat also had chin acne & her numbers did go up as it was slightly infected..
Without sufficient data in your SS, it is hard to figure out what is going on--
And if you do drop the dose, after 3 days, you will see whether it is working or not..She did have a green at 2.00 but that could be from left over shed action...
I think you will need to give this some patient observation, monitor on a weekend when you are off, and really see what is going on here--Please ask the vet to check the next acne outbreak for infection--My Moonie did have that!
 
Re: Help with dosing

Julie and Roni,
Thank you for the input. I appreciate it very much.
As for her chin acne, she has been battling that since March, also. It will start to improve and then suddenly flare. She IS on Clavamox right now, along with Duoxo to see if we can whip it. We had her on pyoben, but that seems to make it worse :sad: She did have a flare up shortly before the relapse, but not sure it is related.
I suppose I should hold her dose until I have more data.....I am working on that daily.
 
Re: Help with dosing

And p.s. The green at 2.0 units .......she was actually at 4 units and I gave her 2 units on the advice of my vet in order to avoid the bounce like we had on 9/14 when she was at 101 and I skipped he am shot.
 
Re: Help with dosing

i think there's no exact answer for you - but if you want others to weigh in then i'd suggest changing your subject line to say something like "should i reduce and start over?"

in your post the other day where marje and jessica were encouraging you to reduce and start over, i'm thinking they were looking at your starting dose of 3.0. it is higher than normal, but you've said she's a big cat and because she was on insulin before, i think it's fairly common to start back up at the dose that you ended at. not positive about that, though. i understand their rationale on it.

i don't recall what you said in earlier posts about how heavy she was - wasn't she 25 lbs or so? what is her current weight? obesity alone is one cause of insulin resistance, just like in people. if i recall correctly, at least in people, fat puts out hormones that keeps the insulin from doing its thing.

the chin acne - several people have had cats with that problem and i think it has been known to cause higher numbers, just like any infection. it might be that until you get that cleared up you're going to have a hard time getting on top of her BG. i saw someone the other day say to use specific kinds of bowls and specific soaps along with the antibiotic.

you could also put "chin acne help" in your subject line. the more specific you are the more the right people will stop by to help.
 
Re: Help with dosing

That was me Julie--I use Hibiclens--antimicrobial, antiseptic soap & Oxydex on the sore itself after washing with the soap--Got rid of Moonie's--You need to use a glass or corelle bowl--cats get acne from bacteria on their plates--stainless & plastic are bad for acne--OK? just to verify! :mrgreen:
 
Re: Help with dosing

Julie,
I think you are probably right and that is why I am struggling so hard trying to decide. I want to do the best thing for her, not the easiest thing for me. Thank you for the hint on subject title...I don't really have a clue. And I can imagine many don't want to weigh in due to my small amount of data.
Roni
The dishes are good...no plastic for my babies. Shallow ceramic dishes. I looked for Hibiclens at the grocery store yesterday......would I need to go to a drugstore to find it?
M&M
 
Re: Help with dosing

i think you have enough data - you have several weeks worth and have been really consistent with the preshots. i closed her ss now and for some reason they take forever to open, but as i recall you had some mid-cycles. the midcycle tests are what determine dosing.

was missy on a different insulin before lantus?

thanks roni! i couldn't remember who was talking about it and didn't want to say wrong. i was thinking hibiclens but you never know if i just made it up! :lol: i gotta watch that! ;-)

you could call around to find the hibiclens. i think it's pretty common.
 
Hi there!! I'm by no means an expert, but I've been at this for a few months and want to give you my opinion. Looking at Missy's SS, I don't think you should start over. She's a very large cat and even her midcycle tests are in the 200's so I don't think starting over would be a great idea. I DO think you need more tests, especially in the PM cycle. If you do nothing else besides PS tests, you really need to get a test before you go to bed. I know it can be difficult during the day to test because of work schedules, but just test as often as possible for now, during both the AM and PM cycles...the more data you collect, the better decisions you can make. You won't have to be a testaholic forever...just until you get some good data in order to make some good decisions. If you can't test much during your work week, try to get a curve (test every two hours in a cycle) on the weekends. By the way, congratulations on helping Missy lose weight!! Champ is 18.5 pounds and I can't get his weight to budge!!! Drives me crazy. He acts like I'm starving him if I cut his food down by even a mouthful!!

Good luck with whatever decision you make. I'll second Julie's suggestion that you start a new condo for Missy here every day so we can cheer you on and help you out. It will make it easier for you when you know you have so much help!!!

And I sure wish your vet worked in my town....I'd be taking Champ to her like nobodies business!!!! We need more vets like her!!!
 
hi and welcome to the group! someone asked me to stop by to take a look at missy's spreadsheet.

initial starting doses are usually based on a cat's ideal weight not actual weight. for example, if a cat's ideal weight is 20 pounds, a reasonable starting dose would be approximately 2.25 units. we do not suggest starting doses of the same amount they were on the last time they were on insulin.

you mentioned missy has been losing weight and is now down to 22 pounds 2 ounces. how much should she weigh?

is there a reason for not getting spot checks at night? many of our lantus kitties show more action at night than they do during the day. since lantus dosing is based on nadirs and not preshot numbers we need to know how low any dose is taking her before we can suggest adjustments. getting at least before bed spot check every night will give you an idea if further testing will be needed that night to keep missy safe.

missy has been on 4 consecutive cycles at 4.25 units. if i were in your shoes i would hold the dose and continue collecting random spot checks... at least one mid-cycle spot check per cycle over the next few cycles to determine exactly how low this dose is taking her. 4.25 units shot twice a day might be too much or it might not be enough. those who have recommended lowering the dose have a legitimate concern. the current dose was not arrived at safely when dose adjustments are made in increments of whole units (3u to 4u) and the starting dose was set too high. the only way to find out where we're at is to get those spot checks.

make sense?

Be prepared:
HYPO TOOLBOX <----------- stock your hypo toolbox so you're prepared to handle low numbers
LIST OF HYPO SYMPTOMS
TREATING HYPOGLYCEMIA

please familiarize yourself with this document: STICKY: LANTUS & LEVEMIR - SHOOTING & HANDLING LOW NUMBERS

fwiw, just my thoughts...
hope to see you posting often. we can help you get this sorted out.
 
Thank you all so much for your interest, time and advice! :-D It is so much appreciated.
I am not truly sure what Missy should weigh. I will ask my vet. That said, she is still way overweight. I am guessing she should be between 12-15. Her and her brother are fairly large cats. Phoenix weighs 20 lbs and I think he looks good...has a waist, etc, but my vet might think he should be a little lighter. Missy should definitely weigh less than him, as she is shorter, both in height and length, but she is still a big girl.
I will put some effort in to getting some post PM shots in. I have multiple sclerosis and fatigue is a big factor, but I can spend a few nights on the couch and do some PM tests. Daytime tests ate not an issue as I am retired. I had a back injury that made bending over excruciating before, but physical therapy has been making it much easier....hence the increase in testing lately. I could NOT inject her without a test after her hypo incident the end of March. That put the fear of God in me, just as this last incident with the 64 made me realize why I have to do mid-cycle tests.
I agree that starting her out at a high dose was not the best decision, most likely, but at first I did not know any different (and freaking out) and she DID remit so quickly, I had no reason to question my vets advice. It is obvious she is not going down the same path this time, so I started looking at this board in more depth, which led me to my current dilemma. I KNOW she does not feel as well as she did in remission, due to her behaviors, and I want her to feel as good as she possibly can, especially since I am recently retired and have the time to work with her.
I will hold her dose, since that seems to be a general consensus and collect more data. Hopefully, with your help, I can make some good decisions on which way to go.
Thank you all SO much. (and, please, anyone else.....weigh in, if you have something to add. I know I make the ultimate decision, but I don't have the experience you all have......and it IS my kittie's life)
Mares and Miss (and her civvie brother, Phoenix)
 
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