Still working on Akbah's dose, currently = nil

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akbahsMum

akbahsMum

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I would appreciate any comments on Akbah. He's not had a shot for 36 hours now, and I'm a bit new, so I'd be glad to compare notes with someone, make sure I'm reading this alright.

Quick recap: 5.7kg (12.6 pounds), 12 yo.
diagnosed Nov 2011 at 29mmol/L (500mg/dL), started on 3U of an insulin called Protaphane (Humulin N variant). Never seemed to have good numbers at the vet. A week ago (was it only that short time?) I got sick of a woozy, thirsty cat, discovered BG curves, and then found FDMB. Changed to him to all wet diet and then realised that could be dangerous, so tested and found very low numbers. Vet was away on holidays btw till 30 Jan. Lowered Insulin 0.25U at a time, till we got down to 0.25U. Sorry, I know it was a fast descent but he was getting really low every day and I was trying to get to a point where he wasn't in hypo-figures.
I was still seeing swings but things were safer at 0.25U; to see if it helped the swings, and to try and placate two endlessly hungry cats, four days ago we changed from two meals a day to four smaller meals a day (same quantity, spread over the day).

I planned to keep him at 0.25U for a week to see how he settled, but yesterday his AMPS was 140. Yesterday was a public holiday in Australia so I had planned to do a BG curve for the 0.25U dose. Decided to do a curve for his nil dose instead. Here it is. Sweet ay?


He has been more or less steady, since then too. Or maybe I should call it a slight rise from 140 to 160. See his SS in my signature.
I figure:
  • He seems pretty stable, which is better than all the ups and downs he was getting out of Humulin N.
  • He is in the "safe" range.
  • He is bright eyed and talkative, getting into things and being his old self (like, the way he was a year ago or something)
  • If he goes over 11mmol/L (200mg/dL) I'll give him 0.25U again and keep an eye on him.
  • When the vet gets back from his holiday on 30th Jan, I'll bounce in there first thing asking for Lantus so that when Ak next needs 0.25U it will be something that doesn't pick him up and then chuck him on the floor again 8 hours later. (And tell him about wet food, FDMB and all my recent adventures) ;-)

Does this seem reasonable?
Oh and I think starting tomorrow, I'll try for five meals a day: Three in the day and two at night. Maybe he responded to the 4 small meals a day, maybe 5 would be even better.
 

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I think things are looking great! Maybe the small frequent meals will continue the downward trend. You can see if the lowest carb foods impact the numbers also - staying away from seafood more than a few times a week - sometimes lower carb =lower numbers.

Not sure you need to invest in Lantus at this point. What you may need is an insulin you can give as needed to bring down the rising numbers above 120 or so. With Lantus' shed, it isn't the easiest to use that way. You might be as well off with the insulin you have now, using mini doses as needed.
 
What insulin would be better for this kind of cat?
He's blue again today (8.7 = 156.6) so again no shot. Started him on 5 meals a day to see if that suits his pancreas even more.
 
Assuming that he is headed to remission (that is what he looks like), the easiest insulin to mini dose with is one that allows flexible dosing as needed. So you could have given him a tiny dose at the 156 if you were sure he was headed up. Then you'd wait until he reaches your threshold number again (say 150 or whatever number you choose) and you give him another token amount - regardless of whether that is 12 hours or 16 or however many hours from now...

Lantus and Levemir are hard to do this with because their potency relies on a shed. You want an insulin that can be in and out of the body with no carryover.

Check out SEv's spreadsheet. He is the OTJ kitty on the board today. At the end he was mini dosing, as needed, not on a 12/12 schedule. He used ProZinc, but I would think your present insulin might work the same way. The trick is measuring the tiny doses (like .3 and .2). With PZI, you can use U100 needles and a conversion chart. Is your present insulin U40 or U100?
 
Sue and Oliver (GA) said:
The trick is measuring the tiny doses (like .3 and .2). With PZI, you can use U100 needles and a conversion chart. Is your present insulin U40 or U100?
Click to expand...

Gosh! This is a new one. Well...
On the box it says "each vial contains 100 IU (units per mL)
Does that make it U100?
 
Sue and Oliver (GA) said:
mini dose with is one that allows flexible dosing as needed. So you could have given him a tiny dose at the 156 if you were sure he was headed up. Then you'd wait until he reaches your threshold number again (say 150 or whatever number you choose) and you give him another token amount - regardless of whether that is 12 hours or 16 or however many hours from now...
Click to expand...

Do you mean, if he had numbers like this:
8am 140
10am 145
12noon 151
then I might give him 0.1 or something, at noon, even though I would have normally shot him on an 8am / 8pm schedule?
:?:

Or today, he's 156 at 8am, if he was then
10am 160
I might give him 0.1? (Blowed if I know how I'll do 0.1 with my current needles though. I think 0.25 is as low as I could go with them. I'll have to find those messages about the "drop" method. )
 
That's the theory. We have people on ProZinc who have done it - Sev being the latest.

My concern is that you would be on your own since no one here uses your insulin. I have helped people mini dose with Canninsulin which is a harsher insulin but I don't know anything about yours. Is there any chance your vet would get on board? With a harsh insulin, you would run the risk of a sharp drop in the beginning and you are at lower numbers already, a sharp drop could be a problem. I would think your threshold should be higher than the ones we use with ProZinc.

The other alternative is to give it a week and see if he sneaks up or down. Some cats in these lower ranges just continue to test lower until they are in normal ranges (40-120 without insulin). Some need that tiny bit of insulin.
 
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