? Theodore 9/7 PMS +326

[NadineTheodore]

Hello,

Theodore's numbers are finally showing improvement with 3.5 units but we still aren't "there".

Brief update on the last week:
- stressful long weekend (airshow where I live) and the jets make a ton of noise!
- Vet visit Tuesday, Mr. Theodore even had an accident in my car
- Blood work came back:
Hemoglobin - 99 (slightly low)
Glucose - 26 (high)
Urea (BUN) - 14.9 (high) previously 12.3-12.4 from April-June 2023 - she believes this is not kidney related but rather dehydration related as Creatinine was 93 and IDEXX SDMA was 10.
Sodium 144 (slightly low)
Chloride 107 (slightly low)
ALP 90 (high)

I'm still waiting for Urine Culture but Urinalysis came back with no surprises.

My vet said results are reflective of an uncontrolled diabetic cat. The internal medicine doctor with the lab really didn't feel an acro test was necessary based on his responding to insulin but said we could rule it out if we really want but rather preferred an ultrasound since previous ultrasound had slightly enlarged spleen, slightly enlarged kidney and some sludge. This all costs a lot of money and I just spent $5500 in emerg when he was DKA 2 months ago plus vet visit and tests so I am prob from that point at minimum $8K in. I am trying to control my expenses and don't want to blow money that I do not have.

I don't know if I am looking at this through rose coloured glasses but FOR ME I think he's shown improvement already AND I think I am getting closer. Vet said given his weight he shouldn't go past 3 units (she doesn't know I've been doing 3.5Units lol).

She was suggesting switching him to 1. Toujeo 2. Detemir which are supposed to be stronger? However wants more tests done. Please advise on thoughts and also I should do a curve soon and dose change soon...we are 4.5 days in on 3.5 units......we had one fur shot day

 

[Wendy&Neko]

Vet said given his weight he shouldn't go past 3 units (she doesn't know I've been doing 3.5Units lol).

There is no correspondence between weight of cat and size of dose. We've had tiny cats on large doses and large cats (Maine Coon/Norwegian Forest) on tiny doses, like less than 1 unit. A cat needs however much insulin they need. It's too bad you can't follow TR, cause it looks like Theodore needs more insulin.

She was suggesting switching him to 1. Toujeo 2. Detemir which are supposed to be stronger? However wants more tests done.

Detemir/Levemir is not stronger. At least not in cats, it is in dogs. Neko's Lev dose was almost the same as her Lantus dose. For some cats, it does provide a bit better duration. Think flatter cycles. As for Toujeo, that's a really, really bad idea. Toujeo is a U-300 insulin. There are no syringes that work for it so you have to use the pen. It is 3 times stronger than Lantus, but you can only change doses by using the pen, which is a much larger change than we make now. I have seen exactly two cats use Toujeo, one was by accident. The first was a really high dose acro cat and the 3 times concentration meant less insulin could be given. The second cat, also acro as it turns out, was a rescue foster and the caregiver accidentally got given the wrong pen of insulin to give. The cat suddenly got much better numbers - turns out because giving the same dose as the U-100 insulin meant kitty was getting 3 times the amount of insulin. And bottom line, no one here has experience with it, you'll not be able to get any help. Levemir on the other hand, is definitely an option, to see if Theo will get flatter cycles, but it's not stronger so the dose will be about the same.

The best thing you could do to help Theo get into better numbers faster is to follow TR, which allows faster increases. But I know you can't get rid of the dry, so that is moot. You could try Levemir/determir. There are no generics for Lev, so it will cost you more. Personally, I loved Lev, wish I had switched sooner. A lot of cats on higher doses, and even some not, feel a sting from Lantus' acid base. Both Neko and I were happier with Lev.

Did you ever look at Neko's spreadsheet for her first year? Spreadsheet here. She saw greens on as low as 3.75 units, but didn't earn her first reduction until 8.75 units. She "responded" to insulin fairly early on, but it took months and frequent increases to break through the insulin resistance. Both acro and IAA.

What "more tests" does the vet want run? I'd rather you spend your money that actually tells you something.

 

[NadineTheodore]

There is no correspondence between weight of cat and size of dose. We've had tiny cats on large doses and large cats (Maine Coon/Norwegian Forest) on tiny doses, like less than 1 unit. A cat needs however much insulin they need. It's too bad you can't follow TR, cause it looks like Theodore needs more insulin.


Detemir/Levemir is not stronger. At least not in cats, it is in dogs. Neko's Lev dose was almost the same as her Lantus dose. For some cats, it does provide a bit better duration. Think flatter cycles. As for Toujeo, that's a really, really bad idea. Toujeo is a U-300 insulin. There are no syringes that work for it so you have to use the pen. It is 3 times stronger than Lantus, but you can only change doses by using the pen, which is a much larger change than we make now. I have seen exactly two cats use Toujeo, one was by accident. The first was a really high dose acro cat and the 3 times concentration meant less insulin could be given. The second cat, also acro as it turns out, was a rescue foster and the caregiver accidentally got given the wrong pen of insulin to give. The cat suddenly got much better numbers - turns out because giving the same dose as the U-100 insulin meant kitty was getting 3 times the amount of insulin. And bottom line, no one here has experience with it, you'll not be able to get any help. Levemir on the other hand, is definitely an option, to see if Theo will get flatter cycles, but it's not stronger so the dose will be about the same.

The best thing you could do to help Theo get into better numbers faster is to follow TR, which allows faster increases. But I know you can't get rid of the dry, so that is moot. You could try Levemir/determir. There are no generics for Lev, so it will cost you more. Personally, I loved Lev, wish I had switched sooner. A lot of cats on higher doses, and even some not, feel a sting from Lantus' acid base. Both Neko and I were happier with Lev.

Did you ever look at Neko's spreadsheet for her first year? Spreadsheet here. She saw greens on as low as 3.75 units, but didn't earn her first reduction until 8.75 units. She "responded" to insulin fairly early on, but it took months and frequent increases to break through the insulin resistance. Both acro and IAA.

What "more tests" does the vet want run? I'd rather you spend your money that actually tells you something.

The more tests being ultrasound, we are also waiting on urine culture which I should have by early next week.

I am OK with acro, hesitant with Ultrasound as he just had one in June and he was just at the vet recently. I don't feel it's fair, they don't think it's Acro so they're not pushing the test, they will run if requested. Since Theo is FIV+ she feels he might have some tumour/cancer potentially throwing him off. He's still so young so I don't know. To me (8 Years estimated) is still fairly young.

@Wendy&Neko when should I look at doing curve to see if I can raise his dose? His Lantus is almost up so if you feel Levemir is better, I am definitely open to trying.

 

[Wendy&Neko]

Hmm, looks like quite the drop tonight. Can you get a test in an hour or two?

Question, what are they looking for in the ultrasound? When I was wondering about a test, I asked my vet "what might you see and what would we do differently as a result"? 3 months apart ultrasound seems like a waste of $$ if there aren't any symptoms that are different now from then. I definitely wouldn't go by just his blood sugars.

We've had lots of FIV+ kitties here. Including Black Kitty, the famous first kitty here diagnosed with IAA (neg for acro), who also had DKA episodes. He was also relatively young.

I can't remember if I asked you his dental situation.

With SLGS you hold the dose 7 days, but you can do a curve before then. It's a bit ECID on insulin type. I like Lev better for Neko, but that's what worked for us.

 

[NadineTheodore]

Hmm, looks like quite the drop tonight. Can you get a test in an hour or two?

Question, what are they looking for in the ultrasound? When I was wondering about a test, I asked my vet "what might you see and what would we do differently as a result"? 3 months apart ultrasound seems like a waste of $$ if there aren't any symptoms that are different now from then. I definitely wouldn't go by just his blood sugars.

We've had lots of FIV+ kitties here. Including Black Kitty, the famous first kitty here diagnosed with IAA (neg for acro), who also had DKA episodes. He was also relatively young.

I can't remember if I asked you his dental situation.

With SLGS you hold the dose 7 days, but you can do a curve before then. It's a bit ECID on insulin type. I like Lev better for Neko, but that's what worked for us.

Ultrasound- they think maybe he has cancer because he has FIV and spleen and one kidney somewhat enlarged....I uno he is a larger cat overall.

Dental - They briefly looked at his teeth (what's left of them) and didn't feel there was any issue.

I haven't had a chance to do a curve yet. Today insulin was 30 mins later than normal as I got home late.

September 8th he was holding his poop in and had two poops the following day. I cleaned the litter and he prefers how my husband cleans it...he's funny like that.

Is it safe to raise .25 or should I do a curve tomorrow then decided? Just had a busy weekend so I didn't have a chance to. Also if I start Levemir, does that change my dose?

We didn't send it out for acro as she's giving the weekend to think about it. Given it has to go to Michigan on ice, she doesn't want the sample getting ruined with it being the weekend
Thank you @Wendy&Neko

 

[Wendy&Neko]

Acros tend to be larger cats, and one symptom of excess growth hormone can be enlarged organs, such as the spleen and kidney that has been observed. The acro and IAA tests are cheaper than an ultrasound. Don't forget to mention that too. Some cats have just IAA and you don't want to pay for shipping and blood work twice if the acro were to be negative. How long ago was that last ultrasound?

I think you've got enough mid cycle data to know you can increase by 0.25 units.

Yes, starting Lev would be at 70% of the current Lantus dose. Some cats have a strong reaction to the change, so it's a safety thing when you start. Also, if you switch, only do it when you can monitor closely for a few cycles.