Vet appt for Friday May 9-would like some advice from Member

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barbp

barbp

Member Since 2014
Hi

Berk seems to be going nowhere with this dosing. Do not think it is me and needle technique, When spoke to vet last night after her perusal of the past 2 weeks, she suggested upping dosage to 6 Wednesday. I will be away from home that evening so will be missing that evening shot, so am not planning to up until Thursday anyway.

Berk is on lantus. Diagnosed March 1 this year, food changed that day to FF classics, last weight recorded 13 lbs 3 z which was April 19 (steady since April 9 which had reflected a 3+lb loss since Mar 1 which may have been the change in diet, change in quantity (I had gone from 18 oz to 12) or the diabetes or everything. She is now on free food (wet).

Wondering if my feeding schedule is bothering the lantus? Typical day is usually up at 7am, feed everyone but Berk and then 9am she gets shot and 3 oz of FF. (Have just added today DM to the mix-half and half for more fiber per vet). Then around 2pm she gets another 3 oz of food, then around 6-7pm another 3 oz, then 9pm after shot, another 3 oz and then when I am off to bed around 11p, she gets another 3 oz. (15 total). Then if I get up for a 4 am test or just up period, I give her another 3 oz). I think she is less rabid about diving into the food dish now.

As far as treats, she gets a temptation treat piece after every blood grab (When she hears the beep of the relion meter she trots to the table!). And also after each shot.

Vet commented that she wants me to start 6 units of lantus (think I mentioned that already) but said this is reaching the limit of dosing and the type of insulin may have to be switched.

Berk was also shaved in 2 locations (each side) of her hip area (tail comes out from between) I do not see the needle poking outside of skin, and do not feel wetness but sometimes when I sniff the area right afterwards I catch the lantus smell which is gone when I sniff twice.

The urine testing shows no ketones from both ketone solo strip and the BG/ketose strip. The strip usually shows 500 for the BG,

Frustrating that she is not responding .

Thanks for reading and would appreciate suggestions to discuss with vet.
 
Re: Vet appt for Friday May 9-would like some advice from Me

I haven't had a chance to read through your previous posts yet. Are there any other issues with Berk, like dental infections, kidney problems, etc..., that might be causing the high flat numbers? I agree with your vet that based on the numbers you've been consistently getting (<300), an increase of .5u to 6u might be needed. I disagree with your vet that you might need to change insulin. Lantus is one of the better insulins for "high dose" kitties. In fact, any time you go over 5u BID, it's usually recommended to check and see if your kitty might have a high dose condition. If your vet were going to switch insulin, the only other one would be Levemir, which works similarly to Lantus but doesn't "sting" at the higher doses (it's pH neutral, unlike Lantus).

As to the treats, the Temptations are chock-full of carbs, but even still, I don't see them being the major cause of the high numbers. What you want to look for are freeze-dried pure protein treats or you can boil up some plain chicken and use that as a treat, too. There's a treat list floating around here somewhere that someone should be able to share with you (I'm on my phone and can't seem to find it right now, otherwise I'd link to it for you ;-) ).

ETA: is it Purina DM wet that you've added? If so, it's expensive and unnecessary, but it's still low carb. If it's one of the other "prescription" DMs, then the rest of them are higher carb and you don't want to feed that. The myth that cats need more fiber is very outdated. If there are constipation problems or other digestive issues, psyllium husks and/or pumpkin can help without significantly increasing carbs or price.
 
Re: Vet appt for Friday May 9-would like some advice from Me

First I would stop the temptations treats, some cats are very carb sensitive and any high carb can spike blood sugar up to 24 hours. My bailey is one of them. One temptations treat and he stays high at least two hours.

Safe Treat list.. http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=9172

However i too agree there may be another issue here.. You need to check for infections (ear, UTI, etc), bad teeth or gums. And access to contraband of any sort. Assuming none, it's time to test for acromegaly or insulin resistance.. See here..

http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375
 
Re: Vet appt for Friday May 9-would like some advice from Me

I also agree, stop feeding her the Temptation treats. I also would have the vet check to make sure there is no infection going on or she does not need a dental. Any of that could cause higher BG readings.

It is also possible that you have missed the optimal dose and Berk is rebounding. In 1 1/2 months, you have gone from 1 unit to 5. That is a significant increase over a short period of time. You want to wait at least one week between dose increases before you determine another one is needed. There are several times in your spreadsheet, where you had several increases over a few days. Also you should only increase it by 1/4 to 1/2 unit at a time. My suggestion, especially if the vet rules out any infections, is to start over at 1 unit and very gradually increase it until you find your optimal dose.
 
Re: Vet appt for Friday May 9-would like some advice from Me

I would talk to the vet about changing to a different type of insulin like ProZinc. I would try proZinc over Levemir since they are different types if insulin while Lantus and Levemir are somewhat similar
 
Re: Vet appt for Friday May 9-would like some advice from Me

Hi Barb and Berkeley Girl
When you go to the vet, have the vet do a blood draw and have the sample sent to MSU to test for acromegaly and IAA....
You are feeding Fancy Feast, the cat's diet is fine, and you are up to 5.5u with horrific numbers in the nosebleed section.... anyone who talks nonsense about rebound or somogyi doesn't know anything about insulin resistance.


Here are the two links for the tests that you need to have done:
IAA Test
IGF-1 (Acro) Test

print out those 2 sheets and take them to the vet with you on May 9th....

If you followed the protocol that others use on this board, you WOULD be where you are in dosing in 6weeks, so rebound is ridiculous.

Do NOT switch to Prozinc or PZI; high dose cats, cats with resistance do much better on Levemir (detemir), so that's the 2nd thing you can have your vet do for you... give you a prescription for Levemir. Almost all cats at high doses and confirmed or suspected as having acromegaly are on Levemir.
Lantus is not as good as Levemir for high dose, acromegalic cats as I know, being an owner of 2 cats confirmed by tests positive for feline acromegaly, and one was also positive for IAA. One of my cats was not good on Lantus and she also had problems with shots but within 2 days on Levemir, she was a much happier cat. If she is having problems with the injetions, it may well be because it stings. Human diabetics have stated that Lantus does sting at higher doses but Levemir does not. The 2 insulins have diff ph so that fact may contribute to issues with some cats.

I don't think anyone has mentioned but cats with acromegaly are NOT diabetic but rather have diabetes because of excess growth hormone secretion from a pituitary tumor.

Do NOT start over at 1 unit BID; that's a great way to cause your cat to end up in the ER.
Do NOT switch to any vet insulin like Vetsulin, PZI, or Prozinc, but please DO consider switching to the longest lasing insulin which is Levemir.
You do want to stop the temptation treats and switch to something like freeze dried chicken or some moist treats that have NO sweetener in them.... just read the ingredients.
Have your vet send out blood to test for acromegaly as well as IAA.
If the cat is healthy and does not have horrid teeth, then an expensive dental is NOT going to do much for the dose... one of my acros was at 14u BID and dropped to 2.75u BID after her dental but that did NOT stay low; she climbed the dosing ladder right after the dental.
There are a couple members on this board who have owned acros, but the majority of owners of acros and other high dose cats can be found in the Facebook group with 136 members.
https://www.facebook.com/groups/acromegaly/

Finally, if you have noticed any noisy breathing or snoring, that would be due to soft tissue growth which all acros get. Please have the vet listen to the heart; heart issues have been shown to be common with acros, so keep an ear on the heart.
... there is treatment - several in the group have gone for SRT in a variety of locations in the US... most members in the group are not members here.

I can relate to your frustration and feeling down in general because I've been there.... twice.
You keep thinking this sucks, but hey maybe this next increase will be the one.... so you up the dose and you hold it and you test and you wait, but nothing changes. So you up the dose again and you hold it and you test for days and you wait, but nothing.
That's how it is but don't worry.... just keep going. I want you to look to Berk for signs because the dose does not matter; what matters is that you slowly begin to see Berk acting a bit better, eating less ravenously, maybe urine less, water input less, coat in a bit better condition, and her old habits seem to be coming back.... then you know that it's starting to work, and then you should slowly begin to see improvements in the numbers. So keep doing what you have been.... hold the dose for 6 shots, then up the dose by 0.5u if still getting the same numbers.

The 2 tests are done in MSU, the only place in North America so it's sent out and takes a week or a bit more to come back. You will then know how to proceed once you get those numbers, OK?
Also, go to the pharmacy and pick up some Humulin R or Novolin R because you need to get those high numbers down lower.... no wonder she is feeling like crap.

Big pats for Berk and smile because you are doing a great job caring for Berk.

Gayle Charambura
 
Re: Vet appt for Friday May 9-would like some advice from Me

Gayle has given you some excellent advice. Please let us know how the vet appointment goes. :thumbup
 
Re: Vet appt for Friday May 9-would like some advice from Me

Not too much to post but thank you for all the help. I printed out the lab forms and headed off to vet this morning.

Firstly, she concurred that Berk has lost weight again- Since April 19 to May 9 she has dropped a pound, now 12 lbs 2 oz but still has a pot belly-I think she has lost muscle-vet was quite disturbed over her physical shape-Berk was alert mentally but was walking a bit wobbly.

Vet examined teeth as I noted Berk turns head to right and chews on left-seems she has a bad tooth on the upper right.

No belly pain on examination, her temperature was normal, not dehydrated and she was breathing in OK but exhaling heavy so we went for an xray. The xray showed (let us see if I can recall everything accurately).:

lot of gas in intestines and intestines were larger (wider? ) than normal, her stomach was not in the normal place, her liver was enlarged and the pancreas was something-(maybe not shaped the normal way?). She had a bit of congestion in her lung bronchioles (butchered that-)

She is now at the peak of her lantus dosage as vet had said it was 1 unit per 2 pounds-hope that is right-in other words when she was 14 + pounds vet was OK with 7 units top, but now she is only 12 lbs and vet was nervous about going to the top (6 units) so we are staying at 5.5.

The sonogram was not done until after 5 pm so I have no results and Berk is overnighting with the vet.

Supposedly Berk was going on antibiotics today for the tooth infection and just general overall, the sonogram was to check for problems maybe causing the diabetes as well as intestinal issues such as irritable bowel and goodness knows what could be the cause of the liver etc problems. (I always worry cancer).

The vet I was seeing left at 5pm so I will not get any info until tomorrow when I go to pick her up. The vet said she would write everything out. She is agreeing that there is something else other than diabetes happening. Possibly diabetes is secondary. She said she would draw bloods for the lab tests but felt we should hold off till after sonogram results and dental work. She was more inclined to feel insulin resistance than acromegly (sp?) I think Berk has oversized head but vet says she does not fit normal profile.

This vet is also off this weekend and I do not think they normally do teeth etc on weekends so I do not think much will happen till next week. The head vet is on this weekend but I do not know if she will weigh in on the case.

I forgot to ask about using short term insulin to reduce her levels and nothing was said today about that.
 
Re: Vet appt for Friday May 9-would like some advice from Me

Oversized head, pot belly, larger organs.... That sounds like acromegaly to me. I'm no expert, but be sure to get those tests done. She might even have both, which is fairly common if I'm not mistaken.

As for insulin dosage, you give as much as needed to get those numbers down. Cats with high dose conditions can get up to 20u or more BID, so if Berk has a high dose condition, there's still a lot of room on the dosing scale.
 
Re: Vet appt for Friday May 9-would like some advice from Me

Did the vet draw blood and have it sent out to MSU to test for acromegaly and IAA?
There is no "max dose for a cat who has insulin resistance; you want to increase the dose every 6th shot.

Cats with conditions you have mentioned usually test positive for acro.
You have been holding the dose for much too long and those continual high numbers are going to contribute to organ damage. She is likely feeling horrible from the constant numbers in 400s and 500s; it's no wonder that her breathing sounds bad.

The max dose for my two acro cats were 21units twice a day and 37units twice a day.

Did Berk get insulin today? There are no doses posted and no BG numbers are posted.

Please keep increasing the dose for Berk. Give 6u dose for only 5 shots / 2 1/2 days and then up the dose to 6.5u and hold for the same length of time.
Continue dosing in this fashion until you are seeing decreasing numbers, OK?

Please tell your vet that insulin resistance does not cause enlarged organs.
IAA is insulin resistance of a sort, and that's why you want the IAA test done because some cats have only IAA.
Most cats who have numbers EXACTLY like Berk often test positive for acromegaly and also IAA like my Oliver.
I am not sure why your vet does not think Berk could be acromegalic because Berk has several signs....
insulin resistance and high dose
enlarged organs
pot belly
diabetes
.... those are pretty common symptoms for acromegaly.
I think you got yourself a sweet acro girlie, so you need to increase your dose more often or the resistance will be harder to break.

Resistance is like a speeding train and you need to be like Superman.... you need to be faster and get in front of it and stop that resistance train. Right now, you are just running alongside the train and the dose will keep going up and up and up unless you get aggressive and stop it.

Gayle
 
Re: Vet appt for Friday May 9-would like some advice from Me

She may well have acromegaly but the temptations treats and the tooth infection isn't going to help either and will keep her high. Any infection will spike BG. What did the vet say about the tooth. Does it need removed? Cats with acromegaly can have issues during surgery.
 
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