Wynken: going to Ohio State (Dr Gilor) Monday

[Cara and Wynken (GA)]

Hi all,
I haven't been around very much this month (very busy) and I've missed everyone! I have been following my vet's advice most the month and so haven't had any questions... But it is not going particularly well.

As some of you know, my sugar kitty has not had the response to insulin that his vet & I want to see... It has been MONTHS now, in what I consider unacceptably high numbers. I have 10 other kitties and 3 of them are have pretty serious issues as well, although Wynk is my only diabetic... I admit he does not get quite the attention he would if he were an only cat or I only had a few, but I committed to all of these kitties many years ago & they are my children. Five of them are 17 years and older. Wynken is 12.

In January there were a few times on 2u or slightly more, when he got a really good drop into yellow blues and even greens... But then we would get what looked like bounces... And so in late January, I asked his vet to consult with diabetic specialists, and she did. She knows Dr. Gilor at OSU, and @BJM had referred to him as well, in an earlier post. She sent out the link to Wynken's sheet and it took awhile to hear from him.... In the meantime another doc on a Vetrinary message board advised a decrease to 1.5 (or 1.6) u. That same day, Dr. Gilor finally answered and advised the same thing. He also said he would like to see Wynken, which I jumped at (!) and made an appt for Feb 29. So on Feb 6 I lowered his dose.... Left town & had sitter give 1.6u the week I was gone. Came home to steady reds/pinks and have spent the rest of the month creeping back up to 2u, consulting with his vet. Was especially unhappy with yesterday's "curve" where he did not drop. I think that clinically he's still "ok" but not as good as I'd like... I shouldn't complain -he actually acts like feels great, though I have noticed signs of larger urine balls in their litter box, and he seems to sleep more. He otherwise does act fine and eats all of his carefully measured food (low carb wet). No ketones... I checked a few times.

So, to sum up, I think he needs more insulin, or different insulin or SOMETHING. I have only ever used Prozinc on him... And it used to work!

I have no idea what to expect or even ask Dr Gilor tomorrow, other than laying out the situation, reviewing his data and asking for how to get him regulated. Thoughts? I'm asking because maybe I might not think to ask something...

 

[BJM]

I suspect Dr Gilor will want to check some of the things that may interfere with insulin response such as duration, food, other conditions - even if he isn't high dose per se, he is a big cat, so acromegaly; possibly IAA, Cushings, imaging for pancreatic abnormalities, etc.
Do show him the syringe conversion chart so he knows you're dosing correctly.
He may want you to try Lantus or Levemir which work very differently as those have a build up or depot effect and have carry over or overlap effects from shot to shot. The US cost is about 3 times higher than Canada. If so, getting it from Mark's Marine has been a good place for our members to get it mail order.
Or he may suggest trying something else. Sometimes, a comination of 2 insulins may work better than 1 alone, where a tiny dose of short acting R insulin might be given along with the ProZinc. This is more common in cats with acromegaly where the R brings it down and the longer acting insulin keeps it down. (See Suki and Crystal over in Lantus for an example in acromegally).

 

[Sue and Oliver (GA)]

Good to "see" you again, Cara. But wish it was with better news. His reaction to insulin is strange. The lower doses do sometimes give you more encouraging numbers, but that doesn't seem to last. And raising the dose doesn't help either.

I would try another insulin. Some cats react better to one insulin over another. The good news is that he hasn't looked like a high dose kitty and he isn't in high dose numbers.

I don't know if you will hear from Robin or Cindy. Cindy lost Merlin and has been working full time. Robin has not been well for some time and isn't posting either. I miss them both so much!

 

[Cara and Wynken (GA)]

I suspect Dr Gilor will want to check some of the things that may interfere with insulin response such as duration, food, other conditions - even if he isn't high dose per se, he is a big cat, so acromegaly; possibly IAA, Cushings, imaging for pancreatic abnormalities, etc.
Do show him the syringe conversion chart so he knows you're dosing correctly.
He may want you to try Lantus or Levemir which work very differently as those have a build up or depot effect and have carry over or overlap effects from shot to shot. The US cost is about 3 times higher than Canada. If so, getting it from Mark's Marine has been a good place for our members to get it mail order.
Or he may suggest trying something else. Sometimes, a comination of 2 insulins may work better than 1 alone, where a tiny dose of short acting R insulin might be given along with the ProZinc. This is more common in cats with acromegaly where the R brings it down and the longer acting insulin keeps it down. (See Suki and Crystal over in Lantus for an example in acromegally).

Thank you BJ, all of that is stuff I can google today... And educate myself a bit. The Lantus forum is intimidating! Even the standard way the title their posts, and so much posting!! I will do whatever I have to, to get him regulated, including coming home mid day from work and mid-night checks and/or micro dosing of other insulin.... I also appreciate knowing where to get Lantus or Levemir.
Thanks for your reply!

 

[Cara and Wynken (GA)]

Good to "see" you again, Cara. But wish it was with better news. His reaction to insulin is strange. The lower doses do sometimes give you more encouraging numbers, but that doesn't seem to last. And raising the dose doesn't help either.

I would try another insulin. Some cats react better to one insulin over another. The good news is that he hasn't looked like a high dose kitty and he isn't in high dose numbers.

I don't know if you will hear from Robin or Cindy. Cindy lost Merlin and has been working full time. Robin has not been well for some time and isn't posting either. I miss them both so much!

Oh Sue, I am really hoping for another insulin (or as BJM said, maybe more than one) to get him regulated. But I will miss you terribly if we go to other forum.
You and Robin were GREAT at gently guiding me when I first got here.... And gave me a lot of helpful tips. I learned so much! I miss Robin too, and hope she's taking care of herself.

 

[Sue and Oliver (GA)]

Cara,

@Bobbie And Bubba switched to Lantus and are having good success. I know she would help you get acclimated.

 

[Sue and Oliver (GA)]

And she comes back to say hello every so often. You can do the same! I need some help - it is only me and Rachel for regulars right now.

 

[BJM]

all of that is stuff I can google today

Just read over the sticky posts at the top of the [url=www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/]Acromegaly, IAA, and Cushings[/url] forum here.

And the stickies at the top of Lantus, while many, discuss how to optimize the use of that insulin and 2 different methods for using it (Tight Regulation and Start Low, Go Slow) They have a format they use for posting every day which is date, cat's name, and then the test values are added throughout the day as you get them so there is only 1 post per day per cat.

 

[Bobbie And Bubba]

Cara,

@Bobbie And Bubba switched to Lantus and are having good success. I know she would help you get acclimated.

Cara, I certainly would help you if you should switch to Lantus and I know that everyone there would as well. I am so glad that I switched because I think it's easier to work with. There is a set protocol for it. Before I switched to Lantus, I was right there where you are : too much insulin/ not enough insulin. In Bubba's case it was not enough insulin and he was a late nadir cat that made his SS very very confusing. A while back I did broach the subject with you that Wynken could also be a late nadir cat and Libby did respond to your thread and also felt that he is. If that is the case, Lantus will allow you to shoot lower numbers and be more consistent with your dosing.

If you decide to switch, post in the Lantus and Levemir forum that you are switching and ask for a starting dose amount. And I just want you to know, that I know how scared you are to switch. I cried the whole day before grieving that I was leaving my ProZinc family ( which in retrospect is silly cause they are just one forum away) but, I do understand. The peeps in L & L are great too and you can come back to ProZinc to visit!

 

[Rachel]

Cara, I'm so glad to see you! Yes, we miss Robin and Cindy greatly. I always enjoyed them being around to help out and just chat with! I hope they'll pop in when they can to say hi.

I'm with everyone else...I think it's time for a switch. I know we all hope that whatever insulin we've got will work, but the best insulin is the one that works for your cat! Bobbie was worried about switching, I know, but I check in on the L&LL forum sometimes and I see she posts often and gets lots of help! She can show you around I'm sure.

As Sue said...if you do switch, please come visit! We can use the help for sure...with my work schedule, it's tough for me to be here during the day, and weekends are busy with errands...though I do what I can! Sue is definitely a rock here for us!

Plus...we will want to know how Wynk does!

 

[Cara and Wynken (GA)]

If you decide to switch, post in the Lantus and Levemir forum that you are switching and ask for a starting dose amount. And I just want you to know, that I know how scared you are to switch. I cried the whole day before grieving that I was leaving my ProZinc family ( which in retrospect is silly cause they are just one forum away) but, I do understand. The peeps in L & L are great too and you can come back to ProZinc to visit!

Thank you so much Bobbie!! I know that you had posted a while ago about the late nadir, but I totally missed understanding that maybe the insulin was part of the problem (Duh!). I think I've had a one track mind with his insulin because my vet doesn't seem to have any experience with prescribing any other insulins except for prozinc. And you're right… I am scared to switch. However, your feeling better about the switch that YOU made gives me confidence! Thanks for being in both forums, so that I can have somebody that I know, when I go over there, if I do.

 

[Cara and Wynken (GA)]

Cara, I'm so glad to see you! Yes, we miss Robin and Cindy greatly. I always enjoyed them being around to help out and just chat with! I hope they'll pop in when they can to say hi.

I'm with everyone else...I think it's time for a switch. I know we all hope that whatever insulin we've got will work, but the best insulin is the one that works for your cat! Bobbie was worried about switching, I know, but I check in on the L&LL forum sometimes and I see she posts often and gets lots of help! She can show you around I'm sure.

As Sue said...if you do switch, please come visit! We can use the help for sure...with my work schedule, it's tough for me to be here during the day, and weekends are busy with errands...though I do what I can! Sue is definitely a rock here for us!

Plus...we will want to know how Wynk does!

Rachel!! Thanks for weighing in. You have also been a big help to me & Wynken. I know you are all right and there needs to be some kind of change... I will check in & visit no matter what. Love you guys!!

 

[Cara and Wynken (GA)]

Just read over the sticky posts at the top of the Acromegaly, IAA, and Cushings forum here.

Ok, I am trying to not get upset here, but I find that I am a little bit upset with myself… Because I'd heard about Cushing's, and I've heard about acromegaly… But I'd never really read up on either one of them. I think it's one of those things where I was just too busy to investigate something that I didn't think applied to me. But now that I read about acromegaly, it's almost frightening how accurate the description is, as applies to my sugarbaby. Wynk has always been an unusually big boy. I happened to see him and his littermate sister (Blynken) when they were just a few days old. They were born to a feral mother who we later calmed down enough to spay and take care of. There were two other littermates who were not pure white, and could hear. So I found good homes for them. However, these two deaf children seemed to be side-by-side all of the time, and I did not have high hopes of finding a home that would appropriately care for TWO deaf cats. I could not separate them, and so they became mine. So I watched them grow up. Until they were a few months old they were identical in size and extremely difficult to tell apart. But then he started growing a lot bigger...and by the time they were over a year old it was easy to tell them apart at a distance even though they're both pure white. By the time he was two or so, he was triple her weight with big paws and a big head. She has stayed unusually petite and has never weighed over 6 pounds. At one time he was 17 lbs and she was 5. I've always wondered about this, and had never considered growth hormone.

I'm not familiar with the name of the test that they do, and so I don't believe he's ever been tested… So I'm going to make sure that I ask about that tomorrow, if the doctor doesn't bring it up. I will be stunned if he doesn't test positive for it.

I'm really wondering why his regular vet didn't suggest this, or offer that we could test for it? I know I'm leaping to a conclusion, but I just know this is it.

 

[Bobbie And Bubba]

Thank you so much Bobbie!! I know that you had posted a while ago about the late nadir, but I totally missed understanding that maybe the insulin was part of the problem (Duh!). I think I've had a one track mind with his insulin because my vet doesn't seem to have any experience with prescribing any other insulins except for prozinc. And you're right… I am scared to switch. However, your feeling better about the switch that YOU made gives me confidence! Thanks for being in both forums, so that I can have somebody that I know, when I go over there, if I do.

You are welcome. Let me know if you are going over and I will look for you. You can get one Solostar pen of Lantus at Walmart for just $86 bucks and do not have to buy the whole set of 5 which is pricey. Did anyone talk to you about Mark's Marine Pharmacy in Canada, a lot of peeps get their Lantus there for much less. A set of 5 pens for about 144 bucks. I purchase a set from Alan in the Supply Closet, it was about 150 bucks for 5 pens including the shipping, comparable to Mark's prices and Alan's is coming from TX. I am currently using one of his pens now and all is good.

 

[BJM]

Some cats are just BIG! Ex. Maine coon cats can be upwards of 30 pounds of all muscle!
So wait until you find out what Dr Gilor thinks and breathe

I've a 13 pound boy and he has big paws, too. He likes to headbutt me, especially when I'm holding a cup of tea!

The test to get is listed in the high dose group. Its done up in Michigan, I believe.

By the way - I live and work in Columbus, so if you need an ear tomorrow, pm me and I'll give you my phone number.

 

[Bobbie And Bubba]

Ok, I am trying to not get upset here, but I find that I am a little bit upset with myself… Because I'd heard about Cushing's, and I've heard about acromegaly… But I'd never really read up on either one of them. I think it's one of those things where I was just too busy to investigate something that I didn't think applied to me. But now that I read about acromegaly, it's almost frightening how accurate the description is, as applies to my sugarbaby. Wynk has always been an unusually big boy. I happened to see him and his littermate sister (Blynken) when they were just a few days old. They were born to a feral mother who we later calmed down enough to spay and take care of. There were two other littermates who were not pure white, and could hear. So I found good homes for them. However, these two deaf children seemed to be side-by-side all of the time, and I did not have high hopes of finding a home that would appropriately care for TWO deaf cats. I could not separate them, and so they became mine. So I watched them grow up. Until they were a few months old they were identical in size and extremely difficult to tell apart. But then he started growing a lot bigger...and by the time they were over a year old it was easy to tell them apart at a distance even though they're both pure white. By the time he was two or so, he was triple her weight with big paws and a big head. She has stayed unusually petite and has never weighed over 6 pounds. At one time he was 17 lbs and she was 5. I've always wondered about this, and had never considered growth hormone.

I'm not familiar with the name of the test that they do, and so I don't believe he's ever been tested… So I'm going to make sure that I ask about that tomorrow, if the doctor doesn't bring it up. I will be stunned if he doesn't test positive for it.

I'm really wondering why his regular vet didn't suggest this, or offer that we could test for it? I know I'm leaping to a conclusion, but I just know this is it.

It's good that you are looking into it BUT, Bubba is a HUGE cat also, much bigger than his litter mates were too. (remember the kitties in one litter can all be from different daddies) At one time Bubba was 25 lbs! He lost a lot due to the diabetes. We have him at around 17 now and he looks good. There are other symptoms for the Acro cats too, not just size. So please don't get too upset yet.

 

[Bobbie And Bubba]

Some cats are just BIG! Ex. Maine coon cats can be upwards of 30 pounds of all muscle!
So wait until you find out what Dr Gilor thinks and breathe!

The test to get is listed in the high dose group. Its done up in Michigan, I believe.

Thanks for responding also BJM . I could feel Cara's panic.

 

[Cara and Wynken (GA)]

Bobbie and BJ, THANK YOU...I was feeling panicky... Nothing makes me feel worse than thinking I've missed something. The appt tomorrow is at noon Eastern, so I will just wait and see what Dr Gilor says. It is almost 2 hours one-way to get to OSU. Luckily Wynk is a ponderously calm boy, although he can meow (like only a deaf kitty can!) on a long car ride.

Interestingly, this will not be his first trip to a University for healthcare. When I lived in Illinois I drove a little over three hours to get him to the University of Illinois at Champaign, because he needed to see a special soft tissue surgeon for a urethrostomy. We got through that in 2008, and we will get through this!

Thanks again! I will create a new thread tomorrow and let everyone know what the doctor says.

 

[Sue and Oliver (GA)]

Cara, I really don't think about high dose conditions until the cat is on 5+ units. It seems like high numbers on higher doses are a big part of the problem and often what sends beans to wonder about other symptoms. I agree - he may just be a big cat. One step at a time, Cara. And remember that breathing thing.

 

[Marlena]

Bobbie and BJ, THANK YOU...I was feeling panicky... Nothing makes me feel worse than thinking I've missed something. The appt tomorrow is at noon Eastern, so I will just wait and see what Dr Gilor says. It is almost 2 hours one-way to get to OSU. Luckily Wynk is a ponderously calm boy, although he can meow (like only a deaf kitty can!) on a long car ride.

Interestingly, this will not be his first trip to a University for healthcare. When I lived in Illinois I drove a little over three hours to get him to the University of Illinois at Champaign, because he needed to see a special soft tissue surgeon for a urethrostomy. We got through that in 2008, and we will get through this!

Thanks again! I will create a new thread tomorrow and let everyone know what the doctor says.

Dear Cara,
Most cats have symptoms when they have acromegaly and they really need high doses of insulin.
I was worried about my cat Rocky as well although he is not on a high dose but he is difficult to regulate. He is a big cat weighing over 17 pounds, he lost a bit of weight when he was on Caninsulin and not regulated. He had a test for IGF-1 twice and I asked the vet to run it. This is a test to diagnose acromegaly. Another test is for growth hormone but it is very expensive and not really reliable but it is that hormone which is overproduced in acromegaly cats. Rocky's level of IGF-1 was too high but not high enough to diagnose acromegaly and was repeated after six months and was almost in a normal range. It is a very good idea to run this test as some cats do not show typical symptoms od acromegaly but have test results and BGs indicative of the disease. It is less common though. I think that Wynken probably hasn't got acromegaly but without testing you will never know. Good luck.
I do understand how distressing this is for you as I'm in the same "boat". We can only support each other, praying for you and your kitties.
Lots of love and hugs from
Marlena and Rocky

 

[Carol & Murphy (GA)]

Hi Cara - we are all anxiously looking forward to hearing about how your visit went, and please tell us everything the vet said - especially about prozinc
I've come to the conclusion that Murphy will probably have to switch as well, although in his case, I am sure his wild numbers are due to the wild swings in his food and all his food aversions and too much wet food causing IBD/pancreatitis flare. Plus I need to be gone for about a week at the end of April and I am flying my niece in to care for Murphy (he needs so much attention especially to make sure he eats) - so I'm scared to make the switch until then
So we are all anxious to hear about your vet appt yesterday

 

[Dawn and Peek-a-Boo (GA)]

I, too, am interested in how your visit went.

 

[Cara and Wynken (GA)]

Hi guys! I am sorry it has taken me a while to get back to this thread. On Monday, so much of the day was spent driving to & from Columbus… And we ended up spending over six hours at OSU. I had taken a day of vacation, but had no idea it would take the entire day. Then, when we got home that night (over an hour past food & shot time!) there were all of my kitties to take care of. I collapsed into bed, and then yesterday morning I had to leave on a business trip. This morning I am waking up early in a hotel, but have two days of meetings to look forward to where I won't be able to write anything at all. I'm going to start another thread where I'm going to write about the things I heard the doctor say. However I won't be very available to answer back for awhile. (dang work, anyway!)

 

[Rachel]

Well update us when you can! We're all looking forward to hearing!

 

[Carol & Murphy (GA)]

Well update us when you can! We're all looking forward to hearing!

Thanks Kara - Rachel - how are things going with you?

 

[Rachel]

So so. Everyone's acting all right (at the moment) but I'm possibly getting a bit obsessive. I follow them around and worry and panic kind of constantly. I'm not even sure what I'm so worried about. I mean, the money is tough, but that's why they make credit cards. My BF is supportive and as he said "if they get sick and we can treat it, we will". So I'm not sure what the huge worry is...I just worry.

Anyway, with luck, the food change will help. I think we're switching to raw once we can afford a grinder, so maybe that will help too.

How are you? I saw you mentioned things are tough in Murphy land...

 

[Cara and Wynken (GA)]

Rachel and Carol, please continue to use this thread to let me know how your kitties are doing! I started a new thread to talk about what the doctor said at Ohio State, but I didn't even mention Wynken. He was such a good guy in the car. And then absolutely exemplary patient. I just love that cat so much!!!!!!!!