1/10 Wally - AMPS: 442, +5: 402, PMPS: 406, +3: 343

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http://www.felinediabetes.com/FDMB/threads/1-8-wally-amps-436-6-405-pmps-433.209194/

Seems like this guy loves to fly flat and high!!

Any suggestion other than threatening him of massive dose increase to convince him to come down to our floor?

Am I going to keep 5.5U for 2 more cycle or not?

Met my endocrinologist today... we had a fast chat ....he suggested to try a fast acting insuline... I don't know if it's a good idea.

Hugs to all of you

 

I'd stick with Lantus and keep up the increases. You rarely have a black PS now and that's progress. You just need to find his good dose range - you're not there yet. As some people have already said the cat needs the dose he needs.

 

Update with 343 at PMPS +3 ....a little better

 

Unless you see yellow later tonight, I think you could resume the fast track increases and go to 6 units tomorrow.

Was he talking about a fast acting insulin in addition to the Lantus? Many of us with cats with high dose conditions (or some prone to ketones) have used a fast acting insulin in addition to the basal Lantus or Levemir. Lantus/Lev aren't good at yanking down numbers, but the right use of R (Humulin/Novolin R are used in North America) at the right time of the cycle as a bolus can take the numbers down a little and give the L insulins a better number to work with. Do you remember the name of the insulin he was thinking of?

If you are interested in proceeding with this, let us know. We usually find someone the "sit" with you the first few times you try the fast acting insulin. There are several guidelines both for when to use it, and when to not use it. It's a powerful insulin and caution is important. We would also slow down the Lantus increases if you want to try the fast acting insulin.

 

Hello Wendy,

I read your message too late ... he had 5.5U today and now closed the 6th cycle with this dose

He will definitely get 6U tomorrow as you suggested.

I was wondering if having 6 cycles instead of just 4cycles on the same dose (as we did) would have any negative effect on the healing...

Concerning the fast acting insuline he didn't mention me the name. He used Humulin when hospitalized. I would like to know if you believe it's a good idea to proceed with it in the hope to reach regulation and hopefully future remission. I am bit of scared it might be more complicated to manage and unpredictable effects compared to lantus

Thank you!

 

Regarding the fast acting insulin, yes it is more complicated to use it in addition to the Lantus. You have to learn it’s onset, nadir and duration in Wally, just like any new insulin, but you also have to figure out when to give it in the Lantus cycle and how the effects of the two insulins combine. Initially there is quite a bit more testing to figure that out. The good thing about using fast acting, and I will assume it’s Humulin R for now, is that if you can’t monitor, you just don’t give it. In addition to helping the Lantus by giving it lower numbers to work with, another benefit happens with higher doses. With a higher Lantus dose comes a higher depot. If a cat’s insulin needs reduce for any reason, you have to also deal with the action of the larger depot. But if you are giving R, you are generally giving a lower Lantus dose so have a smaller depot. Anyway, think about it. There is no rush to add it to the routine, it’s just an option.

As for holding the dose, it’s better for Wally to try to get him into better blood sugar numbers faster. Right now he will have glucose toxicity, and these high numbers are making his kidneys work much harder. You can slow down the increases once you start to see numbers under 300. He’s getting closer.

 

Thank you as always...

 

So I am guessing you shared the actual published article on TR and your endocrinoligist attitude has improved?

 

I took that occasion to ask about his impressions on the paper and he said that he didnt know the TR protocol ....More over the fact that he suggested to switch to some other insulin made me think that he didnt care much about the content of the pubblication!

 

You are welcome. We did help a caregiver in France with a kitty and rapid insulin, so we can get over the time differences. Most of the people who can help you use it are in North America.

Sorry to hear the endocrinologist hadn’t heard about TR. Even Neko’s vet who insisted Caninsulin was a good cat insulin had heard about it,

 

That's too bad, if your endocrinologist would educate himself on the research that has been done on TR he could help a lot more felines to possible diet controlled remission using TR.