11:34am 5/26/2016 TiTi on Thursday

[Kathy and TiTi]

http://www.felinediabetes.com/FDMB/conversations/ss.101206/

I've been advised by an experienced and trustworthy member of this group to reduce TiTi's dose back to 9 units.

During the last 24 hours TTi was urinating less, and drinking less water, so I tested her this morning before her insulin shot. She was at BG 474, which perhaps indicates a downward trend, although I was told that the meter's margin of error is at 20+ or -. She has no ketones this afternoon.

Since TiTi has had so many drastic changes in her insulin, several of which caused to her to get very ill, I am not eager to change her once again, and surely not by 4units.

The most significant error made in the last 2 years was right at the beginning after about 6 weeks. AT 10u/bid insulin, TiTi was asymptomatic, except for BGs that were too low My vet reduced TiTi from 10 units to 1 unit. 10 units was too high, since she was testing at BG50 and BG40 units. But dropping down to 1 unit, was a mistake. TiTi got very ill, and until her dose was raised, she looked pretty bad.

 

[Kathy and TiTi]

ACROMEGALY: Ok, I looked up the flags :
7) Have you noticed changes in the way your cat breathes? Any changes in their eye sight?
8) Have you noticed any behavioral changes in your cat? For example, appearing to be in pain, avoiding bright light.
9) Have you noticed any physical changes in your cat's appearance? : Physical changes are a ratty looking coat, and prominent spine
10) Has your cat had a tendency to gain weight despite no increases in amount of food you are feeding?

For Cushings:
* Increased water drinking: YES
* Increased urination: YES
* Increased appetite: YES
* Weight gain or loss:
* Bloated or "pot-bellied" appearance
* Excessive panting
* Thinning hair or baldness Maybe
* Dull, dry coat YES
* Thin skin that is easily bruised or torn:

But the drnking and urination are the regular symptoms of insulin problems anyway. No?

 

[Marje and Gracie]

Here is the condo discussing a potential decrease of the dose to 9u bid as you referenced above. I was involved in the discussions Julie references.

Yes, drinking and urinating a lot are symptoms of unregulated diabetes. The variation potential in meters is 20% not 20 mg/dL so that's a big difference. for example, if her BG was 600, then 20% variation either way could mean she could be as low as 480 or she could be higher than 600 but since she's at 474, that is within meter variance.

 

[Kathy and TiTi]

Ah, ok. Thanks for the clarification. What is haunting me is, if two years ago my vet had understood the significance of TiTi's apparent "cure" on 10u/bid, 2 years ago, TiTi would either be successfully stabilized , or be off insulin alltogether.

Her diabetes was preceded by large, long term doses of prednisone to treat her pancreatitis. At the time of diagnosis of pancreatitis, there were no irregularities in her BG.

 

[Kathy and TiTi]

Here is the condo discussing a potential decrease of the dose to 9u bid as you referenced above. I was involved in the discussions Julie references.

Yes, drinking and urinating a lot are symptoms of unregulated diabetes. The variation potential in meters is 20% not 20 mg/dL so that's a big difference. for example, if her BG was 600, then 20% variation either way could mean she could be as low as 480 or she could be higher than 600 but since she's at 474, that is within meter variance.

______________________________________________________________________
I am looking over the chart and seeing what you are seeing, but the fructomasine test would indicate that for the last few weeks on 9u insulin, TiTi’s insulin needs had soared upward. Some of this could have been from the infection, though.
I don’t know. I’m not sure of anything.

The other problem I have with the 9Units dose is that during all that time, her copious urination and H2O drinking maintained at a steady volume-way too much.
It is possible, of course, that level of polyuria/dipsia, when TiTi’s BG numbers were rather low, indicates that her problem is either acromegaly or insulin resistance.

Any thoughts on this?

 

[Kathy and TiTi]

I got the other kit today, so I can test TiTI 3 times a day. Her peeing and drinking are definitely slowing down. I need to keep a close eye on her. The last time her water drinking slowed, she got very constipated. I think her system was so used to the excessive water that her intestines went into a kind of slowness needing more water to move.

I want to see if her numbers get lower, on the present dose, and then move down. I am, at present, afraid to change anything. Seems like I have made a lot of trouble for TiTi changing around so much.

Also I have a question. When moving down to lower numbers, did y’all mean for me to go
from 13 to 9 quickly, slowly, or how were you considering the move?

 

[Marje and Gracie]

She's been on 13u since 5/9 and so the fruc test would have been for that timeframe. It's high because she's spiking I to those black numbers.

Because you have not been able to test but once a cycle, we really have no clue what she's doing. For example, I've seen cats go from 300+ at AMPS to 40 at midcycle and back to over 300 at PMPS. Without the midcycle test, the caregiver would have thought the kitty needed more insulin. But, keep in mind that the lowest number is not always at midcycle. Often if they are clearing bounces, the lowest number might be at preshot.

As you can see, there is a lot of data missing so it's hard to put the pieces of the puzzle together. I think you will have to test a lot more than three times a day to determine if this dose is a good one or not.

We would suggest that you drop back to 9u all at once. Take a look at Teronto's SS. The vet had him on 10u twice a day and we suspected overdose. We had her decrease the dose and he went off insulin. This might not be what is happening to Titi how's you what "can" happen and why we are concerned that this dose is too high.

 

[Kathy and TiTi]

She's been on 13u since 5/9 and so the fruc test would have been for that timeframe. It's high because she's spiking I to those black numbers.

Because you have not been able to test but once a cycle, we really have no clue what she's doing. For example, I've seen cats go from 300+ at AMPS to 40 at midcycle and back to over 300 at PMPS. Without the midcycle test, the caregiver would have thought the kitty needed more insulin. But, keep in mind that the lowest number is not always at midcycle. Often if they are clearing bounces, the lowest number might be at preshot.

As you can see, there is a lot of data missing so it's hard to put the pieces of the puzzle together. I think you will have to test a lot more than three times a day to determine if this dose is a good one or not.

I now test before both the morning and evening insulin shot, and I also test at various midday hours, trying to find the nadir.

We would suggest that you drop back to 9u all at once. Take a look at Teronto's SS. The vet had him on 10u twice a day and we suspected overdose. We had her decrease the dose and he went off insulin. This might not be what is happening to Titi how's you what "can" happen and why we are concerned that this dose is too high.

I may have misled you by posting the fructomasine results when I did. This blood test was sent out to the labs sometime between May 9th and May 10th. It took a while for the results to come back, and I posted them to the group even later. so there was a lag of several weeks between when the blood was drawn, and the time I posted the results.

The blood levels were taken for the test on MAY 9th, and reflected the previous 2 or 3 weeks, during which TiTi was on 9 units bid every day of that time period. Thus the test results reflect several weeks of TiTi's glucose levels, while getting 9 unitsof insulin twice a day.

Presently TiTi is getting 3 BG tests a day, as you can see from her SS. That is a new .