4/17/18/Ravan/+3 339/+8 198/pmps448/+3 374/+5 384/+8 445

http://www.felinediabetes.com/FDMB/...3-331-8-260-pmps451-3-321-6-391-8-525.194214/

Looks like a repeat of the last increase?

 

I think the others have told you about NDW (new dose wonkiness)? It looks like Ravan may be a cat that reacts that way to dose increases. My cat does the opposite. He would drop low on a slight increase, then go up and stay there until the next increase. How is he feeling? Has he settled down or still having some restlesness?

 

@Sharon14

I just read about cats having insulin resistance. The study said,"insulin resistance is extremely rare in glargine treated cats"

"Further investigation of the cause of marked morning hyperglycemia in diabetic cats treated with glargine is indicated to determine if inadequate duration of insulin is the underlying cause"

"This generally resolves with time using consistent dosing"

Does that mean to keep the dose the same for a Longer amount of time?

 

I wouldn't hold the dose longer than the 10 cycles. The more time a kitty spends in high numbers the more he/she gets used to it and the harder it is to break through it. I speak from experience having done that with Boomer after a dental last year. You test enough that you could be following TR, at least for a while until Ravan's numbers are lower.

 

I agree with Judy. The longer he stays at an ineffective dose, the more resistant he'll be to the effect of the insulin. It's your choice of course.

 

Insulin resistance is something we see around here, but Ravan’s dose is too low that we would be concerned for anything like that just yet.

Glucose toxicity is a bigger concern. If the numbers are high and you hold the dose too long, you risk having a lot of trouble with anything changing on the next increase because it’s been set in as the new normal again. This can create a situation where you have to eventually give a higher dose of insulin than you would have if you increased as soon as you could on a dose that’s getting him nowhere close to where he needs to be. You’ll really want to consider getting ahead of that.

 

Yes...this! I couldn't think of the name for it

 

Poor word choice on my part. I was referring to the effects of glucose toxicity that create a lack of responsiveness to the insulin. Thanks, Stacy.

 

@Stacy & Asia
@Judy and Boomer
@Kris & Teasel
"This generally resolves with time using consistent dosing"
"inadequate duration of insulin is the underlying cause"

What are they referring to in this study? "consistent dosing " and "inadequate duration" ?

 

If his body is resisting the insulin increase and causing insulin toxicity it must be harming him. He gets very agitated & restless,starts wanting food & water constantly. And now he's more prone to ketones Isn't that correct?

It feels like I'm poisoning him!

I'm not testing him because i want to ,he wakes me every 2 hour crying for food. I feel like I'm falling apart mentally & physically.

Every time I raise the insulin I'm worried sick over ketones or Hypo. Maybe years ago i could have coped better with this but at 71 yrs old & medical problems I'm feeling sick & stressed out.

Did anyone ever think just because this is the way it's been done for a long time that maybe there's a Better way? The medical profession is like that. They stick with the same way they were taught & often refuse to even look for a better way. (If it worked for all these years for hundreds of people it must be OK.) Then someone comes along & finds a better answer. I don't know where to look but do you think there might be someone out there that is working on this? I'm not real good with the computer so I don't know how to look things up like that.

I've been complaining for years ,why don't they do more testing on cats? There use dogs most of the time.

 

Higher AM numbers is something a lot of us deal with on a regular basis. Hormones tend to drive the cat's BG up in the wee hours of the morning (I think it happens with human diabetics too). Right now, and in my opinion, you don't need to worry about getting the AM numbers down but getting all of the numbers down. That won't happen until you reach the correct dose of insulin. I would encourage you to try TR. You test enough to keep Ravan safe. And you could increase his dose every 6-8 cycles instead of waiting 10. I know how frustrating this is! I've been there!

 

Have a look at this:
http://petdiabetes.wikia.com/wiki/Glucose_toxicity

 

@Kris & Teasel

In June of last yr Ravan had blood work His Glucose was normal . THe following January blood work showed High glucose 500. He was started on Lantus within a week. (Ravan had not been in a car or to a vet in nearly 15 yrs The car & exam were "Extremely" stressful for him. I'm sure it raised his bg at that time of the blood test.

It's been 10 1/2 weeks that he's been on Lantus. It did seem in the beginning he was having a good response, some blue. His bg went up to 500 when I increase the dose.

So now to continually increase the dose seems to be putting his body under a lot of stress also. A lot of the cats I've read about with high doses get heart problems.

Has anyone used insulin sensitizers or metformin? It stated these medications will improve glucotoxicity without elevating endogenous insulin or amylin.

2. Use of newer medications to decrease glucotoxicity without elevating endogenous insulin or the amyloidogenic amylin

 

These don't work well in cats and, from what I've read here, can put undue stress on the pancreas by forcing insulin production (or similar - apologies if I have that wrong).

Not sure where you've read this. It's true that very high dose cats have other medical issues like acromegaly driving their need for a lot of insulin. Those conditions take a toll on the whole body and I imagine the heart can be part of that.

Right now his body is under stress because his BG levels are too high.

 

@Kris & Teasel

Thanks for all the info. I read about the heart problems in the http://petdiabetes.wikia.com/wiki/Glucose_toxicity that you provided

Yesterday I had trouble seeing, I was told it's called ophthalmic migraine , due to lack of sleep & stress. I'm here alone so if i can't see to give him his injection I'm in big trouble (Which is causing more stress!)

I know not everyone gets this stressed out & can handle it better but it's just me .

 

I know this can be very frustrating and confusing! Been there; done that! If you take a look at Boomer's ss starting around July 2017 you'll see what happened when I decided that, after a dental, Boomer didn't need as much insulin and started him back on a very small dose. The numbers got away from me and even though I was increasing regularly the numbers went way up. And then since he would give me the odd green number, I would hold the dose too long. It was several weeks before I started seeing a response to the insulin. This is a good example of glucose toxicity. I believe that Ravan might have glucose toxicity. Even though he hasn't been diabetic for very long, unfortunately he has got used to being in the higher numbers; his body thinks it's normal. I think that, if Ravan is feeling unwell, it's because of the high BG and not because of the insulin. 1.5u is a tiny amount of insulin. Again, please think about following TR at least for a while. There are lots of experienced people on this board that will help you through it! And if you ever have any doubt as to whether you should shoot, take Raven's BG a few minutes before shot time and post for help.

 

@Judy and Boomer

Thanks judy, i don't think I could handle the added stress of his bg dropping to hypo levels At this point I'm also worried about my health. If something happens to me no one is here to take care of my cats.

I'm Ok with increasing the dose every 5 days if that's required, I just want to help him & not make everything worse!

 

FWIW - glucose toxicity is a type of insulin resistance. Insulin resistance can be caused by many other things too, such as pancreatitis, infection/inflammation, kidney or heart disease as well as high dose conditions. That quote that says insulin resistance is rare is wrong. Given that acromegaly is just one of the high dose conditions which is on the list of possible sources of insulin resistance, and 1 in 4 cats has acromegaly, the number of resistant cats has to be even higher. As for high dose conditions, we don't suggest people think about testing for that until you get to 6.0 units. You are no where near that. We have a lot of cats that need 3-5 units before turning around. A cat needs however much insulin they need. It's even possible for the high dose cats to get regulated. They just need more insulin than others.

Inadequate duration is when numbers rise sharply to the end of the cycle. That usually means you've either overcarbed your cat, or the dose is too low.

They used to tell you to shoot blindly for a couple of weeks, then come in for a curve. I think what we do is a better way.

It's extremely common for cats to have an initial good reaction, then have it poop out. We have seen this dozens if not hundreds of times. Insulin is a hormone, not a drug. You have to keep increasing until you get to a breakthrough.

As for hypos, everyone is afraid of them. And they should be. They are not something to be treated lightly. However, you do learn over time how to bring a cat up from low numbers. There is almost always someone on who can walk you through what you need to do. Just make sure you have a "hypo" or low numbers kit around with high carb food and plenty of test strips.

 

@Wendy&Neko

Thank you for the info I'm just very tired & upset.

 

I understand the stress; I totally do! When Boomer was first diagnosed we were 4 weeks away from a 2 week vacation. I had no idea what we were going to do and I was envisioning my boy having a hypo with no one around to help him since our cat sitter was only coming in twice a day. I was so stressed that I started having health problems.
You and Ravan will be fine! Just take it one day at a time. And please take time out of every day for yourself. And also just to sit with Ravan, brush him or just cuddle him; whatever both of you like!

 

Clinical trial for cats in remission

http://vetmed.tamu.edu/clinical-tri...on-the-duration-of-diabetic-remisison-in-cats

 

@Judy and Boomer

I'm with ravan constantly. I love him! He has slept in my bed all his life. Now he sleeps downstairs ,alone. It's very upsetting for me to see him like this.

 

I know and I totally understand.

You will get there! You just need to break through these bad numbers. Consistent dosing with consistent increases when needed. I don't follow/know SLGS but perhaps you could increase every 8 cycles instead of 10? @Wendy&Neko ?

 

@Judy and Boomer

I do appreciate your advice. I think the SLGS says to stay for 1 week at the dose but other have advised me i can increase in 5 days if the bg isn't coming down?

 

Just to add on to what Wendy said, yes, a lot of vets still tell you to shoot blind. And this (testing and using Lantus) isn’t the way it’s been done for years, unfortunately. The TR protocol was developed by laypeople, people just like the people on this forum, except they happened to be in Germany. They found that Lantus and Levemir were better insulins for cats and they found a protocol that had improved odds to get cats into remission. You are at the better answer, for now, and hopefully new improvements are to come, but they may come from a board like ours and not from the medical community. There isn’t much money/interest in solving diabetes for cats. Just to highlight some things that are improvements here, and mind you, you can still find vets that suggest the old way because they’ve always done it that way:

Longer acting, gentler insulins, Lantus and Levemir, as opposed to Vetsulin and ProZinc (you can go look at other SSs in the different insulin forums if you wanted to get a good idea what they look like). Many vets still prescribe these older insulins because they think they are better for cats. You can read the scientific literature on it and decide who is right.

Less incidents of hypoglycemia (if you read the published TR protocol, they reference studies how with insulins like ProZinc, hypoglycemia is much more common compared to Lantus and Levemir). Side note, there is wiggle room and safety built in, when numbers go below 50, it does not mean your cat is hypo. Symptomatic hypo is extremely rare on this board because we have that safety number to get your attention to take action so that the cat may come up and stay out of hypo territory.

Feeding a low carb, wet food diet. This increases the odds for remission, it also allows the insulin to do what it needs to do instead of pulling down high numbers from dry food, high carb wet foods and prescription high carb foods that spike the numbers.

TR, or tight regulation was based off a similar human study. The findings for the human study were that when blood glucose was kept within the range of a non diabetic, complications from diabetes disappeared, some existing complications were even reversed. The human study was so successful, they switched the control group to tight regulation before the study was even finish!

Lastly, SLGS can be tailored to meet the needs of your cat. It is more difficult to do this without more time and experience under your belt, but you do test enough that I don’t see why it would be a problem for you to increase after 5 day if the numbers warrant it, and and at least until you arrive at a working dose.

You got this, JoyBee! We all felt just like you are feeling, in the beginning. It’s a lot to take in, the learning curve is steep and it can be very overwhelming. I promise you, it gets better.

 

I know you worry about low numbers and it's stressful. You definitely want to have a hypo kit ready and be prepared to post for help here. However, you've never been there with Ravan and I think it's the idea of it and the notion that he'd have a seizure or something that's causing you the most anxiety. Until you actually go through an episode of lower BGs successfully, it'll be a huge fear-inducing nightmare in your mind. You only have 4 green numbers on your entire SS since the beginning of February and none was near the "take action number of 50 on a human meter. Ravan might well have had a few other lower numbers - maybe lower than those 4 - and you weren't aware because you weren't testing at that precise time.

Getting Ravan under better control requires some calculated risk-taking but you can be helped every step of the way by people here. As Stacy said above: "Symptomatic hypo is extremely rare on this board because we have that safety number to get your attention to take action so that the cat may come up and stay out of hypo territory."

 

@Kris & Teasel

Thank for your encouragement. (bg went to 68 in march)

I'm just not handling the stress & lack of sleep very well.

 

Hi Joy, you’ve gotten some great info in this thread. Please try to relax and get some rest. As the others have said symptomatic hypos are rare when you are testing as frequently as you are. The 68 you got in March was a good number, nothing to be afraid of, in fact it’s something to want to see because it’s a normal number and is healthy for Ravan. The longer he stays in those healthy numbers the better chance his pancreas will heal and less stress will be on his kidneys and other organs. You said he’s still getting agitated. Is there a pattern to it, like when he’s hungry or before or after his shot? What supplements is he on now? Are you still giving fluids everyday?

 

@Sharon14

He gets his shot at 9am, about 1 -2 hrs later he gets up from the chair by my computer & lays next to me. He falls asleep for 5 mins then he goes back to the lounge chair next to me He'll do this repeatedly. 6 ,7 times. he looks agitated, restless.

After a while he'll go lay under my Ficus tree & fall into a deep sleep. He'll sleep for 4-5 hrs if I don't wake him for a test.

I was giving him Ringers every day for a week then off a week. Now i give him 50 -100 cc every few days. He seems to relax & feel better after . I warm it up in a bucket & the electrolytes are probably good too.

I've been giving all my cats supplements & vitamins for a long time. B-12, Taurine, Milk Thistle, Vit E Alpha lipoic, Q10 , Fish oil, vit C I recently started giving Ravan a pinch of Chromium Picolinate For the diabetes,

If they look like they're nauseous Slippery Elm. If they stop eating a drop or two of CBD Oil. When they only ate a Raw meat diet i added the vitamins & necessary supplements & they ate,no problem. About a year ago they all stopped eating the raw meat. It was chicken,I tried different brands, tried beef, turkey.

They just wouldn't eat it.One day I was cutting up chicken & dropped a piece on the floor Ravan sniffed it & ate it. I tried giving them plain chicken without any supplements & They all ate it. That's when i started adding the vitamins & supplements to baby food & giving it in a syringe.

I split it up, a couple one day & some others another day. I really don't understand how people sprinkle it on the food None of my cats will eat if I sprinkle anything on their food. Tried it all.

I recently tried a very small amount of Food Fur Life. 1/4 teaspoon mixed in real good & was surprised when all three gobbled up the food. I was happy I finally found something. 2 hrs later all 3 vomited everything up.

I just checked his bg 198. if only it would stay low & not go way up again!

Thanks again for your advice.

 

@Sharon14
I think I get most confused when i read the sticky's & SLGS states Hold the dose for at least a week:
Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Then several people say "you need to increase the dose now(5 Days) " After I read the sticky's I had my mind clear on what to do. Now I'm confused again!



My cat's pre-shot level was way below the usual value. Should I give the injection?

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

Ravan's bg is 198 now it might go back to 400 by shot time If his pre shot bg was 300 tonight According to the "Guidlines" I should REDUCE the Dose CORRECT?

 

How long until shot time? That guideline says a reduced dose MIGHT be wise if the PS is above 200 but lower than you're accustomed to seeing. You've had yellow PSs and didn't reduce the dose you were at then. I wouldn't reduce tonight. You really do have to push out of your own comfort zone a little bit in order to get Ravan's BGs down. The negative effects of him staying too high outweigh the slim chance of you getting a low dark green number that frightens you. That dark green number is what you want. No one looking at your SS would say you're rushing the process.

 

Nice +8

 

My BK was an example of extreme insulin resistance. It took a long time before we discovered his body started to produce antibodies to insulin, s condition called IAA (insulin auto antibodies ) I shot insulin in and the antibodies made it unavailable. Up and up his doses went in an effort to get a little ahead of the antibodies.

No one here had been down the IAA path. No studies, no scientific papers to read. All we knew was that it was idiopathic, generally resolves in about a year and requires very high doses.

Now we had no way to know when it would resolve, just that it could be very abrupt...and there BK was with a 13u Lantus Depot. we were in a tough spot,
one that required a certain leap of faith that those ‘folks on the internet’ know FD.

Long story short, after 21 months the cat that no one imagined would go OTJ did just that.

I’m glad I took that leap. BK spent the rest of his life at the Falls-6.5 years

 

@Kris & Teasel
VERY disappointed! pmps 448 !

 

@Sandy and Black Kitty

How long did Black Kitty live? How old?

 

we figure he was about 13 when he crossed the rainbow bridge. He was kind of “high mileage “ a neighborhood stray, intact male, about 5 yrs old when we took him in. FIV+ as well.

 

@Sandy and Black Kitty

I'm sure he had a wonderful life, full of love. I've had my share of neighborhood strays. They all made the best of companions!