6/5/16 Olive AMPS 394; +3.5=242; +6.5=119; PMPS 403; +1=433; +2=374; +3=331; +4=266; +5=232; +10=156

Yesterday

Something needs to give here. The lev is acting more like R. Brings her right down then peters out. The one thing I was doing was using new pen in AM and using vial for PM to finish it out. The vial could have lost its potency as I opened it 3/25 but doesn't expire until 2020. So tonight I will use pen. But it doesn't explain lev only lasting an hour or 2. Then tomorrow up the dose again and deal with the daytime lows.

Options

Raise dose and deal with hypos cycle after cycle
Give Lantus another shot
Another insulin altogether
Give much higher carb food over 10% so dose can be raised, as this dose does drop her to the 60's during the day
TID dosing
Add R although I have no clue about how to do that, but it was suggested
Wait until teeth are checked in 2 weeks

Still trying to find vet who will do IAA, 2 more said no why waste the money when it won't change anything. At this point it won't. Other high dose conditions ruled out. Unless there is another tumor somewhere else.

One said why am I doing all this to her, needless to say we don't go there. I'm making an appt to see one more and that's it. I just don't have the money to keep spending on vets who's views on fd are less than favorable.

I don't know anymore.

 

Sorry things are so stressful. I hope you can figure out a dosing plan that works for Olive. Hopefully the teeth checkup will give you some answers.

 

Paula, I feel your pain! It's difficult to get them to level out. I don't know much about Lev. What about doing an hourly curve to see when the onset is (and when the insulin poop-out is). At one point you tried feeding a small meal to slow her descent; perhaps the curve would assist you in trying that again? Same with when the insulin seems to stop working but obviously you wouldn't be feeding then but maybe withholding food or at least adjusting the times?

 

You're seeing a more extreme version of what I see with Lev in my cat. I've said on previous posts that it often acts more like an in and out insulin with a very weak depot effect. There was much consternation about my comment at that time - won't go there again. Occasionally I get a cycle where it acts like a depot insulin but mostly not. Recently my cat's onset is almost immediate, he dives too low and then he's up in pink by end of cycle. When I started him on Lev onset was late, he'd spend a short time around a decent nadir (sometimes!) and then would be up again at PS.

My theory re Lev is that it's much more susceptible to variability in absorption, the mechanism of depot formation involving binding to albumin is less reliable and some cats get significantly reduced duration. I stuck with it because my guy feels better on it generally speaking.

 

It's frustrating but she's still very new to insulin and only been on Lev for 3 months. It's usually recommended to stay with one insulin for 6 months to 1 yr. She's also an Acro cat which are harder to regulate with possible IAA. Although IAA doesn't change anything it helps explain some unpredictability. There are a few early nadir Lev kitties. Rusty and Murphy are two that come to mind.

• When I seen green in the first 6 cycles of an increase I held the dose 5-7 cycles especially if under 70 nadirs. Sometimes they need the extra few cycles.
• Agree on getting some earlier tests and more then one day. Depending on the tests like if the +2 is lower then preshot, play around with the % of carbs you give. It might take hourly tests for a bit to see if that'll help flatten her out. Some even need higher carb food at preshot, +1 & +2.
• I think she's zooming up from steep drops based on the data you have
• Are you changing your shot placement at all? Have you tried shooting in the flank? Just something to consider.
• I'm not a fan of R when a kitty is spending a good amount of time under the renal threshold which to me Olive is. Although ECID with what is the renal threshold. It also requires a whole lot more testing to be used correctly and even then can create a cause and effect of bouncing. I think it's been over used in the forum...JMHO
• TID - lots of work, extra needles and pokes....hard on you and Olive IMO. Not something I'd personally do.

The beans can't control everything. We get focused on "green" which of course is the goal but also have to focus on how they are feeling and QOL. Unless you're going to try cabergoline or SRT it's very unlikely she's going OTJ.

 

Remission not a consideration since we found out about the tumor and now the acro. Have been doing the +2 & 3 feeding with 6% for few weeks now. Maybe a higher carb at shot time might help, will try that tonight. It's just the preshot are getting higher, nadirs are only for an hour or two. Daytime is better than nighttime. I shoot sides of chest. Scruff is just impossible with her. My vet doesn't think she is acro so cabergoline won't happen with him. Two others don't even think she worth their time. Making appt with one more. Just thought of another I can check out. The very first vet I used here, they have a new in the office, so maybe I can try them. It's just they bungled Patches but the new associate wasn't there then.

 

I so hear and understand your frustration. I feel the Lev duration is less with Asia than with Lantus, some cats it’s longer than Lantus, really ECID. I still prefer the Lev for a few other reasons though. My two cents looking at her SS, while duration can be an issue, all the fluctuations could likely be from the steep diving she likes to do and the bounce that results from it. I have found Asia is so much more even keel when the preshots are not too high and she doesn’t have to struggle with the insulin to lower that number. Olive being an acrocat makes your situation totally different though. She probably makes her own insulin and it’s just very unpredictable when it’s working vs not. If she were my cat, I’d try to address the acro first, perhaps with cabergoline and see what happens. If acro is causing the diabetes and you address the acro, insulin is a secondary consideration. I do think the R would only make things worse, you already have plummets and extreme (although not extremely high) rises, the R will likely exacerbate that. Teeth can also make such a difference, I’d be curious to see how things pan out after a dental. I’m so sorry you are frustrated with your vet responses, I can relate to that as well. I hope you figure out something that works to keep Olive more even. I wish there was an easy fix, I’ve tried lots of things, they are not fixes but band aids, and none of them have been easy.

 

You got some really good advise. Just some of these

 

So just had a call from one of the possible new vets. They said we would not be a good fit.

 

I agree with the others, R would just make the dropping problem worse. I would try something even higher carb at +2 and +3. When she drops, she drops hard. I might also get a few +1 tests. I don't see any of those with Olive on Lev. It'd be good to get a better idea what sort of food bump she is getting with her current food, before changing it. Yes, the acro does make a difference. The pancreas could be kicking in a couple hours after her main food, contributing to the drop at onset, so you need to boost her more just before that happens.

Don't worry so much about the IAA. IAA does make a difference in dosing, but Olive sees more green than I'd expect with a cat with a higher IAA score.

It took Neko over a year to stop including red in her daily colour selection. With acros, patience is really important.

 

Ok, so +1 tonight with regular food. Keep +2 & 3 at the 6% I've been doing. I leave her dose as is tonight and tomorrow?

Not to worried about iaa now, 1 other vet said it would only tell if type 1 or 2 diabetic, I'm like really, ok thanks anyway. Just the acro and seeing if I can find someone to treat it and prescribe cabergoline and give it a try.

 

No, the IAA does not tell if type 1 or type 3 diabetic. With acro, Olive is a type 3. Where is good to know if IAA is when it breaks, you may have to be more aggressive on reductions. Plus have to keep on top of greens and be a wee bit more aggressive on increases.

Good luck finding a sympathetic vet.

 

If no green tonight. Increase tomorrow to 7 units. Never heard type 3 reference before.

 

So we do hourly pokes and what does she do? Comes down nice and slow for once.

Dosecrease tomorrow.