Ceenka--History of DKA...and Insulin Resistance??

Discussion in 'Acromegaly / IAA / Cushings Cats' started by ellenr319, Apr 10, 2012.

  1. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    Hello, I posted this on the main forum last night. Someone suggested that this forum might be a better place for it.

    Postby ellenr319 » Mon Apr 09, 2012 10:38 pm
    Hello,
    My name is Ellen and my cat's name is Ceenka, aka Jungle-Kitty. Ceenka is a 5yo blue Aby dx'd with FD in March 2011. For the last year I have been treating her with Dr. Hodgkins's tight regulation protocol on the diabeticcathelp.com forum. I am happy with her treatment method, it is a good fit for her and me. However I have run into problems getting her regulated and am coming here to see if anyone has encountered a cat with the problems Ceenka has had.

    Ceenka has been on four different insulins. She did best on ProZinc, her first insulin. For 5 months she did well on it, in her fifth month it looked like she was imminently going into remission. Her longest "run" was +105 hours on a dose of 0.4u. That month she had lots of runs in the +70s, +80s, +90s with shorter ones in between. Then in her sixth month, something went awry. She stayed in the lower 200s no matter what dose she was given, reductions or increases. It was like shooting water. It seemed like her numbers stayed the same no matter what dose I gave her.

    In September I changed Ceenka to Lantus. I was seeing a lot of success with Lantus with other kitties on the board. Ceenka did great on Lantus at first. She seemed to go to +16-+24 runs very quickly. She would stay in double digit BGs, which we seek with our version of Tight Regulation, for hours and hours. As with the ProZinc, Ceenka seemed like the model kitty who was going to go into remission in short order. At the end of her third month on Lantus, Ceenka did an about face. Again overnight she was in BGs from 200 to 250. This time we tried for two months to regulate her. We tried doses from 0.25u to 2.5u. Her normal dose had been 1.0u. Again it didn't matter what her dose was, she stayed in the same numbers. Again like shooting water. I had extensive labs done, nothing was off significantly except her BG and cholesterol. After about 2 months in these numbers, Ceenka went into DKA. This was the second time, the first was when she was dx'd. My vet was astounded at her off-the-chart ketones--she had the highest level of ketones with dipsticks and blood tests. The vet said it couldn't be DKA, it had to be pancreatitis or a UTI. She tested for both, both came out negative.

    So we changed Ceenka's insulin again, this time to BCP bovine PZI. We figured that perhaps Ceenka would tolerate the bovine insulin better than ProZinc or Lantus since it was only one amino acid away from a cat's insulin. Ceenka did SO well on the BCP--she was getting +27 runs after 8 or 9 days on it. And hours and hours in ideal numbers. Her doses were markedly larger than her doses on ProZinc. Since they are both PZI insulins I kind of expected that her doses would be similar in size, but this time Ceenka's doses averaged about 3.5-4.5u, as opposed to the 0.4u dose she was geting with ProZinc. And this time Ceenka's insulin honeymoon lasted only 6 weeks. Then back into the 200s. That was a little over two weeks ago. We tried adjusting her dose again, thought it might be going up from too much insulin. Tried reducing her doses. Nothing. Increasing, nothing. Same old, same old.

    So then we decided to try ProZinc again. I started Ceenka's doses at the dose she had done well on, no effect. Started moving her up slowly. Within a couple of days she was still in the 200s. Since she was in the 200s again, I was testing for ketones. I managed to catch her a couple of times peeing. No ketones. Then I did a blood test--.01. Last Friday she stopped eating. I thought maybe a tummy problem, gave her pepsidAC. My husband caught her peeing in the late afternoon and she was at the next to highest color. He called me at work to tell me and I called my vet. When she heard that Ceenka had stopped eating and her ketones were so high, she prescribed Humulin-R which I went and picked up before going home. When I got home, Ceenka had that trance look that I had seen the previous two times, she was getting in the bathtub and staring at water but not drinking. Her blood ketone test registered 5.0. We shot her with both insulins.She looked better the next morning. But her numbers didn't come down for about 36 hours. She still wasn't eating, we gave her food and water with supplements by syringe. Added pinch of salt and half that amt of potassium chloride to add a bit of electrolytes in hopes of preventing dehydration. Saturday night I wondered if I might be losing her--her breathing seemed really labored and the trance-state continued. I took her to bed and tested every two hours. Fianlly during the night her numbers started to come down. Sunday morning she seemed alert and affectionate. Her ketones were down to 2.0. She stayed in ideal numbers all day, she didn't need to be dosed again for 19.5 hours. Go figure. (Because of the new insulin, R?) She had a couple of short runs after her long one. But she is coming down, not staying in the 200s.

    So, here are my thoughts. It looks to me like it could be insulin resistance, that she stops responding to each insulin after awhile. But she doesn't fit the profile of IAA, acro or Cushings. She doesn't get huge doses. (But they ARE huge for her compared to the initial doses that seemed to work wonders for her.) She doesn't have the incessant hunger that the acro cats on my board exhibit, nor any enlargement of head or paws, though I know that acro doesn't always present this way, especially early on. She is on the thin side rather than pudgy. (She has lost at least a lb with the last 2 DKA's, with the Lantus down 1.5lbs over about 3 weeks, from 9.5 to 7.9lbs, with BCP down from 9.1 to 8.1lbs over a week. With her DKA at dx she was down to 6.9lbs). She doesn't have any skin tearing as they describe with Cushings. Sounds more like the IAA to me, but could it be any of these conditions with her relatively small doses of insulin?

    So far my plan from here is to continue with the ProZinc, but to keep raising the doses to really big ones if necessary to see if she breaks through to a point where her BGs come down. I am keeping her on the R until her ketones are gone--she was still 2.2 on the meter this morning. Will taking the R away push her numbers back up?

    The fact that Ceenka stops responding to the insulin after a honeymoon period, which pushes her numbers up, and that she goes into DKA at relatively low numbers, seems to me to be a deadly combination. It also seems to me that Jungle-Kitty's honeymoon period is growing shorter and shorter with each insulin, and that she is going into DKA in shorter and shorter periods of time in high numbers. Sadly, all of this does not seem to bode well for my kitty's longevity.

    Any suggestions? Should I test Ceenka for the 3 insulin resistance conditions? What else should I do? Any other thoughts on what this might be? Has anybody seen similar experiences with DKA or with insulins? I would appreciate any feedback you may have for me.

    Thanks,

    Ellen and Ceenka
     
  2. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Ellen,
    I think you should give the Levemir a try as it's your best bet when it comes to gentle and long lasting insulin for cats who are resistant.
    Yes, I would speak to your vet about having the two tests done as a start. There is no point in testing for cushings unless you are seeing signs such as thin and tearing skin.

    Here are the two links to the test to have done. You can print them out and take them to your vet.

    IAA Test
    IGF-1 (Acro) Test

    For one of the tests, it's advisable to fast the cat because lipemia could affect the test result.
    If you can look on some past test results from blood work for Ceenka and look for any + signs by lipemia, you would do well to fast for the nite prior to the blood draw for shipping to MSU for the tests.
    My Shadoe had issues with Lipemia, so I fasted her and the blood draw was early the next morn, but Oliver had no lipemia issues so I did not fast him.

    There are not that many of the acro owners who post here on FDMB because of the sensitive nature of insulin resistance, and most are on facebook in a group.

    If you have any questions, just post here and I'll watch for your replies.
     
  3. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    Hi, Gayle, I talked to my vet this evening and we are going to do the two tests. I will probably take Ceenka in on Friday to have her blood drawn. Which values in her labs would indicate lipemia? It has something to do with fats, right? She is also going to show me how to give fluids when I go in.
     
  4. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    hi Ellen!
    Great news to hear your vet will do the draw and send off to have the 2 tests done. I know that many may say you won't really treat Ceenka differently, you will still give insulin and aim for decent BG numbers, but if the results ARE positive, there are some precautions, and some health issues that you may encounter that come along with acromegaly.

    Not all cats would have all symptoms as that would be crazy, but they do usually have some of the common ones. My Shadoe was one who got the big pot belly.... she looked like a football on little legs! My Oliver was just BIG and he definitely looked acro to me... they have organ issues that should be watched, and soft tissue growth, etc, so while it's true, you will still give insulin to get decent numbers, you are not standing on firm ground with a faulty pancreas, but rather you are in a rowboat with a healthy pancreas but also a tumor that is secreting excess growth hormone.
    A positive result means that you do not have a diabetic cat; you have an acromegalic cat who happens to be diabetic because of the excess growth hormone.

    I am also glad that you will get some fluids and the vet will show you how to give them. It's way less stressful for any cat to be treated at home. The vet may give you needles for the fluids that are size 18ga, but they are very BIG and uncomfortable. some people may call them harpoons; I think of them as milk shake straws.... both of my cats did NOT like fluids with those needles and I got 22ga which were finer and did take longer for the fluids to go in, but my cats did not try to slink away to get away from the needle. If you vet can, ask for some different sizes - get some 22ga and 20ga.

    My Shadoe was always showing a bit of lipemia, it's near the bottom of the blood result sheet and will show you amount in + signs not numbers; she was my chunky monkey, with fat blood. My Oliver never had any present. I believe you can fast overnite and then take Ceenka into the vet early and then it won't be too bad. You going to the vet early in the day I hope?
     
  5. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    Over the weekend when Ceenka had the high ketones, and wasn't eating, I knew she needed fluids in addition to the R insulin. Since I couldn't do the sub q or the iv fluids, I syringed her watered down baby food. I added salt and potassium chloride, b/c those are the main ingredients in the electrolytes I make to give my horses when I do long-distance riding. It worked surprisingly well. Her fur was looking oily and dandruffy, and within a couple of days all that has disappeared and her coat looks remarkably shiny and nice. The salt also made her thirsty, so she drank quite a bit.

    Thanks for the tip on the needles, Gayle. I actually have a box of 22g needles that I use for horse vaccines, so good to know.
     
  6. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    So good to hear that Ceenka's doing better. Please keep a close watch for ketones... test often, you have KETOSTIX to test her urine? .... it seems that some cats are just ketones prone, and it may be the Ceenka is one of them, so test her urine as often as you can, and keep her well hydrated.

    I added equal amounts of water to the wet food that I fed to Oliver because he has never drunk water from a bowl.

    you said you could not give her SubQ fluids, how come? Can you not get fluids from the vet? With pancreatitis and ketones in Ceenka's background, it would be good if you can keep fluids and pain meds on hand.

    I am glad to hear you are seeing a good difference in her coat as well.

    ETA: If you need to ask me any questions, you will find me faster on facebook. Just send me a friend request there - Gayle Charambura, with the picture of my Shadoe on my profile.
    I hope you can get the fluids for her.
     
  7. ellenr319

    ellenr319 New Member

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    Apr 9, 2012
    Gayle, I don't have the equipment or the experience to give her subq fluids. I'm taking her to the vet tomorrow for the tests and a demonstration and prescription for the fluids. So it's all in the works. I remember reading about giving cats with kidney disease fluids. I thought, thank god Ceenka has diabetes, I could NEVER give fluids! And the universe heard me thinking, and said, oh yea? :twisted:
     
  8. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Ellen,
    Right now are you giving injections to Ceenka? Yes.
    Giving fluids is really no different...
    For injections, you have a syringe attached to the end of the needle. You push the plunger on the syringe and the insulin goes through the needle and into Ceenka.
    For fluids, you have a bag of fluids with a line from the bag that is attached to the end of a needle! You adjust the wheel on the line and the fluids go through the line and through the needle and into Ceenka.

    Both needles are into the scruff or thereabouts. You learned that Ceenka was diabetic and have been doing all that you can, yes? Fluids are easy and they may well save Ceenka's life and prevent the DKA and ketones issues and trips to the vet.

    Home testing. I can't see where you are home testing.
    If you are, can you please advise what blood glucose numbers you have been getting for Ceenka.
    If you are not yet testing, please DO start now.

    We keep track of our cats' test numbers in a google spreadsheet.
    The template is searchable in Google Docs "12/12 Insulin ..." or maybe it has FDMB 12/12... just search for 12/12 and you will get a few copies pulled up.
    Here are the instructions for the sheet setup.
    Create your Spreadsheet

    For high dose cats, we have found that Levemir is the most gentle insulin and also the more long lasting. We frequently use R to pull down the high numbers, in the 400s or high 300s, and then the Levemir works better on the lower numbers.
    You will get used to giving fluids as it is not as bad as you think. It's just like home testing and poking the tip of the ear. I am sure you will be fine with it all!
    Testing on cat’s ear
    Good video of giving SubQ fluids

    Best of luck at the vet today. I know that you will be fine with the fluids and it's perfect that you can get the vet / vet tech to show you how to give the fluids today. There will be less stress for Ceenka now if she is getting treated in her own home.
     
  9. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    Hi, Gayle, I have been doing Dr Hodgkin's TR with Ceenka on the Diabetic Cat Help forum for the last 13 months. Hubbie and I test her BG 6-10 times a day, and currently dose her according to scale every 6-8 hours with ProZinc. Her log is on DCH. I will think about posting her numbers on the google spreadsheet here. If she tests positive for IAA or acro I will consider changing to Levemir. I am committed to the TR and plan to continue with it.

    I did look at Shadoe on Facebook. What a beautiful kitty! I couldn't figure out how to request you as a friend on Facebook! :oops:
     
  10. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Ellen,
    I accepted your request on facebook; you can see pictures of my Oliver who tested positive for acromegaly and IAA in 2010, but is currently off insulin and has been since the start of this year.

    I will try to figure out how to get to DCH to see Ceenka's numbers; I wonder if there is a way to copy your numbers into a google spreadsheet? It will make it much easier for others to help you as they may not be members on DCH and without the numbers, it's tough to help.

    Lots of BG testing? Awesome! I have to admit that I was often testing even more frequently than you are and for both of my cats... test strips for my Bayer meters never collected any dust in our place!

    I am not familiar with the Hodgkins protocol, but if your tests come back positive, you will likely need to adjust your approach because if positive, it means that your Ceenka is not a diabetic with a faulty pancreas, but rather a cat with a healthy pancreas but also a tumor that is secreting excess growth hormone which results in Ceenka seeming to be diabetic.

    If the secretion stops, so does Ceenka's need for insulin. Oliver was at 21u Levemir BID end of December. By Jan04/12 he got his last shot of 4u and then nothing at all since that day.

    Best of luck at the vet and hope Ceenka is not too stressed on the visit.
    If you have any questions at all about giving fluids once you return home, just ask because giving fluids is a pretty common thing as many cats need them for a variety of reasons.
     
  11. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Hi Ellen,
    I can't find where you numbers are, except for one post on March 17th... can you let me know where I can look on YDC for the numbers over the last yr? thx so much.
     
  12. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    hi ellen,

    i'm wondering why you didn't continue increasing the dose beyond 4ish units? on this forum, we see many cats with doses higher than that and usually don't consider a cat for testing for a high dose condition until it's over 6 or 7 units per dose. i wonder if you were running into Glucose Toxicity, where the cat's body has become accustomed to a higher BG range and then it takes even more to get them to come down. Often, just committing to following the protocol and continuing the dose upward until your cat hits the "sweet spot" and suddenly the cat's body starts responding is the best plan to follow.

    Here's some info on Feline Diabetes and Glucose Toxicity

    I also wonder about Ceenka's teeth. We've seen many cats that have dramatic dose improvements, sometimes even going off of insulin, after having their teeth cleaned and any problems resolved. If a cat has any kind of inflammation or infection, it can take a lot of insulin to counteract the increased BG from the problem.

    Keep posting and we'll help you get to the bottom of it. This particular page isn't active. The Lantus TR Support Group is very active with many cats with high dose conditions using both Lantus and Levemir. Most people come to FD.com when their cat is diagnosed with diabetes, so they start there and just stay. The protocol we follow sounds similar to what you're accustomed to - keeping the cat's BG in the range for a normal non-diabetic cat, ie, 50-120 on a human glucometer.

    Welcome to the forum - we'll be glad to give you a hand.
     
  13. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Ellen is already committed to the Hodgkin Protocol and is not looking to switching to a different protocol.
    How she proceeds with Ceenka will depend on her test results. Until that time, I believe that Ellen and her husband will keep Ceenka on Prozinc and their TID/QID ways of treating.
    Posting in the Lantus TR would not be of any use to one using Prozinc, but should Ellen wish, she may find more in common with those posting on the Prozinc forum on this site. Should she decide to switch insulin upon a positive acro result, switching to Levemir would be the obvious and preferable choice, and Ellen could then post in the Levemir forum on this site.
     
  14. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    Hi, Julie, thanks for your post. I have gone higher in dosage for Ceenka just in the last week. Today she got 17u for the day, so she's getting up there! I was thinking about why we didn't push her numbers up before. I think it was because Ceenka's numbers were rather deceptive. She would be responding really well to small doses, and then she would do an about face. Suddenly she would be in the low 200s. When she was on Lantus, her "sweet spot" was 1.0uF. This dose would keep her in DDs (double digits) for hours and hours. But when she stopped responding, we tried moving her up, I think we pushed up to 2.5u. Her numbers didn't budge. Then we thought she might need a decrease--we started lowering her doses. We went down to 0.25u. The numbers didn't move. When we pushed the doses down to 0.25u, her numbers didn't go higher, they just stayed the same. I think that was what really confused me and my DA.

    Looking back on it, my theory is that Ceenka had developed antibodies--and it was as if she were getting NO insulin at all in doses from 0.25u to 2.5u. I think the low 200s is Ceenka's BG range from the low carb diet alone. The fact that there was no variation whatsoever in this dosing range kinda blindsided us. It didn't make sense at all. We were used to looking at her as a LOW DOSE KITTY!! It did not occur to us that if we pushed higher, way, way higher, we might break through the "shooting water" zone. When we switched Ceenka from Lantus to bovine PZI, we took her off of the insulin for 24 hours, and her numbers actually went down a bit. We had to wait a bit longer than the 24 hours because her BG was below 150, she wasn't in dosable numbers. Not for long, maybe an extra 3-4 hours. Then her numbers went back up to above 150 and we began to dose her with the BCP.

    People have said to me when she's in her low 200s, why don't you just let her stay in those numbers, just take her off insulin altogether? There are people who think that cats are fine in those numbers. I think that's because they have never seen their cat in double digits. Ceenka feels so great in that range, she does butt slides across our wood floors, acts like a total kitten! And unfortunately, Ceenka goes into DKA in the low 200s, so it is not an option. My vet thinks she's a complete freak for getting ketones in those numbers, she didn't believe it till she witnessed it herself.

    So that's a very long explanation of why we didn't keep increasing her doses, Julie. From our POV it looked pointless. Her numbers didn't move at all if we went one direction or the other. It only occurred to me with her last DKA over the weekend, that we had to keep pushing her scale up, and do so aggressively.

    I'm interested in this idea of glucose toxicity. I'll read more about it. However it doesn't sound like Ceenka to me. All you have to do is give her a new insulin, and she comes down in a heartbeat! Last weekend when she went into DKA we gave her R insulin and in a day she was in DDs and had a +23 duration! Each time she has switched insulins, ie, to Lantus from ProZinc, then to BCP from Lantus, she went into beautiful numbers and durations within a matter of a few days. I think that was one of the factors that camoflaged her insulin resistance, her high dose condition. Does that make sense??

    I've had Ceenka's teeth checked and the vet says her teeth look good, that she doesn't need a dental. She's the third vet to say that!

    I am relieved to hear that the Lantus TR strives for 50-120 BGs. I was kinda expecting a reaction if I posted some of Ceenka's "good" numbers. I actually know someone who treats her cat here on FDMB, and she has freaked out when I have told her about some of Ceenka's BGs! :lol:

    How does Levemir compare to Lantus? I don't think I would consider putting Ceenka back on Lantus again. When it was all said and done, I don't think my kitty ever felt totally well on Lantus. Couldn't ever quite put my finger on it, but Ceenka seemed a bit subdued when she was on Lantus, not her Jungle-Kitty self. I have heard various opinions on Levemir, that it is gentler than Lantus, that it is harsher than Lantus....What do you all think?
     
  15. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Ellen,
    Your best bet is to wait till you get the results from the acro and IAA tests. Depending on what the results are, you will treat a bit differently. With a dose of 17 units today, I would think that you are just waiting to learn if Ceenka is acro, IAA, or both.

    Quick question: What BG meter are you using? I ask because I want to be sure you are not using any Free Style meters as they are no good for cats and you will get the majority of your numbers in the 200s. All people who switched from Free Style to any other meter at all experienced immediate higher numbers.

    OK yes, you can develop a resistance to insulins, and being slow on increasing can contribute to antibodies generating.

    For insulin best to be used is turning into Levemir, for high dose cats and other diabetic cats in general. There are differences and one of my acros, Shadoe who you have seen, did poorly on Lantus but much better on Levemir. Others have also realized a marked improvement in their cats after switching from PZI to Lev and Lantus to Lev. The curves are not as extreme and some have had later nadirs on Levemir.

    There is nothing harsh about Levemir. Actually, Shadoe had more odd BG numbers and was always tense and edgy while on Lantus, but it passed within days of switching to Levemir. The vet mentioned in the story of Tilly in Tilly's protocol recommends Levemir to her clients now instead of Lantus, so I think that recommendation speaks volumes.
     
  16. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

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    Feb 17, 2011
    i think the difference between lantus and levemir is really just about personal preference, although we have seen great results in cats who "dive" fast and furious on lantus (hit their low point 2 hrs after their shot) will sometimes even out on lev. lantus has a slightly acidic base and some cats seem to feel a sting. not every cat though - my cat was unphased by it at 15+ units per shot, twice a day. punkin's had a great response to it and i like lantus, but i think lev is a great option too. if it had bothered him, i would've tried lev. lantus onsets in about 2 hours after the shot and usually peaks about 4ish hours later. lev onsets in about 4 hours after the shot and peaks about 4 hrs after that. if one doesn't work, try the other. Lantus vs Levemir

    the Rand/RoompTR protocol is about pushing cats into the 50-120 range, most of the time under 100, on human glucometers, so that their pancreas will heal. Punkin got to 49 today and lived to tell the tale. he was there yesterday too. That is what Tight Regulation is about - keeping them tightly regulated in the normal cat range. There are a lot of people on this site who don't seem to grasp those are the good numbers and are afraid of having their cats go under 100. some people celebrate their cat getting into the 200's - and i just clench my teeth on those comments. those are numbers to move down from, imo. a lot of people don't seem to realize that the dangers of higher numbers are as great as from lower numbers, just slower acting but still damaging.

    some of our insulin support groups have more experienced people who know the ropes than others. The TR forum is one. It has "Lantus" in the title but it's about 50-50 users of lantus and users of lev. The commonality is that we all (mostly) are following TR. The Tight Reg description on Your Diabetic Cat is basically the same as the TR protocol we use, although we don't usually shoot around the clock. Lantus doesn't need that - which might be why you didn't have good luck using Lantus. Dr Hodgkins has a preference for Prozinc and you have to think differently to use Lantus & Lev. Lantus/Lev dosing is based off of the lowest point in the cycle, not the preshot number.

    If you were basing your lantus dose on a preshot number, if you were changing doses more often than every 6 shots, , if you didn't dose every 12 hrs consistently, if you went 19-24-whatever more hours between shots, that would explain why ceenka felt yucky on it. i can imagine you would've had really horrible results trying to do it that way. Lantus really likes consistency - same dose for several days pretty close to 12 hours apart. we try to keep shot times consistently at 7am/7pm at our house.

    on lantus and lev, experienced users will shoot down into the 50's once they know their cat's patterns. we don't wait to see how long we can go before their numbers rise and then shoot more - we try to shoot consistently. Click on punkin's ss link in my signature and you'll see what i mean. He has acromegaly and we unfortunately, were using the Freestyle Lite meter, so it's like we started over again in dosing on jan 21st of this year. you can see a dramatic difference in the appearance of the spreadsheet before that point and after. it was grim and discouraging, but we've almost recovered from it. you can get an idea of what we're looking for - he's having pretty good cycles right now with a lot of time spent under 100 most days.

    what i'm getting at here is that there is a whole different way of dosing with Lantus/Lev than with prozinc, or the method described by Dr. H. If you were following her dosing protocol with Lantus, you were guaranteed failure. the L's are such good insulins i hope you will reconsider trying it again. We have about 1 user every week go off of insulin using Lantus - it really is a good insulin.

    The protocol we follow is specifically written for both Lantus and Levemir, most of the dose changes by .25u and allow the dose to settle 2-5 days before re-evaluating and increasing if needed. It is the only published protocol and was in the Journal of Feline Medicine. I read Dr. Hodgkins' hesitations about the study that showed Lantus/Lev to be superior to other insulins, but i don't know enough to comment on that. the study shows the best remission rate using Lantus.

    if you click on the link i gave you above, you can see the collection of basic good information about both insulins, including the TR Protocol, is contained in the yellow starred "stickies" at the top of the second second of the page. if that makes sense! :lol:

    you must be really in tune with her after all of her episodes to be able to recognize the ketone look like that. that sounds scary. one easy way to check the urine is to make a spare box with something non-absorbent in it. i slipped a box lid inside of a garbage bag and dumped in a couple of cups of lentils. you can use aquarium gravel as well. after she's peed you can dip the ketostix in the urine to test it.

    my understanding is the "recipe" for ketones is not enough insulin + not enough food + an infection - just high numbers alone won't cause ketones usually. many cats stay in high numbers for periods of times without developing ketones. has she been checked for an infection? white blood cell count ok? cuz that is unusual to have ketones in 200ish numbers, although i believe you. we had one kitty who developed ketones in the 200's, but he had pancreatitis along with it.

    which also makes me wonder - are you using a Freestyle Lite meter? if not, what meter are you using? have you compared any tests with another meter to see if your meter is reading accurately? the Freestyle people changed the strips and they no longer are accurate for our cats. also, many meters with "True" in the name were rated poorly for accuracy by Consumer reports.

    i don't know that much about ProZinc, although we used it for a couple of months, it was before i got here and knew anything! :lol:

    i do use R sometimes - the trouble with R and cats is that it does pull the numbers down, but it's quick and dirty. fast in, fast out - although i have thought that punkin almost seems to still be having a better cycle the next day even with R. Yes, when you stop using the R, ceenka's BGs will rise because she will have less insulin. personally, i prefer to rely heavily on the lantus because it's long-lasting and only occasionally use the R. you can get into what's called an "R Bounce" where the cat's BGs drop fast or low and that will cause the cat's liver to let loose counterregulatory hormones and stored sugars, bouncing them right back up to the moon. then you see the high number, use R again, and repeat the process. it's a merry-go-round! so i use R carefully and rely more on the underlying insulin.

    Do you know about bouncing (rebound?) and did you recognize it when you were using Lantus? Because that it probably the trickiest part of using it - learning to recognize when the dose needs to be increased or held. if you don't know what i'm talking about, then certainly learning about it will help. it's a big issue!

    Prozinc doesn't last nearly as long as either of the L insulins, although it is a good insulin. cats have such fast metabolisms that they benefit the most from the longer effects. Take a look at the starred posts i referred to and see if any of the information is new to you. Also, just below this post there are 2 posts that might be helpful to you - the one on FD & Glucose Toxicity that i linked to you above, and the one i posted earlier tonight on Punkin's experience with acro this past year (one acro cat's experience - or something like that).

    i think we can help you - sounds like there might be some things in the dosing, especially that we might be able to help with. i'm very spreadsheet oriented - any chance you could get one up? it's hard to picture the numbers you are talking about in my head and what they might look like laid out on paper.

    there aren't any rules about where you have to post. you can post where you will get the help you need. the forum designated as "Levemir ISG" doesn't follow Tight Reg, which is why many Lev users are combined on the Lantus TR group.

    this forum is inactive, as you can see.
     
  17. Grayson & Lu

    Grayson & Lu Well-Known Member

    Joined:
    Jan 9, 2012

    By now you're probably doing fluids like an old pro, but in the event you're not, let me tell you, it's easier than pricking their ears!

    Before I start, I've replaced the needle and flushed the line. It's already hanging up so it's just a matter of Grayson being in the right position. Place the food bowl, and voila! It helps to have a cat highly motivated by food! Once the food is down, and Grayson has his face in it, I put the needle in (chisel side facing up), open the line, and about 4 minutes later, 100 mL have been infused, he's still licking the bowl, and we're done! Remove needle.

    A couple of times he's tried to walk away. I just clank the fork on the food bowl and he's usually back. There was one time he moved and fluids were squirting all over... but all was fine! I think that's a rite of passage!
     
  18. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Sorry, but the difference between the two insulins is not just about personal preference.
    I know for a fact, first hand experience and observations, that some cats are not good on Lantus, but are fine on Levemir. There are also vets who once recommended Lantus to their diabetic clients, but have switched to Levemir. The Canadian vet mentioned in the story of Tilly the cat, on which this Tilly protocol is based, has switched her recommendations to diabetic animals from Lantus to Levemir. I would be worried if a vet made such a major change based on a personal preference. The vet states her reasons for the change as well.
    Why? Because there is a very noticeable difference, especially to many HIGH DOSE cats.

    I can speak for one acro cat better on Levemir, and there are others who will speak of marked improvements in their cats when switching to Levemir, many owners of acro cats as well as owners of normal diabetic cats. I think a major consideration is the sting which occurs at higher doses, and when you are approaching doses in the 40s and upward of 100 units BID, sting matters.
    It is not about personal preference as has been suggested by Julie.

    Onset for Lantus and Levemir did not differ for either of my two cats; the changes were in how Shadoe acted, not the onset. The first choice for use by any cat who tests positive for acromegaly, IAA, or both, should be Levemir.
    I would hope that Julie could mention that her cat has gone for SRT and so is in a different category than other acro cats. After SRT, I would imagine that your goal IS to get off insulin because of the treatment. Pushing her cat to the 50s may be fine if the treatment has altered how the tumor is acting and affecting hormone secretion.
    Pushing an acro cat who has not gone for SRT is not the same as pushing an acro cat who has had SRT.

    There is no point in speaking about a healing pancreas because cats with acromegaly and IAA do not have any problems with their pancreas, but rather an issue with growth hormone secretion. When the hormone excess is stopped, the cat no longer needs insulin, as in the case of one of my acro cats, who was at 37u, then dropped to 21u within 6wks, and then off insulin 10days later. He is still off insulin, since the start of this year. His pancreas is fine.
    The 100 BG cutoff is relevant for cats with acromegaly. If you have not had a cat who has consumed FIVE 5.5oz cans of high carb food, been given karo, and still have the BG numbers keep dropping, you may speak lightly of that cutoff line. I do not; I have experienced just such a scare and it is not fun. I was terrified. After that day, I stayed clear of the any number under 100 because I had seen what can happen and you can't stop a drop in some cases.
    Why is that? Well, because the acro cat has a functional pancreas, and what happens with food? The food test to check if the pancreas is working is to test, feed, and then test again in an hour or so. The 2nd test will be a lower number with a working pancreas, so feeding mass quantities of high carb food CAN have the opposite effect on an acro cat's dropping numbers. Shooting an acro cat down to the 50s could be harmful, and is foolhardy.
    The goal is to get your acro cat's BG numbers under 250 at all times, and aiming for low 100s. You have NO influence over the acro cat going off insulin without surgery or possibly after SRT treatment. There is no point in pushing your cat to numbers that could possibly be dangerous.... 100 - 250 is a decent range for an acro.

    There is no remission for cats with acromegaly unless your cat has surgery to remove the tumor. In all cases of removal, the need for insulin stopped immediately, and not a single cat needed insulin shots again, indicating that every pancreas was functional. Other medications were needed but insulin was not one of them. There is no healing of the pancreas required.

    Acromegalic cats are not diabetics in the usual sense; they just happen to have diabetes more like a side effect of the tumor, so get rid of the tumor or cut off the flow of hormone secretion, and you have a non diabetic cat.

    If you want to speak of the other resistance issue, IAA, you are into a whole different area.
    With IAA, you MUST push the cat's numbers to the 50s and even to the 40s, because IAA can be temporary and the condition is much like a tug of war, or arm wrestling. You cannot let up and you have to push for low numbers to beat back the resistance. It's up to you if you want to work hard at the possibility of defeating the antibodies, or you can maintain an approach similar to those following the Rand protocol.

    The third combination would be if you test positive for both acromegaly AND IAA. In this case, acro trumps IAA.
    Oliver tested positive for both and I was able to defeat the IAA by June6/2010, after which time, he as what I would consider just an acro cat. His dose on June6th was 21u Lev and 7uR BID and he then started his drop down to 6u BID 10 days later. His IAA was considered broken at that point as no amount of R was needed to fight high numbers after June6th.

    Please know that TR may be fine for many cats, but it's just not followed for high dose cats.
    Feline diabetics are standing on dry land, with a faulty pancreas, and getting a helping hand with insulin shots.
    Insulin resistant cats have a functional pancreas but are in a boat, and their dose depends on how choppy the waves are that will affect their dose. There may be days you will have calmness and may chop the dose by 10units, while other days, you have huge waves and are finding the need to increase the dose by 4u and also use R maybe 4times a day.
    Turbulence vs terra firma. Apples and oranges.
     
  19. julie & punkin (ga)

    julie & punkin (ga) Well-Known Member

    Joined:
    Feb 17, 2011
    ah, ellen, i'm sorry. now you can see why this forum is dead. :YMHUG:
     
  20. ellenr319

    ellenr319 New Member

    Joined:
    Apr 9, 2012
    I quit YDC after maybe a week or so there. Ceenka's numbers are on diabeticcathelp.com and diabeticcatcare.com. These two sites used to be one and there was a split from differences of opinion last December. You would have to register and then go to the Name and Numbers forum. I think you can reach Ceenka's earliest logs from diabeticcathelp.com. I may have to go in and change some of the links. But you can also access them on DCH by looking for their topic names. There is a different log for each insulin she has used. Her current one is "Ceenka on Prozinc 2nd Time Around". The others are something like, "Ceenka on BCP PZI," Ceenka on Lantus,'" and Ceenka on Prozinc."

    There are 3 acro cats on DCH who are doing quite well with the Hodgkins TR protocol. One is named Kitty, and the user name is "ozzy" with a number, I think (there is more than one cat with the name of Kitty!). Then there is a cat named Boss, and another named Andrew.

    With the TR diet, canned wet food under 10% dry matter carbs, the cats don't get clinical hypos (symptomatic)on low numbers. We NEVER give karo syrup when their numbers go low, we just keep feeding them with their regular food. We aim for numbers of 45 to 120, but sometimes cats go lower. Ceenka has gone quite a bit lower on occasion. When she goes low at night, she will wake me up by purring loudly in my face. If that doesn't rouse me, she will start licking my nose! I feed her and test her 15-30 minutes later and she always goes back up.

    Ceenka's numbers finally came down today. Here is her current run:

    +6.5..........11:30pm.............197/10.9.....6.0u...........................ate 1oz

    4/14/12
    +6...............5:30am............108/6 :D ......................................ate 2oz
    +8.5............8:00am..............72/4 :yahoo:
    +10.5..........10:00am.............47/2.6 :yahoo:
    +12.5..........12:00pm.............72/4 :yahoo: ...............................ate 1oz
    +14.5...........2:00pm.............46/2.6 :yahoo: (She brought it back down on her own!!)
     
  21. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Nice numbers Ellen.

    Your dosing is 6u every 6hrs or every 8hrs?

    I'll keep trying to get onto DCH; I sign in, says I need to register. I register, says I already exist. Oh well.
    Once I get back on, I'll look at your numbers.

    Good luck on the test results.
     

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