Finally Acromegaly Dx for Coco

My cat coco was diagnosed with diabetes on November 30, 2010. Since then we really have had a lot of problems with it. I would greatly appreciate advise and feedback about my specific situation.

Coco is 12 years old
Male
Neutered
Diabetic
FIV Positive
Grade 5 Heart Murmur
Current clinical toxoplasmosis infection (due to FIV)

We still do not have his insulin under control.

In November, when he was diagnosed, he was put in humalin N. basically we kept raising it for 2 months, with no luck at all. He was up to 16 units two times a day. Then we decided to switch to lantus.

With lantus we didn’t really have time to notice or even get a dosage set up because 3 days after switching to lantus, he got sick. Coco got Clinical toxoplasmosis because of his FIV. His glucose was still out of control. He was in the ER for 3 days, and another vet for 2 days.

He is currently on clindamycin to treat his toxoplasmosis we were told to give it to him for 28 days. The last day will be march 7th. Then it’s a matter of really getting his glucose good.

he has been on W/D for years. I just recently learned about the low carb thing. The only low carb food I can find that he will eat is friskies.. specifically flaked tuna in sauce. So that it what I have been feeding him since we brought him home.

I do cephalic blood draws to test his glucose. Believe it or not.. this is much less stressful on him then the ears. And he pretty much just sits there while I draw blood. I’m in veterinarian technician school atm, so I have some experience with blood draws, so that’s not the issue. I mainly want to make sure that its ok to draw blood from there for glucometers.

Now his insulin. It seems to be that lantus on my cat only last 8 hours. At 4 hours after the am injection he is at his low, which is about 200 on 6 units atm. Then 4 hours later he is back up to 500+

I was wondering, instead of boosters, since he only seems to be lasting 8 hours, what about giving him lantus injections 3 times a day instead of 2.

Instead of
9am and 9pm

It would be
10 pm – 6am – 2pm

And I would probably lower it to 4 units while starting this off. I just want a second opinion about this before I start it. At this point. We have been to 3 vets.. none really seem to understand feline diabetes at all. I just want to take it in my own hands. It is vital I get this under control soon.

I do not want him to have out of control glucose since he has a fair chance of relapsing toxoplasmosis from his FIV. I really just need him as stable and healthy as possible. Please, any advise at all will be greatly appreciated.

 

Re: Diagnosed over 4 months ago ~ Still not controlled ~ hel

It sounds like you are really on top of things and trying to work with a lot of complicating circumstances.

The Lantus Support group may have the answers to your questions about dosing. Have you read the stickies about how to dose and how Lantus works? viewforum.php?f=9 I would post on that forum and ask your specific dosing questions. (They will ask if you have read the stickies so read them first. :mrgreen: )

As far as the food, some kinds of Friskies are great. The ones in sauce tend to have more carbs. We try to stay under 10% carbs and feed fish a couple times a week, not daily. (Too much mercury and phosphorus) Check out this food chart: Janet and Binky’s chart

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Thank You! :]

I will go read through those.

Also, After reading your post, I went to the store and bought a few more varieties and he likes the Special Diet Friskies.. turkey and giblets dinner, which is 5% carbs based on the chart link you gave me :]

and it says its for urinary health, so I think this one may be a good one? hopefully.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Sounds good. Be extra careful checking bg levels. Sometimes just a little difference in carbs can lower the levels.

If you read something that is confusing, be sure to ask. The only stupid question is the one that isn't asked. :mrgreen: And we all asked them and someone answered.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

I'm sure i will have a few... questions after reading the 200+ pages printed out from that lantus link xD lol

Also, I would like to add, I am not comfortable doing many blood glucose tests. we have to do as few as possible because of the risk of giving coco an infection through the blood draws. Coco is FIV positive as I stated. basically i call it kitty AIDS x3

so he has like no immune system. so what times are most important to test during? we are talking about a total of 3 times a week probably.

I have been checking it on Saturdays generally. I try to get one before his morning injection. then I try to pin point his low point with the other 2. The FIV makes this so much harder for us, but it's something we have to work around.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Your poor kitty with FIV and diabetes, etc. You sound like you are doing a great job of trying to figure out how best to help get those things under control. I'm new here as of last week so I can't give much advice except that changing my kitty to all canned high protein and fat and low carb, grain free has made it possible to not even have to start any insulin routine yet. I know what you mean about your kitty only liking one flavor of food, I'm dealing with that now and it's a fish based one as well... as soon as I try to mix too much of a non-fish one in with it to wean him off he turns his nose up to it. I'm off today for more flavors to try out on him. Luckily his tummy is doing pretty good with the changes.

Anyway, I just wanted to say hello and the folks here are very kind and helpful.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

I don't know about FIV, but would doing glucose testing by the ear be safer than the draw? We have seen hundreds of kitties that suddenly throw a low number - after days, weeks or even months of higher numbers. If you give the same amount of insulin twice daily without checking for the blood glucose numbers before each shot, you run the risk of hypo. If he is unregulated after 4 months, maybe it would be worth trying a different approach? Using the wet lo carb diet and testing, we have very few unregulated cats on this site after the first month. They may never go into remission, but they are in safe numbers every day and night.

I would think you would have to weigh these various factors - the FIV, the testing of the ear and the possibility of hypo and the possibility of regulation - to decide on your plan.

You might want to start a new topic and ask about FIV and diabetic cats. We do have members dealing with both issues.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Since you have also gotten up to a whopper of a dose on the Humalin, and are in a high dose on the Lantus already - have you thought about having your kitty tested for insulin resistance (IAA) or acromegaly? If he comes up with either one of those conditions, then the target numbers you are going for are slightly different since kitty technically has a functioning pancreas.

One thing that worries me about only testing 2 times or so a week and getting a nadir of 200 then zooming to over 500 is the possibility of rebound. You don't know what is going on the other 5 days a week, and on such a high dose, I wonder if his body is responding to too much insulin now that you have changed his diet. A change to lower carbs can have a significant effect on how much insulin is needed. I understand your concern about infection due to the FIV. Have you thought about testing the ear and then putting an antibiotic cream on it after each test (like neosporin or something)?

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

He does seem like he would do okay with ear testing. I think it may just need some getting used to..

last time i tried was horrible. by the time i even poked the vein he was so stressed out,.. and no blood even came out, it kind of just bubbled up inside his ear. Maybe I'll give it another go today

he does respond to insulin. The ER vets were giving him Regular insulin and it brought him down to the low 200's pretty fast. So i assume its having some effect. But i don't know if he has either of those things.. i don't believe he has been tested for either. I'm going to try to get a full curve to post if i can get the ear to work.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Some ideas for ear testing.

Warm the ear using a rice sack warmed in the microwave or some use a small pill bottle with hot water. Use a 25-27 gauge lancet so you get a bigger hole at first. Double poke if needed - quickly in the same spot. Have something behind the ear to poke against - like the pill bottle or the sack or a folded piece of kleenix. Milk the ear if you see blood, starting from the bottom edge toward the place you poked.

We all have tricks that worked for us. The trick is to find out what will work for you and your kitty. But just ask - we will bombard with tricks we used.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

When testing the ear you want to aim for the space between the edge of the ear and the vein. If you poke the vein, there will usually be a lot of bruising.

R insulin hits fast and hard, so it it is still possible to have IAA and respond to R. Usually what happens with insulin resistance is you up the dose until you overwhelm what ever is blocking the insulin receptors. At that point, people can usually bring down the dose from there. There have been some IAA kitties that have gone off insulin too. Depending on how much R they gave to get results in the ER - I would still consider IAA. Usually kitties only need .1 to .5u of R to bring them down into the mid to low 100s. If he got more than that and it only brought him to the 200s, then something is different. I have seen one kitty here that got 1 - 2u of R + 4u of prozinc and it was almost like shooting water. She actually had better control using only prozinc without the bolus since regulation is actually harder when adding a bolus to the mix. I have only used R to bring down numbers quickly when ketones were in the picture.

Since your baby has only been diabetic for 4 months and you have worked up to a large dose on 2 insulins - How were dose increases determined and by how much was the dose increased each time? What dose did you guys start out with? Have ketones ever been an issue? No matter the number, no matter the weight, most vets recommend to start with 1u as a starting dose and work up from there. The Queensland protocol for dosing Lantus says to increase by no more than 0.5u every 3 days if the low point is greater than 200. Most of us here increase by 0.25u since a lot of kitties will get drastically different numbers with such a small change. My Oscar is one of those. He will go from 200-300s at one dose, and when raised by 0.25u he is hitting numbers below 100.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Here is a link to the lantus dosing protocol developed by the University of Queensland School of Veterinary Science

http://felinediabetes.com/Roomp_Rand_20 ... otocol.pdf

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

I have all the documents from the ER. they did alot of glucose checks so ill post that. maybe it will help some.

the first time he was in the ER was when he was diagnosed with diabetes. he was at 370mg/dL
they gave him 1.5 units of Regular Insulin at 3:00 am..

checked glucose at:
4:00 am - 240
6:00 am - 187

Then we transferred him to our vet since the ER is only open at night. they decided to use N insulin.
9:00 am - 253
9:05 am - N insulin - 2 units
11:00 am - 277 -
1:00 pm - 239 -
2:10 pm - 240
3:10 pm - 238
5:05 pm - 250

that was all in the 24 hour period of him being diagnosed. we then started him on 3 unit BID on N insulin and we went to the vet to get his glucose checked once a week, he didn't recommend us trying it at home, so we just brought him in weekly at his 6 hour mark after the insulin. sometimes he had us raise it 2 units because we weren't getting anywhere with it. this continued until he hit 16 units. and i decided i wanted to use lantus at that point.

we went straight from 16 units of N insulin to 2 units on lantus. he said we were only supposed to give lantus once per day, but i read differently online. but before i could really bring that up with our vet, coco got toxoplasmosis from FIV. so

once again in the ER. i have more glucose readings. this is more recent. dating feb 5-7 of this year.
i do remember him saying he was +1 ketones this time. I'm not sure what that means honestly..

once again they added Regular insulin to his lantus.
during this time, a feeding tube was inserted, so he probably was not on a proper diabetic diet. sinse he hasn't eaten or drank for 3 days at this point.

Also they did something a little confusing to me which would affect his glocose levels. it says they put 5.5 units of Humulin R insulin in his fluids.. so he was getting insulin continuously through his fluids i guess.

Feb 5-6:
11:00 pm - was on fluids with Regular insulin mixed in
12:00 am - 389 - was on fluids with Regular insulin mixed in
1:00 am - 333 - 2 units of lantus was also given at this time. - was on fluids with Regular insulin mixed in
2:00 am - 319 - was on fluids with Regular insulin mixed in
3:00 am - 292 - was on fluids with Regular insulin mixed in
4:00 am - 288 - was on fluids with Regular insulin mixed in
6:00 am - 244 - was on fluids with Regular insulin mixed in
7:00 am - 3 units of lantus was given
9:00 am - 289
11:00 am - 286
1:00 pm - 282
3:00 pm - 279
5:00 pm - 309
6:00 pm - 0.5 units of Regular insulin given
7:00 pm - 254 - 3 units of lantus was given
9:00 pm - 210
11:00 pm - 196
Feb 7:
1:00 am - 225
6:100 am - 243

maybe that info will help. So he was given 1.5 units of humulin R the first visit, but on the second the 0.5 units seemed to bring him down

I just don't understand why he was in the 200's there but here i see 450's and stuff. its really frustrating.

 

Re: New! Diagnosed 4 months ago ~ Still out of control ~ Hel

Thanks for posting all that. Infection can cause glucose to raise too, so until the toxoplasmosis is taken care of completely, the numbers may be slightly elevated.

For your boy to get 1.5u of R and only go down to 187 throws up a flag for me. My Yoda would get 0.25u of R with glucose in the 400s and he would get into the low 100s 3 hours later. The 5.5u of R in with the fluids is probably because they were giving dextrose in the fluids. Dextrose + R is commonly given in the ER.

Since he does have an active infection and has given ketones before, you probably should get a bottle of ketostixs from your local pharmacy. It is a strip with a reagent pad on the end that you put in his urine stream to check for ketones.

Based off of this info, I would recommend getting him tested for both IAA and Acro. I think both tests run about $150 total. I believe there is only one lab that runs these tests. If you change part of your thread title to "high dose" or something similar, you'll catch the attention of the high dose moms around here to get more input.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

I will try to see if my vet will test for those. what would it mean if one or the other were positive. would i do anything different?

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Here is a link to info on IAA and acro:

viewtopic.php?f=12&t=375

For each test, there is a normal range, and if your kitty tests higher, then it is considered testing positive for the condition. There is also info on there about where to send the blood draw for testing.

Having a positive test will help people trying to help you and your kitty. You won't be constantly second guessing the dose you are giving - whether it is appropriate, or it is too high and kitty is in constant rebound. It will also help us understand your kitty's situation when we try to give advice on what to discuss with your vet for treatment options. Anytime someone comes in here with a whopper dose like that, you will usually have droves of people wanting you to go back down to 1u twice a day to rule out rebound. If your kitty has a tested reason for the dose to be that high, then you won't have to go through that trouble.

If kitty tests negative/within normal range for IAA and acro, then we have to figure out why your dose is so high. Is there another underlying infection somewhere? Is the carb content of the food you are feeding too high? Is the insulin working the best or do you need to switch? Is kitty in constant rebound which is forcing the numbers to stay high?

Hope this helps!

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Thank you for the links. I have been reading about Acromegaly a lot and am very worried he has this. he does have some symptoms of this.

enlarged kidneys
grade 5 heart murmur
the diabetes obviously
high cholesterol levels
pot belly

I am for sure getting him tested for this. we are taking him in to the vet on Thursday probably. i have a question about the website though. I'm not sure if i am supposed to obtain a blood sample and send it in myself or if i print out the papers for it and have my vet do it? I'm not sure what the site is asking for, or how we pay for it on the site.

I did attempt ear testing just a few minutes ago after buying larger lancets. the ones i had tried before were 33 Gage, the new ones are 26 Gage and i managed to get a drop of blood! yay! :] unfortunately the drop was too small for the glucometer to read lol. But progress is progress. I Am going to try again 30 minutes before his insulin tonight.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Getting your kitty to allow ear pokes is definitely progress! Especially in the beginning you should give a little low carb treat each time you test, even if you don't get blood. That helps to train your kitty to not mind the pokies at all. My Oscar knows testing time and walks over purring all on his own when he is ready to be tested!

As far as your acro testing questions - I cannot help with the specifics since I have not personally tested for it. You should maybe start a new thread with a title about the testing logistics for acro so the acro kitty parents will take notice (something like "need help getting kitty tested for acro"). In that post, just include a link back to this one in case anyone wants some back history on what has been discussed so far.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Most of us have our vet do the blood draw and send it to the lab. Then results are faxed back to the vet.

There is only ONE lab in North America that does the IGF-1 test. Make sure you and/or your vet contact them directly so you aren't paying some middle-man to reship your sample.

Also -- a second test for IAA Insulin Autoimmune Antibodies is available at the same lab for $14 more -- worth it to request both tests and ship once. If acro is negative, sometimes IAA is positive. Occasionally both are positive.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

It's late so i'll be brief- and check on you tomorrow.

In the past the tests are run/started on Wednesday, so I usually suggest a Monday draw, then overnight shipping via Fed Ex with ice packs, directly to the MSU vet lab, so they are there in time for a Wed set up.

The folks at the lab are very nice and the phone number is on the link, so call them to find out if fasting is needed, and the number of vials required.

Definitely test both as Phoebe suggested. The expense is in the blood draw, the cold shipping, and about $65? total for the lab. Your vet will probably not know anything about it and will discourage you from testing because acro was considered rare- it is not rare. Just insist its your money. The vet clinic may need to set up an account with the lab by providing a credit card number.

and if its positive, you will have a new set of friends to guide you through your dosing.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Sorry to cut and paste a recent post - its late and maybe this will help-

It does help to hold your fingertip pressed up against the back side of the ear when you pop the lancet, wrap your finger in a tissue in case the needle pokes all the way through the ear.

Also meters vary significantly according to the blood droplet size required. The strips are expensive but the Freestyle lite needs only like .3 microliters. There probably are other newer models that require a small amount also- and some meters only cost $10, so its an option if he doesnt bleed well. Cody bleeds easier the more I tested- it does get better

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Alright. Thank you. i think i will talk to them about it this thursday then and then maybe have it drawn on the first Monday i can get him there. I already suspect they will not want to test him for this but I am going to try to push it.

Also, coco is using the Relion confirm meter. i heard the strips don't require much blood. I did get a pretty small drop and knew it probably wasn't going to work, but tried anyway.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Go in prepared with the print out of the MSU lab reqiurements and contact info for both tests

Go in with a acro article or two

maybe drop them off on Monday, with a note that you have an appt to discuss the testing on Thursday- so they have a chance to do some homework, and not feel so clueless. Most vets are not programmed to consider acro, and respond by dismissing the idea, ...but to me at quick glance, your guy sounds very suspicious.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

i've only been testing at home for 2 weeks today, and realized it took about 4 days of trying til i mostly was getting blood the first poke. it's definitely frustrating and you feel like you're wasting a lot of money with the test strips when you can't get quite enough to get a number. i feel for ya, but it really, truly does get easier.

one thing someone suggested to me was if you got a little blood, but not enough to test, poke them again right next to the first poke. sometimes together they are enough.

i always use a rice bag to warm his ear and i shone a flashlight under his ear to see the vein. i admit that sometimes i hit right on that vein, especially if i'd already poked him a couple of times without successfully getting a drop. mostly now, though, i poke, then kinda try to rub some blood toward the poke and make it come out. someone also told me that the blood runs from the inside (eye) side of the ear out to the tip and down the outside, which was kinda helpful.

if you need more suggestions about getting a successful poke, keep posting! people have lots of ideas. here's the link with some suggestions people gave me:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=37627

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

I tried to test again today. i warmed his ear, kind of rubbed it for a few minutes to get him used to me touching it alot, then just poked.. he jumped but i got a big enough drop this time. I did it at 8:30 pm. 2 hours before his insulin for tonight and it was 324. I am going to try to get some kind of curve tomorrow after his morning injection hopefully with any luck.

I also bought ketone strip things. and he was negative for ketones when i tested him earlier today.

i printed all the papers out i think i need for my vet and have been thinking about my presentation like all the time for when i explain this to him.

My mom thinks its embarrassing asking for this test, because it sounds way out there to her (she is a nurse and I'm in college for vet tech.) , and doesn't want me to do it. I think it needs to be done though, especially when even I now suspect acromegaly. I wont be able to stop wondering and stressing until i find out if he has this. i will get the IAA test done as well. might as well for only 15$ more :3

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Good for you! To me the peace of mind is worth the $150 and the "embarrassment" of asking the vet to do something they probably haven't heard about. But look at it this way - you save yourself the constant worry about this high dose and his numbers, and you will be learning new things about diabetes along side your vet

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

My vet initially refused to test my girl for Acromegaly. I went back a second time and insisted much to my vets annoyance! She was pretty shocked when it turned out that, yes indeed, Chika had Acro.

I am very glad I persisted.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Just wondering if you used the lancet device when he jumped when you poked his ear. If so, you can try freehand. If you are f/h poking, maybe try pinching the ear slightly to numb the nerves after you've heated. It doesn't affect the blood supply but for a second and you still get blood.

What a great job you are doing managing Coco. He's one lucky guy.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

dont forget the yummy testing rewards for being such a good boy. After awhile I shook the testing strip vial and Cody came running lol. For him it means "MEAL TIME" Yayyyy

Ditto here what Juanita said.

Truly, it will help if the vet has the chance to look over the materials days BEFORE the appointment, so they can still be "the smart one", (kind of like we 'smart ones' treat our DH's LOL) You aren't going to get what you want, if they feel out of their comfort zone and expertise.

Heres a link to an excellent article on feline acromegaly- I copied it to a cd for my vet.

http://www.sciencedirect.com/science?_o ... 58b97d9ea5

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

also remember to HOLD the lancet on the spot with pressure for 5 sec before and after the pop. Trust me... )

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

oh, i didn't know about holding the lancet on the spot . . . so much to learn. i have had some success with making the poke, seeing a micro too-small amount of blood, and massaging around the spot a bit to get more to show up.

you're being a very good mom to insist on your kitty's care. kudos to you and be encouraged to stand your ground!!

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

I managed to do a 12 hour curve on Coco today. Its not exactly what i expected to see and I'm a little confused. ill try to start making one of those spread sheet things in a bit.

but his numbers for the day were:

9:00 am - 278
10:30 am - 242 (6u Lantus)
12:43 pm - 285
2:24 pm - 305
4:19 pm - 357
5:00 pm - 308
7:00 pm - 291
9:10 pm - 245
10:10 pm - 275 (6u Lantus)

i don't understand why his glucose goes up when i give him insulin instead of down.

its like making a hill shape curve instead of a ditch shape :s

is this .. normal at all? it is better then when he was on 5 units at least. he showed 400+ on 5 units.. still i don't understand why the curve is like this.. i thought his glucose was supposed to go down after an injection.. not up.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

You will not see results immediately from the shot. It can take 3 or 4 hours before you may see any decrease in BG numbers.

Also, with Lantus, the shed plays into the numbers as well. If you have just increased the dose, the shed will need to be topped up and it may take up to 5 shots to see an improvement with the BG numbers.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Each insulin has a typical mode of action, which I'm betting you can read about Lantus in the Lantus ISG permanent posts (stickies)
For example, Levemir, (which I think is similar but not identical) takes 3-4 hours before the "onset" of action, then it slowly brings numbers down for many hours, hits a low ("nadir") for a couple hours, and then gradually (or not, sometimes, if the shed isnt filled yet) comes back up until about 3-4 hrs after the next shot.

oh and you noted the dose as +6

we use "+" to denote the number of hours post injection, so folks seeing +6 would possible think that means 6 hours after your injection. We do not express time as actual clock time, but rather as +1, +2, +3....+12, and if you are late or skip a shot as +13, +14 etc. ---- +12 is typically your AMPS or PMPS reading (AM preshot PM preshot)

I always put a "u" after my dose, so I know that number is dose units, for example 6u, means 6 units. everytime you shoot, you start over at +1 regardless of the clock time. we have folks posting to you from the other side of the globe, so it just makes it easier/clearer to communicate.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

I just studied your numbers and I see that (on this 1 day), he had his nadir near the preshot, and his highest number at about +6.

Lantus is one insulin that I have not used, so can't really comment on what is an ideal or typical curve.

I do know that timing of food can significantly alter the curve, so if he is a grazer, and chowed down 15 min before your +7 reading it would raise those numbers.
Also, home glucometers are not "precision" instruments, so remember you are seeing numbers that are +/- around 15%-20% of accurate. for example your 357 might really have been (35 x2=70,) 70 points up or down of 357. ( so in the future, before you panic about some number, recheck it ) At lower number 20% is a smaller variation (bg of 50 is probably 20 pts +/- correct)

At this point you are collecting data, which helps when you get a lot of data to see trends. If he tests positive for a high dose condition, you can get help from high dose moms, if not, you can post in the Lantus ISG to get help figuring out that curve.

Hang in there you are doing great! the spread sheet is very important

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Using a tiny bit of Vaseline on the ear gets the blood to bead up so you can see it better.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

My Oscar is a late nadir kitty - some kitties just do that and who knows why. The important thing is that your kitty isn't going above 400 now which is a really good thing! I would hold this dose for a few more days and get the occasional spot check in just to see if the pattern is continuing. (preshot tests and maybe a +8 or +10 since he likes to hit the lowest point somewhere around there). I can't wait to hear those acro/IAA test results

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Alright, Thanks for the information. Im having trouble getting the spread sheet atm.. i found it before but cant seem to find it anymore lol

Today is my vet appointment. i was thinking about also bringing up neuropathy. coco does limp up the stairs and almost falls over when you pet him too hard, cuz his hind legs don't have alot of strength, he has a hard time jumping too. I read on here that its treated with the Vitamin B-12 something. I just want to make sure this sounds like neuropathy to you guys before i bring it up with him today :3

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Here is the thread with the spreadsheet: viewtopic.php?f=6&t=18207 They were having trouble but I think it is working now. If you have problems, just ask for help.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

i found that it made a huge difference in my cat's BG numbers when i fed him. again, i'm just a newbie, but i've been told and found it helped a lot to

1. test his blood sugar in the am, then immediately feed him and give him his lantus shot. punkin is 14 pounds and i give him 1 can of Fancy Feast low carb food.

2. at +3 hours i test him again, then give him 1/2 can.

i repeat that sequence in the evening and don't give him any other food except a tiny, 1/4"x1/2" piece of chicken for a treat every time i test him. it's helped even out his numbers, at least they've evened out and i think it played a role.

i say that because initially i was giving him some food as a treat - like maybe a tablespoon or so, and his numbers were higher later in the cycle. if you are feeding him more than a tiny treat after +6 it might be affecting his numbers.

he thinks i'm starving him, but he's surviving. if you look at his profile in my sig line you can see him staring at me when he thinks i should be feeding him.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Coco is a grazer. we did try set meals for him before, but he would only eat a few bites then he would have to basically wait for his next meal. he eats almost every 30 minutes to an hour. He absolutely hates being on a set feeding schedule. We tried the set schedule, didn't work too well lol, so I'm wanting to keep him a grazer.

I just got home from the vet. This is the deal with the acro test and the IAA test. he was willing to draw blood for us, but said that we can just send it ourselves based on all the paper work. it didn't seem like he had to it. he said that if he drew then now they should be fine if we kept refrigerated until Monday to ship. so i have the blood samples in my fridge now. he didn't charge us for them or anything so no loss really except for coco having to go through blood draws. my vet actually said he thinks its acro also so he was perfectly okay with our wanted to test for it.

So we are going to ship them ourselves i guess o.o

he told us how to package them and gave us the icepack to be shipped with it. so i think we will be okay with it.

Also, im thinking that the only reason his numbers are below 400 atm is because i switched his food to the low carb mushy stuff. so im thinking his insulin dose is going to raise a lot probably. im going to increase 1 unit at a time instead of the .25 or .5 because i do rly think he most likely has acro and i don't see the need to go up in such small doses. so tonight I'm going to start him on 7 units i think.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Big changes can sometimes happen with smaller dose changes, even with acro kitties. Can you maybe do a 0.5u increase now? Keep testing the preshot numbers and try your best to get a mid cycle test when you can just to be sure. Once you have the acro confirmed, then I would feel a little more comfortable with an increase that big....maybe

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

WOW- this may be a first! You have a great vet, did you drop off the papers ahead of time?

I tend to agree that 7u may still be time for .5u increases. I forget exactly, but once I got to hummmm 9 or 10u we started full unit increases, depending on how far "off" of ideal nadir you are. As I get close, .25u changes can make a big difference.

You are probably right about his diagnosis, but you still need to be careful. Actually acros never try to achieve double digits. Some cats are on 60u/day... can you picture the shed?,,, and how long that takes to drain, trust me its not a few licks of Karo.

Do you have a ss yet? The acro moms will appreciate data to help you. I'll ask some to pop in.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

By the way, do you mind telling us your name?

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

My name is Andrea xD and im 22, in college :3
i should prolly edit my first post with my name

Sorry i know i made my name wrong. i didn't really pay attention to the first name + cats name thing til after i made my account. lol

I actually did not drop off the information ahead of time. He did say he had an acrocat before and so thats why i think he suspected it and was happy to help us with it. He is curious to our results and that's all he wants to know in return for drawing the blood for us.

I will go up .50 units then tonight

Also actually filling out the spread sheet right now. i will add it to my sig. soon hopefully.

is it recommended to do a full curve every time i raise his dose?

edit* Got the Spread Sheet up

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Andrea- official welcome!

I have a 22yo DD in nursing school )

I can't help with Lantus,
but for testing, really you just need preshots and a couple readings around the time you suspect the low point (nadir). Dose adjustments are made in the L's (lantus and lev) primarily based on the nadir, less so on the preshots. In lev, it can take several days before the full effect of a dose change is completely apparent, so stick with it awhile before increasing again. For this help, post a new thread each day in the lantus insulin support group, here in fdmb.

Its good to alternate hours, on different days, so when you have your ss you can look back over a month of data and see trends, and eventually find the typical nadir time. You might check at amps,+5, +8, then PMPS one day, and you might check PS's and +7 and +10 another day. If you are home one saturday, you could check every 2 hours every once in awhile, to get the whole picture. Its costly to test a lot, but it does really help finding the dose. In acro, dose typically stays the same for awhile , then fluctuates up and down a few units, stays like that awhile and then back again. testing is needed to stay on top of it. I like to test right before bed, to catch an overnight low coming on- this is not uncommon.

Many acros switch to levemir because the larger doses may sting with lantus. Something to consider before you increase too high. lets see about those results...

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Methocobalamin is the active form of B12 you need. ask again and someone will post online sources and dose. I get it at a local health food store. Be sure it has no artificial sweeteners esp xylitol. I get the 5000 micro?gram sublingual tabs and give 1/2 each day.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Hi Andrea
Just another acromom popping in to say hello - give you some support - more emotional than anything else. Everyone has helped you so much already. Just wanted to let you know there are so many more of us out there should your results come back positive and we will be there for you.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Oh I meant to add - if you have a super supplements store near you - they have pretty good prices for the methylcobalamine (another name is xobaline). Also check out:
http://www.houseofnutrition.com/lilixof ... s+Xobaline®+(for+cats)+3mg+60Tabs&ovtac=CMP

I hope this helps you a little!

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Hi Andrea and Coco,

Sounds like you've got a lot together in a short amount of time. Coco is very lucky to have you.

I've been buying our Methyl B12 from this site, it was the best price I could find online, and it's practically impossible for me to find it locally: http://www.vitaminlife.com/product-exec/PNAME/Xobaline_3mg/product_id/37728. I know Hilary and Maui have a source they like for this that does not contain any sugar at all (Xobaline does contain fructose, but not a primary ingredient).

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Thank you all for those links and information. i will get a bottle of the methylcobalamin b12 asap. I am looking forward to him being able to run up the stairs again! xD I actually miss it.

I did have issues testing today >.> he got too stressed out at both the AMPS and PMPS times, to the point where i just didn't wanna force it on him anymore after spending 20 minutes poking over 10 times with either no blood or very little (not enough for the meter) I'm worried im going to make his ear look like a slice of Swiss cheese :[

I'm trying not to go through his ear, but i can tell i do it sometimes. and having a hard surface under his ear seems hard to do, I feel like i have more control by holding a folded paper towel under his ear. I'm fairly certain i was hitting the right spot, since i did get some blood. it just wasn't enough. Might try the Vaseline suggested to me to make it bubble up instead of soak into his fur, which is black >:l makes it harder to even see the blood. I only know its their because its shiny.

And thank you for the welcome to everyone and for all your help so far, i do feel like i made a lot of progress in this from this last week of being here :]

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Norton, our first diabetic, was black -- we got a headlamp to help see the blood.

http://www.rei.com/product/799818 Like this - might not be the exact model.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Some people put hot water in a pill bottle instead of the rice sack. They hold the bottle behind the ear until warm, then they have it to poke against. We always poked Oliver on the inside of the ear because he had very furry black ears.

Are you double poking? just a quick second poke in the same spot.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Are you milking the spot you poke too? Some times I have to massage the area I poke for a few seconds before the blood starts flowing. It is rare that I can poke and immediately get blood.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

Sent the blood samples to the lab on Monday for Acro and IAA :3
they arrived there this morning less then 24 hours after i shipped them.
Just have to wait for the results now.

I am starting to have more luck with the blood tests.. for me A lot of times, i just poke and blood comes out >.> Lately it has been enough blood for maybe 10 tests.. Seems like a lot.. I just put pressure over it when I'm done with gauze until it stops though.

 

Re: New! Hige Dose Kitty ~ Still out of control ~ Help :[

you're doing great, andrea! i have a 24 year old daughter and can imagine how this might be for her. it's like having a sick kid!!!

i'm new at this game, so am not really going to offer advice. But i will say that my 14lb punkin gets 7.5 u of Lantis twice a day - it was a mistake that it went that high (wrong size of needles after we switched from Prozinc to Lantus) but he is doing fine and we are now on our way lowering the dose because his numbers have gone down. People here caught the error for me. I don't want to suggest a dosage for you, I'm just saying that his isn't a crisis. My point being that you are doing fine and will be able to learn what you need to help your kitter! You probably want to slide on over to the Lantus forum (look on the main page under Insulin Support groups) and start posting daily there.

as far as the nadir goes for my cat, and i realize it seems to vary a lot between cats, testing his blood between +3 and +6 seems to tell us his lowest numbers, and for Lantus, the lowest number of the cat's blood sugar is really important in the dosing. I can tell that for punkin because i've done so many spot checks at different times of the day, and then can see the pattern emerge on the spread sheet. In our case, he gets his insulin about 7:30am, so I always try to test by 10:30 and then depending on what it is, go from there. I repeat that in the evening.

Good job helping your little guy!

 

We got Coco's Acro result today and he does have Acro. his igf was 249. Still waiting on the IAA

 

It is good to have the diagnosis. It does mean a whole "new ball game". Have you seen the high dose support group? viewforum.php?f=12 There are lots of good stickies there with information. It is not as busy as this health forum, but if you post and check back in, you should get replies.

 

It is good to finally get confirmation! Now you don't have to always worry about if the dose could possibly be too high.

Other high dose mom's will be in here soon. Dosing goes a little different for acro kitties.

 

No worries - Andrea & Coco are already in full communication with the acromoms

Welcome to the club nobody WANTS to join!

 

I am so frustrated that if it weren't for this site, i wouldn't have even known Acro existed for cats. And i probably would have went for greens and made him sick.. and ugh.. I cant thank you guys enough for bringing up Acro to me. Will be switching to Levemir soon :]

 

Hi Just catching up on your situation. What a relief to finally have a proper diagnosis and know what's going on. The acromoms are a great group on here and know what they are dealing with. Some of them even have multiple cats with this issue.

Sorry you had to join the groups both FD and acro - but you're in good paws here!