? Help! amps +388, high flat with dose increase

I’m not sure what to do with little one. I’ve never caught a bounce with him, but when he went up to 4units twice daily I haven’t seen his numbers drop at all. I’ve been super busy and haven’t had time to do a curve. Now I’m wondering if closer to 3.5/3.75 was his better dose, but those yellows and blues only lasted a short period of time. Sigh.

 

Hi Elizabeth. A curve would be helpful to see exactly what this dose is doing. There is some missing data especially at nighttime where there were no tests after the PMPS for a several nights. So, it's a guess as to how low he might have gone and then bounced back up. Do you have time to do a curve soon? Any data you can get today would be good .

Sometimes kitties respond to a dose and give a few lower numbers, ( like the yellows and blue with the 3.75 dose ) and then start requiring more. But more tests will reveal if the 4 u dose should be held or an increase is in order.

 

It’s been seven days, time for that curve. And as Bobbie says, spot checks when you can are a good idea at night. However, I suspect he needs an increase. The goal is mostly blue with some upper greens in there, and this dose doesn’t look like it’s giving him that. You will get there. There will be a dose that moves him.

 

The fact that when his dose went up to four he saw no blues or yellows like when it was 3.5 or 3.75- could it be too high? I’ll curve tomorrow as it’s the first time I’ll be home for a whole day in awhile. My silly work schedule...

 

I doubt it, too much red and pink in there. It does look like he bounces a lot during the day. Any night time before spot checks you can get will give us a good picture of what is happening. Good luck with the curve tomorrow.

 

So curve done yesterday; numbers are so high! I’m worried that his stomatitis is exacerbating his BG numbers and I don’t get why an increase would mean a loss of blues and yellows. Wondering if a full mouth extraction would benefit his BG numbers, but the vet is worried about anesthesia when his diabetes isn’t regulated. Plus he has a heart murmur. Ugh!

 

Looks like he definitely needs an increase. He could be seeing some glucose toxicity, and getting used to higher numbers. That makes it harder to break through to good numbers. Or the stomatitis is getting worse. Insulin is a hormone, not a drug. You don't necessarily increase and see a little bit of improvement each time. You keep increasing as per the dosing method, until you hit that fitting dose.

Do you have any veterinary dental specialists near where you live? When my Neko got a heart murmur, that what I started using. They are used to older animals and animals with issues. They usually have extra monitoring of the heart and might even have a veterinary anesthiology specialist available. Yes, they cost more, but are worth it in my opinion. My vet was going to remove one of Neko's teeth, but the dental specialist discovered the red gum was due to soft tissue growth (from her acromegaly) instead, so she got to keep the tooth. And yes, solving teeth issues often makes a world of difference in blood sugar and getting a cat regulated. Unfortunately many general practice vets aren't comfortable with special cases.

 

Ok, thanks. I’ve left two messages in two days at the vets office and she hasn’t called me back. I’m not sure if she’s unsure of what to do, or what. I called around to a few places and asked if they had specialists, and while they do seem to have more access to stuff, none said they had specialists. I’m also on the Banfield plan, so I’m paying per month whether I go there or not. They’ve always been helpful up to this point, so I’m unsure what to do. I’m a graduate student who is already paying now about $200/month on the low side and afraid to drop a couple hundred at another place only to get the feeling that either they don’t know what they’re doing or asked to drop several hundred more. His teeth cleaning is also included on his plan here that I’m already paying for. I’m so frustrated as he’s peeing more and losing weight again and my vet is telling me that most internists suggest holding a dose steady for at least 2-3 weeks at a time, and yet he’s getting worse not better.

 

Go with your gut. What your vet says is not working. People here live feline diabetes for years. I was the first client to home test at my vet, the first to use Lantus then Levemir, the first to use Tight Regulation for dosing, the first to get tests done for and positive results for acromegaly and IAA, the first to get radiation treatment at that clinic for acromegaly. You get the picture. I had to advocate for my cat and push to get results. But my vet was willing to learn and work with me. She got a lot of articles from me. Shortly after Neko got her acro diagnosis, she recognized another at the clinic.

I would increase to 4.5 units now. The nadirs are high enough and numbers aren’t getting any better. If you can’t get the needed dental, then you will have to use enough insulin to get the blood sugar down. Glucose toxicity is setting in if you hold the dose too long, Note for any lurkers, in spite of this caregiver using SLGS, I am suggesting a slightly larger increase because this cat is stuck in high numbers and we have enough data to know an increase is needed. I too started out waiting for a call from the vet to do any increases, but got impatient waiting for call backs while Neko was in high numbers, and started working with people here.

 

Thank you! Vet got back to me and had been looking over my data I shared and doing extra research. She recommended a dose increase and that we increase a bit more quickly. She also referred me to a dentistry specialist and I have the earliest appt available in late March. She is worried that there are so many different things happening: stomatitis, small heart murmur, resistant BG numbers, etc. but I feel better now hearing from you all and hearing now more similar things from her. I also appreciated the specific referral as I was making calls all over the place this am and felt lost.

 

So my vet wanted to move him to 5, because she’s worried about him sitting in these high numbers for too long, but then of course they’re not getting better. Should I bump down to 4.5 even though he’s gotten 5 for a few days? And then move back up?

 

We usually increase in increments of .25 unit until kitty hits 5 units then the increase increments go to .50 units. This is the 4th cycle on this dose so the 5 unit depot should be getting full soon. I think I would hold this dose for now and try to get a curve tonight to see just how low this dose is taking him.

Just curious, what food are you feeding and do you know the carb %? Higher carb food would keep his numbers higher.

 

Thanks for the input. I know the slow dose increases, and was gonna do 4.5 but got worried about getting his excessive high numbers down. I always second guess myself in everything I do with him! He is a very skinny 10.5 lbs, and gets roughly 3.5 cans of FF pate classic (low carb) spread out over the day, mostly at his AMPS and PMPS.

 

Small correction, under 5 units, we go up by 0.5 units if all nadirs are over 300, which they were.

As Bobbi said, you might see action today or tonight, so I would be vigilant,

 

Sounds good. I’m seeing very very small improvements, so the next step would be 5.5?

 

Yes, 5.5 units would be the next step. Good luck with that increase.

Next time, could you start a new thread with a link to this one. People don’t often notice new comments on an old post.mwe typically do one post a day here.