? Maxi/14March2020/Need Info for Vet Appt./No improvement at 6 weeks in, now 4.25 units

bambinaki

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/...axi-pmps302-question-re-binder-dosing.226908/

Hello-

I need some info from you, please.

Maxi is now up to 4.25 units twice a day, still with zero improvement in his glucose levels.

The vet would not give me another prescription for Lantus without seeing Maxi. She wants to check his fructosamine, which is fine with me; I think it's time to check Maxi's condition. I will ask her to check anything and everything else. Our appointment is first thing Monday morning.

*What tests should I ask for? (NB: Maxi also has kidney disease.)

*Are these articles (linked below) the best ones to show the vet about TR and Lantus as the best feline diabetes treatment? What other data can I show her?

I have a feeling she will ask me to change back to Vetsulin, which she originally prescribed, saying they had good results with it.
Also, please see Maxi's spreadsheet: on 2/21, he finally had good numbers at 2.5 units, and when the vet saw that, after he was already up to 2.75 she advised me to go back to 2.5. I asked you about it, and you said NO, so I didn't go back to 2.5. So, could you please provide me with a sentence (about the depot?) to tell her why going back was not a good idea?

https://www.dovepress.com/managing-...spectives-peer-reviewed-fulltext-article-VMRR

http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

https://journals.sagepub.com/doi/pdf/10.1177/1098612x15571880

If you are confident that I should continue as I have been, if you think this is the best line of action for Maxi, would you please arm me with information to persuade the vet?
Please don't advise me to find a different vet.

Thank you!
 
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When was Maxi diagnosed with kidney disease- and what stage is he ? Your lab values ( Bun, Creatinine, Phos, ratios) are within normal limits and less than my cats- who has never been diagnosed with kidney disease...So, I think that's an improvement overall if you are just treating the diabetes and using a phos binder.

I think the 2.5 units is a moot point, as he is already up to 4 with little improvement( as you said).....so going back down instead of increasing as you were likely advised here wouldn't have made much difference I think. You are past that.

Do you think you had better results with Vetsulin? Are you confident that another insulin yielded better results? Ultimately, you are the one caring for Maxi and will need to do what you think is best. My vet has always told me that Lantus sees flatter curves and that most cats do better on Lantus/ Levemir. There are tons are articles on the internet, but it really is up to you. Diabetes is a long road condition- you have to decide based on many factors what you are comfortable with....We've been at this 5 months...it's a process. What worked 4 weeks ago, likely doesn't work now. I know there isn't a quick fix though and that some cats will need insulin for the rest of their lives.

Everything I read points to similar studies suggesting most cats did had better remission rates with Glargine. But the best insulin for your cat and the best dose is the one that works- ECID.

" Significantly higher remission rates were achieved by 16 weeks of treatment with glargine (8/8 cats), compared with lente insulin (2/8) and PZI (3/8) in newly diagnosed diabetics fed a low-carbohydrate diet" (2018)
- From the Dove press article you already listed


Articles- which your vet has likely seen.
https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/insulin-therapies/
 
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If it's possible when you get a script for lantus, send to Marks Marine in Canada. You don't have to tell the vet where your getting it. This way you won't be caught short of insulin if you get the box of 5 pens. You will go through them quickly if dose goes up more. You won't have to see vet just to get more. Marks only needs a one time script.
 
Si am cat mom said:
When was Maxi diagnosed with kidney disease- and what stage is he ? Your lab values ( Bun, Creatinine, Phos, ratios) are within normal limits and less than my cats- who has never been diagnosed with kidney disease...So, I think that's an improvement overall if you are just treating the diabetes and using a phos binder.

I think the 2.5 units is a moot point, as he is already up to 4 with little improvement( as you said).....so going back down instead of increasing as you were likely advised here wouldn't have made much difference I think. You are past that.

Do you think you had better results with Vetsulin? Are you confident that another insulin yielded better results? Ultimately, you are the one caring for Maxi and will need to do what you think is best. My vet has always told me that Lantus sees flatter curves and that most cats do better on Lantus/ Levemir. There are tons are articles on the internet, but it really is up to you. Diabetes is a long road condition- you have to decide based on many factors what you are comfortable with....We've been at this 5 months...it's a process. What worked 4 weeks ago, likely doesn't work now. I know there isn't a quick fix though and that some cats will need insulin for the rest of their lives.

Everything I read points to similar studies suggesting most cats did had better remission rates with Glargine. But the best insulin for your cat and the best dose is the one that works- ECID.

" Significantly higher remission rates were achieved by 16 weeks of treatment with glargine (8/8 cats), compared with lente insulin (2/8) and PZI (3/8) in newly diagnosed diabetics fed a low-carbohydrate diet" (2018)
- From the Dove press article you already listed


Articles- which your vet has likely seen.
https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/insulin-therapies/
Click to expand...


The vet said it was early stage kidney disease.

Maxi wasn't on Vetsulin long enough to judge. I changed to Lantus right away.
 
Olive & Paula said:
If it's possible when you get a script for lantus, send to Marks Marine in Canada. You don't have to tell the vet where your getting it. This way you won't be caught short of insulin if you get the box of 5 pens. You will go through them quickly if dose goes up more. You won't have to see vet just to get more. Marks only needs a one time script.
Click to expand...

Great! Thanks a lot.
 
Karen:

Maxi saw blue numbers for one cycle. I wouldn't let that brief time dictate the dose. Ultimately, the best dose for your cat is the dose that has an effect on the numbers.

While this may not be the case with Maxi, he may have a high dose condition. If you are going in to the vet for labs, rather than wait until the dose is over 5.0u which is when we usually make this suggestion (in other words, why pay for another office visit), you could ask to have blood drawn to test for acromegaly (IGF-1 - insulin growth factor) and insulin auto-antibodies (IAA is the test for insulin resistance). The blood needs to be sent to the lab at Michigan State which is the only place these labs are analyzed. This is a link to information about the testing. Please keep in mind, this may be premature.
 
It felt like giving Freckles insulin was just like shooting water. I was seeing really no effect until I realized the difference when I did a total furshot and her numbers increased. With the start of insulin, Freckles started to regain back the weight that she lost prior to the diagnosis, her fur was nicer, she did not have as much dandruff as previously and her appetite decreased a bit. So even though the insulin was not noticeably affecting her numbers, it was helping her body overall. We continue to look for a dose that will bring Freckles numbers into consistent blues and greens, but we are not there yet.

Are you seeing any changes with Maxi?

Freckles was diagnosed with acromegaly and IAA about 1 month ago.
 
Sienne and Gabby (GA) said:
Karen:

Maxi saw blue numbers for one cycle. I wouldn't let that brief time dictate the dose. Ultimately, the best dose for your cat is the dose that has an effect on the numbers.

While this may not be the case with Maxi, he may have a high dose condition. If you are going in to the vet for labs, rather than wait until the dose is over 5.0u which is when we usually make this suggestion (in other words, why pay for another office visit), you could ask to have blood drawn to test for acromegaly (IGF-1 - insulin growth factor) and insulin auto-antibodies (IAA is the test for insulin resistance). The blood needs to be sent to the lab at Michigan State which is the only place these labs are analyzed. This is a link to information about the testing. Please keep in mind, this may be premature.
Click to expand...


Thank you, Sienne. That is extremely enlightening (and scary). I will ask for the 2 tests.

The page mentions this: "Have you noticed changes in the way your cat breathes? Any changes in their eye sight?"
Do you have more information about the breathing? Maxi has been kind of a snuffler and snorer for a while (before diabetes diagnosis). I don't know if it's my invention, but his snoring and snuffling seems to have increased lately.

This also might be my invention, but sometimes his eyesight doesn't seem good. (Other times it seems fine.)
 
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Judy and Freckles said:
It felt like giving Freckles insulin was just like shooting water. I was seeing really no effect until I realized the difference when I did a total furshot and her numbers increased. With the start of insulin, Freckles started to regain back the weight that she lost prior to the diagnosis, her fur was nicer, she did not have as much dandruff as previously and her appetite decreased a bit. So even though the insulin was not noticeably affecting her numbers, it was helping her body overall. We continue to look for a dose that will bring Freckles numbers into consistent blues and greens, but we are not there yet.

Are you seeing any changes with Maxi?

Freckles was diagnosed with acromegaly and IAA about 1 month ago.
Click to expand...



Hi Judy-

"Are you seeing any changes with Maxi?"

Maxi has been kind of a snuffler and snorer for a while (before diabetes diagnosis). I don't know if it's my invention, but his snoring and snuffling seems to have increased lately.

This also might be my invention, but sometimes his eyesight doesn't seem good. (Other times it seems fine.)

What do you make of this?

Why did you change from Lantus to Levemir? (Please forgive me if you've already told me. I asked someone some time back about an insulin change. I don't remember if it was you.)

Thank you
 
Not in the US, but I also used the Petsafe 5.

A cat needs however much insulin they need. You keep increasing until you find that dose that gets them into good numbers. TR is a method that gives you a quick and safe method to do so. Remember that insulin is a hormone, not a drug. You don't just add a little insulin and necessarily see the same corresponding improvement in the blood sugar numbers.

Neko's FD journey was very frustrating for me. She saw green at 3.75 units briefly, and then it was gone. Next increase, just blue, increase again, a brief green and gone, increase again, nothing, then green would make a guest appearance again before disappearing. It wasn't until 7 units until green lasted more than 1- 2 hours and 8.75 units before her first reduction. It felt like something was fighting the injected insulin. It turns out it was two somethings, both acromegaly and IAA. It made so much more sense when I knew what I was dealing with. As I found out later, she probably had acromegaly at least 6 months before her diabetes diagnosis.

It's also possible Maxi has something causing insulin resistance. The two MSU tests will let you know one way or another. One in four diabetic cats has acromegaly. At this point he has at least glucose toxicity, which is itself a from of insulin resistance. Be prepared you may have to push to get the tests done. Not that long ago, vets were taught these were rare conditions. I used the words "humour me" a lot.

Answering for Judy, and one of the reasons I switched, at higher doses Lantus' acid base can sting. Levermir does not. And for some cats, Levemir has a bit better duration/flatter cycles.
 
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Wendy&Neko said:
Not in the US, but I also used the Petsafe 5.

A cat needs however much insulin they need. You keep increasing until you find that dose that gets them into good numbers. TR is a method that gives you a quick and safe method to do so. Remember that insulin is a hormone, not a drug. You don't just add a little insulin and necessarily see the same corresponding improvement in the blood sugar numbers.

Neko's FD journey was very frustrating for me. She saw green at 3.75 units briefly, and then it was gone. Next increase, just blue, increase again, a brief green and gone, increase again, nothing, then green would make a guest appearance again before disappearing. It wasn't until 7 units until green lasted more than 1- 2 hours and 8.75 units before her first reduction. It felt like something was fighting the injected insulin. It turns out it was two somethings, both acromegaly and IAA. It made so much more sense when I knew what I was dealing with. As I found out later, she probably had acromegaly at least 6 months before her diabetes diagnosis.

It's also possible Maxi has something causing insulin resistance. The two MSU tests will let you know one way or another. One in four diabetic cats has acromegaly. At this point he has at least glucose toxicity, which is itself a from of insulin resistance. Be prepared you may have to push to get the tests done. Not that long ago, vets were taught these were rare conditions. I used the words "humour me" a lot.

Answering for Judy, and one of the reasons I switched, at higher doses Lantus' acid base can sting. Levermir does not. And for some cats, Levemir has a bit better duration/flatter cycles.
Click to expand...





Thank you, Wendy
 
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bambinaki said:
Why did you change from Lantus to Levemir? (Please forgive me if you've already told me. I asked someone some time back about an insulin change. I don't remember if it was you.)
Click to expand...
There were actually two reasons to switch to Levemir. One is what Wendy said above - Freckles would start occasionally flinching when I gave her Lantus once we started shooting 5u and above. The second was Levemir has a different make up than Lantus and I was hoping that the switching of insulin may confuse her antibodies and her body wouldn't resist the the 'new' insulin (Levemir) as was happening with the Lantus. In the end, Freckles doesn't flinch anymore, but I did not see a change in her numbers when I switched insulins. Trying short acting insulins did not make sense to me so that is why I kept to the long acting ones like Lantus and Levemir.

I also use the Petsafe autofeeder.
 
Judy and Freckles said:
There were actually two reasons to switch to Levemir. One is what Wendy said above - Freckles would start occasionally flinching when I gave her Lantus once we started shooting 5u and above. The second was Levemir has a different make up than Lantus and I was hoping that the switching of insulin may confuse her antibodies and her body wouldn't resist the the 'new' insulin (Levemir) as was happening with the Lantus. In the end, Freckles doesn't flinch anymore, but I did not see a change in her numbers when I switched insulins. Trying short acting insulins did not make sense to me so that is why I kept to the long acting ones like Lantus and Levemir.

I also use the Petsafe autofeeder.
Click to expand...



Thanks, Judy.
 
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