New R Experiment Tonight!

Okay. So, this is a carry over on a previous thread. However, I needed to move the thread to the appropriate location. I am new to this... Sorry!

Either way, I am starting a new R experiment with Pig tonight. He was diagnosed with acromegaly a few weeks back and now I am experimenting with Lantus and R to get him into acceptable ranges. I have ran 2 tests with a .25u dose with little to no result. Tonight, pending pmps number, I will be dosing a .5u of R alongside his 15uL.

I plan on posting hourly updates as well! Wish us luck and yellow numbers!

 

No apologies needed. This is challenging enough to help your kitteh, in addition to doing computer stuff.

Previous thread from Acro sub-forum was here:
http://www.felinediabetes.com/FDMB/threads/new-acro-diagnosis.189184/page-2#post-2111839
.

 

Thank you!!!

So, his pmps was @ 411...
Last meal of 2oz was @ +9

I feel we are safe to move ahead!

 

Good luck

 

"See" you at +1.

 

Yay! Okay... It is done... Running a tad behind. Still trying to adjust the new addition to the routine... lol

 

Thank you!! This is very exciting and nerve wracking at the same time!

 

Okay..

His +1 is @ 395

Lets hope for some movement tonight!

 

So far so good

 

Not fantastic yet and no yellow, but definitely in the right direction...

+2 @ 352

Keep them coming down!

 

Additionally,
Tomorrow's am cycle will mark an increase of L to 16u. I also have the ability to safely administer and monitor R every night this week until Saturday. This will help me to get some more data in. I am looking forward to some good progress this week!
Very excited!

 

We are actually seeing a good dip (I think.. ) tonight.

+3 @ 312

He will want to eat soon, so there will be that spike.. But, we are close to yellow!

 

Looks like you are seeing a little movement tonight.

 

Yes! Finally!

So, I will raise to 16uL in the am tomorrow. I am wanting to run with R again tomorrow night. Should I stick to the .5u?

 

Let's see how the rest of tonight's cycle goes before deciding.

 

Yes. You are right, of course. I am just anxious.

 

So, not exactly the direction we wanted to go, but that is only because he had a meal. It was about on point. Typically he spikes about 50-75 pnts after a meal...

+4 @ 361
2oz food w/ water @ 3.5

 

Alright... So not a bad run. He quickly got over the food spike and went back down!

+ @ 317

Still no yellows, but lower 300s. I will take that for now... It is off to bed for me. My alarm is set for two hours out... I a sure he will be hungry again by that time!
We will have another run tomorrow night!

 

A nice gentle float down from 411 to 312 in 3 hours, a regularly scheduled meal at +3.5, ending up at a+5 of 317.

Perfect

Was he tested for IAA? If so, what was the result?

 

I'm watching your chart. Good luck! I hope to start Yum on R tomorrow.

 

R can make for an interesting dance. Sounds like you are in good hands with Sandy and Wendy checking in. I used R for awhile when Jack's Lev dose was sky high. It can be a great tool but knowing when not to use R can be just as important. It looks like the action last night was just right. Dropping them too fast can cause a bounce. Most cats respond to R for around 4 hours, my boy with IAA frequently had action later in the cycle so I had to put the patience pants on waiting for it to kick in. I suspect this was due to him having IAA.

Another thing to keep in mind is the next cycle can still be influenced by the previous cycle with R insulin. I'm not sure if anyone mentioned it in a previous condo, but unlike Lantus which likes a consistent dose, as you get more experience with R, it can be used on a sliding scale. I think Suki had a tab on her SS that had her guidelines in it. Obviously hers will be different from yours, but in essence, higher numbers you can give a little more R, lower (think yellow) get a smaller or no dose. The R is good at bringing numbers down which lets the Lantus keep those lower numbers flat.

At 16u, getting the Acro/IAA test from MSU would be a good idea. It can help you know what you are up against. Both are high dose conditions but can add some insight into why Pig is responding the way he is to the insulin.

Good luck

 

For others on this thread - Sarah did ask for both IAA and IGF-1 testing, but looks like the vet didn't add IAA to the request to MSU.

If you are going to be able to use R regularly, and 0.5 looks like a good place to stay for a bit, I'd slow the Lantus increases down to every 6 cycles again. You either fast track the Lantus, or use R, but not both.

 

No... When we ran the tests I was unaware that both Acro and IAA were not ran on the same blood sample. My vet did not ask them to test. By the time I caught it, the blood was no good. I am planning a trip back to do just that. I am also sourcing for a good endocrinologist close by. I hear there is one in Tulsa, but I will need to do my research...

And... Yes!! This is all so exciting. His amps was what made me smile!
We saw a 264 with amps!
Increased to 16u and fed. His regularly scheduled meals in the day time fall at +3, +6, and +7. That will carry him through.

 

All the luck and well wishes!! When are you starting? What time? I would be curious to see your results as well!

 

Yes, he has been tested for Acromegaly, but I did not realize that IAA was not included. He was dxd acromegalic on the 5th of Jan. I want to get him back and test for the IAA. I need to know exactly what his happening so that I can rise to meet it.

Trying to understand the R use.. For now, I only dose if I am home and can monitor. We have been in higher numbers so long that the lower ones scare me. I hesitated on his increase this morning because of his amps. However, since it was >250, I went ahead with the raise. He will get 3 scheduled meals in between which will help to coast his numbers in.. Thank you!! All of this help is so invaluable!

 

I made his increase this morning as I had planned. However, I did hesitate. His amps was @ 264. I only continued because it was >250. Did I make the wrong choice? Should I wait out the R tonight?

 

I suggested fast tracking (increasing every 4 cycles) as long as you are only seeing numbers over 300, so I would have held the dose on seeing the 264 as I consider that mid yellow. But no worries, let's hold 16U at least 6 cycles now. Plus if you are going to shoot R regularly, you want to slow down the Lantus increases.

It'll be interesting to see how he does today with that lower start.

 

Oh my god! I totally misunderstood or got mixed up! I am so sorry! You think he will be alright? His +3 was @ 367... His appetite seemed down today and he was not feeling well... Now I am so worried...

 

Don't worry. He is still a long way from green.

As for appetite and how he feels - remember that to him, pink is normal. Anything lower feels "off". The first few times Neko hit normal number greens, she hid under the bed. For the longest time I could tell she was in low pinks, cause that's when she wanted to play. Thankfully, over time, that became low blue. Someone described high BG as like having a coffee addiction. Withdrawals as the numbers get lower.

 

Okay. Thank you. I have a massive panic button in regards to him...

He seemed fine this morning, early, but then he threw up a very small amount of foamy stuff... He will do that when its been a while in between meals. Not everytime, but periodically. His tummy might have been upset. Someone said famotadine is good for that, but how much? He ate at +3.5 last night, but that was it. So he was empty. He did eat quite a bit with his morning shot. I worry soooo much! He just didn't want to be around anyone today.

Pig hasn't played in forever... Makes me sad. I am hoping lower numbers will help that. He did cuddle this morning though... Mostly because he wanted food.. Haha.

And, on a side note. Should I have started another thread this morning? I am learning.

 

We typically start one new thread a day, and link to the previous one for continuity.

As for foamy vomit, there are a couple things you can try. One is to try elevating the food bowl so they don't have to bend over. Second, and he'll like this, is don't go too long between food. I would feed right before you go to bed. Try not to feed carbs after nadir, but a zero carb treat like freeze dried meat or boiled/baked chicken breast pieces are good. If you have an autofeeder, you can set it to go off while you are asleep. I tried to stay away from fatomadine.

 

I have a massive panic button for Yum too.
Yum has CKD which causes acid stomach. She would throw up foam in the morning on an empty stomach.
After reading about acid stomach at felinecrf.org, I put her on 200 mg of slippery elm bark twice a day.
That pretty much stopped the vomiting. Or so I think. I haven't stopped the SEB to see if she starts vomiting again.
Pepcid AC (famotadine) (suggested by the vet) also worked, but I think the SEB is a less aggressive approach. Also it's a powder not a pill.

 

Perfect! Thank you... I feed him Tiki cat along with the Sheba, so I will just know to leave that for after nadir. He does eat from an elevated bowl. He seems to like it. I do have an auto feeder and that is what I use during the day. It was my fault last night. I set my alarm for three hours out like I normally do, but life has me sleeping about 3 hours a night... So, needless to say, I did not hear the alarm. I feel terrible. I will set the feeder out from now on. I just do not have the extra ice packs is why I just wake up to feed at night. I've never skipped an alarm...

Yes.. The famotodine does scare me, just as with any meds...

 

I well have to look at that! Thank you! How did you know Yum had CKD? ,I worry about that with Pig. His BUN was elevated and the longer he is unregulated.... I moved to Shea because it was lower phosphorus, but I worry...

 

That is a best practice.

I used to feed a chunk of kitty crack (freeze dried chicken breast) each cycle at +10, using the timed feeder. I started doing that when I realized I had no idea if he was eating his +8 meal at +8 or grazing until +11.

I agree wuth Wendy that at this point it would be best to, in the absence of a compelling reason not to, wait a full 6 cycles before increasing the L dose.

 

She gets regular complete blood work done. Her creatinine, BUN and SDMA all shot up last August. I put her on phosphorus binders, but they weren't enough. I couldn't get her phosphorus number down until I found a low phosphorus/low carbohydrate food that she would eat: Radcat raw chicken. She rejected everything else. Right now her BG is so high she is ravenous---maybe she wouldn't be so picky.

 

Okay.. I am sorry for being slow with this... I am just trying to really get a feel for R. So, I am assuming that tonight's R use will depend on his pmps number, correct? As in, if he is above 300, then .5u is appropriate. However, if he is lower than 300, then I do not want to shoot it. Correct? Of course, this would also be assuming that his pmps is higher than his amps. Also correct? Again, I apologize... Lol. Numbers are not my thing.

Also, please forgive the typos. I am at work and squeezing in replies on my phone.. I am horrible with typing on a phone..

 

SDMA?? And what are phosphorus binders? Sorry, I am very new to CKD or the possibility of it presenting. I want to prevent if possible. Where do you get radcat?

 

I wish I could do this! He simply loves raw and freeze dried chicken! However, his megacolon really will not allow it. He has the most awful time moving his bowels.. I actually blend all his food into a soup with spring water. That's seems to help a lot!!!

I agree. No need to rush. I feel bad that I misunderstood and raised when I should not have...

 

If lower than 300, but still over 250, you could try a 0.25 unit R dose. Might be worth an experiment.

SDMA is a lab test value done by Idexx labs, that is a measure of kidney function. It is fairly new. If your vet doesn't use Idexx Labs, you may not have seen it. Phosphorus binders are used if the phosphorus number is too high. If your vet hadn't mentioned kidney disease, it may not be a concern. I presume Pig had a blood panel done at diagnosis.

 

Yes. He has had two recently. One at diagnosis and one just the other week. His BUN went up, but is considered borderline. My vet feels its just the unregulated glucose numbers. However, I do not want to take any chances.

The .25u sounds like a good plan. Anything lower than 250 I will stay with L only...

Thank you!

 

Housekeeping note- please keep your ss up to date with the latest numbers.

 

Yes... I am trying! I will update it every night when I get home. However, the +3 I take on the am cycle is always right before I leave the house. Sometimes I have to rush it out the door! I am sorry!

 

Okay. So, running a tad behind AGAIN tonight. I have to adjust to the new medications in the routine. That being said, we are off the ground and going.

pmps is @ 406

16uL & .5uR down the hatch. Ready to see some movement!

 

Looking 'okay'... No huge food spike. Seems to be feeling really relaxed tonight.

+1 @ 411

 

C'mon Pig, show your momma some downward movement!

 

Yes! Thank you! We are hoping for some good numbers tonight! Just increased L this morning and now a good .5u of R to boot!

 

Seeing a little movement! About the same as last night.

+2 @ 368

 

Paws crossed for a gentle slide down.

 

Hmm... He seems to have stalled out a little tonight. Not a whole lot of give on this one...

+3 @ 340

He will want a meal soon. Typically he eats around the +3.5

 

Fyi.. He just started his Gabapentin regime tonight. I only gave half of his prescribed dose, which put it at 25mg. The medication was in chewable tablet form, which I have to separate and crush to get the right dosage. I do not know if this could be effecting the reads or not. Just thought it worth mentioning.

 

And just to keep things interesting...

Meal was @ +3.5
+4 @ 319

 

Okay, now I am just really scratching my head...

+5 @ 326

However, now it is off to bed for me. I will be setting up my 'cat butler' for the night so we do not have a repeat of last night.. I am going to set my alarm and try to get a +7-+8 number. However, judging on last nights results, I may not even hear it.. Either way, thank you to all for your help and we will see you tomorrow..

 

Let's hope Pig doesn't have kidney disease. There are many low carb/low phosphorus foods out there: Yum just won't eat them. Petco's Soulistic pate and shreds chicken is low carb/low phosphorus. Radcat is usually sold at small pet food stores. The Radcat web site lists stores that sell it by zip code or area.

 

Soulistic isn't special, except it's the most pate like. The Sticky's at the top of the Lantus forum show Dr. Pierson's food charts with carb and phosphorus numbers. There is a low phosphorus list as well. felinecrf.org also has food charts.

 

It will be good to get Pig into some lower numbers soon. You are doing the right stuff.

I remember when Leo's Acro was at the peak before SRT. He was getting 18 units/dose. Supplies, insulin, test strips - were always a worry. If you are still getting insulin from Walmart or Walgreens, you may want to consider a supplier from the Supply Closet sub forum. I procure from Alan Hamman, and he beats the store prices substantially. There is also Mark's Pharmacy in Canada.