PONY. PS is HI, +1 is HI!

please scroll to the bottom of this thread to understand why i am changing this post to 911 status. please look at pony's ss, is this somogyi?

ugh, i really haven't found my niche yet on FDMB, i have made a few posts and gotten some great feedback but feel really confused and stuck and exhausted. i have a spreadsheet up and running but don't know if there is somewhere i am supposed to post pony's situation so i don't have to keep rehashing the basics in each post. we are in the middle of a very confusing switch from 8 units of vetsulin BID to Humulin N BID. I have written out a lot of Pony's background in my previous posts and i am a REALLY slow typer so this is part of my frustration with message boarding. but for the sake of helping pony, i continue.

Pony is 12 and she has been diabetic for several years. She eats canned Wellness chicken food. Started out with Lantus, got up to a pretty high dose maybe 8-12 units BID, cannot recall exactly. fructosamine testing kept suggesting increases based on poor regulation. then switched to vetsulin and had better luck. At 8 units BID of vetsulin got up to "fair regulation" according to fructosamine testing. The clinical improvement with the vetsulin was huge and we have been a happy duo for about a year. Well, vetsulin was taken off the market and my vet said to start Humulin N at 3 units BID. After several days at that dose she was laid out sick, with PU/PD, bloating and no energy at all. So since may 10th, that has been the case despite a few dose increases. i did start with home BG testing after a few days due to my concern and the story from there is on my spread sheet.

The plan now is to keep increasing after holding the dose for a few days, but it still looks like we are a LONG way off from even reasonable numbers. I have been testing for ketones and it is always negative. Pony feels terrible and i am not seeing any statistically significant changes even as i increase her dose. but we are still well below the 8 units of vetsulin we had been on so maybe i just need patience. i just don't want to be patient if that is the wrong move. i want to emphasize that pony has been laying on her side either next to the litter or the water since the switch. this is heart breaking.

I think i am looking for some, "what would YOU do" kind of advice, backed up by your reasoning. i would be happy to answer any more questions if anyone is willing to offer advice or take on the challenge of wrapping your mind around what is going on. i asked my diabetic friend what he would do if this was his spread sheet and he said that he'd go to the hospital. i don't have a ton of money but i have been managing to support her until now and have every intention to keep trying things, but what should my strategy be? I realize that she may be a high doser due to an underlying health condition, but i just barely have resources to treat her diabetes. so want to focus on the diabetes. On an opposite note, what if she is not a high doser and never even was and that is why regulation has always been poor, because it was pushed to far? seriously, from her numbers and story can that possibility be excluded?

Please look at my spreadsheet and comment. How long can a kitty make it with such high BG's? Are there any cats with a similar tale on here? What does it look like....like, is it reasonable to think that i could hold the dose at 5 units for 5 days and have super high BG's like i do, and then go through the same at 6 units and 7 and 8 and then maybe see improvement and then maybe just have fine tuning to deal with? cause i think that is what my vet is thinking will happen.

well, thanks for reading.

 

Re: The trouble with pony

I really sorry to hear Pony is so miserable, but welcome!

Hey its really late now, so for the short answer:
-it certainly looks like Pony needs more insulin. and sooon
-Ideally his doses would lead me to believe he should be tested for acromegaly. read the stickies above.
-A lot of high dose cats use Levemir. since it is a u100 insulin (1000 units /vial), and long acting it is apparently cost effective.
-Take a look at the spreadsheet for Feeburt here in HD. He switched lantus to lev and finally got to a dose that worked.
-Spread your testing out some - save your money and spare his ears. every 2-3 hrs is still a lot of information and shows the trend.
- if you can figure out the "profile", you can skip the re-inroduction every time. viewtopic.php?f=6&t=531

Hang in there

 

Re: The trouble with pony

Hi Elise,

You guys have had a rough time. My advice - get her tested for insulin resistence (IGF-1 and IAA) from Michigan State University. The information is here: viewtopic.php?f=12&t=375 MSU is the only lab in the country that does this testing; all your vet has to do is draw & process the blood and then ship it to MSU. If you get the blood shipped out Monday evening, you could have your answer by Friday. The tests are fairly inexpensive (I'm thinking $44 and $14?; the actual price is posted on the web); of course, your vet will add on some fees.

This really is the only way to safely figure out what's wrong. You can't keep switching insulins and starting over on the dose - you see how terrible she feels. Also, Lantus & Lev really are the best insulins for high-dose cats. However, I wouldn't change anything else (except increase the dose) until you get the test results.

If you create a profile on GoogleDocs, you can attach it, just like your signature. Nancy gave you the link to some instructions. Also, you could always find your old posts and just copy/paste what you've already written. You can find your posts by clicking on your name, which will take you to your board-profile, then go to the right-hand side and find "Search user's posts".

 

Re: The trouble with pony

i inquired with my vet on thursday about acromegaly. she hasn't gotten back to me yet....so maybe on monday. i had asked about it a long time ago and she said it was doubtful pony had that and there was no test. well, i see there is a test. since her diabetes diagnosis several years ago pony has lost almost half of her body weight, and i think most acrocats gain weight. but i did notice a prominent bone ridge in her skull and inquired with the vet and she said i was probably just noticing skeletal features because of how skinny pony had gotten. when i took pony to a specialist i remember that as she was looking pony over and making observations aloud that she said pony had kind of a weird shape, especially around her back end, saying that her ass kind of protruded and stuck out (not a prolapsed anus, more of a general observation about her skeleton). but then, and now this is the big one for why i suspect acromegaly, a few months ago when pony was seen by my vet for an episode of runny butt, i asked her to look again at pony's teeth. i was worried she was having a dental problem because she seemed to be acting a little funny about eating. the vet said her teeth looked fine but then said, and she couldn't believe she hadn't noticed it before, that pony had an EXTREME OVER BITE. In fact, it was so extreme she was laughing and called in the vet techs so they could also see this extreme case of what she was calling "parrot mouth". anyhow, looking back at all of these things together i could see how this could be acromegaly. now about 3 years ago this same vet had performed dental surgery on pony, removing several teeth, and never mentioned a thing about her parrot mouth- so i am thinking it is a more recent development. now, i do want to say quickly that i am not at all bashing my vet here. she really has done so much for us and i know will be willing to help me pursue any actions that i want to take. i think she has been a bit stumped by pony's case, and that is why she sent us to a specialist a year ago. i just could not afford what the specialist was recommending- cat scan, ultrasound, etc. here is my question to you: if i did have the blood test done and it was discovered that pony was an acrocat, would that info alone help me to manage her diabetes, given that it doesn't seem like i'd be able to pursue treatment for the acromegaly based on cost. treating acromegaly is a huge expense, right? if she did test positive it would help me by letting me know that i was headed in the right direction with the really high insulin dosing, right?

i will try to set up a profile soon, thanks for the link.

 

Re: The trouble with pony

Vets used to think acro was very rare. More recent studies indicate that it might be as high as 1/3 of all diabetic cats.

You're thinking is right on the test...it simply lets you know why Pony is so difficult to regulate and that she truly does require large doses. It gives you a diagnosis in case treatments become more affordable. I wouldn't waste your money on a CT or MRI right now - the acro test is enough. Most of the acrocats on the board simply treat the diabetes. A few of us have had the surgery and a few more are getting ready to participate in a drug trial. However, none of these treatments are guaranteed. For instance, Boo has been off insulin since September, but her IGF-1 is still very high, which means her body is likely still growing in places.

 

Re: The trouble with pony

I vote for getting the tests done. There ARE tests and they DO tell you something - positive or negative, the results either explain the reason for insulin resistance or eliminate the two conditions as a reason.

I had to find out the info and spoon feed my vet office in order to get the tests done. The results came back positive for Shadoe.

A short time later, I adopt another beautiful kitty, and run in to the same issues so I go into my vets office and TELL them to get ready to draw blood for another set of tests. I take in Oliver and get both the IGF-1 and IAA tests done, and guess what the results were ... positive for BOTH conditions!
Maybe the next time your vet says oh it's too rare, you have a come back that you know a person who has TWO acro cats, so just draw the blood and be a good vet and send it off for the tests.

I started Shadoe on Caninsulin and you can see her numbers on her ss in my signature. See how all the numbers were horrible, then we switched to Lantus and still all high, flat numbers. We kept moving up and up. The tests confirmed she had acro. You can take a look at Oliver's ss as well to see how he started and what we went through with regard to numbers.

I don't know a thing about Humulin N, but I do use Humulin R along with Levemir. It sounds like you like your vet but she does not sound like a vet I would keep, because discouraging testing is too negative for my liking. It sounds like you are going to have to take charge by TELLING your vet what you intend to do and what you want done, and that's that.
But first things first. There is NO WAY I could afford the expensive treatment or that sort of thing, and you don't need any CT or MRI until you know if there is a real reason for them! If you get the blood tests done and they are both negative, what's the need for the CT or MRI? The tests should be done first and then if any results are positive, the others here can tell you about the need for u/s or Xrays.
For Shadoe, I went with the u/s, but mostly because there are some things that can be seen that can't with Xray. Plus I wanted the pictures and thought that it would be possible to see other things that could be wrong. The young vet kept saying oh ya better bang for your buck so go with u/s and not Xray.
It turns out that Xray would have been just as good for what I wanted to see - check organ size - so for Oliver, I am going with Xrays, and skip that big bang for my buck.

I am going with just treating both my acro kitties with insulin. It can be done just fine, and some acro kitties have actually gone off insulin - there is one lady on this board whose kitty has gone off insulin 4 times I think, so don't you worry about having to do all those expensive things and treatments.

So, one step at a time.
Tell your vet you want Pony tested for IGF-1 and IAA.
When the results come back, you MAY want Xrays or u/s but not now.
The dental is kind of important and you can't look in a mouth and say oh it all looks fine! At the least, a cleaning may help and then afterwards if a tooth looks iffy, an Xray of that tooth can confirm if something is wrong where the vet's eyeball can't see. Vets don't have Xray vision, so how can the vet see what's happening under the gum?
Why do I say dental is important? Because Shadoe had her first dental, and the vet saw 4 'iffy' teeth, took Xrays of them and found one molar HAD to come OUT! After that extraction, Shadoe dropped her need of insulin and I think some of her problems were due to that bad tooth. So get the dental done when able.

For the insulin, like has been said, no need to change now until you have the tests done. If you get a positive result, then you may want to consider switching to Lantus or Levemir, but that can wait till later.

i have likely missed alot but bottom line, the acro condition may be for life but remember there are humans who take insulin every day and they live fine lives, so there is no reason at all that Pony won't be just fine as well.

If you need any info on the tests or anything related, just ask because there are several of us from all over that have had the tests done.

 

Re: The trouble with pony

Many vets think its rare because that what was known until recently. Educate her:
-print info from the stickies above and
-print or copy a cd of the article in this link. It is from a Jan 2010 vet Journal. (Read it as a PDF)
http://www.sciencedirect.com/science?_o ... 58b97d9ea5
-print off the testing info from MSU website found in the stickies.

-Drop them off ASAP, attached to a note saying you have an appt the following Monday for a blood draw. The clinic has to set up an account with MSU as they probably don't have one -

-Get a MONDAY appt so that the blood can be frozen and sent directly to the MSU lab by FED EX or UPS, for next day delivery on Tuesday (not the USPS - lost in the university mail room) The IGF1 test is set up on Wed, and the IAA is set up on Thurs.

As for the teeth thing- on a cat they normally have an underbite (lower fang sit closely in front of the upper fangs) Typically, on an acro kitty the lower mandible (jaw) grows forward, so the Underbite becomes more extreme. There are pictures in the online article.
Does he snore?

 

Re: The trouble with pony

lots of great advice, friends. i will certainly be printing out the info and taking it to my vet on monday. i will talk with her about acromegaly and also the teeth situation. just wanted to clear one thing up real quick, pony, the little darling and sweetheart, is a female. also, she does snore.

everything is going just the same around here, she is not feeling well at all. i am awfully sad and trying to keep a good attitude around the house so she doesn't feel worse.

all of your info and stories have really been helping. and you are right, i should find out if she is an acrocat. i'll keep you all posted, and i haven't forgotten about setting up a profile.

 

Re: The trouble with pony

Oliver snores and also snorts alot like he's purring but it's snorty.
Shadoe does not make any noises.
You are not going to have all acros having the same bunch of symptoms; all I had for Shadoe was the high dose.

Did someone already give you this link? there may be some helpful info in there for you.
New to the Group

I was looking for pictures of the jaw and teeth, but can't find them at the moment.

 

Re: The trouble with pony

My Boo snores and has an underbite. She looks a little like a bulldog!

 

Re: The trouble with pony

I just thought of something; do you have any pictures of Pony and would you be able to take some pictures of Pony, maybe the front face and from the sides.

I wish I know something about that insulin you are using but those numbers look just horrible.
Lantus or Levemir I have used and understand.

Anyways, once you have the profile put together, just add it into your signature by your ss for Pony so we can know the history and better help you .

 

Re: The trouble with pony

Hi Elise, and welcome to you and Pony

There are a lot of us here, many of us are infrequent posters, but we watch

I would recommend you look into a longer duration insulin such as Lantus or Levemir. I think that you would be very happy with the results you get as opposed to using N. The two insulins are gentler, and since they last the whole cycle, the kitty will experience a lot less glucose "turbulence" with them. Vetsulin and N can both contribute to cats who don't feel good. The jerky up and down movement of the insulin action is pretty rough on them. At high doses, it's magnified. Levemir is often cheaper than Lantus, and you can buy both insulins in a 5pack of cartridges rather than buying the vials. You would not use the pen they are for, you would just use U100 syringes as if it were a vial. 1 vial is 1000 units. 1 cartridge is 300 units, and there are 5 cartridges per pack, so 1500 units total. Knowing that helps with the math. I pay $86 for a vial of Levemir here, and the Lantus is about $15 higher. In some areas Lantus is cheaper so call around if you're interested. I get mine from Rite-Aid with a discount card for Leo, but you can buy a 5 pack of cartridges in Canada for $125 shipped, even if you live in the US.

If Pony has acromegaly, it causes diabetes, and it causes the insulin resistance you are seeing. There are other things which cause insulin resistance, such as glucose toxicity, Insulin Auto-Antibody (IAA), Cushings disease and high carb foods, so I wouldn't immediately jump on the acromegaly boat, however, she does have some characteristics. Snoring and bite changes are quite common, as are oversized organs, paws, face, ears, and body length/height. Potbellies are often present. There are some acrocats who show no physical characterics at all, not even diabetes, and there are acrocats who are diabetic but don't have insulin resistance. With acromegaly, the disease itself causes diabetes, so diabetes is a side effect. It is thought that upwards of 1/3 of diabetic cats are instead acromegalic, but without overt signs, they don't get tested. I am sorry that your vet has mislead you about the test which has been available for a number of years. If you choose to get the testing done, also get the IAA test available. It's cheap, like $14 +/- and can be done at MSU along with the acro test. The biggest cost you're going to have is the overnight shipping to MSU. For me, blood draw, Acro and IAA tests shipped were $110.

Oh.. and unregulated acrocats CAN lose weight. I adopted Leo, who was picked up by animal control weighing 7lbs. He looked like death warmed over, all skin and bones and nothing else. He is a huge cat, over 20lbs now. He's sorta too big :mrgreen: but he should be right at 20lbs. It had just gone unregulated for too long for him.. it can happen.

I would not bother holding that dose 5 days. It's not working, so you'll want to keep up with the faster increases. Unfortunately with insulins such as N or Vetsulin (which was recalled) they need to be dosed at least 3, and sometimes 4, times a day to regulate an acrocat and get them out of the resistance, they just don't have the duration - if you don't have duration, you can't break through the resistance. I honestly wouldn't recommend dosing N more than twice a day though, due to unpredictable action. With the L insulins, you have pretty much a 12 hour duration.

((((hugs)))) and welcome!
..Carolyn

 

Re: The trouble with pony

Cody can't meow, hasn't been able to for a long time. When he wants to be fed he comes and stares me down and kind of grunts, "ahhh" I think the vocal cords/airways get affected. Oh and he did lose weight for awhile.

Cody was on Humulin N for awhile in the beginning (3 yrs ago), but I don't remember if I was home testing back then. I imagine there should be some info on the other ISG or the web somewhere about the typical onset, duration, and nadir in cats. My sense was that it was short acting (6hrs?), with sharper drops and rises (not a perfect insulin...because of the roller coaster) Have you checked around for its characteristics? How are you deciding about dose increases? Her numbers and behavior sound like you need one... I agree you could do better with a different insulin.

The wonderful thing about knowing the diagnosis is that you can keep increasing the dose to ridiculous numbers until you get her numbers down and she feels better.

 

Re: The trouble with pony

please everyone look again at pony's spread sheet. i am concerned that this is somogyi and that she may not be a high dose kitty! if i am not freaking out one way, it's the other , i guess. of course i am calling the vet tomorrow- but i am concerned she won't know. she already said if there was a curve then it wasn't somogyi, but now i have been reading otherwise. pony's preshot seem to be getting bigger and bigger!

 

Elise, you said she's felt terrible ever since switching. You really might want to switch to Levemir today. Carolyn could help you decide on a starting dose. I know nothing about N, but I really, really don't think Pony is being overdosed. I think she still hasn't gotten the amount she needs. You've done a lot of testing recently and she's NEVER dropped to a decent number (270 is still really high). Additionally, you may want to get Humulin R to help the numbers as you switch, but you would need for Carolyn to help you with that.

I'm sorry it's been so hard. You might want to look at the spreadsheets for some of the acrokitties just to see how bad their numbers are and then how good when they finally get enough insulin. Again, we don't know if Pony has acro, but let's get the test today so we know by Friday.

 

Hi Elise,
It is very hard to help, for me, because I don't know a thing about the insulin you are using now other than hearing it is not a great choice and is short acting. If the insulin is not lasting long, you are going to have problems.

Also, without a profile, info on what you feed pony, any other health issues, etc, nobody can say a thing. The numbers on the ss are just a small part of the picture; the numbers are not everything.
Just by changing foods, eliminating ALL DRY foods and treats, a person can see a huge drop in numbers. Because we don't know of the diet or any other health issues or medications, it's impossible to say what is wrong. Throwing more insulin at the situation is not going to help either, unless you know that's what is needed.

I started on Caninsulin and if you look at the start of Shadoe's ss, you can see how she went through the same high numbers. When I moved onto Lantus, she improved greatly. As has been said already, you likely need to try a longer lasting insulin like Lantus or Levemir, and most assuredly may find that diet change to low carb, and a lower dose could help.
You would not make all the changes at once; that would be dangerous, but you can look at the foods right away, and arrange to try another insulin starting at a lower dose.

Can you say how Pony is feeling and acting? Is Pony eating and using the litter box ok, are there any other odd signs you are seeing, any changes in behavior? All of this info is VERY important.
I know for a fact that if Shadoe eats just a couple pieces of Booboo's dry food, Shadoe's numbers will go through the roof! Food matters.

I know none of this helps today, but you can likely get better help if you went back to your posting in the other group for Humulin N and then others using your insulin can offer help. You stated that Pony has had issues since day one when you switched from Vetsulin and started using N, so that right there tells me the issues are mainly related to this insulin switch.

Maybe you can try calling a vet hospital and ask a few questions what you can do right away.

 

she eats all wet food, canned wellness chicken variety. i am sorry to frustrate with lack of profile and photos. i have a substandard internet connection and am slow with computers myself. i am trying. i plan to go to a friends who has better internet and a printer later today. i tried to go earlier but my friend was not there to meet me when i showed up as scheduled. pony drinks and pees excessively. drinks every 15 minutes, maybe. she just lays around on her side on the hard cold floor. she is still pooping normally and using her litterbox for both pee and poop. she looks bloated and uncomfortable. she has no history of uti's or crystals or anything major. no ketones, never ketones. she has no energy now, although was never a particularly energetic or nimble cat. on vetsulin she would beg for her twice daily meals and gobble them right down. now she seems to want her meal but then turns from it after eating maybe a third and then goes back to graze what is left over the next 5 or 6 hours.

 

Hang in there Elise. You're not frustrating us...we just feel bad that we can't help more right now. N just isn't used much; almost all of the acro cats our on Lev or Lantus. A few still use PZI, but none of the newly diagnosed. Just see about the test, and maybe Levemir and R.

 

also, the humulin n group told me i'd have better luck on this board which is why i am posting here. and i did call the vet hospital and they said they can't give any advice over the phone. i have phoned 7 other vet offices asking to arrange to speak with a vet to basically do a pre visit interview so i could decide if i wanted to use that vet and each time was told if i wanted to talk to a vet i'd have to schedule an appointment. not one office worker was even able to tell me if their vet advocated home testing. yet each office was eager to have me bring pony down for an appointment with a vet they couldn't even verify had experience treating difficult diabetes cases.

 

I had a lot of trouble with vets in the beginning as well. The vet that I had used forever refused to test for acro. I finally sent out an e-mail to all of the local vets until I found one that was willing to do the test.

Gayle just scares her vets to death! :mrgreen:

 

I have put a link to this thread over in the Humulin N group as those people have better experience with the insulin you are using.
I would be calling a vet to ask for some immediate suggestions because Pony could be sick and showing itself in the numbers.
I forgot to ask about teeth. Teeth could also be an issue.
I sure don't see any bouncing and don't think you are looking at any chronic rebound, not at all. Pony is just high and flat which says to me, more.
I don't know what else to say, but if it were my cat, I would be on a vet's doorstep, any vet actually if mine were not around. Do you have any other insulin around? Could your insulin be bad? It's not impossible and maybe something to consider? Ask in the other group about the handling of the insulin you are using because I know different insulins are handled differently - I was told to roll the Caninsulin, but you do NOT do that with Lantus or Lev.
Are there any emergency vets you can call in area?
And keep testing often to see where Pony is going with the numbers. The ps may have been high but after the shot, you want to know what happens, and when.

I don't care if my vet is OK with my testing or not. I do it and that's that. My vets know squat about FD but |I am forcing them to learn with me. I don't use my vets for their FD expertise; they have NONE. I use them for regular feline issues like pancreatitis and stuff where it's not FD related health issues. I'd pick a vet that would take me now and I would go to ensure the general health is good. Rule out non diabetic issues first.

 

Elise,
I most likely terrify my vets and all their personnel. And I don't particularly care because I am the customer and they are to provide a service. Unfortunately, there are very very very few vets who know much about feline diabetes so count your blessings if you find one that does. I do my own research, and along with the awesome help of people on this site, I dictate to my vets what they are GOING TO DO.
I had the same problems with my vets to get Shadoe tested. First off, they had never heard of the tests and vaguely knew of the condition but never would have connected the 2 together. I had to bring them the info, tell them what to do and where to send it and how to send it. I told them you do this or I go elsewhere and you will have bought yourself a heap of bad advertising.
They finally did what I told them and then the next time, when I wanted Oliver tested, it was a piece of cake! I dropped in, set up an appt, and said we need to get the same tests for Oliver. They had learned what needed to be done, and so they had the experience. His tests went ahead without a hitch. I did not have to say a word and they had all the info including the phone contacts at msu.

The vets serve a valuable purpose but you cannot expect your vet to be an expert at everything. You don't expect that from your own family dr, right? You expect to be sent off to a specialist for stuff. With a vet, they are great at the regular non-diabetic stuff, and you definitely need that expertise for all your pets. One of my vets is a dear lady and does incredible work in the dental area. The other vets won't even consider the dental stuff; they say we will get Dr Vihos to look and do the work. it's her specialty and she did an awesome job on Shadoe. But she did not even know that no rx was needed for Lantus in Canada and gave me the rx and said to give once a day. Why? Because it's a human insulin, they don't know a thing about it, and they treat animals not humans. I don't fault them because they need to tend to the rest of the cat, and they took care of the u/s and dental and all other manners of care. The FD part, I am SOL and on my own.
Just pick a vet you like and Pony likes then go with it.

So getting back to Pony. Over 600 and bloated and change of ways makes me want to have a vet look at Pony to figure out the reason. What about an infection or virus or a whole host of other things? If his numbers continue to test high, you want to keep organ damage in mind. Just like with humans, if you have a high fever, what does that do to your body? Not anything good is my guess.

 

I would get Pony into the vet today.... second guessing the dosing/insulin and such right now isn't doing any good if Pony is sick and feeling terrible. I don't like what you're describing re the behavior. Can you get an appointment TODAY?

 

I'm sorry to see Pony isn't feeling well. With unregulated diabetes, regardless of the cause, nutrition needs are not met and organs don't get the blood flow they need. I hope a change of insulin will help Pony.

If he has trouble eating I'm wondering if adding water and mushing it up good will help? I add water to all of KB's meals to make sure he gets enough hydration, and also to make it easier to digest because he really wolfs his food down. Some cats don't like things soupy so try a little to see how it goes before making it too runny. If his appetite seems off, you can try sprinkling some freeze-dried chicken, or a little parmesan cheese on top. Or try a fishy flavor, maybe he can smell that better.

 

Hi Elise,
I too am concerned. I am thinking his dose is not high enough, and that N is a very quick acting, but short duration insulin that is contributing to his woes. By the way, there *are* two Carolyn(n)'s on this board, you're not seeing things, and we both have orange acro's I agree with Carolynn that Pony may need some intervention, such as fluids, and a faster acting insulin such as Humulin R, which you do NOT need a prescription for, but which IS a dangerous insulin to use too much of, so be very aware of that. There are plenty of us here who have used this insulin and we'd be glad to help, you would use it in conjunction with your N, or if you choose to switch to Levemir/Lantus you can use it in conjunction with them. It's a controlling insulin, meant to drop the numbers to a region where your base insulin (basal) can work better. Onset of R is roughly 2 hours, and offset is usually 4-6 hours, so it's in and out very quickly.. but harshly. You MUST start low with that insulin.

I heavily recommend you look into the L insulins, I know it's not cheap, and you're very worried, and I understand. It's just that with acrocats, and higher dose cats, they need the extra duration they get from the L insulins. PZI can be dosed more than twice a day there are people who can help with that, and I hear N can, but I can not help you with N, I just have no physical experience. Vetsulin having been recalled due to inconsistent strengths, pretty much rules out you returning to that insulin, it would be too dangerous.

If you choose to go that route, and your vet doesn't want to, just ask her/him to humor you. It is your cat, and your treatment of the cat. Always remember that.

 

vet and i are preparing to do the acro tests. she said increase to 7 units right now, and has procured an emergency bottle of vetsulin that i will be able to get tomorrow. of course i am aware of the vetsulin danger but considering the current circumstance i am going to switch back at least until the acro test results are in. because i don't have my profile up yet, many of you have understandably missed some of pony's back story. she already tried lantus, when she was first diagnosed and we did not have success. i will try to get all the details from my vet about exactly what her lantus dose reached and i will put it in my profile. i would not be eager to try it next because of that, although it certainly is possible that the reason it never did the trick is because we never dosed her high enough. i will wait for the acro results before picking my next insulin, which will probably be levemir or prozinc. it will be interesting to see now that i am hometesting, what BG numbers i will see with the vetsulin. i always thought she was doing pretty well on it, but i was only looking at clinical signs. i'll let you know.
thanks again for all your input and sharing. i am taking the 911 off this post now. you all have such amazing passion and response time. this board is unbelievable. someone should do a documentary about the phenomenon known as the FDMB!

 

While I am almost afraid to say this, I expect the vetsulin will work better than the N is working. N is just a hardcore insulin that can't handle the bg's of an insulin resistant cat in my opinion. I feel the same way about vetsulin, but of the two, I expect V will help you. Please do look hard at switching, regardless of Pony's resistance cause, duration would help you greatly.

We'll be glad to help you, whatever you do, and try to get you help with whatever insulin you end up with, it's just that we don't have a lot of users with experience in high dosing with Vetsulin or N.

Just to show you the range of dosers we've got here, we've got one cat on site who was once up to 60 units BID.. yes that's 120u a day, with massive R booster shots as well, often reaching 30-40u a day of that in conjunction - she's now down to the 20u area. That's Girlcat, she always wants to be different. ;-) My boy was once up at 40u BID with R boosters, and is now quite comfy at 21u BID and no R in months. On the opposite end of the scale, we have Fletcher, an acrocat who prefers to be off the juice, and lower dose acrocats such as Nina's KB. Gayle's got one of each, a lower dose and a higher dose LOL For IAA kitties, we have one off the juice, and one bouncing between 6 and 6.75u. Cats with ordinary glucose toxicity can be broken and dropped to a "regular" dose in the span of a few months if treated aggressively. The reason I am telling you this is because we acromoms, IAA moms and HD moms sometimes have to get together and vent about our dosing. It's really easy to fall into the trap of thinking that you're doing something wrong when your cat isn't doing as well as someone else's cat. Never feel like that. High dosers, whatever their reason, are there because of something inside them contributing to the glucose problem. With acro's, we're responding to hormonal fluctuations that we can't see, same as cushing's moms, IAA moms are responding to fluctuating antibody build up. Toxicity moms are responding to liver "over-defense" - so you just gotta do what the kitty needs, even if it's scary, and even if you don't see anyone else doing what you're doing. It's hard, but you've been doing this a long time, so take time to remember that you're an awesome mom busting her butt to help her cat. That's absolutely commendable.

You are your cat's hero.
(((hugs)))
..C

 

I'm the only Prozinc acromom ( I think_) and I'm about to switch to Levimir. I REALLY like prozinc and I think its a great insulin, gentle, extremely stable, flexible and has a good duration of about 10-11 hrs. But Cody still has a preshot that are higher than I want, which I could probably treat with more insulin, but the thing that finally got me was the price. Because it is a U40 insulin a 10 ml vial only has 400 units and last us 2 weeks for $84. Apparently I could get lev with 1000 units for a similar price, so OVERALL at 14 u 2x/day, Prozinc costs about $2300/year and Lev from Sams for example about $1050/year, soooooo, and a lot of folks really like it.

My vet was unfamiliar with Lev and did some research on VIN at my request. She apparently trusts a VIN consultant named ALICE WEST DVM, who apparently endorses it as a safe but newer alternative. So this might be very helpful to your vet...

 

Well, I used Humulin N for Norton for about 18 months. He was up to 13 units BID at his highest.

Changing from High carb food to Low carb food reduced his dose to 8 units BID.

We switched to PZI (from BCP) and used a sliding scale and syncopated TID dosing developed for Norton here at High Dose ISG. (by syncopated... we couldn't do an equal 8-8-8 hour schedule. we did 6-8-10 and about every other day, he would be too low to shoot - normal numbers at +6)

Getting a diagnosis of Acromegaly or IAA basically allows you to "take the gloves off" and be more aggressive with dose increases -- and yes -- not be afraid to inject 60 units if that is what Pony needs (building up to the dose 1 unit at a time)

 

Elise,
I should add that my higher dose acro cat, Oliver, also tested positive on the IAA test, so he's got both to deal with, while my low dose acro cat, Shadoe, is doing just fine on only 6.75u Lev and she may be ready for a decrease soon.

I was like you, tried with Lantus and it seemed like it was not working, but that was of course due to her being an acro cat. I did switch to Lev because I had thought that some cats experience a stinging from the shots when in high doses, then when I adopted Oliver and he was on Lantus, it got confusing to have 2 on different insulins, so I switched him too.

No matter what insulin you select, the tests are most important so you know with what you are dealing. Then you can decide which one. Best of luck on the tests, and I sure hope Pony comes down ALOT with the new vial of insulin.

 

so, these are the tests i sent links to my vet for, these are the right links to the right tests, right?


the specific tests i think we need are for IAA: tests insulin auto antobodies
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1494

and IGF-1: tests growth hormone
http://www.animalhealth.msu.edu/Bin/Cat ... st&Id=1401

 

Yes, these are the correct links for the tests.

 

I wanted to mention one thing about the IAA test - there is a comment on the sheet:
Collection Protocol
Avoid hemolysis or lipemia.

Before I took Shadoe for her blood draw for the tests, I fasted her from midnite because she does have lipemia issues on her bloodwork.
Do you have copies of Pony's past bloodwork to check if lipemia is mentioned or can you ask your vet about it before you take Pony into the vet for the draw? Oliver did not have any mention on his papers, but Shadoe doe has the mention on all of her draws.

 

thanks for mentioning that. i will make sure to tell my vet about the lipemia thing, and have her check some of pony's past blood work.