Raffy at 4.0u

Hello again. This evening we ve reached 4.0U. PMPS was 423, but +3,5
is 605
I was not able to insert last 2 days data to SS beacuse of my abnormal duty time,but you can have an idea if you are going to check my previous post http://www.felinediabetes.com/FDMB/threads/raffy-3-75u-levemir-need-dose-advice.181943/#post-2024623.

 

Uggh, those #s remind me of Bronx's #s early on. Why did you lower the dose on the 9th?

 

I reduced the dose, beacuse i might be at overdose.

 

If a kitty goes up after preshot, there a few reasons why that might be. He could be bouncing from lower numbers the previous cycle. If you just increased, it could be something we call New Dose Wonkiness, which are temporary higher numbers as the depot is adjusted to the higher dose. NDW only lasts a couple of cycles. Another reason for higher numbers is getting into high carb food if he managed to find something else to eat. But it does mean he will be safe tonight.

 

It was the first cycle with 4 U. Also we let him to go out for WC purposes just 10 min. Maybe he found something to eat as well.

 

Things are not going well with 4.0U.
Even with 1,25 and 2.0U i was able to see pinks.
Right now lots of reds and blacks.
These days beacuse of my duty times i was not able to make so many checkes, that is way i am not sure about ;how many cycles more to stay on this dose... i need your adviceses.

 

I think that it is what Wendy mentioned, NDW which happens sometime with new doses. If you want you can hold the dose a bit longer and see how Raffy reacts. You will probably still need to increase the dose, but it may give the numbers time to settle.

It is possible he has an insulin resistant condition, which you may want to look into if he reaches 6U, or he maybe a cat that just needs more insulin than others. Since you are in Turkey not sure if your vet has option to check for the high dose conditions (IAA and Acromegaly), in Europe the tests are sent to RVC Royal Veterinary College (university of london).

If your vet doesn't have ability to get blood test to RVC, if you get the sample and you fly to the UK, you maybe able to drop the sample at a vet office that can get it done or at RVC .... link to RVC http://www.rvc.ac.uk/pathology-and-...s/diagnostic-laboratories#panel-diabetic-cats

 

I hope i will not have to fly to UK with a blood sample
This morning we ve started the day with 375. It is quite good for Raffy, beacuse if the AMPS is around 350-370 we have a chance to see 250s....

 

You wouldn't have to fly to the UK with a blood sample. The vet would draw a blood sample and mail it to the UK.

I hope you get a chance to spot those yellows today.

 

It was a joke, Gurkan is an airline pilot

 

Tomarrow i ve a flight to London, i hope he is going to let me to take an sample
Amps was 375 , +8 is 445. This was the 6th cycle with 4.0U. Do you think i should keep it maybe 2 or 3 days or should i increase it?
And if i am going to increase; the dose should be 4,25U or 4,5U ?

 

I think I would increase as you have been as we aren't seeing any movement. @Wendy&Neko what do you think Wendy?

 

You now we ve started to use insulin with Humalin N. With 4.0U Humalin, we were able to see values between 50-150 but for max. 3-4 hours. So if we can reduce the BG levels with Humalin, do you think he can have insulin resistant?

 

Yes, it's possible he's insulin resistant after being high for so long. This can be caused by the negative effect that high blood glucose has on his body's ability to respond to insulin. The way through this is with regular increases in dose. You could try increasing by 0.5 units at a time while he's still high. Let's see what the experts here think.
@Wendy&Neko

 

It's possible, or he might just need more insulin before he starts getting better numbers. Most people start looking into the high dose conditions when cat reaches 6u. It helps understand why the cat needs more insulin, and understand other treatment options if needed. Alot of people just keep going with the insulin, increasing until they find a dose that works.

 

In that case i am going to wait until i get a response from Wendy&Neko. I ve still have 3,5 hrs. for the PM shot.

 

Glucose toxicity is definitely a possibility with him being in high numbers so long.

I think you'd be OK going up to 4.5 units.

 

Thx for reply
This evening i gave him 4.0U, tomarrow morning we ll start 4,5U cycles. I hope things will be better.

 

Dear Wendy we have started the day 4,5U. I was not able to check both AMPS and PMPS .
I can only check +3,5hrs after Pm shot; result is 385
Tomarrow is my off day, so i ll be able to make more checks. But for the begining things look better.

 

Nice to see a lower number today. Hope we see some more

 

Good luck with the dosecrease

Did someone else give the shot? Shooting blind can be a very risky strategy, if someone else is doing the shot I would encourage you to teach them to get the test.
It might feel like it's not important now, but at some point you will get a lower ps and it's important that you don't get any nasty surprises.

 

My wife gave the shot. She knows how to make a test but Raffy is a little bit strange and i am the only one who can take a test; he is a little bit angry .. Thx for the advice...

 

I hope so and belive me it is going to happen with your help and adviceses....

 

This morning we gave the fifth shot with 4,5u, but as usual we are stucked again between 420-490.....
Do you after the 6th shot with 4,5, should i increase the dose to 5.0u?

Also i m trying to make random ketone tests , they r looking good.

 

Yes, I think you can increase to 5.0 u. It's good that you have negative ketone tests.

 

Raffy is around 5,7 Kg. For such a weight ; what is the max. dose should i go up?
And my thought he has insuline resistance. Do you have any advice for that?

 

The insulin dose needed is rarely proportional to the weight of the cat. The weight is sometimes used to calculate a starting dose but that's all. Insulin is a hormone and is dosed according to the cat's physiological need. It's not like a drug that is dosed by the weight of the animal. The dose size can be affected by the degree of impairment of pancreas functioning, the responsiveness of the cat to a particular insulin as well as the presence of other factors that create resistance.

Insulin resistance can be caused by other medical conditions like acromegaly (secretion of excess growth hormone by a pituitary gland tumour), production of antibodies against the insulin, or (simple) glucose toxicity. Glucose toxicity can be present if the cat has has high BG numbers for a long time. The excess glucose circulating in the blood impairs the cells' ability to respond properly to insulin. Generally, this condition is reversible by gradually raising the insulin dose until a "breakthrough" dose is reached that overcomes the toxicity-caused resistance. Once this dose level is reached and toxicity clears, the insulin dose often needs to come down significantly.

You don't know yet why Raffy's BG is staying high. It's possible he has acromegaly or is making antibodies but you'd just increase the dose in either of those cases. Usually if the dose gets above 6 u that is an indication that those might be the causes. However, other members' cats have had the dose go high because of glucose toxicity then suddenly the BG numbers began dropping. I suggest that you continue with the 0.5 u increases every 6 cycles for now.

 

Gurkhan is there anyway you can help your wife to learn to test Raffy?
I know you said he gets angry when she tries.
FWIW I did most of the diabetic care for George, as my husband was working away at the time. George never gave me any trouble, he was super compliant and docile when it came to shooting and testing, but when may husband tried to do it he would fight back, my husband had to be very firm with him.
George also gave my petsitter trouble, he drew blood, so she wore gardening gloves to protect herself.

Maybe she could try to test while you are there, both of you doing it, so he can gradually get used to her handling him, until eventually she could do it all alone.

I really do worry about his BG dropping or being low at preshot when you are away, your wife at them moment has now way of monitoring him to know he's safe, by the time they show symptoms of hypoglycemia it can be to late to prevent a serious symptomatic episode.

Better for her to become competent at testing now while he is high that have her go through the distress of dealing with a hypo event when she is on her own.

 

Thx for all

 

Now she is ON THE JOB TRAINING
You r definitely right, she has to find a way to make a test. But she is perfect at giving shots....

 

Good to know that you are on it, sorry to be a nag.


Yo Raffy, if youz lets your mammabean pokie your ears, sheez give youz extra treets and loadz of cuddlez,
Beez a gud kitty, da treets are sooooo gud
Dep BFG

 

Goodmorning.... Everything was going very similar, but yesterday i saw 2 small lesions located inner side of his upper lip. I took him to the VET , and she said this is Eozinofilic Granulom. The only good thing is, it was recognized just at the beginning?
Do you think this kind of a sickness can effect the BG level?

 

This is related to an overreactive immune system and is a type of allergic reaction. It can be part of a larger issue with body-wide increased inflammatory responses and some sources associate this with a greater likelihood of developing diabetes. It can make them harder to regulate if they have diabetes. So - not impossible to regulate but you might have to work at it harder and longer. We can help you with that.

 

Dear Nat, finally we saw numbers below 400s all day long.
Nadir was 351, anyway it is better than 450...

 

Very nice, looks like a bit of a bounce since the low number, but that is good shows that he is reacting to the lower number. He should break the bounce in a couple more cycles and hopefully we will see more activity then.