Tigger 1/30 PMPS 326, +1/262, +2/310 +5/309 - Insulin not getting traction - potency issue?

Hello Everyone in LL! It's been a long time since we last posted, actually a really long time! Sure miss you guys! Hugs & Healing vines to all those kitties & beans in need!

Tigger's 8/25/14 Post[http://www.felinediabetes.com/FDMB/...9-having-to-use-hc-again.124150/#post-1287540]

I'm at a loss here. For the last month at least, Tigger's BS has been trending higher & higher. And higher.
1) I reduced his fuds from 4.5% to 2%, which helped in December for several weeks, then he trended back up.

2) Potency issue. I tried a new pen. This made no difference. I purchased (5) pens in 2/2014 & the expiration date is 7/2016.

3) Meter issue. I used control solution, all normal. I got a 2nd Relion Confirm meter - they read within 6-10 points of each other.

4) Infection? Monday 1/26 we went to the vet. Bloodwork & U/A were great, except for Creatine Kinase due to a puncture wound he'd just received. Tigger accidentally sneaked outside the night before & got 2 tail bite punctures in a fight. He was under the weather when he came back inside 1/25, & I gave him 3mls clindamycin & .2mls Bupe right away that night which helped. Tonight is #6 on Clindamycin, tomorrow will be Day #7 (final). He's been totally fine with good appy since the vet visit. Puncture wounds are pretty much healed, no abscess, but slight inflammation in upper tail still. Vet checked it today & said not to worry.

5) We had a power outage of 20+ hours back in December. All the pens stayed in the fridge - cool, but not up to their regular temperature.

6) Vet checked Tigger's 'dead' eye & said it felt fine - I'd wondered if maybe the silicone eye was leaking & causing higher numbers. WBCs on the bloodwork didn't indicate infection.

7) Tigger used to be so sensitive to increases in dose, so I'd only been increasing in small amounts, 5-10mm at a time (38mm = .25 units). Maybe I let his depot get horribly low? I've also had to hold him a little higher in the previous months due to too many issues, including sick Mom (now in remission! but another surgery last Friday)

8) Could Tigger have Insulin resistance???

Tigger gets another dosecrease tomorrow (I'm increasing .25 units at a time now), but this will be the highest dose he's EVER had, and more than double where he was a few months ago.

I still have almost 1.5 pens left, but I'm wondering if I should bite the bullet & buy new? I opened an unused pen & there was no difference, & even if the expiration says 7/19, maybe its lost potency? It's completely clear with no stringy stuff.

The vet says these 'cycles' are normal, & not to be worried, but it just doesn't feel 'normal' to me & isn't Tigger's pattern.

Can anyone shed some light on this for us???? I'm getting pretty worried at this point!

Good thing is, Tigger acts totally NORMAL with all this!

I'll try to attach Tigger's bloodwork below.

Thanks so much for your time & input!
Suzanne & Tigger

 

Hi Suzanne - good to hear from you, even if it is because you are worried.

Has Tigger's mouth been checked lately? When's the last time he had a dental? Neko had a dental a few weeks ago and X-rays found a deep pocket that wasn't otherwise visible and it was affecting her numbers a bit. Sounds like you've checked the rest of the possible causes of inflammation.

I've seen here and found myself that increases by .25U are much better. I'd only do smaller ones if you want to tweak some green numbers. And you should try to keep on top of the increases as much as possible. Only 6 cycles if he isn't getting blue nadirs, and 8-10 for blue and green. You held the 1.78U dose a lot longer than that. You want to make sure he doesn't develop glucose toxicity or you'll end up going even higher. Just keep following the protocol. You'll get there.

Try not to worry about the size of the dose. I know it's hard - been there, done that. What's important is his BG numbers. Amy's Trixie, for no known reason, fell out of regulation a couple of years ago and she had to take her up to 5U to get her back again. I've seen other cats that for know reason all of a sudden needed more insulin than they've needed before, and then found the fitting dose and headed back down again. We don't usually worry about insulin resistance until over 6U.

 

Thanks for your input, Wendy!

Glucose toxicity makes the most sense, thank you. I've been holding back on increases due to my wonky schedule and preoccupation with DM, getting ranch ready for sale, etc. I haven't been able to focus as much on Tigger, & since he's prone to huge drops, I wanted to make sure he was safe. I forgot about the potential for glucose toxicity, though

I asked about dental- last dental was May, 2013. BUT - Tigger only has 4 or so front teeth left + his tiny front teeth, due to stomatitis. The vet said all looked fine. 2 v. small pockets of gingivitis in the back are normal for him due to his stomatitis. He takes Oralguard for that (zinc / vit. c drops). Re-check in 6 months. Bloodwork showed no elevated WBC, only elevated creatine kinase - vet thought from the tail bite. He's on Clindamycin now, which is also good for dental infection, so I don't think that's it, luckily. His dead eye's bulging a little today & I'll watch for a possible abscess, but it's not painful for him - I think it's air from inhaling his fd treats the other day . We'll see.... I told him with 1 eye & 4 teeth he can't sneak out of the house & play tough guy with the ferals at night - he's gonna lose big time! I don't know what he was thinking there !

I'm back on the .25u increase regimen (he got a dosecrease this AM, but no traction yet) & won't worry unless we get waaay up the dose ladder. Your stories & info are a huge anxiety reducer! Thank you!!! I'll also stick with the insulin we have & not worry about buying new for now ($261 for 10ml, $416 for pens)

I'll try & post again Sunday with any progress

Hope Neko stays doing as well as she has been! Thanks Again & Take Care, Wendy!

 

Q: had you x-rays of his mouth to make sure no roots were left after any extractions? That can maintain stomatitis symptoms.
Many cats with stomatitis wind up needing full mouth extraction (FME) to subdue the disease. Some have had successful remission of stomatitis with FME, plus use of the Dallas Syrup (the Yahoo group will tell you about it).

 

As a cost saver for the insulin purchase, you might want to consider buying from a Canadian pharmacy. Check out the last post in this thread.

 

Thanks, BJM!

The vet took x-rays of his mouth (at least his l. dead-eye side) when his eye had an abscess last year from his URI sneezing - drainage going up the tear duct & getting trapped in the eye cavity. There were no root remnants. Tigger was a starving feral rescue kitten with severe malnutrition & probably a horrible immune system. He had teeth issues & extractions all his life, till 5/2013 when we extracted almost almost all his teeth except the very front 4. This really helped - he used to need dentals q. 6 months & the (ex) vet didn't diagnose the stomatitis till late in the game. His gums are pretty pink now (2 v. small gingivitis pockets only), even after 1.5 years w/o a dental.

I've never heard of Dallas Syrup, but will definitely check it out - anything that will help! The Maxiguard has parabens in it which I don't like. Maybe the Dallas Syrup will be better.

Thanks Again!

 

Oh, thanks, Wendy - I read the thread & will PM Chris to see if she's still using that Canadian Pharmacy with good results - what a price difference!

 

I am Suzanne...and they're still great!

Jordan (the pharmacy manager) even called me last week to thank me for sending them so much kitty business!!

He also wanted to let me know that he'd made a new video about why they can sell so cheap (Canadian government sets limits on profits) and how they ship. Here's the video http://canshipinsulin.com/

I can't say enough good stuff about their customer service and willingness to help!

 

Wow, Chris - you're on top of things! I didn't even PM you!

That's fantastic- I'll definitely try them next time! Costco just quoted me $417 for the 5 Pens, & $261 for the vial - I can't believe how good your pharmacy's prices are! After getting Wendy's input, I'm going to keep going with the 1.5 pens I have left, then I'm buying from Canada!

What size do you order for China & have you ever had any problems with the potency weakening before it was all used?

My daughter's cat just got diabetes (dry food even though I warned them), & they could barely afford the vial - they'll be thrilled to hear about this!!!

I looked at China's SS the other day & she sure is doing well - I love how level she runs! Your efforts are really showing.

Thanks Again for your information!

 

I get the 5 pack of pens and the expiration date on the box was over 2 years away, so no problem on the potency

Everyone I've heard from that's gotten their insulin from Marks has said that the expiration date on the pens has been at least 2 years away, so it shouldn't be a problem for you!

The insulin doesn't start to degrade until it's "opened", so I just keep the whole box in the refrigerator and use 1 pen at a time

 

Hi Suzanne!!!

So glad to see you and Tigger back (I owe you a PM, btw). I'm glad to see Tigger's tail is ok. His labs look great.

I agree with Wendy that getting back on the protocol for increasing is the best course of action for him. And she also gave great advice about not getting attached to a dose.....just keep going up as she described until you start seeing some more routine blue.

You'll probably have to go up quite a bit more; if he's developed some glucose toxicity, it might take a little work to find that fitting dose.

Glad your mom is better! Hope to see you all around more now.