? Time to increase dosage?

Meggie's updated spreadsheet... https://docs.google.com/spreadsheet...lv1zalGcRpwWCRC_prxlQqiUE/edit#gid=1131435116

Is it ok to go ahead and increase her dosage, or do I need to wait? We are new to Levemir (transitioned from ProZinc), just started day 4 today.

 

I would wait the full six cycles on 4.5 units, which is includes tonight. It can take that long for the depot to build and for you to see what a dose can do. Have you decided whether you want to follow Tight Regulation or Start Low Go Slow for dosing? The answer to that questions tells us when you can next increase.

 

Think it is best for her to do Tight Regulation. I would like to get her numbers down to see if that would help her 'start feeling better'. She currently just lays around waiting for food and her shots. It's been over 6 months since her diagnosis. The vet thinks there are underlying issues. She is referring me to an endocrinologist at one of the local universities. Her latest issues have been that she can't or doesn't want to go up and down the stairs, she's favoring her left leg and not walking on the tips of her hind legs. She has also developed a weird sneeze, almost seal like and she wheezes while she is sleeping (maybe this is just snoring). These symptoms have just been within the past few weeks.

 

If you are doing TR, you can increase tomorrow by 0.25 units. I presume you are feeding all low carb wet or raw, which is prerequisite for TR. Do you mind putting TR in your signature, along with a link to the spreadsheet, and any other pertinent information such as date of diagnosis.

Are you giving methyl B12 or Zobaline? That can help if her back leg issues are neuropathy.

One of th things your vet may be thinking of is acromegaly as an underlying condition. One in four diabetics has it. My Neko did. It's a benign pituitary tumour that sends ou excess growth hormone. It can cause soft tissue growth in the throat, making raspy breathing sounds on the exhale. Some cats also snore, but so do non acros. It's more an issue if that's a recent change. How is Meggie's weight? Which university is the vet recommending going to? It's great if you have an endocrinology specialist near you.

 

Definitely doing all low carb wet. Currently Friskies Pate, she had a bout with a really loose stools last week while on Fancy Feast (even though she has been on that for almost a month)...thought I would try Friskies to see if it made a difference.

I am not giving methyl B12 or Zobaline. I was giving Cosaquin but stopped because I didn't know how it would affect her BG numbers. The vet gave it to me after I mentioned that she was having a hard time coming down the stairs. The vet hasn't seen her for any of these issues (the walking or wheezing) but I discussed them with her over the phone with her last Friday evening. I kinda have an issue with my vet now. She thinks that Meggie's BG numbers were fine (prior to 1-25). She always reported numbers in the 400 range with spot checks which she said was in the acceptable range. Never really did a full curve. The lowest values that she got in house were 302 (values on the spread sheet--that was the only curve that she ever did since her diagnosis). She says that her fructosamine values are in a good range (all of this prior to 1-25)--I do not have those numbers in my file. I haven't been back to the vet since Meggie's last bout with nausea and lack of eating on 1-16-18 when she was given fluids and Cerenia which helped her (in Dec and Jan, we were at the vet every 2-3 weeks for this). Since then, I've been reading the message boards and trying to help my cat without the help of my vet. All signs of monitoring at home pointed to switching to a longer acting insulin. I got a Levemir pen and started it not long ago. I had left several messages for my vet requesting a prescription for the future. I never thought she would have an issue with it. When I spoke with her a few days ago, she said she would not give me a prescription for the Levemir because it was not good for cats to use--I'm pretty sure she said the same for Lantus also. I told her that I have been reading and following the message board and that there were many people who use Levemir. She said that the people on the message board were not vets. She also didn't recommend using human meters. I didn't push it any more and didn't tell her that I had already started it without having a prescription. Because Meggie has not been a typical diabetic patient (her cat even has diabetes), she thinks there are underlying problems and that I should see an endocrinologist. She even thinks that the limping may be a complication of the diabetes (I just mentioned this issue on the phone with her, she has not seen her in the office about it). There are 2 endocrinologists about equal distance away from me. One at Univ of Tennesse, Knoxville and Virginia Tech, Blacksburg (about a 1.5-2 hr drive) that she recommended. She said that she would speak to them and send a referral Monday along with all of Meggie's records. Since we spoke on the phone late Friday, I have been searching to find 'scientific' journal papers supporting my choices and I have found several. I am really not happy. She has never mentioned acromegaly. Maybe because she thought Meggie was 'in control'. She was not happy that Meggie was taking so much ProZinc insulin (@3.5-4.0U) and said that she didn't recommend Meggie taking more than ~4.0 units...that more than that was not recommended for her body weight. Right now, I'm just going to wait to hear about the referral and continue doing what I'm doing with the Levemir...I just really don't want to have to go in with a hypoglycemic cat and have to explain my use of Levemir without a prescription. I'm just trying to do the right things for Meggie and I feel really torn and wonder if I am or if I'm just making it worse. This is really causing a lot of stress and worry on my behalf

I'm new to the message board. Just figured out how to do a signature, so I input the info you requested. Yay me!

Thank you for your help, input and advice. It is GREATLY appreciated!!

 

I'm not sure how to get my signature to show up... Do I have to post a new thread to get that to happen?

 

One more thing...you asked about her weight...it has gone from 12.4 to 13 lbs over the past few weeks. Over the past few months, her weight has been in the 11-12.4 lb range...lower when she had the 'pancreatitis' issues, then back up to ~12 lbs. She's been eating a lot. I have 2 cats so I put out wet food for both...I know now she has been eating it all and not letting her brother eat any. I think that is why she is up to 13 lbs--this is a high for her. Also found out that he hates the wet food and gags just smelling of it and walks away. I'm having to feed him separately (he was down from 11 lbs to 9.4 lbs--I didn't notice until it got noticeable because she's been taking all of my attention). She got in to his dry food a few times last week. I keep it upstairs now since Meggie has a hard time going up and down the stairs. He's back up to 10.4 lbs, so that's good. These 2 cats are STRESSFUL...that and 2 middle school girls are going to be the death of me . I am somewhat stressed out!

 

First to the signature, on the top right under your name is a drop down with Signature in it. Select that and you get a text box you can edit.

I had serious doubts about my vet at first. She prescribed Caninsulin which is an icky insulin for cats. The locum vet who showed me how to shoot said I could reuse syringes up to three times and that the time to watch Neko was the half hour after the shot. A better locum got us on Lantus and pointed me here, where I was lurking already anyway. I talked to a couple of other vets when I thought about switching. One sounded promising when she had a diabetic rescue, then I found out it hypoed and died. I kept my vet. She let me handle the diabetes side of things, and she was great at other things. We learned together about acromegaly.

We normally wait until people get to six units before testing for high dose conditions, but acrocats can have smaller doses. Ravenous appetite and gaining weight in spite of being unregulated are other symotoms.

Cosequin should be fine for the blood sugar. You might want to look into zobaline. If you look for cats with neuropathy on YouTube, see if that is what Meggie looks like.

 

Thank you so much for the info about neuropathy! I looked at the YouTube videos and that is EXACTLY what she looks like!!! Called and left a message for the the vet with my most recent diagnosis and requested zobaline (methyl-B12). I also saw that I could just order it from Amazon, but I thought I might be able to get it from the vet quicker. This diagnosis goes along with my feeling that her BG numbers have been way too high...even though the vet doesn't think so. I'm really hoping that she's open to listening to what all I have learned and working with me. I really think that she truly wants to help. If not, I will have to find another vet.

 

The vet probably won't have zobaline. I would order it on line.

Having a vet willing to listen to you and learn and work with you is a vet worth keeping.

 

Ordered the Zobaline and should have it by Friday. Have an appointment at UTn Knox internal medicine, diabetic specialist next Wednesday. Hoping that we (my vet, the specialist and me) can all get to the same consensus with a treatment plan. Really want this girl to start feeling better! Her numbers are coming down...slowly and there has been no bouncing that I can tell with the Levemir. I think her high numbers correlate well with her getting into her brothers food.

 

You are doing a great job testing. The Levemir is probably keeping her flatter, which may make her feel better. Any chance of changing her brother over to low carb wet food? We had one cat who's caregiver thought he wasn't getting into dry food upstairs, and Scooter was on 5.5 units of Levemir. He got a dental, then she banished dry food from the house, and he went down to zero units (remission) in a couple of really scary days. It was almost four years ago today. I remember staying up late with Linda as her kitty went low and we watched the Winter Olympics women's hockey final.

Good luck with the vet visit.

 

I had him on the wet too. Then I noticed he was losing weight. He went from 11 to 9.4 lbs. I prefer to feed them the same. Would make my life 100x easier! He literally gags when he smells the wet. Both FF and Friskies. I had to get weight back on him fast. I tried dry kitten food and it took about a week for him to gain 1 lb. I’m not sure what else to do. We have to feed him and take it up before she can get to it...she’s somewhat of a food bully. I first thought she wasn’t letting him eat the wet so I tried feeding them separately, but now I think he is just refusing to eat it since I’ve observed the gagging when he smells it. I looked in to the no carb dry food to feed him in case she does get in to it but it is sooo expensive!! I will definitely keep in mind that her sneaking in to his food could really mess up his numbers and be super careful when feeding him. If you have any other advice regarding that, I’m up for input.

 

If she's got neuropathy, can you feed him at a higher location? I had to guard my second kitty until he finished or Neko would bully him out of the way.

 

That’s what I was attempting to do when I started feeding him upstairs. She hasn’t been going upstairs for awhile now because of the neuropathy but she decided to give it a go and drag herself up there . I will have to be smarter. She’s my climber...he doesn’t jump up on things. I yell at them both when they do. He’s compliant...she isn’t. I will come up with something. Surely, I’m smarter than they are! maybe?!?!?