Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Stacy n kendra, Apr 28, 2018.
I can't seem to get her down i mean I can see slowly should I go up 1\2 more
Are you following TR or SLGS?
In any case I think an increase is in order.
I would recommend not holding a dose for too long as you then invite glucose toxicity
I'm wondering if at 8ui and still swimming in pinks you shouldn't be going up by full-unit increments? Calling in @Wendy&Neko for the high-dose expertise...
Usually 1u increments are done over 10u.
Holding on to the dose for to long may be contributing to the high numbers/ by way of Glucose Toxicity, how to proceed will in part depend on whether Stacy is following TR or SLGS.
I noticed that Kendra was diagnosed with IBD a little over a year ago. I also noticed that you're feeding your kitty rabbit -- which is a good novel protein. You may want to consider alternating between 3 different novel proteins. If you've not come across it, there is a great site on raw food for IBD cats. If you don't want to switch Kendra to a raw food diet, there is still a wealth of good information on feline IBD on the site. Gizmo was diagnosed this past February and the information on the site was extremely helpful.
Has anyone suggested that you get you kitty tested for a high dose condition?
Is Kendra still on steroids? I saw it mentioned on the ss. It looks like you travel also, is that why the dose is held a bit longer because you can't monitor when you do?
No steroid free as of the 25 April n yes travel days aren't even worth mentioning she gets freaked out n they go high
Kendra doesn't like won't eat duck cause when she was on a feeding tube that's what I fed her only will eat rabbit don't like deer. I have already changed her food when she became diabetic took me this long not to flare up her ibd not messing with that again. I only went up 1\2dose not a whole unit
TR is Tight Reuglation
SLGS is Start Low to Go Slow
They are the two dosing methods that most people follow on the board, the links above outline them both. It helps us to help you if we know which of the methods you think is better suited to you and your cat.
TR will allow you to take up the dose more quickly, given the higher dose and with all the pink on the ss this would be my choice if Kendra were my girl. But you ultimately would have to be comfortable with it, and we will support you whatever your choice.
I am glad you increased today Stacy. Those continuing high numbers are hard on Kendra. We need to get her numbers down so she is spending the majority of her time under renal threshold. That number varies by cat, but with the AT it's probably somewhere in the low 200's. You've stepped up the testing lately, which is great! If you can keep on testing twice a cycle (two preshots plus one other test per cycle) every day, I would try increasing by 0.5 units every three days. If you see some blues, then you can slow down the increases.
For others on this thread, I am suggesting these faster increases because Kendra likely has a high dose condition and we need to get her into better numbers ASAP. Faster increases as I've described, are safe and follow the Tight Regulation protocol. With a high dose condition in the picture, we need to be more aggressive (but safe) on the increases. Stacy, I know I have mentioned getting testing done for acromegaly (IGF-1 test) and IAA (insulin auto antibodies) previously. Have you discussed these with your vet? The vet would draw blood for both and send it to Michigan State University (MSU).
One other thing, cats need as much insulin as they need. The amount of insulin each cat needs is completely different. We have one kitty currently here that is wonderfully regulated at 52 units. He was up to 59. Just keep following the dosing guidelines, and we will fine a dose that helps Kendra.
Stacy, if you can please take @Wendy&Neko advice into serious consideration. She has guided me with Olive. We were 8.5 units and today just earned our 2nd reduction. I don't know if Olive has a high dose condition yet, tests will be done in 2 weeks, but she does have a tumor that might be adrenal based.
I am taking the advice thank you i havehave a vet appointment shortly i will ask her to check her then. I have had 2yellows today 244 n 234 at 8.5 maybe I found the magic number we will see thanks again
How is Kendra doing?
Did she go the Vet? get the BW?
I see she's saw blue briefly, hope you get to see it again soon.
I'm going to tag @Wendy&Neko to stop by.
Now she is up to 10u, usually the increases will be done in slightly larger steps, that blue puts me in a little doubt if it's ok to do that in this case, so I'd like Wendy to take a look, before you change anything.
Vet will be at my house on the 18th.
I'm glad you've got the vet coming in soon.
Unless you see green on a dose, I think you are fine moving to 1 unit changes over 10 units total dose. So 11 units would be the next dose. Just make sure the cycle you increase is one you can monitor closely.
Ok I got a blue tonight so I just stay n see at the 10doseage before I go to 11 ty
Ok now on 11 units ugh thanks
Hi Stacy - you are getting good advice from others. Many high-dose kittehs have acromegaly. Wendy, myself, Pig (cat), and others here have dealt with it. If you need more info on acro, there are some good FAQ in the acromegaly subforum.
As an example, Leo was at 18 units a dose and I got him treated with SRT at CSU in Ft Collins. Now Leo is at 3.0 to 4.0 units/dose. And his acro symptoms have subsided. Like Wendy said, the first step is to get a blood test and get it sent for analysis of IGF-1 (Insulin-like Growth Factor) .
Was looking what if this is it is the cure
If it is acromegaly, there are two treatment approaches people here are using. SRT or stereotactic radiation therapy is one. The current low cost version of that is at Washington State University. Read some of Pig's posts for more details. Sarah and Pig are on the road now after SRT this week. The issue with SRT is the travel, and there is some cost. Neither my Neko nor Jeff's Leo have gone off insulin, but gone to low doses which means slowing down harmful effects of the growth hormone. There have been some acros goes off insulin after SRT.
The second treatment option some have chosen is the drug cabergoline. We have had two kitties go off of insulin, and most are on lower doses than when they started. It's a very new treatment option. We don't know long term outcomes yet. But it is cheaper and you don't need to travel.
First things first, is to find what is causing the need for Kendra's increasing amounts of insulin. Glad you increased today.
Agree with Wendy (as always). I made a chart this week. It shows Leo's insulin usage before SRT, then after SRT. While SRT is expensive, it pretty much neutralizes the tumor cells. Plus it reduces the future side effects from continued tumor growth.
Now Leo is ~3.0 to 4.0 units/dose. Leo also has small cell lymphoma and is getting chemo. He may have pancreatic diabetes at this point. I never got him retested for IGF-1 levels because it does not matter at this point. He has been through a lot, but is still hanging in there. He gets a few carb treats every day, since ya never know how long he will be here. We treat each month as a gift.
Wow looks like it really worked good job Leo n thank u
The graph is a good proof point - that SRT does wonders for Acromegaly. You can see where the SRT happens, and then Leo started using less insulin soon after that. The SRT + 2 month mark was the most exciting. It was obvious that his Acromegaly was subsiding and there was light at the end of the tunnel.
Yes it is good proof n light at the end of tunnel is the best feeling
Acrmegaly didn't really turn out slightly high but in conclusive i raised her to 12 n in the blue I'll take that no more DrDrinking n peeing happy now
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