We ve reached 5,5U

http://www.felinediabetes.com/FDMB/threads/raffy-at-4-0u.182688/#post-2032798
Hello again.... Step by step we are on dose 5,5U. Yesterday , with 5.0U on 6th shot , his BG was around 350-390. But today we are back again 450-500s. This evening , we were on 7th shot with 5.0; that is why i increase the dose to 5,5.
I need your adviceses again .

 

Just keep up the increases, 0.5 u at a time, until you get better numbers. There's no other way. Eventually you'll reach a dose that will get him down. Now, the reason why he might end up on a high dose is another issue. It's possible he has acromegaly or insulin antibodies. He might also have built up a lot of glucose toxicity from being high for so long. Either way, dose increases are needed until you break through. Are you testing his urine for ketones?

 

Just keep methodically raising the dose by 0.5 units as you are doing. And eventually you will hit the break through dose.

 

I make random Ketone tests, we r lucky the results are always Negative.

 

My cat was up to 7U twice a day, when we hit a breakthrough dose. Suddenly, after that last increase, numbers started to come down and the dose reductions were pretty rapid. If it is glucose toxicity only, be ready once he finally sees that breakthrough - it can be surprising.

 

Dear Meya, one day we ll find the dose as well. But sometimes i am loosing my belief....

 

Hi Gurkhan, how's the training going? Is your wife feeling any more confident testing?

Shooting without testing makes me very nervous, and with you being away with work there are big gaps in the data, when I see those pinks then no tests and then a black, I wonder if he dropped lower at some point and you missed it.

There is so little data in the pm cycle, any chance you could always get a before bed test.


Best of luck to your wife with her training. Just a thought has shown watched the videos on how to test, I found them really useful.

 

Wow ... your spreadsheet and story give me hope with Gizmo's high dose.

 

It's tough when they seem to be stuck in higher numbers. Gizmo was there for months, but we finally (after 7 months total, but only 3 months following TR) are seeing some great progress. You'll get there.

 

He's gone into remission twice, but after a couple months starts to creep up and get into that glucose toxicity again. We've had him on 1/2 to 1 unit only once a day for almost the past year, and his numbers don't creep and stay in the normal range. I'm ok with this, his body seems to just need that extra little kickstart. We have been able to stop insulin for a few days to go on vacation and BS remains in normal range for about a week, then starts to creep back up.

 

AMPS was 435, but +7 is 486 , he is strange....

 

Individual numbers are less important that the overall range of numbers. Just keep increasing as you have been. You will get to a dose that brings him down. Don't leave him too long at an ineffective dose because that only makes it harder to get him down.

 

Hang tuff Raffy, Titan is right behind you in the dose increase. I'm doing an every 4 cycle increase now just to try and get out of the blacks which we have been in for awhile. We totally understand the anxiety (rowing in the same boat). Titan is eating well and interacting with his brothers plus also neg for ketones. We will be watching your progress!
Peace, Ed, Paula and Titan.

 

I ll keep this dose for max 6 shots, then i ll go up to 6 units. And do you think is it a good idea to change Levemir to Lantus?
We saw 300-350s with Lantus with 4U....

 

It's hard to say. The dose Raffy needs will change over time. Your Lantus experience is in the past. Raffy probably has glucose toxicity to overcome. He might get down to a lower dose once you're past that. Cats will never tell us what they want to do!

 

So , i should keep on Levemir until i find the right dose,,

 

Yes, stick to Levemir. It's a better insulin for higher dose cats. Lantus has an acid base which can sting at higher doses and Lev seems to have a bit better duration. Going back in dose was a mistake-don't worry, you are alone in having done that. And whatever condition is causing Raffy's need for more insulin can also change over time and change insulin requirements.

Any chance you could update the spreadsheet with the latest results?

 

Curious to see how Raffy is today, he's a tough one.

 

I ve updated SS Still so strange. Esprcially today, same food, same dose and we did not let him to go out, he ate nothing from outside but AMPS was 417 , +6 560.... This morning it was the 6th shot with 5,5.
Keeping him inside the house makes him so nervous, can it make a negative effect on him?

 

Nice to see you again but Raffy..... he is going to make me crazy. One step forward two steps backwards.

 

I suggest you try 6.0 u tomorrow morning. I don't have advice about going outside except to say that stress can raise BG. If he's accustomed to going out and stays close to home so you can give insulin at the proper times maybe try letting him outside to see if it helps.

 

I suspect he went lower last night than he is used to, hence is bouncing today. Many cats gomlower at night, which is why we keep mentioning getting those tests before going to bed.

I agree you are Ok to increase.

 

I understand how frustrating it is. Now that Raffy is at 6U, you may want to ask your Vet about testing for insulin resistant conditions: IAA and IGF-1 (acromegaly). If he has one of these you will have a better idea why it is harder to get Raffy to the right dose.

 

You cannot get IAA testing done in Europe, only Michigan State University does those tests. The acromegaly test can be done at the Royal Veterinary Clinic in London. Be prepared that your vet may think these are rare conditions, as that used to be the thinking, current reasearch shows one in four diabetic cats has acromegaly.

 

This evening i increased the dose to 6.0 U. If we continue like this we will reach two digit doses . I hope this black day was a reaction of going a low level which is lower than his standarts. This evening PMPS was 568 , +3,5 538.....
Here in Istanbul, it is very hard to find a Vet , who is so familiar with diabetic cats. That is why i m trying to find the solution by my self with all of your supports.
Lets see what will happen with new dose.

 

You may need to tell the vet what to do for the testing. Hoping at least that they have or can send samples to RVC.

Hope he shows some nicer numbers on 6U,

 

This morning we ve started the day as usual. Amps 405....
Today i was not at home all day, that is why i locked the cat flap , so he won't be able to go out and not able to eat harmful food, but he has broken the flaps lock so he was free all the day.
As a result of this escape PMPS was 664.
I gave 6.0 U and +565. In four hours BG level dropped approximately 100 units.
According to this, can we say , insulin is working but his metabolism stucks on 400s?

 

Carbs can do nasty things. Neko once got into bread starter which got her into the black zone. When it wore off she was back to green the next day. Put some notes in the Remarks column that he got out ant probably ate forbidden HC today. It helps us to know that happened when we look at dosing.

As for vet's, we can help you with most of the diabetes part, but you would still need a vet to do a blood draw and package it for sending to London for high dose testing. I had to research how to do that for my vet here in Vancouver.

 

That drop of 100 tells you that he's responding to the insulin. However, the numbers are still high because the dose is too low. Continue the careful increases and eventually you'll reach a dose where the pre shots BG and the nadir will be in a much better range.

 

Oh Raffy, it's nice and cool inside, no need to go out..... Maybe Raffy needs new toys to play with.... what cats do for attention

 

Beacuse of my flights i ve been away from home since wednesday.
His BG was around 370-430 at 6.0 U, we gave 6.0 u for 7 shots, and since this morning my wife increased the dose to 6.5 U.
Amps 420 , +6 485
400s are standarts for us....
I ll keep it 8 cycles , let's see what will happen...

 

This is very difficult and frustrating for you but you're not alone. Many others have cats that didn't respond much until they got to a high dose.

 

He wants to go out because he hates to use litter box. That is why i bought CatGenie for him but he is not happy with that as well.
Hope to see him in Catgenie

 

Do you we can go up to 10 U ? As you briefed me before; we can accept doses which are more than 6 u as high....
And if we can take BG levels lower with a high dose, is that dose going to be constant ?

 

Have a look at @StephG 's spreadsheet. Her cat is on a very high dose of Lantus right now. She has not yet had him tested for high dose conditions. Once you get to a high dose (6 u and higher approximately) you can still increase. The dose can:

1. stay high if there's an untreated high dose condition like acromegaly or insulin antibodies
2. come down if the high numbers were caused by glucose toxicity that has built up because of high BG for a long time
3. come down in a cat making insulin antibodies and the antibodies stop at some point
4. come down in an acro cat being treated - eg. @Marvin's Mom - Nat.

It's easy to get worried about the high dose but many people here on FDMB say that a cat needs the amount of insulin he needs (and they're all different) and they say that there IS a dose that will pull down a cat's BG.

 

Have you seen this, Gurkan?
http://www.felinediabetes.com/FDMB/...conditions-heres-what-we-kno.2336/#post-21454

 

We were able to see BG levels between 50-120 with HumalinN. That was at May 2017.
But the curve was very choppy, nadir was 50 but PS values were again around 450. For a flat curve i changed the insulin first to Lantus then Levemir, but as you see we are stucked to 400s maybe for 3 mounths.
So it was coming down with Humalin; can we still say he can be a Acro Cat or something, and is it a good idea to make a new test to check for is he still coming down with HumalinN?

 

Yes i know that; and if you are living in such a country (Turkey) facilities are very limited , Acro Test, versed Vets etc....

 

Yes, HumalinN will cause sharp drops and those ups and downs are hard on the cat's body. That's why a depot insulin can be better. Your data for Humalin isn't on the spreadsheet but if I recall what you said in earlier threads the dose was lower. Your signature tells me you weren't on it long - around 2 months. Here are some thoughts I have:

• comparing HumalinN to Lev is something like comparing apples to oranges - very different in action
• what happened in May is now ancient history in September because the cat's responses to insulin and the dose needed can change over time
• it's possible that your cat develops glucose toxicity quite easily when he sits in high numbers. That is reversible with careful dose increases. I recall one member here saying it took months to break the toxicity and get her cat responding.
• it's possible your cat did not make antibodies to Humalin but has done so for Lev - antibodies are very specific to the protein molecule and I'm assuming (maybe incorrectly) some structural differences between Humalin and Lev
• your cat might have acromegaly but you can't easily test for it or treat it where you live. There are others on FDMB who are in the same position and just raise the dose until they get results.
• it's possible to add a fast-acting insulin to the depot insulin in tiny doses to pull the BG down low enough for the Lev to have a better effect. Depot insulins are known to be good at keeping low BG low but not as effective in pulling down from high numbers. Using this fast acting insulin is an advanced technique that should only be used with a lot of guidance from experienced members once you've worked on getting to a higher dose. I don't think you're there yet.

So - it all comes down to increasing the dose for now. And being patient ...

 

Hello Gurkan, our Titan is also going through the increasing dosage trying to find the one that stabilizes his BG numbers. We have been stuck in the blacks with a few reds and I just increased to 5.5 units 2x today. So Titan and Raffy are in a similar situation. I do know about kitties that have had out door privileges and you try to turn them into indoor kitties, it's tuff BUT can be done. You have to put up with a lot if yowlling for a few days but they do adjust. Careful they will escape and then it's back to square one.
On a side note, my wife Paula lived in Istanbul as a child and has very fond memories. Her Dad worked for the U.S. Government in the early 1960's overseas. Also you mentioned "flights" , do you work in the aviation industry?
Ed

 

Butting in here: yes, Gurkan has said he's an airline pilot.

 

No, I would not do this. He has a large Lev depot right now. You'd be adding another insulin with a different action profile and it's hard to know what test dose would be safe. I think there are too many variables in this situation. My opinion only.

 

I m working as a Commander at Turkish Airlines. It is very nice to hear good things about Istanbul from a foreigner
And Blacks and Reds are our lifestyle
Hope to see pinks and yellows in a short time.

 

Ok, keep on running with Levemir.

 

How nice to meet you, unfortunately on this forum but good things will come out of it. I also fly here in the states. Rated as a commercial pilot but only fly for fun. I am a retired air traffic controller, working out of Minneapolis Center. If you have flown into Chicago KORD, we may have spoken before .

 

I used to fly at A343 and A333 as a F/O for 7 years , and i ve been there for several times, what a windy city

 

That's why I'm in Wisconsin , less wind more snow . Good luck with Raffy, we will be watching.

 

Chuck is on 17 units twice a day. A few days ago I decided we were going to increase to 17.5 units but we had a breakthrough and didn't need the increase.
I agree with the others to continue increasing until you find his breakthrough dose. It might change once you do find it, going up or down, but you will probably see the results of the changes much quicker than you are now.

For the litter box... Have you tried using dirt mixed in with the litter? I had a cat that was indoor and outdoor before we adopted him. He was a little nightmare until he got use to being inside. We don't have house plants anymore because he was using them as a litter box! We started mixing in dirt (top soil) with the litter until he got comfortable using it. We decreased the amount each week until he was only using litter. It did make a mess in the beginning but the tipped over plants made bigger messes and they smelled awful.

 

Another thought is you may want to contact RVC directly and see if it is possible for you to ship the blood work directly to them to check for Acromegaly. If you can arrange the shipping, then all your vet would need to do is to take the blood for you. RVC should be able to tell you how to package the blood. People in the states often do it themselves and send it to MSU which is where they can test for Acromegaly in North America. I would think that happens in Europe too, as I saw on RVC facebook site someone from Germany had their cat tested there. Or of course you can fly it there

 

My AlphaTrak stripes are running out and here in Istanbul it is impossible to find them at any store. Beacuse of this , i ll switch to a human calibreted meter, until i get the Alphatrak stripes.
I bought AccuChek Performa Nano .
So do i have to create a new SS or shall i continue with present one?

 

You can continue with the same spreadsheet. Just put a blank line in the row after you stop using the AT, and put something like "new accucheck meter" in the line. Many of us use the human meter because the test strips are much cheaper. And our dosing method/protocol were written for human meters too.

 

I ve switched to ACCU-CHEK... This evening i gave the fourth shot on dose 7.0 U.
I think the day after tomarrow i ll increase the dose 7.5 U.
Any different advice?

 

Your plan sounds good. The numbers will look a little lower on the human meter vs. the AT, but they still say increase. You would only slow down the increases if you see a blue, or below 200.

 

. We saw 300s today..... I hope it has started to come down. Do u think i should keep 7.5U for more days?

 

I suggest you continue with increases after 3 days at one dose. When you get to yellows and blues that might change.

 

So u mean; should i go up 8,5U ?

 

After a dose of 7.5 u tonight (the sixth dose of this size), go to 8.0 u for three days (six cycles) and then 8.5 u for three days, etc.

 

Low 300's are better, but the goal is to get some blue/green in there. I would increase to 8.0 units tomorrow morning.

 

This evening i gave the 5th shot with 8,0U. Details on SS
PMPS was 277.
Should i go up to 8,5 U after 6th shot or stay on 8,0U for more shots?

 

Go up to 8.5 u after the sixth shot. You're starting to make some progress.

 

Awesome yellow preshot! Tonight would be a good night for a before bed test.

You want to go up every six cycles until you see blue. Who knows, that may be tonight.

The next time you post, could you start a new thread, this one is getting long.

 

I am so happy to see that yellow. Good job Raffy, keep it up