cobbsmom said:
I am not opposed to a larger increase since we are this high. My DH and I were just talking about, even without an IAA diagnosis, it's obvious there's some kind of resistance there, so would it be prudent to treat him as if he had the resistance to get his numbers down until we can get the test? I understand what you mean about getting ahead instead of chasing the numbers down.
I'm not opposed to the R either. My first question is how do I know when to use it? Would I have used it today when his number jumped over 500? I noticed on some people's SS, the R is used for a short amount of time. Is that because it gets the numbers down and the liver learns more wuickly? How do I get the R? How much is it usually? Is it OTC or do I need to talk to the pharmacist but they can sell it without a prescription? How closely do I need to watch Cobb after injecting the R? Would I ever inject both L and R at the same time? Are there any additional risks associated with the R, other than hypo?
He was doing so well with his pink surfs and then the ugly black number reared it's head.
He could also have acromegaly - that's more common than iaa, although a fair number of kitties have both. For now, several of us are talking about a good strategy to help move him out of high numbers. In the meantime, let's stay with the same plan, so don't make dosing strategy changes from what you're currently doing (4 cycles, if everything's over 300, increase by 0.5u) until we get back to you.
It'd help if we got a little more info.
One thing that can affect cat's BGs is if a cat's dental condition isn't perfect. Diabetic cats tend to have bad teeth - not all, but the potential is there. Have Cobb's teeth & gum ever been looked at by a vet or cleaned? does his breath smell bad, not just like cat food, but bad? if you look, do you see any red areas near the gumline around his teeth?
Another question - i think you've mentioned before, but would you repeat what his feeding patterns are? When he is fed, if it's on a schedule or grazing, and what he's eating.
Sometimes infections can raise BGs - do you see any signs that might say "infection brewing?" overall, is he mostly energetic?
In response to your questions - R can behave differently in iaa cats than others. So we would choose the "Right" time to try using R, depending on his cycle and your schedule, and one of us would monitor him with you. We would start with a miniscule dose to see if he reacts to it. then you would check his BGs for the subsequent 5 hrs or so, so we could determine how he reacts to it. If he doesn't react, then we would try it again a different day with a slightly bigger dose.
I'm actually thinking that I saw a reference on the High Dose forum by Jojo (former advisor here) that the way a cat responded to R was one indicator of iaa. So it might tell us something about that.
You seem very level-headed and well able to handle this. I just want to add, because there are always people who read everything posted, this isn't a tactic for someone to apply to another cat. it needs to be done carefully. So lurkers, don't copy.
R isn't used as a primary insulin except by vets because it will bring cat's BGs down, but in the average cat, it's duration is about 4 hours and then it's out. in iaa cats, it can last significantly longer. my experience with an acro cat is that it lasted about 4ish hrs and was out. One of the nice things about it is that you can really lower the range overall with it. Overall, cats do best with a long-lasting insulin like the Lantus/Lev insulins, so R is used as a "bolus" insulin to supplement the L (basal) insulin that provides longer support.
In Oregon we can buy R at any pharmacy, no prescription required. The Humulin R was about $65 when i bought it at least 2 years ago. One bottle that's practically indestructible. I still had at least 1/2 vial left when punkin died. I want to say the Novolin R is more like $25 - but I'm repeating what I heard second-hand, so you'd want to check on it. Either one would work. I don't know if your state needs a prescription for it or not.
You do need syringes that can measure a very tiny amount. Donaleen ended up ordering syringes that would make that easier. The Terumo thinpro from American Diabetes Wholesale cost something like $13.79 and have a nice long thing barrel that lets you measure small amounts. The first dose to try would be 0.1u, so you might play with your syringes and see if you can measure that amount with whatever you're using. There are pictures of tiny doses on the New to the Group sticky. you can draw up 1unit and then, holding your syringe needle up, "screw" the plunger to press out drops. If you can get 10 drops out of a unit, that is the equivalent to 0.1u per drop. Donaleen's syringes would only work 4 drops out per unit. I suspect the difference might come from how fine the gauge of the needle is.
There are no other risks associated with R, other than hypo, which is true of any insulin injection. You do have a hypo kit (extra strips, high carb gravy cat food or karo) already pulled together, right? if you don't, you need one. A lot of people put an unopened box of strips away so they always have 50 available. If you have a low numbers run, you can go through 20 pretty easily in a day.
Yes, there might be a time when you inject both Lantus and R at the same time. We time things carefully so that the nadir of L and the nadir of R do not hit at the same time. We'll figure out the onset of R, the nadir and the duration of R by doing a test with one of us that have used the R. So timing is very important. If you want to go this route, we'll pick a day and a time in the cycle when his numbers are "right."
*whew* did i overwhelm you with info? what other questions does this bring up?
If you're in a hurry, maybe send a PM to one of those people helping you on this or add to your subject line, I tried searching but came up with nada, sorry :? I'm so glad to hear that Ole is playing and purring, it does make a person feel better 
. Yay for negative ketones! I give methylcobalamin (vitamin B12) with no sugar for Chyna, she did have some neuropathy and the vet said she would pee it out if it wasn't needed. Some say it doesn't do as much when they aren't regulated but I started it right away. A lot of members use Zobaline, but I didn't want to wait for it to show in the mail so I just went to the local health food store for the methyl and made sure it had no types of sugar in it. Have a good Sunday 
