5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increase?

5/11/2014 :
viewtopic.php?f=9&t=118605

I feel like crying; I feel so bad for her with these numbers, and she just accepts all these tests. Her attitude andappetite is good. And I am positive there were no mistakes with fur shots this time, I did not smell anything. So, increase to 2.5 units tomorrow? Also, I cannot give the shot anywhere except the scruff of her neck because she is too skinny to grab skin anywhere else? She has a vet appt. next week. Thanks for any advice.

Re: 5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increas

Hi Ruth - I agree on the dose increase (dosecrease) as long as Tiger doesn't show anything different tonight. We do want to get her out of these ugly colors quickly. You are doing a great job following the protocol Ruth - you will get there. :YMHUG:

Don't worry about the location of the shot. I mostly do the shoulders below the scruff but I alternate sides and move around on either side. I'm lucky that Neko has a white "collar" so I can just rotate in, below or above the collar and towards the sides vs. spine. That still gives me lots of room to vary the shot location.

What are you getting done at the vet appointment? Has Tiger had bloodwork done recently? I'd get the vet to take a good look at the teeth cause that is a common source of issues with blood sugar.

Re: 5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increas

This is my first visit to your condo, so want to add my "Welcome"! You really are in the best place to help Tiger!

We know it's hard to watch those high numbers! We all want them to be cured yesterday! All I can say is to remember that he's probably been diabetic for awhile now, so his body has gotten "used to" those higher numbers. High numbers, while icky to see, take time to do their damage...it's the low ones that can kill quickly

I think there's a good argument to be made for going ahead and increasing tonight, but I'd want to get some other opinions before doing it. We usually don't want to increase faster than every 6 cycles, but we'd also like to see him in lower numbers

It's good that you're checking for ketones and that they're negative though!

If Tiger has a dental issue, that could be keeping his numbers high, so although I know your vet doesn't want to do anything with him right now, it might be worth pressing. Depending on where you live, there also may be a dental specialist you could see. They have the necessary equipment to do the x-rays that are needed, as well as usually having a dedicated anesthesiologist (who's only job is to monitor kitty while under) and all the other safety equipment to do dentals on "fragile" cats.

Hopefully some others will be along to take a peek at your condo and spreadsheet and add some words of wisdom.

Re: 5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increas

Yes, I'd go ahead and increase in the morning. That gives you 6 shots at this dose. I've highlighted the part of the protocol that i think applies to Tiger right now. She's having nadirs over 300 almost every cycle. I would increase by 0.5u, to a new dose of 2.5u.

You could increase tonight if you want to. The Tilly page suggests that with high flat cycles you can increase after 4 shots. It's your choice. http://www.tillydiabetes.net/en_6_protocol2.htm

I'm looking back at how the 2.0u got her to 48 on 4/25, but she's been high since then. I'm mentioning this because it would be easy to assume that because 2u got her there before, it might again. We know that when cats get accustomed to high numbers it can take even more insulin to get them to come down. Here is a post about Glucose Toxicity that might help explain what's going on in her body.

"General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Click to expand...

edited to add - Sienne responded to your post in Mom-Mom's condo. Just want to make sure you see it. Cats really need some kind of anesthesia to remove teeth - just imagine having your own pulled without anesthesia, especially if you didn't understand what was happening. Her teeth may very well be the reason for her high numbers, so as soon as it's safe to get them taken care of, you probably will want to do it.

Re: 5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increas

Thank you Wendy, will do. I had a bit of a surprise at PMPS, Tiger went down rather than up, not much of an improvement but hey, it was something. I called the vet clinic and rescheduled for tomorrow. She coughed up a bit of grayish foam, she is not one to vomit. She ate just fine, but I think it was bile. Also, I learned her regular vet is leaving to take over another practice in Snohomish, I hate when that happens, so the appt will be with the principal owner of the clinic. I want to discuss exactly what happened when she was hospitalized in March, what her numbers were etc, plus I want his opinion on glucose toxicity and her dental needs. Thanks for your reply.

Thank you for the welcome Chris and China, I will be discussing dental issues tomorrow with the vet.

Thanks Julie, I had seen that report on glucose toxicity, scared the bejeebers out of me - I fear that she is becoming insulin resistant. Yes, Tiger's teeth concern me, I don't think she has a loose tooth, but two vets have told me she needs cleaning but they are afraid to put her under, she needs to gain weight and strength first I am told. I will go back and look for Sienne's comments, thanks for pointing that out. There are so many posts on this forum I had trouble finding mine lol.

Re: 5/14/2014 Tiger's AMPS =535;+1.5=509;+4=444 Dose Increas

Hi Ruth

I'd like to also welcome you and Tiger to Lantus Land. I enjoyed reading her profile and she is a beautiful girl.

I know Wendy mentioned to you that there might be a better quality food for her that has 4-5% carbs and more calories so you can get some weight on her. I understand she is a picky eater. I'd still like to link Dr. Lisa's food charts. I am a firm believer that the best food for a cat is the one it will eat but I wonder if it's possible to offer her a little smorgasbord of some of the 4-5% foods that have more calories and see if there is one she likes?

A couple other things I'd like to mention. Are your vets keeping an eye on her kidneys and also her thyroid levels? Hyperthyroidism untreated can mask any kidney dysfunction. I'm surprised they did the I131 so fast as it is more typical to put them on meds for a few months until the thyroid levels are normal. Once you have euthyroid, then you can tell if the kidneys are functioning properly. If kidney levels are normal, then it's safe to do the I131. They need to be checking her thyroid levels because they can become hypothyroid as a result of I131. This happened to our kitty, Gus, and he took thyroid meds (for hypothyroidism) for eight years. They also need to keep a close eye on her kidneys. Gus's bloodwork was done monthly for three months after I131 and then quarterly for the first year.

I would also ask if there are any veterinary anesthesiologists in your area. A board certified vet anesthesiologist would be a better person to consult with as to whether Tiger can handle anesthesia. Even though anesthesia these days are better than they used to be. Vets can use inhaled anesthesias that are not processed by the organs but just breathed in and out of the lungs so once the gas is turned off, the kitty wakes up and doesn't have all that anesthesia to rid from all it's organs.

I hope the increase will allow her to start coming down. We're here to help!