? 07/24 Sir Tom AMPS. 19.3, 21.6 @ +2, 23@+4; DOSAGE HELP NEEDED

Hi everyone!

My sweet boy Sir Tom has been through the ringer and it is amazing he has pulled through and is here but now I need advice.

We are still working on getting his liver and kidney values better as he has some damage, and may need surgery in the future. His IBD was severe and the internal medicine specialist has given us strict orders that he needs to be on a IBD diet first and we need to increase insulin for diabetes, and once he is more stable and his numbers are better I can work on switching to limited ingredient and hydrolyzed proteins and find one that is more low carb but for now we are not there. fancy feast and the normal ones have not worked for him and its been a serious reaction.

My current Problem: since going on his recommended food, Royan Cannin AN allergenic high carb kibble, his BG has been SO HIGH, but he is doing so much better overall. The ER visits have stopped so far and I am grateful, but we were still working on increasing insulin to help get him regulated. Royal Cannin now abruptly has a supply issue and we could not get his food anywhere or even order it (tried 12 vets in the area) and he had to abruptly switch Royan Cannin Hydrolyzed protein. Despite continuing to go up in .25 units, his sugars seemed to sky rocket on this new food, even thought it should be the same high card (40%) as the other one.

My husband made an error and gave him 4 units this morning instead of 3.25 to increase and so we are testing every 2 hours now.

The internal medicine specialist vet has done a split dose initially of 3units in the morning and 2.5 in the eve. I told him that this group recommends the same dose both am and pm and he said that is old information and new case studies with the freestyle libre show this is not needed to be the case for cats sensitive to insulin that have risk of going hypo as mine has in the past and that as he eats less in the night, even naturally his insulin would be lower here. It is very confusing getting this conflicting info!

I am wondering now how to proceed with the dose now that we accidentally gave 4 units?? Should I post again before his pm shot? If its still high do we go back to 2.5units in the eve? I feel like it's a mess right now, thanks in advance!

 

Just some added info if it is helpful:

Here is my original story/ welcome thread:
https://www.felinediabetes.com/FDMB/threads/introduction-and-help-pls.244898/#post-2762917

And here is one figuring out lantus that also ended at the ER vet with some other diagnosable problems and a recommendation to stop lantus for now and do a food trial; to revaluate in 10 days (6 days left now):
https://www.felinediabetes.com/FDMB/threads/3-23-sir-thomas-amps-7-8.245127/#post-2766481

@Bron and Sheba (GA) I know you (and others) helped me tons in the past get him through his life threatening stages, many thanks!

 

Can you add when you changed foods in the "Remarks" column?

I don't know where your vet is learning that cats eat less at night. Cats are nocturnal...that's when they do their best hunting.

The problem with continually changing the dose is that Lantus is a "depot" insulin and each time you change the dose, you disrupt the depot. Here's some information on depot insulin's.

My suggestion (others may have other opinions and that's fine too) would be to try 3U both AM and PM for the next several days and then re-evaluate.

Would you be willing to try it "our way" at least for a few weeks? See if the numbers settle down into some kind of pattern.

 

Charlene, are you in the US?

I agree with Chris and China - please hold the dose steady for a while. I'm not sure where that vet gets the idea 'this is old info' - but Lantus/Levimer are depot hormones - not a drug - and consistent dosing will help things level off - I've seen it many times, too many dose changes up/down and inconsistent dosing usually result in some crazy numbers...

I hope at least his BG's will settle for you - it sounds as if he has a lot going on...

Hang in there...steady as she goes.

 

It’s not at all surprising that his numbers are up on a high carb diet. Depending on when he was put on the high carb diet I would try either 3.0 or 2.5 both cycles. What type of surgery might he need? Does his RX food can in canned too?

 

Hey! Thank you so much for your reply.

When I changed foods is in the remarks section, you can see it on Jul 22 I am definitely willing to try it that way for several days, clearly what we have going on right now isn't working and I am terrified he will go into DKA being high so long. I keep checking keytones and he seems ok so far, fingers crossed. I did 3units tonight and will try 3 units in the morning and do this for a week, or do you think longer before I re-evaluate?

We are in Alberta Canada Thank you that is reassuring! I am hoping it will settle sooner rather than later as he has had a lot going on for so long and deserves to feel better soon. This gives me some hope!

He needs a liver biopsy of some sort to clarify what he has going on because he has a lot...to see if it is IBD or lymphoma and/or if he has something else as his liver and kidney values have been elevated for some time. Apparently it is quite invasive and he wasn't looking quite well enough to do it at the time we were considering, and the vet said we will focus on getting his diabetes under control for now. He has been on this high carb diet since mid April. He has many allergies and his IBD is quite severe, and he hasn't been stable enough to figure it out completely yet. His Rx food does come in canned but he will not touch it no matter what topper I put on and it also is not in reliable supply unfortunately. I have ordered some limited ingredient canned buffalo from identity to try in hopes it won't send him into a flare but this is a special order item and I have no clue when it will come in but I have hopes to switch him to that if he will eat it.

I will take all of your advice and hold steady at 3units am and pm for a while and see if that helps! How long should i expect to see it levelling out?

 

Let's re-evaluate in about 3 days. The fact that he's eating kibble means we really can't recommend using the Tight Regulation method with him, but with his numbers being so high, I hate to leave him on a dose that's not working for the full 7 days that Start Low, Go Slow requires either.

 

Okay sounds great! I will post again in 3 days

 

It would be great if you can get a before-bed test in the PM cycle as well. Some cats go lower at night.

 

Okay perfect I have been doing that but I have been concerned about that. In the past his numbers were okay during the day but he'd be on the lower side when I woke up, which is why the vet made the night dose lower...but it sounds like that's not good either. I will keep monitoring the BG the best I can You helped me so much before too, thank you!

 

You don't have to wait that long if you don't want to! Heck, I posted every day for several years! (even after I started to make my own dosing decisions). This group becomes very much like a family.

Even if you don't have any specific questions, it's good to report on other things like the "Whole Cat Report" (WCR). How Sir Thomas is feeling and acting are important parts of treatment too. He's a lot more than just a spreadsheet full of numbers.

We talk about giving the WCR which includes the 5 "P's"....peeing, pooping, playing, preening and purring!

 

Oh this is such great information, THANK YOU! I am going to make a new dosing thread now and will post a WCR soon