09/11 Elsie; AMPS: 217; +2: 255; +4: 202; +6: 178; +8: 175; PMPS: 174; 1 year since DX

Kat & Elsie

Kat & Elsie

Member
https://www.felinediabetes.com/FDMB...7-4-5-262-7-260-pmps-260.293719/#post-3204227

Another week of the usual. We're up to 6U now. Every time she drops to blue I hope it's going to be the time it sticks, but not yet. Overall, there's less pink & more blue in her ss than there was at the worst of this, so I'm looking at that trend as positive. Her little bounces seem like they're continuing to mellow out. Come on, kitty! :confused:

Today officially marks 1 year since Elsie was first diagnosed. I know the chances of remission go up when caught & treated early, which we did, and she was responding well. Now with this likely toxicity build up, are we getting into territory where we may see our chances going down? When are they considered "long term" diabetic (is it a year?), and what does that mean for our treatment moving forward?
 
Lots of kitties go otj in the second year or later. She’s now a long term so reductions will be if under 40 rather than 50. I’d follow TR and increase every 6 cycles. In the past 2 units was held way too long and I think it led to toxicity. I’m wondering if it is time to test for Acro. I’ll tag Wendy. @Wendy&Neko

You are doing a good job of increasing now. :bighug:
 
tiffmaxee said:
Lots of kitties go otj in the second year or later. She’s now a long term so reductions will be if under 40 rather than 50. I’d follow TR and increase every 6 cycles. In the past 2 units was held way too long and I think it led to toxicity. I’m wondering if it is time to test for Acro. I’ll tag Wendy. @Wendy&Neko

You are doing a good job of increasing now. :bighug:
Click to expand...
I think the gum disease & being unable to increase dosage for a couple of months didn't help the toxicity either. Is acro something that can be developed later on? Since she initially seemed to be responding well to the lower doses, wouldn't she have been more resistant in the beginning if there was preexisting acro? I'm not arguing, just trying to learn & understand how it all works.

*EDIT: I've had a chance to look it up now and I've just answered my own question re: when acromegaly develops in cats. I will continue to research.
 
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The gum disease definitely could raise the bg. It could just be glycine toxicity for sure. I didn’t think you were arguing. :bighug: All good questions.
 
A couple things when you reach this size of dose. First, think of increase as a percent of the size of the total dose, around 10-15%. You should increase by 0.5 units now, unless you are just tweaking a dose that is seeing pretty good green numbers.

There is definitely something at play causing insulin resistance. Insulin resistance means you have to keep on top of increases, and doing them when TR says you safely can. Insulin resistance can be caused by many things. In addition to acromegaly (one in four diabetic cats has it), there is also IAA or insulin auto antibodies which is like an allergy to the injected insulin. Neko had both those conditions. Seeing a small bit of good numbers blue, then having it fade away is a very common way of seeing insulin resistance. I used to call it "the dose going stale". I strongly recommend getting testing done for both. There are treatments for acromegaly, and treating can both improve quality of life and we've even seen some cats go OTJ. But you can't treat without knowing what you are dealing with. Cushings is another possibly condition, but you'd like be seeing hair loss or skin conditions.

Other conditions like kidney disease, pancreatitis, heart conditions, hyperthryoidism can also cause resistance, but not to the level of 6 units. Plus you've had blood work done fairly recently for the dental, which would rule out most of that. Glucose toxicity is a form of insulin resistance, but not to that high t dose. Note, we've seen cats here with acromegaly, Cushings, or IAA with doses less than 6 units, but once you get that high, the list of other possibilities is really short. As long as she's eating all low carb wet or raw, has good teeth, thanks to recent dental, there isn't a lot of other options.
Kat & Elsie said:
Since she initially seemed to be responding well to the lower doses, wouldn't she have been more resistant in the beginning if there was preexisting acro?
Click to expand...
Not sure what answer you came up with, but yes it's possible for a cat to look good and responsive to insulin in the beginning, then to lose the ability to respond. Either the benign pituitary tumour grows more and overcomes the insulin or the insulin autoantibodies get stronger and overcome the amount of injected insulin. For both, that's why it's important to keep on top of increases and by a good amount. I've seen a few cats now that even went OTJ, then came back the second time on insulin and be tested and positive for acromegaly. i've also seen an IAA only cat look like he was close to remission, got heart disease and he tested positive for IAA when the caregiver realized his almost 10 units dose meant something was off.

Lastly, reading your spreadsheet, we don't delay an increase because a cat is bouncing. We try to avoid an increase on the same cycle as they are breaking the bounce, as that can cause extra downward momentum, but if a cat need the increase, just do it. Post #17 in this thread has more detail:
 
Wendy&Neko said:
A couple things when you reach this size of dose. First, think of increase as a percent of the size of the total dose, around 10-15%. You should increase by 0.5 units now, unless you are just tweaking a dose that is seeing pretty good green numbers.

There is definitely something at play causing insulin resistance. Insulin resistance means you have to keep on top of increases, and doing them when TR says you safely can. Insulin resistance can be caused by many things. In addition to acromegaly (one in four diabetic cats has it), there is also IAA or insulin auto antibodies which is like an allergy to the injected insulin. Neko had both those conditions. Seeing a small bit of good numbers blue, then having it fade away is a very common way of seeing insulin resistance. I used to call it "the dose going stale". I strongly recommend getting testing done for both. There are treatments for acromegaly, and treating can both improve quality of life and we've even seen some cats go OTJ. But you can't treat without knowing what you are dealing with. Cushings is another possibly condition, but you'd like be seeing hair loss or skin conditions.

Other conditions like kidney disease, pancreatitis, heart conditions, hyperthryoidism can also cause resistance, but not to the level of 6 units. Plus you've had blood work done fairly recently for the dental, which would rule out most of that. Glucose toxicity is a form of insulin resistance, but not to that high t dose. Note, we've seen cats here with acromegaly, Cushings, or IAA with doses less than 6 units, but once you get that high, the list of other possibilities is really short. As long as she's eating all low carb wet or raw, has good teeth, thanks to recent dental, there isn't a lot of other options.

Not sure what answer you came up with, but yes it's possible for a cat to look good and responsive to insulin in the beginning, then to lose the ability to respond. Either the benign pituitary tumour grows more and overcomes the insulin or the insulin autoantibodies get stronger and overcome the amount of injected insulin. For both, that's why it's important to keep on top of increases and by a good amount. I've seen a few cats now that even went OTJ, then came back the second time on insulin and be tested and positive for acromegaly. i've also seen an IAA only cat look like he was close to remission, got heart disease and he tested positive for IAA when the caregiver realized his almost 10 units dose meant something was off.

Lastly, reading your spreadsheet, we don't delay an increase because a cat is bouncing. We try to avoid an increase on the same cycle as they are breaking the bounce, as that can cause extra downward momentum, but if a cat need the increase, just do it. Post #17 in this thread has more detail:
Click to expand...
Wow, thank you for this information. And here I thought I was finally almost getting out from under overwhelm, with understanding things & getting everything under control. :confused: I will do my best to research more here and consult with our vet. In the mean time, she's managed to get under 200 again today, and I guess I'll just keep watching things & increase by 0.5U after tomorrow, assuming it will be needed.

I would be lying if I said I wasn't concerned about the potential cost of more testing and treatment. Not that I'd be unwilling to move forward that way, but it certainly is something that will be on my mind as we try to figure all this out.
 
If acro, there is a daily med (compounded liquid) that most give now called cabergoline. Less expensive than other treatments, and most kitties have their dose reduced, some quite a bit. But we need to figure out what is causing the insulin resistance first.
 
Wendy&Neko said:
If acro, there is a daily med (compounded liquid) that most give now called cabergoline. Less expensive than other treatments, and most kitties have their dose reduced, some quite a bit. But we need to figure out what is causing the insulin resistance first.
Click to expand...
I will look into it further for sure. Thank you again for your guidance. Just as an update, we've stayed under 200 for the afternoon so far, the most blues in a row I've seen during the day for months now. I don't want to get my hopes up too high, but I'll still cross my fingers for luck while we try to figure this out.
 
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