? 1/24 Dosing? AMPS 394

[Armani’s mom]

Hello! I am hoping someone can please offer help with dosing for Armani. Last time I posted, I was advised to continue increasing his dose. I have done this very, very gradually, but don't notice his numbers getting better. His lowest readings are still in the upper 200s. Should I keep gradually increasing? Does he need to go back to the vet for more testing? Looking back over his spread sheet, his best numbers were around a dose of 3 units, should I go back to this, though it will be a big drop in dose? He doesn't ever seem to have quite low numbers, it is mostly a slight curve that stays high.

Thank you so much for your help! I'm getting very upset and discouraged we've been working since August and his numbers aren't improved at all, I'm worried all the sugar in his blood is wreaking havoc on his system. Thank you!!

 

[Wendy&Neko]

Here is that link to your last post here, for continuity: https://felinediabetes.com/FDMB/thr...444-4-384-6-360-8-372-10-384-pmps-332.238567/

A couple comments on the dosing. First, if you are following SLGS for dosing, which I'm guessing by the testing, you should increase every 7 days unless you are seeing nadirs in the 90 to 149 range. Which you aren't. Holding a dose too long can result in glucose toxicity. It sounds worse than it is, basically their body gets used to higher numbers and it takes even more insulin to get over it. With SLGS, you do need that curve after 7 days.

Second, over 5 units total dose, you should be increasing by 0.5 units at once. Think of the increase as a percent of the total dose. At Armani's current dose size, a 0.25 unit increase is only 5%, where a 0.5 unit increase is 10%. For a smaller dose cat, the 0.25 unit increase is more effective.

Is it possible for you to get more mid cycle testing done? Many cats go lower at night and we dose based on how low the dose takes the cat. If you could get a before bed test every night, even if it's a +2 or a +3 test, then it's extremely helpful to give us an idea how he's doing on a dose. I don't think he's overdosed, but more spot checks in between the preshots will let us know for sure. An overdosed cat will eventually see lower numbers.

Does he need to go back to the vet for more testing?

Given you are over 5 units dose already, there is a possibility that he has another condition that is causing insulin resistance. There are two secondary endocrine conditions that can mean a cat needs more insulin. They are called acromegaly and IAA, my girl had both. Acromegaly is caused by a benign tumour in the pituitary, that send out excess growth hormone and in turn the diabetes. One in four diabetic cats has it. IAA or insulin auto antibodies, is like an allergic reaction to the injected insulin. There are blood tests for both these conditions. There are also other conditions that make it hard to regulate the cat, like hyperthyroidism and a complete blood panel would rule that out.

 

[Armani’s mom]

Thank you so much for your help, and for including the link to my previous post. I very much appreciate your time and expertise, and the help for Armani!!

I understand what you say about increasing every 7 days and by increasing by .5, I thought going as gradually as possible would be preferable, so I was definitely wrong there - thank you for explaining! I have been very nervous about over-dosing so I am relieved to hear you say I'm probably not over-dosing. I will increase by .5 starting tomorrow, and do a curve in 7 days, and then post that information here in a week for some feedback. Since I've stayed with the same dose for so long, if I can ever find the right dose, will he forever need a higher one (the glucose toxicity lasts permanently?) or is there a chance he could gradually drop to a "usual" dose eventually?

I can definitely do more mid cycle testing, especially the +2 or +3 at night. I'm currently feeding him 4 times a day, two breakfasts 3 hours apart, and two dinners 2-3 hours apart (so small meals at 8am, 11am, 8pm, and 10-11pm). This was recommended to me here, I don't know if this is changing his nadirs or keeping them from getting as low?

If he has acromegaly and/or IAA, will those conditions need treatment, aside from higher doses of insulin? Do you recommend I get these blood tests done right away? Armani is a (previously feral) rescue cat and vet visits are terribly stressful for him and me - that said, of course I'll do what is needed!

Thank you again for all of your help!!

 

[Wendy&Neko]

Glucose toxicity is by itself a type of insulin resistance. Breaking through it could mean the dose goes a bit lower. But finding out why he needs the dose he does would help answer the question about whether he'll always need higher doses. For reference, most of Neko's diabetic life she was on less than 3 units, in spite of the secondary conditions. IAA typically resolves by itself around a year after starting insulin, it was 9 months for Neko. There are treatments for acromegaly, one includes a daily medication given orally at home. There are actually more options now than when Neko got her acromegaly diagnosis. Some people do just treat with insulin as needed and managing any side effects. I did radiation therapy with Neko. Basically, a good goal is getting Armani to a point where he's relatively well regulated and good quality of life.

Your feeding schedule sounds good for now.