? 2/1/2021 Kierra 1u dose increase?

I am following the tight regulation for Kierra finally. Don't ask why it took me so long (clue: vets). Every two days I am upping the dose 0.5u and testing the am and pm nadirs. So far no response and we are at 7.5u (tomorrow will be 8u). I can't get into google drive right now to update her ss, anyone else have this problem occasionally, very frustrating? I have tried three times with the get a code emailed (can't text on my phone) and it never works and I don't know why I bother trying since I just have to wait a few days until I can get back in again. We are still awaiting results for IGF-1 and IAA, any day now. My question is can I jump to 1u increases yet? I am axious to get some sort of response. Also wondering as we get closer to a "regulated" dose, does appetite tend to increase before decreasing? Seems like she is maybe more hungry than usual (didn't think that was possible) like eating puke from one of my other kitties, yuck.

edit: just got IGF-1 results - 393 , IAA - negative

 

First, sorry about the IGF-1 results. At least no IAA should help and now you know what you are dealing with and can plan if you want to consider treatment. Most important thing someone told me at this point, Kierra is still the same sweet cat she was before the diagnosis. She doesn't know she's acro.

Second, congrats on starting TR. That does mean increasing faster, but ONLY if you can get a second test in every night. I only see 1 night time test in the last week. But the spreadsheet is not up to date, so please get that sorted first. What sort of problem are you having with google? Maybe post on the tech support forum and someone can help with that.

Since you are seeing the odd yellow, you should not be fast tracking, and only increasing every six cycles to allow the depot to fill. You also wait until 10 units total dose before increasing by 1 unit at a time. You don't want to go too fast with the increases.

I never noticed Neko's hunger getting worse - I didn't think that was possible! My girl snacked on litter. I had to change to something non edible, corn litter is carbs.

 

Yes, I am doing AMPS, AMPS+6, PMPS, PMPS+6.

I was going with Tilly's info: "if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU." While there is an odd yellow, they are usually just below 300. I am concerned about how long she has been above 300 and what it is doing to her kidneys and so fourth and that is why I am going with the 2 in the "2-3 days." We have spent too much time holding a dose for too long because of vets telling me to do that or not giving me any direction at all and me not being more proactive. If you think I should do more testing if I am going with the 2 days and increase schedule I can do that but I am not sure there is much point in doing so at this time since there is no sign of a response yet. If she is going to be one of those 40 or 50 unit acro-cats, I don't want to doddle any more than we have to.

Google wants verification and to either text or email me a verification code. I can't text so I opt for email. For that option, I have to enter a previous password which I do and then it sends a code via email. I enter the code and and it says it still can't verify the account. This happens every once in a while and it seems to go away after a while and lets me login again. I have the most current data in a pdf file but when I click on the upload button below it says I don't have permission to do that???

 

But until I can see those data in the spreadsheet, I can't suggest what to do with dose other than general guidelines. At a +6 test is not always at nadir, I would mix those tests up a bit. Acrocats often nadir later. When you can, try some tests in the +5 to +8 range. Neko's Lantus nadir varied from +3.5 to +13.

Emphasis mine, Kierra's nadir is NOT always over 300. Plus we don't even know if you are testing at the right time for her nadir. It might be instructive to do the odd curve or at least grab a few tests in that +4 to +9 range to see if you can spot the nadirs. Even for cat that are really all over 300, we get them to take a pause every few increases and do the full six cycle hold so the depot can build. You will get Kierra there. With the yellows you are seeing, I don't think she'll be a 50 unit cat. Soon enough you can move to 1 unit increases. Safety first.

As far as the spreadsheet issue, I suggest posting what you typed above in the forum
Spreadsheets, Tech Support & Testing Area

 

It let me in again yesterday. I think it has to do with my cookies/history/data being cleared. Every once in a while it decides I am logging in from an unrecognized location. Fortunately it doesn't happen that often and I am only locked out for a day or two.

 

Great to see the SS is updated and glad you figured out what the problem is. How about holding the dose the full six cycles this time, you have that depot full. I'm worried about continuously doing increases every 4 cycles when you have some nadirs under 300.

 

Kierra's numbers are similar to where Willow was for a while. When I switched from Lantus to Levemir (as noted in the spreadsheet) that helped her get to the blues consistently, and then when we started Cabergoline (also noted), she started going green consistently. Have you asked your vet about either of those?

 

I am waiting for my vet to refer us to an int med specialist and hope to discuss all the options then. My vet said this is out of her expertise. What dose of cabergoline are you using? Good to know switching to levemir helped with bg levels. Do you know if it has helped other kitties as well? I read on the acro sticky that one human study found switching insulin didn't make a difference for IAA. Was your IAA negative? I saw on a post that your IGF-1 was 329 but didn't see your IAA results.

 

A couple posts you might be interested in:
Switching from Lantus to Levemir, JoJo & Dr. Lisa, dvm
Switching from Lantus to Levemir, Doodles, advice before switching

 

I'm giving Willow 50 micrograms per day, going with the 10 mcg/kg guideline since she weighs between 5-6kg.

Yes, Willow's IAA was also negative! So Willow and Kierra have a lot in common it seems.

 

Are these about acrocats?

edit: ok, read through them. My take away is to switch if Lantus sting occurs (and maybe save some money). Is that it in a over simplified nutshell? FYI - I couldn't find the UofQ study, link broken.

 

Some yes, some no. Doodles was IAA only, but I gave examples of cats with acro too. The first post the cat hadn't been diagnosed yet.

 

I've totally been where you are. Wound up at 13 as my highest and then numbers started coming down. I remember being upset when I hit 10 because it was double digits. Once I got past that milestone I just kept telling myself "she needs what she needs". Good luck! I hope you see more yellows soon!!! Once you find a good dose and the numbers come down you might be able to reduce the dose. My cat is currently down to 3-3.5 which I didn't think would ever be possible.

 

Yes, but you were giving Prozinc, not a depot insulin. Increasing too fast is bad with depot insulins - you do need to let the depot catch up to you periodically. Otherwise you can't see what a dose is doing and can get overdose.

 

Oooh. Yeah hadn’t thought of that. You’re absolutely right. I’ll erase that part of my post.