? 3/11 Pantera amps 266 swapping insulin

Hi, I have been having trouble regulating Pantera with yesterday’s amps at 430 The highest it’s ever been.
Took him to vet, they suggested a change of insulin as he is looking to be resistant to lantus(optisulin). He went well on it last year and achieved remission fairly quickly. This time we have tried TR and SLGS with not much reduction in mid range readings and climbing fairly high at pmps. He has 1 good day, but general trend is a big increase at pmps time. What are the thoughts on changing to caninsulin. I was going to ask for levemir. No food changes he is low carb wet. No changes at home. No infections blood tests look fine. Getting another one today. What will I ask for FBC /IGF 1

 

Yuck, not Caninsulin! Both Neko and I hated it. It didn't last nearly long enough in her and she did much better on Lantus, then even better on Levemir.

I think the primary problem is that you aren't giving Lantus a fair trial. You have no idea how low his Lantus dose is taking him. You need to do more than just preshot tests. And you've been going down in dose, not up. Best to just pick a dosing method and follow it. Holding doses too long can lead to glucose toxicity, meaning his body gets used to those high numbers so you have to go even higher in dose.

What are you feeding him now? In your last post here, sounds like he was getting higher carb foods.

 

https://docs.google.com/spreadsheets/d/1qAnrCvQZJmFQ_cwy792wVKocuPdCcxLmZWeK0mkevyQ/edit
I test frequently not just preshot . I’m not sure if my spreadsheet is up to date on here. I thought it automatically updated. We have gone from 0.5 to 4.5 then reset at 1.5 back up to 4u. Such conflicting info from vet and forum. I was told to hold it for up to 14days. I really have no idea even though I have been doing this a while. His food has never changed and I even went to FF to see if it helped. No difference. He had a PU operation at 2yrs old hence the urinary food. On the Australian food list it says pro plan urinary focus is 3% carbs on the US it’s 9% I think.
He went into remission on this food before. I stopped the RC diabetic wet over a Month ago.

 

How high of a dose should I go before worrying or testing for Acromegaly. Could he have this even though he didn’t last time?

 

OK, that's a different spreadsheet than is linked in your signature. Or rather, Ruddy's in your signature, not Pantera. Thanks.

When a kitty falls out of remission, it's very common to have to go higher in dose than the amount of insulin they were on the first time. Looks like you did a "reset" or went backwards in dose on October 17th. That never works if you've been following the dosing methods, testing enough to know how low the dose is taking him, and increasing in safe amounts. If following TR, you hold doses 3-5 days, depending on the nadirs you are getting.

That's a tricky question. When a person has a cat that gets to 6 units dose, the chances there is some secondary condition like acromegaly are high enough we suggest the testing. However, there are cats that have acromegaly that are on smaller doses. I have seen the occasional cat go into remission and then come back diabetic and test positive for acromegaly. Was he tested for acromegaly the first time he was on insulin? Just wondering why you say he didn't have it last time.

 

Sorry not tested just thought because he went into remission and food change really dropped his levels. Probably a wrong assumption. Ok I feel better knowing this. I will hold the dose for 5 days as he seems to bounce a bit first 3 days. It’s just weird that just when I think his dose was great and he had a day of blue numbers; he heads straight back to the high pinks. That’s why I thought at one point it might be to high a dose, especially as he just mainly rises all day. Looking like it’s just not enough insulin. Would you recommend changing to levemir or just stick to lantus up to 6u then look into more things. I am getting a blood test today. He has just had gabepentin as he totally lost it yesterday and vet couldn’t get a test and said he was to stressed. I could hear him screaming definitely won’t start caninsulin. Thank you Wendy.

 

I'd recommend trying to get a before bed test every night if you can and it's at least 2-3 hours after shot time. That second test in the cycle is actually a requirement if following TR and a really good practice if following SLGS. Without it, we don't know if he's going lower at night then bouncing during the day.

Try not to hold doses too long, it can cause glucose toxicity to build. And we do increases by 0.25 units at a time when seeing blue nadirs. I see you've been increasing by 0.5 units at a time. We don't usually move to that size increase until the dose is at least 5 units.

That's bouncing, he's not used to blues yet.

 

Ok great. Yes I was doing test 4hrs after shot and he is always high. Now that I am increasing dose I will do this again. He is completely different this time than last. With bouncing, more insulin, higher numbers. I had it easy with him first time round I think. Is SLGS a better way? I know it's individual but do I hold 7- 10 day on each dose before increase and on TR 3-5 days hold before increase.

 

I followed TR. TR allows you to increase faster, and a lower reduction point that allows you to achieve regulation soon. With that there are a couple requirements so you can do TR safely. One is feeding only low carb wet or raw food. The second is the need to test at least twice per cycle each day. Not everyone can meet those requirements, and/or do they feel comfortable with their cats in lower numbers, so SLGS works for those people. You really have to chose a dosing method that works for your lifestyle and comfort level. For SLGS, you hold 7 days, not longer.