? 3/3 Tubbs High Dose - Help AMPS 358 / +4 272 / +5 184 / +8 162 / +10 263 / PMPS 311

Hi all,

I desperately need some dosing advice. Tubbs was diagnosed end of June 2022, went into remission about 6 weeks later, came out of remission and back on insulin beginning-mid Nov/22.

She's been unregulated for 4 months and I'm losing my mind trying to figure out what the next strategy should be aside from testing for acro/cushings/etc. Any thoughts would be greatly appreciated, our vet is wondering about possible Somogyi effect so we've reduced by .5U and held it over the last 1-2 days so far. I forgot to update the spreadsheet this morning, but her BG was around 425-250 this morning.

Suggestions on what I should do moving forward? If she is indeed bouncing due to too much insulin, what's the correct way to resolve this?

Current conditions:
- Eating Fancy Feast Turkey & Giblets pate - 4x 3oz cans (12oz total) each day but she's so ravenous I'm going to have to increase this back up, as I caught her this morning getting into the other cat's microchip feeder (same food but also has Dr. Elsey's kibble since he's a grazer and not 100% sold on wet food; I don't feed Tubbs the dry)
- Has been steady recently around 12lbs weight, but lost a lot of weight upon diagnosis
- I add water to all of her food, and when she was in remission, that water seemed to be sufficient as she likes to drink out of the tap when she's thirsty, and she wasn't asking for additional water while in remission (now asks for water multiple times per day on top of the pate water)
- Probably still peeing a lot but not as noticeable
- 50% of her stool is well formed and in the litter box, the other 50% is outside the litter box and is soft serve ice cream, semi-formed so not quite full diarrhea but definitely not formed. She also scoots after both of these types of stools, so it seems to be hurting her / making her uncomfortable when she goes. Fecal sample came back no ova or parasites seen, negative for Giardia Antigen
- Not lethargic but seems depressed most of the time, constantly crying for more food

Lab stuff:
- Recent bloodwork Feb 4/23 - see LABS tab on spreadsheet - SpecFPL wasn't conclusive, slightly elevated but online shows this doesn't always confirm pancreatitis unless it's higher
- Urinalysis done end of December (see LABS tab on SS), started on amoxicillin (chewables) in the meantime with the thought that she may have UTI. Came back negative for bacteria, lab identified checking for cystitis/FLUTD. X-rays done, were unremarkable, no real answers from vet, but she vomited blood about a week into the amoxicillin so we took her off it
- Another urinalysis done mid-February (see LABS tab on SS), bacteria was found, wasn't able to bring her in for a cystocentesis for urine culture until about a week later (original UA was free catch), no growth was found though? They accidentally did another UA (long story), and now it shows no bacteria

 

Second remissions are harder to achieve but totally possible. Would you consider following TR at least until the BG comes down. You could increase every 3 days. Pancreatitis can definitely increase the BG. Any symptoms of it or history of it?

 

I don't have any dosing advice, but I've had cats with soft poops from the Dr.Elsey food.

Also, if kitty was on abx in December, she could still have some bad gut flora. Do you give them probiotics at all? Fortiflora is my go to for soft poops.

 

First of all, we need to see a more current spreadsheet, if you could enter the last two weeks, that would be great. As of end of January, I see a 4.75 units which is not a high dose, though getting up there and it did seem like you weren't at a good dose yet. Typically we suggest that people test for acromegaly/IAA/Cushings when they get to six units. But there's nothing stopping you from doing that earlier. We've seen plenty of acros on less than 6 units, Neko (IAA and acromegaly) was on much smaller dose for most of her diabetic life. And if Tubbs does have acromegaly or Cushings, there are treatments but you have to know what you are dealing with first.

The ravenous hunger can mean typically one of three things. The first is diabetes, and cats with acromegaly or Cushings even more so. The second is hyperthyroidism but I don't see any T4 test done. By the way, the last labs I see is June last year, that's a long time ago in a cat life. Could you update the labs tab with the latest? The third thing causing hunger is some GI condition that is causing her not to process food properly. If you get labs redone, I'd add a GI panel.

Symogyi has been proven to be very rare in cats, especially those on long lasting insulin like Lantus and following dosing methodologies with sufficient testing to know increases were safe to do. It's unlikely that is the problem. Resets, or going back in dose is not the answer, and cause glucose toxicity where kitty gets used to higher numbers. However, without current test data, we can't help you with dose. Those last two weeks worth of data in the spreadsheet will help.

 

Thank you! Apologies as I don’t seem to get emails showing that a response was posted <3
I’m working now on trying to get a Freestyle Libre so that I can do TR. I’m at work 10hrs a day 5 days per week, and my sleepy self tends to shut off the alarm if I try to test in the middle of the night. Waiting for the vet to call me back.
RE Pancreatitis, we did the SpecFPL but it wasn’t conclusive; it was slightly out of range (high), but the lab identified retesting a few weeks later, which we’ll be doing in the next week or so.

 

Yeah, I stopped giving her the Dr Elsey’s awhile ago, she wasn’t getting into the feeder this whole time so unfortunately wouldn’t be the primary reason she has the soft stool thank you though! And yes, I actually put her on the Adored Beast Leaky Gut protocol due to the antibiotics and puking up that small amount of blood - it includes pre and probiotics, digestive enzymes, and some stuff for the liver.

I ended up reducing her by .5 to make absolutely certain this wasn’t too high a dose, and she didn’t respond well, so I’ve reverted back to plugging along increasing to breakthrough the possible glucose toxicity after seeing someone else’s spreadsheet with a similar situation (started making progress around 6.5U), so fingers crossed as FINALLY there wasn’t poop on the ground the last 1-2 days!

 

Thank you so much for the response! I just realized that I never updated my spreadsheet link. I was having some issues transitioning to 2023 and I think I created a new file. I’ll update this shortly, I keep her numbers up to date and her labs are all up to date as well, including urinalysis. T4 was in normal range.

She’s currently at 6.5U as of March 5, I’m trying my best to get a +6 test at night since I’m 1hr away from home for work during the day, once I get a Libre on her it’ll be so much easier. I did reduce dose temporarily as I didn’t realize I had responses, but quickly realized that was the wrong answer and sincerely hope I didn’t cause any bigger issues. I’ll be powering on to get her to the right dose as quickly as possible.

Thank you for the additional info! I plan on testing for Acro/IAA/etc at the same time that we get the Libre on, just in case, and plan on having the SpecFPL done again to confirm whether or not she has pancreatitis. I’ll also ask for the GI panel because I do have suspicions that there’s something going on there too - I didn’t know they had a GI panel! <3

 

Here’s the link in the meantime:
https://docs.google.com/spreadsheets/d/1UrLqvtBTQJAzn2Pgc6poE3NNzlQyYgsC6HUMPJzQUe0/edit

 

It's possible that you're just getting to a good dose now with the 6.5. Is Tubbs a large kitty?

My last sugar cat was average/small, his biggest dose over 4 years was 3 Units and that was when he was unwell.

With Sly, it took us to 4.5 units, just to see action, and I noticed that if I held the dose for too long, there was alot of bouncing, and not enough low numbers for him to get used to being under 300.

How long you're holding the dose may also be something to consider. Just a thought!

 

Thank you for the suggestion, and I'm feeling like yes, holding the dose too long may be causing an issue! Downside is that I can't test her during the day, and I'm struggling to wake up to the alarms I'm setting to test her in the middle of the night. I'm glad to hear confirmation that this may be it, as it's difficult to try to make the right decision with so much information out there!

She's always been a large kitty, she's dropped down to 12lbs from the diabetes but still technically "large" I guess! That would make sense if that's another item contributing to the high dose, even if it's marginal/in combination with holding the dose too long.

Thank you everyone for all of your help, my spreadsheet in my signature is fixed now LOL, I'm going to push the vet harder to get this Libre on her and get those tests done, including the GI one mentioned above (she pooped on the floor again last night), and continue on with increasing her dose per TR if I can get a proper mid-way test in the meantime <3 Worst case, I'll do her curve on Saturday when I'm home all day.

 

Thanks for making the current spreadsheet available. I agree that holding the dose too long could cause some glucose toxicity, but I think it's time to think about getting those tests done for acromegaly and IAA. There are treatments for acromegaly, but you'd have to know what you are dealing with first.