? 5/5 Kole Did I do the correct thing?

Good morning! We're back! Yesterday Kole hit a 113, being a number he hasn't hit we retested 2 minutes later and it was 86 @+10. His pmps was 142 so I reduced his insulin by .25. His amps this morning was 266 so I upped it. Was this the right thing to do? Can someone please check his ss?

 

Link to previous post:
https://www.felinediabetes.com/FDMB/threads/4-30-kole-dosing-advice.289451/

If you are feeding kibble and therefore following SLGS, a drop below 90 (5 mmol/L) earns a dose reduction. However, looking at his numbers, I'm not sure I would trust the 86 and take the reduction. I would stay with 6.5U for now.

Btw, when a reduction is earned, it's not just for a single cycle. Dosing is based on nadirs and not preshots. If he earns a reduction, that would be his dose going forward till it is evaluated at the end of a week (with SLGS) - unless he earns another reduction before that week is over.

 

I just wasn't comfortable giving his full dose after a 142 pmps. Would it be possible that the 4.8 could have been correct. He does seem to hit him nadir later in the cycles or very early. I've also noticed if I test him soon after he's eaten his numbers go down as well. Yes he does have some kibble but doesn't eat it all that much. Thanks for your help!

 

I see that you were asked in a previous post about testing for secondary endocrine conditions that can cause insulin resistance, specifically acromegaly and IAA (insulin auto antibodies). My girl had both conditions. We suggest that people get their cats tested for these conditions when the dose gets above 6 units. Although there are cats with those conditions on less insulin, the chances are very high that a cat on six units or above has a secondary condition.

There are reasons to get a kitty diagnosed. First of all, there are treatments for acromegaly but you have to know the cat has it first. The latest research shows about one in four diabetic cats has it. Second, there are also side effects that come with acromegaly which is caused by a benign growth on the pituitary tumour. Knowing to look for side effects means you can treat those too. An example with Neko - her vet saw a red mark near a tooth and though that tooth needed to be pulled. I went to a dental vet, and he discovered the red mark was due to soft tissue growth on her gums (caused by acromegaly) and the tooth above was rubbing on it. The vet shaved the tooth, Neko didn't have to have it extracted.

Third reason for knowing the cause of the need for higher doses is we can tweak the dosing to get Kole to better numbers faster and to respond to how his dose needs might change over time.

With later nadir cats, you have to get used to shooting lower numbers. Neko would occasionally show me her nadir at PS time.

 

Thank you for this great information! I'll be making his appointment and discuss with his vet. I'm not sure how they handle this here in Ontario Canada. I have mentioned it while at an appointment but he didn't have alot to say. It's as if he didn't know what IAA or acromegaly was.

 

You need to get a blood draw, and the blood is sent to Michigan State University. It's the only place in North America that does the tests. I am in BC, even further away. And had to walk my vet through it. But that was before the research came out showing how common the conditions can be. My vet didn't think Nedo was acro, thought you had to get up to 10 units - which you don't. Vets "of a certain age" were taught is is a rare condition. The newer research came out in 2015. Right after the positive diagnosis came back, she identified another acro in her practice.

 

Oh wow! This isn't sounding fun at all because I'm clueless about it all too really.
Ok on another note..I just tested Kole and he was 4.4@ +9 so I retested and he was 3.8. Do I do a reduction for his pmps?

 

Since you are following SLGS, yes, back to 6.25 units.

As for testing, it's possible that Idexx in Ontario may be able to do the testing. But they'll tack on a hefty charge to be the "middle man". It wasn't Idexx, but someone local told me about a similar company in Vancouver who did the same.

Basically your vet has to set up an account at MSU, if they don't have one already, and ask them to send a mailer for the blood sample.

 

Ok Thank you! I'm assuming we stay at the reduction for 7 days unless he goes lower.

What do I do if his vet won't do that? I feel so lost.

 

Yes, hold the dose unless he goes lower again.

I had to practically beg my vet - back then it was a "rare" condition and she though I was wasting my money. I finally asked her to humour me. Turns out I was right and earned a lot of respect after that. If the vet won't humour you and get the test done, maybe you should ask if you can get a referral to an internal medicine vet. They have more knowledge of endocrine diseases. My vet wanted to pass me onto an IM vet with the positive diagnosis, but I liked her for everything else, so it wasn't until Neko got yet more complicated that I went to the IM. In the mean time, I got what i needed from FDMB.

 

Ok thanks!

My vet wouldn't even do a second fructosamine test because he said it was a waste of money with his numbers still higher. I do think there is another Dr. in his office and I have spoken over the phone with her and imo sounds like she knows more of the updated information about diabetes so maybe I could get him to talk to her. They sure don't make it easy for us and our babies.

Kole was 9.2 @ pmps so we'll see where he goes from here since I believe he did get into the other kitties kibble. When he was on the 6.25 he had terrible numbers most of the time. I hope we don't repeat. Thanks so much for your time and information.