I know it's not easy as we expect numbers to go down when starting insulin. I was so frustrated when I started as I had to keep increasing up to 8.5 units during the first year .... Then we started seeing better numbers and he went slowly down to 2.75 units with an average number of 90 for this year but I went through a lot of patience pants !!! I'm not a dosing expert but I would increase. Remember that cats on 5 units and above are considered high dose kitties so maybe @Wendy&Neko or @Bandit's Mom can give you a good direction. When you have a chance, test for ketones and update your SS. At one point Oscar will reach HIS dose and then he'll start coming down!
Every cat has a dose than moves their numbers, you will find Oscar's dose if you follow the dosing methods. Since your signature says you are following TR, you should be increasing every 3 days/6 cycles if you aren't seeing anything under 200. But that assumes you can get a second test each and every cycle. Even if you work during the day, you should still be able to get those second tests at night. We don't want to increase without knowing how low the dose is taking Oscar. Having said that, you've held this dose a week, which is too long. Plus you have enough data to show that you aren't missing any lows. When you get to 5 units total dose, we increase by 0.5 units at a time, unless just tweaking a dose that is already giving you a lot of green. So I would move to 5.5 units now. As for size of dose and what it means, typically we wait until 6 units before suggested a cat get tested for acromegaly (IGF-1 test) and insulin auto antibodies (IAA test). Provided that the cat is all low carb wet or raw food. My cat had both those secondary conditions, which can cause a cat to need higher doses.
I did go to 5.5 units and did Oscar’s curve today. Seemed like every time he was about to be tested he was eating. I have noticed that his dandruff is down to a minimum. He is such a good boy. “Time to test your blood” and he walks into the kitchen. I have to send the spreadsheet to his internist. She may wonder why he is now at 5.5 …..oh well…
That's not an issue. It takes 20-30 minutes for the carbs to hit the blood stream so you had time. Plus it looks like today was a flat pink day anyway. Come on Oscar, work the new dose!
Oscar’s spreadsheet reminds me a lot of my Chewie’s… I was just so depressed at the beginning. She was eating all canned and wet food and I thought we would have an easy go of it, and she would only need a unit or two and be in remission within a month. It didn’t turn out that way, and although I felt awful increasing her dose, thats what ultimately got her numbers better. @Wendy&Neko always urged me to keep going, assuring me I was doing the right thing, and she was right! Take heart, keep testing and keep following the protocol, and when you hit the right dose, you will get all those blues and greens and it will be soooo worth it
I sent Oscar spreadsheet to the internal medicine vet he sees. His curve was Friday. Here is her reply which I think is too extreme.. “Dr. Mabry reviewed the BG curve for Oscar. The BG curve is much improved on the increased dose of insulin compared to last month. While his hair is growing back, he still exhibits increased urination and drinking. As such, she recommends increasing his insulin to 7 units twice daily and re-evaluating a full BG curve in 1 month.
Can you fill in the last couple days of the spreadsheet? I would hold each dose for six cycles/three days and no more. And if you don't see anything below 200 at that point, raise the dose 0.5 units each time. Something is causing Oscar's insulin resistance, and you need to stay on top of the increases to get ahead of that resistance. As per the IM vet, he probably does need 7 units, and if you had been following the guideline in the previous paragraph, he'd be due to go up to 7 units tomorrow. But no way you hold the dose a month, that is way too long.
Glad you are going to increase. With TR, you really need to try and get a second test in each PM cycle as well. That's the only way you can safely increase, by knowing how low he's going each cycle.
@josette I was in your shoes very recently, where each dose increase seemed outrageous, and I was so worried that I was just giving too much. It was what Chewie needed though, and we only started to see better numbers when she reached 7.5 units. Hope the increase nudges Oscar's numbers!
Yes I feel anxious with each increase and keep looking at him to make sure he is okay. I did the 5.25 and 5.5 based on this group.
Hm? I don't know, I just noticed that it seems like Oscar needs a lot more insulin than the average diabetic cat. You'd typically see this in acro cats. They often need like 10-15 units of lantus 2x per day to be regulated.
When cats get to 6 units, we suggest that they get tested for acromegaly (IGF-1 tst) and insulin auto antibodies (IAA) test. The tests are done with the blood being sent to Michigan State University, the only place that does the tests in North America. Note, there are cats with acromegaly on lower doses, but once a cat gets to 6 units and above, acromegaly is one of the likely causes. Recent studies have shown 1 in 4 diabetic cats has it. It's caused by a benign tumour on the pituitary gland, that sends out excess growth hormone (GH). The extra GH can cause diabetes, and a few other symptoms. Common ones are extreme hunger (thinking growing teenagers with growth spurts), pot belly, raspy breathing/snoring due to soft tissue growth in the airways. Neko's only symptoms at the time of diagnosis was her dose and extreme hunger. Which got better once her BG numbers improved too, but was still there.
If I had listened to my vet, Chewie would still have 400s every day. You can trust the experts in this group (Wendy & Neko, Tiffmaxee, Bandit's Mom, FrostD are the main ones that come to mind), they have helped sooo many people just like us. It's hard because vets typically don't know much, or make you feel guilty and irresponsible for doing things differently, but I can vouch for the knowledge and guidance I have gotten here. If you test diligently to make sure Oscar doesn't go too low, he will be safe following TR.
Just got a call from vet. Marks Marine called them because the original prescription I sent did not have a dose listed, just “as needed”. She said they were not familiar with them. So I told her all about them. Told her I would be in the poor house with this increased dose if I did not use them. Although I still might be!
I'll second that. Wendy in particular has been an amazing help to me, and is helping me currently with Sam. It blows my mind how amazing the people here are. No place like this anywhere else.
I can also vouch for this; my vet was not thrilled this morning when she saw the spreadsheet. I almost was tempted to just go "fine; then just give me a script and leave me alone". She did actually apologize to me later though.
Is there a reason that after an increased dose the BG is higher? Seems to be the trend. Especially in the morning preshot
Have you talked to your vet about testing for acromegaly? It might just be that your cat will need a lot of insulin to be regulated. Could also be like sam who was going hypo at night and bouncing the next day. Doubt it though; likely acromegaly, but you’d need to get him tested.
Well this morning it was actually lower than the morning before and AMPS +6 Just now was a good number. Perhaps the 6 units is helping. also I want to start showing the AMPS pluses and the PMPS pluses like I have done a while ago. Should I try to find those or just start a new thread ? Please tell me
A phenomenon we call New Dose Wonkiness.New Dose Wonkiness (NDW) and failed reductions Please start a new thread. This one is getting too old. You'll get answers faster if your post follows some of the guidelines we suggest due to the volume on this forum. Making the Most of Your Lantus, Levemir, & Biosimilars ISG Experience
