Sooty (was 11) now 14u/BID Lev - still FLAT #s..

Would love to hear any dosing comments, as we are (as, I'm sure, will come as no surprise to you!) still very much wondering just when on earth we will ever see any drop, or reaction, in Sooty's numbers! Roght now it seems as if his system is (still) fighting the insulin.

Does our spreadsheet look at all familiar to anyone - and do you see any sign yet that we are getting any closer to wherever it all may change?

Is there anything we should be looking for - or anything that we may have already missed?

What can we expect to see going forward, if, as we have been for the past couple of weeks, we keep on raising the dose by 1.0 unit every 4 cycles if no significant change?

Any guidance anyone can offer, will be SO welcome...!!

Perry & Cathy

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Hi Perry and Cathy,

Perry, I think you said you were a computer person. Here's the protocol in "computerish-speak".

if BG-Nadir >= 300 and Time in [2-4 days] then +0.50 U
else if BG-Nadir >= 200 and Time in [2-4 days] then (dose = low then +0.25) or (dose = high then +0.50)
else if BG-Nadir < 200 and Time in [5-7 days] then (dose = low then +0.25) or (dose = high then +0.50)

I generally did .5 increments, but your current dose was my top dose. Therefore, I'm not sure if you should go up in .5 or 1.0 increments. You seem to be getting close though, which is great (although with an acro, things change). It also appears that someone is home during the day to get spot checks, so you can be on the more aggressive side. I'll bet Gayle will stop by and give some good advice.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Hi Perry,
I'll take a look at Sooty's ss, but you can also look at mine for Shadoe and Oliver because you may see that both are different.

You basically give Sooty what he needs. If he needs more insulin, then that's what he gets.
When you are looking at his ss, look for things like how quickly he reacts to dose changes, whether he bounces, how badly and when, does the moon affect him much, etc.

When you say he eats alot, how much do you mean by 'alot'? How many ounces and are there any times that he is less hungry?

It's nice if we can stick to the protocol for dosing but sometimes, it just don't work. Sometimes, if you wait to long, you let the resistance get ahead of you and you end up chasing it. I do try to hold a dose for at least 4 cycles for both and maybe 6 for Ollie as he's slower to respond, but some times, you have to go with sudden unexplained BG changes.

At one point, I was increasing by full units and not much seeing results. If you look back from a 22u dose, the decision at 11u to go with full unit increases looks like it was a good idea.

Anyways, I'll look at the ss, but there are others who are much better at squinting and reading ss better than I ever will!
Take a look at my two ss and it will give you an idea of what I did when I was around 11u. Eventually it becomes just a number.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Thx Gayle, responses in blue:

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

You mentioned he seemed better before, do you mean before insulin entirely or better when he was on Lantus.
I wonder if he feels better on Lantus than Lev. I know that Shadoe is not good on Lantus and becomes much better, calmer, all around nicer on Lev.
What things specifically are worse now - maybe you can make a list of positive and negative changes you have noticed over time, before insulin, on Lantus, and on Lev. Things like urine and appetite and all other habits you can recall.

For the food, how are you feeding? I wonder if you spread out the total foods in an autofeeder, maybe he will feel better if he is getting several smaller meals as opposed to a few. Oliver was up to around 30oz of foods a day and Shadoe was close to 24oz; I felt my entire life at home was opening cans of food, testing and shooting.
Oliver is down to half or maybe 15oz and Shadoe is beck to eating like a bird and maybe eating 6oz per day.
What helped me was that I 'souped' Ollie's food alot. Shadoe loved it for quite some time and for awhile refused to eat unless I gave her soupy slop. The extra water will be good for him and it will also fill him up so that it may kill his hunger. You will go through alot more litter, but less foods.

As for why he's all snarky now and had better BG before, I don't know. Hopefully the others will have some good ideas or suggestions for you.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

I wish I could help but am seeing far too much yellow and recently some pinks in KB's SS to offer advice. May be coincidental, but his shed was accidentally drained a little and we seem to have lost a decent momentum.

I am really conservative with dose changes. KB usually responds to them pretty quickly but as the dose has gone up I'm thinking maybe the increases need to, too, because they are such a small percentage of change. I think Gayle may be right about "trying to get ahead" of the resistance if you have the luxury of spot-checking during the cycle.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Hi Perry and CAthy,
I'm sorry as I've been absent for awhile and haven't even welcomed you here. I'm Patti and my Merlin left me a couple years ago now but I still try to help when I can. Your Sooty reminds me so much of Merlin when I read about him - black - a big guy - eats several times a day :razz:

I'm wondering reading over things - and forgive me if you've addressed these issues already - does Sooty seem to have any pain issues in his back legs or along his spine that might be making him feel uncomfortable. these are sometimes things that contribute to increased BG's and "snarkiness" too. I know Merlin would sometimes run higher BG's and be quite cranky. ONce we got his pain under control - much of those 2 things became better. Just wondering if that might be some of Sooty's issues?

Otherwise I don't have more to offer re: dosing besides what Heather mentioned re: increasing your dose again or what Gayle mentioned - if perhaps Sooty feels better on the Lantus. "Unfortunately" every cat is different and while we have found most do better on Levemir it may be your Sooty likes his Lantus. I wish I could help you more this way. You might try going up again on the dose and/or addressing perhaps some pain issues and then if still no improvement in his general disposition perhaps try going back to the lantus.

I would like to add your names to the acro sticky at the top if that is ok with you also.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Thanks for this - I meant better before when we temporarily stopped the Lantus altogether. His numbers remained the same (~250s) but he was just more comfortable and seemed happier and his appetite diminished noticably. We've noticed several times over the last months that when we increase the dose he gets hungrier and hungrier as if the insulin is just making things worse (yet still having little effect on BG levels!)

As to food we give him smallish portions (2-3oz at a time), often through the day. But when he's in the hungry state he can eat a whole 3 or 5 oz can of food and then come right back and meaow for more - just as if he hadn't eaten anything at all...! he drinks plenty of water too and stil pees large amounts - so I haven't felt the need to add water to the food...

Hopre this helps?

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Hi Patty! Nice of you to come by! yes, Sooty's a big boy alright. A pity we never knew Merlin (a lovely name too...) but it is great that you still visit here!
Yes please do add us to the Sticky - that is just fine!

I'm not sure about possible pain issues, that is certainly a new suggestion that we hadn't really thought of. His rear quarters are a bit weak-looking, but we had put that down to Neuropathy (and we give 3.0mg BID of Methyl-B12 for that)... however, I DO see what you mean - and it sure would be good to try and rule it out. Can you suggest an OTC pain med that we could safely try, or do we need to talk to the Vet about an Rx?

As to the Lantus vs. The Lev, we really aren't seeing any appreciable difference at all - except less flinching sometimes! The Lev indeed seems much gentler. But as to the effect or lack of, they seem to be acting very much the same.

HTH - it's so hard to understand all this isn't it... especially when they don't seem to respond in any logical way...

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Because with Merlin - so much was so new to all us acromoms and we had so much to learn...

I started with cosequin - something you can buy on line - my favorite site is KV vet as I get the best deal for shipping to WA state. You can also buy it as your vet. It takes awhile to work as it's a supplement. We also added a drop or 2 of fish oil. It too is considered to help with the joints and pain control. Again this is all more of a supplement - not an actual pain medicine. But arthritic changes in the spine are one of the things our acrocats most experience.

We used Buprenex eventually - it's a narcotic tho - definitely something from your vet. And Metacam altho now that isn't recommended except perhaps for end stage comfort issues - certainly not where your Sooty is.

Something I've become a big fan of in this year and Nancy another acromom uses it - again from your vet tho - is Gabapentin. I use it in 2 of my cats. Both with hind end weakness and tenderness/pain. Within days they seemed like new kitties. It was an amazing difference. Neither are as big as my Merlin or your guy Sooty but for them we give 15mg bid. They are both about 7 lbs. It's an older drug that was "put aside" for years but is being found to be quite useful for pain control in cats and with little to no side effects.

Like I said tho - the pain control issue was very obvious with Merlin's bg control. We used PZI idexx - which we dosed about every 6 hours so I think it was abit more obvious then. It just might be something to consider for your big guy - at least to see if it would change anything.

I so hope this helps a little.

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Thanks Patti, you have provided us with food for thought. I did a lookup on Gabapentin and found references for its use to help with pain associated with Neurpathy, but also found this: "The commercially available human liquid-product contains xylitol..." so I guess you have to be quite careful, as xylitol I hear is a no-no for cats...!

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

We get gabapentin ordered from the vet to a pharmacy that compounds it. I'm not sure how Nancy gets hers. But it doesn't have any xylitol in it I know and it's chicken flavored - oh yummy! at least Boris and Nellie think so! It's mixed so it's 50mg/ml suspension. Sometimes Boris isn't too thrilled with it - he's got a mind of his own - so then we stick the 0.3ml in a capsule and give it to him that way. I hope that helps a little.

Do you also know about getting a Rite Aid or Walgreens or if you have triple A (the automobile club card) - that you can get discounts on some meds then at pharmacies? Just thought I'd throw that out while I was thinking of things! My mind tends to go in a million directions at once.... @-)

It's late by me right now but I have more info on gabapentin too - so I"ll get that to you tomorrow....

 

Re: Sooty now at 11u/BID Lev - any dosing comments?

Thanks - that's all great information !! Look forward to hearing more... I'm off to work now (heck I'm late already!) but I will try and watch this thread...

 

Still can't crack those mid 200s - but stil cranking up the dose...! Now at 14.0u...

 

Hi Perry,
How's Sooty doing this week, compared to last week? Is he still progressively hungrier, and crankier? What has changed and in what ways?

I haven't anything more to add as far as dosing; have you thought any more about Sooty maybe liking the Lantus better?

 

He's better, overall behavior and appetite-wise. Less cranky, a bit more playful, and calmer. And yet the BG #s arent all that different really... He's also taking care of LB business better too now, (covering it up instead of just doing it and walking away - both Ps!)

He's no different at all on Lantus or Levemir, that we can detect. He didn't even seem to notice the change. (Except at shot time - the Lev doesn't sting!)

 

That's good to hear he's settling in with the Lev and the appetite is as well.
I suppose we just keep going with the same dose increases and eventually you will hit a number that Sooty likes.

 

i think you are due for another increase for sooty and hes just not at that dose yet. could be soon,who knows we dont till you get there.

 

Thanks!! - helps to get this support, I'm sure we all think there is somehow, something different or something else, more, we could be doing...!

OK will keep on going on up the ladder!! We did increase to 15.0u today...

 

hello just takin a look at your ss. keep in mind some things with acros.most acros have voracious appetites.i have seen this with GC all her days regardless of when she was her highest(62 units BID..thats not a typo) to her present 9 units bid. this is whether regulated or not. i think this is an acro characteristic.not all of them but alot of our acros have this need for foor. GC has calmed down somewhat,but she is always looking for food. i give her a healthy amount, and ive found for her putting food in a timer feeder thruout the day is good for her. looking at your SS keepin in mind that any time yu increase/decrease a dose there will be a period where that dose has to stabilize. sometimes we call it new dose wonkiness. keep in mind if yu have changed the dose and its noat least 6 to 8 cycles not to get crazy about it its merely settling. you really wont know what that incr/dec is doing till 6 to 8 cycles.k?
and another thing i must remind you of as well.you have an acro cat. you do not have a diabetic cat.you have a cat with a fully functioning pancreas as well as an unknown variable which is the the tumor that is putting out hormone that changes from time to time.so keep this in mind. it is not uncommon if yu feel in your observations that your cat is more comfortable in what would be considered higher numbers. this is something else many of us have seen w acros. we dont strive for double digit greens with acros. u may find the blues to be where sooty s comfy. naturally we want him under threshold and preferably blue.as much as his numbers are flat.i dont consider this to be a bad thing. i think with some increases and holding like youare doing that sooty will be underway. and no dont worry about him getting up to 62 units bid. from what i see on the ss i dont think you will be anywhere near that number. oh and by the way my cat is now around 9 ish. hang in there u doing good!

 

Thanks! All good stuff! We're still on the aggressive side of dosecreases as we'd love to get him into the 100s sooner than later! We want to take a trip to England to see out new grandson but we would really like to get Sooty's #s down a bit before we disappear for a couple of weeks and have to leave him at the vets (our vet also boards animals)...
Just off to check FB - email says there are a few unread messages there...!!! Thanks for stopping by here, you never know how the comments on here maybe may also help someone else, huh!?? Have a great Friday!

 

Hi Perry,
I haven't been on much lately, but saw Gabapentin and Cody mentioned, so I thought I'd post.
Cody has been on various insulin for 3.5 years and we found out last winter that he is acro. He started lev in June 2010.

He started Gabapentin for non-specific pain (the hiding in a dark closet, the growing bone structure, the stiff movement etc) in July 2010. He now weighs about 13 (very solid) pounds, and was initially started on 30mg 1x/day. I choose to split that dose into 2x/day because it seemed to wear off and I gradually increased that dose. His vet recently increased his dose to 30mg 2x/day.

We get it compounded at a mom and pop pharmacy, and they add tuna flavor, I think - yummers....
as someone said, the human liquid has xylitol, so it needs to be compounded from the powder.
The only side effect is suppose to be drowsiness-.... how many 14.5yr old cats do you know that don't sleep a lot anyway, so what else is new ... :lol: I just hope its keeping him from suffering. I like it. Its non- narcotic, it probably helps his headaches. He actually will sleep near a window now (bright light).

As for lev, Cody hangs pretty reliably between 150-250 with an outside range of 100-340, and I test a lot and adjust all the time as needed. Honestly I don't keep track of how many cycles he's been at a dose, but I do consider
the data I get,
the influence of recent doses & shed status,
and I have to allow for variations due to his twice weekly aspirin (for his heart) which drops the following days numbers.

During our ramp up stage, we progressed very aggressively- best if you look at the ss. The excessive testing and the fact that I'm mostly around, made it possible to be this aggressive and to FINALLY get ahead of the +#+*$*^%$# disease (after years of trying).

 

just looked at your ss and wondered if you are splitting the dose into multiple spots, that can help.
also, would you be able to shoot closer to his belly- that also may be worth a try

 

Thanks Nancy.. we're still not sure if he's in any pain or not but maybe we ought to discuss with the vet, can this is one of those "try it and see" things?

 

Yes I do now split the dose into two shots, in his sides (in the loose-ish skin area just behind his shoulders and just in front of his hips), AM right side, PM left side. He seems fine with this so far... but if there's any better places I am happy to try!

 

Cody gets around 15u 2x/day, (divided into ~4u in 3-4 spots each AM and PM)

(ie 6-8 sticks per day)

Could you try splitting each shot into 2 locations?

 

Yes - already do that, current 16u is given in two shots, different places. (I just don't write it as such on the SS, I just put the total amount given...)