Kathy and TiTi
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and a wonderful kitty, Layla. This story illustrates why I want to keep my vet. She is remarkable, talented, caring, (I was given a year to pay off my debt), and always interested in learning.
TiTi 's BG is 622 at 4:30pm
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and a wonderful kitty, Layla. This story illustrates why I want to keep my vet. She is remarkable, talented, caring, (I was given a year to pay off my debt), and always interested in learning.
Kathy and TiTi
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The link soesn't seem to have appeared, or I cannot find it. Do you mind resending it, please?
julie & punkin (ga)
Very Active Member
It's right here on the Tight Regulation Protocol yellow-boxed sticky.
Can you remember why TiTi's dose was increased after being at 9u for quite a while? Or on any of the dose increases - do you recall why the vet was increasing? Were the decisions based upon fructosamine tests, or lab tests there at the vets? If you can't, it's ok, I'm just wondering.
The Tight Regulation Protocol with Lantus or Levemir for Diabetic Cats was developed by laypersons from theGerman Diabetes-Katzen Forum. The protocol was eventually published in the Journal of Feline Medicine and Surgery.
Some vets are willing to learn from what we know here. Sounds like your vet might be one of them.
Can you remember why TiTi's dose was increased after being at 9u for quite a while? Or on any of the dose increases - do you recall why the vet was increasing? Were the decisions based upon fructosamine tests, or lab tests there at the vets? If you can't, it's ok, I'm just wondering.
Tricia Cinco(GA) & Harvey
Very Active Member
You should have been able to access it by clicking on the word "Here" in my previous post, but here's the actual URI: http://www.felinediabetes.com/Roomp_Rand_2008%20dosing_testing%20protocol.pdf
julie & punkin (ga)
Very Active Member
Several of us have been talking about TiTi's dose. The tricky thing is that too much insulin can cause high numbers and not enough insulin can also cause high numbers. That's the reason that our dosing methods - either the Start Low Go Slow or the Tight Regulation Protocol, all have the dose being adjusted by small increments, waiting a certain number of days in between each dose increase. When a cat's dose is increased that way, then we can be confident that the cat isn't overdosed.
When the dose is increased by larger increments, like the way TiTi's has been, then we don't have that confidence that the dose is appropriate. So there is a question when we see high numbers on what the reason is for them. Do they need more insulin or less?
Since she has survived 2 years on a lot of insulin, it's very possible that TiTi has one of the high dose conditions, either Acromegaly, Insulin Auto-Antibodies, or Cushing's. Acro is pretty common - latest info is that it's likely present in 1 in 4 diabetic cats. One major symptom with acro is a raging appetite, with some cats even eating things that are not food. We also see iaa fairly often, sometimes by itself, sometimes along with acromegaly. IAA means that the cat's body is forming antibodies against the insulin, binding up the insulin so that it can't get into the cells as it should. We don't see Cushing's as often, although we have one kitty here right now that has it. With Cushing's the cat's skin is typically very fragile, even tearing when the cat licks herself. Click here to read a little more on these high dose conditions.
What would you think about reducing her dose to 9u, letting the dust settle for maybe 3 days, and seeing what that does to her blood sugar? When she was on it before, she had several tests in the 200 range. The tests you had at that time look better than how she is right now.
The risk of lowering her dose if she actually needs 13u or even more, is that she won't be getting enough insulin.
The pro of trying the reduction would be that it would give us some more confidence about what to do with her dose moving forward. Right now, this dose doesn't look good and because of the way her dose was increased, it's possible she needs less insulin.
I was in a very similar position to yours and had to make the same choice. Click here to read the thread where I went through that process and had to decide whether to decrease punkin's dose or not. The difference is that punkin was getting pretty good blood sugar control at that time. TiTi's numbers are very high on this dose.
If you do want us to help you, can you promise to post every day for now, so that we can watch what's happening and help you make changes as needed? Also, whether you reduce the dose or not it would be good to test for ketones every day when she is unregulated like this.
Moving ahead, it would be good to get tests before you give her shot, and at least once in the middle of the day and once before you go to bed. If you tell me what time you shoot her insulin, I can give you some suggestions on actual times that would be helpful for tests. If you can do that every day, it will really help us see what's going on.
When the dose is increased by larger increments, like the way TiTi's has been, then we don't have that confidence that the dose is appropriate. So there is a question when we see high numbers on what the reason is for them. Do they need more insulin or less?
Since she has survived 2 years on a lot of insulin, it's very possible that TiTi has one of the high dose conditions, either Acromegaly, Insulin Auto-Antibodies, or Cushing's. Acro is pretty common - latest info is that it's likely present in 1 in 4 diabetic cats. One major symptom with acro is a raging appetite, with some cats even eating things that are not food. We also see iaa fairly often, sometimes by itself, sometimes along with acromegaly. IAA means that the cat's body is forming antibodies against the insulin, binding up the insulin so that it can't get into the cells as it should. We don't see Cushing's as often, although we have one kitty here right now that has it. With Cushing's the cat's skin is typically very fragile, even tearing when the cat licks herself. Click here to read a little more on these high dose conditions.
What would you think about reducing her dose to 9u, letting the dust settle for maybe 3 days, and seeing what that does to her blood sugar? When she was on it before, she had several tests in the 200 range. The tests you had at that time look better than how she is right now.
The risk of lowering her dose if she actually needs 13u or even more, is that she won't be getting enough insulin.
The pro of trying the reduction would be that it would give us some more confidence about what to do with her dose moving forward. Right now, this dose doesn't look good and because of the way her dose was increased, it's possible she needs less insulin.
I was in a very similar position to yours and had to make the same choice. Click here to read the thread where I went through that process and had to decide whether to decrease punkin's dose or not. The difference is that punkin was getting pretty good blood sugar control at that time. TiTi's numbers are very high on this dose.
If you do want us to help you, can you promise to post every day for now, so that we can watch what's happening and help you make changes as needed? Also, whether you reduce the dose or not it would be good to test for ketones every day when she is unregulated like this.
Moving ahead, it would be good to get tests before you give her shot, and at least once in the middle of the day and once before you go to bed. If you tell me what time you shoot her insulin, I can give you some suggestions on actual times that would be helpful for tests. If you can do that every day, it will really help us see what's going on.
julie & punkin (ga)
Very Active Member
By the way, when you are ready to respond, go ahead and start a new thread (we call them condos, for kitty condos) and answer there. We try not to bump up posts from previous days, just to keep everything manageable. You can answer in the new thread.
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