Dose? 5/8 Tiger AMPS 262

J9pearson

J9pearson

New member
Another curve day for Tiger. I am concerned as his numbers feel pretty flat when I've tested occasionally and he is definitely shedding even more and is more lethargic. Wishing for those numbers in the 100's like 5 weeks ago. Confirming that I should increase by .5 now to 7.0?

Spreadsheet: Tiger's Sugar Sheet

Tiger/9 years old/Dx 3_2024/Lantus 4_2024 /Relion meter /YoungAgain Zero Mature free fed/ SLGS/ Outdoor

Previous Post on 5/1:
Feeling a little disheartened and worried. I have to go out of town later today until Monday night. Trying to teach a high school neighbor to test and give blood sugar. I observed her testing and giving insulin this morning and got a fur shot. Today is supposed to be a curve day. Tiger has been more lethargic/increased shedding and thirst. My high hopes for his last 2 increases to help him get to the lower 100's have been dashed. He seems to be struggling more than when he was on 5.5 units. I have an appointment with an internal medicine vet (a specialist my regular vet recommended) on June 9th to see if they have any recommendations that might be helpful (change insulin?) I'm worried about how much the visit will cost. Am I over thinking all this? Am I doing things right? Should I have stayed at 5.5 longer? Stay the course? Looking for some advice and/or confirmation that I'm doing all the things I can and it "is what it is"
Previous Post: https://www.felinediabetes.com/.../4-17-tiger-amps.../...
 
Laurie & Petey said:
He certainly is very consistent so once he finds that breakthrough dose -magic!

Good luck with your curve today. 🤗
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Is it typical that about 5 weeks ago he was in the 100's at a 5.5u dose and now he's going to 7.0 and his numbers are flat? I'm continually worried his breakthough dose is 5.5 and I moved past it. He seems worse, the shedding and lethargy have really increased since his 5.5u days. His quality of life has decreased also. All he does is sleep. It's breaking my heart. Sorry to keep asking!
 
Don't be sorry at all, that's what we're all here for. I'll let someone with more experience answer that question but I can say Petey has gone up in dose, had great numbers then started resisting it so he earns another increase, only to earn a reduction! It is certainly a merri-go-round for some of us, based on different factors.

Take a look at @CharliesMom22 SS she's been going through something similar with a dose that high as well. 🤗
 
Laurie & Petey said:
Don't be sorry at all, that's what we're all here for. I'll let someone with more experience answer that question but I can say Petey has gone up in dose, had great numbers then started resisting it so he earns another increase, only to earn a reduction! It is certainly a merri-go-round for some of us, based on different factors.

Take a look at @CharliesMom22 SS she's been going through something similar with a dose that high as well. 🤗
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Thank you! Charlie's spreadsheet gives me hope <3
 
J9pearson said:
Thank you! Charlie's spreadsheet gives me hope <3
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Oh good, that makes me happy! I know it can be really hard to see blues earlier on in the spreadsheet and feel like all your progress was lost. Charlie had some blues in the beginning too, but as you saw, he was then stuck in the pinks for quite a while. It was very disheartening, and I definitely had made a few angry posts on the board, haha (IIRC in one of them I was like "I hate this f'ing color!!!). But eventually we hit a dose that moved him, and trust me when I say, you'll know when you've hit it!

Hopefully someone with more experience will stop by soon and offer some dosing advice. From my understanding, though, the reason a dose that's too high can look like a dose that's not enough is if it's dropping them low and then making them bounce within the same cycle. You would see that in your curves if that was the case--that's one of the reasons we do them. But again, lets wait and see what someone with more experience thinks.

Hang in there. You'll get to the right dose!
 
Lantus is a great insulin for cats and Levemir is no longer available in the US. I don't think you want to change insulins. You might want to talk to the internal medicine vet about testing for conditions that might be causing insulin resistance like Acromegaly and IAAA.

On the dosing front, it doesn't look like you have bypassed a good dose. You can take him up to 7U from tomorrow.

@Wendy&Neko
 
Bandit's Mom said:
Lantus is a great insulin for cats and Levemir is no longer available in the US. I don't think you want to change insulins. You might want to talk to the internal medicine vet about testing for conditions that might be causing insulin resistance like Acromegaly and IAAA.

On the dosing front, it doesn't look like you have bypassed a good dose. You can take him up to 7U from tomorrow.

@Wendy&Neko
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Thank you.
 
I agree with Bhooma. When you talk to the IM vet (or even your own), I'd recommend requesting the tests for acromegaly and IAA (insulin auto antibodies). These are blood tests that go to Michigan State University. One in four diabetic cats has acromegaly, so it's not uncommon. We also have a few cats with IAA, or some have both, like Neko did. There are treatments for acromegaly, so it's good to know if that is what you are dealing with.

As far as dosing goes, the hallmark of the conditions mentioned is that it feels like you are combatting insulin resistance. You make progress and get better numbers, then the resistance gets the upper hand again. Just keep on with increases as needed and you WILL get to a dose that moves him. Every cat has a dose that moves them. With doses over 5 units, increase by 0.5 units at a time, unless you are tweaking doses seeing nadirs close to green. Smaller increases aren't enough to combat resistance.

As far as confirming you haven't gone too far in dosing, it'd really help if you can consistently get a before bed test, each and every night. TR is actually a better dosing method for higher dose cats, as it allows you to get to a good dose faster. But with dry in the picture, that's not currently an option for you. So just keep on as it, but make sure you have a curve every dose, and PM 2nd tests every night, and during the day when you can.

I wouldn't worry about hair shedding - 'tis the season!
 
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