1.12 Fa amps356/+2.5,277/+4.5,275/+7.5,324/pmps 333/+3,301/+5,360/+7,342

http://www.felinediabetes.com/FDMB/...ps-308-3-311-5-297-7-299.224147/#post-2507602

Yesterday.

 

Still no sign of blue, time for 6 units.

How is Fa feeling/acting these days?

 

No signes of blue and green. It seems 5.5 u is not even as good as 4.75u.

When Fa was on Lantus 5.75 u, it took quite a few days until she showed some blues and greens. Any chance that we can try holding on longer to see? Otherwise we might wait till Thursday night again so we can keep monitoring better?

It seems when on higher dose, if Preshot BG is 300 around, not much response but if around 350, it will drop around70. I know we should not use sliding scale for lantus and levemir, but I wonder if we can try maybe giving less when BG is around 300?

Any chance it is overdose? I heard that when insulin is too much, it might act like not enough ?

I am just bringing up all these questions in my mind and see if anything we can find out?

 

Symptom wise, Fa seems to want more food. Easy to get grumpy when she does not get what she wants, just like before diagnosis.

 

I kind of wanting to go back to 4.75u to try. I know it’s not what TR does but it seems it was better back then. Do you think we can try that ?

 

One thing to add. I was away from work and stayed at home in November for two weeks, that’s when her BG turned better after staying at lantus for 5.75u for over a week.

when I returned to work, 5.75u lantus did not do as well.

This time the Christmas holiday I was home, she seemed to be better on 4.75 u Levemir.

it seems same pattern that BG not as good after I returned to work.

She sleeps most of the day when we are not at home. And eat less. If I am home, she asks for food more.

not sure if these will give some more insights about what’s happening .

 

Not a good idea. Numbers weren't good on 4.75. Remember, the goal is blues and greens, ideally the majority of time under renal threshold. So far, you aren't anywhere near that.

Mid November, you were still seeing lots of red on 5.75 units. And the greens were high. You had room to move up to 6 units. Since then, two months ago, Fa has had plenty of time to build glucose toxicity, because it's been nothing but yellow and above since you reduced the dose. Breaking through glucose toxicity happens by going to an even higher dose. Plus, what a cat needed two months ago isn't important. What is important is the last two weeks. I see numbers starting to slowly come down.

I wish people would quit with the "too much insulin looks like too little". Then other members read it and think it's true. It's probably the most common myth I have to rebut. If you had started at 10 units and needed way less, maybe too much might look like not enough. But it's not what happened. You started at a reasonable dose, you have tested enough to know how low the dose was taking the cat, you waited for the depot to fill, you have increased by safe amounts. This dose is only taking her to yellows, therefore, she needs more insulin.

Also remember, insulin is a hormone, not a drug. You don't add a little bit and see a little bit of improvement. You keep adding until you get to a dose that starts to move her. You aren't there yet. And, what you are seeing is very common. With almost every cat there is a point where a previous lower dose looks better. But if the overall numbers at a particular dose aren't where you want them, it doesn't matter. Keep going until you get to a dose where most of the numbers look good.

We determine dose based on nadirs, not preshot. Nadirs have a long way to go down yet. Changing doses based on preshot will just disrupt the depot.

You can hold longer if you want. But if you do, it's not going to help. You need to get Fa down into lower numbers, where she is below renal threshold. Holder longer doesn't do her kidneys any good, and will just add to the glucose toxicity. If there is something else contributing to her need for a larger dose (acromegaly or insulin auto antibodies), then you need to keep increasing to try to catch and then keep up with the insulin resistance.

By the way, myself, and almost every other person with a cat need a higher dose than others have probably asked the same questions you are asking. You have been increasing safely, the numbers aren't where they should be, therefore, Fa needs a higher dose.

 

Thanks Wendy for the detailed explanation. The concern I have is to keep her testing to know how it goes. Night time I cannot test too much after +6 and day time I cannot test after +2.5, except weekends. This just makes me worry if I increase but cannot keep an eye on her. If I were still on holiday, I would not have this worry at all.

I understand that holding on for too long is not good. We are Sunday almost 5pm now. Maybe I can increase Tuesday night so at least I can keep an eye on her for Wednesday when I am on leave?

 

I will see if I can ask for Tuesday off, so I can increase the dose to 6u on Monday night.

 

Pm +5 is a bit high maybe from stress today someone visiting at our home

 

Sure, increasing Tuesday night would work as well, so you don' t need to take the day off.