Advice re: dose change after trying lower dosage

So the vet and I chatted about Josie's progress on Friday afternoon and decided, with two "no shot" numbers (+ one that maybe we shouldn't have shot on: 197) in three days, to reduce her insulin from 2 units to 1 unit.

But yikes! The first pink since fully low-carb diet! (I don't know if it's coincidental, but she is super-hungry again, eating everything at once after a couple of days of eating most of her food at one meal and then returning a little later to polish it off.)

Her next shot is in 6 hours. Should we go back to 2 units? She's had 4 one-unit doses over the last 42 hours. I *think* that's enough to have good data -- ?

We have the U-40 syringes, so I would have to eyeball 1.5. Also, she's going to have to be by herself for about 2 1/2 hours after her next dose.

Thoughts?

 

I'm having a hard time putting my thoughts together here, so I'm going to list them out.

• Obviously 1 unit isn't enough. You're getting into blues but not greens, and your numbers keep going up. I think the hunger is related to this too...with higher numbers, she isn't able to process the food as well so she's hungrier.
• I disagree that you shouldn't have shot on that 197. It got you into BEAUTIFUL mid cycle numbers and though the next morning was a bit low, it wasn't really bad at all.
• That 130 probably was too low to shoot at this point. That shows that 2 units MAY be too much insulin (it's hard to know for sure since we don't know if that was a fluke or not).
• However, overall 2 units was getting you lovely numbers.
• I think the pattern I see is that when you give 2 units after a NS, it gives you fine numbers. If you give 2 units twice in a row, it tended to give you a lower preshot number.

With all this info, I think I'd hop up to 1.5 for now. I think dropping by an entire unit is just too much...cats can't change by entire units because they're so small...they need more refined doses. 1 was too little and 2 might be too much...so 1.5 would be a good compromise. Give that 3 or 4 cycles and let's re-evaluate. If it isn't doing enough, then you know that you need to go back to 2...but it might help even things out by not giving you too much so that you end up with a NS cycle but not giving you so little that the numbers keep going up.

I know you have to eyeball it and that means it won't be perfect, but it doesn't have to be exactly 1.5. The thing to do is to have a consistent dose...so if it's really 1.6 because you're eyeballing, it doesn't matter as long as it's that same amount every time. Make sense? You could do a test syringe by pulling up some colored water to what you think 1.5 is and then compare your dose to that syringe each time to make sure you're getting the same amount.

Now this is totally your decision of course! But these are my thoughts. If she was mine, I'd do the eyeballing of 1.5 (I did that all the time in my days before I switched to u100s) and see what that does. Let us know if you have any questions or my process here doesn't make sense.

 

Thank you, Rachel! We will try eyeballing 1.5 and use your clever colored-water sample idea. She’ll of course be eating with that shot, and we’ll take a Bg when we get back to the house around +2.5 and see how she is doing with the 1.5. Who knows? Maybe that will be her sweet spot.

 

A green! 95 at +5

 

AMPS was 105?? Thinking it was a bad strip, retested . . . 108.

I am just so confused now. No shot on that, obviously.

She was so ready for her breakfast that she was pulling on the the counter with her front paws (which is pretty impressive when you consider she has hind leg neuropathy!) and went right at it when I put the bowl down, but then did her, "I'll save this teaspoonful for later" routine and washed her face. So she's acting just like her healthy self. In contrast, yesterday morning (AMPS = 370!), I caught her finishing off the civvie's food, she was so hungry.