Not sure how to proceed. Very Uncomfortable

Goma's numbers have skyrocketed again from a low of 376 upto 747 tonight. I am uncomfortable doing any increases while she is bouncing like this. I truly recognize the numbers have to come down, but everything is very erratic at the moment. From my other thread, she was at the vet today to get regular fluid therapy and we had blood tests and urine tests completed and everything appears normal other than the bg and protein in her urinalysis. No ketones...Her appetite is still very ravenous which I guess is to be expected.

I am getting ready to give her the 1.50 units tonight, and hope for some settling down in the a.m. Will monitor again tonight of course. As I mentioned, I am just uncomfortable with what is happening. This is the highest number she has recorded. I have changed nothing else.

This will complete the 4 cycle round of 1.50. But what is the best course of action in everyone's opinion, giving the bouncing situation going on right now.

I thank all in advance. Realize there is no time prior to the evening injection.

 

Kitties bounce, it's just the way of things, especially in the beginning.

I don't think what she's doing now is a reason to hold off on increases-- the goal is to get her in lower numbers, and right now, those lower numbers are inevitably going to come with a reaction like the one you're seeing now. Less insulin isn't going to give her low numbers without bouncing, it's just going to keep her in the higher numbers all the time. The only way for her body to get used to the lower numbers and stop bouncing is for her to see those lower numbers more.

Someday, when you get to a dose that brings her numbers way down below 100, you may want to be cautious about dose increases during a bounce, but she isn't close to there yet.

If you shot 1.5 for this cycle, that's fine and will give more information about how she responds to that dose, but please consider the advice of the Prozinc folks on here about increasing soon.

Hang in there. I know it's tough to see this much variability in the BG (and it can't be making Goma feel very good!), but I don't see another way to get her out of the high numbers, which is vital for her overall health.

 

No need to panic! That high number is very likely a reaction to the pinks that have appeared. Relative to the pink nadir BG it's a moderate, not severe, bounce. Even though your BGs are still high you're beginning to see a drop from the insulin dose. This is what you want.

I suggest you increase to 2 u now. I know that's frightening for you but Goma needs to go down in BGs as quickly but as safely as possible. We're here to help when ever you have a question or moment of panic.

 

I would actually consider it a good sign that after going to 314 in the previous cycle then up to 653 by pre-shot, she dropped again to 376. A lot of times, with a bounce, once they go up, they do not come down very much again for a cycle or two; they stay fairly high and pretty flat. At least Goma is following the pattern of going down during the cycle and back up for the next shot. And, while 747 may be the highest number you have recorded, it is not out of line with her previous results. She has been in the 700s before.

The decisions are up to you. All we can do is offer suggestions and personal experience. I second the recommendation from Kris. I would up the dose to 2u sooner rather than later. These numbers are crazy high.

 

Id do 2 as well.

 

She will do better at 2u. It might take a few cycles to calm down, but she will be going in the right direction. Callie got those high numbers when we first started insulin, but in time, her numbers came down. Later on, her doses came down. It took several months to see good numbers and lower doses.

 

When Goma gets regulated, I hope she gets to some good numbers soon:
250-350 during preshots
80-120 during nadirs

 

Really appreciate you sharing those target numbers with me. I had no idea what I should be looking for. After an extremely heated discussion I have left the dosage at 1.5. But am anticipating increasing this evening or tomorrow a.m. Unfortunately I have no vet available for the next three days due to holidays here in Japan. This coupled with the long closing hours during New Year's is making decisions extremely difficult.

With Goma having high numbers (717 this morning) and the current dosage dropping her nearly 400 points (yesterday) I am concerned that if I increase now with a lower number than say 500 I may get into a situation here with no assistance.

 

Your concerns are valid. You could increase to 1.75. Since you are monitoring at home, you could continue nadir tests. The key it to get Goma into a reasonable range.

Goma has not even touched blue - which is the normal range. Those high numbers are really bad for her body (neuropathy, body weight, organ damage).

I'm out tomorrow (Friday in U.S) on a 1 day family visit.

 

We'll continue to encourage you to increase her dose but you hold the syringe as we often say. You have to feel comfortable with what you're doing. Our advice comes from concern over her very high BG range. I like Jeff's compromise increase to 1.75 u.

 

I also appreciate your concerns about not having a vet but I seriously urge you to listen to what these experienced people are telling you and I agree with their suggestion to increase to 2 units. If you don't feel comfortable with 2u then at least move up to 1.75u as Kris suggested because Goma isn't anywhere close to being in danger by this small increase and the longer she stays at such a high number, the more damage is being done to her body over time. If there's one thing I know all too well, it's get your kitty's numbers down as quickly but as safely as possible.

 

Sustained high numbers can cause organ damage.... Particularly to the kidneys. It also causes them to become insulin resistant. Please consider a dose increase today. We wanna see her out of the red and black numbers.

 

I wonder if you might find it helpful to read some of the research behind the suggestions people are giving you? This is an article from Roomp and Rand who published the research behind the protocols we use. Their study was done using glargine and determir, but they considered PZI (an earlier insulin similar to Prozinc) to also be a long acting insulin, so the protocol, especially in higher numbers, is very similar. The article also talks a little about the urgency of effective treatment as early as possible. I do understand it's scary to take advice from people you don't know on the internet, so I hope that having access to some of the research will help.

https://drive.google.com/file/d/1jPj48WtB2qRx7JrAOhgsJ3ym0NG4H7AS/view?usp=sharing

Please continue to post and ask questions. We are all here to help in any way we can!

 

Honestly I understand - the people in this board are really like a phone call away. They absolutely know what they are talking about! No one here would suggest a raise in units of insulin until it was given a lot of thought! They really are trying to save your cat from other damage to his body. Just trust is all I’m saying. You’re doing such a grand job at this! Really...