When to worry about glucose toxicity?

Good morning everyone,
A little background: I have been having issues with a bouncy kitty after what I call his pseudo-remission. We have been trying different doses to see if it breaks through and gets him back into the blues around nadir. So far, nothing I have tried seems to help, as it appears he is either bouncing or the dose isn't working enough. We recently tried lowering the dose again and just raised it up to 0.5 from 0.25.

After last night's lingering stay at 300 and this morning's AMPS of 325 (which he hasn't had such a high number since just after his diagnosis), I really started looking more at his spreadsheet. Excepting 1 time where his pancreas decided to work, Lou has not had a BG value within the normal range at all in the last month. In fact, it's rare that I can even get him into the blues during a cycle. I am really concerned about the effects of these prolonged stays at higher BGs, especially now that he's going over 300 more. I have been trying to research glucose toxicity this morning, and I am not sure at what point/number Lou would qualify. Is there anything else I should try at this point or is it time to talk to the vet about other insulin options?

 

You are at an extremely low dose of insulin right now and have plenty or room to move up the dose, so I don't think you need to consider changing insulins just yet. Glucose toxicity happens when the kitty stays in high numbers for too long, it becomes harder and harder to break them back out of those high numbers. You end up having to up the dose. The main thing about tackling suspected glucose toxicity is getting ahead of the numbers by regular insulin increases. Don't wait too many days in between dose increases.

My cat as well hovers near remission, when hes having good weeks he can go days without insulin and stay in normal numbers, but eventually starts creeping back up. If I don't stay ahead of the numbers it's hard to get him back to baseline.

 

You have to increase your dose. Try 1u. If u look at your SS, u do get blues when u give 1u at numbers of 200 plus. Look at your data in June where u gave him 1u and even 1.25u and you get nice blues in mid cycles.

 

That seems to be his problem at this point. Prior to his failed OTJ trial (June), he reacted beautifully to insulin, and it didn't take him long to move from yellow PS's to blue. Now, after he was off insulin for 3 weeks (but not in remission), he does not react as you'd expect. He seemed to be bouncing to start, but overall the doses don't seem to affect him like they did previously. I recently decreased his dose again to see if I had possibly missed his ideal dose or to see if he was still bouncing. Obviously this last week or so his numbers look like what I'd expect from him being at too low a dose. The problem is, I'm afraid of increasing too fast and causing him to bounce again (since he seemed to bounce even at higher numbers). The fear of bouncing has kept me at the 0.5 for now (to at least give it a fighting chance before increasing again), but reviewing his spreadsheet makes me really nervous about how long he's been in the yellows. I want to be aggressive in getting him regulated, but right after his OTJ trial, it seemed my aggressiveness pushed him to higher numbers. Now that he's high, I can't seem to get him in lower ranges again. It feels like a vicious cycle at this point.

 

Hmmm I don't really see much bouncing when u gave him 1u in August. It was a flat yellow and u did get some blues mid cycles. If u are worried about giving him 1u, then try 0.8u for few days and if it still doesn't push him down then increase to 1. He may even need slightly more than 1u.
@JanetNJ do you agree? I see CC giving u wonderful blues and greens. I like your dosing scale. It's effective.

 

I'm not seeing bouncing either, just a bg that's too high. Id try 1 unit as well.

 

Alrighty then. I really wanted to up his insulin to 1 unit this morning, but I was trying to be good and stay the course. I guess I can't completely ignore my own instincts with this process. Hopefully I can start getting him lower, because these continuous yellows are running this gal ragged with worry.

ETA: Thank you all for your advice. I really appreciate you all taking the time.