Hi Darnell,
I think if you are able to test in the way you've been doing for the past couple of days, it would probably be ok to increase Sprocket's dose. It's a little hard to tell - the insulin depot plays a part that is really important.
Let me take a shot at explaining a little more about the depot. When you shoot a depot insulin (Lantus or Levemir) some goes to work lowering the blood sugar right away. Some builds up in the body. Lantus and Levemir build up differently.
There is a good description of that here. As it builds in the body, it forms a depot. The depot gives out over the following hours - think of it like a timed release medicine.
The important thing for you to know when adjusting the dose is that the depot size is in relationship, in an equilibrium, with the size of the dose. A larger dose = a larger depot. Smaller dose = smaller depot.
When a dose is reduced, the depot is still at the larger dose's amount and it will gradually reduce as well, over the next 6 cycles or so. With a 3.5u dose, Sprocket has a depot that fits with the 3.5u. The day at the vet's with the extra fast-acting shot, followed by a skipped shot and a 4u one time increase the next day all would affect the depot.
When you're looking at what to do with the dose, having the dose be stable so you can see what the depot is doing can be important. You've got 5 cycles at 3.5u and now tonight will be the 6th cycle. That should be long enough that the 4u is out of the picture now. Therefore, I'd look at how low the 3.5u is capable of getting Sprocket's blood sugar, which looks to be not less than mid 100's, and because he's had ketones this week, I'd go ahead and increase by 0.25u.
Hi.
Thanks. I think I understand this but a question I have is how long will that hypo friday night last on his body or depot?
And how can I increase .25? Is there a different needle that has markings like that? We use 8mm in length.
Just curious, I see he ate 8 pill pockets yesterday. Are they being given in order to give pills or for snacks? Which variety of Pill Pockets? The only one that I understand to be sugar-free is the Dog version of the Duck and Pea Pill pockets. The rest have some form of sugar in them, as far as I know.
Pill pockets are all pills being taken. 8 doses a day but some pills he has spit out but ate the pill pocket. I do have the cat chicken flavor and the dog duck & green pea flavor but since coming back from hospital this time he has caught onto that "crunch" inside. I coax him to eat them, threaten that Grammy will shove it down his throat so this is better. And so pills i have crushed then syringed with water but that doesn't go the greatest either.
I am trying to get some stuff compounded so its easier to get him to take since those will have flavors.
His med list is somewhere but here it is: marboflaxocon (had 5 left but vet added 7 more days due to the hypo) , cyproheptadine 2x a day, famotidine 2x a day ( which she said only works a few days then doesn't work as well. I disagree), ursodiol for liver, Denamarin for liver support ( which she wants me to stop to decrease stress of takin so many meds) , cerenia ( which she also wants me to stop to reduce meds too). Plus he gets 100ml subq fluids a day too for at least 8 more days.
Back to the depot information - when you increase the dose there can be a delayed response to see what the dose can fully do, just like when you decrease the dose. Let's say you were going up the dosing scale and increased to 3.75u. The depot that had developed to "fit" 3.5u now wouldn't be big enough for the 3.75u dose. To know what the dose + the depot can really do, you hold the dose for a few cycles to allow the depot to build. That's why we don't suggest increasing too quickly. You want the depot to "catch up" to whatever dose action you're taking.
So you can also see why changing doses too frequently can create wonky cycles and then it can be difficult to see what dose is doing what. Think of it like being on a boat in a lake: still waters allow you to see what's going on. Changing doses is like rocking the boat. You want still waters to see the picture.
With recent ketones you do have to get as much insulin as you safely can into a cat. Have you read all the information on DKA/ketones from the "Basics: New to the Group?" sticky?
There are also more links to good discussions on the
Where Can I Find? thread -look for ketones in the lower part under "my cat may be ill/have a special condition." You may want to bookmark that thread to help you find information - a ton of it here, but not necessarily easy to find!
