Hello and welcome. Congrats on getting your first couple of blood tests in. At this point it's really hard to say what is a good dose for Titan. Some cats have secondary conditions that mean they need larger doses of insulin. Neko got up to 8.75 units and Linda's Menace also got into higher dose territory. With the high carb wet food in the picture, that will also mean a need for larger doses of insulin. 4 units twice a day is not a really large dose, though your vet did increase in larger increments than we do here.
On a side note, there are other options than high carb C/D wet for urinary issues. Giving low carb, low phosphorus wet or raw food with plenty of water added is also an option. When my Neko was diagnosed with FD, she started stealing my other cat's CD. I had to find a food they both could eat, so I went the raw route on her vets recommendation. More about appropriate diets for urinary issues on Dr. Pierson's website
here. Just don't change the diet until you are able to test more. Changing from high carb to wet food diets can make a HUGE change in insulin requirements. If you look at Dr. Lisa's
food chart, you'll see that even some of the Wellness Core options are medium carb, not low cart. We consider foods under 10% carbs to be low carb.
My question is if we drop his insulin down to 1/2 unit twice a day how fast can we drop it down?
You can drop a dose down right away to 0.5 units if you wanted, though the depot from Lantus will impact 4-6 cycles after you drop the insulin dose so you won't see what the lower dose is doing until after those 4-6 cycles. However, and this is a big one, I would not reduce the dose unless you are testing regularly for ketones. It's possible that Titan needs 4 units and even more, and dropping the dose too low will set him back. How is Titan's appetite? Another option might be to get some more mid cycle test when you can, and see if those 300's you are seeing is because the dose is too low, or if he's bouncing.
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Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."
Note, bouncing is not Symogyi. The high numbers you are seeing could mean either (1) the dose is too low or (2) the dose is fine and he's bouncing or (3) the dose is too high. Only blood sugar test values will tell you which of these scenarios is at play.
