Hi Tanya and Bron,
I can't really give much feedback on the dosing because there are very few mid-cycle tests so no visibility of how low the doses have been taking Coors. Two readings of concern are:
12 Feb 2021 AM Cycle - Dose 2.0IU Caninsulin
Assuming this is a curve day and the readings were done on an Alphatrak, the 4.8 reading is below the 5.0mmol/L recommendation for dose reductions in the
FDMB Caninsulin/Vetsulin Guide. (Also of more concern because the guide threshold is based on a reduction threshold of 5.0mmol/L | 90mg/dL as read on a human meter so there's less of a safety buffer if a cat's BG reads at that level or below on a pet meter.) Even if just looking at the straight reading, the guide recommends an immediate dose reduction of 0.25IU.
The big bounces into black on the 2.0IU dose would also be a flag that this dose could be too high. If it was my cat I would not give 2.0IU, even for higher preshots, particularly as Caninsulin can be quite effective at pulling down the higher preshots to significantly lower nadirs. Because there is typically no linear "if x amount of insulin is given then BG will drop by y points between preshot and nadir" relationship I don't recommend sliding scale dosing for this insulin. (Note: Other members have a different view on this, but to the best of my understanding they consider that first a lot of data is needed to understand the response of the particular cat to Caninsulin before attempting to use such a dosing method: a case of 'know thy cat'.)
13 Feb 2021 PM Cycle - Dose 1.0IU Caninsulin
Assuming this is a non-curve day and reading was taken on a human meter, again the mid-cycle reading was below the 5.0mmol/L | 90mg/dL threshold for dose reductions. Of additional concern is that this was a +6 reading. Given that this was relatively far on in the cycle it is possible that BG may have been even lower than this earlier in the cycle. Again, the relevant FDMB guide would recommend an immediate dose reduction of 0.25IU.
Given that there have been yellow preshots on the 1.0IU dose I would suggest a conservative approach to dosing since some of the higher preshot BGs could possibly have an element of 'bounciness' to them, as can be the case due to the fast steep drops earlier in the cycle that are often seen in cats on this particular insulin. Note that this is pure conjecture here based on typical action of this insulin. It is impossible to say whether or not this might be happening in Coors' case because there's not enough mid-cycle data upon which to base a more solid appraisal of how he's responding.
Tanya, if it's at all achievable for you, it would help you get a much better picture of the safety and efficacy of Coors' dose if you could get mid-cycle tests AM and PM every day. Grab them wherever you can. If that's manageable then, with extra readings available, we'd be able to give you more specific feedback and suggestions.
The best I can suggest at the moment:
- hold the 1.0IU dose for a few days. (Based on my experience and the data available, I think the 2.0IU dose is likely to be too high, especially as you got a reading below 5.0 on a 1.0IU dose.)
- get mid-cycle tests (even a +2 'before bed' test on PM cycles would help).
- check urine daily for ketones (general safety precaution, especially when reducing the dose).
- post again to request feedback.
Hope some of the above helps. What do you think yourself, Tanya?
Mogs
.
