12/1 Tink AMPS 463 - increase not helping. :( Advice?

[JenM]

Last condo: viewtopic.php?f=9&t=129071

Increased to 3.25u as planned the night before Thanksgiving. Not getting great results. Still bouncy. Maybe more so. Wondering if an increase was the way to go. Planning to do SOMETHING Friday - just not sure if I should be going up or down. We were seeing a lot of green for awhile (at 2.75 I think). Seeing a LOT of red/pink on 3.25. Given that he's had DKA before, it worries me. He FINALLY had a decent cycle last night, but then is bouncing again this morning (which I'm not really sure why, as he didn't fall far nor fast - though I guess if I look at the whole day rather than just the cycle, it makes more sense)...

Just not sure what to do at this point. Go up again? Go back down? Someone (BJM maybe?) had warned me back in our ProZinc days about too much insulin looking like too little insulin - how the body releases sugar to compensate for the extra insulin, resulting in high numbers despite the increased insulin. Then eventually when the sugars deplete, they can crash. Just something that's always in the back of my mind when doing increases. We were on such tiny doses the first time. Now we're up to over 6u of insulin per day and still getting crappy numbers.

He ACTS fine. Play some, grooms often, appetite was crazier than normal yesterday. When I made myself a tuna sandwich he actually came into the kitchen WITH the crazy dog (who loves the kitties, but is a bit rough with her love) - which normally is enough to make him think twice. Even with her nuzzling him into the ground, he was still determined to get to me (and the tuna). Then this morning he LITERALLY gobbled his breakfast down in ONE bite, which he stole off the plate before I could even get it into his bowl.

Would appreciate suggestions. Do you guys see anything I don't? Should I increase again this weekend, or should I consider going back to a dose that was working better (but still not great)?

 

[julie & punkin (ga)]

I would increase again. One thing I learned from having a high dose cat is that the important numbers are the blood sugar - not the size of the dose. Don't get stuck on the dose size.

BJM is right in that too much insulin can look like not enough on a spreadsheet. However, the important thing here is that you've increased methodically and with appropriate intervals between increases and small increases. When a cat is overdosed, typically the dose was increased in too large of increments, like 1 unit at a time, or too quickly, not waiting a decent length of time in between increases to let the dose do its thing.

Often the ss of a cat with too much insulin will also be constantly high, not showing a normal curve. Tink definitely has a normal curve - he's going lower at night and then bouncing in the morning.

When you're following the TR protocol, you don't have to worry that your cat is overdosed. You've done things by the book, Jen, I think Tink just needs more. Cats need what they need and those needs can fluctuate.

You've given this dose 10 cycles and it's getting Tink solidly into blues. I'd increase by 0.25u and have my fingers crossed for greens. He'll get there!

the usual "cure" for bouncing is more insulin, not less. When you increase, you may need to help him stay long enough at the larger dose by holding up his nadirs for a few cycles. Sometimes even doing that for a short time can help the higher numbers come down. Take a look at Max's ss and look where Elise started doing that.

 

[JenM]

Ok, thanks. That makes sense. It just had me concerned that the number seem to just rise with the dose. I'll go ahead and increase again this weekend - and can do so the following weekend too if needed.

Going to have to start looking into vial prices though - I don't think the pens are saving me money anymore.

I do find it curious that he tends to hit blues in the evening, but not in the morning. Granted, MOST of my data is in the evening... but even on weekends, he's higher ALL morning cycle than he is in the PM.

At least I kept him out of the Thanksgiving fixins. Not for lack of trying - but he's been carb-binge-free for quite awhile! (anti-jinx!!!!)

 

[tiffmaxee]

Hi Jen. Julie is right about Max. I still have to feed him often when he starts to drop to prevent Max from earning a reduction. I've only been able to take a couple of small reductions. I tried again last week but it failed. So when he hit 59 today he got some hc+ a couple drops of karo to bring him up. We've been at it for a year. It will get better I just can't tell you how soon. Hang in thre. :YMHUG:

 

[Wendy&Neko]

Good luck with the increase Jen. Neko has a bad habit of doing most of her lows at night, although she's a bit better this year than last. A lot of cats just prefer to go lower at night. :roll:

Take a look at the total volume of insulin when you are comparing vials to pens. There are 3ml of insulin in a pen and you get 5 to a set, vs. 10ml in a vial. So you get 50% more insulin in a set of pens. You have two alternatives if you want to go cheaper. (1) take a short trip across the border. (2) order online from Canada. Marks Pharmacy is near me so not far from you. They charge $20-$30 more than it costs over the counter here, but it saves you a trip.

 

[JenM]

I'm buying pens one-at-a-time. They WERE $72 after tax up till the last time when they jumped to $82 after tax. Even the pharmacist was surprised that it went up so much.

From what I can tell, a vial is around $250 here. Essentially the same price (give or take), just potentially more convenient (but a bigger hit to the pocketbook all at once). I'll have to look into online. Thanks for the link.

As far as nighttime lows - I'd MUCH rather they happen at night than during the day. When he drops at +2 in the AM, it affects my work schedule. My sleep schedule is far easier to adjust on the fly.

 

[JenM]

WOW. :shock: Now I see why folks order through the Canadian pharmacies! I can get 5 pens (I think, it says 3x5ml pens - should be 5x3ml pens... but same amount either way) for the price of TWO down here! Thank you, thank you, THANK YOU!