Re: 12/8 Noodle AMPS 272
hi Christi,
Jill asked me to take a look here because I have experience with some of the things you're dealing with. DKA, cats needing a higher than usual dose, and cats that absolutely cannot get enough to eat. I know how frustrating it can be when you see most people giving a small dose, yet you can't even find a dose that will work.
When you say you can't fill Noodle up, about how much food are you giving? Just curious. And I know you said he is gaining back the weight he lost during DKA, but was he gaining weight before that too?
Looking at your spreadsheet, it looks like you have tried doses from 0.5u up to 3.5u and so far haven't seen any movement. I would say you haven't reached Noodle's good dose yet. You already tried dropping back, and that didn't work, right? And he still throws ketones frequently, which means his insulin is not sufficient for his needs at this time.
Lucy was a cat who just needed a bit more insulin than a lot of cats. Her breakthrough dose was 4.25 units BID. Other than her initial DKA, there was not a thing wrong with her. I remember being very frustrated, though. One of the odd things about Lantus and Levemir is that you expect a cat receiving insulin to have their numbers go down. If you need the numbers to go down more, you give more insulin. With the L's, what we usually see instead is a whole lot of nothing. You increase the dose, again and again, and the numbers don't change. Then one day all of a sudden wham, they're green! So hang in there, there will be a good dose for Noodle but I think you're not there yet.
There are a variety of reasons why cats can need higher doses, and I'm not ready to draw any conclusions about Noodle yet. Lucy just did, who knows why. There could be resistance from the infections, from DKA, from glucose toxicity that has built up over time and will require a higher dose to break through. You mentioned needing a dental and that could definitely contribute. There are also high dose conditions like acromegaly that can cause a need for a higher dose. Usually we don't start worrying much about those until the cat's dose is higher than this, so I don't think you need to worry about it much at this point, but it is a possibility.
I read the game plan you and Jill discussed last night, and I agree with it. If you can start getting a few night spot checks, you might be able to safely increase the dose a bit more aggressively to get Noodle to a breakthrough sooner. Who knows, that dose might be just around the corner. When Lucy was at 4 units, I remember thinking we would never get there. One more dose increase and all of a sudden she was hitting green like nobody's business. Jazzy had acromegaly and I had to wait longer for her to "snap" to good numbers, but eventually she did too.
I know you are not doing Tight Regulation, but my post in the TR forum might give you some ideas for how to squeeze in a few extra tests:
STICKY: CAN I DO TR WITH A FULL TIME JOB? YES!
I hope there is something in this long post that you find helpful. What are your thoughts?
