bagheerathediabeticcat said:
Even now we've only seen one normal blood sugar reading, and that was close to where my nadir would be. I have been getting 5.5 units for about a week now so there is some consistency established. Since consistency of dosing is critical, shouldn't we keep this?
I think the issue is that without more tests, we don't truly know yet where Bagheera's nadir is. Lantus
generally has a nadir around +6, however Levemir's nadir is much later (I believe around +8 to +10). Even then, our cats like to keep us on our toes and they don't exactly follow the rules. ECID and some nadirs might fall earlier or later in a cycle, or even move from time to time. A perfect example would be Michelangelo's nadir from last night that happened at his +2! So, until we can find Bagheera's nadir over a few cycles, we don't really know how this dose is affecting him.
At the very least, we can suspect that if he hit 121 at his +6, he still had at least 2 more hours till nadir with the Levemir and so was probably even lower. Here's some more math to help explain this: he dropped from his AMS to his +6 yesterday by 175 points, or approximately 29 points an hour. So, if he was at 121 at his +6 and hypothetically he had a regular Levemir nadir at +8, that means he could have potentially been at 63
on an AlphaTrak, which is BELOW 70, the number you should start worrying about a hypo occurring at. If his nadir was even later, he could have dropped even further. Let's say he didn't drop any further; instead his liver panicked and released glucagon to counteract all that extra insulin and saving Bagheera from a hypo. What happens next is a bounce, so you see high numbers and fluctuations,
like you've already been seeing.
The safest option is to potentially allow for slightly higher numbers
at first as you slowly increase the dose over time to make sure you don't skip over a good dose and to make sure the kitty is able to handle each increase without dropping too low and bouncing back way too high. Eventually, you end up at the
right dose and it doesn't matter how long it took you to get there because once he's there, he's healthy and happy and
alive.
Choosing to start high, on the other hand, means that you're risking an immediate hypo event at any time. You've been lucky so far that Bagheera has had no
known problems on this dose since August, but the bottom line is that it only takes
ONE TIME for a cat to crash. There is is a saying around here that goes: "better high for a day than low for a minute." Basically, hypos kill immediately. No takebacks. Hyperglycemia/diabetes, on the other hand, can be left
completely untreated for months and months and the cat can not only recover, but go into remission. It's always easier to put more insulin in (i.e. increase the dose) than it is to take it back out (i.e. try reversing a 36-hour hypo event or even death).
I think a lot of people's concern is that they're not willing to take that hypo gamble with Bagheera's life without the data to back it up. And even though he's been seemingly fine so far on such a high dose, if you're transitioning him entirely off dry food, this can cause BG to drop by 100 points or more, which is another reason why it's been so strongly suggested for you to reboot and reduce to 2u.
bagheerathediabeticcat said:
Can you make this work with the higher dosing that I'm currently on?
To revisit your earlier post, you had a
decision to make: either maintain the 5.5 dose with more frequent testing (to find the nadir) or start at a lower dose (2u is what was suggested) that would allow you to continue with minimal testing three to four times a day and work your way up as needed to the appropriate dose. I'm going to re-paste Libby and Lucy's quote here because they summed it up nicely:
Libby and Lucy said:
Bagheera is your cat. You hold the syringe and you are the only one who can decide what dose to give.
So..... You need to make a decision. Do you want to maintain the high dose of 5.5 units, or do you want to hold the amount of testing down to just a few tests each day?
You can start over at a lower dose, test 3-4 times a day, and adjust the dose depending on what those numbers show. Or you can keep the high dose and test a LOT more. If you choose#2, then you need to be committed to doing whatever it takes to keep Bagheera safe.
We have had people who choose this route, but I will tell you that it is quite a bit more stressful to start at a high dose and work down than it is to start at a low dose and work up. It is stressful because you don't know for sure that your cat is safe from hypo, so if he is running low then you will have to stay up all night or call in sick to work or whatever until he is safe. I don't mean this might happen, I mean it will happen.
If you start low and work up to a good dose methodically, you know your cat is not over dose and you don't have to worry so much about leaving the house or falling asleep. As I said, though, it is your choice.
Edited to add: I want to add that generally the people who would choose the more aggressive "start high" approach are people who have enough experience to fully understand risks, as well as knowing what they will have to do when they see low numbers that they can't control. It's not something we recommend to people who post for advice.
So, as long as you're willing to do the work, there are plenty of people willing to help you out. Everyone here only wishes to help Bagheera not only get regulated but also hopefully into remission. With all the accumulated knowledge from people living and breathing feline diabetes 24x7x365,
I TRUST THEM WITH MY CAT'S LIFE! :YMHUG: I have seen the evidence day in and day out on here. They know what
doesn't work and they know what works best in the safest way. :thumbup
In the end, it is up to you since you are the one giving the shot.
