Tony
First of all, you are doing a better job at getting more tests so thank you for that.
I'd like to show you some cycles where even just a couple additional tests would have put the pieces together a little better.
If you look at the a.m. Cycle of 3/21, he started to clear a bounce. Great that you caught that midcycle test that day which shows us he was continuing to clear. But what happened between that test and his +12 of 86? We don't know if he went lower or if the 86 was on the way back up. Under the TR protocol, an 86 on an Alpha Trak is very close to the reduction number of 80 for a newly dx cat (newly dx is one that has been dx less than a year and his dx was last summer). However, because Bagheera is still getting dry food, the TR protocol is not appropriate for him. It might be more warranted to reduce him when he goes below 120 on your AT.
What we do know is he got low enough for his liver to not like it and between that and the skipped shot the night of 3/21, his BG skyrocketed. Your response was to dose on the preshot and raise the dose considerably. When we raise the dose, quite often the response in the first 2-3 days is higher numbers which we refer to as New Dose Wonkiness. So Bagheera has three things attributing to his high numbers after 3/22: bounce, skipped shot, NDW.
Now compare the a.m. Cycles of 3/10 and 3/25. Look how far down he came on 3/10....296 to 121. From that we know he is capable of Dropping that much in a cycle. It's possible he dropped down again on 3/25 OR he could have stayed flat and come up a bit. The point here is that even when he's high, your mid cycle testing gives us a great clue as to his patterns.
It's important to note that while we may not see clinical signs of a hypo when our kitties are in really low numbers, we actually have no idea the extent to which those low numbers affect them physically because they are not connected to any heart or brain monitors. That's why when I catch my Gracie low, I get her up as fast as possible. I don't know what any residual effects might occur from allowing her to stay low. If you aren't catching those lows and bringing them up, then you don't know what residual effects they could be causing Bagheera.
At the risk of sounding like a broken record, we'd still like to see you reduce the dose...even if you could reduce to 3u and give him some time, it would tell us more. Think of dose changes as a cruise ship. You can turn the wheel but it takes quite a bit of time to actually see the course change.
And if you still don't want to reduce his dose, I have to ask you to please stop dosing on the preshot numbers. You can get him seriously overdosed by doing that and at some point, his numbers will take a definitive crash which could cause a clinical hypo. The other thing Id like to ask is that when his numbers are coming down as they did on 3/21, please continue to grab a spot check until you see the numbers rise. That allows us to tell how low he is going and when he starts back up.
Please let me know if you have questions. I will check beck in later today and I will be up late tonight as well.
