5/24/10 NAY dose question

[Traveling Cats]

We've held Nay at 1.5 units for almost a week now. He had one night of blues then went into rebound with 400's and 500's. It seems Nay needs Liver Training to stay in "lower" numbers without the rebound. We decided to hold at 1.5 and switch to scruff shots for slower absorption which seems to be helping. Yesterday and today his BG #'s were all yellow and pink with none of the dreaded red!
I know the protocol says we should increase his dose but I am tending towards keeping him at this dose a little longer. I don't like to see him bouncing all over the place. Maybe his body needs more time to adapt to lower BG numbers? When he's in the 200's he is happy! and purring! and acting like his old self!
Also, we are in the process of switching both of our cats to fancy feast. We're mixing wet and dry right now to keep their tummies from getting upset. They've been getting FF + dry for about 4 days now.
What do you think?

 

[Sienne and Gabby (GA)]

It's your choice about raising the dose. There is another side to the coin that you may want to consider. By holding a dose overly long, Nay's body continues to stay comfortable with the higher numbers and regard them as "normal." This is why the liver panics when numbers dip into the blues and greens. What are really normal BG numbers are reacted to as too low and the liver releases glucose and counter-regulatory hormones. Allowing the numbers to stay in the higher ranges also means that it is harder on Nay's body especially since these numbers are above renal threshold.

 

[Traveling Cats]

I understand the ramifications. However I was hoping more for a discussion of the advantages of aggressively forcing the BG down versus slowly stair-stepping the dose to allow the body time to adjust to lower BG. If a cat is experiencing BG's approximately half of his pre-treatment norms, albeit still higher than normal, shouldn't his body be allowed a longer adjustment period than 3 days? Once a cat does experience the Somogyi Effect how long will his BG be falsely elevated?
I don't mean to sound unappreciative of the help I have received here. I am just a "why" kind of person. Maybe I am missing something but IMO the aggressive approach sounds like a crash diet to me.

 

[Sienne and Gabby (GA)]

By all means, questions are good!!

With regard to Somogyi, I've copied a quote from the Tight Regulation Protocol.

Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.

The distinction here is between a bounce vs. a chronic state of rebound. With the latter, you would see high PS numbers and low nadir. If you're not testing mid-cycle, the temptation is to keep increasing the dose which then perpetuates the rebound situation. We typically don't see that here because Lantus is a gentler insulin AND we push people to get mid-cycle spot checks.

The protocol is designed to insure a safe means of increasing dose that balances actively increasing doses with safety. Remember, there is published research data supporting this protocol. That said, every cat is different (ECID) and what works for the larger number of cats may not work for Nay. To be honest, I have had to weigh some of the same concerns. There are times when it seemed prudent to hold Gabby's dose because she was getting good numbers and I wanted to stabilize her progress. But, I have a lot of data and Gabby has the unenviable reputation for big bounces -- well, plummets, actually, followed by bounces.

You have to do what you are comfortable with. All I would say is be open to trying new approaches if what you're doing isn't working. I've worked with several of the experienced members here to try different strategies to move Gabby's dose either up or down, whether to change dose by 0.25u or to shave, using food in a variety of ways, etc.