There's no definitive way to tell if the high numbers are from the drop into the blues a few days ago of if it's from a pancreatitis flare. What do you keep on hand to manage pancreatitis? The pancreatitis is painful and the pain will increase Ravan's numbers. The kidney disease would have not effect on numbers. Is Ravan acting like he's in pain or discomfort. My guess is that if he didn't want to go outside, it's due to pancreatitis. Do you have any buprenorphine at home? (It's a pain med.) Also, chances are that he leaks urine because when his numbers are up, he drinks more and he may be too uncomfortable to want to get up to go to his box.
As Chris said, the issue is more that if a bounce breaks at the same time you increase the dose, there could potentially be a lot of momentum behind the dropping numbers due to a bounce that's breaking. It could be a wild cycle which is why we are cautious about when to raise a dose in a cat that is bouncy.
I would have to go back and see the context of the post you're referring to. Generally speaking, Lantus and Lev are gentle insulins. They do not "yank" numbers down the way short acting insulins do. When numbers are coming down, it's easier for Lantus and Lev to "grab on" and bring numbers down further. There are options like using a bolus insulin (e.g., Humulin R) but it requires a great deal of attention and someone who is familiar with it's use to guide you since the use of a basal insulin (Lantus) with a bolus insulin such as R can be dangerous if you don't know what you're doing.
Bounces can last 3 days/6 cycles. In some cats, they may last a bit longer. As a cat gets used to being in lower numbers, the bounces may not last as long.
So help me understand. Your signature says you're following TR. If so, why didn't you increase Ravan's dose on 7/8? With TR, you evaluate the dose every 6 cycles. If the nadirs have been below 200, you hold the dose for a total of 5 days/10 cycles and then evaluate. If the nadirs are mostly above 200, you increase the dose after 3 days/6 cycles. I think you're holding Ravan's dose too long. If you are worried about the effect of the high numbers on your kitty's kidney function, then you need to be diligent with regard to aggressively increasing the dose when an increase is warranted.
Regarding the kidney issues, did your vet discuss diet with you? You want Ravan on a high protein, lower phosphorus, and low carb diet. Weruva (Steak Frites) and Tiki Cat (their chicken flavors) that will meet those criteria. My vet also started Gizmo on calcitriol. Not all vets use calcitriol -- apparently, a lot depends on where the vet is trained. FWIW, when Giz was diagnosed with Stage 2 kidney issues, his SDMA was elevated as was his creatinine. They are both back to normal levels. His urine concentration is still off but otherwise, he's doing very well. He's now on a raw diet due to IBS.
