I’m glad he’s doing better, Lori. Did you try to give him a half dose of the bupe as we suggested? Some vets prescribe tramadol and I, personally, would not use it having used it in one cat before. I do not like the side effects.
I know you are likely exhausted but I have to encourage you to get at least one test after PMPS every single night. Cats tend to go lower at night. If you have no nighttime tests but they are high the next day, it could be the dose OR it could be they dropped down lower or fast and are bouncing back up. Our response to those two scenarios is different.
If you can get a +2 and/or before bed, that would really help. If you go to bed at +3, get a +2 and a +3. If you go to bed after +2, then that’s fine. I”m not asking you to stay up but the more data we have that we can interpret the better. Our philosophy here is “don’t raise the dose unless you know how low the current dose is taking the kitty”. We take that seriously and that could Max in danger from hyperglycemia if we aren’t willing to advise a dose increase if we can’t see how low he’s going.
I hope we see some progress on this dose!! Feel better, Max!