hi emily. trust me, you're not alone in your confusion. to successfully follow a tight regulation program, it's necessary to not only understand the action of the insulin used, but also how your cat responds to the action of the insulin. imho, this is the hardest part to understand of this thing we call the "sugar dance".
when a cat dips to numbers lower than it's body is used to kitty will bounce. it's a given. in most cases, these bounces can last for as long as 72 hours (some may clear their bounces in more or less time). eventually, kitty becomes used to lower numbers and ceases to bounce.
part 1:
in tableau's case...
you wanted to know what was happening. 1.25u brought him down to mid-greens (normal bg range). what we saw afterwards was the
expected bounce. you want to give the cat time to clear that expected bounce (usually up to 72 hours, some cats *may* need more time) before increasing the dose again. you want to remain consistent with dosing because you
know that particular dose has the ability to bring tableau exactly where you want him to be... in the normal range. in other words, why increase the dose when the current dose is bringing him down to where you want him?
now that doesn't mean the dose would never have to be increased. chances are, the dose would have to be increased for various reasons (eg. fine tuning, some kitties "get stuck" and need a nudge, you want to bring down the entire range, etc).
however, combine what we know about the action of the insulin along with kitty's response (dumping counterregulatory hormones into the bloodstream after a drop to numbers lower than the body is used to). we don't want to increase the dose before that bounce has cleared. this is why protocol suggests holding each dose for 5 - 7 days
except in cases where nadirs are over 200.
"However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose)."
http://www.tillydiabetes.net/en_6_protocol2.htm
"If nadir blood glucose concentration < 200mg/dL but peak is >200mg/dL (11 mmol/L) - Increase every 5-7 days by 0.25-0.5 IU depending on if cat on low or high dose of insulin"
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf
these guidelines for increasing the dose are based upon nadirs greater than 200. tableau had dropped into greens. therefore, no increase according to protocol guidelines. the bounce cycles do not count.
ignore them. base all increases on how low the dose can drop your cat.
we know cat's will experience a temporary bounce lasting for as much as 72 hours. holding the dose as suggested for 5 - 7 days (or at
least 3 days) will allow those counterregulatory hormones to clear the body. once you know how long it takes YOUR cat to clear bounces, you will be able to assess where he's at and shorten that time period accordingly.
part 2:
when the dose is increased prematurely (kitty becomes over dose), one of two things will happen. either kitty's numbers will remain high and relatively flat OR kitty will experience steep drops followed by dramatic bounces into high numbers. vicious circle. no matter which happens, in most cases, the dose just gets higher and higher before it forces a break through.
re: sam's comments
it's certainly possibly there have been some missed lows on the current dose. remember, lows which set up a bounce are not always green numbers. actually, missed lows and then seeing those blacks and reds illustrate a steep drop followed by dramatic bounces as mentioned earlier.
so, what to do?
there are three options: test like a crazy woman to determine how low tableau is dropping, reduce the dose in an effort to get off the rollercoaster, or plunge onward and upward in dose
while sticking to protocol guidelines. all three options will require more monitoring than usual in order to get a clear picture of what's going on. the reduction earning cycle will come 'round again.
hopes this helps. i know it can be very confusing...
