hi Scarlett,
I was just reading through this thread and have some thoughts. I can relate to your dilemma somewhat. In one of the posts, Dale mentioned my high-dose cat, Jazzy. Our situation was somewhat similar because, like Taffy, Jazzy was brought up the dosing ladder without a lot of data. Jazzy was a foster kitty, and by the time I got her she was already on a high dose. I was familiar enough with her situation that I was fairly sure she was an acrocat before I brought her home (for lots of reasons I won't go into right now), but of course I could not be positive that her dose wasn't too high because there had been very little testing. I knew I was planning to get the acromegaly and IAA tests done, but I couldn't do them immediately and needed to come up with a plan for treating her in the meantime.
What I ended up doing was knocking her dose down by a few units, then fast-tracking back up the dosing scale until we got to a dose that did something. You can see on her spreadsheet that reducing the dose turned out to be unnecessary, as she ended up on an even higher dose than the one she had been on before. I wish I had gone with my gut and held the higher dose, but it is what it is. That is what we usually see when someone decides to drop the dose way back, but as Mel pointed out, occasionally there is a cat for whom reducing the dose works. Keep in mind that if you drop the dose way back, you will need to test for ketones daily. Any sign of ketones, post for advice. We do suggest that you not hold onto a dose that clearly isn't working for too long. If the numbers stay high, then a few days or maybe a week is usually sufficient to see that a dose isn't working. Then, onward and upward.
Somebody may have mentioned this already, but actually Taffy's patterns are not atypical of what we usually see with Lantus. Sure, her dose is a bit higher than most, but the pattern is normal. Most people expect to see that when you give insulin, the numbers go down. With Lantus, what usually happens instead is that the numbers don't move much until you get to a good dose. It can be frustrating - increase the dose again and again, and the numbers stay the same. One day, though, you get to a good dose, and all of a sudden the numbers are completely different. It's not very logical, but that's the way it almost always happens. So don't worry too much if you think the numbers aren't moving. It doesn't mean she isn't responding, it just means that she hasn't found her breakthrough dose yet. She'll get there.
If you've read this far, thanks. :smile: I think if I were in your shoes, I would try to schedule the acro/IAA tests when you can. I don't see anything in her spreadsheet that screams that she needs a dose reduction to stay safe. That said, you are the one who is there with her, so if your gut says something different then absolutely go with that. I tend to agree with Dale that it might be significant that her urine has decreased as her dose has gotten higher, plus her numbers look better on 6 units than the numbers that you have on lower doses. BUT... if your DH is taking care of her this week and won't be able to test, you might feel better reducing the dose for him. We suggest that often for people who are leaving their cats with petsitters. I know, one more thing to think about. :roll:
One thing I want to mention about the acro/IAA tests. You are right that even if Taffy has acro/IAA it might not change your daily treatment. Regardless, you are going to give her however much insulin she needs. When it does come in handy to know whether your cat has a high-dose condition is when they are on their way down the dosing ladder. Acrocats and IAA cats can have very sudden and drastic changes in their insulin requirements. If your cat suddenly starts getting very low numbers, knowing whether there is an underlying condition can really help with knowing how to deal with the lows safely. That's why I did the tests for Jazzy. I knew I wouldn't be able to pursue any of the acro treatments, but I still wanted to know what was going on. I don't like guessing. :lol:
I hope this helps a little. I'll try to check back for questions, but I'm not in the Relaxed forum often, so feel free to send me a PM to call my attention to your thread if I don't respond.
and because our cats don't speak English it is trial and error
