Advice on dosing- numbers in the 400s before shot

[Lupe & Patch]

A quick history on Patch. We stopped insulin for a while and he was doing great. This January (2022) I started noticing weight loss and drinking water all the time. We have a new doctor and she confirmed his diabetes was back and she gave me Prozinc.
We started with 1 unit but at the end of Jan. on the 29th we had a hypo incident. It scared me so much and I completely stopped giving him insulin. I would test him randomly and his numbers were ok.
In June I started noticing again weight loss and excessive thirst, I tested him and his diabetes was back. Doctor gave me a brand new bottle and we're doing 1 unit.

-His numbers are pretty high every time I test him before shot (7am and 7pm), and I don't know what to do! I'm realizing I have been testing only before shot, and now I'm going to try to get readings in between. Last night +5 I got a pretty good reading, but his high numbers before shots have me so worried.
- the doctor mentioned he has a lot of tartar and needs a teeth cleaning but she wants his diabetes under control first.

Should I just keep testing him? The doctor told me she's going to want me to do a glucose curve at home. I can only do that on the weekend. Meanwhile should I just keep giving him 1 unit? have a feeling he's going to need an increase.

 

[FrostD]

A quick history on Patch. We stopped insulin for a while and he was doing great. This January (2022) I started noticing weight loss and drinking water all the time. We have a new doctor and she confirmed his diabetes was back and she gave me Prozinc.
We started with 1 unit but at the end of Jan. on the 29th we had a hypo incident. It scared me so much and I completely stopped giving him insulin. I would test him randomly and his numbers were ok.
In June I started noticing again weight loss and excessive thirst, I tested him and his diabetes was back. Doctor gave me a brand new bottle and we're doing 1 unit.

-His numbers are pretty high every time I test him before shot (7am and 7pm), and I don't know what to do! I'm realizing I have been testing only before shot, and now I'm going to try to get readings in between. Last night +5 I got a pretty good reading, but his high numbers before shots have me so worried.
- the doctor mentioned he has a lot of tartar and needs a teeth cleaning but she wants his diabetes under control first.

Should I just keep testing him? The doctor told me she's going to want me to do a glucose curve at home. I can only do that on the weekend. Meanwhile should I just keep giving him 1 unit? have a feeling he's going to need an increase.

Sorry nobody replied more quick, this forum is slower. If you need quick advice, it's vets to post on Feline Health.

We dose based on nadir, or how low a dose takes him. We want that to be around 90-150. The 163 last night tells me this dose is probably pretty good for now.

The downside to a curve is sometimes you end up doing it on a bounce day where theyre high and flat, so it looks like they need an increase. But when they clear the bounce they can drop dangerously low. It still is possible 1U is too high, but without more tests I cannot say for sure.

Dental problems are actually a very common reason for cats to come out of remission. I would actually get that taken care of and not wait. There are special dose considerations before and after a dental so be sure to ask about that if you do it

 

[Lupe & Patch]

Sorry nobody replied more quick, this forum is slower. If you need quick advice, it's vets to post on Feline Health.

We dose based on nadir, or how low a dose takes him. We want that to be around 90-150. The 163 last night tells me this dose is probably pretty good for now.

The downside to a curve is sometimes you end up doing it on a bounce day where theyre high and flat, so it looks like they need an increase. But when they clear the bounce they can drop dangerously low. It still is possible 1U is too high, but without more tests I cannot say for sure.

Dental problems are actually a very common reason for cats to come out of remission. I would actually get that taken care of and not wait. There are special dose considerations before and after a dental so be sure to ask about that if you do it

Thank you for the info!
Could you explain to me a bit more what a bounce is and why does it happen or how? Is it one day of high numbers and then he goes back to "normal" numbers? and would 2 curves be better? 2 days apart from each other for example?

The vet wants to see Patch in 2 weeks, July 8th, for a follow up check up. And I'm going to request blood work and an appointment for his teeth cleaning. Should I still do a curve this weekend? Or wait until after his teeth cleaning?

And what are the special dose considerations for the dental cleaning?

 

[FrostD]

Bouncing is when they drop lower and/or faster than they're used to; it can also be due to extended time in numbers they're not used to. The definitions of "lower" and "faster" vary widely for each cat; some cats almost never bounce, some bounce a lot. When this happens, their liver perceives it as life threatening (whether or not it actually is) and panics - dumping stored glycogen and counterregulatory hormones into the blood stream to spike BG back up. The effects of this can last up to 6 cycles, you'll usually see (1) a big or fast drop followed by (2) solid high yellows/pinks/reds for a few cycles when this happens.

Example - on the 26th PM cycle, he went from 393 to 162. And within that, he went from 302 to 162 in 2 hours. That's quite a swing and a fast drop, so he bounced. 27th - high flat pinks and reds.

Unfortunately you don't have quite enough data for me to help predict when curves might be best. Truthfully you don't even need a full curve, but they don't hurt. If you can just vary your test times each day (a +4 here, a +6 there, a +3, etc) it will help us get the overall picture. The main focus is the +4 to +6 range (and don't forget nights!).

If the vet wants a fructosamine don't bother, you're testing enough to have an idea what his BG is doing. Fructosamine won't tell you anything you don't already know.

The considerations vary by cat, dose, and current BG trends at the time. Since the fasting required for surgery and anesthesia lowers BG, and undergoing anesthesia can also lower BG, you typically have to give a reduced dose or skip the shot...and if you give a shot you probably want to time it around the procedure (for example, so nadir isn't right in the middle of when he's under).