Hi Ellie!
I know you are so frustrated right now. I've been there. I completely understand! It feels like nothing you are doing is working, so why even try? Am I right?
We spent MONTHS with Cobb above 500 with no explanation as to why. We just kept going up and up and up on insulin. We originally started on Prozinc but the vet had us keep Cobb on dry food. Big mistake. I know it definitely contributed to glucose toxicity. We were discussing having Cobb PTS when I found FDMB. This was my last ditch effort to save him, and we've come a LONG way. This is a busy, but exciting, week for us. Not exactly sure what is going on, but Cobb's insulin needs seem to be dropping - pretty much from out of nowhere.
One thing I added to our toolbox earlier this year was R insulin. R is a different kind of beast because each cat reacts to it so differently. Some cats it takes a drop or two and their BG plummets. Some cats it takes several units. I think Black Kitty (sandy and black kitty) got up to 7u of R at one point. He is an extreme case of insulin resistance, but I know Sandy was shooting R around the clock to try and get his numbers down. Cobb hasn't gone that high in his R usage, but we've used about half of that at some points. At one point I was shooting R 3x a day -- 2, sometimes 3 units. Now I'm shooting none.
The one thing about the R that always frustrated me is that I couldn't always see that it was working. I know yesterday you said you didn't think the R had made that big of a difference. That may or may not be true. It's possible it wasn't enough R to make a difference. It's also possible that the dose you gave him held him where he was, instead of allowing the BG to get higher. Every time I saw that I'd give R and the BG didn't move, people told me it probably just held it steady, instead of rising.
You will want to develop a "R scale" for Charlie. It sounds harder than it is. But, at some point, you'll be able to see how Charlie reacts to the bigger Lantus dose and more R combined. That scale may changes frequently or infrequently, depending on Charlie's response to it. My R scale must have gotten deleted from my spreadsheet tabs, but here's what it looks like: (BG numbers are on a human meter)
250-275: 2.5uR
275-300: 2.75uR (sometimes 3uR, depending on what the day before looked like)
300-325: 3uR
325+: 3.5uR
Sometimes I will shoot R when Cobb is below 250. Not often. But sometimes. It depends on how the day before me shooting goes. Since he's been doing better, I try to let him clear the higher numbers on his own without any intervention from me. Charlie isn't there yet though. We need to get his body to recognize and realize that normal numbers are, well...normal! :lol:
I would up the R dose from 2u though. Since it's shot on a sliding scale, you'll want to let the numbers guide you. So if he's at 308 (on the AT), I'd try 2.5u. If he is still above 300 at +6, shoot another 2uR. If he's above, say, 400...try 3uR. You'll have to let the numbers guide you -- and be around to test his response to a higher dose. You don't want him dropping more than 40-50 points an hour from the R. Otherwise you can set up a bounce, and then you'll shoot more R to counteract the bounce, and get caught in a vicious cycle of R, bounce, R, bounce, etc...
