Hi Jenny!
Great job getting the spreadsheet set up!
I think it would help to understand a little more about the process of getting regulated. Dogs are very easy to regulate. A vet will keep the dog for a few hours, inject insulin and measure the blood sugar drop that results over the next few hours. You get a dose to give your dog, and for the next 6 months or so, that's the dose the dog gets til the vet checks the dog again. If you see signs of hypo, a little karo syrup brings them up. I have a friend whose dog was diagnosed while Punkin was still alive - so probably 4 years ago. She's been giving her dog the same dose since then, and I think twice has had to give Karo to the dog. She doesn't hometest at all.
Cats, on the other hand, are an entirely different beastie! They have a several quirks that make it so that particular process doesn't work for them:
~ when the Lantus or Levemir dose is increased, the cat's blood sugar sometimes will rise for a day or so after the dose increase. We fondly call this "New Dose Wonkiness." No one knows why this occurs, but it goes away on its own so you just wait it out.
~ a cat's body will accept whatever blood sugar level it is used to as normal. It looks like Grady is spending some time over 300 - if so, then that's going to be the level that his body now thinks is its norm. That's called Glucose Toxicity - sounds worse than it is. Nevermind that a non-diabetic cat has blood sugar in the 30's-60's range (on a human glucometer, around 50-80 on your pet meter). When you give insulin and that drops the blood sugar out of the 300's, Grady's body is going to think that he's having a hypo - even if it only goes to 200, which is still too high. His body will release stored sugars and counter-regulatory hormones to bring it back up over 300, where the body now thinks it is safe. That can often shoot a cat's blood sugar to 500 even. We call this a bounce - and it can last for as long as 3 days. The body will eventually clear out those hormones and sugars and then the blood sugar will drop back down again.
Those high bounce numbers do not signify that the cat needs more insulin. This is a time to wait and see what happens when the bounce "clears" so you can see accurately how low the cat's blood sugar is capable of going on that dose.
~ cats also have the ability to have their pancreas heal and potentially begin putting out insulin again. That is unique to cats - once dogs are diabetic, it's rare (impossible?) for them to become diet-controlled and for their pancreas to heal. If a cat's pancreas begins to heal, then they need less insulin injected. That's critical - cats don't stay at a dose endlessly like a dog might.
~ in a cat not enough insulin can cause high numbers. Too much insulin can also cause high numbers - which is so very counter-intuitive! The numbers can look exactly the same - which is why we look at the blood sugar tests in context to figure out if a cat might be overdosed or underdosed when they get here. Where the dose increases done appropriate? Long enough interval in between? Small enough dose increases? What is the cat eating? Are there any other concurrent conditions that might make the cat need more insulin? Are there any meds that could be raising the blood sugar and therefore causing the cat to need a higher dose?
~ in a carb-sensitive cat, we have seen it documented that even 3 pieces of regular dry cat food - 3 little crunchies - can raise the blood sugar by 100's of points and can keep it there for even as long as another day after they ate the food. Conversely, when a cat is switched from dry food to low carb wet food, their blood sugar can drop significantly, thereby lowering the amount of insulin they need.
~ in a sensitive cat, the stress of vet visits can also raise a cat's blood sugar by 100's of points.
One thing that we frequently see here is that vets have gotten the word that the depot insulins (Lantus and Levemir) are excellent for diabetic cats, but they might not have enough experience with them to realize that the dosing strategies are different than what was done with the older in-and-out, non-depot insulins.
To know what to do with the dose, you have to be able to answer the question "how low does this dose make my cat's blood sugar go?" Low numbers are the most dangerous ones - so knowing the answer to that question is very important. The difficulty is that sometimes, if a cat is bouncy, the low point might only show up every 3 days! That might or might not work if you're testing for 1 cycle once a week - what if it the cat is in a bounce and the low numbers were the prior day? The way to get the "just right" dose of insulin is to start with a lower dose, and increase it methodically by small amounts - 0.25u to 0.5u - slowly enough (roughly every 3-7 days, depending on the test numbers) and gradually work up until the cat is getting into normal numbers at the lowest points on a dose, under 130 or so on your pet glucometer.
I hope some of that illustrates why people are suggesting what they are. Getting regulated can take weeks, if not longer. It is the rare cat that has it happen quickly. Literally thousands of people have learned how to take care of their diabetic cats on this message board.
I'd encourage you to go ahead and switch to a cheaper human glucometer. I just put some information on saving $$ on
Cricket's thread - maybe some of that will also help you.
As far as his dose, if you can create a situation where he can't get any dry food, then he will likely need less insulin. I feed my 3 cats (all not diabetic, we call them civvies, all on low carb canned food) in 3 separate rooms. Get 3 bowls ready, put one down in the laundry room for Frodo (starving but slow eater), one down outside the laundry room (McGee voracious) and one in a bedroom (Anya, would like to come back and graze, thank you very much) - after 10 minutes or so I open the doors and let everyone out. You might see if you can do something like that with yours so Grady doesn't get access to any crunchies.
Insulin is so powerful - I want to encourage you to get switched to the human meter asap so that you can test him prior to every test. That will only catch the high points, because cat's blood sugar is typically highest at shot time when the prior dose has mostly worn off, but at least you will know he is high enough to get insulin. To be able to answer the question "how low is this dose taking him?" you'll need to catch a test in between the shots. Many, many cats have their lowest numbers in the pm cycle, so we often encourage people to grab a test before bed. The only motivation we have for encouraging you to test at home is for Grady's protection, based upon what we see here every day. Just because he's been high in these 3 cycles doesn't mean that he stays high all the time. He doesn't. Cats' blood sugar goes up and down and up and down.
Here is a link that will help you find information that we use frequently in this group "
Where Can I Find?" You might want to look through it and bookmark it for future reference.
You're off to a good start! You're here, you've got a great insulin, you're ready to learn! Keep asking questions and we'll do our best to help you learn how to help Grady!
