HELP! Dosing advice needed.

[Mel Harvey]

Hi.

I am so lost. Apologies that this post is somewhat of an incoherent ramble.

Oliver's Freestyle Optimum Neo glucose monitor arrived 6 days ago so we have been testing twice daily since then. (Please note - In his spreadsheet the readings from May 22 and May 29 were from the vet, using an animal glucose monitor, so I acknowledge these will not be aligned with the monitor we are using now.)

On previous advice from members in here, we had decreased his dose to 1 unit twice per day from the vet's initial 4 unit dose (which we had been told to increase to 5 units).

Based on numbers in the high yellow area, this morning I gave him 2 units (I am in Australia and it appears we are unable to purchase syringes that will allow accurate drawing of half or quarter units.) And now tonight his reading is even higher 22.9mmol/L (412mg/dL).

I am very concerned/worried/upset that his readings appear to be going in the wrong direction. Oliver eats no kibble, has between 5 and 10 individual pieces of Ziwi Peak air-dried lamb and is currently eating Tiki Cat Seafood selects canned foods as he was refusing to eat the Fancy Feast pate's. Every couple of days he has vomited stomach bile - which I assumed to be because he was hungry due to refusing the FF canned food. He is otherwise his normal self.

Is this normal? Is there something I am missing?

 

[Bron and Sheba (GA)]

Previous thread for continuity https://www.felinediabetes.com/FDMB...llie-melbourne-australia.278266/#post-3077967

Hi Mel,
Looking at the spreadsheet, I can see you are not getting any tests in during any of the cycles. It is really important to do this because we need to see how low the dose is taking Oliver each cycle. And dosing is based on the nadir, or lowest point, not the pre shot BGs.
Oliver could be dropping low each cycle and then bouncing back up at the end of the cycle and unless you are testing you will not know.
I am going to give you some information about bouncing, which Oliver could be doing. Just looking at the tests tonight he has dropped from 412 to 283 in one hour. That is enough to trigger a bounce. Please keep testing tonight to see how low he drops.
If he is bouncing his numbers will shoot up for up to 6 cycles and there is nothing you can do about it. Getting those all important tests in during the cycles will help us work out what is going on. Remember he is a newly diagnosed kitty and it takes times for him to settle into having insulin.
Here is information about bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

With SLGS you hold the dose for 7 days then do a curve to see if you need to increase. Then based on the numbers, you either increase by 0.25 units or 0.5 units. Increasing by 1 unit each time is too much. I know you can’t get 1/2 unit syringes in Australia but that did not stop me using them and measuring 1/4 unit increments for several years. You just need a magnifying glass and a good light.
Feline diabetes can’t be rushed and if you don’t follow a dosing method you will have numbers all over the place. It really is a case of slow and steady wins the race.
I would recommend you post each day for advice and support. You can start posting over on the Lantus page now that you are all set up. There are a lot of people there to help and support you who are going through exactly the same things as you.

In regards to the food, are you giving him snacks during the cycles as well as the pre shot meals?
Has he got access to food when you are at work?
If he is vomiting bile, he might be going too long between snacks. He needs to eat well, so if he won’t eat the FF food it is fine for him to eat another low carb food.
I would encourage you to post each day instead of worrying at home …we are very used to seeing what is happening to Oliver in newly diagnosed kitties and if we can see more BGs in your SS we can help you a lot more.
I would also use the remarks column of the SS to tell us what food he is eating each day, if he seems well, alert, etc.
Bron