Just want to make sure you've had a chance to read back through all the comments above. Lots of good information there, but when it's coming at you fast and furious it's really easy to miss posts.
Is there any dry food at home? Any chance at all that he's getting any?
At 5kg his dose would be 5.3 x 0.25 = 1.3
It may be that his high numbers are from him being overdosed. That does happen. There are also some diabetic cats who need more than the average amount of insulin (mine was one of them). The best way to know the dosing is correct is to start at a small dose and adjust per the protocol, in 0.25u increments and with enough days in between dose increases.
Are you able to vary the times you get tests? If you think of the spreadsheet like a jigsaw puzzle, when a person has a sprinkling of pieces throughout the puzzle, you can get a pretty good idea of what the picture is. If you have only the edge pieces, you may not be able to tell anything about the picture.
With only stripes down the spreadsheet, it's hard to know what's going on with Rupert. For safety's sake, we always encourage a preshot test - both cycles, every single time you give a shot. Then to get a picture of what the dose is doing, we suggest a test somewhere in between those 2 shots. Different cats have their low point (or nadir) at different times in the cycle. So until we know more about what Rupert is doing in the middle of the cycle, it's going to be most helpful in deciphering his puzzle if you can mix up your testing times.
For the moment with his dose, Wendy & I had a chance to talk about it and are suggesting you drop back the dose to a starting amount - 1.25u or 1.5u and then hold it there for 6-10 cycles unless you catch him under 50 - i think that's about 2.8mmol. We do use the US numbers, as I mentioned, as our common language, so wer're going to need to get your US page fixed. Marje is great at getting these back on track, probably in just a few minutes.
From the Rand/Roomp TR Protocol:
REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
- Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
- It will be necessary to test kitty's blood glucose levels multiple times per day.
- Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
- Feed a high quality low carb canned or raw food diet.
- Feed small meals throughout the day. Some kitties adapt well to free feeding.
Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
(Revised 10/28/2013)
"General" Guidelines:
- Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
- Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.
You might see higher numbers at first, but if you choose to reduce his dose you'll want to hang with it for at least the 6 -8 cycles (3-4 days) to let the counter-regulatory hormones and stored sugars clear out of his body. After about 3-4 days & some varied test times, we should be able to help you figure out the next step with his dose.
Here is the spreadsheet of a kitty that arrived at FDMB overdosed, on 10u of insulin:
Teronto's BG Log What to notice here - on 10/6 he was receiving 10u of insulin per shot and all the blood sugar test results were high. They dropped his dose to 1.0u on 10/7 and it took until 10/11 to get a blue number and 10/12 to get a green number. The blues/greens are more normal numbers. So he had 4-5 days of everything still high after they decreased his dose before the hormones cleared out and the cat's body stopped overreacting too the too high insulin dose. At that point they began adjusting his dose based upon the tests and he stopped needing any insulin after 10/21. That doesn't happen to every cat, but it does happen.
For small dosing, the skinnier the barrel of the syringe is, the easier it is to make these small adjustments in dose. Cats can have a very strong response to even a tiny amount of insulin, so most adjustments are done by the quarter unit. Ordinary reader magnifying glasses will help and if you have prescription glasses you can also "stack" a pair of reading glasses on top of your regular ones. Having a light behind the syringe can help.
What is most important with dose is that your dose can be repeated fairly accurately at each shot time. It doesn't matter if your 1.25u is the same as someone else's. It only matters that you know what you are measuring and are able to repeat it at the next shot, and then able to increase or decrease the dose as needed. Some people do a sample syringe with colored water/tea/coffee and hang on to that to use as a comparison model.
What would you like to do next, Laura? The choice is yours. You'll find that people here will respond fairly quickly to your questions, so please ask so we can help you learn whatever seems confusing.
