OK. It's valuable to know that Jai Jai's BG was very high last night and that it seems to have recovered a bit today. It gives some pointer that there is probably still a fair amount of insulin in the depot looking at this morning's cycle.
OK. Here's my take.
Skip the next shot to let the build up (called the depot) drain somewhat. Reduce the insulin dose to 0.5 units ASAP. It will take a minimum of 3 days to stabilize at the new dose and may take up to 7 days.
I very much agree with
@BJM's analysis of Jai Jai's data. If it were my cat I would reduce the dose to 0.5 units of Lantus and hold that dose for at least 5 and probably 7 days (unless a dose reduction was indicated in the meantime in which case I'd reduce the dose further as appropriate). I would also diligently monitor urine for ketones as part of normal diabetes management good practice.
Here is my reasoning:
- First and foremost, the safest dose you have given Jai Jai to date has been 0.5 units.
- Too much insulin can produce hypos.
- Too much insulin can result in high numbers as the cat's body works to dump glucose into the bloodstream to prevent hypos (i.e. too much insulin can sometimes look like too little).
- Looking at your spreadsheet, for doses of 1.0 IU Lantus or greater, Jai Jai has either gone too low or has remained in high numbers much of the time (for the test data available). Also his data for a 0.75 unit dose is ambiguous (may have been too high).
- Jai Jai has had
FIVE known hypo events at doses of 1.0 IU or greater.
- It took a lot to raise Jai Jai's blood glucose back to safe levels last night.
- Jai Jai has just had a hypo in the last 24 hours. I think the 'hiding' in the litter box may have been evidence of a symptomatic hypo (some cats lose control of their bladder/bowels when they are low). This is conjecture, but what if Jai Jai *felt* he might be about to go to the toilet when he went into the litter box last night? Cats may be much more sensitive to insulin after a symptomatic hypo. Even though Jai Jai may have 'got away with' 1.0 units recently, the possibility that his insulin sensitivity may have increased is yet another risk factor that should be considered when deciding whether 1.0 units is still too high a dose.
- Per Roomp-Rand Tight Regulation Protocol guidelines, a starting dose of 1.0 unit is right for a cat of Jai Jai's weight - BUT - the 0.25 IU per kg formula is for
a cat that has not received any insulin treatment at all. The protocol has a modifier for starting doses when a cat has previously been treated with insulin, viz. any data on the cat's previous response to insulin MUST be considered when determining an insulin dose, and the starting dose should be adjusted accordingly to make sure it is safe. (Saoirse, for example should have started at 1.0 unit Lantus for her bodyweight, but I agreed with our vet to start her at 0.5 units instead because we knew from her Caninsulin data that she was very sensitive to insulin. This worked well, and kept Saoirse safe. In fact, Saoirse never got as far as needing 1.0 units of Lantus. She actually only had four cycles on 0.75 before I needed to reduce her dose back down to 0.5 units again.) You may be 'starting over' but you're not 'starting from scratch': 1.0 units may now be too high a dose (and the data supports that possibility).
- You may see higher numbers after the hypo from bouncing. Also Jai Jai's numbers may still be influenced by the carbs he got at the hospital. (No way of proving that until the data is in but if it were my cat I would err on the side of caution and treat the current numbers as though they may be temporarily 'falsely' elevated and dose conservatively to be safer).
- It may take several days for any bounce to clear. But it
will clear. Some cats take longer than others.
- Going back to 0.5 units is a better safety hedge. If after the dose has been given a longer time to settle Jai Jai's numbers need improvement, the dose can be increased again. (NB: Looking back at Jai Jai's data, for where he was earlier in his treatment I think somewhere between 0.5 and 0.75 IU may have been his 'goldilocks' dose. Sometimes even the 0.25 unit increases are too big, especially in cats that don't need a lot of insulin.)
I have always had a very conservative approach to treating my cat with insulin. It has served us well and kept her safe. Tight Regulation is a very aggressive treatment protocol. For Jai Jai's safety I wanted to give you an alternative view to consider. Again, I say that I fully support BJ's analysis of Jai Jai's earlier data. She has much more experience than me, and if I were in your position I would give her advice serious consideration. Other members may have very different opinions for you to consider.
You hold the syringe, Hollis. It is for you to decide whether 0.5 or 1.0 units is the dose you wish to give. Whatever you do decide, we will be here to support and help you both in any way we can.
Mogs
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