increased dose ≠ lower numbers

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Marshmallow's Mom

Marshmallow's Mom

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I have noticed on some other spreadsheets, as well as Marvin's, that an increase in dose doesn't correspond with lower BG numbers. Why is that?

For example, when Marvin was on 1.0 and 1.5 units early in the month, he was as low as 220s mid cycle. But now, with 2.75 units, he is quite a bit higher. His diet has overall improved as well. Especially these last few days with all low carb Fancy Feast and no bad treats.

Thank you for any information.
 
There's rarely a clear and straightforward path to better numbers. There's an allowed variance of 20% in the way meters give readings so your numbers in the 220s and those in the 260s are essentially the same. The few yellow PMPSs you had at the lower dose aren't really relevant any longer and the majority of your other PSs are pink so they're more representative of what's going on.

Your SS values show that he's responding to the ProZinc because his mid cycle BGs are lower than PS. However the BG range at PS and mid cycles shows that you need to keep increasing the dose carefully. You can actually increase by 0.25 u after three cycles until you see yellow PSs and blues mid cycle. At that point you might be able to slow the rate of dose increase somewhat.

It would be very helpful if you'd set up your signature with some basic information.

Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
 
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Oops...I was typing and just saw that Kris posted. I agree with what she has said, and would add:

I can't give you a science explanation, but I can tell you patterns I've seen.

One reason (and this is the saddest one), is that the longer a cat is in high numbers, the more damage is being done, so they need more insulin to get the same results that they used to get on a lower dose. This is particularly true for cats who have been diabetic closer to a year though, so less likely in Marvin's case.

Another thing we've noticed is that many cats seem to have a "breakthrough dose". So they'll go up and up and up in dose, and it seems like nothing is really happening, or they'll just occasionally have a good cycle. And then all of a sudden they hit a breakthrough dose and start getting more and more good cycles and the insulin need starts to drop and drop. This is a pattern we see a lot. If your cat is under three months of diagnosis, this is what we really hope is happening.

NDW: New dose wonkiness. Sometimes the first few cycles on a dose are just weird. The numbers don't make sense. And then the kitty settles in and you can see what the dose really dose. This is seen most often when a cat is in good numbers, and close to being regulated. Sometimes the dose change bring strange results.

Other health issues: Sometimes there is an underlying health issues, often undiagnosed, that stops the cat from responding well to the insulin. It may be a high dose condition (Acro, IAA), pancreatitis, triaditis, IBD, a dental problem (super common cause of this), etc. Any number of things. Any type of inflammation, infection, or irritation can impact the BG numbers and make them "stick" up in higher ranges. If the underlying health issue can be discovered and treated, the BG and insulin need often improve.

So basically there is no one simple answer to why that happens. My hunch in Marvin's case is just that it's early and he hasn't reached his breakthrough dose yet. Kris' suggestion for dose increases is a good one, and the best thing to do at this point, in my opinion.
 
Thank you Kris and Djamila! This all helps tremendously.

I fear that Marvin had diabetes for some time before being diagnosed. He had a terrible bout of irritable bowel started in January after having a dental procedure. The diarrhea cleared up immediately once I got him on insulin. We had tried several other things - antibiotics, prednisolone,...

I'm trying to get all my information straight as the vet tech called this morning to check in on Marvin. They had said I could increase to 1.5 a few weeks ago. And I haven't been corresponding with them since that time and just going on my own here. And the vet tech was pretty adamant about my talking to the vet because of all the complications of Marvin going too low. The vet himself is going to call soon to give me his opinion on whether I should increase. It's nice that they care and are helping. I emailed them my spreadsheet. We'll see what he says.

Thank you again for helping. I updated my signature.
 
Like @Kris & Teasel and @Djamila numbers are doses are really confusing and hard to explain honestly. My spreadsheet is a perfect example. NY boy was on 2units for quite some time and didn't really see any inprovments, then we raised his dose a couple times, then lowered it and then ended up back at 2units which at the time I didn't think would work because he wasn't getting good numbers with that amount before, but that time he did. Their bodies just start changing so a dose you are at now might not work as well as it may in the future.
 
I'm wondering, what are the pros/cons of waiting longer to increase a dose? Especially wondering about the cons.

My vet has informed me he prefers to wait 7 days on a dose before increasing. I believe his concern is about missing the 'breakthrough' dose that might not become apparent until after several days. However, many of you have recommended about 2 days (3-4 cycles).

I don't want to upset my vet (he's wonderful), but at the same time, am I causing more harm to Marvin by dragging this out?
 
The two big cons are 1) the longer you take to get to a good dose, the longer the cat is sitting in high/damaging numbers and 2) some cats will get "stuck" if they sit at one dose too long, which then necessitates even more insulin to push them off of their stuck-ness (how's that for technical jargon? ;))

Maybe compromise with your vet and do changes every 4 days? Once you get into better numbers, the changes slow down, but when a kitty is sitting as high as Marvin, we start to worry about developing DKA.

One other thing: the vet/prozinc manufacturer protocols usually call for dose changes of one full unit. We recommend smaller changes more frequently, but the ultimate difference doesn't end up being all that big. We've just found it more effective to move a little quicker, and we've found that full unit increases lead to bouncing - and it's that bouncing that requires the slower changes. We minimize the bouncing (although a little bit is inevitable in this dance) so we don't have to hit pause as often or as long.
 
Thank you Djamila. I think tomorrow morning I will move from 3.00 to 3.25 and see where that goes.

I don't understand the "stuckness" technically, but it seems that his system is fighting back the increase in dose! It's like his numbers are getting higher with the increases.
 
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