Is this bouncing?!

[fluffles5178]

I just increased to 4.25 units twice daily, but it almost seems like too much now. The HI readings are coming in now, and I’m worried. I have tried to get mid-cycle readings when I could, so please go easy on me. I’m thinking maybe I should back off a bit (maybe to 4u) tomorrow. Thoughts?

 

[MrWorfMen's Mom]

I know we sound like broken records about mid cycle testing but quite frankly, without it, it's impossible to know what is going on. It's quite possible that Fluff is dropping a lot lower than you are aware of on some occasions and then bouncing up high again and those highs can last for 3 days. This leads to a perpetual roller coaster and what can look like persistent hyperglycemia.

When we speak about mid cycle testing, that test can be at any time during the cycle. ANY mid cycle testing will help but you have a lot of days where no testing is done other than pre-shots and that doesn't tell you much other than it's seemingly safe to give insulin. The question is not just whether to give insulin but also how low the dose is going to drive BG.

How is Fluff's feeling overall? Is he purring, playing, preening, peeing, pooping? Has his urine output changed at all from when he was diagnosed? Does he hang out by his water bowl? How is his appetite? When is the last time you had the vet check his teeth as that often causes elevated BG.

Given that your vet started out at 1u but then increased in full units at the beginning, I have to still wonder if the dose is way too high. I would expect that we'd have seen some low numbers at some point in time if that were the case but without more mid cycle testing and all the unknowns that leaves, it's still something to consider. I do find it interesting that the pre-shot following skipped shots always seems to be reduced rather than elevated as would be expected.

With those persistently high BGs I'd suggest testing for ketones regularly and reduce the dose back to 4u and see if numbers improve. Right now it looks to me like the numbers were better somewhat better around the 2u dose.

It's possible Fluff could have a high dose condition or that the ProZinc just isn't the right insulin for him but without more mid cycle tests to truly see what is happening, all we can do is guess.

I'm tagging @FurBabiesMama to ask for another opinion.

 

[FurBabiesMama]

This is a hard one. I looked back at a previous post where you had dropped to 2 units for the PM shot on 9/21, and I suggested holding that a few days (at least 3) and getting in mid-cycle tests then increasing by 1/2 unit if the numbers remained high. It looks like you have roughly followed that method, going up by 1/2 unit at a time, ever since. Though sometimes you held just two days and other times over a week. There is not as much mid-cycle data as I would like to see. When you are trying to figure out a tough case like this, you REALLY need data from every possible cycle. There are so many cycles where we have nothing. With what you do have, I feel like we should see at least some low number somewhere if the dose is too high.

I have the same questions as Linda - how is he doing? Still eating, drinking, peeing as much? Also, how old is the ProZinc vial you are using? Do you keep it refrigerated and roll it before drawing any insulin out? Does the insulin still look okay (a little milky, no floaters)? When did he last have bloodwork and an exam? There could be something else going on with him that is elevating his glucose. Have you talked with your vet recently about how high he is staying?

Definitely be sure to check for ketones with him running this high, and get in whatever mid-cycle glucose tests you can so we can get a fuller picture.

 

[fluffles5178]

Thank you both. He is still really hungry and eliminating outside of the box here and there. He is purring and has the neuropathy still. He began grooming here and there, too. I know I need to get more mid-cycle numbers. He has a checkup at the vet on Monday. I scaled back to 4u this morning and am interested to see what his pre-shot reading is. It does seem like we had some better numbers when he was on the low to mid 2’s. I just want him better!!