it's really hard to know what to suggest, Amanda. Let me throw out a few thoughts for you to consider.
I see you started new insulin on 12/20. While she was already having some pink numbers by then, she definitely got worse after that point. Where did you buy your insulin and do you have another pen/vial that you can switch to and see if it makes any difference? Often when we suspect the insulin, it's just fine, but we just had a situation this past week where Ozgood's insulin had come from Wedgewood Pharmacy and had been repackaged and was definitely bad. When they switched to a new 1ml vial it looked like they were shooting water and nothing was happening. In some ways, that's what it looks like with Lee Lu. As though she's not getting insulin at all right now. Insulin should come only in 10ml vials or 3ml pens or cartridges from Lantus. Some people are buying from Canada, off of Craigslist or elsewhere. You increase your risk of something going wrong if it's bought anywhere except directly from a local human pharmacy.
Are you familiar with
Glucose Toxicity? When I look at Lee Lu's ss, I see that in November she was doing really well at about 1.5u. So I wouldn't assume at all that 1.5u is too high. Once a cat gets into higher numbers and their body gets used to it, going up in dose is about the only way to bring them back down again. How she was in November is a world away from how she is now, and even if the 0.5u was a good dose in December, once her body has gotten used to these high numbers, typically the only way to overcome glucose toxicity is to go up in dose until you hit a breakthrough.
Another thought is that it's still possible she's going low at night and bouncing every day. Some cats do that. Wendy's Neko earned all of her dose reductions in the night cycle for months - for her, not just night, but really early morning. My guess is what you're thinking by saying you want to reduce the dose is that you think Lee Lu is overdosed, and that is what's causing her high numbers. That is possible, too.
It's also possible that she's underdosed now. When I look back at how well she was doing on 1.5u in November, and then she worked down the dosing scale until she lost regulation at about 12/7 at 0.5u.
The other factor here is the peeing. It's possible she doesn't have an infection, but instead has sterile cystitis. That is fairly common and can cause pain and inflammation, but it is not an infection. Pain relief (bupe) and fluids to dilute her urine are helpful for it. Look here at
"Where Can I Find?" and scroll to the bottom and look for UTI's by Dr. Lisa for some help on that topic. It may be that her urinary issue is directly connected to the blood sugar issue.
If I were guessing, I'd think that she was being dosed appropriately in November. Something happened in December - she developed a UTI and/or the insulin isn't effective like it should be, and then she's not getting enough insulin after that. Skootching up in dose rarely works - instead of going from 0.5u to 0.65u, if you need an increase it often works better to go by 0.25u increments. I think at that point she likely has developed Glucose Toxicity.
If she were mine, I'd read the info above, talk to the vet about sterile cystitis and getting pain relief for her. I'd also switch to another thing of insulin, but I wouldn't reduce the dose. I know the relaxed group was in love with resetting the dose, but i've rarely (never) seen it work. From the
Tilly Diabetes Page,
"don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy) hyperglycemia."
Phase 2: Increasing the dose
Most cats need to have their dose increased. Do it in 0.25 IU or 0.5 IU steps (0.25 IU if the cat is getting a low dose and/or relatively low BGs, 0.5 IU if the cat is getting a higher dose and/or relatively high BGs). Hold each dose for 5-7 days. However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose). From this point onward test for ketones once per week, or more often if the nadirs are still >=200 mg/dl.
Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations.
It is likely, because of the way Lantus and Levemir work (they appear to work for >12 hours, therefore producing overlap between doses), you will face the problem of having a low pre-shot BG and wondering what dose you should give. Try reducing the dose the first few times to see what happens - in all likelihood the cat will have higher BGs as a result. A second alternative is to feed the cat, wait 1 to 2 hours, test again, and when the BGs start rising, give the normal dose. A third alternative is to split the dose: feed the cat, give most of the dose immediately and give the remainder 1 to 2 hours later when the BGs start rising. However, in most cats none of these alternatives have shown themselves to work as well as consistent dosing. You will have to learn how your cat reacts to Lantus/Levemir before you determine the best way to deal with this problem.
Try to find a way to dose as consistently as possible, time-wise and dose-wise: sliding scales don't work. Don't skip shots. Fluctuations are very common in this phase before BGs start to stabilize under consistent dosing: a typical curve of cat over the first 1.5 months on Lantus can be seen here.
When the cat first begins to have daily nadirs in the normal range of a healthy cat (50 to 80 mg/dl) and spends significant amounts of time in this range each day, stop increasing the dose and switch to Phase 3. It doesn't matter when you measure these lower BGs, it can be at pre-shot or sometime between shots. Getting to this point generally takes 1 month, sometimes a lot longer. Cats are extremely variable in terms of the maximum dose they end up requiring: they have ranged from 0.5 IU to 10.0 IU BID in the German forum, with most cats lying between 1.0 IU and 5.0 IU BID.
Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
Hopefully, this has given you some things to consider that will help you get Lee Lu back into better control. Keep asking questions, Amanda! She'll get there.
