Looking for some dosing advice

[Melissa and Celle]

Could someone please look at Celle's spreadsheet and see if this pattern as we raise the dose is ever typical for a high-dose kitty? I suspect that she's rebounding from too high of a dose because things are getting worse as we increase the dose. But I'm afraid to decrease because we suspect she may be an acrocat.

Here's a graph of her pre-shot values.

 

[Dragonnns]

I think she isn't getting enough insulin. Her nadir isn't that low (still well above 150) for an acro cat and her highs are very high. I'd bump her up as Gayle recommended.

Also what do you feed her and when?

 

[Blue]

You are not increasing too fast or by too large of increase - the dose needs to be raised.
Just curious why you think of rebound?

 

[Melissa and Celle]

Just curious why you think of rebound?

It looks like rebound to me because we got similar nadirs with much lower doses and we didn't get the bounce to such high numbers afterwards. The curve just keeps getting steeper. We just didn't see 500s except at the higher doses. I think it's rebound from a steep drop rather than from a low nadir.

Also what do you feed her and when?

She free feeds Fancy Feast <5% carbs.

Also, to be clear, I'm not sure she's an acrocat. If I knew for sure she was, then going up would make more sense. I'm just wondering if someone could point me to an acrocat spreadsheet that showed similar results, where things got worse before they got better on the way up in dose.

 

[Blue]

Every single cat is different. There was an acrocat who always had bg numbers in the 200s, from low dose and it stayed the same up to 30u, 40, 50u, 60u, ..... always 200s.
One of my acros shortly after I adopted him, on a dose of 3u Lantus, one shot started at 403, dropped to 113 at mid cycle and then was up to 445. People accused me of giving him too much insulin, claiming rebound, so I dropped to 1u and started over, but the numbers just got worse with 500s for ps values. His dose tonite was 25.5u - he tested positive for acro and IAA.
My other acro had 513, 169, 414 on a shot of 3.75u. She tested positive for acro and her dose tonite was 15.75u.

It is for this reason that I suggested you increase the dose.

Some cats fight the lower numbers - think of putting your shoes on the wrong feet and being told that is how you should have been wearing your shoes all the time. It feels wrong and it would take some time to get used to the new way. Your cat has grown used to the high BG, so when you give insulin and it pulls down to decent numbers, your cat feels that something is wrong very wrong. In time, the more your cat spends in the lower numbers, it will feel better and you will see less resistance.

Your nadirs are far from a big low, so you have room to increase the dose. if you are concerned about the drops being too steep in the front of the cycles, try food to slow the drop. If you give a spoon of food at +1, +2, +3, you may see a slower drop as you are steering the curve with food.

 

[Melissa and Celle]

Some cats fight the lower numbers - think of putting your shoes on the wrong feet and being told that is how you should have been wearing your shoes all the time. It feels wrong and it would take some time to get used to the new way. Your cat has grown used to the high BG, so when you give insulin and it pulls down to decent numbers, your cat feels that something is wrong very wrong. In time, the more your cat spends in the lower numbers, it will feel better and you will see less resistance.

So do we need to hold each increase longer so that she has time to get use to its effect? With Celle we are absolutely not seeing less resistance as she spends more time at the lower numbers -- we're seeing more.

Celle free feeds, so it is hard to steer the curve with food, but generally she eats most of her food in the first half of the cycle. After that point I stop putting down any fresh food, and she tends to not eat much at all.

 

[Blue]

try spreading out her total food. I used an auto feeder, 5 compartments. With a feeder, you can ration out the foods so that everything is not eaten right away. Diabetics do better with food spread out evenly and you may see some numbers level a bit.

I would not hold the doses longer; follow the protocol and keep going up the dose ladder.
When are you having the tests done for acro and IAA?

 

[Blue]

The BG numbers should dictate the dose, not if a cat is acro or not. There have been cats that reached a dose of 6u but finally healed - Randi/Max is a perfect example.

Acros have functional pancreas, so their dosing needs change all the time. One of my acros has been as low as 2.75u and as high as 17u. It all depends on GH output.

 

[Punkyp]

This is all excellent advice.. I'm still learning too!