My natural inclination at all times is that I have to DO something or FIX something. I know that I have to be patient. It is comforting and such a relief that I can keep coming back here.
That's a totally understandable inclination, and makes us all happy to read it. The patience thing has got to be the hardest thing for anyone to deal with.
It just dawned on me that I haven't even consulted our vet about this.
That is very common. ;-) That said, you should consult with the vet, and balance his advice against what you are getting here. He might suggest something we haven't thought of in the way of tests he might be able to do? My hunch is that he will advise you to increase your dosage, because it seems that vets tend to be a lot more aggressive than we are when it comes to increasing and with increments of increasing or decreasing. Many of them don't realize, or don't have experience with dose adjustments less than a unit or a half-unit at a time.
This past four days I have noticed that the water intake/urine output has increased again. Not as much as before we started the insulin, but that kitty litter pail is pretty heavy.
Observations like this are very important, and can help us in figuring things out. Good or bad, what your eyes see beyond the display on your meter are indications as to whether the condition is improving or not. Reading this leads me to believe that things aren't getting better quickly. And that's okay, but important to note and consider.
Now for the questions about dosage...
I'm including some info and a link about "glucose toxicity" because I think it's a huge factor in a case like Lucy's. I look at her SS, and I can see where she's had a decent reaction to doses of both .6 and .8 in the past. Good amount of drop to lower blue numbers, but not too much of a drop. It looks like she does okay for a few cycles, then you get to flat cycles with overall higher numbers.
As the disease progresses, I think that insulin needs change, of course. But sometimes, instead of less insulin being needed, they can reach a "stalling point" and end up needing more juice for some time. I think the key is the point at which healing occurs that enables the pancreas to do what it's supposed to do. According to the link here, the magic number seems to be "300"?
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=62960
Glucose toxicity occurs frequently in type 2 diabetes. When profound hyperglycemia (blood glucose > 300 mg/dl) is persistently present, pancreatic β-cell insulin release is downregulated. In the presence of underlying insulin resistance, this contributes to progressly greater hyperglycemia and may lead to ketosis.
Glucose toxicity can be reversed by aggressive treatment of severe hyperglycemia with insulin. The goal is to return blood glucose to near-normal values for several days or weeks to allow restoration of islet-cell insulin production.
What follows is "MY opinion". I'm not a vet, I'm not a scientist, and I'm in no way shape or form an "expert". I just read a lot, I spend hours every day on the board, and when I see something I don't understand or a question I can't answer, I do my best to explore and learn. I HATE feline diabetes. It's a maddeningly confusing disease. I HATE "ECID". They shouldn't all be different when it comes to treating this. There should be a magic freaking pill and a clear cut set of instructions to follow that just fixes the damn thing. Even more than the pain and suffering it causes the kitties, what I HATE most of all is what it does to the care-givers. It drives people crazy, and makes them feel so inadequate because this is THEIR baby, and they can't just make it all go away. To many of the people who come here, these cats are no less important to them than a human child would be. Some have never had children, or there all grown up and moved on, and their dear kitties ARE their children. And then they are diagnosed diabetic, and the care givers for the most part are faced with advice and treatment options from a vet medicine community that is either un-trained or under-exposed, or hopelessly "not current" with FD management, and in some cases is just as "lost" as the beans are. I don't blame or find fault with that. If I were a vet, and I only saw 2 or 3 cases of FD a year, heck I don't have time to study all the latest scientific studies and papers, and even if I could, my head would EXPLODE if I tried to cram all this crap into it.
So, sorry for the rant, but this whole thing just PISSES ME OFF once in a while :lol:
When the BG is above 300 for the majority of time things can't get better, then can only "hold" or get worse. Dr. Lisa, who posts here on occasion called glucose toxicity the "crux" of feline diabetes, and the way she put it was "a kitty who is drowning in glucose toxicity". I agree 100% with her opinion that the most important thing is to put a stop to that, get the numbers below that "line", and let things heal as quickly and early on in treatment as possible.
With a kitty like Lucy, she responded pretty well to a .6u dose, but she was still seeing numbers above 300 for at least parts of the day. And all the 300s and 400s can be undoing what the nice low yellow and blue numbers have been doing in healing her body. So you end up with enough 300+ readings, and the dose just doesn't "do it" anymore, because of glucose toxicity making her resistant to that dose. So you increase to .8, and the nicer numbers come back, but there's still 300s happening. Cycle repeats itself. Now .8 isn't enough to do the job. Now you're at a point where you're thinking..."well, she did good before on .6, she's no better at .8 now, so maybe it makes sense to go back to .6u and see if she can still do well on that much...".
My guess is that it won't happen. I don't see numbers on the spreadsheet that scream "hey, .8 is too much, the curves are really inverse". You could argue that they are flat and high, and that one red number in the middle of a cycle looks scary maybe, but really, if you look at the AMPS of 395 and the +6 of 426? They are well within the margin of error on the meter, and are basically the same number. To me, that's just high and flat. And high and flat usually means "more juice needed".
I know what I would do. I would increase the dose every 3 days until I got a green nadir.
BUT THAT'S ME AND I'M NOT ADVISING YOU TRY THIS AT HOME. If Bob were to relapse, or Mullet was dx'd with FD, knowing what I think I know now, I'd be aggressive as hell trying to get the numbers below 300 as soon as possible. I don't care if it took 3u, 5u, whatever. I'd keep trying "more" until I saw a green number, I'd live with the bounces, and I'd be going through test strips like crazy. I would have a "hypo kit" nearby, and I'd know how to use it. And every decision I made would be "all on me".
Now, the conservative part of me would tell you:
I would up the dose to 1u, and try to get tests in the area of +5 to +7 every cycle, to see if the pattern repeats. See if it gives you blue nadirs and yellow preshots like .6 and .8 did. And see if the numbers stay there. That, to me, is the key. If the numbers stay below 300 most of the time, then some healing should be taking place. If she starts to heal inside, then the numbers will stay that low or drop lower. At some point, you reach a dose that turns things around and her numbers will get better at that dose. That's the point where you start to climb down the dose ladder, as she needs less insulin from you because she's producing some on her own, and her cells are healed enough to start sucking the glucose out of her bloodstream and into her cells like they are supposed to.
Help any?
Carl
