Please help. I'm just at a loss and losing motivation. After advice a couple weeks ago, I was recommended on a dose reduction because my boy's numbers were looking pretty wonderful for him and I wasn't able to give full doses. He then hit ~90 and reduced again. Ever since then, his numbers have been horrendous and based on the dosing method which recommends to increase after 3-6 days if the numbers have gone back up. He's now not even close to 200 and the last two days, they've pretty much flat-lined which virtually no dip? Should I be bumping back up to 3U? He was/is on the MPM which is a bit more aggressive which is why I was changing it so quickly (based on advice here) and he seemed to make really good progress and broke through that insulin resistance. Now, I'm just not sure what to do. 3 is too much, 2.75 earned a reduction, but 2.6 sent his numbers sky-high and now 2.75 is flat-line.... What? lol Also, he is eating between 400-600 calories a day (however much he wants. He's 10 lbs and a bit underweight). He has an automatic feeder that gives him 2 cans of FF in 4 small meals throughout the night at 1AM, 3AM, 5AM, and 7AM. His shots are at 10AM and 10PM. His insulin is only about 40 days old, so I'm not too worried about potency.
Also, he has no access to any high-carb food at all throughout the day and night anymore. The other cats are on low-carb wet and when I feed the dog, I don't leave the kitchen until she either eats it all or it gets put up. So I'm confident these high numbers aren't "sneaky diabetic a$$ of a cat" related. He used to sneak food all the time, so we had to make a routine to ensure he doesn't.
Is there any chance of another underlying issue or infection? does he have any other conditions or medications? The numbers/trends just aren't quite adding up to me. If you're totally sure high carb food is out of the picture, like not sneaking into garbage and such, then yes I'd be looking to increase.
He just went through a bout of pancreatitis and had a lot of testing done and everything was fine except for the pancreas inflammation, but he got over that and is great now. He's not on any medications. I'm 100% positive high-carb food is out of the picture. 1+ month ago I would have said I'm not sure, but we have gone through great lengths to reduce the chances and now there's no possibility. There's no cabinets he could get into, dog food is locked away, and our other cats are on low-carb as well. The only thing I can think of is that I broke through his insulin resistance, but he wasn't at that dose long enough to reduce his glucose toxicity, so when I reduced again, I'm like starting back at square-one? Also, no ketones.
Ok, thanks! Insulin resistance and glucose toxicity are two different things. Insulin resistance is generally defined as a cat requiring a dose of more than 1U per kg body weight, and can be tested for. Marley isn't close to that yet. Glucose toxicity results from a cat being in such high numbers for so long that they kind of get stuck up there and need to hit a "breakthrough dose" to start.coming back down...so realistically that's probably what you're dealing with (as am I currently). Looking at your spreadsheet, I don't think you ever truly hit a "good dose". Ideally, all your nadirs would be 90-100 and preshots in the blue range, but it takes awhile for the preshot numbers to come down. It looks like Marley might have bounced 2/4-2/5 then kind of got stuck. I would continue to follow the MPM dosing guidelines, so you've waited long enough at this dose. You can increase by 0.25-0.5U...the "textbook" answer is 0.5U since nadirs are above 200.
Isn't glucose toxicity a reduction in insulin production and increased insulin resistance? I'll definitely increase for tonight. I hate changing so often, but there really isn't ever a time where he "balances out" even if I hold a dose for longer. It seems like I can get a good idea on what his dose is going to do after like, 2 days since he has such high numbers and they don't move unless I break that insulin wall.
Oh I see what you mean. I thought you were talking about officially diagnosed insulin resistance. Glucose toxicity is temporary insulin resistance, yes. I would continue to follow the MPM guidelines. At some point if you're really not getting anywhere, it may make sense to try a different insulin. And if you start creeping up on 5-6U, that's when it might be time to look at other conditions like IAA or acro...but you're not close to that just yet
