? Need advice w/ Jack's dosing- still in the black & dose is now 5U

Jack came out of a 2 year remission in May, and his numbers are still very high - in the reds and blacks at preshot numbers. I've been raising his dose - mostly .5U at a time b/c his numbers are a little scary to me. I increased by .25 yesterday and this morning bumped up another .25U. He needs dental work . (He had dental work 2 years ago but his teeth are bad.) He has so many heath issues that I'm afraid to put him under for surgery. I'm afraid he won't make it. And being broke doesn't give me the best options. Here's my post voicing my concerns - https://www.felinediabetes.com/FDMB...gery-for-jack-w-so-many-health-issues.249971/

I don't know if his numbers are high because of needing dental surgery or if another health issue is doing this now. Could it be acromegaly? He's such a sweet and happy little boy. You'd never know that he has so many issues. He follows me around the house, purring and just wanting love. I'm worried and I want to do the right thing.

I could use some dosing advice. Is what I'm doing now the best I can do until I find a breakthrough dose?

 

Carolyn -

I don't think this looks like the spreadsheet of an acro kitty but I'm tagging @Wendy&Neko so she can take a look.

I think Jack is bouncing. You're getting lower mid-cycle number and they his liver and pancreas are going into hyperdrive. I'd suggest giving some thought to switching to Lantus or Levemir (or one of the bioslimiars for Lantus). You are likely to get better duration since there's overlap between the cycles.

 

I get happy when I see those lower blue numbers, but then he shoots right back up, even higher.

 

That's the nature of a bounce or an indication that you're not getting adequate duration.

 

I agree with Sienne that it looks like the insulin isn't lasting long enough. At his size of dose, I'd suggest Levemir instead of Lantus. Lantus has an acid base that can sting at higher doses. Levemir has similar long last action, with the main differences that typical onset is later (+4) and nadir also later (typical +8). My Neko on Lev didn't like being typical.

Sounds like you might be dealing with pancreatitis too? That plus teeth can contribute to insulin resistance and the need for higher doses. As for whether or not this is a spreadsheet of an acrokitty, I can't really tell. Also, most of the nights there is no test data after PMPS. Something is causing insulin resistance, though not sure what. There could even be some glucose toxicity.

I see Jack has some muscle wasting. That is actually the opposite symptom to what you typically see on acros. They are often build like little line backers with good strong muscles. Growth hormone and IGF-1 (in excess with acros) are muscle builders.

 

He definitely doesn't look like a little line backer! But he does look good right now, with some weight gain that has him looking like the big cat that he really is.
I'll do some reading about Levemir and talk to my vet. My only worry is that I don't always have flexibility with my schedule, so Jack isn't always shot 12-12. I stay within 30-45 minutes (usually) as far as difference in time from shot to shot (if needed), but every 12 hours doesn't always work for me and I'm not sure if Levemir is as forgiving as Prozinc. But I may not have an option because I need to get him more regulated than he is.

Yep. He has some flair ups but no where near how it used to be.

 

If you're close to being within a 30 min window with shot time you should be fine.