Good morning everyone,
I wouldn't say a crap shoot. What you have done is established a baseline. You can see pretty consistent patterns on what 1.5 does. My observations....
You are getting a fairly consistent drop.
He seems to nadir around +5 and is climbing back up by +7 or +8.
Every other day, his AMPS is red, then black, then repeat.
He seems to spike at +1 sometimes (could be a food timing issue)
I don't see any obvious bounces, at least none that throw the next cycle out of whack. There aren't an inverse curves that make it appear that the dose is too high.
Sue laid out three courses of action, and explained each in detail. I had thought that maybe the dose was too high, but I'm not seeing data to convince me of that.
So, I think you can narrow it down to two options:
Raise the dose to 2.0, or consider shooting a TID schedule.
A) It looks like there is room for Kitty to go lower safely at nadir. However, if you increase the dose, he might then go through the "liver panic bouncy" patterns. BG goes lower than his body is accustomed to, liver dumps glucose to compensate, and the BG spikes as a result. That happens a lot, drives you crazy, and you just have to put up with it until his liver calms down. Negatives to that - his PS numbers may stay higher for a while, which keeps him above the renal threshold, so ketone testing becomes even more important and you'd want successful tests every day to make sure he's not ketonic. "Progress" would be evident when his PS readings become consistently lower while the nadir remains in the safe zone, at which time you would most likely be able to begin stepping down in dose while keeping the same smiley shape in his curves.
Things you would not want to do - don't react to the "bounces" by thinking he needs more insulin. They bounces just need to be allowed to clear. Upping the dose makes it worse, making the cycle repeat and you end up with chronic rebound.
B) If you decide to go TID, you should definitely start posting in PZI to get the help of the 3? beans that are currently using TID dosing. Gets confusing to BID eyes. Concept is the same, you just do it three times a day instead of two. You also have to probably play with the timing of meals more to try to get the food and the insulin working better together. It can be pretty overwhelming, but some people find it easier to work into their daily routine somehow. If you were to do that today, you would take his daily insulin intake and divide by three, and that becomes your new "starting dose" every 8 hours. Shooting TID would give you less leeway with shot timing. You pretty much have to do it on a strict 8 hour schedule, because otherwise you will see dose overlap and have to tinker with dose adjustments on a smaller scale based on early or late shots.....gets confusing and like I said, overwhelming.
Personally, I would choose option A, but like with everything..... all we can do is suggest and explain. There are no easy answers, no perfect solutions. ECID. What worked for Bob is not going to work for Kitty, and vice versa.
The ultimate choices on everything come down to what you think, and what works for you given your daily routine and "life" outside of managing feline diabetes. And a lot of it has to do with your cat, because the kitties lead on this "dance". All you can do is follow and try not to step on his paws.
Carl
