New Member - In of Need Guidance

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RogueKnite

RogueKnite

Member Since 2022
Hello, everyone!

First of all, please forgive any lack of decorum I might have in my initial post. Correct me, please!

My cat, Loomis (12 years old; 18 lbs), was diagnosed with diabetes on 9/2 & he just had his first follow-up yesterday (10/3). He started showing symptoms on 8/22, primarily excessive drinking & urination. Prior to this, he's had no ailments of any kind.

During the diagnosis on 9/2, the vet took a blood glucose reading of 418 & the blood work results corroborated that as well. The doctor prescribed ProZinc insulin (40 units per ml) & administering 4 units, twice daily.
That dosage seemed a little high but what really concerned me was that the vet advised reusing needles (which I have not done), no mention of home testing & discouraged any change in Loomis' diet until after the "diabetes was under control."

For the last 30 days, his drinking & urination have curbed slightly & his appetite has remained unchanged. Yet at the vet's office last night, his weight is now 16.9 lbs & his blood glucose was 464. The doctor prescribed a higher dose of insulin, 6 units twice/daily.

I administered the 6 units of insulin last night with no adverse reaction from Loomis. This morning after giving him the 6 units though, he threw up his breakfast & started howling in his litterbox trying to urinate. I called the vet & they advised giving him a fingertip of karo syrup & watching him closely. Which I did. 8 hrs later, Loomis has eaten numerous times & is acting normally. I spoke with my vet again & advised reverting him back to 4 units of insulin, twice/daily.

The vet has been in practice, at the same location for over a decade, with glowing reviews. Yet after all the articles I've read & perusing the threads on this forum... It seems everything I've been advised to do runs antithetical to the conventional practices when it comes to feline diabetes.
 
Welcome.
I consider that 4 units twice daily is a very high starting dose. Most cats start at 1 uit twice daily.
If you have too high dose and the cat does not go too low, BG can actually go higher with a higher dose. That is until the cat goes low.
Most of us here test our cat's blood sugar before each shot and periodically between shots. Most use a human meter since the cost of the strips is very high. If in the USA a good meter is Walmart's Relion Premier line. THe Premier Compact is ~$9 and 50 strips are about ~$9 too.
Most record BG in a spreadsheet
HOW TO CREATE A SPREADSHEET
HOW TO USE THE SPREADSHEET
The SS allows other to see your cat's BG history and can then fiving dosing advice if needed.
 
Welcome Sorry to say but your vet doesn't know that much about diabetes
If it wasn't for the advise from the members here Tyler wouldn't be in remission today
We have many experienced members here
I'll tag a prozinc user for you 4 units is a high doze to start with
We adjust the dose by 0.25 units at a time and we don't adjust the dose by Pre Shots ( the BG taken first thing in the morning which is called AMPS and same goes for the PMPS first test taken in the evening.
We also feed our cats low carb wet food.
I'll give you the link below
If you can fill out your signature ,info about Loomis that would be helpful
To set up your signature which you will see is at the end of everyone's post in gray, click on your name up top and then tap on the word signature and add this information
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

Take a look at mine
You need to definitely start home testing Loomis to keep him safe
We also use a spreadsheet to track our cat's BG numbers once you start testing to see how the insulin is working and how low it's dropping and in case you need any advice , if you are interested in setting one up just ask , we have a member who will be happy to do it for you


The spreadsheet is easier than it looks
Just some info about it look at mine at the end of my signature it says Tyler's spreadsheet to get a look at it, you can look at anyone's spreadsheet

About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers


If you want to try and set it up here the link, if you need help just ask we have a member who will be glad to set it up for you
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
this post on helping us to help you. The post is considerably more concise and has everything in one place making it a bit easier if you need to bookmark the information

The Relion Premier Classic human meter is 9 dollars
https://www.walmart.com/ip/ReliOn-Premier-CLASSIC-Blood-Glucose-Monitoring-System/552134103

Test strips for it 100 count 17.88 better off getting 100 you will go through them fast
https://www.walmart.com/ip/ReliOn-Premier-Blood-Glucose-Test-Strips-100-Count/575088197

We also use U-40 syringes with half unit markings even you can only adjust by half units these are easier when you need to adjust by 0.25 units
https://www.adwdiabetes.com/product/18553/ulticare-u40-pet-29g-3-10cc-1-2in-half-unit

Or these
https://shoppettest.com/advocate-pettest-u-40-insulin-syringes-31g-3cc-5-16-100-box/

Here's a coupon if you order from ADW diabetes
DIA10
adw-coupon-dia10.jpg

10% off your next order!
 
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You can read all about prozinc here , read all the yellow stickys especially the 2 dosings
They will let you know when an increase or decrease is needed.
We don't base how much insulin we give going by the Pre Shots (AMPS)
or the PMPS we base the dose of insulin on how low the BG is dropping
https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/

Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
 
Here is the food chart we like to feed 6% carbs or less like 2 or 3% carbs
A lot of members feed Fancy Feast Classic Pates
https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
Make sure you have a hypo kit set up in case Finn ever drops too low and you need to bring his BG back up to safe numbers Such as

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.
 
About testing
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up
c2b8079a-b471-4fa6-ac36-9ac1c8d6dcca-jpeg.57072
fec17d29-5ab4-44a8-912b-3a91944c3954-jpeg.57073

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming

A video one of our members posted, she is using a pet meter ,strips too expensive plus you have to code it
A human meter is just fine, most of us use human meters ,that's what our numbers are based on


VIDEO: How to test your cat's blood sugar
 
RogueKnite said:
Hello, everyone!

First of all, please forgive any lack of decorum I might have in my initial post. Correct me, please!

My cat, Loomis (12 years old; 18 lbs), was diagnosed with diabetes on 9/2 & he just had his first follow-up yesterday (10/3). He started showing symptoms on 8/22, primarily excessive drinking & urination. Prior to this, he's had no ailments of any kind.

During the diagnosis on 9/2, the vet took a blood glucose reading of 418 & the blood work results corroborated that as well. The doctor prescribed ProZinc insulin (40 units per ml) & administering 4 units, twice daily.
That dosage seemed a little high but what really concerned me was that the vet advised reusing needles (which I have not done), no mention of home testing & discouraged any change in Loomis' diet until after the "diabetes was under control."

For the last 30 days, his drinking & urination have curbed slightly & his appetite has remained unchanged. Yet at the vet's office last night, his weight is now 16.9 lbs & his blood glucose was 464. The doctor prescribed a higher dose of insulin, 6 units twice/daily.

I administered the 6 units of insulin last night with no adverse reaction from Loomis. This morning after giving him the 6 units though, he threw up his breakfast & started howling in his litterbox trying to urinate. I called the vet & they advised giving him a fingertip of karo syrup & watching him closely. Which I did. 8 hrs later, Loomis has eaten numerous times & is acting normally. I spoke with my vet again & advised reverting him back to 4 units of insulin, twice/daily.

The vet has been in practice, at the same location for over a decade, with glowing reviews. Yet after all the articles I've read & perusing the threads on this forum... It seems everything I've been advised to do runs antithetical to the conventional practices when it comes to feline diabetes.
Click to expand...
@FrostD
 
Thank you for all the resources, Diane Tyler's Mom!
I've been pouring over all your posts for the last 30 mins & it's truly a treasure trove of information.
I have so many answers & even more questions (the good kind though)! I will start testing & posting Loomis' readings to the spreadsheet.
Thank you again! :)
 
4U and 6U, good grief! If I had a nickel for every time a vet did something like that and nearly killed a cat this would actually be a paid job :eek:

Anyway, welcome! None of this is your fault, nearly every newcomer here has a very similar story. By nature we trust medical professionals, until something happens and we realize maybe they don't actually know as much as we thought they did.

So, as everyone else mentioned, 4U is a larger dose. 6U is even larger - as in very very few cats here on a low carb diet need that much insulin, and those that do usually have another underlying condition.

Had your vet ever mentioned ketones? Or had you ever seen a positive result in labwork (usually in the urinalysis)? You will want to pick up some urine ketone test strips, like Ketostix, and try to test 2-3x a week. DKA is a life threatening condition for diabetic cats, they must be hospitalized and it is a rather expensive stay. Monitoring ketones will help keep an eye and make sure you catch any issues in time.

Any chance he has a UTI or blockage? Have his litterbox habits been normal otherwise?

I would actually reduce down to 3U to be safe. I don't really have a good explanation other than - experience tells me he's likely going lower than you want on 4U as well, but his body has protective measures (we call bouncing) to spike BG back up. The problem is that ability drains over time and they can't fight it - which is likely what you saw today (the additional insulin just completely overwhelmed him, assuming it was a hypo event).

So, priorities;
1. Get your testing and hypo kit supplies that Diane listed, plus the Ketostix.
2. Be persistent about learning to home test. There is definitely a learning curve. For now, focus on testing before you give the shot, and again 5 hours after each shot. A few days of that will give me just about all the information I need to see what to do about dose. I would post here each day as you get tests in so we can keep an eye for potential issues.

Do not change food yet. Changing to lower carb can drastically affect BG. So first, we need a picture of his current BG at 3U. From there, we can decide how to safely transition.

By no means do you have to wait til he's "under control" - rather, it's the opposite. It's usually easier and safer while BGs are high, because it gives you wiggle room for safety. But first, data!

Ask away!
 
To add - see my spreadsheet from 2020, the very beginning. Note how he started at 2.5U, and within 3 days of diet change his numbers dropped about 100 points. Within two weeks - which is how long we say to give the diet change time to take effect - down to 0.1U. If I hadn't been testing, he'd have been in big trouble.
 
Thank you as well, FrostD, for the plethora of answers & explanation!

I will be going to Walmart today to pick up all the aforementioned supplies.

As for any other underlying conditions, the doctor stated that his blood work was “uneventful.” Including his kidney functions. He’s never had a UTI in his life. The only thing worth noting was that his muscle enzymes were a tad high, which signified lethargy on Loomis’ part.

24 hrs later, his litter box routine has resumed as normal & no additional vomiting since that lone instance. Still excessive drinking & urination but he is no longer frantically going in & out of his box while crying out. His appetite is as strong as ever.

Questions:
  • I’ve read that using Walmart's Relion Premier meter provides a BG level that needs to be “adjusted”… Is this true? And if so, what do I need to account for?
  • For further clarification, when should I home test him during the day? You mentioned 5 hours after his morning injection. What frequency should it be checked thereafter? How many hours before his morning injection?
 
"adjusting" is a common...myth? Misconception? There is no direct correlation between the meters. The pet meters tend to read higher overall; the difference is larger at higher numbers, and smaller at lower numbers.

High is high, we don't really care about that (other than we know kitty doesn't feel good and is over renal threshold). The lows are what we care about; on a human meter the "take action" number is 50, and on a pet meter it's 68. Take action means you need to intervene with higher carb food to stay ahead of a hypo. We also have different dosing methods with different dose reduction points for the different meters, but we'll cover that later. For now, we use the conservative method where reductions are below 90 on either meter.

*5 hours (we call this +5) after each injection, if you can manage it. We do recommend getting nighttime tests at least twice a week, because they do usually go lower at night. As his trends show themselves, we'll be able to tell you which nights would be good, and which ones you should just sleep.

Other tests that help:
1 to 3 hours after the injection. We don't need a lot of these, it just tells us when onset is and how hard it is. Sometimes we need to increase carbs early on in order to slow drops and minimize big swings.

Nadir is usually 4 to 8 hours after the shot, it can and does move around. I asked for 5 hours to start as that's most typical/at least will tell us quickly if dose is perhaps too high.

7-12 hours after injection, again don't need these very often. This tells us what duration is. When they are unregulated, duration is usually poor. But over time it should increase. Sometimes though, a cat just does not get good duration from an insulin and it's time to look at other insulins.

Some people choose to do curves once a week. Those are not always reliable, as you may end up doing it on a day where they are bouncing (he went lower or faster than his body is used to, then his liver spikes BG back up as a protective measure and it can last a few days).

I much prefer a smattering of tests throughout the week to get the overall picture, but I understand schedules and life can make that difficult. So one day you might get a +2 and +8, another you might get a +4, next day you can't get anything, next night maybe a +6. It sounds like a lot, but realistically once you find your groove it takes less than 2 minutes.
 
I purchased all of my supplies yesterday & some wet food that’s on the lower carbohydrates side. Much of it is food he ate & enjoyed in prior years! Yet not completely phasing out his current food either. A slow transition is all.

I tested his BG twice so far. Last night & this morning, both before his insulin injection. This morning I lowered his insulin dosage from 4U to 3U. I will be going home during my lunch break to get the +5 BG reading.

I will post in this thread & fill in my signature once I have more numbers from today. Thank you again, both of you!! I’ve re-read your posts countless times yesterday, due to the wealth of information & knowledge.
 
Good thatyou are testing BG. After you get the +5 BG please post the BG values. Also, setup and use the spreadsheet. There are caretakers here who can setup a spreadsheet for yu is you want.
 
I have about 4 days worth of data. Please look at my signature & let me know if 1) It makes sense 2) Where do you recommend we go from here
Thank you again, everyone! :)
 
He’s been eating 1 can of Fancy Feast pate spread out over breakfast & lunch. Then he receives 1/4 cup of Purina Beyond kibble. Which is part of his pre-diagnosis food that I am slowly phasing out.
 
Ok. In that case I would increase by 0.25U tomorrow (the increase would have been larger on strictly low carb).
 
RogueKnite said:
3.25 units, it is
Click to expand...
Hi can you update your spreadsheet
Also you have TR method in your signature
That is not one of the dosing methods for prozinc
Here are the 2 dosing methods you can follow
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
You need to be testing at AMPS every day
You also need to get some night time tests in after his PMPS shot, is there any reason you aren't testing at PMPS instead of @+11?
You are only seeing half the picture
Can you pick a dosing method for prozinc and correct it in your signature and add prozunc to your spreadsheet up top
@RogueKnite
 
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I am learning in real time. As it is clear, my vet is not the most knowledgeable on feline diabetes & neither am I. Please be patient with me. :)

I live alone & my work schedule does not allow a mid night testing. I’m trying to figure out an arrangement where that would be possible though.

I will change the spreadsheet the absolute first chance I have.

What’s the correct amount of food to feed Loomis?

I’m dosing him twice a day, what is the correct term for that?
 
We don't need midnight tests every night, but it does help to have nighttime tests at least twice a week - they often go lower at night, so a dose that looks ok during the day may not be ok at night. Some people choose to shift shot times in order to make testing easier.

What does he currently weigh, and do you have a rough idea as to his ideal weight?

Twice a day dosing is also called BID (it comes from some sort of Latin)
 
I weighed him this morning & he's ~17 lbs.
I'd like his weight to be under 12 lbs, ideally. At this current juncture, I'd be happy with under 15 lbs though.

I will definitely get some night readings in the near future though!
 
So he needs roughly 350 calories per day for safe weight loss - the FF latest are usually about 100kcal/can, and the dry food is about 410kcal/cup. So right now he isn't getting quite enough...now that said, the diabetes changes things. More often than not we see weight loss with the diabetic cats. Has he lost any weight recently? Or did he gain?
 
At his diagnosis vet visit on 9/2/22, he was weighed at 18.1 lbs. During his follow up on 10/3, he was 16.9 lbs. As of yesterday, he weighed 17 lbs.
I will increase his calorie intake with more portions of Fancy Feasts pates going forward.
 
RogueKnite said:
At his diagnosis vet visit on 9/2/22, he was weighed at 18.1 lbs. During his follow up on 10/3, he was 16.9 lbs. As of yesterday, he weighed 17 lbs.
I will increase his calorie intake with more portions of Fancy Feasts pates going forward.
Click to expand...
Ok. Just weigh him at home about every other week to make sure he's not losing too quickly.
 
Good evening, everyone!
Loomis is doing well! His excessive drinking & urination has curbed. It's more than it was pre-diagnosis but less than 2-4 weeks ago.
His appetite is strong. He receives a Sheba Perfect Portion, on top of his aforementioned diet. Plus he seems more energetic and playful as well.

I have a follow-up appointment with my vet tomorrow. It will be the first visit since joining & participating on the boards here.
Last I spoke to them, they believe he's under the 4U twice per day dosage, with no testing on my part.
Is there anything you all recommend I discuss with my vet tomorrow?
 
Nothing at the moment. Depending on the vet, some of us tend to keep it short and sweet.

I would go up to 3.5U though
 
The vet appointment on 10/17 was uneventful.
My vet advised giving him 5U for his PM dosage & 4U for his AM dosage. Which was dutifully noted.
His diet consists mostly of Fancy Feast Pates (2x daily), Sheba Perfect Portions (1x daily) & his kibble (very minimal, once every few days).
For his behavior: His appetite is insatiable. His drinking/urination is the same as last post (more than it was pre-diagnosis but less than 4+ weeks ago). Personality wise, he's unchanged - a ball of energy wrapped in fur!

Any recommendations at this juncture?
 
hi and welcome!! what an adorable kitty you have there!!

I see you've been getting assistance from one of my personal heroes, FrostD(Melissa). She was one of the experts that helped me get my kitty Hendrick well regulated and ultimately into diabetic remission! Can't say enough good things about her and the other FD gurus that spend so much of their time and energy on this site helping strangers and their cats.

As far as the vet recommending 5U and 4U -- hopefully you are going to ignore that and stick with the 3.5U BID that Melissa has suggested?

Have you looked at the dosing methods for ProZinc yet? There is a ProZinc specific forum here where you may want to consider posting daily threads for active guidance on dosing and other things. Check it out: https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/
 
Thank you for the warm welcome. :)
FrostD has been stellar since the beginning!
I am not following the 5U/4U dosage recommendation.
I read through the pinned posts as much as I can but it requires a guided hand at times to fully comprehend the information presented.
I’m just getting concerned because his BG seems to rise with higher doses. Plus he’s losing weight. He’s currently at 15.4lbs. From 18lbs, when he was initially diagnosed.
 
It's a little hard to say for sure without more midcycle tests, but it does appear to be ok to increase to 3.75U. Will you be able to do a curve or grab a few more midcycles over the weekend?

Technically with our more aggressive methods you probably would be increasing to 4U so your vet isn't too far off...ish. At the moment we can't follow that method though, given the small bits of dry food.

Have you managed to get a ketone test?

As for hunger and weight, it will take time even with the extra food. My cat could really only maintain current weight while eating all the extra food.
 
Also I should add - please do tag me if you need anything. You'll want to re evaluate the dose every 5-7 days, so by all means tag me and I can take a look. Unfortunately I've got a lot of cats I'm following at the moment, am due with a baby any day now, and I don't have as much time as I'd like to keep up with all of them!
 
regarding weight, all of our cats lost weight when we switched from free-feeding dry kibble to regular feedings of canned food or homemade raw (using E-Z Complete)

Looking over his numbers, I don't think there is really a correlation between higher BG and higher doses of insulin. In fact, looking at the numbers from a zoomed out perspective, there really doesn't seem to have been much change at all as you have increased the dose, which is super-common at first. And very frustrating!! I remember that feeling.

This is a marathon, not a sprint, and you are only at the very beginning of the race. It takes time to get to a dose which starts to have a real impact.


side note -- like I said, definition of a hero. About to give birth and still hopping around on the forums helping lots of people and their kitties. <3 Melissa.
 
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Hendrick Cuddleclaw said:
regarding weight, all of our cats lost weight when we switched from free-feeding dry kibble to regular feedings of canned food or homemade raw (using E-Z Complete)

Looking over his numbers, I don't think there is really a correlation between higher BG and higher doses of insulin. In fact, looking at the numbers from a zoomed out perspective, there really doesn't seem to have been much change at all as you have increased the dose, which is super-common at first. And very frustrating!! I remember that feeling.

This is a marathon, not a sprint, and you are only at the very beginning of the race. It takes time to get to a dose which starts to have a real impact.


side note -- like I said, definition of a hero. About to give birth and still hopping around on the forums helping lots of people and their kitties. <3 Melissa.
Click to expand...
:bighug:
 
Congratulations, FrostD!

You have been incredible this entire time & I could never thank you enough for your patience & guidance through this.

I’m off the next few days, so I’m going to do my best to get a curve reading. My question is this:

How long after feeding him should I wait before I test his BG?
 
You're always welcome!

If you mean specifically for the curve, I would start with +2, then go every 2 hours roughly.
 
On 11/21, my vet advised giving him 5U for his AM/PM dosages. Which I have not followed.

Loomis' diet consists now exclusively of Fancy Feast Pates (3x daily), Sheba Perfect Portions (1x daily) & no dry food whatsoever.
With no dry food, I've upped his AM/PM dosages to 4.25U, gradually, from my last post in October.
What concerns me though is that whenever I up his dosage, even at .25U at a time, his BG tends to spike in response. Is that to be expected?

His appetite is very much there. Excited to eat at each meal. He's maintaining a weight of ~15lbs. His drinking/urination is a bit odd. I'm filling his water bowl up less, when I replenish it. His urination is also less but a bit higher than pre-diagnosis levels. Personality wise, he's the same.

Any further recommendations at this juncture? @FrostD
 
RogueKnite said:
Any further recommendations at this juncture? @FrostD
Click to expand...

I'm sure Melissa will get back to you ASAP but her bouncing baby finally decided to come out and meet the world but they were exposed to RSV at the hospital so instead of being able to go home (with her other young children) she stayed away until it was safe to go home (which just happened) so there's a new baby to care for and her other youngsters are all excited to meet their new sibling!

Could you start getting at least 1 test on the PM cycle? Most cats go lower at night so it's important to know he's not dropping at night and then bouncing by morning. Also, without tests on the PM cycle you're missing half the data. If you think of your spreadsheet like a puzzle, if you only have pieces filled in on one side, you can't tell what the whole picture is! Just a quick "before bed" test will help.
 
Based on the midcycles you have I'd increase to 4.5U - but like Chris said some night ones would be good to make sure he's not dropping lower at night.
 
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