Hi Ellen,
I realize the 3-4u's I've been giving him goes against most of the input I've gotten here but I am hoping that I'll still get feed back and advice as it is all being used along with my Vets input and my gut feeling to help me down this complicated path with my furboy.
You will keep getting feedback no matter what you shoot. You might get tired of hearing the same old thing, :smile: but we aren't just going to kick you to the curb for not following any advice we might give you. Ultimately, it is your call. You are the person holding the needle, and you are the one who has the kitty right there in front of you. The hardest thing (for me) about giving advice, especially on dosing, is that I can have my opinion, and I can tell you what I think, and I could be wrong instead of right. And then you follow my wrong advice, and it's you and your sweet kitty who have to deal with the consequences. That's a pretty big deal to me. What that causes in "us" is one of a couple things. Some people just won't give advice on dosing. Other people will, but will be extremely cautious and opt to "play it safe" to protect you and Robbie (and to protect themselves to some extent). I've given people advice and had it go bad, and there's no worse feeling in the world. It plain sucks. What I personally try to do is put myself in your shoes, and advise as if your kitty were my kitty. I'm probably more agressive with dosing than many other people are, but only when I can look at your spreadsheet and see that a dose has shown to be safe before and nothing has happened recently that would make me feel it won't be safe now.
When I see what I consider high doses early on in the treatment process, it makes me concerned. As I've already demonstrated the past couple days on your threads.
What I think, and what I said yesterday, is that the dose is too high and is causing either curves that are too deep, or cycles that are too long. What I look for is a 12 hour cycle that more or less ends where it starts (BG-wise), with a nadir that is 50%-60% lower than the AMPS and PMPS numbers. To me, that's a good curve for a new kitty on insulin. Gradually, I look for the preshot numbers to come down, and the nadir to maintain that ratio of drop, which usually means the dose needs to come down a bit, or you have to be able to live with lower nadirs.
Looking at Robbie's recent numbers, if all I look at is yesterday's AM cycle, the dose looks "right". Because you got about a 60% drop, the nadir seemed to happen around +6, and he came back up to where he started. I realize that the number you got for the PM reading was higher than the AM number, but it was also an hour and a half "late", and I'm betting he was about 325 at +12. Just looking at the one cycle, every thing looks good. But I can't just look at one cycle and say "all good". You have to look at the whole SS and look for patterns. One cycle is just one cycle, you have to look at trends and see if you see things happening regularly.
When I do that, I see cycles on 4u that run too long. Not sure how low they go in the middle, but the +12's are all too low, which makes it look like the 4u is too much and it's giving him too much duration. When the duration is too long, you get overlap in doses, so even if you shoot less next cycle, the effect is cumulative. The first dose is still "active" when the next dose kicks in a couple hours after you give the shot.
There are a couple of cycles that appear to be good on 3u, but there's not data in the middle to see if they gave you good nadir numbers. They could have been flat, or deep, but if I had to guess, I would guess "flat" because there isn't a bounce evident in the following cycle.
Many people, when they see a flat cycle, assume that the dose isn't high enough and the gut instinct is to raise. I don't believe that to always be true. I think that what can happen is that the cat's body will fight the decrease in BG and the liver will dump "sugar" to raise it. You don't even have to see the "drop" happen on your meter. The liver just does what it is supposed to do, protect the body instinctively. What I believe can happen is that the liver will just keep doing that but one day, it'll just quit doing it. Maybe it does it so often that it just can't do it any more. When that happens, there's nothing to stop the drop, and the dose that appeared to be safe and okay suddenly becomes like a time bomb, and the kitty's system can crash, causing a hypo.
In the past couple of weeks, I and others have "watched" a new kitty go from seemingly okay to clinical hypoglycemic emergency. It was a "higher dose" kitty. Unfortunately that kitty didn't make it. At least 3 other cats have died from hypos in the 9 months I've been on the board. The worst part is that for the most part, hypos are avoidable, even the ones that don't result in ER visits. Some times they just happen out of the blue, nobody sees them coming, and nothing on the spreadsheet would indicate that a dose would cause really low numbers. That happens pretty frequently in fact, as many of the current PZI posters can tell you.
Beyond all of that, specifically with Robbie and today -
You did the absolute right thing posting your number and holding off with shooting on a blue number. Looking at your notes, you fed him 1/2 can when you saw the 120, and another 1/2 can 2 hours later when you got the 139. You would think that would have pushed his numbers up by AMPS this morning, but it didn't really boost him much at all. That tells me the 4u dose was too much. It caused a long cycle again.
So, where are you at now? Have you gotten another test since the AMPS? And has he eaten, and if so, when and how much?
Carl
