((((hugs))))
I have a little different perspective than some of the others because I have a high dose cat (Jazzy has acromegaly, and also Lucy's breakthrough dose was 4.25 units which isn't exactly a tiny dose either).
Yes, I would rather see more spot checks, and especially some at night. Even if you go to bed at +2 or +3, grab a test then every night (and if you wake up at +10, get one then too). You'll be surprised at how quickly your spreadsheet starts to make more sense once you start getting those random spot checks every now and then. I also agree with Laurie's suggestion that it might be time to replace your insulin. Most of us don't get good results after a vial or cartridge has been in use for that long.
Even so, in my opinion you're doing a good job of getting data most of the time. I'm known for being aggressive, but personally I would have done the same dose increases that you did. I wouldn't have held some of the doses as long as you did.
There is a little clause in our
Tight Regulation Protocol(under Increasing the Dose) that says:
"However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU." When I see high, flat numbers all above 300, I often suggest increases of 0.5 units at a time, every 4-6 cycles,
provided that the bean is able to monitor sufficiently and has a well stocked hypo toolkit. Then once the numbers start moving a bit, I would slow down the dose increases and possibly to to increasing in increments of 0.25. This is only for cats that are high (mostly red and black with some high pink), not showing much movement in numbers, and are being tested sufficiently at home.
Based on that part of the protocol, a plan you might choose to try would be this: a) monitor more. You're doing a good job, just do a little better. Grab spot checks whenever you can, including bed time and/or when you get up in the morning, when you get home from work, just before you leave the house, etc. b) Tommy's current dose is 4 units. Don't increase again until you can get a bunch of spot checks just to be sure he is not getting lower, but do that as soon as you can, then c) as long as you are maintaining a schedule of getting spot checks in almost every cycle, then increase every 4-6 cycles by 0.5 unit at a time. NEVER do a dose increase unless you have at least two mid-cycle checks on that dose, preferably more and preferably around nadir. Continue that until the numbers start to move. Also, please stay in touch and post here every day, if you can. It will help us help you.
Regardless of what option you choose, if you don't already have a hypo toolkit, including lots of high carb wet food (something with gravy), be sure to make a toolkit ASAP.
For those who don't understand why I'm saying the dose increases were ok, here's a brief explanation of the thoughts in my head. I might be totally wrong, but I wanted to make sure all the options are out there.
* Numbers didn’t look too bad on 2.5 units of Humulin. When he started Lantus he went to 1 unit, which was fine (maybe even a little low, usuallly we suggest starting slightly below the "good" dose of the previous insulin).
* Don't have a ton of spot checks on 1u but enough to be fairly sure he was staying high. I agree with 0.5 unit increases when the cat is all pink/red/black. He held 1 unit for 5 days, 1.5 for 2 days, and at that point I would have also suggested 0.5u increases every 4-6 cycles (because he is still high and flat).
* Held the 2u and 2.5u doses too long. Holding doses too long can allow the cat to build a resistance to the dose. Not a big deal, resistance can be broken through, but usually it requires more insulin to get the breakthrough.
* The only dose increase I don’t really agree with is the last one, because Tommy did see some yellow on 3u and 3.5u. I would have done more testing at that point before increasing the dose again. If you do want to drop back in dose, I would suggest dropping to no lower than 3 units. In my opinion, Tommy WAS given enough time on the lower doses than that. I also think that if you choose to stay at 4 units and work up from there, Tommy should be safe and if he needs a reduction from 4 units, he'll tell us soon enough. You have to test more, though!
Also, you mentioned in one of your posts that you thought the point was to reduce the insulin eventually. Really the point is to give him whatever amount he needs to be healthy. Not all cats do well on small doses, and not all cats will go OTJ (but having a higher dose does not mean that he CAN'T go OTJ, if the circumstances are right). There are a ton of variables so we just have to follow Tommy's lead.
