[Emphasis mine]
At the end of the day what we are doing here is all about improving our little ones' health and quality of life; clinical signs MUST be taken into account alongside BG data. If your cat is feeling better on less Caninsulin that would be a signal to me that the higher doses aren't doing her any good or, more importantly, that Caninsulin itself is really hammering her system.
Here's an excerpt from Saoirse's journal during the time she was being treated with Caninsulin:
Lethargic, grumpy, withdrawn (often on floor behind curtain) during periods of Caninsulin peak action. Tries to hide in most inaccessible place she can find after pre-dose feeds and looks to be avoiding the injection which she knows comes next. Protests and tries to wriggle away when I am trying to give her the injection. Really doesn't like the insulin therapy. Mood/sociability markedly better when insulin dose wearing off: it's like having two different cats.
Any of that sound familiar? Other members have reported similar reactions in their cats to Vetsulin/Caninsulin treatment.
When Saoirse was switched to Lantus she still had her post-dose snoozes but they would only be for about an hour or so and thereafter she was a happy camper for the rest of the cycle. With the change to Lantus I got 'my cat' back.
If I were in your shoes I'd opt for the switch to Prozinc (the only choice available to you at the moment under UK cascade rules). I'd also look to the
FDMB Prozinc guide for recommendations on starting dose and method for managing dose adjustments. NB: the BG reference numbers quoted in the guide are for human meters but I'm sure that the members active in the Prozinc group will be able to help you with the Alphatrak side of things. (
@Sue and Oliver (GA) - if you're online could you perhaps give Ann and Liz a bit of a heads-up on starting dose, please?)
I've experienced trigeminal nerve pain and I really feel for Lila. (((Lila))) Pain and inflammation can drive up BG levels. If you need to reinstate pain management meds at any stage keep a closer eye on BG levels as they may drop and a previously 'safe' dose may start taking her lower than previously.
The weakness could potentially be due to neuropathy. Neuropathy improves with better regulation and also methylcobalamin supplementation (e.g. Zobaline from the US - available online). I recommend discussing this with your vet, especially in light of Lila's issues with nerve pain. I have no idea of whether or not methyl B12 supplementation would be appropriate for her or contraindicated. With kidney issues in the mix you need to be cautious about B12 supplementation.
Go to
Tanya's Site for more info on CKD. Also ask questions here on Feline Health when you need to; some members have experience of treating cats with both FD and CKD. There's also a very good support group on Yahoo. Here's the link:
https://groups.yahoo.com/neo/groups/Feline-CRF-Support/info
Did your vets check Lila's potassium levels? That, too, may cause weakness but treatment for potassium imbalances needs to be done under strict veterinary supervision and requires regular blood testing (not safe otherwise - too high or too low a potassium level is dangerous).
On the incontinence at the vets, there's no way of knowing for certain but sometimes cats with high BG do urinate inappropriately. Fear is another potential cause of unusual toileting behaviour. Other members may be able to suggest additional things to consider. Again, occult neuropathy may feed into inappropriate elimination problems.
What age is Lila, BTW?
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