Hi Misty,
While I don't totally disagree with your vet on the increase, I wanted to post some stuff from earlier days to try to help you out.
First, the amount of the increase being .5u as advised by your vet. I think it's just a "vet thing". Here's something that Dr. Pierson posted here over a year ago. Keep in mind, she's a very well known and respected vet, and her "peers" probably wouldn't just be the run of the mill vet clinic down the street sort of vet...
Unfortunately, my colleagues rarely raise or lower a dosage by any amount less than a full unit. I am trying VERY hard on VIN to change this mindset and to remind them that there really are smaller doses. I am having luck with getting them to embrace 0.5 unit increments but forget anything lower. I get laughed at when I mention anything lower than 0.5 units….mainly because they feel that it is impossible to accurately measure. I also got laughed at when using "fat" and "skinny". On a good note, at least they are now discussing syringes with half unit marks.
.
So the advice to increase from 1.0 to 1.5u seems to "make sense" to me from the standpoint that apparently, a lot of vets just don't think in less than 1u increments, and finding one who would advise .25u or smaller increases or decreases is probably next to impossible. A half unit adjustment might be all your vet is willing to consider because he might not feel A) you can see well enough to accurately dose in .25u increments, or B) he might not believe that an adjustment that tiny is really going to make any difference. (something I've never been really convinced of myself either).
Also, I can understand your vet's logic, based on your Spreadsheet. Like Sue said, it's getting you yellow numbers. But that said, there's also plenty of room for lower numbers before you get into territory that is going to freak anyone out, like 40 or 50. What you vet might not be considering is the consequences of having the BG drop to 75 when your cat is used to numbers in the 200, 300 or higher range. What we call "bouncing". Maybe your vet isn't concerned with bouncing? My vet wasn't.
The issue I and most of us have with "bouncing" is this - If your cat's BG as shot time is high, that could be a result of bouncing, not because the dose
isn't high enough. It can actually mean the dose is
too high. It drops the BG down too far, and causes high numbers later in the cycle that aren't "real". Yes, the 400 is a 400, but what caused it? If it's due to really low numbers at nadir, that indicates that a dose is too high. And the
last thing you want to do in that case is to increase the dose.
Let me illustrate using a quote from a very experienced Lantus user a couple weeks ago that I thing makes this point very clearly:
6/15/08
AMPS - 302
PMPS - 416
AMPS on 6/19 - 459
Pretty high, right? Makes you want to increase the dose, right?
But look what really happened between those shots:
6/15/08
AMPS - 302
+4 - 52
She didn't start to climb out of the 50s until two hours later, and that was with a good amount of high carb food to help.
PMPS - 416
Then down to the 90s before heading back to 459 by morning.
I'm glad I knew about those lows so I didn't increase her dose! Lots of cats' spreadsheets look like this when they first start hitting low numbers. Eventually she flattened out, and finally went off insulin.
To me, this points out where your vet is DEAD WRONG in telling you that all you need to test for is "pre-shot" numbers. You simply MUST KNOW what is happening in the middle of the cycle, at least at nadir, to safely determine if a dose is too high, too low, or just right.
Looking again at your spread sheet - It looks to me like your vet is correct in advising you to increase the dose. There is plenty of room for more downward movement in the nadir numbers to accomplish what he's after. Lower numbers in the middle will eventually cause the preshot numbers to improve. BUT THE ONLY WAY YOUR VET CAN SUGGEST DOING THIS IS BY LOOKING AT YOUR SPREADSHEET. if you didn't have all that great data in the middle of the AM cycles, there's no way your vet would know that Rumpelteazer can handle an increased dose. He would have no idea whether the preshot numbers are from "not enough insulin", or "too much insulin". If he is looking at all the great data you have, and forming a logical conclusion from it, then he's doing his job. But if he is telling you that just because your cat has higher preshot numbers than he thinks he should have, and he isn't "seeing" the 200s in the middle (which is exactly what he is asking you to do from this point forward - "just give me the preshots and I'll give you dose advice") - then his advice isn't logic based, and frankly, I think it's wreckless and dangerous.
Telling you to test every 12 hours, and hoping to get it right with dose, is like telling you that it's safe to drive down the highway with a bag over your head, as long as you remove the bag every once in a while to make sure you're still in your lane. It's unsafe and dangerous to your kitty.
Bottom line? I think the .5u increase is fine to try. On one condition. That you are able to test "in the middle" to make sure the numbers don't go low enough to put your cat's life in danger. That doesn't mean you have to test 6 or 8 times a day. But getting a test in the 5-7 hour range after a shot is a must, in my opinion. In that, your vet is just blatantly wrong.
My vet was very heavy handed with dose advice. She only thought "1 unit adjustments". It was me who, after reading here, suggested I do .5u ones. Bob was increased to 4u twice a day based largely on his preshot numbers. They weren't getting better. Then I caught a couple of nadir readings in the 40s. Followed by really high preshots. Had I not seen those tests, the advice would have been to kick him up to 5u doses. That increase would most likely have been fatal, and Bob would no longer be with me. And I wouldn't be here.
Carl
