Should I increase Alex's Dose?

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Ginny & Alex

Ginny & Alex

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I felt encouraged over the weekend as Alex was holding in the mid-300s and there was less litter box flooding, but this morning, before his shot, he's back up to 389 and the litter box had a least one heavy soak.

I know we've talked about this over the past few days, but after 5 full days of 1.25 units BID, should I increase him to 1.5 units?
 
Yes, I would increase, Ginny. And any mid cycle tests would be good - going out the door, coming in the door, at night before bed. Every one helps.
 
I agree. I was hoping you would see better #s on this dose, but you aren't, and symptoms definitely are a clear sign the dose is too low. It may be that my read that 2u is too high was wrong, or it could be that something like 1.8 ends up being the magic ticket, or it could be that he has overcome the 2u and it may have been too high at one point but isn't now. In any case I think you have the same path: increase in increments around 0.25 every few days until you get a breakthrough.
 
So, what would cause this spike of 508 this evening? Over the weekend, I did feed more frequent meals and today, he went from his early morning b'fast (around 6:30 or 7:00) until we got homa around 6:00-ish.

I did buy an automatic feeder, so we are ready for tomorrow.

How many meals should I feed? 4 meals, 6 hours apart? Or should I allow for less snacking at night while we're sleeping (who knows that Alex and Audrey are doing?)?
 
Though there is that Every Cat is Different thing, lots of cats do better with small frequent meals. The thought is food helps support the pancreas heal. And some cats have a lower amps if they eat overnight. So I would try small frequent meals and see. If you have the 5 section feeder, you could divide the amount you serve into 10 servings and feed one of those servings every five hours day and night. You just have to coordinate things so Alex isn't eating the 2 hours before you test am and pm.

The numbers should tell you if he is a kitty who will respond.
 
I'm so upset, I could just cry!

Alex's BG was 502 this morning. Are any of these shots doing him any good at all?

I got the automatic feeder and set up a 2:00 am snack, so I thought that might improve his morning number, but it certainly doesn't appear to have done so.
 
Well, darn. Wonder if he went low at night and bounced up. Can you get a before bed test tonight? Has anything else changed? Any chance of an infection? Are you sure testing for ketones? How old is your insulin? Any chance he is getting into dry food? (Sorry - just trying to cover all the bases)

If you try this higher dose a few days and get no results, and the mid cycle numbers are pretty flat, we might try a reduction in dose this weekend, when you are around and can keep an eye on him. He did good that first day on one unit and then good on the first day of 2 units...... and nothing has been great since then.
 
From prior discussions, I increased his insulin from 1.25 to 1.50 units yesterday for the PM shot and also gave 1.5 this morning.
I gave him a snack at 2:00 am, using the PetSafe5--not sure WHEN he ate it, but it was gone this morning at 6:30 am.

Other than that, no changes. I tested for ketones Saturday evening and the stick didn't have a hint of color.
We've had the insulin since mid-April and the exp date on the bottle says July.

I can get a bed time test in tonight--probably be a +3.5 or +4.
 
So maybe we just need to be patient and give it till the weekend on this dose with mid cycle tests whenever you can get them. Then we can discuss increase or decrease.
 
Sorry to hear that Alex's BG #'s are higher. This first part figuring out how the insulin works on Alex can be the hardest. Like Sue said, mid-cycle tests whenever you can get them help fill in the picture of how the insulin is working. Hang in there.
 
Maybe he's just adjusting to the dose? I know with Sam, his numbers are all over the place, no matter what the dose it seems. I wish it was easier, but for many of us, it's not. Hang in there.
 
I know how frustrating it is, sorry you are not seeing better #s. Try not to let the #s freak you out - for most of us, it took a while to get things lined up to where we started to see better #s. Some cats just seem to have higher #s that others and it can take time to sort out what is going on and get it fixed.

It may help if you can think of this as a data gathering phase - first thing is just to figure out what is going on, and then you can make more informed decisions about the dose. Like others have said, I would try to get spot tests in whenever it's practical, varying the times if you can. That will help start to fill out the picture of what is going on. Because higher PSs can be either from the dose being too low or too high, the spot checks can really be invaluable.
 
Another factor is how he is doing - not feeling well and lots of symptoms, vs. doing ok even with icky numbers. That can help you too in deciphering things - if he is drinking & peeing tons, the dose is likely too low.
 
I think Alex feels OK. He is more vocal than he was prior to his diagnosis and I've noticed a few other differences (lays on his side more and his tail, while not twitching violently like someone else reported, it frequently moving). Maybe not as often and for not as long, but he still plays. He's a bit lazier than his sister, Audrey, but I think that's been the case since birth.

When his numbers were, say >350, there is definitely lots more urine in the litter box. Both cats like to drink from the bathroom sink, so I'm unsure on how much they're drinking, but they are drinking.

Incidentally, I do have some new numbers (a couple of mid-cyc #s down in the 200s). Later today, I will start a new thread with today's numbers.
 
Yes, they appear better, and while I want to be optimistic, it seems anytime we have a dosage change, he does better for a few days and then the numbers climb again. I'm really hoping we're getting close to finding the "magic" number.

So, let's talk about target BG level. I see lots of spreadsheets here with numbers in the double-digits, but my vet, I think would be happy remaining in the 200s.
 
Well, the general rule is that non diabetic cats (not on insulin) run anywhere from 40 -120, spending the majority of their time in the double digits. A regulated diabetic cat (on insulin) usually has ps numbers in the 200s and nadirs in the low 100s. There are people who are happy with well regulated cats, and that is fine. Most people want to try for remission. In that case, you try for nadirs above 50 or so but may have some nadirs where you go lower and have to intervene with low carb food first and then maybe higher carb food.

It is your decision to make. I do think that if a cat runs in the 200s generally for months, you may lose your change to heal the pancreas. But we have had regulated cats who suddenly throw a low number and go into remission. It is that #%&! Every Cat is Different thing that makes this whole dance so challenging.
 
I'm working from home again today and forgot to do the +6 BG poke, so I waited until +7. Alex had a snack at +6. Could his snack cause the spike?
 
Re: Should I increase Alex's Dose?--

so, what now?

It's only been a couple days with 1.5 dose? Is that long enough to determine if that dose is right/wrong?
 
I would say yes. Why don't you start a new topic and ask about increasing/decreasing the dose and see what others say? Usually there are several people on in the pm so check back to get other opinions.
 
Ginny & Alex said:
Yes, they appear better, and while I want to be optimistic, it seems anytime we have a dosage change, he does better for a few days and then the numbers climb again. I'm really hoping we're getting close to finding the "magic" number.

So, let's talk about target BG level. I see lots of spreadsheets here with numbers in the double-digits, but my vet, I think would be happy remaining in the 200s.
Click to expand...

With PZI, that thing where they get good #s and you lose them is a fairly common pattern. It is like their body overcomes the dose and it doesn't work anymore. Someone likened it once to a drug addict - first they get a high, but then need more insulin to get the same results. Once you get to the dose that works that pattern seems to stop, but as long as the dose is too low you can see that pattern sometimes with each increase.

On the target BGs there is a link I like, I will post it if I can hunt it down.

On the dose, it is looking like too little insulin to me, I would consider raising to 1.75. Will go look for new thread and post there. :-D
 
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