ellen, what's the protocol you use with PZI? what i mean is, with the L insulins, after 3 days on a dose that isn't getting you into greens, you would increase the dose. i don't know if that's the same for the P insulins, but it seems logical to me. i've asked before and i'm not clear there even is a protocol for the P insulins. he could be developing tolerance to the insulin as a dose is held. i think if i were you, i'd consider a couple of options. well, 3 that i can think of off the top of my head.
1. if you're not seeing green numbers by the time you've had 6 doses at one amount, increase by .25u. and then repeat that process every 6 doses. if you're seeing greens, delay time between increases to see what it does, but if he starts going up in overall numbers again, don't hesitate to increase the dose.
2. switch to a longer-duration insulin. however, if you do this, PLEASE don't restart at .5u or 1u. he clearly needs a dose somewhere around where he is right now or more. for whatever reason, people seem to want to start over and that just puts the cat in high numbers even longer. remember, your goal numbers are 120 or less for him.
3. reduce the frequency of P dosing. instead of shooting every 12 hours, try going to every 8 or 10 hours. that's a curse on sleep, however, and hard on many people to monitor. you might get the same results without staying up all night if you just switched to a L insulin because they have longer duration. Lantus has the studies behind with the highest OTJ rate - so i'd go there, but i think lev is fine as well. if he were mine, i'd try this first because i've seen how many cats do well on Lantus. you could still chat with your friends here, even if you use a different insulin.
anyway, i saw your plea for people to look at his ss and wanted to respond. i understand how discouraging it is to not see good numbers. i'll just remind you (since i had mental blocks on the dose size, i assume others might too) that the number to focus on is his blood glucose. i tell myself this daily. his dose amount is almost irrelevant if it gets him into good numbers. i tell myself this one as well! Robbie may have a little bit of iaa, or he may just be developing glucose toxicity because he is staying at too high of numbers for too long. the solution for both of those is more insulin and not holding doses too long. if he does have iaa, you don't really need to test him to figure it out because iaa is self-limiting. you just give enough insulin and eventually it breaks. if he gets up to 7u and you're seeing the same patterns, at that point i'd probably do the iaa/acro tests. for me, it was better to know than not. but at 5u, i think it still could be glucose toxicity from dose holding. in fact, there is one cat (infrequent poster) who is getting 10u doses who is negative for all the high dose conditions - she's obese, however. if robbie's overweight that could be playing a role in this.
for what it's worth, those are some options i can think to suggest. good luck, ellen, i do know how discouraging it is. send me a pm if you want more help - i'm not on that much anymore.
