Re: White Flag up! Wrong way?
Lori,
I went back in time and searched for this, and I'm just going to copy/paste it so we can all read it again.
Here's my opinion, not just concerning Copper and you, but with every kitty and every bean who is currently wrestling with small incremental dose adjustments.
To me, any adjustment of less than .25 units if unfathomable, because I never did it. The smallest adjustment I ever made in a dose was .25u. For probably the last four weeks of Bob's dance, I am almost sure he never got the same amount of insulin for two consecutive shots. I was using a self-created sliding scale based on each PS I got, day and night. He rarely got the same dose day and night, or day to day. He went from 4u BID to zero in about 4 or 5 weeks. The last shot I ever gave him was .5u at PMPS after he had gotten no shot at AMPS. His BG when I gave him that .5 was either greeen, or low blue, but it was less than 120 if it was a blue. A "non-diabetic" number.
I am NOT SAYING that anything I did was right. I do not want ANYONE to dose their cat the way I dosed mine. But I do not believe that any adjustment of .1 has any effect whatsoever on any cat no matter what his BG is. There are multiple "non-insulin" factors that are taking place in a cat's body every hour of every day. And we have zero control over them. None. You can give your cat the same exact dose of insulin every shot and every day for two months, and I will guarantee you that you will not get two cycles that match.
Here is what Dr. Lisa posted on PZI a couple of months back. I believe it beyond a shadow of a doubt. I have read it a hundred times. This is the reason I tend to avoid advising discussions about mini-dose adjustments. I might agree with someone on the .1 up or down, but not because I really think it is going to make a big difference. I agree because I am trying my best to be reassuring to people who just aren't convinced that what they are thinking is "right". If the result of the mini-adjustment "works well", I am thrilled that it worked. But although I am thrilled, I really don't believe that the "result" had much if anything to do with the adjustment. I think it had to due with a half dozen other things, and was coincidental.
This is NOT meant to be critical to anyone, not at all. It pains me, it breaks my heart, to see so many people agonize over tiny insulin adjustments. It makes me sad when someone goes up .1 for a couple of days, then is heartbroken, sad, or confused when they don't see the progress they were hoping for, or it works for a couple days and then stops working, and they have to go through the same process three days later.
Anyway, here's Dr. Lisa's words:
I have been so busy lately and have not been following Copper's saga but I want to reiterate the above because I often see folks on this board getting so caught up in the insulin dosage (down to overdone minutia....driving themselves crazy....) as if that is the only issue...and as if 0.1 (not even measurable...) or 0.2 units (highly doubtful that this level is accurately measured...) is the end all...be all...'deal breaker' for the cat's situation when it simply is only one TINY (at that level of change) piece of a very complicated puzzle.
Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.
(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)
Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:
*Exogenous insulin absorption
*Endogenous insulin production
*Intracellular uptake of exogenous and endogenous insulin
*Insulin degradation and elimination - different for exogenous vs endogenous
*Intestinal glucose absorption
*Endogenous glucose production
*Tissue glucose uptake and utilization
and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....
....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)
When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.
http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=61241&p=663242&hili
I'm sorry if this offended anyone. I love you all.
Carl