Why is BG still high with .5 increase at this stage

[Rick & Mr. Grey]

I can't understand why Mr Greys BG is not lowering like I'd expect it to and it appears like it's staying the same or higher even after this latest .5u increase. His diet has been 1 main meal at AMPS then @ +4 a snack of the same food Wellness Wet Chix or Turkey, @ +10 same snack, then main 2nd meal at PMPS then snack of same food @ +6 right before my bedtime. Sometime I will be woken up by Mr Greay @ + 9 or +10 PMPS and give a snack...Am I over feeding and counter acting the Lantus ? but he seems hungry way more often than my other 2 civilian cats and the Wellness wet food is highly recommended by everyone here. According to protocol it looks like I should raise him up tomorrow to 4u Lantus as his nadir appears to be at a point to increase by +.5u. This increase will be after 5 days at 3.5u and based on the using the best data I could collect of his BG.

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[Sienne and Gabby (GA)]

The most obvious answer is that Mr. Grey needs more insulin. I think there are a couple of other factors to consider. I'd encourage you to not stick with a dose that's not bringing numbers down for more than 3 days/6 cycles. The risk with holding a dose where you're not seeing any movement is that glucose toxicity develops and it's harder to get the numbers to come down. That said, I would shoot your current dose tonight and raise the dose tomorrow if you're planning on following the Tight Regulation Protocol.

Another factor may be one of consistency. Lantus does best when you're as consistent as possible. Some of the changes in shot time may be unavoidable. It may help your understanding to know that more than a 30 min. shift in shot time may effect Mr. Grey's numbers.

I wouldn't suggest feeding your cat either past nadir or any time after +10. There's not enough insulin to counterbalance the food during the latter part of the cycle. It's not that you're over feeding. It's simply a matter that the insulin is doing the bulk of it's work during the first half of the cycle.

Finally, there may be some bouncing going on. Mr. Grey isn't used to visiting lower numbers. When he does, his liver and pancreas overreact and dump a stored form of glucose along with counterregulatory hormones which spike his numbers back up. In part, his body has become used to these higher numbers and they are his new "normal." (This is the result of glucose toxicity.) Lower numbers, while better, cause the overreaction. The more time your kitty spends in lower numbers, the more his body will get used to those numbers.

 

[Libby and Lucy]

Hi Rick, I don't think I've posted to you before. With Lantus cats, what we usually see is that they don't look like they are responding at all until they get to a good dose. You would expect to see a gradual lowering of numbers with increased doses, but that isn't usually what happens. Usually there's just a whole lot of high/flat numbers, dose increase after dose increase, until one day all of a sudden there is a breakthrough. Then once they break through, you'll start seeing lower numbers all over the place. It's frustrating while you're working up to the dose, especially when your cat is one who likes more insulin than some.

I agree with increasing tomorrow, unless something changes tonight. He is getting some nadirs in the 200s, but I still think you can increase by 0.5u, since he is on a higher dose. You do a good job of monitoring, so when he has his breakthrough you'll catch it.