? 4/22 - Chloe - All over the place in 24 hours. AMPS 84, PMPS 50

Last night at this time she was in the 400’s and then high 300’s.

Tonight is completely different. I chose to skip shot for a bit. I usually give her shots at 8a & 8p. It’s currently 9:30p.

Should I go ahead and give it? I’m struggling to figure out her dosing. I think .75u is almost too little, but her being low like this makes me think 1u is too much. Oy.

Suggestions??

Heather

 

Hi Heather.

You’ve been following TR since 2015? Is there a reason you aren’t getting daily tests in between the preshots? I don’t think TR is a good choice if you can’t do that, TR or not, you need mid cycle tests with long acting insulins like Lantus in order to properly evaluate the dose. You will not know how low Chloe is going or be able to keep her safe without at least a test or two in the middle of the am and pm cycles. It’s also impossible to say if the dose is too much or too little without this information just looking at preshots, it’s a guessing game, and a dangerous one.

It’s tricky about the skipped shot, since she has had DKA twice, skipped shots are generally not recommended, however, if you’re not able or willing to monitor closely to keep her from going too low, it is never recommended to shoot a number that low.

 

looks like you did shoot after all.....
please be sure and check again more than once tonite, even if you have to set an alarm.

think of the tests as pieces of a jigsaw puzzle, we can't see the whole picture so we need you to start
getting more pieces.

since you delayed, you will need to re-adjust your spreadsheet.

If the 95 was when you shot, then that needs to go in the pmps...

you stack the numbers in the same box and will have to manually make the box green.

So if the 95 is your pmps....

Please be sure and get a test in 2 hours from that shot time.

 

Hi! I would definitely try and get a mid-cycle test in during the day, whenever you can get it, to start. That will really help interpret the numbers you are seeing in the SS and figure out what needs to be done with the dose.

If you have the opportunity, try and do a curve or a mini-curve on one or two cycles: test every two hours or every three hours, it will give you much better visibility on how low this dose is taking her. Preshot tests alone are not enough to ensure the dose you're giving is the right one.

With all the green numbers there is a possibility the dose is too high and she could be at risk for a hypo. If that's the case, you'll want to reduce the dose or monitor more. And if it isn't the case, you don't want to reduce the dose. Only data can help you figure out which case you're in.

 

What you are seeing is a bounce breaking. Chloe's number were high due to a bounce and the bounce then cleared and numbers dropped back down.

I want to echo what Stacy and Stephanie posted. With a depot insulin like Lantus or Lev, dose reductions are based on the lowest number in the cycle and not pre-shot numbers. Typically, nadir is later than the pre-shot test value. Just looking at the PM cycle on 4/21, you reduced the dose based on the pre-shot number and Chloe dropped to 45. Even with several additional tests, by +11, she was back down to 58. There's no way to know just how low her numbers dropped between +3 and +11. Getting tests, particularly in a situation like this is crucial if you making sure Chloe is in a safe BG zone.

 

Hi @Sienne and Gabby (GA) and @rhiannon and shadow (GA) - I remember you two commenting before, so thank you. I have been updating via my cell phone and it's been hard to update the info correctly, so I'm on my computer now. I need to update my signature - it's terribly outdated.

So, I gave the 1u at 9am - an hour later than I normally do. Staying up later to test her threw off my sleep schedule a bit. I've tested more today, but during the week, it's really hard as we both have very busy professional jobs outside of the home. I'm not sure if you saw my previous post a couple of days ago, but this upcoming Saturday 4/28, we're leaving for 2 weeks to go internationally. My sister - a fellow cat mama of 4 will be house sitting and watching Chloe. She's super wonderful with cats, so I'm blessed to have her here to help keep her insulin regimen going.

Based upon the numbers today - should I adjust her PM dose (due normally at 8 - I really need to get her back on the 8a/8p schedule), or leave it at the 1u BID? I don't want her jumping up to those 300's and 400's. That is when she starts throwing up a LOT and with light carpets, we've spent so much money on having professional companies come in and steam clean them pretty often. In fact, we started doing that when we wore out our SpotBot. It just left little circles of semi-cleaned areas anyway....

Thank you again to all who have commented. It's so appreciated. <3

P.S. I will update my signature as soon as I figure out how to do it! lol

 

I found/started TR then after she went DKA during a trip out of the country with a pet-sitter who knew NOTHING about diabetic cats. It was horrendous. You can see my message history is from May of 2015 when that happened. Then, unfortunately, we either got comfortable or something - wait - personal things happened that kept me away for a while - and her testing was sporadic and therefore she went DKA slightly in 9/2016. Thankfully, even with not testing her that frequently, and watching her habits, (my charting for that time was sporadic and not updated on her Google doc), I was able to know when she was high or low. Now I feel like in the last couple of months (hence why I've started testing her again so much more) she's been so sick - vomiting a lot, etc. When I started testing again, I realized her dosage we'd had her on - we were able to cut back to .5-.75u once a day - was not enough. I thought maybe she had eaten something she wasn't supposed to, but then realized her high #'s were making her sick.

I can test AM and PM, but due to professional jobs that keep me out of the house more lately, testing during the day has gotten harder, but there is a possibility of testing at +6 from AMPS and then from +9 on to PMPS. I know that is not probably ideal, but I'm hoping that will help.

It's not unwillingness - although she hates having her ears poked and scratches at them more and more these days (losing hair on them in fact), but lack of the ability to do so during the daytime.

 

As she's been DKA twice and you mention vomiting, I'd make really sure to test for ketones. Can you do that?

If you can manage to get a mid-cycle test ("somewhere" in the cycle) that will really help, in addition to AMPS/PMPS.

That 31 at AMPS+7 means you need to reduce the dose to 0.75, I'd say. I hope you were able to give her some extra food/sugar to make sure she didn't drop much lower. Was she acting OK?

ETA: based on that 31 I'd guess the red numbers you've seen recently are bounces.

 

She was acting just fine! I updated with a new post with that info. I took a +7.5 and she's back up to 50. I didn't have to give sugar, but just gave her more food (she always has food, but just gets SUPER picky if it has sat out too long - old age, lol!).

I was wondering if they were bounces - it's crazy she'd bounce like that. I will lower to .75. I've created a new thread with that question - wasn't sure whether to post on here, or create a new one. I'm out of practice on all of this FDMB stuff!

 

Oh and as for ketones - I'm not sure how to do that. I didn't have much success with that before, but with her already back up to 50, I'm feeling more confident she's ok. She keeps hopping from window to window (we just opened them all of the way) and seems very content at the moment.

 

That would be great and helpful! People have all kinds of obligations and distractions, you do what you can, but a couple more tests in the daily cycles where you can get them and perhaps a curve or mini curve on your day off would do her a world of difference. Do you give her treats for testing? It seems to work for many cats, especially if it’s something they like and they only get it at test time.

I’m sorry you went through that with your pet sitter. With her DKA history, it’s really imperative you test for ketones, you can keep it from happening again. You can use the urine strips or a blood ketone meter (works just like your glucometer with special strips). I also worry about ketones when you say she’s been vomiting, I hope you can test for ketones today somehow. I’m not sure what you mean that because she’s back up to 50 she’s okay? DKA is more often related to higher numbers, not eating/getting enough calories, not enough insulin and stress/infection. It doesn’t have to be all those things either.

1 unit is too much for her, I would try the .75 now and see how it goes.

 

@Stacy & Asia - Do I have that backwards? My mind is a myriad of chaos as we get her regulated and we prepare for our trip! I have in my mind that DKA is low, but no the weird short-term blindness, etc is when she's low. That's what I meant! Oy!

She hasn't vomited but maybe 5 times since I started regularly testing her in March (see chart). She had an episode the other night, but she was in the 60's, but I think it had to do with her getting into something she should not have. She is so used to starving all of the time and since we no longer have a dog (GA), she looks for things on the floor and eats them. I had done a vinyl decal project last weekend and hadn't cleaned up the mess on the floor when I saw she'd been sick and it went EVERYWHERE. We have light carpets and her food is a pinkish salmon color (yuck).

If she was still vomiting as regularly as she was - she was literally getting sick every single day, then I'd think there was something else going on. But, when I started testing her glucose again and saw how high she was - I knew that was likely the culprit. So far, that and the occasional hair ball seem to be the only things that cause her to get sick (since late March when I started testing again).

Thanks for the feedback - I can try to test for ketones - I have strips as hubby and I (coincidentally) follow a low-carb lifestyle. No diabetes for us, but just a way for us to lose weight and it works! I will see if I can get a reading. I used to put a plastic liner in her litter pan and then test from that.

I appreciate your help! <3

 

Oh, I forgot to add - I tested again at +9 and she's at 72 now. Whew!

 

even with a long term diabetic, getting a number under 40 means dose Reduction.

you need to be at 0.75 u , the 1 u is too much.
Next time might not be as lucky as today that she went back up....

perhaps you should look into this meter where it takes glucose number and ketone number...
http://www.novacares.com/nova-max-plus/

if her vomiting isn't hairball related all the time, she could have a food allergy to something.
Wheat is a very common one, and most of the gravies in the foods irritate so many cats.
Irritants become inflammation over time.
Mine had ibd/lymphoma and it's very difficult to figure out what the trigger is. I couldn't figure it out myself.

 

Thanks @rhiannon and shadow (GA). I dropped her down to .75 and I will hopefully get 1-2 testings in before a zonk out for the night. I'm hoping hubby can test her in the AM. (He's up at +9).

Thanks for the monitor suggestion. Right now I'm using the Contour Next EZ - but the strips are getting more and more $$$$. I've seen others for less, but I've been so used to this one, I'm hesitant to change. Hubby thinks I should try one with a lot less costly strips. These Contour Next strips are almost $1/strip at some places.

 

i had an bayer contour.... and I think the cheapest i ever found strips was 40 cents a piece on ebay.
the cheapest one is at walmart called the relion...

but since ketones are an issue, i'd go research the cost of that one because with a ketone prone kitty, you
have to monitor that condition too.

I'm so glad you reduced the dose.

IF you happen to get up again, grab a test. that data would be so very very helpful. Very....

 

I have ketone strips and was able to test last night - she is ketone free! I do think changing to that type of monitor would be nice. I'll look into it.

I grabbed a dose at +9. I couldn't get myself up for any earlier to get any more.

 

Yay! That’s great news. Just to clarify, the blood ketone meters can also monitor glucose (they take 2 different strips), but the strips may be more expensive for glucose than you want to pay. You can use it just as a ketone meter and get whatever meter you want for glucose, like the Walmart Relion, the strips for that are very inexpensive.

 

Thanks! I have the ketone strips and just collect her urine and go about it that way.

How do the glucose Relion meters work compared to the Bayer Contour? I am surprised the varying prices in monitors - just for blood glucose! My hubby was tempted to switch over to that brand when he saw how cheap the strips are. But, I've used the Bayer Contour Next since day 1, and even though they are pricey, there is a level of comfort knowing that. But, if the Relion are just as good, it seems silly for me to keep paying more... Not sure what to do!?