911? Disco 11/4 Update, +6 110, feed snack? Retest in 20 min?

I'm sure I'm not the only sugar cat nurse that has ever done this, but it embarrasses me as an experienced veterinary healthcare professional that I made this mistake! I have tested diabetic cats I have cat sat numerous times but with machines that were already calibrated to the test strip code AND I MISSED THE STEP OF CALIBRATING my new AlphaTrak when I started using it last Thursday 10/24!!!

So until last night when I tested Disco one last time before bed, when I looked at the screen at the right time and the code 14 came up, and I looked on the strip bottle and it said 28 for cats, I knew what I didn't do!! It's water under the bridge now, but I frightens me that I could have harmed my cat!

So, with the new code in, last night's reading 2 hours post inj was 428. (yesterday I did a +3, +4, +8, and the last test of the day was +2 post PM inj) and this morning was 390. I am still giving him the 1u of Vetsulin as I began with, but his initial BG at the vets on 10/22 was 427, so I am thinking that 1u has not been enough for him? I am also sending the spreadsheet to his vet with the above notes and will let you know what she says, but have come to trust this groups feline perspective and experience so much more in just a week!

 

I'm sure realizing the mistake sent your blood pressure up a few notches!

I am truly hoping you consider getting Disco switched over to a longer acting insulin. The duration with Vetsulin is just not a good match for a cat's metabolism.

 

Yes, I am planning on changing him over to Lantus, but having just moved back to Oregon and having one visit at a clinic I used to work at when I lived here 18 years ago, started out with what they recommended but have already contacted another clinic that is AAHA and is AAFP Gold Cat Friendly practice and want to make a consult appt with them to discuss Disco and see if they are progressive in their thinking as the cat practice I worked at in Virginia, even though they are a general small animal practice, I would hope that the extra effort they made to get a gold level cat friendly status speaks well of them.

 

It's Wed 10/30 and Disco's PM reading on the AlphaTrak was 450. Today I also bought a ReliOn Prime and on that it was 484. I did not do any + tests today. He is hungry, more ravenous and usual interactive and vocal behavior. I'm about to give his PM inj of 1u. I am sending his spreadsheet to his current vet tomorrow but am anxious tonight. He has been on Vetsulin 1 week now and until last night, the meter wasn't set with the proper code.

 

Mid-cycle tests are useful in figuring out the whys and wherefores of the preshot numbers.


I do not give dosing advice. Tagging @@MrWorfMen's Mom

From Vetsulin Guide/
Q: Why is my cat so hungry?
When initially diagnosed your cat may behave like she is starving. That’s because prolonged high BG, and insufficient insulin, make it hard for her body to utilise her food. Once her BG is under better control her appetite should return to normal.
Your cat may need feeding more than twice a day. Many cats do well on a number of smaller meals fed throughout the day. Some cats can be ‘free fed’ for much of the time.

Sorry for bruskiness – am in bed and on a wonky laptop.

Are you checking for ketones?

 

Thank you for the reply even though you’re in bed and on a wonky unit! I have ordered urine stix, they should be here tomorrow. I will start feeding him more food and do plus readings tomorrow. Thank you again!

 

@TERI THORSTEINSON

Are you giving insulin twice a day? Your spreadsheet has a lot of blank cells in the U column on the PM cycle.

 

Yes, 7:30 am and 7:30pm, I will go in and correct my mistakes on the spreadsheet, I’m on my phone right now in bed and I can try and do it from here

 

No worries....I figured you were and just wanted to let you know it wasn't on the spreadsheet. We're very data driven here so the spreadsheet needs to be up to date and correct before we can give much in the way of helpful advice.

What's your schedule like? Do you work during the day so you can't get tests in on the AM cycle?

All that being said, I think I'd hold the 1U dose just a little longer. He dropped into blue yesterday and he could be bouncing now.

I'll tag @MrWorfMen's Mom too

 

Thank you so much for your recommendation and advice and experience. I am newly retired and have yet to start seeking part-time work to supplement my Social Security. I just closed on my new house yesterday and am more fortunate than many as I can make myself available to test Disco whenever I need toAnd will do another every two hour testing tomorrow now that my AlphaTRAK2 Is “on track”

 

I responded yesterday on the other thread and agree with @Chris & China (GA) that holding the 1u dose for the time being would be best given the drop into blue recently.

 

Thank you so much for your support and guidance! I updated his spreadsheet this morning and used both meters, AlphaTrak (356) and ReliON (381) and will have to use the ReliOn today as I ran out of AlphaTRAK test strips (yes... I used 50 in a week, sigh--lots of room for improvement in my technique) and ordered more but they won't arrive until Saturday.

 

Friday 11/1 Update: Yesterday I did another curve on Disco and have updated the spreadsheet. I am using both the AlphaTRAK2 and the ReliOn Prime just for comparison and I will probably change over to the ReliOn as the supplies are so much cheaper. He is still getting the 1u of Vetsulin and I have ordered Keto-DiaStix and hope they will arrive today.

I am following this regimen-Test, Feed and then inject 30 min after eating, though I need to start setting an alarm on my phone and the time flies by and while not off by more than 20 minutes, I need a reminder! I let him graze on the remains of his morning meal until about noon and then take it up (he is eating Darwin's Raw and FF Classics. Should I do the same with his evening meal? This morning, when I awoke at 6am I heard him eating, and I think he is not supposed to eat for 2 hours prior to testing, correct, so I tested him at 8am instead of 7:30am. This morning his reading on the AlphaTrak was 475 (with new strips and proper code entered in) and on the ReliOn 335. His +6 nadir yesterday on the ReliOn was 270 (I was out of AlphaTRAK strips but they arrived last night)

I spoke with his vet yesterday and she seems to think that the readings I had that were good (181, 199) when the AlphaTRAK had the wrong code entered were not that inaccurate (said the tech that use the machine a lot said they don't see much difference in readings when they have corrected a code). She also said I should not let him graze or increase his calories. Still offering DM canned and RC Glycobalance, but not real pushy. She wants to leave him on Vetsulin 1 more week but is open to changing to Lantus or Pro-Zinc if not improved and will write a script so I can order from other sources or Mark's. I still plan on visiting the seemingly more cat-versed practice near me (AAFP Gold Feline Friendly and AAHA) and have sent all my cats records there already.

I don't want to change his diet from what he has been on the past 3 years because it's species appropriate and has helped his IBD, and is within the guidelines of this group and Dr Lisa. I am letting him graze as he doesn't finish either AM or PM meal within 30 minutes typically (though Wednesday he was ravenous). I need confirmation on taking up food when I go to bed and mid-afternoon, so he isn't snacking even a little bit before testing.

He is being really good about his paw pricks and I did change to the ReliOn Alternate Site lancets and it's helped and I'm warming the pad and putting neosporin before poking, but still am finding myself having to do multiple pokes, sigh. Soon as his ears look better, I will try the ears again. I did read that I should poke at a 45 degree angle for best results, not straight down and I was doing that wrong, so next poke I will try the angle. I'm going to do some + readings today too.

 

Typing this with one eye open. I hope it makes sense.

There is no need to change Disco's food. As you said, it helps his IBD and is within the low carb guidelines.

The reason food is taken up is to make sure the preshoot number is not food influenced. With vetsulin being an in-and-out insulin, it is less of an issue. The duration of vetsulin is 8-12 hours. If you do a couple of curves with your human meter (cheaper), you will see how long the durations is. It looks like you will be switching to Lantus soon. With Lantus being a depot insulin, taking up food, especially at the beginning, is important.

An automatic feeder helps. For a multi-cat household, you can get feeders with chip readers. You can set an alarm for 2 hours before shot and pick up the food. Or pick up the food if you wake up during the night to use the facilities. If you do not leave food out past bedtime, and you wake up, you can give a small snack. A few freeze-dried treats are not going to raise his BG a lot.

From: https://www.aaha.org/aaha-guidelines/diabetes-management/dietary-management/

Feeding portioned meals has several advantages for dietary management of diabetic cats:

• 
  It is easier to monitor intake and appetite.
• Portion control is facilitated.
• Free-choice feeding is acceptable if a cat’s eating habits cannot be changed (the Task Force recommends that the daily ration be divided into multiple meals. The use of timed feeders may be helpful in this scenario).28

 

Sounds to me like you have things pretty much under control and I agree that I wouldn't change diet if the IBD is under good control. While it's a good idea to withhold food for 2 hours prior to doing that pre-shot test, the really important thing is to know kitty has food on board when the shot is given. If kitty has been eating in the 2 hours prior to the shot, they may be reluctant to eat at shot time which could cause a steep early drop in BG.

Diabetics cannot properly utilize the food they eat and don't get the nutrients they need from a normal amount of food so there is often a need to increase caloric intake to maintain weight or to get kitty to regain lost weight. No reason not to let Disco graze and no harm giving him a little more than he used to eat until his BG is better regulated.

Looks to me like a dose increase will be needed. We recommend dose adjustments in 0.25u increments however half unit increases with the Vetsulin would be fine for now since you are planning to switch to Lantus and will need different syringes for the new insulin.

I love the way Disco sits on your lap and lets you play with his toe beans!

 

He is a cutie

 

Thanks to all who replied with feeding recommendations! I so trust your experience and advice! I have relaxed and let him graze now up until 2 hrs befor AM and PM testing. I'm sure this is posted somewhere, but is he supposed to fast when doing a curve? As in no food after he has eaten the morning meal after his AM inj until the last +6 test is completed? If so, that might be affecting the results though he is not eating much, just leftovers.

Yesterday, did some + tests though I missed the +6 by an hour. Today, Sat 11/2, just finished a curve. Not happy with the results (I updated spreadsheet) and last night it took me probably 15 minutes to get a good blob of blood. Poor patient Disco! I am going to get a pair of baby socks at the Dollar Store today and make a nice little rice sack for him, but I did try the 45 degree angle today rather that a straight in stick and it was better! I'm still mostly using his paw pads, but did get a nice stick to an ear this morning.

The syringes I have don't have 1/2U markings on them (U-40 20 unit) but this morning I gave him a smidge more than 1U, but not sure it was quite 1.25U. I need to order some more syringes online but as I will probably be switching to Lantus before long, I will get the U-100 syringes with 1/2U markings, but did print off the conversion chart so I can use them for both Vetsulin and Lantus.

I'm glad I shared his photo with you yesterday as it brought some smiles I think.

 

When doing a curve, do everything just the way you always do. He doesn't need to be fasting. In fact, if Disco was fasting, his numbers might be artificially low.

 

Have done curves past 2 days after going from 1U to 1.25U starting Sunday night. Numbers where not much changed until just now, +6 reading is 110 on ReliOn and 153 on AlphTRAK2. I have updated his spreadsheet and read the Vetsulin document on the Vetsulin forum and it said to slow that quick a drop by feeding a snack. I just did that, how soon should I retest to see if it slowed the drop or is 110 ok?

2:00pm Just retested at 30 min and it's 128 on the ReliOn, didn't use the AlphaTRAK2.

2:30pm Just retested and it's 210 on the ReliOn, didn't use AlphaTRAK2.

 

You don't need to do any "rescuing" unless BG drops below 90. By "quick drop", it means if BG changes by roughly 100 points or more in the span of an hour or 2. Disco dropped but it took 6 hours to get down to that 110 so while it's a good size drop, it wasn't what we'd consider "quick" and problematic. If however BG should drop to the 90's, then I would definitely feed Disco to slow the drop and keep him safe. Vetsulin may cause another very small drop around +8 so another check of BG them would give you some useful data. Some cats show a second small drop while other don't. BG may also be up from a bit of bouncing after those lovely blue readings.

Definitely an improvement with that dose increase.

 

Whew! I hope you know how much your reply and your advice and your experience is such a comfort to me. I am learning as I go along with your help! Thank you so much!!

 

Teri -
Would it be possible for you to get some PM cycle tests? Given that Vetsulin can slam numbers down, I'd encourage you to get a +2 or +3 so you have some idea where numbers may be heading. We generally encourage people to always get a before bed test, as well.

 

Yes, Ian do that. I’m staying at my mom’s house until my new place is ready to move in and everyone in the house goes to bed real early because they have to get up early so I’ll have to set my alarm for a couple of them LOL

 

@TERI THORSTEINSON No comment on dosing or anything, but he's adorable!

 

I'm a little slow this morning but got up every 2 hours for 3 readings during the night: +2 351, +4 170, +6 212 all on the ReliOn.

 

Hi Terry,

To manually colour in boxes on your spreadsheet, look for the paint can icon at the top of the spreadsheet.

 

Nice numbers. Sorry about the bounce this morning.

 

Awww, Thx! I love his face--so expressive! And if he makes you smile, these little rice 'newborn" socks I made to warm his toe beans will make you smile, too!

 

I see a paint roller, but when I click on it, nothing happens. Found the paint can, got it!