12/30 Quintus AMPS=184, 0.5ui. blue (touched lime), PMPS=164, 0.25ui +2=175 +10=117

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
condo: http://www.felinediabetes.com/FDMB/threads/12-29-quintus-pmps-85-1-68.188738/

EDIT Breaking news!!! found open vet in neighbour city who has strips!!! Not huge but I'll have 50 instead of 25 to get through these days. Still a restricted diet compared to the last two days, but a little comfier. Suggestions regarding which moments to test still welcome.

[So, after yesterday and the day before's abuse of strips (and my lack of foresight regarding the consequences) I have counted my remaining strips and need to function on 5 strips/day for the next days. I have approx 25 strips left, plus 10 "backup" strips which might not be all good.

Vet opens on 3rd and it is not certain their order of strips will have arrived. I have an order in the post that might arrive on third, plus another package maybe containing strips that might also arrive on third. If worse comes to worse, other vet practices will be open on the third and I might be able to go and beg for a few strips there.

So, knowing that, I'm wondering what the best way to use those 5 strips/day is :)
Suggestions on that welcome!

US readers please note: this is Switzerland, everything is closed (really closed), I can't order stuff online and get it tomorrow, there is no Walmart ;)]
 
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Are there any human pharmacies open? We have Walmart in Canada, but they didn't have the American brands there and I never shopped there for diabetic supplies. Having a human meter as a backup may be a good idea. 10 strips per day hard limit may work, but hard to say given the antics Quintus has been up to lately.:rolleyes:

In addition to preshot tests, I would get a +2 test if he's over 100 at preshot. (I see you already got a +1.) The general rule of thumb is that if the +2 is lower than the preshot, it'll be an active cycle needing more testing. A similar +2 means a normal Lantus curve, which could still mean going low. A higher +2 means you can save your strips for the rest of the cycle. Also look at whether he's dropping into preshot or on the way up. Dropping may mean testing earlier. If you ever skip or fur shot, put the test kit away, provided he's high enough at the time. Of course, if you are trying to manipulate the curve with food, that's another reason for earlier tests.

Other guidelines while strips are short: if all he's had to eat is regular low carb food, and his numbes are heading up during the cycle, stop testing. Does Quintus give any clues that he's going lower? Neko would often lie on the floor on the kitchen when her numbers were plummeting, or try to lead me to the most common testing spot.
 
Stephanie & Quintus said:
c I have counted my remaining strips and need to function on 5 strips/day for the next days.
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Goodness. I hear you.
I did that self same thing today. Counted up strips and suddenly found myself on the 5 strip thing over the days needed. Supplies from online over NZ are ordered but on shut down already so no delivery until after the 6th Jan with no notice. Spent two hours plus on the phone and finally sourced one box of 50 strips at over $60NZD. In the car a good 90 mins plus to get strips and then return . Do all this before 1pm when everything SHUTS. This is for human meter strips.

As per Switzerland. This is NZ. Everything is SHUT including online. At least until over the 6th.

Note to self: Order 4x before this and other shut downs.
 
@Wendy&Neko thanks, helpful guidelines! I haven't noticed anything particular with Quintus when he's going to head low, except that when he is nice and low, he becomes active, wants to eat, play, cuddle. If I notice that behavior and test, chances are he's bottom dark greens or top lime greens.

I actually have 10 strips/day now, so it's more "normal comfy".

@PussCatPrince heck! I'm lucky, only had to drive 30 minutes, but only got 25 strips, and they were nice, they charged me half the price of the box and not the "per strip" price I got from another vet once. I feel like a junkie trying to score. Glad you managed to find some strips!

I am considering getting a spare human meter. Thing is, here human meter strips aren't that much cheaper. Well, they are cheaper, but not that cheap.
 
Stephanie & Quintus said:
Ah, you know what, I've had a few thoughts for batteries over the last weeks. Like "oh, I hope the battery doesn't just die".
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And it might - I was in mid test - had Silver on the table, blood drop all ready - and the meter died No spare meter OR battery. Thankfully things were open and I had to make a mad dash out to the pharmacy for new meter and battery. Strips - I dont tend to test as much as most so I generally only use about 4 a day unless its a curve day - AMPS, PMPS, and two in the evening cycle. Ten a day should be more than enough - I don't even use that many on a curve day - every two hours for a 12 hr cycle is just 6.
 
As Bronx's Dad noted, if it can go wrong, it will. I had no less than 2 back-up meters (all the same brand) each with their own container of 25 - 50 strips that I would rotate. I would also order 10 boxes of strips at a time. As you've seen with Gabby's SS, I was a bit of a testaholic and would go through strips like mad. A
 
Yeah, as I mentioned to @Stacy & Asia last night, the diabetes diagnosis arrived at a point where I thought my cat was shortly going to be dead from pancreatic cancer. I'm only now starting to think I can stop buying food for just 4-5 days at a time. I've ordered two packs of Freestyle strips from the UK, and will order more if that works out well. The meter that was being shipped to me from the US actually hasn't been sent yet :( (learned that this morning), but should be today or tomorrow. I'm looking to order either an AT or a Freestyle so I can use the same strips.
 
Stephanie & Quintus said:
Yeah, as I mentioned to @Stacy & Asia last night, the diabetes diagnosis arrived at a point where I thought my cat was shortly going to be dead from pancreatic cancer. I'm only now starting to think I can stop buying food for just 4-5 days at a time. I've ordered two packs of Freestyle strips from the UK, and will order more if that works out well. The meter that was being shipped to me from the US actually hasn't been sent yet :( (learned that this morning), but should be today or tomorrow. I'm looking to order either an AT or a Freestyle so I can use the same strips.
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I use a Freestyle Lite meter and like it. Strips for human meters are very expensive here in Canada but still cheaper than AT strips.
 
Stephanie & Quintus said:
Yeah, as I mentioned to @Stacy & Asia last night, the diabetes diagnosis arrived at a point where I thought my cat was shortly going to be dead from pancreatic cancer. I'm only now starting to think I can stop buying food for just 4-5 days at a time. I've ordered two packs of Freestyle strips from the UK, and will order more if that works out well. The meter that was being shipped to me from the US actually hasn't been sent yet :( (learned that this morning), but should be today or tomorrow. I'm looking to order either an AT or a Freestyle so I can use the same strips.
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Go online to the freestyle website. Almost (if not all) companies will send you a voucher for a free meter with the purchase of strips. Freestyle does and so does accucheck.
 
Kris & Teasel said:
I use a Freestyle Lite meter and like it. Strips for human meters are very expensive here in Canada but still cheaper than AT strips.
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I have just been given a freestyle lite. Price for strips is same as accucheck Aviva but in Canada the strips are like gold. I order from eBay.
 
Stephanie & Quintus said:
To clarify: clearly, I don't think so. But wouldn't an ear tag or something working with a similar system be great?
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It's pretty awesome technology, but I think it's in its infancy, even for humans. From what I understand, you have to replace them every 14 days or so and many fail out even before the 14 days is up. Girlie's mom didn't care for it and wrote something about it somewhere. It's hard on cats because you have to stick it to them and getting it unstuck is the troubling part. I'm waiting for the day they can check glucose without blood, sweat, saliva, something like that. One day!
 
Stacy & Asia said:
It's pretty awesome technology, but I think it's in its infancy, even for humans. From what I understand, you have to replace them every 14 days or so and many fail out even before the 14 days is up. Girlie's mom didn't care for it and wrote something about it somewhere. It's hard on cats because you have to stick it to them and getting it unstuck is the troubling part. I'm waiting for the day they can check glucose without blood, sweat, saliva, something like that. One day!
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In my last chat with my vet we dreamt about the day when we could put insulin pumps in cats as we do in humans now (I have an acquaintance who has one).
 
I’ve had a vet school in the eastern US contact me about a continuous monitor for pets. They are in the infancy stage of it and might find it doesn’t pan out. I haven’t heard from them in quite some time so I’m assuming they hit snags.

Stephanie....I saw your response to yesterday’s when I got up this morning but I’m headed out shortly so I’ll have to answer your questions later when I get back. But I will get back to them. Thanks for your patience.
 
Shot 0.25 tonight. Yes, I know, that's a lot of dose-changes, and I'm ok with having to go back up if it proves I was too bold.

My objective for the next few days is to not have to try and stuff food into Quintus and let him relearn to go and eat when he's hungry. If we can avoid lime greens and honey I'll be happy too, even if it means the numbers are a little higher. Will report later tonight if I'm still operational, or tomorrow!
 
Stephanie & Quintus said:
@Marje and Gracie: so, thanks for your explanations, and sorry if I have been defensive. I also understand, as you had told me previously, that you have not been able to follow the previous episodes in Quintus's story closely, and that the advice you are giving cannot obviously take into account all our constraints and history.
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You’re welcome and thanks for the apology :) Moving forward. :)

Stephanie & Quintus said:
trying to follow, but I can't quite.
Indeed, he went low early 25th and therefore I didn't shoot. After discussion with @Chris & China I decided to give the 18h cycle a try, because the previous morning (24th) he had come up with similar PS numbers, and I hadn't shot, and he had ended up in the black. Do we agree that the rise we see between +12 and +18 (shot time) on the 25th is the insulin given 12+ hours before wearing off?
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Yes.

Stephanie & Quintus said:
By 26th morning, he has gone through a dose reduction (2.25 on 23rd down to 2.00), skipped one shot, and replaced two shots with one through the two 18-hour cycle. If we look at what might be acting in the depot (as I understand it), there would be 1 2ui shot 18 hours before, another 36 hours before, and two 2.25 shots from the 23rd. It would seem normal to me (but again, this is where I'm maybe missing something?) that his numbers on the morning of the 26th be higher. I'm assuming the yellow and pink is what you interpret as the bounce? What makes us say it's a bounce and not simply due to "not enough insulin" following the reasoning I just outlined?
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He’s been receiving shots even if he got them over 18 hours and not 12 and if the dose was high, the depot was full even though you spread out the shots. I’ve seen depots last over ten cycles in cats with overfull depots. It looks like a bounce to me because of his activity the night of the 26th and how he “slid” from PMPS to AMPS.

Stephanie & Quintus said:
On the 26th he ate normally, and ended up lime green at the end of the PM cycle, the second one with 2.00 ui after resuming "normal" 12-hour cycles. Again, the way I'd interpret that is that we are building up the depot and that 2.00 ui is already showing us it is too high a dose for him.
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I’m seeing that the depot was likely not that depleted to have to be filled very much. See my above comments.

Stephanie & Quintus said:
We then have the same situation on 27th morning, with the skipped shot, as the 25th or the 24th: what makes us affirm the higher numbers (blue to pink) are a reaction to the AMPS-time low numbers and not simply his BG going back up because he doesn't have enough insulin to deal with it correctly, as the last shot was 24h before?
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Here’s what I said about that cycle: "he lost duration and likely also bounced from the low numbers on the 27th.”

Stephanie & Quintus said:
Seems to me the pancreas can also be healing because the pancreatitis that caused the diabetes is being dealt with and more normal function is resuming, also probably because overall lower numbers (even if not all green by far) means less glucose toxicity.
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A cat that is in all blue numbers is not building up glucose toxicity but that doesn’t mean the pancreas is working. I don’t mean this in any snarky way but I’m not a vet; I also never say “never”. Is it possible that one episode of pancreatitis sent him into diabetes...I suppose it’s “possible” but usually it’s more chronic episodes. However, could he have been having many mild episodes that you were not aware of? Absolutely. Could his pancreas be healing? Anything is possible but it doesn’t look to me like he’s spending enough time in green numbers. But I’m not doing to discount that. We are talking about physiology, hormones, etc. I don’t know his complete medical history and even if I did, as I said, I’m not a vet.

Stephanie & Quintus said:
Can a cat diving and bouncing explain that he's still headed for the lime greens on 0.5 when a week ago he was on 2.25?
Regarding the diving and bouncing: I understand the mechanism behind bouncing, but don't yet see why a bounce should result in an "artificially low" dive. What happens in the body to cause it?
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It isn’t artificially low. When the bounce clears, the excess glucose released by the liver/pancreas (in a different form) can quickly leave the blood which causes the BG to drop quickly into potentially lower numbers than we would expect. Not all cats have really active bounce clearing cycles but many do. Again...ECID.

Stephanie & Quintus said:
This looks straightforward, but try as I might, I cannot find the % carbs in the NF kibble that goes in his mix. DM seems to be 6%. NF wet (but is it the cans or the pouches? can't tell) is 27%. I mix them. It's a heterogeneous mixture. He eats more of the paste at first. Often some kibble is leftover.
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You might check the bag and see if there is a European phone number to call to get the dry matter basis on the NF Kibble. The DM and NF wet % carb numbers....are those calculated from the as-feds or DMB or are those the guaranteed analysis? If they are the GA, then they aren’t what is actually in the food.
 
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Marje and Gracie said:
Is it possible that one episode of pancreatitis sent him into diabetes...
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I've checked his lab history (I know I didn't put it in the SS) and until end September his glucose levels were perfectly normal. He had pancreatitis (acute) in early 2016. He was diagnosed with "chronic" pancreatitis end Sept following labs I had done because I was going to be starting a new job where I would be less available to run at the vet's for a sneeze, and he seemed under the weather to me. His lipases were sky-high. Ultrasound showed pancreatitis and very upset (thick) gallbladder. (That is also the occasion we diagnosed the hyperthyroidism). First round of treatment improved him over the next weeks. End oct he started going downhill again, had him re-checked, pancreatitis was back (or still there but worsening). The ultrasound showed the pancreatitis was much more important than a month before. Treatment started (the gallbladder got another round as the ultrasound showed it had improved but wasn't yet "normal") and he started slowly but steadily improving. Mid-nov I had labs done again before putting him on steroids because his water intake had sharply increased (over the last couple of weeks but could have been a bit longer). That's when the diabetes was diagnosed. ETA: so following the lab results, we of course did not start the steroids.

I am pretty sure we did labs on 1.11 when his pancreatitis was "re-diagnosed" but I don't have them in his file. I'll check Wednesday when the vet opens if they have them on paper, because I'd be very curious to know if we have a glucose reading at that date. But in any case the diabetes showed up between end Sept and mid Nov.

Marje and Gracie said:
could he have been having many mild episodes that you were not aware of?
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It is possible that he has been having chronic, mild pancreatitis for quite some time before diagnosis end Sept, yes -- that has been our hypothesis with my vet.

Just giving you this so you have a clearer picture.
 
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Stephanie & Quintus said:
I've checked his lab history (I know I didn't put it in the SS) and until end September his glucose levels were perfectly normal. He had pancreatitis (acute) in early 2016. He was diagnosed with "chronic" pancreatitis end Sept following labs I had done because I was going to be starting a new job where I would be less available to run at the vet's for a sneeze, and he seemed under the weather to me. His lipases were sky-high. Ultrasound showed pancreatitis and very upset (thick) gallbladder. (That is also the occasion we diagnosed the hyperthyroidism). First round of treatment improved him over the next weeks. End oct he started going downhill again, had him re-checked, pancreatitis was back (or still there but worsening). The ultrasound showed the pancreatitis was much more important than a month before. Treatment started (the gallbladder got another round as the ultrasound showed it had improved but wasn't yet "normal") and he started slowly but steadily improving. Mid-nov I had labs done again before putting him on steroids because his water intake had sharply increased (over the last couple of weeks but could have been a bit longer). That's when the diabetes was diagnosed.

I am pretty sure we did labs on 1.11 when his pancreatitis was "re-diagnosed" but I don't have them in his file. I'll check Wednesday when the vet opens if they have them on paper, because I'd be very curious to know if we have a glucose reading at that date. But in any case the diabetes showed up between end Sept and mid Nov.



It is possible that he has been having chronic, mild pancreatitis for quite some time before diagnosis end Sept, yes -- that has been our hypothesis with my vet.

Just giving you this so you have a clearer picture.
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Thank you. That’s very helpful especially since I did not know he had been on steroids right before he was dx with FD.

He could also very likely be a steroid induced diabetic and once the steroids were withdrawn, the pancreas could then function normally.
 
Marje and Gracie said:
I did not know he had been on steroids right before he was dx with FD
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No, he wasn't on steroids. We were planning to put him on steroids to help with the pancreatitis. As we was drinking a lot, I was worried about starting the steroids (possible diabetes or increase in CKD), so I held off starting the steroids and had his blood work done. So no steroids. (Just edited the post to clarify)
 
Stephanie & Quintus said:
No, he wasn't on steroids. We were planning to put him on steroids to help with the pancreatitis. As we was drinking a lot, I was worried about starting the steroids (possible diabetes or increase in CKD), so I held off starting the steroids and had his blood work done. So no steroids. (Just edited the post to clarify)
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Ok....thanks. Post did sound like he’d had steroids.
 
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