7/22 Girlie AMPS 697; +6=275; +8=94; +10=115; PMPS=157; PM+2=439

[Girlie's mom]

Hi,
Darrah (Girlie's mom) here in Australia, hence date/time discrepancies with US - we're basically a day ahead. We're new (dx 20 June), and Girlie has just started showing a real response to Lantus after being in hospital for 10 days since diagnosed (see at end). She's really dropping quickly during the day - 181 points between +6 and +8 yesterday.

Our first hypo scare on 4 July ended up with her in hospital for 8 days, so I get anxious about giving her 1.5U for her PM shot if she's low, but then she bounces up in the evening. So she's missed shots, which can't be helping her regulate herself.

I'm just not sure how to help her get on track, or how to know whether her current dose (1.5 U am/pm) is correct; this is all new to me (and still daunting).

Just fyi: all BG results in her SS from 4 - 15 July (am) come from the Freestyle Libre implant; not sure the readings for 13 - 15 July are accurate as it was giving problems by then. I've been using the AlphaTRAK2 since pm of 15 July: she sleeps through it, good girl that she is...

I'm reading links like a mad thing, but any help or suggestions would be so welcome! I'm so new to this and very anxious. Bron & Sheba mentioned how helpful this forum was for her when Sheba was bouncing and diving, so I'm turning to you as well for advice...

Girlie is 18 yo and has had a really rough time since being diagnosed on 20 June, putting me through a roller coaster of fear and trembling:

• enema under anesthesia (severely constipated and impacted);
  
• pneumonia;
  
• ongoing constipation;
  
• hypo and in hospital for 8 days where she was taken off Lantus, put onto Caninsulin; given ActRapid (not sure what that is in the US) during day and night when so high; back to Lantus and sent home on 12 July.
  
• ongoing issues as she's a very picky grazer (new med Mirtazapine is helping a bit there).
  
• In addition to all the new meds, she has her meds for Asthma, Idiopathic epilepsy, and Arthritis. It's a lot for an old girl!

Sorry to write so much - and thank you so much for any advice or suggestions...

Darrah

 

[Chubba (GA)]

I can't offer any advice as I'm fairly new myself. But welcome! You will get lots of great advice here. Everyone is so helpful.

 

[Bobbie And Bubba]

Hi and Welcome! She really has some extreme BG readings.

Good job shooting your lowest number to date last night even if it was a reduced dose. You will get more comfortable shooting numbers under 150 as you get some more data to see how she responds to the insulin better. As you saw she bounced right up after that fast drop in the AM cycle and hitting a green number.

After a hypo event, I am sure you have a hypo kit with all the supplies you'd need like extra testing strips and higher carb food and syrup.

With the constipation, have you tried giving her a tsp of pure pumpkin? Do you have it in Australia? If so, has to be pure, not the pie filling with sugar and spices. Also, add water to all her meals. I have to do that with Bubba as he suffers with constipation also as he just doesn't drink enough water so I add 1 tbsp. to each of his 6 mini meals a day.

What are you feeding her? I know your pet food is different there and I'm sure Bron has provided you with a list of the lower carb foods.

Keep posting and asking questions; that is how we all learned and reading all you can here and others post as you will learn a lot that way too.

 

[Bron and Sheba (GA)]

Hi Darrah! Really glad to see you on the L&L forum.

Looking at Girlie's SS I can see she is still bouncing after the low numbers and probably from less insulin last night. That was good you didn't skip but gave a dose, even if it was reduced. If you are going to be home and can test...if her BSL is on the way up and you can see it is, like last night, and she has eaten for you, you could give her closer to the full dose and monitor closely...I know it is hard for you because she is not a great eater. And you have to feel comfortable with what you are doing. But you can gradually get to where you are comfortable shooting low numbers. There is a saying here on the forum." Shoot low to stay low" and it is true although it may be scary to do in the beginning. But people will help you get there.
Getting a +10 or +11 will give you a heads up on where she is heading and if her BSL is on the rise or not.

I know you have alphatrak2 in your signature but I will mention you use it here because it does change the numbers.

I am going to tag @Wendy&Neko and @Chris & China

Here are your previous posts

http://www.felinediabetes.com/FDMB/...new-insulin-scared-silly.180248/#post-2001630

http://www.felinediabetes.com/FDMB/threads/should-i-give-insulin-bg-low-new-and-unsure.180760/

 

[Wendy&Neko]

Hello and welcome. You girl sure has a colourful spreadsheet. Reminds me of a certain log haired black and white girl I knew. Since you have had to skip or reduce doses lately, and had a hard time getting consistent dosing, which Lantus likes, it might be better to reduce the dose. I might try 1.25 or 1.0 units and try to get at least six to eight cycles with the same dose, then evaluate what to do. When you are new, it's easier to start a little lower in dose. However, I would only go to a lower dose if Girlie is not showing ketones or had a recent DKA incident. Did the vet's mention anything about either of those at her recent hospital stay? Are you testing regularly for ketones?

 

[Girlie's mom]

Hello and welcome. You girl sure has a colourful spreadsheet. Reminds me of a certain log haired black and white girl I knew. Since you have had to skip or reduce doses lately, and had a hard time getting consistent dosing, which Lantus likes, it might be better to reduce the dose. I might try 1.25 or 1.0 units and try to get at least six to eight cycles with the same dose, then evaluate what to do. When you are new, it's easier to start a little lower in dose. However, I would only go to a lower dose if Girlie is not showing ketones or had a recent DKA incident. Did the vet's mention anything about either of those at her recent hospital stay? Are you testing regularly for ketones?

Hi Wendy,
I do a Urinalysis every day: ketones have always been negative so far, and no DKA since diagnosed (thank goodness!). I measure her water over a 24-hour period; I just put those in her SS. I have a Drinkwell Avalon water fountain, so she drinks a lot.
I looked at Neko's SS and the archived one from 2012: so little black, and so much more blue and green - but very colourful! In the 2012 sheet, it's interesting that the numbers from the Freestyle (Libre, I assume?) are so much lower than those after: I'm curious why Neko went up after being in the yellow for so long - was it the meter, do you think?

 

[Wendy&Neko]

Definitely the meter. When we started out, I used the Freestyle Lite. At that time, it had a notorious reputation for reading a lot lower in the high numbers than other human meters. I believe that is no longer true. But at the time, many of us were dosing based on seeing much lower numbers. I switched to a Relion with a Bayer backup, and both read much higher. And I got a better picture of what was really happening. Neko had two high dose conditions, so we ended up on quite a bit higher dose, but I could have gotten their faster if I had started with another meter. At that time, in Canada, the Freestyle took the smallest drop of blood, which is why I chose it.

 

[Girlie's mom]

Hi and Welcome! She really has some extreme BG readings.

Good job shooting your lowest number to date last night even if it was a reduced dose. You will get more comfortable shooting numbers under 150 as you get some more data to see how she responds to the insulin better. As you saw she bounced right up after that fast drop in the AM cycle and hitting a green number.

After a hypo event, I am sure you have a hypo kit with all the supplies you'd need like extra testing strips and higher carb food and syrup.

With the constipation, have you tried giving her a tsp of pure pumpkin? Do you have it in Australia? If so, has to be pure, not the pie filling with sugar and spices. Also, add water to all her meals. I have to do that with Bubba as he suffers with constipation also as he just doesn't drink enough water so I add 1 tbsp. to each of his 6 mini meals a day.

What are you feeding her? I know your pet food is different there and I'm sure Bron has provided you with a list of the lower carb foods.

Keep posting and asking questions; that is how we all learned and reading all you can here and others post as you will learn a lot that way too.

Hi Bobbie,
Thanks so much for the encouragement! I was full of anxiety because she dropped so quickly yesterday from +2 to +8, dropping 12 points by +6 and then another 10 points by +6: is that a lot to drop in just four hours - from black to green? I was also exhausted and knew I couldn't stay up to test through the night (bad mom) in case she did drop.

I printed out the hypo sheet (was invaluable on the night when she did go hypo, though with no symptoms); I've got honey, glucose syrup (from the vet), and high carb dry food (Hills Active Longevity) which she'll go for, as well as my last resort - Liverwurst, which she'll climb a mountain for even with her poor arthritic hind legs. The problem is that she's picky, and when she's done eating, she's done and that's all there is to it. That's why we're on the Mirtazapine - to try to get her to eat consistently and get her weight up.

I haven't tried pumpkin yet; I've been using Osmolax (Miralax in US?) and Cisapride: those have been helping a bit, finally. I will add water to her meals. She's drinking a lot right now (because she's been so high?); I've recorded those levels in her SS; I'll start adding water to her wet food, though - great idea!

I've added a sheet to my SS called "Oz food" (as we're in Australia) and the brands/carbs are different. She's getting an all wet diet now: Fancy Feast; Whiskas (her fave); and the vet gave me m/d and Purina DM. I know m/d is considered a no go, so I'm waiting for the shouts about that one! She prefers the FF, Whiskas and Ultimates indulge instead, though. All the foods are low carb.

 

[Girlie's mom]

Definitely the meter. When we started out, I used the Freestyle Lite. At that time, it had a notorious reputation for reading a lot lower in the high numbers than other human meters. I believe that is no longer true. But at the time, many of us were dosing based on seeing much lower numbers. I switched to a Relion with a Bayer backup, and both read much higher. And I got a better picture of what was really happening. Neko had two high dose conditions, so we ended up on quite a bit higher dose, but I could have gotten their faster if I had started with another meter. At that time, in Canada, the Freestyle took the smallest drop of blood, which is why I chose it.

I see; the meter makes a lot of difference, it seems. Girlie had the Freestyle Libre implanted at the beginning; I loved the convenience of it (even if she did look silly with that on her shoulder), but I don't know that I trusted the readings on it. I feel more comfortable now using the AlphaTrak2 (because she sleeps through it) as I think it's more accurate. I'm turning into a bit of a BG testing monster, though: can you test too much, do you think?

So much to learn!

 

[Girlie's mom]

I can't offer any advice as I'm fairly new myself. But welcome! You will get lots of great advice here. Everyone is so helpful.

Thank you so much! I can see that you had a lot of high numbers as well, but now you've got blues and greens.

 

[Wendy&Neko]

The AlphaTrak will read a little higher than human meters. Both of our dosing methods were created using human meters. That and the cost of the strips were why we use them here. Might be interesting to compare your Freestyle to another human meter, though too much meter comparison can drive you crazy!

Nothing like too much data to start, when you are trying to learn Girlie's patterns. Knowing her onset, nadir, duration, and reaction to food will stand you in good stead. I eased off testing over time.

 

[Girlie's mom]

Hi Darrah! Really glad to see you on the L&L forum.

Looking at Girlie's SS I can see she is still bouncing after the low numbers and probably from less insulin last night. That was good you didn't skip but gave a dose, even if it was reduced. If you are going to be home and can test...if her BSL is on the way up and you can see it is, like last night, and she has eaten for you, you could give her closer to the full dose and monitor closely...I know it is hard for you because she is not a great eater. And you have to feel comfortable with what you are doing. But you can gradually get to where you are comfortable shooting low numbers. There is a saying here on the forum." Shoot low to stay low" and it is true although it may be scary to do in the beginning. But people will help you get there.
Getting a +10 or +11 will give you a heads up on where she is heading and if her BSL is on the rise or not.

I know you have alphatrak2 in your signature but I will mention you use it here because it does change the numbers.

I am going to tag @Wendy&Neko and @Chris & China

Here are your previous posts

http://www.felinediabetes.com/FDMB/...new-insulin-scared-silly.180248/#post-2001630

http://www.felinediabetes.com/FDMB/threads/should-i-give-insulin-bg-low-new-and-unsure.180760/

Thanks so much, Bron!
I'm just wondering how low is too low to shoot her 1.5 U (which seems so small compared to other people's SS, but I don't know?)? I guess I see that huge drop down from the AMPS to just a few hours later, and it makes me nervous. Last night I read the FAQ #4.4 and I thought I'd give her a token shot instead of skip it. I feel like she's just starting to show a pattern of response to the insulin after the rocky start we had with all of that time in hospital and her new and entertaining conditions.

When she had PMPS 6.1 (110), the vet said that I could give her the 1.5U, but to give 1 U if I was feeling too anxious about that.

Last night she was going up from the 5.2 (94); if I see a rise like that in the hours before her PM shot is due, and the PMPS reading is also going up, can I feel pretty confident that she won't take a dive post-shot? Or does that sort of thing take longer to figure out?

 

[Girlie's mom]

Hello and welcome. You girl sure has a colourful spreadsheet. Reminds me of a certain log haired black and white girl I knew. Since you have had to skip or reduce doses lately, and had a hard time getting consistent dosing, which Lantus likes, it might be better to reduce the dose. I might try 1.25 or 1.0 units and try to get at least six to eight cycles with the same dose, then evaluate what to do. When you are new, it's easier to start a little lower in dose. However, I would only go to a lower dose if Girlie is not showing ketones or had a recent DKA incident. Did the vet's mention anything about either of those at her recent hospital stay? Are you testing regularly for ketones?

I'll have to figure out how to do 1.25: I need a bigger magnifying glass, I think!

I guess my anxiety about shooting with (relatively) low numbers is the hypo incident: she'd had no insulin for 3 days; had the Freestyle Libre reader implanted; I brought her home; PMPS was 27.8 (500); fed her (for once she ate like a creature possessed); gave her 1 Unit - and bang: three hours later she was 2.8 (50), then lower still even after chowing down on high carb dry and Liverwurst (as she wouldn't eat anything else). Then 8 days in hospital. I guess I don't know enough yet to feel confident.

My vet seems to feel confident, though, and would probably have liked me to give her the 1.5 or at least 1 unit last night (if she'd known).

Do quick, deep drops during the day mean a cat might have equally quick, deep dives in the evening? Or is there no way of really predicting that?

Thanks, Wendy!

 

[Bron and Sheba (GA)]

Thanks so much, Bron!
I'm just wondering how low is too low to shoot her 1.5 U (which seems so small compared to other people's SS, but I don't know?)? I guess I see that huge drop down from the AMPS to just a few hours later, and it makes me nervous. Last night I read the FAQ #4.4 and I thought I'd give her a token shot instead of skip it. I feel like she's just starting to show a pattern of response to the insulin after the rocky start we had with all of that time in hospital and her new and entertaining conditions.

When she had PMPS 6.1 (110), the vet said that I could give her the 1.5U, but to give 1 U if I was feeling too anxious about that.

Last night she was going up from the 5.2 (94); if I see a rise like that in the hours before her PM shot is due, and the PMPS reading is also going up, can I feel pretty confident that she won't take a dive post-shot? Or does that sort of thing take longer to figure out?

I think Wendy's suggestion of dropping to 1 unit or 1.25 units (correction) so you can shoot the same dose morning and night is a good idea. Lantus likes consistent dosing and if you are having to shoot different doses all the time you will find it hard to get sorted out. And holding it for the 6 to 8 cycles and then ask for help in what to do next.
If you are concerned about if it is safe to shoot the number....post and ask for help. Usually the person who advises you can stay with you and help in the next several hours if you decide to shoot and are worried about dropping low. Or they will find someone else to stay with you. Use the ? Sign to alert you want help or say 'help needed' in the subject line.

Cats can drop in any cycle morning or night but you will get to know her cycles as you go along. If she is on the rise, say at +10 or 11 you should be safe to shoot as Lantus will take a couple of more hours after the shot to start taking effect and hopefully she has eaten.

Any dry food is not good. If you can, try and get a canned high carb food because the dry takes longer to have an effect.
There are a couple of FF ones that are high carb. FF Tuscan Style Turkey and Rice is one you could get.

I used pumpkin I cooked myself for Sheba. I just steamed a batch. Nothing else added, mashed it and put it into ice trays and froze and got out as needed. I used it every day.

 

[Girlie's mom]

I think Wendy's suggestion of dropping to 1 unit so you can shoot the same dose morning and night is a good idea. Lantus likes consistent dosing and if you are having to shoot different doses all the time you will find it hard to get sorted out. And holding it for the 6 to 8 cycles and then ask for help in what to do next.
If you are concerned about if it is safe to shoot the number....post and ask for help. Usually the person who advises you can stay with you and help in the next several hours if you decide to shoot and are worried about dropping low. Or they will find someone else to stay with you. Use the ? Sign to alert you want help or say 'help needed' in the subject line.

Cats can drop in any cycle morning or night but you will get to know her cycles as you go along. If she is on the rise, say at +10 or 11 you should be safe to shoot as Lantus will take a couple of more hours after the shot to start taking effect and hopefully she has eaten.

Any dry food is not good. If you can try and get a canned high carb food because the dry takes longer to have an effect.
There are a couple of FF ones that are high carb. FF Tuscan Style Turkey and Rice is one you could get.

I used pumpkin I cooked myself for Sheba. I just steamed a batch. Nothing else added, mashed it and put it into ice trays and froze and got out as needed. I used it every day.

Hi Bron,

I didn't understand that Wendy was suggesting that I take Girlie down from 1.5U am/pm to 1.25 or even 1.0 am/pm: that's interesting. I've been concerned that she's not getting consistent doses am/pm lately.

Silly newbie question: 6 - 8 cycles would be 6 - 8 days, right? Or if I give her 1.0 tonight, then that cycle would be tomorrow night?

What's the etiquette of this as far as the vet goes: are you supposed to discuss dose changes with the vet first, or does it depend, I wonder?

Thanks for the hi carb info: the dry is banned, then: got it. I'll get those others you suggested.

 

[Girlie's mom]

Another question that I might as well ask now: Girlie is currently on 6 am/6 pm. I have a problem two days in a row: next Friday, I have to leave home at about 5 pm, and then on Saturday I won't get home until about 6:30 or 7:00. What do I do in a situation like that?

I hate to mess up her insulin yet again...

 

[Bron and Sheba (GA)]

Hi Bron,

I didn't understand that Wendy was suggesting that I take Girlie down from 1.5U am/pm to 1.25 or even 1.0 am/pm: that's interesting. I've been concerned that she's not getting consistent doses am/pm lately.

Silly newbie question: 6 - 8 cycles would be 6 - 8 days, right? Or if I give her 1.0 tonight, then that cycle would be tomorrow night?

What's the etiquette of this as far as the vet goes: are you supposed to discuss dose changes with the vet first, or does it depend, I wonder?

Thanks for the hi carb info: the dry is banned, then: got it. I'll get those others you suggested.

Sorry I meant to say 1 or 1.25 units. I corrected it in my above post. When cats do what Girlie is doing...ie having to skip doses because she is too low to shoot, if you drop the dose a bit, you will probably find you are able to shoot all the time. The only time you would not suggest that is if the cat has had DKA or has ketones in the urine...that is why Wendy asked you that question.

A cycle is 12 hours so 6 cycles is 3 days.

As far as etiquette goes .....it is up to the individual. You might like to tell the vet you are getting dosing advice from the forum and see what her reaction is. Some vets are fine with it ....especially if they do not know a lot about FD....and some vets don't like it. My vet was fine with it.

Just noticed Girlie is dropping quite fast again. I'd take another test at +7 and if she is dropping too much give her some food or you could give her some food now but still test +7. The trick is to stay ahead of her!

 

[Girlie's mom]

Sorry I meant to say 1 or 1.25 units. I corrected it in my above post. When cats do what Girlie is doing...ie having to skip doses because she is too low to shoot, if you drop the dose a bit, you will probably find you are able to shoot all the time. The only time you would not suggest that is if the cat has had DKA or has ketones in the urine...that is why Wendy asked you that question.

A cycle is 12 hours so 6 cycles is 3 days.

As far as etiquette goes .....it is up to the individual. You might like to tell the vet you are getting dosing advice from the forum and see what her reaction is. Some vets are fine with it ....especially if they do not know a lot about FD....and some vets don't like it. My vet was fine with it.

Just noticed Girlie is dropping quite fast again. I'd take another test at +7 and if she is dropping too much give her some food or you could give her some food now but still test +7. The trick is to stay ahead of her!

Here we go again! She had 47g of Ultimates Indulge before her test at noon (+6), and now she's sunning herself. I'll test her at +7 and then try to tempt her with a fresh tin of something. How much of a drop is too much?

Honestly: although she accepts these tests with great grace (and often sleeps through them), she's started giving me these looks that I interpret as "you have GOT to get over your thing with my ears; it's just not seemly...I love you, but get a real life or another hobby and leave my ears alone..."

 

[Bron and Sheba (GA)]

Here we go again! She had 47g of Ultimates Indulge before her test at noon (+6), and now she's sunning herself. I'll test her at +7 and then try to tempt her with a fresh tin of something. How much of a drop is too much?

Honestly: although she accepts these tests with great grace (and often sleeps through them), she's started giving me these looks that I interpret as "you have GOT to get over your thing with my ears; it's just not seemly...I love you, but get a real life or another hobby and leave my ears alone..."

What brand is Ultimates Indulge?....it sounds as if it may be higher carb by the sound of the name!
ECID but if a cat drops much more than 50 points (US) or about 3 (world points) in an hour it might trigger a bounce. Sheba was usually ok unless she dropped about 70 points. I sometimes had to feed Sheba some higher carb food to get her 'safely' down. If you feed Girlie during the first half of the cycle....'feeding the curve' you will have a better chance of getting her down without too big a drop. It is all trial and error and will probably take time to get it all right and be successful but don't be disheartened.
I see she's 9 (162) @+7. Hopefully she will eat something else for you and slow the drop more.

It is amazing how quickly our kitties accept us testing them.

 

[Girlie's mom]

What brand is Ultimates Indulge?....it sounds as if it may be higher carb by the sound of the name!
ECID but if a cat drops much more than 50 points (US) or about 3 (world points) in an hour it might trigger a bounce. Sheba was usually ok unless she dropped about 70 points. I sometimes had to feed Sheba some higher carb food to get her 'safely' down. If you feed Girlie during the first half of the cycle....'feeding the curve' you will have a better chance of getting her down without too big a drop. It is all trial and error and will probably take time to get it all right and be successful but don't be disheartened.
I see she's 9 (162) @+7. Hopefully she will eat something else for you and slow the drop more.

It is amazing how quickly our kitties accept us testing them.

Here's the Ultimates Indulge I gave her at +6 today: Whitemeat Tuna with Fish Roe and Chicken Breast. Using the Scheyderweb calculator, this should be about 6.5% carb - unless I'm not using the calculator correctly.
I gave her some Whiskas (7.5% carb) after her +7 test, but she only ate 7g; she wants to nap in the sun instead.

When you say feeding her in the first half of the cycle - would that be her meal before her AM shot? Is the idea to giver her a higher carb food like the FF Tuscan with rice as her am meal as she's dropping down so quickly by+4 on: today she dropped 12 (world)/218 US by +4; then 124 US (6.9 world) by +6; and 3 world (61 US) by +7; I'll see where she is at +8 and hope she's not going to go too far down again.

Oh, she does test me, indeed! But she's worth it...

 

[Bron and Sheba (GA)]

Here's the Ultimates Indulge I gave her at +6 today: Whitemeat Tuna with Fish Roe and Chicken Breast. Using the Scheyderweb calculator, this should be about 6.5% carb - unless I'm not using the calculator correctly.
I gave her some Whiskas (7.5% carb) after her +7 test, but she only ate 7g; she wants to nap in the sun instead.

When you say feeding her in the first half of the cycle - would that be her meal before her AM shot? Is the idea to giver her a higher carb food like the FF Tuscan with rice as her am meal as she's dropping down so quickly by+4 on: today she dropped 12 (world)/218 US by +4; then 124 US (6.9 world) by +6; and 3 world (61 US) by +7; I'll see where she is at +8 and hope she's not going to go too far down again.

Oh, she does test me, indeed! But she's worth it...

Yes that food looks ok. Nothing listed in the ingredients that are carbs. I use Ultimates at times. It is an ok brand. But I didn't connect it with that brand when you said ultimates.

Feeding the curve means giving food to stop the numbers dropping too fast and causing a bounce. You would feed a normal meal at shot time, then depending on where the numbers are at, you would either feed her in response to dropping numbers or not feed as the case may be. In saying that.......most of us feed at shot time and then again at say +2 or +3 and again at +4 or +5 routinely. That is because it is better for the cat to eat several small meals a day instead of just one morning and one night......better for the pancreas and they are getting some food when the insulin is at its strongest. Then on top of that, if you can see she is going to drop you can feed her some food to slow her down. If you think she won't eat much, you could give her some of the higher carb food at that point because she needs something to slow the drop and a bit of HC is better than nothing. You will get to know when you need to feed her to manage the drop.
We don't normally feed in the second half of the cycle ...+7 to +10.... but if your cat is still dropping and you are concerned then of course you do feed. Some cats have a late nadir around 10.
Unless the cat is still dropping really low after +10 we don't feed them because it influences the preshot number. But keeping kitty safe is the prime concern always.
HC food is normally kept for when kitty has dropped below 50 in TR or I think 90 in go slow( but I could stand corrected in that one) but I found it also worked well when Sheba was dropping fast and I knew that LC food would make no difference to her dropping. ( these numbers are for human meters...I think the alpha track number is 75... maybe someone could verify that.
I hope that makes sense and I haven't confused you.

 

[Chris & China (GA)]

When you say feeding her in the first half of the cycle - would that be her meal before her AM shot?

There are two cycles per day...an AM and a PM....each one is 12 hours long.....so when we say "feeding in the first half of the cycle", we're saying to feed more in the first 6 hours of the cycle (when the insulin is likely to be working it's best) and not so much in the last half of the cycle (when the insulin is naturally starting to wear off)

 

[Girlie's mom]

There are two cycles per day...an AM and a PM....each one is 12 hours long.....so when we say "feeding in the first half of the cycle", we're saying to feed more in the first 6 hours of the cycle (when the insulin is likely to be working it's best) and not so much in the last half of the cycle (when the insulin is naturally starting to wear off)

Thanks so much, China!
I'm wondering if you have any thoughts on Girlie's latest numbers. This is all new to me, so I'm still trying to figure out what's going on and how to respond to things. As far as her SS goes, she didn't get home from hospital until pm of 12 July, so I consider her real treatment with Lantus to have begun then; she was getting other insulins and then had a roller coaster of other health issues before that. I don't know if it's right to look at her SS that way, though....
Thanks so much for stopping by! It must be late in MO right now...

 

[Girlie's mom]

Yes that food looks ok. Nothing listed in the ingredients that are carbs. I use Ultimates at times. It is an ok brand. But I didn't connect it with that brand when you said ultimates.

Feeding the curve means giving food to stop the numbers dropping too fast and causing a bounce. You would feed a normal meal at shot time, then depending on where the numbers are at, you would either feed her in response to dropping numbers or not feed as the case may be. In saying that.......most of us feed at shot time and then again at say +2 or +3 and again at +4 or +5 routinely. That is because it is better for the cat to eat several small meals a day instead of just one morning and one night......better for the pancreas and they are getting some food when the insulin is at its strongest. Then on top of that, if you can see she is going to drop you can feed her some food to slow her down. If you think she won't eat much, you could give her some of the higher carb food at that point because she needs something to slow the drop and a bit of HC is better than nothing. You will get to know when you need to feed her to manage the drop.
We don't normally feed in the second half of the cycle ...+7 to +10.... but if your cat is still dropping and you are concerned then of course you do feed. Some cats have a late nadir around 10.
Unless the cat is still dropping really low after +10 we don't feed them because it influences the preshot number. But keeping kitty safe is the prime concern always.
HC food is normally kept for when kitty has dropped below 50 in TR or I think 90 in go slow( but I could stand corrected in that one) but I found it also worked well when Sheba was dropping fast and I knew that LC food would make no difference to her dropping. ( these numbers are for human meters...I think the alpha track number is 75... maybe someone could verify that.
I hope that makes sense and I haven't confused you.

Thanks, Bron.
Is there some info on the difference between numbers and how to respond to them in TR vs go slow? I've been reading heaps of posts and other info, so I probably just missed that.
I haven't had a chance to go out to get the FF Tuscan; would the i/d stew would be a high carb though, wouldn't it? If she'll eat it, that is! Picky girl...

 

[Wendy&Neko]

If using TR, the point at which kitty earns a dose reduction is 50 (human meter)/68 (AT). In SLGS, 90 is the reduction point. With SLGS, you hold each dose a week, unless they earn a reduction. With TR, you can increase the dose faster, with the timing depending on the nadirs or low points they are seeing.

For both dosing methods, you want to use carbs to prevent fast drops, as fast drops can cause bounces.

As far as discussing doses with vets, I started out doing that. Then I had questions when the vet wasn't in the office. So told her I was following TR, gave her a copy of the protocol, and came here for answers. At the beginning, I gave her a copy of my spreadsheet every week so she knew I wasn't going off base.

 

[Marvin's Mom - Nat]

I have a feeling that the dose maybe too high at the moment causing those bounces. too high of a dose from what I understand can cause high numbers too. I know it's confusing. The mid cycle, nadir number is the one you want to look when deciding on dose as Lantus is a long acting insulin. The pre-shot numbers will eventually level off once you know how your cat reacts to low numbers and how to address.

 

[Girlie's mom]

If using TR, the point at which kitty earns a dose reduction is 50 (human meter)/68 (AT). In SLGS, 90 is the reduction point. With SLGS, you hold each dose a week, unless they earn a reduction. With TR, you can increase the dose faster, with the timing depending on the nadirs or low points they are seeing.

For both dosing methods, you want to use carbs to prevent fast drops, as fast drops can cause bounces.

As far as discussing doses with vets, I started out doing that. Then I had questions when the vet wasn't in the office. So told her I was following TR, gave her a copy of the protocol, and came here for answers. At the beginning, I gave her a copy of my spreadsheet every week so she knew I wasn't going off base.

Sorry, Wendy - I see numbers and my mind just blanks out; numbers are not my friends!
I don't understand what you mean by a reduction point of 90, say, for SLGS and 68 (AT) for TR. I'm re-reading the SLGS to see if that info is there as I read that a while ago and haven't revisited it....

 

[Girlie's mom]

I have a feeling that the dose maybe too high at the moment causing those bounces. too high of a dose from what I understand can cause high numbers too. I know it's confusing. The mid cycle, nadir number is the one you want to look when deciding on dose as Lantus is a long acting insulin. The pre-shot numbers will eventually level off once you know how your cat reacts to low numbers and how to address.

I'm wondering that too - and Wendy seems to think that as well. She just had so many issues and other health concerns when she was first diagnosed (only 33 days ago!), that I really see her only starting to get on track with a good diet, steady Lantus shots, and her other health concerns fairly sorted by the time she came home (after 12 July, so just a week and a half ago). And now she's bouncing and diving quite creatively in the past three days, especially... oh boy! All very entertaining (kind of...)

 

[Marvin's Mom - Nat]

reduction point of 90

a BG of 90 or less (US measure) you would reduce the dose if you are following SLGS. Did you recently change her diet to low carb wet only as this can cause her numbers to go low fast in a lot of cats affecting the amount of insulin needed?

 

[Girlie's mom]

If using TR, the point at which kitty earns a dose reduction is 50 (human meter)/68 (AT). In SLGS, 90 is the reduction point. With SLGS, you hold each dose a week, unless they earn a reduction. With TR, you can increase the dose faster, with the timing depending on the nadirs or low points they are seeing.

For both dosing methods, you want to use carbs to prevent fast drops, as fast drops can cause bounces.

As far as discussing doses with vets, I started out doing that. Then I had questions when the vet wasn't in the office. So told her I was following TR, gave her a copy of the protocol, and came here for answers. At the beginning, I gave her a copy of my spreadsheet every week so she knew I wasn't going off base.

Sorry, Wendy - got it: the numbers are the US mg/dl, aren't they?
Since I'm using an AlphaTrak2, should I view the numbers I get from that differently on the SS than I would if I were using a human meter? I know there's a conversion for US to world for BG levels, but I'm not sure I understand the difference between human and ATrak2 readings... Sorry, I'm sure it's in a post; I'm not sure where to find it just yet...
I really appreciate your help!

 

[Wendy&Neko]

We figure out what Lantus dose to give a cat, based on how low it takes the kitty. If you are following TR, and the blood sugar goes below 50 (68 on the AT), the dose should be reduced by 0.25 units. If you are following SLGS, and the blood sugar goes below 90, the dose should be reduced by 0.25 units. You haven't said if you are following SLGS or TR. When you decide which dosing method you are following - please include it in your signature. Until then, it's harder for us to suggest what to do.

Since I'm using an AlphaTrak2, should I view the numbers I get from that differently on the SS than I would if I were using a human meter?

There is a World version of the SS for AT users. The main difference is that the numbers below 68 go light green, instead of those below 50 on the human meter version of the SS. If you want, you can manually change those cells yourself.

And yes, even those of us in other parts of the world speak "US mg/dl" as the common language. I am in Canada so understand the World numbers.

 

[Chris & China (GA)]

the numbers are the US mg/dl, aren't they?

Yes.....those are US numbers

In World numbers, if you're doing Tight Regulation, the reduction point is when they drop below 2.8 (on a human meter)....below 3.8 on the Alpha Trak

On SLGS, the point at which you'd reduce is 5 no matter which meter you use

To convert from US to World numbers, just divide by 18....and vise versa....when converting from your numbers, multiply by 18

 

[Wendy&Neko]

There is no conversion from human to AT numbers. The TR guidelines suggests 68 be used on the AT as the reduction point instead of the 50 used on the human meter. Other than that, there is no common conversion. Some people have done comparisons on the same drop of blood, but there isn't any consistency. It seems to depend on which human meter is used and the individual AT meter.

 

[Girlie's mom]

There is no conversion from human to AT numbers. The TR guidelines suggests 68 be used on the AT as the reduction point instead of the 50 used on the human meter. Other than that, there is no common conversion. Some people have done comparisons on the same drop of blood, but there isn't any consistency. It seems to depend on which human meter is used and the individual AT meter.

I see - thanks, Wendy. Again, I appreciate your taking so much time to help me out here. There's a huge learning curve involved here, isn't there?

 

[Wendy&Neko]

The first couple months is a steep learning curve. But we've all been there so don't mind answering questions. Keep asking. Tho' I'm off to bed now.

 

[Girlie's mom]

Girlie's PMPS is 4.9 (88.2) so I won't give any insulin (doing start slow, go slow). I've given her her normal low carb food; not sure in this situation if I should give her a higher carb food? Should have known that before I was confronted with this situation. Still learning...

I don't think that starting Girlie's Flixotide again (none since 20 June) with the Aerokat inhaler should influence her BG levels, but I did start it again on the pm of 21 July; I assume that the next three days' numbers are just coincidental, though. If anyone thinks that might not be coincidental, could you let me know?

 

[Wendy&Neko]

Low carb would have been fine. Just test again in an hour to make sure she stopped dropping.

That 88 earns a 0.25 reduction on SLGS. And you were right to not give a shot.

 

[Bobbie And Bubba]

Congrats on the reduction! Perhaps 1.25 units will give her more consistent dosing for both cycles in a day.

Something I just wanted to reiterate and I think Chris mentioned it too, with dry food the BG's don't come up as fast. So, if you are steering her when she drops to low and she won't eat higher carb wet for you at that time, add a drop of two of syrup to the dry food to help boost her up. I know her not eating sometimes is a concern for you and wanted to make sure you knew that about dry food.

I don't the answer to a correlation with her numbers since you started back the inhaler and the Flixotide as I am not familiar with either and hopefully someone will weigh in. If you have recently switched to lower carb food, that can make a big impact on lowering her lowers.

 

[Girlie's mom]

Congrats on the reduction! Perhaps 1.25 units will give her more consistent dosing for both cycles in a day.

Something I just wanted to reiterate and I think Chris mentioned it too, with dry food the BG's don't come up as fast. So, if you are steering her when she drops to low and she won't eat higher carb wet for you at that time, add a drop of two of syrup to the dry food to help boost her up. I know her not eating sometimes is a concern for you and wanted to make sure you knew that about dry food.

I don't the answer to a correlation with her numbers since you started back the inhaler and the Flixotide as I am not familiar with either and hopefully someone will weigh in. If you have recently switched to lower carb food, that can make a big impact on lowering her lowers.

Thanks so much for that tip. I've avoided dry completely since 27 June (not sure what happened while at the vets but assume they fed wet), except for the night she went hypo (4 July), when I offered her some of her old Hills Active Longevity fry so she would eat something; I didn't know at the time that BG's didn't come up as fast with dry! I have some glucose syrup (from the vet) now just in case.

 

[Girlie's mom]

Low carb would have been fine. Just test again in an hour to make sure she stopped dropping.

That 88 earns a 0.25 reduction on SLGS. And you were right to not give a shot.

Thanks so much for that confirmation, Wendy. She came up, so I went to bed; of course she was high this morning for her PMPS. I'm hoping the lower insulin over the next while will allow me to give her the same dose 2x/day so her body can start trying to accommodate to things. Fingers crossed!

Unfortunately, I'm going to run into real life this coming Friday and Saturday. I usually shoot at 6 am/6 pm, but Friday I have to leave earlier than that, and Saturday I might not be home until 6:30 pm. I can cancel going to my event on Friday night, but I'm wondering what to do in situations like this, especially as they're two days in a row that make a consistent shooting time difficult. And I hate to do this so soon after starting a reduced dose and trying to get her to 2 regular shots/day. Any suggestions would be greatly appreciated!

 

[Bobbie And Bubba]

You can move the insulin injection either way by 30 minutes without too much repercussions. Anything more than that you can move the shot time by adjusting 15 minutes a cycle to adjust. But, if it is just 30 minutes earlier or later, I wouldn't try to change the shot time rather just shoot the earlier or later 30 minutes.

 

[Girlie's mom]

You can move the insulin injection either way by 30 minutes without too much repercussions. Anything more than that you can move the shot time by adjusting 15 minutes a cycle to adjust. But, if it is just 30 minutes earlier or later, I wouldn't try to change the shot time rather just shot the earlier or later 30 minutes.

Thanks so much - so it's okay to move it 3o minutes earlier on Friday (to 5:30 pm) and then Sat am at 6:00 am and Sat pm at 6/6:30 pm? Just wanted to make sure I understood you correctly...

 

[Bobbie And Bubba]

Thanks so much - so it's okay to move it 3o minutes earlier on Friday (to 5:30 pm) and then Sat am at 6:00 am and Sat pm at 6/6:30 pm? Just wanted to make sure I understood you correctly...

Yes, that shouldn't be a problem. Just keep in mind that an earlier shot can act as a dose increase and a later shot as a dose decrease. So, if on the time you would shoot earlier and if her BG is lower and you are concerned then just give her some higher carb food to boost her up. I am linking a really good post about feeding the curve that you should read. It is perfect for times like this.

http://www.felinediabetes.com/FDMB/threads/8-10-tashie-pmps-high-questions.101989/


Scroll to Post # 15

 

[Wendy&Neko]

Here's a post on Getting Back on Schedule. It includes examples. I regularly had to move my shot time up an hour for an evening meeting, so I'd plan ahead and move it up over a couple of days, then back afterwards.

Another general post that includes links to all sorts of useful posts is "Where Can I Find".

 

[Girlie's mom]

Here's a post on Getting Back on Schedule. It includes examples. I regularly had to move my shot time up an hour for an evening meeting, so I'd plan ahead and move it up over a couple of days, then back afterwards.

Another general post that includes links to all sorts of useful posts is "Where Can I Find".

Super - thanks so much, Wendy. I've started a new folder for myself so I can find things I refer to frequently; I'll put these there now.

 

[Girlie's mom]

Yes, that shouldn't be a problem. Just keep in mind that an earlier shot can act as a dose increase and a later shot as a dose decrease. So, if on the time you would shoot earlier and if her BG is lower and you are concerned then just give her some higher carb food to boost her up. I am linking a really good post about feeding the curve that you should read. It is perfect for times like this.

http://www.felinediabetes.com/FDMB/threads/8-10-tashie-pmps-high-questions.101989/


Scroll to Post # 15

Thanks so much! I'll add that to my new folder.