Booger PMPS

After to hypos this last week, I have had Booger on 2 units the last two days. His preshot reads have been high. Tonight his PMPS read is 360. Questions is should I still give him 2 units or should I lower it a bit? He has been dropping 100+ after 2 hours and +4 hours when his preshots have been in the 500 and 600s.

 

On 3/13 he had a similar pre reading and did well at his nadir BG. However, I think it looks like he's bouncing from too high a dose. It might be safer to give him 1.5U for 3 cycles then do a curve. If he's not going getting at 50% drop at lowest, then you could very slowly start increasing dose.

 

What is considered a cycle? Days or each shot? Just trying to clarify.

 

A cycle is the 12 hours after a shot. We recommend keeping a dose at least 3 or 4 cycles before changing it so you should give 2 u tonight. He's still bouncing from the lower blue numbers yesterday. The nadir (low) number a dose gives is the most important in judging the dose's effectiveness. That 148 yesterday (on your AT meter) is a good number. I wouldn't change the dose yet. Keep the 2 u for a bit longer to see if he settles. Too many dose changes can cause very erratic numbers.

 

Ok well I did not see this until now I and I gave him 1.5. Should I give him another .5???

 

No, don't do that. Let's see what AMPS you get. Go back up to 2 u then if BG is similar to today's.

 

This is all just so confusing... Just all of it

 

It really is, you're not alone though! It's all app new to me and it's so much information it takes s long time to learn. The most important thing is your trying, which is way more than most people do.

 

Yes, VERY confusing! The learning curve is steep but you'll get there.

Re not giving the extra 0.5 u (should have explained above): It's possible measuring 1.5 u then 0.5 u separately could add up to a little more than 2 u. That might not be an issue with your current numbers but it's best to have the mind set of one poke only at injection time. It's too easy to make a mistake and end up giving too much insulin. You can look at this as an opportunity to see what 1.5 u does.

 

Booger did really well over night. 3:30 he was in the 500's. We shall see what he is about 7:45. If he is 500 or 600, should I keep him at 1.5 or go back to 2?

 

Why not try eyeballing 1.75 u? Or you can give 2 u again.

 

I guess it will just depend on what it is at before I feed him this morning. Not sure where you are @Kris & Teasel, but I am in Texas so CST. It is 7:30 am here now. I will be checking him in about 15 minutes and feeding him. I will post and let you know what he is at.

 

I'm in Canada, eastern time, so you're an hour earlier than I am.

 

Ok cool. I will keep you posted shortly. I just want to get this right. I feel like with him all over the place I am failing.

 

No, you're not failing. This is a very hard thing to figure out. I've been at it over 2 years and still get stumped ...

 

He is 693 @Kris & Teasel

 

Give 2 u again today. Can you test between +4 and +6 to see what the dose does?

 

Yeah. I work from home so I am here all day every day

 

Update on Booger, He did well today with 2 units this morning. Meaning he didnt get too low. Gave 2 units tonight. Will be checking him at about +4 hours to see how he is doing. Hopefully, eventually, I will be able to get him back up to 2.5 units and steady. How long do you recommend I keep him at 2 units?

 

You could try eyeballing 2.25 u tomorrow AM. Don’t jump up to 2.5 u.

 

So really I should just check him before meals and around +4 - +6 hours since that's really when he will get lowest and a chance at hypo correct?

 

Here's the basic testing routine (not sure if I gave it to you before):

1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
3. do extra tests on days off to fill in the response picture
4. if indicated by consistently high numbers on your SS, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
5. post here for advice whenever you're confused or unsure of what to do.

You work from home so that's ideal. Those pre shot tests are important and then one in the +4 to +6 range. If you're away all day sub in a before bed test.

 

Thank you

 

Concerned with high before meal glucose readings.. Why is he staying so high?

 

Your pet meter reads higher at high BG than a human meter would so high can be a black. It’s Vetsulin’s nature to drop BG fast and fairly low and that can set the stage for a rebound by PS time. It’s possible you’re getting less than 12 hour duration with Vetsulin so it poops out before PS time. And finally the dose might be a bit too low right now. Any/all of those things can be the cause.

Re dosing: keep a dose at least three, if not four cycles, before changing it. It’s the mid cycle tests that carry more weight in dosing decisions. It’s best to avoid dose changes in response to a pre shot number right now. That’s a technique best used to tweak or fine tune a good dose.

 

What's your feeding schedule like? Is he getting a lot of the dry versus wet food?

 

I am trying to get him completely on wet food but he still snacks on dry food during the day. He will lick all the liquid out of the wet and then go to his dry food.

 

Thats great you're trying to get him onto wet food. Jai (my furry) was pretty high too (and on Alphatrak - ~450 pre-dose) until we switched her completely over to wet food. Now she's much lower pre-dose (still not perfect, but I like that she's not in red all the time). The dry food is irresistible to them - we had to just completely get rid of it and ride out begs for a few days before Jai moved on. We also started with an Alphatrak2 (still have it for spot checks) but the human meter is much more wallet friendly. I was finding the Alphatrak would read 100+ higher than human meters, so curves from pinks to blues are a great starting point (struggled with wanted to always have jai hit green). Also, have you tried calibrating your alphatrak2? It has control solution that you can use to make sure it is reading within a standard range.

 

Yeah I have used the control solution several times and especially last night when I checked him and it said he was 45 so I double checked and it read he was 317 I was like what the what?! Anyway, Yes I know the human meters are more wallet friendly but it is just the accuracy that concerns me. I know people say that if they are lower glucose readings that the human monitors are usually not too far off from the alphatrak but how can you gage what the correct glucose reading is?? I mean what if you test with the human meter at nadir and the human meter shows 110 but you check with the alphatrak and it shows well over 200. I mean does that really help with dosing at all? I dont get it.

 

Yeah, I felt the same. Jai was going 450 to 250 and it left me feeling like she wasn't "dropping" far enough. But in reality, she's responding well to insulin. Pharmacologically (<- I have a PhD in that) you want a consistent response. In this case it seems aiming for a 50% reduction in nadir numbers from pre dose. So if you're starting at 400-500 - going to 200-250 range is great. There is always this time frame when drugs are first introduced to the system that you see "bouncing" - the system responds, then goes "oh wait that is way different that we're use to" so it compensates - this leads to over compensation and the body shooting up past what is normal levels. So if you're seeing a consistent response (it looks like you're on the right track), thats great and stick with the doses for a few days. You also mentioned Booger needs a dental cleaning? I've read that it might actually help pre numbers to get that done, although hopefully someone with more experience in that realm can give some advice.

 

That makes sense. Thanks for the info. I just want to make sure he isn't dropping too low. I have already gone through almost 100 alphatrak strips and it is expensive. I wish the strips were cheaper! The vet said that we could look into the dental cleaning once we get his diabetes more under control but at this time, she doesn't suggest doing it right now.

 

Just checked booger at nadir. Alphatrak meter read 105. Relion meter read 77. This is what concerns me about the human meters.

 

First, thats a really great response. Second, I agree the difference is a little weird. My plan is to spot check if Jai is high/low on the Alphatrak2 (the "take action" number is a little lower with human meters) and use human mainly for keeping track of her response trend. Luckily, she only bounced for the first few days and then starting coming from from red numbers, so I felt more comfortable making the switch. If she hadn't I'd still have been using the ATK2.

 

I compared meters maybe 10-15 times while I had both strips. I got anywhere from 10-30 difference with the exception of one that was off by 80. I think that one was just a fluke because the rest were really close. The 2 meters use a different amount of blood too and it took some getting used to getting the right size drops.
I read a post once (sorry I can’t remember who said it) that said to pick one meter and stick with it. Comparing the two will drive you crazy.
High is high. Low is low. As long as you know your take action numbers and your pre-shot numbers are safe that’s all that matters!
77 and 105 are little further apart than I saw when comparing, but not so far apart that I would have concern. You could always try to compare a few more times to make sure this one test wasn’t a fluke. Maybe bad strip maybe the relion needs a bigger drop or something. If there is consistency in the variances I think using the relion and saving some money and being able to test as much as you want/need is the better option.

 

I understand. I was told that the dosage should be based off the nadir level and it concerns me that with such a difference between the two monitors that he might end up getting more insulin than needed. If that makes any sense.

 

I get it. I was firm in my choice to use a pet meter in the beginning.
When I got low 100’s on my pet meter I got around low 90’s on the human so I think this one comparison of yours may be out of the norm. That’s why I was thinking maybe try a couple more comparisons but then if you want/need to go the cheaper route, by then you’ll be more confident in the numbers. I think if you decide to and can afford to stay with the pet meter, even the difference with 77/105 is a close enough range to have the relion as a back up. I wouldn’t be discouraged from using it when needed. It really doesn’t matter which meter, whichever you decide!

 

I see huge differences between the ReliOn Prime and alphatrak2, yesterday Jai had a low nadir and we compared the two, even low there was a 60 point difference! On relion it was 85 -> 145 (ATK2). I have seen up to a 140 pt difference. So I agree, don't compare the two, just know whats high and low respectively and use the rest for trend!

 

Booger was in the 2 and 3 hundreds today at nadir. Is that a sign that he is needing to now go from 2.25 units to 2.5 or should I do a glucose curve in the morning? Or could this just be a reaction to him not getting his insulin the night before (didn't go in he was fighting me) and I should just wait a few more cycles?

 

I see you're using both SS the last few days. Going by the human meter data I'd say you could try 2.5 u today. Even the last two days of AT data suggest that.

Have you decided to settle on one meter or the other? It'll be a lot less stressful for you to do that.

 

No not really. I would prefer to at least get an accurate nadir each day and use the relion meter to just spot check. I cant afford to go through the alphatrak strips like I have.

 

I worry you might actually not get the most accurate info this way. If you’re mostly following with the relion, then checking when you assume nadir is, you might actually miss it. The relion is going to always give you a lower reading so the AT reading being higher might actually make it harder to see the pattern. If you pick one you’ll be able to follow one consistent pattern through the cycle without the odd number tossed in the middle.
If cost is a concern I would definitely just make the switch. Maybe save the AT for days you make a dose change or see any odd behavior and want that extra reassurance? That way you can stay with it for the day and not mix meters. I just worry trying to use both might make this whole thing a lot harder than it needs to be.

 

I understand. I am just concerned with the relion numbers being so off. I ordered some freestyle strips and they should be here in a few days. Hopefully will be able to use those and get a somewhat accurate reading. More so than what I am getting with the relion.

 

The thing with the numbers is they aren’t exactly off, they’re just different. His glucose is just registered on a slightly different scale, but I wouldn’t call it off exactly. The concern I have is not being able to see the whole correct pattern when you mix meters. So- 3/23 you have amps 524, +4 182, +5 on AT +224 then back to relion for +7 202. See how you lose the “smiley face curve” when you throw in the AT number in the middle? What would your line have looked like if you stayed with the relion for the whole thing? What would the percentage drop be from amps- nadir? Same with after pm shot. That one AT at +5 375 then relion +8 366 so here you can’t see his lowest point either. The AT reads high so it sort of jumbles up the info and hides the pattern. I’m really confused trying to follow it and it really makes me worry for you trying to maintain it and maybe missing something.
I have to say again I get the hesitation trusting the human numbers. I used the AT and I really do understand! But in the meantime, if you need to use the relion more, it might be best to use it for the whole day. If you don’t trust a number you get(unusually high/low) you can always go back and retest.