Checking for opinions/direction on Fuffly's remision

Discussion in 'Feline Health - (The Main Forum)' started by Athenaglaukopis, Mar 21, 2019.

  1. Athenaglaukopis

    Athenaglaukopis Member

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    Feb 15, 2019
    Fluffy has been about 17 days without insulin and please check her spreadsheet for the numbers.
    stopped giving her insulin once we were at 0.25 units and that even took her to hypo.
    I just wanted some opinions about how do you guys think she is doing and what should I do next in order to keep an eye on her and not annoy her with too much or unnecessary testing. how should I proceed from now on?

    Thank you! also if you guys know where can get some Henry schtein pet gluco meter strips I would be deligthed! :)
     
  2. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    To be completely honest, I would not feel comfortable providing an opinion as to whether Fluffy is in remission or not based on the readings you have logged. The readings are quite erratic and some quite honestly don't really make sense. When you have not given insulin I find it hard to understand why you would get readings in the 20s which in most cats would likely only occur during a symptomatic hypoglycemic event. Highly unlikely that a cat on ProZinc, having had no insulin for several days would ever get that low. On the other hand, some of your readings are still high and would lead one to think Fluffy still needs insulin.

    I have no idea where you would get strips for the pet meter you are using. Have you checked with your vet or the retailer you got the meter from?

    I would suggest you get a human meter and keep testing Fluffy to see if BG is consistent with remission or a continuing need for insulin. I quite honestly don't think your pet meter is functioning properly.
     
  3. Dusty Bones

    Dusty Bones Member

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    If Fluffy is in fact in remission, the only thing you can do going forward is make sure you only feed low carb food (wet is best), absolutely no high carb or you risk pushing her off the wagon. Keep an eye on her weight, her thirst, and her peeing. Keep an eye on her teeth, any tooth issues or infections will cause her BG to go up. I started off checking Dusty's BG once a week, then every couple of weeks, then every month and every couple of months, etc., whatever you feel comfortable with. Good luck!
     
  4. Athenaglaukopis

    Athenaglaukopis Member

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    Thank you, ok, I’m going to get a human meter, any suggestions which one works best?
    Also maybe the readings are justified due to the following: ( I really don’t know but your opinion would be super helpful), when I get up in the morning and test her, she has eaten her food the night before and there is no more food available, she nibbles on her wet many throughout but at night time she is usually hungry and would eat all, so when I test her in the morning she has fasted for at least a good 8-10 hours, if she doesn’t eat it all, the kitten would sneak and eat it. Now, after testing in the morning I leave her wet food and lock her in the room so the kitten doesn’t get any of her food and she can eat, often she snacks up to 2 hours prior re checking in the afternoon (I have a camera), I’m thinking that contrast between the morning eating and the night eating is what is giving the low readings earlier as she has been fasting and higher readings in the afternoon since she has been eating intermittently until then. What do you think? Also she has been on antibiotics for a tooth infection and this is a once a day thing given with her afternoon food ( maybe is affecting somehow early morning reading?), she has been on it for about 10 days more or less
     
  5. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    While the feeding schedule could very well cause lower readings in the morning, the numbers you are getting are abnormally low......low enough I would expect Fluffy to be displaying symptoms of hypoglycemia like frantic hunger, wobbly gait, staring into space, head bobbing around due to possible vision loss, and possibly a seizure. I'm sure if Fluffy had shown any of those symptoms, you would have noticed. That makes me seriously wonder about the readings you are getting with that meter. Did you purchase the meter? If so, I would take it back or call Henry Schein and discuss the erratic readings with them. Interestingly, when I did a search, there were two reviews on the Hwnry Schein site by users that I assume were animal health professionals. One review indicated they were happy with the meter. The other indicated they were getting erratic readings and often went through several strips retesting and getting readings all over the map.

    If you are in the US, you can go to Walmart and pick up one of their Relion meters that takes a small sample of blood. They have the most reasonably priced strips and the meters are used by a lot of folks here. If you are not in the US, let us know where you are as we have members from all over the world who can offer some suggestions.
     
  6. Larry and Kitties

    Larry and Kitties Well-Known Member

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    I Googled and could not find where you can purchase the test strips. Thew company sells a case of 20 boxes of test strips. Amazon shows that the meter kit is out of stock and it is not know when available.
    You can contact the company
    https://www.henryscheinvet.com/contact-us
     
  7. Athenaglaukopis

    Athenaglaukopis Member

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    thank you so much! im stopping at Walmart this afternoon and will get a relion, should I start a new spreadsheet? how should go about it? .
    I didn't see any of the symptoms of hypo, once in a while some space staring but nothing to make me thing that something is wrong with her, she is actually quite sassy in the morning and goes and gives a good beating to her scratching post before feeding and after testing (I think she does it out of being frustrated, lol), she has been a bit on the lazy side but ready to play when I get there (she is much more active than what she was before diagnosis, and she is drinking and peeing normally)
     
  8. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I think for now it would be sufficient to just add in a row and put "switched to human meter" across the row and start entering the human meter readings below below that row. While the colour coding may be off a tad, that can be fixed manually for now and automated later if you find Fluffy isn't in remission and needs to continue insulin for the moment. If you need any help, just holler. .
     
  9. Athenaglaukopis

    Athenaglaukopis Member

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    That sounds good, but aren’t the numbers in the human meter different for a cat? Like if I get a 90 in the human meter how would that translate to cat BG level?
     
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Yes the human meter will read lower than the pet meter but as long as we know what type of meter you are using, it doesn't matter. There is no way to convert human meter readings to pet meter equivalents or vice versa. The only differences on the spreadsheet is the bold bar at the top stating a pet meter is in use and the auto colouring of readings in the green zones. Unless you are getting a lot of readings below 68 on the human meter, you won't need to manually change any colour coding. And I'd leave the bar stating "Using Meter Calibrated for Feline Blood" there because the readings below it are from a pet meter. That is why I suggested putting a new row in with "Switched to Human Meter" across and entering the human meter readings below that row.

    What you need to know is that a reading of 50 or less on the human meter is your warning that BG is dropping toward dangerous levels and you need to take action by feeding Fluffy. If you do resume giving insulin, then we can determine what your no shot number should be based on the readings your are getting. Normally we'd say 200 for someone with no data but you do have some data even if it's a bit suspect for accuracy so you may be able to lower that cutoff number.
     
  11. Athenaglaukopis

    Athenaglaukopis Member

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    I got the ReliOn anwasted 3 strips w code 04, needs new battery. I used the pet ,eater and started an experiment since yesterday,. No outside stressors (kitten) and more food ,available at nigh (since the kitten tends to eat some of it): her read this morning was 71 so the reads do seem to reflect changes :/. I’m going to get a bettery today and check in the afternoon
     
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  12. Athenaglaukopis

    Athenaglaukopis Member

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    ok I updated the sheet. did 3 strips with the pet meter and one with relion premier, I think they are all in the same page so the read might be accurate. now my question, in the morning her ear is noticeable more cold and despite attempting to warm it up, etc, sometimes I have to milk the ear (massage it after pricking to get a drop of blood) sometimes the sample is tiny, could this be a factor affecting the morning read and giving me a lower number?
     
  13. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I am not familiar with the pet meter you are using and I don't recall anyone else using it in my time on this forum. Most human meters and the most frequently used pet meter won't read unless they have a big enough sample but whether that is a feature on that particular meter or not, I don't know. What you are suggesting seems plausible. You could call Henry Schein and see if their customer service can tell you if the meter will read despite a sufficient test sample. How large a sample does it need? Is there any information about the sample size in the meter documentation?
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    It looks like the readings you took this evening are accurate. There is no way to convert human to pet or pet to human readings but the difference you got, 120 vs. 93 is certainly within the ballpark of what I would expect.
     
  15. Athenaglaukopis

    Athenaglaukopis Member

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    ok I did both readings this morning, and she ate pretty late (1 am at +6) so taking that into account I think we are seeing a 120 average BG. now she has surgery this Friday coming up so I don't want to mess her up and I wont prob give insulin until a few days after surgery,( IF we determine that the best is to give her insulin of course).
    what im scared of is: if after getting all the readings we determine that I should give her insulin, if you look at the chart, even giving her a 0.25 unit took her down like 170 GB points. my question is : can I give her less than that? and if so, what precautions I should take? I am a teacher so I work from 7am to 4 pm. this week is one of my last breaks so I'm a bit weirded out.
     
  16. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I take it Fluffy is having dental surgery? That may very well bring her numbers down too. I see your concern with the 0.25u dose but there are smaller doses e.g. 0.10u and a drop dose should Fluffy need insulin going forward. Her numbers right now are very good but look a bit higher than we'd like to see for a kitty in remission. Keep testing at AM and PM pre-shots so if her numbers trend any higher, you'll be able to catch it early and take action.

    I really think it would be much easier to stick with one meter (preferably the Prime given the questionable readings with the pet meter) to monitor Fluffy right now. Using both is just going to confuse all of us and muddy the picture if we have a mix of readings in any given day on one spreadsheet. If you want to continue testing with both meters, it would be easier to keep all the pet meter readings on one spreadsheet and all the human meter readings on the other.;)
     
  17. Athenaglaukopis

    Athenaglaukopis Member

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    Feb 15, 2019
    I think im ready to move forward with checking if she needs insulin.

    ok, fluffy has had her surgery (several teeth removed), she had an infection (also developed stomatitis, wasn't eating, and was on opioids). I was told by the vet to stay off reading as is very likely they will be all over the place.

    Now: she is off opioids, still on antibiotics, eating pate that has been processed with the bullet so it wont irritate her or make her stomatitis worse and seems to be improving. she probably has a good 5 more days to go on the antibiotic ( a wide spectrum one). I started testing again and although I just have 2 reads, it seems very much consistent with the numbers we have seen before.
    I would like to do at least tomorrow with another am and pm testing to have more data to proceed.
    it seems her number have been steady in the 100's. (seems) my plan (or at least intention) is to check her numbers on Saturday and test with a 0.10U dose, then do a mini curve that day to check the nadir. my hopes is that her nadir will be about 70-80 and then go from there.

    if effects are negative and even with a 0.10 u she tends to go on hypo then I will not be able to dose her anymore (I don't think you can dose less than 0.10u.
    if the effects are positive then I will continue with regimen until more stable lower numbers show.

    let me know what you think. thank you for any help.
     
  18. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Welcome back....nice to see you and good to hear Fluffy has had her dental work done and is recuperating!

    When exactly did Fluffy have her surgery done? Just wondering because if it's only been a couple of days and she has 5 more days to go on antibiotics, it may be a bit premature to make a determination given the readings you took in the last day or so. It would be a good idea to test her AM and PM every day to see if her numbers go any higher than what you are currently seeing. While her numbers are still a bit elevated they are in normal range. I assume those readings were done with the human meter even though they are on the pet meter SS? Were those recent tests taken after at least 2 hours without food or are they food influenced readings?

    Fluffy is looking good and with those readings there is no need to rush getting her back on insulin. I'd wait till the antibiotics are finished, keep taking fasting readings every day morning and night between now and the completion of the antibiotics. You may see her BG coming down and if it does, it would seem unlikely she needs insulin. If the numbers stay in the same range or go higher, then a teensy dose of insulin may be all she needs to hopefully put her into remission. Fingers crossed! :D
     
  19. Athenaglaukopis

    Athenaglaukopis Member

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    im so glad we are back!I cannot thank you enough for the help!!
    ok, her surgery happened on mach 29th. we took her back because she wasn't eating on Friday 5th of April, has been on antibiotics since and the instructions were one dose every 24hrs "give until the liquid is gone" and im ball parking that we might have about 5 more days of antibiotic liquid to go.
    the reading were in the pet letter, that is why I entered them there, since the meter seems to still be accurate (after the testing with the multiple strips and the relion check) I will continue using it until I ran out of strips then change to relion-
    yes, she had no food 2 hours prior to it. but I want to do a day where she is fully isolated and controlled to check her readings again (if the kittens leave any fancy feast patte on their plate she might sneak a bite).
    thank you so much for your amazing guidance! I will continue checking her BG every day until the antibiotics are done, and then ill check how to move forwards, but at least we will have more data to figure out the path! :)
    question for the future, I do have 1/2 U syringes, how do I measure a 0.1 u in those? how do you go about making sure the dose is that low?
    Thank you again for all the help. with 3 new kittens, the move, her diabetes, surgery, infection and the new kittens biopsy and granuloma, it has been a challenge, but this group and you have given me a steady support where I feel that I can take good care of them and have them enjoy life :)
     
  20. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Wow, you certainly have had a lot going on but you're obviously staying on top of it all. You're amazing. Hope the kitten is doing better now too!
    Given those readings the last few days were taken on the pet meter, I'd like to say I am even more optimistic that Fluffy may not need insulin antijinx-emoticon.png but I have to admit, with those odd seriously low readings (21 and 23) you got with that meter before, I'd feel more comfortable that you are getting reliable numbers with the Prime. Just not sure what could have caused those strangely low readings and I don't want any of us to be duped into thinking Fluffy is doing better than she really is. Is Fluffy eating Ok now?

    There is info on drawing up tiny doses HERE. It's a bit tedious but it can be done. The other option is using Calipers. Let's see what Fluffy is up to for the next few days and then decide if she is really ready to go without insulin or not. :D
     
  21. Athenaglaukopis

    Athenaglaukopis Member

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    I think I must have messed up on those read. :/
    She seems to be eating ok. I wanted to check my prozinc in the fridge and I don’t remember if this is ok. 42F7B220-ED84-4975-B736-C8C6D4CD6F37.jpeg
    The due date (60 days after opening it) is April 23rd, the white stuff had setttled in the bottom so I rolled slowly in between my palms but I don’t remember if it was this whitish color. Does it look ok? I’m not going to give her any until we are done with antibiotics and i get more readings though. :)
    Thank you!
     
  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I think the ProZinc looks fine to me. After you roll it, you don't want to see particles in it so as long as it's milky but not "lumpy" it should be fine. While there is an expiry on the vial, that is only indicative of how long the pharmaceutical companies test their insulin for. Many folks get far more time out of their ProZinc vials as long as they are stored appropriately in the fridge. I can't remember exactly how long. I think it's between 4 and 6 months and I certainly wouldn't go replacing the vial at this point in time. :)
     
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  23. Athenaglaukopis

    Athenaglaukopis Member

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    Feb 15, 2019
    Thank you!!! ok, I have been collecting more data an d her numbers are starting to go a bit up :/
    im hoping I can start her this week on her dose. based on the current numbers I am thinking about either a 0.1 u or 0.25 u, what do you think? I will also start her in the afternoon so I can be there to check her nadir.
    what do you think?
     
  24. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    If I were you I don't think I'd try anything over .10u at this point. The numbers while a bit higher are still within normal range. And I agree you only want to try this when you can monitor. Does Fluffy have a checkup appt. with the vet again (assume the antibiotics are finished now)? I'm surprised at the numbers not going down rather than up and wonder if there is still any infection there that needs addressing.
     
  25. Athenaglaukopis

    Athenaglaukopis Member

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    ok, I will be doing it tonight and monitoring :), no follow up with the vet though but I checked her and her mouth looks nice pink and not irritated. she is also eating pretty good :), weird think though is she is liking more her friskies mixed grill (pate of course) instead of her fancy feast. she is eating g about a 5.5 ounce can a day. ill keep you in the loop on how it goes today with the .10u :)
     
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  26. Athenaglaukopis

    Athenaglaukopis Member

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    Ok, update. Wasn’t able. To do it last night because she didn’t eat much yesterday and she was at 106 (kittens might have bothered her)
    This morning I checked her and she was at 115, that made me more comfortable and I gave her the 0.10 u (such tiny amount was actually pretty hard to measure, but thanks to the caliper I was as close as possible to that :)
    I’m doing a mini curve, and checking right now at +3 she is 64, +5 she is at 68 after food, so she is going up buy even a tiny dose is bringing her down a lot...
    I’ve given her 1 treat and more of her regular food, and she munched it up a bit, I’m doing another check in 2 hours but always visually checking on her for signs of hypo in case I have to address it.

    Useful info that I’m getting out of this is: 115 is too low to shoot even a 0.10 u, once I see the full BG readings I’ll be able to extrapolate numbers to have a “no shoot” number at the current dose.
     
  27. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Assuming your pet meter is reading more accurately now, 64 is TOO low on the pet meter so you do not want to give Fluffy that dose again. If you get a pre-shot you consider safe to shoot, try a drop dose by pushing in the plunger as tightly as you can before inserting it in the vial. Let go of the plunger once it's in the insulin and withdraw the needle. When you inject, you need to push the plunger and hold it while removing the needle. It will look like you don't have any insulin in the syringe however, there will be a drop you just can't see.
    Bare in mind, that after that low green today, Fluffy may bounce and you DO NOT need or want to increase the dose while she is in a bounce because it could break suddenly causing a major and possibly dangerous drop in Fluffy's BG. Dose is not based on pre-shot numbers. Pre-shot numbers tell you if it's safe to give insulin. Mid cycle tests tell you how low that dose can take BG. Try the drop dose if needed but be very careful about increases as Fluffy is obviously getting a good drop out of very small doses and start getting some mid cycle tests whenever possible to be sure that Fluffy is not going too low regardless of dose.
    A test before you go to bed every night if insulin is being given is also recommended. Many cats go lower at night so getting that night test in can give you a clue as how the night may pan out.
     
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  28. Athenaglaukopis

    Athenaglaukopis Member

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    I don't know what would I do without your experience and advice! I just checked again and she is up to 94, of course she has been feeding on fancy feast at will so she can regulate herself.
    I will keep on checking her BG but with the current numbers I don't think she will reach a safe number to shoot even a drop dose (you are right the 0.1 u is giving a big drop and its not safe). i feel that a safe number for her to shoot even a drop dose would be above 140 just because she seems so sensitive to it (I guess its a good problem to have?) , if she is not a that number when I check her before PM dosing I will just skip, does that sound like a good strategy?.
    but overall with some ups and downs on daily checking she has been pretty stable, blue all around, even though I might want her to be on lower numbers that are more consistent with remission, could it be possible that staying on blue is still ok? just worried that even the drop dose could be too much for her and exploring if staying on blue is still ok.....oh my old finicky kitty for sure its special! lol.
    again thank you so much for all the help and clarifications! also she has lost like a pound a half since first diagnosed :/,
     
  29. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Happy to help and very happy to see that 94.:D Aside from the too low 63, today has been a very nice cycle so far. It will be interesting to see if Fluffy has bounced by PMPS.
    You do ideally want Fluffy to get more dark green readings to consider her in remission although with your pet meter, you're likely to have a mix of blue and green to stay in the safe range. The blues should be approx. 120/125 or lower from my experience.

    Technically the drop Fluffy got today was not that big (roughly 50 points) which is fine, BUT with a pre-shot of 115 the 0.1u dose was definitely a bit more than she needed because it dropped her below the safe low threshold for a cat on insulin. While I am not usually a fan of sliding scale dosing, it may be something that could work for Fluffy. If you know you don't want Fluffy going below 70 (for a round number) and you know her BG usually drops by about 50 points on a dose of 01.u, then you would not give 0.1u for any preshot lower than 120. I'd build a little more cushion in there and make 135 or 140 your preshot limit until you get more data and definitely monitor if you try the 0.1u dose again.

    You don't have any data for a drop dose but a drop dose might be fine if BG is between 115 and 135/140. All you can do is experiment and only when you can monitor for both pre-shot and mid cycle. Once you get more data, if safe to do so and Fluffy still isn't in the range you want, you could try giving a drop dose at a slightly lower BG say 110 etc. Does that make sense? Make changes systematically, get those mid cycle tests so you can better predict what Fluffy will do.
    Her numbers are not bad at all but she is running on the high side of ideal. Take it slow and hopefully you'll start seeing some high green readings. The more she stays in the high green range the more her body will get accustomed to being in those lower numbers.
     
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  30. Athenaglaukopis

    Athenaglaukopis Member

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    Feb 15, 2019
    thank you so much! I want those green numbers and fluffy and I will work for them!
    her PMPS is 105, I hit her small ear vein and now she has a little bruise :(, but she is miserable right now and not wanting to eat so I will skip tonight and do an AMPS tomorrow to see how should I move forward, yeah I totally agree with the BG numbers for either dose options, I got the feeling her BG might not be even high enough for a drop dose next morning, but well see :). I think is safe to say that if he PS BG is 110 or less that should be a no shoot at all situation, given her read a BG of 110 or less is rare though. well that is a wrap for me for today and fluffy's ears, thank you one million times over! ill keep you in the loop if there are any updates! :)
     
  31. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    I'll be checking in on Fluffy (always think of my first dog as a child when I see that name. Wonderful memories!) so please keep the SS going so I know how you two are faring. :D
     
  32. Athenaglaukopis

    Athenaglaukopis Member

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    awww! fluffy must have been so happy to spend his time in this earth with you :), I a so grateful I have my fluffy girl (my ex husband when we were married used to scare her as she is super loving when she knows you but skittish otherwise, but my husband now loves his fluffy queen :)
    the last few measures have been almost a joke, is as if she knows that if I get a 115 number she gets a drop dose so she has been staying consistently under that number on the pet meter. lol. but I have also been taking readings with the relion (to get more used to how the reader works and also to transition readers and have a control reading when I see something off), now, with the relion she has been in the higher end of green.
    so I am kind of re evaluation two things:
    1-if I should do a drop dose at anything above 100 in the pet meter (as I would like her number to be in the solid/lower number green).
    2-or I f should go with the relion meter readings and consider her in the safe range.
     
  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    Fluffy's numbers on both meters are excellent. High greens on the Relion and low blues on the pet meter are both great. Remember, there is a normal BG range and you don't know if Fluffy ordinarily ran in the low, middle or high end of normal before diagnosis. Very few of us have that luxury. I would not give Fluffy insulin at the numbers you are currently getting.
    If you happen to get a higher blue number on the pet meter (like over 150) or over 115 on the Relion, then feed Fluffy and retest again 3 hours later. If the 2nd test is lower, Fluffy's pancreas is working and the question becomes how well and whether that is just an off day. All of our kitties will probably have a higher than usual BG at times for any number of reasons. The question is whether numbers keep rising or level off or drop again.

    I see no reason not to be counting days with out insulin based on the numbers you are seeing now. If Fluffy can go 14 consecutive days without insulin then you can declare her in remission. You've got 2 good days so far. Fingers crossed!
     

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