confused over glucometer readings

OK, so I have been using the alphatrak2 glucometer, and am low on test strips, as I have been testing my cat
"Trouble" quite frequently of late since a hypo episode on 8-13-13, so I just used did a back to back test, using the
alphatrak, and then my walgreens trueresult, my meter read 162, the alphatrack read 270.... ??
this was just under 3 mins apart, so if my math is correct that is a 108 / 66% difference...?

Since I spent the money on the alphatrak, I guess I should use that, the problem is my vet is out of the test strips, so I ordered them online and got overnite shipping, so they will be here tomorrow, but I will need to use my meter later tonite and first thing in the AM, since I have only two of the alphatack strips left..

so I am confused on that difference, from what I have read here, 30 seems to be norm?
maybe it is the walgreens system??

 

The relative unavailability of strips (delays from shipping, vet office closed) is one of the reasons we use human glucometers.
AlphaTrak reference numbers
< 70 - treat as if hypo; earns a reduction in dose
< 80 - may earn a reduction in dose

At the low numbers, human and AlphaTrak meters are approximately 30 mg/dL apart. At higher numbers, the difference can be much greater.
Part of this is due to the +/- 20% the FDA allows meters to read differently from what a lab would get.
A test of -> range of lab
50 -------> 40 - 60, a 20 mg/dL span
500 -------> 400 - 600, a 200 mg/dL span

We really only care about the low numbers, because we want to prevent or treat hypoglycemia.
High is high and it really doesn't matter (how high is "up" anyway?). You just follow the insulin protocol for dose adjustment.

 

When it comes to cats, the Tru meters have been known to relay lower numbers than they actually are (they're fine for humans), so they're not good for long-term, cyclical readings. But, as BJ said, the meter will still give you an accurate enough read on low numbers for the time being. Going forward, might I suggest you pick up another meter as a backup? ;-) (The Walmart ReliOns are ridiculously cheap and many Walmarts are even open 24 hours.)

 

Thanks,

So I did run into town after posting, went to Walmart and bought the ReliOn Prime meter, only 16.24 and 50 test strips for 9.99
unbelievably inexpensive.

I saved the last alphatrak test strip for his PMPS, so I did not test the new meter last nite.
However this AM, I did use the new ReliOn before his AMPS, and then checked again with the Walgreens TrueResult,
interesting comparisons;

AMPS - ReliOn - 266 - which has been around his AMPS reading since started check after the hypo scare
AMPS - TrueResult - 155
so the TrueResult reads very low across the range.

I am so relieved I found this forum, and am still getting over the shock that our Vet, did not recommend home monitoring
after prescribing Lantus....

Trouble was diagnosed in late May, so the Vet started him on Lantus, 2 units BID,
then at his 30 day checkup and fructosamine levels, the Vet changed the dosage to 3 units AM, 2 units PM.
the next 30 day check, the Vet told us his fructosamine was still a little high and changed his dosage to 3 units BID,
well 5 1/2 days into this dosage change he had the hypo event and we had to rush him over to the animal emergency hospital
were there doctors could not believe what we had been told and could not believe Lantus was used without home monitoring.
Of course we bought the expensive meter that night based on all that had happened and what the ER Vet brought to light...

Needless to say, we are looking for a new Vet....

 

Now that you've got the ReliOn Prime!

ETA: updated to include mmol/L and AlphaTrak estimates

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

thank you !!
Trouble thanks you too!

 

Good hunting for a new vet.

There are some Vet Interview Topics in my signature link.
Google Maps enter "veterinarian near, street, city, state, zip" and put in your address to see candidate vets near you.

 

Many times, vets don't suggest it simply because a lot of owners will balk at not only having to give shots twice a day but also have to test their cats. I wish they'd at least casually mention testing as an option vs. just ignoring it completely. :YMSIGH: As for having you give 3u AM and 2u PM, that is not the way Lantus works. It requires the same dose given twice a day, not a different dose. We also don't like to increase more than .25u to .5u at a time.

But, vets treat many different species and many different diseases of which feline diabetes is only a small sampling of. It's hard for them to keep up on everything. Depending on how much you like your vet, you might want to see if he's willing to work with you and "brush up" on his feline diabetes management so he doesn't make similar mistakes in the future with his other feline diabetics.

 

Thanks BJM

 

HI KPassa,

oh, I was not aware of using the same dosage equally....thanks

so I assume that the 3 units BID caused the hypo event, and that I should ask for the syringes and go with 2.5 units BID
and run a new curve?
that is the only real change, no food changes since May, everything else has been status quo ...

as far as talking to the Vet about all of this, I am afraid it will do no good, they have the techs do everything, and if you
ask to speak with the doctor, you get billed extra for a consult.....
The doctor at the emergency clinic was up on all of this, but their practice is limited to emergency only....otherwise
I would have gone with him in a heartbeat.

Now it will take another act of congress for me to ask our Vet for a script for the syringes with 1/2 unit markings....gerrrrr..

Update..
ordered the syringes recommended on the other board online.... and the doctor over at the ER will help me with a new
dosage etc.... hopefully the curve will not be all over the place now.
very relieved, maybe I can get a good nites sleep, haven't had one in 8 days...

Thanks again!!

 

Yep, you want to have a dose that is safe to give twice a day. If you find him going too low, then you decrease both the AM and PM dose across the board. You don't have to run a full curve in a day. In fact, it's often better to do spot-checking across a week because testing throughout only one day will give you exactly that: how Trouble reacted to the insulin in that one day. If you do it throughout the week and get a few tests across each cycle, this will show you more of a pattern on how he reacts day-to-day and account for any discrepancies (i.e. appetite fluctuations, bounces, higher activity levels, etc...).

The prescription doesn't need to specify the 1/2 unit markings, just the needle length (1/2" vs. 5/16") and size (3/10cc).

And yes, in that case, I would find a new vet if I were you. ;-)

 

What are you feeding him? Ideally you want a low carb canned food like fancy feast classic pates, friskies pates or wellness grain free canned since those are under 10% calories from carbs which can bring the blood sugar down enough to reduce the lantus dose or even cause remission.

Wendy

 

I updated the glucose references posted previously.

 

Hi Wendy,

yep, we do feed him fancy feast classic pates, friskies pates, he eats about 5 to 6 oz of food each day.....
once in the morning, once in the afternoon, and a small portion right before his PM injection.
although he did eat the friskies grilled before....

he is 8.5 pounds, which is down from his 9 pound average weight the last few years prior to the diagnosis, but
up from the 8 pound low when diagnosed.

 

Thanks BJM,

so the syringes arrived here last Sat, but they sent u-100, .5cc, so I did not use them, am waiting for the correct ones.
in the mean time since your post, I went back to 2 units BID, and his numbers are high, so when the syringes get here, I will be able to adjust the dose by 1/2 units...

here are his numbers since going back to 2 units BID:

08/22/13 9:05 AM 358 8/22/2013 - 9:15 AM 2 UNITS
08/22/13 3:38 PM 285
08/22/13 11:00 PM 262 8/22/2013 - 9:15 PM 2 UNITS

08/23/13 8:30 AM 309 8/23/2013 - 9:15 AM 2 UNITS
08/23/13 3:30 PM 279
08/23/13 9:00 PM 275 8/23/2013 - 9:15 PM 2 UNITS

08/24/13 9:00 AM 362 8/24/2013 - 9:30 AM 2 UNITS
08/24/13 4:00 PM 211
08/24/13 9:12 PM 255 8/24/2013 - 10:00 PM 2 UNITS

08/25/13 9:00 AM 313 8/25/2013 - 10:00 AM 2 UNITS
08/25/13 9:56 PM 315 8/25/2013 - 10:00 PM 2 UNITS

08/26/13 3:10 PM 57 8/26/2013 - 10:00 AM 2 UNITS
08/26/13 3:12 PM 55 checked again as 57 seemed way too low??
08/26/13 9:35 PM 215 8/26/2013 - 10:00 PM 2 UNITS

08/27/13 9:52 AM 328 8/27/2013 - 10:00 AM 2 UNITS

don't understand yesterdays afternoon low ??

 

Please, please, please do NOT give insulin under 200 mg/dL

That low of a pre-shot can be dangerous without lots of data showing it is safe to give Lantus. Folks who shoot that low are testing during the middle of the cycle, often repeatedly, to ensure the cat doesn't go below a safe level of 50 mg/dL.
He may be on too much insulin still - the dose adjustments are made based on the lowest value between shots, NOT on the pre-shot data.

I strongly suggest you back off to 1.5 units

 

Any chance you can get that standard format spreadsheet setup? Directions here: ss set and link to your signature

It will really help us to help you better. If you need a hand with the setup, just ask, we can help.

 

Until you have a spreadsheet set up, please use this format for listing tests

MM/DD/YY (on it's own line, once for a day's numbers)
AMPS for morning pre-shot
+hr ## for a test taken ## hours after the shot was given
PMPS for evening pre-shot

 

ok, I think I got the spreadsheet right??

edit*

had to download the xlxs and convert to xls, then uploaded after adding the data, was confused on the colors as some cells
auto filed the color, the others did not??
maybe the conversion messed things up?

 

Try going directly to your google drive to access your spreadsheet so you don't have to upload it from excel and you can update it directly online. You also want to share the "Published" link with us; it starts with https://docs.google.com/spreadsheet/pub... and not https://docs.google.com/spreadsheet/ccc.... To get this link, within the spreadsheet, select File -> Publish to the web. Check the box that says "Automatically republish when changes are made" and copy the link that appears under the section "Get a link to the published data."

ETA: looks like you already fixed it to the correct link. :thumbup

 

Hi Frankie and Super Sweet Trouble!!

I might have missed it, but are you shooting and then not feeding for 1 hour? (that's what it looks like on your spreadsheet)

We generally test, shoot and feed all right together..or test, feed and shoot, but again, all at the same basic time. Lantus takes a couple hours to "kick in", so if you can test and then get a +2 or +3 test in to add data to your spreadsheet, it'll help let you know how active you can expect his cycle to be. If there's a big difference (lower) between his PS (pre-shot) number and his +2 or +3, you should plan on an active cycle and would want to test more (if at all possible). If it's about the same number, you can figure it's going to be a quieter cycle.

Don't worry if it seems overwhelming...the learning curve here is steep, but we're with you all the way! We did it..You can too!

 

HI Chris & China White,

trouble has always eaten first around 9AM, and between 4PM and 4:30PM, since always.
then after he was diagnosed our Vet did mention to give the insulin 12 hours apart, but she did not tell us when...
basically she said whatever fits into your schedule as long as it is 12 hours apart, SO I take my meds at noon
and at midnight, so that was when I gave him the shots, which seemed to be working for almost 3 months...

then the night he had the hypo event the ER Vet told us to give the inject within an hour after he eats.

so since aug. 15, his still eats at approx 8:30 - 9AM and I take his reading right before his AM shot at 9AM,
and his reading at 9PM, before the shot, I only give him 1/2 of his 4PM food and the rest
right after I take his 9PM reading.

so I guess to answer your question, he gets his AM shot within an hour after eating, and his PM shot within 10 mins or so after eating at 9PM.
so the numbers on the google spreadsheet are the actual numbers after the AM shot.
so if I understand, the number at +2 is the reading 2 hours after his shot, yes?
but that number could be up to +3 hours after eating, as I give him a shot within the hour after he eats...
guess I am making this more confusing....the more I write..

 

When first starting out, you want to make sure you don't feed within 2 hours of shot time so the numbers aren't food-influenced. It takes about half an hour to start seeing the impact of food on BGs, so you want to make sure the pre-shot test is within that half-hour food window. It's recommend to hold off on food until after you get the test just in case they give a low number and you have to stall a shot. Once you have enough data on how the BGs react to food, then you can pretty much feed them whenever you want.

 

Yes...+2 means 2 hours after shot. Since we're from all over everywhere here on the message board, we use the + system instead of actual times so we don't have to always figure out time zones

You have PS (pre-shot) tests, shoot/feed, and the clock starts ticking. Each cycle will have a PS (AMPS and PMPS) number, and then it's + however many hours...so if you test at 9am, then +2 would be 11am, +5, 3pm, etc. until your next PS test

If you get a PS number under 200, we recommend you not feed, and retest in 30 minutes...during that time post and ask for help! If you have to stall your shot, then you'll have to adjust your shot times...so if you stall 1 hr., instead of your next shot being at 9, it'd be at 10/10. You can move back to the schedule you like 30 minutes per day (or 15 minutes per cycle)

Sometimes we forget that we had no idea what all the abbreviations meant when we first started so sorry about that!

 

Good job on the spreadsheet!

Just in case you missed it - tonite give 1.5 units and ONLY if he is over 200. By dropping under 80 he has shown that 2 units is too much. Lets see how he does for the next few days on a lower dose and if he drops under 80 again you want to reduce dose again

Wendy

 

Thanks Wendy,

oh.....just got back online and saw your post....
but his PMPS was 271 at 9:55PM, and just gave him 2 units. 10:00Pm here
also until the new syringes get here, hopefully tomorrow afternoon, I am only able to give in whole unit dosages, am using
the lantus pen....

I should also note, I am using the alphatrak meter, since I bought more strips,
I will use those up, then start using the new relion meter, so that dip below 80 and all of the SS numbers are from the alphatrak
readings, except the one relion test reading on 8/21/13 AMPS of 266.

 

Once you move back to the relion please mark it on your sheet. And mark when you started and ended with the alphatrak.

Keep an eye on him tonite and reduce dose tomorrow then.

Can you get a test at midnight? If its a bit lower than PMPS you might want to set the alarm for a later test middle of the night.

 

Just seeing how he is doing? With that 57 the other night you missed taking the dose decrease. I strongly advise you take him down to 1.5. 57 was an indication he is getting too much insulin

Wendy

 

just an update;

3:20PM here and no info back from the new syringe order, ordered them online Sat, received the confirmation email
but checked the order status yesterday and it shows order still processing... called customer support and left a message
yesterday PM, still no return call....
not sure if I can post the website name, but this is horrible customer support and service...

anyways was a bit panicked last nite with his numbers so I placed another online order for syringes, so am still unable to
give 1/2 unit dosages...

*alphatrak readings
8/27/13 PMPS - 271 - 2 units

8/28/13 AMPS - 309 - 2 units
+5.5 - 133
+6.0 - 109
+7.0 - 151 - ate @ +6.0
then
+11.5 - 116
+11.5 - rechecked - 98
+11.6 - rechecked - 97
PMPS - 99 - NO shot

8/29/13
AMPS - 338 - 2 units
+2.0 - 355
+5.0 - 291
+6.0 - will test in 25 mins
+6.0 - 286

 

Ok then drop to 1 unit for now to be safe. He might be able to handle it - unless you think you can eyeball somewhere between 1 and 2 units?

Wendy

 

Hi Wendy,

ok, I will go down to 1 unit tonite, assuming the PMPS level is safe

I can not give 1/2 unit dosage as the lantus pen dial click settings are in whole units only..
too bad they do not make the pen dispensers in 1/2 units, that would be really great, of course the lantus pens
are designed for humans, maybe humans never have to dose in that low of units, or there might be some accuracy issues?

thanks!

 

Eek. You don't want to be using those pen needle tips and dial a dose. They are ok for humans who need big doses but for cats they are too inaccurate like you said !! especially when cats are sensitive to small changes of even 1/4 unit.

When using pens you want to get separate syringes. You insert the syringe into the rubber end of the pen to remove the insulin.. See pic


For U-100 syringes (Lantus, Levemir), get 3/10 cc, half-unit marked, short needle, 30-31 gauge ie Relion 3/10cc 30 & 31 gauge short, BD Ultra fine 3/10cc short, Terumo Thinpro Insulin Syringe 31G 3/10cc, Kroger 0.3cc 8mm, 31 gauge

For now keep with the 1 unit and give that for at least three days unless you see another drop under 50 in which case another decrease is needed. And let me know when you get those syringes.. You are going to need them if she keeps dropping low like this.

Wendy

 

Hows things going? Are you still using the pen tips? I dont see any updates to the SS for a few days and hope Trouble is ok.

Wendy

 

Hi Wendy,

Trouble is doing pretty well....thanks!

The syringes came Sat. afternoon, so starting Sat. nite I have been using the syringes instead of the pen tips.
I haven't had any time to update the SS, with the holiday etc... but
I did change to 1 unit BID, per your suggestion while waiting for the syringes,
interestingly he had much higher numbers on 1 unit BID over 2 cycles - with the pen tips.
then using the syringes starting on Sat. PM shot of 1.5 units per your suggestion, he had some very low numbers
in the 2nd cycle, really low...so I had to skip an AM shot.....and am now on 1 unit BID - with the syringes.

his AMPS was 151 this morning, so I have not given a shot and he is eating while I write this.
SO, since everything else is the same, eating, food, etc....
what are these numbers showing?
it seems he is needing less and less insulin, but it also could be the pen and pen tip dosages are very inaccurate ?

 

Pen tips are inaccurate for cats due to the small doses.

Humans take much higher doses of insulin, and a 1 unit difference is no big deal ... in a cat, it could be disastrous.

 

We'll need to see the updated spreadsheet before we could really advise you much, but the numbers we see in the first 72 hours after a low number (like the 57) would be influenced by a "bounce". You also did exactly the right thing by decreasing Trouble dose after that low of a number!! We do usually take decreases (and increases) in .25 units, but dropping down .5 (to 1 unit) was a good SAFE thing to do! SO good you finally got the syringes too! The "dial a dose" on the pens isn't anywhere near exact enough for the tiny doses we give to our cats, so now that you're using the syringes, you may see some much different numbers.

Bouncing is normal..it's the liver going into "panic mode" because it's gotten used to the higher blood glucose numbers and when it drops too low (or too much too fast), the liver releases counter regulatory hormones and glucogen to bring the glucose back up to where it's "used to". It can take up to 72 hours to "clear the bounce", so during that time, we all just have to be patient.

After Trouble has gotten better controlled, the bounces will be less high, and clear faster though! China used to bounce into the 400's and take the full 3 days to clear....now she usually only bounces to the 200's and can clear the bounce in about 2 cycles

All that being said, good to hear that Trouble is doing well!! We are real worriers here, so when we don't hear from one of our extra sweet members, we worry! I do have a few suggestions for you if you haven't already done them.

1. Next time you get a pre-shot number under 200, don't feed and "stall" for 30 minutes. If you can, during that time post here and ask for help. 200 is our "no shot" number for new cats until we have enough data to really know how they react to both insulin and food. Since food increases the blood glucose, we want to know where Trouble is before you give any insulin..and not have that number influenced by food. You should also not feed for 2 hours prior to those pre-shot times for the same reason. Eventually, as you learn more about how Trouble reacts, you'll bring that "no shot" number down.

2. Please try to get some readings during the PM cycle. Most cats drop lower at night, and without some tests during that cycle, it isn't a "complete picture". If you could even just get a "before bed" test, that'd be great!!

3. Although Lantus "normally" nadirs around +6, that can be different from cat to cat, and even cycle to cycle, so it's also important to take an occasional "spot check" at different times during the cycle...not only at +6.....IF you can

You're doing great, and we're all here to help you, so ask all the questions you might have, and let us know if you're having any problems...I think with the number of cats that have been through this message board, I doubt if there's many problems that someone hasn't already had to figure out a solution for..lol

EDITED TO ADD...could you add some information to your signature line? (Where the link to Trouble's Spreadsheet is?) Your name (and Trouble of course!), where you live, what insulin you're giving, and that you're using the AlphaTrak2 meter would be very helpful....any other health problems, what you are feeding, and any other details that you might like to share would be great too!!

 

well now I am really confused...

I just took a reading, he is at 99, now 15 mins from his PM shot, or at +11.75 the previous reading was 65 which was +8.5
He had 1 unit at his AM shot.
I will have to skip the PM shot, yes?

 

I'm sorry, but without having all the data from the last several days, I wouldn't know what to advise you. He is coming up, but there's not enough data yet to know if it's safe to shoot a lower number.

If he's not above 200 at PMPS, I think for safety's sake, I'd skip the shot

 

Thanks Chris,
I will recheck him over the next few hours.

hopefully I can get the data into the spread sheet...just a super task for me with my vision

 

Good evening! Chris asked me to drop by.

Is there any way we can help you with the spreadsheet? As Chris mentioned, it's very difficult for us to provide you with suggestions if we can't see the waves of patterns on the SS. If you send me a private message, I will be glad to help you with it in any way at can.

 

Hi Marje, Mike, and Gracie and all,

Thank you, I worked on the SS this morning and is up to date....
hope the added comments make sense...

so as I posted last nite his PMPS was 99, and I held off the shot, he moved up to 152 a tad over an hour later
and I gave him 1/2 unit.
the AMPS was 122, so I have held off his AM shot so far, I did feed him his usual AM food, and he is at 159 1.5 hrs after eating
which is about the time it took me to update the SS - :sad:
do you think I should check in another hour and give 1/2 unit?

Thanks !!

 

Hi again!!

GREAT job on the spreadsheet! It'll make it much easier for all of us to see the "trends" we need to look for to help advise you!!

I'd like to also suggest you move over to the Lantus forum. There are lots of us over there that are using Lantus, and it'll help keep your posts from getting a little "Lost" in the Main Health Forum. You'd post once/day (if you can...we call these posts "condo's). I think it'd be easier for you and us to keep track of you there. Lantus Forum

Your "condo" would include the date, cats name, your AMPS reading to start with. Then each time you test, you can go back and "edit" the subject line to show the latest numbers. You can also tell us more about his general health...How he's "feeling"...the 5 P's, peeing, pooping, purring, preening, playing in combination with his appetite are the clinical signs that give us the WCR (Whole Cat Report)
Here's one of mine just as an example (a shorter one...was busy, but it'll do) viewtopic.php?f=9&t=103573

Here's what I see:

1. I think that since Trouble has gone too low twice in 3 days, you might want to just skip the shot this cycle. Let the depot drain a little. "Better too high for a day, than too low for a minute!" is a big saying we have here! I might start over tonight at an even lower dose. I'd suggest holding the .5 dose. Now that you're using the right syringes, these smaller doses will be much easier (although I'll agree that the doses that fall in between the half unit lines like .75 are sometimes a challenge..especially for us older people who's arms aren't long enough anymore to see those tiny lines...LOL)

2. Make sure you understand that if you stall your normal shot (don't give at the 12hr point because of low readings) your next shot time would be moved so that every shot is given as close to 12 hours apart as possible....So if your "Usual" pre-shot times are 7am/7pm and you "stall" for an hour because you get a low number, your new shot times would be 8am/8pm (If you want to get back on "schedule', you can adjust times back 15 minutes per cycle until you're back on the schedule you want)..HOWEVER...if you don't shoot during this AM cycle at all, you can restart your schedule where it's most convenient for you for your PM shot and moving forward.

3. If you "stall", don't feed. Recheck every 30 minutes. Post in the Lantus forum and ask for help. Our general rule is if he's below 200 (for now since he's still very new), you stall and ask for help. When you feed, the numbers you get later will be influenced by food, and if the number is "food influenced" and 200, that is different than if there's no food and it's 200. Also, take food up 2 hours before shot times so the number you get at pre-shot times won't be food influenced either.

You are doing fine, and we'll be happy to help you along the way. We DO understand this is all very new and there's a lot of information being thrown at you, so please make sure to tell us if we're going too fast or you don't understand something. We can sometimes be overzealous in our attempts to give you ALL the information at once. We won't be offended by a "SLOW DOWN!!" comment.....LOL

 

How is Trouble doing?

Wendy

 

HI Wendy,

Trouble is going really well..... thanks

although he had some pretty high numbers on thursday, I discovered he got into a bag of dry food we feed our other cats
which is somewhat odd as he never liked dry food...
but this was a new bag / flavor, the friskies rise and shine.... go figure

 

Trouble is trouble!!!

Can you update your SS?

Wendy

 

Got the SS updated, and now checking on the ReliOn as indicated on the SS

 

Hi again!!

Looks like Trouble is bouncing but you're also getting some nice numbers during the AM cycle!

You're missing a lot of information that would help you (and us) guide you since you don't have any PMPS numbers. Most cats drop lower at night, so it's possible Trouble could be dropping below 50 during that cycle, and would earn a reduction in his dose.

With that high AMPS today, I'd have to wonder if he dropped really low last night during that cycle so the 329 you got this morning is because of the bounce. When our cats blood glucose goes lower than their body is "used to", their liver panics and sends out hormones and glucogen to bring the number back up to where it thinks normal is supposed to be. Bounces can take up to 72 hours to clear. As they get better regulated, the bounces won't be as high, and will clear faster as the liver learns that lower numbers are ok.

Can you try to get some tests in during that cycle? A +2 and a "before bed" test would help us help you...as well as keeping Trouble safe.

 

Hi Chris,

well getting PMPS numbers is the difficult part for me here.....
I take my meds within an or or less of Troubles PM shot, and not much more than an hour or so after I am out for the nite
I take a pretty hefty dose of morphine 2x a day, and at nite a strong sleep med as morphine has a paradoxical reaction for me.
having said that I understand your point, and why a reduction might be right, but, how do I reduce a 1/2 unit
injection?

his reading at 11:09 PM, just before the time it takes me to type this post was 178, now that is the relion, so it would
be close to 210 or so with the alphatrak, yes, so his PMS time is, 11:30PM, which I am now 1 min past...

so I will give the shot and wait on my meds...and try to get some readings during the nite....
and will update tomorrow.

Thanks!!!!!

 

I understand the problem. I'm on a morphine pump and take some pretty heavy medications myself and once I decide I can safely go to bed at night and take them, I have to hope China doesn't pull any surprises on me. This is also where getting those tests can help you in the long run though. You'll learn how low Trouble tends to go at night, and it'll give you a better idea on if it's safe to give an increased dose (if you need to) or if you need to set the alarm to wake you up. Most of us get to the point where we hardly even wake up to test...I call it "zombie testing"...LOL

The other option is to move your times back...I had originally started our schedule at 11am/11pm because I'm NOT a morning person, but that meant if China threw me a low number at PMPS, I'd have to stay up most of the night to make sure she didn't hypo. I knew I could always go back to sleep in the morning, so worked her back to a 6am/6pm schedule. I don't like getting up at 6am at all!! but I can get up, test/feed/shoot and be snoozing again by 6:15...then I usually wake up by +2 or +3 and can get those tests too (those are good ones to get to give you an idea of how active the cycle is likely to be)

Then the PMPS is at 6pm...so I have the rest of the evening to test and if I have to be up later than midnight, I know not to take the medications that really knock me out. If you can move your test times back, and get a +2 and a "before bed" test, that'd be great!!

Of course you know what you can do better than any of us do. Just an idea I thought I'd throw out there in case it would be something that might work for you too.

 

so I got some PM numbers

PMPS 178
+2 - 134
+4 - 102
+5 - 72
+6 - 60
+10 - 269 - it seems he was fed the wrong cat food this AM, so this gets me mad!!

 

Put away the wrong food somewhere that can only be used for emergencies and not get confused with normal food.

At these numbers I almost would be inclined trying to reduce the dose to 1/4 unit for a few days. Heres how it looks



Wendy

 

I keep all my higher carb cat food shut away in a separate drawer, in another room, far away from the regular low carb foods. I've also labeled each can of high carb (HC) food with a black magic marker, listing the carb percent right on the lid of the can. The low carb foods aren't labeled. If I pull out a can, and it has something written on the top, I know it's one of my high carb foods. That's how I keep from mixing up the foods.

 

Hi All,
just updated the SS, have had 3 PM shots skipped the last 3 nites, any ideas, should I start lowering the AM dose, or
continue as is?

 

boy do I feel dumb, I have this board bookmarked, and haven't seen the two new replies which is on a new page, until
now when I posted and the page refreshes...

yes, I have put the high carb food away now, I had stayed up almost all nite, to get the PM post shot numbers,
and my girl friend got up early, and let me sleep, so by accident she grabbed one of the wrong cans....my fault
I should have had those cans in a different place.

 

We need to find a dose you can give every 12 hours, so I'd suggest you try the .25 unit like the picture above here shows and see how Trouble does.

Trouble "earned a decrease" on the AM cycle on the 15th, so you should have dropped back to .25 then.

If you're unsure if you should shoot, you should post here and we'll be happy to help you decide what to do

 

Thanks Chris,

I will see what his PMPS reading is tonite, and will post if I have any questions.

 

Give the new dose 3 days unless he drops below 50. Same 0.25 dose both a.m and p.m.

Also you know you can "subscribe" to a topic by clicking the link in the blue bar below? The board should then send you emails when you get a reply to your post. Doesn't always work that well though so you should still bookmark.

 

ok, his PMPS is 128, should I skip again?

 

Do you have everything you need if he goes too low? Plenty of test strips, high carb food and are you able to test later if needed?

 

yes, I just bought 100 test strips, yesterday, have high carb food, very high carb food, and karo syrup.
BUT, his pattern seems to be +6 hours, when he is at the low, so that would put the time around 6 AM....
I could do a +1, and +2 tonite, but not sure about any more...
maybe I should skip to be safe and start the new 1/4 unit tomorrow with the AM shot, ?

 

You hold the syringe. If you'd be more comfortable skipping, then that's what you should do.

What I see on your SS is that when you have skipped the PM dose before, he's been bouncing up during those cycles, but we'll never tell you to shoot if it makes you uncomfortable or you can't for any reason be around in case you need to wake up in the middle of the night to grab a test.

(I'll be up at 3am myself doing just that...LOL)

 

Hi Chris,

I see what you mentioned about bouncing up when skipped, but am really not comfortable shooting this low, and if I would not be able to do something if he went low, I would never forgive myself...

If this was the AM cycle, I might try it....

but I will start the 1/4 unit in the AM, yes?

thanks

 

Yes...give .25 whenever you want in the morning. Since you're skipping, now would be the time to change your schedule if you wanted to.

I started at 11/11, since I'm not a "morning" person, but then had to be up too many nights to get tests, so worked our way back to 6am/6pm.....I can wake up long enough to test/shoot/feed at 6, and go back to snooze for a few hours....then I'm up all day to test if I need to, and PMPS at 6pm means most nights I can get a midnight test in and as long as she's got a good number, can go to bed feeling pretty secure she'll be fine the rest of the night

Will look forward to seeing the numbers you get on the reduced dose tomorrow!

Give Trouble some ear scritches and call it a night

 

Thank you Chris....

have a good nite there!!

 

Tomorrow, why don't you go ahead and come over to the Lantus Tight Regulation board

You're less likely to get "lost" there and it'll probably be easier for us to help you as well as you'll learn a lot just reading how others are doing.

Each day, you post once..we call them "condos"...The subject would read 9/19 Trouble AMPS ###.......(you might want to add "new to board" too)....then in the body of the message, you'd give the Whole Cat Report (WCR)...how he's feeling, how good is his appetite, are the 5 P's in place (Purring, playing, pooping, peeing and preening) as well as any other questions you might have.

Then during the day, you can go back to your first post and add the numbers you get when you test to the subject line..so maybe it'd say 9/19 Trouble, AMPS 189, +2 178, +5 96

If you have a question to ask, add the ? icon from above the subject line, and if it's a medical emergency, add the 911

 

Thanks Chris,

posted over on the new board.