Dose advice needed following low numbers

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Thanks for posting this Elizabeth and for all your support. Lolly's bg is 314 at 4:14 pm EST . Since no am shot, guess that is +19. Marje has done my SS, I'm looking at it try to get it up.
 
Some cats, after experiencing very low numbers, can be more sensitive to insulin. You'll want to keep an eye out for that.
 
Since the thread is so long from last night, can we get a few details (at least until you get your SS up?)

How much does Lolly weigh?
Did you get a chance to go to the store to stock up on high carb food like Fancy Feast Gravy Lovers?
Are you doing good with the number of strips you have? You must have gone through a bunch of them last night!

Since you did skip this morning's shot, IF YOU WANT TO, you can safely change your shooting schedule tonight. Let us know when you'd like to shoot and how much time until then

GREAT JOB keeping Lolly safe last night!!
 
What I found interesting is how she surfed and surfed.... 40's and 50's (in human meter number) for so many hours. She just was stubborn about eating more. I think key is really making sure she always has food on board when you shoot. And then finding some foods she cannot live without and making sure to keep those on hand.
Martha you have learned so much already, was so impressed with what you already researched and read even before yesterday, but we need to remember you are brand new and may be missing a few basic pieces. Don't want to clutter up this thread, so lets be sure once you get past figuring out your next dose and things are back on track which blanks we need to fill in. I can think of a few tips from last night that may have gotten buried with all that was going on.
So glad you were able to get some sleep. Poor Lolly's ears must be sore.
You got the +'___' part down right!
She may run high between bouncing from low numbers and the dry, but that is ok, this too will pass.

Do you need help getting your SS linked? Other than dose are there any questions you have right now?

hugs girl. What a night!
 
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BTW, should we make Martha a separate thread so it is 'hers'? ....or does it matter. may not.

Chris has a good point on the strips. BTW, those AT strips are expensive! you were burning 'em up, weren't you. Do what your are most comfortable with, but most here do use human meters because of that point especially, and also they can be replenished more easily. As long as you are using AlphaTrak you want that information prominently displayed, in your signature, in your subject, etc... The ranges are different and the guidance different accordingly.
 
Vet recommended alphatrak -- I thought human glucometers weren't accurate in lower numbers. (and now I now mine's only +/- 20% accurate.) You are right though, I burned through strips, and this whole thing is daunting financially. Plus, I have to get the alpha strips by mail, (which is why I'd stocked up thank God) Anything I can do to reduce cost with low risk is welcome. Can someone repeat the conversion formula from alpha to human for me?
 
Human glucometers have the same 20% variance as the AT ....the FDA allows it. If you have a WalMart, the Relion brand "Confirm" or "Micro" are great meters that lots of us use! It also uses the exact same tiny sample size as the AT does. (and 100 strips for the Confirm or Micro are only $35.88)

Once you get used to the "human numbers", there's really no need to do any "conversion", but for as long as you're using the AT, you take the number you get times .66 and that gives you the approximate number on a human meter
 
Martha most vets will recommend AT because that is what they know. They are accurate and good meters but cost prohibitive for many. Some vets are using human meters though. The main thing is the scales are different. Schools of thought have changed a bit, but most recent is AT reads about 35% higher than human meter...but BOTH have a 20% +/- variance. We have tons of tricks for frugal diabetes. One big savings you are already doing is home testing and not doing in-office curves which do not produce reliable results anyway, as kitties numbers are often spiked as a result of stress, sometimes 100-150pts or more. So making dose adjustments off those stress skewed numbers can often mean kitty ends up on too high a dose.
 
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Marje did my spreadsheet for me- I just edited, emailed her back; should I try to publish using directions on site? There are two options.
Click to expand...
Yes.. attaching the SS to your signature will be very helpful...and if you create a profile it helps you not have to answer the same questions over and over.
 
Well this is embarrassing. I just tried following directions for attaching the spreadsheet but it didn't work. Marje still has permissions to it, but I don't see why that would affect it. From Google, sheets I published, got the URL, then posted into a link in my signature, but now my whole sig has disappeared. I'm getting to the end of my rope here....
 
A lot of stuff you can add to your signature (you can have up to 3 lines)

As long as you're using the AlphaTrak, make sure that's in your signature..and I suggest using a larger font with a different color so it really stands out!

You'll see some of the other info in my signature as well as other people's and you can work on a real "profile" with the whole story of Lolly as you have time! Looking forward to reading it!
 
WooHoo on getting the SS up!
Did you see what Chris said above...about option to re-set your shot time if you so choose to whatever time you choose since you skipped last night. You said your schedule varies, but you do want to find a time that you can shoot as close to every 12 hours as possible, since consistency is important with Lantus. When is your shot time tonight? ...or what would you like it to be going forward? (so it would be 12 hours later in the AM)

ETA:
might want to add using AlphaTrack...or similar at top of your SS. Want to make that a clear distinction
 
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OK..the correct starting dose would have been 1.7 units, so we would have probably started you at 1.5, but since she's already had a hypo and they can be more sensitive to insulin afterwards, I think it'd be entirely reasonable to start at 1 unit tonight and let's see what happens, but let's see what some of the others think

When do you want to resume shooting? Now's the time to decide what time works best for you to be able to give consistent shots every 12 hours since you could change times tonight if you wanted to

Pick a time when you can usually always get at least a +2 if you can. That's a good test to get to get an idea of where she might be going later in the cycle.
 
I've got a big scheduling problem. I don't think I realized just how strict everything is. 3 bg a day, eating right before insulin, insulin exactly 12 hrs apart -- I don't know if I can do this while working. I want the best possible outcome, and my vet recommended this protocol for possible remissions. Can any of you look at below notes and advise how I can do this???

MWF my schedule: out of house 8:30 am - 6 pm
T TH out of house 12:30 - 9:45 pm
Also my job is fairly high pressure, I'm required to stay longer sometimes.

My husband is 8:300- 4:30, and is willing to do the midday test.

We've been feeding at 7:30 am and 4:30 pm (my husband's schedule) we leave food out, but Lolly doesn't eat much past her 4:30 feeding.
Then we've been giving insulin around 8 or 9. (Vet said we could vary as long as no shorter than 10 hrs apart) I guess we have to feed later? I have 5 other cats, they will go nuts.

My husband's been ok with the insulin shots, but he's not keen on the tests. I think I can get him to do the mid day test, I can do the MWF am and pm tests, by T TH is a problem.

I don't see we can do this and get groceries, other things done, etc. We don't even have much of an outside the house life, and this sounds hard. Do I just have to do the 3 shots a day for a short period? Dr. K said try for 6 months. I can't follow this strictly for a long time, and may have to miss a shot or a test.

How do you DO this?
 
You don't do 3 shots per day...Only 2

How about if you were to shoot at 6am/6pm? That would allow you to get a +2 every morning before you leave so you'd have an idea of where she might be going later in the cycle, and your husband can get a test as he comes home in the afternoon (if not sooner)

Then if he can shoot the 6pm shot on the days you can't, you'd be able to get a test when you get in about 10pm before going to bed (and if you can get him to test too, all the better!)
 
And if you have to skip an occasional shot, you have to skip an occasional shot...same for if you have to give a late shot once in awhile...If you give a late shot, you have to be careful about paying attention to when the next shot is due though

We usually say if you have a schedule change, work your way back to your "preferred" schedule 15 minutes per cycle or 30 minutes per day, but a lot of it will depend on Lolly...some cats can have a little more "flexibility" in their schedules without much problem, while others are more dependent on "every 12 hour" dosing
 
Thanks- I'm going to test and dose now. She doesn't usually eat now, and isn't hungry. She eats a bit at 7:30am, then grazes. Ever since we switched to the low carb, none of the cats really want to eat a second meal. We are trying to cut back on the am feeding. I read that I need to feed right before the shot, but she won't, as she's a grazer. Can I shoot based on the numbers even if she hasn't eaten a meal?
 
We ask that they don't eat for the 2 hours prior to shots so that when you test, you get a non-food influenced number

You test, feed, then shoot...all within about 10 minutes (you want to at least make sure your cat will eat somewhat normally before giving the insulin)
 
Thats a great article to read. And for sure you can do this....people with all kinds of different schedules do with some adaptions to make it work. You may be able to test more mid-cycles on weekends, days off for instance. if you spot test at different times on different days patterns start to appear...it does not have to be same time each day. Let's get some opinions and ideas how to best work with your schedule since it is varied.
I have to tell you Martha I felt the same as you, but Hank was on a mission responded very well and was flying down the scale pretty quickly and in remission in a matter of weeks. It seems like a lot I know, is such a change, but it all pays off. Trust me it gets easier and more manageable before you know it.

Question:
what are you feeding, how much and when? The reason we test, feed, then shoot is to be sure there is food in them at onset. Last night was perfect example of why. It takes Lantus a couple hours to onset, so you have time to get more food on board between that. Another thing is it also really helps to spread their feedings out over the day, it's easier on their pancreas and keeps them more level. Once option is to make catsicles (40/60 water food made into cubes or containers) and pop a couple out when you leave. They thaw and are ready to eat in a couple hours. Many here also use timed feeders.
I never fed at exact times but did feed multiple meals spread out through the day, depending on when I was home. He almost always was fed 2 breakfasts an hour or so apart, and a before bed meal...the rest were around whatever we were doing. This can work with all your kitties.
I think you already had links to the food charts we use.
I know it feels overwhelming at first, but the payoff is great. You don't have to have it all figured out in a day. We are here to help with anything, just ask lots of questions as you go.
 
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Not everyone can get the mid day tests in during the week. They get what evening tests they can and do more on weekends. If your husband is good w/ doing the evening shots on T, Th you should be good. My DH didn't like testing either, but he got used to it. Once the cat (and you) get used to it it's really pretty easy. I was going to suggest 6:30/6:30 to give you a little breathing room when you get home and an out the door test in the morning. I find I have more control if I use the lancet w/out the device. I can see just where the point will prick. I give two very light "touches" and then milk until I get a droplet.

Keeping the insulin shots within 15 minutes is pretty important though. Shoot too early and it effects the shed like an increase, too late and it acts like a decrease. Lantus likes consistency. But as Chris said, an occasional late shot isn't the end of the world.
 
Vyktor was always free fed before his diabetes so we kept doing the same thing when he had it, except for the removal of food 2 hours prior to shooting. If the kitty is free fed you don't have to make sure that they eat right at the time of the shot, you just have to know that they are eating, i.e. they have been eating through the day so you've got no reason to think they won't keep eating as they want to duringhe next cycle.

Iwas thinking 6.30/6.30 too then you have time to get a +2 on your way to work and your before bed test will probably land up at a good time for testing nearer to nadir. That was my schedule too, the only bad thing was getting up at 4.30am to remove food but I soon got used to that so I was almost doing it in my sleep
 
Thanks guys-- very good info.

I was doing great- watched as my husband tested (he has ways to go, look who's talking), got food in- had the syringe ready to go at 7:45 - and bam, cat on the lam. She is freaked over last night, we are trying to get her out of the basement. note to self- shut basement door. Can I lower testing tomorrow? She was so easy before the hypo, now running from me, squirming. There goes my 7:30 schedule. Off to plead some more.
 
Oh NO..poor thing. If you get off schedule you want you can work your way back in 15 minute increments twice per day or 30 minutes once per day. She will forget about last night soon enough. Did you get some pain relief for her ears? Remember to pinch it for 30 seconds after the test?

As long as you are getting pre-shot tests and trying to get at least one mid-cycle test somewhere in there that is good to shoot for, Yesterday was not normal, so of course you both are still freaked out.
You had no idea how low you were shooting. Are you clearer now on the ranges and how to allow for those with your AT?

What was the number BTW?
 
She came up from the basement for the birdie toy. 318 at 7:50. She was 314 at 4pm. I've put some neosporin on, and I've been squeezing her ears. Still they look pretty bad- tests every half hour.

My vet started her on 1u, then went to 2 based on an in office reading of 420. My vet's instructions were to decrease by .5 if pre-insulin bg < 180 or Nadir <65

Two weeks ago she was in 100s Sat, 200s Sun on the 2u. I spoke to vet on Tuesday 1/13, she said to stay on 2u, get a curve this weekend. Obviously came down big time this weekend- at least on Sun. I decreased by .5, but I did not educated myself enough- I knew I should have come down more.

My understanding now is that 100mg/dL -180 is target for diabetic cats, min 90.

So if I had gone with the first Vet who prescribed 2u lentus and advised against home testing, Lolly might be dead now?

BTW how do I get to my spreadsheet to modify it?
 
Just a couple of things. First, to my knowledge, she did not hypo. Low numbers are not the same as a hypo.

Martha...did she actually have any symptoms of a hypo when her numbers were lower last night? I recall you said repeatedly that she was just fine.

Low numbers are not the same as a symptomatic hypo. While the numbers she had last night were low, they weren't so low that we would expect to see any insulin sensitivity.

Second....Lantus kitties do not have to have food on board before you shoot. Since lantus doesn't onset for two hours, you just need to have food in her before then. Most of us do test and then feed/shoot at the same time within 10-15 minutes of the test but mostly because if kitty is eating while shooting, he/she is unlikely to notice the shot.

Third...yes we like to get as close to shooting 12 hours apart as we can but if you are off 30 mins, it isn't the end of the world. Just shoot at your regulsr time next shot. For example, if your regular shot time is 7 but you need to shoot at 6:30 then do it and shoot at 7 the next shot. No big deal.

Also...not feeding two hours before a shot is mainly so you aren't shooting a food spike. But if it's just a tiny bit of LC food, it is unlikely that you would get a huge spike so if she gets into a little bit of LC food, it's ok and if you are worried, then stall and see if she comes up.

Martha PMd me earlier and asked what I thought about her shooting 1u tonight. Martha....it's hard to say what she needs right now, although we know it's at least 1.25u....but it could even be less than that. If you want to shoot 1u, go ahead and then we will see how she does. We can always edge the dose up to 1.25u if 1u is not enough. We want you to be able to shoot a dose twice a day that is safe. So give it a go and let's see where she ends up when she clears the bounce and the skipped shot.

I have to give Gracie her shot. BBL for a little more info.

Edited to add: to get to your SS to edit it, go to your Google account, google drive, and it should be there. Also the email Google sent to you should have a link to take you straight to it. I have Gracies bookmarked for fast access.
 
Thanks Marje,

No, she never had symptoms of a hypo

Can you confirm: My understanding now is that 100mg/dL -180 is target for diabetic cats, min 90.

I'm going to have to sign off, I'm ready to drop. I'll post her #s from tomorrow... Thanks...
 
With an AT, the target range for a cat would be 68-160ish. That's the rough equivalent of 50-120 on a human glucometer. Translating between the 2 types of meters is complicated, so generally it's easier for people to choose one and stick with it. Human glucometers and strips are a fraction of the cost of AT strips and human strips are perfectly fine for cats.

A non-diabetic cat might run in the 30's or 40's -100 or so on a human glucometer. We keep our diabetic cats over 50 so there is a safety margin because they are getting insulin.

The numbers you have are likely for someone who is not hometesting and would (i think) be more geared for maintaining a diabetic cat on insulin rather than trying for remission. It's just a slightly higher range than the Tight Regulation Protocol suggests. What we know is that a newly diagnosed cat that gets their blood sugar back under control as quickly as possible, before permanent damage is done to their pancreas' beta cells, has the potential to have their pancreas heal and begin producing insulin again. That does not happen to every cat, and there is no way for us to know which cats might/might not be able to become diet-controlled. The first goal is to get the cat's blood sugar under renal threshold (around 200ish, depending on the cat) to protect the organs from damage from high blood sugar.

And welcome. Sounds like you had a rough night. Sleep well tonight.
 
Just wanted to make a note here (for anyone reading this thread in the future) that a cat can appear to be fine one minute and can be seizing the next.

Some cats show symptoms early on. Some when hypo is moderately advanced. Some cats don't show symptoms until the hypo is severe. 'Absence of symptoms does not mean absence of hypo'. This is not just a phrase. I've seen it happen on this forum. I have had it happen with my own cat (who incidentally had his first symptomatic hypo just seconds after a reading in the 40's).

Some folks here know from experience that their cat is just fine at low numbers. But experience is the key: they've learned over time that their cat will be OK. When someone is new to dealing with diabetes they don't know that their cat will be fine at low numbers, and neither does anyone else here.
It's better to be safe than sorry.
 
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