Dosing advice, please!

Discussion in 'Feline Health - (Welcome & Main Forum)' started by mariko, May 20, 2013.

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  1. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Hi everyone!
    I haven't visited here for some time since she went in remission last year, but unfortunately we are back and hoping you could help us.
    Lucy was first diagnosed in June 2011, put on Lantus, went in remission in Feburary 2012, and recently became diabetic again.
    If you could please take a look at her spread sheet (I know I haven't tested regularly enough), her numbers vary but never too low.
    We tested her fructosamine 3 times since last month, and 1st result was within the normal range and the 2nd and 3rd result was below normal.
    This had made it difficult for the vet to decide whether to put her on insulin or not, and we still don't know why her fructosamine is low when her blood glucose does not seem to have gone too low.
    This is what's been going on and how her does has changed.
    April 15 - BG tested at the vet was 504 mg/dL (28 mmol/L), but the fructosamine was within the normal range. Started insulin 0.5 unit twice a day. Assumed fructosamine was normal because she hasn't been diabetic long enough.
    April 27 - BG tested at the vet was 252 mg/dL (14 mmol/L). Fructosamine was below normal range, so we stopped insuline.
    May 4 - I did some home testings since April 27 and her BG was high, so we put her back on insulin but only 0.5 unit once a day.
    May 18 - BG high, but fructosamine was again below normal.
    I did a curve last night, and besed on the result, the vet and I decided to start giving her 0.5 unit twice a day from tomorrow.

    Does anyone have any idea or similar experience about high BG & low fructosamine?
    Even her lowest number is not that low..... so I really hope that deciding to give her insulin twice a day rather than once a day is a good idea. But Why... Why her fructosamine is low????

    Some additional information about my kitty.
    Lucy is a 16 yr old cat, has some other health issues - IBD, chronic pancreatitis, gallbladder stones, early stage of kidney disease.
    Her Spec fPL test value has been particularly high recently, over 50 both time tested on March 31 and May 18.

    Any comment/advice will be very much appreciated!!
    Mariko & Lucy
     
  2. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Guesses: She may be an easy food spiker and/or the renal disease may be flushing the glucose out of her system fast enough the fructosamine doesn't get high.

    Can you eyeball 0.25 units? Lowering to that may allow you to shoot more frequently and keep her more stable.

    Remember that as you get data to show it is safe, you may gradually lower the no shot number to 150. If you follow the tight regulation protocol, there are some folks who shoot lower when they have data to show it is safe.
     
  3. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Re: Blood Glucose HIGH but Fructosamine LOW

    Can you post the fructosamine values?
     
  4. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Yep, I also would like to know what the vet considers below normal etc. her blood glucose levels certainly are high enough to merit insulin currently but maybe she is bouncing up and down.. Did you start the 0.5 twice a day yet? I would like to see tests from then to see how low she is going..
     
  5. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Lucy is getting 0.5 unit twice a day starting today, so I updated the SS.
    I think her numbers are better and seem more stable. In fact her BG started getting better since last nigh even though she didn't have the morning shot yesterday. I am thinking her pancreatitis improved because her mood is also much better.

    BJM - Thank you for your suggestion, but I have a question. If she is flushing the glucose out of her system too fast, wouldn't I get lower BG as well? Shouldn't BG and fructosamin results support each other?

    Larry&Wendy: Thank you for your reply also.
    The report from the lab that did the blood work indicates that normal range of fructosamin is between 191-349 umol/L = 11-20 mg/dL.
    Lucy's values were: April 15 - 242 umol/L = 14 mg/dL
    April 27 - 147 umol/L = 9 mg/dL
    May 18 - 165 umol/L = 10 mg/dL
    What do you think about these numbers?

    My biggest question is, if the BG and fructosamin disagree, is it OK to go by BG as long as I test often?
    I am going to check at least 5 hrs and 8 hrs after the evening shot as her BG seems to be the lowest at these times, and on weekends I am going to do a curve - something like every 2 hrs for 12 hrs.

    Please let me know your opinion!
    Thank you again - Mariko & Lucy
     
  6. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Good idea on the testing. Do your syringes have 1/2unit markings in them? Reason i ask is that lantus is a depot insulin which means it builds up a bit in the cats system. Which makes me wonder if you are getting nice blues now, how low she will go in a day or two. Try and watch and see how low she goes, if she drops below 50, then I would reduce to 1/4unit instead.

    Wendy
     
  7. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Yes, I use syringes with 1/2 unit markings.
    I just tested her and she was 234 - yellow.... 3 hrs after shot. Is this because I let her steal the other cat's snack!?
    I will test her again in 2 - 3 hrs, and one more time before the next shot.
    And I will pay close attention to how low she will go in the next couple of days. Thank you for your advice!
    Mariko & Lucy
     
  8. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Depends, what was the other cats snack and was it high carb?
     
  9. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    That was just a guess and it would depend on when you test. The spike possibility might make the most sense. After eating, the BG might go up high (about 2-3 hours after eating), then go down fairly fast, so overall, the average looks good, either because the kidneys flushed out the glucose, or the insulin allowed it to be used. Is she gaining or losing weight?

    Visualize the profile of a mountain, right next to a valley, and draw a straight line across from start of the mountain to the far side of the valley. The line straight across (fructosamine) looks great, but in reality there was a big climb and then a slide down before returning to the next starting point. The trick is make sure the valley isn't too low (nadir), and the mountain is not too high (food spike). If you feed multiple small amounts, in may help keep that food spike from getting too high by matching the food intake to the insulin onset. Then you check your nadir to see how low it is going. You don't want it any lower than 50 mg/dL.

    Note: a blood glucose is a point in time, while a fructosamine more closely reflects an average over time, wo they aren't measuring the same thing.
     
  10. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Another note: many cats go lower overnight, so if you were only to give 1 shot, morning might e a better time.

    Lantus really works better if you do 2 shots, of the same amount, every 12 hours. You were giving 0.5 just in the evening. Switching to 0.25 morning and evening might work better.

    With that low amps of 124 mg/dL, do you have your hypo kit ready? Please check around +2 to +3 hours after the shot to see how low he is going. You may need to support him with some higher carb food, if not today, then within about 3 days of twice daily dosing.
     
  11. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
  12. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    I think that BG testing is going to show you much better what is going on with the blood glucose levels than the averaging that the fructosamine test does.

    Since you are using our standard spreadsheet format, we can see what is going on and help advise better.
     
  13. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you all very much for your advice!!!
    And thank you very much for explaining to me about fructosamin so patiently - BJM.
    Mountain and valley explanation really made me understand much better.

    I give both my cats a small amount of better quality canned food as snack - a couple pea size for Lucy and a couple table spoon for the other cat Ginger.
    By the way, Lucy eats Wellness, and Ginger eats raw. Unfortunately Lucy didn't do well on raw (thickened intestinal walls and weight loss) when I tried some years ago.

    As my hypo kit, I have a bottle of corn syrup and some cans of cheapy food such as fancy feast/friskies (I though these kinds have higher carb. Are these good enough?

    She gained weight over the past couple weeks. She lost some weight when she was sick and wasn't eating well in March (before insulin), but she is gaining back.

    She has been on Lantas 0.5 unit twice a day since yesterday.
    I tested +3 hr this evening, and am planning to test again at +5 and +8.
    But so far, do you think she is doing OK by looking at the spreadsheet?
    I think Lucy's energy and mood are better, and she seems generally happier.
    Please let me know what you think!!!

    Thank you again - Mariko & Lucy
     
  14. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Those numbers you got yesterday, 5/22 Wed, look really good.

    I would definitely recommend getting a pre-shot test this morning before you give the insulin, especially since you got those wonderful green numbers later last night.

    If you are able to also get a +11 before the pre-shot test, that will help us see if the pre-shot test is a rising or falling number. That is important to know if you are going to be shooting those low numbers.

    It would be a good idea to test, post and hold off on feeding until you get advice from us here. Ok? Tell me when your test,shot cycle is in your local time and what your local time is Eastern Central, Pacific, etc.

    p.s. Those look like healing pancreas numbers. :mrgreen:

    Which of the fancy Feast/Friskies do you have? The pate styles are usually lower carb but the other styles with gravy are higher. Tell me exactly what you have and I'll look it up in the food chart. food chart Or you can look it up. It would be a good idea to label the cans with a black magic marker and write the percentage of carbs right on the can. You don't want to be scrambling during a hypo to figure out the carb percentage. :shock: :eek: :shock:

    You can always add a drop or two of Karo to raise the carb content of any food.
     
  15. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you, Deb&Wink.
    I was just writing a SOS message (little panic) when you posted your message because I thought the number I got last night at +10 was too low.
    Is 68 not a good number?
    I did give her a couple table spoons of her regular food because I got scared!

    I will test as you suggest, so please let me know what I should do about today's morning shot.
    I am in Vancouver BC Canada, Pacific time, so now is 5:13 am.
    I am going to test her now as 5 am is her +11.
    I start feeding them at 5:30 am & 5:30 pm, Lucy takes a while to eat, so she gets shot at 6 am every morning.
    I will post her +11 number as soon as I successfully get it (sometimes not easy, she resists).

    I feed & give a shot. "pre-shot number" is supposed to be tested even before feeding?
    I wasn't sure if it's supposed to be the number after eating or before....
    I will be back! Thank you - Mariko & Lucy.
     
  16. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Yes, please get that +11 now and then another test before you give the insulin, what we would call a pre-shot test.

    Pre-shot number testing is supposed to be before you feed. if you have fed already, please let us know.

    Do NOT give any insulin until you hear back from us here on the board. Ok?
     
  17. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you so much for staying with me, Deb & Wink.
    I just posted +11.
    She is up, probably because I fed her 2 tbsp of food after seeing the +8 BG.
    Today's +11 value is more accurately +11.5.
    I will wait to hear from you before giving her next insulin shot, but can I feed her breakfast before I test the pre-shot BG?
    Or, should I hold both breakfast and insulin shot until pre-shot testing?

    Breakfast --> pe-shot test --> insulin after hearing from you
    OR Pre-shot test ---> Breakfast ---> insuline after hearing from you

    Which pre-shot number would be useful for you to see? Or doesn't matter?

    Thank you again, Mariko & Lucy.
     
  18. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Please hold breakfast until after the pre-shot test.

    pre-shot test, wait to hear from us, then maybe breakfast or another test, then maybe insulin, then breakfast

    Are you going to be around this morning or do you need to go to work?

    ETA: What meter are you using for testing?
     
  19. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    OK, I will test her again in about 30 min or so, and wait to hear from you.
    I usually give her breakfast/dinner before each shot because sometimes she refuses to eat, but today I will hold both breakfast and insulin until I hear from you after pre-shot test.

    I normally do in the order of meal --> shot, not shot --> meal, because sometimes she refuses to eat and I don't want to give her insulin without food, but these days her appetite has been good. In fact she is starting to beg for food just now.

    I do have to go to work, but today I will try to be at home as much as possible, although I would have to leave home at least for 5 hours or so at some point. I will consult you again when is the better time to leave her alone after a couple more tests this morning, but I am thinking if her pre-shot & +1 test give safe number, I'd better go to work early and come home mid-afternoon to test her around +7 to +10 since these seem to be the time she goes lowest.

    The meter I am using is one tough ultra mini.

    Could you please stay with me and Lucy to give further advice?
    Thank you - Mariko & Lucy
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Mariko, I'm not going anywhere. Don't have to work today, errands can wait.

    I'll add more to this post later but wanted to reassure you I'm not going anywhere.

    ETA: Here is what I am thinking and why I had you do that +11, asked for the pre-shot, and had you hold on feeding breakfast and the shot.

    Lucy went low last night with that 68. She may go low again today. I do not want her to go below 50 unless you will be around to support her with food or can leave some extra higher carb food out for her to eat.

    I see 3 options for this morning.
    1. stall. wait to see rising numbers and then shoot the full 0.5U dose you have been giving. leave out some extra food for Lucy to eat.
    2. reduce. Since you need to be away today, giving a smaller dose would be safer than a full dose. She may still go low so I would want you to leave out some extra food, restricted from the other cat eating it.
    3. skip. do not give the insulin. This is the safest way to go since you will not be around to monitor all day.

    Our motto is 'Better too high for a day, than too low for a minute'. I'm not sure you have enough test data to shoot low this morning. We really need to have that pre-shot test before every insulin dose, AM and PM.

    It's your choice, you hold the needle in your hand. What do you feel like you want to do?

    Also, would you go back to your very first post in the this topic, click on the edit button and change the radio button from none to 911. It's not a health emergency yet but I'd like to get some other folks opinions on this.
     
  21. TheBowHuntress

    TheBowHuntress Well-Known Member

    Joined:
    Nov 22, 2012
    Re: Blood Glucose HIGH but Fructosamine LOW

    Hi,

    What we usually do with our FD cats is to not feed them for 2 hours before the shot. The reasoning is that if you feed your kitty less than 2 hours before his/her shot is due, the BG you are getting is influenced by the food (which makes BG's higher).

    We use this order--->withhold food for 2 hours--->test--->shoot--->feed immediately after shot.

    For example, if you feed at +11 and test at +12 (when shot is due, if you are using Lantus), and get a 90, that number is influenced by the food you fed at +11. If you feed at +10 and get a 70, that is more likely the actual BG aka "shot number".
     
  22. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    I just posted her pre-shot.
    She is slightly higher than +11.
    Please let me know what I should do. Can I feed her breakfast now?

    I have an idea about why she went unusually low last night, and would like to know what you think.
    I gave her sub-Q fluid at +5 last night, and I thought it might have changed how the insulin was absorbed.
    It maybe a coincidence but I think she went low (not as low as last night) previously too when I gave her sub-Q fluid, and that's why I tried to space out as much as possible.
    Do you think that might be the reason?

    Thank you, TheBowHuntress, for your explanation.
    In that case, I may have to adjust her feeding & shot schedule a bit.....
    Is that what everyone else does too?

    Anxiously waiting for your next advice - Mariko & Lucy
     
  23. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    I had posted this earlier:

    I see 3 options for this morning.
    1. stall. wait to see rising numbers and then shoot the full 0.5U dose you have been giving. leave out some extra food for Lucy to eat.
    2. reduce. Since you need to be away today, giving a smaller dose would be safer than a full dose. She may still go low so I would want you to leave out some extra food, restricted from the other cat eating it.
    3. skip. do not give the insulin. This is the safest way to go since you will not be around to monitor all day.

    I suppose the sub-q fluids could affect the absorption of the insulin, especially if you are giving them in the same area. I have no experience with that though.

    You did get a nice rising number from your +11 to your pre-shot test.

    If this were my cat, I would shoot the 0.25 to be safe, feed, leave out extra food for Lucy to munch on while you are gone, test as soon as you get home.

    It's not my cat, so you may feel more comfortable with option 3, or feel confident and want to go with option 1. You have already stalled, so you could give the full 0.5u dose.

    ETA: let us know what you decide. I think it's safe to take the 911 down from your first post in the topic now.
     
  24. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you again.
    I am going to take the option 2.
    I will check her again in 1 hr, leave for work, and come home to test as soon as possible in the afternoon.
    Mariko & Lucy
     
  25. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Ok. Thanks for letting us know what you decided to do. Have a good day at work.
     
  26. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Lantus, which has a slightly acidic pH, precipitates after injection, when it meets the more neutral pH of the body. These tiny clumps are supposed to slowly dissolve. A guess: by adding the fluid which has a more neutral pH (closer to 7), if it was in the same location, the dose may have precipitated completely, been spread out, and then absorbed in approximately the same time period, maybe resulting in more of a bolus effect. This is a guess.

    In general, you want to do sub-Q fluids on 1 side and the insulin on the other. You may want to move the insulin a bit more towards the hind end, too, if you can get a decent tent of skin for injection.
     
  27. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Before I leave for work, I wanted to thank you again for staying with me and Lucy for hours this morning.
    I was quite scared....
    I gave her 0.25 unit, was hard to measure but did the best I can.
    I don't know how important the +1 BG is in today's case, but I just checked her anyway and she was 171.

    Thank you, BJM, for your comment about sub-Q fluid. It is helpful.
    I did not do them in the same spot, but maybe it was too close - about 4 inches or so apart.
    When I give sub-Q fluid next time (probably on Saturday), I will do as you mentioned and see how it goes.
    I think I can make a tent towards her bumbum.

    Mariko & Lucy
     
  28. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    No problem staying with you this morning Mariko.

    That 171 is probably at least 30 points higher from the food. You're good to go to work.

    When you get a chance, I'd like you to add a couple more things to your signature.

    1. Go to user control panel in upper left of screen, click on those words.
    2. Click on Profile tab
    3. From the list of options on the left hand side of the screen, select Edit Signature.
    4. In the free form text box, where you already have the link to your SS, please add the meter you are using, the insulin, the food you usually feed, any complicating health conditions, any additional medications (like those sub-q fluids).
    5. Click on submit to save the changes.

    So it would look something like this:

    Mariko & Lucy
    One Touch Ultra Mini, Lantus, Wellness food, sub-q fluids every 3 days because ????
    Lucy's SS

    This helps to provide a quick snapshot of your cat and helps us to help you better. You didn't have all this information this morning so I had to ask a few questions and that delayed the response.

    When you have some extra time, it is nice to have a bit more information. To do this, there is another google doc called a profile to tells us more about you and your cat Lucy. I believe these are the most up-to-date directions on creating a profile to link to your signature. You can make it as free form as you like, no reason to stick to the standard format. profile instructions
     
  29. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Hello again.
    I came home from work as quickly as possible, and have been checking Lucy's BG since +5.
    I will check pre-shot before the evening shot, but I am wondering if 0.25 unit may be more appropriate for her....
    She got 0.25 unit this morning because she went quite lower than usual over night, and her lowerst BG was at around +5.
    Her full does is 0.5 unit, and her lowest point seems to come at +8 ~ even +10 with the full does.

    I heard that normally the lowest is at around +5.
    Is that what I should aim for? To adjust the does so she will have a peak at +5, rather than +10?

    I am trying to decide whether I should give her 0.25 unit again this evening rather than 0.5 unit, and see how she does with the reduced dose.
    I am beginning to think that 0.5 unit may have been too much for her since now her pancreas seems to be better.

    I updated the signature with a big more info (hope it worked).
    I will do a sheet of profile sometime soon (Lucy has one of the thickest files at the vet, a lot of medical history).

    Thank you - Mariko & Lucy
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thanks so much for adding that info to your signature. It helps us to see that Lucy and you are dealing with quite a few medical issues.

    With the BG numbers you got today, those were good "healing the pancreas" numbers. Anytime we can see those blue numbers and some greens, it means the pancreas is working to heal, probably making some insulin on it's own to help out. I would consider that 68 you got last night a good healing number, not too low, but scary for you since you had not had a number that low before.

    Any number below a 50 is a cause for concern. That is hypo (hypoglycemic) territory and needs support with food and karo syrup. If you ever get a low number, put that 911 icon on the post and scream for help. Lots of people can walk you through a hypo event.

    If you are more comfortable shooting the 0.25U, certainly you could do that.

    Some of the numbers you are seeing may be because the lantus depot still has some extra insulin to be slowly released and help keep the BG's low. Once the insulin depot is drained, you may find the numbers going up high again.

    Lantus usually peaks somewhere between +5-+7. But every cat is different. My Wink always nadired around +4.

    I have to tell you that I will not be around later this evening or even tomorrow morning to help you with advice. Fridays are my really early morning this time of year, up at 4:30 am EDT so I'll be going to sleep early tonight, up early tomorrow, no time to look at the board, and not back until late afternoon, 1pm EDT or so. Unless it rains here in Massachusetts. Then my adventure is cancelled and I'll be around. But you shouldn't count on me is what I'm saying.

    You could go back to your first post and edit it again, change the subject to dosing help? or something similar.

    At some point, we should have you look for a low carb, low phosphorus wet food to feed Lucy to help with the CKD. There are other members here that have diabetic and CKD kitties and have food lists and can help out with that. I can also do a search. This is not something we need to do today or even in the next week. Keep it in mind and make sure we come back to this in a week or so.

    ETA: Would you add one more piece of info to your signature? user control panel, profile, edit profile, location field - enter where you live, province/state and country would be good. City if you like is nice to know.
     
  31. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you so much again for the info.

    Lucy's pre-shot was 175, so I ended up giving her a full does of 0.5 unit, but I made it a skinny dose.
    I'll check her BG at around +5 and +9 or something like that tonight.
    Hopefully she'll let me sleep a little better tonight.......
    I want to give her a break until +5 - she is getting more irritated at being poked.
    Also her ears are red.... sad..... are everyone's diabetic cats being home tested have red ears at the edge?
    I do hold the poked spot for about 10 sec to prevent bruising, but she hates that part sometime more than poking.
    I am worried about damaging the tissue permanently.....
    I do alternate right ear / left ear, and try not to poke on the same spot, but her ears still look painful - heart-breaking.

    Thanks - Lucy & Mariko
     
  32. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Hi there

    Don't worry about the ears, they won't be permanently damaged, just make sure they are nice and warm before you poke so you don't need to poke more than once. As you get better and the ears learn to bleed better, they won't bruise as much. Although my cats have a few red bits sometimes, and I have been doing this over a year. Put a little polysporin complete pain relief ointment on afterward,that will help too.

    Wendy
     
  33. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you very much for your information about red ears.
    About polysporin, doesn't it contain antibiotic? Is it safe if she licks it?
    She can't lick her ears of course, but when she grooms, she repeats licking her paws and rubbing her ears.
    Thank you - Mariko & Lucy
     
  34. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    It does, but its a very small amount you put on, very sparingly. I use the polysporin complete triple with pain relief. I smear a pin drop on and wipe it off so its very little and I only use it occasionally maybe once or twice a wek. Many of our US members use neosporin and some use it every time. It seems to be safe for cats, I just use it less to be on the safe side.
     
  35. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    OK, thank you so much again.
    Good to know there is something I can do to help with sore ears.
    And you are right, it seems her ears are bleeding more easily.
    In the beginning, I really wanted to stomp on the meter screaming, but it has become much less stressful for both Lucy and me.

    I have a question, not about Lucy's condition, but about this forum and posting etiquette.
    I would like you more experienced people to keep an eye on Lucy's SS (please!) for a little longer while since she hasn't been on insulin for long yet, and I am constantly worried if the dose and numbers are right.
    I do not have the experience to interpret the home test results yet, so your advice/opinion is very valuable to me.
    Also, Deb, I would really like to talk about the low carb low phosphorus food to help with CKD at some point in the near future as you mentioned in your last comment.

    My question is: Can I keep this topic going even though the subject may no longer reflect the contents, or would it be better if I start a new topic?

    Thank you! - Mariko & Lucy
     
  36. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    We can help as little or as much as you like. If you want more experienced eyes looking at her SS, I would start posting daily ( or as often as you can) on the Lantus Tight Regulation board. Its a strong sense of community and very active. There are many very experienced people there who will look at your posts every day and advise on what you should do and answer questions.
    http://felinediabetes.com/FDMB/viewforum.php?f=9

    Deb and I visit (and post!) there too.

    heres how it works
    1. every day you open a new topic - we call them "condos"
    2. in the subject line you put the date.cats name and blood readings i.e. 05/23 Lucy AMPS 140 +1 171 +5 119 +7 122.. PMPS 175 ... you can add a ? icon if you have a question. You can update this subject with every reading or at the end of the day. whatever works for you.
    2. in the content you give a short update on how Lucy is doing regarding the 5 PS ( playing peeing pooping purring and preening) and a link to the previous condo and any questions etc. ie Today Lucy was so happy running around and attacking my feet. But she is still peeing a lot, should I increase her dose?

    For your first post put "newbie" also in your subject line so people can welcome you!! I have been on that board since Tiggy and Bailey were diagnosed, and since they arent OTJ, I still post every couple of days to get advice and eyes on them!
    Wendy
     
  37. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Mariko, you can keep this topic going as long as you want. After it goes to a second and third page, it starts to get too big to track, so we often suggest someone starts a new topic, but provides a link to their old topic.

    If the subject does not meet your needs any more, you can always change it. To do that, you need to go back to your very first post in the topic, and look over towards the right. There is a little rectangle with the word "Edit". Click on that little rectangle and your first post will be opened and the subject line pops up. Change the subject line to whatever is your current concern.

    Please, do not change any of the text in your first post, we probably will not notice it. Most times, I will open a topic to read, and click on the "First Unread Post" over on the right hand side above the first post, and then start to read from there. I will only go back through a topic, if there is some information I am hunting for, that I need so I can answer any questions better.

    This is a good website to learn more about Chronic Kidney Disease in cats. http://www.felinecrf.org/

    Dr Lisa Pierson's food chart lists the phosphorus content of many commercial foods found in the US. See here catinfo food chart You want to keep the phosphorus numbers low ( I forget the number) and also select a food with < 10% carbs.

    You may want to write a topic asking if someone has a shortcut list for the low phosphorus foods already. It is likely that someone does, but I don't remember who has this list.

    As Wendy said, you can stay here in the Feline Health forum, or you can decide to go to one of the Insulin Support Groups. Lantus TR tends to be quite hectic and fast paced. If you are not ready for that, stay here in health and we can either PM other members to come over to give advice or post over in Lantus TR to ask for 'more eyes' on someones topic.

    People stay here for months, years if they need to. We aren't going anywhere. We will not abandon you. Did anyone mention that when you joined and started posting here, you gained a whole new family? Well, welcome to the FDMB family. We try to help each other the best we can.

    There is so much traffic over in Lantus TR these days, that I no longer can find the time to read every post. I do read the ones with questions and chime in if I feel I can add some value and additional information. So, be sure to put the question mark radio button on your post when you need an answer to a question, ok?
     
  38. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Fortunately it's not a requirement to read all the other posts on the lantus tr board so you don't need to worry about the pace, that's more for the experienced members who go on to read all the posts and advise. And there are a lot of very experienced people here, way more so than myself or deb, who are always available to advise on that board so I wouldn't worry! lastly, they keep track of all members on that board so will be better suited to watch over you.

    FYI the way you can tell experienced members is the have over about 3000 posts.

    Wendy
     
  39. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you very much, Wendy & Deb!
    I will visit the Lantus TR forum sometime this weekend, and see if I can post there too.
    I may post here and there at the same time, that's OK right?
    But first, I'd like to get Lucy's profile done as Deb previously suggested.....

    I updated the SS with yesterday's & this morning's AMPS numbers.
    Yesterday, between AMPS PMPS, she went down, up and a little down again, so her PMPS number was lower than +8.
    Is this not strange?
    I gave her only 0.25u yesterday night because of late shot.
    Overnight, her number went down, up and down again.
    Fluctuation is not big, but is it OK how her 5/24 PMPB is lower than AP+8 when her AM+6 was the lowerst?
    She did the similar thing again after 5/24's PM shot.....

    I ended up giving her 0.25u again this morning instead of her full 0.5u.
    I can stay at home most of the day today, but will have to go out around +2 ~ +3.
    Maybe I shouldn't have given her the morning shot.....so worried if I'm doing it right....

    Mariko & Lucy
     
  40. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Since the doses have fluctuated over the past couple of days, it'll take about 3 full days (6 shots) for the dose to stabilize enough to evaluate if it should be adjusted. Stick with 0.25 for at least that amount of time, unless he goes too low (<50 mg/dL).
     
  41. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you very much, Wendy & Deb!
    I will visit the Lantus TR forum sometime this weekend, and see if I can post there too.
    Sure - you can post on both.. maybe post on Lantus TR all your questions etc but put another post here with just a link to the TR post and then people can hop over and keep the discussion on one thread.

    I would love to see a profile - more pictures! she is such a cutie..

    and
    Nope because meters vary by 20% so those numbers are actually pretty much the same. If anything she was kinda flat blue. She did do more of a curve overnight.

    Interesting - lets see how she does on this dose like BJ says - if she starts to head back up to yellow ( I think she might - the 0.5s was working pretty well but lets see) you probably will want to move her back to the skinny 0.5IU but give it a few more cycles. Can you put 0.5s in your dose column so we know you gave a skinny 0.5 the other day?

    Wendy
     
  42. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Mariko,
    There a couple of items I wanted to make you aware of.

    First, giving a late shot acts like a reducion in dose. It's nothing to worry about, but you may see slightly higher numbers the next day when you need to give a late shot, an hour or so later than your normal schedule. Giving an early shot, acts like a dose increase. Again, nothing to worry about, but you may see slightly lower numbers if you need to give a shot an hour or so early.

    Even if you took two tests, at the same time, off the same blood drop, you would not likely get two numbers exactly the same. This is because of meter variance.

    Blood glucose meters are allowed to vary by as much as 20% and still be considered to be accurate. This means that a number + or - 20 percent, is for all practical purposes the same number. Falling within that 20% variance range up or down,we consider that number to be the same.

    I'll give you an example from your spreadsheet. On 5/24, your PM +7 was 133 and the +10 was 112. These two numbers are so close to each other taking into account the meter variance, that we consider them the same number. Same thing with those morning numbers on 5/24. Meter variance is playing a big part in what you are seeing as different numbers.

    So where your SS shows a little down, up,down from the PMPS, I see a nice drop into a wonderful green number at +5 ( around nadir), then a very slight rise at +7 and a 'surf' or maintaining the same range of numbers for +7 to +10.

    You don't have to test so much at night unless you want to or are concerned that Lucy may drop too low. More data, especially, at the beginning of this journey with your cat Lucy, will not help. I'm only saying you do not need to test as much if you are staying up at night to do so. There may be times when you want to do that. I'm just letting you know you do not always need to do that.
     
  43. Blue

    Blue Well-Known Member

    Joined:
    Dec 28, 2009
    Re: Blood Glucose HIGH but Fructosamine LOW


    What are you doing for the pancreatitis, how are you treating it?

    Pancreatitis is extremely painful and causes higher BG numbers. so your cat may not need insulin if you treat the pancreatitis.

    You need pain meds for sure. Buprenex is best for the pain.
    You need to give subQ fluids to flush the system. I was giving at least 100cc a day for a week.
    You need something for nausea / upset stomach. Most often, people give 1/4tab Pepcid AC 10mg strength. Give 1/4tab about 30min before shot time / meal time so that the stomach is settled in time to eat.

    What about B12 shots? One of my cats have frequent bad flares, and my vet had me start to give her weekly B12 shots, 25u. Within a few weeks, she had no more flares and only one minor one, and I was able to stop giving her the pepcid which I had been giving her daily for months.... the B12 helps to bring down the inflammation of the pancreas along with many other benefits to the cat's health.

    Some cats have been known to come out of remission because of pancreatitis, so be sure to keep testing as you may not need to give insulin once the pancreatitis issue is better controlled.

    Last, BG tests done at the vet office are often higher than normal because of stress from being there, so combine stress at the vet plus higher numbers because of ongoing, untreated pancreatitis and you have a cat that likely dose not need insulin.

    Gayle
     
  44. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you, everyone, for your advice.
    OK, I will keep her on 0.25u for the next couple days, and ask for your opinion again.
    And thank you for the info on meter. I will stop worrying too much about small fluctuation.

    I am a little confused about the late/early shot.
    Can you please explain to me again?
    Most likely on every Friday, I will have to give her a late shot, late about 1 ~ 1.5 hrs late.
    I gave her 0.25u yesterday because of this, but wasn't sure if it was the right thing.
    Can you please let me know how should I deal with a late shot?

    Yes, I am getting up in the middle of the night two or three times to check her because I am just so scared of her going too low and not noticing, but it's tough! I am not at home during days on weekdays, so I have only night cycle to check regularly to understand her tendency. Last night, I saw her go green at +5, and didn't know if it's a safe number not to check again, so I got up again to check. I test because I'm scared her going too low, but I really don't want to have to get up at night so many times unless I have to, but I'm not really sure what are the "have to" circumstances, so I end up doing it every night....
    Hopefully I will have a better understanding of her reaction to insulin over the weekend and start getting decent sleep from next week....

    About her pancreatitis, when she is having an obvious flare-up, I give her buprenorphine.
    If she seems nauseated, she gets an anti-nausea shot (serenia) at the vet.
    And sometimes, appetite stimulant if she refuses to eat.
    She now gets 0.05 ml of V-B12 once a month only, because the last test indicated she was getting a bit too much of it.
    As a long term treatment, she is getting acupuncture regularly since April.
    I think it's helping.

    Today is the day I am giving her a sub-Q fluid, and that is partly why I gave her only 0.25u this morning (again, scared of hypo) because last time she had a sub-Q fluid, she went unusually low.
    I gave her the morning shot on her left hind area, so will do the sub-Q around upper-right.
    I will post how she does!
    Thank you - Mariko&Lucy
     
  45. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Think of pouring water through a funnel.

    If you pour too fast the funnel overflows.
    If you pour too slow, the water goes out as fast as it goes in.
    If you pour a little fast at first, then slow down, you may keep a small pool in the funnel.
    If you slow down a smidge then resume a constant speed, the level lowers; like a delayed shot
    And if you speed up a little then resume a constant speed, the level increases; like an early shot.
     
  46. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    The explanation that BJM gave with the funnel, was talking about the insulin depot. The depot is a storage area within the cat, that stores some of that insulin you inject for later use. There is supposed to be about 24 hours worth of insulin in the depot when it is filled. When you need to give a later shot because of your schedule, the body will have some extra insulin it can use, and will release some of that stored insulin from within the depot storage area. When you give the next shot, the late or delayed shot, some of that insulin from the new shot, will be used to fill up that storage depot again, leaving a little bit less for your cat to use in this cycle. That is why I was saying that a late shot is like giving a reduction, or less insulin. Because not all of it will be used up right away, some goes to rebuild the depot. Does that make sense?

    It's perfectly ok to give a early shot or a late shot. Some people need to shot Lantus on a 11/13 or a 10/14 schedule instead of the more normal 12/12. You should keep to the 12/12 schedule when you can, but we know there will be some variability in that schedule. Management of diabetes in your cat, needs to be worked around the rest of your life. You need time to take care of you and all your other responsibilities.
     
  47. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    You are currently shooting very low numbers. That is good, because it may mean that Lucy will go into remission again. A number below 50 needs more tests and more food. We say "feed the 40's" which means if the BG is in the 40-49 range, you should feed some food. If the number is in the 50's, you can also give a little bit of low carb food, maybe a teaspoon or so. Numbers in the 30's need karo syrup, higher carb food, testing every 30 minutes to make sure the numbers are going up, and posting a 911 on this board for support, and maybe staying up for several hours until Lucy has BG's higher than the danger zone. Numbers in the 20's or lower mean an emergency visit to the closest 24 hour emergency vet clinic.

    Let's get some more information about your schedule and see if we can make some adjustments in when you test, when you shoot insulin. I'm looking for ways to make this process of caring for your diabetic cat easier for you.

    If you could give me some information like the following list, I'll try to make suggestions on changing when you test, feed shoot.

    For example, up at 6 am, test at 7 am, feed, 7:30 shoot. Leave for work at 8 am
    Get home at 6 pm. Start your own dinner, maybe take care of your kids or other animals in your house.
    Test Lucy at 7 pm, feed, 7:30 pm shoot
    Relax some, talk to friends, catch up on your posts on FDMB, etc.
    Go to bed at 11 pm.

    Do you have other animals in your house?
    Other family members to take care of?

    We want to simplify this management of the diabetes so you don't feel so stressed out and can get a good nights sleep without worrying about Lucy going too low at night.

    So far, I have not seen a dangerous low. Yes, that 68 you got with the last sub-q fluids administration was the lowest BG you have gotten so far, but not a dangerous low. We start to worry if the number goes below 50.

    There are also ways to leave some food out at night. Cats will usually eat some food if their BG numbers are dropping too low. Have we mentioned making frozen cat food sicles?

    When was Lucy's last pancreatitis flare up? That can make the BG numbers go up.
     
  48. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Hey there

    If you know you are going to be out late you can plan for it by moving the shot schedule by 30minutes a day or 15 minutes each time. for example say your normal shot times are 6am and 6pm
    Sunday AMPS 6am PMPS 6.15pm
    Monday AMPS 6.30am PMPS 6.45pm
    Tuesday AMPS 7pm PMPS 7.15pm

    and so on. Then move them back afterward!
     
  49. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    OOOhhhhhhhh, that makes a lot more sense..... Thank you all.
    That explains why her PMPS wasn't higher even though I was late to give her the PM shot yesterday....
    My (incorrect) logic was, her PMPS should be higher because I'm late, but it's not, so maybe she is using it too slowly and if I don't reduce the dose of a delayed shot, she may end up with too much and go hypo after the next shot....
    Ah, I don't think I'm ready to go to Lantus TR forum yet, so many beginner's questions and errors. I'd better seek your help here at the Health forum for a while longer....

    About the delayed/early shot, I think I understand better now that you both explained to me about the depot. (I was completely misunderstanding about that before. I though depot meant it stores and releases the insulin slowly during one cycle of 12 hours only.)
    But I am still not confident if I got it right (sorry - please be patient with me!).
    Do I now understand correctly as below?

    Is this correct? #1) If I am late to give her a shot, her insulin storage starts releasing stored insulin she accumulated from the previous shots.
    When she gets the next shot, some of it goes into her storage to compensate the lost insulin she used during the previous delay, so she will not get the full amount to be used for that particular cycle. I should not adjust (reduce) the dose just because it's a delayed shot or she will have even less to use during the cycle. Instead, I should give her her normal dose even late because excess will be used to fill the insulin storage.

    Is this correct? #2) If I am early to give her a shot, the excess will go into her storage. Her back-up insulin volume will rise, and if too much, overflows, causing higher BG. But still I should keep the same usual dose because an early shot means she will have more than 12 hours until the next shot, and use of stored insulin will be needed.

    Is this correct? #3) Since I have already given her a reduced dose of 0.25u for the past 3 shots already, I should keep this dose for at least 3 more shots to see what her storage does. If her BG increases, her storage is empty and probably needs an increased dose - back to 0.5u. If her BG stays at the same level, 0.25u is the right dose for her.

    My cats start waking me up at 5:30am every morning using various very effective mothods, and I used to use them as my alarm clock and got up and fed them right away. But since Lucy is now getting insulin and it's more difficult to give her the PM shot at 5:30pm, I now try to ignore their morning calls until 6:30am. They expect to be fed right after I get up, and right after I come home. Lucy is a very difficult cat to feed, not only finicky but she needs to be fed while she is begging. If I make her wait too long, she will lose interest in eating all together and becomes harder to get her eat her normal amount. On top of that, she needs to be finger-fed. She started refusing to eat by herself when she was first diagnosed with diabetes in 2011. Since then she insists on being finger-fed, so that's how I'm feeding her, and on good days it takes 20 minutes, and on bad days it takes over an hour. Even when her appetite is good and she really wants to eat, she would eat only a few mouthful by herself, and then insist that I hand-feed her. At first, I struggled to fix it by ignoring her begging, but now I accept it as a part of being her mom.
    This make it impossible to go on vacation, but it's a deal I made with Lucy, I don't go away, you stay happy, not sick.

    So this is my schedule:
    Get up at 6:30am, test, shoot and feed right away. Leave for work at 8am.
    Come home between 5:30 - 6:30pm. Test shoot and feed at 6:30pm.
    Every Friday evening, I have a volunteer duty that I'd really like to continue. So on Friday evening, I come home at around 7:30 - 8pm.
    I don't have anyone else who needs taken care of (fortunately!) - Just Lucy, Ginger (healthy cat) and myself.
    I usually go to bet at 11 - midnight.
    Could you please let me know when I should schedule her regular test apart from AMPS and PMPS?
    And of course if something happens and needs additional tests, I can go to work later or come home early or get up in the middle of the night, but when is the better time for scheduled tests for you to evaluate her dosing? Please let me know!

    Lucy has had 2 major pancreatitis flare ups.
    The last one was in March, when she had all sorts of symptoms, and that is how the vet realized she is back to be diabetic.
    I believe she had a smaller flare up on 5/18 but she was over it by 5/20 afternoon.
    How I guess if she is having a small flare up is usually her appetite. She starts taking a long time to finish her meal, and purrs less when brushed.
    Small flare ups are not easy to tell sometimes like major ones, because she has so many other reasons (health issues) to feel a bit off.

    Thank you - Mariko & Lucy
     
  50. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Re: Blood Glucose HIGH but Fructosamine LOW

    Yup, you got the basics of the depot concept.
    More precisely, Lantus is a somewhat acidic solution. When it enters the more neutral pH body, it precipitates. These small clumps slowly dissolve and that usually takes more than 12 hours, resulting in an overlap effect between shots. That overlap is the depot.

    Testing around +5 to +7 hours after a shot will help you check the nadir, the lowest point between shots which guides dose adjustment.
    Testing before bedtime let's you see if you might need to stay up and steer low numbers safely.
     
  51. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Mariko, you are the best mommabean any cat could wish for. This made me cry, that you love Lucy so much to take care of her so well. I bet she gets the best hugs in the world. If I die and come back as a cat, I would want you as my mommabean.

    Lantus can last 15-18 hours or more in a cat. We make use of the overlap effect between the two shots to keep the BG's at the correct levels.

    You might want to go over to the Lantus Tight Regulation forum to read the Stickies over there about Lantus. They are at the beginning of the list of topics, have a star icon next to them and a little lock symbol. The best ones are New to the Group and Tight Regulation Protocol. Read all of the stickies when you have some time. You might want to read Shooting and Handling Low Numbers also.

    On your understanding of the depot, good, very good.
    #1 You got it.
    #2 Small correction. Some of the excess insulin from an early shot will go to storage, but some will be used by the body. You may see some lower numbers with an early shot.
    #3 yes, minimum of 6 cycles (12 hrs in a cycle) to hold a dose, UNLESS you get a BG under 50. That is an automatic reduction is dose.
    Hold this 0.25 dose for 3 more cycles and then we will reevaluate.

    Mariko, You are really getting the hang of managing diabetes with Lucy and learning so much. I equate this process to a crash course, graduate college level in managing the diabetes. It's tough, stressful emotionally, spiritually, physically. You get an A so far. Be sure to take some time for yourself to relax and enjoy life.
     
  52. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Oops, I forgot to include some suggestions for a testing schedule to fit your work/life obligations better and not keep you up at night all the time. I'm not giving you exact times but more general observations that others have made and suggestions based on those observations. ECID so your cat Lucy may not follow this pattern.

    1. Pre-shot. You always want to get a pre-shot number. Always. So you know the number is not too low to give insulin. We start new members at a shoot/no shoot number of 200. Then as time progresses and we get more test data, we lower that number.

    2. +2 One good number to get in the evening is a +2. Here is why, some basic rules of thumb to base decisions on:
    A. If +2 is a lot more than pre-shot, it's probably going to be an inactive cycle. Not much change in the numbers, ok to get a night's sleep without worrying about getting up for testing.
    B. If +2 is similar to pre-shot, it's likely to be an Active Lantus cycle. You want to get at least one more test before bed to see which direction Lucy is headed.
    C. If +2 is much less (50 points or more) than pre-shot, it's likely to be a very active cycle. You may see some low numbers that require you to test in the middle of the night and support with lc food and then maybe some HC food and syrup.

    3. Before bed test. This will show you how Lucy has done since that +2. It's more important to get that before bed test if +2 is that similar to pre-shot or much less than pre-shot.

    You already are getting those pre-shot tests in the morning. Please continue to do that.

    I want you to be able to feel that you can keep doing your volunteering on Fridays. I think that you have a better understanding of the depot and overlap, you can feel confident in doing that and adjusting your insulin schedule.

    If she has another pancreatitis flare, do not be surprised if the BG numbers spike higher. The pain with the pancreatitis can affect the BG numbers as can inflammation (think UTI's) or infection ( think gums and teeth). Just be prepared and be sure to mention it in your post if you think Mariko is having a pancreatitis flare.
     
  53. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you, Deb and BJM. I am glad to know that I'm making a progress....

    I will always test AMPS and PMPS. On weekdays, I may not be able to do any additional tests between AMPS and PMPS unless AMPS number worries me, but I will do +2 and before bedtime tests. On weekends, I will do some more between AMPS and PMPS. On Fridays, I will see if I can get away with just giving her a late evening shot. If it affects her numbers too much, then I will try the time adjusting method Wendy suggested.

    I have updated the SS with today's numbers so far. I tested a little less often last night & today - wanted to give Lucy and myself a break. I will test +2 and before bedtime later today. I really wanted to create Lucy's profile to introduce Lucy better to you this weekend, but I couldn't! So much to learn and so much information to read through.... I will try to do it next weekend. My cats are complaining that I've been spending too much time on computer reading stuff these days, and I am getting a bit overwhelmed too, so tonight I'd like to have a good cuddly time with Lucy & Ginger.
    I realize that you must be spending a lot of time on computer helping me and other people on FDMB. I can't thank you enough. So again, thank you so much.

    I forgot to mention yesterday that giving an insulin shot on her bumbum and sub-Q fluid on her scruff on the other side worked!! Her number stayed stable after the sub-Q fluid, so I am very happy about that. Thank you again for the advice.

    Tomorrow's AM shot is her 6th cycle on 0.25u.
    I will ask for your opinion on dosing sometime tomorrow evening, so please please check back on us!

    Thank you! - Mariko & Lucy
     
  54. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Nice blue numbers and seems to be holding the dose.

    The testing plan sounds good to me. Maybe an occasional mid cycle test at night maybe +5 to +7 sometime just to check for lows. Her numbers look so good I wouldnt be surprised to see some greens soon at night. And rememeber if she drops below 50 she gets another dose decrease to 0.1IU so its worth it to get up at night for 5 minutes!

    I prefer the time shifting plan to skipping a shot. she is getting really nice numbers and we dont want to lose momentum since she is doing so well.

    Wendy
     
  55. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Thank you, Wendy, for your advice.

    No no, I will not skip a shot on Fridays.
    But I'd like to try giving a delayed shot on Friday without shifting the timing of previous shots first.
    So single 1 - 1.5 hr delayed shot on Friday evening.
    And it it does not work, I will do your time shifting.
    Time shifting plan is a better idea, I can see, but as I mentioned in my previous post, feeding Lucy is very tricky.
    I am worried that letting her beg for food on Friday morning for a long time by shifting may throw her appetite off.
    Feeding her late is OK. But it seems letting her beg for long is not so good. Maybe as soon as she expects food, he stomach prepares for food, and if it doesn't get food, she gets too much stomach acid? Or maybe it's just because she gets mad?

    I wanted to ask you, Wendy, about syringes since you also live in Canada.
    The only syringes with half unit marking I can find is BD Ultra-Fine II. Is it the same for you?
    I got a few bags from the nearby Shoppers recently, and the bag I opened had contaminated products.
    What happened was that I opened a bag and took a syringe and pushed the plunge before drawing the insulin, and a small amount of clear liquid came out from the tip of the needle. I took another syringe, and the same thing happened.
    I brought the bags back to the Shoppers, the pharmacist tested another syringe, and the same thing happened.
    I returned all bags as they came from the same box.
    I bought some bags from other store, and they seem OK, but if I can get a different brand, I'd prefer that.
    I didn't see any re-call announcement of BD syringes, I though this was a serious health hazard, to have some contaminated syringes in the market.
    If I can buy 1/2 marking syringes other than BD in Canada, please let me know!.

    Thank you - Mariko & Lucy.
     
  56. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Re: Blood Glucose HIGH but Fructosamine LOW

    Ah ok so you are going to shoot an hour or two late at night? Then what do you do the next morning? Its going to be off by that much too and you will have to time shift it back.

    I use the BD Ultra-Fine II 3/10 cc short. The clear liquid might be extra lubricant - they use lubricant to make the plunger easier to move up and down. I have never seen any come from mine though and I always empty first - I have been using 4 syringes a day for over a year. Could be a bad batch box issue and you were unlucky. I have never looked for another brand.

    Wendy
     
  57. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Re: Blood Glucose HIGH but Fructosamine LOW

    Yes, we have to keep the mommabean happy and healthy too. Please, take an occasional break, some down time for yourself. You need to relax and refresh yourself so that you will be ready to take care of Lucy and Ginger better.

    I like a piece of chocolate to treat myself.

    Don't stress on not being able to do the profile yet. We have some key information in your signature and that helps a lot. When you get to the profile, remember that we like to see pictures, of both cats, not only Lucy.

    When you are ready to post tomorrow, remember to go back to your first post, change the subject and change the radio button from None to ? That will help to alert us that you have a question that needs answering.
     
  58. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Hello!

    I have given Lucy 0.25u for the past 7 shots including today's PM shot.
    Could you please look at the spreadsheet, and let me know if I should change the dose back to 0.5u (maybe skinny) or keep 0.25u?

    Thank you always - Lucy & Mariko
     
  59. Wendy&Tiggy(GA)

    Wendy&Tiggy(GA) Well-Known Member

    Joined:
    Nov 15, 2011
    Let me ask someone on tight regulation to pop over and have a look..
     
  60. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    The nadirs are high enough that you could increase, maybe just by fattening, rather than going to 0.5 units. Perhaps start that in the morning?
     
  61. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Let me look at his spreadsheet and catch up on the thread. BRB.
     
  62. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I don't think Lucy got too low on .5u so I'd probably go back up to that provided you can test and monitor.

    With a cat coming out of remission, we tend to recommend you be more aggressive in dosing then you might have been the first time around. Cats are hard to get back into remission but it can be done and she's already looking pretty good.
     
  63. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Thank you very much for your help & advice.
    I would like to regulate her a little tighter in order to increase her chance of going back in remission, but since I'm not at home to test her much during the AM cycles on weekdays, I'd like to increase her dose back to 0.5u in steps unless you don't think it's a good idea.
    What do you think about the below plan?

    - Increase her dose to *fat* 0.25u from tomorrow morning first, and keep it for a week or so.
    - If the test results indicate it's safe to increase further, increase her dose to *skinny* 0.5u, and keep it for a week or so.
    - If she has room for more, increase to 0.5u.

    What do you think?
    I am guessing that her numbers will not change much at *fat* 0.25u.
    I've been practicing measuring *fat* 0.25u this evening, and it's very very hard....can't really tell if it's 0.25u or *fat* 0.25u, so it's entirely possible I'll just be giving her an imaginary fat dose, but at least it will not be less than where I think is 0.25u!
    I'd like to plan this so the increase to *skinny* 0.5u will take place during weekend when I can do more tests and monitor her, so maybe from Saturday PM shot?

    Please let me know if increasing in steps is a good plan or not, considering I am out at work during days.

    Thank you - Mariko & Lucy
     
  64. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Lucy looked much better getting 0.5U twice a day. Normal BG numbers in fact.

    If you feel more comfortable with only increasing to a Fat 0.25u, yes, I would say start that, and get some evening tests. I think Marje would prefer to see you increase back to the full 0.5U 'provided you can test and monitor'. Since you are working during the week and not around to monitor, it sounds like you do not want to increase back to that full 0.5u all at once?

    A slight increase now, would be better than holding that 0.25U. The numbers are going up since you dropped to the 0.25U. The numbers looked much better at 0.5U, normal numbers. We want to get you back to that 0.5U dose level ASAP and Lucy in better numbers as soon as you can test and monitor.

    By the time the weekend is here, you will be ready for the 0.5U dose. Maybe by Friday evening or Saturday morning instead of waiting until Saturday evening? I do remember that you work later on Friday's so always have to give a later shot(later = dose reduction) that day. Your next increase for the weekend could be a skinny 0.5U or a full 0.5U at that increase. I see no reason to not give the full 0.5U for the weekend since you will be around to monitor.

    Marje did say:
     
  65. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Good morning, and thank you.
    I wasn't aware that the dose increase had better be done sooner than later, but if I think about it of course making Lucy better sooner is definitely better than later.

    So, after thinking about it again hard, I ended up giving her a full 0.5u shot this morning.
    Her BG since yesterday's PMPS has been higher including this morning's AMPS, and besides I wasn't confident if I can give reliable *fat* 0.25u consistently.
    I can at least test her AM+2 ish before leaving for work, and if needed I will stay at home.
    And I will also try my best to come home early to test her again before the PMPS, somewhere around AM+9.
    After submitting this post, I will send an e-mail to my boss asking him permission to leave office early until I know how she does with the increased dose of 0.5u. He will say OK since I can get some work done at home too (that's home I've been testing her in mid-AM cycle since last week).

    Does testing at AM+2 and +9ish sounds good enough testing? Unless she goes way lower at AM+2 than AMPS?

    Thank you - Mariko & Lucy
     
  66. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, Mariko. That sounds like a wonderful plan. Glad you decided to up the dose sooner than later. Lucy's numbers were creeping up there to the higher blue numbers and definitely needed more insulin.

    It's nice you have an understanding boss and can do some work from home sometimes.

    Would you tell me what time your +2 test will be, stated in your local time is fine? I'll pop back in to check on you.
     
  67. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I think that is a good decision and I think the +2 and +9 tests are perfect.

    The folks here are doing a great job but if you'd like to come over to the Lantus TR ISG, I think it would be a good time. If your goal is to get her tightly regulated and back into remission, we can give a little more specialized help and there are more of us there to help you. We have a pretty good track of record of getting cats back into remission.

    Many of our members work and we take the cues from them....we try to come up with a testing schedule around work...but you've already got the same idea we would have given you.....+2 and +9 tests during the day cycle and a +2 or before bed test at night. Then, if you are up early enough a +10 or +11 in the morning so you know whether she's dropping into AMPS or not.
     
  68. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Thank you, Deb & Marje

    I will do her +2 test at 8:30am, and after that if the number is good I will have to power-walk to work, huffing & puffing.
    I'll wait to hear from you after posting +2.
    Please check back on us!

    And thank you for inviting me to the Lantus TR forum.
    I would definitely like your help getting her back into remission, so I will start posting there tonight / tomorrow.
    I thought I might be to early for me to move to the Lantus TR since I seem to be still full of beginner's questions, but I will at least start posting dosing questions there.

    Thank you - Mariko & Lucy
     
  69. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Mariko,

    Marje is one of our most experience members and helps out a lot of people. If she feels it's time for you to go over to the Lantus Tight Regulation Insulin Support Group (ISG), then I would take her up on her offer.

    There are two regulation protocols SLGS (start low, go slow) and TR (tight regulation). Since Lucy has fallen out of remission, it sounds like TR is your best method.

    She will explain to you how they like people to post. She may or may not suggest to you that you read some of the Stickies over in Lantus TR. This one is always a good one to read: New to the Group?

    You can still ask questions over there too, simply remember to use the question mark ? radio button to let people know you are seeking information.

    I'll try to pop over now and then to see how you are doing, but you would be in very good hands over in Lantus TR. Many more experience eyes over there to keep a lookout for you.
     
  70. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Just tested her +2, it was 122.
    Good to go to work?

    I will read the stickies in the Lantus TR forum and prepare myself to start posting there tonight.

    Thank you - Mariko & Lucy
     
  71. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Leave a little food out for her, to munch on if she gets hungry.

    Enjoy your day at work.
     
  72. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Thank you!
    Since today's is the first day on 0.5u, I will try to come home to check on her sooner than +9.
    Mariko & Lucy
     
  73. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Mario

    If you can check on her around +4, it would be good. Her +2 is much less than her AMPS so she might have some green numbers today. Leaving food out is good...maybe some medium carb if you can't get back in a couple hours.

    I will watch for you tonight in LL. Deb has given you some great info. We are always happy to answer questions.

    Have a good day.
     
  74. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Hello!
    I rushed home to Lucy after seeing Marje's message from work.
    I couldn't make +4, but I just checked +6 and it was 130.
    I'll be working from home the rest of the day, so I can check her every two hours or so until PMPS.

    I did leave a little food - something neither of them really like, put it where Lucy normally hangs out.
    But I would like to manage this without having to leave food if possible because they hate it when they can't go where they usually can go, but if I don't separate them I can't see who eats when. So I'd rather come home when an additional testing is necessary.

    I hope there is a way to leave food for Lucy without having to separate them in different rooms....
    Maybe I should try to find something Ginger wouldn't touch, but only Lucy would eat.....

    Mariko & Lucy
     
  75. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    We didn't mean to worry you. That +6 of 130 is a good number. She may have gone a bit lower at +4 or +5 but she is certainly in safe numbers.

    Cats that feel their BG dropping too low, will often seek out food on their own. One way to provide some food that can be slowly eaten, is to freeze some of the canned food and put out a piece to slowly thaw during the day. You might try that to see if Lucy will eat it but not have Ginger steal it all.
     
  76. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    Thank you! I got worried because it's her first day back on 0.5u.... Mariko & Lucy
     
  77. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    I just wanted to say what a beautiful cat Lucy is :D and her numbers are looking pretty good, too.
     
  78. mariko

    mariko Well-Known Member

    Joined:
    Jul 10, 2011
    I just wanted to thank you all one more time for your great advice, patience and education I received here since I first posted this. I could not have learnt so much and taken care of Lucy as well without you.
    I am now going to post Lucy's updates over at the Lantus TR as suggested, so please check on Lucy there too!

    Dyana, thank you for your nice comment about Lucy.
    Lucy and Ginger are my pride and joy!

    Mariko & Lucy
     
  79. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Your welcome. We could not do all we do without the support from everyone here.

    good luck over in TR. They are a great group of people. You'll find lots of help there.

    I'll be sure to pop over now and then to see how you are doing.

    Be sure to say you are a "newbie" on your first post.

    date, cat's name, AMPS number is the format so today would be 5/28 Lucy AMPS 180 new here
     
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