Help Please, testing advice and dosing questions

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by Dee Dee C, Jul 23, 2019.

  1. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Clarence went to vet on 7/11 and vet did a +4 and +6 test on him to help get him regulated. He decided to increase his dose of Vetsulin from 2 units to 3 units. I didn't like the idea of increasing it 1 whole unit at a time, so he said it was okay to increase in 1/2 unit increments -- give 2 1/2 units for seven days, then increase to 3 units. Today was his first day with the 3 units, so I tested him every two hours. At +6 his BG was 100. In the past, the testing I've done has indicated the nadir at +4, so I tested him again at +6 1/2 and it was 79. Because I haven't seen it go that low before, I fed him some of his usual food and called the vet. I gave them the numbers from all the tests of the day. They called me back and said he was probably just 'adjusting' to the 3 units and to go ahead and give him the 3 units at the 12 hour point and not to test him again until Friday (of course, I'm not going along with the 'not testing' advise
    I was concerned about giving him the full 3 units, so I only gave him 2 3/4 nits (his PM pre-test showed him at 332). I tested him at +1 and his BG was 407.
    I'm concerned about him going to low, so I will be testing him every hour until I'm sure he will be okay.
    Can someone take a look at his numbers for today on the spreadsheet and tell me whether this seems okay or should I be worried. He had no symptoms when he was at 79, I just had not seen him go that low before and since I've read that the AlphaTRAK reads a bit high, I didn't want to take any chances. Help, please.
     
  2. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    @MrWorfMen's Mom

    Basing dosing off of tests at the vet definitely isn’t a good idea since the cat will most likely be stressed and have elevated BG. You’re also right to not want to increase his dose by a whole unit - that’s a lot! I’ve tagged a more experienced member for you so she can take a look at your spreadsheet and see what she thinks :)
     
  3. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    His +11 test this morning was 195. He is eating right now and I will test him again after he eats. It is about 15 minutes shy of his 12 hour mark right now.
     
  4. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Typically you should test him before he eats not after, as the reading will then be food influenced
     
  5. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I’d probably stick with 2.75 a few more times and see.

    Nice blues!
     
  6. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Alphas don’t read high... they read what the vet gets. Human meters read low. Normal on a human meter is 50-120 and on a pet meter it's 68-150. So those lovely blues are just what you want.
     
  7. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Sorry, I'm a little confused about the testing before he eats vs. after. I have read both on the internet. I really don't want to give him an injection, since his test after he ate was only 238. What about skipping this morning's injection and then seeing where his BG is later in the day and right before feeding this evening?
     
  8. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Janet and Linda, please correct me if I’m wrong! But for Vetsulin, for preshots it’s typically test, feed, then give insulin. That way the reading isnt influenced by food, which will make it higher but the food eventually wears off. Some also advise to wait for 20 or 30 minutes after he eats before giving insulin to make sure the food stays down.

    Now for tests throughout the day, I’ve seen both opinions for when to test in relation to feeding so I’m not sure there

    ETA: From the Vetsulin sticky: “So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot.“
     
  9. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    In the past I had been testing him before he ate anything. But then I read that for a curve, I should test after he ate, so I began doing that shortly after his increase from 2 to 2.5 units. Guess this means that the numbers I entered on the spreadsheet are inconsistent. I'm still learning all of this and not wanting to make my cat go hypo. His numbers were nearly always above 400 in the mornings and in the evenings when I did the pre-shot test before eating.
     
  10. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Sorry.... I may be a little late to the party here but I don't think I'd give a full dose on a pre-shot of 238 if that was taken after he ate. The question is how long after his meal did you get that reading? If you tested immediately after he ate, it's probably not too influenced by the food but if there was some time between him finishing his food and the test, then it definitely is food infuenced.

    I see your SS indicates you skipped the shot this AM which is fine as long as Clarence has no history of ketones or DKA. I was thinking 2.75u might be a good dose for now until that pre-shot this AM. Now I would suggest backing off to 2.5u if BG after a minimum of a 2 hour fast is at least 225 to 250. I would also suggest getting a test around 3 hours post shot if possible to see where Clarence is headed.

    FYI- curves are testing starting with a pre-shot non-food influenced reading followed by testing every 2 hours for 12 hours or every 3 hours for 18 hours. Grabbing random tests mid cycle especially in the +3 to +6 post shot time frame will determine how low the dose is taking Clarence and dose is determined based on that information along with the pre-shot testing. Pre-shot testing will tell you whether it is safe to give insulin. Testing only at +4 and +6 may be totally missing the lowest point in Clarence's cycles.

    Let's see what his BG looks like tonight.
     
  11. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you. I don't have any solid info on the ketones, but I suspect he did have ketones in his urine before his diagnosis. The 238 after eating was maybe 15 minutes to a half hour after he ate. Since he had no injection this morning, at what point should I test him to see how he is doing?

    FYI, he normally gets his food at 6:00, and when he has eaten most or all of it (normally around 6:30), I had been giving the injection. Then I read that waiting 20 minutes is advised so that you can be sure they have food on-board, so I started waiting a little - 10-20 minutes. This resulted in his shot usually being given between 6:30 and 7:00. Last night, I was a bit late -- 7:20 -- with his injection due to being a bit indecisive about how much to give. I'm surprised he was still so low when the last test was done this morning at 7:23
     
  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    The lower pre-shot this morning may be indicative of the dose being too high. I would assume the food was in play in that 238 BG this AM with a 15 to 30 minutes delay between the end of Clarence's meal and the BG testing. Today since there was no shot given, you really don't need to test Clarence but if you can get a test about 3 to 4 hours post his morning meal it can sometimes show whether the pancreas is working to help level out BG. FWIW, I think your decision to skip the shot this AM was a prudent one.

    We don't generally deal with clock times here because we are all spread out around the world. We deal with pre-shots (AMPS & PMPS) and then +1, 2,3 etc post shot times. Ideally you would test Clarence, feed him, wait 20 to 30 minutes after he finishes his meal and then administer his shot. With Vetsulin, as long as pre-shot is high enough to safely give insulin, you have an hour's leeway in shot time.....you can give the shot up to one hour early if needed. Late shots don't matter but will affect timing of the next shot.
     
  13. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Ok, got it. I will get a reading or two as you suggest. A couple more questions:

    When I do his PMPS should I go ahead and give the 3 units or should I decrease it to 2.75 or maybe 2.5 units depending on his reading?

    I'm running out of test strips, do you know -- are there retailers in the U.S. (California) that carry these strips for the AllphaTRAK2?

    Thank you so much for your help, I'm super frustrated with myself trying to do the right think for my kitty and just not knowing.
     
  14. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I would try 2.5u for now if BG at pre-shot before food is 250 or at minimum 225. The lower BG this AM suggests Clarence may have gone lower last night than you are aware of so until you get a bit more data, I would be a little more conservative with the dosing. The increase of 1u suggested by the vet is huge. We normally make dose adjustments in 0.25u increments to ensure we don't jump over the ideal dose. Insulin is not medicine...it's a hormone and although it's counter intuitive, too much insulin can look just like too little which often leads to slowing down the process of regulating the cat. Slow small incremental dose increases can have a big impact.
     
  15. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    As for the strips for the AT2, if there is a pet pharmacy around you, they would likely carry them but they are not available in regular retailers or pharmacies. Your vets office may have some on hand to sell to their clients. There are online pharmacies including adwdiabetes.com that sells the AT2 branded strips.

    In a pinch, you can use Freestyle Lite/Insulinx strips, available at Walmart and pharmacies, in the AT2 meter however without the correct code the readings won't be as accurate as is possible but will be in the ballpark. You would just leave your AT2 meter set to the cat code you are currently using.
     
  16. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thanks so much. I'll get some strips ordered and maybe make a trip to Walmart as well. I'm not feeling much like trying to purchase any from my vet right now, not feeling especially warm and fuzzy about the 'give 3u twice a day and don't test again until Friday' advice I was given by their office yesterday...
     
  17. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    When I was still using the AlphaTrak, I used freestyle strips in it and it seemed to work fine. I kept the meter set to the same cat code and made sure to test the strips with the control solution. However, they were VERY pricey at Walmart, I believe around $80 for 50, and like $35 on Amazon (which doesn’t help you needing them today unfortunately)
     
  18. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I think I can get by with what strips I have left until tomorrow, especially since I didn't inject this morning. I already ordered the AT strips on Amazon and they should be here tomorrow. I'll do the minimum amount of testing I can get by with today. I'm gonna look into the Freestyle strips, though, when it isn't so crazy and I'm not so tired. I was up all night testing, so only got a couple hours of sleep. Thankful for caffeine today!
     
    Sarah&Soph likes this.
  19. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Just tested Clarence and he was 429. I put this in the remarks section of the spreadsheet.
     
  20. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I'm going to post again when I do his PMPS test, gonna go take a nap for now.
     
  21. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Clarence's PMPS reading was 475.
     
  22. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'd stick with the 2.5u dose for now BUT only if you have enough strips to keep tabs on Clarence should he go low again. I doubt it will be an active night tonight but you never know. The high BG is from a natural phenomenon called bouncing along with the missed shot this morning. Bouncing happens when kitty's BG drops quickly, drops a lot or drops to levels that kitty is not used or are too low. You don't want Clarence going below 90 on Vetsulin because of the quick action it can have on BG. It's caused by the body's defences that cause stored glucose to be released into the bloodstream when the body perceives BG is dropping too fast or is too low.

    If you are low on strips, I'd drop his dose down to perhaps 2u for tonight and go back to the 2.5u dose when the strips arrive. You don't want BG dropping and having no way to check on Clarence.
     
  23. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Ok, I went ahead with the 2.5u for tonight. I will test him at +2 and see where he is. That will be in about 45 minutes.
     
    MrWorfMen's Mom likes this.
  24. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    What about testing him at +3 or +4 hours instead of the +2 ? He ate a good meal and I could save a strip that way...
     
  25. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    If he ate well a +3 should be fine but I wouldn't go any longer so if he is dropping you can prop him up early to avoid a PJ party or running out of strips.
     
  26. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Okay, I will do that. Thank you for all the support, I would be totally beside myself without this forum, that's for sure! I'll test him in an hour and see how he's doing.
     
    MrWorfMen's Mom likes this.
  27. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    +3 test results: 308
    I put this in his spreadsheet.
     
    MrWorfMen's Mom likes this.
  28. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I noticed I had some incorrect information regarding his dosage amount on the spreadsheet for the period 7/11 thru 7/14. I have corrected it. The info in my post was accurate, but I had it incorrect on the spreadsheet -- I was slightly stressed when I input that info yesterday on the spreadsheet. Sorry if that confused anyone. When the vet wanted to increase him from 2 to 3, I wanted to do it in 1/2 unit increments, rather than all at once, and that is what I did. Prior to yesterday AM, he was getting 2.5 units.
     
  29. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Once you get your new batch of strips, I think 2.75u is looking like the dose to try at this point. He is looking good. I think if you want to get some sleep, you could give Clarence a low carb snack now and maybe do one more check before bed.
     
  30. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I'll take it! Thank you so much for all you have done. I'll do a follow-up post in the morning and update the spreadsheet. I gave him 2.5 tonight, so you think I should give 2.75 in the morning if his AMPS is high enuf?
     
  31. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    … or 2.5 until I have the new strips in my hot little hands?
     
  32. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    +5 test result: 180
     
    MrWorfMen's Mom and JanetNJ like this.
  33. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I think the dose this morning has to depend on the pre-shot reading and how many strips you have on hand right now. Looking at the readings for the last couple of cycles it looks like Clarence may have a later nadir than most cats on Vetsulin. This is good because he is getting quite a good run in better BG range but also means that if he does seem to be dropping quickly or a lot, you may need to do a bit more testing so I think sticking to 2.5u until the strips arrive would be prudent.

    It's a good idea to always have a spare supply of strips just in case an order gets delayed or you go through more strips than expected. I kept an unopened supply of strips in my Hypo Kit and every time I bought a new supply of strips, I swapped out the extra in my hypo kit so the hypo kit supply was always fresh.
     
  34. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Good morning! His AMPS is 310. I really don't know how much to give him?
     
  35. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    And right now I only have 4 strips..
     
  36. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Neither his AMPS nor his PMPS has been this low since I began testing him. The closest was a 326 at the end of June and I believe that reading was right after he was increased from 1.5u to 2u.
     
  37. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I'm thinking maybe I should give him 1.5u to be safe. And I think I may take a drive down to town and look at getting a human meter and some strips -- something inexpensive so I can test him with that at least for the day. This may be a silly question, but is there such a thing as partial remission? Is it possible that the insulin I'm injecting is somehow stimulating his pancreas to make additional insulin?

    Another thing I will do when I get a chance is input those numbers from when I first got the meter. The testing I was doing was more random, but many times I did test him
     
  38. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    I think earlier in the thread Linda mentioned giving 2 units until your new strips arrive, but it’s really about what you feel comfortable doing, especially being low on strips.

    If you want to, you can always just switch over to a human meter permanently as many people do. It’s much cheaper in the long run and strips are more readily available (although I did love my AlphaTrak!).

    I don’t know if “partial remission” is the correct term, but yes the pancreas can heal and start to work again. Sometimes it starts functioning normally on its own which is remission, but a lot of times it just means you need to reduce to dose
     
  39. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Since his pre-shot readings have mostly run in the mid 300s to mid 400s, 310 feels low to me and I'd like to have a better handle on what's happening with him. I don't like changing the amount, but maybe 1.5 will be okay and less risky.

    Any human meters that don't require a large drop of blood or that you would recommend? Drug stores within a 30 minute drive from me are Rite Aide, CVS and Walgreens.
     
  40. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    310 is still quite high, but it definitely feels like a lower number after being used to higher ones!

    The ReliOn prime (the one I use) requires a 0.5uL sample, which is a smidge more than the AlphaTrak but not much. It’s also super cheap and available at Walmart. 100 strips are $20

    I considered the Freestyle lite which is basically the human version of the AlphaTrak and requires the same small sample size, but the strips were just not a whole lot cheaper
     
  41. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you for that info. Walmart is a bit farther for me, but not by much and it seems worth the extra few miles. The cost looks good and I don't think I'll have any trouble getting enough blood, so that's probably the one I'll end up getting. It is amazing to me that in a lot of cases you can buy a meter with strips for less than just the strips. And in the case of the AT2, the strips are about $1 each.

    As for 310 still being quite high, I agree that it is. I'm really confused about the way he is responding to the insulin now, tho, because it appears to be different than before. Since I've been testing him, he has not been that low on any pre-shot test. I realize I haven't been doing it for very long, and my inexperience makes me feel more conservative until I can really get a handle on this.

    I've plugged the numbers into the spreadsheet from when I first got the meter and started testing Clarence. In the beginning it looked like the insulin was not lasting as long in him, but I didn't do that many tests throughout the cycle. I am confused now by how late in the cycle his numbers are still low and how slow they rise back up on these last couple cycles.
     
  42. Sarah&Soph

    Sarah&Soph Member

    Joined:
    Jun 18, 2019
    Yeah I loved the AlphaTrak but it was just so much more expensive, especially with how often I was testing. Just a word of caution if you decide to stick with the human meter, they do read lower so don’t panic! Just know that normal range for that meter is 60-120. Also don’t try to compare readings between the two as it will just drive you crazy lol.

    And it’s definitely a learning curve with feline diabetes! The more you test, the more you will understand his patterns and how he responds to insulin, and it will make things much less scary. But what you’re wanting is for the insulin to his pancreas and for his numbers to come down. Not sure if this helps, but here’s an explanation of the different BG values and ranges
    • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
    • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
    • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
    • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
    • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
    • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
    As for his spreadsheet, there are others much more experienced than I am that can hopefully help decipher that for you :)
     
    CandyH & Catcat likes this.
  43. CandyH & Catcat

    CandyH & Catcat Well-Known Member

    Joined:
    Apr 23, 2019
    yes, that ReliOn Prime is definitely the winner when it comes to the expense of doing a LOT of testing -- and when you need the strips NOW not next week !

    but don't compare the results from a human meter to an AlphaTrak -- they use different reagents in the strips, there's no correlation, per se -- they have similar readings at lower BG, great differences at the high end -- but LOW is low and HIGH is high, just compare the readings on a meter to those on the same meter

    I was lucky enough to get the last ReliOn Confirm before it totally disappeared from Walmart -- fortunately the strips for it are still available online, and at a closeout/reduced price at that, though still not as inexpensive as strips for the Prime -- I'm stocking up when I can, as they aren't being manufactured by the original manufacturer either (Walmart just slaps their own brand on them, they're really made by Arkray)
     
  44. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    This info is all great. Thank you both! I'll stock up on strips for the ReliOn when I pick it up if I can. And I'm gonna copy that summary of ranges and pin it up at his feeding spot for easy reference.
    Just did his +2 test...365
     
    CandyH & Catcat likes this.
  45. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    What dose did you give this morning?
     
  46. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I gave him 1.5 units. I should probably given him 2, but I was afraid since his AMPS was lower than it has been (except yesterday when I gave him nothing). I should get those strips today, but if I'm testing all the time, I'll run thru them pretty quickly. I had no idea when I started this journey that it would be such a roller coaster ride. I'm sur my Clarence is 'feeling' the same way.
     
  47. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    The first little while when you are both trying to get used to the routine and figure out how the insulin is working can be overwhelming and you can go through a lot of strips because of unknowns and dose changes, failed tests etc.. It all gets easier. I think it was prudent to keep the dose lower today given the low supply of strips and the lower AMPS. Let's see what PMPS looks like after the 1.5u.
     
  48. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Yes, I've experienced all of the things you mentioned and those frustrating failed tests.

    Got my strips, so I can continue testing. He has been staying in the 300s today, with a couple of ups and downs. His +8 (closer to +8 1/2) test was lower than the one before it.

    How low can his pre-test shot be and still be safe to give over 2 units?

    This is tricky stuff with a steep learning curve! I admire all of you with all of your knowledge and experience. What a challenge.
     
  49. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    It definitely looks like 1.5u is too little a dose. You can increase to 2u and see how Clarence does if BG is over about 225 to 250 on the AT2 meter. You tested Clarence a lot today. When his numbers are up in the pink zone, you can hold off testing so much and just grab one or at most 2 mid cycle tests but you don't need to be testing every hour or 2.

    I'd suggest you plan to test Clarence around +2 or +3 (one or the other) and then if he is dropping a lot or quickly, decide when you next need to test based on how low BG is and how fast BG is dropping. If BG is still up, then you can wait to test till a bit later. When BG gets around 100 or close, then you need to intervene and monitor more to ensure Clarence doesn't drop too low. With Vetsulin, you want to aim to keep him 90 or above.
     
  50. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I'm getting his insulin ready and guess I'll give him 2. His shot was a bit later than normal this morning. Weird thing, I fell asleep and my son tested him at +10 1/2 hours and he was 367. I woke up and tested him at +11 hrs (not realizing my son had tested and then fed him). When I tested him, he was 354.
     
  51. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you so much for the advice on the testing increments and a better way to deal with monitoring him. Since it is p.m. where I am, I will test at +2 and see where he is. And I don't want him going below 90 with the Vetsulin. It will be so much better to get all this down and get him regulated. We will all feel better. My poor little dog is feeling neglected lately. And I don't want my Kitty hating me with all this testing. I'm really hoping for a better night tonight.
     
  52. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    +2 is 383
    I don't get it, why did it go up?
     
  53. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    While one wouldn't expect BG to go up it happens sometimes. I see Clarence came down nicely after that higher readings so it was a pretty normal cycle and for now the 2u dose seems to be working reasonably well. Give it a few cycles to see the full effect of 2u, then re-evaluate and if a dose increase is needed, I'd increase by 0.25u to ensure you don't jump over the ideal dose.

    When you get a reading of 114 in the middle of the night, you can give Clarence some food to slow down his drop and if need be, a little higher carb can be used to keep him from dropping too low so you can grab some sleep.
     
  54. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    His AMPS was 190, so I only fed him ff fish and shrimp. Should I still give an injection of 2u?
     
  55. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    P.S. I did give him food after that +5 114 reading, I put it in the remarks section of his ss.
     
    Last edited: Jul 26, 2019
  56. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    That's a tough one. I think I'd reduce to 1u if you can monitor. If you can't I think I'd skip.
     
  57. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I think I can monitor. Should I maybe run a quick test to see where he is -- it is about 15-20 minutes after finished eating right NOW.
     
  58. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Sure test him again and see how much he's come up.
     
  59. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    He was at 248 and I gave 1u right after testing him.
     
  60. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    In the rush of the moment, I get forgetful, so I want to take this opportunity to thank you for the tremendous help you have been. I'm sure it isn't easy for anyone out here to take care of their own cat(s) and household, let alone take the time and have the courage and compassion to help others care for their cat(s) as well as their sanity. Just so you know, I am always appreciative and thankful you are all are here.
     
  61. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    No problem. My pleasure. I know all too well what it's like but I am one of the lucky one's. Thanks to this board, my girl is in remission so the least I can do is pay it forward! :D
    Check Clarence around +3 to see what he's up to. He tends to hit his nadir (lowest point in cycle) later than some on Vetsulin so depending on what he's up to at +3, will dictate when you should test him again. I'll check back in later.
     
  62. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Just did the +3 test: 316

    Since I gave him only 1u of insulin, he might be on the rise. On the other hand, I noticed that his numbers at +5 have been lower than I was expecting last night, like he drops quickly from the Vetsulin. Should I wait and test at +5 or maybe try for a +4 and see if he increases slightly?
     
  63. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I think you can safely wait till +5 and test then to see if he is starting to come down at all. The lower dose may mean a flatter cycle but he's gone up over 100 points since AMPS before food so I expect he should start coming down soon.
     
  64. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Sounds like a good plan. I'll test him at +5 and hope that he comes down instead of going up more or sticking around the same thing. When I gave him the 1.5u dose yesterday morning, he mostly stayed stayed in the 300s all day with only slight fluctuations -- I guess that is what you mean by a flat cycle. But then when I gave him the 2u dose in the evening, he dropped to the 100s. Would you consider that to be normal given the AMPS/PMPS and dose amounts? I'm so new to this, but if 1.5 doesn't do much for him, and 2 puts him down to where I have to monitor so close, why is that and is that usual?
     
  65. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Exactly. The 1u dose will likely be too low BUT with his AMPS being so much lower, better to try it out and see what happens than to dose too high and be chasing numbers. You need to look at where Clarence starts the cycle and how much he drops on a given dose from that pre-shot BG. So yesterday he started off at 367 and dropped down to 114......a drop of over 250 points. Today when he started off at 190 and you definitely don't want him dropping 200 points so the dose needs to be lowered for safety reasons or skipped altogether. Rather than skip, since he was so close to 200/225, I suggested trying 1u to hopefully keep his BG down a bit but not take him too low.

    We don't usually change doses by 0.5u.....we usually only do 0.25u because even a quarter unit can make a big difference for some cats. Some even need finer dosing with skinny or fat doses to keep them in optimal numbers.

    Do you have half unit markings on your syringes? If so then it's easier to eyeball quarter unit dose adjustments consistently. If not, then depending on where you are located, you can either order syringes with half unit markings online or go to Walmart and pick up some U100 syringes with half unit markings for even finer dosing options. If you use the U100 syringes you also would have to use our conversion table to ensure correct dosing.

    I think that pink cycle yesterday may have been some bouncing (elevated BG) from beautiful blue readings of the previous cycles. It's normal and sometimes can take several (up to 6) cycles to clear. He went to blue again last night and was still in blue this morning telling us 2u is likely too much insulin. So I'm guessing right now that the ideal dose for Clarence will be 1.25u to 1.75u. That said, it's still early in the game so only time and data will tell.
     
  66. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    +5 reading is 185
    so, you were right on -- he started going down, that is 131 points lower than his +3 reading and 5 points lower than his AMPS. So should I do a 6 hr to see if he is on his way down or on his way up?
     
  67. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    You can do a +6 and see what he's got up his sleeve. He may still go down a wee bit. Glad to see him in the blues again.:D
     
  68. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thanks, I will do a +6
    And yes, I do have syringes with half unit markings on them. I wasn't happy with the ones I was using from the vet (no half unit marks), so I ordered a couple different brands to try, so now I have a lot of syringes!

    With a 3 hour time difference between you and me, I appreciate your time so much!
     
    MrWorfMen's Mom likes this.
  69. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Oh, one other thing, I usually feed Clarence the chicken and beef feast or the just the beef feast (both of those are supposed to be 5%). This morning I gave him the fish and shrimp (flaked) which is supposed to be 0% because I was hoping his BG wouldn't be affected by his food since it was 190 and I didn't really know what I was gonna do about insulin (time difference and I hadn't seen your post yet). That would probably make a difference in his ideal dose, wouldn't it?
     
  70. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes carbs can effect how much insulin Clarence needs BUT if you are staying below 10%, which you are, the difference between 5% and 0% probably won't make any instantaneous or major difference of consequence. Now that said, it's a good idea to mark your SS with what you fed so you can look back on it in the future. As much as we stress low carb foods, some kitties do better on 5% than on a 0% carb food for whatever reason. It's good to note if certain foods seem to elevate BG a bit or keep BG down. Knowing how carb sensitive your cat is comes in very handy when and if you are ever dealing with low BG that needs a boost. Some kitties need high carbs to get their BG to move while others will spike on food with 8 or 10% carbs. It's really a matter of getting to know your own cat.
     
  71. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    +6 is 169
    so he is actually in the process of lowering.
    Since his lows are happening so late in his cycle right now that it causes his next PS test to be low, how can an ideal dose be achieved (I was looking at his ss and just seeing how his PS numbers have gotten a lot lower than they were when I first started testing him.
     
  72. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Love it! He won't necessarily stay that low by PMPS. There are 2 parts to Vetsulin. We usually see the first part of the Vetsulin's action starting almost immediately and evident and sometime it's lowest as early as +3 while other kitties seem to get better mileage (Clarence) and don't start dropping until about +3 or +4. There is a second little dip with Vetsulin and it usually happens around +7/+8 timeframe but in some cats it's so small it's not noticeable. Looks like Clarence is late enough with his initial drop that the second drop looks like an extension of the first. Vetsulin for some cats doesn't last long enough through the cycle. Clarence seems to be getting good duration and that's a good thing. Once you know what your cat's pattern looks like you simply dose accordingly.
     
    CandyH & Catcat likes this.
  73. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    So in the beginning of our journey, the vet tech told me to feed him twice a day, which I did for the first week. Clarence likes to eat often, and almost always begs for more food. when I asked the vet about feeding him in-between his regular meals, the vet said I could do that. I started doing that (around the time I got the meter) but only would allow him to eat FF Fish and Shrimp in-between meals. That was his regular routine: 1 can of Tender Beef Feast for breakfast and 1 can for dinner. In between he would eat about 1 1/2 cans of the Fish and Shrimp. Around 7/23, I began feeding him 1 can of the Tender Chicken and Beef Feast for breakfast and dinner. And, Because I was going to be testing him on the increase to 3u, I fed him his 'snack' Fish and Shrimp either as soon as he finished breakfast/dinner or otherwise sparingly because I heard from the vet that he shouldn't eat a couple hours before a test. Maybe my food changes have caused some of these swings I'm seeing--specifically not feeding him much thru the day? Also, it has been pretty hot here and he hasn't wanted so many between meal snacks. I don't want to do anything to harm him.
     
  74. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Do you mean I should maybe be altering his dose based on his AMPS and PMPS?
     
  75. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    It used to be routine to tell kitty parents to feed twice daily before shots. That leads to a ravenous cat whose BG doesn't necessarily regulate very well because it's not as easy on their pancreas and also the stress of being hungry all the time can elevate BG. What you are doing currently seems to be working fairly well. Every cat is different so feeding times are something you have to experiment with a bit. The only general rule would be to keep the majority of food if not all in the earlier part of the cycle so as not to lessen the duration of the insulin's action. With Clarence, he doesn't seem to be having any problem with duration now and that may be thanks to your feeding schedule or it may just be Clarence.

    Not exactly. Ideally you would find a dose that works well and allows you to shoot twice daily on a routine basis. In some cats, it's possible to set up sliding scale dosing depending on pre-shot tests. I am not a big fan of sliding scales as a rule but they do work for some cats but only after you have plenty of data.

    You've only got about 15 days worth of data right now and it's only been the last couple of days that Clarence has been getting a good run in the blue range and starting to see lower AMPS/PMPS readings. Right now it's still not clear exactly what dose works best for him but I think we can safely say 3u was too much insulin, 2u might be too much and 1u isn't quite enough. You're narrowing down the best dose right now and numbers are a bit erratic but slowly increasing as needed by 0.25u will help figure him out.

    The dose increases your vet recommended were too much all at once. It's harder to back up the dose than to just increase slowly by a quarter unit at a time and that I think is why BG seems a bit erratic right now. Looks to me like Clarence is settling a bit now so let's see what he does in the next few days. This is a marathon not a sprint so just take each day at a time and remember each reading is just a moment in time. It's the big picture that matters and Clarence's picture is definitely improving!
     
  76. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you for all that info. It helps me to understand more and also not to feel so overwhelmed and SCARED. It feels good to have a better understanding of this. Got it, marathon, not a sprint... Big Picture...
    Thanks!
     
  77. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Clarence's +9 was high at 382. He was begging for food, so I fed him a small snack of fish and shrimp a couple hrs ago, it didn't stop his begging, tho, so maybe that has something to do with the high BG? And he seems hungry and agitated.
    I'm thinking about trying the 1.75u and see what that brings -- dependent upon what his PMPS is. But, he was high last night and 2u seemed a little too much.
     
  78. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Do you suppose it would be better for him and better to try to figure out what an ideal dose would be if I just increase to 1.25 tonight and go the route of increasing in .25 increments rather than a jump from the 1u he got this morning to 1.75u? Sort of ease him up in hopes of keeping him from any type of rebound type of activity?
     
  79. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Yikes, PMPS 524 ?!!
    Help, what to do?
     
  80. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I'd give him 1.75u tonight. He's bouncing from the long run of lower numbers earlier. It's normal.....frustrating but normal.
     
  81. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Ok, 1.75 it is! thanks for the quick response. Whew! that made me panic. then I noticed that he had some fairly high 400s, and didn't feel so icky! I think it was the black on the spreadsheet that did it! He just finished eating, so Ill give the shot in about 20 minutes.
     
    MrWorfMen's Mom likes this.
  82. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Clarence's numbers are still high. I am going to go to bed and set an alarm to check in on him, maybe do another test in a few hours, but he has only dropped 86 points in the last two hours. If I test I will record on his sheet. Question: should I still give him 1.75 in the morning, or increase to 2 assuming he is still very high on his AMPS?
     
  83. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    I would hold the 1.75u dose for a few cycles provided his pre-shots remain high enough to give insulin. I expect his readings will come down as he clears the bounce from those blues. You can always increase the dose if need be but you don't want to be fighting low readings when the bounce breaks.
     
  84. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you. That's what I was thinking and what I was hoping would be the suggestion. Clever: 'when the bounce breaks'... reminds me of that nursery rhyme! I did a test in the wee hours at +9 and he was at 305. His AMPS was 370. I gave 1.75 and will do a test probably at +3 and go from there.
     
    MrWorfMen's Mom likes this.
  85. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    His +3 was 354 and his +6 was 134. I gave him a small snack in hopes of keeping from going a lot lower -- I hope that was the right thing to do. I will test again shortly...
     
  86. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Looks like Clarence is getting back to business.....YEAH! Loving that blue again! It's fine to give him a snack if he's hungry but his BG is fine and doesn't need any help at this point. :)
     
  87. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Even with the food, I just tested him again and it was 124, so still coming down. Should I test in another hour or wait -- I'm unsure at this point.
     
  88. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    No give the little guy and you a break. You just fed him so check him at +9 at which time I think he'll be heading up again so you can wait till shot time to test again. It could be the second hit of Vetsulin kicking in right now.
     
  89. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Thank you. :) Ok, yes we could both use a break. I hope he goes up enough by his next pre-shot time. Which, I do have a question about -- it is a silly question, but here goes: Clarence normally takes about 15 - 30 minutes to eat his food and then with the 20 minute wait for giving his shot, it is almost an hour after his pre-shot test. So basically what I'm saying is that his pre-shot test is actually the +11 test so his shot can be 12 hours apart. I'm not supposed to be putting that number in both locations on the sheet am I?

    By the way, I got the ReliOn Prime and have been using it at the same time with the AT2, just to get to know it a little. I guess I will have to convert the spreadsheet when I start using the ReliOn regularly. Do you know if there are instructions somewhere for what to do when I change meters?
     
  90. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Just want to clarify........are the readings on your spreadsheet right now all AT2 numbers? If not, that is going to muddy the picture a bit. Both meters are fine but the human meter will read lower so mixing the numbers will skew the picture of what Clarence's BG is doing.

    As for the spreadsheet, you need to add a row to the sheet to indicate you have changed to the human meter. The last colour coding conditional formatting will need to be fixed to show the right ranges. We can get someone to help you with that when you decided to make the change.
     
  91. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Yes they are all AT2 numbers. I should have stated that to eliminate any confusion, sorry.
     
  92. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    I notice that when his BG is higher, the difference between the two is larger. Is that normal?
     
  93. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Absolutely normal and what we expect. Either meter is fine but pet meters are expensive to use. The bonus is that the readings do look better with the human meter. :woot:
     
  94. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Haha! When I'm ready to switch (which will depend on when Clarence's readings stop fluctuating so much, I guess), where do I post for help in converting it over? I used to be expertly proficient in excel spreadsheets, so I'm pretty certain I won't have a lot of trouble with it, but I haven't used google sheets before this.
     
  95. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Just post in your thread or tag me. I think I can fix it for you and if I can't, I know someone who can.
     
  96. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Ok, will do. Thank you so much!

    Can you advise what is a safe number for me to give Clarence the 1.75 just in case he doesn't go back up high when do the PMPS?
     
  97. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    Ok, his +9 was 198. :)
    I will be doing his PMPS in two hours.
     
  98. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    It's hard to be specific due to the bouncing he's coming out of but I think for now, I'd stick with a PMPS of 225 or even 250 on the AT2. I'll be checking back in around 9pm my time so let's see where he's at.
     
  99. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    OK, thank you. You've been so helpful--with the time difference you're probably low on sleep, too. Marathon...
     
  100. Dee Dee C

    Dee Dee C Member

    Joined:
    Jun 16, 2019
    PMPS: 310
     

Share This Page