? It appears Sadie is going into remission. Thoughts or suggestions?

Hello wonderful members of this group!

I would like to sincerely thank everyone for their time, advice and expertise. My cat Sadie, who was diagnosed on 10/30/19 is living her best life due to all the help I’ve received from this group. I started reading and corresponding when Sadie was hospitalized and by the time she was discharged I had a plan- the lan would’ve been extremely different had I listened to my vet exclusively. I learned the importance of testing before insulin which makes plenty of sense to me.
Now over the last few days we have been seeing Sadie’s numbers in the 100’s and below and it appears she is going into remission.
I had 2 conversations with my vet- on Friday and again this afternoon. I told her that I reduced Sadie’s insulin to 0.5 u and also no insulin at all based on her lower numbers. She advised me to not bolus any insulin under 80. Seems like a good idea. But I wanted to post Sadie’s spreadsheet over here to get any advice because this group really comes up with excellent suggestions and I always get so much out of the advice.

here is her spreadsheet - hopefully it’s visible
Thanks so much!
Sharon Drozdowski



https://docs.google.com/spreadsheets/d/1nc5iXtJHITBr2Mgt8txhzvx_cK0KLGnWQvfiY55G6AM

 

Hi Sharon!

Great numbers! Looks like Sadie is doing wonderful! I do know that to be considered in remission Sadie would have to go 14 days without insulin and have good numbers. I am pretty new here so I will let someone more experienced jump in and give you some advice.

 

I disagree with your vet. Your AMPS values are not remission numbers -- yet. I'd like to make a suggestion. How about lowering the dose to 0.25u and shooting twice a day? It looks like Sadie's pancreas still needs some support. We typically very gradually lower the dose so the pancreas has support as it continues to heal. It would also help if you could definitely get some PM cycle numbers -- all we're seeing so far is a 192 (again, not a remission number). How about getting a test before you go to bed every night.

 

Excellent suggestion! This is why I posted. I never would’ve thought about lowering the morning to 0.25 u. I agree she’s not in remission bc I’m still
Bolusing insulin in the am and pancreas cannot compensate without any insulin. But like you said if I do 1/2 the dose to 0.25 u in the am then probably in the pm she might be a little higher and I could bolus another 0.25 u and I won’t see those high numbers in the am. I’m having a tough time getting blood- so the 3 x I got today is a lot. I definitely do glucose testing 2 x a day- today I snuck in that 3rd but maybe tomorrow night I can do a late night check like you suggested. Thanks and I will plan on a 0.25 u dose in the morning as long as her blood sugar is similar to the previous mornings

 

The Lantus is actually the basal insulin. A fast-acting insulin, like R, would be considered a bolus insulin. I agree with Sienne that shooting 0.25u twice a day is a better option. Another possibility, if that does not allow you to shoot twice a day, is to feed a higher low carb food.

One further point I’d like to make is the BGs you’ve been skipping at night are shootable. Next time you get a green preshot, if you will stall the shot without feeding, and post, we have options to help you.

Can you please add the SS link to your signature block? The SS link should end in pubhtml. If you need help with this, please PM me.

 

Thanks. I don’t know what the ss link is. This message board is all new to me so I’m
Kind of navigating in the dark a little as I’m trying to understand it all. The more I’m on it the more I’m becoming familiar with it all but i still logon through a link I saved on my messenger and then I click on lantus section Etc. I will look at my original message to see if there’s somewhere that says ss link. Thanks
And I did do the 0.25 u this morning. Her number was 104 this morning even after no insulin last night. I’m always worried that I might drop her too low so I’m always a little over cautious. Her numbers went from 192 in the morning Saturday am with no insulin the night before (too high, I know), to 156 yesterday morning with no insulin the night before to 104 this morning with no insulin last night. I had previously been giving her 2 insulin injections- 1x before each meal but then with the lower numbers I was a little worried.
Thanks so much for your input

 

Given that is the lowest pre-shot you have shot, I'd be sure to grab some mid cycle tests today. Not sure how long ago you shot, but getting a test in early (+2 or +3 post shot at latest) will help you see how this cycle might play out and then you can decide what other testing might be needed. Also, do you feed Sadie only twice daily or do you feed some snacks too? Providing a small snack or 2 in especially in the first half of the cycle can help to keep kitty's BG more stable.

 

Thanks so much for your email. it is very difficult to get a blood sugar when I don’t have a second set of hands. However after your message I thought maybe it was a sign and should check it. She was partially asleep so it was a little easier and I got it. Blood sugar was 62!! On a human meter- so compared to the alpha trak- which I’m having a very difficult time getting readings on since changing the strips to pet sure strips- they’re usually 10 points higher so cat meter would likely be 72. So I gave Sadie a little turkey- 0 g. Do I feed her a 2 g carb fancy feast meal - liver and beef? This blood sugar test was after 4 hours of the 0.25 u injection. So last night 0 insulin. Today in the am 0.25 u only and she’s that low. I’m thinking of skipping the night insulin. Makes sense right? And the peak of Lantus (I get it’s a basal/ background insulin) is 4 or 6 hours? Ugg- do I attempt another blood sugar in 2 more hours

 

Great job getting that test! Sadie is still quite safe and with that snack she should surf for bit. Since you don't have a enough data yet to see where Sadie's nadir (lowest point in cycle) usually occurs, I'd test her again in an hour just to be sure her BG is not still dropping. With any dose change, it's always a good idea to do a little more testing to see how kitty is reacting. You do not want Sadie to drop below 50 so the goal now is to keep her surfing in the range she is in.


Can I ask you to bring the spreadsheet up to date and keep it that way so we can more easily help you as needed. We rely on the spreadsheet to deal with any questions regarding BG levels or dosing.

ETA Peak time for Lantus would generally be anytime from +4 to +7 but every cat is different and the nadir can change and sometimes occur earlier or later than expected.

 

One other thing, if you are now switching over to a human meter, that needs to be indicated on the SS and the spreadsheet needs to be fixed to show the proper colours for readings.

 

Thanks. Total wrench in my plan..,, I did another stick as you suggested. The freestyle human glucometer read 105 so it appeared her number rose 30 points a couple hours later. But I managed to get a nice large blood drop so I tried agsin on the alpha trak with the petvsure strips and it registered and the reading was 160!!! Normally through all of my double testing on both meters there was typically a 10 point difference so this number really threw me for a loop and ruined my hopes of a pending remission. I never had such a discrepancy in numbers - a 55 point gap between meters. It’s very frustrating and it’s a little bit of a set back. I boluses an entire 1 u with food and I’ll check after 4 hours post injection. It’s frustrating bc often times I can’t get that much blood so I prefer to use the freestyle human glucometer but if the numbers could be that far off I really need to keep using the alpha trak.
I’m going to try hard to stay on the alpha trak so I could get the most accurate numbers for her. Thanks

 

This is your SS link: https://docs.google.com/spreadsheets/d/1nc5iXtJHITBr2Mgt8txhzvx_cK0KLGnWQvfiY55G6AM

However, it should end in pubhtml.

Here are instructions; starting with #5, it tells you how to do it.

 

Sharon, there is no way to convert the pet meter readings to human or vice versa and using both meters and expecting the difference to be the same on each test is an effort in futility. At low numbers the readings will be closer but the higher BG gets the bigger the difference will be. There is also a 15 to 20% meter variance allowance on all human meters and I presume it may be the same on the AT2 which further serves to change the differences seen. The Pet Sure strips have been getting mixed reviews from folks here and I think most fall on the side of negative. The only way to use the AT2 meter properly is with the correct AT2 branded strips using the correct code for the vial of strips you are using.

The interesting part of all this is that human meters have been used on pets for far longer than pet meters because pet meters are a relatively new product and while some vets tend to use them, there are still a lot of vets who use human meters. Most research on feline diabetes has been done using human meters and I doubt that will change going forward given how expensive the pet meters are to use. The normal range of BG using a human meter is well established and the human meter is a totally safe and less expensive way to keep Sadie safe and get her into better BG range.

The choice is ultimately up to you but as one who initially was a diehard pet meter user, I can tell you that my human meter has served me just as well and got me to the ultimate goal of remission with my girl. I really suggest you pick one meter and stick to it for consistency. Otherwise you are going to confuse yourself and us which could lead to wrong advice being offered unintentionally due to meter readings being misinterpreted or attributed to the wrong meter.