Kizzy in the House =)

Hi all =)

While this is my first post, I have been reading in your WONDERFUL forum for weeks and weeks.

I'm a little stuck and wondering if anyone has some insight.

Cat name: Kizzy

Female, ~10.5 years old, Burmese, weighs about 11-12 pounds (has lost some since diagnosis).

Kizzy has a sister cat, Bailey, who is about to turn 11 (female domestic short hair, NOT diabetic).

Original diagnosis - early August 2015 (about 3 months ago).

Took Kizzy to vet, suspected maybe a mild UTI... got the, "Surprise! Your cat is diabetic!" phone call the next morning with a BGP of 346 (note: Vet uses an AlphaTrak meter)

Immediately switched Kizzy to FF Classic Chicken canned food (one can, twice a day). Both cats have always been free-feeding dry food eaters (Iams... gee, I thought I was feeding them good food).

There IS some dry left in the house, but it's that Nature's Instinct Chicken Grain-Free Formula stuff. Kizzy would gladly go 100% canned food only, but the other cat - no wayyyyyy. The other cat will eat SOME of the canned, but has to have her crunchies. I figured the Nature's Instinct was somewhat of a 'happy medium' while we get a grip on all this around here.

Vet started Kizzy on 1 unit, twice a day mid-August.

We are using a Lantus SoloStar pen (WITH the pen needles).

About a week into beginning insulin, and after reading in here, I decided to be proactive and went and bought a LifeStyle Meter and set out to learn how to do a curve.

What a DISASTER! To anyone new to this diagnosis... please be nice to yourself as you attempt to learn ALL there is to learn. It takes practice...and patience...and a sense of humor.

Finally got the testing procedure down (I was testing EVERYONE... the other cat, myself, the hubby...if you came near me, I tested you...lol!)

Did my first curve feeling all proud of myself. Called my vet to share the numbers....

And he refused it because I didn't use an AlphaTrak meter. yippeee.

Ordered an AlphaTrak and did another curve on September 22, 2015 (about 6 weeks into the 1 unit/twice a day).

What in the WORLD makes an AlphaTrak read SO high? Wow! Scares me to death!

I did the first curve and used both meters - mainly because I was curious as to why I HAD to have an AlphaTrak.

The numbers are so different - take a look:

First Curve 9/22/15:

ALPHATRAK
AMPS = 464
+2 = 435
+4 = 414
+6 = 431
+8 = 475
+10 = 502
+12 = 507 (PMPS)

FREESTYLE
AMPS = 300
+2 = 270
+4 = 238
+6 = 302
+10 = 335
+12 = 317 (PMPS)

There I was, using the LifeStyle meter, thinking we were getting somewhere... then my vet has me use the AlphaTrak and she's WORSE than her initial diagnosis?!?!

AND, her diet had been changed and regulated. What the fur balls is going on?


So, that vet read the first curve numbers (and charged me $30) and called me telling me to now go to 2 units twice a day.

So for 6 weeks now, Kizzy has been on 2 units/2 times a day. Feeding and shooting is pretty consistent time-wise. She has missed 2 shots in that time frame, but didn't miss feedings. (real life got in the way...sick grandkids, etc...gets too late to shoot so I skipped those 2 shots).

Today, I did another curve (with fingers crossed HOPING we're getting SOMEWHERE with Kizzy's sugar levels).

Again, being the obsessive person I am, I used both meters (note: I always tested with the AlphaTrak first. Both tests from same blood drop).

TODAY'S CURVE:

ALPHATRAK
AMPS = 459
+2 = 457
+4 = 424
+6 = 432
+8 = 422
+10 = 406

FREESTYLE
AMPS = 334
+2 = 154
+4 = 273
+6 = 281
+8 = 289
+10 = 241

(note: I am about to do Kizzy's PMPS in about an hour)

I don't feel like we're getting anywhere =(

How in the world can her diet be changed (carbs DRAMATICALLY reduced), have weeks of insulin in her, and the AlphaTrak numbers almost make me feel as if she's getting WORSE!?

After alllllllllll the reading I've done in this forum (y'all are SO awesome!), it seems as if more insulin in not always the answer - is that correct?

Meaning, you don't just keep upping it and upping it - there's another way?

I don't know how our day-to-day life would do with tight regulation - and vet claims to be a 'start low, go slow' kind of guy...

Point of this novel I've just typed - What am I doing wrong?

Kizzy acts fine. There is no way I ever, EVER would have known she was diabetic if it wasn't for that random vet visit. And even through all of this, she has acted no different (except she IS a bit more demanding come meal time).

Does anyone have any insight? I'd be so grateful....

I just feel like we've take a LOT of steps backwards and have made no improvement at all.

Thanks so very much!!!

Kizzy's Mom

PS - I'm working on getting my SS together. Will add when there's more to look at.

 

Hi @KizzysMom and welcome.

I'm going to try to give you a little wisdom on meters, although I don't use an AT (AlphaTrak) myself.

Human meters read differently than a pet meter like the AT because they are designed for humans. Please don't let anyone tell you that it's anything like Fahrenheit to Celsius in a thermometer because it isn't anything like that. You cannot translate one to the other consistently.

For your purposes, you need to be aware that 68 on an AT is roughly equivalent to 50 on most human meters. But even human meters can vary - trust me I have three human meters and they all read differently. My own OCD struggles with this, but I have learned to live with it. There can be up to +/- 20% variance allowable in how they report a BG number. But you cannot make any precise correlation between the two meters as you go up or down the scale.

My advice: Don't get caught up in the specific numbers. IT'S A TRAP! Kidding. But I do mean it about the numbers themselves. A high reading is high -- be aware of the possibility of ketones. Low is low - be on guard for a hypo event. Specifically 50 on a human meter and 68 on your AT. If Kizzy is getting close to those numbers, it's time to act.

I know we all crave precision but nothing about this sugar dance is an exact science.

Make sure when you create your spreadsheet, note if you are using the AT or the human meter for your readings. Also put it in your signature. This will help folks if you ever need to post for dosing help or (God forbid) a hypo event.

ETA: I'm no veteran but my last (albeit unasked for) piece of wisdom is that while the SS is an incredibly valuable tool, it's made up of numbers that can only be a guide. Use that guide in conjunction with your senses in observing Kizzy. Is she peeing a lot? More? Less? Drinking? Is she playful? Lethargic? This is the WCR (Whole Cat Report) because we all know they are much more than just a number.

 

The reference numbers for an AlphaTrak are in the range the vet expects to see according to his background.
On a human meter, we'd expect to see 40-120 in non-diabetic cats and aim for 50-130 mg/dL when working to control diabetic cats' glucose.

Also, the FDA stipulates all meters must read within +/- 20% at the lower end of the scale, so any of the numbers you have could be higher or lower by 20%. This is supposed to be good enough for home monitoring, although there is a proposal to restrict this variation amount in the future.

Just starting out, you aren't going to have perfect control - its a process, not an event, unfortunately. Around here, to be safe, we increase 0.25 to 0.5 units at a time. We've seen that if you increase by too much, the numbers will get worse, not better.

We have 2 sets of guidelines for using Lantus. You'll want to review them and select one to follow for managing the diabetes.
Tight Regulation
Start Low, Go Slow

 

@Brashworks and @BJM

First off, THANK YOU for not only your super speedy replies, but for your smart and encouraging words.

"It's a process, not an event" - will write that down and put in on the refrigerator.

Two follow up questions, if you don't mind.

1 - Can I just use my (affordable) human meter for my own day to day needs and save the AlphaTrak for when the vet wants curve numbers?

2 - RE: "..We've seen that if you increase by too much, the numbers will get worse, not better."

I'd like to take Kizzy back to 1 unit/twice a day, and then make changes based on my own regulation and testing in the .25 or .50 increments (as opposed to the vet's choice to jump from 1 unit to 2 units) Any thoughts on that? If Kizzy were your cat, what would you do?

Again, thank you so very much!

Kizzy's Mom
a.k.a. Jennifer

 

Sorry I never answered this, not directly. You're not doing anything wrong.

You're here and you're trying to do the best for Kizzy. This is a marathon, not a race (or as BJM put it so well, a process, not an event). You ARE making progress!

 

Hi Jennifer, I'm Melanie and you're welcome!

First - yes, by all means you can use the human meter for day to day.
Second - yes, sometimes too much insulin can look like too little.

If Kizzy were mine, I would gather some data (with your OCD I'm sure that's no problem - and I had to laugh at you testing everything in sight LOL) and then post in the Lantus section of the forum. There are some extraordinarily experienced and helpful folks who know Lantus very well. Get some curves, or particularly pre-shot numbers and sprinkle in some more readings. Try not to always take readings at exactly the same time - it's nice to get a few here or there to get a picture of how Kizzy is responding. It will certainly help if you post for dosing or other help. I'm sorry but I cannot give any dosing advice with a ton of confidence - it doesn't look to me like 2u is too much but you probably wouldn't go wrong holding 1 unit, gathering data and posting for dose advice once your SS is set up.


Lastly, as long as Kizzy has access to dry food (trust me, I know the challenges as I have a "crunch junky" civie cat, too) I'm pretty sure you will need to use SLGS protocol. It's less aggressive than Tight Regulation but lots of folks have found it very successful.

 

Oh, and darn it I keep forgetting to say - I noticed you are using the Pen Needles. I'd suggest getting some syringes to be able to fine tune the dose for Kizzy. The pen needles can only make 1u adjustments. I personally use 3/10 mL 8mm needle syringes with half unit markings. These will help you make the .25unit changes more easily.

 

@Brashworks - Melanie, thank you...and very nice to meet you

I had a sneaky feeling that Kizzy having ANY access to ANY dry food was probably the problem. I just don't know how in the world I will be able to get the other civie cat on can-only. She's not a fan - and it tends to come back up a lot.

I imagine I could mix dry in with her canned food feedings and do my best to not leave any sitting out for the sugar kitty to find. I've started adding water to canned food and freezing it in small chunks to put out for Kizzy (I have a timed feeder) in hopes that she will snack on that. She prefers canned so keeping fingers crossed that the kitty popsicles help.

And yep, I'm gonna need some syringes. They just make me so squeamish...it's weird. BUT, I've learned to test her...and I've learned the pen shots, so I can do that, too. Love sure can get you out of your comfort zones, can't it?

Thank you for the syringe numbers. Quick question.... do they make syringes with shorter needles? I really think I'd do better with that. The pen gives me a bit of security that I won't shoot thru...or shoot her and hurt her.

Just did her +12/ PMPS test. Oddly, with the AlphaTrak, the +10 and the +12/PMPS were her lowest numbers of the day. I thought that nadir was supposed to be around +6?

So now, me and my OCD self are gonna work the SS and head to the Lantus forum.

Thank you SO much!

 

Hey Jennifer - I feel your frustration on the food front. Do what you can and what is manageable in your situation. It's hard sometimes to balance out everyone's needs so don't be too hard on yourself.

To answer your question - I believe BD does make a 3/10 mL syringe with half unit markings and with a 6mm syringe. I pull up a big tent and in 5 months I've never shot through or hit anything but skin on Genghis. You will do fine!!

Ahhh moveable nadirs. They happen! Like they say around here ECID or every cat is different. I've also heard that with Lantus there can be a second dip toward the end of the cycle. This could be what is happening.

If there is one thing I am sure of in this whole crazy thing it's that you can't be sure of anything. The meter is like a tiny roulette wheel or a lot machine. Cha- Ching you never know! I have been surprised many times by readings, just when I thought I was getting the hang of it. This does not suit my personality at all, but I'm learning to roll with it.

Good luck and I know you will get some excellent help over in Lantus.

 

ECID... yes, every cat is different...and different minute to minute =)

Now that Kizzy and I are a couple months into this, we're both calming down. Even my family and friends are used to hearing, "Sorry, gotta go home and shoot the cat" lol!

In the beginning of her dx, I was so scared of a) hurting her and b) a hypo episode that REALLY hurts her. And naturally, I was all, "I am SO getting her OTJ!"

We're much calmer now. While OTJ would be awesome, my overall and main concern is Kizzy's quality of life. That little stray soul was entrusted to me when she was maybe 4 weeks old (found out in the street), and I'm going to do, and doing, the best I can for her to continue to have a great life.

Bless her heart, she was an ugly kitten. She was all head, eyes, and ears - looked like a bat if you held her upside down...lol! But she is the sweetest thing - even my hubby, who was never a "cat guy", adores her. She's like a puppy cat. We had no idea she was a breed, either. Come to find out, Burmese are more likely to be diabetic than other breeds of cats.

We've had both our cats for the same amount of time (they adopted us within months of each other). Lived in the same house, at the same food, same EVERYTHING... yet one is diabetic, the other is not. Weird.

Anyway, I'm rambling...

Thank you for the alternative syringe numbers and for all your help! It's very generous of you to give up your time!

 

Hi Jennifer and welcome! Melanie has given you a lot of great info!

I just wanted to chime in and mention that while you may feel more comfortable with the 6mm needles, I have tried them and personally wouldn't recommend them. I found them too short and have seen several others here make the same comment. Our kitties have a thick hide and no matter how co-operative a patient your little one is (mine usually sleeps through her shots), they don't always stay as still as a human patient would. The tiny bit of extra needle length the 8mm provides (and it really isn't that much longer) makes it less likely to end up with insulin in the fur instead of in kitty where it belongs. It's entirely up to you if you want to try them, but many veterinary papers on feline diabetes recommend at least a 1/2 inch needle and the 8mm are already a little shorter than that.

 

Good to know, @MrWorfMen's Mom , thank you!!! Certainly don't want the insulin in her fur. Being a very dark brown/black cat makes it hard enough as it is =)

Hey, quick question since I see you are familiar with AlphaTrak - the 'Start Low, Go Slow" method makes reference to readings in Step 3 to base when you increase/reduce dosage. Do you happen to know if those numbers are based off a human maeter or an alphatrak?

 

I just read some interesting info about using control solution whenever you open a new pack of strips. Can't remember the thread, but it was a recent one. Until I had some wonky numbers on a new pack, I hadn't even heard of testing solution. I have some ordered now. Have you used it on either meters, just to be sure everything is working properly? Just a thought.

 

I'd pop over to the Lantus forum, read over the sticky posts, pick one of the protocols to follow, and start posting there to get specific feedback on Lantus on a regular basis by Lantus users with experience and/or ideas on how to improve the glucose control.
There is a specific formula for determining the starting Lantus dose in those sticky notes, but that may need to be adjusted based on the numbers you are getting.

 

All the numbers used in the protocols here are based on human meter readings. The only specific AT numbers used in the documentation here are low reading alerts to keep our cats safe and avoid hypo events. There are folks here familiar with the AT meter and they can guide you regarding dose adjustments using the AT meter if you did decide to use it on a daily basis. The important thing is to pick one meter and base your dosing on that meter. Both pet and human meters work just fine because dose increases and decreases are based on lowest cycle readings and the patterns that show up on the spreadsheet as you get more and more readings. Whether you use the human meter or the pet meter, the patterns are basically the same even though individual number comparisons don't seem to indicate that would be the case.

 

We may not have a formula at present, but I believe it is exactly like Celsius vs Fahrenheit.
There are reference numbers for use with human meters.
There are reference numbers for use with pet meters.
And I believe there is a way to develop a function to represent that. I'm just waiting on a friend to repay a short term loan so I can get some supplies to collect and run some analyses.

 

My vet let me use any meter, but I switched to the Alpha Trak because I got a couple of low numbers that I thought meant super low blood sugar. It turned out that my Relion meter read 46 and the Alpha Track read 112 when I tested it at the vets on the same drop of blood. Peanuts numbers took a big jump on his spreadsheet when I changed. Very discouraging. It is definitely harder to follow the info on here when using the Alpha Trak numbers. I started using 100 as my no shoot number instead of 50 when his numbers started dropping.

I also noticed food had a big impact on his numbers. If he got into the dog food or any food off schedule (12 hours) it really increased his numbers. When his numbers starting dropping they dropped suddenly, so watch for that.

 

Beautifully said!!! All of it.

 

Love this! I have a new expression which will make my husband happy as I curse like a sailor.

 

Wow, y'all are so awesome! Thank you for all this info!

The two meters thing has been making me a little nuts. It's so weird because the AT2 and my human meter (FreeStyle Lite) look exactly the same. The testing strips are exactly the same (but to note: I have never interchanged them). The only difference is that the AT2 has the solution to calibrate for felines (which I did do).

As a new Sugar Mommy, the AT2 scares me to death... all that RED on her spreadsheet terrifies me.

But I realized something as I was falling asleep last night - The Mommy is me is looking and reacting to Kizzy's glucose numbers with the same mentality of taking my child's temperature when they were sick.

All I see are the numbers going up and staying in the red zone, and I panic which brings out the Mommy reaction of, "The meds aren't working gotta go to the ER!!"

Kizzy's readings are NOT like a child's temperature. (saying that again to MYSELF so I can clear my head and analyze her numbers with new eyes)

The test readings I do on Kizzy are to show me trends of how she reacts to x,y,z to enable me to make the best decisions for her.

The most important thing is for me to watch are the LOWS so I've decided to use my human meter for day to day testing.

I'd much rather treat a hypo that really isn't happening than miss a hypo due to the crazy high numbers on the AT2.

I also believe the human meter readings will allow me to see the trends I'm looking for based on the color-coding on that spreadsheet. It's hard to see any changes when it's all red...haha!

I did a full curve yesterday with both the AT2 and my human meter (same drop of blood, always tested with AT2 first). The difference in the numbers is scary. But my vet insists on any curves he will read being done with AT2 - so I'll do curves with an AT2 for him as needed.

As for dry food... yes, I agree. ANY access to any dry food will mess things up.

If Kizzy is satisfied, she won't touch dry food. Last night, I left out a Kitty Popsicle for her (frozen canned with water added). This morning it was gone... very, very little of the other cats dry food was missing...and Kizzy's AMPS reading was 250. That tells me she didn't eat dry food during the night (or very very little) and it's a piece of data to store in my notes.

I'm going the SLGS method. I have to be gone for 2 days this weekend. She has a caregiver coming in while I'm gone so I know she'll be fed appropriately, but shots/testing...well, we'll see how that goes. I have the sweetest friends in the world, but giving shots and getting blood from each other's pets is tricky so my hopes are not high.

Y'all are so wonderful... THANK YOU for popping in and helping me figure out what in the fur balls is going on

Kizzy's Mom

 

Wow, that would be really something! Keep us posted on your progress, as I'd be interested to see it. I think with seeing more and more AT meter users, a reference would be helpful to keep more kitties safer. Will you be creating the formula vis-a-vis human meters (and which ones) or establishing reference numbers with the AT on its own? I don't envy you the inherent challenges of doing all that.

Until then, I believe all meter users are faced with the same dilemma, i.e. +/- 20% variance allowed in reported readings. I've accepted that my human meter has a margin for error and that it is ultimately my responsibility, combining the reading with my powers of observations of my cat, to determine what I should do. Whether it's a no-shoot number, a dose change number, a hypo-vigilance number, I can't just rely on the meter to tell me what to do. It's a guide, and can only be such. Just like I can't 100% rely on a thermometer to tell me if I need to put a sweater on. Is 70F the cutoff? Not for me, but it is for some people. My Dad, a physician and 20 year Type II diabetic, feels better at 8.0 mmol/L. It's outside the normal range for a human, but I can't tell him how he should feel. ECID - I've been reading enough posts to see cats dip into the 30s with a human meter and been fine; others, not so much. Is the difference the cat? The test? The meter? The day? The alignment of the constellations? Heaven knows - we can only do what we can with the tools we have. I really, really wanted absolutes where my cat's health is concerned, mostly because she can't quite tell me how she is doing. Oh if they could speak! But they can't, at least not in words, so I have to use the guide that I have and keep an eye on HER. It is my opinion and experience that the meter readings are roughly equivalent to a quick glance at a thermometer from a distance -- I can see when it's "cold" and I'd better wear a coat, or perhaps it's "cool" and I should bring a sweater, and I can see when it's "hot" and I should break out the shorts. But if I really want to "know" I should use my sense and just step outside.

@KizzysMom - I know that feeling of feeling discouraged with the colours, but don't get too caught up in that. And don't fall into the trap of thinking the Freestyle meter is "better" just because it gives you numbers you like more! Remember -- Kizzy's BG is an actual, real number -- there is a gold standard. The tools you currently have can give you an idea of where Kizzy is at but better that you not be discouraged by what a little machine tells you. Low is low. High is high. You WILL make progress and you WILL be able to tell how she is doing and you're less "blind" about how much no matter which meter you choose to use. You're already ahead of the game.

 

We are really lucky to have you on this forum @BJM !

 

Well said, @Brashworks !!! I so want absolutes as well. "If this, then do that - if that, then do this" kind of clarity, but as you said, it's not that way...and our little fur babies can't speak and tell us.

I like the thermometer analogy. While 70 degrees on a thermometer can mean different clothing for different people, for me, if it was 68 3 days ago and 72 2 days ago, and then 69 yesterday, I can look back on my own 'trend' to know that when it was 72, I took a sweater so when it's now 70, that would be good idea for today as well.

Apparently, that's 'all' our spreadsheets are... historical data to help make future decisions.

 

I like how your brain works, Jennifer! Now is that "birds of a feather" or "misery loves company" ?? LOL.

 

Miserable birds of a feather?

 

LOL you are too funny.

I was waiting for "Great minds think alike". Or wait, is that "Fools seldom differ"? I always get those mixed up.

 

hahahahhaha!!