Leoberry (aka Leo)

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JeffJ

JeffJ

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I've posted about Leo before. This will be his new thread for awhile. Current summary:

"old" History:
  • Leo is 10 years old, and he was the cutest black tabby kitty ever - a true heart melter
  • Inside-only kitty
  • Leo is a high-dose kitty
  • Insulin started August 2015 , after he dropped to skin and bones weight (and he had acid ketosis)
  • Insulin was low dose (3 units/day) initially, with 150-200 nadirs
  • Started on 1.0 Lantus/day then over 8 months ramped to 9 units twice daily - without low nadirs.
  • Kept him at 18 units/Lantus for too long - his nadirs ramped to 250/300
  • Our vet has never had a high-dose kitty, but she is a very experienced vet
  • Never a single hypo incident
  • Low carb, wet food only
New History:
  • PZI started 7/7/2016 - at 1.0 unit/twice daily
  • Nadirs >400 until 8 units/day
  • Ramped 1/2 to 1.0 unit additional over 20 days
  • 22 units/day current PZI
  • Preshots are 500-540
  • Nadirs now 320-380
  • Neuropathy in hind legs getting worse
  • 7/15/2015 started - 3mg B12 cobalamine daily, and weekly B12 shots
I didn't test him for high dosage conditions yet. He has no external signs of Acro. But even if I test him, the treatments are effectively very expensive (ie. radiation for Acro). The alternative is high dosages of insulin. I'll type his numbers over the weekend.

My sweet kitty now lives in the kitchen always waiting for more food. And still using the litter box with substantial urine. I've read a lot of similar posts. I've read the high dosage literature (acro, IAA, Cushings). It's hard to remember that Leo used to just be a regular fun loving kitty. His brother Duma (aka Scoobs) recently died - thread here. Leo misses Scoobs too.

JeffJ
 

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Hi Jeff! You're totally right to start a new thread...I'm REAL bad about hijacking others!

I don't have experience with high dose conditions other than just reading about them some. Honestly, it sounds like you're doing everything right. So, to clarify, preshots went UP after you moved beyond 8 units? His numbers for the last bit will help. Have you ever run a curve?

It's possible Sue will have more suggestions. I need to do a bit of research on high dose conditions before I can make any suggestions.

I'm sorry to hear about Scoobs. The cats are our kids here in this forum!
 
Hey there and sorry about your kitty. There are several people over in the Lantus and Levemir forum with cats with IAA. Maybe post there for help.
 
I am sad to read about sweet Leo, Jeff and losing Scoobs. It does sound like Leo is a high dose kitty. @Sharon14 has a high dose kitty on Levemir and may have some ideas for you, and know some others who may have suggestions. It sounds like you started him on a low enough dose and raised the dose slowly and carefully. Other than continuing to up the dose, I don't have any ideas, never having dealt with this myself. Many people with kitties who have high dose conditions use Levemir as it is thought to sting less at the higher doses.
 
Hi Jeff. Leo is indeed a very handsome fellow.

I'm the proud Mom of a high dose girl with IAA.

Unfortunately cats with acromegaly usually don't have any physical symptoms until later on as the disease progresses. Yes the condition is very expensive to treat but because there can be other medical problems as a result of acromegaly, it could be helpful to know if he has the condition so symptoms of other associated problems can be identified and treated promptly and appropriately. The only caveat is that unfortunately a negative test is not necessarily conclusive because aromegaly is a pulsative condition with the blood factor being measured going up and down.

IAA often goes hand in hand with acromegaly but can also occur on its own. With IAA, the condition usually burns itself out after about a year and then out of the blue, suddenly the BG numbers start dropping and kitty starts down the dosing ladder. Knowing this abrupt change in circumstances was likely to occur made it much easier for me to figure out how vigilant I needed to be as far as monitoring to keep my girl safe and to take precautions when I knew monitoring would not be possible.

Cushings is the rarest of the high dose conditions and rare enough that I'd be inclined to rule out Acro and IAA before pursuing that testing.

The testing for Acro and IAA are not expensive. The biggest part of the expense is the blood draw at the vet's and possibly shipping costs as the tests are only done at the University of Michigan.

I'm guessing you switched insulin in the hopes of getting Leo better regulated. Most folks with high dose kitties use Lantus or Levemir because of the gentler curves they produce. Levemir seem to be a little more common in this population due to the discomfort some kitties experience with the injecting of large doses of Lantus.

Some folks use regular insulin along with a basal long term insulin to keep the BG more regulated but this is something that should only be done with the guidance of people experienced in it's use. If you are interested in considering that option, there are some wonderful people here who can help you but as Bobbie indicated, most of the high dose helpers are over on the Lantus/Levemir board.

I'm so sorry to hear of Scoobs' passing. Your poem was a wonderful tribute to a special kitty and Scoobs and Leo lucked out having you for their pet parent!
 
Hi Jeff, Leo sure is a handsome guy! I'm sorry you and he are having a tough time. It sounds like you've gone up in dose slowly so it's unlikely that you've passed his optimum dose. In your introductory thread, you said Leo was on OM food. Have you switched him to low carb wet food? if so and he's still high, it's possible that Leo has one or more of the high dose conditions. Do you plan to get the Acro and IAA tests done? I ask because if he were to test positive for IAA, there are things you can do to help him break through that resistance. Also, my cat, Colin, didn't show physical signs of Acro at the time of diagnosis either. The treatment for Acro is very expensive- out of my price range, so all I can do is treat him the best I can and aim for as high a quality of life for him as I can, for however long I have him. And really that's all any of us do for our kitties anyway. I knew that I wouldn't be able to afford the treatment if the test was positive, but I chose to have it run anyway, mostly to be sure there was a reason for his high dose and it wasn't something I was doing or not doing. I had racked my brain trying to figure out what I was doing wrong, why my cat wasn't responding to treatment like all the others on the board were. Once I knew, I was able to work out a plan that worked for me and my financial situation. If you choose to test, I hope he's negative, and if you choose not to test, just keep taking care of him the way you have, you are doing a great job! Remember Leo doesn't know he is a high dose cat.
 
Thank you everyone for the Leo support, and for condolences about sweet kitty Scoobs. We sure miss Scoobs a lot. We still see his ghost all over the house and the backyard :-(

Summary of answers for Leo:
  1. Preshots have not moved up recently, they are always 450-550 in recent months.
  2. I run 12 hour curves every couple weeks, like drawing blood from a wriggling worm. I test him every couple of days for nadir and preshot.
  3. PZI was started to see if it was more effective than Lantus. For Leo there is no change in effectiveness. And both seem equally expensive, mostly because of the high dosage insulin depletion.
  4. I do not like the high 27 gauge needles for the U-40 syringes. But at 11 units, I'll keep using those with the PZI because of the fluid volume. And what's with the 1/2" needle length - I'm not drilling for gold.
  5. Thanks for additional info on IAA, Acro, and Cushings.
  6. Leo's last vet visit was right after Scoobs died, I could barely drive to the vet much less think. It was a mistake for me to forget the blood work, since I had joined the forum prior to the visit. I may make another appointment just for that. The vet and staff are very capable and caring.
  7. Leo did get a complementary laser treatment on his back legs for neuropathy. I don't know if it helped, but the process was easy.
  8. Food is now Fancy Feast classic. He was on it before and the OM food was a temporary mistake.
I have read dozens of threads. And lots of insulin online literature. The links from the forum are very good. I don't blame my vet, she doesn't have dozens of hours to become a high-dose expert for a single patient.

Acro:
Acro is a horrible disease. But I also read some of the side effects from the cures. Some of those are bad, and there are unknowns. I am not willing to spend $6k-$10k and then Leo ends up with another issue, or doesn't recovery from the procedure, or dies within a few months. Heck, one of the potential side effects is blindness. I'd rather him have Acro.

Did any of you take blood yourself and send it to Univ of Michigan? I never drew blood before. And it's 100 degrees Fahr, everyday in Austin now, so maybe the vet should handle this.

Food:
I am going to spend some more time on food selection in the next 2 days. He also gets baked chicken, which is very good for cats (and people).
 
I just read thru some of the signatures. Wow, glad to have help from MrWorf'sMom and Sharon. You have some high-dose kitties too.
 
Jeff, the University of Michigan used to allow "civilians" to send samples directly to them but sadly they don't now so a vet visit to draw blood would be the only way to get the testing done.

I hear you about the treatment for Acro. I am in Canada and despite being in the largest city here, would have had to travel great distance to get Menace treated had she been positive for Acro. While obviously the financial burden of treatment would have been a major deciding factor, even if it wasn't expensive, I know my girl does not travel well to my vet who is 8 minutes away by car. Knowing this as well as the potential side effects, probably would have had me taking the same stance as you....I'd rather deal with the acro.

I don't know if anyone mentioned it to you, but many folks in the US order their Lantus and Levemir from Canada where it I considerably less expensive. If you wanted to switch back, that might make the associated costs a little easier on the pocket book.

It would be helpful if you could set up a spreadsheet with Leo's BG numbers. There is a pattern of readings that suggests IAA. Someone here coined the phrase, "dose going stale". What that means is that when the dose is increased, there may be a slight bit of movement in the BG readings for a cycle or two and then the numbers just go back up. With my girl who is a kibble addict, I lowered her from a diet of about 35% carbs down to 8% and didn't see any change in her numbers whatsoever. These were my clues that something was up and made me pursue the testing for IAA which my vet told me was so rare it wasn't necessary to test. I insisted. My vet has plenty of experience with diabetes but like yours, has never had a cat with IAA before, so she can't help me much. The members here who have walked the path already, have been terrific about sharing their experience and knowledge and my girl has now gone from 16u to 7.5u twice daily and I'm hopefully she'll continue a little further down the dosing ladder.
 
Hi Jeff - I am the one who coined the phrase "the dose going stale". Neko has both IAA and acromegaly. Your vet draws the blood, and the samples are send to Michigan State University. The two tests you want are the IGF-1 and IAA tests. Try to arrange the blood tests so that the samples arrive at MSU by Wednesday, as they only run the tests once a week. A fair percentage of acrocats (cats with acromegaly) have both conditions - Neko did. I say past tense because IAA is a condition that can be self correcting, after around a year. A cat having just IAA (like Menace), is less common.

One in four diabetic cats has acromegaly. My vet also thought she had no previous cats with high dose conditions, but that was likely wrong, she just didn't recognize it. A month after Neko got her positive test results (the vet was more surprised than me), she identified another acrocat in her practise. And acros don't all have high doses. A recent large scale study in the UK testing cats going into a diabetes remission study found acros with doses from 1 unit to 35, with an average of 7 units BID.

I don't know what side effects you have heard about as a result of treating acromegaly, unless it's from older forms of treatment. Yes it's expensive, I also live in Canada. Neko has been treated twice with stereostatic radiation therapy (SRT) in Colorado State University. Three years after her first treatment, the tumor started to come back. It's now almost 4 years since her first treatment. The only side effects of SRT are some possible short term inflammation (which Neko did not have either time) and hypothyroidism (small percent of cats), and that is simply treated with a daily pill. There is anesthesia involved, and there are always risks with that. There is a new surgical option for treatment, hypophysectomy, but the surgeons who perform this operation in the US do not have much experience yet. It is a viable option for those living in the UK. The Royal Veterinary College has done some amazing work and research on acromegaly in cats. Personally, I rejected surgery as an option last year, even though it's done closer to me than CSU. There is also a new drug treatment, but the cost of the drug is ridiculous - no one is treating outside of a research study. Treatment does involve travel. Neko used to hate the 8 minute trip to her vet too. After 3 days of 9 hours a day in a car, each way, she's a much better traveller now. Last year we went by air.

But treatments aside, the most important thing you can do for Leo is try to get his blood sugar to spend as much time as possible under renal threshold. The majority of people with acrocats do not get them treated but focus on treating the diabetes. As others have mentioned, most high dose cats gravitate towards Levemir. High doses of Lantus can sting, but the longer action of Lantus and Levemir seem to work better for higher dose cats.

I believe that knowledge gives you power and knowing what you are dealing with can help Leo. Getting the tests done is a good idea. I can give a couple of examples. Acromegaly means excess growth hormone which means soft tissue and bony growths. A few years ago, Neko's vet saw a red mark on her gum and thought that meant tooth infection and probable extraction. I took Neko to a dental vet (she has a heart murmur and I wanted their extra care through anesthesia) and the dental vet instead saw soft tissue grown on the gum, which meant her canine was rubbing the gum. So Neko got a tooth filing and not an extraction. Acros can have soft tissue growth in their throat, which means being careful with pilling and intubation should they undergo anesthesia. And more seriously, excess growth hormone can also mean organ growth. Cardiomyopathy (enlarged heart) is a common issue with acrocats, but unfortunately can be a silent disease until it's too late. When Neko recently went off her food and lethargic, we knew to check her heart, though there were no other signs of heart disease, all because we know she is acro.

I thought Neko didn't show any acro signs at her diagnosis, other than living in the kitchen and getting her paws on inappropriate foods when she could (muffins, banana bread), but I found out later her eye tearing was probably due to soft tissue growth in her tear ducts. That started 6 months before her diabetes diagnosis. It's thought that acrocats may be acro well before they get diabetes (if they do).

Sorry for the long novel, I guess I have lots to say.;) Once you get Leo's blood sugar numbers back into good range again, you'll find his loveable personality will start to show again.
 
Hypoglycemia event, dosage suggestions welcome. Next dose 8:30pm CST.

We just had our first pseudo hypoglycemia event. Summary:
7/28 Thur - normal
9:00am - 11.0 units
11:30am +2.5 = 530 BG
2:30pm +5.5 = 450 BG
8:30pm - 11.25 units
Above is normal
He gets fed every 2 hours - fancy feast classic and baked chicken

7/29 Friday event
6am-8am, normal food, Theresa said he ate a lot, normal
8:30am - 11.25 units
8:31pm, small portion of food as normal
12noon +3.5 = 78 BG - VERY LOW, didn't occur in 1+ years
12:05p +3.5 = 75 BG - Second test, triple checked AlphaTrak2 settings, test strips are all new
+food
+1tablespoon karo
Lots of sweating (me, not Leo)
12:55p +4.5 = 162 BG - Also very low, haven't seen this in 1+ years
12:56p +diced baked chicken, vanished in 60 seconds as usual
1:45p + 5.5 = 145 BG
1:46p +small bowl food (normal) +1 teaspoon karo

Dosage suggestions for 8:30pm CST are welcome.

One of these happened:
1. hit a vein, unlikely, it was a typical skin shot in the flank
2. Low food supply, but he had normal food right after the shot
3. Break thru on condition?


 
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Thank you Wendy and Linda for the long posts. I read them twice. Leo does seem to be doing fine except for the high glucose symptoms and the advancing neuropathy.

I'll consider insulin from Canada when temps cool down here. I read one of the good posts on it. I'm going to get Leo tested in the next 6 business days. Need to get thru the current (and first) hypo event.
 
Hi Jeff, well isn't that an interesting turn of events and hopefully a sign of good things to come. It will be great to see the numbers on his spreadsheet. I look forward to having a look.

First of all, 68 is the reading on the AlphaTrak2 meter that warns of the potential for a hypoglycemic event. Unless kitty is actually showing symptoms of hypoglycemia (wobbly gait, unusual head movements, etc.) he's not hypoglycemic but rather in numbers he is not accustomed to and warranting monitoring. 75 is a totally normal reading for a cat. I'm so glad you triple checked the reading, Double checking would have sufficed but I SOOOO understand the angst! :). When our kitties get into numbers that they have become unfamiliar with, they do get very hungry and may even seem frantic for food. When my girl pulls one of her "feed me now" tantrums, I immediately test because she does this if she is either high and low and while usually I can judge which is it, sometimes it's tough to detect the difference by her behaviour alone. Next time you get a number around 68, you can just feed Leo again and skip the karo. The karo doesn't need to be introduced unless kitty is showing symptoms or won't eat. Here is info for handling low numbers.

Now that Leo has had a reading of 75, he's definitely earned a reduction in dose. Folks using human meters generally make reductions at a reading of 90 with high dose kitties to give a little extra cushion. I use the AT2 meter and my reduction number is 120 or less but that is my personal choice based on my personal experience. You may want to do the same or you can set the number a bit higher if that makes you more comfortable.

We usually recommend a reduction of 25% so in Leo's case that would take him down to about 8.5u. Leo will probably be higher again for a few cycles as he will probably bounce from that unfamiliar lower number. Hold the dose as the bounce can take 3-6 cycles to clear. Every cat is different. You may find yourself going up and down on doses if this is a case of IAA starting to break. Once you have done a couple of reductions you will get a feel for whether you want to reduce by 25% or less depending on how well the reductions hold.

Since you haven't seen any low numbers until now, I suggest you get your pre-shot test tonight and post for advice if Leo's PMPS is lower than 300.
 
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I can't believe how helpful you guys are. It brought tears. It has been extra tough, just losing Scoobs 4 weeks ago. Anyhow.

Leo is normal and symptom free all day, like "Thanks Dad for all the extra special attention, including the warm chicken meals." No outward signs anything is different. He is back in his favorite space, laying right in front of the refrigerator door :-)

Thank you for the advice. I read the new posts twice. I'll continue to test today. I have ~75 recent AlphaTrak2 strips. Expensive but they work. All of it is cheaper than a single emergency vet visit.

8.0 or 8.5 will be his dose for tonight. I can test him until 2am.

These low numbers came out of nowhere. Literally. He had nadirs of 300 since Sept 2015, and all high numbers since then. I feel guilty for not being aggressive on the insulin until now. Maybe this move to PZI was what he needed. Below 100 - that is extraordinary for him.

Will work up his spreadsheet now. I'm pretty much not working today. I'm a computer security consultant in my other life, and have a PhD in computer science. But none of that helps here.

THANK YOU SO MUCH :)
 
Jeff, I well remember the first time my Menace gave me one of those shocking numbers. Thankfully she wasn't quite so dramatic as she had been dropping slightly before the first major drop occurred so I was a little more prepared for the possibility. You've been through quite the emotional upheaval of late and to have that low number arrive out of the blue had to be terrifying. I feel for you but you handled it like a champ, did what you needed to do to keep Leo safe and next time it won't be nearly so scary.

The PZI you are using may very well have been instrumental in pushing Leo's body into "submission". It is beef based which is the closest to cat insulin. I had considered trying it myself but Menace started her reductions before I got around to it and my vet wasn't sure if that switch would help or not because she didn't know if the antibodies were against all insulin or specifically against the human recombinant insulins. You may be on to something!

This is indeed a different ballgame than any of us were ever prepared for in the beginning. We often call it the sugar dance and as you can see, our kitties sometimes like to change the steps just to keep us on our toes! :)
 
Although it was surprising, it was good to see lower numbers today. Thank goodness you are home testing! Neko went absolutely crazy yelling at me for food when she got to 100 for the first time.

Sometimes a change in insulin will impact the antibodies for a while, if IAA is present. I've seen several high dose cats start out on Prozinc with either acromegaly or the combo of acro/IAA and seen no progress until they changed to Lantus or Levemir.

I have a MSc in computer science. I find that with my math degree help me see patterns in spreadsheets. But otherwise useless. :p The last couple of years I've been reading every paper I can get my hands on about acromegaly and IAA (precious few there) and have to learn a whole other set of jargon.
 
@JeffJ I was just peaking back at your summary of numbers and wondered, have you been doing pre-shot tests to ensure it was safe to give Leo insulin? We recommend getting tests before each shot to determine if BG is high enough for a full dose, needs a reduced dose or should be skipped all together. We also test as you have been doing to see where the insulin dose is taking the BG. I'm assuming you will be preparing to give Leo a shot about an hour and half from now. I am in EST. Please take a test before feeding Leo and before giving any insulin just to make sure it is safe to do so and also that the dose we proposed is appropriate. You don't want your pre-shot tests to be food influenced. :)
 
Thanks everyone for the continued help, all of which I've read twice.

Updates.
1) Leo's spreadsheet is now in my sig...that was a procrastination for sure.
2) PZI - this may have done it. I like the fact it is beef based and human recombinant DNA based, it sounds so technical :-)
3) 8pm (+11 hrs) Leo is at 363 and dying for food as usual. He'll have to wait until +12 hours PMPS for more.
4) Wendy - yes, too bad our fancy degrees don't seem to help much here.
5) Linda - yes I skipped a bunch of pre-shot testing for awhile. He was always at high numbers. Now I'll be more diligent.

+11hr test is 363 today. I'll test PMPS and if above 300 will give 8.0 units.
PM dose will be in 1 hour (9pm CST). I'll test, then dose, then test and monitor thru Saturday 1am.
 
9:00pm PMPS 340
9:01pm applied 7.0 units to be conservative
9:02pm fed the voracious kid, he was "starving".
 
7u tonight is fine. Don't be discouraged by that higher reading again. He's probably bouncing from that run of lower numbers yesterday. He might stay up for a few cycles but don't be tempted to up the dose back to 11.25u again. Keep him on a lower dose for now. I do think though the 7u may be a bit too much of a reduction but I understand completely that you want to keep him safe especially over night. You could take him up to 8.5u when you can monitor.:)
 
1:30am - got major cuddling and rubdown on kitchen floor. Lots of purring.
AMPS: 380 (9:29am)
Food: 1:30a, 5:20a, 7:30a, 9:31a;
Dose: 9:30a - 8.5u PZI ...spreadsheet updated
Alert and hungry as usual. BG lower than normal...hope he is making a breakthru.
Measuring weight now too - see column by comments. He is a big boned boy. 15-17 is normal for him. Diagnosed last year at ~12 pounds...we felt real guilty since he had lost so much weight before we diagnosed.
 
I can tell your kitties aren't spoiled! ;) Looking good! We'll see where that 8.5u takes him today. I'm just running out to do errands but will have a peak at Leo's SS numbers when I get back. You must be thrilled to see that lower AMPS today. I hope this is the sign of a breakthrough!

As for missing the weight loss, I think many of us have done the same. I was trying to get my girl to shed a few pounds and initially thought my efforts were finally succeeding. It wasn't till I picked up my young male and my sugar in quick succession that I realized just how much she had lost. I also attributed the sheet of cement on the bottom of the litter box to my old guy whose kidney's are not working 100%. Wrong on both counts. The important thing is we did get the diagnosis and are giving them the best care we can. Hindsight is 20/20. :)
 
Thanks Linda. I'll test at +2 and +4 today. He is getting real cranky during blood testing.

Yes they are really spoiled. Theresa and are both hopeful on the new low numbers. I clean the litter boxes 2x/day. Glad to hear that Leo isn't the only one who was diagnosed late. He sure does pee a lot.
 
Are you sure giving him his favorite treats every time you poke? bonito flakes and PureBites are favorite low carb treats at my house. Once they know a treat is coming, and the treat only then, they start to put up with the pokes. You also can get a +2/3 and then somewhere around +6 rather than a full curve at first. That should give you a clue if it is going to be an active cycle and how low the insulin is taking him that cycle.
 
Thanks Sue. He is getting fed little amounts every 2 hours. I'm going to get those treats too. Good suggestion on measuring the cycles.

Chart updated thru +4 for today, with nadir = 360. Will PMPS test too.

Problem over last 2 months is (pee + litter) on his back hocks. What a mess and it is glued on from the litter. He hates having it cleaned. Hoping the BG can get driven low and we can resolve the neuropathy.
 
Hi Jeff. Wonderful to see all the numbers on the spreadsheet but you used the sheet for those using a human meter.

To make sure we keep the fact that you are using the AlphaTrak meter front and centre for anyone providing assistance, can you please add another row onto the sheet at the top indicating the readings are from a pet meter. See Menace's sheet HERE to see what I mean. That red bar along the top grabs attention and with the two scales of measurement between pet and human meters being different, it's important to make your pet meter use is obvious to ensure you get the right advice.

You may also want to put a row in to indicate Leo is a high dose kitty too just so some lurker doesn't take a look and think his dosing is "normal" and decide to copy it. :)

As for Leo's numbers, I'm not seeing the pattern for IAA however, you missed a lot of pre-shot tests and didn't hold doses more than a day or 2 in most cases so it would be hard to discern the pattern with the data you have accumulated so far.

If you can get pre-shot tests twice a day and random tests between about +3 and +8 when the expected nadir (lowest reading) would occur as often as possible, you''ll get a better idea of how Leo is doing on a dose. Unless there is a low number calling for a reduction or skipping a shot, we usually hold doses for a minimum of 6 to a maximum of 14 cycles. You have more flexibility with the PZI to make small dose adjustments for overnight or personal commitments when needed based on pre-shot test numbers. I used to hold doses for 5-7 days but now while Menace travels down the dosing ladder, it's a little more erratic and based on readings as they occur. It really comes down to knowing your own cat because some cats settle into a dose faster than others.
 
Oh cxxxxp (cussword self censored). I put the banners on the top for now. I'm going to see if I can cut/paste this into the proper spreadsheet. That looked like the correct spreadsheet because it has 1-600 for the blood glucose range. The other sheet has BG range for 1-30.

I'll start doing tests for preshot, and 2 within (+3, and +8).

I don't understand this entirely "we usually hold doses for a minimum of 6 to a maximum of 14 cycles". I need to give him shots every 2x per day, everyday correct?

Thank you for the continued help Linda. It looks like Menace has pretty high numbers too. I'm glad we're in the tech age with online interaction and modern medicine. Probably most cats before 1980 just died from diabetes.
 
Yes my Menace has proven to be quite the "menace" when it comes to getting her regulated but we are making progress now and her dose has reduced considerably. :D With IAA, it's a two steps forward and three steps back proposition sometimes but I am happy that her dose is now more than 50% less than it was a few months ago. Right now, I am not sure Menace isn't on too much insulin so I am "experimenting" a bit and reduced without her getting all the way to my usual reduction number. Every cat is different to some extent and it's learning to read your own cat that gives you clues as to what to do at any given time.

Ok my turn to do the OH C&&P! I didn't mean to confuse you, I'm in Canada. We use a different scale to measure BG thus the 1-30, so not only do I need to make sure everyone knows I use a pet meter but also need to be able to translate my readings to US numbers. Look on the US values tab on my spreadsheet and it will make more sense. Finding the right sheet can be hit or miss for new folks with so many to choose from. I use the International one whereas you use the US one.

When I said "6 to 14 cycles" I meant at least 3 days up to 7 days with two shots being given each day. We try to keep the dose the same so if kitty bounces on a new dose, we leave enough time between dose changes to ensure the bounce (increased numbers) has cleared before making changes. :)
 
PMPS = 591, back in black (bad)
7:30pm last food
9:29pm PMPS test
9:30 8.5u

Ok, thanks Linda. I understand the 6-14 cycles now. Maybe I don't need to change the spreadsheet. The Alphatrak2 puts out content in 1-600 range.
 
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AMPS = 470
+4 = 410
PMPS = 440
Dosed 8.5u (9:30am, 9:30pm)
1:30am next test

I'm doing more blood samples these days (on Leo). Is Relion Micro calibrated for cats? Is it accurate?

I just saw the amazon prices
$29 for "Relion Micro Blood Glucose Monitor System"
$35 for 100 strips ($0.35/each)
That sure beats the AlphaTrak2 at $1/strip.
 
Jeff, the Relion Micro is quite popular here but the scale of measurement is different because that meter is calibrated to read human blood which is quite different from feline blood. That said, the reference numbers on this site are for the most part based on the use of a human meter so if you want to switch, there is no problem. You will find Leo's numbers lower using the Relion meter. The lower the BG, the closer the readings would be on the two meters. When kitty is running in high numbers....high is high. The difference in the readings is really only important when you get down to lower numbers like Leo did the other day. With a human meter the warning of the potential for a hypo event is 50 rather than 68.

The human meter does not read as high as the pet meter so if numbers are high enough (roughly over 500) you might only get a "HI" rather than an actual number on the human meter. Hopefully Leo is going to behave himself and stay below that threshold from now on but just something to be aware of.

I would also suggest you speak with your vet about switching just so they understand your readings should you need to consult them in the future. If you make the switch, we have the human meter equivalent of "normal" numbers for cats that you can provide your vet.
 
Thank you Linda. That is something to think about. I appreciate all the details and the implications. Relion does seem to be a better match for FDMB because of the scale. I could always setup a 2nd tab with an auto-converter for the other tab (via some spreadsheet magic). If I work the numbers with the vet, I'll let her know. She is not experienced with high-dose cats.
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The low BG scare the other day made me distrust a single meter. It would be nice to have a second meter around.

I cloned and modded your sig, and included pics in mine. Scoobs is in the pics too :-(

I re-reviewed Menace's numbers. That must be a great feeling to get him down from 16 all the way to 6 units/shot. Do cats still eat and pee excessively when you get them regulated? Leo is always starving (and peeing a bunch).
 
JeffJ said:
I could always setup a 2nd tab with an auto-converter for the other tab (via some spreadsheet magic).
Click to expand...
Unfortunately there is no conversion formula for the two scales of numbers. We know what the normal BG ranges are for both meters but to translate any one reading from pet to human or vice versa is virtually impossible with any accuracy. There is also the 20% meter variance that is allowed by the FDA for human glucometers and that % applies to the AlphaTrak2 meter too. It's really best to pick one meter and stick with it unless you're into driving yourself crazy. As a retired medical professional I was curious about the correlation of the readings particularly at moderate readings so I have been dual testing for over a year. At this point, I can pretty much guess what the human meter will read but every so often it throws me an unexplainable curve ball. So I use my AT meter as my final decision maker when it comes to dosing but quite frankly, I see no tangible reason not to use a human meter with the reference numbers provided on this site. It's really a matter of preference.

Cats definitely drink and pee much less as their numbers come down. I used to deal with a cement slab and conpletely understand the foot cleaning issues that result. At this point, the litter boxes look far more normal although when Menace's numbers go up, I notice an little increase in urine output but certainly not to the same degree as when we started this journey.

As a general rule, you can expect Leo's appetite to go back to a more normal pattern once he's better regulated. Menace gets antsy for food when her numbers are high, is pretty much normal when in a decent BG range but when her numbers drop lower than she is used to or too low as they did last night, she often gets absolutely obnoxious. I call it her early warning system but even that doesn't work all the time and I personally wish it would go off sooner than it does. She didn't start her frantic food pleas until she got to a reading of 61 on the pet meter last night which is too low! :eek:

Love the pics of your furkids! Absolutely stunning kitties! :cat::D
 
Thanks for the kudos on the pics. I also appreciate the help with Leo, and additional info on BG meters.

Wow, Menace sure did get low last night. She almost looks too low. You're doing something right to be able to get her more back to normal dosing!

I am looking forward to some regulation with Leo. The eating and persistent meow/crying from him is tough. He has perfected the art of acting like he has never been fed ever.
 
I know how tough the food issue is and admittedly, saying no to my kitties is not one of my strong suits. When they are unregulated they can't use the food they take in as well, so within reason, if Leo is at an ideal weight or needs to put some on, it's OK to indulge him a bit. Unfortunately my little girl needs to shed some pounds so I am trying desperately to keep her on a set amount of food but I do have my weak moments!:)
 
I got busy at work, last 2 days. Just gave Leo his PM PZI shot. Have one dose left for tomorrow am. Will go to vet. I think they have to order it.

I still have Lantus. Should I give him a similar amount? 9.5 units? Or cut it in half to be safe. He does not have a recent history of ketones. Last ketones were 1 year ago on initial DX. Thx.
 
Hmmm...I don't know about that. Since Lantus is so different, I'm not sure about the idea of just using a dose or 2 to hold him over. Is it possible your vet will have some PZI in stock?
 
If he doesn't have any in stock, maybe another vet in town will, and he could write you a script
 
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