New member just diagnosed

Hello All,

My baby boy Lucky (not really a baby anymore, he is 11) was diagnosed last week.

I have no trouble giving him the insulin shots, but I am having a seriously hard time testing his BG.

I am using the AlphaTrak monitor and I have tried his ears, his paws, heating both areas and I just can't seem to get enough blood.

I have to test him twice a day, and it usually takes 3-4 sticks before I can get a reading, if I can get one at all. This typically leaves me in tears, my poor boy aggravated and in pain and way too many wasted strips.

Is this typical? Does it just take a long time to get the hang of this?

Is there a better monitor that I should perhaps look into?

Thank you for your help!

I am keeping my fingers crossed that I can get a good sample. It is time for his evening dose :?

 

Welcome! Sorry you're having a hard time doing the testing. I think nearly everyone struggles with it at first.

My big problem at first was just being stressed about it, which made the cat stressed and squirmy and just turned into a bad scene :shock: Usually I also suggest warming the ear, as that made a big difference for me, but I see you're doing that already. Hometesting Links and Tips has all kinds of good information, in case you aren't familiar with any of it.

Ears should be a lot easier to get a blood drop from than paws so I would concentrate on those. Have you seen this photo of The Sweet Spot? Aiming for that area should work the best.

Hmm, what else could I suggest . . . how are you using the lancet? If you're not already poking the ear freehand (rather than putting the lancet device up to the ear and clicking for the spring action), that might help. And make sure you have something firm behind the ear, like folded tissue, for some resistance so you actually can poke the ear instead of just moving it.

I haven't used the AlphaTrak so I'm not sure how much blood it requires relative to other meters. I first used the OneTouch Ultra, and it was okay, but I like the Relion Prime better because it is fine with a really tiny drop. A drop that would have been iffy for the OneTouch Ultra is fine for the Relion Prime (plus the strips are really cheap, 50 for $9).

In what general area are you located? There may even be someone close by who would be willing to come over and help you get comfortable with the testing. I'm really glad that you are working on hometesting - it's so important to keep Lucky safe. Don't give up!

 

Hello and welcome to the board!

The alphatrak is a good meter but its strips are expensive so many people here use the Walmart relion brands (if you are in the US)

Here are some testing tips https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Are you free handing the lancet or using a tool?

Wendy

 

It gets easier to get blood. The ears in fact do learn to bleed a lot better.

 

Thank you all so much for your quick replies!

This time, I placed the warm washcloth inside of a plastic bag. Still no luck with the ears though, and he has a bunch of spots on both ears from previous attempts :-(

I was able to get it on his back paw, which he does not seem to mind so much but I have read that this is not suggested because it might get infected. I clean the area off with alcohol before I test and hold a piece of gauze with peroxide on it afterwards.

Since he does not seem to mind as much, I would prefer to test on his paw pads. Do others routinely test on the paws?

Thank you again, and I will check out those links, as well as the relion strips from Walmart!

Thank you, thank you!

Lucky's Mommy

 

Hi Lucky and Lucky's mom and welcome to the FDMB. What is your name?

I'm Deb and that picture over to the right is my foster sugardude Wink. He's been living with me for about 7 months now and no longer needs insulin. It's possible for many cats, if you get them on a good diet <10% carbs, like Fancy Feast classic pates and Friskies pates, to get them not only regulated but diet controlled.

If you let us know where you live, country, state/province, city or general area, we could give country specific advice and maybe know someone that lives close to you to help you learn with your home testing issues. If you are interested that is.

 

Yes some people on here routinely use the paw pads - those are fine!

Wendy

 

Hi there and welcome! I used to test my cat, Gobbles (now in remission), very regularly on his back paw pads, especially the first month or so. Then I'd test on his ears and paws. My method was to rub the paw pad a little, then poke quick) and then slowly "milk" the poked area, test, and put about 10 seconds of pressure on poked area. In my experience, it takes the blood longer to seep on the paw pad verses the ear. You can rub a little triple antibiotic ointment with pain relief on the paw pad before poking (to numb it). And always put the ointment on afterwards--even if you don't draw blood--that will help with keeping infection at bay. I tested Gobbles on his paw pads for 6 months, and he never had an infection. I hope this helps

 

Hi - welcome! I'm pretty new here myself, but I can tell you what works with my cat, Tootoo. You might have already solved the problem, if so, ignore this. I set up first on the bathroom counter with a cosmetic pad with Neosporin (with pain relief) on it, the tiny lancet, the meter with strip plugged in (I use Relion Confirm), and a bag of low carb treats.

I let him sniff the treats first. Then I massage his ears and under his chin (which he loves) and his ears some more. This gets the blood flowing in the ears and calms him down. Then, I take one ear and hold it taut between my fingers with one hand and prick the edge of the ear (you should look at a video to see the best spot) with the other hand. Then, after I get the reading, I keep massaging a bit to keep him calm, clamp the cosmetic pad gently on the ear and hold for 10-20 seconds. Then treats and more petting.

Maybe that will help. Stay with this board. I've been following the protocol recommended by the members of this board, and my kitty is doing well. There's lots and lots of good advice here. Stay with it!

 

I am using the lancet pen, and I just checked the price on then strips for the alphatrak. They ARE very expensive!
I do not think we will be able to continue with that monitor. Is the Relion a good replacement? The AlphaTrak only requires 0.3 units of blood to test and we have a hard enough time getting that amount.

 

I will definitely try the ointment in the morning. Thank you for the tip!

 

The relion confirm uses the same small sample size as the alphatrak and is a good meter.

If you do use the ear you might find more control by freehanding instead of the tool

Wendy

 

Arkray USA Glucocard 01 or 01 Mini is the unbranded/generic version of the WalMart ReliOn Confirm or Confirm Micro.

The former are available from our shopping partner ADW (link at top of board) and they have some free shipping deals if you order enough stuff at one time.

 

Thank you all again for your help!

I can't tell you how much I appreciate it!

We tried the ointment this morning, and testing on the TOP of his ear instead of underneath and it went MUCH better!

I think I will look into the ReliOn monitor as others have suggested. The strips are only sold at my vet locally and will cost $67 for 50

Thank you again!

 

You can get 100 Relion Confirm/Micro test strips at Wal-Mart for $36. Tiny bit of cost savings for 100 instead of 50. So twice as many strips, for about half the cost of the Alphatrak strips.

 

How are things going otherwise? What insulin are you using and what are you feeding? These are key if your goal is remission...

Wendy

 

Hi Wendy,

Things are going much better! He still squirms a lot, but I can pretty much get a sample with one prick now!

We started wet food, Hills M/D and the insulin is Lantus and he gets 1ml twice a day. I bought the ReliOn meter this week and that seems to be working. I just wonder if the BG is as accurate as it was on the AlphaTrak since that's made for animals.

His numbers have been pretty good. For the past few days he has been below 200. Our vet suggests doing. Curve as soon as possible.

 

Think of it as reading temperature in Celsius vs Fahrenheit. Both are correct.

Human glucometers read roughly 30 points lower than the AlphaTrak at the low end, which is where the numbers are most important.

All retail glucometers read within 20% of what a lab value would get. This range of possible values gets wider as the number gets higher.
Ex
50 -> 40 to 60, a span of 20
500 -> 400 to 600, a span of 200

At high numbers, the actual number isn't important. High is high and you follow the protocol for your insulin.

 

Can we see some numbers? Would like to check what's going on. The key thing is his nadir or low point. How low is he going during the day? Under 50 and a small dose decrease is needed. The nadir is usually 5-7hours after the shot.. But can vary. Many cats drop even lower at night.

We recommend you track readings in a spreadsheet like this to watch for trends etc, and you can even share it With us if you want eyes on it... http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Wendy

 

Hi Wendy,

Thank you again for all of your help! I would love to get someone elses take on his numbers.

I completed the spreadsheet, and posted it in my signature. But just in case that does not work: https://docs.google.com/spreadsheet/pub ... utput=html

Looking at his numbers from yesterday and today, I think I need to do the curve as soon as possible and get the numbers to my vet. We haven't changed anything (except for the monitor) since he started getting the insulin so I am not sure what would account for the drastic drop yesterday morning, and again this morning :/

 

His numbers look pretty good... It's nice always to see blue and green... These are healing numbers which help the chances of remission. And it looks like his numbers are dropping over time into more normal cat numbers... He just is not ready to be off the juice yet.

However you can't assume that the morning low number is the lowest point of the cycle. He is probably dropping lower overnight. Maybe dangerously so.

So I would strongly suggest you get some more tests in on a daily basis to keep him safe.. I would recommend a test every night before bed 2-3 hours after his evening shot. If his before bed test is lower than the preshot number you may also want to set the alarm for a test later on that night. Plus do a mid day test around 5-7hours after his morning shot if you can do it with your schedule

What we are trying to do here is see how low he is going. If he goes below 50, he needs a dose decrease ..We usually decrease in 0.25 unit increments.

Wendy

 

Which meter where you using when you got that 77 this morning? The Alphatrak or the Relion Confirm? If the Alphatrak, Lucky earns an automatic dose reduction.

We really need to see some mid-cycle numbers. If Lucky was that low, 77, at pre-shot, how much lower did he go with the insulin. Possibly, dangerously low.

My recommendations are:
1. get those mid-cycle tests
2. drop the dose to 0.5U max

We don't want Lucky to drop dangerously low and have a hypo.

 

Thank you both for your help! I am definitely going to try testing him a few hours after the evening shot from now, but unfortunately, I live to far away to check his numbers during the day. I plan to do the glucose curve with him on Sunday.

This morning he was at 321!

Also, the days that he tested 67 and 77, I had already been using the ReliOn monitor for two days.

 

If you note on your SS, when you switched to the Relion meter, that would be helpful.

Thanks for the reassurance on which meter you were using when you got those lower 77 and 67 numbers. Those low numbers are ok with a human meter, getting a little worried if that was the Alphatrak. Now I can breathe a sigh of relief.

 

Hi Deb,

I noted in the Comments that switched to the ReliOn meter on 8/9, but I bolded it so it would stand out. I am going to send this sheet to my vet once we do the curve, so that will be good for her to know as well. From BJM's post above, I understand a little better how the numbers will be different on the human meter, but I am still concerned about what is going on at night.

He was 114 last night and 66 this morning, so I am planning to check him a few hours after he gets his PM shot tonight and go from there and stay up for additional readings if I need to!

 

We really need to see a few more test numbers. It's great that you are getting those pre-shots now, but we need to see some more numbers after that time. We often suggest that someone get a before bed test as a regular test every day. It helps to fill in our knowledge of how the insulin is affecting your cat.

Many people are not able to get those mid-cycle numbers during the day when they are working, but can do some on the weekends. That may mean, setting the alarm to wake you up at night around +5 or +6 to get some tests at night, or staying up later to test.

I'm betting that the numbers in the middle of the cycle are really low, but don't know that for sure without some tests. Your cat Lucky may have earned a reduction, by dropping under 50, and you have not caught it with a test.

I would not be at all surprised to see higher numbers with a bounce through this evening. I'm thinking Lucky may need a dose reduction.

Please, let us know how those tests this evening go. After your PMPS test, I'd recommend a +2 to start, and go from there.

 

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mf/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

 

Overslept a little, but we just got started. He went from 462 at 7:30pm (no insulin this morning because of low BG) to 309 now at 10:00pm. Lucky is definitely not happy with the extra pricks, but It will be worth it to see his numbers.

Looking forward to getting feedback in the AM. Back to bed for a few more zzz's before the next test!

Thank you so much!

 

Thank you for this BJ, this is VERY helpful. I was just speaking with my mother this morning about this, and she mentioned that I needed to understand what numbers are acceptable for cats. Mom has diabetes, so she is a big help as well.

My vet did not discuss testing his urine at all, so I am going to ask about this as well.

I look forward to your feedback, as well as the vets in the AM.

thank you so much!

 

So the +2.5 was down 153 points or about a 33% drop from PMPS.

I'd get a +4 next.

Where do you live? Time Zone?

Want to know how long until your next test.

Would you be willing to add your location to your user control panel, profile tab, edit profile, location field?

With the skipped shot, the numbers will probably remain higher this evening. Don't let your vet raise the dose based on this atypical cycle.

 

See my signature link Secondary Monitoring Tools for tips on urine testing and other assessments you may wish to track.

 

Hi Deb,

I thought he would stay higher this evening as well, but he is down to 83 now at 5 hours after his pm shot.

I am in Delaware, so EST zone. His next text will be at 2:30am.

Thank you so much for your concern. This board and its members have been more helpful than my recent visits to the vet!

 

Hi All,

Everyone has been so helpful, and I am looking for some more advice at this point :/

So you can see from his numbers that he dropped pretty low as the night (8/14) went on. After he dropped to 39, I pretty much stayed up to keep an eye on him. He was not walking or acting very funny, but he definitely did not fight with me as much when we did the next shot, and his BG went up a little bit.

I sent the spreadsheet to my vet and expressed my concern about the low numbers during the night. The response I received was that I should not be using the ReliOn meter as the numbers are not accurate for cats. She said that the low numbers were probably not that low and they recommend that I go back to using the AlphaTrak, which I really can't afford to do. She also mentioned that the 1 unit every 12 hours should be fine to keep him regulated, given how high his numbers were in the beginning, but I am just very nervous to continue as is!

 

With that 39 BG you got 2 days ago, that is an automatic reduction by 0.25U with the Tight Regulation protocol we use. This is the only scientifically researched and sanctioned protocol for Lantus insulin and has been vet journal published.

Dropping that low, tells us that 1U is too much insulin for Lucky. Did you follow the hypo protocol, feeding and testing every 30 minutes to raise his numbers up? He's fortunate he did not have a seizure or fall into a coma. Lucky lived up to his name.

Please, print a copy of this and keep with your hypo kit Hypo instructions and keep them with your hypo toolkit of Karo syrup/honey and high carb gravy type wet food and lots of spare test strips.

If you ever get a low number like that again, please post here, use the 911 icon and yell for help. We'll walk you through the hypo protocol.

You are endangering your cat if you continue to give him that much insulin. I strongly recommend that you reduce the dose immediately to 0.75U.

Please, please keep your cat Lucky safe and decrease the dose immediately.

ETA: Please add the insulin you are using and the meter you are using to your signature. Thanks.

 

Are you home to test? I'm concerned because you gave Lucky 1U with a BG reading of 74 this morning. That is likely to take Lucky very, very low and in danger of a possible hypo.

My recommendation is to get another test ASAP.

 

hey there

I second Deb - every time he goes under 50 you want to drop by 0.25IU. Plus with that low preshot today I really hope you got more tests.. we dont want a hypo and the 39 you got the other day is low!!!


Wendy

 

Thank you both for your input. I will be putting a hypo kit together ASAP.

I was very concerned about Lucky's numbers but the vet tech seems adamant that the monitor is not giving accurate results and he is not that low. She also mentioned that 1 unit should be fine when I asked what I should do next, based on those numbers.

When I went for the diabetes consultation right after he was diagnosed, the way it was explained to me is that he needed to get insulin if he was going to eat, regardless of numbers. That's why I gave him the shot this morning. His PMPS was 53, so I am glad he lived up to his name as well! I did not give him a PM shot, and will be watching him ths evening and testing again in a few more hours. His +2 was 108.

 

You might want a second opinion. Ask your vet, not the tech.. Techs aren't as experienced, they dont have the school or experince, and these numbers are very low. He could be going into remission!!

My bailey has a hypo only on 1/2 unit. He was in a coma, I was lucky to find him and give him syrup.he measured at 19.

It's better to be safe than sorry.. Please.

I look at hundreds of cats and I am worried here.

If it was my cat I would be giving 1/2unit starting tomorrow but only if he is over 150... Since 50-130 are normal cat numbers.


Wendy

 

At the lower numbers,
A 40 on a human glucometer is about equal to a 70 on an AlphaTrak.
A 50 on a human glucometer is about equal to a 80 on an AlphaTrak.

At higher numbers, the differences become wider and it doesn't matter - high is high. You follow the protocol for dose adjustments and check for ketones.

 

Hi Wendy,

The vet tech asked me to email her, because the vet doesn't check emails and she would share everything with him. She said that she shared the SS with him, but I guess I can't be sure?

I hate to say it, but I didn't know what normal cat numbers were! I planned to ask when I called the office tomorrow to try and speak with the vet directly, so thank you for that. I just talked everything over with my mom and we both agreed that reducing his insulin is a good idea. I agree it's better to be safe than sorry.

Thank you again for your help. This board is a life saver. I have received some negative feedback from people when I told them that my Lucky had diabetes and what we were going through. It is so comforting to know that I'm not the only one!

 

Hi BJ,

I printed out your information on the differences between the monitors and planned to speak with the vet.

Thank you so much!

If they won't give me any guidance becausevI am using a human monitor, I may need to find another vet.

 

Sorry, but I strongly disagree with that vet tech telling you the meter you are using is inaccurate and you should not be using it or relying on the numbers it gives you. Probably 95% of people here use human glucometers to test their cats. We have the reference ranges to use with human glucometers. BJM gave those to you earlier in this post.

With that BG of 39, your cat has already told you quite clearly that 1U is too much insulin. What protocol is that vet tech using to base her recommendation on?

Many cats show no symptoms of hypoglycemia until they start convulsions and go into a coma. We certainly do not want to see that with your cat.

You don't base the dose on what the BG numbers used to be. You base the dose on the nadir or lowest BG reading in the cycle and what the trends are over time.

Please reduce the dose, and ask here first if you get a number below 200. "Better too high for a day, than too low for a minute."

A diet change can dramatically lower the BG readings. The Hill's M/D is 14% carbs and may be the only thing keeping his numbers high enough so he does not hypo with that 1U dose of insulin.

Lantus has a cumulative effect, and you do not see the full effects of the dose for 6 cycles, 12 hours in a cycle. Lantus is a depot insulin, so only part of the shot you give goes to work right away, the rest goes into storage aka the depot, for later use. Once the depot is full, you will see the full effects of the dose. What we are seeing, is that the 1U dose is too high.

 

Normal cat numbers - see the chart I posted previously. It's listed. In fact, print it out and share it with the vet.

 

Good morning. The pink today was likely a result of a bounce from a low yesterday ( bounce explained below). Since we dont know how low the low was, this was a good idea to drop the dose. He may bounce for a day or more so just hold the dose for now and dont worry if you see a lot of yellows or pinks but start getting more tests once you see him starting to drop.

Also it will likely take a day or two before we see how this dose is working so lets wait and see (because Lantus takes a few days to build or drain from his system - its a "depot" insulin)

Wendy

Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

 

Thank you, Wendy!

I am going to continue testing him every couple hours. He seems to be dropping pretty slowly, which is a huge inference from before. At +8, he is down to 199, so we will be doing another test about 3:30.

Thank you again!

 

You might be heading to a low PMPS too. So definately get a +11 and come here and post so we can coach you through shooting low if need be. No food after +10.

Read this http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Wendy

 

Hi Wendy,

I lost my internet connection for a while there. I have been testing him since 5:00am so we are already past +10

The feeding schedule Lucky is on per the vet is 1/2 can of Hils M/D every 12 hours, so he has not had dinner yet. We agreed that 7 & 7 would be the best with my work schedule during the week. I expect him to be lower when I test again, so should he get insulin?

 

We won't know if Lucky should get insulin until you get the PMPS (evening pre-shot) test. If it's over 200, then you are safe to shoot the insulin. If it's lower than 200, we advise new members to hold off on feeding, retest in 30 minutes to see if the number is rising or falling.

Depending on now low the number is, it may be best to skip the dose or give a reduced dose.

Since it is early days yet, you do not have a much test data to know how your cat reacts to the insulin and how low his dose takes him.

We'll have to wait a bit and see that PMPS number.

 

Hi Deb & Wendy,

Thank you both again.

Wendy, I apologize, I got anxious and did not read the post that you included!

I do not know what Lucky and I would be doing right now, without your help. My vet is just not that helpful.

I just tested Lucky and his BG is 310, so I can continue with the reduced dose of .5, correct?

 

Wow, he bounced right up again!

Yes, that 310 BG reading is high enough to give him his 0.5U dose. I recommend getting a test at +2, to see how Lucky is doing.

Vets look at the big picture, we here on the message board, look at the day-to-day management of feline diabetes. Glad we could help you and Lucky. We're pretty successful in getting kitty's OTJ too. Hope that is possible for Lucky. We'll have to wait and see.

You're doing great! But, your head is probably spinning and you feel a bit like this. :dizcat :dizcat :dizcat It's ok. That's normal when you are starting out, but let me reassure you, it does get easier and you will develop a routine.

 

My head is spinning! But the info you and the other members have given me so far is so beyond helpful, and I truly appreciate it!

I was thinking I should test him in a few hours as well.

Thank you so much!

 

Yep let's hold the 0.5 for 3-5 days unless he drops below 50.

A before bed test would be good .. If its less than the preshot then you also might want to set your alarm for a +6..

Wendy

 

So his +2 is EXACTLY the same as the PMPS, 310. I will be testing again soon!

 

Looks like a bounce. Normally I wold say you would be fine to go to bed but the other day he suddenly dropped at PMPS+5 so if I were you I might set the alarm for another test then.

Wendy

 

He tested 166 last night at +4, and this morning his amps is 132.

I hope that I understand the Tight Protocol. Based on Lucky's data, I think the insulin will go into effect in about 2 hours, so if he eats now and I give him the shot, he should be good to go, right?

 

Make sure you get a test at +2 so you dont get any surprises about which way he is going. At +2 any food will have worn off so you will get a clear picture of his plans.

This dose is still building up in his system ( takes 2-3 days) so we will see soon how its going to work.

Wendy

 

Hi Wendy,

Unfortunately, I was already on my way to work when he would have been at +2. I tested him when I got home, which would have been about +8, and he was at 123. The PMPS will be the next test about 7pm.

Now if I understand this correctly, if he is high like he was yesterday, above 200, than he can get the shot. If he is low, I should wait to feed and test again in 30mins, to see if he is going up or down.

 

PMPS is at 86, so we will wait 30mins and test again.

 

Yes, wait 30 minutes, hold the food, post here with the number.

 

30mins later, went from 86 to 82. Should I continue to hold his dinner and test again in another 30?

 

Yes if it doesnt throw you off schedule ...

Otherwise you can skip this shot - or - give a reduced dose ie 0.25 but make sure you get a before bed test in a couple of hours and be ready with syrup etc if he does drop low.

Wendy

 

Thank you for your help!

He typically does not eat later than 7:30, so we are only a little off schedule. I just tested him again and he is at 84. I will skip this shot tonight, since I do not think I would measure .25 accurately.

I am having trouble finding syringes with 1/2 unit measurements. The smallest measurement on my syringe is 1 unit.

 

They should have 1/2 unit syringes in pharmacies.. ask for U-100 syringes 3/10 cc, half-unit marked, short needle, 30-31 gauge

ie Relion 3/10cc 30 & 31 gauge short (Walmart brand)
BD Ultra fine 3/10cc short
Terumo Thinpro Insulin Syringe 31G 3/10cc

Would be good to have them as I think he might be on 0.25 soon. I am loving these numbers and hope he keeps it up so his pancreas can heal.

Wendy

 

Thanks Wendy!

I checked Walmart, CVS, and Walgreens today for the syringes. No luck

I did find them on the ADW website, they are a little pricey, but I hope we will need them soon too!

 

Did you ask at the pharmacy section? They quite often keep them behind the counter.

 

Hi Wendy,

I did ask the pharmacists and they all said what I had was smallest.

I was reading more about the Tight Protocol when I saw the pics with the 1/2 units measurements.

Since Lucky's PMPS was low last night, he did not get any insulin, but I woke up this morning @ 2am to spot check and he was at 364. I didn't want to risk him going any higher before his regular shot at 7:00 so I gave him .5 units. This morning at 7, I tested as usual and he was at 262.

Would it have been better if I had just waiting until 7 to check him again and then give him insulin?

 

yes because now your schedule is totally off as the next shot needs to be 12 hours later. We need to tweak your sheet a little to reflect this -the 364 you got at 2am really should go in the AMPS column for today now instead and 0.5 beside it in the dose column.

What it does show you is that last night if you had waited a little longer we probably would have seen his BG shoot up and you would have been able to shoot.

Ignoring what the pharmacists actually said, did they not have the syringes i listed? those should have 1/2 unit markings on them.

Wendy

 

Wal-Mart has 3/10 cc insulin syringes with 1/2 unit markings.

 

Yep those are the relions I mentioned. The staff there dont seem to always know that the syringes have the half unit markings on them though.

 

Thank you again for your help.

I knew I should have posted again after I got the third reading to get recommendations before I fed him. He was just so hungry and crying a lot, I felt terrible.

I am going to go back to Walmart tomorrow and ask her to show me the 3/10cc's they have. You may be right, they may not realize they have 1/2 unit markings on them.

 

Unfortunately, my internet at home is completely down

I got the 1/2 unit syringes at Walmart after all! I started using them last night with his evening shot, and I think he may have been getting a little more when I was using the old syringes without the 1/2 markings?

He was kind of high this morning so I am concerned, but I know it will take time to see how this new dose will work out. Planning to do another curve very soon.

Thank you!

 

Glad you were able to get those 3/10cc syringes with the 1/2 unit markings. They make it so much easier to give those tiny doses.

 

Hold the dose for a few days and if we dont see greens etc again we can increase back to 0.75.. however it looks like he might be clearing a bounce so you might see some later today.

However I am thinking you might want to post on the lantus board.That board has lots of very experienced dosing members on it and is a great sense of community.Since you are now up to speed with testing etc I think they will really be able to advise you better on dosing etc. I post there myself every day or two to get their eyes on my cats.

http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Here’s how to post:
Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report, or the home you live in and the cat trees some people have)

Subject line: The subject has the date/cats name and BG readings ie 08/17 Lucky AMPS 400 +2 333 + 5 224. You add a ? icon if you have a question. You should update your subject line in the very first post for the day as you get a reading, or whenever you have a question. For your first post put "newbie" also in your subject so everyone can welcome you!

Contents: The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today Lucky was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?

There is no rush to post there. I like to suggest that people go over to their insulin specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. Get a feel for how the forum works. See if you think it would be a good fit for you.

But you are always welcome to post here in the Feline Health forum for as long as you want.

Wendy

 

Thank you again Wendy! I will check out the new forum ASAP!

Lucky's PMPS was 171, so since he is below 200, we are waiting 30 mins so I can test him again before he eats. If his BG is rising, I know I can give him his shot but If he is continuing to drop, would you recommend just skipping the dose for tonight? He is doing some serious crying right now so I know he is super hungry already.

 

Lets see where he is, if he isn't rising you could skip but be prepared for a big number tomorrow. I think it wold be better to shoot though as you want to maintain momentum if you can.. Plus you have shot low before now, anything over 150 and a promise of a test at +2 and you are good to go.

 

Thanks! I am starting to feel a bit more confident about all of this!

Thanks again!!

 

Got another test yet?

 

Yes! He jumped up to 217, so we were ok for his shot. Sorry for the slow replies. I am, not sure what is going on with my Internet connection. I can't update his SS either :/

 

Ok good, get a +2 just to be safe.if its lower then you might want to set the alarm for a mid cycle as it usually means an active cycle..

 

Hows things going? I saw you jumped the dose up - and back down. I dont know if he was ready for a dose increase - did the tight regulation board or your vet recommend it to you?

Heres normal protocol which tells me I would have held the dose for 5 days before increasing.. See bold. I would take him back to 0.5 and hold the dose longer to see

Wendy

 

Hi Wendy,

Thank you for your help as always.

I have not been able to get online at home for days, but I kept his sheet updated when I could get WiFi in random places.

It was suggested that I increase his dose earlier this week, so I thought it would be a good idea to test him last night since I didn't have to work this morning.
He did not get very low last night at all, but he seems to still be dropping right now. His AMPS was 199 so I waited 30mins and he dropped down to 99. We are off schdule by 1.5hrs now, but I thought I should wait another 30 and see what's happening and he went up to 195.

Would you sitll recommend reducing his dose back to .5? Or holding .75 for a few more days?

 

I would hold the 0.75 for now - since he is rising you are fine to shoot - just maybe get a +2

Wendy

 

Hi Wendy,

I think I am going to post on the Lantus board as was suggested, but I am so confused by his numbers right now. It seems as though he is all over the place?

Also, he has been getting 0.5ml since I switched to the new 1/2 unit syringes on 8/19. I am an idiot, and I was not measuring correctly. The last time that I did a curve was on 8/23 and his nadir were greater than 200, but less than 300 which would mean an increase, but that was only after a few days of getting 0.5ml.

As of today, he has been getting this dose for 10 days, so I am wondering if I should do another curve before increasing? Or just increase to .75?

 

I think you need to get more data before making an increase, it looks to me like he is bouncing up and down and I want to know how low he is going that is triggering the bounce.

0.5 might even be too much. Can you get some more mid cycle tests in? This morning he was high but I bet its a bounce and he will come down soon, so I would get a +6 and maybe every 2-3hours after that if he is dropping.

If you can get a +6 today let me know and I can say when I think the next test should be . If we do that for a few days we might catch the low.. Deal?

Wendy

 

Hi Wendy,

His PMPS was high this evening, so I will try and get up and do a +6 tonight, which would be after midnight and see where he is. I can't do anything during the day because of work unfortunately.

I was not even considering a bounce.

Thank you!

 

Every time you see a green or blue followed by a day or two of pinks and Reds you gotta wonder ..bounce.

Yesterday morning you got a 75 at preshot. Was that the lowest he went? Unlikely... unlikley that you happened to catch the low given the limited testing . So he probably went lower than that, maybe even below 50 and then bounced.

And then today I see two reds. Did he stay red all day or did he drop too low midday and bounce up again? Both scenarios are equally likely. A +6 might well show the low.. Or he could still be bouncing. We will see..

Wendy

 

Hi Wendy,

Thank you again for all of your help.

I tested him twice last night after his shot. His PMPS was 448 and at +6 he was down to 209, and then rose to 295 at +8.

This morning his AMPS was 432. I have not been at this very long, but is it likely that he dropped low enough to cause a bounce from 295 around 4:00am to 432 by 7:00am?

Thank you for your help!

 

If he dropped I actually suspect between PMPS and +6 because he started to rise after +6.

 

Hi Wendy,

I wish I could test more during the day, instead of in the middle of the night so that I could get more feedback :-(

I just tested Lucky again, this time a little past +3 to see if he is dropping as low as we think and bouncing, but he is only at 372. His PMPS was 465.

 

Any chance of some mid cycle tests the next few days? I am wondering if a dose change is needed or if Lucky is dropping low during the day..

Wendy

 

Hi Wendy,

I should have been posting this whole time andd getting feedback from you and the other members and I probably wouldnt be so unsure right now. After speaking with the vet and my mom (nurse and also has diabetes) I have to say I don't know what to do next.

Lucky was on .5ml for a while, and his numbers just seemed to stay high. There were a couple mornings where he was low, but I did a few midcycle tests (in the evenings) and he was not dropping low.

My vet is not pleased that I am not using AlphaTrak, and is concerned that I changed his dosage from 1ml, based on the human glucometer. But I know from everything I have learned on this board, that he was dropping much too low when he was getting 1ml.

He just started getting .75, and it has only been about 2 days, but his midcycle numbers made me nervous last night. He never got below 50, but he was still pretty low this morning so I didn't give him a shot.

My mother says he may need a different dose in the am and in the pm, but I know that does not fit with the Tight Protocol.

 

I dont want to contradict your mother's experience but given he's dropping to 59 - and thats borderline too low- I would not increase the dose! Reason is that normal cats are 50-130 , anything under 50 puts him at serious risk of a hypo. Increasing the dose will push the lows even lower.

I have a few scientific published reports we can share with your mum that show why Lantus should be dosed consistently. Would you like me to send them?

Here is hypo information - http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

His numbers the last few days on 0.75 looked quite good - lots of blues and greens - except for todays red but that was because you skipped the shot. So I would hold 0.75 for now unless he drops under 50 which means decrease by 0.25 units.

So we need to teach you what to do when you see a low preshot, so that you dont lose momentum by skipping the shot. I will do another post to explain.

Wendy

 

So as I said above, his numbers the last few days looked good except when you skipped the shot.He is bouncing into pink a little but thats totally normal and over time the bouncing stops and remission can occur. he is spending more time blue and green which is great!!

But you had to skip this morning because he was too low.. so how do you handle that? Well we have ways...

1. Stall. Remember you dont feed for 2 hours before a shot? Well this is why because now you know he doesnt have food in his system so any bloo dsugar changes are due to his body and not the food. So say you get this low preshot number.. wait 30 minutes and dont feed or shoot. And if the number goes up then you shoot. If its going down then see below. You can keep waiting as long as it takes for the BG to rise but remmeber the next shot has to be 12 hours after you shoot so it can impact your schedule.

AND/OR
2. Shoot a reduced dose - go with half the normal dose instead. just make sure you get a test in 2 hours to make sure he isnt dropping too fast

Read this but if in doubt - come onto the lantus board and we will help you through it - even stay up with you at night if need be: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=147

Wendy

 

Thank you Wendy.

I think my biggest issue with shooting low is that I am not able to stay home and test him/keep an eye on him. Except on the weekends where I have more time in the morning, I am not home long enough to test him 2 or 3 hours after the shot if his AMPS is low.

I did have my hypo kit out and ready last night, just in case, but thank you for the shooting low sticky, I think I forgot to bookmark that one.

I should go onto the Lantus board as you have suggested. I think I am just nervous since I am still kind of new at this and asking too many questions!

 

There is no such thing as too many questions!! Ask away!

If you can't be home and he's low, then skip for now. But over time you will get enough data to know if you can shoot and go out, shoot a low dose, or have to skip. Unless he goes into remission before then if course. If we can get the dose right then that's always a possibility.. And this current dose is looking good.

I will be ready to welcome you on lantus land. Remember its pretty much everyone you have met here, and more!

Wendy

 

Thank you so very much for all of your help and support, Wendy.

You are an angel!

 

I just love cats. Crazy cat lady. And I love when a cat goes into remission, or if not, when he feel better and perkier and we have added another member to the community..

Wendy

 

So I have yet ANOTHER questions Is it normal for cats with diabetes to have hairball issues? Since he started getting insulin he is sort of wheezing, which usually ends with a hairball but not always.

I got some hairball relief drops by Sentry, but I am not sure if they will really impact his BG levels? I figured it was better than getting the treats which I am sure are carb heavy.

 

Maybe he is just feeling better - feeling better = grooming more = more hairballs.

Try a small dab of vaseline on the paw. He will lick it off and it will help her pass them. No carbs either!

Wendy

 

I think you mean units, because 1 milliliter has 100 units of Lantus.

You might print out the reference values I posted previously for your vet. And unless the vet is planning to donate an AlphaTrak and all the strips you'll need, you use what will fit your budget.