Starting off the juice trial & have ?'s

Discussion in 'Feline Health - (Welcome & Main Forum)' started by weetdog, Mar 20, 2020.

  1. weetdog

    weetdog New Member

    Joined:
    Feb 26, 2020
    I'm starting my babys OTJ testing but I have questions. I know I test both AM and PM but how does food factor in? Do I do the test before he eats or after or does it not matter? I would be very appreciative if some one could give me detailed instructions when it comes to food timing and testing for the OTJ. I want to make sure I do it right.
     
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  2. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Which insulin are you using. It matters.
    I'll go hunt up the OTJ trial instructions.
     
  3. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Your cat needs to have been stepping down the dosing scale, from 1 to 0.75, to 0.5, to 0.25, to 0.1 and getting good numbers all along before you attempt an OTJ trial. Any blues at mid-cycle tell you your cat is not ready for an OTJ trial. A blue pre-shot tells you your cat is not ready for an OTJ trial.

    Your cat should have been getting green numbers across the board, at all testing times before you attempt an OTJ trial. For a week, all greens for a week.

    Cat needs to be steady in the greens before attempting an OTJ trial.

    OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)

    Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. Start the trial on the next green pre shot.

    If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

    1. Test at your normal AMPS and PMPS times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

    2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

    3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

    4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

    Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.
     
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  4. weetdog

    weetdog New Member

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    Feb 26, 2020
    He was on vetsulin but went to low and almost died (we were still waiting for the monitor to arrive) 4 days with no insulin he went to the vet and they said they think he's in remission and not to give him any more insulin. That was on the 13th. My meter finally came (chewy is behind on orders) so now we can do the OTJ test to confirm
     
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  5. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    If you could put some information in your signature, that would be immensely helpful to us.
    Takes about 60 seconds. (Took me longer to type out my response and copy a write up on how you do that.)

    Signature instructions.

    Sure would love you to take 60 seconds and put some helpful information in your User Id profile, including the "Signature" portion.

    Go to the top right corner of the screen, click on your user name, a drop down list will appear, select "Signature" from that list. Start typing in the text box that appears and be sure to click on the "Save Changes" button at the end of the text box.

    Information like your first name, your cat's name age and sex, DX: (diagnosis date), insulin used, meter used (when you get one), food fed, and then the SS (spreadsheet) link when you get that setup are so, so helpful to those of us responding to members. That signature information will be "magically" attached at the end of all your posts. Signature and other user profile information can be updated as needed.

    While you are there, editing your user profile, if you could update your profile to include your location, that is helpful also.

    p.s. Ignore that last sentence, since I see you already have your location in your profile.
     
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  6. weetdog

    weetdog New Member

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    Feb 26, 2020
    Ok I will do that but as I 1st asked ...... can I feed him before I test in the AM or should it be fasting
     
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  7. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Well, darn. Didn't realize you didn't know about not feeding a cat before the pre-shot test.
    No food for 2 hours before the pre-shot tests. Or no food for 2 hours before what are now your morning and evening blood glucose tests. Only the first tests of the 12 hour cycle need to be uninfluenced by food. The rest of the tests, feed as you normally would.

    Fasting, 2 hours before pre-shot tests.

    Kicked myself in the butt hard. I'll update the OTJ trial instructions to include that part.
     
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  8. weetdog

    weetdog New Member

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    Feb 26, 2020
    Thanks ..... I'm very new to this and the vet didn't give as much info as we'd have liked. I'm still trying to learn all the terms and abbreviations
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    We have a great way to track the BG (blood glucose) tests, and other things going on with your cat.
    That way is our standardized, color coded spreadsheet. The colors in the OTJ trial instructions don't make much sense of you've never seen our spreadsheet (SS).

    We have a template that you copy, so you don't have to start from scratch and "reinvent the wheel".
    FDMB Spreadsheet Instructions includes detailed steps on how to do the setup, with directions for PC, tablet, and smartphone. You do need a google account to set it up.

    What it all means is here.
    Understanding the Spreadsheet/Grid

    Anything you don't understand, please ask. There is a glossary of terms here if you think it would help. I try not to abbreviate too much, and if I do, I try to put the full words in brackets also.
     
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  10. weetdog

    weetdog New Member

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    Feb 26, 2020
    Thank you so much!!
     
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  11. weetdog

    weetdog New Member

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    Feb 26, 2020
    His PM test was 148. I think he was stressed though because we had to try 4 times to get the blood from his ear. The vet was also having trouble. This is of great concern for me and it's why I had asked my brother to come over and take it for or 1st time because he has been a diabetic for over 12years and is very familiar with using the tools to draw blood.
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Are you giving him a treat when you test?
     
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  13. weetdog

    weetdog New Member

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    Feb 26, 2020
    It's not that he won't let us take it. There is just a lack of blood.
     
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  14. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Are you warming the ear first with some rice in a sock?
    Also before you test try milking the ear up towards the tip to get blood moving up there?
    What size lancet are you using?
    When you first start out it is best to have a 26 or 28 gauge lancet as they are a bit bigger.

    As you keep testing, the body will produce some more capillaries in the ear and it will become much easier.
     
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  15. weetdog

    weetdog New Member

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    Feb 26, 2020
    I am using AlphaTrak 28 gauge lancets. I'm so new to all this and I had not heard of using rice in a sock. I don't eat rice so when I can get out to get some I will give it a try. I really like the idea of milking the ear towards the tip . That is a great tip..... it makes total sense!!! I will definitely do this in the morning when I test. About how long should I do it for?
     
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  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    The gauge size you have should be OK.
    With the rice in the sock....just put enough to fill the toe and microwave for a very short time...test it to see it isn't too hot.

    Just milk the eat 3 or 4 times to get the blood up there. You can even do it after the prick if no blood is showing up.
    Have you seen this link
    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
     
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  17. weetdog

    weetdog New Member

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    Feb 26, 2020
    No I have not seen that link so thank you. I'm sure the videos will be of great help. I'll post tomorrow about the results of milking his ear.
     
  18. Judy and Freckles

    Judy and Freckles Well-Known Member

    Joined:
    Oct 20, 2019
    You can also use a pill bottle or small bottle filled with warm water to warm his ear. Using the pill bottle will allow you to stay home and not go shopping for rice - during this crazy time in the world.
     
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  19. weetdog

    weetdog New Member

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    Feb 26, 2020
    Great idea because I wasn't sure when I'd be able to go to the store. Thanks a bunch
     
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  20. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    You can also use any other sort of grain or dry beans you might have on hand. It does not need to be rice. Dry lentils, barley, buckwheat, small dried beans. Think creatively for your "grain" to put in the rice sock.You are looking for something that will hold the heat, and can be safely microwaved over and over again.

    Have you seen this picture of where to poke?

    "Testing
    We all know the basics:
    • Warm the ear with a rice sock or a warm washcloth wrapped in a plastic bag.
    • Either freehand or use a lancing device; new members usually start with a larger gauge lancet such as 28g or 29g until the ear learns to bleed; then progress to a 31g or 33g which are finer.
    • Be sure to poke in the "sweet spot" and not the major vein that runs along the length of the ear. Poking the vein will not only hurt, but will result in a lot of blood. The sweet spot is on the edge of the ear.
    [​IMG]
    But did you also know there is a particular way for the lancet to be used? It has one side that is beveled so the sharpest part goes in first, if used correctly."

    It's buried within that Hometesting Links and Tips document,
    within Marje and Gracie's Testing and Shooting Tips

    The ears will "learn to bleed", meaning they will grow more capillaries in that sweet spot area and you will get better at doing the poke.
     
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  21. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    Hi, that's a pretty good number; the top of the normal range for Alphatrak.

    My current diabetic kitty was really hard to get blood from at first. It was like she had a turnip for a head, haha! So I do understand your frustration. She also hated her ears being touched, so we had a few challenges to work through. But we got there...
    With testing, THE most helpful thing is that the ear is warm. Warm ears bleed so much more easily. Many folks use a 'rice sock' (that has been referred to in the posts above) to warm the ear. It doesn't have to be made with rice, any smallish grain will do (there's probably 'something' in your store cupboard that might work). Edited to add: I actually wonder if these could be made with cat litter....? Hmmmm....

    The rice sock is made by filling the toe of a thin sock with rice (or other small grain), tying securely with thread or string, and cutting off some of the excess fabric. This can then be heated in the microwave until nicely warm, but not hot.
    Some people make theirs like little golf balls, quite firm; and these can even be held against the inside of the ear while pricking the outside. I made mine quite squishy, rather like a tiny bean bag, and so that it fits comfortably into the palm of my hand. Then before a test, I stroke my kitty with it (she likes the warmth) and stroke it over her head and down over one of her ears, just holding it there for a few seconds.

    I got both my diabetics used to the idea of testing by breaking it down into small steps and getting them to associate those with a reward. So, for example, at times when I wasn't trying to get a test, I'd go to wherever they were in the house, give them a little stroke, then hold or massage an ear for just a second or two, no more. Then I'd immediately give a treat and some praise, and just walk away. Similarly, I'd rattle the test strip vial, or click the lancing device near them (it can be used like a training clicker), then give a treat. I did these things maybe 6 or 7 times a day for a couple of weeks. It only takes a minute or two each time. But that repetition gets the cat to associate these new sensations and sounds with something positive.
    Before long my diabetic boy would come running when I rattled the test strip vial. And my newer girl goes to her favourite armchair (our testing spot) when she hears me set up the test kit.

    Both my kitties have gone into remission. But my girl had three OTJ trials before achieving that. That is actually quite unusual, and I hope that hasn't put you off! I just wanted you to know that if your kitty's OTJ trial doesn't work out there may well be other opportunities.

    BTW, here's a list of tips that I wrote out for someone else a while back. You 'may' find something useful here. But if you need more help, shout out! :bighug:

    - - -

    HOMETESTING TIPS & TRICKS

    1. WARM EARS. Probably THE most important thing. Warm ears bleed very much more easily than cold ones. You can warm an ear by massaging it, or by holding something warm against it; ie a pill bottle filled with warm water, or a ‘rice sock’ briefly warmed in the microwave.

    2. MASSAGING immediately below the ear prick, with finger and thumb, can ‘milk’ more blood out. I almost always do this, if only for a second or two.

    3. VASELINE. A teensy weensy smear of Vaseline on the outer edge of the ear will enable the blood to ‘bead up’ and stops it disappearing into the fur. This also makes it easier to see the blood droplet if the kitty has dark ears.

    4. RESISTANCE. The lancet needs something to ‘resist’ otherwise it can push the ear away rather than pricking it effectively. Some folks use a piece of cotton wool or folded tissue. I use one of my fingers, but sometimes do accidentally take a blood sample from myself that way.

    5. TWO EAR PRICKS close together can often produce enough blood for a test when one ear prick might not.

    6. SCOOPING THE BLOOD DROP ONTO YOUR FINGERNAIL. Doing this is a game-changer for some people. If you can get that drop of blood on your finger or thumb nail you can then let the kitty go and finish the test without her/him.

    7. TREATS. It is important to reward the kitty for each attempted test, whether the test was ‘successful’ or not. Cats very soon learn to associate tests with treats. And some will soon come running for their tests. A ‘treat’ is usually a food reward of some kind, but some folks reward their kitties with a cuddle or a grooming session. I actually crumble a few treats for my cat and test him while he’s hoovering up the crumbs.
    Remember to reward yourself too. Chocolate is good…

    8. GET COMFORTABLE. If you are physically comfortable you’ll be more relaxed, and also less likely to try to rush the process. Some people like to test their cats on a counter top or a desk, maybe next to a desk lamp. Some people prefer to hold their cats on their laps when they test. Some folks incorporate testing into a grooming session. You’ll find what works best for you. And once you get used to home testing you’ll quite possibly be able to do it anywhere, and maybe even while the kitty is asleep.

    9. RELAX. Cats pick up on our moods. The more relaxed and ‘matter of fact’ we are, the more relaxed and confident the kitty is likely to be. Some people chat or sing to their cats while they test him. Try it. It might help you too.

    10. PATIENCE. Be kind to yourself. You’re learning something new. (And you’re learning something wonderful!)
     
    Last edited: Mar 22, 2020
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  22. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    One addition to Elizabeth's tips.

    Some people test on the inside of the ears. Some people poke on the outside edge of the ear.

    If you have a black or dark eared tortoiseshell kitty, use a safety razor to shave a tiny patch on the outer edge of the ear. As you get better at the poking and testing, you can let the fur grow back. I found this invaluable for testing my long haired black eared kitty who also had gigantic amounts of "ear floof" on the inside of his ears. So I had to poke the outside of the ear to get a blood drop that would not be caught in that inside the ear fur.
     
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  23. weetdog

    weetdog New Member

    Joined:
    Feb 26, 2020
    So sorry I didn't respond sooner. I'm not sure why but I didn't get email notifications for any of yesyerdays replies. I still have not had success. Saturday I realized I could not do it by myself ..... lucky my parents house is right next door so we've made plans to have 1 of them help when I test. Sunday was frustrating ..... the needle was not doing a dang thing when I'd push the button (reloaded it about 7 times) so I tried it on my own finger and it didn't do anything to me either. Today we are going to try with just the needle itself. My cat has black ears and they are seriously hairy so that does cause and extra challenge. I will try the suggestions mentioned in the last 3 comments. Thank you all for helping me with the beginner tips and tricks ...... I'd be so lost if it was not for your advice.

    As far as his OTJ testing goes ..... I have to put a hold on it because my starter kit only came with 25 testing strips. I ordered from chewy and it took EXTRA time to arrive and that was before things in the world got so crazy so I want to wait until I get more strips so day 11 doesn't comes and Chewy still has not delivered my order and then I have to start at day 1 again. This will give me time to figure out how to become successful at testing him. I think once a day is better for him to get use to it until my order comes.

    Once again I appreciate all the advice I've been given. I know it might take a few more tries but thanks to your encouragement ..... I know I will eventual get the hang of it.
     
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  24. weetdog

    weetdog New Member

    Joined:
    Feb 26, 2020
    UPDATE!!!!!! At 8:30am we had success!!!! I just used the needle on the outside tip of his ear and got blood. I was so happy but what made me more happy was that his reading was 110!

    I do have a few questions ...... It's been mentioned to have a treat for him. What are the best types of treats for diabetic cats that aren't too expensive. He loves tuna from the can but we rarely give it to him ...... is a spoon full of that ok as a treat?
     
  25. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Welcome to the Vampire Club and your successful blood poking efforts!
    vampire smiley small.jpg
    Any kind of pure protein treat is fine. A tiny bit of tuna, say the size of a kernel or corn is about right. 1/4 to 1/2 a teaspoon of tuna or another pure protein treat is plenty. Cheese, fish, egg, cooked chicken, ground beef or pork or turkey, freeze dried treats from the pet store. A tiny bit of his favorite canned food. Even some luncheon meat or ham could be ok, but they do tend to be a bit salty.

    Treats can be non-food related also. Pats, brushing, praise, play time.
     
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  26. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Yay! Well done for getting that test. And what a lovely number! :woot:
    Keeping fingers and paws crossed for continued good numbers....
     
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  27. weetdog

    weetdog New Member

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    Feb 26, 2020
    Tested him tonight (I want to vary the times while I'm only doing once a day) and he was 95. I also gave him a little skinless chicken (cooked in crockpot) right after as his "treat". He ate it right out of my hand and was purring right away.
     
  28. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Great job! Another lovely number. And how wonderful that he was literally 'eating out of your hand', and purring! :D
     
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  29. weetdog

    weetdog New Member

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    Feb 26, 2020
    Chewy currently doesn't have the AlphaTRAK test strips in stock so I did not test yesterday. I tested this morning ..... had to poke him 3 times. He was a little fussy and was less than happy. He was 123 but I figure he was stressed after having to poke him 3 times.
     
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  30. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Stress can raise the BG numbers.
    Amazon, ADW Diabetes, other online human diabetes supply places may have the Alphatrak test strips in stock. Some of them carry pet diabetes supplies also.

    p.s. Your signature says Alphatex. Would you take a moment and correct that to say AlphaTrak?
    Thank you.
     
  31. weetdog

    weetdog New Member

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    Feb 26, 2020
    Sorry about that .... I changed the signature. I thought I checked amazon yesterday but thank you for letting me know that they do have them. I am ordering now.
     
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  32. weetdog

    weetdog New Member

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    Feb 26, 2020
    His numbers are up some. Friday 8:27pm he was 167 after not eating 2 hrs. Today at 12:15 pm he was 164 after not eating 4hrs. The vet did not tell us at what # we need to start giving him insulin again. If someone can tell me what they think about these last 2 # and if I need to do anything?
     
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  33. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    I'm sorry to say, but this looks like a failed OTJ trial to me. If your cat is feeling poorly, upset stomach, UTI, that could raise the numbers too. In any case, I think you need to restart with just the tiniest bit of insulin. No more than 0.5U. Maybe even a teeny tiny amount like 0.1U.

    Above 100-120 mg/dL on the Alphatrak indicates your cat needs insulin again.

    On an OTJ trial, you want the majority of the BG tests to be under 100, preferably under 80 for a successful OTJ trial.

    Sure would help if you had a spreadsheet (SS) setup and linked into your signature.
    There is a template you copy, so you don't have to invent your own version. Detailed instructions include setup on a pc, tablet, or smartphone.
    FDMB Spreadsheet Instructions

    What it means is here in this link: Understanding the Spreadsheet/Grid

    Would you please do that Spreadsheet setup? It would be greatly appreciated. Thanks.
     
  34. weetdog

    weetdog New Member

    Joined:
    Feb 26, 2020
    Like I said on Monday I was not doing the OTJ trial because I didn't have enough test strips so I've only been testing once a day and not twice. I just gave him an injection ...... only a small amt as you suggested. When should I test again or should I keep the same schedule?

    I will try to do the spreadsheet soon. It's a crazy time right now and I have not had time to sit and learn the program but I will try to do it soon.
     
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  35. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yes, it is an absolute crazy and overwhelmingly busy time.

    How much insulin did you give?

    The spreadsheet is a simply grid. All you need to do is set it up, and then enter the numbers into the cells on the spreadsheet. There is no "Program" to learn.

    Let me tag the 2 people that are able to set up spreadsheets for folks. Neither of them are signed on at the moment, but hopefully they will see the tag.
    @Chris & China (GA)
    @Marje and Gracie
    Spreadsheet setup help desperately needed for @weetdog.
     
  36. weetdog

    weetdog New Member

    Joined:
    Feb 26, 2020
    Sunday he was 136 at 7:45am and today (tuesday) he was 130 at 6:00pm.
    Spoke with the vet yesterday and they said his numbers have been in an acceptable range and they do not think he needs any insulin shots. Even the days that he was back to back 167 and 164. Their responce left me confused and frustrated.
     
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  37. Deb & Wink

    Deb & Wink Well-Known Member

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    Jan 31, 2013
    Alphatrak pet meters do read a bit higher than human meters. At lower BG numbers, they are closer together.

    Many vets do not like to see their clients dose insulin if the BG numbers are below renal threshold (180-250 depending on your literature source.) Too much legal liability, if something happens to your cat.

    But here, we like to know that your cat is going to have a strong remission, so we like to see those BG numbers below <100 md/dL (5.5 mmol/L) for an OTJ trial.

    It's also why we like for people to reduce the dose gradually, when the BG testing justifies the reductions. Going from 1U to 0.75U to 0.5U to 0.25U to 0.1U dose, eases the workload on the pancreas and helps to support the healing a bit longer.

    Not every cat is "cooperative" with that approach. Wink certainly wasn't. He crashed down the dosing scale, like tumbling down a steep set of stairs. Of course, it didn't help that the vets and shelter staff were trying to dose according to the pre-shot numbers, with a fixed scale. Wink would not have survived, if I had adhered to their insistent demands.
     
  38. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Sometimes, the change to a lower carb food, like the Friskies pates, is enough to get those BG levels down.

    Keeping all paws crossed for Woody, and a successful OTJ trial.
     

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