Values confusing - need help

Hi Lifesavers
Purrcee's values are driving me crazy because I don't feel comfortable giving insulin. I call the vet and they are not sure either since it's so close to being dangerous to give it.
Today his AMPS was 186. He was originally on 1 unit 2x/day. Yesterday vet lowered it to 1/2 unit 2x/per day. His last 1/2 unit was last night at 7:30 p.m. Yesterday I retested in 2 hours and it was 457! Today I'm waiting 4 hours. I don't want to give insulin until tonight at 7:3 to keep on schedule but is this the right thing to do?? Is it too dangerous to wait?

Thanks

 

Can you post all your BG with when in relation to shooting they were given and the dose given. It is not clear if you gave a dose this morning. It is also not clear what dose is associated with the 457 and what the preshoot was.

 

High BG readings can look scary, but they are not immediately dangerous. It can take a few days to settle into a regular cycle.
Too low is more of a concern.
I don't give a shot if Chester's BG is under 200. Better that he be too high for a day than too low for an hour.

 

Hi Larry
I'm still new at this so I hope I answered your questions. If not please let me know.

Yesterday 6/5
1st Test 6:30am Value 206 no dose given Fed 7 am
Retest 9:07 am Value 268. dose given .5 unit
Retest 4 pm 457. no dose too soon. Ate 7:20 pm shot 7:30. This day seems like a mess since I didn't wait a full 12 hours and had to check his sugar at a weird time and then it was so much higher than am.

Today 6/6
Test 7am
Value 186
No dose given
retesting in a minute

 

6/6
Just retested
11:30am.
Forgot to mention he ate at 7:15 am
Value 286
went up 100 in 4.5 hours

I want to wait until this evening 6:30 to 7:00 to test/feed/shoot. Do you think that is okay?

Thanks.

 

Yes, it's OK to wait till then. The goal is to get a number that allows you to shoot every 12 hours, so if you want to stay on that 7am - 7pm schedule, go with waiting till then.

And for now, I'd say go with the .5u dose that your vet advised. With Lantus, it is best to stick with a consistent dose for several cycles and to try to test around midway between shots (nadir) so you can see how the dose does. It's the nadir value that the dose is determined by, rather than the preshot tests.

At first, people are encouraged to not give a shot when the preshot number is below 200. At least until you have collected enough data to show that it is safe to give shots on lower numbers. Eventually, you will be able to give insulin on lower numbers. But for now, when it doubt, always ask if you aren't sure. And if an answer isn't posted before "decision time" err on the side of caution. Skipping the shot is not a bad choice if you aren't sure.

 

"Better too high for a day than too low for a minute".

What would be really useful is to create our standard format spreadsheet and link it into your signature. That way, we have a better idea of what is going on and if you should get some tests at different times. We can also see how the numbers change and flow on the spreadsheet. We can see bounces, and when you have changed the doses. It really does help us to help you better.

Here are the instructions from over in the Tech Support forum on how to set up a spreadsheet and link it into your signature. http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 If you have problems with the setup or the link to your signature, let us know. There are people that help with that.

We normally tell people to stay with the same insulin dose of Lantus for 6 cycles or 3 days at a minimum. It takes time to build up or drain down the insulin depot and for a cat to settle into a dose.

We like to see at least 4 tests a day.
1. pre shot AMPS is your morning pre-shot test. PMPS is your evening pre-shot test. Always take these pre-shot readings to make sure the BG (blood glucose) number is high enough.
2. mid day test. Somewhere in the +5 to +7 timeframe (The + hours are the number of hours since you gave a shot)
3. a before bed test. To see which direction the BG's are headed. Many cats drop lower overnight.

For now, your shoot/no shoot decision number is 200. If below 200 do not shoot. There are some delaying tactics that can be used to see if the BG is rising or falling. These may enable you to shoot but you need to withhold food and insulin, post here for advice, retest in 30 minutes.

Later as you gain more data on how your cat is doing, that number will drop. In fact, over on the Lantus TR ISG, the shoot/no shoot number is 150.

 

I have been using the spreadsheet and I think it is now linked to my signature. Not clear how to use it if the shoot cycle is 24 hours versus 12 hours? The +5, etc doesn't seem to fit my cat. For example:
6/5 no am shot; pm shot 7:30
6/6 no am shot; pm shot 7:10
24 hour difference
Not sure where to put the tests during the day since no shot give. I have just been putting that info in the notes section.

 

You can just put the numbers in the columns after the skipped shot, like +3, +5 or however many hours after you "would have" given it. As long as you put a zero or "skipped" in the column where the dose normally goes, we'll be able to figure out how many hours it has been since his last shot.
For instance, if you checked six hours after the skipped shot, you'd put that reading in the +6 column, but you would know it's actually +18 hours since the last shot.

Make sense?

 

I can't access your spreadsheet. The share options are probably not correct.

 

You're right the share option wasn't changed...it is now.

I will change my spreadsheet to put in all the tests like Carl suggested.

Thanks!!

 

Can I suggest a few edits to your SS?

I would do this
for June 4 in the PMPS + 11 - enter 206

for june 5
in the AMPS enter 268 and enter dose 0.5IU
at AMPS +7 enter 457
for PMPS - leave blank since you didnt get a test - enter dose 0.5IU

6/6
At AMPS +4 enter 286 - you got a test at 4.5 you forgot to add

Make sense?

Wendy

 

Wendy....sorry I don't understand the changes you suggested?

 

Ok how about I use cell numbers instead - the letter is the column and the number is the row. So for example todays AMPS is in cell B19 right?


June 4 cell AA16 enter 206

for june 5
cell B17 enter 268
cell C17 enter 0.5
cell J17 enter 457
cell O17 leave blank
cell P17 enter 0.5

June 6
G18 enter 286

Make sense?

 

Sorry...doesn't make sense to me.
June 4 206 was reading for June 5 AMPS

June 5 - AMPS was 206 not 268
no shot was given that morning so I don't understand why C17 would have .05 in it.

I know I'm missing something here but the brain isn't kicking in.

 

Don't worry about it.. I just thought you gave 0.5 on June 5th?

 

I did 2 hours after - it's just me not getting how to do it. I just did his PMPS and it was 241 so I will be shooting .5 after dinner in a few minutes. I will add it to the spreadsheet and I'm assuming I put it in the +11 column since it has been almost 12 hours since last shot.
Thanks for your help.

 

Sorry I have confused you. My point was you put the preshot blood level in the preshot column... No matter the time. So since on the 5th you gave a shot when she was 268 then you would use that in the preshot column.

For tonite, you measured 241 and are shooting now right? If so then the 241 goes in the pm preshot column PMPS.


Wendy

 

I think my confusion is where to put the PMPS value. Do i put it twice...once 12 hours from last shot (N19) and then again in the PMPS column?

 

Its two preshot tests a day because you test twice a day and shoot twice a day...

In the morning you put the am preshot value in the amps column. Then 12hours later, when you do your p.m. Preshot test you put it in the PMPS column.

So this morning preshot reading 281 is in b19 (correct!) and tonites preshot level (241) goes in 019.



Wendy

Ps The only reason I asked you to use +11 was for that reading you took on the 5th but didnt actually shoot for 2 more hours. Since you shot two hours later and got a test at that time , that's the reading you would put in PMPS. S then what do you do with the earlier reading? That's where I suggested +11.

 

Can you get a midcycle test (between +5-+7) and a before bed test? you want to see trends and how low she is going.. that way we can see if a dose change is needed..

 

With my schedule it's hard to get a midcycle test after the am shot. Purrcee is hard to handle alone and trying to get good readings for am/pm is more than challenging. I free fed canned food so not sure if that makes a difference. After pm shot I feed all the cats again before bed since I can't free feed dry anymore. I will try to get another test before bed.

 

Free feeding low carb canned is fine.. It's what I do.

A before bed test would be great

Wendy

 

Julie,

Understood. Most of us that work full time can't get that am mid-cycle. Weekends. Or other random tests.

I'm with Wendy on getting a before bed test at a minimum. We need to fill in some of these empty spaces on the SS, especially at nadir times.

I took a look at Purrcee's SS today. It's hard to tell if a dose change is needed without those mid-cycle tests. Since you work during the day, the only way to get a mid-cycle test would be to set the alarm and get one at night. We all hate to do this, but it's important.

Lantus dosing changes are based on the nadir, not the pre-shot tests. Right now, we don't know when Purrcee's nadir is. Most cats nadir around +5- +7 but ECID. My Wink nadired around +4. Without those nadir tests, it's impossible to know if this dose should be increased or decreased. My gut is telling me which direction, but I can't know for sure.

You only started the Lantus on 6/3, reduced the dose from 1U to 0.5U already, had to skip another shot on 6/6 am because the number was under 200. Low yellows to high reds on 6/5. Then the numbers are up to some higher pinks from pre-shot to pre-shot the last two days. These are all indications that Purrcee is dropping really low mid-cycle and bouncing back up. No way to really tell without more test data.

We'd love to help you more, but need that data. Please?

 

Purrcee is very difficult to get blood and I have to manhandle him which I don't like. Tried hot water and vaseline. Vaseline is a mess and not worth it since it gets everywhere and I can't hold on to his ear. It took me 5 times to get the 11:30 test and his ears are bruised. Not sure why the midcycle is not colored coded on the chart?

 

I color coded it manually for now?

 

Sorry to hear that Purrcee is fighting the testing. Are you giving him a treat before and after? Something pure protein so he looks forward to the test?

Have you read this write-up on making your cat more accepting of the process, written by member Kpassa. https://sites.google.com/site/michelangeloprofilefdmb/feline-diabetes/ear-testing-psychology

 

Whoa - check the dose entry on your spreadsheet for today and confirm - did you really mean 5.0 units instead of 0.5 units?

The 5.0 is a typo!

There's a small roller paintbrush icon which can be used to copy the conditional format from a cell where it is working to a cell where it is not. Place your cursor on a cell that is color-coded correctly. Click the icon. Click the cell that isn't working. That should do it, I think.

If you can't test easily right now, and you've been skipping shots due to low numbers, I would suggest dropping to 0.25 units. This will keep your cat somewaht safe until you can test more easily.

Some folks burrito wrap the cat to gently restrain while testing. It helps to do this in a half bathroom with the door closed so there is no where to go and hide. Place the towel on the floor. Put the cat in the center, towards the edge. Now wrap each side of the towel around your cat until secure. One kitty burrito, to go.

I find that straddling the cat in a bigger space and using my thighs for a bit of pressure may help with restraint, but wear jeans in case the claws are out.

Check my signature link Secondary Monitoring Tools for tips on urine testing, and test for ketones and glucose. This too, will assist in monitoring the diabetes.

 

Hi Julie,

I just went in and fixed your chart.

All of you smart computer people out there....

It seems as if when the chart is first set up, only the first 20 rows have the conditional formatting rules applied. Many people are not Google Doc savvy enough to know how to apply the formatting to the rest of the chart.

Tell me if there is an easier way than what I do:

1) Scroll to the bottom and add ~200 rows.

2) Control C (copy) a cell in one of the first (formatted) rows.

3) Highlight the AMPS column....scroll all the way down.... and PASTE SPECIAL > PASTE CONDITIONAL FORMATTING ONLY

4) Highlight the AM +1 - +11 cells....scroll all the way down.... and PASTE SPECIAL > PASTE CONDITIONAL FORMATTING ONLY

5) Repeat for the PM cycle.

Is there an easier...faster....way to do this?

 

That was a typo...I am having trouble with the spreadsheet. It won't let me fix it? In fact now I can't type anything in the cells; I have no idea how to fix it...I'm open to suggestions if someone can guide me.
thanks.

 

Do not click on the link in your signature. That is a read-only view.

See if this will work:
Go to http://docs.google.com
Log in, if necessary.
Open your spreadsheet.
Now, it should let you edit it.

 

I haven't used the link in my signature. I stay logged in and haven't changed anything. I tried logging in to google and that didn't go anywhere either. I just tried logging in where I bookmarked the spreadsheet and it's still now letting me edit so it's read only which doesn't make sense.

 

Weird.. I can see it though! Is it still not letting you edit it?

 

Got into the google website and it's working...now I can't remember which password I used!!! I am totally stressed out with Purrcee's diabetes and ready to give up. Some one suggested I lower his to .25 but I can't even get a read on that from the syringe. I don't understand why going lower than .5. What is considered a somewhat safe number????

 

That was me. You've been having trouble testing, the glucose levels you had weren't really high, youv were skipping shots due to low preshots, and keeping a small dose of 0.25 going was likely to be safe for your cat and shootable twice a day, even if you didn't get a glucose test accomplished.

 

I hate having to have a ton of passwords so I have an excel SS with them all in.. although its probably not the safest

Try not to be stressed! you are doing a great job with Purcee! Just remember to take time for yourself... she is slowly getting better with your help - you dont need to worry as much!

Looking at her numbers , you dont need to decrease the dose though. And you look like you are getting better at testing?

 

my google chart still is not color coding so I did it manually. Is there a way to start a new chart and copy the program so it doesn't happen again.
Thanks for the support. I'm usually a fighter on things but I have a lot of animals in my home and some also require medication. My dog is to have surgery (struvite stones for the 2nd time), parents are in their mid 80s, I run a nonprofit for cats with my sister, so I know it's whining but there is only so much a person can handle. Purrcee was a total surprise and just went in for his usual physical. Time for myself hasn't been happening for years. No one's fault but my own.

I have a excel spreadsheet with my passwords too but forgot to right down the one for the google chart of all things. Then when I finally got in I forgot and then the stupid chart still won't color code but I can at least plug in the numbers.

You all have a great week!

 

Lol I hope your parents don't find out you lumped them in the "lots of animals in my home" sentence

You can copy and paste formatting from a cell that does work, to one or a range of cells that don't..you click on a cell with the colour, then click the paint roller icon, then click and drag to select the cells that are missing the colour..

 

Julie - did you read my post above? The color coding works fine for me - since I fixed it a few hours ago.

 

When I had to re-log in it wouldn't work. If you insert numbers now it won't color code it...this is the link I'm using
https://docs.google.com/spreadsheet/ccc ... XNHc#gid=0

 

Using that link....it works perfectly fine for me.

 

This morning I tried it and it worked then I went back to put the real numbers in and it didn't work. It seems I have to completely log out each time and log back in which wasn't happening before. Weird!

 

Gremlins!!!!

Any chance of a before bed test? I am thinking she might need a dose increase soon but I want to be sure first she isn't dropping low at night, like many cats do...

 

how many hours after PM shot would work...PM shot was just now at 7:40...thanks for your help.

 

Three would be great as it gives the lantus time to kick in and give you an idea of Purcees' nighttime plans

Wendy

 

okay will try to get it done. I didn't know that it took about that long for Lantus to kick in. There's a lot I don't know! Thanks again!

 

This is a typical lantus curve below. A good guide although every cat is different..

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

 

Thanks for the curve chart - very helpful. Purrcee actually went up a bit at +3. My vet wants to keep him at .5 for 2 weeks but I don't know if she is following his stats on here. I sent her the link so will need to check on that.

 

Purrcee high this morning 409

 

Meters vary by as much as 20% so 282 and 298 are pretty much the same...

 

i was more worried about the 409 number; just gave shot will try to get +3 before I leave. If I'm home at +6 I will get a sample to see how low he really goes. I have a call into the vet as well. Maybe increase to .1. Don't know how to do .75 on the syringe which would be where I would really like to go if I need to increase dose. I have .3ml syringes....not sure if they come any smaller.

Good to know about the meters varying up to 20%...seems like in the 21st century they could get perfect accuracy :smile:

 

Is there any way to get the most recent posts on top. I have tried hitting the ascending/descending button but I must be doing some wrong?

 

Go to the User Control Panel, click the Board Preferences tab, click Edit Display Options, change Display Post Order Direction to descending, click submit to save the change.
Syringes do not come any smaller than the ones you have. They do come with 1/2 unit markings on the barrel. I can provide a picture of a syringe with 0.75U if I can find it.

 

Got +3 318 wont be home for +6

 

+8 going up 397
wish I would have been home for +6
sometimes giving .5 makes me doubt I'm giving anything but I fill the syringe with more than needed so I can make sure there is insulin in it.

Thanks for the info on how to change to descending

 

After selecting the order, click the GO button.
Only sorts it for 1 post, I think.
The control panel option is permanent until you change it again.

You can also click first unread post to get to that part of the thread.

 

+6 322.....
.5 doesn't seem to be doing the job
at what point do you decide on an increase?

Thanks.

 

We hold a dose for 6 cycles or 3 days minimum with Lantus. Looks to me from looking at your SS, that Purrcee could use a bit of a dose increase.

I would only raise the dose from 0.5U to 0.75U if this were my cat.

Try to get a +5 , +6 ,+7 BG numbers during the next day or two. That is the usual nadir. Let's see if we can find when Purrcee's is.

When you get a chance, would you please create a profile for Purrcee over in Google docs, like you did for your spreadsheet. Directions here: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=79123

 

Vet said to increase to .1 (not sure if that's because it's hard to figure out .75 on the syringe). I was going to start tonight. I don't want to overdo it but not sure how to consistently do .75.
Will set up profile sometime soon.

 

+5 215
wont be home for +6....maybe +7

 

Ok, +7 would be good.

Looks like a typo and you meant 1.0U , not 0.1U?

What have you decided to increase the dose to?

If you place the little black disc at the end of the plunger, so it is just below the 1U line, you will have 0.75U.

 

I don't know how to do .75 so 1.0 tonight

 

+7 176 which is lowest in a long time and I think I really shot just a little over .5 last night and this am.

Do you think I should just try to shoot just a little over .5 and hope I hit it around .75 or go to a full l.0?

Advice appreciated.

Thanks.

 

Oops just noticed your note about the plunger. Did you mean just above the 1.0 line rather than just below??

 

Here is a picture of a syringe with the plunger at the 0.25unit mark on a syringe with 1/2 unit markings. Click on the photo for a larger image.



The needle end is the top of the syringe. The top of the plunger is the part closest to the top of the needle. It's the part with the little round disc that pushes the insulin out.

The disc has a certain thickness to it. About 0.25U worth of thickness.
The lines on the syringe have a certain thickness to them. About 0.25U.
Think of the top of the disc as the part closest to the needle.
Think of the bottom of the disc as being towards the handle of the plunger.
Think of the top of a line being towards the needle end of the syringe.
Think of the bottom of a line being towards the handle of the plunger.

You want to have the bottom of the plunger disc at the top of the 1U line. That will be 0.75U.

 

Thanks for the help. I gave it my best shot so to speak.

 

Do the best you can. Try to be consistent. That can be more important than if it's 0.7 or 0.75 or 0.85. The hardcore members use calipers for measuring out the dose. Not necessary at this point in time.

 

Paws crossed the new dose works better! It might take a few days for the depot to build up to see the effect and of course Purcee has to clear the current bounce off of the recent blue..

 

+5 was disappointing but hopefully it will be better in a couple of days.

 

I suspect he is bouncing off that blue yesterday. He is kinda flat right now. We will see where he is at PMPS to see ifit starts to clear. Then a before bed test too or mid night cycle test in case he decides to drop overnight..

 

Purrcee has a profile now but it won't let me include it in my signature because my signature is too long with it. I don't understand the instructions on how to make a "word link". Here's the link:

https://docs.google.com/document/d/1p_s69fpWdMGptSRTe381odVzfz9lVwQnir-mssHzFbE/pub

 

There is a character limit in your signature so maybe edit your signature like this and note what I did with the URLs especially in red.

Julie & Purrcee
ReliOn Confirm + Lantus
DX: May 23 '13
Feed: Various canned LC

then for the URLS see what I did in red - you can probably copy and paste?

 

i copied the url you provided so let's see what happened.

 

It worked great! Can you do the same for his profile? I just don't understand the instructions to make it look right. Thanks so much for your help.

 

No worries

Here you go..

 

Perfect....thanks!

 

Fantastic!

Now, That you are set up i am thinking If you don't see him come down by end tomorrow you might need a dose increase. He might be clearing that bounce soon though I hope.. Maybe even today so a mid cycle test would be good.

However I would propose you start posting on the tight regulation board since you are now more experienced. That board has a great sense of community and I feel it could really help you in terms of dosing since there are many very experienced dosing members on there. I am on there every day myself. http://felinediabetes.com/FDMB/viewforum.php?f=9

You are welcome to continue to post here, I just think that they might be able to help you more over there.

Heres how to post
Every day ( or as often as you can) you open a new thread/post. We call them "condos"
- The subject has the date/cats name and BG readings ie 06/14 Purcee AMPS 339 +5 328 etc You add a ? icon if you have a question and maybe even a few words of the question in the subject too. You can update your subject as you get a reading, or whenever.

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

For your first post put "newbie" also in your subject so everyone can welcome you!


Wendy

 

Midcycle 1 am 206...lowest since 6/6/13
Do you think I should increase dose to 1.0 or give it another day?

 

Does anyone have a recommendation on syringes? I'm using 30G 5/16" from Walgreens but I paid $35.88 for 100

Saw these on line at American Diabetes. I would rather have 31G
http://www.americandiabeteswholesale.co ... 278_88.htm

Thanks!

 

Hold it another day.

I get 30G 5/16" box of 100 Relion from Walmart for about $12.56

Some people don't like the BD syringes because they always get bubbles that seem hard to get out and make consistent dosing difficult. Some people love the Terumo syringes but you need to watch yourself with the plunger because it moves real easy with a slight touch and you can end up squirting the insulin out before you inject.

 

Holding another day but unfortunately not great progress this am.
Thanks for the advice on syringes too.
I like the ones at Walgreens but they are so expensive! Kind of wish I would have bought a more common glucometer because I have to get all supplies at Walmart and would rather have some options on buying. I'm at Target a lot!

 

Looks like he may be bouncing a bit from that overnight low.