Vet will never understand all this. VET UPDATE

Last time I went to vet I had an inch thick pile of papers printed off the internet and he said I was going to drive myself crazy. He may be right. However, I did get my Lantus prescription (and one for PZI) and that was all that mattered.

I was merrily going along for 2 months with my trusty Freestyle Lite meter until 2 days ago and now I have 3 meters (4 actually) and trying to get readings on all of them from the same tiny speck of blood.

Very discouraged. Here is what happened though it is hard to explain.

In addition to FSL meter I have a Nova Max for ketones. After several errors, 2 days ago got my first ketone reading that said 3 to 4 (!!!!) but the urine strips said no ketones or maybe a trace. BG on FSL meter was 277 so decided to test with the Nova Max and it said 345! I ran to Walmart and got a Relion and it said 405!!! From these high readings I thought maybe the ketone reading was correct, tried Nova Max again and got an error so rushed Pinky to vet as they stay open late on Wed. But they were closed. Feeling very panicky.

Came home tested ketones again and it was .1 (point 1) (whew) Think that is accurate as it matches urine strips.

But there is 100 points difference between the meters. All those yellows I was getting with FSL were really pinks and reds.
I found something on internet where he mentions that his FSL meter reads 70 points lower than others.

Both Relion and Nova Max are reading super high compared to FSL.

Anybody else use FreeStyle Lite meter?

My DH says go to vet tomorrow and see what he says. Vet knows nothing about Lantus but I have to tell him I give 5 u twice a day and the numbers are lousy. nailbite_smile Sigh. Would you go to vet now ? Should I ask him to test for other problems? With the FSL meter I thought I was finally hitting a dose (5u +) that was going to make a difference and now I don't know what to think. Tonights Pre shot #s FSL meter 233 / Walmart Relion 340.
Elaine and Pinky

 

Re: Vet will never understand all this.

i use a freedom freestyle lite and love it. if you're questioning the accuracy of a meter, you can contact the manufacturer and have a control solution sent to you (for the freestyle lite it's free, i think) and you can check the accuracy yourself. there is a phone number in your box if you still have it. if you want me to look it up (i have mine) just send me a pm.

yes, i think you would make yourself crazy switching back and forth between meters. i'd get the control solution, check out a meter and if it's working right stop using multiple meters. that would make anyone crazy! the cats are already trying to accomplish that so you don't want to give them any help! :lol:

 

Re: Vet will never understand all this.

I can't address the FSL since I use a different meter. The newest Consumer Reports gave it a good rating. Personally, I would suggest that you pick a meter and stick with it. Moving between meters will make you a little crazy. The Nova Max did not get a particularly great review by Consumer Reports.

Urine ketone strips are calibrated differently than blood ketone meters. You get a much more fine grained reading from the meter. However, if you are showing trace on the strips, the meter should be within the same range. Chances are you got a bad reading initially.

 

Re: Vet will never understand all this.

elaine, just looking over pinky's spreadsheet - there is a 99 this morning. if she really got down to 99 you could expect a bounce from that and high numbers for up to 72 hours or so afterwards. anytime a cat gets into lower numbers than they are used to they could bounce from it.

do you feel confident the lantus is ok? i see it's not that old - and i'm just exploring ideas here, so don't be offended. can you look at this sticky and see if everything is happening ok with it? Care of Lantus

i understand why you're frustrated. hang in there and maybe we can help untangle the issue or offer some ideas to explore.

 

Re: Vet will never understand all this.

The best and easiest advice I can give you is to PICK 1 METER and stick with it. You'll drive yourself crazy comparing results from different meters. They are all considered accurate with up to a 20% variance in readings. I seem to remember someone testing with different meters and finding the higher the BG the more the results varied.

For what its worth - I've checked by cat's BG before heading to the vet before and they've gotten similar readings to my meter which is a Freestyle Lite. I've compared it to a Relion and gotten results within 10pts of the Freestyle Lite.

 

Re: Vet will never understand all this.

Thanks for replies,

Believe me I wouldn't have all these meters without that high ketone reading.

I was perfectly happy with Freestyle Lite --never gives an error and takes hardly any blood at all.

I realize you have to stick with one meter but these readings are 100 or more points off. So I am throughly confused.
If one meter says 200 and the other 320 that is quite a difference. I just can't choose one and stick with it as those numbers would be handled differently when looking at BG targets.

I think you are right about getting a control solution and double checking accuracy. And I wonder about the Lantus all the time. I don't even finish 1 pen before switching as I am disappointed with the numbers and progress. Even more so if I think my 'low' yellow numbers gotten over the last 2 months weren't even accurate. ohmygod_smile

I can take her to the vet tomorrow though I dread that for some reason. I guess because I wanted these wonderful results to report to him since I was the one that wanted the Lantus. Based on his BG reading I will choose a meter. I hope it is the Freestyle Lite one too. I really did like that one . Thanks again for all your insights. Elaine and Pinky

 

Re: Vet will never understand all this.

We use a Relion Micro and love it.
We have a Nova Max, and detest it...
it gave a positive reading for ketones when I tested it on myself, and I am so far from diabetic it's ridiculous.

the relion read lower than the others we tried, and I decided that was safer than one that read higher than actual...
but that was just a personal preference.

I can only say what others have said...
pick one and stick with it

I will say that Lantus has worked fabulously for Binks...
he was OTJ for 5 months, and after returning for 2 months, we're doing an OTJ trial again.


hang in there...
and best of luck to you!

 

Re: Vet will never understand all this.

Here is what I found that added to my concern:

http://petswithdiabetes.yuku.com/topic/7017

I will pick just one. I am not fond of testing with one meter much less 3. :smile:

(PS Nova Max does stink. Can't stand that meter. Prefer Freestyle over Relion. I just have to make sure the numbers are reasonably accurate.)

 

Re: Vet will never understand all this.

elaine, try not to be discouraged yet. it can take a while for a cat to get regulated and pinky only got diagnosed 2 months ago. you haven't hit the magic dose yet, but it doesn't mean that you won't.

if you are caring for the lantus like it needs, not putting anything back into the pen (ie, don't move the lantus in and out of the syringe/pen) and refrigerating it, it probably isn't the problem.

forgive me for not remembering if people have gone over this with you, but is there any possibility pinky has some kind of infection? has she had a dental? did she have lab work done when she was diagnosed and was there anything out of normal parameters?

are you getting labs done tomorrow?

and for what it's worth, i think you made a good choice to go to lantus. i've read a number of articles (and will look to see if i can pull up the one i'm thinking of - i think sienne gave it to me) that say lantus is the best for diabetic cats. i don't think levemir has been included in the articles - it's even newer. but compared to the older insulins, there is no doubt that lantus is better for pinky. i think you probably need to just be patient while you're looking for that just right dose - it will arrive and then you'll see results that you're hoping for.

 

Re: Vet will never understand all this.

Julie, thanks so much for reminding me about the dental aspect.

I would have completely forgotten that tomorrow. I will have him check her teeth.

She had complete blood work done 2 months ago when diagnosed.

I did read that article about "Problem Cats' needing 5 to 6 u so I guess I need to hang in there.

Thanks for encouragement.

 

Re: Vet will never understand all this.

i wouldn't worry about that old yuku post - for one thing it's a year old. i'd put more weight on the consumer report comparisons of meters which show the Freestyle lite is fine.

also, what amanda said i've heard as well - the meters seem to vary more at higher numbers and be more similar in numbers in the lower range. the lower range is what matters most - we don't want our cats to go too low.

i think you'll feel better if you order the control solution and check out your meter.

 

Re: Vet will never understand all this.

i so understand, believe me! it's hard to not get results when you're trying so hard to do everything right. really - been there!!!!

i've heard MANY people say that a dental cleaning dropped their cat's dose dramatically. any inflammation at all can put their numbers into high ranges.

in the labs that were done 2 months ago, were there any numbers not in the normal range? if you don't have a copy of those labs, get a copy tomorrow for your files. you'll want that for the future.

 

Re: Vet will never understand all this.




there ya go - based upon these, along with the Roomp/Rand Protocol, you are following the best possible course for Pinky and you have documents to back you up. just remember that pinky is yours - your vet doesn't have to understand as long as he/she doesn't hinder you. go armed with documents, ask for copies of those previous labs, ask about any signs of inflammation or indicators that pinky might have infection or need a dental.

good luck! you're doing fine - many illnesses take time to learn and manage and you're doing all the right stuff.

 

Re: Vet will never understand all this.

Thanks Julie.

I thought I dug up every internet research report there was but I haven't seen either one of those. Looking forward to reading them.

 

Re: Vet will never understand all this.

I've been collecting them - of course i'm specifically interested in acromegaly, but have gathered all that i see about feline diabetes as well. you never know when you need some random information.

i don't know if this one would be helpful, but i'll pass it on because it does talk about conditions that might cause a cat to not respond to insulin.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&Category=8391&PID=56172&O=Generic
Feline Diabetes Mellitus: How Relevant are Acromegaly, Hyperadrenocorticism and Pancreatitis as Underlying Disorders?

 

Re: Vet will never understand all this.

I've done tons of research on meters and have done lots of testing on myself with 3 different meters. I am a type 1 diabetic and have the Freestyle Freedom Lite, the Precision X-tra and One touch Ultra. The ONe Touch ultras and Precision are both calibrated for plasma values so they read higher than the Freestyke freedon Lite. and Freedom Lite, a smaller meter that uses the same strips as the FS Freedom. The FS deals with whole Blood values which is what the protocol is based on. I also saw my endo a couple of weeks ago and he is totally on board with the Freestyle Lite. My comparisons did show numbers to be similar at lower ranges and then the higher the numbers, the higher the variance. Freestyle is made by abbott labs so it is a company that has been around for a long time. I decided to stick with that meter for myself and for morgaine and have had good results lately. Morgaine took a while to regulate even though her numbers were not ever very high. She is on a relatively high dose for a kitty who was not much higher than 200. Look at her SS.

Another point I would make regarding the FS. I have an hbA1c done every 6 months. It measures 3 month glucose control. I started using the FS in Jan. 2011. My hbA1c for the following 3 month period was comparable to what it was using the Precision so that tells me that my FS meter is doing its job by giving me numbers that allow me to maintain excellent regulation.

I don't have time right now cuz it is late and i have to wash my hair and get some rest but I will try to check back with you this weekend. I would choose one meter and not the one that doesn't get a good rating on consumer reports.

If you search my posts you will find much of the info I shared previously. I will try to compile it for you when time permits if you don't find it yourself.

To sum up, Freestyle is a good meter and does read lower than those that are calibrated for plasma values. The variance at numbers below 200 is not that great.

 

Re: Vet will never understand all this.

The accuracy of meters is a percentage, so that means at higher levels, it is naturally going to be a bigger range.

100 -20% = 80
100 +20% = 120

300 -20% = 240
300 +20% = 360

So while it is frustrating - realize that the difference between a 240 and 360 is not a big deal. BG is high. OK. Pinky doesn't care about the number - just health -- feeling good? feeling bad?

If you are up to 5u BID, I would recommend getting the IGF-1 and IAA tests done (acromegaly and insulin auto-antibodies). A diagnosis, while not happy, will at least explain why you've been struggling to achieve regulation and lead to some additional help and options.

 

Re: Vet will never understand all this.

Thanks for additional thoughts on meter and poor regulation.

Skybar, I am familar (but can't say I understand completely) the notion that human meters use whole blood calculations.
I know that Roomp and Rand makes the distinction between human meters using whole blood calculations and meters like Alpha Trak and that it is important to modify numbers correctly when using dosing charts.

BUT this morning I called Abbott to find out if meter is a whole blood meter or plasma equivalent and she said it is a plasma equivalent meter NOT whole blood. confused_cat (EDIT) Does this make a difference when looking at dosing charts--do you have to modify numbers???

This morning Freestyle Lite read 219 and Relion Confirm 370. Yes, I do prefer FSL and certainly prefer that 219 number over 370 but even taking into account 20% variance that still seems a notable difference to me particularly as you rely on numbers to dose. But I am trying to drive into my head what Phoebe and others are saying.

Anyway, after warning me repeatedly that their meters are not for animals the conversation ended with her sending me some control solution.

I do recall in the very beginning taking a reading on my FSL and comparing to vets meter number. Even with the stress of being at vets it was off by one point only so I thought great. Now I wonder if he was using an Alpha Trak or human meter. I will find out later.

 

Re: Vet will never understand all this.

just fyi - i think most of us have found that you hit a brick wall if you say you're using diabetic supplies on a cat. i now avoid ever saying that and it's surprising how much you can say without having to lie. they will assume you're using it on a human and if you don't correct it you'll get more help.

 

Re: Vet will never understand all this.

Hi Elaine & Pinky, and good luck with the vet tomorrow.

I'd just like to underscore something that Rosalie (Skybar) does and that many of the rest of us do when we worry that a meter (or strip) isn't giving a plausible reading: Test the meters on yourself. I periodically test myself with the FreeStyle Lite and the Relion Micro and get numbers that are always very close. A self-test works just as well as the control solution (and it doesn't expire!).

Hang in there!

Ella & Rusty

 

Re: Vet will never understand all this.

Well that is a real surprise to me. I know i saw a chart and it said the FS was whole blood calibrated but the manual says plasma. in any event, with the variance at lower numbers the values are close enough. It is the higher numbers that are going to vary the most. I agree that if BG is high, it is high and you have to work on getting it down to lower numbers where the variance will be less. Since we use Lantus and we go slowly in dose increasing and decreasing, it keeps kitty safe.

 

Re: Vet will never understand all this. VET UPDATE

Went to vet yesterday. Tested Pinky before we left with Walmart Relion Contour (365) and Freestyle Lite (229). The vet used Relion Ultimate and it was 349. Very close to my Relion. Even though I don't like it as much I will use the Relion until I get control solution for FSL. This morning it was 418.

Talking to the vet yesterday--he has never even heard of anyone testing at home. Nor is he familar with Lantus. I tried to explain the remission results that can be obtained with Lantus but honestly my cat is doing poorly on it and I can't see him trying it with anyone else.
He only prescribes Humulin N and he said he is looking for the BG number to be around 150.

I explained that we should start see control with a 5 to 6 u dose as Pinky is not responding as well as other cats do on lower dosages. I had the "Problem Cat ' article with me. I asked about Hyperthyroidism and that test was already done and was negative. Dental exam was OK too. I won't do the other tests until I give a 6 u dose a try for a month I guess.

I did ask for a fructosamine test --I know it has its drawbacks but I was curious as to what the results would be.

I told him I tested for ketones with Nova Max and with urine strips. He said to stick to the urine strips --they were more accurate than blood. Before I went there the Nova Max said .2

Pinky is not a well cat. Very lethargic. Sleeps alot. No improvement in 2 months except maybe her fur is not as coarse.
I wonder if she should be on Humulin N and Lantus? I didn't ask him this as I know he would want her on Humulin N and forget the Lantus. I know that people here advise people dealing with DKA to use Hum N --to bring BG down . Do you think it would help Pinky' to use both? It would make me very nervous to do so particularly as I don't have a vet backing me up.

I am going up to 5.5 tonight and will keep going until I hit 6 --the article says most all cats respond. I have reviewed all the procedures for handling Lantus and nothing has been amiss. My vet said, as he is looking at all my papers, that Pinky is not reading them. :YMSIGH:

 

Re: Vet will never understand all this. VET UPDATE

I have a lot to say. Bear with me! This is going to sound mean and I don't intend to sound mean. I see you getting frustrated. Most people whose cats start to get about 3-4 units go through a period of frustration. I do think there are still a lot of things you can do to help Pinky better, though.

I read all the comments in this thread, and like everyone else I have an opinion too. ;-) I LOVE my Freestyle Lite. I have a ton of meters (been doing the FD thing for a while now) and the Freestyle Lite is my favorite by far. I did use a ReliOn for the past few months with Jazzy, but that was simply because money became an issue and the ReliOn strips are quite a bit cheaper. Even if the numbers are off in one meter or the other, I would rather use the one that runs lower. It's more important to be overly cautious in low numbers than in high ones, know what I mean? Testing on yourself is a good idea, though, to be sure the meters are working.

I'm glad your vet is willing to work with you using Lantus. Lantus is a much better choice for cats than Humulin. FWIW, the reason he looks for BG around 150 is that with a short acting insulin like Humulin N, it can be unsafe to aim for numbers lower than that, especially with a caregiver who is not hometesting. Any hypo is bad, but humulin hypos can come on fast and hard. The vet needs to leave a pretty big safety margin using that insulin without home testing.

What is the "Problem Cat" article?

Don't worry about the size of the dose. Look at other spreadsheets on this board. We tend to have a LOT of cats in the 5-6 unit range and even more, and they are not all acro or IAA cats. My Lucy had her breakthrough at 4.25 units. We've had cats at 6 or 7 units that eventually went OTJ. On the German forum, which also uses the Roomp/Rand Tight Regulation Protocol, it is not uncommon to see cat on doses around 10 units BID. Some of them might have undiagnosed high dose conditions, but I'm sure not all of them do. The size of the dose is not important, as long as you arrive at that dose safety and methodically so you know it is the proper dose. More on that below...

Maybe this will make you feel more (or less) comfortable with your meter.

I'm sorry that Pinky is not feeling well. That means it is time to get serious and work on getting her better regulated. That will be much, much easier to do with Lantus than with N. Almost everyone who switches to Lantus from another insulin notices that the cat feels better on Lantus. The swings are not as wide as the swings on N, and the cats seem to notice. Lantus works, you just need to learn HOW it works in your cat so you can use it to its best advantage.

Some people on the board use Humulin N or Humulin R as a bolus along with Lantus or Levemir. Sometimes that is to help bring ketones down, sometimes it is to help keep a high dose cat's numbers steady while the caregiver works toward finding the right dose for that cat. However, I do not think that is a good idea in this case for a couple of reasons. One, Pinky's numbers overall are not that high. I think you'll do better to try to learn to use the Lantus to her benefit rather than throwing another insulin into the mix right now. Two, because to use a bolus insulin you have to test A LOT. You have to learn the onset/nadir/duration of the basal insulin in your cat, and you have to learn the onset/nadir/duration of the bolus insulin in your cat, then you have to learn how to use the two insulins together. That requires a lot of data. You're just not ready for that. Sorry, I know you are trying, but you're not ready.

I disagree. You might think this is harsh, but the one big, big thing that is missing is data. Increasing doses without data is a big no-no, and you have done it quite a bit. Was she green the night of 10/13? Maybe, but you increased the dose the next day anyway. That is when the numbers started getting wonky. Were the pinks showing bounces off of low numbers at night? Probably. Then you increased to 4.5 with no data at all. On 4.5 she was getting a good bit of blue. There are a LOT of missing tests, even preshot tests are missing, and no PM tests, but then you increased to 5u.

In my opinion, increasing tonight to 5.5, after 6 cycles on 5u with the only PM test being a green number, would be a big mistake. One thing I notice - see the 99 at +10 on 11/2, and only 2 hours later she was all the way up to 272? That looks like a bounce, and a bounce probably means she was already on the way up when you caught the 99. Where was she on the way up from? Who knows. Bounces can take up to 72 hours to clear. If that is true for Pinky, she might clear the bounce tonight. You for sure don't want to increase the dose on a cycle when the bounce might clear. You want to give her plenty of time to clear the bounce and see where her numbers go once that happens. She might go even lower than she did on 11/2. In some cats, a seemingly random high number like today's 418 can signal a breakthrough about to happen too. Please do not increase for a couple more days, at least.

You are doing dose increases with NO IDEA how low the dose might be taking her. She has had green on 5u, so you absolutely, positively, without question HAVE to stop doing dose increases until you can figure out how to get some data in the AM AND PM cycles. Have to. I realize that you have some additional obstacles standing in the way of getting it done, but there is a solution somewhere and I know you can find it.

 

Libby is correct, IMO. She knows her stuff so please review what she is saying and try to follow her directives.

I can't imagine giving Humilin N and Lantus. From a human perspective, to help you understand, Humilin N is considered long acting as is Lantus. Before Lantus, human type 1's and some type 2's were given N as their basal insulin. Some probably still are using N. Lantus is also a basal insulin but it doesn't have the kinds of ups and downs as N and is thus gentler. By giving both, you can create a serious hypo that you might not be able to control. If anything is added in addition to Lantus, and I am not suggesting you should add anything, it would R because it is fast acting, in and out in a few hours. Again, from a human perspective, R used to be used when people needed a bolus insulin to eat carbs/meals. We now mostly use Lantus for our long acting basal insulin and Humalog, a very fast acting insulin, not used on cats, for boluses to eat. I wear a pump and only use Humalog. The pump gives tiny amounts of insulin throughout the day and then I give myself boluses when I eat. My back up insulin if the pump fails, is Lantus. After reading all of the research, it makes so much more sense to me to use Lantus in our kitties or Levemir. Their little bodies can not handle the shocking ups and downs of N. Humans can't either. It is now considered an inferior insulin because of that.

With Lantus, because cats metabolize faster, you have the greatest prospect for good control. It is gentle and you will eventually understand how it acts in your cat. Please follow Libby's advice and do your best to test more often so you can determine what your cat needs for regulation.

 

I agree with Libby, and I would listen to her because she is very very smart and has been doing this for a long time.
My cat often feels wonky, out of it, and lethargic, when he is bouncing all over the place.
I hope you are able to get some more tests in, so we can help you with your kitty's dose.
I know how frustrating it is. I have been doing the sugar dance with my cat for a long time, too. I thought I was a patient person, but had to learn even more patience, and trust. Hang in there, okay?

 

We all know how frustrating this can be, but listen to Libby. She has so much more experience w/ FD than most vets.

First and foremost it is important to keep our kitties safe from hypos. To do that you need to get the extra tests in. I know it may not be possible during the workday, but at night set some alarms, test and go back to bed. If you kitty sleeps w/ you, you don't even have to get out of bed! You can find a way!

Dosing for Lantus is based on the lowest point in the cycle! You aren't getting those tests, so you have no data for your increases. Yes, it is frustrating. You will see many of us on the verge of upping a dose, and then comes a breakthrough. The 6 cycles is only a guideline, often we just have to sit tight for just a little longer. You see many of us joking about "patience pants", but it is really no joke. That can be the hardest part of all this, waiting it out!

Hang in there! This weekend is a great time to start getting those extra tests in. Yes, it plays havoc w/ our lives, but we must make a choice on what is really important to us.

 

Libby, I appreciate all the help and won't increase dose tonight and will do some tests tonight.


The reason I was going with Relion until my control solution comes is because 2 months ago the vet's meter and my FSL were only off by 1 point. Yesterday it was off by 120 points so I thought it might need recalibrated or whatever the control solution does. The 2 Relions (his and mine) were nearly alike. The control solution comes in 5 to 7 days. I will only use Relion until then as I do prefer FSL. Much easier to use.

The 'Problem Cat' article is by Rand and Marshall:
http://www.uq.edu.au/ccah/docs/diabetes ... ticle4.pdf

I have been greatly 'influenced' by the article I guess. Pinky fits most of the clinical signs of problem cat. I was hoping that somewhere between 5u and 6u greater control would be seen as that is what it says (though ECID) .

I did feel (right or wrong) that the much higher meter readings were more accurate and could possibly explain her tiredness , etc. I was pretty much discounting any FSL reading last 2 days as 'wrong' ( ie the 99, etc). Libby, you are right, I did ask for fructosamine test to test the accuracy of FSL meter.

Now, I don't look at dosing advise as be 'harsh' at all nor asking for more tests.

But to add more information --I am not sure the pinks (starting Oct 16) you see are bounces off of greens. I decreased dose from 4u down to 3u thinking my husband could give that dose as I was going to be gone for 10 days. I messed her up for 3 days by doing that . On the 15th couldn't dose 12 hours (more like 13 and 1/2) so it went up to a pink.

He never tested before and he was supposed to test at least twice (and 3 if he could manage it) but on 4 days he only did it once. Not a good idea so he won't be babysitting in future. He is gone alot (20 days out of month ) and is not up to speed on treatment.

The 4u dose was held 13 days --the evening I got back I set alarm and tested at +6 and got a 272. Looking at all his mid day high numbers and that 272 I went to 4.5. How many times should I test at night before raising the dose? I understand that it would have been better had I waited and tested more the next day .

I won't raise the dose tonight --I do appreciate what you are saying and will get more data. Thanks for your reply.