12/31 Ole AM 499 +3 369 +6 389 +9 381 monitor switcharoo

Hello all,

Happy New Years Eve!

viewtopic.php?f=9&t=110900

Today I will be switching to the Relion Micro monitor. I will do some side by side tests for comparison.

Ole had another high BG this morning and also tested negative for Ketones. I gave him 3U of Lantus.

To answer some questions from yesterday's condo, I don't believe he has never tested for FIV, but I do know that his white and red blood counts were normal. I'll ask my wonderful vet (who completely supports Ole's new protocol, but she wishes he wasn't taken back all of the way to 1U) to send me the test results from the internist who did TLI/Cobalamine/Folate:TAMU, a Pre-Op Screen, CBC, PT/PTT a 3 view digital radiograph and an abdominal ultrasound. He has also had a Senior Screen, a Free T4 by E/D and a Fructosamine/Idexx. He had Spec fPL- feline add-on to diagnose his pancretitis. I will post his labs when I get them. The tests have all been normal, except for the things Ole has been treated for.

He has not been treated for pain because he doesn't really behave as though he is in it. He did take an antacid along with his steroid in the beginning of November and he was exhibiting belly ache behavior, like not curling up when he was napping. He has never had an issue with vomiting nor has he had diarrhea or constipation.

I was interested in reading about High Dose. When Ole first came into our house, I had a 18 year old kitty lover named Little Buddy. Little Buddy was a gentle old soul and took the somewhat feral Ole under his personal care and taught Ole everything he knew about how to be a gentleman. It was really sweet. They did everything together including sleep. Little Buddy, in his advanced years became quite the snorer, and Ole seemed to join right in, creating a symphony of nocturnal noises, day or night. Little Buddy has left us, but Ole continues to snore, but only when he is sleeping, and not all of the time. Also, he has always had a big head, which gives him that perpetual kittenish look. He has had this since the day I adopted him and I always assumed it was genetic, like his green eyes. He does not have big feet or a big tongue. Let me know your thoughts.

Thank you again

Rebekah

Re: 12/31 Ole AM 499 increase to 3U

Thanks, Rebekah, for the info.

I agree with your vet...I wouldn't have dropped him back to 1u either. I probably would have taken him to 3u because that's where he started showing progress on the Humulin.

Julie and Wendy are both very knowledgeable about high dose conditions, especially acro. I will leave them to respond to those questions. I do believe that snoring can be one piece of the puzzle but my GA Gus snored like a freight train and he never had a high BG.

Let's reevaluate this dose after four cycles. If Julie/Wendy may feel there is some potential for high dose and his numbers stay this high, we might want to start increasing after every four cycles but let's see what this dose does first. Ok?

Have you ever visited Cobbs condo or seen Cobb's SS? It's worth a study....we are thinking he might be an acro/IAA kitty but you can see he was at a high dose, she dropped him back, and now fast tracking him up per the protocol.

Re: 12/31 Ole AM 499 increase to 3U

Hi Marge,

I have studied Cobb's SS and Suzannes condo's. I feel that Ole and Cobb are kindred spirits.

I feel really bad about the 1U thing. I felt under a lot of pressure form this forum to reduce to 1U, I resisted and took him to 2U for a cycle, then felt
more pressure to begin at 1U. We solder on though and hind sight is 20/20, always! hahaha

Ole is acting lethargic today and he doesn't look well. I'm about to do a +3 test, my Alpha Trak along side the new Relion Micro.

Thank you again for all of your help and encouragement.

Rebekah

Re: 12/31 Ole AM 499 increase to 3U

Good luck with the increase. I hope Ole gets some good use out of it. Sweet that Little Buddy could welcome him into the home so gracefully. Happy New Year!

Re: 12/31 Ole AM 499 +3 442/369 monitor switcharoo

Hello

Not sure how to record this on the spread sheet.

I am switching Ole off of the Alpha Trak 2 and on to the Relion Micro. Just now, using the same blood sample, he tested 442 with Alpha and 369 with Relion. I have to order test solution for the Relion and I'm not quite sure what to do from here.

Any suggestions?

Thank you,
Rebekah

Re: 12/31 Ole AM 499 +3 442/369 monitor switcharoo

You can just put your ATrak away and make the note in your ss that you're using the Relion Micro now. I think I merged the cells across the ss so that it was very obvious dividing line.

We have so many kitties that come in overdosed inappropriately that it's common for people to encourage reducing and starting dosing over. It may have been a wrong decision in Ole's case. It can be difficult to tell because too much insulin looks a lot like not enough insulin. When we arrived here punkin was on about 3.0u, but as our story unfolded we learned that he was actually getting 7.5u because we were using ProZinc syringes instead of the correct ones. We had it explained to us and we opted to stay at the 7u and increase from there.

As we continue to see these constant high numbers, we can do the increase every 4 cycles. If we continue with this protocol, we make sure we haven't missed a good dose on the way up the scale. At this rate he'll be back to 5u, where he started, next Tuesday. The downside of doing this is that he's sitting in high numbers waiting for increases. The plus is that we won't miss a good dose on the way up, and it's less anxiety-inducing to be going up the dosing scale rather than down it.

There's also no reason that we couldn't make a bigger increase in dose as far as i can see. We could go back to 5u and see how he does. The risk there is that we might miss a good in-between dose. It's also more nerve-wracking to be going down the dosing scale rather than up. The pro is that it might get him out of these high numbers sooner.

What would your preference be?

There's no hurry for us to figure out if he has a high dose condition. At this point we wouldn't do anything differently, although if we know a cat has a high dose condition, we are more aggressive about increasing the dose. But perhaps keep it in the back of your mind. It never hurts to read what others are going through - so Cobb's and Ozy's condos might be interesting to you.

Re: 12/31 Ole AM 499 +3 442/369 monitor switcharoo

Thank you for your expertise Julie.

I prefer to stay on the same track we have started, continuing with 3 units. I don't like the idea of moving his insulin around so quickly, now that we have slowed it down. Yes, I have been following Cobb and Ozy quite closely and have been learning from them.

He is acting much better this late morning, and I'm about to give him his +5 test.

Thanks again!
Rebekah

Re: 12/31 Ole AM 499 +3 442/369 monitor switcharoo

I hope Ole slides down for you today.

I wanted to warn you that you can drive yourself crazy comparing meter readings. When I tried the Prime for a little while, I was comparing readings between the Prime and the Confirm. They were never exactly the same and with meter variance they never will be. It about drove me crazy looking at the differences. At the encouragement of others here who had been through the same thing, I just started using the one meter and stopped comparing numbers.

Re: 12/31 Ole AM 499 +3 442/369 monitor switcharoo

yeah, i compared the first day and then stopped and just went with the new meter. it does drive a person crazy. i do wonder why they aren't more accurate.

I think that's a good choice, Rebekah. It'll just be a week til he's back at 5u and you'll have the confidence that we didn't miss a good dose on the way up. I thought you'd been following both of them. It's good - you might or might not recognize patterns or symptoms in Ole. That's how we all have learned.

Hope you have a Happy New Year!

Re: 12/31 Ole AM 499 +3 369 +6 389 +9 381 monitor switcharo

Good luck with the new monitor, I hope you like it Happy New Year to you and Ole, I hope it's a great evening!

Re: 12/31 Ole AM 499 +3 369 +6 389 +9 381 monitor switcharo

Hi Rebekah!

We also switched meters after joining FDMB. We switched to the Confirm. I just noted it in the remarks on the spreadsheet. I put our ipet meter away and haven't touched it since. I also didn't compare numbers. It's my understanding that AlphaTrak consistently reads higher than the human meters.

I understand the pressure you feel, but I also know the experienced folks are just drawing on that experience to get our kitties better. When we came in at 10units, everyone was concerned, and when I saw he dropped on one of his first cycles after switching to wet food I felt slowly going up .5 unit by .5 unit was going to be less nerve wracking for me than risking a hypo episode. Can you imagine a hypo episode when you're by yourself and having to drag the cat and a baby to the emergency vet? (Both of whom weigh roughly the same?!) I figured reduce and increase would be best. If I had to do it again, I don't think I would have reduced quite as much because Cobb definitely spent more time in the higher numbers than he should have. I would have just cut the dose in half to 5. But what's done is done.

As for the testing, yes...it's important. I feel some pressure to get it done now, but I just can't afford everything at the moment. We'll get it done when we can. But I'm seeing good changes in Cobb as we near the right dose. We're already being pretty aggressive with his dosing increases, so I'm guessing the only thing we'd change is when we notice a creep up, increase immediately instead of waiting the 4 cycles or adding in some R. The R concerns me because when I'm back at work, I won't be able to test him as frequently.

Ultimately, you have to do what you are comfortable doing. You know Ole better than anyone. And you are the one making dosing changes. I lost track of how many cycles Cobb had been on 8units last night because I typically increase at night and I increased him a cycle too early. Not recommended I know, but we saw a great drop under 200. I know Donaleen got an itchy finger and increased early as well, and it looks like Ozy is responding well.

You know your cat. Trust yourself. If you want to increase every 4 cycles like Julie said, go ahead. You can always slow back down to 6 cycles instead.

You and Ole are in good hands! And others of us are definitely here for support!

~Suzanne

Re: 12/31 Ole AM 499 +3 369 +6 389 +9 381 monitor switcharo

Pet-specific vs human glucometers is like reading temperature in Fahrenheit vs Celsius.
Both are correct. As long as you have the reference numbers for the one you are using, you know how to interpret the tests you get.

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.

Unsubstantiated information about pet-specific meter reference numbers has been removed by Moderator.

< 40 mg/dL (2.2 mmol/L)
- 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)
- 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)
- 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)
- no shot limit for ProZinc, PZI, or other non-depot insulins.

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

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

180 - 280 mg/dL (10 - 15.6 mmol/L) - 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) , 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.


How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)7

Re: 12/31 Ole AM 499 +3 369 +6 389 +9 381 monitor switcharo

Hello Rebekah. I haven't stopped in your condo yet, so thought I'd say hello before the old year ends.

My Neko seemed like a healthy cat two years ago, except for extreme hunger. She was quite savage around food and her favorite carbs were bread products. :roll: OK, she still likes bread. :lol: That was the clue that tipped us to get some tests done at the vet, then we got the diabetes Dx. Neko has two high dose conditions, acromegaly and IAA, lucky us, but she is no longer on a high dose.

BTW, you can look at the beginning of Neko's 2012 SS to see how we noted a meter change, and what a difference a good meter makes. We got up to 5 units of Caninsulin, and restarted back at 1U of Lantus. In hindsight, that was too far to go back, but water under the bridge now. We increased as per the protocol and when she got up to around 6 units, it was suggested that she be tested for high dose conditions. We normally suggest those tests if the cat is eating low carb wet food, the 6U dose was arrived at by following the protocol with safe increases so a good dose isn't passed, and there are no underlying health conditions - such as a dental or other infection.

Neko doesn't have a much in the way of an acro look. She is 14 lbs, but has been around that for 10 years. I think she's part maine coon, so her head size and paws are a bit large, but not noticeably larger than before. She doesn't snore, but our other cat does. One thing I did notice was her sensitivity to light. The tumor can press on the optic chiasm. It seemed like Neko didn't like bright light and her eyes never reduced to small slits. And she recently had some soft tissue growth on her gums, so one of her upper canines was rubbing against the lower gum. And she has a heart murmur, which can be a result of acromegaly, but the cardio vet she saw didn't think that was the cause of the murmur.