06/05 TASHIE AMPS = HIGH +2.5/425 8.5 /358 PMPS = HIGH

ww.felinediabetes.com/FDMB/viewtopic.php?f=9&t=96758&p=1036085#p1036125

Tashie seems in good spirits even though she was HI at PMPS and again this morning at AMPS. She is eating and was very hungry - water bowl was "normal" and not drained down. Think we've established that she is bouncing - will try to load her with food this morning and I think I can do a + 2 1/2 BG test and post. Not sure I can get a +6 - will try my best! (work)

So, I hold the dose at .5U - and wait yet ANOTHER 72 hours for the bounce to "clear"?

........another question - is it possible that the .5U just isn't enough for her - after the vet had given her the 1U and then I went to one dose of .75U and then .5U from then on - could she have stored some of the higher dose that now may be gone? (all on SS)

This morning was her 8th dose of .5U

THANKS!

 

Re: 06/05 TASHIE AMPS = HIGH ?

It is possible that Tashie will need a dose increase. However, you want to base the need for an increase on non-bouncy numbers. If you were to increase based on your high pre-shot, when the bounce clears, it could be too high of a dose. Also, Lantus dosing is based on nadir, not on pre-shot values.

This is the hard part with Lantus -- patience!

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Sienne, just did a +2.5 testing - she is at 425. My vet just called and has asked me to do the following:

1. Get a +8 as she thinks this may be Tashie's nadir?

2. Increase dosage tonight to .75U

3. Start using the Alpha Trak 2 meter tomorrow ( I have it, just haven't used yet - she would prefer me to have the same numbers as she deals with as she is viewing my SS)

Opinion?

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

We used an AlphaTrak for a long time and it was expensive! Ouch. We finally switched to a human meter and wished that we had started with it. It is much cheaper and actually easier to use. The AlphaTrak reads about 30 higher than a human meter. Maybe your vet could just add 30 to the values that you get?
Liz

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

I know they are more expensive but aren't they more accurate? Also, as she is monitoring Tashie's SS - she will be more familiar with the numbers - I can't expect her to do the math - and, it's not a constant percentage. Look below at the numbers from last week using BOTH meters:

ALPHA RELION CONFIRM
441 392
336 273
180 140
72 53


I can't find a CONSISTENT percentage here - can you?

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

I pretty much disagree with everything your vet said.

There is no evidence to suggest that Tashie is nadiring at +8 consistently. She could be occasionally but on the days that you have alot of tests, she nadired earlier.

Because Tashie has gotten into low blues on this dose, we typically hold it for ten cycles. I'd let this bounce clear and see where she is and then decide.

Alpha Traks are not more accurate. Yes...they are designed specifically for animals but they doesn't mean they are more accurate. Personally, I would not expend that kind of money just so my vet doesn't have to do the math. If you show her the TR protocol, that will show the kinds of numbers we are looking for on which to base dose decisions. The TR protocol has one for human glucometers and one for AT. You can give her both.

That's JMO but ....unless she wants to help you with the cost of strips or you are fine with spending that much, I'd stick with what you have. (I also ordered an AT from my vet the first day Gracie was dx but, thanks to the members here, I cancelled it and have been very happy with my decision).

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Okay, I'm listening. Where do I find this info to print out for her and where do I find the protocol for BOTH of the meters. Also, I just read that you only INCREASE a dose at AM and DECREASE a dose at PM - is this also correct? (this is coming from ME, not her)

Tash is right now in her 8th cycle - so you are suggesting we wait ONE MORE day? That will be 10 and make a decision then?

I am just trying to make the VERY BEST decisions for Tash. It's not about the money - it's about her! I'll eat tomato soup for the next year if it will help HER.

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Hmmmm.....I don't know where you read that about the increases/decreases. But, no, it's not true. Lets say you got a 45 in the p.m. Cycle. Unless she bounced really high by a.m., you would want to decrease.

I would let her have ten cycles. I agree with Sienne that I do think Tashie is going to need an increase but you will need to test a little more to find out where she is going low. That is to keep her safe, ok?

TR Protocol. Table 3A is the protocol using human glucometers; Table 3B is for the AT.

I know you want to make the best decisions for Tashie. But using a human glucometer vs an AT doesn't affect her treatment. It just costs you lots more. The majority of cats who have gone OTJ (and stayed in remission) were tested with human glucometers. BUT...it is your decision and we will work with you regardless. We can do the math

Just as an observation, I use a One Touch Ultra Mini. I compared it with the LAB tests (which probably use serum) and Gracie's BG was amazingly close to the lab results. One of the most amazing things about it was the tests were from different blood samples.

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

I pulled this of this page : http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Seems I get more confused every day ...... just when I THINK I know, I DON'T.

To recap:
Tash right now is at 8 cycles of .5U. Wait until say THURSDAY morning for a dose increase up to .75U

Marje, she was very spry at 5AM this morning - and she wanted to jump away at AMPS (7:30) ......but then she is slumpy cat when I went to test at 10AM.

Skip the +8 test and to a +4 PM? ......need to know as I have to arrange a LOT to try to get home and also involve a neighbor who is up to her ears in graduation stuff.

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

The above refers to the outcome when we shoot early to accommodate a schedule or because numbers are rising quickly OR (the latter) when we stall a shot waiting for numbers to rise so we can shoot.

Example: Tashie is cruising along in gorgeous green numbers and then you test at +11 (6:30 EDT) and she is 340. Once you have data, you can shoot an hour early as long as your schedule can accommodate it because then your shot time will be 6:30 until you gradually move it back to 7:30 (we teach you how to do this). Because shooting early is like giving a dose increase, you need to watch the next couple of cycles closely.

Conversely, lets say you test Tashie at +12 and she is at 50. We are going to ask you to stall, without feeding, and retest every 20-30 minutes. When numbers start to rise to the point we agree its time to shoot, you shoot the full dose. But stalling acts like a dose reduction and you might see numbers climb a bit the next couple of cycles. ECID.

Of course, it would be beautiful if you could get a mid cycle AND the +8 test or at least the mid cycle and a test as soon as you get home from work. Because we like to be safe, it's helpful to know how long it is taking her to clear bounces and how low she's coming before we increase.

If she clears the bounce and doesn't come into green, we might have you increase sooner. Baby steps

Questions?

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

The difference between most meters isn't a constant value. What you noticed when you did a side-by-side comparison of the AlphaTrack and your meter is that the 30 point difference is toward the lower end of the scale. I'm sure if I diddled around with a lot of side-by-side numbers (or if Liz, Zener's "other" mom who's an engineer and no doubt better than I am with this sort of thing), I could come up with a formula that showed how the two meters overlap. It's pretty common for meters to be closer at the lower end of the range.

I suspect your vet doesn't know the difference in cost between the two meters. I'm always astonished when MDs prescribe a drug and they are flabbergasted to learn just how much the prescription costs (if you don't have insurance). I suspect it's the same for your vet and strips. The strips for an AlphaTrack run about $1.00 a strip at ADW where they are discounted by 30% (e.g., 50 strips cost $98).

You might want to print out and share the published version of the Tight Regulation Protocol with your vet. The protocol has research to support it and was published a few years ago in one of the leading vet journals.

The table that Marje mentioned is at the end of the article. Sometimes handing a vet an article published in a journal he/she is familiar with goes a long way to establish that we're not a bunch of crazy internet cat people!

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

I, for one, do admit to being a crazy internet cat person! :lol: :lol: :lol: And I thank Zener's lucky stars every day to have found this place, full of people who are as crazy about their cats as we are about ours. Seriously, you are doing a terrific job with Tashie and I greatly admire you.
Liz

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Thank you Anne! Just had an interesting email from my vet - I had emailed her the doing protocol that Marje sent me. This is her reply:

Just glanced at it quickly. I guess these people are the experts so if you want to follow them that is fine. This is not exactly how I do it because I find that the Lantus takes a while to stabilize the sugar and I expect that. Most of the cats (90%) that I put on Lantus and DM do come off of Insulin. So long story short, if you want to follow this protocol that is fine but I think they do too much adjusting tho during the initial phases. I am not familiar with this amount of fine control and frankly do not think that it is important as they do! Have had very good luck otherwise.

The other interesting factor with Tasha is that she was never an obese cat. Most (not all) obese cats are the ones that I think are most like the Type II diabetics in humans. Diet and weight loss helps them a lot. My question with Tasha is whether we will ever get her off Insulin because I am wondering if she is more like a Type I because she was thin to begin with. This does not change how we should manage her however.

I know this may not be the answer you wanted and I am just raising more questions! I would just go with what we had talked about today and try not to over manage her. Take care and I will see you Saturday!

****Any comments?

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

I think that's a great email from your vet. That's ideal, is a vet who is willing to listen to other approaches and lend her expertise about all things feline and respects your responsibility to make decisions for Tashie's care.

I took up Sienne's gauntlet and made a plot of the values that you have. I don't know how you feel about plots but this is what I made. The blue line is the AphaTrak. The red line is the Relion. The green line is the Relion + 30. You can see that the green and the blue are very close, especially at lower values where it's most important. So taking measurements with the Relion and adding 30 gives pretty close values to the AlphaTrak. That's as good of agreement as you will get with any two meters, quite frankly.

Liz

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Gees Anne, I am IMPRESSED! On my vet's email ........I was really concerned that she mentioned that Tasha could have Type1 because she has always been very small - never ever fat in ANY way. Top weight has been 6# and she is hovering around 5 now. BUT I was thinking - can't even a "skinny" cat get diabetes from eating a DRY FOOD diet most of her life - which is what Tash did. Fortunately, I have had no issues changing her over - that is except for yesterday - bought them "expensive" LC wet and even fresh shrimp - NO WAY MUMMY! Ewwww! And she didn't eat as much last night due to the new "ikky" food. Went back to FF today! They don't have to tell me twice Meooooowww!

Speaking of food - she seems really partial to the seafood varieties - (ew) and it says to limit to feeding to twice a week due to high mercury levels? If that will get her eating for a while - do you think I can give it to her more often?

Wow! It never ends does it?!!!

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

HUGE QUESTION! Duh! I went to a specialty high end pet shop and bought a whole bunch of new food that the owner looked up on line and GUARANTEED me was LC. Yesterday, at about 4 O'clock, I fed Tash WERUVA "Pumkin Jack Splash" ......... which he told me was UNDER 8%, in fact, I want to say he told me it was 3% ........


I went here http://www.weruva.com/catsitk-pouches-nutrition.php ..am I reading it right that it's 13.5%?


COULD THIS BE WHY SHE'S BEEN SO HIGH?????

 

Re: 06/05 TASHIE AMPS = HIGH +2.5 = 425

Yes....that could definitely contribute to it. That Pumpkin Jack Splash is 14% calories from carbs. (I do limit all my cats on fish).

Most of us use Dr. Lisa's Food Charts. They are very comprehensive and Dr. Lisa did a huge amount of work on them.

I'm glad your vet is open to the TR protocol. I have to laugh at her comments, though, because that is what I hear from most vets...that there are too many dose changes. especially initially. That's because they don't understand the protocol and they also rarely see a SS when a cat might be on, for example, 1u for six cycles as the depot fills and then drop too low. Also.....if she were to thoroughly read the protocol, it does discuss "holding the dose" and that the cat might be on a specific dose for a very long time. We've had some cats in this group that were on the same dose for a month to several months.

I had this discussion with my former vet who also said most of the cats they saw went off insulin and ate DM. One day, I was in her office and a lady brought her diabetic cat in to be tested (as she did EVERY day) and the cat was at 30 on the AT :shock: :shock: (Further evidence that numbers between the AT and human glucometers are probably pretty close at very low numbers). A few days later, the vet told me this cat was off insulin. And we've seen something like this around here as well. I have to wonder if these cats' pancreas are just shocked into jumpstarting by those dangerously low numbers. It is not a way I would ever want to get Gracie into remission because of the extreme risk of a clinical hypo.

Do remember that lantus/levemir have a pretty high rate of remission if the diabetes is dx and treatment is started within six months.

Type I diabetes is rare in cats. There is no test to distinguish between Type 1 and Type 2 diabetes in the cat. I think you hit the nail on the head that Tashie has been on dry food her entire life but I would wager that most of us don't really know why our cats became diabetic. And we don't really know who will go into remission and who won't. We've had cats in this forum on insulin for 22 months and whose SS looks like Tashie's initially. And then, boom....off insulin they go.

 

Re: 06/05 TASHIE AMPS = HIGH +2.5/425 8.5 /358

Thanks Marje. Just took an +8.5 and shes come down to 358. She's in a funk today - easy to grab because she's been hiding in the back of a closet :evil: Fed her and left her to chill. How dare she be in a prissy mood when she puts me through all this! Little princess! Will get a PM either +3.5 or +4 (depending on Daddy!) and get a nighttime number and then she can have her midnight feast.

Does this EVER calm down?!!!

 

Re: 06/05 TASHIE AMPS = HIGH +2.5/425 8.5 /358

Great job today!!! Don't forget the PS.

Yes....it calms down. Take a stroll through other SSs. You'll see....it gets better.

 

Wondering if there is any point to doing a +4 PM test as she is HIGH again! Advise? WHY is she so high?

 

Can't we up her dose to see if it helps? She really is beat.

 

She could start clearing the bounce and if you raise the dose, she could come down low. If you decide to up the dose, you really need to get a couple more spot checks each cycle. Because if you don't and she comes down low, you will continue to see the same thing.

For tonight, I think a +4 is a good idea in case she starts clearing this bounce tonight. Sometimes they have a high before the break where the number goes way up before it comes down.

 

Okay Captain! BUT the next tube of neosporin is coming out of Gracie's allowance! How long do these flippin' bounces take to clear anyway?!!! Gave them some lamb food (eeee) for dinner and she is picking away at it! Really have to think that PART of the issue was that 1) that stupid pouch food at 4:00 and then at bed time a new "shredded" kind (LC) that they BOTH turned their noses up at! They think they are judges now on the Cat Cooking Network - hey, have you ever watched that? There is this fat cat named "Paula Preen" that has her own show! But, it's NOT for diabetics as she does not believe in LOW carb! LOW cal or LOW fat!

 

:lol: :lol: :lol: deal. I buy it in mass at costco :lol:

I'd double check all your foods against Dr. Lisa's list and make sure you are feeding in the 4-8% range.

Bounces....they cause us all to be apoplectic from time to time. Some cats clear them fast, some cats take 6-7 cycles. Some cats stop bouncing fast. Some have been on insulin years and still bounce. Who knows? We just say they bounce until they don't and encourage you to ignore it. Focus on the numbers between the bounces.

 

Gracie! Quit squandering your money! You will owe! And tell your mummy that I am using that food guide - it was just the darn pouches that the man checked and said were "good" HA! Lesson learned! Double check EVERYONE! Gracie, do you want a play date with Tash to perk her up - Oh, wait, Boris might want to bite your neck because he loves PG's (Pretty Girls)

Night night

will get a +3.5 or +4

Bounce ........ please GO AWAY!

 

She's a principessa and that's what they do...squander!

Hope tomorrow is better

 

Hi Bern,
I don't know if it was mentioned, but I was told that a dose change won't effect the cat until the next cycle...So say, for example, you increased her on 6/5 PM cycle--the increase wouldn't even start to take effect until the 6/6 AM cycle. This is only an example, I'm not suggesting a dose change... I hope I'm making sense; perhaps an Advisor can explain it better.