Glucose monitoring (fog)

Discussion in 'Prozinc / PZI' started by MLT, Mar 21, 2019.

  1. MLT

    MLT Member

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    Mar 21, 2019
    The more I read to learn, the more confusing....I started administering 1 unit insulin, 2ce daily to my 16 y/o cat on 3/10. The vet suggests I administer insulin while Storm eats and that I do a curve next week. Most advice is to give after food intake, and that glucose m-u-s-t be metered before each dose. Are those preference (?) Is a prescription needed for syringes?! The 1st two days, Storm's behavior and movement improved. As of yesterday, looks like his back legs are weaker. Due to his anxiety at vets, I will administer all. But his ear areas are sensitive. Anyone have any experience using a glucometer not at the ear?
     
  2. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    Good morning! Sorry we didn't get to your question last night. I was fast asleep when you posted. :) I love your cat's name, by the way!

    First off, yes you want them to eat before shooting. However, if Storm is a good eater, it's fine to administer the dose during eating. You just want to make sure that he gets some food on board. I usually let Gypsy eat for a minute or so, and once I knew she was eating fine, I'd go ahead and give the dose while she continued eating. That way, I knew she was eating and had food, and then I could give her dose while she was distracted.

    Second, yes you ALWAYS want to get a test before eating and before the shot. You want to be sure that Storm is high enough to shoot. I always did the test in the ear, but I know several have also used the paw pads. It's totally possible to do that and if it's easier for you two, then that's fine. I'm sure you can find videos online of cats being tested in the paw pad...there are plenty of videos of testing in the ear, so there should be paw pad as well.

    As for syringes, I'm not sure. Where do you live? It's different everywhere. We didn't need a prescription here, but others have.

    His back legs being weak could be neuropathy. I don't have experience with that, but many give b-12 for it. @Djamila can you give some info on this?

    Let us know if you have any other questions! We're more than happy to help!
     
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  3. Djamila

    Djamila Well-Known Member

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    I'm not quite sure I'm understanding the original post -- you already have syringes, don't you? Otherwise how are you giving the insulin? I wonder if you're asking if a prescription is needed for the glucometer? In which case - no, you can just buy one at most any pharmacy. You'll want to choose one that is from somewhere close and convenient because you can't run out of test strips. Don't worry as much about the cost of the meter as the cost of the test strips - because you'll be buying a lot of them, you'll want to make sure they are at a price point you can keep up with. They range anywhere from 20 cents to over a dollar/strip. Many folks around here use one of the Relion meters from WalMart because they are affordable, so if you have one near you, you could try there. I use this one: https://www.adwdiabetes.com/product...ose-test-strips-lancets-and-free-presto-meter because I prefer to order by mail and have them delivered (the lancets that come with this are too thin when you're starting though - you'll want to get 26 or 28 gauge lancets, especially if you might be doing paw testing instead of ear testing).

    As for the neuropathy -- without any test data, I always wonder if the weakness you're seeing is neuropathy or low blood sugar (which can be dangerous), so pretty please start testing as soon as you can! Assuming it is neuropathy, Zobaline is the easiest option. You can buy the B12 and folic acid separately, but in the beginning, it's just easier to get one product that has everything you need and is easy to sprinkle into the food. That way you can be sure you have the right type of B12 and the right proportions. It can take awhile to see improvement, but it's important to get started on the zobaline and keep at it consistently.

    Back to testing -- my guy has sensitive ears too, but in the end, he decided he much preferred the ear pokes to the paw pokes. If you click on the "profile" link in my signature and scroll down, there is a whole section about how I taught my cat to tolerate the tests. Hopefully something in there will be helpful for you. And as Rachel said, there are lots of videos around here of people testing their cats that can help you see how to get started. If you have trouble finding one, let us know and we can help direct you there.
     
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  4. MLT

    MLT Member

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    Mar 21, 2019
    Thank you both! (I am the one in 'the fog'). I read up on neuropathy, which points to methylcabalamine...generic for what you has been mentioned here?! Storm is actually under weight- usual for him is 13 lbs, he recently weighed in at 9. HOWEVER, he is eating like gangbusters. I see that increasing food without adjusting insulin is useless (and might actually be harmful).I'll head to Walmart this AM for glucometer and strips. Also found how to heat rice in a sock and then warm the cat's ear, which I will try. I'm worried that I will muck up the readings/amounts, so I'll review info on that too....
     
  5. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Here is a link to the spreadsheet we use: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

    Once you set it up, you just enter the numbers, and the color coding happens automatically. It's pretty fun (in a nerdy way) ;)

    Don't try to adjust the dose on your own for a little while. Read the stickies so you can make good decisions, but ask for help. It can be tricky at first. We all learned from the people who came before us and we're happy to help!
     
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  6. Lisa and little

    Lisa and little Well-Known Member

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    Sep 24, 2018
    You all beat me to it. As for the neuropathy, I give Zobaline. It’s a special formula that has no sugars especially formulated for diabetic cats. I have seen a great improvement in my girls back legs but cannot as to whether or not it is attributable to the Zobaline, the insulin or combination of both. All that said it wouldn’t hurt. Just make sure there is no sugar. Zobaline can be ordered online from life link directly.
     
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  7. MLT

    MLT Member

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    Mar 21, 2019
    OK. I have gotten a ReliOn PRIME unit, lancets and test strips. And named/published a spreadsheet (SS). I've read through Understanding the SS/Grid, but I think that the grid is actually more than I need....in theory, I will be testing AMPS and PMPS, at which point I would note down a value within the specific range. So, as I am testing, there will be two values per day (another way to look at- 2 values per line), yes? Also, I had expected that the info gathered would be date, time, #units, reading value; however, the SS is broken down into ranges. Is there specific importance to the range breakdowns? I think that I made life more difficult- the ReliOn info gives ranges for humans...iI am missing a piece, a resource that shows what feline levels should be, and how to adjust (?!) Thnx. Marie​
     
  8. Ramon's mom

    Ramon's mom Member

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    The numbers in the colored ranges listed on the SS refer to the glucose readings. Its important to know that a normal cat's readings are between 70 and 150 ish. You should read the insulin protocols threads at this website, its important to know this stuff when you give insulin. Most of us test in the middle of the day/cycle because that's when they go to the bottom of the curve and you need to know if your insulin dosage is too strong (taking them dangerously low) or too low (taking them too high, which over time can also be dangerous). I'm a newbie here myself and have been focused on keeping an eye on at least 3 readings a day to be safe. There is a lot of great info in those protocol threads. Also advice on getting the blood tests. Over time it gets easier and the cat tolerates it more. Good luck!
     
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  9. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    @Ramon's mom This normal range applies to your AlphaTrak meter. MLT is using a human meter which reads lower than a pet meter.
    @MLT normal for a cat using your Prime meter is 50 to 120. :)
     
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  10. Ramon's mom

    Ramon's mom Member

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    Dec 6, 2018
    Sorry. I was just trying to emphacize the importance of testing midcycle too since she was saying she is only going to test at AMPS and PMPS. And actually I am also using a human meter (I stopped using the Alpha Trak in December) but I never really get numbers close to the normal range anyway so I guess I just get it wrong. My apologies.
     
  11. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

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    No need to apologize. There are so many numbers floating around here it's very easy to type the wrong ones. ;)
     
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  12. MLT

    MLT Member

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    Mar 21, 2019
     
  13. Djamila

    Djamila Well-Known Member

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    I second this! That's why this forum is "peer reviewed" so we can help each other keep the details straight. And the range you gave is a correct range for anyone using an AT2, and certainly not going to put a cat in danger. Honestly, the most important thing to me is that you are reaching a point where you are able to help out new people and share what you have learned. This board keeps working when people learn, and then turn around and help others. So thank you for helping, and don't even worry about it! :bighug:

    And you're right about the importance of those mid-cycle tests. Just getting the PS numbers is not enough to assess the effectiveness of a dose, and can frequently lead to either under or over dosing.

    MLT - if you're at work during the day, let us know and we can share some ideas of how to manage this. It is possible to have a full time job and manage this well. Of course if you're one of the lucky folks who can work from home or has some flexibility in your schedule, it's even easier. :)
     
  14. MLT

    MLT Member

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    Mar 21, 2019
    Ditto RE the built in 'cross-checks'! My takeaway from that did not involve this forum, but the vet- he (probably) prefers the feline glucometer....** Storm does not seem any more phased than usual, so I have taken the first reading- after 3 fails/blanks using the ReliOn lancet device, I pricked him in the ear directly. 0800 feeding was 1/4 can of DM plus 1/3 of a quarter; blood measured @ 1130. Value was 49. I need to go back and read, as I still do not understand the progression of the SS (ie the way the columns and headers are set up).
     
  15. Kris & Teasel

    Kris & Teasel Well-Known Member

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    This is helpful: http://www.felinediabetes.com/FDMB/threads/understanding-the-spreadsheet-grid.156606/
     
  16. MLT

    MLT Member

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    Mar 21, 2019
    I understand the 'mechanics' of the SS, it was moreso the theory behind the design. But I think that I see it. If not, anyone please advise- felines will start the day with a high BG level, which is expected to decrease throughout the day (ergo the various columns with the ranges and time periods). I measured Storm, my cat, early in the day but his BG level is below the end of day range (!) Is that how the SS is interpreted?!
     
  17. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    wait....you got a 49? That's too low, my friend. Please give your kitty a snack and test again!
     
  18. Djamila

    Djamila Well-Known Member

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    As for the spreadsheet - we all live in different time zones and have different shot times, so when you say you tested at 11:30, I have no idea what that means. But if you say your AMPS (the BG reading just before the morning dose = AM Pre-Shot) was....let's say 200 (I can't see your spreadsheet to find out what it really was), and then your +3.5 was 49, then I know that 3 and a half hours after you gave the insulin, the number is already down to 49. Since cats will usually keep dropping until sometime around +6 (six hours after the shot), that tells us that Storm is getting too much insulin right now and may be in danger of going hypo if you don't start bringing that number up with some food.

    I hope that helps explain it a little more, and why it's set up the way it is. It just really helps us communicate more clearly with a community that spans all over the world.
     
  19. MLT

    MLT Member

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    Mar 21, 2019
    Tried the lancet device on myself- zip.

    Just tried again with Storm. The ReliOn lancet device is useless.I pierced Storm's ear directly, got the same amount of blood, but the glucometer is not recognizing it....Thanks for the detail re the SS. Was my one interpretation correct, that if all is well, a cat's BG should fall within the specified periods throughout a day?
     
  20. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    To get a reading, make sure you are....
    1. pushing the test strip fully into the meter (the screen should change - mine shows a drop of blood when it's ready to go, but I have a different type of meter -- but somehow the screen should indicate it's ready to read)
    2. poke the ear
    3. "milk" the ear to get a little bead of blood
    4. touch the opening of the test strip to the drop of blood and let it suck in the blood
    5. wait for the reading to appear

    From the time you push the strip all the way in, until the time you suck in the blood, you'll have a set amount of time. Depending on your meter it might be 60, 90, or 120 seconds. After that it will time out. If you end up needing more time (for example your cat decides to wander off and chase his brother), you can pull the strip back out, and re-insert it to reset the clock.

    And yes, those clicky devices are useless. Most of us just use the lancet (the sharp part) and free-hand poke.

    As for the interpretation of the reading - in a regulated cat (and it can take months to get to regulated), the curve should look like a smile. The pre-shot numbers will be higher, the nadir will be lower. So you inject, in about two-three hours the insulin starts to kick in, then the BG will start to go down, down, down, until somewhere around +4 to +7 (varies by cat, and sometimes by day), then the BG will start to rise again until it's time for the next shot.

    As a cat gets well regulated, they will often drop on the earlier side of that range (+3 to +4), and then flatten out in the middle of the cycle (we call that surfing), and then rise again towards the end of the cycle. So still a smile, but a little flatter in the middle.

    Looking at your numbers, it looks like you had an 800 for PS and a 49 for +3. While that's not impossible, my hunch is that one of those numbers was a bad reading. If the little window in the test strip has too much or too little blood, you can get a bad reading. So when something seems particularly out of place or dramatic (like dropping over 700 points in three hours), we usually suggest testing again to see which reading was wrong.

    Anytime you get a lime green number, it's time to take action. Hypoglycemia can be dangerous. At 49, he wasn't hypo yet, but if he kept dropping for three more hours, he could be in danger, so it's important if you get a lime green number to follow the directions in the yellow sticky for hypos.
     
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  21. MLT

    MLT Member

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    Mar 21, 2019
    How does one correlate the numbers in the SS column headers- which are in the hundreds- with the feline range of 50- 120 (human glucometer) ?
     
  22. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    50-120 is the range for a healthy, non-diabetic cat. The range of a cat's BG can unfortunately span quite high. In some cats even above the 500 listed on the spreadsheet

    As far as converting, there is no correlation. You can't convert from feline numbers to human numbers. They aren't that far off though. If you test using a human meter and a pet meter, in the lower ranges (under 200), the two meters will read fairly close together. In the higher numbers, they will diverge more. Most cats when they are first diagnosed are in those yellow, pink, and red numbers. The fact that storm isn't in those numbers is just lucky. It means his diabetes isn't as advanced as many at diagnosis.

    Please please test every day. Since his numbers are so healthy, there is a reasonable chance that with active care he could go into remission.
     
  23. MLT

    MLT Member

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    Mar 21, 2019
    OK. Goal is to do three tests a day- AM, +6 and PM, but strips fail due to insufficient blood. By the 3rd attempt, I stop- if the cat is so agitated, won't that skew the value, making it useless?! Or does one continue, regardless?
     
  24. Djamila

    Djamila Well-Known Member

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    If you click on the "profile" in my signature, and scroll down, there is a section on testing that you might find helpful. It talks about when to take a break, and what to do next.
     
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  25. MLT

    MLT Member

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    Mar 21, 2019
    I licked on your cat's photo, then Profile (earlier and just now), the following is thrown: "This member limits who may view their full profile."
     
  26. Djamila

    Djamila Well-Known Member

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    If you look at my signature, it's the blue letters that say "profile" there - not the profile for the website. Sorry for leaving that so unclear! Right next to the blue "food list" and above the link to Sam's Spreadsheet.
     
  27. MLT

    MLT Member

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    Mar 21, 2019
    Sweet story! I realize that perseverance is the trick, and am also trying to de-stress myself; Storm, however, is still drawing (my) blood. The AMPS measure is right before the 1st insulin injection. Again today, after half an hour, the only thing I had was a fresh bandage. Which is more important- the glucose reading or the meal (IOW- should one delay the meal and start the 12 hour count from that point, or forego the BG reading, which is what I've been doing)?
     
  28. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Given the numbers you're seeing, I would absolutely not shoot without knowing what the BG reading is. Storm shouldn't be hurting you in this process. That's a sign that he's upset and you need to re-set and start over. Without being there, it's hard to know what exactly is the cause of that, so we'll start with the simplest to fix:

    If he's very hungry at testing time, he's more likely to fight the process, so one trick is to give him a small amount of food (like a small tablespoon), then as soon as he's done eating it, do the test. If you do it right away, the food won't have impacted his BG yet, but it will have calmed him down enough to cooperate for the test.

    If that isn't enough to settle him down, then I think you'll likely need to start over with the testing process. You can't stop testing at this point, but you can do all of those desensitizing practices that I talked about in the profile in between your regular tests. Lots of "acting out" the test, and lots of chin scratches (if he likes those) and a treat, then release. Start to really build those positive associations. One location. One fake test. One treat. Release.

    Over and over. and over.

    Cats really are creatures of habit, and they aren't that hard to train if you are consistent, calm, and confident. Cats can't be forced or they will fight, but they can be trained to participate with us in the process.

    I think Storm has a good shot at remission, but he's reaching the phase where the injections could bring him too low, so testing right now is more important than ever. Deep breaths, put on some music, and take your time.

    Oh, and in answer to your question, it's fine to delay the meal and start the 12 hour clock from whenever you actually give the injection. Especially since you're only shooting once/day right now. However, again, the longer he waits to eat, the hungrier he gets, and the hungrier he gets the less he'll cooperate, so you may want to start the testing process earlier, or do the one-tablespoon trick.
     
  29. MLT

    MLT Member

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    Mar 21, 2019
    Am using TBSP trick and pricking within 15 minutes, and also wear a shirt with slits at the wrist, for the thumbs- fabric is like a brushed cotton (soft) and I can pull it up and down my hand for protection...rather then go to sleep after eating, Storm has restarted staying at his food place, near his water bowl. This week, there was mostly no change in the level of water in his bowl...since @ 2 days ago, he is back to sipping water (when I started insulin, I had to refill water 2-3 times a day).
     
  30. MLT

    MLT Member

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    Mar 21, 2019
    With a large blood drop, Storm just measured '23'. (no treat before) That would be w-a-y low...I gave him some treats. His behavior has not changed since AM. (yesterday, he had chewed some leaves of a spider plant). With a true value so low, wouldn't there be a noticeable change in the cat? (I am wondering if the meter is defective.)
     
  31. Djamila

    Djamila Well-Known Member

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    Oh dear. No, there may not be any visible change in the cat. Doesn't make it safe though!

    With a newly diagnosed cat, we don't recommend giving a full dose when they are under 200. Giving the full 1u on a green number this morning was very dangerous.

    Please take some time to read the stickies at the top of the forum, both the guidelines to know what to do about dosing, and the sticky about hypos. Getting a 23 and not doing another test is really putting Storm at risk. Cats don't show symptoms of a hypo unless they are really in critical condition. It can happen in an instant. Reading the stickies will help you know what to do if this ever happens again.
     
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  32. MLT

    MLT Member

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    Mar 21, 2019
    Vet- who said not to adjust dose/he will do post curve- is back from vacation, has not connected, no reply re SS. Will keep trying to connect. Initial starting point was to be 1U, but Storm was probably getting @ .25U. Has been 1U since 3/29.
     
  33. Jasper Blue and Jay

    Jasper Blue and Jay Member

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    Mar 15, 2019
    How is he doing now? What kind of treats did you give after 23?

    Is it normal for him to chew on a spider plant? Or might he have been ravenous from hypo? Was there food out at the time he was munching the plant?

    Our guys don't eat plants luckily but I'm still super cautious with which ones I put where they can get, and I know from past research the aspca says Spider Plants are non-toxic to cats but I don't know if it has an effect on blood sugar. https://www.aspca.org/pet-care/animal-poison-control/toxic-and-non-toxic-plants/spider-plant
     
    Last edited: Apr 1, 2019
  34. MLT

    MLT Member

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    Mar 21, 2019
    He's been his usual sleeping, following me around. After the ow measurement, I have him 7-8 Blue Wilderness Soft-Moist Cat Treats(Chicken and Trout) and a Raw Boost Mixer (Instinct). It's a running joke in my house- the plants have never been safe, because he has always munched on them. I keep them up as high as I can, and have't had a spider plant for years. But I got one recently, and had it on top of a radiator (for extra heat, thinking that it would be safe as he has been reaching/jumping less). That morning when I had woken, he had toppled it, chewed some, and spit up pieces.

    RE FF- I sometimes fed it to my cats, and went to Petco to get some last week (lots of sites say it is good for diabetic cats). I commented to the cashier that it was s-o discounted....she and another lady told me that Petco was going to discontinue carrying it, as it was not good, that FF was going to come out with an improved line, which the store would stock. (we are in Northern Virginia) Hear anything like that?
     
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  35. Rachel

    Rachel Well-Known Member

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    Aug 25, 2013
    I haven't heard anything about that, but you might contact FF and ask them. They should be able to give you some info on it, as well as info on what the new line will include.
     
  36. MLT

    MLT Member

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    Mar 21, 2019
    AHA! Sent an online message to the FF folks, and am still waiting for a reply; however, I found a reference to FF being pulled in another forum- "Petco new food: WholeHearted carb content ok?".
     
  37. MLT

    MLT Member

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    Mar 21, 2019
    @Rachel Here's another thread "Petco website message about Fancy Feast..." I checked out the first link, but rather than an alert, it looks to be mainly for sales.....
     
  38. Zoey & Carol

    Zoey & Carol Member

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    MLT - I bought a can of the Whole Hearted and checked it with the carb calculator. It was way too high, although I can't remember the exact %. I ended up giving it to my non-diabetic cat, and even he wouldn't eat it!
     
  39. MLT

    MLT Member

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    Mar 21, 2019
    Got an 'official' response from Purina RE is FF changing its line. Basically, it was 'we don't respond to rumors'.... I called Purina at 800.933.0991- the rep had no knowledge of a line change 'at this time', and referred me to Purina.com. Seems to me that because of all the variables, a good rule of thumb is to check cat food labels and then rely on your cat's gut instinct to know what works for his/her body!
     
  40. Zoey & Carol

    Zoey & Carol Member

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    I'm going to keep using FF until I see a bad reaction or get further information. It is not the only food Zoey eats, so if I have to quit using it, she won't starve!
     
  41. MLT

    MLT Member

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    Mar 21, 2019
    (Thanks to all who kept me moving ahead...) Continue to notice this- Storm has less control over his hind legs and front paws- they slip, and when I touch his paw pads, rather than push back, they remain limp. Good neuropathy resources- trying to educate myself before informing vet, who wants periodic curves only, never says to make changes (but it seems to me that we should be more proactive?!) Overall QUESTIONS:

    RE insulin- board says not to administer full dose if BG under 200. Storm is consistently under 200. (I had moved to .5. vet did not say anything, so I moved back to .75. Does .25 change even do anything?)

    RE neuropathy- treatment should start whenever cat within 'normal' BG range?

    RE BG Range- should I be aiming to keep Storm on less insulin- measurements to be in blue- or should the goal be to maintain him within GREEN ?!
     
  42. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Those are great questions!

    Neuropathy treatment should start now. Zobaline is the recommended combination for treating neuropathy in cats. You can buy it from amazon or most pet pharmacies. It's tasteless and just mixes into the food. It does take awhile to start noticing a difference (several weeks to a month or so).

    Not shooting under 200 is for new folks, or folks who are not testing regularly. It's a guideline to keep the kitties safe before their responses are known and more predictable. Over time, the "no shoot" number can be lowered.

    A healthy, non-diabetic cat is typically between 50-80 most of the time, without insulin. On insulin, good control would most likely have PS numbers in the blues, and several hours in the middle in the dark greens. Maintaining in green, while on prozinc, would be very difficult. That can be done well on Lantus and Levemir, but Prozinc has a slightly steeper curve. In general if a cat on prozinc has PS numbers in the greens, it's time to come off of insulin.

    Given the infrequency of data on your spreadsheet, I'm a little nervous about the current dose. I think I'd lower to 0.25u, and try to collect data daily (at least before every shot, but preferably some mid-cycle data - even if it's just a before bed test at night). If you lower the dose and the PS numbers start to climb again, post and have someone check the updated data.

    And yes, a 0.25u change does make a big difference. A single drop can make a big difference. We often adjust doses by what we call a "skinny" or a "fat" dose (just above or just below the line), and even that can make a difference. Insulin is powerful.
     
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  43. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Hi. Yes, .25 absolutely does have an effect. It seems like so little to us, but we weigh about 10 times more than our kitties do, and if you think about it, it's 50% of what Storm's dose is.

    Now I freely confess that I didn't read through this whole thread, but I'm not sure I would be shooting even .5 units with such a low pre-shot number. The normal cat range on a human meter is 50-120, and I get that Storm is there with some insulin support, but he's so newly diagnosed (6 weeks, yes?) that I wonder if he can do well on less and ultimately do it all on his own? Do you have any mid-day data? (I know sometimes I have data but take awhile to getting around to posting it :oops: ) I would be very curious to know how low he may be dropping at nadir . . .
     
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  44. Jenna Josie

    Jenna Josie Member

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    Oops -- cross posted with Djamila!
     
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  45. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    (Okay, and also, I thought the range was 50-120, but maybe it's really *mostly* between 50-80, and up to 120 on occasion?)
     
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  46. Djamila

    Djamila Well-Known Member

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    Yes, exactly! And even with that there is some wiggle room. For example, it's 68-150 on an AT2, and I've also read 70-180, and a few other ranges cited as normal. Around here and from studying spreadsheets, we generally use 50-80 as normal, non-diabetic, with occasional numbers up to 120.
     
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  47. MLT

    MLT Member

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    Mar 21, 2019
    Yes, I got remiss- was going to do curves on Sundays and 3 bg checks/day but it is still stressful...and that skews the numbers. (And we were not home) Also, I thought he was getting better with the hg pricks, but it's more likely that Storm seems calmer because he is not also clawing at me. Vet replied to my email- he suggested I get an AlphaTrak2 because he can't advise me because 'there are no studies that support the glucometer that I am using in cats', that I should bring Storm in for a fructosamine test, that what I am noticing in legs could be arthritis or something else...
     
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  48. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Meh. Human meters work just fine. Your vet may not be able to help with dosing, but I'm keeping my fingers crossed that Storm isn't going to need insulin much longer anyways. :D Oh, and here's a study that uses human meters (although it does say AT2 is good when possible) www.felinediabetes.com/FDMB/attachments/management-of-diabetic-cats-pdf.11641/

    I'd hold off on the fructosamine until we figure out if he's going to go off insulin or not. If he does, your vet will want to verify that with another fructosamine anyway. Might as well save the money and just do it once.

    The back legs could be arthritis. He's in pretty low numbers to be showing severe neuropathy to be honest. Although my kitty shows it in pretty low ranges too, so it's not impossible.
     
  49. MLT

    MLT Member

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    Mar 21, 2019
    Will read the study, thanks for that info. I would expect pain with arthritis, but I don't see any. He does let go with a howl- different than his food growl- about once per day, but what really gets me is when I pick him up, he doesn't squirm/legs don't move at all. Need to read up on the Zobaline - my thought is that we should start using it, unless it has negative effect if the issue is something else. But that begs a question- is there a 'scientific' test for nerve damage, or is the diagnosis made based on what is seen?!
     
  50. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Not that I know of, but I believe an x-ray could help identify arthritis.....? Maybe someone with more knowledge about that could chime in. Or you could ask out on Main which is a great place to get more eyes on general health questions. Zobaline won't hurt regardless.
     
  51. MLT

    MLT Member

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    Mar 21, 2019
    ** He is not showing severe neuropathy- his stance is a bit off. I would think that with arthritis in the legs/leg joints, Storm would show some pain while walking. He shows none. Very informative study....sent it to the vet (I think that put him off). Just called Banfield (national vet)- they only use AlphaTrak2. I'm in the process of getting that meter, because 2/2 on this area will only use pet meter. BUT- if the vet 'may not be able to help with dosing....'. What can they do then?!
     
  52. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Lol...great question! They can help with lab work, charging money, and writing prescriptions :D

    As far as the dosing help -- we can do that part. And right now, Storm is skimming a little too low during the cycle, which means it's likely he's dipping below that at night since most cats (though not all) run lower at night. I would lower the dose to 0.25u and see how that goes.
     
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  53. MLT

    MLT Member

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    Mar 21, 2019
    Storm is down to .25 syringe measure (as eye-balled). Ironically, when I started, vet recommended 1U, but because of the incorrect way I was dosing, Storm got air and @ .1U insulin. (No records in 1st two weeks, as vet said to do curve only...) His excess urination stopped within 2 days. Pre insulin, Storm was usually fed soft food in the morning and at dinner time, with kibble down for free grazing; this past year, I worked remotely, and shifted him to my 3x/day meal schedule (not good, soft food returned to 2x/day), plus kibble.

    He now gets soft, DM food 2x/day, no kibble. He is still ravenous at mean/insulin times (because of the insulin or because the little dude is used to grazing?!) 1) Can I introduce a high protein kibble and reduce soft food a tad, making sure that the bg measurements stay within the same range?

    2) in general, if a cat gets other food during a 12 hour period, does that reduce the efficacy of the insulin/create the need for more insulin, or?

    I thought that a nadir occurred after each dose; however, I've been rereading- 3) the nadir occurs about 7-8 hours after 1st dose, and lasts for @ 8 hours...so there is one 'nadir period' per 24 hours, yes? So logically, rather then schedule additional tests during the day, I should try to do them starting a few hours after his PMPS?
     
  54. MLT

    MLT Member

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    Mar 21, 2019
    And his higher, blue numbers seem to be related to days when he got treats (and ergo my question about food in addition to 2ce/day soft food.
     
  55. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Can you share the article where you read that? I'm curious... Typically cats will nadir twice - once each cycle. However, when they are close to regulation, or close to going off insulin, the cycle will usually be fairly flat.

    I absolutely would not introduce hard food. Storm looks very close to possibly going into remission. And kibble, no matter how low carb, would likely mess that up as it's very unhealthy for them aside from the carb count.

    There is no reason not to let Storm graze on wet food. Most of us leave wet food out all day for them to eat as they wish. As long as you control the total amount so that Storm doesn't start gaining weight (unless he needs to gain weight?), then it's fine to let him eat whenever he wants.

    Add some extra water to the wet food - I usually add about 3 Tablespoons to a can of fancy feast - and that helps keep it from drying out when it's left out. You can also mix the food with the water, freeze into a patty, and leave that out - then he can eat as it thaws and avoid scarfing it all down at once.

    In truth, only feeding twice/day can be a little hard on them, so spreading the food out more during the cycle can help him not be ravenous at meal times.

    I'm still concerned about how low he might be going overnight. Nighttime cycles are often lower than daytime cycles, and giving a dose on a green number is not quite safe for a newly diagnosed cat. I would really encourage you to get a before-bed test at night to make sure he's staying in safe numbers.
     
  56. MLT

    MLT Member

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    Mar 21, 2019
    Tried back tracking to the reference. Today, all I can find says nadir starts within 3-4 hours of insulin shot, all point to 2 phases. (I will keep looking) In theory, if a cat is getting too much insulin, BG readings decrease (worst case scenario is hypo);therefore, since Storm's BG readings are so low, is it logical that he should be getting even less insulin in order to raise the levels?
     
  57. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    No worries about the article -- I've definitely had that happen too where I read something really interesting and then can't find it again. I've got to get better at bookmarking! Onset for Prozinc is typically somewhere between +2 and +4, with the 3-4 range you cited being reasonable. Nadir is the lowest point in the cycle - so it can happen at any time, though typical is somewhere in the +4 to +7 range. So if you tested all the way through the whole cycle, whatever number was lowest would be nadir for that cycle. And when the nadir occurs can change from cat to cat and from cycle to cycle. Most cats will have a "typical" time, but can still vary. We use the term a little loosely around here since we don't test every hour -- sometimes we are making our best guess based on patterns, trends, and what we've learned from studying hundreds of spreadsheets. We should probably be more careful about being precise with that term. ;)

    As for Storm's dose -- Based on the data we can see, it's not that you need to raise his BG levels - everything you've caught so far has been safe. However it's possible that he's dipped lower during the night - there are a couple of daytime cycles that hinted at that, so that's why I suggested lowering to 0.25. And now the question is if he could stay mostly in that 50-80 range on his own, without insulin. Your one test last night - the 56 - is making me think you could try dropping down to a 0.1u dose and see if he still hangs out in the greens. You would just pull in a teeny tiny bit of insulin - just to that first line - the line for zero. When you inject, it won't feel like you gave anything at all, but even that tiny bit can make a difference. Give that a try and let's see how he does. And I'll keep my fingers crossed that he might be just about ready to go off of insulin altogether.
     
  58. MLT

    MLT Member

    Joined:
    Mar 21, 2019
    (I am more nervous than Storm...) Eye-balling it, I gave him a smidge under .25/on top of initial line this AM- after eating, I got him playing with his pop toy, which he continued to swat and chase around for @ 20 minutes. Now sleeping. (Had meant to measure BG him @ 4 hours before his AMPS, but I overslept.) I setup and practiced with the AlphaTrak yesterday, and will do a curve on Sunday.
     

    Attached Files:

  59. Djamila

    Djamila Well-Known Member

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    He's looking good on his first day with the 0.1u. Keeping my fingers crossed he'll be ready to go on his own soon...
     
  60. MLT

    MLT Member

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  61. MLT

    MLT Member

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    Mar 21, 2019
    So much for a "curve" (results are in the AlphaTrak SS). Storm's numbers were fairly consistent, with the exception of one nose dive. Yesterday, I still gave him the PM insulin. No insulin today. I have introduced one more feeding of DM (soft food).
     
  62. MLT

    MLT Member

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    Mar 21, 2019
    What does the curve indicate? (vet not responding) Dosing?! Not sure what to do....will return Storm to .1U with morning feeding.
     
  63. MLT

    MLT Member

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    Mar 21, 2019
    Morning bg w/th AlphaTrak= 147; with ReliON Prime = 108.
     
  64. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Well, my hunch is that the 39 was a bad reading. While I suppose anything is possible, having such a flat curve, and one steep diving hour like that, seems unlikely. If you ever get a number that seems out of place, it's a good idea to run a second test to double check. All it takes is a little too much or too little blood and you can get a false reading like that.

    And as for what it says, it's saying that he's not ready to be off of insulin yet. His numbers are still just a little too high to be where you'd want to see them when he goes off insulin altogether. The vet may say differently since they tend to tolerate higher numbers than we do. But if it was my cat, I'd keep up with insulin support until his numbers start looking a little bit lower than what you saw yesterday. He's close though!
     
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  65. Yong & Maury GA

    Yong & Maury GA Well-Known Member

    Joined:
    Jan 11, 2017
    Hi MLT!
    I've not been following the entire thread but just the most recent comments. I'd have to agree the 39 was probably a bad reading and agree with Djamila in doing a retest whenever you get wonky numbers like that o_O. I also agree he isn't quite ready to stop insulin but his pancreas is showing some good signs :woot:!

    Such an adorable face, he has :cat:
     
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  66. MLT

    MLT Member

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    Mar 21, 2019
    Am doing another curve today with AlphaTrak meter. Two days ago, Storm got out and hid under porch. Until he came toward my daughter/was brought in house, he 'munched on grass'. The 1st day, loose stool and what looked like vomit in litter box (to be expected). This morning, dangerously low AMPS- gave food and raw topper treats. Gave Zobaline in AM 3x/day, did not give this morning. I have a food question, will ask the nutrition group. AND, it takes me on average 3-4 pricks to get blood. Is there any way to estimate the impact of increased 'stress' ?! (I might have asked before, but that could be skewing all his numbers....)
     
  67. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    What size lancets are you using? And are you warming the ear before poking?
     
  68. MLT

    MLT Member

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    Mar 21, 2019
    Warming with a rice sock worked a few times, then he saw it as aggravation, started biting again...I massage the ear gently, but that can aggravate him as he has ear polyps/growths, which causes him to start scratching his ears with paws. I started with 26, have been using 33's , and started using 28 this afternoon. I am back to stroking him for @ 20 mins and post treat. I am aiming for up to 2 pricks. Bigger question (I had started to post on Main this morning, but was booted off the site)- 2ce/day feeding is NOT normal for Storm. Everything I read says that one should maintain eating pattern...that would be soft food for breakfast and dinner, with grazing during the day. I have been giving him soft food in small portions, to make the total with the PMPS timing. (I have the luxury of being home now, but that will end, so I have ordered Young Again Mature Zero kibble). I have frozen some DM in ice cube tray- he bit at the stuff when it was still icy.... Kibble should arrive this week, so I will return his regimen to AM soft food meal (kibble down during day) PM soft food mean.
     
  69. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    The 28's should help, and you can go back to the 26s if needed. Rachel used to do two pokes right in a row to help with the bleeding. Since it's just bam-bam, it doesn't cause any more stress than just one poke, and might help until his ears start bleeding better.

    YAZ can be really hard on their digestive system - often causes stinky poo and diarrhea. And it can vary from one bag to the next - one bag might be fine, and then the next bag can cause liquipoo. In some cats, it can also raise BG quite a bit, and again, varies by bag. Just some things to be aware of as you try that.

    It's also fine to just leave out wet food - frozen or not. When I freeze chunks of it, mine will sometimes bite into it early too. It doesm't hurt them any, and they abandon it quickly and come back later. I honestly think Sam prefers it a little bit frozen.

    And cats who tend to scarf it all down at once will often settle down after a few days when they learn to trust that there will always be food available and they don't need to panic and eat it all at once.
     
  70. MLT

    MLT Member

    Joined:
    Mar 21, 2019
    (FYI- this past week, keep getting database errors, unable to access) Missed 2 PM curve measure yesterday...Storm more lethargic last week (than he has been);back to sitting at his food bowl. This AM, stopped eating his 'usual' amount, so I added additional water (2X) Second time, he nibbled but left some, which I have left down. The shot that I gave him was exactly on the 1st line (ie none). Will put out a frozen soft food cube for mid morning-early afternoon. Is there value to doing curves more often than 2 weeks?
     
  71. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    Hi there! It looks like Storm would like you to stop giving him insulin. See those lime green numbers? Those shouldn't be there. They tell you that he's going too low to be getting injected insulin.

    Also, if you are giving insulin, it's really dangerous to do so without testing, so all of those skipped tests have me a bit worried.

    I would suggest doing an OTJ trial (off the juice). So don't give a shot, but do test twice/day. Any two times is fine - keeping the AMPS and PMPS is easiest for most people, but there is some flexiblity when not injecting insulin. If you start to see the numbers creep into the blues (human meter), or over 150 (AT), post and ask for someone to take a look at it - you might need to restart insulin. But let's give it a try without and see if Storm can keep his numbers down all on his own.
     
  72. MLT

    MLT Member

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    Mar 21, 2019
    Without insulin, looks like there is a consistent drop in bg. If anything, I had expected to see numbers rise (??) This morning feed was an hour late. He has not touched DM. Added more kibble to his other bowl- he ate one or two pieces, then just sits by eating area. (Too much protein?!)
     
  73. MLT

    MLT Member

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    Mar 21, 2019
    (I restart full time work out of house on 6/17). A dish had fallen and cracked, which had startled him as he started to eat. I left kitchen (thinking he would eat if there was no movement around him). He followed me upstairs, did a turn around the room, then left. He jumped on toilet in the bathroom (to then jump on sink, for water in the sink?). I went downstairs. He returned to the kitchen, looked at food bowls, pawed a few times at water dish, then started taking sips. Hovered around food mat, then came into room where I was sitting, stayed on floor, jumped on sofa. I just gave him three Blue Wilderness cat treats, which he ate. He has settled down, but not in sleep position. Also notice this AM- he is using front and back legs as little as possible. EX: when I picked him and put him on sofa in order to take AM bg, he just lay in the same position (vs adjust himself). Why are numbers decreasing, when increase would have been logical?
     
  74. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I'm afraid I'm not understanding what you're asking right now. BG only goes up in diabetic cats because they don't make enough insulin to counter-balance carbs. Storm's pancreas ismaking insulin, so is able to keep the numbers down. However, taxing his system with all of those carbs can bring him right back out of remission, so I would really encourage you to stop the kibble and BW treats and just keep him on the canned low carb food and freeze dried treats. Once a diabetic, they will always have a rather fragile pancreas so you don't want to overwork it.
     
  75. MLT

    MLT Member

    Joined:
    Mar 21, 2019
    I stopped insulin as of 5/27, and have been monitoring Storm 2x/week. His AMPS this morning is 'in the blue'. Because he hangs at his food bowl, I would 'remound' it for him; @ half a week ago, I also started moistening the DM with water- he eats @ half, waits for it to be moistened again, and finishes most (the level of his soft food intake has not changed). Should I monitor bg more than 2x/day?
     
  76. Djamila

    Djamila Well-Known Member

    Joined:
    Aug 1, 2015
    It makes me giggle how many of us stir and revive the food for our kitties. They are soooo spoiled! :rolleyes: (I do it too when I'm home)

    I wouldn't be too worried about that blue since it's still under 120. We say they are OTJ after 14 days without insulin. You're really close right now! I would keep testing twice/day to finish out your 14 days, and let's see if any more blues pop up. Sometimes they just have an off day. It looks like most of his numbers have been 80's and below.
     
  77. MLT

    MLT Member

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    Mar 21, 2019
    O K. What also concerned me is he eats less, waits for more water to be added to the food (at which point he starts up again). His legs are really not the same. Since his numbers are back to 'normal' does that point to arthritis? (I bought Zobaline, but is neuropathy now ruled out?)
     
  78. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It can take awhile to heal from neuropathy, so I would go ahead with the zobaline. However, he's old enough that arthritis is certainly possible. :(
     

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