Help Please, testing advice and dosing questions

Dee Dee C

Dee Dee C

Member
Clarence went to vet on 7/11 and vet did a +4 and +6 test on him to help get him regulated. He decided to increase his dose of Vetsulin from 2 units to 3 units. I didn't like the idea of increasing it 1 whole unit at a time, so he said it was okay to increase in 1/2 unit increments -- give 2 1/2 units for seven days, then increase to 3 units. Today was his first day with the 3 units, so I tested him every two hours. At +6 his BG was 100. In the past, the testing I've done has indicated the nadir at +4, so I tested him again at +6 1/2 and it was 79. Because I haven't seen it go that low before, I fed him some of his usual food and called the vet. I gave them the numbers from all the tests of the day. They called me back and said he was probably just 'adjusting' to the 3 units and to go ahead and give him the 3 units at the 12 hour point and not to test him again until Friday (of course, I'm not going along with the 'not testing' advise
I was concerned about giving him the full 3 units, so I only gave him 2 3/4 nits (his PM pre-test showed him at 332). I tested him at +1 and his BG was 407.
I'm concerned about him going to low, so I will be testing him every hour until I'm sure he will be okay.
Can someone take a look at his numbers for today on the spreadsheet and tell me whether this seems okay or should I be worried. He had no symptoms when he was at 79, I just had not seen him go that low before and since I've read that the AlphaTRAK reads a bit high, I didn't want to take any chances. Help, please.
 
@MrWorfMen's Mom

Basing dosing off of tests at the vet definitely isn’t a good idea since the cat will most likely be stressed and have elevated BG. You’re also right to not want to increase his dose by a whole unit - that’s a lot! I’ve tagged a more experienced member for you so she can take a look at your spreadsheet and see what she thinks (:
 
His +11 test this morning was 195. He is eating right now and I will test him again after he eats. It is about 15 minutes shy of his 12 hour mark right now.
 
Dee Dee C said:
Clarence went to vet on 7/11 and vet did a +4 and +6 test on him to help get him regulated. He decided to increase his dose of Vetsulin from 2 units to 3 units. I didn't like the idea of increasing it 1 whole unit at a time, so he said it was okay to increase in 1/2 unit increments -- give 2 1/2 units for seven days, then increase to 3 units. Today was his first day with the 3 units, so I tested him every two hours. At +6 his BG was 100. In the past, the testing I've done has indicated the nadir at +4, so I tested him again at +6 1/2 and it was 79. Because I haven't seen it go that low before, I fed him some of his usual food and called the vet. I gave them the numbers from all the tests of the day. They called me back and said he was probably just 'adjusting' to the 3 units and to go ahead and give him the 3 units at the 12 hour point and not to test him again until Friday (of course, I'm not going along with the 'not testing' advise
I was concerned about giving him the full 3 units, so I only gave him 2 3/4 nits (his PM pre-test showed him at 332). I tested him at +1 and his BG was 407.
I'm concerned about him going to low, so I will be testing him every hour until I'm sure he will be okay.
Can someone take a look at his numbers for today on the spreadsheet and tell me whether this seems okay or should I be worried. He had no symptoms when he was at 79, I just had not seen him go that low before and since I've read that the AlphaTRAK reads a bit high, I didn't want to take any chances. Help, please.
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Alphas don’t read high... they read what the vet gets. Human meters read low. Normal on a human meter is 50-120 and on a pet meter it's 68-150. So those lovely blues are just what you want.
 
Sorry, I'm a little confused about the testing before he eats vs. after. I have read both on the internet. I really don't want to give him an injection, since his test after he ate was only 238. What about skipping this morning's injection and then seeing where his BG is later in the day and right before feeding this evening?
 
Janet and Linda, please correct me if I’m wrong! But for Vetsulin, for preshots it’s typically test, feed, then give insulin. That way the reading isnt influenced by food, which will make it higher but the food eventually wears off. Some also advise to wait for 20 or 30 minutes after he eats before giving insulin to make sure the food stays down.

Now for tests throughout the day, I’ve seen both opinions for when to test in relation to feeding so I’m not sure there

ETA: From the Vetsulin sticky: “So, the sequence would be: 1. Test BG. 2. Feed. 3. Wait 20 - 30 mins. 4. Give the insulin shot.“
 
In the past I had been testing him before he ate anything. But then I read that for a curve, I should test after he ate, so I began doing that shortly after his increase from 2 to 2.5 units. Guess this means that the numbers I entered on the spreadsheet are inconsistent. I'm still learning all of this and not wanting to make my cat go hypo. His numbers were nearly always above 400 in the mornings and in the evenings when I did the pre-shot test before eating.
 
Sorry.... I may be a little late to the party here but I don't think I'd give a full dose on a pre-shot of 238 if that was taken after he ate. The question is how long after his meal did you get that reading? If you tested immediately after he ate, it's probably not too influenced by the food but if there was some time between him finishing his food and the test, then it definitely is food infuenced.

I see your SS indicates you skipped the shot this AM which is fine as long as Clarence has no history of ketones or DKA. I was thinking 2.75u might be a good dose for now until that pre-shot this AM. Now I would suggest backing off to 2.5u if BG after a minimum of a 2 hour fast is at least 225 to 250. I would also suggest getting a test around 3 hours post shot if possible to see where Clarence is headed.

FYI- curves are testing starting with a pre-shot non-food influenced reading followed by testing every 2 hours for 12 hours or every 3 hours for 18 hours. Grabbing random tests mid cycle especially in the +3 to +6 post shot time frame will determine how low the dose is taking Clarence and dose is determined based on that information along with the pre-shot testing. Pre-shot testing will tell you whether it is safe to give insulin. Testing only at +4 and +6 may be totally missing the lowest point in Clarence's cycles.

Let's see what his BG looks like tonight.
 
Thank you. I don't have any solid info on the ketones, but I suspect he did have ketones in his urine before his diagnosis. The 238 after eating was maybe 15 minutes to a half hour after he ate. Since he had no injection this morning, at what point should I test him to see how he is doing?

FYI, he normally gets his food at 6:00, and when he has eaten most or all of it (normally around 6:30), I had been giving the injection. Then I read that waiting 20 minutes is advised so that you can be sure they have food on-board, so I started waiting a little - 10-20 minutes. This resulted in his shot usually being given between 6:30 and 7:00. Last night, I was a bit late -- 7:20 -- with his injection due to being a bit indecisive about how much to give. I'm surprised he was still so low when the last test was done this morning at 7:23
 
The lower pre-shot this morning may be indicative of the dose being too high. I would assume the food was in play in that 238 BG this AM with a 15 to 30 minutes delay between the end of Clarence's meal and the BG testing. Today since there was no shot given, you really don't need to test Clarence but if you can get a test about 3 to 4 hours post his morning meal it can sometimes show whether the pancreas is working to help level out BG. FWIW, I think your decision to skip the shot this AM was a prudent one.

We don't generally deal with clock times here because we are all spread out around the world. We deal with pre-shots (AMPS & PMPS) and then +1, 2,3 etc post shot times. Ideally you would test Clarence, feed him, wait 20 to 30 minutes after he finishes his meal and then administer his shot. With Vetsulin, as long as pre-shot is high enough to safely give insulin, you have an hour's leeway in shot time.....you can give the shot up to one hour early if needed. Late shots don't matter but will affect timing of the next shot.
 
Ok, got it. I will get a reading or two as you suggest. A couple more questions:

When I do his PMPS should I go ahead and give the 3 units or should I decrease it to 2.75 or maybe 2.5 units depending on his reading?

I'm running out of test strips, do you know -- are there retailers in the U.S. (California) that carry these strips for the AllphaTRAK2?

Thank you so much for your help, I'm super frustrated with myself trying to do the right think for my kitty and just not knowing.
 
I would try 2.5u for now if BG at pre-shot before food is 250 or at minimum 225. The lower BG this AM suggests Clarence may have gone lower last night than you are aware of so until you get a bit more data, I would be a little more conservative with the dosing. The increase of 1u suggested by the vet is huge. We normally make dose adjustments in 0.25u increments to ensure we don't jump over the ideal dose. Insulin is not medicine...it's a hormone and although it's counter intuitive, too much insulin can look just like too little which often leads to slowing down the process of regulating the cat. Slow small incremental dose increases can have a big impact.
 
As for the strips for the AT2, if there is a pet pharmacy around you, they would likely carry them but they are not available in regular retailers or pharmacies. Your vets office may have some on hand to sell to their clients. There are online pharmacies including adwdiabetes.com that sells the AT2 branded strips.

In a pinch, you can use Freestyle Lite/Insulinx strips, available at Walmart and pharmacies, in the AT2 meter however without the correct code the readings won't be as accurate as is possible but will be in the ballpark. You would just leave your AT2 meter set to the cat code you are currently using.
 
Thanks so much. I'll get some strips ordered and maybe make a trip to Walmart as well. I'm not feeling much like trying to purchase any from my vet right now, not feeling especially warm and fuzzy about the 'give 3u twice a day and don't test again until Friday' advice I was given by their office yesterday...
 
When I was still using the AlphaTrak, I used freestyle strips in it and it seemed to work fine. I kept the meter set to the same cat code and made sure to test the strips with the control solution. However, they were VERY pricey at Walmart, I believe around $80 for 50, and like $35 on Amazon (which doesn’t help you needing them today unfortunately)
 
I think I can get by with what strips I have left until tomorrow, especially since I didn't inject this morning. I already ordered the AT strips on Amazon and they should be here tomorrow. I'll do the minimum amount of testing I can get by with today. I'm gonna look into the Freestyle strips, though, when it isn't so crazy and I'm not so tired. I was up all night testing, so only got a couple hours of sleep. Thankful for caffeine today!
 
I'd stick with the 2.5u dose for now BUT only if you have enough strips to keep tabs on Clarence should he go low again. I doubt it will be an active night tonight but you never know. The high BG is from a natural phenomenon called bouncing along with the missed shot this morning. Bouncing happens when kitty's BG drops quickly, drops a lot or drops to levels that kitty is not used or are too low. You don't want Clarence going below 90 on Vetsulin because of the quick action it can have on BG. It's caused by the body's defences that cause stored glucose to be released into the bloodstream when the body perceives BG is dropping too fast or is too low.

If you are low on strips, I'd drop his dose down to perhaps 2u for tonight and go back to the 2.5u dose when the strips arrive. You don't want BG dropping and having no way to check on Clarence.
 
What about testing him at +3 or +4 hours instead of the +2 ? He ate a good meal and I could save a strip that way...
 
If he ate well a +3 should be fine but I wouldn't go any longer so if he is dropping you can prop him up early to avoid a PJ party or running out of strips.
 
Okay, I will do that. Thank you for all the support, I would be totally beside myself without this forum, that's for sure! I'll test him in an hour and see how he's doing.
 
I noticed I had some incorrect information regarding his dosage amount on the spreadsheet for the period 7/11 thru 7/14. I have corrected it. The info in my post was accurate, but I had it incorrect on the spreadsheet -- I was slightly stressed when I input that info yesterday on the spreadsheet. Sorry if that confused anyone. When the vet wanted to increase him from 2 to 3, I wanted to do it in 1/2 unit increments, rather than all at once, and that is what I did. Prior to yesterday AM, he was getting 2.5 units.
 
Once you get your new batch of strips, I think 2.75u is looking like the dose to try at this point. He is looking good. I think if you want to get some sleep, you could give Clarence a low carb snack now and maybe do one more check before bed.
 
I'll take it! Thank you so much for all you have done. I'll do a follow-up post in the morning and update the spreadsheet. I gave him 2.5 tonight, so you think I should give 2.75 in the morning if his AMPS is high enuf?
 
I think the dose this morning has to depend on the pre-shot reading and how many strips you have on hand right now. Looking at the readings for the last couple of cycles it looks like Clarence may have a later nadir than most cats on Vetsulin. This is good because he is getting quite a good run in better BG range but also means that if he does seem to be dropping quickly or a lot, you may need to do a bit more testing so I think sticking to 2.5u until the strips arrive would be prudent.

It's a good idea to always have a spare supply of strips just in case an order gets delayed or you go through more strips than expected. I kept an unopened supply of strips in my Hypo Kit and every time I bought a new supply of strips, I swapped out the extra in my hypo kit so the hypo kit supply was always fresh.
 
Neither his AMPS nor his PMPS has been this low since I began testing him. The closest was a 326 at the end of June and I believe that reading was right after he was increased from 1.5u to 2u.
 
I'm thinking maybe I should give him 1.5u to be safe. And I think I may take a drive down to town and look at getting a human meter and some strips -- something inexpensive so I can test him with that at least for the day. This may be a silly question, but is there such a thing as partial remission? Is it possible that the insulin I'm injecting is somehow stimulating his pancreas to make additional insulin?

Another thing I will do when I get a chance is input those numbers from when I first got the meter. The testing I was doing was more random, but many times I did test him
 
I think earlier in the thread Linda mentioned giving 2 units until your new strips arrive, but it’s really about what you feel comfortable doing, especially being low on strips.

If you want to, you can always just switch over to a human meter permanently as many people do. It’s much cheaper in the long run and strips are more readily available (although I did love my AlphaTrak!).

I don’t know if “partial remission” is the correct term, but yes the pancreas can heal and start to work again. Sometimes it starts functioning normally on its own which is remission, but a lot of times it just means you need to reduce to dose
 
Since his pre-shot readings have mostly run in the mid 300s to mid 400s, 310 feels low to me and I'd like to have a better handle on what's happening with him. I don't like changing the amount, but maybe 1.5 will be okay and less risky.

Any human meters that don't require a large drop of blood or that you would recommend? Drug stores within a 30 minute drive from me are Rite Aide, CVS and Walgreens.
 
310 is still quite high, but it definitely feels like a lower number after being used to higher ones!

The ReliOn prime (the one I use) requires a 0.5uL sample, which is a smidge more than the AlphaTrak but not much. It’s also super cheap and available at Walmart. 100 strips are $20

I considered the Freestyle lite which is basically the human version of the AlphaTrak and requires the same small sample size, but the strips were just not a whole lot cheaper
 
Thank you for that info. Walmart is a bit farther for me, but not by much and it seems worth the extra few miles. The cost looks good and I don't think I'll have any trouble getting enough blood, so that's probably the one I'll end up getting. It is amazing to me that in a lot of cases you can buy a meter with strips for less than just the strips. And in the case of the AT2, the strips are about $1 each.

As for 310 still being quite high, I agree that it is. I'm really confused about the way he is responding to the insulin now, tho, because it appears to be different than before. Since I've been testing him, he has not been that low on any pre-shot test. I realize I haven't been doing it for very long, and my inexperience makes me feel more conservative until I can really get a handle on this.

I've plugged the numbers into the spreadsheet from when I first got the meter and started testing Clarence. In the beginning it looked like the insulin was not lasting as long in him, but I didn't do that many tests throughout the cycle. I am confused now by how late in the cycle his numbers are still low and how slow they rise back up on these last couple cycles.
 
Yeah I loved the AlphaTrak but it was just so much more expensive, especially with how often I was testing. Just a word of caution if you decide to stick with the human meter, they do read lower so don’t panic! Just know that normal range for that meter is 60-120. Also don’t try to compare readings between the two as it will just drive you crazy lol.

And it’s definitely a learning curve with feline diabetes! The more you test, the more you will understand his patterns and how he responds to insulin, and it will make things much less scary. But what you’re wanting is for the insulin to his pancreas and for his numbers to come down. Not sure if this helps, but here’s an explanation of the different BG values and ranges
  • Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs
  • Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs
  • Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia
  • Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia
  • Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin
  • Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin
As for his spreadsheet, there are others much more experienced than I am that can hopefully help decipher that for you (:
 
yes, that ReliOn Prime is definitely the winner when it comes to the expense of doing a LOT of testing -- and when you need the strips NOW not next week !

but don't compare the results from a human meter to an AlphaTrak -- they use different reagents in the strips, there's no correlation, per se -- they have similar readings at lower BG, great differences at the high end -- but LOW is low and HIGH is high, just compare the readings on a meter to those on the same meter

I was lucky enough to get the last ReliOn Confirm before it totally disappeared from Walmart -- fortunately the strips for it are still available online, and at a closeout/reduced price at that, though still not as inexpensive as strips for the Prime -- I'm stocking up when I can, as they aren't being manufactured by the original manufacturer either (Walmart just slaps their own brand on them, they're really made by Arkray)
 
This info is all great. Thank you both! I'll stock up on strips for the ReliOn when I pick it up if I can. And I'm gonna copy that summary of ranges and pin it up at his feeding spot for easy reference.
Just did his +2 test...365
 
I gave him 1.5 units. I should probably given him 2, but I was afraid since his AMPS was lower than it has been (except yesterday when I gave him nothing). I should get those strips today, but if I'm testing all the time, I'll run thru them pretty quickly. I had no idea when I started this journey that it would be such a roller coaster ride. I'm sur my Clarence is 'feeling' the same way.
 
The first little while when you are both trying to get used to the routine and figure out how the insulin is working can be overwhelming and you can go through a lot of strips because of unknowns and dose changes, failed tests etc.. It all gets easier. I think it was prudent to keep the dose lower today given the low supply of strips and the lower AMPS. Let's see what PMPS looks like after the 1.5u.
 
Yes, I've experienced all of the things you mentioned and those frustrating failed tests.

Got my strips, so I can continue testing. He has been staying in the 300s today, with a couple of ups and downs. His +8 (closer to +8 1/2) test was lower than the one before it.

How low can his pre-test shot be and still be safe to give over 2 units?

This is tricky stuff with a steep learning curve! I admire all of you with all of your knowledge and experience. What a challenge.
 
It definitely looks like 1.5u is too little a dose. You can increase to 2u and see how Clarence does if BG is over about 225 to 250 on the AT2 meter. You tested Clarence a lot today. When his numbers are up in the pink zone, you can hold off testing so much and just grab one or at most 2 mid cycle tests but you don't need to be testing every hour or 2.

I'd suggest you plan to test Clarence around +2 or +3 (one or the other) and then if he is dropping a lot or quickly, decide when you next need to test based on how low BG is and how fast BG is dropping. If BG is still up, then you can wait to test till a bit later. When BG gets around 100 or close, then you need to intervene and monitor more to ensure Clarence doesn't drop too low. With Vetsulin, you want to aim to keep him 90 or above.
 
I'm getting his insulin ready and guess I'll give him 2. His shot was a bit later than normal this morning. Weird thing, I fell asleep and my son tested him at +10 1/2 hours and he was 367. I woke up and tested him at +11 hrs (not realizing my son had tested and then fed him). When I tested him, he was 354.
 
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