3/3 Minnie - PMPS 406, +2 102, +3 451, +4 434, +8 318, +9 354

Yesterday.

She seemed a bit off yesterday but couldn't put my finger on it. This morning she is RAVENOUS again, I guess this confirms her numbers are back up.

Got another blood ketone test from the Novamax, 0.4 today was 0.3 a couple of days ago.

 

Lots of watered down food and insulin is needed today. Hope she is better today. Hope the bounce clears soon.

 

Thank you! I was wondering if this is a bounce, I can't recognize them yet. In a way I'll be pleased to move up to 4.5u, it will be easier to measure the right dose. Extra stress with the 0.25 (and bubbles). I have a light up magnifying visor thing arriving next week too

 

My question is a bit vague - what do I need to do/do I need to worry/does this reading look strange?

Just grabbed a reading because she was up and eating - 79 with AT. Trying to feed her since then because up to now (I think) her nadir has been more like +10ish so I don't want this dropping more. She has eaten a bit but not much. Unfortunately when I went for the repeat reading she stopped eating and lost interest. Should I apply some Mirataz or am I just panicking unnecessarily?

Took a repeat reading with 71 with human Novamax. And before anyone says - yes I know mixing meters is an issue! The Freestyle coming soon and will swap completely but stuck with where we are for now. I don't trust the AT now so when I get an off reading I don't want to repeat with another AT strip from the same container, I couldn't get a 2nd reading with the Petsure strip in the AT meter and the Novamax reading 71 was in the same general region so I believe the number.

She did eat a big breakfast and a very low carb snack at +2. Slept til +5. Was eating at +5 til I poked her, then had 12g of 8% food. Now sleeping again.

Thank you!

 

She’s still okay. It’s hard to say if strange. Offer a little more food every 30-45. Just a couple teaspoons will do. Is there a food she really likes? Mc is fine.

 

Thanks. Need a voice of reason calming me down, I'm so unused to the lower numbers! I'm pre-emptively worrying. Offered more food she normally likes but no interest, just wants to sleep. Will dig out the MC fancy feast next.

 

Getting more panicky. Next reading lower, she has 1tsp MC FF chicken/beef gravy lover 15% but didn't want any more.

Also had email back from IM vet who basically said 1) there's too much data and 2) she thinks the 4.25u is too low a dose. I increased to 4 and 4.25 following this group - she was out of the office, only available Tues-Fri. She wants a fructosamine and acromegaly test. Will make a separate post with some of her email, interested in opinions.

 

She's had another couple of tsp FF, seems a bit perkier. Should I keep giving her more MC food if she's interested?

 

I have 2 things I would please!! like input on at the moment, both getting me very stressed at the same time. Thanks so much.

1) Minnie's BG this afternoon. She's had about 1.5oz of the MC and would probably take some more

2) This response from the IM vet (the one who transitioned us from 3.5u Lantus to 0.5u Levemir and ended up with a DKA 5 days later). She didn't want the spreadsheet so I adapted it for her, will attach image as a reply to this.

There is just a lot of data and it is challenging to pick out the needed information. From what I can gather from the curves the 4.25 worries me that it may be slightly too much insulin given the lower reading of 88 and a few of the readings in the 100s. If we decrease her blood sugar too low, the body will response to increase her sugar levels to much higher levels that can last for a few days following the low event. This is called a somogyi effect. I have a bit of concern that with the 4.25 you may create this effect which can given the appearance of poorly controlled management. This is something your primary care veterinarian has been concerned by given our challenges controlling her but as we have yet to have any low readings this and not worried me until now. Should Minnie be stable at home with stable water consumption, weight and eating well then it may not be as important to so tightly monitor her blood sugar levels. The frucostamine gives us the averages of her blood sugars and may allow us some comfort that we are adequately controlling her diabetes in spite of her sporadic readings.​

 

Up to 107 now. How often do I need to keep feeding/testing?

edit - OK have calmed enough to re-read the "Don't Panic" which answers my questions for now. Also I should have put a 911 on this.

 

Elizabeth, how is Minnie doing now? Are you okay?

 

Thank you for checking in! Numbers rising, thank goodness. She seems ok, sleeping again. Has been sleeping most of the day so I had given her ears a rest...not any more. Nothing like a hypo to help sort out your poking technique! The last few have given nice sized droplets first time.

I am recovering from the stress of seeing her numbers (caught me completely by surprise) then that awful email from the IM vet arrived right in the middle of it, had me thinking I was doing the wrong thing with Minnie. Bad time for second guessing yourself....I didn't include the paragraph about billing. Looks like I need to find a local IM/specialist quickly.

Thanks again for the check-in, it's made me feel so much better!

 

Good catch today - nice to see those greens and blues.

Good luck finding a new and more up to date IM vet. Don't get us started on Symogyi. A tiny study done on humans years ago, on fast acting insulin. In no way does that relate do what happens with cats using long lasting insulin. The paper to prove that posted here. A fructosamine tells you averages, as the IM said. But doesn't differentiate between average middling numbers and a bunch of lows followed by a bunch of highs averaging out to the same number. Your spreadsheet says much more. IM can't see the forest for the trees.

 

PM dose is in 2h and I know there will be less eyes around then, so asking now.

After this afternoon's hypo, have been feeding MC and numbers slowly rising. She just had a bit more. Do I stick with the same dose?

Email from the vet coupled with the low numbers has got me very anxious and nervous. thanks.

 

Hi Liz. Tell me about the light up magnifying thing. I hate air bubbles and trying to measure small dose changes... I wonder if this is something I need.

 

Doesn't arrive til next week but it's only (another) $13 so seemed worth trying. I'll let you know how I get on. https://www.walmart.com/ip/5-Lens-A...ying-Glass-Magnifier-with-LED-Light/794865360

 

Thanks. Your vet seemed very condescending. Keep on with what you are doing now and learning. Don't worry about that vet.

 

With TR, you reduce if you see a number under 50 on a human meter, or 68 on the AT. Otherwise, you hold the dose and hope she gets back to more healing green numbers soon. 61 on a human meter is not a hypo, nor even a low number.

 

At the lowest reading today @6.75, numbers were 61 on AT and 51 on the human meter. Still hold?

Thanks again. Trying not to panic but now I'm in the thick of it of course the first thing you want to do is lower the dose! But I knew to check.

FYI the Freestyle Lite arrived not long ago but in all the excitement haven't had time to open it, and not sure I want to switch in the middle of all this...but will transition as soon as things (I) calm down.

 

61 on the AT means reduce. Be glad when you have just the one meter!

 

You have no idea how glad I will be!

Sorry to be so needy, but just to confirm - back down to 4u tonight, and stay at 4u? PM dose due in 30min.

 

Not sure I understood the question, but she has earned a dose reduction and her dose now goes down to 4U from tonight's dose

Congrats!

 

Nice progress @Liz & Minnie, i can only imagine the stress that came with it but that is what we are all looking for: active cycles which confirm we are on the right track

 

Thanks, Bhooma. And tomorrow we can start with the Freestyle Lite! Can you help me understand why she earned it?

I re-read the Dosing Methods sticky and it's not clear to me based on the reduction guidelines. Minnie is not newly diagnosed and didn't drop below 40. She dropped below 68 on the AT (61) with a repeat reading on the Novamax (51) to verify the odd AT number.

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
• Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.

I'm relieved to go back to 4u but I just don't understand how we got there!

Also, do I need to test through the night again to check for a possible similar drop to what happened in the daytime?

SO MUCH STRESS! I haven't eaten all day (but there are at least 6 different partially used cans of cat food scattered around)

Glad you're here!!

 

A cat is considered "newly diagnosed" if it's been less than a year since diagnosis. If she doesn't hold the reduction, you will go back up.

Get a +2 to see what will happen. She could bounce and let you sleep.

 

It took me a very long starring at Chico's spreadsheet to read his numbers and to understand when is it a bounce and when he needs a dose increase. I will try to comment on Minnie's response after the last dose increase to 4.25U and maybe help you understand a bit better as well. I am not extremely experienced so i might make some wrong assumptions but hopefully it would help you start understanding Minnie's numbers better. I will link the Lantus, Basaglar, & Levemir ISG Slang Dictionary for you to be able to find these terms yourself

on the 2/25 Dose increase followed by a NDW (New dose wonkiness) - which based on the dictionary usually lasts approx. 24 hours
on the 2/26 AM cycle you started seeing the NDW clearing, therefore the blue values by the end of the cycle
on the 2/26 PM cycle there is really not enough data to judge but based on the +2 being higher than the preshot i guess it was a bounce which started clearing by the end of the cycle
on the 2/27 AM cycle another short bounce which cleared during the same cycle and gave you the light green value which caused another bounce. [Edited] Now looking back, the light green might have been a bad measurement as well, and the black values just a continuation of the red bounce. Makes much more sense considering you measured a 273 20 min later.
on the 2/27 PM cycle i believe a bounce started which cleared by the end of the cycle on the 2/28 PM. I cannot explain the blue value in the PM cycle on the 2/27, i would suppose it was a faulty reading.
on the 2/28 PM cycle the bounce started clearing which gave you the green reading at the end of the cycle
on the 3/1 AM cycle looks like an active cycle, there are not enough data to judge, i can only speculate that she had a low value somewhere between +3 and +8 that caused an immediate bounce which
on the 3/1 PM cycle started clearing by the end of the cycle - but again there is really not enough data to judge that, it is only a speculation
on the 3/2 all day seems to be a bounce (judging purely on the low +10 from the 03/01 PM cycle) which cleared
on the 3/3 AM cycle and resulted in the light green value in the +6 AM cycle. This +6 reading will most probably cause a bounce in the next cycle, but you would know for sure just by measuring +2.

My conclusion would be that this dose wanted a reduction for a while, that Minnie's bounces can clear in the same cycle and that you might need to test more to be sure to catch all lows and get a better understanding of what is happening to Minnie during the day. I recommend always getting a +2. If the +2 reading is lower or similar to PS it usually is an indicator of an active cycle. We measure +4 and +6 even when we suspect a bounce just in order to catch a possible bounce clearing in the middle of the cycle.

Judging on 03/03 AM cycle i would say that Minnie's nadir is around +6 (but in unstabilized cats it is fluctuating). What you considered as nadirs at +10 in my opinion is Minnie clearing the bounces and showing you she is doing pretty well

[Edited] We measured once a blue pre shot value that was completely out of place, which we learned after unnecessarily stalling for 20 min (turned into red). Since then we try to measure 2x when we receive an "unexpected" value.

I want to emphasize again that i have 2 months experience with feline diabetes and in no way say that my judgment is 100% correct, i just wanted to help you understand better the numbers that you are seeing. Hope this was helpful

 

Marina, thank you SO much for spending all that time on this and explaining. It is now gone midnight and I only just ate, so my brain is not functioning well enough for me to digest your info but wanted to let you know how much I appreciate it! Will take a look tomorrow after some rest (might be late tomorrow because her +2 has dropped, so I have a long night ahead.)

Thank you!!! and have a good day!

 

Ugh, +2 and she's back down again. She ate a little MC. Will test again in an hour, see where things are going.

 

It was my pleasure, i know it took me a long time to start seeing patterns.

Good job for Minnie with 109@ +2, not very good for Liz's sleep though we had an active night yesterday, actually it looks like Chico likes it more active in the night than during the day, he really likes keeping us awake, haha

You should be very proud though, she is doing much better than just a few weeks ago Looks like the 4.25 dose gave her a boost

 

And I cannot wait for that human meter! I keep wondering which test is real and which is a bad strip! We'll know in an hour!
What is MC%? 15%?

 

I tried to get a reading from the human meter at +2 along with the AT but not enough blood.

Yes, the MC is 15%...but I don't have any more left of that. I've got some 20%, 10.5% DM Select, 8% but she's being very picky today. She just had a pill pocket with 1/2 ondansetron. Do they get nauseous with all the fluctuations in BG?

That was my guess, but if not I don't need to continue with them. Up to now, not wanting to eat has always been precursor to DKA so I'm all over the anti-nausea meds when she's off her food. But also I can't remember when she hasn't been ravenous.

 

You can mix LC and HC to get MC.

I've experienced appetite going up and down with numbers. Is it possible that she's either full or holding out for higher carb food? I have a tough time getting Bandit to eat "healthy" after she gets a taste of high carb!

How much has she eaten today?

 

Btw, you haven't moved up your shot times to your original time yet? Still shooting at 22:00 vs original 20:00?

 

Phew, I thought that was probably true but don't believe anything from my brain right now!

Both are possible. She really liked that fancy feast gravy lovers!

And alas in all the stress I did not keep a good track of what she ate today. She had a big meal of 5% when we got up and a low carb snack at shot time, then slept for a really long time so I thought I'd give her ears a rest today. Such a shock to see that bright green! Since then she had a 3oz can of the 15% FF and tsps of other food which I should have tracked but didn't. My next project will be to add columns for the food time and move my food info out of the BG cells, which will make it easier to read...stealing the idea from @Butters & Lyla, Butters' Spreadsheet.

Sigh. It actually got later. I keep trying but things get in the way (e.g. bad strips) and tonight at 8pm she went and started eating Sam's food - I was so happy she was eating that I didn't stop her, now we're at 10:15

And (drum roll) I got my first reading from the Freestyle Lite at +3! Especially in your honour. I will double up a few readings, not to compare the meters but so I can feel comfortable before switching off the AT....and quite likely throw it out the window.

Interesting how in the middle of the anxious readings, I had no issues getting blood. No warm water, no vaseline - just get in there, stab and done. Then this last one needed 3 pokes for a stingy drip of blood. Hmm.

 

Looks like the +2 was a bad strip? Don't know any more!

Call it a night. Let's see what tomorrow brings!

 

It is difficult to read the SS, but I think the last few cycles at least it's the comments in the remarks section that are making the cells bigger and so we can see less days on a single screen shot.
One thing that is useful is to mark with an * along side the numbers that you fed at a particular time, then you/or anyone looking at your ss can look to the comments to see what you fed.

Bad strip, not enough blood.... seems out of place for sure.

and it's yellow

 

There was only another 15min, I had to wait and get the +4. Only AT this time though, her ear was stingy.

Thanks again to my half-way round the world support crew. Have a good day!

 

Liz, her ketones were only .4 so don't worry to much about that. She's probably just being picky... and yes.... Darcy is getting really picky these days and doesn't want to eat his "old regular" food when he gets so much of the Weruva Best Feline Friends or the Tiki Cat After Dark Chicken with Quail Eggs (he loves those little eggs). Luckily he's only ever eaten the FF Gravy Lovers once or twice... and I panicked and let him eat the entire can! He loved it and his BG soared. I didn't know about only giving a teaspoon at a time.

 

...or on the Freestyle, 212 @+8

 

...on the Freestyle 234 @+9.5. And that was the last of the dodgy AT strips!

Next row will be Freestylin numbers, will adjust the s/s. The only difference is the conditional formatting, right? The lime green kicks in at 50 instead of 68?

 

Do you need help with the ss? I can’t wait to see what the numbers look like with the new meter.

 

Yes please! I would LOVE some help. I'm trying to fiddle around with it but struggling. It's not the same as excel.

EDIT - I think I've done it. There are a bunch of dummy values in the AMPS column for now. Thank you for the offer!! Now wait another 90minutes for the unveiling of the human meter values...and Minnie's cooperation.