Changing diet, fighting neuropathy

Done! I got 134 mg/dL, which I think is fine, right? (I've been eating until recently.)

 

Yes that is a good blood glucose reading for a human.

Looks to me like something with Viamo suddenly made a big difference.
Insulin dose is still 4 Units?
Did you get a new vial of insulin by any chance?

Just confirming some things.

 

We got a new insulin pen on Wednesday last week, and also started a new set test strips for our meter some days ago. But there were no changes in this last three days when the BG readings started to get lower, nothing that could explain this change directly. Note that I have also checked the test strips with the test solution provided with our meter.

I had made this questions to myself too.

Yesterday we still had some higher values, and I took that as a sign that the change could be legit.

 

How old was the insulin pen you were using before?
Do you store the insulin in the refrigerator?
Did you insert the code chip into the code chip slot when you started using the new vial of test strips?

 

URGENT: meter says HIGH

Two readings in a row confirm this.

Ate for the last time 30 min ago.

 

Test again please, but first make sure you inserted the code chip in the code chip slot when you started using the new vial of test strips.

More of a concerned if the meter said LOW or LO.

You feed at +8 in the morning (AM) so that can make the BG's rise.

 

I did insert the chip when I changed the strips. Sorry for the "urgent" thing but I got really disappointed.

 

Also I edited this because I measured two times.

 

You feed at +8 in the morning (AM) so that can make the BG's rise.

We have discovered that Viamo can get a very fast increase in BG readings after he eats.

How much did you feed Viamo? Was that the +8 feeding?

 

Definitely. Sorry for the fuzz, but I had never gotten the "HI" value with Viamo.

He ate something like a quarter of a can, an hour ago. Not much.

What does this imply for the treatment? I'm baffled, I did not expect this.

 

The pen we were using before was something like two months old.

We always do.

Yes, and quite shure because we've only used two different test strip vials.

 

Thanks for confirming code chip used with new vial of test strips, storing insulin pen in the refrigerator, pen only 2 months old. Insulin pens can often be used until the last drop.

Are you only feeding Viamo the beef flavor of the Vitalcan Complete or are you also feeding the chicken flavor?

Trying to check everything I can think of.

 

We have been feeding him both flavors without much distinction, but lately more beef flavor than chicken.

 

Do you remember which flavor he got this morning? +3 +8 today?

Track it on the SS for each meal?

 

Today we only gave him beef flavor. I can track that on the SS.

 

Please start tracking what flavor you are feeding for each meal on the SS.

Don't know until we can gather more data if the flavor of Vitalcan Complete is making a difference.

 

What I don't get about this is that he had already eaten at +4 AM and we did not see this fast glucose increase.

 

Feeding later in the insulin cycle with lantus insulin can cause the BG levels to spike (go higher) as the insulin wears off a bit.

There are ways to 'manage the curve' but you are leaving at the end of the week and I did not want to have you do too many changes before you left and had your cat sitter come in. Especially with no testing and cat sitter being there less to observe.

I'd rather wait to have you do food changes related to WHEN you feed in the 12 hour cycle until after you come back.

 

Then it might actually be a good thing that our cat sitter won't be at home for most of the day cycle. He will mostly feed at the time of each injection and a little after, but certainly not at the times late in the cycle when we usually still do it.

By the way, he is coming home in a minute to talk about his chores as a diabetic cat caretaker. If there are suggestions regarding the time of feeding, it is a good moment to tell him.

 

Have the cat sitter feed first.
Give the shot.
Take care of other things that need to be done.
Leave more food for Viamo.

How long will your cat sitter be staying for each visit?

Change Viamo now to the feeding schedule your cat sitter will be using.

 

I have a question.

We were with our sitter teaching him how to give the insulin injection just now, but when he pressed the button in the pen Viamo flinched for a second, our friend got scared and he pulled the needle out of his skin too early. We all saw a big drop on the end of the syringe, so we are pretty shure some insulin got inside him, but most probably not all 4 units.

So, the question is, knowing that his values today were too high, that he really needed that insulin, and that the injection was unsuccessful: would it be totally unacceptable to give him one extra unit of insulin to compensate for the lost dose? Is it always better not to risk it?

 

Always better to not risk giving more insulin if you think some or all of the insulin has not gone into your cat.

You can never tell how much actually got into Viamo.

Note on your spreadsheet that it was a partial shot.

That 'big drop' you saw on the end of the insulin pen needle could have been anything, from a couple of units to maybe only half a unit.

Lantus dosing is not based on the pre-shots. It's based on the lows and it can take 6 cycles or more to see changes in the insulin dose.

 

This is interesting, what do you mean by pre-shots? And what do you mean by seeing changes on the insulin dose?

Anyway, do you still think it's a good night to make a curve? If you tell me, I do it tonight. If not, tomorrow.

 

Sorry. I did not explain that well at all. I used some words incorrectly. Let me try again.

1. The first test in a 12 hour cycle is the pre-shot test. The test you do at +0 (AMPS or PMPS). The test you do to see if your cat's Blood Glucose level is high enough to safely give insulin. For new members we usually set that safe Shoot/No shoot number at 200 mg/dl. So if the BG is above 200, then give insulin. That limit is set to keep your cat safer from hypoglycemia. As you test more and gather more data, that Shoot/No shoot limit can be modified to a lower number.

When you inject the insulin, it goes into a place we call "The Depot" which acts like a small storage area. That storage area takes time to fill completely and can affect up to 6 cycles. The time tends to be less when a cat is on a smaller dose, and more when a cat is on a larger dose. Other factors can apply as well, but using the generalization of 6 cycles is a good starting point until you have learned your particular cat's patterns.

After you inject lantus into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that's not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back into solution over time and then to the bloodstream.

2. There are 2 dosing methods used here on the FDMB message board. They are Tight Regulation (TR) and Start Low, Go Slow (SLGS). You can read about them here http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

3. Random Notes:

• In the case of a furshot, NEVER give another shot. There's no way of knowing how much of the first shot "got into" the cat.
• NEVER give a second shot because "numbers are too high" in a 12 hour cycle.
• Test often for ketones.
• Be consistent in timing and type of food.
• KNOW THY CAT. Shooting early or late is a practice best reserved for those who have a full understanding of the insulin used and it's effects on their kitty. Because of the cumulative nature of Lantus and Levemir, please be aware:
  • Shooting an hour or two early *could* act like a slight dose increase.
  • Shooting an hour or two late *could* act like a slight dose reduction. Please ask for guidance if you're unsure.
• A "cycle" refers to the period of time between shots. There are 2 cycles in every 24 hours when shooting on a 12/12 schedule.

Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

• Carryover - insulin effects lasting past the insulin's official duration
• Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect
• Insulin Depot - a "spare tank" of insulin, which has yet to be used by the body
• Lantus, Basaglar & Levemir: What is the Insulin Depot?
• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

 

Good morning! That post was very informative. Thank you.

We finally did a curve yesterday night and I am still puzzled at what happened with his BG during the day compared with how it went after. Can you make sense of it? For the first time he had steady values in the ~250 range. That was until he ate at +8 AM, then his BG skyrocketed, and after the insulin it went slowly down. His AMPS was higher than the previous days. Now, 3 hours after his morning, he is in the "red zone" again.

The only explanation I can think of after reading your notes on Lantus insulin is that maybe this was a bounce. Is it possible?

 

Sorry Teo. I forgot to say yes, please do a curve last night. Tired and I missed that last night. Happy to see you went ahead and did the curve last night.

Yes, I do think it was a bounce. Nothing you can do about that. You have to wait out those bounces. They can take up to 6 12 hour cycles to clear. It's a self protective mechanism that protects from lower BG levels than a cat is used to. Not necessarily dangerous low hypoglycemic BG numbers, but lower than the cat has been having. So even those 200+ range BG readings yesterday AM cycle were not something Viamo's body was used to and that was a bounce.

Keep with the same insulin dose for now. Keep feeding the same food for now. But change to the feeding schedule your pet sitter will be able to use.

1. Did you change Viamo to the feeding schedule your cat sitter will be able to use?
2. Did Viamo eat any people food or only his cat food?
3. Are there any other pets in the house?
   
4. Do you leave any food out on the kitchen counter or elsewhere and he may have sneaked up on the counter to eat some of that food? Bread? Anything?
   
5. Does he open cabinets or drawers by himself? I had a cat that opened the cabinet where some dry food was and he chewed through the bag.
6. Was any food dropped on the floor and maybe Viamo ate it without anyone noticing?
7. Is someone else in your home sneaking food to Viamo? Family? Friends? Roommates? Because he is begging for food?
   
8. What day do you leave?
9. Want one more curve a couple of days before you leave. Wednesday? Thursday?

I condensed and copied only limited portions of some of the most relevant info that is available over in the Lantus/Levimir forum. That is what I posted for you yesterday. Did not write that information from scratch. Too much work, when lots of other people have done that work already.

There is a lot more information in the Lantus/levimir forum here if you are interested. It's all in English, so no idea how well google translate will do in making it understandable for you. Look at the "Sticky" posts at the top of the forum for more info.

Viamo is nowhere close to having a 'typical' Lantus cycle at this point. No where close to being regulated either. If we can get him better regulated, the neuropathy will improve. It all takes time.

You have changed his diet to a lower carb food. That's a big step.
You are home testing. That's the second big step.
You are giving him a good insulin for cats, with the lantus (glargine) insulin. That is the third big step.
You have a spreadsheet (SS) setup and we can look at that and see some of what is happening. That is the fourth big step.

Now it's fine tuning. Seeing what works best for Viamo and you.

We'll wait to make any more changes until you get back. Such as using an insulin syringe 3/10 cc 30 ml with 1/2 unit markings to draw the insulin from the pen (mini-cartridge of insulin) that you are using. That way you can change the dose in smaller increments. We usually do 0.5 or 0.25 unit changes at a time. The pen only allows you to change the dose in 1 unit increments and that can be too much or too little.

ECID. Which means both Every Cat is Different and Every Caregiver is Different.

 

Hi Deb. Thank you, what you said cleared up some things for us.

First I'll try to briefly answer the questions you enumerated regarding Viamo's "bounce". Then I have a question.

1: We are trying to change the feeding schedule to adapt to our sitter's. This means not giving him food from 12 am to 18 pm. We are not doing this rigorously because Viamo is usually stimulated with smells when we use the kitchen, so he begs for food at the usual times. This will certainly not be the case when we're not home.
2-7: The other pets in the house are two other cats. They eat from a different plate which is at a height Viamo can't reach. The food is not accessible to any of them and no one is giving Viamo other types of food. The only disturbance to his diet is that, once in a while, he will find a cockroach and devour it completely. As far as we have seen, this has happened two times in the last 10 days (its summer, insects abound), and he could also eat some at other times without us noticing.
8: We leave this very weekend. I'll leave on Friday and my mother on Sunday.
9: It'll be hard to have another night curve, but I'll do my best to manage it. It wouldn't be as good if it was only during the day cycle, right?

So, now Viamo seems to have gone back to yellow values. We also have some good news: we teached Viamo's sitter to make BG tests! So he will be testing each time before injections.

The question is: what should the sitter's "No Shoot Number" be during our absence? If Viamo keeps getting this low values, it is reasonable to think he might get some BG measurement under 200. In this case, should the sitter give insulin?

The question of what dose to give him is still open to debate, too.

 

Yellow values are good!! Glad to see that Viamo is doing better again.

1. No shoot number should be set at 200 for your pet sitter. If <200, do not give the insulin. No tests will be done except the pre-shot tests. Since cats usually have lower BG readings in the middle of the cycle, but we won't know what they are, it's better to skip the dose then to risk hypoglycemia.
2. If pet sitter can not get a successful test, reduce dose by 1U so the new dose would be 2U. Either 3U or 2U is what I've been thinking for the reduced dose when you pet sitter was caring for Viamo.
   
3. Another curve in the daytime would be fine. Would like one more curve if possible.
   
4. If another curve is not possible, that's ok. I already know I want the dose reduced to 3U while your pet sitter is taking care of Viamo. Thought would be safer when your pet sitter was unable to test at all.

Will your pet sitter be updating the spreadsheet?

 

Have a good vacation in Montreal.

 

Hi have a good vacation, Viamo's numbers are already looking better !!

If necessary do you think your sitter could post in the forum if he/she needs help?

 

Hi, thank you! Yes, his numbers are slowly going more and more into a better range.

Not directly, because I'm the only one who can write fluently im english, but he will keep us informed of any irregularity or doubt that he may have, and I will try to write here if anything importan occurs.

I won't post as often from tomorrow on, but I'll keep an eye on the forum. And certainly on Viamo

 

OK.
Yellow values are good!! Glad to see that Viamo is doing better again.

1. No shoot number should be set at 200 for your pet sitter. If <200, do not give the insulin. No tests will be done except the pre-shot tests. Since cats usually have lower BG readings in the middle of the cycle, but we won't know what they are, it's better to skip the dose then to risk hypoglycemia.
2. If pet sitter can not get a successful test, reduce dose by 1U so the new dose would be 2U. Either 3U or 2U is what I've been thinking for the reduced dose when you pet sitter was caring for Viamo.
3. Another curve in the daytime would be fine. Would like one more curve if possible.
4. If another curve is not possible, that's ok. I already know I want the dose reduced to 3U while your pet sitter is taking care of Viamo. Thought would be safer when your pet sitter was unable to test at all.

 

Viamo is still bouncing I see. That will probably keep happening for at least 6 cycles. You have to be patient and wait it out, and not increase the dose.

 

Tell him to private message me in Spanish if he needs some help

 

Hi! Yesterday my mother starting giving Viamo 3 units each time. Today he hit the black range again. She asks if she should go back to the original 4 units.

I understand this, but I'm not shure if you meant it for the new dose (3U) or the original one (4U).

 

We're going to give him 3 units again following your previous advice. Tell us if we decided the right thing.

 

I meant it for the new (3U) dose.
Lantus dosing is based on the nadir or lowest point in the insulin cycle.
We have no idea how far down in BG level the 3U dose took Viamo.
I suggested you lower the dose because your pet sitter will only be there 2 times a day.
Your pet sitter will not be testing during the middle of the cycle.
Viamo will likely run a bit higher in BG readings at that lower 3U dose.
I thought that reduction to the 3U dose was safer than keeping Viamo at the higher (4U) dose while you are away.
You can monitor more often when you get back home.

The choice is yours. To keep Viamo at the higher dose of 4 U or keep him at the 3U dose.

@Veronica & Babu-chiri also said you could PM her. To do that, go to the top of the screen, click on your user name, click on Conversations. Start a New conversation with Veronica. I won't be able to see what you say to her, unless you click on the check box to

• Allow anyone in the conversation to invite others

at the bottom before you hit Post.

 

First blue number?!!!!!! Just saw this for 22/1/20.

Looks like your cat sitter did not give insulin, which was good. Please enter 0 in the units column for yesterday, 1/22/2020 if the dose was skipped.

Would you please give me the date you are back in Argentina? Thanks.

 

Hi, sorry for the late reply.

It seems like we did have our first blue number! Viamo's sitter checked two times to make sure, so he was confident not to give insulin. Still, his values at the times of the injection are high. Higher than before, when we were giving him 4 units, I think. Our sitter will hopefully be doing a curve tomorrow. That should give us more data to understand what's going on.

My mother will be back on february the first.

 

Safer to skip the shot when you are in the blue numbers and can't monitor as much. Shoot/no shoot BG reading for Viamo is still at 200, so your cat sitter did exactly what he should have done. I had you set that number a bit higher than normal, since your pet sitter was not going to be around as much.

Viamo is bouncing again. His body is reacting to those lower BG (blood glucose) readings by using a self protection mechanism. It doesn't have to be really low, simply lower than Viamo's body is used to that causes that self-protection mechanism to kick into gear. We sometimes call it 'liver panic'.

Remember this? "Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Those higher red and black BG (blood glucose) readings are from the reaction to the bounce. Need to wait at least 3 days for those higher numbers to subside.

A curve tomorrow 1/26/20 would be fine. That will be the 3 day wait (6 cycles) for the 'bounce' to clear and get a realistic look at what the 3 Unit dose is doing for Viamo.

You don't change the dose for lantus based on the pre-shot numbers. You change the dose based on the nadir or lowest BG (blood glucose) reading the insulin has taken your cat.

Hope you are having a great time in Montreal.

 

Looks like high flat numbers in that BG curve done on 1/26/20.

Could mean too much insulin, too little insulin or bouncing. Yes, too many possibilities to know what to do here.

A typical difficult curve when you first begin regulating is high and flat, between 300 and 500. This can indicate either not enough insulin, or too much insulin and bouncing. It may also indicate insulin resistance due to glucose toxicity. Telling the difference is difficult, and requires looking at a full dosage and curve history. The best method is to avoid bouncing rebound by starting low and going slow.

 

Sienne and Gabby (GA) has suggested that there are many more experienced users of Lantus on the Lantus ISG. You may want to think about posting over there.
Lantus / Basaglar (glargine) and Levemir (detemir)

 

Hi Deb. I'm writing you at the beginning of the last week of my trip. My mother has already arrived back home, and she is measuring Viamo herself again. He seems to be doing allright, not much has changed. He often gives values over 500, but every once in a while he is starting to get pretty low numbers.

I know that response is a bit old now, but we have seen more low numbers since. This situation is confusing me now, because the range of values his BG is taking is really big: yesterday he got his first value under 100!

So, do you suggest I move to the Lantus forum?

 

Hi Teo! Glad to hear from you.

Yes, please go to the Lantus ISG (Insulin Support Group) forum to post about Viamo. Seeing the first green blood glucose number is fantastic, very exciting. But scary too. There are lots of nice people over there in the Lantus/Basaglar (glargine) and Levemir (detemir) forum to guide you and your mom.

Here is that forum
Lantus / Basaglar (glargine) and Levemir (detemir)

Start a new thread over there, link this post into that one, at the very top of the post. And then explain what is going on. Brief explanation for now would be enough. People will ask you questions.

I'm very glad your mom knew to skip the dose last night, February 1st. That PMPS of 71 is too low to give 3 units of Lantus. If you can, please change your signature to indicate the food you are now feeding. The Vitalcan, not the Royal Canin Diatetic.

Also let people know you are in Argentina, your primary language is Spanish, your mom is testing, and that you are away on vacation. Let them know you understand some English, but may need google translate to understand.

Explain that you use an insulin pen and do not have U100 insulin syringes to use right now. Let people know that your insulin pen only allows you to change the dose in 1 Unit increments.

You or your mom should try to get some U100 insulin syringes. Have your mom look for 3/10 cc (volume) U100 insulin syringes with 1/2 unit markings on the barrel. You may not be able to find any syringes with the 1/2 unit markings. It's more important that you obtain the smaller volume insulin syringes that are also U100.

I'll watch out for you for a bit, over in the Lantus forum. More to give people some background information than what to do about the changing the insulin dose.

 

Teo, You do not have to post on the Lantus forum if you do not want to.

The reason I suggested you post a new thread there, is because there are many more people over in that Insulin Support Group that are able to help you.

They know much more about Lantus and the nuances of using it and adjusting doses than I do.
They have some guidelines to use if you think you might want to post there for help. Please read this link to get some good information.
The Basics: New to the Group? Start here!

It's your choice. To stay here in the Welcome and Main Forum or post over in the Insulin Support Group.

 

Hi Teo,

I checked Viamo's SS (spreadsheet) this morning.
Viamo has been in the good yellow range with his blood glucose (BG) numbers since your mom arrived back home.

Both last night and this morning, Viamo had good pre-shot blood glucose test numbers.
Was your mom able to obtain some insulin syringes?
Is she able to get some more blood glucose tests than the pre-shot tests and the blood glucose test at +2?
Does Viamo let her test him? Or does he struggle and run away?

I think we may need to lower the dose for Viamo, but would like to see some more blood glucose numbers to see if that is true.

When we do lower the dose, it would be better to do that in 0.25 unit increments. You can't do that with the insulin pen you use.

There is a video here that shows how to withdraw insulin from an insulin pen using an insulin syringe. It's in English, but I don't know of one in Spanish.

• How to Draw Insulin from a Pen or Vial With a Syringe (Video from Julie & Punkin)

Once you withdraw from the insulin pen (miniature vial of insulin encased in plastic) with an insulin syringe, it changes the pressure within the pen. That means you can no longer use the 'dial-a dose' feature of the insulin pen. You must continue to use an insulin syringe from that point on to withdraw the insulin from the pen.

 

Hi Teo,

Saw that your mom was able to get a +6 and a +7 blood glucose test today, 2/3/2020.

I think you need to reduce the dose.

Was your mom able to obtain insulin syringes?

 

You need to reduce the insulin dose for Viamo by at LEAST 0.25U. Immediately. With the insulin dose for tonight, 2/3/2020.

If you do not have insulin syringes, then please reduce to 2 units for this evening.

Please let me know you have read this message.
Please let me know your mom has this information.

Using Start Low Go Slow (SLGS) dosing protocol.
"If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"
"Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately."

I'm giving you a link to the lantus dosing protocols we use here. Look about halfway down in this document where it explains more about the START LOW, GO SLOW (SLGS) dosing method.
Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

We want to keep your kitty safe while you are away.

 

Hey there! Congratulations on earning a reduction!

How about moving to the Lantus Forum so that the experienced people with Lantus can help you and Vismo? You’ll have a lot of eyes on Viamo there.


The link is here:

http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/

Starting a new thread would be a good idea too as this one is getting very long.

Looking forward to seeing you over there.

 

Hi Deb, hi Bobbie!

I've read everything you've been answering to this thread, and so has my mother. She is at home, but I'm not. I'm abroad. My mother understands english but she is not comfortable writing it. So it is really difficult to get a fluid conversation until I come back on sunday.

We have some syringes but we have never used them, so we prefer not to risk usung them until I'm back home. So you think we should change to 2 units this night?

Also, I'll be glad to change to the other forum, I just don't have the time to write an introduction there right now. I may do it this week, but I'll certainly have my mind more set on Viamo and the forum when I'm back home.

 

Thanks Teo for replying.
Have your mom reduce the dose to 2 Units for tonight.
Viamo may "bounce" like crazy, have high blood glucose numbers, until you get back.
Let's not change to using insulin syringes for now.
We can do that change to insulin syringes drawing from your "insulin pen" when you get back.

I'll keep looking at Viamo's spreadsheet every day.
After you get back from vacation is soon enough to start posting in the Lantus ISG (Insulin Support Group).

Sorry to interrupt your vacation.

But the dose needed to be lower to keep Viamo safe.

 

Great. Thank you, Deb. Don't apologize: you keep on helping us a lot. We appreciate it!

Another thig: what should be our no-shoot number now?

 

If your mom wants to write in Spanish, I can use google translate to understand what she says.

I've actually been helping a new member in Spain that does not write or understand English.
We use google translate to write back and forth to each other.

If your mom would like to write a reply to us, that would be ok.

 

I want to keep the "no shoot" blood glucose number at 200 for now.
That is higher than normal, but we don't have a lot of blood glucose numbers to use. To let us know if a lower "shoot/ no-shoot " threshold would be appropriate.

We can work on reducing that "no shoot" number later.

Would need some more tests to see when that could change.
Would your mom be willing to do 1 or 2 blood glucose tests in the evening, before she goes to sleep?
Somewhere in the +4 to +7 hour time frame would be good.
The same should be done in the +4 to +7 hour time frame in the AM testing cycle.

We need to teach you and your mom about how to handle a low blood glucose reading, by using food to bring the blood glucose numbers up, slowly and safely.
I do not want to do that right now. But if you and or your mom would like to read this document, it gives you some ideas on how to handle low blood glucose numbers. It also gives some of the hypoglycemic symptoms to watch out for.

How to treat HYPOS - THEY CAN KILL! Print this Out!!
Don't let the title on that post scare you too much. But a hypo or hypoglycemic number can be dangerous.
I believe you translated this to Spanish and left it for your cat sitter to use as a reference document.

 

Expected those higher blood glucose numbers for Viamo last night 2/3/20 and this morning 2/4/20.

It's a combination of the low blood glucose numbers Viamo had yesterday morning and the reduced dose from 3U to 2U you needed to do because you are using the "insulin pen".

 

Hi Teo, I saw you were signed on. What is your mom's name? If you and she are willing to share her first name with us, I'd like to know what it is.

Hola a, vi que habías iniciado sesión. ¿Cual es el nombre de tu mama? Si usted y ella están dispuestos a compartir su nombre con nosotros, me gustaría saber de qué se trata.

 

I realize your mother is a very busy woman. All those tasks of daily life like cooking, grocery shopping, errands, maybe she works. She wants to visit friends and other relatives. All of those life responsibilities take up a lot of time. "Life is Full" is an expression we say here in the US.

She needs some time to take care of herself as well as the rest of her family. I don't want to ask too much of her with the care of Viamo.

When would it fit better into her schedule to get some tests for Viamo? I don't want to impose on her time too much. Or yours.
Trying to remember to give the Spanish translation. To see if that helps.

Me doy cuenta de que tu madre es una mujer muy ocupada. Todas esas tareas de la vida diaria, como cocinar, comprar comestibles, hacer recados, tal vez ella trabaja. Ella quiere visitar amigos y otros parientes. Todas esas responsabilidades de la vida toman mucho tiempo. "La vida está llena" es una expresión que decimos aquí en los Estados Unidos.

Necesita algo de tiempo para cuidarse a sí misma y al resto de su familia. No quiero pedirle demasiado con el cuidado de Viamo.

¿Cuándo encajaría mejor en su agenda para hacerse algunas pruebas de Viamo? No quiero imponerle demasiado tiempo. O el tuyo.

Tratando de recordar dar la traducción al español. A ver si eso ayuda.

 

Hi Deb, hope you are doing well today, thank you for your help with our beloved Viamo. I am available to do the tests you need.

 

That's my mom by the way

 

Hi Ana! Very nice to meet you. I see that you have created your own user id for the message board. That is good. I did not realize until a few days ago that Teo had never told us your name.

Would you be able to get a blood glucose test at +3 tonight and tomorrow morning? That is 3 hours after the pre-shot test.
Then if you could also get a test in sometime tonight a couple of hours later, that could be helpful.

I do not want you staying up later than your normal bedtime to get these blood glucose tests for Viamo.
You need your sleep too.
I do not want you to stay up too late and deprive yourself of sleep.

So you tell me what is better. Would it be easier for you to get a +5 night time test? Would it be easier for you to get a +6 test?

Night time testing can be a strain on the person doing the testing. Teo is young, and he can feel better on less sleep than some older people like I can. Resiliency of the young. They have more energy.

¡Hola Ana! Mucho gusto en conocerte. Veo que ha creado su propia identificación de usuario para el tablero de mensajes. Eso es bueno. Hasta hace unos días no me di cuenta de que Teo nunca nos había dicho su nombre.

¿Podría hacerse una prueba de glucosa en sangre a +3 esta noche y mañana por la mañana? Eso es 3 horas después de la prueba previa al disparo.
Entonces, si también pudieras hacerte una prueba en algún momento de esta noche un par de horas más tarde, eso podría ser útil.

No quiero que te quedes despierto más tarde de tu hora normal de dormir para hacerte estas pruebas de glucosa en sangre para Viamo.
Tú también necesitas dormir.
No quiero que te quedes despierto demasiado tarde y te prives del sueño.

Entonces dime qué es mejor. ¿Sería más fácil para usted hacerse una prueba nocturna de +5? ¿Sería más fácil para ti obtener una prueba +6?

Las pruebas nocturnas pueden ser una carga para la persona que las realiza. Teo es joven y puede sentirse mejor con menos sueño que algunas personas mayores como yo. Resiliencia de los jóvenes. Tienen mas energia.

 

I think Teo is very lucky to have a mother like you Ana. I think he is very proud of you and all you are doing to help your beloved cat Viamo.

Creo que Teo tiene mucha suerte de tener una madre como tú, Ana. Creo que está muy orgulloso de ti y de todo lo que estás haciendo para ayudar a tu querido gato Viamo.

Does it help you if I use google translate to provide my responses to you in both Spanish and English?
¿Le ayuda si uso el traductor de Google para proporcionarle mis respuestas en español e inglés?

 

We ask about the blood glucose levels/readings/numbers for a cat, because it is a good way to see how effective the insulin dose is for any 12 hour testing cycle. Lantus is a "depot" type insulin, with a little storage area under the skin. So the dose you give one day may take a while to see any changes in the blood glucose. It is a very good insulin. The best one available for cats in my opinion.

But a cat is more than simply their blood glucose numbers.
How is Viamo feeling?
How is Viamo's appetite?
Are the size of the urine puddles in the litter box or tray getting smaller?
Is the urine output still high?
Is his diabetic neuropathy better at all?
Is he still walking on his hocks or is he able to walk better now?

Does he jump up on furniture or is that still difficult for him?
Does Viamo groom himself?
Does his fur look good? soft and shiny? dull and lifeless? lots of dandruff?
Does he purr?
Is he playing again and chasing the other cats you have?

How is Viamo feeling overall is what I would like to know. Like the questions a vet might ask you when you take Viamo to the vet for a visit. Anything notable in his behavior or habits.

Preguntamos sobre los niveles / lecturas / números de glucosa en sangre para un gato, porque es una buena manera de ver qué tan efectiva es la dosis de insulina para cualquier ciclo de prueba de 12 horas. Lantus es una insulina de tipo "depósito", con una pequeña área de almacenamiento debajo de la piel. Por lo tanto, la dosis que administra un día puede tomar un tiempo para ver cualquier cambio en la glucosa en la sangre. Es una muy buena insulina. El mejor disponible para gatos en mi opinión.

Pero un gato es más que simplemente sus números de glucosa en sangre.
¿Cómo se siente Viamo?
¿Cómo es el apetito de Viamo?
¿Se está reduciendo el tamaño de los charcos de orina en la caja de arena o en la bandeja?
¿Sigue siendo alta la producción de orina?
¿Es mejor su neuropatía diabética?
¿Sigue caminando sobre sus corvejones o puede caminar mejor ahora?

¿Salta sobre los muebles o todavía es difícil para él?
¿Viamo se prepara?
¿Se ve bien su pelaje? suave y brillante? aburrido y sin vida? mucha caspa?
¿Ronronea?
¿Está jugando de nuevo y persiguiendo a los otros gatos que tienes?

Lo que me gustaría saber es cómo se siente Viamo en general. Al igual que las preguntas que un veterinario podría hacerle cuando lleva a Viamo al veterinario para una visita. Cualquier cosa notable en su comportamiento o hábitos.

 

Hi Deb! Thank you for your nice words! I´m a lucky person to have Teo as a son. I´m going to take with pleasure the test you ask for +3 tonight and tomorrow morning after the shot. Also +5 at night. You are very kind, your responses in Spanish are helpful, especially with Teo abroad.

 

These are the tests you will be doing for Viamo for now.
2/5/2020 PMPS evening pre-shot test.
+3
+5

2/6/2020 AMPS morning pre-shot test
+3
maybe one more test later in the morning, but I'd like to see the +3 test number first.

Teo, sleep well on that airplane on your trip home Sunday. Because I'd like you to do a curve as soon as you get back. Monday would be ok.

Estas son las pruebas que harás para Viamo por ahora.
2/5/2020 Prueba de pre-disparo nocturno PMPS.
+3
+5

2/6/2020 AMPS mañana pre-tiro prueba
+3
quizás una prueba más más tarde en la mañana, pero me gustaría ver primero el número de prueba +3.

Teo, duerme bien en ese avión en tu viaje a casa el domingo. Porque me gustaría que hicieras una curva tan pronto como vuelvas. El lunes estaría bien.

Teo, we will want you to practice with some colored liquid with using the insulin syringes when you get back home. Use only one syringe, and mark it well with some colored tape if you have any. That is so you do not confuse a used syringe with a fresh syringe. You will be surprised how small the insulin doses are. Practice first and learn how to do that. Before you use the insulin syringes for drawing the insulin dose from the pen.

Syringes have a lubricant inside them. You will want to move the colored plunger in the barrel of the syringe up and down a few times before you withdraw the insulin dose. If you don't, the plunger can stick a little bit.

Teo, queremos que practiques con un poco de líquido coloreado usando las jeringas de insulina cuando vuelvas a casa. Use solo una jeringa y márquela bien con cinta adhesiva de color si tiene alguna. Eso es para que no confunda una jeringa usada con una jeringa nueva. Se sorprenderá de lo pequeñas que son las dosis de insulina. Practica primero y aprende cómo hacerlo. Antes de usar las jeringas de insulina para extraer la dosis de insulina de la pluma.

Las jeringas tienen un lubricante dentro de ellas. Deberá mover el émbolo de color en el cilindro de la jeringa hacia arriba y hacia abajo varias veces antes de retirar la dosis de insulina. Si no lo hace, el émbolo puede pegarse un poco.

 

Are you referring to +3 and +5 in the morning or in the evening?

We are actually having problems finding the correct syringes. The ones we have at home actually had only half-unit markings, not 0.25. At our main diabetic supply store they don't know about those syringes with such small markings.

Anyway, I can't really focus on this right now! I'm sorry, but I will have to do the proper research when I come back home.

 

There are no insulin syringes with 0.25 unit markings. You will have to use the ones with 1/2 unit markings and make your best estimate of the 0.25U doses. My fault for the poor explanation I gave you previously.

Will send you pictures when you get back home.
No hay jeringas de insulina con marcas de 0.25 unidades. Tendrá que usar los que tienen marcas de 1/2 unidad y hacer su mejor estimación de las dosis de 0.25U. Mi culpa por la pobre explicación que te di anteriormente.

Te enviaremos fotos cuando vuelvas a casa.

PM is the evening. PS is the pre-shot. Put them together and you have the PMPS.
The +3 and +5 shots are for the times indicated.
PMPS is the evening pre-shot test so a +3 and a +5 for this evening.

AM is the morning. PS is the pre-shot. Put them together and you have AMPS.
AMPS is the morning pre-shot tests so a +3 and maybe a +5 for tomorrow morning.

My meaning got lost in the translation I think.

Don't worry about too much right now. We'll wait for more lessons until after you get back home.

PM es la tarde. PS es el pre-tiro. Póngalos juntos y tendrá el PMPS.
Los disparos +3 y +5 son para los tiempos indicados.
PMPS es la prueba nocturna previa al disparo, por lo que un +3 y un +5 para esta noche.

AM es la mañana. PS es el pre-tiro. Ponlos juntos y tienes AMPS.
AMPS son las pruebas de pre-tiro de la mañana, así que un +3 y quizás un +5 para mañana por la mañana.

Mi significado se perdió en la traducción, creo.

No te preocupes demasiado por ahora. Esperaremos más lecciones hasta que vuelvas a casa.

 

Hi Deb, answering your questions about how is Viamo feeling, today was a very hot day cause we are on summer, he spends mostly of time lying on the floor. However his appetite was very good.
His neuropathy is not improving, is still walking on his hocks and sometimes jumps on the furniture with difficulty, but he go up the stairs waiting for me to wake up every morning.
His fur doesn´t look soft and shiny and he loses a lot of hair, so I brush him frequently and it looks better.
He always purrs, he answers looking to me when I call his name and he is aware of all the movements around him.
I could assure his urine output is less.
Sorry about my previous confusion about the schedule, I could already understand now.
Have a good night!

 

Good Morning Ana. How are you and Viamo doing today?
Buenos dias Ana ¿Cómo están tú y Viamo hoy?

Maybe I should have said good afternoon, since the time of day is later where you live.
Tal vez debería haber dicho buenas tardes, ya que la hora del día es más tarde donde vives.

Will you be able to get more blood glucose tests for Viamo today?
Always test before giving insulin.
Would you be home around +6 and +9 today to get tests for the AM (morning) cycle?
Then how about 2 more tests in the PM (evening) cycle. +2 and +5.
Will that work for you? You may choose different tests times if that works better for you.
¿Podrá hacerse más pruebas de glucosa en sangre para Viamo hoy?
Siempre pruebe antes de administrar insulina.
¿Estaría en casa alrededor de +6 y +9 hoy para hacerse las pruebas del ciclo AM (mañana)?
Entonces, ¿qué tal 2 pruebas más en el ciclo PM (tarde). +2 y +5.
¿Funcionará para ti? Puede elegir diferentes tiempos de prueba si eso funciona mejor para usted.

I'm trying to have you get those blood glucose tests at different times of the day. It gives us a better idea of how Viamo is doing on this dose of insulin.
Estoy tratando de que te hagas esas pruebas de glucosa en sangre en diferentes momentos del día. Nos da una mejor idea de cómo le está yendo a Viamo con esta dosis de insulina.

 

Hi Deb! We are fine. I don´t notice any significant change in Viamo, he looks like always. Only these last few days is asking for food very frequently but is something normal in Viamo, because of his diabetes I understand. I will take the tests you are asking for. I will handle it so it can be useful.

 

Viamo needs more insulin. But the insulin pen can only give does in 1 unit increments.
After Teo is back and rested from his flight, I'd like you to start giving Viamo 2.5U of insulin, withdrawing from the pen with an insulin needle.
I realize that may not be until Monday2/10/2020. Simply trying to plan ahead a little bit, for the next step with Viamo.

Viamo necesita más insulina. Pero la pluma de insulina solo puede ceder en incrementos de 1 unidad.
Después de que Teo regrese y descanse de su vuelo, me gustaría que comience a administrarle Viamo 2.5U de insulina, retirándose de la pluma con una aguja de insulina.
Me doy cuenta de que puede no ser hasta el lunes 2/10/2020. Simplemente tratando de planificar un poco por adelantado, para el siguiente paso con Viamo.

p.s. Teo and Ana. Please remove the country from your signature. I mistakenly had you add it and it should not be there. Thanks. Sorry for the bit of extra work. No hurry to do this. This can wait until Teo is back home.

Teo y Ana. Elimina el país de tu firma. Por error te hice agregarlo y no debería estar allí. Gracias. Perdón por el poco trabajo extra.
No tiene prisa por hacer esto. Esto puede esperar hasta que Teo vuelva a casa.

 

If I may make a request...

It would be very helpful to start a new thread. There are 170 posts. Having more than 50 is a long set of comments.

 

Maybe when he gets back from vacation he'll be able to do that. But his mom is the one posting for now.

 

I'm about to start a new thread.

 

Sounds good. Be sure to link this old thread at the top of the new one.

 

I've finally done it! This discussion will continue HERE.

Thank you so much @Deb & Wink and everyone else who has contributed to this first thread where my mother and I have learnt so much and, I like to think, made real progress.