Confusing Numbers - Could Use Some Advice

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Danielle Shuck

Danielle Shuck

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I'm hoping a knowledgeable admin can take a look at Maddy's spreadsheet. My goals here are to 1. Make sure Maddy is receiving the insulin she needs and give a consistent and appropriate dose. 2. Avoid hypoglycemia (in fact, I am terrified that I might accidentally cause a hypo and have deliberately been giving lower doses because of it). 3. Determine if a switch to Lantus is in order because I do have that now and can start when it's time.

About two weeks ago, Maddy was getting 5 units of Vestulin 2x a day, nadir was in the 100 range and pre-shot was 400+ regularly. Out of nowhere, I noticed nadir at 70, 60, 50 and started to diligently pre-shot test. I'm getting pre-shot reads under 200 on a regular basis with a random spike here and there.

What seems to be happening is that if I give a dose higher than 2 units, this drops the BG down into the 60 range and then this lasts all day and well into the time when her next dose is due. This causing me to either skip or give only 1 unit.

Maddy's numbers have changed so abruptly from notoriously high to quite manageable (or maybe even too low?) It has been so sudden and I need guidance on how to handle it. I spoke to the vet this week and I'm worried she is taking this too lightly as she recommended 3 units 2x day, even at a BG under 200.

I feel like I'm spinning my wheels. Surely there must be a better way to do this. Can someone assist?
 
Hi Danielle
Could you put the type of insulin you are using in the spreadsheet please instead of the dose in the top left hand corner.? And could you set up your signature that tells us all about Maddy please? I’ll post the link below about what to put in the signature.
At the moment there are no tests in the pm cycle at all. Cats often drop lower at night. Could you get at least one test in during the pm cycle every night please?
We need some data from the pm cycle before we can advise on a dose of Lantus.
Also what type of food are you feeding and how often do you give food?
 
HELP US HELP YOU info for signature and hypo box

This looks as if this is your first post on the forum. Hi and welcome. Once we can get a bit more BG data we will be able to help you with Lantus dosing. :)

In the meantime I am going to tag @Suzanne & Darcy to help you with a Vetsulin dose you can use until you do the switch to Lantus which is a much better Insulin for cats. Has Maddy ever had ketones?
 
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Bron and Sheba (GA) said:
Hi Danielle
Could you put the type of insulin you are using in the spreadsheet please instead of the dose in the top left hand corner.? And could you set up your signature that tells us all about Maddy please? I’ll post the link below about what to put in the signature.
At the moment there are no tests in the pm cycle at all. Cats often drop lower at night. Could you get at least one test in during the pm cycle every night please?
We need some data from the pm cycle before we can advise on a dose of Lantus.
Also what type of food are you feeding and how often do you give food?
Click to expand...
Thank you! I made the changes requested. My signature kept saying it was too long so if my abbreviations don't make sense please let me know. Also, I don't know what the abbreviations behind dosing means so I can't answer that.
 
Bron and Sheba (GA) said:
Hi Danielle
Could you put the type of insulin you are using in the spreadsheet please instead of the dose in the top left hand corner.? And could you set up your signature that tells us all about Maddy please? I’ll post the link below about what to put in the signature.
At the moment there are no tests in the pm cycle at all. Cats often drop lower at night. Could you get at least one test in during the pm cycle every night please?
We need some data from the pm cycle before we can advise on a dose of Lantus.
Also what type of food are you feeding and how often do you give food?
Click to expand...
Oops, I forgot to answer your question about feeding. Maddy grazes on Dr. Elsey's kibble during the day and night. She eats wet food twice a day at shot times. Fancy feast pates and occasionally I will add tiki cat mousse or broth. I believe they are all low carb foods. I don't check for ketones and have not seen any evidence of DKA. Yes, I'm sure I can check her nighttime numbers... Does it matter exactly when? Can I do 2 hrs after shot?
 
Testing at +2 may tell you if Maddy's numbers are dropping. The problem is that we won't know how far the may drop at nadir. From your AM data, it looks like Maddy's low point is at around +4. The nadir can, and does, move around. It would be helpful if, as Bron suggested, you started getting at least one PM test every night. It may also help if you were able to get a curve (i.e., testing every 2 hours over a 12-hour period) so we have a better idea of how your cat's cycle plays out.
 
Sienne and Gabby (GA) said:
Testing at +2 may tell you if Maddy's numbers are dropping. The problem is that we won't know how far the may drop at nadir. From your AM data, it looks like Maddy's low point is at around +4. The nadir can, and does, move around. It would be helpful if, as Bron suggested, you started getting at least one PM test every night. It may also help if you were able to get a curve (i.e., testing every 2 hours over a 12-hour period) so we have a better idea of how your cat's cycle plays out.
Click to expand...
Then I will definitely plan to add in a nighttime test right before I go to bed. Maddy is becoming a bit impatient with me poking her ear all the time. Like with her insulin shots, we started off going really well and then she was over it. I'm really trying to prevent this with testing too. I can try doing a curve or is it okay for me to do that with the freestyle libre? I am planning to have it installed Wednesday.
 
Oddly enough now Maddy's numbers are going back up. This is so incredibly confusing. I'm basically guessing at how much insulin she should get. I was so happy seeing the lower numbers and now I'm seeing more and more 300-400s.
 
Danielle --

It will help all of us if you can start getting at least one PM test. I'd encourage you to get a "before bed" test. Many cats have lower numbers at night. Without a PM test, you're missing half of Maddy's data and you have no idea how low her numbers may have gone.

My best hunch is that what you're seeing are bounces. When a cat's numbers drop low or lower than what your cat is used to experiencing, the liver and pancreas release a stored form of glucose along with counterregulatory hormones. These cause the blood glucose numbers to spike upward. It can some time for the numbers to level back out. The bounces are a normal part of your cat getting used to being back in more normal numbers. It's annoying but it's normal.
 
I think since you went up by whole units, you may have bypassed what could have been a "good" dose. With Vetsulin, we usually don't want them to drop too much below 100 at nadir. I don't have any personal history with using Vetsulin, but from looking at your spreadsheet, I think I'd start with 2 units and stay there while you gather more testing data, especially the PM tests.

Vetsulin usually does better with a consistent dose instead of always changing and chasing numbers. Sometimes a sliding scale works, but I'd try a consistent dose first. (If @Suzanne & Darcy sees her tags, she has much more experience with Vetsulin so she may have another suggestion and I'd listen to her over me).

If you get a Preshot under 200, try stalling, DON'T feed and test again in 20-30 minutes. Knowing which direction the glucose is going can help when deciding what to do next. Another thing to consider is "Are you able to test as often as may be needed?". If not, it's better to be safe and either skip or give a token dose, like 0.5.

Use that stall time to post with a good subject line like "STALLING! NEED HELP!" (It usually gets somebody's attention...LOL) Once you have somebody to help you, you can go back and change it.

If you can do that for the next several days, and do a curve at some point (test every 2 hours for 12 hours or every 3 hours for 18), we should be able to give you a better idea of where to start with the Lantus.
 
Chris & China (GA) said:
I think since you went up by whole units, you may have bypassed what could have been a "good" dose. With Vetsulin, we usually don't want them to drop too much below 100 at nadir. I don't have any personal history with using Vetsulin, but from looking at your spreadsheet, I think I'd start with 2 units and stay there while you gather more testing data, especially the PM tests.

Vetsulin usually does better with a consistent dose instead of always changing and chasing numbers. Sometimes a sliding scale works, but I'd try a consistent dose first. (If @Suzanne & Darcy sees her tags, she has much more experience with Vetsulin so she may have another suggestion and I'd listen to her over me).

If you get a Preshot under 200, try stalling, DON'T feed and test again in 20-30 minutes. Knowing which direction the glucose is going can help when deciding what to do next. Another thing to consider is "Are you able to test as often as may be needed?". If not, it's better to be safe and either skip or give a token dose, like 0.5.

Use that stall time to post with a good subject line like "STALLING! NEED HELP!" (It usually gets somebody's attention...LOL) Once you have somebody to help you, you can go back and change it.

If you can do that for the next several days, and do a curve at some point (test every 2 hours for 12 hours or every 3 hours for 18), we should be able to give you a better idea of where to start with the Lantus.
Click to expand...
Thank you, Chris! This is incredibly helpful and I appreciate it.
 
Sienne and Gabby (GA) said:
Danielle --

It will help all of us if you can start getting at least one PM test. I'd encourage you to get a "before bed" test. Many cats have lower numbers at night. Without a PM test, you're missing half of Maddy's data and you have no idea how low her numbers may have gone.

My best hunch is that what you're seeing are bounces. When a cat's numbers drop low or lower than what your cat is used to experiencing, the liver and pancreas release a stored form of glucose along with counterregulatory hormones. These cause the blood glucose numbers to spike upward. It can some time for the numbers to level back out. The bounces are a normal part of your cat getting used to being back in more normal numbers. It's annoying but it's normal.
Click to expand...
This makes sense to me! I will definitely work on getting those PM tests in.
 
Hi there. I am sorry I have not received notification of a lot of these tags. You have gotten great guidance from Chris. I would not exceed 2 units for the next few days at least — and try to gather as much data as you can so you can start with the Lantus.
 
I have wonderful news! We saw the vet today to have Maddy's freestyle sensor removed and she is in agreement to switch to lantus. She told me to start with 1 unit and I just wanted to make sure that's a good starting dose. I will go over to the lantus section and read those stickies, but I would love to know if there is anything I should be aware of before I switch.

Miss Maddy's numbers are going back up again. I'm seeing numbers in the 400-500 range pre shot and not many instances below 200 for her nadir. It feels like we are back where we started, which is annoying. Since my last post, I upped her dose twice, after waiting the 3 days in between. She is currently getting 2.5 units of Vetsulin.

Just to give an update on our end, I had been out of town for a week. My husband used the sensor to help monitor her BG but he didn't record numbers into the spreadsheet. I thought I would be able to get that data after the fact but all I'm seeing is a chart with no numbers - so the time period between 9/15 and 9/20 is rough estimates based on a graph. One thing I did notice is that her afternoon numbers have been lower than her middle of the night numbers, at least based on this sensor. Now that it's been removed, I'm trying to bump her schedule around making her shot time closer to 8 am/pm so I can get that good nighttime read on the relion before bed.

There are a couple dislikes about the freestyle - 1. the numbers are either lower or higher than the relion meter by about 20 which makes it hard to know which way to compensate. 2. The adhesive my vet used really irritated Maddy's skin. She has a big red sore spot now. Is this a common reaction?

Thanks all.
 
Danielle Shuck said:
1. the numbers are either lower or higher than the relion meter by about 20 which makes it hard to know which way to compensate
Click to expand...

There's no direct conversion. You just deal with the numbers as they are given, BUT, the Libre is infamous for being wrong at lower numbers....like it will alert and say the BG is too low but if you re-check with a regular meter, most of the time you get a higher, safe number.

Danielle Shuck said:
The adhesive my vet used really irritated Maddy's skin. She has a big red sore spot now. Is this a common reaction?
Click to expand...

Unfortunately, it can be. The adhesive they use has caused some pretty yucky wounds. If you intend to continue to use the Libre, I highly suggest you join the Freestyle Libre for dogs and cats group on Facebook.

Danielle Shuck said:
She told me to start with 1 unit and I just wanted to make sure that's a good starting dose.
Click to expand...

We don't "start over" when switching insulins. We take into consideration the dose they were on using the original insulin (Vetsulin in your case) so I'd suggest starting at maybe 2U for now. It's important to get tests at various points in the cycles if at all possible, and it's always important to get at least a "before bed" test on the PM cycle to make sure she'll be OK while you're sleeping so I'm glad you're working on getting those done. Most cats go lower at night so it's best to know how she's doing before going to bed (or staying up or setting an alarm to re-check if she's dropping too fast)
 
Thank you both! We are getting started, she got her first lantus 2 unit dose this morning. I will be checking her BG frequently just because I'm nervous. I switched lancets a couple of weeks ago and it makes checking BG with the relion a breeze. I only plan to use the libre when I'm traveling and my husband or the sitter needs to use that. But I did request to join the group. I would love to be more self-sufficient. This poor cat hates going to the vet, so of course she's the one who has to go all the time now. Learning to do some of these things at home is essential!
 
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