Ketones

[Susan and Toby]

Hi everyone.
Toby's BG readings don't seem to make a lot of sense. For example on 11/18 at 9:00 AM
his reading was 445 +6 it was 577. 11/19 his 9PM reading was 478 +6 it was 531. Most alarming was on 11/20 his 9:00 AM reading was 453+6 it was 395 and at 9 PM it was 110! Today 11/24 9 AM it was 389 +6 it was 388. Anyone seen anything like it? He has a spreadsheet that I recently created. I don't know how to attach it to this message. His name is Toby Pressman Thank you.

 

[Diane Tyler's Mom GA]

Hi everyone.
Toby's BG readings don't seem to make a lot of sense. For example on 11/18 at 9:00 AM
his reading was 445 +6 it was 577. 11/19 his 9PM reading was 478 +6 it was 531. Most alarming was on 11/20 his 9:00 AM reading was 453+6 it was 395 and at 9 PM it was 110! Today 11/24 9 AM it was 389 +6 it was 388. Anyone seen anything like it? He has a spreadsheet that I recently created. I don't know how to attach it to this message. His name is Toby Pressman Thank you.

Sorry no one got back to you
Tagging some members for you to take a look at your spreadsheet


@Bandit's Mom
@Bron and Sheba (GA) since Toby was Dx with DKA at diagnosis

@Susan Pressman
I noticed on your spreadsheet you have noted in the remarks section
last day of Freestyle Libre which was on 11-14 -24
Then on 11-15-24 you have
first day of AlphaTrak

Are you using the Alpha Trak now all the time?
Is so can you put a blank line above the date you switched to the Alpha Trak and just put Alpha Trak Now and highlight any color you want to
I don't think members will see it in the remarks section
Also on the top of your Spreadsheet can you put after you have Freestyle Libre put
Freestyle Libre/ Alpha Trak and the date you switched

Also on your signature please add Alpha Trak 11/15/24. So members are aware of this
The last 2 color codes on the spreadsheet up top will need to be changed to reflect the Alpha Trak
The Dark green would be 68-99
And the Neon green would be BG<68
Are you still feeding the same food you have listed on your signature ?
If you can't change it yourself I'll tag Bhooma
@Bandit's Mom to get in touch with you to change it for you

Previous post Introduction post
https://felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/#post-3219210

Susan you haven't picked a dosing method for Toby
Each one will tell you when an increase or decrease is needed. We don't adjust the dose on the AMPS or PMPS BG number , we adjust the dose on how low the BG is dropping
You can read about it here and the add it to your signature and spreadsheet up top
Do you have the U-100 syringes with the half unit markings?

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Bandit's Mom]

It's possible he is high because of the skipped shot on 11/20. For a cat with a history of DKA, you do not want to skip insulin. If you get a lower preshot, post and ask for help. Did you get a second test that day to see if that 110 was a faulty strip?

It looks like Toby needs more insulin though and I would take him up to 3.25U

I have the same questions as Diane about the food he is eating and the meter you are using
The AT can read much higher than a human meter in higher numbers.

 

[Diane Tyler's Mom GA]

@Bandit's Mom
Thank you Bhooma

 

[Bandit's Mom]

You want to start posting on the LBL forum.
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

 

[Diane Tyler's Mom GA]

@Susan Pressman
Once you answer all of the questions I asked , I agree with Bhooma to start posting on the Lantus Forum
Please try and post everyday
We have a certain way of posting there
You would Start with the
Date Toby AMPS # and any additional tests after that. You can continue with Toby's PMPS and any additional tests after that
To add the additional tests look to the right and tap on Thread Tools, then tap on Edit Title and add those tests , then tap save

We also link the previous days post to the new one in case members need to go back and read something

To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it

 

[SmallestSparrow]

Hi everyone.
Toby's BG readings don't seem to make a lot of sense. For example on 11/18 at 9:00 AM
his reading was 445 +6 it was 577. 11/19 his 9PM reading was 478 +6 it was 531. Most alarming was on 11/20 his 9:00 AM reading was 453+6 it was 395 and at 9 PM it was 110! Today 11/24 9 AM it was 389 +6 it was 388. Anyone seen anything like it? He has a spreadsheet that I recently created. I don't know how to attach it to this message. His name is Toby Pressman Thank you.

I’m a beginner so can’t offer much help

I can say that the AT has an accuracy of 10% at values above 100 —meaning add and subtract 10% of the number you get and it’s highly likely that within that range is the real number you’d get if tested in the lab. So at very high numbers, there’s a lot of overlap. So 450and 405 are essentially the same number as are 450 and 495 (edited-having to dictate is confusing)

I also noticed your kitty has asthma—how is that treated?

 

[Susan and Toby]

Sorry no one got back to you
Tagging some members for you to take a look at your spreadsheet


@Bandit's Mom
@Bron and Sheba (GA) since Toby was Dx with DKA at diagnosis

@Susan Pressman
I noticed on your spreadsheet you have noted in the remarks section
last day of Freestyle Libre which was on 11-14 -24
Then on 11-15-24 you have
first day of AlphaTrak

Are you using the Alpha Trak now all the time?
Is so can you put a blank line above the date you switched to the Alpha Trak and just put Alpha Trak Now and highlight any color you want to
I don't think members will see it in the remarks section
Also on the top of your Spreadsheet can you put after you have Freestyle Libre put
Freestyle Libre/ Alpha Trak and the date you switched

Also on your signature please add Alpha Trak 11/15/24. So members are aware of this
The last 2 color codes on the spreadsheet up top will need to be changed to reflect the Alpha Trak
The Dark green would be 68-99
And the Neon green would be BG<68
Are you still feeding the same food you have listed on your signature ?
If you can't change it yourself I'll tag Bhooma
@Bandit's Mom to get in touch with you to change it for you

Previous post Introduction post
https://felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/#post-3219210

Susan you haven't picked a dosing method for Toby
Each one will tell you when an increase or decrease is needed. We don't adjust the dose on the AMPS or PMPS BG number , we adjust the dose on how low the BG is dropping
You can read about it here and the add it to your signature and spreadsheet up top
Do you have the U-100 syringes with the half unit markings?

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Susan and Toby]

Thank you Diane for your prompt reply.
I will make the adjustments on Toby's spreadsheet
when I have time later today. The instructions sound very complicated. I will do the best I can and reach out to Bhooma to help if I need it.

I feed him Fancy Feast because he has days where he doesn't want to eat and this is his favorite. When he won't eat that I give him Purina DM dry. Baby food at last resort.
I do have the syringes with half units. I draw his blood from his ear and now use AlphaTrak exclusively.

Sad and sorry to see that Tyler passed away.

 

[SmallestSparrow]

Hi Susan
Does Toby take prednisilone for his asthma? Steroids can affect BG pretty dramatically
Hopefully someone experienced is by soon to help. colleen

edit: also I know you’re overwhelmed now without extra paperwork, but it may help the experienced folks if you note in the comments if you had to feed him higher carb food. It’s important for kitties who’ve had dka to keep eating so you’re doing right by giving him something when he’s being fussy but it will help people who review his spreadsheet if they know which days had more carbs than others. But again, it’s really important that Toby eat, and in Fact eat extra calories if his ketones are up—are you checking ketones? If so you can put those results in the comments also.

good luck I know this is so hard

 

[Susan and Toby]

Hi Colleen,
Toby takes fluticasone inhaler twice a day.
I think the prednisone may have caused the diabetes.
Yes it is very overwhelming for both of us. Pricking his ear is the worse part.
I'm tempted to go back to the Libre.

I have a ketone meter and strips for his blood. NovaMax.
I don't think it is accurate. This week it was 3.8 so I brought him to the ER. After a two hour wait and almost $400 there were no ketones present. Maybe the strip was defected.
They said just go by clinical signs.
Thank you.

 

[SmallestSparrow]

Hi Colleen,
Toby takes fluticasone inhaler twice a day.
I think the prednisone may have caused the diabetes.
Yes it is very overwhelming for both of us. Pricking his ear is the worse part.
I'm tempted to go back to the Libre.

I have a ketone meter and strips for his blood. NovaMax.
I don't think it is accurate. This week it was 3.8 so I brought him to the ER. After a two hour wait and almost $400 there were no ketones present. Maybe the strip was defected.
They said just go by clinical signs.
Thank you.

Fwiw the ear pricking gets easier for both human and cat but I totally get wanting the ability to know his BG whenever you want.
Whoa that’s a big difference from 3.8 to none. I’ve seen ketones in Methos come down from say 0.8 or 1.0 to 0.4 after insulin, sub q fluids, and waiting a few hours. But 3.8 is huge. I do wonder if strip was bad. I usually repeat at least once (twice if the second is really different) and do a control solution check to be sure the meter is working. I would have had to stop at a human ER on the way home after a 3.8! for someone to check my heart.

you’re doing a great job, I wish I knew more to offer suggestions because his numbers are all over the place (that’s where tracking what he’s eating might help, methos got into his brothers food once and it really made a difference in his next test). I guess the only other thing I can suggest is make sure your AT is set to “cat”—someone once posted they’d accidentally set to “dog” and once corrected their numbers looked better.
I think it doesn’t help that the cat icon and dog icon look similar

 

[Diane Tyler's Mom GA]

Pricking his ear is the worse part.
I'm tempted to go back to the Libre.

Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up

6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 10 or 20 seconds until it stops
Get 26 or 28 gauge lancets
A lot of us use the lancets to test freehand not the lancing device
I find it better to see where I'm aiming
Look at the lancet under a light and you will see one side is curved upward, that's the side you want to poke with

Try putting a thin layer of Vaseline on the ear so the blood will bead up

 

[Diane Tyler's Mom GA]

Sad and sorry to see that Tyler passed away.

Thank you so Susan , if it wasn't for the experienced members here and taking their advice I know I would have never gotten Tyler into remission for 3 and a half years . He passed away from cancer at the age of 16 years and 4 months .
His brother Perry passed away from kidney disease at the age of 12 . How I miss them both so much.

 

[Susan and Toby]

Sorry no one got back to you
Tagging some members for you to take a look at your spreadsheet


@Bandit's Mom
@Bron and Sheba (GA) since Toby was Dx with DKA at diagnosis

@Susan Pressman
I noticed on your spreadsheet you have noted in the remarks section
last day of Freestyle Libre which was on 11-14 -24
Then on 11-15-24 you have
first day of AlphaTrak

Are you using the Alpha Trak now all the time?
Is so can you put a blank line above the date you switched to the Alpha Trak and just put Alpha Trak Now and highlight any color you want to
I don't think members will see it in the remarks section
Also on the top of your Spreadsheet can you put after you have Freestyle Libre put
Freestyle Libre/ Alpha Trak and the date you switched

Also on your signature please add Alpha Trak 11/15/24. So members are aware of this
The last 2 color codes on the spreadsheet up top will need to be changed to reflect the Alpha Trak
The Dark green would be 68-99
And the Neon green would be BG<68
Are you still feeding the same food you have listed on your signature ?
If you can't change it yourself I'll tag Bhooma
@Bandit's Mom to get in touch with you to change it for you

Previous post Introduction post
https://felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/#post-3219210

Susan you haven't picked a dosing method for Toby
Each one will tell you when an increase or decrease is needed. We don't adjust the dose on the AMPS or PMPS BG number , we adjust the dose on how low the BG is dropping
You can read about it here and the add it to your signature and spreadsheet up top
Do you have the U-100 syringes with the half unit markings?

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

I am having trouble moving through the spreadsheet. I was unable to put in a blank line indicating the switch to AlphaTrak. I don’t know what the letters mean regarding dosing methods. It is very challenging for me to keep records and attend to details. Will do my best. Anything for Toby.

Thank you so Susan , if it wasn't for the experienced members here and taking their advice I know I would have never gotten Tyler into remission for 3 and a half years . He passed away from cancer at the age of 16 years and 4 months .
His brother Perry passed away from kidney disease at the age of 12 . How I miss them both so much.

 

[SmallestSparrow]

Hi Susan

SLGS is start low go slow a more conservative approach
TR is tight regulation, takes cats lower quicker so requires more testing, among other things

I can try to figure out how to show you to add blank line so I will be back w/ some screen shots (how tech savvy are you) but if all else fails eventually @Bandit's Mom may intervene—she’s super nice and a computer wiz so don’t let the spread sheet be an issue for you right now

 

[SmallestSparrow]

These are on my boy’s ss. Select the date of the last libre and click on the add line button below

Then highlight the new line that appeared

and click on the collapse

If at anytime you make a mistake use the undo arrow to undo

(Or wait for @Bandit's Mom )

 

[Diane Tyler's Mom GA]

I am having trouble moving through the spreadsheet. I was unable to put in a blank line indicating the switch to AlphaTrak. I don’t know what the letters mean regarding dosing methods. It is very challenging for me to keep records and attend to details. Will do my best. Anything for Toby.

Do you see the blank line you have already for 11-15 just Type on that line under where it says +1 so we can see it right away Type Alpha Trak Now and up top where you wrote Alpha Trak put 11-15 after that
@Susan Pressman

 

[Diane Tyler's Mom GA]

@SmallestSparrow
Hi Colleen she has the blank for 11-15 I told her to just Type on that line Alpha Trak Now and up top where she wrote Alpha Trak put 11-15 after that

 

[Diane Tyler's Mom GA]

Hi Susan
If you are using the Alpha Trak exclusively you can go to your signature and after you have Freestyle Libre just put
Freestyle Libre/ Alpha Trak as of 11/15/24
Just tap on your name up top and then tap on signature and add that , then tap save

If you must feed dry food these are about 5 or 6% carbs

About the kibble
Here are some low carb dry foods ,they are about 5 or 6% carbs
None of them are cheap
You need to order them online they are not cheap
Dr Elseys you can buy on chewey site
https://www.chewy.com/dr-elseys-cleanprotein-chicken/dp/146269?utm_source=google-product&utm_medium=cpc&utm_campaign=12791446238&utm_content=Dr. Elsey's&utm_term=&show-search=1&gclid=EAIaIQobChMI0PvU2Zj79wIVRIdbCh3JawEkEAQYASABEgIInfD_BwE

Young again on their web site
https://www.youngagainpetfood.com
Take a look at the young again zero or the zero mature. Some members have said the Young Again caused stinky poops

In the past I have used The Dr Elseys and had no problem

Dr Elsey's also at Walmart
https://www.walmart.com/ip/Dr-Elsey...ViI3ICh0suwO_EAQYAiABEgJrOPD_BwE&gclsrc=aw.ds

Dr Elsey's Amazon
https://www.amazon.com/dp/B07FCJHDPR/ref=twister_B09GHFJY65?_encoding=UTF8&psc=1

the Dr Elsey's comes in different size bags
None of these can be bought in stores

Also
Wysong Epigen 90

If you call they will send you samples
Phone: 877-311-2287… Dr Elsey's

PHONE:
800.311.6646. Young Again

1-800-748-0188 •Wysong Epigen 90

 

[Diane Tyler's Mom GA]

@Susan Pressman
Can you add to your signature Alpha Trak and the date you switched please , if you are feeding any dry food at all you will have to follow SLGS method can you add that to your signature and spreadsheet up top

 

[Susan and Toby]

Sorry no one got back to you
Tagging some members for you to take a look at your spreadsheet


@Bandit's Mom
@Bron and Sheba (GA) since Toby was Dx with DKA at diagnosis

@Susan Pressman
I noticed on your spreadsheet you have noted in the remarks section
last day of Freestyle Libre which was on 11-14 -24
Then on 11-15-24 you have
first day of AlphaTrak

Are you using the Alpha Trak now all the time?
Is so can you put a blank line above the date you switched to the Alpha Trak and just put Alpha Trak Now and highlight any color you want to
I don't think members will see it in the remarks section
Also on the top of your Spreadsheet can you put after you have Freestyle Libre put
Freestyle Libre/ Alpha Trak and the date you switched

Also on your signature please add Alpha Trak 11/15/24. So members are aware of this
The last 2 color codes on the spreadsheet up top will need to be changed to reflect the Alpha Trak
The Dark green would be 68-99
And the Neon green would be BG<68
Are you still feeding the same food you have listed on your signature ?
If you can't change it yourself I'll tag Bhooma
@Bandit's Mom to get in touch with you to change it for you

Previous post Introduction post
https://felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/#post-3219210

Susan you haven't picked a dosing method for Toby
Each one will tell you when an increase or decrease is needed. We don't adjust the dose on the AMPS or PMPS BG number , we adjust the dose on how low the BG is dropping
You can read about it here and the add it to your signature and spreadsheet up top
Do you have the U-100 syringes with the half unit markings?

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

 

[Diane Tyler's Mom GA]

@Susan Pressman
Did you have a question?
Only asking because you copied what I said above

 

[Susan and Toby]

I'm not sure how I copied what you wrote.
With giving him several meds ( Cerenia, Mirataz, Renal K and Zofran prn) twice a day, getting BG readings four times a day which I still have some difficulty with, often struggling to get him to eat, plus twice daily inhaler for Asthma I feel like a vet nurse for much of my life. It is very upsetting to put him through all this. He is a very good boy and compliant
but I know that he isn't happy with it all.

Also I am constantly worried about his readings being so consistently high and bouncing too low.
I am devoted to his care though and will do whatever it takes. Fortunately clinically he is doing relatively well.

I am very confused with all the instructions I am receiving. The only thing that I got down is recording his readings. I don't know where to find my name on top or my signature. I don't see any place for this on Toby's spreadsheet. I tried to write on the line when I changed to AlphaTrak but it was only contained in one small square as you see.
I am feeding Toby almost only wet food now.
I occasionally will give him some Purina DM at last resort. Strange that they make prescription food
that has a high carb. I'll order the Dr. Elsey kibble from Chewy. Do cats like it?
Never thought that I was lacking so much in technical skills. Mostly, I am not good with details.
I just re read the text you wrote beginning with the suggestion that I join Lantus group. Also included
additional testing, URL etc. Anyway unfortunately I did not understand any of the message. I like to keep things simple.
I am eager for feedback as to why some days his BG
is very high all day and some days he will stay in a good 200's. I have other questions as well. His vet said he was the most challenging diabetic kitty that she has ever had.
I guess I need to take care of getting the documentation right before I can address these concerns.
Thank you Diane for all your help and time.

 

[Diane Tyler's Mom GA]

I don't know where to find my name on top or my signature. I

All the way up top where the pic of that car is with a vial of insulin click on your name , the you will see the word signature then after you have the Freestyle Libre
Put this
Freestyle Libre/ add Alpha Trak 11/15/24
And add SLGS and after the Purina DM add DRY
Let me know if he will like the Dr Elsey's Dry and then we can add that to your signature after we know if he'll eat it
Then tap save
@Susan Pressman

On your spreadsheet up top where you have
Meter: Freestyle Libre /AlphaTrak
Just put the date after Alpha Trak 11-15-24

 

[Diane Tyler's Mom GA]

I tried to write on the line when I changed to AlphaTrak but it was only contained in one small square as you see.

That's fine the way you did it
@Susan Pressman

 

[Diane Tyler's Mom GA]

I'll order the Dr. Elsey kibble from Chewy. Do cats like it?

Yes most cats do. Tyler loved it
@Susan Pressman

 

[Diane Tyler's Mom GA]

I'm not sure how I copied what you wrote.
With giving him several meds ( Cerenia, Mirataz, Renal K and Zofran prn) twice a day, getting BG readings four times a day which I still have some difficulty with, often struggling to get him to eat, plus twice daily inhaler for Asthma I feel like a vet nurse for much of my life. It is very upsetting to put him through all this. He is a very good boy and compliant
but I know that he isn't happy with it all.

Also I am constantly worried about his readings being so consistently high and bouncing too low.
I am devoted to his care though and will do whatever it takes. Fortunately clinically he is doing relatively well.

I am very confused with all the instructions I am receiving. The only thing that I got down is recording his readings. I don't know where to find my name on top or my signature. I don't see any place for this on Toby's spreadsheet. I tried to write on the line when I changed to AlphaTrak but it was only contained in one small square as you see.
I am feeding Toby almost only wet food now.
I occasionally will give him some Purina DM at last resort. Strange that they make prescription food
that has a high carb. I'll order the Dr. Elsey kibble from Chewy. Do cats like it?
Never thought that I was lacking so much in technical skills. Mostly, I am not good with details.
I just re read the text you wrote beginning with the suggestion that I join Lantus group. Also included
additional testing, URL etc. Anyway unfortunately I did not understand any of the message. I like to keep things simple.
I am eager for feedback as to why some days his BG
is very high all day and some days he will stay in a good 200's. I have other questions as well. His vet said he was the most challenging diabetic kitty that she has ever had.
I guess I need to take care of getting the documentation right before I can address these concerns.
Thank you Diane for all your help and time.

@Bron and Sheba (GA)
@Wendy&Neko
@Bandit's Mom
@Sienne and Gabby (GA)
Can someone please help Susan

Here is her introduction post

Susan Pressman
Hi everyone.
Toby's BG readings don't seem to make a lot of sense. For example on 11/18 at 9:00 AM
his reading was 445 +6 it was 577. 11/19 his 9PM reading was 478 +6 it was 531. Most alarming was on 11/20 his 9:00 AM reading was 453+6 it was 395 and at 9 PM it was 110! Today 11/24 9 AM it was 389 +6 it was 388. Anyone seen anything like it? He has a spreadsheet that I recently created. I don't know how to attach it to this message. His name is Toby Pressman


Susan answered some questions me and Bhooma had

She is now using the Alpha Trak from now on , she put it in her SS ,
She also said up top

I am feeding Toby almost only wet food now.
I occasionally will give him some Purina DM DRY at last resort. Strange that they make prescription food
that has a high carb. I'll order the Dr.Elsey kibble. from Chewy. She is also feeding Fancy Feast Pates

I'm asking
any advice on whether or not Susan should increase the dose , she's following SLGS it's in her SS, can you take a look



Susan Pressman
Hi Diane,
I filled in the dose last night as well as tonight's reading. So discouraging to see this go up to almost 700. Up until the last few days, his appetite has been great. Now he will only licks his food, will eat a small amount of Purina PM (should get the Dr. Esley food in a couple of days) and a jar of baby food. Seems like the Mirtazapine isn't working. Gave him some Zofran with it tonight. Hope he eats tomorrow.

 

[Diane Tyler's Mom GA]

I just re read the text you wrote beginning with the suggestion that I join Lantus group. Also included
additional testing, URL etc. Anyway unfortunately I did not understand any of the message. I like to keep things simple.

Yes Bhooma suggested you post on the Lantus Board once you add everything I asked boy to do
Here is the link to the Lantus Board

https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

To the right you will see Post New Thread
So when you are ready to post there you would put in your title
Date Toby AMPS # and any additional tests after that, you can continue there with his PMPS # and any additional tests after that

To add the additional tests look to the right and tap on Thread Tools, then tap on Edit Title and add those tests , then tap save

Then you can introduce yourself and Toby and say this is my first post on the Lantus Forum and any questions you have

We also link the previous days post to the new one in case members need to go back and read something

To link your previous posts
Your previous days post will always be in the URL all the way up top ignore where it says insert or cancel I'm just trying to show you where your previous days post will be
Just ignore where it says insert and cancel
Just copy your previous days post and then paste it when you do your new post new thread





Like I said
your previous days post it will be the one all the way up top, above the pic of that cat and the picture of a bottle of insulin there, let me know if you understand it. I hope so
You will post everyday and link your previous days post to your new one

 

[Diane Tyler's Mom GA]

I would suggest try to get more tests in during the day cycle mix it up
One day get a+3 and +5
Another day +4 and +7
Same goes for the night cycle
Susan do you know how to tag a member?
You would put the symbols @then start typing the first couple of letters of the members you want to
tag . A drop down menu will appear then just tap on that members name. You will know if you did it correct is it appears in Blue after you tap post
@Susan Pressman

 

[Diane Tyler's Mom GA]

It's possible he is high because of the skipped shot on 11/20. For a cat with a history of DKA, you do not want to skip insulin. If you get a lower pre shot, post and ask for help. Did you get a second test that day to see if that 110 was a faulty strip?

It looks like Toby needs more insulin though and I would take him up to 3.25U

I have the same questions as Diane about the food he is eating and the meter you are using
The AT can read much higher than a human meter in higher numbers.

Hi Bhooma Susan answered some of the questions we asked
She is now using the Alpha Trak from now on , she put it in her SS ,
She also said up top

I am feeding Toby almost only wet food now.
I occasionally will give him some Purina DM DRY at last resort. Strange that they make prescription food
that has a high carb. I'll order the Dr.Elsey kibble. from Chewy. She is also feeding Fancy Feast Pates
@Bandit's Mom

 

[Diane Tyler's Mom GA]

@Bandit's Mom
Hi Bhooma any advice on whether or not Susan should increase the dose , she's following SLGS it's in her SS, can you take a look

 

[Diane Tyler's Mom GA]

@Susan Pressman
Hi Susan on your spreadsheet for last night how much insulin did you give , it's not filled in .
How are things going . I'm sorry that the members I tagged didn't respond. I'll keep trying

 

[Susan and Toby]

Hi Diane,
I filled in the dose last night as well as tonight's reading. So discouraging to see this go up to almost 700. Up until the last few days, his appetite has been great. Now he will only licks his food, will eat a small amount of Purina PM (should get the Dr. Esley food in a couple of days) and a jar of baby food. Seems like the Mirtazapine isn't working. Gave him some Zofran with it tonight. Hope he eats tomorrow.

 

[Diane Tyler's Mom GA]

@Susan Pressman
Hi Susan can you add to your signature SLGS and add Dry after you have Purina DM
I'm going to private message some experienced members for you. Susan a member may reply back to you ,but won't tag you so you have to check where it says alerts up top every day and see if someone responded to you.

Just so we know you have read when a member replies back to you can you tap on the word Like so we know you read it. The word like is to the right of each post

 

[Wendy&Neko]

It looks like Toby both likes to bounce, and needs more insulin. In your previous post here: https://felinediabetes.com/FDMB/threads/new-member-constant-high-reading.295443/, which I'm linking for background for people reading, you got a good description of bouncing. Almost all newly diagnosed cats bounce, and I've even seen it in cats that have been on insulin for years. I think it's more bothersome for us that for our cats.

One reason his numbers seem higher since you switched to the AT. The pet meters tend to read higher in higher blood glucose (BG) ranges than human meters, which is what the Freestyle is. The other reason for swings to higher numbers is whenever you shoot a reduced dose or skip. Lantus is a depot style insulin, meaning that one dose builds on the previous one. Ever time you reduce the dose, you interrupt that process and the effects of that reduction or skip take a while to build up the Lantus depot again. Meaning it's like shooting lower doses than you are.

Since you are following the SLGS dosing method, it's time to increase to 3.25 units. With SLGS, we hold a dose for a week, and if it's not getting him nadirs (lowest point) consistently in the 90-149 range, you increase by 0.25 units.

Are you home testing for ketones? I saw that you have done one test, but haven't seen if you've done it lately. With a cat with a history of DKA, you should be testing regularly when he's in high numbers.

How is Toby's appetite and energy level?

 

[Wendy&Neko]

With giving him several meds ( Cerenia, Mirataz, Renal K and Zofran prn) twice a day,

How often are you giving the Zofran? I see prn which is as needed. You can actually give Zofram 3-4 times a day if needed, meaning his appetite isn't good. I hope you are using ondansetron, the generic instead of Zofran which is much more expensive.

 

[Diane Tyler's Mom GA]

Thank you Wendy

 

[Diane Tyler's Mom GA]

Susan when you test for ketones with your Nova Max please put what they were in the remarks section
@Susan Pressman

 

[Susan and Toby]

@Susan Pressman
How are things going with Toby now? can you post so we can help you with dosing.
Are you still testing for ketones ?

 

[Susan and Toby]

Hi Bron,
As you can see from his spreadsheet, his readings are still too high. Been that way for weeks. His vet has been very conservative for fear of hypoglycemia. He did run too low a few times, even below 100.
She hasn't been able to see why he is not responding to insulin or that his readings are so erratic. Even the internist wasn't all that helpful after all these normal tests results.

We saw his vet today for an unrelated issue (eye infection). She mentioned that cats with very high readings just don't feel well. It is true on the rare days that he is in the 200's he is brighter and seems happier.
I think she was insinuating that maybe because he feels lousy most of the time that I should consider euthanasia. I can't bear this option and I still have hope for that his diabetes can be managed. I will send her all his readings on Monday.
She had a consult with the internist who suggested that she should consider changing the insulin.
What do you think of that? Problem is that he would have to start real low on that.

Regarding his Ketones. His NovaMax blood reading was 3.40 the other night. I took him to the ER and they retested him and did not find any ketones. Company said that the strips might defected and have sent me new ones.
ER said not to worry if his clinical signs are OK.
Hope that the NovaMax is reliable. How often do you recommend testing?

How do people work with advice from the group with
their vet? Especially if they contradict. I think that dosing is the main issue. It certainly seems that you here are a lot more thorough and even more knowledgeable.
Thank you for your message.

 

[Susan and Toby]

I would suggest try to get more tests in during the day cycle mix it up
One day get a+3 and +5
Another day +4 and +7
Same goes for the night cycle
Susan do you know how to tag a member?
You would put the symbols @then start typing the first couple of letters of the members you want to
tag . A drop down menu will appear then just tap on that members name. You will know if you did it correct is it appears in Blue after you tap post
@Susan Pressman

 

[Wendy&Neko]

Hi Susan, I moved your last post the most current thread, so the current stuff is all in one place. Just makes it easier for us to follow the story.

So sorry your vet was hinting at euthanasia. Toby was only diagnosed 3 months ago, it is still early in his diabetic journey. It's not uncommon for people to come to us having followed a vet's suggestion for dosing and not seen a lot of progress. Some cats also need higher doses. My girl got up to 8.75 units before she had a breakthrough. It took 8 months. In fact, my vet started us on Caninsulin and Neko was on that for 3 months before I was lucky enough to see a locum vet who switched me to Lantus - which I had been asking my vet for since the beginning. Neko wasn't doing well on Lantus. Switching to Lantus and following a more aggressive dosing protocol than the vet suggested made a huge difference. I could only do that with sufficient home testing.

It took a while, but I finally got her regulated. You can do the same. But it starts with getting him to a good insulin dose. As I said above, he needs to be increased to 3.25 units as soon as possible. Once a kitty spends more time in high numbers, their body gets used to it and you have to go even higher in dose to see a breakthrough.

Below 100 on the AT is not low, it is normal number range. With our more conservative dosing method SLGS, it's OK if he gets down to 90, and even a bit below that is not hypo range.

She hasn't been able to see why he is not responding to insulin or that his readings are so erratic.

It's amazing how little training vets get on diabetes. One of our members asked someone teaching at a large vet school, and they were told 5 hours on diabetes for dogs and cats! They do learn a lot in practice, but the people here have had a lot more hands on training. Also, most vets aren't used to the detail in the spreadsheets we have. His reading are erratic because he's bouncing - a perfectly normal thing that cats do.

To deal with my vet, I printed off a copy of the dosing protocol I was using, and dropped off copies of the spreadsheet every week, until she figured out what I was doing was safe. After that, she stopped helping me with dosing.

 

[Susan and Toby]

Seems like I missed this text. Ear pricking has been a very unpleasant process for both of us. He obviously often feels some pain. Sometimes I do get it right
the first try. Sometimes I have to prick him several times. Or I'll get too much blood. Anyway tomorrow I am having a new Libre put on. I will still use the AlphaTrak before he gets insulin.

 

[Bron and Sheba (GA)]

Please do not even consider euthanasia.
I get very angry when I hear that from vets about feline diabetes. It is a very treatable disease.
Would you be willing to post here every day so we can help you? That way we can look at what is going on and guide you. We have very experienced people here who have been looking after diabetic cats for years.
Many vets (and specialists) do not see many diabetic cats and it is only when you actually live with one you actually learn so much more.
As I am writing this I can see Wendy has also posted.
Please persevere with home testing. A ReliOn prime meter from Walmart is much cheaper to use than an alphatrak meter. Have you seen the link to hometesting? I’ll post it below.

 

[Bron and Sheba (GA)]

HOMETESTING HINTS AND LINKS

 

[Susan and Toby]

Hi Bron,
Toby's vet is increasing his dose from 3 units to
3.5. I suggested 3.25 as recommended here
but she said .25 is such a tiny dose and 3.5
is more consistent. I haven't received an answer to why his readings at times at the nadir have been much
higher than when I give him a dose.
Today for example at 9:00am reading was 595
and at 3:00 pm it was 673. It is very worrisome that these readings are so high too.

He was eating very well until about a week ago.
Now he only licks the wet. He'll eat a little Purina DM
Mostly I have to give him baby food sometimes mixed with Churu.
I just got the Wysong 90 yesterday. The bag says
to add to regular food slowly starting at 10%.
Anyone use this food?

He looks miserable. I know he doesn't feel good.
This breaks my heart.

 

[Susan and Toby]

Ps Checking his ketones. Doesn't have any,

 

[Wendy&Neko]

Good news on the lack of ketones.

Your spreadsheet is missing the dose in the Units cells the last couple mornings. Have you been continuing to give 3 units? The answer to that may explain the higher number during the cycle today. It's also possible he went lower last night and is bouncing today. That's why those before bed tests are so important, to give a hint what he's doing at night.

We dose Lantus based on how low it takes the cat. He did get to 105 a few days ago, which is a pretty good number. I'd stick to increasing to 3.25 units.

 

[Bron and Sheba (GA)]

Hi Susan. I’m sorry Toby isn’t feeling well.
Are you still giving him the ondansetron for nausea. Licking food and not eating is a sign of nausea. Ondansetron can be given 3 times a day.

I can see the last three am cycles don’t have insulin recorded. Did you give it to him?

Those higher numbers in the last 3 days could be from bouncing from the blue BGs which he is no longer used to. A lot of newly diagnosed diabetic cats bounce. It’s nothing to Worry about.
I would wait for 1 more day to see if the BGs come down again before increasing th dose. And I would only go up to 3.25 units.