? Shorshe: Issues with Freestyle Libre Sensor

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Update: 4 August 2024

Free Style Libre vs Ear prick with Contour Plus Elite:


I am having issues with the freestyle libre sensor for continuous monitoring. The difference between the sensor and contour plus meter (via ear prick) is huge. The sensor barely shows her BG below 300. Where's now at +5.5 via the meter (contour plus) strips show it to be 213, the sensor reading is 304. At +2 it was 245 (contour plus) and 292 (libre sensor)

Has anyone faced similar issues?

Sensor placement and Stress: Effects on BG

The sensor has been placed on her flank with some tissue glue. She can reach and lick it so she's wearing a small vest on top. She seems super affectionate today but at the same time, her BG has been all yellows (even with the ear prick use of human meter). Can it be stress? Is there a better placement area that causes less irritation perhaps that anyone has tried?

Subcutaneous fluids and Freestyle Libre Sensor

Has anyone given subcutaneous fluids while having the sensor on? I have had a previous experience where the sensor stopped working after sub q fluids. Any suggestions? Shorshe still has high-ish liver enzymes and would benefit from sub q fluids on alternate days.



BG going down around the 11th hour

Shorshe's blood glucose sometimes goes down just before the insulin shot is due. Can there be any reason for this beyond double dipping? Is this something to worry about and adjust dose accordingly?

Injecting air into the Lantus vial (?)

I have been reading multiple guidelines about drawing insulin into the syringe which says to inject air equivalent to the number of units if insulin before drawing into the syringe to keep the pressure inside stable. Is this correct? Will this not contaminate the insulin?

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Original Post:

Hi All,
Shorshe is 12 yo. She was diagnosed with diabetes 1.5 years ago but I didn’t discover this forum until recently. She also has asthma and has had slightly elevated liver enzymes for years. But recently it has climbed up very very high. Shoutout to Bandit’s Mom for handholding through the pst 10 days and more and helping and supporting me every step of the way.

here’s her labs and BG sheet:
https://docs.google.com/spreadsheets/d/1YoDK-12qRmhPZxLLqIEbQuUKKIVbIn69-HtC6RxUn3w/edit?usp=sharing

she has previously been on freelibre system and alphatrak but now using contour plus to monitor.

my questions re the food:

What can i give her that’s good for her liver too? Currently i am force feeding her Big Little Paw’s tuna mousse and she will also have applaws tuna by herself and ocassionally the hill’s m/d dry. When she is feeling better she’s having the dry food. But because of the liver i think it’s been very up and down and the cause of the liver issues not getting diagnosed well in the city we live in.

also, given she is bouncing so much, and bouncing involves the liver, is the liver issues because of the repeated bounce? How can I minimise/mitigate the effects?

her weight is 5.2kg

currently her treatment is
50ml of ringers acetate fluid iv twice daily given over 1-1.5 hours
Samylin small breed tablets twice daily after food
Seroflo 125 inhaler with aerolat 1 puff twice daily


I am sorry if my post seems very brusque and disjointed. I am very anxious and have not slept much monitoring her BG. I would be grateful for some advice. She’s the sweetest most people friendly cat and I found her abandoned at 3 weeks when she could fit into the palm of my hand. Sorry if I made any mistakes in posting this.
 
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I can only see the reference range for a few of your blood values. I do see that the liver enzymes are quite elevated. I have given my cats Denamarin and had it help with elevated liver enzymes, but they weren’t quite as high as your baby’s. Are you getting help on another forum with your dosing?
 
What are her symptoms from the high liver enzymes besides no appetite ? Has your vet given you a diagnosis? There are several causes for liver disease I believe. Max had high ALT when he had pancreatitis flares but never more than double the high range. It would come down to high normal. My vet was not concerned. But your cat’s are higher and not just one enzyme.
 
You don’t have a signature. It needs particular information. Wendy gave you the link on the Cindi on the LLB forum. That and our spreadsheet will help us to help you. :bighug:
 
Just wondering why you are giving this?
Are you really giving it IV (intravenous) vice normal @home method of subQ (subcutaneous)?

She received IV until 4 days ago. Now on subq. 50 ml twice a day. Her ALP values have reduced a bit, AST value has reduced to within twice the normal range and albumin and globulin are also more normal.


What are her symptoms from the high liver enzymes besides no appetite ? Has your vet given you a diagnosis? There are several causes for liver disease I believe. Max had high ALT when he had pancreatitis flares but never more than double the high range. It would come down to high normal. My vet was not concerned. But your cat’s are higher and not just one enzyme.

She is intermittently not eating. She vomited this morning but that was probably because she was on antibiotics for the UTI. I skipped the last dose because she's not feeling well and the vet said it's unlikely to be UTI or a serious UTI if she is showing no symptoms or discomfort during peeing. And since the urine was a free catch instead of cystosentosis, it could also be contamination.

Currently receiving Samylin small breed tab once/twice a day. She weighs about 5 kilo but has lost weight. The vet initially felt it might be feline babesia infection but the tests came negative. Another vet I consulted in a bigger hospital in a different city said that we need to do her serum bile acids. But that test is not available in my city so I will have to send the blood after getting a lab to centrifuge it.

Also, she has a persistent ear infection. She received zymox otic (without steroid, green bottle) for 14 days. But it's not better. One of teh vets said to uise Posatex. But it has steroids and I am not sure if these antifungal med (posaconazole) is hepatotoxic. Should I wait for her liver values to come down within range to start treatment?
 
https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

This is our spreadsheet you need to use. Please take a look at other member's spreadsheets so you can see what it looks like.
It will also explain how to use it
Also please add the dosing method you are following to your signature and SS once you have the correct SS done
. If you are feeding any dry food you have to follow the SLGS method

Take a look at this members spreadsheet to see what it looks like
Mikan's SS

This is the spreadsheet you want
If you have trouble setting it up just ask we have a member here that would be happy to do it for you
@Madhura/Maddie
 
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I don't understand what is happening with her BG. PMPS was 56. I decided to recheck in teh next 2 mins and it was 149.. Then rechecked in 10 mins after feeding some and it was 234. So I gave a shot of 1.25 U. Now rechecked +1 and it's 80. Just fed her some high carb food. Her ear is painful and she's very reluctant to let me prick it. shoudl i just keep feeding her high carb food? Have also ordered a new meter that I will get tomorrow.
 
You still have not added our spreadsheet.

As for feeding when the bg is low at preshot, we suggest only lc and if over 50 no food as will food influenced bg and as you now are seeing once it wore off the bg drops back down. With a preshot, if you were going to attempt a shot and hc is fed, you don’t want to shoot for 2 hours without hc. Did you feed hc or regular food at preshot.?

Please start our spreadsheet asap. You will need to monitor this cycle as it looks to be active.
 
You still have not added our spreadsheet.

As for feeding when the bg is low at preshot, we suggest only lc and if over 50 no food as will food influenced bg and as you now are seeing once it wore off the bg drops back down. With a preshot, if you were going to attempt a shot and hc is fed, you don’t want to shoot for 2 hours without hc. Did you feed hc or regular food at preshot.?

Please start our spreadsheet asap. You will need to monitor this cycle as it looks to be active.
Hi Elise , she has our SS set up ,I see it. Bhooma did it
@tiffmaxee
 
I tried the SLGS and her BG was not coming down and she had ketones in her urine. So I increased the dose but sticking to the same dose for 3 days even seemed impossible given she was having hypo events or low-ish BG. reducing dosage by 0.5 and holding it for two days on te other hand meant that she was only getting yellows. Also, her food intake was very atypical in that I was syringe feeding her. Since yesterday she is very interested in eating the N&D dry food that Bhooma flagged as having relatively low in carbs (but still 16%) so she is now on dry food. I started her on 1.25 now. I was giving 1.6 on the basis it was more than 1.5 but less than the half way mark between 1.5 and 2. And the same re 1.4.

I was reducing dosage based on when she was going into greens because it usually meant if I didn't reduce the dosage she would likely have a hypo event. I am trying to reduce her bouncing. So it's something I was trying out and 1.6 seemed to work for a bit till yesterday when her AMPS was in the 40s. But now I am thinking the meter might be faulty. So I will check with the new meter and the Freestyle Libre continuous monitor (to be also put on her tomorrow). I actually asked about what kind of difference exists between Freestyle Libre BG values vs ear prick (in a separate thread) but didn't really hear back about it. She is not letting me prick her right ear because she had a recurring ear infection in that ear which seems better now (less exudate, less scratching) but she's still very sensitive. However that means the multiple pricks are on one ear and it's painful and irritated. Does anyone think it's okay to put on some heparin gel (thrombophob) on her ear?

Finally I am very very keen to find a low enough dose where she mostly stays in blues and doesn't go down to greens simply because as I mentioned, I need to get back to Bangkok. My parents cannot monitor her so closely. So it's important for me to find a dose she can stay at without causing hypo events or going back to over 200s. Also, I am worn out I am working full time and getting 3-4 hours of sleep per night since I need to monitor her at least for 5 hours after each dose.

I am a bit reluctant in skipping her dose because she had ketones in her urine not very long ago and suddenly lost like 10-15% of her bodyweight in the span of a month or so. Is it safe to skip when even the High carb induced highs go in the mid 200s or higher?
 
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With a dry food diet you want her 90-150 so following SLGS should work for you. The Libre is liked by many but reads lower than an ear prick in low numbers. I only checked Max’s BG using one ear and he never minded.

If too low to shoot, stall without food and retest in 20-30 minutes to see if going up. Of you find it going down give a small amount of regular food and see what happens. If still on the low side but over 100 you could give a token dose of 25% of the normal dose. A reduction would then be taken the next cycle.

Before you go away you would decide upon a vacation dose that would be lower than the current dose.
 
The reason it’s not good to skip is because of the ketones history. So you need a high enough dose so that it’s not needed. When you say she was hypo was she symptomatic or just low numbers. There’s a big difference.
no symptoms. When she went down to 37, she was sleeping but it is usually her sleep time. I woke her to check but she didn;t seem to perturbed. When she was 46, she ate quite fast.

she asked for food today but vomitted within minutes of eating and when I checked ger BG is 266 (+10 hours)
 
They usually do get very hungry in low numbers. Without symptoms it’s not a hypo event. If a symptomatic hypo there’s a chance they may react more strongly to insulin but not with low numbers.
 
Does anyone think it's okay to put on some heparin gel (thrombophob) on her ear?
@Madhura/Maddie
I have never heard of this

pure coconut oil
I have read that many members use pure coconut oil, I have copied this from one of the members posts
just make sure the only ingredient is coconut oil (mine is solid at room temp and I would take an itty bitty dab and rub on his ears)
It seemed to help with the healing
You might be able to get it at a health food store or just Google pure coconut oil
I would add to your signature ketone history ,so members are aware of it :cat:
 
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I read on one of your posts you mentioned
https://www.felinediabetes.com/FDMB...e-libre-continuous-glucose-monitoring.292677/

I am planning to take her to Thailand with me in October (though this is fraught with hurdles, chief among them lack of direct flights in an airline that will permit her to travel in the cabin with me).

Too bad you can't take her with you where you live :(
I read that you said
If I switch now (as I need to go back to work: I live in Bangkok, Thailand and my parents with Shorshein India)
 
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Freestyle libre reading seems much higher. But given her dosage was reduced (due to possibly faulty meter) it's probably not very surprising. I will try to simultaneously read with the new meter and libre. Just wanted to give her poor ear a break for a day.

Has anyone had any issues with SUB Q fluids after installing the libre sensor? I have had two instances when teh sensor stopped working within a day of giving fluids.

I also wanted to ask about stress and BG. When I do take Shorshe with me to Thailand, what can I do to minimize stress related BG elevation? I have three other cats there and I doubt they will recognise Shorshe (and vice versa) after nearly 9 years apart. If there is stress related elevation as she settles in, can I increase the dosage accordingly?

finally I will be in New York in September. I guess I need prescription to buy the 0.5 U marked insulin syringes there. Can anyone help me with this? Also, I have another cat (Kaju, stays with me in Bangkok) with chronic pancreatitis and idiopathic non-infectious enteritis. I was hoping to buy some "prescription diet" like blue buffalo single protein. However, Chewy won't let me buy it without a prescription. I have prescriptions from my Bangkok vet but I don't think this will work. Does anyone have any idea of how I can acquire both some syringes for Shorshe and some good quality food for Kaju?
 
No stay with this thread for now.

day.

Has anyone had any issues with SUB Q fluids after installing the libre sensor? I have had two instances when teh sensor stopped working within a day of giving fluids.
Did you put the SubQ fluids in near the libre sensor?

I don’t understand what you are saying about Thailand and New York. Are you saying you are taking Shorshe with you to those places? And are you going to stay there permanently?
 
No stay with this thread for now.


Did you put the SubQ fluids in near the libre sensor?

I don’t understand what you are saying about Thailand and New York. Are you saying you are taking Shorshe with you to those places? And are you going to stay there permanently?


I live in Thailand. My parents live in India with Shorshe. I came back to take care of Shorshe because her liver values suddenly became high and she wasn’t doing so well. Touchwood her liver values have improved.

I will return to Thailand soon, as I cannot stay here in India indefinitely.

I will be visiting New York for a work trip, in September for 15 days so I can order food/meds/syringes not available here (in India or thailand). Hence the request, to help in assistance in how to approach buting ceratin things not availbwithout prescription. For instance, cerenia or blue buffalo single protien food (for a different cat with suspected IBD and confirmed pancreatitis)

I am planning or considering taking Shorshe with me to Thailand. But this process takes time with arranging import and export permits. So the earliest I can take her would be October. And even this process is stressful as there’s only one carrier that allows cats in the cabin but doesn’t have a direct flight between my city and Bangkok.
 
I travelled with Neko into the US twice, once by car and once by plane. I went United cause their rules were the easiest for me to follow. All airlines had a max 15lb weight limit, thankfully Neko was just under. You can get pet carriers of the size needed to fit under the seat in front of you, Go with a soft sided carrier, it's more flexible. I sprayed Neko's carrier with Feliway - you can also get wipes that will work. I also gave her Rescue Remedy for pets before getting on the plane.

I had a harness (brand Kitty Holster) that is easy to get on and helped calm her down. You need to take the cat out of the carrier and carry to go through x-ray. I also had a tag or the harness made up saying she was diabetic and my phone number as well as her name.

Make sure to have all your paperwork needed by the state you are going to visit. It varies by state and can change over time so double check closer to the time of travel.

More general stuff on travelling with a diabetic cat in this post. I had all medications in a lunch box size cool pack - some of Neko's meds needed to be kept cool. Plus I had an unopened can of cat food in case I needed it. The letter from the vet should say what conditions being treated for and what are necessary medications, including syringes, so you could take that as carry on. If you carry cat litter with you, keep it in it's original bag. I didn't and got taken to secondary screening. :rolleyes: Yes, almost all my carry on was one cat and a back pack mostly filled with her stuff.
 
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I travelled with Neko into the US twice, once by car and once by plane. I went United cause their rules were the easiest for me to follow. All airlines had a max 15lb weight limit, thankfully Neko was just under. You can get pet carriers of the size needed to fit under the seat in front of you, Go with a soft sided carrier, it's more flexible. I sprayed Neko's carrier with Feliway - you can also get wipes that will work. I also gave her Rescue Remedy for pets before getting on the plane.

I had a harness (brand Kitty Holster) that is easy to get on and helped calm her down. You need to take the cat out of the carrier and carry to go through x-ray. I also had a tag or the harness made up saying she was diabetic and my phone number as well as her name.

Make sure to have all your paperwork needed by the state you are going to visit. It varies by state and can change over time so double check closer to the time of travel.

More general stuff on travelling with a cat in this post. I had all medications in a lunch box size cool pack - some of Neko's meds needed to be kept cool. Plus I had an unopened can of cat food in case I needed it. The letter from the vet should say what conditions being treated for and what are necessary medications, including syringes, so you could take that as carry on. If you carry cat litter with you, keep it in it's original bag. I didn't and got taken to secondary screening. :rolleyes: Yes, almost all my carry on was one cat and a back pack mostly filled with her stuff.
Hi wendy I am not in the US and beither is Shorshe. I have travelled between India and Thailand with cats but they were mych younger and went in the hold. If you read my post above you will see only one carrier allows cats in cabins bw India and Thailand which doesn’t have a direct flight bw my city and bangkok. Which means I have to travel donestically to Delhi (a 3 hours-ish flight). Stay there for 7 days. Get the export permit from Delhi dept of animal quarantine. And then fly from Delhi to Bangkok (4.5hours). Which is doable but quite stressful for a cat who has never flown in all 12 years of her life.
 
I know you are not in the US, but you talked about travelling to the US. I'm not in the US either. The document I linked on travelling with a cat, is about a diabetic.
 
I know you are not in the US, but you talked about travelling to the US. I'm not in the US either. The document I linked on travelling with a cat, is about a diabetic.

I am not travelling with Shorshe to US. I will be there in September for about 2 weeks for work meetings. Thanks for sharing the tips It's really useful. Shorshe tends to get car sick if she is in a cage even for very short rides within the city. So this is really helpful in terms of how to prepare.

I live in Thailand. My parents live in India with Shorshe. I came back to take care of Shorshe because her liver values suddenly became high and she wasn’t doing so well. Touchwood her liver values have improved.

I will return to Thailand soon, as I cannot stay here in India indefinitely.

I will be visiting New York for a work trip, in September for 15 days so I can order food/meds/syringes not available here (in India or thailand). Hence the request, to help in assistance in how to approach buting ceratin things not availbwithout prescription. For instance, cerenia or blue buffalo single protien food (for a different cat with suspected IBD and confirmed pancreatitis)

I am planning or considering taking Shorshe with me to Thailand. But this process takes time with arranging import and export permits. So the earliest I can take her would be October. And even this process is stressful as there’s only one carrier that allows cats in the cabin but doesn’t have a direct flight between my city and Bangkok.
 
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@tessa's mom I read your detailed post on Libre. Unfortunately, the ear prick and sensor are not matching or even close (and varying from one reading to next in terms how off it is). The libre sensor was installed on 3rd august evening (india time) and it has been about 36 hours.

I have started a comparison between the human meter (Contour Plus Elite) and libre sensor. it's the third sheet on Shorshe's spreadsheet (linked in signature) It will be of great help if you can take a look and advise.

The version I am using is probably an older version of the sensor that is commonly available in India and I scan using a device (libre reader). Unfortunately the phone app, while availble in App store in India is not available in Thailand so I cannot download it on my phone. I will try with my parents, if you think it's a better fit than the sensor.


Update: 4 August 2024

Free Style Libre vs Ear prick with Contour Plus Elite:


I am having issues with the freestyle libre sensor for continuous monitoring. The difference between the sensor and contour plus meter (via ear prick) is huge. The sensor barely shows her BG below 300. Where's now at +5.5 via the meter (contour plus) strips show it to be 213, the sensor reading is 304. At +2 it was 245 (contour plus) and 292 (libre sensor)

Has anyone faced similar issues?

Sensor placement and Stress: Effects on BG

The sensor has been placed on her flank with some tissue glue. She can reach and lick it so she's wearing a small vest on top. She seems super affectionate today but at the same time, her BG has been all yellows (even with the ear prick use of human meter). Can it be stress? Is there a better placement area that causes less irritation perhaps that anyone has tried?

Subcutaneous fluids and Freestyle Libre Sensor

Has anyone given subcutaneous fluids while having the sensor on? I have had a previous experience where the sensor stopped working after sub q fluids. Any suggestions? Shorshe still has high-ish liver enzymes and would benefit from sub q fluids on alternate days.



BG going down around the 11th hour

Shorshe's blood glucose sometimes goes down just before the insulin shot is due. Can there be any reason for this beyond double dipping? Is this something to worry about and adjust dose accordingly?

Injecting air into the Lantus vial (?)

I have been reading multiple guidelines about drawing insulin into the syringe which says to inject air equivalent to the number of units if insulin before drawing into the syringe to keep the pressure inside stable. Is this correct? Will this not contaminate the insulin?

---------------------------------------
 
@Bandit's Mom @Bron and Sheba (GA) @Wendy&Neko @Diane Tyler's Mom

PS Lows (greens)

I am not sure why her AMPS or PMPS is going so low (80 and lower)? this has only been happening in the past 3 days or so more consistently. Previously the PS numbers were at least in the 100s and the lower numbers came between +3 and +6. Any idea why this is happening? Should I give a small meal after the nadir, maybe at +6 to ensure this doesn't happen?

Vaccines for travel

Also, any thoughts about vaccinations? I need to get her vaccinated before she flies out of the country. She is already microchipped. We skipped her vaccines last year as all three cats in the household are indoors only and the other two received their vaccines. Shorshe has recieved the recommended amount of vaccine from 8 weeks of age (both rabies and combined panleuk, calici virus and herpes virus) until maybe the last year. Unfortunately, titer tests are not available in India except for rabies. And one of the conditions for issuing export certificate (india) and import certificate (thailand) are the vaccine certificates along with microchiopping.
 
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@tessa's mom I read your detailed post on Libre. Unfortunately, the ear prick and sensor are not matching or even close (and varying from one reading to next in terms how off it is). The libre sensor was installed on 3rd august evening (india time) and it has been about 36 hours.

I have started a comparison between the human meter (Contour Plus Elite) and libre sensor. it's the third sheet on Shorshe's spreadsheet (linked in signature) It will be of great help if you can take a look and advise.

The version I am using is probably an older version of the sensor that is commonly available in India and I scan using a device (libre reader). Unfortunately the phone app, while availble in App store in India is not available in Thailand so I cannot download it on my phone. I will try with my parents, if you think it's a better fit than the sensor.

The app and the reader should give the same numbers so no worries about it being different because of that. I think it's likely a bad Libre sensor, bad placement of the sensor (too close to ribs maybe?), or the needle of the sensor bent when it was installed. If you can get another one installed, I would do that. You could contact Abbott (company that makes the Libre) and tell them that it's way off and they should send you a replacement sensor. Just be careful to not tell them it's for your cat, if they ask tell them it's for your child. We all consider our cats our babies, right?
 
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