2/5 Noodle AMPS 186 NS, PMPS 342

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Patricia & Noodle

Patricia & Noodle

Member Since 2015
Last nights numbers (I finally mastered testing and got my first readings ever... then had to test all night):

1U Lantus @6:30 pm

+3.5 - 49 (~1oz LC, 1tsp gravy)
+4.5 - 52 (1tsp LC 1 tsp gravy)
+5 - 54 (1tsp LC 1 tsp gravy)
+5.5 - 61 (1tsp LC 1 tsp gravy)
+6 - 69 (2 tsp LC)
+6.5 - 81 (didn't eat)
+7 - 84 (1 tsp LC)
+8 - 74 (small bit of gravy)
+8.5 - 139 (no food)
+9 - 117 (~2 tsp LC and a little sleep)

http://www.felinediabetes.com/FDMB/threads/testing-advice-tested-low-3-5-49.132600/

So that brings me to this morning, I gave her the regular 2 mg dose of Cypro at 5. Tested at 6am (regular dosing time, last night was late because she threw up a hair tie that's maybe been there since 1.18!).

2/5 AMPS 186

I want to NS this because I'll be gone from about +2.5-11 with no chance to stop home to grab a test. Thoughts?
 
It'd always better to skip if you can't be around to monitor and you're uneasy. She'll probably be high tonight but she earned the reduction.
 
Suzanne & Cobb(GA) said:
It'd always better to skip if you can't be around to monitor and you're uneasy. She'll probably be high tonight but she earned the reduction.
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Thanks for the reassurance. I worry about ketones, but her bloodwork 1.26 didn't show any ketones or glucose in her urine despite two fur shots that weekend. I'll use my strips to be sure.

We have a vet visit tomorrow at 11 where we were going to talk about home testing... I'm glad I listened to my gut and got it figured out yesterday.

I know our vet would prefer I use an Alphatrak. I would get one if it meant she'd let me do curves at home (trying to avoid more mega vet bills as I pay off her hospital stay--she needs a job), but I'd rather the affordability of the Relion for day to day. I have @BJM 's glucose meter notes printed, are there any published studies that discuss human vs animal meters I can show her?
 
That is the source for most of the numbers, plus experience here, and the Merck Veterinary Manual for 1 estimate of the renal threshold.

You did great last night.
 
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BJM said:
That is the source for most of the numbers, plus experience here, and the Merck Veterinary Manual for 1 estimate of the renal threshold.

You did great last night.
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Thanks, it was very nerve wracking and from what I understand her numbers weren't *that* low, can't imagine if they were lower.

I don't know how to broach the topic with the vet that I'm testing, skipping, and adjusting doses the day before a visit. The hospital got Noodle through very dire circumstances and I trust them, but I also feel like the success with aggressive testing and the TR protocol can't be ignored. I just so happened to catch something in progress last night, but who knows if that's a normal reaction to insulin for her? She did vomit up a foreign object that could have been there for weeks, maybe she typically doesn't dip that low? Should I change her dose before I know that for sure?
 
Hi Patricia you did an awesome job last night. I will tell you been 5 years since I first had to test my boy Trey and I was so scared but with the help of these great people (Angels) as I call them he went into remission after only 2 months of insulin. He has a relapse last April had to go back on insulin (lantus) took 8 months but he is back in remission. I own it all to these angels at FDMB. As for the vets they have so much on their plates and do not study the diabetic thing with cats and dogs. Just yesterday my sister had to start her 9 year old cat on insulin and of course they use the old protocol .5 for each lb body weight I think that is the way it works out. Anyway 3 unites for him every 12 hours since I was her mentor since she just didn`t want to do any of it we went this way. .5 of a unit slow to start he went from 19 +4 he was 13 and Amps was 10 ....just telling you this because they know here. You are doing so awesome home testing is the way to remission......doing a curve is better at home because of the stress at the vets numbers will be higher. I guess you know FDMB is the only way to go in my books ...can`t give them enough praise. Tons of healing green light for a quick recovery and into remission for (Noodles) Oh another thing with our beautiful sugar babies they pick up on our moods so if we are stressed so will they be. Deep breath and be calm tell Noodles little poke treats and your done ...never make a big deal out of it. If you think you are going to hurt her she will feel it and be unsettled cause you are sending her that signal......surrounding you both with angels and calm blue light ...Hugsssssssssssssssss
 
Patricia & Noodle said:
Should I change her dose before I know that for sure?
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I personally believe you should give reductions when they earn them. No, Noodle's numbers weren't scary low, but they were low enough to earn the reduction.

Remember, you can always go back up in dose if Noodle's BG suggests you need to. You can't take the insulin out once you've injected it. Since you're new to this, I tend to err on the side of caution.

Also, one more thing I meant to mention earlier. You do not need your vet's permission to home test Noodle. If your vet insists you get an AlphaTrak, which really isn't necessary, you could get one and use it just for curves, and use the Relion for the day to day home testing. That would save you some money in those AT strips. BUT...you can't compare that curve to the home testing numbers. I mean, I think you can but the AT will run in higher numbers than the Relion -- just because it does. But while 50 is the cutoff for a human meter, the cutoff for an AT is higher (68, I think?).

Sounds like you did a great job last night -- and it showed you how important home testing really is!
 
Suzanne & Cobb(GA) said:
If your vet insists you get an AlphaTrak, which really isn't necessary, you could get one and use it just for curves, and use the Relion for the day to day home testing
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Personally, I would only get the AlphaTrak if the vet insisted AND was willing to pay for it and the strips. You've got far better things to spend money on.

Great job last night Patricia - I hope you got some sleep. You are not the first person here who has had a trial by fire with a low numbers on the first successful test.

And yes, do take the reduction to .75 U tonight. Our motto here is "safety first".
 
If your vet wants you to buy the AlphaTrak, just say "No thank you....at least not right now. I really can't afford it unless you are willing to provide me with the meter and strips" and leave it at that

The strips for that meter are on average, $1 EACH, so even if you only test 4 times/day, that's $120/month in just strips...The Relion Confirm or Micro (the better two meters at WalMart even though the Prime's strips are cheaper) would cost about $43 for the exact same 4 tests/day...that's 1/3rd the cost

And when you test more than 4 times a day, the savings using the human meters just gets more significant
 
I may be the odd person out but I am not a big fan of skipping shots with a cat that's recently been dealing with DKA. The recipe for ketones is not enough insulin, infection/inflammation, and not enough calories. I would sooner see you feed a higher carb food if you can't be home to monitor than to skip the shot. Ketones can dev
 
Sienne and Gabby said:
I may be the odd person out but I am not a big fan of skipping shots with a cat that's recently been dealing with DKA. The recipe for ketones is not enough insulin, infection/inflammation, and not enough calories. I would sooner see you feed a higher carb food if you can't be home to monitor than to skip the shot. Ketones can dev
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I worry about that, too, Sienne. She tested completely free of them at the vet last Monday even after several fur shots as I was learning to do her insulin. I try to grab a urine test whenever I can, too. We have a vet appt tomorrow at 11:30am.
 
You'll check her when you get home. Because you skipped this morning, you have the option of changing the shot time if you need to do so.
You do the best you can with what you know at the time you make a decision.
 
Home now and gave her Denamarin (liver supplement). We need to wait 30 min before eating and she is trying to convince me otherwise with purring and meowing and snuggles. I need to order an autofeeder ASAP so she can munch during the day, grazing isn't an option. She eats everything in front of her!
 
Hi Patricia & Noodle (cute name)! I'm a "new" oldie....my Gobbles went into remission 5/2013 (with the help of FDMB, patience and bravery!!!!) and decided the other day to sweeten up....thus, he is back on Lantus. Welcome :) It will be interesting to see what her next BG test reads....
 
How long have you been giving insulin Patricia?

It's going to be really important for you to get your numbers into our spreadsheet as soon as possible...If you're having trouble with it, let us know! We have several people who can get it started for you and then turn it over
 
She's been on 1U BID since 1.19

Will do the spreadsheet when my Internet is installed. Can't use my laptop until then. I'll try to get it with my phone as a hotspot tomorrow.
 
It's really hard to say without more data, but since you skipped this morning, I think I'd be ok to give her the 1 unit tonight and then reduce in the morning

Since you'll be feeding with the shot, she should be fine until you're home at +2 to +2.5

We really don't know how much of this high number is due to the skipped shot and how much is due to the low number yesterday, so it's possible it could still be a busy night for you
 
Annndd she just threw up again during dinner. Looks like a tiny hairball.... of my hair and a little plastic. On the phone with the vet now.
 
Spoke with the vet. I'm going to wait a bit on giving her more food and call again around 8. Says it's ok to skip again and try in the morning if I must. No ketones on the strips.
 
If your schedule is flexible enough to shoot late tomorrow morning, I think since you already know her PMPS without food, if you give her a little food every 20 minutes or so and she keeps it down, I'd go ahead and give her SOME insulin tonight...even if it's not the 1 unit
 
You may need to give a token dose of 0.25 to 0.5 units to keep the glucose from zooming up.
You can adjust your time a total of 30 minutes per day, either as 15 minutes per shot, or 30 minutes on 1 shot each day.
 
BJM said:
You may need to give a token dose of 0.25 to 0.5 units to keep the glucose from zooming up.
You can adjust your time a total of 30 minutes per day, either as 15 minutes per shot, or 30 minutes on 1 shot each day.
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For a dose like that, do I just give it when she's had enough food then dose as normal tomorrow? She's eating now, giving her little bits at a time. I think she's eating way too fast and has earned herself a reduction in Cypro.
 
Tomorrow I can shoot anytime, her vet appt is at 11:30am. +9 would be normal shot, 6am.

What works for tomorrow doesn't work for Saturday, though, I have to shoot by 7am Sat. 6am/6pm is really the best schedule for us, ultimately.
 
I think getting some insulin in tonight is better than skipping two cycles in a row. Especially with a history of ketones.

We have another trick we can use to help you get back onto schedule, if it'll work for you. And that's to shoot two back to back 18 hour shots, or 16/17 hours if that's what it takes to get you back onto schedule for Saturday.
 
See this is when I'd punt, go to the pharmacy and get some NPH (Novolin or Humulin) and give a token dose of that, then get back on schedule with Lantus the next day.
Except most pharmacies are closed by 9 pm.
 
BJM said:
See this is when I'd punt, go to the pharmacy and get some NPH (Novolin or Humulin) and give a token dose of that, then get back on schedule with Lantus the next day.
Except most pharmacies are closed by 9 pm.
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And I feel like I just don't have the experience to make that call myself. I don't even know what an NPH is!

I'll call the vet in a minute to see what they think.
 
It is an insulin which lasts about 6-8 hours in the cat and in the US, may be gotten over the counter by request.
It is not our standard protocol; it would, however, provide a short-term drop in glucose.
If you are ketone testing and they are negative, I wouldn't worry about it.
Your vet may say to shoot anyway; I'd be concerned due to the overlap issues..
 
I'm concerned about the overlap, too. Will that occur even with a small dose? I would think yes since the lantus has a 12 hr cycle, no matter how small the dose?

Earlier, they said that it wouldn't be the end of the world if I'm ketone testing and just decided to bail on tonight's shot, too. I just want to do the right thing for her!
 
That's why I suggested the 18 hour dosing as an option, although by now it might be more like 16 hours apart to get her back to her normal schedule. Unless kitty is really high, shooting more sooner than 11 hours apart is not a good idea, and only with consultation with some of the more senior members.
 
The vet just said it's ok to skip and get back on schedule tomorrow morning if that's the call I feel comfortable making. I have two negative ketone tests 3 hours apart, she's eating (though I'm making her eat slowwly), playing, putting, and chirping at me. Thoughts?

& yes, @Wendy&Neko , it would be two 16 hour cycles if I shot right now to get her back to 6am Saturday.

Also: Thanks for the help, again, everyone. I'm running on 2 hours of sleep, and a long work day, and it's catching up.
 
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