First, and most importantly....
Happy Birthday, Millie!!!!
Millie, I would guess that most of us here have felt exactly what you are feeling at some point in time. Remember, too, that the AT (as any meter which is calibrated for cat blood and is the most accurate way to hometest BG in cats) numbers are going to make his SS look worse than those of us that use human meters. In reality, it isn't any worse. It just looks that way. We all feel the stress of higher numbers. Even as long as we've been at this and know we aren't running the show here, high numbers (for Gracie) make me start scratching my head again. I have to chase away the "demons" (in my own mind) that want to pound me with questions like "why is she up there?" "what changed" "is it the insulin or did she decide the dose isn't good for her anymore" "is there an absorption issue". I just have to tell myself, and my demons, "let it go". If she needs more insulin, she does. It took a while, but we did get past every single conversation being about Gracie and letting her numbers control our moods. You will get there, too. While this group is great at helping you decide what to do about dosing, it is also the most amazing support group for when you are down.
mstyles said:
Marje, I agree with you. I feel like his patterns have been fairly consistent and I really don't think he got into blues and greens very often, if much at all, on nights I didn't test overnight. So what would the comparable BG be on an AT2 if it's 300 on a human meter? Probably 450ish?
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So this is where is it a "bit" of a challenge. As I indicated in yesterday's condo, the 2013 Roomp/Rand TR protocol refers human meters being 30-40% higher than the AT
in the low range. They don't really interpret "in the low range" but I'm thinking they potentially mean "in the normal range" as they also state in the document:
Alternatively, use the normal range for feline blood glucose concentrations as a target when using a meter calibrated for feline blood.
Normal feline BG on meter calibrated for feline blood being approximately 68-170 mg/dL.
To tell you the truth, I'm not sure what to advise you on percentage because it isn't spelled out for the higher ranges but what I will say is you should be consistent. So if you decide to use, for example, 35%, (e.g. the number on the human meter would be 35% higher if you were using the AT) then always use that percentage. There isn't a wrong or right answer because we don't have the data. Others may have different ideas, but it might be reasonable to use 35% because it isn't too aggressive or too conservative. Again...be open to other ideas because I'm just brainstorming and it isn't based on any data.
mstyles said:
Take a look at the nighttime readings I got last night. He stayed pretty flat overnight and was in the 400's this morning. When I checked him at lunch, he had jumped back to 533.
I am crying here.
Yes, he is pretty flat. Good job doing the tests last night!
mystyles said:
So if we fast track his dosing and go up every 4 cycles, would we go up .25 or .5 units? I can definitely get nighttime tests in. I will just set my alarm and my husband's alarm and between the two of us, one of us will get up and do the tests! So we've done 6 cycles at 3.5 as of this morning, so time to go up tonight? To 3.75 or to 4?
I agree with Sienne's idea that if you fast track and raise every four cycles, do it by 0.25u but if you decide to raise every six cycles, follow the TR protocol with respect to nadir and increases (e.g. nadirs over 300, increase by 0.5u; otherwise, increase by 0.25u when increase warranted). If you elect to fast track, as soon as he starts seeing what would be the equivalent nadirs below 300, then hold the dose six cycles and see what he does. For tonight, if you are going to fast track and hold for just four cycles, increase to 3.75u; if you are going to hold six cycles, increase to 4u.
mystyles said:
Is this the consensus among those of you that have been discussing Cooper?
It was the consensus that you could fast track if you could get a test or so at night. I'd try to conserve my sleep so if you got a before bed (if you are still up at +4, super; if not, do what you can) and perhaps a +10 or +11 (depending on when you normally get up), that could definitely help.
mystyles said:
This gives me great comfort that you guys are taking the time to look at my Cooper's case and try and help me. Thank you.
You're welcome. As you can see, you have a whole community of like-minded and caring people supporting you, your DH, and Cooper. The key is to ask questions....no matter what they are or how many.
And, BTW, although he wasn't diabetic, our kitty with CKD stayed stable for four years. It can be done and they can feel well, too. I don't think you are in a situation of diabetes vs CKD. Yes, having to find a lower carb, lower phosporus food can be a little more limiting but we have several members who have already done it and have lists of foods (Ann/Tess; Jill/Alex).
Just take it one step at a time and you'll start to see some progress!
