? 8/4 - Milo AMPS 263, +2 218, +4 180, +6 108, +7 84, +8 109, +11 109 - Using AT Meter

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Danielle & Milo

Danielle & Milo

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I everyone! I posted a few days ago about my newly diabetic kitty Milo. It has been a very long few days and I am completely stressed, overwhelmed and feel helpless at this point.

Here are the important details for Milo, before I begin recapping the past few days.

Milo is 2 years old, diagnosed in June 2015. His last vet trip he had ketones as TRACE still in his urine. I recently took him OFF the Hills Prescription Dry Food m/d. He know eats Fancy Feast Classics Pate with Pure Bites Chicken Dog Treats sprinkled on top. He is on Lantus (One unit, twice daily). His dosages have changed at least 4 times in the past 2 weeks. He was originally on one unit, once daily. Then was on 2 units once daily. Then 2 units in the morning and one unit at night. Now he has been on 1 unit, twice daily. Tomorrow will be his 3rd day on this dosage of one unit, twice daily. I shoot him at 7:30am and 7:30pm. I use the Alpha Trak testing meter.

Here is a recap of the past few days:

Friday, July 31st

-BG test reading: 509 at 7:30am - Gave 2 units of insulin
-BG test reading: 360 at 11:15am
-BG test reading: 266 at 7:22pm - Gave 1 unit of insulin
-BG test reading: 177 at 10:13pm

Saturday, August 1st

-BG test reading: 134 (His lowest number since on insulin) at 7:15am - SKIPPED INSULIN DOSE!!!!!!!
-BG test reading: 342 at 12:30pm
-BG test reading: 427 at 7:20pm - Gave 1 unit of insulin
-BG test reading: 291 at 12:00am

Sunday, August 2nd

-BG test reading: 394 at 7:15am - Gave 1 unit of insulin
-BG test reading: 224 at 12:30pm
-BG test reading: 636 at 7:15pm (His HIGHEST number he has ever been since diagnosed)
-BG test reading to determine if false reading: 641 at 7:20pm - Gave 1 unit of insulin

***I think his numbers could be high today because we were dog sitting and he HATES dogs and never again will we be dog sitting. So Milo was crouching around all day from smelling the dog but he has been acting like himself other than that!

***Milo has also been throwing up. He threw up this past Friday and then tonight he threw up right after eating (He tends to eat too fast too)

***I will be testing again at +2 (9:30pm)


At this point I do not know what to do anymore and any advice about Lantus would be greatly appreciated. I really thought Milo was taking a good turn and then he got into the 600s and I do not understand why.

My vet originally told me to do 2 units twice daily but I thought that was too much for him.

HELP!!!!!!!!!!!!!!!!

I am beyond depressed being new to all of this, the cost of all of this and emotionally drained with not know what do to anymore for him. I am not ready to lose my baby and will do whatever it takes to get him regulated. My husband and I are suppose to go on vacation in 2 weeks but if we cannot get him regulated that will not be happening.

I am DESPERATE for help!!!!!!!!!!!!!!!!!!!!!
 
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Looks like Milo is bouncing Danielle, which is frustrating, but a normal part of the sugardance. We don't have any way of knowing how long Milo was diabetic before he was diagnosed, so his body may have become used to living at higher numbers, so when he dropped to 134 yesterday, his liver reacted by releasing stored sugars and hormones to bring him back up fast. He ALSO didn't get a shot yesterday morning, so he basically has to "start over" at filling his depot. He'll need to be kept on the same 1 unit dose at least 6 cycles (unless he drops below 68) before we'll REALLY know how well the 1U dose is working.

Bounces happen for any (or all) of these reasons
1. going too low (like under 68 on the AlphaTrak)
2. dropping quickly...over 50 points an hour is a very fast drop
3. dropping lower than their body has gotten used to living at

As they get into "normal" numbers more and more, the bouncing usually settles down, but some kitties bounce all the way to OTJ (Off The Juice) What's important is learning to identify when they're bouncing, and just holding the course.

As soon as you get your spreadsheet up and running, it'll really help to start to see it and we'll be able to help you learn what it's telling you
 
Thank you for all of that information! So starting today at the one unit twice daily dose (since today was the first day of that) I need to do 5 more days of the same dose even though I skipped we have to start over? I take him back to the vet on Thursday and I know I will be in trouble since I did not do what the vet said.
 
Since you've been giving insulin for a couple of weeks, you only need to hold the dose for 6 cycles (Unless he drops below 68) IF you decide to do Tight Regulation.

TR gives the best chance at remission, but isn't for everyone. It is important to get at least 4 tests in per day though....before shooting (the Pre-shot) and one mid-cycle during the AM cycle and at least a "before bed" test at night. Most cats go lower at night, so if the "before bed" test indicates it's important, you may have to set an alarm to get more tests in later in the night.

The SLGS method is a little different....You'd decrease the dose if he dropped below about 120 (since you're using the AT). Dose adjustments are only made once a week, but it's important to still always get the Pre-shot numbers (and any others you can get...if you work and can't test during the day, the night tests are even more important) and at least once a week to do a curve (every 2 hours for 12 hours or every 3 hours for 18 hours)

Lantus dosing is based on how LOW it takes them, so we're always watching for that
 
Chris & China said:
Since you've been giving insulin for a couple of weeks, you only need to hold the dose for 6 cycles (Unless he drops below 68) IF you decide to do Tight Regulation.

TR gives the best chance at remission, but isn't for everyone. It is important to get at least 4 tests in per day though....before shooting (the Pre-shot) and one mid-cycle during the AM cycle and at least a "before bed" test at night. Most cats go lower at night, so if the "before bed" test indicates it's important, you may have to set an alarm to get more tests in later in the night.

The SLGS method is a little different....You'd decrease the dose if he dropped below about 120 (since you're using the AT). Dose adjustments are only made once a week, but it's important to still always get the Pre-shot numbers (and any others you can get...if you work and can't test during the day, the night tests are even more important) and at least once a week to do a curve (every 2 hours for 12 hours or every 3 hours for 18 hours)

Lantus dosing is based on how LOW it takes them, so we're always watching for that
Click to expand...
 
Chris - So how do I know when to skip a dose, at what number on the Alpha Trak? I skipped yesterday morning at 134, should I have shot him 1 unit of Lantus?

Is it okay to prick his ears this much?
 
Danielle Giannakis said:
Is it okay to prick his ears this much?
Click to expand...
It is, yes. A lot of us go through times where we're testing more than that again, especially on days when our cats might drop low. I tested anything up to 18-20 times a day some days and Rosa had no ill effects from it - and her ears aren't at all damaged.

As regards your question about skipping the dose - personally, I'd have skipped too on a 134 as it's the first time he's given you a low pre-shot. For me that would have been too low for comfort this early in the sugar dance with him, but I'd be interested to see if others agree. :)
 
As far as the high numbers, if you were indeed pet sitting a dog, stress could do it. My kitties readings were in high 500s and 600s at the vets. Tests at my house have all be mid-300s or lower. I will be doing a glucose curve with her on Friday when I'm off from work. She's on 1 unit 2x/day of insulin - vet lowered this from 2 units as her readings dropped significantly while at the vet - higher numbers were immediately after arrival (stressful car ride, vet took her to an exam room without me, did a different blood test) she then had a 375 later in the exam room with me after she'd relaxed some, so vet talked with others and lowered the dosage. She also recommended that I do the glucose curve as it would be more accurate at home (unstressed) than if I left her at the vets all day (stressed - higher readings).

I've also seen that if you have a dry food addict and are transitioning to wet food throwing up the new wet food is pretty common and will lessen. I've experienced the wet food throw ups and we're working on transitioning to all wet food.

Hints I've seen to help with ear pricks (and they work): 1) baby sock filled with uncooked rice warmed in microwave for 15 seconds (test heat on your arm first) held against ear to help with blood flow and 2) vaseline - a thin strip on the ear will help blood to bead up instead of spread into fur - huge help!
 
***UPDATE****

Milo has gone up from his last night test to 383 PS. I gave him one unit of insulin and unfortunately got some on his fur so I am not even confident as to how much I got in him. Then I fed him Fancy Feast and he threw up immediately after. I have not seen him drink water either.

I just do not know what to do anymore. I am beyond upset at this point.
 
I totally understand, I'm going through the same with Bojangles. She is a grazer and eats throughout the night which I think (but can't guarantee) can make numbers higher in the morning. We get up at 6am and she very well may have eaten just previous to our ear prick. I know that affects humans if you eat shortly before a blood glucose test and would guess it is the same for cats - maybe someone else can weigh in on this??

This weekend Bojangles had 3 dishes of wet food, plus some of the dry out all at once as I was panicked about how little she ate. I've found if I leave her alone for a while, but occasionally bring wet food to her, she'll eat a few bites. I also have multiple water sources - bowls, water fountains, large "free flow" water storage holders (1/2 gallon tank) so that helps her to drink more too.

I'd suggest leaving a couple of different flavored food options out. Bojangles definitely prefers fish or liver flavors to chicken. It does sound as though it can take a while to transition from dry to wet (not eating as much as well as the wet food throw ups), so I'm trying to reassure myself that she'll eat when she gets hungry. This has been a very costly transition for us $400 in vet visits, $200+ in diabetic supplies, and about another $100 in food just in the last week alone. Thankfully Fancy Feast was just on sale, so I stocked up to supplement the very costly DM. Read Dr. Lisa's information (some posted here, but she does have another website you can find if you search by Feline Diabetes - http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf) she has a lot of information on diets, transitioning to the canned food diet.

It is hard not to panic and over think things. I don't have human babies, so my furry children are all I have....I'm just maitaining my sanity right now.
 
Danielle Giannakis said:
I just do not know what to do anymore. I am beyond upset at this point.
Click to expand...

Will it help to know we were all overwhelmed at first? The more information you absorb and more confident you begin to feel, the easier this will all seem. You are already doing the most important things for your sweet Milo: hometesting to keep him safe (so glad you didn't shoot the low pre shot number), change to wet low carb and a good insulin.

Someone smart once said this sugar dance is a marathon, not a sprint. He didn't become diabetic in a week; you can't fix it in a week. You know the insulin works because he has had good numbers; it is just a matter of learning how to work with it.

You might post on the Lantus forum and get daily advice on your doses. Everyone there has experience with Lantus and can offer advice and encouragement. Tell them you are using the Start Low, Go Slow protocol (it seems like that is what you have decided on?) and give them his latest numbers. The forum is here

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

Be sure to read the stickies at the top of the page - they are full of great info.

Can I set up a spreadsheet for you? It is a great color coded tool that lets you share Milo's history of doses/levels with your vet and with people here, when you need dosing advice. It is something the Lantus forum will want you to have. If you want me to do that, just click on my picture and send me a note in a private conversation (as I'd need an email and you don't want to post that in the forum)

Some one early on told me to remember to breathe and it proved to be good advice. Also, you might get a smile out of this letter from a diabetic kitty:

http://www.felinediabetes.com/FDMB/threads/letter-from-your-kitty-to-you-during-this-time.131186/
 
It helps to repeat this mantra:

My little one needs me. It will get better. It will get easier. I can do this.

This sugar dance can sometimes be a case of 'fake it till ya make it'. ;)

:bighug:


Mogs
.
 
Sue and Oliver (GA) said:
Will it help to know we were all overwhelmed at first? The more information you absorb and more confident you begin to feel, the easier this will all seem. You are already doing the most important things for your sweet Milo: hometesting to keep him safe (so glad you didn't shoot the low pre shot number), change to wet low carb and a good insulin.

Someone smart once said this sugar dance is a marathon, not a sprint. He didn't become diabetic in a week; you can't fix it in a week. You know the insulin works because he has had good numbers; it is just a matter of learning how to work with it.

You might post on the Lantus forum and get daily advice on your doses. Everyone there has experience with Lantus and can offer advice and encouragement. Tell them you are using the Start Low, Go Slow protocol (it seems like that is what you have decided on?) and give them his latest numbers. The forum is here

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

Be sure to read the stickies at the top of the page - they are full of great info.

Can I set up a spreadsheet for you? It is a great color coded tool that lets you share Milo's history of doses/levels with your vet and with people here, when you need dosing advice. It is something the Lantus forum will want you to have. If you want me to do that, just click on my picture and send me a note in a private conversation (as I'd need an email and you don't want to post that in the forum)

Some one early on told me to remember to breathe and it proved to be good advice. Also, you might get a smile out of this letter from a diabetic kitty:

http://www.felinediabetes.com/FDMB/threads/letter-from-your-kitty-to-you-during-this-time.131186/
Click to expand...


Thank you so much! Your information and that sweet letter from a diabetic kitty helped me out so much!!! :)
 
Bojangles' Mom said:
I totally understand, I'm going through the same with Bojangles. She is a grazer and eats throughout the night which I think (but can't guarantee) can make numbers higher in the morning. We get up at 6am and she very well may have eaten just previous to our ear prick. I know that affects humans if you eat shortly before a blood glucose test and would guess it is the same for cats - maybe someone else can weigh in on this??

This weekend Bojangles had 3 dishes of wet food, plus some of the dry out all at once as I was panicked about how little she ate. I've found if I leave her alone for a while, but occasionally bring wet food to her, she'll eat a few bites. I also have multiple water sources - bowls, water fountains, large "free flow" water storage holders (1/2 gallon tank) so that helps her to drink more too.

I'd suggest leaving a couple of different flavored food options out. Bojangles definitely prefers fish or liver flavors to chicken. It does sound as though it can take a while to transition from dry to wet (not eating as much as well as the wet food throw ups), so I'm trying to reassure myself that she'll eat when she gets hungry. This has been a very costly transition for us $400 in vet visits, $200+ in diabetic supplies, and about another $100 in food just in the last week alone. Thankfully Fancy Feast was just on sale, so I stocked up to supplement the very costly DM. Read Dr. Lisa's information (some posted here, but she does have another website you can find if you search by Feline Diabetes - http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf) she has a lot of information on diets, transitioning to the canned food diet.

It is hard not to panic and over think things. I don't have human babies, so my furry children are all I have....I'm just maitaining my sanity right now.
Click to expand...


Thank you! It is good to know that I am not alone but sorry that you are having a hard time as well. I have lots of water out and about and I leave their wet food out for awhile they like to come and go and eat. I have two kitties and no children so they are my children!
 
Danielle Giannakis said:
***UPDATE****

Milo has gone up from his last night test to 383 PS. I gave him one unit of insulin and unfortunately got some on his fur so I am not even confident as to how much I got in him. Then I fed him Fancy Feast and he threw up immediately after. I have not seen him drink water either.
I just do not know what to do anymore. I am beyond upset at this point.
(& 52 min. ag0: I tested Milo at +3 and he was 414
Click to expand...
Hi, Danielle - Did you try giving him a little more food after he vomited, say 15 min. or so later? Did you feed before you shot? As the way you wrote it above, looks like you shot, then fed.

Sequence should always be:
Test/ feed/ shoot. (If pre-shot # is high enough to shoot, that is!)
If 1st pre-shot # is not high enough: Wait 15 min & test again (often it rises). Then if high enough, do the above. (You may have to do multiple tests ...)

I sometimes had to do 3 to 4 pre-shot BG tests before Bat-Bat's BG would rise high enough to shoot. Sometimes it just didn't. After an hour of repeated tests without ample BG rise, I would have to skip the dose. (Temporarily too high is generally safer than too low!)

Regarding the vomiting of a meal: Does Milo tend to eat too fast? A few tricks to help avoid "scarf & barf" ---
1) Add a little water to his meal (slows him down.)
2) Elevate his feeding dish. I put Bat-Bat's plate on top of a shoebox - the perfect height for her! (Helps when they are not eating nose-to-floor.)
3) When he's halfway through his meal, pick up the plate & let him take a 5-minute "food rest." Then let him finish.

Don't worry, all of this will get easier & less stressful to you over time. You're doing fine! :bighug:- Robin
 
Robin&BB said:
Hi, Danielle - Did you try giving him a little more food after he vomited, say 15 min. or so later? Did you feed before you shot? As the way you wrote it above, looks like you shot, then fed.

Sequence should always be:
Test/ feed/ shoot. (If pre-shot # is high enough to shoot, that is!)
If 1st pre-shot # is not high enough: Wait 15 min & test again (often it rises). Then if high enough, do the above. (You may have to do multiple tests ...)

I sometimes had to do 3 to 4 pre-shot BG tests before Bat-Bat's BG would rise high enough to shoot. Sometimes it just didn't. After an hour of repeated tests without ample BG rise, I would have to skip the dose. (Temporarily too high is generally safer than too low!)

Regarding the vomiting of a meal: Does Milo tend to eat too fast? A few tricks to help avoid "scarf & barf" ---
1) Add a little water to his meal (slows him down.)
2) Elevate his feeding dish. I put Bat-Bat's plate on top of a shoebox - the perfect height for her! (Helps when they are not eating nose-to-floor.)
3) When he's halfway through his meal, pick up the plate & let him take a 5-minute "food rest." Then let him finish.

Don't worry, all of this will get easier & less stressful to you over time. You're doing fine! :bighug:- Robin
Click to expand...


Hi, I gave him more food after he threw up and he kept it down. I shot while he was eating, not before he ate. He doesn't always eat before the shot and I was told that we don't want him to eat 2 hours before we shoot. He tends to be too high than low and now he is high. His last BG was 414 and that was at +3. I add water to his dish already, he does eat fast! I will have to try the elevation!

I hope this gets better :( I am trying to stay calm I know that is most important too! Thank you for your tips!
 
Danielle Giannakis said:
Hi, I gave him more food after he threw up and he kept it down. I shot while he was eating, not before he ate. He doesn't always eat before the shot and I was told that we don't want him to eat 2 hours before we shoot. He tends to be too high than low and now he is high. His last BG was 414 and that was at +3. I add water to his dish already, he does eat fast! I will have to try the elevation!

I hope this gets better :( I am trying to stay calm I know that is most important too! Thank you for your tips!
Click to expand...
It's totally fine for you to shoot while he is still eating.

Re: "He doesn't always eat before the shot and I was told that we don't want him to eat 2 hours before we shoot." After you check his AMPS/PMPS blood glucose, he NEEDS to eat right before you administer insulin. Not after you shoot it; before. What you'd heard about not eating two hrs. before administering insulin means that you do not want him eating in the two-hour window before you check his glucose at AMPS or PMPS, as having food in his stomach then will give you a a food-elevated blood glucose reading - which could result in you administering insulin when you should not.

You want to test his pre-shot glucose level when he has an empty tummy, but you do not want to shoot insulin on an empty tummy.
So always have him eat before a shot of insulin. (Again, injecting him while he's eating that meal is ok, too.) Have I clarified this for you?
 
Robin&BB said:
It's totally fine for you to shoot while he is still eating.

Re: "He doesn't always eat before the shot and I was told that we don't want him to eat 2 hours before we shoot." After you check his AMPS/PMPS blood glucose, he NEEDS to eat right before you administer insulin. Not after you shoot it; before. What you'd heard about not eating two hrs. before administering insulin means that you do not want him eating in the two-hour window before you check his glucose at AMPS or PMPS, as having food in his stomach then will give you a a food-elevated blood glucose reading - which could result in you administering insulin when you should not.

You want to test his pre-shot glucose level when he has an empty tummy, but you do not want to shoot insulin on an empty tummy.
So always have him eat before a shot of insulin. (Again, injecting him while he's eating that meal is ok, too.) Have I clarified this for you?
Click to expand...


yes this makes sense :) So much info to remember :(
 
If your schedule permits it, try giving Milo his preshot meal in two servings with, say, a 5-10 minute pause between to let his food go down better. That's what I'd try.

.
 
Critter Mom said:
If your schedule permits it, try giving Milo his preshot meal in two servings with, say, a 5-10 minute pause between to let his food go down better. That's what I'd try.

.
Click to expand...


I can work from home this week to give Milo my full attention. So at 7:00pm I will test, fed in 2 feedings, and shoot at 7:30pm?
 
Danielle Giannakis said:
I was not able to pull up the Glucometer Notes.
Click to expand...
I just checked the link using my smart phone (Android-based) and was able to open it in a new window. Let's see if we can figure out why you can't.
What device are you using?
PC
Macintosh
IPhone
Smart phone
 
That's great news, Danielle. It will definitely do a lot for your peace of mind.

Are you working on a spreadsheet for Milo yet?


EDITED TO ADD:

Cross-posted! Glad to hear you're working on Milo's spreadsheet.

In the meantime, after you've taken Milo's evening preshot BG test, pop a note up here with the test result while he's eating his dinner. Might reassure you a little to have someone keeping an eye out in case you have any questions at that time.


Mogs
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Critter Mom said:
That's great news, Danielle. It will definitely do a lot for your peace of mind.

Are you working on a spreadsheet for Milo yet?


EDITED TO ADD:

Cross-posted! Glad to hear you're working on Milo's spreadsheet.

In the meantime, after you've taken Milo's evening preshot BG test, pop a note up here with the test result while he's eating his dinner. Might reassure you a little to have someone keeping an eye out in case you have any questions at that time.


Mogs
.
Click to expand...


Thank you! I will be doing the spreadsheet tonight if I can figure it out I promise!!!!! I am really hoping someone can help me through this because I am not in a good place with this mentally. I am doing all that I can and I feel like it is no good enough. I am not a negative person but this is turning me into a nightmare! :(

I will be taking Milo's pre-shot at 7:15pm CST time tonight and then will feed him Fancy Feast Turkey and Giblets Classics and should I post a new thread with his PS BG test or just post to this thread?
 
My other problem is when I give him insulin sometimes he moves on me and then I miss and it gets on his fur and then other times I feel like I am not getting it into his fat like this morning he got insulin on him and i am not even sure how much insulin I got in him and correctly :(
 
Danielle Giannakis said:
I am really hoping someone can help me through this because I am not in a good place with this mentally. I am doing all that I can and I feel like it is no good enough.
Click to expand...

I was in exactly the same state this time last year, Danielle. Saoirse spent several days sprawled and unmoving on the floor. I was terrified. The FDMB community got me through it. They'll get you through it, too.

You are NOT alone with this, OK? :bighug:


Mogs
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Critter Mom said:
I was in exactly the same state this time last year, Danielle. Saoirse spent several days sprawled and unmoving on the floor. I was terrified. The FDMB community got me through it. They'll get you through it, too.

You are NOT alone with this, OK? :bighug:


Mogs
.
Click to expand...


Thank you so much, I appreciate you and everyone else who can get myself and Milo through this. Hoping his 1:20 numbers aren't in the 500s or higher. He has been sleeping the past 2 hours and ate about 3 hours ago
 
Danielle Giannakis said:
Thank you so much, I appreciate you and everyone else who can get myself and Milo through this. Hoping his 1:20 numbers aren't in the 500s or higher. He has been sleeping the past 2 hours and ate about 3 hours ago
Click to expand...

OK. To recap, you're going to do Milo's preshot test at 19:15 CST.

You need to make sure he doesn't eat after 17:15 (so that PM preshot test - PMPS - is not influenced by food. (NB - if Milo shows any signs of distress as described in the How to Treat Hypos guide, follow that instead. Unlikely, but for safety I always like to cover the bases.)


What is your local time right now?

.
 
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