Cliff Notes, pt 1

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MiCo

MiCo

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new thread, switching to # system rather than dates b/c I was getting lazy abt creating new weekly threads.

Amps=276
A little bit of picky eating this am. Gonna keep an eye on that! Had to open a second can of something to get him to clean a plate. But in the end, he ate second offering heartily.
7units
 
+2.5 370
+4 443
+7.5 489

Blood ketones 0.2--which is very low/good (0.1 lowest next to "lo" reading)
 
Pmps=475
7 units

Just realized we may gave bought some hi carb sheba cans/pouches. We are still getting used to reading the sheba packages and I realized Cliff may have gotten 3 or fewer servings of this. :( oops. We caught our mistake and moved this food to the "in case of emergency" box.

Also, got our relion prime meter in the mail. Going to switch over soon. However, new meter didn't come w control solution. I called manufacturer and will get some in the mail in 10 days. Is there any other way to test new meter/strips without? Can i use my AplhaTrak control solution?
 
Welllll....I never used any control solution with the relion. To be honest, I didn't realize you were supposed to! I just used it straight out of the box.
 
Rachel said:
Welllll....I never used any control solution with the relion. To be honest, I didn't realize you were supposed to! I just used it straight out of the box.
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I'm sure that's fine and what most people do...:) I've just gotten in the habit of testing my strips w control. Also, user manual says to use... Which is why it confuses me that it's not included or available online!
 
MiCo said:
I'm sure that's fine and what most people do...:) I've just gotten in the habit of testing my strips w control. Also, user manual says to use... Which is why it confuses me that it's not included or available online!
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Some people poke themselves to see if the meter is working properly. You could Google what normal human BG is and see if the meter gives you a number in that range.
 
Normal for humans is roughly 50-120 mg/dL.
Per the Merck Veterinary Manual online:
"The normal fasting value for blood glucose in dogs and cats is 75–120 mg/dL."
and
"The renal threshold for glucose is ~180 mg/dL in dogs and ~280 mg/dL in cats." (the tilde means approximately), This the level at which glucose is excreted through the kidneys.
 
BJM said:
Normal for humans is roughly 50-120 mg/dL.
Per the Merck Veterinary Manual online:
"The normal fasting value for blood glucose in dogs and cats is 75–120 mg/dL."
and
"The renal threshold for glucose is ~180 mg/dL in dogs and ~280 mg/dL in cats." (the tilde means approximately), This the level at which glucose is excreted through the kidneys.
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Thank you, All! I will self test tomorrow w the new meter.
 
Doing a curve (w/AlphaTrak2) today:

Amps=299
fed
7u

+2 390
+4 433--fed snack
+6 468
+8 372--gave cerenia, fed lunch
+10 523
+11/PMPS 513

Need to email vet with a checkin, so I figured I would provide a curve-even though he's not really dipping much into a curve during day. He's staying High/flat.

Started cerenia again, since he was picky eating yesterday (at one meal only) but I'm being extra cautious.

Edited to add +10 & PMPS =513 ( shot early cuz he was so high)
 
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MiCo said:
Doing a curve (w/AlphaTrak2) today:

Amps=299
fed
7u

+2 390
+4 433--fed snack
+6 468
+8 372--gave cerenia, fed lunch
+10 tbd
+12/PMPS tbd

Need to email vet with a checkin, so I figured I would provide a curve-even though he's not really dipping much into a curve during day. He's staying High/flat.

Started cerenia again, since he was picky eating yesterday (at one meal only) but I'm being extra cautious.
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Those yellows that are starting to pop up are a good sign. :)
 
Kris & Teasel said:
Those yellows that are starting to pop up are a good sign. :)
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Thanks for the encouragement. He ended the day/curve in black, but in looking back at all his curves, he usually ends high. I think the day starts to stress him. :(

Shot early since he was black. Today was the easiest/most stress free curve for me. I guess it Does get easier!
 
Amps=413
7u
+3 399
+6 367

PMPS=404

Nice to see lower #s during cycle. Lower than ps #s, that is.
I truly believe the curve testing stressed him out yesterday, leading to blacks.

We will increase by 0.25 tomorrow am.
 
+3 at2=408; relion prime=321

Wow, this relion meter is gonna take some getting used to! Hoping to switch fully to relion tomorrow.

The vet wrote me back, and she wants me to test every hour for 4hrs after insulin for next curve to make sure we're not missing a low. (Somogyi) Otherwise, she says he might be reistant to Prozinc and suggests switching to glargine? I gotta admit, the idea of switching insulin makes me really nervous, I haven't even read much abt the other insulin options.
 
Glargine is Lantus, and it is very different. If you do switch, we will help you figure it out. Have you considered the tests for acro and IAA? I ask because if he has a high dose condition a switch to Levemir may be the better option.
 
Sharon14 said:
Glargine is Lantus, and it is very different. If you do switch, we will help you figure it out. Have you considered the tests for acro and IAA? I ask because if he has a high dose condition a switch to Levemir may be the better option.
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Thanks! I will ask the vet abt those tests.
 
I agree with Sharon that you might want to look into acro or IAA...Cliff's on a fairly high dose and he got there methodically.

I know switching to a new insulin is scary, but we have several who have done so, so if you do that, we can tag them to give you an intro into the L forum and to help you out.
 
As you know I'm one of those switchers, Michele, and I agonized over it for weeks and weeks. I'm calming down now that Teasel has completed his first week (back) on Lantus.

I'd really think about getting Cliff tested for acro or insulin antibodies. Many cats on here have those issues and they're not necessarily treated for them but the insulin is dosed around them. The doses are very high in some cases although they can come down with careful management. Generally, U100 insulin is used, though, because the volume of a U40 insulin you'd have to inject would be huge.

@MrWorfMen's Mom, Linda, has a lot of experience with this.
 
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Hi Michele. I had a look at Cliff's SS and I too would recommend getting the IGF-1 and IAA testing done. My girl has IAA only. With her, I often thought I was making progress with a dose increase on the day of or the day after only to have her numbers shoot back up to where they had been until we were up to 16u twice daily. Wendy & Neko coined the term "dose going stale". I never saw blue or green numbers at all.

You've been dosing methodically and Cliff does seem to be stuck but he's had some blue and green readings so not quite the same pattern I experienced. You might want to try increasing doses by 0.5units now because when you get to higher doses, an increase of 0.25u is a drop in the bucket and the trick is to get ahead of his numbers and then keep him there.

My vet was willing to test for Acro but tried to dissuade me from testing for IAA because it is thought to be so rare. I insisted and my vet was quite surprised when it came back positive. IAA seems to occur more often in Acro cats than on it's own.

The U100 insulins Levemir and Lantus not only require less volume per shot but also provide a longer duration with a "depot" of insulin which can help to keep the numbers down. Because Cliff is on a higher dose of ProZinc, I would recommend Levemir over Lantus if you do decide to switch so that you don't find yourself having to switch insulin again if Cliff's dose remains high.

Don't be surprised if your vet hasn't used Levemir or is totally unfamiliar with it. It is similar in action to Lantus and is dosed pretty much the same way. There are lots of folks here who can help you with it.
 
MrWorfMen's Mom said:
Hi Michele. I had a look at Cliff's SS and I too would recommend getting the IGF-1 and IAA testing done. My girl has IAA only. With her, I often thought I was making progress with a dose increase on the day of or the day after only to have her numbers shoot back up to where they had been until we were up to 16u twice daily. Wendy & Neko coined the term "dose going stale". I never saw blue or green numbers at all.

You've been dosing methodically and Cliff does seem to be stuck but he's had some blue and green readings so not quite the same pattern I experienced. You might want to try increasing doses by 0.5units now because when you get to higher doses, an increase of 0.25u is a drop in the bucket and the trick is to get ahead of his numbers and then keep him there.

My vet was willing to test for Acro but tried to dissuade me from testing for IAA because it is thought to be so rare. I insisted and my vet was quite surprised when it came back positive. IAA seems to occur more often in Acro cats than on it's own.

The U100 insulins Levemir and Lantus not only require less volume per shot but also provide a longer duration with a "depot" of insulin which can help to keep the numbers down. Because Cliff is on a higher dose of ProZinc, I would recommend Levemir over Lantus if you do decide to switch so that you don't find yourself having to switch insulin again if Cliff's dose remains high.

Don't be surprised if your vet hasn't used Levemir or is totally unfamiliar with it. It is similar in action to Lantus and is dosed pretty much the same way. There are lots of folks here who can help you with it.
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Thanks for weighing in, Linda.
 
MrWorfMen's Mom said:
You might want to try increasing doses by 0.5units now because when you get to higher doses, an increase of 0.25u is a drop in the bucket and the trick is to get ahead of his numbers and then keep him there.
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Linda, what is considered "a higher dose" where this would apply? Does it apply to all types of insulin?
 
Generally any dose over 6u is considered high although I've seen some vets suggest not testing for high dose conditions until they reach 8u. I've never seen a reference to any particular insulin so I believe it applies to all insulins. I've also seen 1u per pound of body weight as a reference so if kitty is large, they may need more insulin without being suspect for an underlying condition.

When kitty is on 1u of insulin we increase or decrease by 0.25u which is 25% of the dose. When they get to 5u of insulin an increase of 0.25u is only a 5% increase which is fine if you are finessing a good dose but not helpful in an unregulated kitty whose sitting in high numbers and not seeing much movement. The problem is that the longer they sit in high numbers, the more difficult it is to get them down so you need to be a bit more aggressive when dealing with the higher dose kitties. There are some cats on copious amounts of insulin so full unit or even larger increases are needed to get ahead of their numbers. There have been cats here on 50+units of insulin.

Pati, Morris is getting some good numbers mid cycle and you seem to be honing in on a good dose so if I were you, I'd probably stick with 0.25u increases even if you do hit 5u or just above so you don't miss his "ideal" dose.
 
MrWorfMen's Mom said:
Generally any dose over 6u is considered high although I've seen some vets suggest not testing for high dose conditions until they reach 8u. I've never seen a reference to any particular insulin so I believe it applies to all insulins. I've also seen 1u per pound of body weight as a reference so if kitty is large, they may need more insulin without being suspect for an underlying condition.

When kitty is on 1u of insulin we increase or decrease by 0.25u which is 25% of the dose. When they get to 5u of insulin an increase of 0.25u is only a 5% increase which is fine if you are finessing a good dose but not helpful in an unregulated kitty whose sitting in high numbers and not seeing much movement. The problem is that the longer they sit in high numbers, the more difficult it is to get them down so you need to be a bit more aggressive when dealing with the higher dose kitties. There are some cats on copious amounts of insulin so full unit or even larger increases are needed to get ahead of their numbers. There have been cats here on 50+units of insulin.

Pati, Morris is getting some good numbers mid cycle and you seem to be honing in on a good dose so if I were you, I'd probably stick with 0.25u increases even if you do hit 5u or just above so you don't miss his "ideal" dose.
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Thanks Linda. Yes Morris is doing great. Kris and Sue have been helping me. Thanks for looking at his spreadsheet. Ok to even if he gets to 5u. I was just curious. I read a lot on the forum to learn what I don't know. Thank you for your detailed reply!
 
PMPS=345
7.25u
+3.5 307
+6 233

*relion prime meter today. Need to update sig and SS. Rough day personally/chronic pain. Will try to update soon.
 
+8 184 --relion

So, I have always told Cliff, "wake me up if you need me."
He came clomping up the stairs just now, so I tested him--human meter in the blues!

Just realized, we will likely switch back the AT2 tomorrow, since vet asked for a mini curve. Sorry for the back and forth with meters!

Also, she mentioned in a follow up email that based on his weight, 8u was the dose at which she would consider him Prozinc resistant. Is it possible he could break thru at 7.25? I hope so!
 
+11=110 relion | 147 AT2

What an interesting development! I meant to get a +9 or 10 in, but didn't set an alarm and fell asleep.

We will see where he is at +12, but I anticipate having to stall, or maybe even feed and stall. Luckily, husband will be home today to test more, if needed. I may back down to 7u too. We will see where he is in an hour.
 
+12 163 using AT2. Gonna use at2 moving forward, for today.

Going to stall 20min and see where we are.
 
Stalled 20min and he's lower on at2--tested twice. 147 and 150.

Ugh. What to do? I think I'm gonna feed and then test bg in 2hrs.
 
@StephG if you are around, can you help? I know you have a higher dose kittie. Not sure what to think of this too low ps.
 
Ok, fed the cats because they've been waiting /begging for 1.5hrs. I will wait 2hrs and test bg again.

Question though--once i get a shootable bg (in 2hrs) does he need to eat again before i would shoot? Never used this feed then test in 2hrs method before.
 
MiCo said:
Ok, fed the cats because they've been waiting /begging for 1.5hrs. I will wait 2hrs and test bg again.

Question though--once i get a shootable bg (in 2hrs) does he need to eat again before i would shoot? Never used this feed then test in 2hrs method before.
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When I feed and wait 2 hours I usually give a lower dose. Not by much but I lower it because chuck won't get the "food spike" after eating. I don't feed him again besides his usual snack.
 
Ok, I was thinking lower dose. He got 7.25 yesterday, so I was thinking 6.75 or 6.5. Is that abt how much you would decrease? And you don't feed again before shot in two hrs (assuming shoot able BG, ok, thanks!)
 
Today might not be the best day to do a curve but just make sure you note that he was fed and injected 2 hours after.
Dose reduction will depend on his BG reading at 2 hours after his meal.
With Chuck I reduced his dose by 0.4 because he was in the 500s. (He didn't really respond like I expect but he never does!) If he was lower I would have reduced more.
If you're going to be able to monitor 6.75 might be a good dose if his BG is near his usual preshot reading. Looking at his SS (the last 3 days on 7 units) if he's over 300 7 units might be OK too.
If anyone has better suggestions before she gives dose, please jump in!
 
He's 364 on the alphatrak 2hrs after getting fed. I'm thinking 6.75 because husband will be here today, not me.
 
Ok, thanks for the help! Shot is in, & hubs should be able to test at +3. I will be home at +5.5 to test/feed. Hubs can test again in afternoon, if needed.

This put us off schedule by abt 3hrs, but I'll make it work for next couple days until the weekend.
 
Exciting, Michele! I'm glad that Steph, the dosing under weird circumstances guru, was here to help. I had success with Teasel using the feed, retest, then shoot a slightly lower dose method. It's a good tool when stalling a long time isn't workable. As for your three hours off schedule, I think you can shift back in 1 hour increments with Prozinc.

I sure hope you're breaking through his resistance. It's scary but good. :)
 
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Yeah--I did feed him before I left the house at 8AM, which was +1 from insulin, but had been 3 hours since they ate--my guys are serious grazers. (I think I did a test before feeding at +1, but I forgot to put in SS. Will do that when I get home.)

BUT, I expected a little bounce from last night's BLUES! Just gotta see what the next couple of days bring us. I ended up ordering a new bottle of ProZinc today, because this current one is not going to last much longer with doses up around 6u and 7u. If we end up switching insulin, this might end up being an extra nearly full bottle, but he was going to run out before we made any decisions, so I had to order!
 
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