Wow, that 95 is great! And good decision to skip the shot!!! Can’t wait to see where she is tonight!
No matter how high her BG is tonight, still only give one unit. If she is below 150, don't give anything. If she's between 150-200, could you eyeball 0.5u?
The spreadsheet can be used regardless of if you gave a shot or not, so go ahead and fill in the numbers you just got. Here is a video for how to link it to your signature so we can all see it too:
And then also make sure you click the blue "share" button in the top right corner of the spreadsheet so we can see it, and then choose "anyone with the link can view" You don't want to let us be able to edit!
At this point I would hold off until the normal shot time in the morning. Is she still eating the dry food? If so, that may have triggered the spike. If not, then it might just be one of those things. How many more hours before bed for you?
Cost aside, the curve numbers are likely to be vet stress inflated. They might then recommend a dose increase when it's not needed. That's why we're proponents of doing curves at home.Do any of you see any real harm with us doing that, besides it costing us money.
I would absolutely positively not give her more than 1 unit.She dove early in the cycle, and stayed low for an entire extra cycle after that 2.2u. I don't want to scare you, but that was a little dangerous last night. You took good care of her, but let's not play that close to the edge anymore!
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It's going to be a little process to figure out what she needs. One unit is likely not the right dose either, but I think it's the next step in figuring out what is the right dose since we really don't know if she needs more than one unit or less than one unit. It's just going to take some time and data to sort out.
It takes about 20 minutes for food to impact the BG number, so you can either test her before the snack, or immediately after - whichever works best for you. I would just aim to get the test in before the snack has had time to register.
Cost aside, the curve numbers are likely to be vet stress inflated. They might then recommend a dose increase when it's not needed. That's why we're proponents of doing curves at home.
It can mean that her pancreas is doing what it should. It's a good sign!Ok, so we just checked Oreo's BG level (+4) and surprisingly it was only 109. That is down from 174 just 2 hours ago. I know we've only been testing for 2 days, but does this indicate anything with her number back down in a good range on her own without any insulin?
If Oreo drops down like that with no insulin on board it is a clear indicator that the pancreas is producing some insulin.Ok, so we just checked Oreo's BG level (+4) and surprisingly it was only 109. That is down from 174 just 2 hours ago. I know we've only been testing for 2 days, but does this indicate anything with her number back down in a good range on her own without any insulin?
It can mean that her pancreas is doing what it should. It's a good sign!![]()
Yes, that's correct. That's actually lower than the 200 usually recommended for newly diagnosed cats. The shootable PS number can come down once the owner has enough data to be able to predict the kitty's responses fairly well (cats are notoriously independent, though!). That 150 is as low as you'd want right now. That 130 is a squeaker but you'll probably be OK.Am I correct going forward that if she is ever at 150 or below AMPS or PMPS we don't give a shot?
Yes, that's correct. That's actually lower than the 200 usually recommended for newly diagnosed cats. The shootable PS number can come down once the owner has enough data to be able to predict the kitty's responses fairly well (cats are notoriously independent, though!). That 150 is as low as you'd want right now. That 130 is a squeaker but you'll probably be OK.
In the early days of insulin treatment the goal is to find the dose range that keeps the BGs at decent levels. It's best to give the same dose AM and PM at the start, PS number permitting of course. Changing the dose frequently in response to the PS numbers can be done once you're tinkering with what appears to be a good dose - fine tuning in other words. Oreo is responding well and giving you good blues but they're still high-ish off and on. He might need some time at very small doses (fractions of 1 u) to get his numbers settled consistently in the normal range.
Did you leave food out for her today? Onset for Prozinc isn't usually until +2 so I am a little concerned about the impact of that dose at a 130. Any chance someone can check on her in a couple of hours?
The answer is ... it depends. It depends on whether she's had an NS the cycle or cycles before, it depends on what the BG data shows about her response to the dose, etc. For example, if she has one or more NSs in recent cycles at a dose of 1 u BID and then gives you a 150 PS, we'd recommend trying a reduced dose. If the PS is 150 and recent history is a set of cycles where that 1 u dose gives a good nadir value in the dark greens with no incidents of NS, we'd recommend staying at the 1 u dose. Make sense? So much of this is judgments made on BG data on the SS in the cycles immediately surrounding the one in question.All of that makes sense. Just to be clear though, for now, at times she tests over 150, we should still be trying the 1 unit correct? Then just stick with 1 unit morning and night for awhile if the numbers are above 150.
If she's your only cat a timed feeder could be very helpful to allow more meals while you're away.We did not leave food out for her. We just put down her bowl and she typically eats it that sitting. She did have a little left though today before we left. Unfortunately no one can check on her today. We won't get home till around 7 PM.
No matter how high her BG is tonight, still only give one unit. If she is below 150, don't give anything. If she's between 150-200, could you eyeball 0.5u?
The spreadsheet can be used regardless of if you gave a shot or not, so go ahead and fill in the numbers you just got. Here is a video for how to link it to your signature so we can all see it too:
And then also make sure you click the blue "share" button in the top right corner of the spreadsheet so we can see it, and then choose "anyone with the link can view" You don't want to let us be able to edit!
Vet advice is OK on the gradual reductions (reducing by 0.25IU is the general FDMB guideline) BUT ... (and it's a very big 'but') ... as Djamila advises above as soon as you see a cycle where BG goes below 68mg/dL on an Alphatrak you need to intervene with food/karo/honey as appropriate (see links below) and keep testing, intervening with more food/syrup as necessary until BG levels come up and stay up without any need for further intervention with food/honey/karo. You then reduce the dose on the very next cycle.The vet suggested based on her curve that we only give 2 units each time and if after every 2 weeks, if her numbers are still good we should lower her insulin by 10% each time so it's a gradual change.
Ain't that the truth!... it's definitely a lot of new information at first!
Hi Matt! It's great to see the data you've collected! Your spreadsheet is for a human meter, but the only difference is that on an AlphaTrak, hypoglycemia starts at 68, and on a human meter it starts at 50. The rest of the ranges are the same.
Normal BG on the AT2 is 68-150.
I disagree with your vet on dosing however. Whenever you get a lime green number (under 50 on human, under 68 on AT2), you need to lower the dose. Also, cats run lower at night, so you really need to get some tests during the PM cycle just like you did on 1/09 and 1/13. Both of those cycles show that Oreo is getting too much insulin right now, which puts her in danger of having a significant hypoglycemic event.
I'm glad to see you lowered to 2u, but please keep monitoring before every shot and at a mid-cycle time or two whenever you can. And remember - 68 = reduce the dose. Please don't wait for a set amount of time to do that.
Hi Matt,
Sorry to hear your grandma had to have an op. I wish her a speedy recovery.
Great job on the BG monitoring. Oreo is doing so well!
I, too, am very glad to see you reduced the dose after that 37 (really was on the low side, that one!).
Did you give any honey/karo/food after that 37 reading, Matt? If yes, it will be helpful to you to make a brief note of what you did to bring numbers back up in the spreadsheet remarks for that night, just in case you need to refer back to it at some point.
Vet advice is OK on the gradual reductions (reducing by 0.25IU is the general FDMB guideline) BUT ... (and it's a very big 'but') ... as Djamila advises above as soon as you see a cycle where BG goes below 68mg/dL on an Alphatrak you need to intervene with food/karo/honey as appropriate (see links below) and keep testing, intervening with more food/syrup as necessary until BG levels come up and stay up without any need for further intervention with food/honey/karo. You then reduce the dose on the very next cycle.
In fairness to your vet, perhaps there are other clients with diabetic felines who aren't home testing, in which case all the vet can do is give general guidelines.
Ain't that the truth!
To refresh your memory about procedure when you get a low BG test result:
How to treat Hypos
And here is info on the recommended supplies you need to keep a stash of:
Hypo Tool Kit
** SAFETY NOTE - Spreadsheet Colour Coding **
It looks like your spreadsheet is based on the human meter FDMB spreadsheet template. Now that you're using an Alphatrak meter it's important to keep this in mind because you won't be able to rely on the colour coding to alert you that you need to take action to get BG levels into safe numbers because the cell background colour won't change to lime green if you enter a BG result between 50 and 68.
Mogs
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Hi Matt - The higher cycles in the morning are most likely her body's response to the low numbers at night. Her liver pumps out stored glucose to try to keep her safe when she drops like that. Then it takes a while to cycle that glucose dump back out again. So it looks like the 2u is actually too high for both cycles, and the numbers that have made it look like it's okay are actually inflated.
I would suggest for both cycles that you try 1u at the most, and as you said, only if she's over 150.
What time zone are you in, and what are your shot times? I'm wondering if we can try to work through this dose by dose for a few days.
The thing is that we don't really know how much insulin she needs right now. We know 2u is too much. But beyond that, we don't really know if she needs 0.5u, 1u, 1.5u, or something in between. So it's going to be some trial and error for a few days to try a dose, wait, see what happens, and try something else. If your shot times land when folks are around, having a few different minds working together might be best as you try to get this sorted out.
Oh that's right! Geez, my memory lately...
Being on the left coast, I'm either asleep or at work during your shot times, but hopefully some of our more easterly folks can keep an eye out for you. And of course I'm happy to help after the fact.Not as good as real-time dosing advice though.
That's a great cycle! Way to go, Oreo! (and of course Matt and mama-bean!)
I think that was wise. My suggestion is that you play it safe for a while as you accumulate more BG data on your SS. The 1 u dose seems OK for now and not shooting unless she's over, say, 150 might be the way to go at this point. The shootable PS number can come down if your increased data base supports that. You've recently switched to a pet meter that will read higher than your previous human meter so you really have to pay attention to those recent lows. They're way under the "take action" number of 68 for a pet meter. Another thing - you're using the human version of the SS which has automatic colour coding that will show lime green only when BG is below 50. That lime green would pop up with a 68 if a pet meter is being used. I suggest you manually colour code any number under 68 with lime green using the paint can icon on the tool bar so we see those immediately when we scan your SS.Thanks! We're just glad she didn't drop down too low, it's a huge relief!
This morning AMPS she was at 138 so we didn't give a shot. We probably could have since her numbers seem to stay higher during the day but aired on the side of caution and we'll see where she is at 5PM.
In the future if she is around 138 in the morning do you think we should be good giving her 1 unit anyways? Based on the prior numbers we got on her chart, it looks like it would be ok.
I think that was wise. My suggestion is that you play it safe for a while as you accumulate more BG data on your SS. The 1 u dose seems OK for now and not shooting unless she's over, say, 150 might be the way to go at this point. The shootable PS number can come down if your increased data base supports that. You've recently switched to a pet meter that will read higher than your previous human meter so you really have to pay attention to those recent lows. They're way under the "take action" number of 68 for a pet meter. Another thing - you're using the human version of the SS which has automatic colour coding that will show lime green only when BG is below 50. That lime green would pop up with a 68 if a pet meter is being used. I suggest you manually colour code any number under 68 with lime green using the pain can icon on the tool bar so we see those immediately when we scan your SS.
There is a pet meter version. The resident techie @Marje and Gracie can fix your SS for you.Got it, makes sense! I will definitely color code on my own in lime green if she ever drops below 68 again (which I hope is never!). As of now, her chart looks correct. The lower numbers not in lime green was with the human meter. The recent lows below 68 using the pet meter are already in lime green on their own since they were below 50 anyways.
Is there a template spreadsheet out there I could use for pet meters or does everyone just use the human spreadsheet template?
Thanks, Kris, for tagging me.There is a pet meter version. The resident techie @Marje and Gracie can fix your SS for you.![]()
We do have a SS for pet meters or I can convert the one you are currently using so you can’t keep the same one. Just send me a private message by clicking on “Marje and Gracie” to the left and then “start a conversation”.Got it, makes sense! I will definitely color code on my own in lime green if she ever drops below 68 again (which I hope is never!). As of now, her chart looks correct. The lower numbers not in lime green was with the human meter. The recent lows below 68 using the pet meter are already in lime green on their own since they were below 50 anyways.
Is there a template spreadsheet out there I could use for pet meters or does everyone just use the human spreadsheet template?
That's a great cycle! Way to go, Oreo! (and of course Matt and mama-bean!)
The 1 u dose has given you nice dark greens recently as well as an AMPS yesterday that was too low to shoot. I wouldn't increase right now.Hope everyone's night or day is going well so far!
Had a few questions for everyone. We've been giving Oreo 1 unit of Insulin the past couple of days and her numbers are a little higher than they've been. Based on the numbers do we stick with 1 unit still in the morning and evening or maybe raise it some in the morning since she usually doesn't get to low then? Or do we just stick with the 1 unit for now since it has only been a couple days and we don't want to keep changing it right now?
Thanks