Help Please, testing advice and dosing questions

So, obviously I will give him the 1.75u tonight. And since you said you'd check in around 9, I will ask you now when you recommend I test him during the night? I don't want to over-test or miss a test at a time that I should be testing him. I'll set my alarm and probably get a better night's sleep based on his performance today...
 
Not sure when you turn in for bed but it's a good idea to get a test in either around +3 or before you go to bed if that is before +3. Then based on what BG is at that time, you can decide when to test. If the cycle looks somewhat like the day cycle, then I'd do the before bed/+3 test and one more around +6/7. If BG has dropped off a lot, feed him and retest in a couple of hours. If BG gets down below 100 then I'd give some Medium carb food or LC with a drip of honey to push number up and retest in about an hour.
 
Thanks, I'll write that on a note for myself. These past few days I don't go to bed anymore, just take cat-naps! couldn't resist saying that...
Seriously, tho, thanks for sticking with me on the marathon. Of course I will be recording his numbers on the spreadsheet and hope for something much like the day went.
 
Cats often go lower at night than they do during the day so getting the before bed or +3 test gives you and idea where things are heading. Once you are surer about the dose, you can sleep better and not be taking cat naps. You need to look after you just as well if not better than you are looking after Clarence. He's counting on you so don't get yourself exhausted.
 
Clarence started out the night much like the day. His numbers were high this morning, tho. I continued with the 1.75u this morning. He was hungry in the wee hours this morning, coming in to my room and knocking items on the floor to try and get me to wake up and feed him. I don't know if he was stressed cause he was hungry and maybe that is why he went higher than he had been.
On the plus side, I got some good rest last night and kitty didn't have to get stuck much.
 
Dee Dee C said:
coming in to my room and knocking items on the floor to try and get me to wake up and feed him. I don't know if he was stressed cause he was hungry and maybe that is why he went higher than he had been.
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You gotta love them. They may not speak "hooman" but they sure do get their point across. Sounds like Clarence is a bit of a character. His BG could have been a bit elevated by hunger stress but I think he's probably bouncing from going into the blue range. This should settle with time but he's become unfamiliar with those lower BGs and his body is basically defending itself against them unnecessarily. He has to get use to being in those lower numbers again. :)
 
Cats love being in control, don't they? He is definitely a character, but, yep, gotta love them! They are smarter than a lot of people think, really, which is super cool to observe.

I thought maybe he was 'bouncing' some. I'm hoping it settles and thinking it will. I'll test him later today to see what he's up to...
 
I tested Clarence at +4 and he was 322. At +7 he is 208. He doesn't seem to be dropping fast, but I'm hoping that I'm interpreting his numbers or pattern correctly. I'm hoping he doesn't go back up super high and figuring that I should still give him the 1.75 and monitor tonight similar to last night and today.
 
He'll probably start rising anytime now but how high he goes is anybody's guess. That 208 isn't bad given where he started today. Possible the bounce is starting to settle.
 
I need to begin using ReliOn and recording readings for it. I can start that tomorrow morning. Help with changing my spreadsheet would be greatly appreciated. I can easily add a row that says I'm using a Human Meter, or whatever it needs to say. As for the conditional formatting, I made the changes to a copy of my sheet (called Test Spreadsheet) and will publish that to my signature if you wouldn't mind taking a look at it for me?
 
Your spreadsheet looks absolutely wonderful!

Looks like the bounce is clearing now and you are going to have to monitor Clarence a little more closely early on tonight or if sleep is a necessity due to work tomorrow, I's be inclined to reduce the dose tonight to 1.5u to avoid a potential PJ party.
 
Thank you. :)

I got some good sleep last night and I also had a cat-nap today, so I should be able to set some alarms and monitor him. I'm retired, so work won't be an issue (and its a good thing because this would be even more stressful for me if I was still workin').

Couple of questions:

I have a can of Friskies - the gravy kind - is that adequate for medium carb food? - he really will mostly just lick the gravy and that's what he would need to do.

You already told me not to let him go below 90 on the vetsulin, what would that number be using the ReliOn (in case I run out of AT2 strips)

Am I off base in thinking that it would be better to keep him on the 1.75 because it might end up being his dose and is consistent? I can give him 1.5 but I worry about so much fluctuation, is that unnecessary worry?

Could I give him a 'skinny' 1.75 just for a little caution???

Okay, that was more than a couple questions, but, I always have questions!!

Thanks!
 
decided to play it safe with 1.5 and this was not one of my best shots - he jumped when I started to inject the insulin. I couldn't really tell whether I got any in him or not, so I tried another spot (same needle, same insulin - or what was left of it) -- is it okay to do that? He has been pretty good lately, but he has started to tense up when he knows I'm giving him his shot. Once He jumped when I was just about to insert the needle, he jumped before it even touched him. I think I must be doing something wrong. Other times he doesn't even flinch. I don't expect him to like it, I just always wonder if others have experienced that.
 
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For simplicity purposes, we generally just use 90 as the goal for Vetsulin for either meter but with the Relion, I think you could safely use 80 instead. There is no way to equate the readings from the two meters and the goal is simply to allow for enough of a cushion to be able to prop BG up if it is dropping quickly in lower range.

Gravy foods in general are Medium to high carb. Not sure what the Friskies you have is, but it should be on THIS FOOD LIST.

While I agree it's ideal to be able to stick to one dose, there is the safety of Clarence and your well being to be considered. When kitty is coming out of a bounce and when monitoring is/may be a bit more problematic or not possible, it's better to err on the side of caution. Clarence's pre-shot was way down last night so I suggested the slight reduction just to prevent a PJ party. If you look at how much the 1.75u dose has been dropping his BG, if he dropped that much at a pre-shot of 289, you might have been chasing numbers for a few hours last night. This is of course all speculation but it's based on what Clarence has done so far. When kitty is bouncing, there is no way to know how much of the BG is bounce related, when it will clear and how much is what his body does normally at this time.

Clarence got down to 121 last night which was good but still allowed a comfortable cushion so you might have been OK with a skinny 1.75u but hindsight is always 20/20.

As for the shot issues, what some folks find helps is to give the shot while kitty is eating. You could withhold a couple of tsps. of food from his pre-shot meal, then give that last bit to Clarence when you shoot. Most kitties are so intent on eating they don't even notice the shot. Some low carb treats would also work. I'd also double check your needles. There have been instances where folks have found the needles a bit dull causing shots to be a little more problematic.
 
Gosh. AMPS is 294 on the ReliOn - that is pretty high, I think, but it is in the yellow, so it will take me a little while to get used to the difference, maybe.
 
The link to your spreadsheet isn't in your signature anymore. The words are there but it's no longer a link. When you have a second can you fix it. You may need to re-establish the share options.

Yes it looks like AMPS is up a bit but there is also meter variance that comes into play when comparing the meter readings so just go with the flow.
 
So, with this reading, I'm unsure of whether I should go ahead and give 1.75 or less? Just a little unsure of myself.

I'll go fix that link.
 
You can safely assume that the AMPS is at least higher than last night's 289 on the AT2....the only question is how much? Since it appears Clarence only went down to 121 (if memory serves) then if you can monitor, I think 1.75u will be just fine.
 
MrWorfMen's Mom said:
As for the shot issues, what some folks find helps is to give the shot while kitty is eating. You could withhold a couple of tsps. of food from his pre-shot meal, then give that last bit to Clarence when you shoot. Most kitties are so intent on eating they don't even notice the shot.
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When I first starting giving the shots, I did it while he was eating, but he caught on to that right away and the minute I touch him when he's eating, he tries to leave. He is a food motivated kitty and has never ever liked to be disturbed when he is eating.
 
They all have their own "thing". My girl loves her food and I could shoot her while she was eating without her ever lifting her head. Maybe some bribery.......give him a treat before and after after each shot (whether he stays still or not) so he knows he gets a treat for just being there and another once you are done? Or coms catnip or a brushing....whatever might work for Clarence as an incentive to co-operate.
 
Good suggestions. I will look for a treat that is low carb that he might like.

I'm reviewing the Beginner's Guide to Vetsulin again (3rd time, I think) and finding it helpful to try and get the info stuck in my head, especially since the meter swap. I'm sure I'll need to review it again. I need to work on finding a different vet, I think, which I really don't want to do. My vet doesn't advocate home testing, though, and after monitoring Clarence for the past week, it is clear that it will be in Clarence's best interest to do the monitoring. I need to find a vet that is happy to have me testing and being diligent about his care. And willing to work with me to get him as regulated as possible.
 
MrWorfMen's Mom said:
For simplicity purposes, we generally just use 90 as the goal for Vetsulin for either meter but with the Relion, I think you could safely use 80 instead. There is no way to equate the readings from the two meters and the goal is simply to allow for enough of a cushion to be able to prop BG up if it is dropping quickly in lower range.
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The side by side I did on that test last night where he was 121 on the AT2, he was 79 on the ReliOn Prime.
 
for a treat at shot time (or test time) -- try dried bonito flakes/curls -- can get more cheaply at stores that cater to those cooking Oriental style

can be fed by themselves or sprinkled over something else -- pure protein no carbs

several cat food mfg's produce these too -- CatManDoo is one -- smaller packages bigger price, but available online

if you are avoiding fish in regular canned food, as many do, it works well to use something fishy as a treat
 
CandyH and Catcat said:
for a treat at shot time (or test time) -- try dried bonito flakes/curls -- can get more cheaply at stores that cater to those cooking Oriental style

can be fed by themselves or sprinkled over something else -- pure protein no carbs

several cat food mfg's produce these too -- CatManDoo is one -- smaller packages bigger price, but available online

if you are avoiding fish in regular canned food, as many do, it works well to use something fishy as a treat
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I think I have some of those, usually keep them in stock for my son 'cause he loves Asian food. I haven't been avoiding fish for him at this point, he loves it and gets it daily. For a time I was giving him the fish & shrimp directly after a shot like a little reward. I bet the bonito flakes would be great for him as a little treat! Thanks. :)
 
Don't be hard on your vet. Nor do you have to switch vets necessarily. If you like your vet for other things, continue with him/her but what you do at home is your business so just continue testing. I think most vets come around when they see the results and if that doesn't work ask the vet if they would give insulin to a baby without knowing what the baby's BG was? Give the vet some food for thought to quell any argument about home testing. Dosing wise, you can always listen to suggestions and nod your head and then follow your gut instincts given the knowledge you have accumulated about Clarence and his patterns. Vets can have several reasons for not advocating home testing. While some may be interested in padding their pockets by requiring useless in office curves and fructosamine tests, most just don't advocate it because they fear their human clients will not want to treat at all if they make things too complicated. Of course there are also control freaks but how much control do they have when they only see the cat periodically?
Most of us here do not consult our vets about the diabetes. We handle that aspect of kitty's care and let the vet handle those things we really need their help for.
Another option for treats would be freeze dried meat treats such as Purebites but buy the dog ones and break them into kitty size pieces. they charge a premium for the cats ones I guess because they had to cut them smaller. :rolleyes:
 
MrWorfMen's Mom said:
Most of us here do not consult our vets about the diabetes.
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My vet is the one that I am getting the insulin from, and I need a Rx to get that, don't I? I don't have a problem with it other than I feel like I am being deceitful when he is telling me (and thinking that I am doing it) to give him 3u.
 
You have the spreadsheet showing Clarence is getting good results on far less than 3u. I dare say 3u could have sent Clarence hypo. The one day you dosed 3u Clarence's pre-shot was in the 400s and he dropped to 88 which I think your vet would probably agree is plenty low enough. When Clarence starts a cycle at a lower pre-shot, 3u would be nothing short of dangerous. Most vets try to keep cats above the BG levels we aim for here so I think if your vet sees the results, he/she won't be able to argue that more insulin is needed. You can always say you were uncomfortable with raising the dose that much.
If your vet is not willing to work with you, that is a problem. As long as you are not endangering your cat, hopefully your vet would be willing to be a partner rather than a dictator and continue to prescribe insulin based on results rather than ego. If they refuse, as far as I am concerned, they are endangering your cat.
 
I have been using the same vet's office for many years. There are other vets operating in his clinic as well and I have always been happy with the care my animals get from him or any of them there.

Testing update: This morning I tested at +2 it was 229 and at +3 it is 135 (ReliOn Prime meter readings)
 
MrWorfMen's Mom said:
he dropped to 88 which I think your vet would probably agree is plenty low enough
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The actual lowest he went to on that day was 79 (this info is in the remarks section). When I called the vet's office, I gave all the numbers to the person answering the phone. She called me later and reported that the vet had said to continue with the 3u and not test again until Friday (this was on a Tuesday). Part of the problem I have is whether or not the vet actually said that and even whether or not she gave the information to him at all. He might have also thought I was using a human meter. I want to discuss this with him but I'm not the confrontational type. I was totally blown away by all of that and there was no way I was going to give him 3u again after he had gone so low on it. That was when and why I started this post in the first place.
 
When Clarence went for his initial curve, his first injection was 3u and he went really low, so they brought him back up again and no more insulin that day. Next day they started him on .5u and the day after that I picked him up and his dose was 1.5u.
 
For now you need to give your vet the benefit of the doubt although I think the dosing methods/instructions have been very questionable. You don't know if the info you relayed the day you had the low readings got conveyed to the vet properly, whether you got his response accurately AND/OR whether the vet could have been distracted when responding to the tech/receptionist. This is a prime example of why the vet cannot take on the care of a diabetic cat from arms length. You hold the needle and if anything adverse happens, the vet is free and clear of any guilt because they have no way of knowing if you really followed their instructions or overdosed the cat accidently.

Vets do not get a lot of training on diabetes in school. They also don't usually have a lot of feline diabetics in their practice. Many see more diabetic dogs than cats and treat cats like dogs. Since they often have very few feline patients, they don't stay up to date on current practice which encourages home testing.
I don't think you have to confront the vet. I think you need to make the vet aware of what you are and are not comfortable with and the vet needs to co-operate with you because you are the one who is giving the insulin and having to deal with the outcome.

Unfortunately, what you are describing is all too familiar and time and time again, the caregiver either gets a baptism by fire (hypo or close situation) or the cat manages to keep their BG up but is running in very seriously high numbers because they are in one long continuous bounce. This not only slows down progress but because too much insulin can look identical to too little, it makes it very difficult to get the cat back onto the right path dose wise. I think most vets come around when they see the proof that you know what you are doing and are making good decisions about how much insulin to give.
 
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Liking those readings today so far. I'd test again by +4. If he suddenly gets hungry, check him then as that is often a sign BG is going down.
 
MrWorfMen's Mom said:
For now you need to give your vet the benefit of the doubt although I think the dosing methods/instructions have been very questionable. You don't know if the info you relayed the day you had the low readings got conveyed to the vet properly, whether you got his response accurately AND/OR whether the vet could have distracted when responding to the tech/receptionist. This is a prime example of why the vet cannot take on the care of a diabetic cat from arms length. You hold the needle and if anything adverse happens, the vet is free and clear of any guilt because they have no way of knowing if you really followed their instructions or overdoses the cat accidently.

Vets do not get a lot of training on diabetes in school. They also don't usually have a lot of feline diabetics in their practice. Many see more diabetic dogs than cats and treat cats like dogs. Since they often have very few feline patients, they don't stay up to date on current practice which encourages home testing.
I don't think you have to confront the vet. I think you need to make the vet aware of what you are and are not comfortable with and the vet needs to co-operate with you because you are the one who is giving the insulin and having to deal with the outcome.

Unfortunately, what you are describing is all too familiar and time and time again, the caregiver either gets a baptism by fire (hypo or close situation) or the cat manages to keep their BG up but is running in very seriously high numbers because they are in one long continuous bounce. This not only slows down progress but because too much insulin can look identical to too little, it makes it very difficult to get the cat back onto the right path dose wise. I think most vets come around when they see the proof that you know what you are doing and are making good decisions about how much insulin to give.
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Oh my goodness, it is amazing that what you have said here is exactly what has been going through my mind since this whole thing started. So Thank You! He is very good with dogs and I know that because I've been taking my dogs to him for 30 years. I very much want to give him the benefit of the doubt on this because I respect him. He is old school and because of that there is a lot of great practical knowledge from him. He is spread thin, I think, and would love to take more time with his patients but the time isn't always there. I also don't know what else could be going on in his life that could impact his decisions/actions without him even realizing it.
 
MrWorfMen's Mom said:
Liking those readings today so far. I'd test again by +4. If he suddenly gets hungry, check him then as that is often a sign BG is going down.
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Okay, I will test him at +4 or if hunger ensues. He was pestering me for food before the +3, so I fed him a little right after the test. He is used to getting food whenever he asks for it, he is a 'grazer' outside of his regular breakfast and dinner.
 
Ok give him a break. While some of that 125 may be food, it wasn't a full meal so his drop seems to be slowing down now. How about grabbing a +6 snce his nadir has seemed to be around that time in the cycle.
 
Because I was going to be working on a little project outside, I tested Clarence at the +7 1/2 hour mark. He was at 273, so I feel fine to wait until the PMPS to test him again. I'm thinking since there is still almost 3 hours before his PMPS that he will be high enough for me to give him the 1.75u tonight, probably.
 
Ok. I'd stick with 1.75u tonight and if Clarence is still up tomorrow morning, then you could try 2u as long as you can monitor to see if we can get him down just a wee bit more.
 
Okay, thank you. :)

I was a little early getting his pre-test and he was quicker to eat, so I managed to give his injection about a half hour earlier than usual. I think hat should be okay and will actually let me do a +3 earlier as well.
 
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+3 was 290 on the ReliOn Meter (btw, I keep saying that mostly to remind myself if/when I go back and reference these posts, which I have been doing when I need to). Test again at +5 or +6 or +7 ?? This morning his lowest tested was at +4, but prior to that, the nadir was around +6 or +7 (maybe more so at night?)
 
After looking at his numbers and noting his behavior around +5 1/2 hours, I will check in on him again around +6 1/2 and if he seems to be dropping fast or anything, then I will test him. Otherwise, I'm gonna leave him be until is AMPS tomorrow. He started out pretty high and hadn't dropped much by his +3.
 
Nadir will not always be at the same time. With some cats you can set your watch by their nadir while others can move around constantly to some degree. It looks like Clarence's nadir was early during the day yesterday but later again, as it has usually been, on the night cycle. You were quite right to give yourself and Clarence a break when his +3 hadn't moved much last night. It will be interesting to see where his BG is at AMPS.
 
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