Another low PS...what is going on

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Okay I'll do that. I'm trying to take readings with both when I can just so I can show the vet when I talk to him. This is just driving me crazy with how all over the place it is. I was hoping the 1.5 would be a good dose since he seemed to respond well to it last night, but I only got two readings so I don't know how low he actually went. My main fear is that he's going low and bouncing which is causing all of this and making him feel terrible.
 
Bouncing is normal and there is nothing you can do about it but ride it out. You are still so very early in this journey and quite frankly Salem is doing much better than a lot of kitties at this point in time. Patience is key.

When I was dual testing with both AT2 and a human meter, I simply created a separate sheet in the same workbook. I could keep the AT2 meter readings for the vet separate and neither the vet or me or anyone helping got confused. If you need a sample, click on my link to Menace's 2015 FS/AT meters SS. Mine is a bit different because I'm in Canada and use mmol but the general idea is still the same.
 
Well at +3 he's at 314 on the ReliOn so he hasn't gone down any. I'm guessing he must be bouncing bc he went down into the 100s last night. I guess I'll try and hold the 1.5 for a couple of cycles and if it's not effective I'll raise it to 1.75? I haven't spoken to the vet in a week but I'm dreading calling him trying to explain all of this. I feel like I'm just making things worse lowering the doses but it's like he's reacting better to it (except for today).
 
Holding doses through a bounce is frustrating but at this stage of the game, when ideal dose is still a bit of a mystery, it's the safest thing to do. We don't know how low Salem might have gone yesterday during the day on the 1u dose. He started lower but even with the lower dose, he might have dropped down more than you think. PMPS was not that high on the Relion (166) as compared to the AMPS. The bounce may have started last night and is continuing today.
 
Okay I'm taking him into the vet on Saturday morning and I'm going to talk to him. I need to make sure I get some numbers using the AT2 though bc he'll want to see that. I'm just so confused about what to do and I feel like I'm making things worse bc he's acting more lethargic and like he doesn't feel well. I'm taking him early in the morning so at least the vet can see how low he runs in the AM. I'm also getting his teeth looked at just in case.
 
Good idea to get the teeth looked at but be aware that the vet, based on the numbers on your AT2 sheet, may suggest taking Salem back up to the 2.5u dose which doesn't allow you to consistently dose twice daily. He won't be seeing the full picture the way you have been seeing it. Vets are great for most things but unfortunately, a lot of them are a little less great with feline diabetes.
You might want to check with your vet as to what he considers "good" readings and when to withhold shots. But if you are having to repeatedly withhold due to low AM readings, then the dose definitely needs to be re-evaluated so you can shoot consistently.
Salem doesn't feel well because of the bouncing and swings in BG. This will resolve as you determine the best dose for him to receive consistent shots.
 
My game plan is to keep Salem at 1.5 until Saturday morning and I can talk to the vet, since I think that dose I can consistently shoot at least. I’m going to go over all of my concerns with him and see what the best option would be going forward. I think he’s not used to people being this involved so he probably hasn’t mentioned things just because most people there can’t handle it. I’m just kind of obsessive when it comes to things and of course my cat’s health is one of them. Also I like to do research and handle things myself when I can but I feel very out of my depth here. Also I’m hoping nothings wrong with his teeth but the way he’s been smacking his mouth all the time has me concerned.
 
Amy, you sound so much like me that it's uncanny. Your use of both AT2 and human meter reminds me so much of myself. Believe me when I say, mixing meters takes a lot of self discipline not to panic over readings on either meter. It tends to confuse the situation when you are so early in this journey. I however was dual testing on the same drop of blood each time I tested so I had comparisons for EVERY test. I admit I like and trust my pet meter the most despite my use of a human meter BUT I also came to the conclusion that unless my girl was in very low numbers on the human meter, the difference didn't matter. I know my human meter (not the one you are using) reads low in low ranges so when I got a low human meter reading, I double checked it against the AT2 to decide what the best course of action was. You have not encountered any readings low enough to be affected by this difference yet.

When I first mentioned a human meter to my vet she looked at me like I had horns growing out of my head. Fast forward and my vet emailed me wanting to know what normal readings were on a human meter because she had a client who insisted on using a human meter. A human mete is just as good as the AT2 but the numbers will read lower.

You are so early in this dance and getting most kitties regulated is a marathon NOT a sprint. You are going to have to be patient and let the numbers from ONE meter guide you as to how to proceed. Your vet is not going to be available to guide you 24/7 so you need to gain some confidence in your ability to interpret and deal with what Salem throws at you. I understand your desire to keep your vet involved but to be honest, most of here deal with dosing ourselves because we are the ones holding the needle and on duty 24/7.
 
Sigh....PMPS is 222 on at2 and 130 on reliOn....

And yeah I agree with that, I just need to figure out what numbers I’m shooting for and what I’m looking for, which is honestly what I’m still confused on. I’m hoping the vet can clarify what they consider to be “good” numbers but I’m hoping that if I can keep Salem in the 200s and 100s he’ll be okay? I’ve read all of those different definitions of regulation and I don’t think I could manage tight regulation but I want to get him in decent numbers.

I've been testing using the same blood with both meters just so I have more data. My problem right now is I know the vet is going to want to see data from the pet meter so I'm trying to use that, while also using the ReliOn so I can have a standard for it too, since once I get him more regulated I'll probably just use it exclusively. I know the numbers are going to be pretty drastically different, I just want to get an idea for how both of them are reading. I'm keeping separate spreadsheets now which I think will help.
 
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Ugh okay +7 is 340 on the at2 so the 1.5 dose isn’t doing anything. I probably need to bump him up again. He barely went down from 437.
 
Amy, when I look at those numbers I see something totally different than you. The day cycle yesterday was not that bad. Salem didn't drop a lot but he also didn't bounce up high at the end of the cycle either. Not quite flat but flatter than he has been. He seems to have a later nadir (around +6 -7) so may have gone a bit lower yesterday than you are seeing. Not sure what he did early in the night cycle last night but you can't jump on one reading at +7 and start altering your plan of attack or you'll never get him figured out.

I understand wanting to get readings for the vet BUT pick one meter and dose according to it rather than reacting to one higher reading on the AT2. When you aren't getting the results you want it's fine to make changes BUT you need to give every change a chance to really see what it is or isn't doing. Salem's BG is not that bad right now and you are able to shoot twice daily so I'd hold the 1.5u dose for today at least.
 
I know it’s hard to be patient when you see not so great numbers because we want our kitties feeling better NOW, but I second everything Linda has said. Salem is looking great considering how short of a time it’s been since he was diagnosed. You’ll hear this a lot on here, but it really is a marathon not a sprint! Gotta give the dose some time to work
 
Okay I’ll keep him on the 1.5 at least through tomorrow. I can’t help but panic when I see those higher numbers since he’s been pretty low for a while. But I need to take it slow and not jump around everywhere.
 
Well you guys were right I’m glad I kept him on the 1.5 cause +3 we’re at 171 on the at2. I have to go to work during his nadir but my brother will be here so I might try and show him how to test and see if he can check on him.
 
Okay I’ve been at work but before I left I took a +4 and he was at 80 on the reliOn and 150 on the at2. That’s on the 1.5 dose. I’m going to hold it through tonight and try and get some readings to show the vet tomorrow.
 
QUESTION- I just accidentally left the insulin out for like 30 minutes is that going to make it ineffective? I really don't want to have to buy a new bottle but I guess I will if I have to.
 
It should be just fine. A sign that it has gone bad would be little white floaty bits in the insulin, but that would most likely be from having been left out overnight or longer. Thirty minutes is not a very long time.

Edited to add: People have left Prozinc out for much longer with no problems. It happens.
 
Yeah the 1.5 isn't going to be enough we're at +3 and 441 on the AT2. I feel dumb going to the vet just to have him look at his teeth when they're probably fine but oh well.
 
No doubt a bounce from the lovely lower readings earlier during the day. It's normal for this to happen and you just have to ride it out. As Salem gets down to lower readings more frequently, he'll get use to the lower numbers and the bouncing should settle.
 
Okay he’s at 309 this morning so that’s not great but not awful. We’re going to the vet which I’m pretty nervous about just because I have to explain all of this. I definitely don’t think he needs to be on the dosage the vet last had him on though and I’m hoping if I show him the lower numbers I’ve been getting with the 1.5 he’ll agree.
 
Proof's in the pudding. If you can't give insulin consistently twice a day, you can end up in one big bouncing session with one high and one low cycle which makes kitty feel awful, gets you frustrated and no progress being made. Hopefully your vet will agree but even if the vet doesn't, you hold the needle and you need to be comfortable with what you are doing. This is a very hands on disease that requires 24/7 attention and no matter how good your vet might be for most things, diabetes is definitely one of those things that really requires the vet to be your partner rather than a dictator. Your vet sees Salem periodically and otherwise only has your reports to base decisions on. It's difficult if not impossible to handle diabetes well with one size fits all instructions and your vet just doesn't have the ability to give you much more than that because he is not following Salem on a day to day basis.
 
It took me way too long to realize this, but even if your vet does not agree with you, you don’t HAVE to take their advice. At the end of the day, you know your cat and what’s best for him, and unfortunately many vets are just not educated or experienced treating feline diabetes. I had one look me in the face and tell me home testing is useless and can’t tell you anything, and this was AFTER my cat had been hospitalized for a severe hypo!
 
He’s at least fine with me home testing and he’s always telling me I ask way more questions that any of the other owners so maybe he’s just not used to someone being this involved. I’m going to suggest to him I keep at the 1.5 for a few more days and see if he levels out and if not I can bump him up.
 
If your vet is Ok with you questioning things, he's a keeper even if you don't always agree 100% with each other. I also love the fact that he is pro home testing. You seem to have a vet who is more savvy than some and likely willing to work as a partner and that makes all the difference in the world.
 
Yeah I’m glad I took him now. The infection is probably part of what’s causing him to not feel well so once it clears up and I can get his teeth cleaned hopefully he’ll be better. The problem now is I have to get him somewhat regulated because they can’t put him under until his glucose is under control. But I’m really hoping getting rid of the infection will make his numbers more stable.
 
Glad you caught the infection quick!
Your vet sounds like a good one. If you are comfortable with it, you could give him the link to your spreadsheet via email, and he can reference it as needed. I gave my vet the link, and always bring my phone to show the sheet to the techs/diff vet, and just to have it handy
 
While I agree you need to get the infection dealt with, the dental issues likely are partly to blame for the lack of regulation. Catch 22. Salem does not need to be regulated to get the dental issues looked after. Getting the cleaning/extraction if needed done, will likely help get her regulated so I'd opt to get that done as soon as the antibiotics have alleviated the infection.
 
Sophie got her dental done when she was not regulated at all. They let her BG run well into the high 300s during the procedure. That being said, she had hers done by a board certified team
 
The vet was saying something about we just need his BG to be low when they do the cleaning since he’s under anesthesia? He wants to do it as soon as the antibiotics clear up the infection bc he thinks that will lower him enough to get him into those numbers. Which at +4 he’s at 104 on the AT2 right now so who knows maybe this dose will be fine. It just means I’m going to be watching him like a hawk for the next few days to make sure he doesn’t get too low.
Not sure how fast the antibiotics work but he’s currently up and playing which he hasn’t done in a while.
 
Salem is looking much better on the 1.5u dose and the last couple of day's BGs shouldn't preclude getting the dental work done. :)
 
Yeah I’m pretty happy with how this is going even though dealing with the dental work will be annoying (and expensive). Hopefully getting that under control will be what he needs to get more regulated.
 
Does anyone have an idea of if the infection clearing up will drop him significantly? He got an antibiotic shot this morning and I'm not sure how long it will take to start working on the infection. I'm still going to be testing him frequently, I just don't know how worried I should be about him dropping suddenly. He was at 261 PMPS on the AlphaTrak tonight.

Okay at +3 he's in the 300s so I'm guessing he's not going low tonight. I'm going to try and take advantage and get a full night of sleep. I'm assuming the infection is probably driving his numbers up at night? Also now I'm paranoid about DKA since he has an infection, but he's on antibiotics already so hopefully that will help clear it up and then I'll get him in to have the cleaning at the end of this week. At least during the day he's getting low enough.
 
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Yes clearing the infection could bring down his BG but you are testing enough to catch it so try not to worry. They'll likely come down gradually.
 
So at +3 today he’s at 423....I don’t understand how he had such good numbers yesterday but they’ve been high since then. I was really hoping this dose would be a good one. I hope I’m giving him the insulin right?
 
Just an update, Salem hasn't gone down much today. I'll see what he's at at +3 before I go to bed. I'm just feeling discouraged because yesterday he went down to 104 (80 on the ReliOn) and now he won't go below 200. I don't know if it's something to do with the antibiotics maybe or if he needs to go up on his dose later this week. I'm still keeping him at the 1.5 for now though.
 
Amy, chances are good it's a bounce (spreadsheet isn't updated so I'm guessing). Bounces happen when BG goes down to levels that are no longer familiar or comfortable for the cat. Salem has to learn that those lower readings are a good thing rather than something to fight against. You can't do anything to stop them.....they tend to calm down with time. They are frustrating and maddening for us but they are simply a normal biological occurrence. Stay the course for the moment until you see whether the antibiotics bring BG down at all.
 
Seems like you're right, we're at 205 AMPS on the AT2. I'm going to stall for about 15 minutes and see if he goes up any but I'll be home around his nadir so I can keep an eye on it. I'm curious to see how much the 1.5 drops him.
 
Oh boy we're almost at +3 and he's at 116 on the AT2. I know he still has room to go lower but that makes me nervous. Sometimes he hits his low point at +4 sometimes it's later.
 
Salem is fine and in perfectly safe range with lots of room to drop a little more quite safely. Those lower BGs can be very hard to get use to when we are so accustomed to higher readings but they are exactly what you need to strive for to allow Salem's pancreas to heal and start to function better.
 
Okay so I just fed him some LC food and we're at +4 at 87 (AT2). Lately he's been peaking at +4 so I'll see if he starts going up after this. He must have been bouncing this weekend bc 1.5 seems like it's enough.
 
Yeah he really does love throwing me for a loop! I just hope this dose doesn't take him too low so I don't have to worry about him going low at night. I mean I'll probably set alarms and wake up and test him anyways but still. Hopefully he won't bounce again because I really want to get him in to get his teeth done this Friday.
 
Okay 30 mins later he's up to 125 so maybe +4 is the new nadir? So weird that he does that.
 
PS tonight was 342. I really hope he's not bouncing again. That must be what he's doing to have low numbers one cycle then go up dramatically the next? I'm going to see where he's at +3.
 
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