? need help reviewing spreadsheet, advising scheduling/dosing

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Heather & Hwy 99

Heather & Hwy 99

Member Since 2020
Hi! I am hoping to get advice based on Hwy 99's data, there has been many changes in past 2 weeks (was originally on vetsulin 3 units once a day, then switched to Lantus 2 units twice a day-only followed that schedule for 2 days before you all advised his dose was way too high and so many doses were skipped, and all were reduced)
I have chronic health issues and have been battling flare up last 3 days so there isnt as much data as I would like but none of his numbers have been over 200 in past 6 days, I was supposed to be on twice a day schedule but based on his low numbers I was advised not to shoot if under 200 but have been giving "token dose" once per day in evening (and skipping AM dose) but I am confused because if I am not supposed to shoot below 200 should I not be giving any at all??
He has switched to about 90 percent ff pate in the past month, so is it possible he is nearing remission?? thanks for your help, still waiting to hear from my vet (as usual)

this was my previous thread:
http://www.felinediabetes.com/FDMB/...-doses-so-far-dose-or-no.230411/#post-2578999
 
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Hi Heather!

hope you’re feeling a bit better.

it’s a puzzle isn’t it? I feel like he must have gone lower than 90 but you just haven’t caught it. You did yesterday though and that 66 at +4 gets him a dose reduction of .25. Are the .5 token doses or his regular dose now? You’ve been right to skip if he’s under 150 for sure but you have some leeway between 150-200 to still give a token dose. I assume you have ready this sticky note right?

http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

here’s the gist:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
Aleluia Grugru & Minnie said:
Hi Heather!

hope you’re feeling a bit better.

it’s a puzzle isn’t it? I feel like he must have gone lower than 90 but you just haven’t caught it. You did yesterday though and that 66 at +4 gets him a dose reduction of .25. Are the .5 token doses or his regular dose now? You’ve been right to skip if he’s under 150 for sure but you have some leeway between 150-200 to still give a token dose. I assume you have ready this sticky note right?

http://www.felinediabetes.com/FDMB/...-low-go-slow-slgs-tight-regulation-tr.210110/

here’s the gist:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
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thank you, yes I have read it but have major cognitive challenges and cant make entire sense of it especially as I dont think I have enough data to know what his "usual or normal" pre dose value actually is ( I have only been getting bg data for 2 weeks and in that time he has changed insulin types, and units as well as I am still having a hard time with testing) and I dont know if that .5 is his new normal dose-I guess that is what one of the things I am asking-vet said 2 units twice per day but it seems you all here are far more knowledgeable so I have basically been relying on advice from here, I was advised to go down to .5 but I wasn't sure if that meant indefinitely or if it depends on his preshoot numbers-it seems with his number last 6 days I could be skipping doses entirely but someone said to do .5...I honestly just dont know
 
Aleluia Grugru & Minnie said:
Oh and it doesn’t indicate in your ss, but I’m also assuming you’re going with SLGS protocol right?
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its embarrassing but I didnt start with either of these but rather blindly went with what my vet said to do (which I know now was completely wrong so I was blindly shooting for 2 months) and have relied on you all for advice since I starting home glucose monitoring, trying to get advice from more experienced people since there have been such drastic changes in his diet and insulin it seems those protocols require some period of time/consistency that I dont yet have
 
Sorry to hear about the flare, ugh. I hope it's getting better now...

Looks like you've been shooting 0.5U once per day for the past several days, and he still went under 68 the other day.

Question: were the morning skips based on a below-200 test, or because you were unable to get any test data?

I think the next step is to take that 0.25U reduction down to 0.25U as his regular dose, but with the numbers you have been seeing, I am also wondering if the food change has brought him close to remission :). Maybe not quite there yet, but he is looking good!
 
thank you-still not great but better than I was! I am hoping to do a curve at home as soon as I can stay awake for 12 hours! So 4 of the days I gave the lower dose of .5 based on AMPS reading, then the 2 days I was most sick I couldn't get him to come to me to get his reading exactly on time and by the time I did (usually within a few hours of his usual time) it was still below 200 so I think I probably would have skipped anyways but cant say for certain...since the lantus is longer acting do you think its been ok only giving once a day? Do you know of any tricks (or perhaps needle alternative I can buy) to give even lower dose? TBH the .5 is my best guess of what I am attempting to give him, the lines are so freaking small and I dont know how I could possible gauge the difference!
 
Heather Bentley said:
its embarrassing but I didnt start with either of these but rather blindly went with what my vet said to do (which I know now was completely wrong so I was blindly shooting for 2 months) and have relied on you all for advice since I starting home glucose monitoring, trying to get advice from more experienced people since there have been such drastic changes in his diet and insulin it seems those protocols require some period of time/consistency that I dont yet have
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That’s totally okay and not embarrassing at all most of us had never heard of these protocols before we joined, so you can just indicate the one you’re following now and it seems to me it’s SLGS right Nan?
 
these are the syringes I have...is there another type that would make it more accurate/readable to do smaller dose?
 

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New question, his initial dosing schedule was 8am/8pm but due to lower readings I have been skipping AM doses, and because of giving 8pm dose I havent been able to get as much data post shot, SO since I HAVE been only giving once a day dose for last 6 days do you think it would be beneficial to change his schedule and give his insulin mid day so I can get more data? The only problem would be is if it is really recommended to continue/revert back to twice a day we would be way off schedule...
 
Heather Bentley said:
these are the syringes I have...is there another type that would make it more accurate/readable to do smaller dose?
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Definitely! Not only do these not have the half-unit marks (as far as I can tell), but they are 1/2cc in volume. That's going to make it doubly-hard to measure the tiny amounts!

What you want are 0.3cc volume, with half-unit markings. Walmart sells them in the Relion brand (although they are not necessarily clearly marked as having the half-unit markings and the salesperson may not know that they are).

The other option is to buy online. Here are some examples I found on adwdiabetes:

Monoject Ultra Comfort U-100 Insulin Syringes 30G 3/10cc 5/16" 100/bx 1/2 unit
UltiCare U-100 Syringes 31G 3/10cc 6mm 1/2 Unit 100 Count
BD Insulin Syringes 31g 8mm 3/10cc 1/2 Unit Markings 100 Count
 
Heather Bentley said:
New question, his initial dosing schedule was 8am/8pm but due to lower readings I have been skipping AM doses, and because of giving 8pm dose I havent been able to get as much data post shot, SO since I HAVE been only giving once a day dose for last 6 days do you think it would be beneficial to change his schedule and give his insulin mid day so I can get more data? The only problem would be is if it is really recommended to continue/revert back to twice a day we would be way off schedule...
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This is a tough one. In general, Lantus really should be dosed twice a day, but yours is one of the few situations I've seen where a once per day dosing schedule might be appropriate, at least in the short term. I'm worried that he went below 68 last night and unfortunately you weren't able to gather any more tests because it was already so late. Between that and the problems with morning testing, I can see moving to a once per day schedule. Then once you're feeling all the way better :), you can move back to twice per day.

That's my take, but let's hear what others think about this before going ahead with this plan, as it's pretty unusual.
 
Nan & Amber (GA) said:
Definitely! Not only do these not have the half-unit marks (as far as I can tell), but they are 1/2cc in volume. That's going to make it doubly-hard to measure the tiny amounts!

What you want are 0.3cc volume, with half-unit markings. Walmart sells them in the Relion brand (although they are not necessarily clearly marked as having the half-unit markings and the salesperson may not know that they are).

The other option is to buy online. Here are some examples I found on adwdiabetes:

Monoject Ultra Comfort U-100 Insulin Syringes 30G 3/10cc 5/16" 100/bx 1/2 unit
UltiCare U-100 Syringes 31G 3/10cc 6mm 1/2 Unit 100 Count
BD Insulin Syringes 31g 8mm 3/10cc 1/2 Unit Markings 100 Count
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AWESOME-THANK YOU!!:bighug:
 
Nan & Amber (GA) said:
Definitely! Not only do these not have the half-unit marks (as far as I can tell), but they are 1/2cc in volume. That's going to make it doubly-hard to measure the tiny amounts!

What you want are 0.3cc volume, with half-unit markings. Walmart sells them in the Relion brand (although they are not necessarily clearly marked as having the half-unit markings and the salesperson may not know that they are).

The other option is to buy online. Here are some examples I found on adwdiabetes:

Monoject Ultra Comfort U-100 Insulin Syringes 30G 3/10cc 5/16" 100/bx 1/2 unit
UltiCare U-100 Syringes 31G 3/10cc 6mm 1/2 Unit 100 Count
BD Insulin Syringes 31g 8mm 3/10cc 1/2 Unit Markings 100 Count
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What she said
Chewy also has them but they only come in a box of 60. The Walmart ones is what I use now but just know they sell in store only so you cannot order from Walmart online. No prescription needed though
 
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Still hoping for advice/consensus on dosing and schedule, Hwy has now hit the 60's several times in past 48 hours (which I was told is very low for alphatrak 2) I have ordered new syringes to try giving smaller dose but in the meantime I am still confused if I should be dosing at all, once a day as I have for last 7 days (based on numbers/my uncertainty) or attempt to go back to giving small amounts twice per day....? I am also considering if I should dose only once and mid day so I can get more post shot data (assuming it is advised I should keep dosing at all given these low numbers?! SO many variables are confusing me, and my own health issues and his growing aversion to testing is making it difficult to get as many data points as I'd like but I think I have a decent amount...please help, thanks!!
 
Whoa....

You're right, Hwy 99 is not fooling around here!

Did you just get the 63 on your spreadsheet? Could you feed a little high-carb snack (definitely skipping this shot!) and re-test in 30 minutes to make sure he's coming up?

It really does seem like 0.5U is too much for him. I hope the new syringes arrive soon so you can try 0.25U, as even 0.5U once per day is sending him into lime greens every time.

I would not shoot 0.5U again, at least for now. Either try to guesstimate a smaller dose on the current syringes, or skip while you wait for the new ones to arrive. Hitting 63 at pre-shot worries me about where he was overnight-- let's not risk that.

It looks like Hwy 99 is one of the lucky kitties who really benefits from the diet change, almost to the point of remission. Many cats need a period of a little insulin support before going into remission, he's likely to be one of them (his numbers have gone up to 170's and higher several times in the last few days), but he may only need a tiny dose :).
 
thank you, finding a "medium carb food" has been on my long list of things to understand, I went down the rabbit hole of 60 pages of cat foods and carb percentages and I just keep getting lost trying to prioritize/process what information is most pressing! I feel like I just need someone to tell me what to do and what to buy honestly its so frustrating ): I am still leaving out 1/8 cup of his previous primary diet hills dry w/d which is about 30% carb to keep the transitioning process easier on his GI system and he ate/regurgitated about half that some time in the middle of the night...he did eat 1/2 can of the 3% carb pate as I was getting his reading an hour ago (its the only way I can get a reading-he is really hating me and his ears look like a pin cushion) so I am trying to gauge/prioritize at what points of the day getting bg data is really essential right now...do you think I should try again now given he didnt eat a higher carb meal?
 
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Nan & Amber (GA) said:
Whoa....

You're right, Hwy 99 is not fooling around here!

Did you just get the 63 on your spreadsheet? Could you feed a little high-carb snack (definitely skipping this shot!) and re-test in 30 minutes to make sure he's coming up?

It really does seem like 0.5U is too much for him. I hope the new syringes arrive soon so you can try 0.25U, as even 0.5U once per day is sending him into lime greens every time.

I would not shoot 0.5U again, at least for now. Either try to guesstimate a smaller dose on the current syringes, or skip while you wait for the new ones to arrive. Hitting 63 at pre-shot worries me about where he was overnight-- let's not risk that.

It looks like Hwy 99 is one of the lucky kitties who really benefits from the diet change, almost to the point of remission. Many cats need a period of a little insulin support before going into remission, he's likely to be one of them (his numbers have gone up to 170's and higher several times in the last few days), but he may only need a tiny dose :).
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I accidentally replied to the whole thread I think, but .5 already is my best guesstimate with my current syringes and my local pharmacy didnt have the other size so until they come in the mail do you think I should be giving NONE or my best guesstimate of .5?
 
Heather Bentley said:
do you think I should be giving NONE or my best guesstimate of .5?
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NONE, or a best guesstimate of 0.25U. That can be really hard to do without half-unit markings, so you'll most likely be skipping the next few shots. Not ideal, but I just don't want you giving him 0.5U again, given how strongly he has been reacting to that dose.

Sometimes, when a cat has had a deep hypoglycemic event, he is more sensitive to insulin for a while afterwards. That may be what is going on here, he may have gone even lower than you saw at some point in the past couple nights.
 
Ok, I think I feel better about giving him none over continuing to try to guess but I am still really confused, it seems like the advice I have been getting/reading is not to shoot if under 200 but also to give him a small dose (something to do with depot I think-IDK....) so those things seem to conflict with my broken brain, if I shouldnt shoot below 200 then I wouldnt have given him any insulin for past 7 days...can you please advise if one of these things is what I should be doing or should I just keep checking with you guys every day?
 
It's not you, don't worry!

The problem is that Hwy 99 is not really behaving like a typical recently-diagnosed cat right now. Usually, what happens is that the no-shoot question hardly comes up at first, because the numbers are high across the board. By the time they start coming down, everybody is comfortable with testing, the caregiver has a lot of data, and the decline is gradual enough that the no-shoot number can be moved gradually. It's a lot easier to contemplate shooting a 190 after shooting several 225's than it is to shoot 100 only having shot 250's and higher! Shooting token doses can be another good intermediate step, it's just that, again, in this case Hwy 99 is making even intermediate steps doozies!

The general advice is meant to pump the brakes a little bit as this process goes along, giving some guidance about when to use caution, some strategies for dealing with lower-than-usual numbers, when to ask for advice, that kind of thing. Hwy 99 has just been in too much of a hurry for all of that, though!

So, for now, just assume you'll be skipping a few more shots. Have you had a chance to test for ketones yet?
 
thank you, I have to say when he was diagnosed 3 months ago I just blindly did what my vet told me as its taking me so long to process/understand how all these variables relate and are important so for a full 2 months I just blindly did the higher dose insulin once a day with no idea of his actual bg numbers, when I look at his curve done at the vet it makes me wonder why he ever had me at such high doses! I honestly have no idea what his numbers were 2 months ago and how much food has factored in all these changes, its frustrating...but I havent had success getting him to urinate in the beads to collect urine, I do have a friend who said I could borrow her keto mojo meter which is how she tests her blood for ketones, do you think that would work or must it be urine ketones?
 
Nan & Amber (GA) said:
Oh, blood ketone meters are great! They usually take larger drops of blood than BG meters, and the strips are super-expensive so it's frustrating to get an error with not enough blood, but once you get past that, you get an answer immediately. No waiting for the cat to oblige with a sample!
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so according to the keto mojo website the "LO" reading I got just now, it means less less than 0.1 so that is good from what I can tell! Yes expensive, between the keto mojo and alpha trak being 1$ each strip this is definitely going to be expensive, after I get thru these 50 I just bought I will switch to reli on as suggested, but how often should I test his ketones do you think?
thank you so much btw, I feel like I have a personal support person!:bighug:
 
Yay for no ketones!!!

That's a good question about how often to test ketones. I think another test or two while you're skipping doses (assuming it's going to be a few days until the new syringes arrive), then once he's back on insulin you can go to weekly. With any of those tests replaceable by the urine test if he cooperates :cat:.
 
Ok if anyone reads this I really need to know if I should give him a small dose of .25 or nothing at all, I just picked up syringes to make that dose easier to give but Im really confused if he should be getting any insulin at all given his low numbers...I kept reducing dose down to .5 but have skipped the last 3 shots and just now he he is averaging 110 over last 2 days...
 
Still on the AlphaTrak, right? No change to a human meter yet?

Those numbers are within the normal range on an AT. Experienced lantus users might shoot them, but I'm unwilling to recommend you do so at this point.

We aren't quite yet at the next pre-shot time though, right? Maybe he'll come up by then, but if not, just keep watching and testing occasionally until he gives you a pre-shot of at least 150.

If he's over 200 at a pre-shot, you can shoot 0.25. If he gives you a number between 150-200, don't feed his meal and post for help here before shooting.

Note that this is a modification (hopefully simplified!) of the usual instructions, given above, in two ways.

1) we are ditching the "token dose" stuff now that you're down to 0.25U, it's either shoot or don't shoot!
2) instead of the option to feed and wait a couple hours, we will try a shorter (20-30mins) "stall" without food to help us make the decision between 150-200. The reason for this is to help you with your schedule-- shooting a couple hours late means possibly having to monitor a couple hours later than usual, and throws off your schedule for the next several days. Let's try not to do that!
 
thank you, yes still AT (I got a relion today but afraid to introduce yet another variable at this point) so technically his 8pm would have been his preshot time, (nothing has been consistent or regular in weeks though) but since he hasnt had insulin now for 43 hours I was going to move that up to now (assuming it was advised to shoot) that way I could better monitor his post shoot numbers-I just cant stay awake much past 9pm due to my own meds. So he hasnt been in the 200's for past 7 days and has only had a few readings of 170's in that same period of time, I dont imagine if I were to wait 2 more hours he would be up to the 200's based on 116 just now and pattern he has kept this week-I CAN test again in 2 hours if you really think but the problem of me not likely getting data after that holds....so, sorry for being dense
 
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Heather & Hwy 99 said:
thank you, yes still AT (I got a relion today but afraid to introduce yet another variable at this point) so technically his 8pm would have been his preshot time, (nothing has been consistent or regular in weeks though) but since he hasnt had insulin now for 43 hours I was going to move that up to now (assuming it was advised to shoot) that way I could better monitor his post shoot numbers-I just cant stay awake much past 9pm due to my own meds. So he hasnt been in the 200's for past days and has only had a few readings of 170's in that same period of time, I dont imagine if I were to wait 2 more hours he would be up to the 200's based on 116 just now and pattern he has kept this week-I CAN test again in 2 hours if you really think but the problem of me not likely getting data after that holds....so, sorry for being dense
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((((Heather)))) you arent dense you have a lot on your plate. Its confusing sometimes for the best of us. I think youre doing good. :bighug:
 
sorry kitty jumped on keyboard, and I noticed I forgot the 7 in "7 days" above too but given his 116 just now do you think I should skip dose again? Because If I re-test at 8 I just wont be able to get more bg data for the rest of night, honestly I am trying really hard not to go to bed now! Plus Im worried you all wouldnt be reachable then also...thanks for being patient and trying to simplify things for me-I really appreciate it!
 
OK, I think we can call tonight another official skip. Get some sleep!

P.S. You are totally correct. I think we are in different time zones, and it's close enough to my bedtime that I'm about to fall asleep where I'm sitting myself. I'm sure someone will be around at your usual pre-shot time, but almost certainly not me!
 
Hello, checking in today for dosing advice, he was 73 this morning after skipping 5 doses, and 150 just now (+80 hours since last dose) should I continue not shooting when he is under 200? Or dose smaller amount of .25 today? How long does the lantus stay in his system (his last .5 dose was 3 days ago now, is that still factoring in his numbers?)
also I am almost out of Alpha trak 2 strips, I have 10 left and with ALL the variables that have shifted in last 2 weeks (dosage, brand of insulin, skipping multiple days etc) I am hesitant to switch to the reli on brand which is definitely much more affordable on my limited SSDI budget, could you please advise on how often I should be truly be testing at this point and if it really is most beneficial for me to buy another 50 strips for 50$ (again, I have very limited budget but he is definitely a priority for me so if given all the other variables you all recommend I should, I will spend that exorbitant amount! I was able to get a large enough sample earlier to test using the borrowed keto mojo meter (111) the new and untested relion prime(99) and our typical alpha trak 2 (152)-I was concerned at the discrepency of numbers but the all seem to indicate within the "ideal range" from what I have bookmarked, the other strips are 1/4 of the cost so Idk how to determine if that is a reasonable expense....thanks!!!
 

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Heather & Hwy 99 said:
Hello, checking in today for dosing advice, he was 73 this morning after skipping 5 doses, and 150 just now (+80 hours since last dose) should I continue not shooting when he is under 200? Or dose smaller amount of .25 today? How long does the lantus stay in his system (his last .5 dose was 3 days ago now, is that still factoring in his numbers?)
also I am almost out of Alpha trak 2 strips, I have 10 left and with ALL the variables that have shifted in last 2 weeks (dosage, brand of insulin, skipping multiple days etc) I am hesitant to switch to the reli on brand which is definitely much more affordable on my limited SSDI budget, could you please advise on how often I should be truly be testing at this point and if it really is most beneficial for me to buy another 50 strips for 50$ (again, I have very limited budget but he is definitely a priority for me so if given all the other variables you all recommend I should, I will spend that exorbitant amount! I was able to get a large enough sample earlier to test using the borrowed keto mojo meter (111) the new and untested relion prime(99) and our typical alpha trak 2 (152)-I was concerned at the discrepency of numbers but the all seem to indicate within the "ideal range" from what I have bookmarked, the other strips are 1/4 of the cost so Idk how to determine if that is a reasonable expense....thanks!!!
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I’ll let others talk about dosage but it’s acceptable to see a difference of 15-20% between the meters. I know the ReliOn’s readings are higher than my freestyle for instance but I’m okay with that because the strips are so much cheaper and it’s still on the annual list of most reliable meters. I’d suggest you switch to ReliOn and you’ll get used to the readings quickly enough. Pet meters are quite new and before that all that was used for pets was human meters. It’s what we use here when we interpret the numbers. It’s your call in the end but my suggestion especially if money is an issue, is stick with Relion. I’m happy with it and whenever I do compare to freestyle the difference is always within the acceptable range
 
I agree, switch to the relion. Don't buy any more AT strips at that cost. It will be a bit of an adjustment to switch over and get used to the new scale, but I really don't think that you'd get value for money out of another set of the AT strips, given where Hwy99 is right now (more on that below).

On meters: part of the difference in numbers is just what Ale is saying-- the relion's 99 and the keto mojo's 111 are both calibrated for human blood, and the difference is within the allowed variance. They're telling you that the "true" number on this (human) scale is something like 105, probably.

The difference between those numbers and the AT is something else. The AT is calibrated for feline blood, not human. There's no way to convert the numbers between the two, really, except for the borderline for "too low", which is 68 on the AT and 50 on a human meter. In general, the numbers on the AT should be higher than for a human meter-- 150 is about what I'd expect to correspond to a "human scale" number of 100-110.

OK, enough about meters! Now onto dosing.... Believe it or not, I'm going to suggest another skip tonight, unless he somehow skyrockets above 200 at pre-shot.

So, here's more about why I think switching to the relion is a good move at this point. I think that, if Hwy 99 is not actually in remission, he's skating pretty close to the edge, and, more than that, he seems to be pretty comfortable with low numbers. I mean, that 73 was pretty darn low for not having had a shot in 60 hours! This is a very good thing (especially remission, if it happens!), but it can be tricky to manage these last stages the way Hwy 99 is doing it (all at once! very dramatic!) and, frankly, most people here are much more familiar with human meters than the AT. So you will have a much wider group of people to get advice from at this tricky stage, and it will be much easier for us to help you keep him safe.

When to test: test at pre-"shot", and then during the day, if you can, try to get a test 2-3 hours after his "shot" time meal. What we're looking for here are hints that his pancreas is working after mealtimes and bringing numbers down-- just a little more information about what is happening with him.

For shot decisions, use the same guidelines as before (even though you've changed meters). And cross fingers he keeps doing what he's doing, he's looking great!
 
hi again, checking in again for advice after a stressful few days and apparent development of feline hyperesthesia, we went to the urgent care a 3 days ago after I thought a bee must have flown in the house and bit him based on his twitching skin, screaming, hiding under bed...but after hours of observation, allergy injection etc. he came home and proceeded to have another episode and basically its like his rear end has got a mind of its own and its scaring him immensely so I am having a very hard time getting him to come out from under bed, let alone test him but I am atleast the twice a day and he is consistently running very low, like hypo numbers (I am still using alpha trak 2 because the relion kept giving me error messages and I couldnt trust it), I cant get him to eat more than a few treats or come out from under bed to re-test this morning, and the vet is absolutely no help so I am trying to figure out why the low numbers and further investigate the possible root cause of hyperesthesia...Im going to write a separate post on that as I am concerned its related to diabetes/neuropathy but am really concerned about his continued low numbers-at this point he has only had ONE .5 and ONE .25 dose in the last week due to his numbers, he is still getting aprox 15% hills dry w/d daily but mostly fancy feast and wouldnt eat the higher carb canned food this morning I left out after getting the 65
P.S. at the urgent clinic I did ask them to check his ketones and they said he had none, and no glucose in his urine (yay!) but gave me no advice on current dosing or possibilities as to why hyperestesia and were in fact upset that I wasnt following their recommendations of 2 units twice a day!
 
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