NEW MEMBER, August 29th, 2020 feeling scared

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Blaze and Paola said:
The test is 9.8...should I worry? It's rising. Sorry it took me longer.
Click to expand...
That's absolutely fine, Paola, and thanks for confirming the time.

A rise at the end of a cycle is normal as the effects of the insulin dose wane.

Please don't feed anything else for the time being, Paola. You always need to make sure that you don't feed anything for at least two hours before each preshot BG test to make sure the reading isn't food-influenced.

.

.
 
Critter Mom said:
25mmol/L on Alphatrak at the vet's office last week.

Working on the summary table now...

.
Click to expand...
Perfect, I will not feed him and just wait until 7 pm. Shoot at 7:15. Pretest at 6:55 PM. I want to start going backwards in 15 minute increments so that by the time work starts I can have 6:30 AM/6:30 PM schedule instead of 7:30am/7:30 PM. Does this make sense? Am I on the right track?
 
@tiffmaxee -

Here's the summary, Elise (including the correct Lantus dosing information for the previous 4 cycles).


------------------------------------------------------------------------------------
Story So Far --------------------------------- 30 Aug // Updated: BST 22:20
------------------------------------------------------------------------------------

BRIEF Hx
-------------

Dx Date: 27 Aug 2020 (Vet office BG spotcheck 25mmol/L on veterinary meter, glycosuria, PU/PD, polyphagia then inappetence, rapid weight loss - 2lb in prev 2 weeks)

Insulin: Started Lantus 28 Aug AM Cycle // First 4 cycles: 1 IU / 2IU / 2IU / 2IU

Diet: Transition started 3 days ago - switch from Blue Buffalo (mixed wet/dry) to FF Patés in 25% increments.

Ketone Status: Unknown


TODAY
--------
BG Meter Type: Human (OneTouch)

AMPS - ??? (??) // DOSE: 1.0 IU Lantus // First day on 100% FF Paté

+5.25 - 4.1 (74) - Fed 1 tsp FF Paté
+5.75 - 4.5 (81) - Fed 1 tsp FF Paté
+7.00 - 5.1 (92) -
+7.50 - __ ____ - Fed 2 tsp FF Paté
+8.25 - 8.3 (150) -
+9.25 - 9.8 (176) -

-------------------------------------------------------------------------------------------------------


Mogs
.
 
A couple of questions. I am sorry if I am taking up all of your time right now. I truly thank you for your guidance.
This is my understanding so far through our conversations:
1) With the human meter, the TAKE ACTION reading is 5.0 and below, right?
2) With the human meter, if I get readings under 9.0, preshot time, I can lower the dose of insulin...by how much is the reduction supposed to be? (1 Unit is the original amount)
3) With reading above 9.0 (preshot before dinner) the insulin should be given in full, in my case, 1 Unit. I am not sure how I can sleep tonight...do our kitties need to be tested overnight?
4) Tomorrow I have to go into work in my classroom to set up my cart. This will happen in the morning 9-11 am. Then I will be back home at around 11:30 AM. I am home until 1:30. I have physio at 2 and will be back home at 3:15. Then I have to take my other cat to the vet at 5:30 for his own blood work (policythemia reading levels). Probably back home by 6:30. Considering all the testing Blaze needs, will I be able to do all this?
 
Paola,

For a handy record of the feeding today, you can copy the line below to your computer clipboard and paste it into the 'Remarks' column on Blaze's spreadsheet:


+5.25: 4.1 (74) Fed 1 tsp FF Paté // +5.75: 4.5 (81) Fed 1 tsp FF Paté //+7.50 : Fed 2 tsp FF Paté


(It'll be there for you to refer back to if ever you need to remember how you kept Blaze's BG in the safe zone today.)

.
 
Critter Mom said:
Paola,

For a handy record of the feeding today, you can copy the line below to your computer clipboard and paste it into the 'Remarks' column on Blaze's spreadsheet:


+5.25: 4.1 (74) Fed 1 tsp FF Paté // +5.75: 4.5 (81) Fed 1 tsp FF Paté //+7.50 : Fed 2 tsp FF Paté


(It'll be there for you to refer back to if ever you need to remember how you kept Blaze's BG in the safe zone today.)

.
Click to expand...
Thank you, I will do that right now.
 
I was a teacher. Retired now. Busy time since the new year is starting. Will you be going in to school or working from home? It sounds like at school. When is the first day?With all you have going on I think you need to be very conservative with dosing. At time in the cycle that you test and get a reading under 90 on the US numbers, you reduce by .25. I should know by now what that means in world numbers but I don’t so someone needs to tell me. The dose should be cut to .50 now that the dry is gone. That one change can make a huge difference in the bg. An argument could be made to go to .75 and others can chime in if that’s what they think. With yiur busy day tomorrow you won’t be able to test a lot.

Cats do often go lower at night than during the. My cat did. If you get a test at +2 (2 hours after insulin) you will likely get an idea as to how many tests after that will be needed. If it’s lower than PMPS it might be an active cycle where more testing will be needed. If a lot higher then not as many tests. This will change as you gather data. Lots of people get auto feeders and set them to open during the night so that they can sleep.

Tonight he very well could be high and you won’t need to test a lot.

Others please chime in.
 
tiffmaxee said:
I was a teacher. Retired now. Busy time since the new year is starting. Will you be going in to school or working from home? It sounds like at school. When is the first day?With all you have going on I think you need to be very conservative with dosing. At time in the cycle that you test and get a reading under 90 on the US numbers, you reduce by .25. I should know by now what that means in world numbers but I don’t so someone needs to tell me. The dose should be cut to .50 now that the dry is gone. That one change can make a huge difference in the bg. An argument could be made to go to .75 and others can chime in if that’s what they think. With yiur busy day tomorrow you won’t be able to test a lot.

Cats do often go lower at night than during the. My cat did. If you get a test at +2 (2 hours after insulin) you will likely get an idea as to how many tests after that will be needed. If it’s lower than PMPS it might be an active cycle where more testing will be needed. If a lot higher then not as many tests. This will change as you gather data. Lots of people get auto feeders and set them to open during the night so that they can sleep.

Tonight he very well could be high and you won’t need to test a lot.

Others please chime in.
Click to expand...

I am very anxious to be going back to work. We are going back 100% in class. The first day of school is September 8th. Please let me know if I should consider my regular dose NOT 1.0 anymore but 0.5. Dry food has been eliminated yes. I am doing the same with my other cat Ash...am I hurting him by feeding him only wet as well, considering he is not diabetic (tomorrow will know for sure on that front though). Do automatic feeders exist for wet food?
 
Blaze and Paola said:
I am very anxious to be going back to work. We are going back 100% in class. The first day of school is September 8th. Please let me know if I should consider my regular dose NOT 1.0 anymore but 0.5. Dry food has been eliminated yes. I am doing the same with my other cat Ash...am I hurting him by feeding him only wet as well, considering he is not diabetic (tomorrow will know for sure on that front though). Do automatic feeders exist for wet food?
Click to expand...
Yes. I think your new dose for the week should be .50 unless others disagree. It won’t hurt your other cat provided he likes the food too. If it becomes an issue there are low carb dry foods which is okay with SLGS. There’s Dr. Elsey’s. You can put wet food in an auto feeder. I used to leave food out all day when I was working which was before Max became diabetic.
 
Blaze and Paola said:
I am very anxious to be going back to work. We are going back 100% in class. The first day of school is September 8th. Please let me know if I should consider my regular dose NOT 1.0 anymore but 0.5. Dry food has been eliminated yes. I am doing the same with my other cat Ash...am I hurting him by feeding him only wet as well, considering he is not diabetic (tomorrow will know for sure on that front though). Do automatic feeders exist for wet food?
Click to expand...
Yes. I think your new dose for the week should be .50 unless others disagree. It won’t hurt your other cat provided he likes the food too. If it becomes an issue there are low carb dry foods which is okay with SLGS. There’s Dr. Elsey’s. You can put wet food in an auto feeder. I used to leave food out all day when I was working which was before Max became diabetic.
 
tiffmaxee said:
The dose should be cut to .50 now that the dry is gone. That one change can make a huge difference in the bg. An argument could be made to go to .75 and others can chime in if that’s what they think. With yiur busy day tomorrow you won’t be able to test a lot.
Click to expand...
I support the conservative dose of 0.50 IU Lantus:

* Four Lantus doses prior to this morning's, the 3 most recent at @ 2.0IU.
* Yesterday's dry food may still be influencing BG levels.
* Dose reduction earned today per SLGS.
* No wriggle room at nadir on today's AM cycle.
* Not able to monitor as closely tomorrow.
* Risk of GI upset following food transition.


Mogs
.
 
Both my cats do not like the low carb treats I bought...the dried up pieces of tuna or chicken. They won't eat it. They only like the Purina Party Mix but I am sure it is not indicated at this point with Blaze's condition.
 
Critter Mom said:
I support the conservative dose of 0.50 IU Lantus:

* Four Lantus doses prior to this morning's, the 3 most recent at @ 2.0IU.
* Yesterday's dry food may still be influencing BG levels.
* Dose reduction earned today per SLGS.
* No wriggle room at nadir on today's AM cycle.
* Not able to monitor as closely tomorrow.
* Risk of GI upset following food transition.


Mogs
.
Click to expand...
So considering he earned a dose reduction, I should only give .25 tonight?
 
tiffmaxee said:
So multiply by about 16. Got it.
Click to expand...
18, not 16.

tiffmaxee said:
Yes. I think your new dose for the week should be .50 unless others disagree.
Click to expand...
I concur with the 0.5 unit dose.
No one knows what the start of the school year will be like. There are new government of Ontario directives, school board directives, the various union regulations, the parents, the kids … and then there will be so many meetings.
The dry food could still be a factor in the numbers we are seeing.
SLGS for now until the above two factors are ironed out.

And thank you, my lovelies @Critter Mom @Aleluia Grugru & Minnie and @tiffmaxee for helping out today. Muah.
 
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@Blaze and Paola read all the yellow sticky notes on the Lantus forum. This is the important one for you when it comes to dosing. Bookmark this:

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

from above link:
Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

How to handle a lower than normal preshot number:

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.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

:cat:
 
Hi Paola
I am very new to having a diabetic kitty too and just wanted to say wow at how well you have done today !
You mentioned right at the start about the pulling back the syringe to check u r not seeing blood at the site before you give the injection - I saw the same videos as you must have done & asked my vet this. He said there was no real need to do this, you would be very unlucky to hit the vein and if you did happen to inject in it wouldn't do any real harm unless you were on a large dose (as insulin is not given intravenously). Indeed if you look at the demo vids for the vetpens, not that I've tried one, there is no possible way to even do that check with one of those so it obviously wasn't that important. Some one will yell up if I am wrong.
I also bought the alphatrak2 meter on the vet's recommendation - I find it good in that it only needs the teeniest bit of blood which is handy as testing Mac is a wrestling match. But everyone is right in just how very expensive the strips are - they work about £1 a strip. :nailbiting: Think the UK needs a Walmart !!
Anyway all the best to you & Blaze & well done for finding the best support group ever

Gill
 
Aleluia Grugru & Minnie said:
@Blaze and Paola read all the yellow sticky notes on the Lantus forum. This is the important one for you when it comes to dosing. Bookmark this:

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

from above link:
Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

How to handle a lower than normal preshot number:

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.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.

:cat:
Click to expand...
Thank you so much for finding these links for me. I have printed this out and bookmarked it as well.
 
Gill & Mac (UK) said:
Hi Paola
I am very new to having a diabetic kitty too and just wanted to say wow at how well you have done today !
You mentioned right at the start about the pulling back the syringe to check u r not seeing blood at the site before you give the injection - I saw the same videos as you must have done & asked my vet this. He said there was no real need to do this, you would be very unlucky to hit the vein and if you did happen to inject in it wouldn't do any real harm unless you were on a large dose (as insulin is not given intravenously). Indeed if you look at the demo vids for the vetpens, not that I've tried one, there is no possible way to even do that check with one of those so it obviously wasn't that important. Some one will yell up if I am wrong.
I also bought the alphatrak2 meter on the vet's recommendation - I find it good in that it only needs the teeniest bit of blood which is handy as testing Mac is a wrestling match. But everyone is right in just how very expensive the strips are - they work about £1 a strip. :nailbiting: Think the UK needs a Walmart !!
Anyway all the best to you & Blaze & well done for finding the best support group ever

Gill
Click to expand...
Thank you so much Gill. I love my cats like they are my kids. I don't have human kids of my own, they are my everything. It's been the most stressfull learning curve day for me ever but I am starting to understand a little bit more. Still confused on some stuff but I will email here if I need help. This group is fantastic and that word doesn't even make justice
 
Because my cats do not like the dried up tuna and chicken pieces as a treat, what else could I give them. The only thing I have here, that I used to give to them sometimes that they absolutely love is the Purina Party Mix. Is that acceptable as a treat (2, 3 pieces max).
 
Blaze and Paola said:
A couple of questions. I am sorry if I am taking up all of your time right now. I truly thank you for your guidance.


This is my understanding so far through our conversations:

1) With the human meter, the TAKE ACTION reading is 5.0 and below, right?
2) With the human meter, if I get readings under 9.0, preshot time, I can lower the dose of insulin...by how much is the reduction supposed to be? (1 Unit is the original amount)
3) With reading above 9.0 (preshot before dinner) the insulin should be given in full, in my case, 1 Unit.
Click to expand...
No. To clarify:

On a HUMAN meter -
-------------------------

TAKE ACTION number: 2.8 mmol/L (50mg/dL in US numbers)

DOSE REDUCTION threshold (SLGS): Reduce dose by 0.25IU if at any time you get a reading BELOW 5.0 mmol/L (90mg/dL US numbers)

NO SHOOT LIMIT: When starting treatment and little data is available DO NOT GIVE ANY INSULIN IF PRESHOT BG IS LOWER THAN 11.1 mmol/L (200mg/dL US numbers)*

(*Ketone-prone cats, especially those recovering from an episode of diabetic ketoacidosis (DKA, a complication of diabetes) should seek immediate advice about insulin dose since it's not a simple case of skipping a dose: the cat's ketone status must be taken into consideration and a token dose of insulin may be needed.)

I am not sure how I can sleep tonight...do our kitties need to be tested overnight?
Click to expand...
Sometimes. Insulin pyjama parties are a thing. ;)

Considering all the testing Blaze needs, will I be able to do all this?
Click to expand...
On 'calmer' days, Blaze will be on a dose better suited to his current insulin needs. As more BG and dosing data accumulates in Blaze's spreadsheet, it will give you far more visibility of how Blaze responds to insulin and the safety and efficacy of the dose.

Today he went a bit on the low side (and well done for catching it!) so you did extra testing, feeding a little as required, to make sure Blaze stayed in safe numbers. On 'calmer' days, you need to get the AM and PM preshot tests (to make sure BG is high enough to give insulin safely) and at least one one mid-cycle test to check how low the dose is taking Blaze (to determine whether it needs to be adjusted).

And as to whether you'll be able to do this, Paola, you handled today's events like a pro and you're a very quick study. You'll fly it. :D


Mogs
.
 
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