02/23 Eddie AMPS 193 +3 322 +8 310 PMPS 394 +5 376

[Jodey&Eddie&Blue]

Good morning, although I've had so little sleep since PMPS 02/23 that I'm a bit challenged cognitively.

Here's the story:

https://felinediabetes.com/FDMB/thr...5-41-3-25-70-4-112-6-169.274491/#post-3048184

If you read the events of last night you'll see that there's a question of whether or not I should have stalled when Eddie's PMPS was 49. I did stall according to the Stickies on Data Ready to Shoot with Low Preshot numbers and the Don't Panic.

I use an AlphaTrak and the point will be if that's the case how do I handle low preshot? I didn't really panic but thought I was doing the right thing. Eddie's BG came up and so I took the shot. That was probably a mistake. I should have reduced but I saw that I had shot a 92 before (which is where the stalling brought him to) and so carried on with the shot.

Eddie's also on Levemir and his nadirs are not as predictable as when he was on Lantus. He's also had SRT and that can contribute to a decrease in the need for insulin as the radiation does its work. I'm concerned in this regard as Eddie's Prednisolone dose will probably be decreased from 2.5mg BiD to half that next week. You can see where I'm going with this. If I'm not to follow the Stickies (and continue to use AlphaTrak) am I flying blind? How is anyone to advise me if he goes so low as for me to post a 911?

This was quite intense. Eddie was fine throughout, however. He just kept showing up on the rug for his test and enjoying the HC snacks. I'm glad he's started the day in a safe way.

 

[carfurby (GA)]

I'm glad Eddie came back up last night. I hope he surfs safely today.

 

[Jodey&Eddie&Blue]

So, AM +3 322: going up between +3 and +5 is not unusual with Levemir. That's why I don't test until later in cycle but because of yesterday PM event, I thought I'd just check now.

 

[Jodey&Eddie&Blue]

An interesting day. Start blue and leap over yellows into magenta. But AM+8 lower than AM +3.

Are we heading back to yellow?

 

[JL and Chip]

f you read the events of last night you'll see that there's a question of whether or not I should have stalled when Eddie's PMPS was 49.

So just to clarify my comments from last night regarding what you should do if you see a BG in the 40s on an AlphaTrak (or any other pet meter):

- Stall feeding? No.
Normal range on an AT is 70-130. The “take action” number for a pet meter is widely quoted around here as 68. “Take action,” to me, means do something immediately to get the BG back up into normal range and out of the danger zone. I would never, ever tempt fate with a number that low (49) and wait and see whether the BG comes up on its own. Again, we’re talking in the context of a pet meter here.

- Stall shooting? Yes.
I would never recommend someone shoot a BG that is so clearly in hypo territory. Too dangerous. Don’t know where the BG has been leading into that value and where it’s heading. Again, that 40s number was well below the threshold of hypo territory on a pet meter. There’s just no margin for error.

I did stall according to the Stickies on Data Ready to Shoot with Low Preshot numbers and the Don't Panic.

I use an AlphaTrak and the point will be if that's the case how do I handle low preshot?

As has already been pointed out, the TR protocol was developed using human meters and the guidelines refer to how to handle situations if you see those BG values on a human meter, NOT on a pet meter. Human meters tend to run lower than a pet meter, so relying on guidance designed for a human meter can put your cat at grave risk (for example, 49 on an AT might be 28 on a human meter, or 34, or whatever; we really don’t know unless you do a side by side test with both meters and, even then, it applies only to that one test). You just can’t take the guideline numbers literally if you use a pet meter.

There is no conversion between a human and pet meter.

That said, you asked what you should do in such a scenario. I would suggest that the “spirit” of the guidelines are valid, even though you can’t lean on the exact BG numbers quoted. What I mean by that is that if you’re going to continue using an AT, you always have to be mindful that any numbers you see referenced in the guidelines have a figurative asterisk next to them that says “on a human meter” and that those exact numbers don’t apply to your situation. You’d need to evaluate what you believe to be roughly equivalent, which is a tricky path to go down. Just know that pet meters read higher, so if the guidelines say you can choose to stall with a numbers in the 40s on a human meter (where low end of normal is often quoted as being 50 or even in sometimes 40s), then it is clearly not safe to do so on a pet meter (where low end of normal is considered as 70).

I have general in my head about how I might handle such situations but the devil is in the detail. The bottom line is I think one should always err on the side of safety. Better to have the BG too high for a day than too low for a moment (and yes, I’ve witnessed a cat die from a hypo and go from no symptoms to seizures and death very quickly, despite intervention).

And finally, you’re also dealing with Eddie being post-SRT, a potentially lowered dose of prednisolone soon, and maybe IAA (though I’m hoping that’s less of a variable now). Wendy once mentioned she used a higher reduction number (70 on a human meter?) for Neko, and that makes sense to me. Because of the variables, I’m relieved you are going with SLGS (if you still are) for now and being cautious, reducing dose under 90.

Hey, all of this is my opinion. Not sure if it’ll help you, but hopefully you can avoid repeats of last night. None of us need any more gray hairs.

 

[Jodey&Eddie&Blue]

So just to clarify my comments from last night regarding what you should do if you see a BG in the 40s on an AlphaTrak (or any other pet meter):

- Stall feeding? No.
Normal range on an AT is 70-130. The “take action” number for a pet meter is widely quoted around here as 68. “Take action,” to me, means do something immediately to get the BG back up into normal range and out of the danger zone. I would never, ever tempt fate with a number that low (49) and wait and see whether the BG comes up on its own. Again, we’re talking in the context of a pet meter here.

- Stall shooting? Yes.
I would never recommend someone shoot a BG that is so clearly in hypo territory. Too dangerous. Don’t know where the BG has been leading into that value and where it’s heading. Again, that 40s number was well below the threshold of hypo territory on a pet meter. There’s just no margin for error.



As has already been pointed out, the TR protocol was developed using human meters and the guidelines refer to how to handle situations if you see those BG values on a human meter, NOT on a pet meter. Human meters tend to run lower than a pet meter, so relying on guidance designed for a human meter can put your cat at grave risk (for example, 49 on an AT might be 28 on a human meter, or 34, or whatever; we really don’t know unless you do a side by side test with both meters and, even then, it applies only to that one test). You just can’t take the guideline numbers literally if you use a pet meter.

There is no conversion between a human and pet meter.

That said, you asked what you should do in such a scenario. I would suggest that the “spirit” of the guidelines are valid, even though you can’t lean on the exact BG numbers quoted. What I mean by that is that if you’re going to continue using an AT, you always have to be mindful that any numbers you see referenced in the guidelines have a figurative asterisk next to them that says “on a human meter” and that those exact numbers don’t apply to your situation. You’d need to evaluate what you believe to be roughly equivalent, which is a tricky path to go down. Just know that pet meters read higher, so if the guidelines say you can choose to stall with a numbers in the 40s on a human meter (where low end of normal is often quoted as being 50 or even in sometimes 40s), then it is clearly not safe to do so on a pet meter (where low end of normal is considered as 70).

I have general in my head about how I might handle such situations but the devil is in the detail. The bottom line is I think one should always err on the side of safety. Better to have the BG too high for a day than too low for a moment (and yes, I’ve witnessed a cat die from a hypo and go from no symptoms to seizures and death very quickly, despite intervention).

And finally, you’re also dealing with Eddie being post-SRT, a potentially lowered dose of prednisolone soon, and maybe IAA (though I’m hoping that’s less of a variable now). Wendy once mentioned she used a higher reduction number (70 on a human meter?) for Neko, and that makes sense to me. Because of the variables, I’m relieved you are going with SLGS (if you still are) for now and being cautious, reducing dose under 90.

Hey, all of this is my opinion. Not sure if it’ll help you, but hopefully you can avoid repeats of last night. None of us need any more gray hairs.

So just to clarify my comments from last night regarding what you should do if you see a BG in the 40s on an AlphaTrak (or any other pet meter):

- Stall feeding? No.
Normal range on an AT is 70-130. The “take action” number for a pet meter is widely quoted around here as 68. “Take action,” to me, means do something immediately to get the BG back up into normal range and out of the danger zone. I would never, ever tempt fate with a number that low (49) and wait and see whether the BG comes up on its own. Again, we’re talking in the context of a pet meter here.

- Stall shooting? Yes.
I would never recommend someone shoot a BG that is so clearly in hypo territory. Too dangerous. Don’t know where the BG has been leading into that value and where it’s heading. Again, that 40s number was well below the threshold of hypo territory on a pet meter. There’s just no margin for error.



As has already been pointed out, the TR protocol was developed using human meters and the guidelines refer to how to handle situations if you see those BG values on a human meter, NOT on a pet meter. Human meters tend to run lower than a pet meter, so relying on guidance designed for a human meter can put your cat at grave risk (for example, 49 on an AT might be 28 on a human meter, or 34, or whatever; we really don’t know unless you do a side by side test with both meters and, even then, it applies only to that one test). You just can’t take the guideline numbers literally if you use a pet meter.

There is no conversion between a human and pet meter.

That said, you asked what you should do in such a scenario. I would suggest that the “spirit” of the guidelines are valid, even though you can’t lean on the exact BG numbers quoted. What I mean by that is that if you’re going to continue using an AT, you always have to be mindful that any numbers you see referenced in the guidelines have a figurative asterisk next to them that says “on a human meter” and that those exact numbers don’t apply to your situation. You’d need to evaluate what you believe to be roughly equivalent, which is a tricky path to go down. Just know that pet meters read higher, so if the guidelines say you can choose to stall with a numbers in the 40s on a human meter (where low end of normal is often quoted as being 50 or even in sometimes 40s), then it is clearly not safe to do so on a pet meter (where low end of normal is considered as 70).

I have general in my head about how I might handle such situations but the devil is in the detail. The bottom line is I think one should always err on the side of safety. Better to have the BG too high for a day than too low for a moment (and yes, I’ve witnessed a cat die from a hypo and go from no symptoms to seizures and death very quickly, despite intervention).

And finally, you’re also dealing with Eddie being post-SRT, a potentially lowered dose of prednisolone soon, and maybe IAA (though I’m hoping that’s less of a variable now). Wendy once mentioned she used a higher reduction number (70 on a human meter?) for Neko, and that makes sense to me. Because of the variables, I’m relieved you are going with SLGS (if you still are) for now and being cautious, reducing dose under 90.

Hey, all of this is my opinion. Not sure if it’ll help you, but hopefully you can avoid repeats of last night. None of us need any more gray hairs.

Hey, JL, would you kindly remind me of how to reply to specific areas of a post such as you've done with my original post. Wendy told me once awhile back and I can't recall or can't find that info...

 

[JL and Chip]

Hey, JL, would you kindly remind me of how to reply to specific areas of a post such as you've done with my original post. Wendy told me once awhile back and I can't recall or can't find that info...

Highlight the area you want to reply to, then click on the “reply” bubble that pops up over the highlighted text. (At least that’s how I do it on my cell phone)

 

[Jodey&Eddie&Blue]

Stall feeding? No.
Normal range on an AT is 70-130. The “take action” number for a pet meter is widely quoted around here as 68. “Take action,” to me, means do something immediately to get the BG back up into normal range and out of the danger zone. I would never, ever tempt fate with a number that low (49) and wait and see whether the BG comes up on its own. Again, we’re talking in the context of a pet meter here.

Ok, well I see where I was really taking wrong action here. I do know that the AT / human meters are different but somehow it did not translate into that different.

- Stall shooting? Yes.
I would never recommend someone shoot a BG that is so clearly in hypo territory. Too dangerous. Don’t know where the BG has been leading into that value and where it’s heading. Again, that 40s number was well below the threshold of hypo territory on a pet meter. There’s just no margin for error.

Ok, I agree. I would never shoot with a 41 but as I followed the sticky to see if the numbers would rise, they did and when I shot he was at 92, so I thought it was ok. You can see where I might take that route since he was at 92 at AMPS on the morning of the 19th. I was reading last night's rise to 92 as getting out of the danger zone and it was ok (in my mind) because he got to 92 without any food. Phew.

As has already been pointed out, the TR protocol was developed using human meters and the guidelines refer to how to handle situations if you see those BG values on a human meter, NOT on a pet meter. Human meters tend to run lower than a pet meter, so relying on guidance designed for a human meter can put your cat at grave risk (for example, 49 on an AT might be 28 on a human meter, or 34, or whatever; we really don’t know unless you do a side by side test with both meters and, even then, it applies only to that one test). You just can’t take the guideline numbers literally if you use a pet meter.

There is no conversion between a human and pet meter.

That said, you asked what you should do in such a scenario. I would suggest that the “spirit” of the guidelines are valid, even though you can’t lean on the exact BG numbers quoted. What I mean by that is that if you’re going to continue using an AT, you always have to be mindful that any numbers you see referenced in the guidelines have a figurative asterisk next to them that says “on a human meter” and that those exact numbers don’t apply to your situation. You’d need to evaluate what you believe to be roughly equivalent, which is a tricky path to go down. Just know that pet meters read higher, so if the guidelines say you can choose to stall with a numbers in the 40s on a human meter (where low end of normal is often quoted as being 50 or even in sometimes 40s), then it is clearly not safe to do so on a pet meter (where low end of normal is considered as 70).

I think if anything, I can work in the "spirit" of the guidelines by extrapolating from last night, including the numbers. Again, I did know about the "human meter" issue but that discrepancy has never had quite the consequence as it did last night. Lesson learned. Amen. And thank you.

One of the reasons I use the AT, besides the small blood drop amount needed, is that all the vets around here use the AT, like the only emergency vet in the Okanagan, for example, and the regular vet and internal medicine vet. I can't imagine having to call emergency with numbers on a human meter if there is no conversatin between a human and pet meter!! I recall some years ago when Blue was fresh out of treatment (Eddie hadn't even been diagnosed with acromegaly) and I got up in the night and checked him because when I awoke I had the oddest feeling that "something" wasn't right. I tested him and I recall vividly being shocked that he was at 2.6! I immediately got Karo syrup into him and called the emergency vet, brought him in and they put him on fluids. I wasn't a member of FDMB and didn't even know about it. All I knew was to give syrup and I thought I had to take him to the hospital.

Anyway, thanks for clarifying the sticky vs what's happening here on the ground.

Anyway, you're right about the SRT and the Prednisolone. I'm going to be on even higher alert with Eddie that's for sure.

 

[Wendy&Neko]

I personally never called my vet with BG numbers, except at the very beginning of Neko's FD journey, and the vet was using a Onetouch. (human meter). After then when I dealt with a vet who used AT (dental vet, emergency, IM) I told them my numbers but that they were from a human meter due to the cost of test strips. End of story. None of them were so young they hadn't dealt with human meters at some point in their career. Truthfully, I was never in discussion with any of those vets where Neko's BG mattered.

OK, onto the sticky. Did you read the part that said "there is no one-size-fits all answer, but there are some general guidelines." One of the most important of those guidelines, emphasis mine:
If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative

Last night's +12 test fits that, it was time to be conservative. Plus, Eddie had hit the 40's on the AT on 15 units not that long ago, it's not surprising he was that low on 14.75 units. And yesterday was also the sixth cycle after the 92 on the AM of 2/19, prime for bounce breaking action. Eddie is just 4 months since SRT. All signs for caution.

Regarding the section on seeing the 40's (human meter) at shot time. Think of the 40's (human meter) as "just under the reduction point" and also some cats not on insulin register in the 40's (human meter). 40's on the AT is way below the reduction point or a valid BG for cats not on insulin. For reference, I think you have another non diabetic cat in the house you could test? The option to stall for a short period of time may be valid if just under the reduction point. Unfortunately we cannot provide guidance for what the equivalent to 40's on a human meter is for the AT, that is why the Sticky Note says the use of pet meters is discouraged.

For tonight, keep in mind that you just shot the reduced dose today. The depot of the dose that got him into the 40's could still be influencing a few cycles going forward.

 

[Jodey&Eddie&Blue]

OK, onto the sticky. Did you read the part that said "there is no one-size-fits all answer, but there are some general guidelines." One of the most important of those guidelines, emphasis mine:
If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative

Yes, I have read that but there's been little "normal" about Eddie in the first place with the latest SRT. So, I followed what I thought was the case. Again and obviously, I was wrong.

Last night's +12 test fits that, it was time to be conservative. Plus, Eddie had hit the 40's on the AT on 15 units not that long ago, it's not surprising he was that low on 14.75 units. And yesterday was also the sixth cycle after the 92 on the AM of 2/19, prime for bounce breaking action. Eddie is just 4 months since SRT. All signs for caution.

Yes, and I was trying to be cautious. For one thing, you had mentioned on Monday that "At least you know this dose gets him to green" and I was taking that to mean "carry on". Again, mea culpa.

Regarding the section on seeing the 40's (human meter) at shot time. Think of the 40's (human meter) as "just under the reduction point" and also some cats not on insulin register in the 40's (human meter). 40's on the AT is way below the reduction point or a valid BG for cats not on insulin. For reference, I think you have another non diabetic cat in the house you could test? The option to stall for a short period of time may be valid if just under the reduction point. Unfortunately we cannot provide guidance for what the equivalent to 40's on a human meter is for the AT, that is why the Sticky Note says the use of pet meters is discouraged.

Well, it looks like the use of pet meters is not only discouraged but also a liability when it comes to negotiating the world of FDMB. I don't know if the meter differences have become this much of an issue before since I can identify other 911 moments in 2022 where the readings of the AT weren't in question.
It seems in spite of what I try to do for Eddie and Blue, I'm frequently lacking. I can say I'm doing my best but perhaps I need to rethink what I'm doing, especially since I'm not really as proficient in reading patterns in the spread sheet.