Nacho and the Libre - tricks for manual tests?

D & Nacho

D & Nacho

Member
I've on and off used the Libre Freestyle 3 on Nacho but we've been running into many different issues with it and have been losing data.

We're just starting to be able to get Nacho to semi-tolerate a manual test (using Relion), but curious if anyone has any tips on how to make it easier? He just doesn't bleed very easily!

@Suzanne & Darcy -- new thread, as requested :)
 
How’s it going? Here are some suggestions I recently gave to another ProZinc person on the. PZ forum….

Many people use a rice sock that they microwave to warm it - and hold it against the cat’s ear for a few minutes. I used warm/hot water in a small glass bottle that I happened to have. Some people will use an empty pill bottle with warm water in it. After a while my cat’s ears bled a lot more easily. This happens as they build up their capillary bed. It does get easier, I promise.

Also the size of the lancet that you are using makes a difference. At first, it’s easier to get blood using a larger lancet. After her ears start to bleed more easily, you can switch to the ultra-fine lancets. I also never used the lancing device because it makes that loud (next to the ear) clicking noise. I would not use a syringe because the small “handle” of the lancet is easier to manipulate. Try to go into the ear at a 45 degree angle with the lancet.

Another thing that can help in the beginning is to put a small amount of vaseline (petroleum jelly) on Fidget’s ear. This can really help the drop of blood to bead up instead of flowing into the fur on her ear. Then your test strip can “sip” up the blood drop. And I think I may have mentioned “milking” the ear to gently squeeze a drop of blood after you poked it. And another thing I just thought of (sorry this is so rambling) is that you can scrape the blood drop onto the top of your thumbnail and hold the test strip to that drop (as long as your hands/nails are really clean, of course.). These are just a few of the things I just thought of that may help you. You will find what works for you, and Fidget sounds like the sweetest cat ever!
 
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And I am so sorry it took me this long to get you a few tips. I am hoping you have found a way that works with Nacho.
 
Wow. Those Libre sensors really are giving you trouble, aren’t they. I just checked his spreadsheet and…. sooo many blanks.
 
Here’s another idea for Nacho …. I just took a screenshot of a suggestion of another way to get a test if it’s just one person doing it alone:
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Hi @Suzanne & Darcy! Sorry I didn't see that you had replied! I'm so over the Libre sensor. He managed to keep it on through the long holiday weekend, which was our goal as we were having guests and out a lot. He managed to get it off this morning.

We've gotten the hang of drawing blood! His numbers are so much better than what the Libre reports. There can be anywhere from a 150-50 difference, with the sensor reading high. I wonder if he's actually been in better shape all these weeks than what we were seeing. We're going to continue doing as many manual tests per day that we can, and probably save the Libre for when we won't be able to test / monitor. It seems like holding him at 3 units is working for him.
 
Hi. I would encourage you to gradually get used to shooting his lower preshot numbers with a little more insulin. When he gets only a tiny dose, his numbers increase really rapidly. You can gradually increase the amount you shoot and just be sure to test so that you can see what happened- or it will just be a wasted exercise if we don’t get to gather data on how he does when starting with a lower preshot. The goal is to be able to shoot lower numbers, but safely of course. Today I probably would have tried 1 unit and then gotten tests to see how that went. If he still went high, I would know that next time I could try a little more insulin if he has a similar preshot test.
 
Yeah we realize he does need more insulin in those times and will make teeny increases as we go. The rules of the thumb on shooting low numbers are a little confusing, so we've definitely played it safe.

The notes about 10-25% -- do they mean REDUCE by 10-25% or give 10-25% of the usual dose? Also have seen some notes on the forum that say give 50% of the dose!
 
It’s hard to make blanket statements about how much to shoot when you have a lower than expected preshot. The guidelines are for safety when people are shooting without the guidance of others here on the forum. Also, it depends on the cat and his/her patterns (some cats are real divers, for example) and very much depends on how much data we have. When I make recommendations on how much to shoot with a lower than expected preshot, I need to look at the data from the spreadsheet. If we don’t have much data, we choose a lower amount of maybe 50 percent of the dose or even less (1/4?) I also have to take into consideration whether the caregiver is going to be able to monitor the cycle or if they won’t be home. In addition, I also take into consideration how nervous the caregiver is - have they ever had a lower preshot before, etc? Then there are other factors like… are ketones present and is there a history of DKA. So there isn’t one cookie cutter answer for shooting low numbers, but it’s always best to start smaller and gather data and work your way up.
 
This evening I gave him 2 units at BG 199 pre shot and he still went up to the 300s in a couple hours. Seems like I could give him a full dose if he’s around that in the future?
 
Hi there! How is Nacho doing? His numbers look better on 3.25 units. It’s looking like he could have handled the full dose today. We hope to find a dose that is shootable on most days.
 
Hi @Suzanne & Darcy! Seems like Nacho is improving! Other than him getting into some contraband snacks the other day, we've been very pleased with the trajectory of his numbers and are getting way more comfortable with shooting under 200 (this morning! so far all is good). Seems like he might be okay with 3.5, but my gut says to hold him for a bit. He's due for a re-check at the vet soon, and they have been considering switching insulin (not sure to which kind yet)... but as we've been making progress on him, I'm kind of hesitant to start over from scratch.
 
@Suzanne & Darcy -- if you are on today, could you take a look at nacho's spreadsheet? We increased him to 3.5 this morning and he got into the green really quickly! As I write, we are currently at +8 of AMPS and I'm trying to prepare myself to make a decision about his PM dosage due to his low numbers today...
 
Hey. Sorry I never saw this. I was out of town all last week. I see he is doing better on a more consistent dose of 3.5 units. I was wondering what he ate this morning to spike him up so much by +2.

What kind of meter are you using now to test him? I hope he’s feeling good (and Taco, too, of course!)
 
Hi @Suzanne & Darcy! Nacho eats Weruva Paw Lickin' Chicken for breakfast and Weruva Meal or No Deal for dinner, every day. He sometimes does spike up around +2 both morning and evening; I figure it's previous insulin finally wearing out... seems like there could be a decent gap between "old" insulin wearing off and "new" insulin kicking in.

We're mostly using the Freestyle Lite meter as it requires the smallest amount of blood that we've found so far. If we are waiting on a shipment of the Freestyle test strips, we switch to the KetoMojo since the same meter tests both BG and ketones (depending on the strips)

He's been feeling pretty good other than a bout of vomiting a couple days last week. He has a recheck tomorrow at the vet. They'll tell me to keep his dosing as-is with Prozinc or perhaps continue to push to switch him to Glargine (... I don't see a group for that insulin??)

Do you think that increasing to 3.75 is worth a shot?
 
Well those foods are really low carb so it definitely must be just the old insulin shot wearing off and the new shot kicking in.

Yes, we have a forum that is dedicated to Lantus/Levemir/Biosimilars (meaning there are a lot of generic biosimilar insulins to Lantus. Lantus is just the brand name for insulin glargine.
 
I wouldn’t increase to 3.75 until holding 3.5 for at least 6 cycles to see how the dose settles in. That would be as per the Modified ProZinc Method and not the SLGS method.
 
He's been at 3.5 since August 3. Where you see 3.25 are on days that he dipped below 90 as he earned the reduction, per the SLGS method, no? Now I'm a little confused about modified prozinc method vs slgs... which one am I doing or am I creating a hybrid? lol
 
Yes. But when a reduction is earned then the new dose going forward is reduced by .25 (it’s not just a temporary reduction.). So you hold the new (reduced) dose until an increase or another reduction is necessary. I hope that makes sense.
 
So for example on August 7 when he dropped below 90, his dose should have been reduced to 3.25 and then help at 3.25 for 7 cycles if following SLGS or 6 cycles if following MPM. Of course if the cat falls below 90 again on the reduced dose, then another reduction is earned. If following MPM, you do not reduce unless the cat falls below 50 (as opposed to 90 with SLGS). I find that most cats do better on MPM as long as enough tests are being done.
 
Oof, yes that makes sense. So I DID create a hybrid method! It kind of looks like MPM would be better suited for Nacho, since a few times when we've reduced to 3.25 for the PM shot, his +2s were pretty high. We'd just need to commit to testing in the middle of the night if so. I don't think that 3.25 is enough for him during the day (yet -- his numbers are improving!)
 
D & Nacho said:
I've on and off used the Libre Freestyle 3 on Nacho but we've been running into many different issues with it and have been losing data.

We're just starting to be able to get Nacho to semi-tolerate a manual test (using Relion), but curious if anyone has any tips on how to make it easier? He just doesn't bleed very easily!

@Suzanne & Darcy -- new thread, as requested :)
Click to expand...
Simon is on the Libre 2. I've had excellent luck getting readings with it on his shoulder. He wears a hoodie sleeve as a shirt.
 
Simon Bojangles said:
Simon is on the Libre 2. I've had excellent luck getting readings with it on his shoulder. He wears a hoodie sleeve as a shirt.
Click to expand...
What insulin do you use? Do you have a spreadsheet? Libre CGMs are convenient (if they work and you don’t mind replacing them every 14 days) but they frequently give very low readings on the lower end of the BG range (frequently causing panic) and when checked against a handheld human meter, the actual BG value isn’t as low as the Libre says it is. Of course, the Libre is measuring interstitial fluid instead of blood glucose. — Gorgeous boy you have there, by the way! :)
 
Did Nacho go to the vet? How did everything go? Oh wait, never mind I just read your spreadsheet notes about the vet visit. Nacho os doing better on 3.5 - getting better overall. Those low BGs the other evening were still in the safe zone on your freestyle meter so he was okay and no reason to give HC — unless you were just exhausted and were trying to get to bed (it happens). It did cause a temporary spike in his BG, but he’s getting back to work now, I see.
 
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Suzanne & Darcy said:
What insulin do you use? Do you have a spreadsheet? Libre CGMs are convenient (if they work and you don’t mind replacing them every 14 days) but they frequently give very low readings on the lower end of the BG range (frequently causing panic) and when checked against a handheld human meter, the actual BG value isn’t as low as the Libre says it is. Of course, the Libre is measuring interstitial fluid instead of blood glucose. — Gorgeous boy you have there, by the way! :)
Click to expand...

Thank you! He is a precious boy.
I haven't kept a spreadsheet, but should do one since all of his data is on my phone. He's on glargine, which has had great success with remission. Right now he's in remission, by almost 2 weeks now. I was able to get the sensor for $46 through Goodrx, which is cheap peace of mind, and Vetbond surgical adhesive holds it on wonderfully.
 
Suzanne & Darcy said:
What insulin do you use? Do you have a spreadsheet? Libre CGMs are convenient (if they work and you don’t mind replacing them every 14 days) but they frequently give very low readings on the lower end of the BG range (frequently causing panic) and when checked against a handheld human meter, the actual BG value isn’t as low as the Libre says it is. Of course, the Libre is measuring interstitial fluid instead of blood glucose. — Gorgeous boy you have there, by the way! :)
Click to expand...

I also switched our 4 boys to Dr. Elsey's cleanprotein chicken so we can continue free feeding. They still get wet food periodically. I think we may be done with insulin now since he crashes from almost 400 to below 70 within an hour with only .25 unit. The food is spendy, but I justify that it's cheaper in the long run with Simon's vet visits, insulin, and litter expenses.
 
Simon Bojangles said:
I also switched our 4 boys to Dr. Elsey's cleanprotein chicken so we can continue free feeding. They still get wet food periodically. I think we may be done with insulin now since he crashes from almost 400 to below 70 within an hour with only .25 unit. The food is spendy, but I justify that it's cheaper in the long run with Simon's vet visits, insulin, and litter expenses.
Click to expand...
I don’t want to hijack @D & Nacho thread, but it sounds like he’s definitely diabetic and not a good idea to stop insulin and leave him in the 400s which is definitely damaging to all of his organ systems and puts him at risk of DKA. Any crash like that in one hour says to me that he may not be eating enough for breakfast (if it really is happening at +1) or the right amount of carbs. Some cats need more carbs to stabilize. Also, I do not trust the Libre readings when it’s that low. Many times, I have been helping people whose cats are on the Libre and they are getting alarms and low numbers and when they check it with a handheld meter they get a higher number. Still if it’s a true drop of even more than 100 points in an hour that’s too much. If you are using ProZinc, it usually doesn’t onset until +2, but in some cats it can work more quickly. Steep drops like that will usually set up a bounce and high numbers to follow. What you could be seeing is a high number from a bounce that is breaking and then you give insulin and have the downward momentum from the bounce break working in conjunction with the insulin. Without more information and a spreadsheet I could not say much more than that. Steep drops need to be managed with more carbs at the right times to help prevent bouncing and help get the cat’s cycles smoothed out and give their bodies time to adjust to being on insulin and starting to get down into lower numbers more gradually — also the timing of the meals and snacks is important. If you want to start a thread here and get a spreadsheet set up, I would be happy to help.
Edited to add: I see you said he’s on Glargine. Sorry I missed that part - you should probably make a post on either Feline Health or on the Lantus (glargine)/Levemir/LLB forum
 
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