01/02/2015

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Cindywith4cutecats

Cindywith4cutecats

Member Since 2014
Here is the link to Normans Spread sheet at the bottom of this note. A little background first on Normans spread sheet. Prior to the LARGE RED LINE I was using ALPHATRK BG METER , After large RED LINE we started using the Relion Micro Human Meter . His numbers have been great since getting new Insulin and throwing away the VIAL that I suspected had lost its strength. SO we decided he earned a 1/4 reduction since being in such a nice range for a couple of weeks. Today we had a BG of 140 but he had a hairball and was puking it up and needed to be refed. I was hopeful that someone could look at his SHEET and sort of help me taking him down further. We just started the 1/4 unit this morning so I am hopeful his numbers trend in staying in normal range. Need help tapering him down and hopefully of the juice . Thank you for all your help and NORMAN sends his love tooo.

https://docs.google.com/spreadsheet/ccc?key=0Aoa4MKaGy620dEFORnJaNnBNbXdhWGh6dTRBSUMzbFE#gid=0
 
On my Android; can't see the sheet.
You may want to learn drop dosing:
Using a colored liquid, so you can see it more easily, fill a syringe to 0.5 units.
Slowly squeeze out equal-sized drops, maybe by twisting the plunger, until you can get the same number of drops per 0.5 units every time.
How many drops make 0.25 units?
Decreases may be done a drop at a time.
You also may find at some point you get to 'chase the numbers, which means wait until the glucose is high enough to shoot, which could take moret han 12 hours.
 
Hi Cindy - my first post to you in the L&L forum (waving Hi!). I've seen many cats get temporarily higher numbers after a hairball so it's good you noted that in the SS.

Are you following the TR or SLGS protocol? In either case, Norman SS is looking pretty great. :D In the TR protocol, we reduce after a week or 14 cycles spent in largely normal numbers or if kitty goes below 50. So if Norman continues with these lovely numbers for a week or if he goes below 50, he'd earn a reduction to .1U. There are pictures in the New to the Group Sticky of what .1U looks like. Alternatively you can use the drop dosing method BJM describes. After a week of .1U in normal numbers (or once below 50), we'd do an OTJ trial.:)
 
thank you all. Yes he is doing great, I am so happy and pleased that I spent the money to replace his VIAL of Lantus as noted on SS. SOMTIMES I had noticed a SPIKE in BG after changing his Lantus dosage so my other question is when we do try OTJ will I see a spike for 3 days or is that on a cat by cat basis ? Second question as dumb as it is, A NORMAL CAT usually sits the range of 50 to 120 (120 being a FOOD SPIKE ) so when Norman goes off the juice I would test and test but am I correct that a food spike within an hour of food and I would NOT want to see anything over 120 ???
 
Great to see you over here Cindy!!

Norman's looking good so far!

Don't panic if you see an occasional higher number. You did good by noticing he was working on that hairball but he may still occasionally throw you a higher number. We just want him to stay in those pretty greens most of the time for the next week and then you get to reduce again!

Come on Norman...You're so close! Keep it up!! :D
 
Lantus dosing is based upon how LOW the dose gets him - so you basically want to ignore the higher numbers for the most part.


Cindywith4cutecats said:
I had noticed a SPIKE in BG after changing his Lantus dosage so my other question is when we do try OTJ will I see a spike for 3 days or is that on a cat by cat basis ?

Second question as dumb as it is, A NORMAL CAT usually sits the range of 50 to 120 (120 being a FOOD SPIKE ) so when Norman goes off the juice I would test and test but am I correct that a food spike within an hour of food and I would NOT want to see anything over 120 ???
Click to expand...

No dumb questions! Those are good questions.

The spike you may have seen after changing his dose - i'm just looking back as far as when you switched to the human glucometer and not seeing what you're talking about, but it could be New Dose Wonkiness or a Bounce. Hard to say, but I wouldn't worry too much about it at this point. Once a cat's spreadsheet goes pretty much all green, that's a very good sign.

As Wendy explained, there are 2 circumstances for reducing the dose if you're following tight regulation:
Reducing the dose:
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. See additional notes in the next paragraph about drops into the 20s and 30s. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.


If you're following Start Low Go Slow,
  • 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 do 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.
Remission:
Remission is reached when kitty can go 14 days without insulin while maintaining normal blood glucose values in the 50 - 120 mg/dL (2.7 - 6.6 mmol/L) range. Most will remain in the 50 - 80mg/dL (2.7 - 4.4 mmol/L) range. However, some will experience infrequent BG numbers higher than the norm. Continue feeding low carb food. Test the cat's BGs once per month. If BG numbers begin to trend upwards, it's time to bring kitty in to see your vet for a check-up. Common reasons for kitty falling out of remission include dental issues, infection, inflammation, pancreatitis, etc. Just about any illness or disease can do it.

When Norman goes OTJ we have a set of directions we give people. We encourage people to do a 2 week trial first when you stop the insulin, where you're posting daily or often so we can help you tweak things if there are any problems. During that time you'd test daily. After that, you want to test once a week for a while and once a month for a long time. Test him before eating, at the normal amps time and if he is under 100 you don't need to do anything further. If he is over 100, then you would retest him about 3 hours after he eats to see if the food has stimulated his pancreas to put out a little insulin, thereby bringing down his BGs.

Sometimes when we see an inverted curve like you had mid-day cycle today (mid-cycle is higher than preshots) that can mean that the cat is overdosed. It doesn't always - it could be a last-ditch-mini-bounce - but sometimes that's what it means.

Keep asking questions!
 
We really thought his mid cycle today BG being high was due to hairball that he puked up and then puked up his mid morning meal NOT his AMPS MEAL. We wish we had noted it in the past any hairballs versus spike in number but thats water under the bridge. This morning was his first shot of a 1/4 unit also.
 
I get a little confused. I see it as a bounce from changing his dose from 1/2 unit to 1/4 unit that we got a high BG this morning of 115 ( I know still in normal range ). I looked at his SS and I am getting the same numbers on 1/4 unit versus 1/2 unit. Am I correct that he needs to stay at this dose of 1/4 unless he should drop below 50 ??? I am going to do more a curve tomorrow since I will home all day. I am just a worry wart over him but he is busy is playing and running while mommy worries about overdosing him
 
You stay at the .25 dose for 14 cycles unless he drops below 50...in which case he'd earn another reduction back to .1 unit

He's doing what we hope he'd do! Stay in normal numbers despite the reduction in dose!

We're hoping he continues to reduce himself right off of insulin!
 
me tooooo , I want him off the juice and at the same time I am so scared. Luckily I bought PENS and 4 are unopened and good until 2017 to have on hand (in fridge with a thermometer for temp control ) I know I will have check check check him and keep him on his low carb high protein diet canned food
 
There are two criteria for a dose reduction:
  • Numbers drop below 50 for a cat that's within the first year of diagnosis
  • Numbers stay largely within the normal range for a week/14 cycles
Looking at Norman's numbers, I suspect you didn't know about the "week in normal numbers" criteria and have been holding the 0.5u dose.

If you see a spike in numbers after a dose reduction, that's New Dose Wonkiness -- not a bounce. Keep in mind, what you've been seeing is a slight bump up in numbers vs. a big spike outside of normal range.

Even with an OTJ trial, you can get a sprinkling of higher numbers -- just like you saw with the effect of a hairball -- and numbers come back down. With an OTJ kitty, if you start to see either numbers are trending up or they are sitting in a higher than usual range, it may be an indication that your cat isn't feeling well or there's an infection brewing. For any number of OTJ cats, elevated numbers can indicate that they have some dental problems that need to be addressed. BG numbers can be a great early warning system regarding your cat's health since infection, inflammation, or pain can cause BG numbers to rise.

Once a kitty is OTJ, you don't have to test with the same frequency as when your cat is on insulin. You want to make sure that your cat is doing well but there isn't the risk of hypoglycemia. Most people seem to gradually reduce the frequency of testing the longer their cat is OTJ.
 
getting a little worried. I am not use to such low numbers (remember I started out with Alphatrak which measure higher numbers) We had an AMPS of 64 and I refused to shoot that. Fed him and waited about 15 or 20 minutes and saw a spike of 78 so he got his shot 1/4 unit. I was gone part of the day for a doc appt. His PMPS was 85 and I was confident shooting him his 1/4 unit but he has dropped to 61 already. A little worried, I am gone in the morning as I have labs for myself. He gets insulin at 5am and luckily my appt I don't leave till 9am , WHAT NUMBER IN THE MORNING would cause me concern to wait on shooting or reducing his units ?
 
looking at his spreadsheet, you can see that he's reached the phase where he is pretty flat now. In the past 24 hours, with the tests you have, he's only moved 24 points all together.

In general, experienced people will shoot most everything over 50 as long as their cat isn't sick and is eating normally, and they have the data to know what their cat is likely to do after the shot.

It's hard to say, and it's up to you, but i guess i'd think that you've seen he's ok with shooting today's 78 (would you fix the ss to show this as the preshot instead of at +1, please?) You weren't there for his nadir, but he appears to be staying fairly flat, which is typical in this phase. Still, it's possible he'll go below 50.

I'm waffling, as you can see, and just thinking out loud for you. :D That's because there isn't a clear-cut answer. I have a few thoughts to toss out for you -

1. you've seen him flatten out and can reasonably expect him to continue doing that tomorrow.

2. you can test up to +4 and that's great because you'll be able to test and feed him up to that point so you know where he's going. If he's flat at +4 (compared to his preshot), he's likely going to stay flat for a while.

3. food is your best tool. Anytime you have low numbers, you turn to food to bring them up. So feel free to leave him food while you're gone.

4. he's showing every sign of being "on a mission" to go down the dosing scale. If you are nervous, there's nothing wrong with skipping his shot or shooting 0.1u. His blood sugar may not even notice a reduced or skipped shot, and even if it bumps up a tad, when you return with the next shot he's very likely to get right back on with his mission.

That doesn't give you a clear-cut response, but at least it gives you some things to consider when you're making the decision in the morning. :)
 
I would test again soon tonight to see if Norman is looking for a reduction. A number under 50 means a reduction in dose. You might want to review the Sticky on Shooting Low Numbers. Next time you get a lower AM number than you are comfortable, try waiting 15-20 minutes WITHOUT feeding to see if he's coming up. If you feed then test like you did this morning, that rise in numbers could have been due to the food you gave him. If after a period of time he is on the rise, you should be OK giving insulin. Remember, you can always leave him some higher carb food to munch on before you leave. Worst case, as Julie says (she just beat me to it;)), you can always skip a shot. He's at a small enough dose he will recover fairly quickly.
 
ok thank you. I understand now as I was reading I should have waited this morning without feeding him first. (stupid vet who I actually love told me at the start to feed if I got a low pre shot number and then shoot, well that was not correct. i am going to fly by the seat of the pants in the morning, Norman loves to eat , he gets breakfast at 5am and then around 8 or 8:30 am he is looking for more chow . I will leave him in master bedroom which always has cat box in bathroom and water and leave him with some food while I am gone. I should only be gone around 1 hor to 1 hour 15 minutes so thats good for him.....will be testing like a mad man tomorrow. I can't believe after changing out the insulin VIAL which was losing its strength and changing to pens , we ere in a nice range of numbers with 1/2 unit and all of a sudden we change him to 1/4 unit and we are sliding down so fast !!! Confuses me to death, I would have thought at the 1/4 unit we would have seen nice flat numbers but a little more higher than they are.. I have to keep reminding myself I am not using AT meter , breathe and remember I still have room to 50. Norman gets a snack of canned food before we go to bed in about another 45 minutes . He sleeps with me so tonight I won't sleep well, light sleep to watch him. Will retest again before bed
 
I don't see a Norman condo (thread) for today so am going to go ahead and post on this one before i forget to get back to your question.

The reason you didn't see his blood sugar numbers increase after you reduced the dose is that it means his pancreas is healing and sputter back to life. It's putting out a little bit of insulin in addition to what you are injecting. As he puts out more, you catch a test under 50 and reduce your dose, so that overall, he's still getting the insulin support he needs. While he is being kept in normal numbers, his pancreas has the opportunity to heal. That's the goal of Tight Regulation keeping a cat in normal numbers (50-120 on insulin). If possible, their pancreas can heal and they go off of insulin, but if going OTJ (off the juice) isn't possible, at least the damage to the cat's body from high blood sugar is minimized.

Hope all went well this morning. I don't see today on the ss yet, but i assume all went well. Let us know.

by the way, you can respond in a new thread rather than bumping this one up again. we're not really supposed to answer on old posts, even though i just did that. ;)
 
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