05/11 Lucy does she need insulin?

[Susan and Lucy]

https://docs.google.com/spreadsheet...wcLAGrGYu6if2Wzx6kzyeam_xI/edit#gid=361360320

Previous thread: https://www.felinediabetes.com/FDMB/threads/05-07-21-lucy-233-amps-insulin-halted.247098/

Hi all,

I don't know if Lucy needs insulin. Six 6 days ago, she was started on 1u Lantus. She hypo'd (34 on human meter) on her first and only shot! I'm very sure I didn't over-shoot her. I was VERY careful - using a magnifying lamp and light box to make sure I could see the markings well. The vet took her off insulin altogether after that rather than decreasing the dose, saying that he "only does full units and no partial units". He said that if I am going to home test (which he doesn't really like) then I need to use the Alphtrak meter ONLY and not the human (Relion) meter that I have been using for 3-4 weeks. He said to test her 2x daily - 4 hrs after each of the two feedings. Days have gone by now with no word from his office, and I'm not sure where we're going from here. Should she be getting any insulin since he says it's either 1u or no insulin?

I'm going to continue using the human meter since I have historical values from it. But I ADDED the Alphatrak to make the vet happy and I am struggling. Lucy's poor little ear doesn't always give up enough blood for two meters and then she gets upset with additional poking and it becomes a scene. Tonight, the Alphatrak errored on 4 strips in a row, I retried to re-poke her several times, she was SCREAMING in fury and I gave up. (She's avoiding me now.) At least I got the human meter value successfully tonight. But when I finally DO hear from the vet, he will expect pet meter values, so I feel like I have to TRY to do both.

Also, does it make sense that sometimes the Alphatrak is higher than the human meter and sometimes it's lower? I thought that it would always be higher. It has been lower about 4 times over the 12 times (so far) that I have tested with both meters. Maybe there is a reason for that, but it makes me worry that one meter or the other is not reliable.

Anyway...I can't tell if I should be giving Lucy any insulin or not. On the human meter, her AM test today was 186 and PM was 157. She had very similar numbers the prior day as well. I don't want to hypo her.

-- Susan

 

[Rebecca & Max (GA)]

https://docs.google.com/spreadsheet...wcLAGrGYu6if2Wzx6kzyeam_xI/edit#gid=361360320

Previous thread: https://www.felinediabetes.com/FDMB/threads/05-07-21-lucy-233-amps-insulin-halted.247098/

Hi all,

I don't know if Lucy needs insulin. Six 6 days ago, she was started on 1u Lantus. She hypo'd (34 on human meter) on her first and only shot! I'm very sure I didn't over-shoot her. I was VERY careful - using a magnifying lamp and light box to make sure I could see the markings well. The vet took her off insulin altogether after that rather than decreasing the dose, saying that he "only does full units and no partial units". He said that if I am going to home test (which he doesn't really like) then I need to use the Alphtrak meter ONLY and not the human (Relion) meter that I have been using for 3-4 weeks. He said to test her 2x daily - 4 hrs after each of the two feedings. Days have gone by now with no word from his office, and I'm not sure where we're going from here. Should she be getting any insulin since he says it's either 1u or no insulin?

I'm going to continue using the human meter since I have historical values from it. But I ADDED the Alphatrak to make the vet happy and I am struggling. Lucy's poor little ear doesn't always give up enough blood for two meters and then she gets upset with additional poking and it becomes a scene. Tonight, the Alphatrak errored on 4 strips in a row, I retried to re-poke her several times, she was SCREAMING in fury and I gave up. (She's avoiding me now.) At least I got the human meter value successfully tonight. But when I finally DO hear from the vet, he will expect pet meter values, so I feel like I have to TRY to do both.

Also, does it make sense that sometimes the Alphatrak is higher than the human meter and sometimes it's lower? I thought that it would always be higher. It has been lower about 4 times over the 12 times (so far) that I have tested with both meters. Maybe there is a reason for that, but it makes me worry that one meter or the other is not reliable.

Anyway...I can't tell if I should be giving Lucy any insulin or not. On the human meter, her AM test today was 186 and PM was 157. She had very similar numbers the prior day as well. I don't want to hypo her.

-- Susan

I’m not an admin or a pro at this by any means, but there is a reason why the group suggests stating at 0.25U! You actually experienced the reason first hand! 1U was simply too much. I was told and have read in the stickies here that you can often shoot right past your target dose (no pun intended) if you increase or decrease too much. Lucy’s numbers are not super high without insulin, but they are higher than a ‘normal’ non-diabetic cat (50-120 on a human meter). I am NOT suggesting you give her insulin, but I’m thinking she needs a lot lower dose than 1U. Her numbers are up and down (she has some good non-insulin numbers but also some higher numbers). I wonder if her pancreas just needs a tiny bit of help? I’m not the one to recommend anything though. Hopefully someone more experienced with chime in. When Max made his run for remission, I was told he needed to stay 100 or below for 14 days without insulin. I tested 2x a day at what would have been our shot time (once AM; once PM). If his number was above 100 (a few times it was), then I should feed him and retest in TWO hours to see if his glucose level came down (luckily, it did). I have no idea why your vet is telling you to only test 2x and 4 hours after feeding. I’d suggest maybe go back to when you were going to give her the shot and test her then (11:15 AM & 11:15 PM). Make sure Lucy hasn’t eaten in the two hours before (so act like you would be giving her the insulin, but you don’t), then test her. Keep track of those numbers for a few days and see how they compare. If it seems like she needs a little bit of insulin (such as 0.25U or 0.5U) you will already have the routine going.
Vets will always tell you that you have to use the AlphaTrak (AT). But, up until 2006, it didn’t exist! Don’t stress Lucy too much in trying to get multiple tests. If you don’t have much blood, use your main meter, whichever you choose to use. The AT takes the smaller sample size, so if testing is hard, maybe that’s the better meter for now? Warm to hot ears bleed best, so keep that in mind if you have never tried warming her ears. I loved catching Max sleeping in the sunlight (hot ears!). Also, treats after ear sticks are important, so hopefully Lucy has a favorite low carb treat. I had a ton of testing struggles with Max in the beginning, so you are light-years ahead of where I was. Good luck, and I hope I helped even a tiny bit.

 

[Butters & Lyla]

Not all cats are started on .25u by this group at all but it seems Lucy needs to be on something less than 1U. It really looks to me like she does need some insulin, but I'll tag some others for you who can help you decide on a lower dose to try. @Bron and Sheba (GA) and @Bandit's Mom are usually around this time of day. @tiffmaxee and @Wendy&Neko and @Chris & China (GA) are around later on and hopefully they can look at your ss and history, and make some suggestions on a dose.

 

[Butters & Lyla]

Did you get syringes with 1/2 unit markings yet? Are you still planning to get the calipers?

As for testing BG, are you warming up the ear first? Getting the ear warm before poking helps a lot with blood flow. As you poke more, Lucy's ears will learn to bleed. More capillaries will grow in the ears and it becomes so much easier to get blood from them. Are you giving her a treat after every single poke, even the ones that fail? Is she a food motivated kitty? Butters will do pretty much anything for a little piece of cooked pork but she is also thrilled with brushing?

As for comparing numbers between different meters, I have done this (most all of us have) and so I can tell you that it is crazy making! I have an AT 2 and two different human meters, all of which I tried to compare against each other, all of which have been higher or lower than the others. Basically, we just recommend that you pick one meter and stick with it.

 

[Summer and Susie (GA)]

You came to the right place, Susan. The pros will help you with this. I am impressed with what you have done so far. I agree that it looks like Lucy needs some insulin but I believe 1 unit is too much since it plunged her so low. You may have to go against your vets wishes and reduce to .25 or .50. I'll let more knowledgeable people advise you. Always remember that you should test before shooting so you can make sure she is safe enough numbers to give the insulin. Your kitties numbers are not bad and I am impressed with your spreadsheet so far. Hang in. Help is on the way.

 

[tiffmaxee]

I just went back and read your previous post. I think she dropped to 34 but did not have a symptomatic hypo. That was a sign that the 1.0 dose was too high. I said at the time your vet was wrong to only increase and decrease in 1.0 increments. We talked about using syringes with half unit markings and digital calipers. Do you now have either one?

What are you feeding her? Would you add that to your signature please?

Please add that to your signature. Meter variance is 20%. You can test the same drop of blood and get a 20%difference.

Given her initial string response I would restart at .50. How do you feel about that?

Rebecca is wrong about starting all cats at .25. In fact with SLGS we start at .50 if on a wet diet and 1.0 if eating dry. Weight of the cat is taken into account if following TR. Many start at 1.0 with TR. How much does Lucy weigh?

Her numbers are not that high so I think she has an excellent chance of going into remission.

 

[Rebecca & Max (GA)]

I just went back and read your previous post. I think she dropped to 34 but did not have a symptomatic hypo. That was a sign that the 1.0 dose was too high. I said at the time your vet was wrong to only increase and decrease in 1.0 increments. We talked about using syringes with half unit markings and digital calipers. Do you now have either one?

What are you feeding her? Would you add that to your signature please?

Please add that to your signature. Meter variance is 20%. You can test the same drop of blood and get a 20%difference.

Given her initial string response I would restart at .50. How do you feel about that?

Rebecca is wrong about starting all cats at .25. In fact with SLGS we start at .50 if on a wet diet and 1.0 if eating dry. Weight of the cat is taken into account if following TR. Many start at 1.0 with TR. How much does Lucy weigh?

Her numbers are not that high so I think she has an excellent chance of going into remission.

My mention of stating at 0.25U comes from the FDMB FB group where a few of the admins here are admins there as well. Sorry for the misinformation!

 

[tiffmaxee]

My mention of stating at 0.25U comes from the FDMB FB group where a few of the admins here are admins there as well. Sorry for the misinformation!

That’s kind of strange that the FB group would be different.

I have checked about this and the starting dose is .50 or 1.0 on Facebook as well. There can be exceptions so perhaps your cat was started lower for a reason.

 

[Juls and Billy]

In the Facebook group, we recommend starting doses of 0.5 to 1 unit. Same as here.

Since 1 unit lowered the BGL too much the first day, I do think a lower dose is needed. I can understand that OP is wary after the first dose caused a hypo, but Lucy is getting BGL over 200 during the day, so Lucy needs insulin. If 1 unit was too much, perhaps Lucy should start at 0.5 and see how that goes. If 0.5 ends up being too much, dose could be lowered to 0.25.

Susan, the thing is that Lucy looks like she might be able to reach remission, but you want a nice strong remission. You note that on some days she is as high as 270 mid cycle. That tells me Lucy needs some insulin to allow her pancreas time to heal. It would also be helpful if you put these mid-cycle numbers into the spreadsheet. I understand you are using two different meters, but it might be better at this point to stick to one. You can always use the pet meter on a curve day to please your vet if you have to. Me, I just used the less expensive human meter and the vet had to deal with it. but it's your choice how much friction you want to have with the vet.

On the Facebook, I'm Mod JulianneQJohnson.

 

[Wendy&Neko]

My mention of stating at 0.25U comes from the FDMB FB group where a few of the admins here are admins there as well.

The people on the Facebook group associated with FDMB are not supposed to be giving dosing suggestions on FB. Period, full stop. They are to guide people to here for dosing suggestions. There is only one mod on that FB group who is a moderator here, and she does only mod duties here. Robert is our admin and he doesn't do dosing help.

As for dosing Lucy, it does look like Lucy's pancreas needs a little help, but definitely not the full 1 unit. We do occasionally see cats that never need more than 0.5 units. So your vet is wrong both on the 1 unit and the need to use the Alphatrak. How would you feed about trying 0.5 units, or at least 0.25 units if that makes you nervous?

As for differences between the AT and human meter, typically the AT is higher in higher numbers, and they are closer in lower numbers. Or if you aren't using the same blood drop for both meters, there could be some differences over time. Maybe one didn't get quite as much blood as it needs and reads low because of that. But there isn't a way to convert one to the other, so we suggest people pick one meter and stick to it.

 

[Susan and Lucy]

I’m not an admin or a pro at this by any means, but there is a reason why the group suggests stating at 0.25U! You actually experienced the reason first hand! 1U was simply too much. I was told and have read in the stickies here that you can often shoot right past your target dose (no pun intended) if you increase or decrease too much. Lucy’s numbers are not super high without insulin, but they are higher than a ‘normal’ non-diabetic cat (50-120 on a human meter). I am NOT suggesting you give her insulin, but I’m thinking she needs a lot lower dose than 1U. Her numbers are up and down (she has some good non-insulin numbers but also some higher numbers). I wonder if her pancreas just needs a tiny bit of help? I’m not the one to recommend anything though. Hopefully someone more experienced with chime in. When Max made his run for remission, I was told he needed to stay 100 or below for 14 days without insulin. I tested 2x a day at what would have been our shot time (once AM; once PM). If his number was above 100 (a few times it was), then I should feed him and retest in TWO hours to see if his glucose level came down (luckily, it did). I have no idea why your vet is telling you to only test 2x and 4 hours after feeding. I’d suggest maybe go back to when you were going to give her the shot and test her then (11:15 AM & 11:15 PM). Make sure Lucy hasn’t eaten in the two hours before (so act like you would be giving her the insulin, but you don’t), then test her. Keep track of those numbers for a few days and see how they compare. If it seems like she needs a little bit of insulin (such as 0.25U or 0.5U) you will already have the routine going.
Vets will always tell you that you have to use the AlphaTrak (AT). But, up until 2006, it didn’t exist! Don’t stress Lucy too much in trying to get multiple tests. If you don’t have much blood, use your main meter, whichever you choose to use. The AT takes the smaller sample size, so if testing is hard, maybe that’s the better meter for now? Warm to hot ears bleed best, so keep that in mind if you have never tried warming her ears. I loved catching Max sleeping in the sunlight (hot ears!). Also, treats after ear sticks are important, so hopefully Lucy has a favorite low carb treat. I had a ton of testing struggles with Max in the beginning, so you are light-years ahead of where I was. Good luck, and I hope I helped even a tiny bit.

Thank you Rebecca! Your message helped a lot. The vet never told me why he wanted me to test 4 hrs after eating (2x daily) though I think he wanted to know how low she was likely to get after eating, since there is no insulin being shot now. I may considering moving her testing back to the original times, though the reason they were at 11am and 11pm-ish was that this is when the vet just happened to get back to me to tell me to shoot her first insulin shot last week. I will figure out the best times and move toward that. I warmed her ear this morning (I had gotten away from that for some reason) and it DID seem to help so I will stick with it. Plus, the warm sock feels good to her! Lucy isn't treat-motivated at all except for butter (as in the best - Kerrygold!). So I will use that as a treat and smear a tiny bit in a little dish for her to lick. Other than butter (and bacon grease), there is no treat that she will eat. At least I have plenty of butter on hand!

 

[Susan and Lucy]

Did you get syringes with 1/2 unit markings yet? Are you still planning to get the calipers?

As for testing BG, are you warming up the ear first? Getting the ear warm before poking helps a lot with blood flow. As you poke more, Lucy's ears will learn to bleed. More capillaries will grow in the ears and it becomes so much easier to get blood from them. Are you giving her a treat after every single poke, even the ones that fail? Is she a food motivated kitty? Butters will do pretty much anything for a little piece of cooked pork but she is also thrilled with brushing?

As for comparing numbers between different meters, I have done this (most all of us have) and so I can tell you that it is crazy making! I have an AT 2 and two different human meters, all of which I tried to compare against each other, all of which have been higher or lower than the others. Basically, we just recommend that you pick one meter and stick with it.

I don't have the syringes yet (will order today) but I have the calipers. I will warm her ear more consistently. I was doing it SOME of the time. As for treats, as I mentioned to Rebecca, Lucy isn't treat-motivated. She won't eat them at all...except BUTTER. So that's our new treat. Thank you!

 

[Wendy&Neko]

Some cats really like being brushed, and the attention is enough of a reward. Just have to find what works for Lucy. Butter was a favourite here too!

 

[Susan and Lucy]

I just went back and read your previous post. I think she dropped to 34 but did not have a symptomatic hypo. That was a sign that the 1.0 dose was too high. I said at the time your vet was wrong to only increase and decrease in 1.0 increments. We talked about using syringes with half unit markings and digital calipers. Do you now have either one?

What are you feeding her? Would you add that to your signature please?

Please add that to your signature. Meter variance is 20%. You can test the same drop of blood and get a 20%difference.

Given her initial string response I would restart at .50. How do you feel about that?

Rebecca is wrong about starting all cats at .25. In fact with SLGS we start at .50 if on a wet diet and 1.0 if eating dry. Weight of the cat is taken into account if following TR. Many start at 1.0 with TR. How much does Lucy weigh?

Her numbers are not that high so I think she has an excellent chance of going into remission.

I'm ordering the syringes today and I already have the calipers. I'm okay with starting at .50. Lucy only weighs 7.5 pounds. Her normal weight is about 9 pounds - she's not a very large cat. I will add her weight and food to my sig. I feed her one can of Friskies pate in the AM and one in the evening, though she only eats about 1/3-1/2 of it. She licks all of the liquid out and then grazes on some of the rest throughout the day. Although she is not a big eater, she IS getting pretty irritated at me for constantly putting it up 2 hrs before testing. Naturally, that 2 hour period is when she decides that she wants to eat.

 

[Butters & Lyla]

Butters also loves Butter!

 

[Susan and Lucy]

In the Facebook group, we recommend starting doses of 0.5 to 1 unit. Same as here.

Since 1 unit lowered the BGL too much the first day, I do think a lower dose is needed. I can understand that OP is wary after the first dose caused a hypo, but Lucy is getting BGL over 200 during the day, so Lucy needs insulin. If 1 unit was too much, perhaps Lucy should start at 0.5 and see how that goes. If 0.5 ends up being too much, dose could be lowered to 0.25.

Susan, the thing is that Lucy looks like she might be able to reach remission, but you want a nice strong remission. You note that on some days she is as high as 270 mid cycle. That tells me Lucy needs some insulin to allow her pancreas time to heal. It would also be helpful if you put these mid-cycle numbers into the spreadsheet. I understand you are using two different meters, but it might be better at this point to stick to one. You can always use the pet meter on a curve day to please your vet if you have to. Me, I just used the less expensive human meter and the vet had to deal with it. but it's your choice how much friction you want to have with the vet.

On the Facebook, I'm Mod JulianneQJohnson.

I think if I can develop a less traumatic testing routine for her, she will let me do it more often. So I will work on the treats, cuddles and warm ears!

 

[Susan and Lucy]

Butters also loves Butter!

That's awesome! I thought it was strange, but maybe not so much!

 

[Butters & Lyla]

I think a love of butter is not uncommon. My last two also went crazy for butter. I can even get Butters to eat some pills by coating them in butter. Actually, I remember @Sue and Luci saying that Luci also loooves butter so much. She steals it out of the butter dish.

I think if I can develop a less traumatic testing routine for her, she will let me do it more often. So I will work on the treats, cuddles and warm ears!

I really think you'll find that warming the ear helps a lot. Some people make a homemade warming pad. Take a small sock, like a baby sock, and fill it with rice and tie it up. Then they warm that in the microwave (no microwave here...I had to use the oven) and hold it against kitty's ear to warm it up.

 

[Wendy&Neko]

FYI - if feeding butter, unsalted is best.

 

[Rebecca & Max (GA)]

In the Facebook group, we recommend starting doses of 0.5 to 1 unit. Same as here.

Since 1 unit lowered the BGL too much the first day, I do think a lower dose is needed. I can understand that OP is wary after the first dose caused a hypo, but Lucy is getting BGL over 200 during the day, so Lucy needs insulin. If 1 unit was too much, perhaps Lucy should start at 0.5 and see how that goes. If 0.5 ends up being too much, dose could be lowered to 0.25.

Susan, the thing is that Lucy looks like she might be able to reach remission, but you want a nice strong remission. You note that on some days she is as high as 270 mid cycle. That tells me Lucy needs some insulin to allow her pancreas time to heal. It would also be helpful if you put these mid-cycle numbers into the spreadsheet. I understand you are using two different meters, but it might be better at this point to stick to one. You can always use the pet meter on a curve day to please your vet if you have to. Me, I just used the less expensive human meter and the vet had to deal with it. but it's your choice how much friction you want to have with the vet.

On the Facebook, I'm Mod JulianneQJohnson.

Nice to see you here too! Sorry, often times starting low was mentioned. Maybe the increasing/decreasing doses at 0.25U got stuck in my head?? But I could have sworn it’s been suggested to start cats at 0.25 to 0.5U and NOT at 1U unless ketones are an issue. Again, my bad for getting the info wrong.

 

[Rebecca & Max (GA)]

Thank you Rebecca! Your message helped a lot. The vet never told me why he wanted me to test 4 hrs after eating (2x daily) though I think he wanted to know how low she was likely to get after eating, since there is no insulin being shot now. I may considering moving her testing back to the original times, though the reason they were at 11am and 11pm-ish was that this is when the vet just happened to get back to me to tell me to shoot her first insulin shot last week. I will figure out the best times and move toward that. I warmed her ear this morning (I had gotten away from that for some reason) and it DID seem to help so I will stick with it. Plus, the warm sock feels good to her! Lucy isn't treat-motivated at all except for butter (as in the best - Kerrygold!). So I will use that as a treat and smear a tiny bit in a little dish for her to lick. Other than butter (and bacon grease), there is no treat that she will eat. At least I have plenty of butter on hand!

Lucy has great taste in butter!! That’s all I buy and use, lol.

 

[Rebecca & Max (GA)]

That’s kind of strange that the FB group would be different.

I have checked about this and the starting dose is .50 or 1.0 on Facebook as well. There can be exceptions so perhaps your cat was started lower for a reason.

No, Max was started on 1U and increased too quickly by my vet to 2U. That’s when I found FDMB. As I replied to Juls, I guess I got the increase/decrease by 0.25U (sometimes 0.5U if numbers are high) as the starting dose.

 

[Rebecca & Max (GA)]

The people on the Facebook group associated with FDMB are not supposed to be giving dosing suggestions on FB. Period, full stop. They are to guide people to here for dosing suggestions. There is only one mod on that FB group who is a moderator here, and she does only mod duties here. Robert is our admin and he doesn't do dosing help.

As for dosing Lucy, it does look like Lucy's pancreas needs a little help, but definitely not the full 1 unit. We do occasionally see cats that never need more than 0.5 units. So your vet is wrong both on the 1 unit and the need to use the Alphatrak. How would you feed about trying 0.5 units, or at least 0.25 units if that makes you nervous?

As for differences between the AT and human meter, typically the AT is higher in higher numbers, and they are closer in lower numbers. Or if you aren't using the same blood drop for both meters, there could be some differences over time. Maybe one didn't get quite as much blood as it needs and reads low because of that. But there isn't a way to convert one to the other, so we suggest people pick one meter and stick to it.

They are not giving specific dosing advice! Many even state post to FDMB fur hemp with that, but it more along the lines of ‘my vet started my cat on 2U of X insulin’ (usually Vetsulin). That is almost always met with ‘that dose is too high for a staring dose’. Then I could have sworn some have mentioned 0.25-0.5U, but again, I could have very well been mixing up the increase/decrease amount with starting dose.

 

[Rebecca & Max (GA)]

They are not giving specific dosing advice! Many even state post to FDMB fur hemp with that, but it more along the lines of ‘my vet started my cat on 2U of X insulin’ (usually Vetsulin). That is almost always met with ‘that dose is too high for a staring dose’. Then I could have sworn some have mentioned 0.25-0.5U, but again, I could have very well been mixing up the increase/decrease amount with starting dose.

My main concern was 1U was too high for Lucy. Her vet, like mine, doesn’t believe in any doses less than 1U. Had I not broken away from my vet and took control of Max’s dosing, he would be dead, and not in remission. I cannot advise on dosing, but I did want to let her know lower doses are possible to shoot- even if her vet disagrees. I was where she was once. I sent my vet the TR protocol, the website for Tilly’s page, the published paper AND Max’s SS... I heard nothing back from him for three weeks! And then it was to tell me he couldn’t help me because I went rogue on him. I had the pleasure of telling him Max was already heading towards his OTJ trial.

 

[Wendy&Neko]

But I could have sworn it’s been suggested to start cats at 0.25 to 0.5U and NOT at 1U unless ketones are an issue

As per the SLGS guidelines in the Dosing Sticky Note, a cat on all wet food is started at 0.5 units, a cat with dry food in the picture at 1.0 units. Lucy is on an all wet food diet, hence the starting dose of 0.5 units.