11/19 Mocha AMPS 305 PMPS 309 +6 221

[Mocha'sMom]

We went to the vets yesterday and we will get the results of his thyroid and clotting factor tests today. She prescribed nutritional clay for his diarrhea, so we'll see how that goes. She was NOT impressed with how often we were testing his BG's, but it seemed mostly like she was worried about him becoming sick of the tests. I'll admit, his ears are very bruised right now and barely bleeding. I am going to put Vit E on them before I leave for work. I warm up his ears before I test and put pressure on his ear every time, and I will either do Vit E or antibiotic ointment depending on what is within reach when I am testing. I am running out of ideas on how to help his ears, other than just testing less. The vet said I should only be testing once a day and to switch up what time I test every day :YMSIGH: That sounds nothing like the advice I have gotten here, makes me wonder about her level of experience with FD. Mostly I am just unsure of how to help the situation confused_cat

 

[Amy&TrixieCat]

Re: 11/19 Mocha AMPS 305

Your vet is pretty typical...most don't understand our approach to treating FD, and most don't know FD as well as we'd like. Really, they do have a tough job...they have to know lots of diseases across several species, so it has to be difficult to be on top of all of it. Plus, following TR probably isn't typical among their client base.

When we took Trix earlier this year for her exam, our vet asked if we were occasional testing; she was absolutely shocked when we said we test her at least 6 times a day. She said Trix's ears look fabulous...she really did not expect to see non-tattered ears, but the ears do adjust over time. She also said that she was going to leave all the dosing and FD treatment up to us, because Trix looked fabulous and we obviously had a strong handle on it. And they do get used to the testing. Trix comes to me when she hears me get her supplies ready; I never have to track her down.

I have to admit, knowing what I know now about FD, about hypos and bounces and highs and lows, I could never go back to testing just once a day...especially because of the risk of hypo, which can kill.

It does take a little bit of time for their ears to adjust to all the testing, but it does happen over time. Does Mocha seem uncomfortable when you test, or is it that his ears look beat up? I know putting a little pressure on the poked area really reduces the bruising with Trix. When we first started her ears were definitely bruised, and now they don't bruise at all. I know others do like to use Neosporin with pain relief on their kitties' ears. ANd, of course, give Mocha treats every time you test, even if it's not a successful test. That way he'll associate it with happy times.

Remember that the folks here live and breath FD....there is a huge storehouse of knowledge among the group. I would just suggest continue asking as many questions as you need to...everyone here is very helpful and willing to share knowledge, experience, and moral support.

 

[Tara & Buster]

Re: 11/19 Mocha AMPS 305

Even if I were to accept Buster would never go OTJ and abandon protocol, I think the minimum I would test is 4 times a day. I almost lost my guy when I was dosing without testing and now I can't imagine not knowing his numbers. I remember in the past I caught myself jabbing instead of gently poking sometimes. Maybe just a lighter touch? Are you moving up and down the ear edge a little bit? Someone on another thread suggested using one ear for a day or two and then the other to let one ear heal. Also, what gauge lancets are you using? You might be able to use a 30 or 31 gauge now that the ears are getting used to bleeding.

I agree with Amy. I don't know how a vet is supposed to be successful in treating FD soley on office visits. There's just too many variables and you need to know what's going on day to day, not week to week. I don't blame the vets. It just seems to be one of those things the owner can manage best at home with consultations as needed.

I hope Mocha's ears feel better soon. "Stick" with it!

 

[Mocha'sMom]

Re: 11/19 Mocha AMPS 305

I will read and respond to everyone's posts when I get home tonight, I much appreciate the feedback you guys give! I just wanted to put up a quick post because I'm feeling a bit distressed.

I just got the call from the vet about his blood work we had done yesterday. His clotting factor, kidney and liver values are normal! Yay! :mrgreen: However she said his BG at +10 (when we were at the vets) was 76. That doesn't sound right. What is bugging me is the blood work got sent out of house, could the BG number have been affected by the delay from cat to lab? Or compromised? Now she wants me to abandon the 1.25U and go back down to only 1.00U. I'm really not feeling comfortable with this because I was consistently getting BG's 300+ on that dose. But how do you argue with a vet? She just says the glucometer's are inaccurate. :sad:

 

[Amy&TrixieCat]

Re: 11/19 Mocha AMPS 305

Do you know if they used an AlphaTrak or a human glucometer? In taking a quick look at Mocha's SS, I see he did hit 94 mid-cycle the other day, so that number the vet got really may not be out of line. I'm not quite sure what to tell you about dosage, though. With TR, we usually don't reduce the dose unless a kitty's BG falls below 50 on a human glucometer. This is where those mid-cycle test come in handy (when you can get them)...you'll eventually start to see patterns.

Some glucometers are better than others, but I would have to say that the blanket statement of "glucometers are inaccurate" is inaccurate. If that were the case, there would be lots of human diabetics in trouble out there! What you do want to do, though, is pick one glucometer and stick with it. If you do constant side by side comparisons between different meters, you likely will see variations in results, and that will drive you crazy!

 

[Mocha'sMom]

Re: 11/19 Mocha AMPS 305

Do you know if they used an AlphaTrak or a human glucometer?

I will admit I do not know what they used. She just said that that was the number the lab got that they sent the blood to. And the number that the lab gets are "the golden standard". Are glucometers the only way to read BG's? Is there another piece of equipment that the lab may have used?

It does take a little bit of time for their ears to adjust to all the testing, but it does happen over time. Does Mocha seem uncomfortable when you test, or is it that his ears look beat up? I know putting a little pressure on the poked area really reduces the bruising with Trix. When we first started her ears were definitely bruised, and now they don't bruise at all. I know others do like to use Neosporin with pain relief on their kitties' ears. ANd, of course, give Mocha treats every time you test, even if it's not a successful test. That way he'll associate it with happy times.

Maybe it's just that I am expecting his ears to adjust too quickly, it's only been a couple weeks. He really doesn't seem to mind the prick, he is just a little ear shy because of a yeast infection that made his ears REALLY itchy.

I remember in the past I caught myself jabbing instead of gently poking sometimes. Maybe just a lighter touch? Are you moving up and down the ear edge a little bit? Someone on another thread suggested using one ear for a day or two and then the other to let one ear heal. Also, what gauge lancets are you using? You might be able to use a 30 or 31 gauge now that the ears are getting used to bleeding.

We are currently using the lancing device that came with the OneTouch and 33 gauge lancets. Maybe the spring in the lancing device is too strong? I have free handed a couple times but because he wiggles I felt like I pricked his ears pretty hard a couple times :shock: so I went back to using the lancing device. But I could try going back to free handing nailbite_smile

 

[Amy&TrixieCat]

Re: 11/19 Mocha AMPS 305

I prefer using the device, too, rather than free-handing. I wonder if - for now - you should use a lancet that is a little thicker than 33g. A thicker lancet might have a bit more of a sting, but should produce a bigger drop of blood more quickly. Once his ears learn to bleed, you could reduce the size of the lancet. I think I use 28g for Trix (the smaller the number, the bigger the lancet), and I rarely have to poke more than once. It's great that he doesn't really seem to mind the poke - for some kitties, that's more than half the battle!

I forgot you said the lab came back with Mocha's glucose, not a meter that was used in the office. I have to admit...I don't know if there would be a difference between what the lab gets and what a meter gets, but one thing to keep in mind....that lab number is just one number in the middle of one cycle. You and Mocha LIVE diabetes day in and day out, and FD can be fickle for day to day, and from cycle to cycle, as far as the numbers go. That's yet another reason why we are so numbers-driven here....between bounces and food changes and stress factors....soooooo many things can affect the numbers, so - if for no other reason - putting safety first, testing with a meter throughout each cycle is important. And as far as what WE can use to test BGs, glucometers are it.

 

[Mocha'sMom]

Re: 11/19 Mocha AMPS 305

I guess the important question at the end of the day is, should I stick with the 1.25U or go back down to the 1.00U that the vet is insisting on? I feel like the BG's I'm getting warrants the 1.25U I am doing now.

 

[Wendy&Neko]

Re: 11/19 Mocha AMPS 305

Good news on the blood work results! FYI - my vetty uses the OneTouch meter in her office. ;-) She has compared blood taken in her clinic with results from the lab (Idexx) and found them very close. I usually test Neko just before taking her in for blood work, just so the vet and I have an idea what might be in the test results.

The lab typically measures glucose in blood plasma, vs. whole blood which the meter tests. From Wikipedia on comparing blood glucose tests from home meters (whole blood samples) with lab results (blood plasma):

Glucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and their health care providers to know whether the meter gives its results as "whole blood equivalent" or "plasma equivalent.

I just checked the box on my Relion Confirm, and it calculates the plasma equivalent.

 

[Amy&TrixieCat]

Re: 11/19 Mocha AMPS 305

I'm not always comfy giving dosing advice unless it's a really cut-n-dried answer. My personal inclination would be to agree with you; however, I'd feel more comfortable if some more experienced eyes would weigh in. What you can do to get more eyes on Mocha's condo is edit the subject line in your very first post to say you have a dosing question, and also select the question mark icon.

 

[Wendy&Neko]

Re: 11/19 Mocha AMPS 305 *Dosage question*

Oops - missed the dosage question. I think I'd be inclined to stick to the 1.25 for now, but I'd really encourage you to try to get a preshot test each cycle, plus at least one more. Whether it's mid cycle if you can, or in the door/out the door in the morning and a before bed test at night. On the weekends or when you are home is a good time to get a mid cycle test. Dosing is based on the nadir and we need to see those mid cycle tests or at least one other test to see what is happening in a cycle. The 1.0 or 1.1 didn't seem to be doing it. A 76 that the vet got is a very nice nadir, and does not by itself warrant a reduction if you are following the TR protocol.

 

[Ella & Rusty & Stu(GA)]

Re: 11/19 Mocha AMPS 305 *Dosage question*

Hi guys, and welcome to LL (my first visit to your condo, a little late!).
What time (at what point in Mocha's insulin cycle) did the vet do the bloodwork yesterday and had Mocha fasted before the bloodwork? It is normal for blood-glucose numbers to be lower if the cat hasn't eaten. Did you give a shot before going to the vet? Many factors can influence a blood-glucose number. In any event, 76 is a good, safe nadir. When you are able to get in more tests over the course of a day, you will begin to see patterns. As everyone has said, dosing is based primarily on the nadir.

Mocha's ears will get used to testing. They have to be "trained". Usually one ear bleeds better than the other (I only test on Rusty's right ear). You are doing the right things (warming the ear; putting pressure on the ear after getting the blood sample). I, too, prefer the lancet device because it delivers a fast, uniform poke. Rusty uses 30-gauge lancets in his lancet device, sometimes 33-gauge in summer, when it is warmer. At bedtime, after the last test of the day, I put a little Neosporin Creme with pain killer on his ear. Many here prefer the Neosporin ointment, but I find that the creme absorbs better and is less messy.

Good luck in dealing with your vet. Don't try to argue with her: just agree with what she says and then follow the TR protocol!

Have a fine evening and just keep doing your best,

Ella & Rusty

 

[Libby and Lucy]

Re: 11/19 Mocha AMPS 305 *Dosage question*

just a note about testing: the Tight Regulation Protocol requires testing several times a day. A nadir in the 70s is safe for a cat following this protocol. For a cat that is not being tested several times daily, a little higher target is a good idea. The Start Low Go Slow Approach used by some on this board recommends 90 as a cutoff. Most vets are not used to clients doing intensive monitoring at home, so they will wisely recommend keeping the numbers higher.

Looking at your spreadsheet, I would say that you have a choice. If you would like to follow the Tight Regulation Protocol, you can hold the dose and step up the monitoring to every preshot and at least one other test per day (more if the numbers call for it), plus other spot checks and curves whenever you can. Or, if you prefer to monitor less per the vet's advice, then I would follow the vet's dosing advice too.

One more point: we keep talking about the nadir being in the 70s, but we really don't know if that was his nadir, or if he was higher or lower before that. Usually a reading at +10 would already be on its way up from an earlier nadir. Food for thought. ;-)

 

[Mocha'sMom]

Re: 11/19 Mocha AMPS 305 *Dosage question*

What time (at what point in Mocha's insulin cycle) did the vet do the bloodwork yesterday and had Mocha fasted before the bloodwork? It is normal for blood-glucose numbers to be lower if the cat hasn't eaten. Did you give a shot before going to the vet? Many factors can influence a blood-glucose number. In any event, 76 is a good, safe nadir. When you are able to get in more tests over the course of a day, you will begin to see patterns. As everyone has said, dosing is based primarily on the nadir.

The vet took his blood around +10 (5:00P). Then we went home and he got his shot then. I had to work from 8:30A to 3:30P so I can't be 100% sure exactly how much he ate during the day, however, the person who looks after him during the day has instructions to give Mocha as much food (FF pate) as he will eat.

 

[Sienne and Gabby (GA)]

Re: 11/19 Mocha AMPS 305 PMPS 309 *Dosage question*

Whenever I hear a vet suggest that someone test once a day, my first thought is to ask if that's what the vet would do if this were his/her child? With humans, insulin is given once a day. Most newer diabetics will test around meal time as well as at pre-shot. That would amount to testing 4 times a day. I can't imagine any parent shooting blind if this were their child.

I also suspect that using a 33 gauge lancet is too fine to adequately draw blood. I use a 30 or 31 gauge. Often, I'll suggest even a 28 gauge for someone who is starting out. It may be a bit less comfortable but you'll have to poke less to get blood with a wider gauge (e.g., 28) lancet.

If you're not able to test all that much during the day, spot checks can be very valuable. Testing at pre-shot every time is essential. Testing before you leave, when you get home, etc. helps to fill in the blank spots on your spreadsheet. Likewise, at minimum, a before bed test is very important since many cats experience lower numbers at night.

Chances are that Mocha's blood was run through a serum chemistry analyzer. This will yield results that are very much like an AlphaTrack meter.

 

[Mocha'sMom]

I just took Mocha's +6 and it was 221. I think that confirms that I am in the right track with the dosing. I will stick to the 1.25U for the full week (unless he hypo's of course) and reevaluate next weekend.

Good luck in dealing with your vet. Don't try to argue with her: just agree with what she says and then follow the TR protocol!

I think this is just what I'm going to do. :smile:

I also tried using our spare lancing device, which is 30g, it was perfect, a nice fat drop on the first try. He did flinch a little, (like you all said, it may hurt more) but didn't try to run. :roll: Thank you again for all your help!