11/6 Ruby Libre Day 3 AMPS 259/+1 292/+5 199/+6 212/+8 280/PMPS 331/+2 226/+4 188/+5 195

Katherine&Ruby

Katherine&Ruby

Member Since 2020
Yesterday.

Good morning to day 3 of the Freestyle Libre show starring Ruby! I find the data from the Libre to be interesting but I also question its validity. Looking at yesterday, Ruby rarely ever stays so flat in a day, especially if she is bouncing from the blues two days ago. I'm going to do a poke today at +6 and compare the readings, with the knowledge that the Libre is going to be a few minutes behind the BG.

I also wonder if her elevated numbers are from the stress of having the Libre on her. She's always scratching at it and she's not being very lively.

The last 24 hours:
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Sending healing thoughts and scritches to all of the sick kitties and hugs to their beans who love them so! :bighug::bighug::bighug:
 

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They really aren’t to be compared side by side and the reason is the glucose that is being measured by each is being measured from different compartments—-the Libre is getting the measurement from what is called the interstitial fluid space, sometimes referred to as ISF reading or sensor glucose (SG) while the glucometer is measuring glucose taken from the blood or BG.

Interstial fluid measurements will lag behind the BG measurements. When glucose is relatively stable, the measurements will be closer, but when glucose is rising or falling rapidly, for example after a meal, the measurements will be further apart.

I am going to attach a link to some videos Medtronic created to explain the difference between sensor glucose and blood glucose using a train analogy. It can be helpful to understand it better.
In addition, they are now doing some preliminary research, both in human and in veterinary medicine, to learn more about the differences between the two compartments, beyond the time “lag”. One such study has actually found the glucose measurement from the interstitial fluid space to be a more “accurate” read for making treatment decisions (for example, when someone is exercising) due to the fact that blood glucose gives a read of what is happening with glucose before other processes occur that would ultimately lower the level of glucose and also reduce the need to address it. The thought is that with additional research, CGM readings will be the recommended way to make treatment decisions vs BG. More research will need to be conducted to determine what happens but it interesting.

In the meantime, the CGM use in cats is going to give you dynamic (real time movements) of glucose vs static readings. Once you know there is consistency of action with the insulin and what the duration looks like, as well as speeds of any drops or rises you can use the trends to make some easy and anxiety free dosing decisions. However, I still used my AT2 to check out any lower or higher trends and to learn about the details of the nadir and responses to food (for example, just like the nadir can move, the response to food can change as well with respect to how quickly or slowly and by how much the food influences the glucose)


 
It looks like this dose is working. I spoke with the vet yesterday, and he said her fructosamine test was somewhere in the mid-400s, which is not good. Otherwise her bloodwork looked fine--no UTI, no ketones, BG 111. Will put all of the lab results on her sheet as soon as I receive them.

Had a bit of an argument with him about her dose, which is 1.25 right now and she's been on it for 8 cycles. So following TR, I should increase it either now or in two more cycles, but he wants me to stay on this dose for two weeks. I don't see the point staying in a dose that isn't actually doing anything for her but keeping her glucose levels up. I compromised and told him I would see where she was in a few more days, send him the Libre data as well as the numbers I collected since I started her on 1.25 and go from there and he acquiesced. @tiffmaxee and @Wendy&Neko : What do you think about this?
 
With that 117 a few days ago, I think you are OK to hold the full 10 cycles to see if she comes down any more. With one caveat, I see that you recorded trace ketones yesterday. And lethargy today. Please try to get another ketones test in today. Any sign of ketones means increase sooner. Is she still getting Cerenia daily along with the mirtazapine?

I suspect she might be bouncing still, numbers can wobble around during a bounce.
 
Wendy&Neko said:
With that 117 a few days ago, I think you are OK to hold the full 10 cycles to see if she comes down any more. With one caveat, I see that you recorded trace ketones yesterday. And lethargy today. Please try to get another ketones test in today. Any sign of ketones means increase sooner. Is she still getting Cerenia daily along with the mirtazapine?

I suspect she might be bouncing still, numbers can wobble around during a bounce.
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The 117 was recorded by the vet from her labs. She is at trace ketones according to my ketostix nearly everyday, but the vet said she had no ketones in her labs yesterday. I have Cerenia but the mirtazapine seems to work on its own, and I only give it when her appetite is down, not everyday. She's eating fine today. I think the placement of the Libre on her shoulder is the source of her lethargy. It's really irritating her, she walks slowly and she has spent the day mostly lying in bed.
 
Thanks for the input, @Wendy&Neko. I’ll give her two more doses and see where she goes and then decide if I wait a few more days or take action to increase without the vet. He may not be happy about it but I care more about Ruby than I do about his feelings!
 
+2 = 226. Will be watching her numbers tonight as she's been sliding down for the last few days. Hope to see some nice blues!
 
I’m pretty sure you will see blues as the +2 is lower than the PMPS. It’s actually a pretty big drop. I’d feed a little 10% or a bit higher.
 
I’d pick up some mc food over the weekend. You can do a mix of lc and hc until then if there’s too big a drop though.
 
tiffmaxee said:
I’d pick up some mc food over the weekend. You can do a mix of lc and hc until then if there’s too big a drop though.
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MC is a bit of a gap in my cat food pantry right now. I made a list already so I can scour the aisles of the local pet store tomorrow. I got her to eat more LC so hopefully we won't get any green tonight.

Thanks for helping me tonight Elise!
 
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