12/8 oj vet and fresstyle libre questions

https://www.felinediabetes.com/FDMB/threads/oj-vet-apt-tomorrow.239705/

Yesterdays post

so oj had a good visit today. They reran a blood panel as its been a month to see where his numbers are and if theres been any inprovement. I'll get the results tomorrow and based on that I could potentially book a dental apt for him in the next week or two. She said shes okay working with higher numbers as long as they're acting alert, active and have a good appetite. She said the same with ketones. That felines can have trace or small amounts without being acidotic and since he was eating and acting totally normal the last two times she doesnt think they were dka episodes. He gained a little more than half a pound in the last week as well. Because of his super bad chin acne she gave him a shot of convenia which she said will help that or any other infections he might have going on. We got new gabapentin this time in pill form so i dont have to wrestle him to get the syringe in his mouth. She did think i was increasing his dose too often though so she wants me to stay at the 3units twice daily for now.
Now for my question. He got a freeestyle libre implanted. I was so excited for it to sync and start scanning him when i got home from work lol. Now im wondering, how much of a difference between the fluid it test vs the blood is it? I want to make sure when i go back to ear pricking i dont have a panic attack if his numbers were showing way differently with this. I will still prick if i get anything that just says high or lo and doesnt give an actual number. Are these numbers similar to the alphatrak2 as well? This was his first scan at around 430pm and usually when i do his blood at this time its in the 300-400range. This is showing in the 200s. He absoulutely hates the shirt they put on him to keep it in place. He's walking around so stiff and he looks so grumpy. I'll upload a picture of his first scan. Thank you!

 

The Libre is a human meter, so you will get human meter numbers from it. That means most times lower numbers, more so in the high number range. So the 200's human meter might line up with 300's in the AT. Double checking if you get a low number with a manual test is an excellent idea. I would actually get a few tests to double check if you get anything below 100, just to help you with the comfort level. Don't wait until you see a "Lo", that is way too low.

 

Thank you. Is there a chart on here anywhere converting human numbers to pet numbers that i can reference? And will do. He hasnt really come close to that at all so im expecting more highs than seeing and lo but i'll def keep an eye on the 100 range

 

No, it doesn't exist. Many people have tried comparing their own specific AT to their human meters, but even then have seen differences between the same two meters. Our dosing methods are written using human meters, and their use is strongly recommended. We do have recommendation for people with newly diagnosed cats following TR, and that is that a reduction is earned below 68 on an AT and below 50 on a human meter. That isn't to say they are the same blood sugar values at that point, but that it's a number that is works and keeps kitty safe given the aggressiveness of TR.

 

Okay thank you. I do plan on switching to a human meter at some point. For now i thought it would be easier to do a pet one being so new to everything. But its costing me about 50$ every two weeks for the strips so i'll probably change after my next autoship arrives and i use up that bottle. I wish i could afford to just do the libre all the time but it was 220$ today which was way more than i thought i'd be paying. I mean if it lasts me at least a few days and i get a better feel for where he is im totally fine paying that. I was just reading multiple places online it would be closer to 60$ so thats what i was planning for.

 

I just hope Oj keeps the meter on. Good thing you've got the shirt on to help keep it there.

 

Oof. I just scanned him again and it said too high to read. So i pricked his ear and he was in the 700s. I did only give him half his insulin this morning because he wouldnt be eating for hours after his normal shot time. And i think he really hates this shirt. And eveeeeeeryone is hissing at him so immhoping just a higher number from stress and the half shot. Im debating cutting the shirt off him. He wont step down anything. Hes paddling his arms like he's swimming. Maybe i can get him a less tight shirt not one of these surgery shirts so he can move a little more freely

 

Looks like he's bouncing again. He's not used to yellows. Did you by any chance get a AMPS test this morning?

 

Not before his shot. I was supposed to be off today hence why i made the appointment but then i had to work. I got him at 7am before i left for work and it was 304. My parents brought him to me at work so i could take him on break. I gave him the half insulin dose at his normal time since it would be a few hours till he'd be able to eat but he screams in the car and i figured an amps wouldnt be accurate because he gets so stressed in the carrier. Poor thing is back to just laying in his spot under the table. I trimmed the shirt so he can move his back legs a little easier but he's growling at me if i pet him over the shirt especially near the belly which he never ever does, i pet him all over every day so i think its way too tight. I'll see how hes acting in it tomorrow when i come home from break for his shot and breakfast and if he's still uncomfortable i'll have to get a baggier shirt or maybe ace bandage material

 

I think some members have put onesies that you put on infants.
Poor OJ looks so uncomfortable with that one on

 

Some said that the neck was a little big , so if it, just sew it up a little so it doesn't hang but you can still get it off and on.
I guess you would have to cut a hole big enough so he could pee and poop lpl
The ace bandage sounds like a good idea, the ones you don't need clips for, that
sort of velco closed

I just noticed we have the same birthdays April 3 rd

 

We put the Libre on Ruby twice and she absolutely hated it. The shirts bothered her but it was the sensor itself that bothered her most. She kept scratching at it and the last one only stayed on for 4 days. During those 4 days, she barely moved off the bed. Totally miserable. It's worth doing at the beginning when you're too freaked out about blood testing like I was, and I was also using the Alphatrak so it seemed cheaper to have the sensor by comparison to the cost of the test strips. The continuous data was great and it was a pleasure to get a number just by booping her with the iPhone. Now that I have the hang of poking Ruby I'll never do the Libre again because the stress on her was too much.

@Tomlin is a big supporter of using CGM systems and can tell you more.

 

I am sorry about the shirt and this experience. Unfortunately, as vets are starting to try to use the CGM more, there are some application techniques that are not recommended as they can aggravate the cat & result in both the cat and human having a bad experience . Application location and avoidance of a lot or any VetBond glue is key.

In any case, I just want to clarify so that you don’t become confused or concerned once you go back to a blood glucose meter. The Libre is NOT a human meter as described above. This is very important to recognize because the comparisons made between human blood glucose meters & pet blood glucose meters vs continuous glucose monitors and blood glucose meters are different. This is because the glucose measurement is coming from a different compartment (interstitial fluid vs blood). Not only does this mean there can be a time lag in measurement between one vs the other with respect to the reading (greater difference in measurements the faster the glucose is changing, so when you see the angled down or up or the straight down or up arrows, you will notice a greater difference in the Libre reading vs a meter reading). In addition, with respect to lows, if using the Libre1, no need to panic and start checking anything with a reading of 100. With the Libre 1, when you get to the lower readings, the actual blood glucose reading is actually higher—to the extent to at you have a safety net built in . So, a 50 or 60 on the Libre 1 is actually a easily over 80 & oftentimes higher on the AT2. On the Libre2 the difference in the lower #s is actually less. So, if I get an alarm at 59 it could be as low as a 70 on the AT2. They made the Libre2 much, much more accurate when it gets down into the lower #s. Humans have confirmed it to be true and now after using it with Tomlin, I have found the same to be true with a cat.

Again, I am sorry that you and your cat are having the pajama/clothing experience . I really am sad when I see this because there is a much easier and more effective way to apply the CGM that makes life easy for both you and the cat. I can’t imagine going back to just relying on BG data ....Especially now that they are learning more about additional differences between the ISF glucose and BG and how the ISF may be the better info to use for dosing. Time will tell .....but in the meantime it is nice to see complete, dynamic trends vs trying to fill in the blanks with BGs over time.

In the meantime, Libre3 should be released in 2021 and is supposed to be the size of a Penny !! This will make a big difference. It will stream the live data & continue to have the LO & HI glucose alarms like the Libre2. I am just hoping it keeps its 8 hour recording capability.....love that feature.

Best. Again, I am sorry for the stressful experience...makes me sad to see it!

 

Here is comparison with Libre and human iHealth BG meter.

 

Thanks everyone! I heard back from his bet today regarding the bloodwork. His liver and kidney levels have lowered and his thyroid came back Good. So he's super improved the last month with that. Im relieved. I scanned him when i got home and it showed his graph rapidly making its way down. I scanned an hour later to see if he was still dropping and a big chunk of the graph disappeared?? I hope it comes back because i have to send the vet all his graphs on friday. I uploaded a picture for reference. He's also way more comfortable today. Kitchen surfing and everything hahaha

 

Hey birthday twin! Thank you! I also saw online some people using facemasks with the adjustable ear loops. But he seems a lot more comfortable today since i trimmed the belly area.

 

Are you using LibreView &/or LibreLink? All of the data automatically transfers to your vet if they have a code. They can see what is happening.

I am hoping the sensor hasn’t loosened and the filament is not secure which can cause an issue like that.

 

Libre link. And okay. She didnt say she had a code. She told me to email her the charts friday and then to call her so she can look them over. And i hope not! I thought maybe i scanned him too close to the last scan, but im sure i can scan him whenever

 

I am attaching a link to share with your vet . They may not be aware that they are able to create what is called a Practice ID. By doing so, they are able to give you the ID info and then, if you are using the original Libre, you download the LibreLink App & all of the info is shared with the vet automatically. If you ever use Libre 2 with alarms, you will have to use the reader and LibreView on a Windows based computer because the APP is still waiting to be approved by the FDA. The data will be auto shared with the vet.

It is nice when they do this because it’s like having a co pilot . They check the data daily vs waiting until the end of the week to help guide you.....especially when first using it.

https://pro.libreview.io/articles/enabling-the-libreview-practice-feature

Really happy to hear he has adjusted, is comfortable and counter surfing

 

Thank you so much! I'll definitely share the info with her. I just scanned him again for the heck of it and while it doesnt show up on the main graph it did still show the data for those hours that were missing so at least its still there and i screen shot it. . We're at his +8.5 and climbing back up

 

Glad he's more comfortable. Since his blood work improved hopefully you can get the dental now

 

Yay for the graph showing back up . Apparently a little glitch!

Have you downloaded LibreView on your computer? If you haven’t, definitely do it . There are pages upon pages of data which is helpful!
I have 15 pages from his most recent Libre2 sensor. You will be able to see the data across the 14 days (fingers crossed you get 14 )

 

Hopefully! I was anxiously awaiting the call all day. I always think the worst so it was nice to get the opposite news.
I unfortunately dont own a computer and thanks! Im hoping i get the 14 days too. He's not attempting to claw it off or anything so if he does loose it im sure it will be from one of his siblings "liberating" him

 

I haven't been here for a long time, reading about other experiences with the FreeLibre sensor. We had a sensor implanted last year, Maggi didn't seem to know it was even there, vet applied it for $40 and it was wonderful to read her levels at will. She went into remission for about a year and then a few months ago, back into symptoms. New vet, living in another state now and the first sensor fell off two days after application. I just got another sensor, went to see vet yesterday and he said charge would be $125 so we said, no thanks. I watched video and think I can do it. Wanted to mention I bought little tape stickies on Amazon for the sensors to prevent it falling off. I miss my former vet! She is on Lantus which I just ordered from Walmart pet prescriptions. $125 for a 3ml solar pen but that included $30 for overnight air as it needs to be kept cold. Costco here, Southern CA, wanted $306 for the solar pen and usually Costco is the best pricing. Egads. Seems the little sticky covers would eliminate the need for clothing that bothers the baby AND keep the expensive sensors in place.

 

You can definitely do it! I put mine on now. The Wahl shaver is awesome. I avoid Vetbond glue as that has been found to be aggravating and causes itching for some cats. I use Smith & Nephew Skin Barrier (it looks like an alcohol swab and you just rub it on the skin where you will place the sensor. Cheap & on Amazon) which helps prevent skin irritation from the Libre adhesive and also helps the Libre stay on. I put the sensor on the side of the neck & put the Kitty Kollar over it for extra protection. After the 14 days, I allow the fur to grow out a little & that helps with removal & avoiding skin irritation. Smith & Nephew also makes adhesive removal wipes (Amazon) that you can use to help get any leftover glue off.

 

I had kept reading online it was about 60 and them when the vet yesterday said 220 i was like lol i must be crazy to be saying yes to this. I think im going to switch to walmart pharmacy. I was using one online and have only ordered one pen so far. I think it was around the same price but it took a few days to be delivered after i placed the order. Im sorry she came out of remission. I hope she gets back there soon! Thanks for the tips )

 

Omgosh cute lil fluffer! I've also seen videos on how to do it and i think i probably could. Do you just have your vet write you a prescription and you get it at a regular pharmacy? I was looking into care credit to help pay for some of his vet bills and potentially more FSL (we're already up to 5,000 the last 30days and his dental will be another 1,400-1,800 i was quoted) but they said because he's diabetic he doesnt qualify as its an already diagnosed illness

 

Yes—I just get the prescription called into the pharmacy with refills .

I did not know that about Care Credit. I assumed it was just like a credit card vs how an insurance plan works.

 

I think its messed up already ( all day he's been saying too high but i just pricked him and hea at 315 with my alphatrak so definitely in range for the libre to pick up.

 

So, one thing to know is that the interstitial fluid glucose will lag behind the BG. The more dynamic the glucose is (dynamic meaning not only whether the glucose is increasing or decreasing but also the speed of the change), the more likely your Libre reading and a BG reading using a meter are going to be much different from one another. The more stable the glucose is the closer together the 2 numbers will be.

One possibility in looking at the history is that the ISF glucose was above the 500 when you scanned it but the BG had already decreased.....& yes, it is possible that this pattern may have repeated.
Keep in mind that BG is a snapshot in time and glucose does not stand still.....especially & more so when you are trying to regulate it .

I am going to attach a link to Medtronics explanation of BG vs ISF or SG. It may help provide a visual regarding why the 2 will often not match. There are 2 videos that do a nice job simplifying a complicated subject .

https://www.medtronicdiabetes.com/c...y-sensor-glucose-does-not-equal-blood-glucose

What is the graph showing with respect to the day as a whole vs the individual readings you got?

 

The graph is really choppy. Missing huge gaps even though i've scanned within 8hrs. This morning for an hour my mom said it told her unavailable try again in 10minutes. I just tried again and now its telling me to wait 10 minutes too. He's been scratching at it a lot today because its easily reachable where they placed it. So while it looks secure still he might have knocked the filament. I scanned him at 11am and it said too high. I went back to work and came back 6hrs later and still saying too high which is usually when hes low which made me nervous. So i pricked the ear and he was his normal low 300. So im happy he's not over 500 but also a little sad if this is bad that it only lasted me less than 48hrs

 

I highly doubt this will be of any use to the vet

 

The wait 10 mins is concerning & I hate to say it but it sounds like the filament was disturbed. He most likely loosened it enough for this to happen .

I am not sure where they are getting these application ideas. Even the latest Feline Endo Textbook clearly states where to apply it.
I wonder if it is disturbed if they would be willing to credit you a sensor and apply it on the appropriate location? Worth a try....never hurts to ask. The only thing is, you would want a Kitty Kollar to use with it. That way you don’t need any VetBond glue, just the adhesive that is already on the Libre.

Again, I am so sorry you and your cat had this experience . Such a great tool but there needs to be a way to help the vets learn the application technique. It’s easy & works well.

 

Thank you~~ when i call her tomorrow i'll see if thats something they could do. Especially since she wanted to use the last few days of data as a determinant for the dental. Just tried it again and not working still. Super high ear prick at 745 but he was really fighting me for the prick so maybe stressed. Also i was told being on gabapentin could raise his BG because pain meds are steroids. Truth to that?? If its still not working in the morning when i do his amps im going to cut the shirt off him so he can at least be more comfortable and maybe the other cats will stop being mean to him. Oh well, it was a nice day and a half of not having to prick and i guess instead of complaining about the money lost i should be content that he's been having a really good last few days as far as activity level/appetite go and just cross my fingers she lets me schedule a dental tomorrow

 

Stress can definitely increase BG.

Gabapentin is not a steroid. It is actually an anticonvulsant. Initially used to help treat epilepsy, they then found that it helped with other issues such as neuropathic pain. There have been a very, very limited number of people who experience hyperglycemia when taking it, but I am personally not aware of it being an issue with cats & specifically, with cats with DM. With that being said, it is a good question with respect to does it happen and how often in cats.....small percentage or not seen at all?

You have a good plan! Be free! Why keep him wrapped up if it’s done?

Here is the link for Kitty Kollar:

https://www.kittykollar.com/

 

Okay thats what i thought. I had read it was more commonly used to treat seizures but then a friend was like no its a pain med so its a steroid and thats not going to help his numbers. Im just like whatever it is has him eating good again so whatever. Just ate 2 cans ff pate so a total of 4 today plus a little boiled chicken for an inbetween snack since hes back in the habit of begging at the table haha. I feel like we're going on the right track with him gaining back a little over a pound in the last 2weeks as well as his bloodwork coming back normal as opposed to a month ago. Just going to keep hoping for some lower numbers. Getting more pinks during the days but his before both shots are so so high still. And i'll check that out. I wasnt sure if maybe a thundershirt would work better since its a thicker material, but the kitty collar looks like a better option because he was not a fan of the shirt around his belly

 

The Kitty Kollar and neck application is definitely the way to go.

I purchased a thundershirt, not for the Libre but thinking it would be helpful for firework noise and I tried it on T before the 4th. Poor guy was SO upset. It freaked him out. I got the opposite reaction I was hoping for! I am sure it works for some cats. Like so many other things, it depends on the cat .

Congrats on the weight gain ! Those numbers will come down as you continue the journey. They are often the ones be the last to come down. Part of the reason for this is Lantus action is more often around 10 hours in cats vs 12 hours. This is why people will often see a bell shaped curve vs a completely flat one.

 

oh no!!! They really are all different. I've tried so many calming products in the past with no luck. Oj's brother(in my profile pic when they were about a year old) is s 30lb giant mainecoon who is so long he can pull stuff off the counters and who is also super aggressive. He gets along pretty decent with his other litter mates but i had another cat who he absolutely hated. I ended up having to separate her from everyone else because my coon would definitely kill her if given the chance (she now has kitten friends so shes not alone). But i tried diffusers, water additives, stuff you rub on their ears, sprays, collars. No luck at all.

and ohhhh gotcha, yeah i just checked him and he's got about 2hrs to go before his next shot and already in the mid 500s so i def see him dropping off more around the 10hr mark

 

It was really “OH NO”! He is my sensitive man and instead of calming we got panic!! His eyes were HUGE.

We had a Maine Coon years ago—Sasha—super intelligent, large and in charge! I can only imagine an aggressive 30 pound male . Yikes! I am happy he was able to able to get along with the rest of the fur crew .

Best with today!

 

Thanks! You have a good day too! His libre is all out of whack. Still showing unavailable but showed a line under 50 so i checked him and in the 500s still preshot so its def finished. Cut off his shirt this morning. But while i have you, i saw this on here. Is this using a human meter? I feel like he would still be higher than he should be but since human meters read lower i heard, he might actually not have as many numbers in the black range. Im going xmas shopping today so i was thinking of picking up a relionmeter while im out

 

Update* they offered to replace the libre for free so we did that today. They moved the spot a little further down on the side. They said it was probably too close to the shoulder last time so him walking probably messed it up

 

If you are still following TR, it's time for an increase. Getting to a better dose will lengthen duration and get rid of those blacks.

I hope this time the Libre lasts longer and doesn't bug him as much.

 

I hope so too! And i'll up him .25 tomorrow morning. The vet was like whoa cool your jets with me upping him so quickly so i wasnt sure if i should hold off but then i was also reading about the toxicity where they get too used to the one dose. She didnt want me to up it because she thought he was bouncing and it would level out in what she said could take a week.
He's been slugging everyone today so back to his normal bully self. I told him to just make sure he doesnt mess with the wrong kitty so that sensor stays in place lol. I also got a bag of dr elseys clean protein in the mail today. Im still going to keep him like 90% on wet but i figured once a week i could give him a bowl of dry to mix it up a little. I gave him a few pieces of kibble before and he gobbled it up

 

If you are going to introduce dry food into the diet, that means following SLGS for dosing so longer before increasing. TR requires all low carb wet or raw food.

Bounces can take up to six cycles (three days) to resolve, so you don't need to wait a week.

 

Even though the dry food is less than 5% carbs like the wet food im using??

 

Correct. The studies that were done to develop TR were done with low carb wet or raw food. Dry food metabolizes at a different rate than does wet or raw. Since TR is already an aggressive protocol, though safe when you follow the guidelines, we don't want to add any more risk with the unknown of dry.

 

Ahhhh okay. I thought it still being low carb would be fine. I'll definitely reconsider giving it to him until he gets more regulated. He has no problem with the wet food, so i can definitely continue just that. i was just looking to give him a little change