3 weeks after Dx, all blues and greens

Status
Not open for further replies.
ramonaghan

ramonaghan

Member Since 2014
Hi all, I'm a newb looking for some feedback on Henry's numbers before his next glucose curve at the vet on Monday. A bit of background on us here and here. I'm posting in Tight Regulation since we have been shooting some low numbers, as I work from home and am here to monitor/test Henry multiple times per day. So far, so good on the 5 Ps, and no signs of weakness or anything concerning.

Henry's first glucose curve was last Friday after a week at 1U BID, and based on those results his dosage was increased to 2U BID, which I now understand was too much of an increase too soon. Add to that the fact that he gets very stressed at the vet and I'm fairly certain I gave him a fur shot the Thursday morning before Friday's curve, and I think the vet was working off very elevated numbers. Despite these concerns, we did give him the 2U Fri PM and Sat AM, and his values dropped to a scary 41 at nadir on Saturday. We reduced his dose to 1.5U and skipped a couple of PM shots to try to get his values in a more comfortable range. I spoke with the vet on Monday about the low numbers and she wanted us to stay the course at 2U BID but gave us a no-shoot value of <70. As you can see in Henry's spreadsheet, we're still not giving 2U. He seems to be holding steady between 1U and 1.5U BID. I am waiting for an order of syringes with half unit markings, so we've been eyeballing the 1.25 and 1.5.

We have been using a CVS Advanced Meter but got an AlphaTrak 2 yesterday, so as of today that's what we'll be using. I think the vet will lend the values more weight if we're using the same meter she is (not that she's been dismissive or unsupportive of our efforts--quite the contrary). I just want to arm myself with as much information as possible before taking him in again Monday, and while I suspect having another curve done there is a waste of $66, I'm willing to pay it again to get a more direct comparison between the values we're getting at home vs. the vet's office. I would like us to be on the same page.

So I'd love to get input on his numbers, dosages, and anything you think I should ask the vet on Monday. Thank you!
 
Welcome to TR.
You don't have to be doing tight regulation to post here but it looks like you are doing pretty well on the testing.
I would try to get some data in the +8 or +9 or +10 pm area.

Your chart looks a lot like mine. It looks like you caught the FD early on before numbers were just crazy. That's good. That increases your odds
of making it to remission status.
The vet curve really isn't any different than what you do already. They just test every 2 hours or every 3....and keep Henry hostage all day at the vets which makes him stressed and can raise his numbers slightly.
I understand you trying to keep the vet happy but if it were me, I'd just share the spreadsheet.
Your vet is wrong to want you to continue shooting 2 units..... it's too much and puts Henry in danger.

I'm betting on you'll be earning a decrease soon.
It sounds like you have familiarized yourself with lantus, but I recommend reading the sticky's at the top of the forum.
I'm adding part of one of the sticky's for dose increases and decreases

"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
•Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
•Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.◦if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
◦when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

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.

Please do not let yourself become complacent or blasé about drops into the 20s or 30s. ◦If kitty drops into the 20s, a full reduction of 0.25u (or 0.5u if kitty is on a higher dose) is strongly recommended.
◦If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are very few exceptions given for caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
◦Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
Please ask for advice.


If anyone suggests otherwise, they are putting your cat at risk! Our kitties are not just numbers. They are living beings who trust us to look out for them. The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive.

Keeping YOUR cat safe is the #1 priority of the FDMB.
Let's keep all our kitties in the Lantus Tight Regulation ISG safe by suggesting and taking appropriate reductions.
Click to expand...


I think Henry is looking very good.
 
The curve done at your vet on 12/12 is VERY telling - look at those numbers compared to the numbers you get. That is vetty stress at play, and is not what happens within Henry's body on a regular basis. Shooting any more than you are currently shooting would be very dangerous.

I agree with Rhiannon - since you are testing at home, you don't need to waste your money and put Henry through the stress of curves at the vet. I do understand that you want to be on the same page as your vet, and she sounds like a good one, but there is really no value in comparing his values at the vet to his values at home, since home is where he lives :-D !

It's unfortunate the vet feels a need for you to use the AT - strips are pricey and not easy to get. The human meters are adequate - you just have to compensate for the difference. With that said, recording from the two different meters on your SS is somewhat confusing, too...it makes it hard to interpret the numbers consistently. So definitely pick one meter and stick with it. If you decide that meter is going to be the AT, make sure to clearly note that in your posts, so that everyone who is helping knows the kind of numbers you are getting.

Also, with that 50 last night, you should have gotten at least one more test in, if not more. That is skating on the edge of hypo, and you want to be sure Henry stays safe, especially since he is responding so well to the insulin.

You guys are off to an awesome start. Keep up the great work!!
 
Thank you both for the welcome and the feedback!

Amy&TrixieCat said:
It's unfortunate the vet feels a need for you to use the AT - strips are pricey and not easy to get. The human meters are adequate - you just have to compensate for the difference. With that said, recording from the two different meters on your SS is somewhat confusing, too...it makes it hard to interpret the numbers consistently. So definitely pick one meter and stick with it. If you decide that meter is going to be the AT, make sure to clearly note that in your posts, so that everyone who is helping knows the kind of numbers you are getting.

Also, with that 50 last night, you should have gotten at least one more test in, if not more. That is skating on the edge of hypo, and you want to be sure Henry stays safe, especially since he is responding so well to the insulin.

You guys are off to an awesome start. Keep up the great work!!
Click to expand...

No pressure from the vet on the AlphaTrak--that was all me. :oops: I was nervous about the fact that the CVS meter is so new (released in early November, I think?) and no one else uses it here, and I just wasn't feeling confident making decisions with it. I think the AlphaTrak will give me a little more peace of mind and at least make a more convincing argument to the vet that Henry is *very* stressed when he's there! But all values on his SS up to this morning's AMPS (and with the exception of the GC at the vet) are with the CVS meter, so hopefully there's enough to interpret there.

Re: the 50, I will definitely get another test in next time. The 79 at PMPS was a 101 on the AlphaTrak, so I guess I felt there was some wiggle room there. I did give him a bit of HC food then and checked on him a few times in the night. I have been tossing and turning a lot since Dx--do you ever sleep soundly again? (Of course, DH sleeps like a baby. :roll: )
 
Yes, believe it or not, you DO sleep soundly again - I swear, it's true! The good thing is you found us - you are among people who have been exactly where you are today, and we understand all aspects of it -the emotions, the stress, the sleepless nights...and then finally getting into the smooth groove of it all!

HC was a good idea, as was checking on him. One thing to keep in mind, though, is that some kitties don't show hypo symptoms until they are very dangerously low. My own Trix acted like she had not a care in the world until she hit the low 30s. So when you see numbers that low, you do want to test as well as a "visual" check, just to be sure all is well, and so you can catch and address the numbers before they fall TOO low.

Remember that the Alphatrak range is different than the human meter range. For the human meters, we want numbers in the 50-120 range; on the AT, the range is 80-150. This is why we all need to know which one you are using - when you get into the lower numbers, this is very important to know.

The CVS meter is probably fine, but most of us do use the Relion meters - strips are available at Walmart and are very affordable. But, you do have to use what YOU are comfortable with, and if you choose the AT, that is perfectly fine - just be sure the rest of us know for sure which meter it is you are using.
 
I can relate to your nervousness.
In the beginning, I couldn't sleep at all, my DH didn't want to be disturbed so I started sleeping on the couch so I could sleep test ( set the alarm at night , roll over test, fall back asleep)
Since I couldn't sleep, I would read every one else's condos and research and learn . I too wanted remission for Christmas.
And I was one of the lucky ones who got it. It's been 2 years now.

Henry looks like he may be one of our surfers. ( like mine)
Surfing those greens.... and that's exactly what you want.
 
rhiannon and shadow said:
I can relate to your nervousness.
In the beginning, I couldn't sleep at all, my DH didn't want to be disturbed so I started sleeping on the couch so I could sleep test ( set the alarm at night , roll over test, fall back asleep)
Since I couldn't sleep, I would read every one else's condos and research and learn . I too wanted remission for Christmas.
And I was one of the lucky ones who got it. It's been 2 years now.

Henry looks like he may be one of our surfers. ( like mine)
Surfing those greens.... and that's exactly what you want.
Click to expand...

Fingers and toes crossed. Shadow's spreadsheet is beautiful...I think I have spreadsheet envy! :lol: Did you always test on the ears? Henry's look a little beat-up and we're testing far less than you did. He wriggles for his treat once he hears the meter beep, so it's challenging to apply pressure long enough to prevent bruising.
 
Hi Rachel and welcome to LL! Is there any way you can hold on to Henry's ear as he eats the treat? As you (and Henry's ears) get more used to testing you might want to try a finer lancet. We use 33 gauge and no trouble getting blood. We test Tess at least 8 times a day and you couldn't tell we test at all. Neosporin w/ pain relief helps to heal and make things mor comfortable for him too.

I hadn't heard of the new CVS meter. I did a little research and it's make by the same company that makes the meter I use, the Target Up & Up. Agamatrix makes both the Target and the CVS meters and the Target meter got Top Consumer Choice from Consumer reports. I really like our meter and I'd say the CVS a good meter to use too, especially as the strips would be so convenient to get. It's awful to have your cat go low and be low on strips and waiting for an order to arrive! I get the Agamatrix Presto strips for my Up & Up meter from ADW and they work perfectly. There may be an equivalent strip for the CVS model too, but the company makes several different meters. ADW also sells AlphaTrack strips for $54 a box. Many of us get our supplies there, I get my Agamatrix strips there for $10.30 a box. Click the "Shop" link at the top of the page, and look for the American Diabetes Wholesale link (under the Walmart link.) FDMB gets a commission, but it costs you nothing.

Henry's SSis looking great and you are very correct in not giving as much insulin as you vet recommends. You are living w/ Henry day to day and know him much better than the vet does.

BTW Henry's avatar is gorgeous! Is he a Russian Blue?
 
Ann & Tess said:
Hi Rachel and welcome to LL! Is there any way you can hold on to Henry's ear as he eats the treat? As you (and Henry's ears) get more used to testing you might want to try a finer lancet. We use 33 gauge and no trouble getting blood. We test Tess at least 8 times a day and you couldn't tell we test at all. Neosporin w/ pain relief helps to heal and make things mor comfortable for him too.

I hadn't heard of the new CVS meter. I did a little research and it's make by the same company that makes the meter I use, the Target Up & Up. Agamatrix makes both the Target and the CVS meters and the Target meter got Top Consumer Choice from Consumer reports. I really like our meter and I'd say the CVS a good meter to use too, especially as the strips would be so convenient to get. It's awful to have your cat go low and be low on strips and waiting for an order to arrive! I get the Agamatrix Presto strips for my Up & Up meter from ADW and they work perfectly. There may be an equivalent strip for the CVS model too, but the company makes several different meters. ADW also sells AlphaTrack strips for $54 a box. Many of us get our supplies there, I get my Agamatrix strips there for $10.30 a box. Click the "Shop" link at the top of the page, and look for the American Diabetes Wholesale link (under the Walmart link.) FDMB gets a commission, but it costs you nothing.

Henry's SSis looking great and you are very correct in not giving as much insulin as you vet recommends. You are living w/ Henry day to day and know him much better than the vet does.

BTW Henry's avatar is gorgeous! Is he a Russian Blue?
Click to expand...

Thank you for all the tips! We'll try holding his ear as he eats and applying Neosporin. The testing process is complicated by the fact that his "sister" Olive is always hovering because she knows the treats are coming out. (How quickly they learn.) So when I am here testing solo, I run out of hands between the lancet, meter, cotton ball, wriggly Henry, and nosy Olive. I'll get better with practice, I am sure...and locking Olive out. We've already made major strides since our first attempts and are getting blood every time.

I ordered the AlphaTrak strips through Amazon ($55) since I'm a Prime member but next time will be sure to use the Shop link so FDMB gets the commission (you've all been so helpful!). I ordered the half-unit syringes through ADW via the Shop link per someone else's recommendation. Hope they get here soon, because I am counting on a reduction soon!

Thanks for your compliment on my boy. He looks like a Russian Blue, but he's probably a mutt, really. My husband and a coworker found him as a stray when he was barely two months old. He was scrawny and starving so they fed him all they had at the office--bits of ham sandwich and potato chips. And so began his love affair with food...
 
Hi Rachel,

Glad to have you and Henry here!

Those of us here are all volunteers/laypeople, but purchasing through those shop links does help pay for the website to keep going.

If I'm reading his ss correctly, today's test numbers are all done on the alphatrak, is that right? If so, he earned a reduction in dose today when he went below 80 on the AT. Because most of us use human glucometers, it is extremely important that you have it be very clear that your tests are on an AT. We encourage people to put it in giant colored letters on the spreadsheet - where you have "new glucometer" in blue would you change it to red and add "AT" in bold? A 69 on a human glucometer is just a great number but on an AT it means a dose reduction - so the difference is very important.

I'd reduce your dose to 0.75u tonight and hold it there until he goes below 80 on the AT again. Lantus works best when the dose is the same both am and pm shots. Because of the way it works in the body, changing doses frequently is like rocking a boat. You'll see wonky cycles if the dose is different at each shot and you won't know what the dose is that needs to be changed. Think of it as timed release - when you reduce a dose the "depot" that has built up in the body from the previous higher dose can continue to slow release, influencing as many as 6 cycles after you've reduced the dose. So today, when I see the 69, I don't know if it's from today's and last night's 1.0u dose or if it's still from yesterday morning's 1.25u dose. Or even the day before's 1.5u dose.

Lantus dosing is based upon how LOW the dose makes the cat go, not the high numbers at preshot. So don't increase the dose at preshot if you see higher numbers. We focus on the low point (nadir) and the dose is based upon that.

If you don't have 0.5u markings on your syringes yet, pay attention to the plunger in relationship to the black 1.0u line on the syringe. You want to reduce the dose to less than you called 1.0u this morning. It's very important to take dose reductions when a cat goes low enough to "earn" them so that you keep him safe.

Does all of that make sense?

Here is a "table of contents" that i'd encourage you to bookmark to help you find information as you need it. Where Can I Find ____? At this point, I want to flag Lantus & Levemir: What's the Difference? for you, not because you need to know how Lev works but because it's really good to understand how Lantus works. Also, if you haven't seen the video on how or read to draw up your Lantus and keep it safe from contamination, there is information here on that. The video is about halfway down the page. Lantus is so expensive that most people want it to last as long as possible.

I'd encourage you to keep posting daily - it does look like Henry is doing great and you want to be able to respond as his body heals and his dosing needs change. Keep asking questions and we'll do our best to help you learn how to help him.
 
julie & punkin (ga) said:
If I'm reading his ss correctly, today's test numbers are all done on the alphatrak, is that right? If so, he earned a reduction in dose today when he went below 80 on the AT. Because most of us use human glucometers, it is extremely important that you have it be very clear that your tests are on an AT. We encourage people to put it in giant colored letters on the spreadsheet - where you have "new glucometer" in blue would you change it to red and add "AT" in bold? A 69 on a human glucometer is just a great number but on an AT it means a dose reduction - so the difference is very important.
Click to expand...

That's correct; today's values are on the AlphaTrak. I've updated Henry's spreadsheet as you suggested, as much as it pained me to add red to it. ;-)

Does all of that make sense?
Click to expand...

Yes, it does; thanks! We will reduce his dose to .75u starting tonight. (The new syringes won't be delivered until tomorrow, so we'll do the best we can.) I do feel like we've been flying a bit blind the past couple of days dosing-wise, so this is quite helpful. I've done a lot of research, but the way the depot works and whether the effect of Lantus is cumulative, etc., has been the hardest part for me to grasp and make decisions around. And his PMPS number has been so close to his nadir (or even lower), which has kind of thrown me for a loop too. But I'm so grateful for the blue and green!

I'd encourage you to keep posting daily - it does look like Henry is doing great and you want to be able to respond as his body heals and his dosing needs change. Keep asking questions and we'll do our best to help you learn how to help him.
Click to expand...

So just post a daily thread (condo?) with his AMPS/PMPS like others do? I can do that. :smile:
 
So just post a daily thread (condo?) with his AMPS/PMPS like others do? I can do that. :smile:
Click to expand...

Yep, we usually include a link to the previous day's condo. Copy the address from today's condo, when you start the new one tomorrow, click the URL button above the text box and paste the address where the cursor is blinking between the two sets of brackets. To give the link a name,type out the name, highlight it, click the URL button, backspace into the first set of brackets, type = and paste the address. Like this: [url=paste address here]Henry 12/18[/url]

During the day, go back to your first post and edit the subject line it to add update tests. Only subjects edited in the first post shows up on the list. If you need help quickly type in HELP!! in the subject box, or in a real emergency click the "911" button. No candles or rainbows please, that means a cat has died and you will give all of us heart attacks!
 
Thanks for making the change on the ss, even if it was painful, rachel. ;-) :-D you just don't want anyone to give you advice thinking you're reporting human glucometer numbers and miss that these are AT. We've had it happen before so we try to make sure that it's super clear if someone is using an AT.

Just for a little perspective, with an AT, everything between about 80 and 160 or so is considered normal blood sugar for a cat on insulin. As his blood sugar is kept in that range his pancreas has the ability to heal. As it heals, the beta cells will begin putting out their own insulin again. The pancreas is sputtering back to life and its insulin is added to what you're injecting.

As that happens, you'll likely see that his numbers will drop down below 80 and then you'll decrease his dose. So it's a see-saw act - he goes below 80, you decrease the dose by 0.25u. You hold the dose there until he goes below 80 again, then you decrease again.

When you see his BGs headed lower and think they may go below 80, you're going to want to retest him again. The AT strips are expensive, as you've seen, which is why most people use the human glucometers if they are following TR. But it's going to be worth it to you to keep him safe by continuing to test if you think he's headed below 80. You haven't been on long enough for us to actually identify when his low point in the cycle is, although it looks like it might be around +5-+6. The reason you want to catch that low point is twofold - on the one hand, you want to keep him safe and know if you need to give him carbs to bring his blood sugar back up over 80. On the other hand, you also need to catch him below 80 so that you know he now needs another dose reduction.

It can be intensive to test a bunch, not to mention expensive, but everything about Henry's spreadsheet suggests that his pancreas may be able to heal. Newly diagnosed cats have the best chance at having that happen, and hopefully, they can become diet-controlled instead of being maintained on insulin. It's an effort well-worth that outcome!

You're doing great, Rachel. You've obviously been doing your homework and reading a bunch. well done! :mrgreen:
 
Thank you, Ann, for the excellent condo posting instructions, and thanks, Julie, for the clear explanation and encouragement. I feel like I have a game plan now. See y'all tomorrow.
 
So we had quite a night, but the end result is that the vet is thrilled by his progress and agrees with us doing Monday's curve at home. She'd still like him on 1U BID, but we'll see what his numbers do. He's up some today (AMPS 101, AMPS+2 137), but that seems expected after the night's events.
 
You may convert another vet to TR! :lol: :lol: Nice to know she sees your point an testing at home and avoiding the stress.

Remember he is your cat and you see how he reacts all the time. The vet sees him for 15 minutes every so often. Many vets don't think caregivers can be trusted to to adjust a dose. Although humans do it for themselves and their children all the time, they aren't constantly running to the doctor for adjustments. I've seen more cats go hypo from following vet dosing than any other time. We have a saying here "Better too high for a day than too low for an hour!"

BTW we try to stick to one condo per day. You've posted a new condo today, so this one can be retired. You have the links in so anyone that needs to can go back and check out the details.
 
Status
Not open for further replies.
Back
Top