40 AMPS reading this morning!

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emchic

emchic

Member Since 2012
AMPS means AM pre-shot right? Anyway, the first thing I do when I get up is check is bg.
When I checked Zoozey's bg this morning, his reading was 40 at 6:35 am! He's not showing any symptoms of hypo, although it could be hard to tell as he's still recovering from his bout with DKA (e.g. he's still sleeping/resting a lot). But, he feels feisty enough to not want to me to read his bg, so that's a good sign. He absolutely did not care when he was really sick. He did eat a good amount this morning, but he wasn't ravenously hungry. Because his reading was so low, I added some dry w/d to his 1/2 can of w/d and he ate most of it. I checked his reading at 7:57, and it had gone up to 51 and just now (at 8:45) he was at 81. So his numbers are going up and that's good. In my signature, I've included a link to a log of his bg readings and some notes about his recovery,as well as a profile for him. I haven't given him his shot yet, should I?
 
I cannot open his spreadsheet, due to work firewalls-- imagine that! What insulin is he on?
 
I have no experience with Lantus , but I would recheck him and post his bg . It appears that when you do give insulin that you need to reduce the dose.

I would post in the Lantus ISG and see of you can get more guidance.
 
I would not shoot a full shot this morning. I know with the DKA you want to make sure he has some insulin so skipping a shot wouldn't be advisable either.

You tested and fed at his normal time and you included dry... any bg information will be tainted by the dry for today at least and you both are new enough that you don't have tons of data to back you up.

You are shooting late as 6:30 is your normal time and it was already 2 hours past that and he has had dry food- perhaps a half dose?
As his numbers have been decreasing through the days I would suggest he needs to be on a lower dose in any case.

Have you posted this in the Lantus forum? I use Levemir and while it is a long acting like Lantus it reacts different.

Are the numbers still going up?

Also- your profile link is broken and goes to an empty page. And this tells how to set up a spreadsheet and link to your signature:
viewtopic.php?f=6&t=18207

Heather
 
Gah! I called the vet and they told me to go ahead and give him his full dose, so I did at 9:30. I can only delay going to school for another hour and a half because I have writing conferences with my students scheduled, but I will check his bg a couple of more times before I go and I will check him again as soon as I get home this afternoon. I will certainly give him his shot later tonight, and I'll transition him back to his 6:30 shots. Is that the right thing to do? I was wondering whether or not to post this in Lantus, but I wasn't sure, so I posted here, so thanks Carl for posting it there. I appreciate it.

I haven't fed him any dry food since his appetite came back a few days ago, but I didn't have any karo syrup or honey (and I don't have money right now to buy either) so I gave him a little bit of dry with his canned this morning to help his numbers come up a bit. Is that wrong?

Also, I fixed the links. They work for me, but if someone else could click on them and see if they work, I would appreciate it. The log will be a spreadsheet as soon as I finish the chapter of my dissertation that I'm working on, but for now the log is quicker.
 
We posted at the same time:-)

How much longer can you be there?
 
Carl,
I checked just now (at 10:32 am), and he's up to 135, and he's quite unhappy I've taken his bg so many times this morning. I have a student coming at 12:30, so I can stick around home until 12:00. Is he on the right track? Should I check him again before I go?

I forgot to put this on his profile, and I don't know if this is of any relevance here, but I took him in for a curve on Friday morning when I got an 80 reading. They wanted to see if he could get by on one dose a day, but his numbers shot up to 495, so he has to have two shots a day.
 
Yes, he's on the right track.
Check him just before you leave and leave out some food. Get a test when you get home.
As far as the next shot timing, we'll figure that out later:-)

Carl
 
Barbi, is there any way you can get a daily mid-cycle check in addition to the preshots? It can be in either cycle. Lantus dose adjustments are based of the nadir (lowest number of the cycle), which usually is about halfway through the cycle. You those daily numbers allow you to dose Lantus safely and effectively. I know how hard it is when you're super busy (I was working two jobs and going to grad school when Bandit was on Insulin), but trust me, those tests will pay off for you in huge amounts in the long run, not only in terms of your cat's health and safety, but also by lessening the amount of stress and work you have to do to get his diabetes under control.

Here's the Lantus dosing protocol if you haven't yet seen it: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

Also, I see from your profile that you were thinking of feeding W/D canned? I'm not sure what food you decided on, but even the W/D canned is too high in carbs (26%) and not appropriate for a diabetic cat (in fact, no Hills food exists that is ok for a diabetic). A diabetic needs less than 10% carbs. Purina DM canned is the only prescription food that is appropriate for a diabetic (3% carbs), but it's way overpriced considering that it's nearly identical to Purina Fancy Feast Liver & Chicken. You're paying a huge markup for just the label, and you can get a premium low carb food with much better ingredients (like Merricks, Wellness, EVO, or Instinct) for less than what you'll pay for the DM. If he is underweight, a premium food would actually be preferable because they are generally higher in calories and will help promote weight gain.
 
The other thing I'm seeing from your log is that you haven't been shooting on a 12/12 schedule--and yesterday night you shot at 6:50am, and then 530pm for the PM shot. Lantus works best on a 12/12 schedule, because when you shoot off schedule it creates an overlap in the duration of the insulin. So when you shot about an hour and a half early last night, that worked the same as a dose increase, which is likely why you had the very low preshot this morning. When you shoot late, that works as a decrease in dose. Is there any way you can arrange your schedule so that you're shooting 12 hours apart? Lantus needs consistency, and while it can be shot off schedule for those who have no choice, it's best if you can get on a 12/12 schedule. We generally recommend not moving the shot more than 30 minutes a day (or 15 minutes for each shot) to avoid the overlap/drain that's caused by early/late shots.

Here's a great post that explains how Lantus works, and why it's best to shoot on schedule: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=150
 
If you don't have Karo or honey, vanilla ice cream, or even mixing a sugar solution (sugar and water) will work fine. The W/D you're using is, as Julia noted, way high in carbs and will do the job. It's not appropriate for a normal, low carb diet. In addition, if dollars are tight, you can do far better both in terms of cost and carbs and nutritional value than Hill's. You would be paying far less than what it's costing you for prescription food if you bought the largest size cans of Wellness (a human grade, premium food) and the carbs would be lower.

Please keep an eye on Zoozey's numbers. 40 is a low number at pre-shot although I suspect you're going to see a wicked bounce. This is information on dealing with low pre-shot numbers and how to handle low numbers during the cycle. Again, like Julie said, getting some spot checks will help you to know what's actually going on with your cat's response to Lantus. Lantus dosing is based on the lowest number in the cycle, which is typically somewhere in the middle. Based on that 40, you will want to lower your cat's dose by 0.25u. I can't tell from your notes what your current dose is.

It will also help us to help you if you could set up a spreadsheet. I've linked you to the template and instructions that we all use.
 
Please be careful if you are currently feeding Hill's W/D and you want to switch to one of the lower carb foods and eliminate dry food all together (which is preferred). The food change alone can cause BG numbers to drop significantly. You want to be sure you can be home to test and monitor to make sure kitty stays safe! Sounds like you have a lot going on and there is quite a learning curve in learning to care for a sugar kitty - hang in there!
 
He's all over the place today! His reading from 5 minutes ago is at 90. However, I'm using an inexpensive meter from Walgreens right now because I needed something that day and I need something cheap: http://www.walgreens.com/store/c/wa...9459&sst=705ca24b-3586-e609-0bbb-00005eb599b3 According to the study you linked Julia that means his reading is actually higher than what the meter is reading? Do I need to get a new meter? I get paid at the end of next week, so I'll be able to get a meter from the link at the top of the FDMB page. Or is what I'm using okay?
My goal is to do his shots at 6:30 and 6 every day, and it's been a process to get into this routine. I'm at the tail end of a six month bout of chronic insomnia, and that insomnia has lowered my immune system, caused anxiety and generally made me feel terrible. So I'm trying very very hard to get on a regular sleep schedule. It's been hard, even in this last week, to adjust to a routine that works for both my health and Zoozey's. The balance is out there though, and if anyone has any advice on finding that balance, I'd love to hear it. Like Julia, I have two jobs and go to grad school. When I'm sleeping better, which I think will be fairly soon, I have no problem getting up to check Zoozey's blood sugar. In fact, it's a great idea since my daytime schedule is different every day. In the meantime, I will do as many mid-cycle readings as my schedule allows. And if I can't sleep, and he's at his nadir, I'll grab him and get a reading.

I'm feeding him DM right now, which is what he's been eating since January, and I've got enough to last me another couple of weeks. I was experimenting with the w/d since it's cheaper, but if it's got more carbs, then I won't use it. I only had two cans and he liked it a lot, but I have even more DM.
Oh--and I do intend to set up a spread sheet. Writing the log this morning was quicker for me, and I wanted to get the info online asap.
 
Anything you have that is sugar will do just fine - some things you may have:

- pancake syrup
- jam/jelly
- canned icing - not chocolate
- ice cream - not chocolate
- table sugar or brown sugar - mix with water and syringe feed
- canned whipped cream
- high carb canned food - anything with gravy - especially fancy feast gravy lovers

I'm sure if you look around your kitchen in the fridge and cabinets you will find these and other sugar products that you can use when needed. Just don't use anything with chocolate.
 
emchic said:
According to the study you linked Julia that means his reading is actually higher than what the meter is reading? Do I need to get a new meter?
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I would test the meter on yourself. If your blood sugar is in a normal range, then it's likely working fine. One very inexpensive meter that is reliable is the Relion Micro or Confirm (they use the same strips) from Walmart. They have some of the cheapest strips around especially if you order the generic strips that fit the meter (named Arkray Glucocard 01) from the American Diabetes Wholesale web site.

The first part of the protocol is written for human meters, so you don't have to do any adjusting with your numbers. The second set of guidelines after the first are written for pet meters (alphatrak), and you can ignore them because you're using a human meter. Most people use human meters for testing their cats. Here's a more user friendly take on it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

emchic said:
. I was experimenting with the w/d since it's cheaper, but if it's got more carbs, then I won't use it. I only had two cans and he liked it a lot, but I have even more DM.
Click to expand...

DM canned is ok for diabetics way overpriced--there are much cheaper foods that you can get that are the same or better quality. You don't have to feed a prescription diet, even though the vet might be telling you differently (remember that your vet makes money off selling prescription diets). There is nothing special in the food--it's just low carb, like many other commercial foods. See this vet's take on them: http://catinfo.org/#Prescription/Therapeutic_Diets_.

What you're looking for is a food that is less than 10% carbs, and there are a ton of much cheaper commercial options. Here's a link to the cat food nutrition charts: http://catinfo.org/docs/Food Chart Public 9-22-12.pdf. Just pick something less than 10% (preferably less than 8% carbs).

I know it seems tough at first, but I would really try the best you can to get on a regular schedule with him. It will make your life trying to regulate him much easier. And yes, if you're up anyway (I often only got 5-6 hours of sleep a night when Bandit was on insulin), get those tests if you can. Bandit's shot's were at 7am/7pm, and there was no way I could test him during the day because I was gone almost a full 12 hours because of my commute to work. So I tested at his preshots, got a test before bed at 10 or 11pm (+3 or +4), and then I set an alarm to get up and get his nadir at 1am (+6). It was a pain at first, but my body adjusted and I was just fine after a few weeks. I also got a curve (testing every 2 hours for a cycle) when I was home during the day on the weekend. I never had a sleeping disorder, and the only advice I really have in that dept. is if you haven't already seen your doctor about getting that under control, and perhaps asked him/her for help with figuring out sleep with your new responsibilities, I would definitely do so. Many people with newborns or young children have similar issues with sticking to tight schedules or having to get up in the night, so they should be able to offer you some help.

When Lantus is dosed according to the protocol, and the cat is fed a low carb, canned diet, the large majority of cats go into remission. And that's where the extra work getting those tests and shooting on schedule are worth it--trust me, it's far easier to have a cat in remission, or even a well regulated cat on insulin than it is to struggle with regulation and high numbers, especially with ketones in the picture.
 
Relion has a new meter called the Relion Prime (sold on ADW as Glucocard Vital) which has the cheapest test strips around!!! It's only $9 at Walmart for a box of 50 strips. I've been using this meter (as have a lot of others on FDMB) for quite a while and it's very accurate and easy to use. When money is an issue, and it always is for me, this is the meter to use!! I ordered strips from ADW a bunch of times and have a couple of the Vital meters, brand new in the boxes, that came with them. I'll be more than glad to send you a brand new meter with some strips, test solution, etc., if you just PM me your address. I can get it in the mail for you tomorrow. Let me know!! All you'll need to do is buy the strips, $9 for 50, at Walmart when you run out.
 
emchic said:
They wanted to see if he could get by on one dose a day, but his numbers shot up to 495, so he has to have two shots a day.
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One thing I didn't see anyone mention is that because of the way it works (12-hour periods), Lantus should generally be given TWICE a day. So if the vet wants to see if he "gets by" on one shot a day, you're basically making Zoozey use up depot stores for 12 hours every day, which then need to be replenished. To decrease a dose with Lantus, you have to decrease it across both shots, not just remove one shot altogether. I'm still fairly new to this whole thing, so if anyone else knows better, please feel free to correct me if I'm wrong. :-D

Patty & Champ said:
Relion has a new meter called the Relion Prime (sold on ADW as Glucocard Vital) which has the cheapest test strips around!!! It's only $9 at Walmart for a box of 50 strips. I've been using this meter (as have a lot of others on FDMB) for quite a while and it's very accurate and easy to use. When money is an issue, and it always is for me, this is the meter to use!!
Click to expand...

I just discovered the Prime the other day at Walmart! All the other times I'd been, Walmart only had the ReliOn Micro and/or Confirm (and test strips) available, so I didn't even know of the Prime's existence. When I saw this for the first time on the shelf, I almost bought it because the test strips were $18 for 100!!! The only thing is that it does require more blood (0.5 vs. the Micro's 0.3 μl of blood). I still might buy it, though....

ETA: Okay, something funky is going on with my message board. I keep seeing these "new" posts that turn out to be several days old. Gonna do a PC reboot since I just updated my browser and that might be causing the problem.
 
Sleep tip:
If you want to wake with less difficulty, let the sleep period be a multiple of about 45 minutes. This is about how long one sleep cycle lasts.
0:45
1:30
2:15
3:00
Etc
 
BJM said:
Sleep tip:
If you want to wake with less difficulty, let the sleep period be a multiple of about 45 minutes.
Click to expand...
As an insomniac with a sleeping disorder who has been to numerous sleep specialists and through numerous sleep studies, this is absolutely true (and as a chronic, time-zone-jumping, business traveler speaking from experience: it's also useful in curing jet lag). One other thing is that some people need to go through a full sleep cycle vs. a half (which is what ~45 minutes technically achieves). If you're one of these people, try waking up in 90-minute increments instead of 45.
 
Thanks for the tips BJM and Kpassa. The semester ends next week, so I'm going to try this the first day I don't have to be coherent to teach in the morning (just in case it doesn't work). I'll probably need to do a full sleep cycle because I've noticed that when I nap I usually nap for somewhere between 90 to 120 minutes. I really do feel like t's important to get more than an AMPS and a PMPS reading. Neither of the clinics I've been to have really emphasized me taking my own readings. They certainly find it useful when I do, and Zoozey's new vet wants me to do a curve at home (which I'm doing today). I just don't get it. I think taking regular readings seems so important. Someone somewhere on FDMB pointed out that if we ourselves were diabetic, we wouldn't not take readings before an insulin injection, why should cats be any different?
 
Someone somewhere on FDMB pointed out that if we ourselves were diabetic, we wouldn't not take readings before an insulin injection, why should cats be any different
Click to expand...
?
Yeah, lots of folks in lots of places on FDMB point that out regularly. :smile:
Another good way of saying it that I've seen is "shooting blind is like driving down the interstate with a paper bag over your head"
:-)

Carl
 
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