5/13 Pixie PMPS=160, +1=158, +3.5=164

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caringcdn

caringcdn

Member Since 2014
Hello, I just can't shoot at 82. I need advice.

Last thread viewtopic.php?f=9&t=118620

Pixie was 88 at +7.5 and I set my alarm for 1.5 hours later. When the alarm went off, I looked in on Pixie and he seemed fine and alert, so I decided to not test as I'm running low on strips and my new strips aren't coming in until tomorrow at the vet's. Needless to say, I was shocked to see 82 at AMPS and I'm not sure what to do. He is eating this morning but it's the Surf and Turf by Merrick and he doesn't want to eat any of his other regular foods. I'm sure we're seeing numbers because of 1. his change to a lower carb food and 2. he isn't eating as much. Please advise. In the meantime, I am going to give him his meds, minus the insulin, and his subq fluids. Thanks, Anne.
 
Re: 5/13 Help Pixie AMPS=82

I will look at your ss in a sec.

Next time you get a number that is lower than you feel comfortable shooting, post and don't feed.

brb
 
Re: 5/13 Help Pixie AMPS=82

I guess you are still using the AlphaTrak.
Since this is your first green pre shot test and because you don't have enough strips to do a lot of testing, I would just skip this shot.
When you have more experience, you could take advantage of a green pre shot and get Pixie into some nice flat numbers, but you don't have enough data yet for that.

I have to log off soon. I hope you have a good day. You can save some strips this cycle, but do get a couple tests in.
 
Re: 5/13 Help Pixie AMPS=82

Thanks Dyana. I really don't have enough experience at these low levels to be able to just sail through. Yesterday, when I phone my vet to bring her up to date, she didn't seem too pleased that I had dropped him down from 4units to 2.5 units without her consult. She thinks it might have been premature. I'm a little worried about bringing him in to the vet because I feel we have been over dosing him and feeding him the wrong food. Have a good day, Dyana. Anne
 
Re: 5/13 Help Pixie AMPS=82

I agree with Dyana. You need more data before shooting low -- but you'll get there.

As for your vet, whether your strategy worked is in the numbers and Pixie's numbers look good. If it were me, I'd tell my vet that I was nervous about the dose so I lowered it. The results are in green! It's better to have a kitty in high numbers for several hours than in very low numbers for 10 min.

I'd also encourage you to think about using the AlphaTrack. The strips are expensive and not readily available. At least get a human meter as a back up.
 
Re: 5/13 Help Pixie AMPS=82, +1.5=85

Hi Sienne, hope all is well with you today. We're very lucky to have another bright day. Things seem so much better when the sun is shining and the birds chirping.

Pixie's BG test at +1.5 is 85 so I guess the food elevated him somewhat. I've run out of that particular brand and so I'll have to run back to the store this morning and get a few new selections. I guess what Dyana was talking about was surfing these low numbers for the next 12 hours? Is this what I should do with Pixie - feed a little bit and test in a few hours. Should I consider trying to give him his higher carb food - Hypoallergenic and/or Sensitivity? I'm not sure he would eat it anyway. I had a bowl of it in front of him all night and he didn't touch it. You know the body has natural mechanisms that I believe help keep a cat safe and I think that's at play here. Pixie's body is keeping him away from the foods that make him sick.

When I go to town I'm going to stop in at Walmart and purchase a human glucometer. We don't have Reliometer but when I was in a few days ago, I saw that they have Accucheck??, not sure about the correct name but I did read online that this is a reliable meter.

Do you think Pixie is safe enough to leave for 1 or 2 hours. It takes me at least 20 minutes to get to town from my place. One of the hazards of living in a rural southwestern Ontario community. Anne
 
Re: 5/13 Help Pixie AMPS=82, +1.5=85

Hello,
I am in Ontario as well. Don't pay for a meter. The store may have an in-store offer for a free meter with the purchase of strips, but before you leave, you should also visit the Accucheck Canadian website and print off a coupon for a free meter. Other brands also often have the same offer.

https://www.accu-chek.ca/ca/
 
Re: 5/13 Help Pixie AMPS=82, +1.5=85

Hi Linda,

Nice to hear from someone so close. Thanks for the tip about the accucheck coupon. I went to the website and it says that I can receive a free meter with a coupon. I just present it to the pharmacist. Sounds like a plan to me however, when I checked the site, there are two types - the Aviva and the Aviva Nano (smaller version). Do you or anyone else on the board have any recommendations? Linda I was also wondering if Shopper's Drug Mart would have this type of meter? If they do this would be a shorter trip for me - 10 minutes there. Thanks, Anne.
 
Re: 5/13 Help Pixie AMPS=82, +1.5=85

Hi Anne,

These are great numbers for Pixie this morning! You did not give any insulin this morning, is that right? If so, that means it has been somewhere over 12 hours since the last shot, and the Lantus is waning. There's no need to feed high-carb food at this point; just feed regular low-carb food throughout the day as you usually would.

Just one more technical tip to learn - if you check the sugar level but don't give insulin, place "AMBG" (AM blood glucose) in your subject line. That let's people know at a glance that you didn't give insulin. "AMPS" stands for AM pre-shot, which means that we did give a shot.

Shelly
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85

Shoppers would have it, and you can use your Optimum card for purchasing strips, insulin, and syringes there. Costco also has good prices. I didn't use those meters, so I can't recommend one over the other, but I expect that they give comparable results. Get one now and get the other one the next time you pick up strips :-D
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85

Hi Shelly,

Did you get my personal message to you the other day? Hopefully you did and all is well with everyone at your house.

Thanks for all the technical information, there's a lot of new jargon to pick up but it helps when someone is pointing these things out. So Pixie has eaten only low carb food but not much - about 2 oz. That's all I had left and that's the only food he'll eat today. So I have my coupon for an accucheck Aviva Nano in hand and I think I'll check Shoppers to see if they have this meter. Shoppers is just a 10 min drive instead of 20. I don't want to be away too long especially since he's not eating. I'll be glad when I feel a little more comfortable with these green numbers. Pixie has been in the red and black for about 3 months and so I got used to these numbers.

Is Pixie displaying signs that he may be coming off the juice? Anne
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85

Linda, I never thought of getting both meters for free. What an idea? When I read the info about the nano, it says it is back-lit and I think this would be a plus for the night-time tests. I also noticed when I went to the Shopper's website that they give you a free sharpies box when you return a full one. I have a full box but I got it from the vet and they're charging me about $15 to $20 to dispose of it. I think I'll ask them when I'm in there. Talk soon, Anne.
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85

If you need to, you can save some room in the sharps box. Take a sturdy pair of dog nail clippers and cut the end off the syringe, disposing only of the sharp end (without cap). Of course, use caution not to poke yourself.
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85

I didn't see your message, Anne. I'll go back and see if it got lost somewhere in the shuffle. The PM system and I don't always get along very well. ohmygod_smile

Thanks for changing that to "AMBG." I saw the "NS" on your spreadsheet but just wanted to confirm. Better safe than sorry!

That's okay that Pixie doesn't want to eat much right now. You haven't given insulin this morning, so Pixie won't go diving on you like the other night.

I am absolutely not an expert by any means, but I have looked at a lot of different spreadsheets in the four months I've been here. When I look at Pixie's, I see that he is responding extremely well to the insulin right now, and the bounces are "mild." I really think it's possible that Pixie can go into remission.

Yep - I know what you mean about being used to the reds and blacks. I didn't realize how terrifying and exhausting it would be to finally start seeing green numbers.
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85, +3.5=90

HI guys .. I think it's our first visit to pixie's condo, so welcome from us! Very nice numbers today! Glad you were able to get some quick advice as well .. have a great day guys!
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85, +3.5=90, +6=99

Thanks for the welcome Peter. Finding the FDMB was a real godsend as Pixie and I were not having much success regulating his diabetes.

Well I'm equipped now. I have a new, back-up glucometer - Accu-Chek Nano with lots of strips, food that Pixie is eating today and another container of Alphatrack 2 testing strips. I had to scrounge around but luckily one of our vets in town had an extra container to sell me.

At the +6 test I tested Pixie with both the Alphatrack 2 (99) and Accu-Chek (86). I was really suprised to see lower results with the Accu-chek as I thought the human glucometers tended to record higher. At this point I think I should continue with the Alphatrack as it gives us a better idea how Pixie is doing vis-a-vis his AMBG test. PIxie did eat about 2 oz of Merrick Surf and Turf - 4% carbs and 0.95% phosphorus. So it looks like Pixie is still surfing in the green, having gained about 9 points in 2.2
5 hours.

If anyone has any other suggestions as to what I need to do, I'm open to any suggestions. This may be a bit premature, but I'm starting to think about the PMPS. I sure hope he isn't so low that I'm up a good portion of the night with him. I'm hoping for 1 night of uninterrupted sleep but maybe that's too hopeful.
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85, +3.5=90, +6=99

Hey Anne,

Great to hear that you have a back-up meter just in case. The human meters actually record lower. The 68 "cut-off" point on the AlphaTrak, for example, roughly equates to a 50 "cut-off" point on a human meter.

I know you've seen the glucose range chart before, but I'm including it below just in case. Notice how it gives ranges for the human meter first, and then the AlphaTrak equivalent is in brackets.

< 40 mg/dL {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
Click to expand...

That's fantastic that Pixie is still surfing in these green numbers. You might test an hour or so before it's time for the evening shot. That way, if Pixie is still in these lower numbers, you'll have time to get some dosing advice.
 
Re: 5/13 Help Pixie AMBG=82, +1.5=85, +3.5=90, +6=99, +9.5=1

If anyone could suggest an evening insulin dose for PIxie, I would greatly appreciate it. He has gone up steadily all day and has eaten at +9 hours about 2 more ozs of Surf and Turf (4% carbs). I will remove food at +10 and +11 in the hopes he is hungry and will eat more before his next shot. I will also test at +11 for an idea of where his BG levels are. If anyone is online at that time, or sooner, please let me know what your thoughts are about insulin dose. Anne
 
Re: 5/13 Dose?Pixie AMBG=82,+1.5=85,+6=99,+9.5=121,+11=149

Pixie had a good day, sleeping a lot but he did eat and he doesn't look like he's in any discomfort. He's drinking normally as far as I can tell but he still creating puddles in the litter box.

I should mention that I have to open a new vial of insulin this evening so I wonder if you could keep that in mind when suggesting a dose for about an hour from now. In addition, over the last week or so, I've noticed that Pixie doesn't usually eat much in the early evening after his PMPS. He tends to do all his eating in the early hours of the morning.
 
Re: 5/13 Dose?Pixie AMBG=82,+1.5=85,+6=99,+9.5=121,+11=149

Pixie's numbers are looking great! When you change meters, it is a good idea to do it at the start of a cycle so you have something to compare against. I've seen a number of Canadians use the Aviva.

Are you going to be able to monitor tonight? You must be pretty tired from the last couple of nights. Do you think Pixie will have a good appetite tonight? All things to consider when suggesting a dose. Your vial is about 3 months old? It should be good for longer if it's been kept in the fridge.

I'd definitely go lower dose, as the lower carb food seems to be having an effect. I wonder if something like 1.5U might be better for tonight. The skip will have helped reduce the depot from a higher dose but that could still influence tonight.
 
Re: 5/13 Dose?Pixie AMBG=82,+1.5=85,+6=99,+9.5=121,+11=149

I want to point out that BJ's chart with BG ranges that Shelly posted needs some tweeking given the new information from Roomp and Rand about comparability of human meters vs. AlphaTrack. All human meters usually run lower than an AlphaTrack. Initially, it was thought that the difference was a pretty consistent 30 points (i.e., a 50 on a human meter was an 80 on a AlphaTrack). A recent summary article suggested that the difference between the two meters is roughly 18 points at the lower end of the range.

What would you think about reducing Pixie's dose to 2.0u?
 
Re: 5/13 Dose?Pixie AMBG=82,+1.5=85,+6=99,+9.5=121,+11=149

Hi Wendy,

Thanks for your quick response. I am not planning to use the new meter this evening. I think I'll leave that for another day and indicate clearly on both my spreadsheet and my signature that I'm now using the Accu Check. I like the idea of decreasing to 1.5u but I'm just reading a post from Sienne and she is indicating possibly 2 units. I have to use a new vial of insulin as the last vial is almost bone dry and I doubt that I can get another dose out of it. So maybe I should split the difference and do 1.75u. What's the consensus?

Yes, I am able to monitor Pixie this evening as I had a short nap this afternoon. I'm not sure if he'll be hungrier but I'll certainly try to coax him. I'll slip away soon to give Pixie all his meds and protocol but I'll be back with his numbers. Anne
 
Re: 5/13 Dose?Pixie AMBG=82,+1.5=85,+6=99,+9.5=121,+11=149

I was being conservative because last night you were really tired and I was worried about your ability to monitor tonight. I don't think switching to a new vial will make a big difference on the numbers as Pixie was getting good numbers on the old one. Sticking with 2.0U will help keep the momentum going for Pixie if you are up to it.
 
Re: 5/13 Pixie PMPS=160

Wendy, I didn't catch your post in time but I have to be honest, it wouldn't hurt my feelings to have a calmer evening. I gave him 1.75units and I'll test in at +1 to see how's he's handling the insulin. He did nibble on his food before PMPS but only a bit.
 
What a great day for Pixie!

I think now that you've gone to the 1.75u, I'd stay there for a few cycles and see what Pixie can do with it. It's not a surprise to see his numbers improve with the reduction in the carb count of his food. we've seen many times where cats are simply on too many carbs in their food, and once they go to low carb canned food their numbers immediately improve. And yes, sometimes those cats go off of insulin and become diet-controlled.

When several variables are changing at the same time it can be hard to know exactly what to do - so now you've got him on appropriate food and we can see if this dose is going to be good for him.

When you've reduced a dose you don't have to hold it a certain number of cycles to see if he'll stay in good numbers, so if you see his blood sugar trending upwards, don't hesitate to go back up to the "last good dose." which in this case is tricky to tell because of the food change. But just watch and if you think they are trending up, put up the ? icon and let's take a look and see if you should increase his dose.

from the Tight Regulation sticky: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction.

Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding a dose in-between the dose that dropped kitty too low and the reduced dose.
Click to expand...
 
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