? 6/6 TiTi YES INSULIN? NO INSULIN?AMPS 70, retest 73, +3 164, so 15.5 insl , +8 272

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Numbers in the 70s are OK. The issue is whether her numbers are still dropping and/or whether it's safe to shoot. By feeding, numbers usually rise so it's harder to know whether it's safe to give insulin.

I'd still re-test in 20 - 30 min.

Also, what was the issue with the coding on your meter? Does the manual say what the effect on TiTi's numbers would be if the coding was wrong? If it doesn't, you may want to call the manufacturer and find out.
 
Sienne and Gabby (GA) said:
Numbers in the 70s are OK. The issue is whether her numbers are still dropping and/or whether it's safe to shoot. By feeding, numbers usually rise so it's harder to know whether it's safe to give insulin.

I'd still re-test in 20 - 30 min.

Also, what was the issue with the coding on your meter? Does the manual say what the effect on TiTi's numbers would be if the coding was wrong? If it doesn't, you may want to call the manufacturer and find out.
Click to expand...

IT should be in the notes I put on my SS. I was testing, while my meter was incorrectly coded at 8; the true coding on the strips was supposed to be 38.

I changed it to 38, which is why you see the note, and the 2 listings for 6/5.

My meter was set up by a vet tech, who was misinformed about the coding for Alphatrak2 .

Harvey advised me that the differences in the 2 codes were not great.

The manufacturer has no notes on incorrect coding that I can find. Calling them on Monday is probably going to mean a very long time on hold, or a request to leave a voice message.

Looking at my SS, I see that the numbers were bouncing around a lot. Could 70 be nadir?
 
Sienne and Gabby (GA) said:
Numbers in the 70s are OK. The issue is whether her numbers are still dropping and/or whether it's safe to shoot. By feeding, numbers usually rise so it's harder to know whether it's safe to give insulin.
Click to expand...
That's on the AT2.

Kathy...I agree you might want to stall if you can be behind on the shot a bit and gradually work back to it each day. Test every 30 mins and when you see a rise, post to see if it's enough to be able to shoot. Try not to feed her anymore until we see if you can shoot sometime in the two hours after her normal shot time.

I indicated yesterday that the difference between my AT2 and the reading the vet tech got on theirs with the wrong code was not that different but meters vary. That was a singular observation so I wouldn't extrapolate that to every situation and I should have mentioned that.

Also....sometime later today, could you please update the SS so we know the units you are shooting? Thank you.:)
 
Kathleen (Kathy) said:
IT should be in the notes I put on my SS. I was testing, while my meter was incorrectly coded at 8; the true coding on the strips was supposed to be 38.

I changed it to 38, which is why you see the note, and the 2 listings for 6/5.

My meter was set up by a vet tech, who was misinformed about the coding for Alphatrak2 .

Harvey advised me that the differences in the 2 codes were not great.
Click to expand...
Marje and Gracie said:
That's on the AT2.

Kathy...I agree you might want to stall if you can be behind on the shot a bit and gradually work back to it each day. Test every 30 mins and when you see a rise, post to see if it's enough to be able to shoot. Try not to feed her anymore until we see if you can shoot sometime in the two hours after her normal shot time.

I indicated yesterday that the difference between my AT2 and the reading the vet tech got on theirs with the wrong code was not that different but meters vary. That was a singular observation so I wouldn't extrapolate that to every situation and I should have mentioned that.

Also....sometime later today, could you please update the SS so we know the units you are shooting? Thank you.:)
Click to expand...


Ok. well I got this too late. She got her normal dose at noon, 15.5. after testing at BG 164

Now how do I calibrate getting her back to her normal AMPS and PMPS times?
Marje and Gracie said:
That's on the AT2.

Kathy...I agree you might want to stall if you can be behind on the shot a bit and gradually work back to it each day. Test every 30 mins and when you see a rise, post to see if it's enough to be able to shoot. Try not to feed her anymore until we see if you can shoot sometime in the two hours after her normal shot time.

I indicated yesterday that the difference between my AT2 and the reading the vet tech got on theirs with the wrong code was not that different but meters vary. That was a singular observation so I wouldn't extrapolate that to every situation and I should have mentioned that.

Also....sometime later today, could you please update the SS so we know the units you are shooting? Thank you.:)
Click to expand...
 
Kathleen (Kathy) said:
Ok. well I got this too late. She got her normal dose at noon, 15.5. after testing at BG 164

Now how do I calibrate getting her back to her normal AMPS and PMPS times?
Click to expand...

So finally she's in low number, and it might not be a bounce, . However, 3 hours late counts as a dose reduction, right? so her numbers will rise, either from a bounce, or from a lowering of the dose, or both. Right? and so now we wait 6 cycles (3 days) more , before we can tell what's up? Have I got that right?
 
Yes - a late shot acts like a dose reduction since the depot has begun to be depleted. However, TiTi has a BIG depot and it might be like steering an ocean liner -- you take action by delaying the shot and you see the response a cycle or two later. For many cats, not just those who are getting large doses of insulin, the depot doesn't respond immediately. (In other words, still get some tests!)

Re. you SS: I would put the 164 in your AMPS column since that's the number you shot. If you look at Gabby's SS, you can see how I stacked numbers in a cell. (You have to color code the cell manually if you do this.). I'd also put a note in the Comments column that you shot 3 hours late.

With adjusting the time, you have a couple of options. You can move the shot time by 30 min once a day or you can move the shot time 15 min at each shot time until you are back on schedule. If TiTi bounces, you could also shoot an hour early tonight. I would not recommend shooting an hour early on a daily basis unless your cat's numbers are way high but you could shoot an hour early and then shoot 15 min early at the subsequent shot times.
 
Kathleen (Kathy) said:
So finally she's in low number, and it might not be a bounce, . However, 3 hours late counts as a dose reduction, right? so her numbers will rise, either from a bounce, or from a lowering of the dose, or both. Right? and so now we wait 6 cycles (3 days) more , before we can tell what's up? Have I got that right?
Click to expand...
You are doing a good job of getting most of it but, no, we don’t necessarily have to wait six cycles. As Sienne said, she has a very large depot and you might not even see much of a change from a shot that was three hours late or, if you do, it will likely be in a subsequent cycle. To tell you the truth, with my Gracie, if I shot late...even two hours, she never skipped a beat.

Because you are still feeding dry food, then you would be following the SLGS approach. Under this approach, a 90 on a human meter earns a reduction. Human meters read lower than the AT2 so, theoretically, with a 73 on an AT, you should reduce the dose. Normally with a larger depot like this, we reduce the dose by more than 0.25u so you might see a normal reduction for this high of a dose being 0.5u or down to 15u for TiTi.

If you like, I can do the SS for you to illustrate how we would do the delayed shot. Please just let me know.
 
Marje and Gracie said:
You are doing a good job of getting most of it but, no, we don’t necessarily have to wait six cycles. As Sienne said, she has a very large depot and you might not even see much of a change from a shot that was three hours late or, if you do, it will likely be in a subsequent cycle. To tell you the truth, with my Gracie, if I shot late...even two hours, she never skipped a beat.

Because you are still feeding dry food, then you would be following the SLGS approach. Under this approach, a 90 on a human meter earns a reduction. Human meters read lower than the AT2 so, theoretically, with a 73 on an AT, you should reduce the dose. Normally with a larger depot like this, we reduce the dose by more than 0.25u so you might see a normal reduction for this high of a dose being 0.5u or down to 15u for TiTi.

If you like, I can do the SS for you to illustrate how we would do the delayed shot. Please just let me know.
Click to expand...

Actually I increased from 13Units to 15.5 units. So I don't think I am on the slow thing. Another problem is that my syringe has only whole units, It's simple to do a half unit reduction, but not possible to do a .25 or 1/4 reduction.

Someone, was it you? suggested that I shoot 1 hour early, and then 1/4 hour earlier for each shot, until I am back on my regular schedule. Is that correct? And if it is, then do I also do the reduction?

Wait a minute. I will be on the alphatrak2 for 2 more days, then switching to a human meter. I think some of this latest instruction from you involves re-calibrating for a human meter. Is that so?
 
Kathleen (Kathy) said:
Actually I increased from 13Units to 15.5 units. So I don't think I am on the slow thing. Another problem is that my syringe has only whole units, It's simple to do a half unit reduction, but not possible to do a .25 or 1/4 reduction.

Someone, was it you? suggested that I shoot 1 hour early, and then 1/4 hour earlier for each shot, until I am back on my regular schedule. Is that correct? And if it is, then do I also do the reduction?

Wait a minute. I will be on the alphatrak2 for 2 more days, then switching to a human meter. I think some of this latest instruction from you involves re-calibrating for a human meter. Is that so?
Click to expand...

There are a couple different things going on which might be confusing. First, there is the appearance that she is high dose so it doesn’t make sense to keep raising her by 0.25u and that’s why we suggested you increase such a large amount. That is separate from how long you hold doses.

If she is still eating any dry food at all, you should be using SLGS regarding reductions and also the length of time for which you hold doses. So each dose should be held for seven days and a curve done afterwards unless she earns a reduction. Reductions are earned under SLGS whenever kitty drops below 90 on a human meter. We do not have any BG parameters for SLGS and pet meters so that is another selling point for you to switch to a human meter besides it being a lot more cost efficient.

I suggested you shoot one hour early if she was higher by +11 tonight. Sienne then suggested that you shoot 15 minutes early each cycle thereafter until you are back on schedule. However, you can also shoot 30 mins early one cycle a day but if you do this, do not do it the same day you shoot an hour early.

There is really no reason to stay on the AT2 any longer. My recommendation on the dose reduction is because she dropped lower than the equivalent of 90 on a human meter and you should be doing SLGS. The amount I suggested you reduce is due to the size of the depot and has nothing to do with type of meter.

I’m not sure if anyone let you know that Walmart has the ReliOn brand of syringes quite inexpensive and they have 0.5unit markings which make dosing easier. Or, you can keep the ones you have and dose more consistently with calipers.
 
Marje and Gracie said:
There are a couple different things going on which might be confusing. First, there is the appearance that she is high dose so it doesn’t make sense to keep raising her by 0.25u and that’s why we suggested you increase such a large amount. That is separate from how long you hold doses.

If she is still eating any dry food at all, you should be using SLGS regarding reductions and also the length of time for which you hold doses. So each dose should be held for seven days and a curve done afterwards unless she earns a reduction. Reductions are earned under SLGS whenever kitty drops below 90 on a human meter. We do not have any BG parameters for SLGS and pet meters so that is another selling point for you to switch to a human meter besides it being a lot more cost efficient.

I suggested you shoot one hour early if she was higher by +11 tonight. Sienne then suggested that you shoot 15 minutes early each cycle thereafter until you are back on schedule. However, you can also shoot 30 mins early one cycle a day but if you do this, do not do it the same day you shoot an hour early.

There is really no reason to stay on the AT2 any longer. My recommendation on the dose reduction is because she dropped lower than the equivalent of 90 on a human meter and you should be doing SLGS. The amount I suggested you reduce is due to the size of the depot and has nothing to do with type of meter.

I’m not sure if anyone let you know that Walmart has the ReliOn brand of syringes quite inexpensive and they have 0.5unit markings which make dosing easier. Or, you can keep the ones you have and dose more consistently with calipers.
Click to expand...

Hi, well, discouragingly , this was just another bounce. Right before Midnight, TiTi tested at 492, so I gave her the insulin at midnight, thus shaving one hour off the 12 hour period. I assume that I measure the time by 24 hour intervals, meaning that tomorrow might I will dose at 10:30 pm, and so on until we aare bak at normal.

I shot 15 tonight, since I was at 15.5. Hopefully I can get the syrunges you mentionewd tomorrow. Yoou may not know the distances I am dealing with. Texas is huge, and the nearest Walmart's is 80 miles round trip. I am almost done with the alphatrak, so will start with the Bayer by Wednesday, or perhaps late Tuesday. It's going to be awkward. I have to hold the thing upside down to gt the strip to hit the blood. With the alpha you use the side of the strip - that angle is a lot easier to achieve. But it's not worth the almost 4 times what the Bayer meter charges.

I picked up some fancy feast pate tonight. Until I work out what I can do with a homemade diet, the fancy feast pate will comprise most of her diet. She sneaks out of the bedroom and cadges her mates' dried food, so she's bound to steal dried food from time to time.

The only problem I have with the SLGS method, is it extends the time her system is exposed to these truly harmful high numbers. I picture her pancreas losing more function permanently. and her kidneys slowly but surely going to a crisis point. Certainly some function of both organs have already been permanently lost. 2 years at these high readings guarantees that. But I would like to minimize any further loss. You know the old saying, "The operation was a success; unfortunately the patient died." If I sometimes rush in a way that perhaps only prolongs the process, it is because I feel strongly that my TiTI is running out of time. The success stories I've read about? None of them have a cat who was uncontrolled for 2 years. There's an uhappy reason for that.
 
You said you shot at noon today and midnight tonight so that is still 12 hours. You could have shot at 11 p.m. The cycles are 12 hours each. Tomorrow morning, if she is still high, you could shoot at 11 a.m. and if she has dropped back down, you would shoot at 11:45 if you want to shoot 15 mins early each cycle or 11:30 if you want to shoot early once a day.

I'm from Texas so I realize how far some things are :) The "Hill Country" encompasses a large area including an area near San Antonio and also Austin so I didn't know if you were near one of the cities.

You'll get used to the Bayer; after I had been using a meter like that for a long time, it was odd to use the AT :rolleyes:. It's just what we get used to. But you don't really have to hold the Bayer upside down. Just let it sip from the bottom of the blood drop. In other words, if you hold the meter in your hand so the strip is at the top, then continue to hold it like that to sip from the drop of blood.

I certainly share your concern for leaving her at high numbers but the requisite for doing the TR protocol includes that she must be entirely on a low carb canned or raw food.....no dry food. It is a safety factor built into the TR protocol, which is a more aggressive method. If you remove the dry food and ensure she can't get it, you'd be able to do TR.
 
I feel your sense of urgency, but you don't want to throw safety out just because she's been diabetic for 2 years. I didn't realize that she was actually eating dry food. I thought that I'd read earlier that the "dried food" in your signature line was freeze dried meats, not regular cat food. The thing is that following the Tight Reg Protocol requires that the cat is only eating raw or low carb canned food.

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Although, some kitties will adapt well to free feeding.
Ah, and I see Marje just posted saying the same thing.

Some people switch all of their cats to low carb canned so the diabetic cat in the house can't get to dry food. We had one cat, Scooter, who wasn't fed dry food, but the other 12 cats in the house were fed crunchies up on top of high tables. He couldn't get up there. But when the dry food left the house entirely and all the cats were switched to low carb canned, Scooter went from 5.5u per shot to off of insulin in 1.5 very long days. Dry food, even snitched from a mate's floor crumbs, can really raise blood sugar and keep it there.

That would be a place I'd start with for getting control of TiTi's blood sugar.
 
Marje and Gracie said:
You said you shot at noon today and midnight tonight so that is still 12 hours. You could have shot at 11 p.m. The cycles are 12 hours each. Tomorrow morning, if she is still high, you could shoot at 11 a.m. and if she has dropped back down, you would shoot at 11:45 if you want to shoot 15 mins early each cycle or 11:30 if you want to shoot early once a day.

I'm from Texas so I realize how far some things are :) The "Hill Country" encompasses a large area including an area near San Antonio and also Austin so I didn't know if you were near one of the cities.

You'll get used to the Bayer; after I had been using a meter like that for a long time, it was odd to use the AT :rolleyes:. It's just what we get used to. But you don't really have to hold the Bayer upside down. Just let it sip from the bottom of the blood drop. In other words, if you hold the meter in your hand so the strip is at the top, then continue to hold it like that to sip from the drop of blood.

I certainly share your concern for leaving her at high numbers but the requisite for doing the TR protocol includes that she must be entirely on a low carb canned or raw food.....no dry food. It is a safety factor built into the TR protocol, which is a more aggressive method. If you remove the dry food and ensure she can't get it, you'd be able to do TR.
Click to expand...

Oh, no, no . I shot AMPS at 1pm today, so I stepped back to midnight for PMPS
Marje and Gracie said:
There are a couple different things going on which might be confusing. First, there is the appearance that she is high dose so it doesn’t make sense to keep raising her by 0.25u and that’s why we suggested you increase such a large amount. That is separate from how long you hold doses.

If she is still eating any dry food at all, you should be using SLGS regarding reductions and also the length of time for which you hold doses. So each dose should be held for seven days and a curve done afterwards unless she earns a reduction. Reductions are earned under SLGS whenever kitty drops below 90 on a human meter. We do not have any BG parameters for SLGS and pet meters so that is another selling point for you to switch to a human meter besides it being a lot more cost efficient.

I suggested you shoot one hour early if she was higher by +11 tonight. Sienne then suggested that you shoot 15 minutes early each cycle thereafter until you are back on schedule. However, you can also shoot 30 mins early one cycle a day but if you do this, do not do it the same day you shoot an hour early.

There is really no reason to stay on the AT2 any longer. My recommendation on the dose reduction is because she dropped lower than the equivalent of 90 on a human meter and you should be doing SLGS. The amount I suggested you reduce is due to the size of the depot and has nothing to do with type of meter.

I’m not sure if anyone let you know that Walmart has the ReliOn brand of syringes quite inexpensive and they have 0.5unit markings which make dosing easier. Or, you can keep the ones you have and dose more consistently with calipers.
Click to expand...

.

Since I am now testing TiTi before giving her her AMPS, and PMPS shots, the AMPS actual shot time is closer to 10am. Give or take 10 minutes.

Oh, ok another Texan eh? Well, I am in BErtam right on the border of Wiliamson County, but because of the gerrymandering, I am out West on a long narrow strip of country road..

The master bedroom is not a problem. Tonght while TiTI was feasting on pate in the bathroom, her bedroom mates chowed down Costco higrade dried food. None was left when I let TiTi out. Two times a day, when TiTi escapes to the large living room/kitchen area, her mates there have sometimes left a few nuggets of dried food. Not often though. And I can control this by snatching up their dishes before TiTi gets any.

I've never been this poor before, used to feed everyone wet food, with dried as an occasional treat. Unless I finally sell my book, I can't afford to feed everyone fancy feast. Half the time they do get Friskies, but keeping 14 cats on fancy feast or friskies isn't possible./ The other 2 cats are on a hyperthyroid diet. Those danged cans cost 275 each, so they also eat the hyperthyroid dried food. By the way, it actually works. It does not stop the thyroid tumor from growing, but it has no salt at all, so it slows down their thyroid to normal.

I've given serious thought to mice. Mice provide an almost perfect cat food, but I am not sure I'm up for buying freeze dried mice, thawing them, and doling them out. Bleah. Poor mousies. Also , it might be just as prohibitive in cost.
 
julie & punkin (ga) said:
I feel your sense of urgency, but you don't want to throw safety out just because she's been diabetic for 2 years. I didn't realize that she was actually eating dry food. I thought that I'd read earlier that the "dried food" in your signature line was freeze dried meats, not regular cat food. The thing is that following the Tight Reg Protocol requires that the cat is only eating raw or low carb canned food.

REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
  • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
    More monitoring may be needed.
  • It will be necessary to test kitty's blood glucose levels multiple times per day.
  • Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
  • Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Feed a high quality low carb canned or raw food diet.
  • Feed small meals throughout the day. Although, some kitties will adapt well to free feeding.
Ah, and I see Marje just posted saying the same thing.

Some people switch all of their cats to low carb canned so the diabetic cat in the house can't get to dry food. We had one cat, Scooter, who wasn't fed dry food, but the other 12 cats in the house were fed crunchies up on top of high tables. He couldn't get up there. But when the dry food left the house entirely and all the cats were switched to low carb canned, Scooter went from 5.5u per shot to off of insulin in 1.5 very long days. Dry food, even snitched from a mate's floor crumbs, can really raise blood sugar and keep it there.

That would be a place I'd start with for getting control of TiTi's blood sugar.
Click to expand...

Pretty frustrating. If only Jane's thyroid tumor would become palpable, my vet could operate on it. She lets me pay of my bills on a timed schedule. Works quite well.

Anyway, the money I'd save on not needing to buy the thyroid food, would pay for all kitties getting transferred to at least a good canned diet. Dunno about raw food - that would be a very hefty price. In the guest bedroom, live Jane, Casey and MaCat. Unfortunately , all three need to stay there. That means that all 3 eat that expensive food. I'm able to manage MaCat and Casey's diet by letting Jane out with the kitchen cats and then taking in regular food to MaCat and Casey. It works, but it's a shame I can't get MaCat and Casey transferred. I guess after 10 years, they find such an idea completely unacceptable.

At any rate , I could manage TiTI's food the way forementioned. I'm a compulsive housekeeper - must be with 16 cats. I sweep up after the morning and evenning feedings, so there's scant possibility of crumbs.

Yet another question. Why are we now going down on the insulin? Is the assumption that she could not possibly need more than 15.5 insulin? Therefore, we go downward seeking her best dose? Is there something I'm not understanding?
 
Kathleen (Kathy) said:
Why are we now going down on the insulin? Is the assumption that she could not possibly need more than 15.5 insulin? Therefore, we go downward seeking her best dose? Is there something I'm not understanding?
Click to expand...

Because there is still some dry food in the picture for TiTi it is not recommended that you follow the TR protocol (there must be no dry food in the picture to follow TR safely), the other method of dosing we follow is SLGS (see link for sticky) with that the reduction point is 90 (on a human meter) that 73 on the alphatrak (would probably read lower than 73 on a human) the other morning calls for a reduction to keep TiTi safe.

If you were able to remove all dry food from TiTi then you could follow TR and you would hold the dose, but while she still is eating dry it is not considered safe to follow the TR protocol.
 
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