61 Pre food, pre shot

[Andrea M.]

Glad I tested 15 minutes early this morning. Sweet Pea is only 61 after being 351 pre food and pre shot at 5:15 PM. Is this normal? No shot this morning but I'm sure she is going to shoot up throughout the day and have another high evening number.

 

[Shelly & Jersey (GA)]

Hi Andrea,

Yes, numbers can move that much from one pre-shot to the next.

I tried to go back and look through some of your previous posts. It looks like you might be using Lantus. Is that correct? If so, remember that Lantus typically brings down glucose levels to their lowest point (the nadir) somewhere around 6 hours after the shot. If you are getting a 61 at pre-shot, it concerns me that Sweet Pea may be going even lower than that during the cycles. Are you using a human meter or a pet-specific meter? That makes a difference in how we interpret the numbers.

Are you doing any spot testing or just testing at pre-shots? The pre-shot tests tell us if it's safe to give insulin. The spot tests tell us how low the dose is taking the kitty. If the dose is taking the kitty too low, we need to reduce the dose.

It would be really helpful if you could set up a spreadsheet to record your test numbers. That way we can help you figure out what's going on with Sweet Pea. @Marje and Gracie is a spreadsheet wizard and could have one set up for you in just a few minutes if you need help with it.

Shelly

 

[Elizabeth and Bertie]

...tested 15 minutes early this morning. Sweet Pea is only 61

Hi Andrea,
What kind of glucose meter are you using, human meter or Alphatrak? (A '61' on an Alphatrak meter would be considered in hypo range).

As Shelley says, it may be that Sweet Pea actually dropped lower during the cycle.
It is also the case that Lantus can, occasionally and in some cats (especially if the dose is too high), continue to drop the blood glucose late on into the cycle (rarely, even past the 12 hour point...)

Have you tested her blood glucose again since that 61? Just wondering how she's doing now.

And it's great that you are hometesting!
(If you weren't then you may have given insulin at that BG of 61.... Yikes!)

Eliz

 

[Andrea M.]

We are using the Alphatrak 2 meter. We always test pre-shot but if something seems off I spot check. Our other cat, Peanut, actually started to scream this morning so I tested a little early. Sweet Pea was acting fine but ate almost 3/4 of her can of FF and about a teaspoon of her Purina DM. I tested again 1 hour later and she had come up to 180 so I gave her 1 unit of lantus. I have been getting conflicting advise from our vet's office this week. Our regular vet, who was on vacation this week, said do not give insulin under 200 but the other vet and vet tech said to go ahead if she ate. If she didn't eat at first, give her some time to eat and give her only 1 unit instead of 2. I had done a mini curve last week for the vet and she was all over. This week was the first time Sweet Pea hit the normal range, or low. I will be doing another curve this week. I have to set up the spreadsheet still. We keep all of her records in a journal and on a diabetes app right now. Thanks for all the advise! I will be calling our regular vet first thing in the morning tomorrow and letting her know what is going on. I am concerned that something else might be wrong. We did a full geriatric screening when she was diagnosed because we weren't sure of her age and everything came back perfect. Just checked her glucose again and she is up to 213, 1.5 hrs after her 1 unit

 

[Shelly & Jersey (GA)]

Thanks for clarifying that you are using the Alphatrak. With the Alphatrak, you don't want your cat's numbers to fall below 68. If kitty is under 68, it's entering hypoglycemia territory. When that happens, definitely feed and keep testing until you get those numbers up. Here is some additional information about dealing with hypoglycemia.

Because Sweet Pea dropped below 68 on 2 units of Lantus, that's a sign that the dose is too much and her dose should be reduced.

Curves at the vet's office can be really tricky. Often, cats are stressed out at the vet's, which can drive the numbers up. Then, the vet thinks the cat needs more insulin. When you take kitty home, the kitty's stress levels drop, and the insulin dosage is now too high. Also, if the vet happens to do the curve on the day of a bounce, the numbers are not a good indicator of what's really going on. It's so frustrating and confusing.....for us and the vets! The best thing you can do, in my personal opinion, is to keep testing at home. Always test before shooting, which you're already doing, and then grab some "in between" tests. Those tests will show us how well the dose is working, if it needs to be increased, decreased, etc. You don't have to test like a maniac. Even just one extra test in between shots can reveal a lot.

You mentioned that you gave 1 unit this morning. Remember that the number you shot (the 180) was influenced by food, so it might be a good idea to grab some extra tests today to be sure Sweet Pea isn't going too low.

 

[Andrea M.]

Thanks for clarifying that you are using the Alphatrak. With the Alphatrak, you don't want your cat's numbers to fall below 68. If kitty is under 68, it's entering hypoglycemia territory. When that happens, definitely feed and keep testing until you get those numbers up. Here is some additional information about dealing with hypoglycemia.

Because Sweet Pea dropped below 68 on 2 units of Lantus, that's a sign that the dose is too much and her dose should be reduced.

Curves at the vet's office can be really tricky. Often, cats are stressed out at the vet's, which can drive the numbers up. Then, the vet thinks the cat needs more insulin. When you take kitty home, the kitty's stress levels drop, and the insulin dosage is now too high. Also, if the vet happens to do the curve on the day of a bounce, the numbers are not a good indicator of what's really going on. It's so frustrating and confusing.....for us and the vets! The best thing you can do, in my personal opinion, is to keep testing at home. Always test before shooting, which you're already doing, and then grab some "in between" tests. Those tests will show us how well the dose is working, if it needs to be increased, decreased, etc. You don't have to test like a maniac. Even just one extra test in between shots can reveal a lot.

You mentioned that you gave 1 unit this morning. Remember that the number you shot (the 180) was influenced by food, so it might be a good idea to grab some extra tests today to be sure Sweet Pea isn't going too low.

The curve was done at home by request of the vet. The vet wants us to test at home where Sweet Pea's numbers are more accurate. I tested again 1.5 hours after the 1 unit of insulin and she was up to 213. I will be testing throughout the day. I am having problems setting up the spreadsheet. The link the instructions send me to gives me an error.

 

[MrWorfMen's Mom]

I agree you should keep a close eye on Sweet Pea today. Not only because you gave insulin on a food influenced reading but also because you don't know how low Sweet Pea went last night. Those low numbers can make kitty more sensitive to insulin or she may bounce and seem very high. Either way, she has earned a dose reduction. I would not give 2u again.

Shelly went back and checked to see what insulin you were using (thank you Shelly) but it would be helpful if you could get a signature set up so when you need assistance or have questions, crucial information is already available to those helping you and we won't be asking you the same questions repeatedly. You can include information like date of diagnosis, type of insulin, type of meter you use, diet, any other health issues including history of ketones or DKA, your location so folks can offer pertinent info, and anything else you feel would be helpful. When you get the spreadsheet set up, a link to that can also be included.

To set up a signature, hover your mouse over your screen name at the upper right of the screen. This bring down a menu. Select Signature. This opens a text box where you can enter the information. You are only allowed 2 hard returns (enter key presses) as the signature can only be three lines. Any questions, just holler.

 

[Shelly & Jersey (GA)]

Aw, sorry I misunderstood about the curve location. Can I blame it on a lack of coffee?

Was this the link you tried for the spreadsheet? If you're still having problems with it, definitely send @Marje and Gracie a PM. She really is a spreadsheet wizard. I'm sure others could also help you with it. (Sorry I can't!)

 

[Andrea M.]

Aw, sorry I misunderstood about the curve location. Can I blame it on a lack of coffee?

Was this the link you tried for the spreadsheet? If you're still having problems with it, definitely send @Marje and Gracie a PM. She really is a spreadsheet wizard. I'm sure others could also help you with it. (Sorry I can't!)

Thank you! That was not the link that was posted on the instructions. Hopefully I can get that started today. Between worrying about Sweet Pea, taking care of my mother (multiple strokes, cancer, and now dementia), and dealing with a serious back injury of my own I have been really struggling. I really appreciate the help.

 

[Shelly & Jersey (GA)]

You're welcome. Awesome job getting your spreadsheet set up! It looks like Sweet Pea may be bouncing today from the low numbers. Bouncing is frustrating but normal.

I'm so sorry to hear about your mom and your back injury. Just take one day at a time, and never be afraid to ask for help if you need it!

 

[Marje and Gracie]

Great job with the SS. If you ever need any help, please just send me a private message.

 

[Andrea M.]

I just checked Sweet Pea again 6 hrs post shot (only 1 unit this morning because she was so low). She is up to 264. Any advice on how much insulin I should give her tonight? If she is rebounding I don't want another morning in the 60s or even lower. I will be calling the vet in the AM.

 

[MrWorfMen's Mom]

Normally reductions would be 0.25u. It looks like you went from 1u straight to 2u so it's possible that 1.25u, 1.5u or 1.75u would be a better dose for Sweet Pea. If I were you, I'd probably go to 1.5u and see how she does. She is going up now probably in response to both the lower numbers and the low dose this morning. Let's see how high she goes at PMPS then you can decide what you are comfortable with and of course help is always available here.

 

[Elizabeth and Bertie]

Between worrying about Sweet Pea, taking care of my mother (multiple strokes, cancer, and now dementia), and dealing with a serious back injury of my own I have been really struggling.

Oh, gosh, (((Andrea))), I am so sorry you're going through all of this. Sending huge cyber-hugs from across the pond in the UK.


Eliz

 

[Larry and Kitties]

I would likely try 1 1/2 units but would have to know the PS first.
Also I find it hard to read the BS values in the blue-shaded boxes.

 

[MrWorfMen's Mom]

Also I find it hard to read the BS values in the blue-shaded boxes.

I noticed that too. Andrea, can you change the text colour to white in the darker boxes so the numbers are readable. To do this, click on the box(es) you want to change. Then click on

in the tool bar right above column "L". Then pick white (far right in top line of choices) for your text colour.

 

[Andrea M.]

Thank you all for your help. I changed the font color so they are easier to read.

 

[Larry and Kitties]

Thanks

 

[Andrea M.]

Just checked Sweet Pea before her evening shot and it is 353. Basically where it was last night when I gave 2 units. Should I drop her to 1.5 units to be safe. Definitely don't want another surprise hypo before her morning shot. Thanks again for all the help and advice.

 

[MrWorfMen's Mom]

If she were mine, I'd go with the 1.5u. The pre-shot tests let you know it's safe to give insulin and enables you to see how much and how fast kitty is dropping in any given cycle. Mid cycle tests let you know how low the dose takes her and adjustments to dose are based on that lowest number. So when she got a 61 today, albeit at her AMPS, we can assume she may have gone even lower earlier on and she definitely earned a dose reduction. If you feel more comfortable with 1.25u then go with that. It's up to you but I wouldn't give more than 1.5u. I would also test her at +3 tonight to see if she is dropping and then before bed just for peace of mind unless of course those two times coincide.

 

[Andrea M.]

If she were mine, I'd go with the 1.5u. The pre-shot tests let you know it's safe to give insulin and enables you to see how much and how fast kitty is dropping in any given cycle. Mid cycle tests let you know how low the dose takes her and adjustments to dose are based on that lowest number. So when she got a 61 today, albeit at her AMPS, we can assume she may have gone even lower earlier on and she definitely earned a dose reduction. If you feel more comfortable with 1.25u then go with that. It's up to you but I wouldn't give more than 1.5u. I would also test her at +3 tonight to see if she is dropping and then before bed just for peace of mind unless of course those two times coincide.

I will definitely be testing her tonight after a 1.5. I will be calling the vet first think in the morning as well. Thanks for the help

 

[Gill & George]

Did you shoot 1u this morning ??
It just that as i have read through the condo it's what you say on post #12 but you haven't got anything inon the units on the ss.
If you shot the 1u, could you pop it into the ss, thanks.

 

[Andrea M.]

Did you shoot 1u this morning ??
It just that as i have read through the condo it's what you say on post #12 but you haven't got anything inon the units on the ss.
If you shot the 1u, could you pop it into the ss, thanks.

Sorry, since it was late I put it in the remarks. I will fix that.

 

[Gill & George]

Sorry, since it was late I put it in the remarks. I will fix that.

No worries
It's just that it's good to see the dose and the numbers on the ss, to give the full picture.
I can't stop, it's midnight for me, and I have a very early start tomorrow, but I have put a shout out to some other Lantus users, hopefully they will check in with you shortly.

 

[Andrea M.]

No worries
It's just that it's good to see the dose and the numbers on the ss, to give the full picture.
I can't stop, it's midnight for me, and I have a very early start tomorrow, but I have put a shout out to some other Lantus users, hopefully they will check in with you shortly.

Thank you!

 

[Tricia Cinco(GA) & Harvey]

If you are at all uncomfortable with the number you get when you test, or are unsure if you need to keep testing, be sure to post and ask. I understand your situation makes this difficult. Just do the best you can. We want to make sure Sweet Pea stays safe!

Oh, and when you get a chance, can you add Sweet Pea's name to your signature, please? Thanks!

 

[Andrea M.]

If you are at all uncomfortable with the number you get when you test, or are unsure if you need to keep testing, be sure to post and ask. I understand your situation makes this difficult. Just do the best you can. We want to make sure Sweet Pea stays safe!

Oh, and when you get a chance, can you add Sweet Pea's name to your signature, please? Thanks!

I test, and test, and test. Sweet Pea looks at me like I'm stalking her. I was just unsure of the dose tonight after her hypo this morning. I will be testing tonight after that surprise. Thank you for pointing out that I left her name off. I have fixed that.

 

[Tricia Cinco(GA) & Harvey]

I test, and test, and test.

Yes, I see you are testing.

The concern we have is that at night, when you have perhaps been unable to test between shots, she may have gone very low. Then in the morning, she's bouncing as a result. It looks like that 61 came out of nowhere, but it's quite possible she was going down all night, and this could even have been higher than her lowest point overnight. That's why you've seen people suggesting a reduction. When you change the dose by such a large amount (and 1 unit is a large amount with a cat), you can miss the "purrfect" dose and end up overdosing. A cat getting too much insulin can often look like not enough. Does that make sense?

 

[Andrea M.]

Yes, I see you are testing.

The concern we have is that at night, when you have perhaps been unable to test between shots, she may have gone very low. Then in the morning, she's bouncing as a result. It looks like that 61 came out of nowhere, but it's quite possible she was going down all night, and this could even have been higher than her lowest point overnight. That's why you've seen people suggesting a reduction. When you change the dose by such a large amount (and 1 unit is a large amount with a cat), you can miss the "purrfect" dose and end up overdosing. A cat getting too much insulin can often look like not enough. Does that make sense?

Yes, I have tested at night when I had some concern with her dropping. This was a first for us both. She has never dropped like that before with a starting number in the 350s. Now that we know there is a concern I will make sure to test during the night tonight. The only reason I dropped her to 1 unit this morning was because it was done late because of her hypo. Earlier in the week I had spoken with another vet at the animal hospital (ours was on vacation this past week) and she instructed me to only dose 1 unit if I had to do it later. I will be speaking with our regular vet in the morning about the hypo and possibly adjusting her dose. Tonight I gave her 1.5 in hopes to keep her from dropping that low again.

 

[Shelly & Jersey (GA)]

You've done a great job, Andrea, and you've helped keep Sweet Pea safe by testing before giving insulin, not shooting the 61, and dropping the dose today. It really does get easier with time.

Sweet Pea looks at me like I'm stalking her.

Jersey has looked at me like that, too. Darned ol' cat.

P.S. I've been calling you "Andrea." I've just assumed that's your name. If it's not, please correct me!

 

[Chris & China (GA)]

It looks like that 61 came out of nowhere, but it's quite possible she was going down all night, and this could even have been higher than her lowest point overnight.

Another possibility is that the strip this morning was wonky....anytime you get a test that's THAT out of the blue, it's best to retest immediately and make sure it's not just a bad strip

 

[Tricia Cinco(GA) & Harvey]

Another possibility is that the strip this morning was wonky....anytime you get a test that's THAT out of the blue, it's best to retest immediately and make sure it's not just a bad strip

Thanks for pointing that out, Chris. I usually mention that, but it totally slipped my mind. I have learned the hard way that this is a very good practice!

 

[Andrea M.]

Spoke with our regular vet this evening. She agreed with my decision to drop Sweet Pea from 2 units to 1.5 after her hypo and the bouncing. She is lowering her to 1 unit of lantus now and only .5 units if she is in the low 100s. Thank you all for the support and advice.

 

[Shelly & Jersey (GA)]

Thanks for the update; I was wondering how you were doing! Something I might suggest: Lantus tends to like consistency. When the shot amounts change, it can cause some wonkiness in the insulin depot and thus the overall numbers. Although some insulins are used on a sliding scale (i.e., shoot X units for this range of numbers), Lantus usually doesn't work best that way. If you find that the numbers are all over the place, you might consider re-visiting the dosing strategy.
Just my two cents' worth. Looks like Sweet Pea might be on the move tonight with that PMPS.

Have a great evening!
Shelly

 

[Andrea M.]

Thanks for the update; I was wondering how you were doing! Something I might suggest: Lantus tends to like consistency. When the shot amounts change, it can cause some wonkiness in the insulin depot and thus the overall numbers. Although some insulins are used on a sliding scale (i.e., shoot X units for this range of numbers), Lantus usually doesn't work best that way. If you find that the numbers are all over the place, you might consider re-visiting the dosing strategy.
Just my two cents' worth. Looks like Sweet Pea might be on the move tonight with that PMPS.

Have a great evening!
Shelly

The vet now suspects that Sweet Pea will be lowered to the half unit. We are going to try dropping to one for now to see if the bouncing stops and to make the drop more gradual. She loved the spreadsheet and had me email her my copy tonight. Thanks for sharing your experience, Shelly! Have a great night.

 

[MrWorfMen's Mom]

I'd definitely make sure to get a test or two in before turning in for the night with that lower PMPS. A test at +3 can often tell you if it's going to be an active cycle and whether more monitoring might be needed although it looks like Sweet Pea may be reaching nadir quite late in the cycle and not showing much movement in the early hours. I agree with Shelly....it looks like it could be an active cycle.

 

[Andrea M.]

I'd definitely make sure to get a test or two in before turning in for the night with that lower PMPS. A test at +3 can often tell you if it's going to be an active cycle and whether more monitoring might be needed although it looks like Sweet Pea may be reaching nadir quite late in the cycle and not showing much movement in the early hours. I agree with Shelly....it looks like it could be an active cycle.

The plus side of my back injury is that I'm used to being up most of the night anyway. Sweet Pea will be watched closely tonight.

 

[MrWorfMen's Mom]

Well now that's making lemonade out of a lemon!

 

[Tricia Cinco(GA) & Harvey]

Sweet Pea's bounce from that 61 sure was short! Nice start to the evening. I hope she's been behaving since then.

I'd like to reinforce what Shelly said about Lantus liking consistency. Because it is a depot insulin, each time you change the dose, the depot has to readjust, so it takes several cycles before you see what that particular dose is actually doing. You should really hold each dose at least 6 cycles, unless the BG drops below 68.

I'm glad your vet is on board with what you did, and likes the spreadsheet. It really is a marvelous tool for keeping track of things, and easy to share.