9/27-Toro - when enough is enough?

[Toro & Ovi]

Hi, we've reached what is deemed safe (by some vets) for a diabetic cat, a 100-300 (on meter calibrated for feline blood)daily BG range.
I'd say that's a range of 80-250 on human maters.
Not too low to get hypo, not too high to be hyper.....
Our target is to stay healthy, in a safe range and lower the multiple daily ear piercing to a few per day or few every couple of days.
Thoughts? Any reasons to push further to even lower numbers?
Thanks.

 

[Sienne and Gabby (GA)]

It your goal is regulation, you're looking for Toronto to be below renal threshold -- roughly below 200. I'm not sure what you mean by, replace the daily piercing to a weekly one..." If your cat is getting insulin, you need to test at minimum, 4 times/day. Testing once a week, if that's what you mean is realistic only if your cat no longer needs to be getting a shot of insulin. The issue of "thinking" it's safe to test once a week when a cat is receiving insulin is that you risk becoming complacent. The second that happens, you risk missing a symptomatic hypoglycemic event or worse.

 

[Girlie's mom]

More experienced people will have to say, but my understanding (also from my vet) was that the blue range and under were the goal. Anything in pinks or reds is still stressing the organs out, isn't it, and doing more damage. I wouldn't consider numbers above blue as a sign of remission myself - but again, more experienced people should chime in here on that.

I've had several close calls before giving shots, and there is no way I would EVER give a shot without knowing her BG levels first. I don't want a cat that might go hypo because I wasn't willing to make sure it was safe to shoot.

It's hard having a diabetic cat, I know - it's a lot of work. But it's worth it, I think, if it keeps my cat safe and healthy. Wishing you luck on your journey with this disease.

 

[Girlie's mom]

Just food for thought: a cat's healthy range is not in the pinks or yellows number ranges: it's in the dark greens and even low lime greens. Again, more experienced people can confirm this, but non-diabetic cats don't - as far as I know - run around with BG levels in the yellows and aboves. I've tested my civvie out of curiosity, and he's always in the dark green range and even a little lower. Nothing higher than that. And pre-diabetes Girlie was always in the dark green range.

 

[Girlie's mom]

The lowest points during the day/at night are really the numbers that are important, so it's good to see those days when you can get tests at +2, +4, or +6 so you know when the lowest point typically is and when the insulin starts to wear off and the numbers naturally start to rise. Lantus doses on based on the lowest numbers in a cycle, not the AM or PMPS numbers. I'd be curious to see how Toronto actually progresses through the day with a reaction to insulin. It's an effort, but I find that the more data I have, the more I'm able to identify patterns and predict what's going to happen and how to respond appropriately. If I didn't have that in between data, I wouldn't know how low she'd gone and whether that's why the PMPS number were higher - a bounce from a too low number? Something else? I find this really helps me help her.

 

[Tricia Cinco(GA) & Harvey]

Hi, we've reached what is deemed safe (by vets) for a diabetic cat, a 6-17 daily BG range.
Not too low to get hypo, not too high to be hyper.....

"Hyper" isn't what you're worried about with consistently high numbers. The worry is kidney damage and even DKA. If your vet thinks readings in the 300s and mid to high 200s is safe, I'd say that vet doesn't know much about Feline Diabetes. FD regulation is a moving target. If you're not trying for remission, the best goal would be to get Toronto in consistently normal numbers. A normal range for a healthy cat, according to the TR sticky, is 50-80 on a human meter. I'd have to guess on the range for a pet meter, but I'd say 68-100 is probably pretty close. As Sienne said, at the very least you want ALL his numbers to be below 200, every day.

As Darrah said, treating FD isn't easy, but if you love your cat and want to give him a longer, healthier, happier life, it's totally worth it.

 

[Girlie's mom]

"Hyper" isn't what you're worried about with consistently high numbers. The worry is kidney damage and even DKA. If your vet thinks readings in the 300s and mid to high 200s is safe, I'd say that vet doesn't know much about Feline Diabetes. FD regulation is a moving target. If you're not trying for remission, the best goal would be to get Toronto in consistently normal numbers. A normal range for a healthy cat, according to the TR sticky, is 50-80 on a human meter. I'd have to guess on the range for a pet meter, but I'd say 68-100 is probably pretty close. As Sienne said, at the very least you want ALL his numbers to be below 200, every day.

As Darrah said, treating FD isn't easy, but if you love your cat and want to give him a longer, healthier, happier life, it's totally worth it.

You're right about the pet meter numbers, Tricia. The rough rule of thumb is to add 18 to the human meter number, but I understand that the lower the numbers go (dark and lime greens), the closer the two get.

Good points re: the danger being kidney damage and DKA. I always keep in mind the phrase "better a day too high than an hour too low": one of my guiding principles in keeping Girlie safe if I have to be away for very long.

Also, if she's in numbers in the high yellows or over, I always do a urinalysis to check for ketones. My vet stressed this as well and told me to call the hospital immediately if there was even a trace of ketones in her urine as we'd need to start taking immediate steps to head off DKA - she was really insistent about that.

 

[Toro & Ovi]

I will add some sites about BG targets for diabetic cats.

http://www.vetsulin.com/vet/Cats_Monitoring_About.aspx
http://www.sugarcats.net/sites/harry/bgguide.html

Just wondering why are so many different opinions online. We agree we shall stay under pink and over light green....blue and green ideal, yellow acceptable from time to time. Light green dangerous if we don't test every couple of hours (which is impossible to do that from the work place).
I'd say numbers for human meter vs. feline meter=30% lower on the human meter. That will traduce in 18 for low numbers but in 50-60 for 180-200 numbers (I couldn't find any reliable data online so it's just math - and can be wrong).
Anyways, we'll follow the Nadir and inject higher doses till we get close to 70 - and stop there.
Thank you all, it's always interesting to see experienced opinions - it helps a lot.

 

[Marje and Gracie]

I will add some sites about BG targets for diabetic cats.

http://www.vetsulin.com/vet/Cats_Monitoring_About.aspx
http://www.sugarcats.net/sites/harry/bgguide.html

Just wondering why are so many different opinions online. We agree we shall stay under pink and over light green....blue and green ideal, yellow acceptable from time to time. Light green dangerous if we don't test every couple of hours (which is impossible to do that from the work place).
I'd say numbers for human meter vs. feline meter=30% lower on the human meter. That will traduce in 18 for low numbers but in 50-60 for 180-200 numbers (I couldn't find any reliable data online so it's just math - and can be wrong).
Anyways, we'll follow the Nadir and inject higher doses till we get close to 70 - and stop there.
Thank you all, it's always interesting to see experienced opinions - it helps a lot.

Yes, you are incorrect. There is no consistent, direct correlation you can make between pet and human meters. I've done a ton of comparisons using the same two meters and, even at low numbers, there was not a consistent difference of 18 mg/dL. I would urge you to not assume there is and I definitely wouldn't say it's always 30%. You can't find reliable data because there is none.

I agree with the others that your goal should be to keep him below renal threshold if you feel tight regulation is too aggressive.

 

[Gill & George]

Hi, we've reached what is deemed safe (by some vets) for a diabetic cat, a 100-300 (on meter calibrated for feline blood)daily BG range.
I'd say that's a range of 80-250 on human maters.

In true cat fashion I see Toronto has read his condo and thrown you a 68@+4.

Looks like he's clearing a bounce with some speed, that 68 on a pet meter is awful low and on the margin for a reduction point on TR, I hope you took a test 30min later, he could still be dropping. At the very least with a number like that, I would recommend feeding some high carb food and leaving food out to keep him safe, if you had to go to bed. Though I must say if he were my cat I wouldn't be able to sleep until I saw his numbers rising.

I think that tonight illustrates the point that Sienna was trying to make if you were testing just once a week there's every chance you'd miss a green like that and run the risk of a hypo event.
It also illustrates Tricia's point about FD being a moving target. With a cats pancreas having the ability to heal, and other external factors affecting BG a dose can mean that an apparently safe dose can end up being too much insulin, or conversely can end up being not enough. Either of these options are problematic, one can leave kitty hypo or worse, the other can see kitty in prolonged and sustained high numbers, this is very hard on the kidneys and potentially you risk DKA, which is a very serious complication.

I agree with Sienne in that while you are continuing to shoot insulin I would continue testing a minimum of 4 times daily, adding that if like tonight, you see a very low reading, please try and follow that up with further tests, or take some precautionary action.

 

[Toro & Ovi]

In true cat fashion I see Toronto has read his condo and thrown you a 68@+4.

Looks like he's clearing a bounce with some speed, that 68 on a pet meter is awful low and on the margin for a reduction point on TR, I hope you took a test 30min later, he could still be dropping. At the very least with a number like that, I would recommend feeding some high carb food and leaving food out to keep him safe, if you had to go to bed. Though I must say if he were my cat I wouldn't be able to sleep until I saw his numbers rising.

I think that tonight illustrates the point that Sienna was trying to make if you were testing just once a week there's every chance you'd miss a green like that and run the risk of a hypo event.
It also illustrates Tricia's point about FD being a moving target. With a cats pancreas having the ability to heal, and other external factors affecting BG a dose can mean that an apparently safe dose can end up being too much insulin, or conversely can end up being not enough. Either of these options are problematic, one can leave kitty hypo or worse, the other can see kitty in prolonged and sustained high numbers, this is very hard on the kidneys and potentially you risk DKA, which is a very serious complication.

I agree with Sienne in that while you are continuing to shoot insulin I would continue testing a minimum of 4 times daily, adding that if like tonight, you see a very low reading, please try and follow that up with further tests, or take some precautionary action.

Yes, we continue to test multiple times per day as he continues to surprise us. If like last night we'll do extra tests and feed him higher carb food. We'll stay @2.5u longer hopefully the numbers will become flat. We don't see anything else we can do right now as he's bouncing from 68 to 400 and back. I wish we could keep him between 100 and 200 - unfortunately is not the case yet. Following the Nadir and going further from there.....BG's only for safety.
Thank you.

 

[Toro & Ovi]

Yes, you are incorrect. There is no consistent, direct correlation you can make between pet and human meters. I've done a ton of comparisons using the same two meters and, even at low numbers, there was not a consistent difference of 18 mg/dL. I would urge you to not assume there is and I definitely wouldn't say it's always 30%. You can't find reliable data because there is none.

I agree with the others that your goal should be to keep him below renal threshold if you feel tight regulation is too aggressive.

Thank you. I have to base my shots on something as all the regulations are based on human meters. Right or wrong, using a pet meter will give me different numbers and getting too low scares me more than sitting too high. We try to condense the numbers between 100 and 200 on pet meter (agree an that, it's a nice and logical target) - but as long as the bouncing is big as now we prefer to stay between 100 and 300 instead of, for example, 60 and 200 - looks more safer for us. 60 is too low. Does this make sense?

 

[Gill & George]

Nice amps. Looks like he might have spent quite a bit of time in green last night.

As ps is lower than usual I would suggest a +1 /+2

Who knows he may just surf a nice curve instead of bouncing to the moon.

 

[Gill & George]

60 and 200 - looks more safer for us. Does this make sense

Fyi 60 would be too low on a pet meter.

 

[tiffmaxee]

To add to what Gill said, 68 calls for a reduction on a pet meter.

 

[Toro & Ovi]

Nice amps. Looks like he might have spent quite a bit of time in green last night.

As ps is lower than usual I would suggest a +1 /+2

Who knows he may just surf a nice curve instead of bouncing to the moon.

+1 shot it was.
3 times in different days under 68 will earn him a reduction. Last night earned only his favorite Friskies pate (instead of FF pate) - we try to stay as low as possible for longer periods of time so we'll hopefully get rid of the bounces.
He seemed to be totally fine at 68, happy Tomcat......

 

[Cherish Gallagher]

Just food for thought: a cat's healthy range is not in the pinks or yellows number ranges: it's in the dark greens and even low lime greens. Again, more experienced people can confirm this, but non-diabetic cats don't - as far as I know - run around with BG levels in the yellows and aboves. I've tested my civvie out of curiosity, and he's always in the dark green range and even a little lower. Nothing higher than that. And pre-diabetes Girlie was always in the dark green range.

Same! I’ve tested our other kitty a few times and he’s been dark greens.

 

[Noah & me (GA)]

"Better a day too high than an hour too low". I understand that the lower the numbers go (dark and lime greens), the closer the two get.

Great quote! Too high can be managed but too low is an emergency. Yes, the lower the numbers the closer the correlation between human and pet meters. Does Ovi dislike being tested? Some cats dislike it intensely but it's something that has to be done twice daily unless your cat is vet certified as being in remission.

The best goal would be to get Toronto in consistently normal numbers.

This should be your goal, consistency. Although it is possible remission may be out of your hands. Don't "push", be in control. Thoughts on that anyone?

 

[Girlie's mom]

Great quote! Too high can be managed but too low is an emergency. Yes, the lower the numbers the closer the correlation between human and pet meters. Does Ovi dislike being tested? Some cats dislike it intensely but it's something that has to be done twice daily unless your cat is vet certified as being in remission.

This should be your goal, consistency. Although it is possible remission may be out of your hands. Don't "push", be in control. Thoughts on that anyone?

As many experienced people here say: this is a marathon, not a sprint (not my quote!). You can't "push" your cat to do something its body isn't ready to do and if you try to rush things, I think you can put your cat in danger. Going hypo or too low is certainly not the goal as I understand it!

Two tests a day isn't enough, is it? That's just AMPS and PMPS. You need to get tests in between so that you know what the actual nadir is as that's what you use as a guide to dosing and to tell you what the insulin is actually doing throughout the cycle. Without the data, it's hard to make an informed decision on what's actually going on with a cat. That's what I think, anyway ... but I'd love to hear what more experienced people think.

 

[Toro & Ovi]

Great quote! Too high can be managed but too low is an emergency. Yes, the lower the numbers the closer the correlation between human and pet meters. Does Ovi dislike being tested? Some cats dislike it intensely but it's something that has to be done twice daily unless your cat is vet certified as being in remission.

This should be your goal, consistency. Although it is possible remission may be out of your hands. Don't "push", be in control. Thoughts on that anyone?

Consistency IS the goal, correct.
Toro dislikes being tested, correct. Hiding his ears wherever he can.
Once the bounces are gone we should be close to the target.
Reducing after one time @68? Not in a big hurry to do that as his numbers at 2.25U were not satisfactory. As per TR rules, 68 is only borderline to reduction.

 

[Marje and Gracie]

Thank you. I have to base my shots on something as all the regulations are based on human meters. Right or wrong, using a pet meter will give me different numbers and getting too low scares me more than sitting too high. We try to condense the numbers between 100 and 200 on pet meter (agree an that, it's a nice and logical target) - but as long as the bouncing is big as now we prefer to stay between 100 and 300 instead of, for example, 60 and 200 - looks more safer for us. 60 is too low. Does this make sense?

No, it doesn’t make sense because I think you don’t understand how the protocol is written. You don’t need to worry about anything except keeping the lowest number on the pet meter above 68 and making sure he does not become hyperglycemic due to glucose toxicity. When we say that renal threshold is approximately 250 mg/dL, that’s the number from the lab equipment which is more closely related to a pet meter than a human meter. That number also varies by cat. By letting him stay all the way up to 300, you are getting above renal threshold based on equipment calibrated for pets.

One of the reasons he is bouncing so much is because you aren’t testing enough to catch the drop. You have to get him flattened out by managing his curve with food and the only way to do that is to test a little bit more at first.

 

[Noah & me (GA)]

@Girlie's mom Sorry, you are right. Testing AM and PM is bare minimum between curves for a stable cat. Sounds like Toro really dislikes being tested if he's covering his ears. Poor Noah will only produce blood from one ear so it's theatre with him. I lay everything out, sing him his name, give him a backrub and after all that I'll still go right through his ear! A lot of people warm the ear first, a sock in the microwave or whatever. What ever is hygienic and works for Toro, including singing, is encouraged. Noah bounces and it's like starting all over, frustrating. He hasn't seen a 68 in what seems like forever. I can't add anything to the discussion past that because I make my own spreadsheets so the "colours" mean nothing and Noah is a Caninsulin cat. I shouldn't even be in this forum, something caught my eye and I can't remember what. We are almost neighbors, we live in Milton. Maybe that was it.

 

[Noah & me (GA)]

No, it doesn’t make sense because I think you don’t understand how the protocol is written. You don’t need to worry about anything except keeping the lowest number on the pet meter above 68 and making sure he does not become hyperglycemic due to glucose toxicity.

Sorry for the double post and Toro & Ovi, really sorry if it sounds like were ganging up on you. For me and Noah flirting with 68 would be like pouring gasoline over your head to cool off. Aim for a slow and gradual reduction with curves, lots of curves! Knowing Hypo is bad is one thing, seeing it is tragic and will make you cry. Now I'm sure I'm done and quite tired.

 

[Toro & Ovi]

Sorry for the double post and Toro & Ovi, really sorry if it sounds like were ganging up on you. For me and Noah flirting with 68 would be like pouring gasoline over your head to cool off. Aim for a slow and gradual reduction with curves, lots of curves! Knowing Hypo is bad is one thing, seeing it is tragic and will make you cry. Now I'm sure I'm done and quite tired.

No worries. We follow him closely. +3/+4 gives us the idea of a deep curve or a light one. If it's deep and he's blue or green low we take blood samples till he's out of the hook. If he's going again under 70 we'll reconsider the dose - he'll probably get a reduction.
As you see on Toro's SS we can't keep him over 70 and under 300 all the time, we aim for over 70 as Nadir and hope he will stop bouncing over 200-250.
As far as I understand the bounces will stop only if he's liver will get used to low numbers and hence stop reacting to these numbers.
The question of making these tests random instead of permanently 4/day was for the scenario when he's eventually get stabilized on a safe range.

 

[Kris & Teasel]

You're working hard at getting your kitty into a good BG range. That's great! You need to know, though, that bouncing doesn't necessarily stop when you have what seems to be a good dose. It's particular to the cat - some are more volatile than others. The good dose can also vary over time. Some people are able to go through logical steps over time and arrive at a narrow dose range that keeps BG within fairly circumscribed limits. For other cats, it can feel like more of an ongoing crap shoot. As we often say here, it's the cat who's leading this dance and your role is to respond using the BG data log as your guide.

 

[Noah & me (GA)]

This can be a terrible way for humans to communicate. No facial expressions, we use different words for the same thing, people get their toes stepped on. We're all after the same thing, a happy healthy cat. All aboard the Looney Train.