Another Newbie

[RG & Mali (GA)]

Enough lurking around the boards, I think I have finally gotten Mali's profile working and hope to get her SS in sig line with a little more help.
Mali is 17 yr old tuxedo that had a brief bout with diabetes about a year ago, but we got it under control with Lantus and omitting the dry food from her diet. She has since been dx with pancreatitis back in late March and we have been trying to get her regulated ever since. I only wish I had learned of FDMB back then. I think my vet means well, but after reading many posts here, I know I would have done some things different. In order to keep repetition down, please see her profile and let me know what I have left out and any thoughts or recommendations from the vast knowledge that exists on this board.

Thank you for your time.

RG & Mali

 

[BJM]

CID is what?
BID = twice a day
TID = 3 times per day
QD = each day, or 1 /er day.

If only 1 shot per day of 1 unit, you might try 2 shots of 0.5 units so the glucose is on less of a roller coaster.

 

[Hillary & Maui (GA)]

I was wondering the same thing. I even looked up CID and could not find it listed anywhere. Please advise how often you are giving insulin.

How is Mali eating now? Does she eat her food or does she turn away and not want to eat?

Pancreatitis is painful and did the vet prescribe anything for pain such as buprenex? I don't see that listed and it may help. The cerenia will help with the nausea but not the pain associated with pancreatitis.

 

[RG & Mali (GA)]

Sorry, acronym fog...1 unit/ twice daily

Buprenorphin is what was given for pain early in dx, but she is eating very well and does not seem to be in any pain

I want to get her SS in sig. Can i copy and paste together with her profile or does it have to be done one at time and submitted separately?

 

[Hillary & Maui (GA)]

Make it a separate line. It will be easier for all going forward.

OK - so you are dosing BID - that is good.

If she is eating well, then she is probably over the pancreatitis, of course it can happen again, but hopefully not.

So, how can we help you.

 

[RG & Mali (GA)]

I think I have her SS in the sig now. When you see it, it looks like i just threw darts at a board, but honestly I went by my vet's advice and talked to them almost daily. I think I have a handle on it for a day or so and then "up jumps the devil" like last night and this morning.
Any thoughts?

Thanks!

 

[Hillary & Maui (GA)]

Well first off, I would like to see you get some tests in during the PM cycle as well as consistently getting tests in during the AM cycle. This will help to gather more data to see exactly what is happening during each cycle.

What we need to try to see is how your kitty is responding to insulin. Here is the excerpt from the following link: viewtopic.php?f=9&t=18139


Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir - the lowest point in the cycle
Duration - the length of time insulin continues to lower blood glucose

A typical Levemir curve will have an onset at approximately +4 and a nadir around +8 - +10. However, please keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to either of these insulins.

Within the link are the definitions of onset, peak/nadir, duration.

Also, please keep in mind that you don't have to do a curve which is testing every 2 hours. But you do need to do more testing in order to help figure out the best dose for your cat.

In addition, I see that you changed the dose by 1/2 (.50) units at a time. You may find that changing by 1/4 (.25) units is better as it will help ensure that you don't skip over the ideal dose.

You did get it right in lowering the dose when you got BG's below 50. However, maybe it was too much of a reduction and the cat bounced or somogyi effect. Here is a link that explains it:

http://www.felinediabetes.com/concurrent-somogyi.htm

Also, here is an excerpt regarding when to adjust the dose: viewtopic.php?f=9&t=1581


Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes:

Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.



Did the vet discuss ketones/DKA with you? Ketone testing is done by taking a ketone test strip and dipping it into the urine. Of course the challenge can be how to collect the urine from said cat! :shock: There are many tips/techniques to do that. With Maui I could wait until she started to go and just put the strip in her urine stream.

If you get Ketostix or KetoDiastix (or generic), one tess for ketones only and the latters tests for both ketones and glucose in the urine. (Note, this should not take the place of BG testing).

A urine ketone test will identify if there are ketones accumulating since the last time the cat urinated. High levels of ketones are a medical emergency as they may be from diabetic ketoacidosis.

A urine glucose is inexact and shows if glucose was spilling into the urine since the last time the cat urinated. It does this when the blood glucose is over about 200 - 240 mg/dL.

Obtain Keto Diastix or similar product from pharmacy.
You will be looking for glucose and/or ketones in the urine.

Use a long handled spoon to obtain fresh urine sample while the cat urinates, or hold a test strip under the cat (tongs may be helpful).

OR - place some strong plastic wrap over a section of the box frequently anointed and
dip into a fresh puddle less than 30 minutes after deposit.

OR - Pick up some aquarium gravel and put it in a clean litter box.
Wait for the cat to use it.
In under 30 minutes, push the gravel aside, tip the pan, and dip the strip.

Compare test strip to color chart (this is an imprecise measure)

 

[Hillary & Maui (GA)]

One more thing, the links I provided are from the Lantus forum. Please go there and read the starred (stickies) posts to help you better understand how to handle Levimer - yes I know I am sending you to Lantus and talking about Levimer.

It is because they are similar insulins and work in similar fashion. Yes, there are differences, but the general protocol and process is the same.

 

[RG & Mali (GA)]

Wow, that's a lot of info! I had read some about the small dosages and wonder how to effectively get under .25 unit dosage with the 1/2 unit syringes coupled with eyes of the aged. No we haven't talked about ketones/DKA, but early on, they gave? sold me several packets of glucotest that i scattered in her litterbox and of course they mostly turned dark when she peed on them. She is such a modest kitty when it comes to her litterbox habits, i don't think i could ever sneak up on her to put a ketostik in her urine stream.
BTW, the vet just called to review the latest BG readings and wants to do abdominal ultrasound tomorrow morning to check her pancreas since it was March when they did the fPL test.$$$
I appreciate the feedback and hope to have more info soon.
Thanks!

 

[Deb & Wink]

Would you please add the Alphatrak to your signature and make the font size large instead of normal. Since most of us use the human glucometers, the hypo territory numbers are vastly different and we want that meter to stick right out, not be hidden in your profile.

 

[KPassa]

Hi and Welcome! :YMHUG:

One thing I noticed right off the bat was the hypo on 5/17. If you hadn't shot that AMPS, it would be a skipped shot due to low numbers. Coupled with the other skipped shot on 5/20 makes me think this dose is too high. You also have a couple of cycles where you only shot .5u instead of 1u. Is there a particular reason for this? Levemir works best with consistent dosing and if you can't consistently give 1u every cycle (i.e. skipped shots or decreasing the dose), then the dose should be decreased across the board. I would suggest to decrease to .5u (or perhaps .75u) and hold that for a few days to see how Mali does.

I think I have her SS in the sig now.

You want to enter the URL code in the following format: [ url=http://blahblah...]Your Text Here[/url ] (but without the spaces). So, it would look like this:

Mali's Profile
Mali's Spreadsheet

(You can click "Quote" in the upper right corner of this post and it'll give you the coded version of what I posted above. You can then copy/paste that into your signature, if you want.)

 

[RG & Mali (GA)]

Would you please add the Alphatrak to your signature and make the font size large instead of normal. Since most of us use the human glucometers, the hypo territory numbers are vastly different and we want that meter to stick right out, not be hidden in your profile.

I will be happy to do that if you will me how. Also, i don't know how long i will be using the AlphaTrak with strips at a buck a piece.

 

[Hillary & Maui (GA)]

That is the problem with alpha trak - the strips are EXPENSIVE!

You can use a human meter (most of us do) and do it economically - Walmart sells Relion Brand and the meter and strips are very reasonably priced. The meters are easy to use and require a small drop of blood.

You can also get other human meters - One Touch Ultra, Bayer Contour, etc. the strips are a little more expensive, but nothing like Alpha Trak.

 

[BJM]

A glucometer many of us have used which is inexpensive, uses very little blood, and has reasonable test strips is the Arkray Glucocard 01 available at our shopping partner, ADW. It is also avaliable at WalMart as their house brand ReliOn Confirm. There are micro versions of both - smaller to hold, same test strips.

 

[RG & Mali (GA)]

Hi and Welcome! :YMHUG:

One thing I noticed right off the bat was the hypo on 5/17. If you hadn't shot that AMPS, it would be a skipped shot due to low numbers. Coupled with the other skipped shot on 5/20 makes me think this dose is too high. You also have a couple of cycles where you only shot .5u instead of 1u. Is there a particular reason for this? Levemir works best with consistent dosing and if you can't consistently give 1u every cycle (i.e. skipped shots or decreasing the dose), then the dose should be decreased across the board. I would suggest to decrease to .5u (or perhaps .75u) and hold that for a few days to see how Mali does.

I think I have her SS in the sig now.

You want to enter the URL code in the following format: [ url=http://blahblah...]Your Text Here[/url ] (but without the spaces). So, it would look like this:

Mali's Profile
Mali's Spreadsheet

(You can click "Quote" in the upper right corner of this post and it'll give you the coded version of what I posted above. You can then copy/paste that into your signature, if you want.)

Thank you. From the start of Levemir on 5/10 at 1 unit and then on 5/11 it fell to 164 and just my inexperience and since the hypo the day before, i just made the decison to drop to a half out of fear of another hypo. Then after the 164 the 1 unit dose seemed to be gradually bringing it down until my another bad decision on 5/17 to give the 1 unit at the AMPS reading. Thanks for the help on the signature...a lot to learn here.

 

[Hillary & Maui (GA)]

That is why we are here. To help you learn and understand how your insulin works, what to look for and when/how much to adjust the dose.

Remember, each one of us that are here, were new once and had to learn, same as you. It's part of the process.

Please ask questions and we will do our best to help. ;-)

 

[RG & Mali (GA)]

A glucometer many of us have used which is inexpensive, uses very little blood, and has reasonable test strips is the Arkray Glucocard 01 available at our shopping partner, ADW. It is also avaliable at WalMart as their house brand ReliOn Confirm. There are micro versions of both - smaller to hold, same test strips.

Thanks for that info. I had seen quite a bit of positives written on the Relion and currently use their syringes so that may be the way to go.

 

[Deb & Wink]

Would you please add the Alphatrak to your signature and make the font size large instead of normal. Since most of us use the human glucometers, the hypo territory numbers are vastly different and we want that meter to stick right out, not be hidden in your profile.

I will be happy to do that if you will me how. Also, i don't know how long i will be using the AlphaTrak with strips at a buck a piece.

To add information to your signature:

1. go to the top left of your screen, under the picture of the cat and look for the words "user control panel". Click on that.
2. a list of tabs appears partway down the screen. Click on the Profile tab
3. on the left hand side of your screen, are a number of selections. Click on Edit Signature.
4. a free form text box appears. This is where you put your link to your SS and profile.
5. type in Alphatrak. In the editing bar, there are some boxes with a B, an i, a u, the word Quote, etc.
6. in the middle of those boxes is a drop down list for the text size. Highlight your word Alphatrak, click on the drop down arrow and select the word Large.
7. Click on the preview button below the free-form text box to see how it looks.
8. submit to save the change.

 

[RG & Mali (GA)]

That is why we are here. To help you learn and understand how your insulin works, what to look for and when/how much to adjust the dose.

Remember, each one of us that are here, were new once and had to learn, same as you. It's part of the process.

Please ask questions and we will do our best to help. ;-)

Once again, THANKS! I'm sure I will become a pest as I am determined to get this ole gal back in good shape

 

[RG & Mali (GA)]

Would you please add the Alphatrak to your signature and make the font size large instead of normal. Since most of us use the human glucometers, the hypo territory numbers are vastly different and we want that meter to stick right out, not be hidden in your profile.

I will be happy to do that if you will me how. Also, i don't know how long i will be using the AlphaTrak with strips at a buck a piece.

To add information to your signature:

1. go to the top left of your screen, under the picture of the cat and look for the words "user control panel". Click on that.
2. a list of tabs appears partway down the screen. Click on the Profile tab
3. on the left hand side of your screen, are a number of selections. Click on Edit Signature.
4. a free form text box appears. This is where you put your link to your SS and profile.
5. type in Alphatrak. In the editing bar, there are some boxes with a B, an i, a u, the word Quote, etc.
6. in the middle of those boxes is a drop down list for the text size. Highlight your word Alphatrak, click on the drop down arrow and select the word Large.
7. Click on the preview button below the free-form text box to see how it looks.
8. submit to save the change.

Genius!! Got it..many thanks!

 

[Hillary & Maui (GA)]

If you become a pest - then you will just become like the rest of us. ;-)

Seriously - ask questions. You are not expected to get it at once. There is a lot to learn and it takes time and then once you understand, something new will happen and you will question everything all over again! That's why they are cats - to keep us on our toes!

 

[KPassa]

Thank you. From the start of Levemir on 5/10 at 1 unit and then on 5/11 it fell to 164 and just my inexperience and since the hypo the day before, i just made the decison to drop to a half out of fear of another hypo.

Actually, this was the correct decision. :thumbup You just should have stuck with that .5u a bit longer. ;-)

And don't feel bad about "pestering" us because one day soon, you'll be "pestered" along with us! Once you join FDMB, there's no escaping! Mwahahahaha! :lol:

 

[Deb & Wink]

Ask questions, as many times as you need to.

Ahhh, did anyone happen to mention that when you registered and started posting, you gained a whole new family?

We will be here with shoulders to cry on, hugs to make you feel better, cheers when your kitty Mali starts to look and feel like her old self, we'll stay up all night with you if your cat has a hypo, give you money saving tips, provide up to date vet journal research to help you understand feline diabetes and talk more knowledgeably with your vet, remind you to take care of yourself as well as your kitty, share in your triumphs and your sorrows.

We will try not to be too annoying but will nag you when we think something is important. Kind of like my Uncle Ed nags me sometimes. ;-)

 

[Wendy&Tiggy(GA)]

Hello and welcome to the board!

You have made some great progress! All the stuff you have done so far is really good and makes it nice and easy for us to go in and see whats going on.

The others have commented on a few important things but what jumped out at me was the hypo on May 17th - the dose is too high. I would reduce by 1/4unit as the others have said. You need to find a dose you can give consistently, and let it settle in for a few days, without causing serious lows. I also suspect there may be more of those greens during the day or night when you arent getting tests in.. thats why sometimes she is so high and black - she dropped low and bounced back up to red or black.

Here are tips for getting a urine sample so you can test for ketones which is very important, https://docs.google.com/document/d/1quta5WLEjdO0Y_t2dAYSwN84h-LNZWxOdtVsJDKZ16A/pub and even more so when you get numbers over about 340. Those sprinkle things test for urine sugar only - which you will see if she spends any time over about 270. What you need is ketone test strips.

Wendy

 

[RG & Mali (GA)]

Wow! Y'all need to watch out "throwing so many flowers" toward an old guy like me....I might regain some youth here... (still haven't mastered the emoticons, they come out with a description rather than the emoticon itself)

Thanks very much for all of your input and time on the board helping out newbies like myself. Mali is not very happy with me this morning since she can't be fed yet. She is going in to the vet for an abdominal ultrasound to check on her pancreatitis. I've been around a while and know how business is done, but I've told my vet that pretty soon they will have to add a new wing to the clinic in honor of Mali...Whew, you can't believe what we've spent there in the last couple of months!!

Enough poormouthing, Mali read a 207 this morning at 7 and she couldn't get food or insulin before her test so we will be off to do that just before 9...she is not happy right now and is wanting to know where her breakfast is
I will report back when the results are in.
Thanks again, everyone!!

 

[Hillary & Maui (GA)]

if she is really hungry - you could give her water and say a teaspoon of food, just to tide her over, that won't affect the ultrasound, just tell the vet you gave a teaspoon to stave off the starvation of Mali.

do you see the smilies on the side when you are writing? if you do, all you need to do is click on the one you want to use and it will automatically post (in word form) where you have the cursor. when you hit submit the word form will turn into the emoticom.