Asher weird +2 number tonight

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donnahc

donnahc

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Hi folks:
I thought things were going along “normally" and got a weird +2 number tonight.
(I say this with the note that we just started a new bottle of test strips, but, we did calibrate the meter/test the strips with the control solution twice and they fall right in the middle of the suggested range)

Anyhow our PMPS was 176. We shot 2 units. I wanted to watch him because the scenario seemed close to last night. So we tested at +2 and got 432 !!

Is that weird? What could this be? I am wondering if the meter is not working or if indeed he could go up after an insulin shot.

Anybody see anything like this before?

Donna and Asher
 
When in doubt, test again. You might test yourself to test the strips.

You do need to be confident your meter is working. I would get in several tests tonight.
 
We have one of those vet meters, so I don’t know if I can test myself, won’t it be calibrated wrong?

(that’s another Q, I would like to get a walmart meter so we don’t go broke buying strips, but that I will ask again later I guess)

Ok I’ll check Asher again soon and report in.

-donna
 
I don't know if you can use the pet meter on yourself. Yes, it would be good to have a backup meter with strips that are easy to get. The ReliOn is a good choice.

Will be watching for another number.
 
We’ll try to get another reading at 11pm east coast time. I guess no sleep tonight either :(

Trying to be calm. Trying.

:)

Thanks so much,

Donna
 
You have safe numbers - no need to worry. I just don't understand the rise. It could be the onset up to +4, I guess.

From the PZI info:


Onset, when the insulin starts taking effect, is typically around 2 hours after injection. The numbers will continue to rise until the point of onset, when they start to go down again.
 
While I’m waiting until 11 for the next test, I might as well ask for the info on the meter from Walmart.

People have talked about the ReliOn Micro Meter. Is that what most people use?

If you buy a human meter, how do you calibrate it to a cat, or do you do a conversion calculation after you take a reading?

The pet meter we have (AlphaTrak) is fine but the test strips (shipped) are almost 60 bucks for 50, which is a lot I think. We just got it because we did what the vet recommended the day he was diagnosed, and we knew we needed one fast. Just figured we couldn’t use a human meter until we came here, which was a couple days later...


-Donna
 
I'm rebound agnostic. But this sure looks like a potential case of rebound/bounce to me. The other thing is that it could be food related. So I don't want to harp too much about making the feeding as even as you can but this is something you might want to look at if this sort of thing continues to happen. Unless you are purposely trying to use food to effect the curve then the objective is to try to optimize the feeding so that food has the least effect on the curve. In the beginning the one of the overall objectives is to eliminate the things, that one can, that could cause variability in the curves [including feeding]. Some cats too can be very carb sensitive and some have found better success with very low carb foods - less than 5% carbs from calories.

What food are you feeding?

I don't think you have one iota of reason to be concerned. You just kind of have to go with the flow. Sometimes you get the chicken and sometimes you just get feathers.

As far as the pet meters go, the strips are generally more expensive. Personally, I've never seen anyone here claim that their pet meter contributed to getting their cat regulated better/faster. And the numbers or ranges we generally talk about here [danger zones etc.] are related to the human meters which tend to run low-er at low numbers. Many like the reli-on meters. My Wal-Mart is difficult to get to so I preferred getting my strips online and I really ended up liking the Freestyle Lite over my OTU. It is important to have a backup meter [your Alphatrak would suffice] just in case one unexpectedly dies. And what you are really after are the relative changes and not the absolute numbers so much. That's why it's recommended to use one meter and stick with that. If you want to use a different meter that's fine - just don't make a habit of switching it around all the time.
 
I am confused about food so that could be part of it. Right now we have Asher on Hills Science diet m/d. Again, it’s what the vet pushed on us (I am not a big Science Diet fan) but he likes it, we have about 10 cans, so that is what we have been feeding. And we cook off plain skinless chicken and cube it (1/4”) and freeze it. We use that for treats after testing or if he’s pesty for food mid day.

The vet said feed twice a day so that is what we have been doing. She said he could eat whatever he needed up to a full can per meal.

But after Asher had some low numbers around +4, and people here said they leave food out, we haven’t been feeding him a portion and then removing the bowl. We feed him 3/4 can, he usually eats about 1/2 can, then he usually comes back in an hour or two and finishes it or eats some of it. Sometimes he “burys it” and we know he’s done. At that point we take the bowl away.

His hunger doesn’t seem exactly the same every day so we weren’t that strict about weighing an exact portion and making sure that is absolutely all he gets.
Do I have to be that regimented? or is approx 3/4 can twice per day plus chicken close enough?

-donna
 
OK the Hills MD is not going to cut it, it is too high in carbs. This is the likely reason for the numbers you got and have been getting.

Here's the food part from the newbie checklist in the PZI Sticky:
2) Get the diet right! Diet and insulin work hand in hand to treat diabetes. Food contains carbohydrates (sugar) so if you feed a high carbohydrate diet you have to give a lot more insulin. Your first goal in mastering the treatment of diabetes is to switch your cat to a low carbohydrate ["LC"] diet, preferably canned or raw foods. There is no such thing as low-carb dry food. There is low-er carb dry food, but if your cat will eat canned (or raw) that's the best. Please see Janet & Binky's list and look for foods under 10% calories from carbs [not the "Guaranteed Analysis" printed on the can] that are available in your community and are priced for your budget. Low carb treats are imperative too. Dr. Pierson's page has many useful suggestions on how to transition cats who don't take to wet food, so if your cat is holding out, don't give up hope! If your cat does not have a history of ketones, and you are giving more than 1u twice per day, you may want to drop back to 1u twice per day when you make the switch to LC - the resulting lowering of blood glucose ["BG"] values are sometimes dramatic. PLEASE NOTE: You must test before every shot if you are switching from dry to wet food. The diet change alone can radically lower glucose levels.

So there are many option in Janet & Binky's list that do not require prescription and are of much better ingredients. MD is old school diabetic thought that high fiber is best for diabetes. Please ask more questions about food if you have them.
 
donnahc said:
So there is no conversion for using a human meter on a cat?
Click to expand...
The "conversion" is already 'done' in the numbers we generally talk about. The difference that matters most is at the very low end and the numbers we talk about here already have that in mind.

This might help you:
http://petdiabetes.wikia.com/wiki/Glucometer
and
http://petdiabetes.wikia.com/wiki/Blood ... guidelines

Janet has done an awesome statistical analysis of some of the various meters.
EDIT: Here's a good post about the various meters vs the Alphatrak:
http://www.felinediabetes.com/phorum5/r ... ?15,327824

It sound that the most important thing you need to address is the diet and the Hills MD which is not ideal.
 
No conversion from human to animal that I've ever heard of. I use the Walmart Relion meter too, Contour, I think. It was $9, strips are 50 for $20.

Is there a chance he had something else to eat tonight? Maybe snuck something he wasn't supposed to have? Sam is really carb sensitive. For example, at 9pm tonight he was at 265. I fed the cats, then because it was a new kind of Fancy Feast, Flaked Trout flavor, I went to J&B's food chart to check the carbs. 7%, which is a little higher than I like to give - I usually shoot for 6% or less. Anyway, 40 mins later, Sam was at 343. Carbs make a huge difference in him.

I wouldn't worry about the overnight too much. Those numbers are plenty high to keep him out of hypo. Get some sleep, you're doing great. Tomorrow is a new day.

PS. If you got that canned food from your vet and don't want to keep using it, take it back and get your money.
 
I mentioned to the vet about the m/d being around 14% and that I had some Blue Buffalo Wilderness canned Chicken that was around 1%. She said I need to go by the “as fed” numbers and brought out a nice Hills brochure for me to look at. I wasn’t in the mood to piss her off, just had other questions that day so we stayed with the m/d. That was the day she also told me I shouldn’t test for ketones. Ugh.

*If I am going to switch him off the m/d, shall I taper it and mix it with another food over a period of days? Am I basically starting over here if we get him off the m/d?

There is no chance Asher got into anything high carb tonight. IF he did get into his brother’s canned food, Alby gets the Blue Buffalo I spoke of here, so it would be lower carb if anything. And we police them while eating so I know everyone is eating and how much. (Alby made the switch to wet food but he isn’t totally happy about it so I have to watch him to make sure he eats enough, and coax him with some chicken mixed in sometimes.)

-donna
 
+4 is 348 now, so it dropped again. I am guessing the meter is working.

We’ll make the food switch next.

-d.
 
donnahc said:
She said I need to go by the “as fed” numbers and brought out a nice Hills brochure for me to look at....

*If I am going to switch him off the m/d, shall I taper it and mix it with another food over a period of days? Am I basically starting over here if we get him off the m/d?
Click to expand...
The numbers in Janet & Binky's list are in % calories from or %Kcal consumed format which makes comparing one food against another easier. These numbers are generally converted from As Fed or Dry Matter basis numbers obtained directly from the manufacturer. So your vet is partially right. But ultimately it is not the right food.

I know I've been throwing a lot of reading at you but if you want to read more about how the As Fed works into the numbers in Janet & Binky's list you can read her FAQ here:
http://binkyspage.tripod.com/foodfaq.html

It is generally recommended to taper over several days or up to a week. That said, I'm personally the impatient type and tend to make it go faster. If you go faster then the effect should be more immediate and potentially sharper. If you do not reduce back to 1u then you will have to stay on your toes about reducing the dose. You are not starting over per say but your old data could become increasingly irrelevant. So how you shot 1.75u into a lowish number and didn't get far with it could really change - and I would strongly advise caution. So this is where point 4 from the Checklist comes into play:

4) Watch for a Blood Glucose ["BG"] drop from the Low-Carb ["LC"]. After the switch to LC food one should start to see the effect of that anywhere from immediately to seven days. Be prepared to lower the insulin dose as necessary and/or have your no shoot number decided upon.

So you may need to wait up to a week after you have completely switched over to low carb to start to see the change. On the other hand it can happen immediately so you have to stay on your toes. :smile:

I think you are doing good, this is a process that just takes time to work though.
 
Your vet doesn't make money off Fancy Feast, so it's only natural they'd want you to buy what they sell. I still say take it back.

If Asher is anything like Sam, I bet you'll see a big improvement when you switch to the lower carb food. And hey, if you want to check for ketones, Asher's your cat. You can test his pee all you want to. lol
 
BTW Donna, I wanted to compliment you on your testing. I would have never been able to ask you the question about the food if you did not capture the data that prompted me to ask. Good work. :smile:
 
Yeah Kristen, after doing some reading (and getting scared) I checked him for ketones this week and thankfully it was neg.

I thought we had more m/d left but we are down to only 4 cans, so if I am going to taper him into another food, we won’t be wasting anything or having to return anything. :dizcat

Thanks Gator!!! We are trying real hard to do the best we can for Asher. Some days I think I just suck at all this, but we keep at it.

So say I half his food with m/d and LC for a day or two then switch to a LC food on the list, do we just stay at 2 units and keep testing? Or do we cut back, and if so how? Gradually? All at once? We always test am and pm. If we are home (which has been a lot lately) we test mid day sometime.
We have work later this week and Sat but I am gonna suggest my partner Tom stay home with him for now until things settle if we are going to change his food.

-donna
 
donnahc said:
So say I half his food with m/d and LC for a day or two then switch to a LC food on the list, do we just stay at 2 units and keep testing? Or do we cut back, and if so how? Gradually? All at once?
Click to expand...
So you are going to make the switch in two days? If you are going to do it that way, I would lean towards reducing back to 1u - maybe on the second day. If you do not go back to 1u then you would cut the dosing back by adhering to the no shoot [I would pick 200] guidelines and the no shoot options I spoke of yesterday that are also in the Checklist here:
3) Pick your “no-shoot” number. This is the Pre-Shot [“PS”] number at which you will not give insulin. For beginners this is usually between 200 and 150 [usually 200 or slightly below]. You can reduce this number as you gain experience. There are other options than just not shooting and you should be aware of your options which you can read about here.

If you do get to your no shoot it's always good to consult here if you can and you get lucky and someone responds in time. Remember you always have the option of just not shooting but the other options should be weighed too.
 
With the m/d we have left I’d prob make the switch in 4 days or so. I can taper longer if that would be safer.

Does halving his insulin put his body thru any undue stress? or should we taper it back as we taper up the lc food?

Does choosing the No-shoot option make you start all over again so to speak? I know his numbers jumped around a lot after we did that. (not sorry we did it tho for obvious reasons)

I’ll prob read any further answers tomorrow. We are all beat here since it’s near midnight.

“See” you all tomorrow ;)

Thanks as always, for all you guys do!

-d.
 
donnahc said:
With the m/d we have left I’d prob make the switch in 4 days or so. I can taper longer if that would be safer.
Click to expand...
My personal feeling is that 4 days should be acceptable. I think Dr. Pierson may have some recommendations on the switch in her page if you would like another opinion.

donnahc said:
Does halving his insulin put his body thru any undue stress? or should we taper it back as we taper up the lc food?
Click to expand...
His numbers may go higher. High numbers for a short time are acceptable but not ideal. But it is also ideal to avoid hypo situations and be safe. So generally safety over high numbers. Also reducing the insulin helps rebound situations from lower insulin needs and the dose remaining high. That said, if you are on the ball and can get some mid-cycle tests [especially of those +6] when you are doing the transition then you can get away with reducing the dose gradually to match the demand. It's really up to you and your level of commitment etc.

The one recommendation I have for you - especially if you drop the dose back to 1u - is to add water to the food. Dehydration can exacerbate ketones. And good hydration can help head off ketones. The food should be much softer but not soupy. I use a $0.99 ketchup/sauce bottle from Wal-Mart and put water in it. This makes dispensing the right amount of water in much easier.

donnahc said:
Does choosing the No-shoot option make you start all over again so to speak? I know his numbers jumped around a lot after we did that. (not sorry we did it tho for obvious reasons)
Click to expand...
How do you mean? Like really shooting 0 insulin? If so it is not so much starting over as their numbers will likely race off. It can take a couple cycles to bring them back down from that. If one of the other options makes sense they are preferred. PZI is a very flexible insulin and it is possible to make up any lost ground quickly because of this. There's really no "starting over" unless you switch insulins and even then you are not starting over with the diet and all the other optimizing in the routine you initiate. This is a learning process, so there really is no starting over unless you get amnesia. :smile:
 
Thanks Gator for all this fantastic info!

We started his switch to the new food this morning, 1/18.

I always did put some water in with my cats wet food so we are good on that. (I started that when one got a UTI a few years ago and they seem to be fine with it so I never changed that.)

I am checking ketones now once a week. Last week was neg.

We shot 2 units this morning, his AMPS was 370. We’ll do mid day testing to make sure no dives occur unchecked. I think we’ll try to gradually decrease the dose of insulin as needed...if we can. Obviously safety first, so if he makes a dive we’ll go back on dose as far as we need to. We’ll do 3x a day testing at the least thru this transition.

I’ll be checking in for all your expertise! Thank you everyone!

New thread later today :)

-donna
 
All this sounds like a great plan, Donna. Some kitties can switch right over to wet; some tummies need a longer transition. Oliver switched right over. The interesting thing for him was that we switched at night one night and the next morning, his blood glucose levels were 100 points lower than the night before. So, as Gator has suggested, a dose reduction was in order! We were switching from dry to wet, not just a lower carb wet, so we may have gotten a more dramatic change than you will see. And there is that Every Cat is Different thing......

Great idea to get some mid cycle tests in so you see what is going on. The more info you have on that spreadsheet, the more in control of this sugar dance you become!
 
Thanks Sue :)
I’m not so worried about the switch in food for Asher’s belly or if he’ll eat it, etc. He is a chow hound and I never saw him walk away from a wet food :)

But, if indeed the carbs being that much lower have an effect, I just thought it best not to slam him with a big change. Plus I have to work out in the real world on Thurs so trying to avoid any major problems for my partner Tom, the kitty daddy, to deal with here alone mid-day ;)

If we make this change, as I see it, there is only one more (big) variable and that is his teeth. He is due for a dental and needs to get rid of a bad tooth, but the vet and I agreed he needs to be regulated more before we schedule that. I hope we can do that sooner than later.

Bottom line he is a happy dude, he prances around here, plays with his brother, does all the normal kitty things.

We’ll keep you posted...

-donna
 
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