Can't understand why Nermal's numbers are still high

Laura bb

Laura bb

Member Since 2018
So I have done what my vet recommended and started giving him 2 units. I know everyone here advised only going up by .25, but I did what my vet advised because I am worried about him getting ketoasidosis. I read about the depot, I still have a little trouble understanding. I appreciate everyone on here-not looking for dose advise rather then understanding why his numbers are still high. Should I do another curve?
 
I could be wrong (I am super new), but I have heard that too much insulin can appear to be not enough. I hope you get the advice you are looking for in regards to your furry friend.
 
Now that you are 5 cycles in at 2u, you need to hold the dose for a week unless Nermal earns a reduction.

Are you able to get more mid cycle tests? With Lantus it is very important to know how low they go.

Also, not to rush you but have read the TR and SLGS stickies? You will need to decide on what protocol/method you would like to use. It will help guide on reduction and dose increases.
 
Hi there :cool:

How did you discover Nermal was diabetic?
You mentioned you are worried about him getting ketoacidosis - is there a recent history of DKA?

Laura bb said:
I appreciate everyone on here-not looking for dose advise rather then understanding why his numbers are still high. Should I do another curve
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There are a lot of moving parts that all can influence BG.
I see in your signature block that you ditched the dry and he is eating all wet low carb - excellent!
I agree with Tracey about holding this dose. Turn your focus to learning about what goes on in between shots. That's where you will find clues to the answer to your question.

Getting mid cycle tests is important not only for safety sake, but also for increasing your understanding of FD and how your kitty reacts to Lantus.
Do read up on onset, nadir and duration
And ask questions.

Get in as many tests as you can both AM and PM cycles and before you know it the true picture of whats going on in between shots will emerge.

Also read up on the 2 methods used here -Tight Regulation and SLGS
and do get on board with one or the other. You will be glad you did.:cool:
 
Tracey&Jones said:
Now that you are 5 cycles in at 2u, you need to hold the dose for a week unless Nermal earns a reduction.

Are you able to get more mid cycle tests? With Lantus it is very important to know how low they go.

Also, not to rush you but have read the TR and SLGS stickies? You will need to decide on what protocol/method you would like to use. It will help guide on reduction and dose increases.
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Yea I was hoping to get in tests tomorrow. My vet did not say he had it-she just warned me if he didn't get insulin, he can get it. He was diagnosed with a blood test-which was 527, and then she had me bring in a urine sample. I just worry about him. My other cat Wednesday I can tell worries about him. I will get more readings tomorrow, just trying to figure out good times to test him, I did testing every 2 hours on 1 unit before doing the 2 units my vet wanted him on. It seems high every time.
 
How low can nadir go from a high number? I feel so nerve racked everyday. I thought this would get easier by now.
 
There is no history but he was thin when I brought him in, but was very alert and still going up and down our stairs. He has only gained 6 ounces since starting insulin and he is still thirsty all the time, and his numbers are still reading high.
 
Laura bb said:
How low can nadir go from a high number?
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The nadir is the lowest point in each cycle....no matter how high they start and no matter at what point the lowest point is.

Example....your AMPS is 394 and at +4 it's 292 and at +7 it's 190 …..at PMPS it's 320....the "nadir" for the AM cycle would be 190 …..On the PM cycle you're at 320 to start and at +3 he's at 210, at +5 he's at 132, at +8 he's at 189....the "nadir" would be 132

Usually it's around +6 (which is why we keep wanting you to get a mid-cycle test) but it can vary from anywhere from +3 to +9

I know we keep harping on testing, but it really is the only way to really know what's going on inside Nermal's body (I still absolutely love that name!!)

If you can manage to get a test somewhere mid-cycle on the AM cycle (like between about +4 and +7) it will be very helpful.

If you can't due to work restrictions (having to earn a living really sucks sometimes!) it's even more important for you to get a couple of tests on the PM cycle, like a +2 and a "before bed" test

If you do work and can't get mid-cycles during the AM cycle, then on days off you'll want to run a curve....that's testing every 2 hours for 12 hours or every 3 hours for 18 hours
 
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Chris & China said:
The nadir is the lowest point in each cycle....no matter how high they start and no matter at what point the lowest point is.

Example....your AMPS is 394 and at +4 it's 292 and at +7 it's 190 …..at PMPS it's 320....the "nadir" for the AM cycle would be 190 …..On the PM cycle you're at 320 to start and at +3 he's at 210, at +5 he's at 132, at +8 he's at 189....the "nadir" would be 132

Usually it's around +6 (which is why we keep wanting you to get a mid-cycle test) but it can vary from anywhere from +3 to +9

I know we keep harping on testing, but it really is the only way to really know what's going on inside Nermal's body (I still absolutely love that name!!)

If you can manage to get a test somewhere mid-cycle on the AM cycle (like between about +4 and +7) it will be very helpful.

If you can't due to work restrictions (having to earn a living really sucks sometimes!) it's even more important for you to get a couple of tests on the PM cycle, like a +2 and a "before bed" test

If you do work and can't get mid-cycles during the AM cycle, then on days off you'll want to run a curve....that's testing every 2 hours for 12 hours or every 3 hours for 18 hours
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Thank you, I guess I was having trouble understanding the nadir, because when I tested him every 2 hours the other day-his lowest number was at +2. I bought a horrible meter ReliOn Prime because I couldn't find strips I needed for that night for my ReliOn Comfirm, I had to repoke him this morning because there was not enough blood-then when I finally got it it would say error. I finally got it. I called Wal-Mart pharmacy, they have some for my ReliOn Comfirm-so got to go get this today. Will order the ones that fit online too, just had to come up with a solution to get his readings. I really liked that Comfirm so much better. I think the thing that was driving me nuts about the nadir is his numbers didn't make sense, since his numbers are not really going down at all, and his lowest number was at +2.
 
I think I am over analyzing things because my other kitty (Wednesday) keeps sitting close to him, I think I am just going crazy worrying about him. Going to test him at 3 hours today, and then +7-- I think, just to make sure he is safe until I can get new strips.
IMG_20181027_225217.jpg
 
Deep breaths! You have excellent advisors here on this forum - trust them. :)

One thing that newcomers struggle with is the idea that getting a kitty in better numbers is truly "a marathon and not a sprint". It won't happen in a few days or even weeks. It's even harder when you don't know whether a dose is effective or not. That's where the testing comes in. It's also important to know that the "good dose" is a moving target because it WILL change over time. A good dose can work well for quite a while (and you only know that from testing data) and then suddenly it won't and a tweak is needed. This tweaking happens a lot more often at the start when you're trying to nail down an approximate dosing range.

Many of us were led to believe by our vets that a few weeks and a couple of curves would give us the "right" dose and that would be the end of it - little or no testing needed. Unfortunately, that doesn't work very well. You're here and you're testing Nermal because you want to do what's best for him. Give yourself a big pat on the back for that. :bighug:
 
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Thank you, I think I haven't let Nermal sleep well too-from over worrying. I keep checking on him- or just staring at him. My other cat Wednesday has been keeping my 1 1/2 year old kitty(Keanu) away from playing with him(kind of like a guard for him). I think she must be able to sense his blood glucose high. She lets Keanu lick his head-but no play, kind of like a momma cat. Keanu also hissed at him after the vet(they are sweet on each other now) so maybe that is why she is so protective, she watches over Nermal like I have never seen before.
 
Kris & Teasel said:
Deep breaths! You have excellent advisors here on this forum - trust them.
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Yes, deep breaths and trust the experienced people here. I can totally relate to your anxiety and worry, and am new enough to feel as you do. Everyone here was once in your shoes, but the experienced members gave excellent guidance to them, and now to us.

Two of my Vets advised me to shoot blindly and not to test much. I quickly saw that the Vet had no clue what they were advising. One Vet had me put Tiny on a high carb kibble for a "balanced diet" - her numbers shot right up.

Both myself and Tiny would be a mess without the guardian angels here. I know having a diabetic cat is unnerving but you are here...the best place you can be...and it was not by accident.

All will be ok, just keep learning and asking questions.
 
Chris & China said:
(I still absolutely love that name!!)
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Me too!
Hang in there with being bombarded with so much information. I felt overwhelmed for what seemed an eternity and then all of a sudden, just like Nelli took a turn towards regulation… Everything fell into place for me.
Hang in there it does all start falling into place :-)! Including that little cutie of yours :cat:
 
Krystina & Nelli said:
Me too!
Hang in there with being bombarded with so much information. I felt overwhelmed for what seemed an eternity and then all of a sudden, just like Nelli took a turn towards regulation… Everything fell into place for me.
Hang in there it does all start falling into place :)! Including that little cutie of yours :cat:
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I looked at your spreadsheet, I guess I just get a little panicky because I have been looking at others spreadsheet to see when they test(to get an idea of when to test), but then I see other kitties in blues and greens, and not many black and reds- I started thinking why are Nermal's in between numbers not going down. I think I do want to rush it, but I will be patient. Other then what his numbers show me, pysically he looks better. He has gained 6 oz, he is grooming himself more, he is standing taller. He was starting to before he got diagnosed be just a little bit more sluggish. Before he got diagnosed I was prepared for the worst for what the vet was going to tell me. I have never had a diabetic cat before. When my vet says he could still have a good life being a diabetic-I just started being on a different path. I keep thinking in my head before he became diabetic I had a horrible vet several years ago, he told me his weight was fine and the food I was giving him was good for him because it was indoor formula(Purina Indoor Formula). My vet that I have now told me to switch to fancy feast, and that lantus was the way to go. She has several cats that live there(including a diabetic cat), this is a cats only vet, she says she sees hundreds of diabetic cats. I suspect the cats that live at the vet(they walk around freely) were taken in from people that wanted to either put down their cat or did not want to take care of them. She really has shown me she cares about Nermal because she gave me her personal cell phone number. She told me it could take a while, but to call her if at anytime his numbers go below 200-so she can know his progress, and maybe readjust his dosage. She said if he is below 200 at all don't give insulin and to call her.
 
The experienced people here know more than our Vets. I'm not sure if you are aware, the guidance given here has helped MANY cats go I to remission. We are conditioned to take the word of people with a degree as God's word. I'm asking you to really take a deep breath and ask questions and trust the guidance here.

The Vet who had me put Tiny back on kibble also gave me her cell number so she could be accessible to me and told me not to test. If you look at Tiny's spreadsheet and look at Sept to Oct, you are going to see HUGE progress.

I'm still new here and still learning from these kind, generous-of-time, caring, experienced members. I don't know how they make themselves so accessible to us, but I couldn't be more grateful.

It is scary to let go and trust someone other than a Vet, but Tiny and I have learned, and she is on her way to remission...I can feel it!

PS: I'm not trying to talk you into anything except feeling comfortable. When you are ready, or feel more comfortable, let go and trust, but not until then.

XOXO
 
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You're at a point where choosing between TR vs SLGS may be helpful. With TR, you evaluate whether the dose is working every 3 days/6 cycles. You wait a week with SLGS. In addition, by using a dosing strategy, you don't end up leaving your cat at a dose that's not working for an overly long period. If Nermal sits at a dose that's not having the desired effect on BG numbers, you risk glucose toxicity developing. The term sounds worse than it is -- it means that your cat's body starts treating the high numbers as the new "normal" which makes it harder to get numbers to come down. Thus, it's important to get some spot checks since Lantus dosing is based on the nadir and not the pre-shot numbers and to evaluate the dose regularly based on which dosing strategy you opt for.

A word about nadirs... They can and do change. Also, not all cat's have their nadir around the middle of the cycle. Some cats typically nadir either early or late. If you look at Gabby's spreadsheet (there's 6.5 years of data and I tested a lot so don't get overwhelmed), you'll see she had an early nadir -- usually at around +2 or +3, except for those cycles when it wasn't typical. The point that several people have made is that the goal at this point in Nermal's sugar dance is for you to learn what's normal for YOUR cat.

 
Joanne&TinySole said:
The experienced people here know more than our Vets. I'm not sure if you are aware, the guidance given here has helped MANY cats go I to remission. We are conditioned to take the word of people with a degree as God's word. I'm asking you to really take a deep breath and ask questions and trust the guidance here.
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IMHO...
I think it is most important, to get the best of best in the kitty’s diabetic care that either/or L & L (Lantus & Levemir) FD forum or the Primary Care Vet advice is focused upon by you completely.
Again, just IMHO :). Choosing either way, I believe you will get the most complete attention and guidance-
Your decision entirely, of course :bighug:
 
Joanne&TinySole said:
The experienced people here know more than our Vets. I'm not sure if you are aware, the guidance given here has helped MANY cats go I to remission. We are conditioned to take the word of people with a degree as God's word. I'm asking you to really take a deep breath and ask questions and trust the guidance here.

The Vet who had me put Tiny back on kibble also gave me her cell number so she could be accessible to me and told me not to test. If you look at Tiny's spreadsheet and look at Sept to Oct, you are going to see HUGE progress.

I'm still new here and still learning from these kind, generous-of-time, caring, experienced members. I don't know how they make themselves so accessible to us, but I couldn't be more grateful.

It is scary to let go and trust someone other than a Vet, but Tiny and I have learned, and she is on her way to remission...I can feel it!

PS: I'm not trying to talk you into anything except feeling comfortable. When you are ready, or feel more comfortable, let go and trust, but not until then.

XOXO
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Well said.
 
Just got strips for ReliOn comfirm-much better then prime. Just tested him way better, barely needed as much blood-better for Nermal. I hate that prime it kept saying errors or never enough blood. It said 315 at +6 easily(at least hes out of 400s)with thr Comfim. Now that I am not torturing him as much trying to get a reading I will test more and more again now. I do not recommend ReliOn Prime to anybody. I am wondering also if my frustration trying to get more blood from his ears rose his blood glucose a little bit-only one little poke just now. And thanks to a Janet(not sure how to tag) on here he loves the way just a little neosporin (clear kind)feels on his ear! Less anxiety today is good!
 
Laura bb said:
... but then I see other kitties in blues and greens, and not many black and reds- I started thinking why are Nermal's in between numbers not going down. I think I do want to rush it, but I will be patient...
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I forgot who told me early on when Bronx was forever in blacks and reds, but it stuck with me..."every cat has a # that will work". I followed TR and did get there. Took a while and much patience, but it did happen. It will happen for Nermal too :bighug:
 
Hi Laura,

I think you and I are in a similar situation in terms of our emotional level. If you take a look at my last thread from yesterday and my spreadsheet... well, you’ll see why I’m such a wreck haha!

We will get there. We will have to remind ourselves time and time again. I, too, look at my cat and maybe I’m overthinking, maybe I’m not, but I’ve got those dark moments where I think I’m doing everything wrong and have an itch to just do SOMETHING to make it better. But patience! I need that and I think with patience, I’ll get there and you will too.

It’s nice too here. If you need to vent or just blab all your worries, everyone is very understanding and very helpful.

It’s okay if you’re feeling worried or insane. Like everyone has said, you’re in the right place :)
 
I remember just being so upset to the point of tears! I am a worrier & a nervous nellie. It doesn’t take much to send me over the edge... It was a struggle to get Baby to hold still & finally get the routine down. After a couple months, I put her on her blankie on the table & she just laid down! Ready to be tested & insulin. I was so happy & beyond belief. She still doesn’t like it but has the routine down pat & knows she gets fed immediately after; along with a few crunchies. (Dr Elseys clean protein) I never thought her or I would get to this point, but we did! My vet knows that I have Baby’s diabetes covered & just lets me be. She isn’t threatened by a person that knows some info that she doesn’t. I have found a wonderful vet that I adore! If it wasn’t for this forum, I’m sure that Baby wouldn’t still be here. I read every stickie & piece of info on this forum & asked plenty of questions. I am forever indebted to all these knowledgeable & kind members! Good luck & just know that it will become routine... as Kris says it is a marathon not a sprint. It just takes time & learning how your kit will react to the dosage. :bighug:
 
This website has really helped me. It has gotten just a little bit easier. I must have watched 30 videos of people giving cats insulin when I found out. Then after that a whole bunch of people pricking ears. Those were the two hardest things. However now I am trying to focus on routine,timing, food, water intake,Nermal's blood glucose numbers, and insulin amount. I got overwhelmed a bit. It helps knowing others are going through the same thing I am. It is a big change.
 
Each cat is different. I've been here 9 months & Ravan is finally starting to get better #'s. Some people get results much quicker & some kitties go into remission.
It takes time ! Patience is a Key word here. It's good to read other posts & look at the spread sheets.In time you will learn more & begin to relax.The more you read the
info here ,the more you learn about diabetes, the easier it will get.
It can be confusing when your vet says one thing & you hear different advice here. It took me a while to understand that the people here really do know more than most vets. They have been dealing with Diabetes for years.
You might want to print out some of the info in the Yellow sticky notes & keep it close where you can refer to it. Some of the slang they use here still has me referring to the sheet :D

I do Yoga, we do Yoga breathing. Breath in slowly thru your nose & slowly out thru your nose. Do it several times.It does work to help calm down when you feel anxious.
The calmer you are the better for your kitties. They pick up on it when you're stressed out.

Everyone here wants to help. You are not alone with this :) It will get easier :bighug: Ask questions. Someone will have the answer.
 
JoyBee&Ravan said:
Each cat is different. I've been here 9 months & Ravan is finally starting to get better #'s. Some people get results much quicker & some kitties go into remission.
It takes time ! Patience is a Key word here. It's good to read other posts & look at the spread sheets.In time you will learn more & begin to relax.The more you read the
info here ,the more you learn about diabetes, the easier it will get.
It can be confusing when your vet says one thing & you hear different advice here. It took me a while to understand that the people here really do know more than most vets. They have been dealing with Diabetes for years.
You might want to print out some of the info in the Yellow sticky notes & keep it close where you can refer to it. Some of the slang they use here still has me referring to the sheet :D

I do Yoga, we do Yoga breathing. Breath in slowly thru your nose & slowly out thru your nose. Do it several times.It does work to help calm down when you feel anxious.
The calmer you are the better for your kitties. They pick up on it when you're stressed out.

Everyone here wants to help. You are not alone with this :) It will get easier :bighug: Ask questions. Someone will have the answer.
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Thank you so much. I think I am finally getting to a point to test more. I think my behavior needs to change towards him. A few months back I gave myself a good cut on my hand from cutting an avocado(avocado hand). Nermal, Keanu, and Wednesday saw me freak out started following me as I flipped out from a bad cut(got 2 stiches in ER).If I cry Nermal is right there to comfort me. Breathing is good, I think I forget to breath sometimes. I tend to freak out a little bit-I need to stay calm for anything that comes my way, everyone in my family is shocked I am giving him insulin-because I don't handle medical stuff so well. But I am doing it. I may not like doing it-but if I have to do this the rest of his life to keep him alive-I will!
 
Laura bb said:
I don't handle medical stuff so well. But I am doing it. I may not like doing it-but if I have to do this
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Excellent! You are going to be just fine! You LOVE your kitties & are willing to do what's needed to help them. Brings tears to my eyes to hear you say that. Not everyone is that willing to do what's needed.
It's wonderful your kitties have you as their mom! :joyful: :bighug::bighug::bighug:
Keep up the good work, I'll check back soon :)

P.S. Remember to Breathe :D
 
I think he is starting to do better. I haven't picked up food in the morning before preshot yet. I do in the evening though. I used to wake up at 4:00 AM every morning(I give his shot at 6:30) but now I wake up at 6 AM. I think his numbers are slowly starting to come down, letting him sleep today without too many pokes from me-I think he needs sleep, me too! Plan on doing another small curve in the next few days to see what is going. In the meantimr I will still do random spot checks due to advise I receive here.
 
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