Clarification on tight protocol and reducing (newbie)

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Anna K

Member Since 2014
Hi!

I have spent a lot of time reading over the PDF from the University of Queensland, as well as Tilly's and also the advice from BJM.

On the "Phase 4 -- Reduction" section, both sources say "When the cat regularly has its lowest BG in the normal range of a healthy cat and stays under 100 overall (130 for Alpha Trak) for at least a week, attempt to reduce the dose."

My questions are:

1. What is the "normal range for a healthy cat"? I think this is 50 - 130 (80 -160 Alpha Trak), correct?

2. I think they meant to write "And *the lowest reading of the day* stays under 100 overall (130 for Alpha Trak) Correct? This is what my vet says.

Or if I read it again I think it means the lowest number should under 130 each day, and the highest number doesn't matter so much?

Thank you for the clarification! Bruno's numbers are mostly in the normal range and I don't want him to go Hypo. We had a scare two days ago, and he does not eat much in general (due to small cell lymphoma). On the other hand, I don't want to reduce too quickly. Today is only my third day of testing. Previous to that, he had a week of 1 unit twice a day and no home testing.

If you look at his spreadsheet remember he is on Alpha Trak so it's 30 higher than for the rest of you.

Thanks,
Anna
 
Welcome to LL, Anna and Bruno! :-D

We consider normal on a human meter to be 50-120 and 80-150 on an AT.

No, it's not the lowest reading of the day in your second question :-D it means they stay under 100 (human meter) for a week. So you would only see green on the SS before you reduce.

Two things I notice on Bruno's SS:
--you are skipping around on the dose a little too much. You were right to reduce to 0.75u but then you should hold that dose until he goes below 80, spends most of the time under 130 for a week, or needs an increase. Since you don't have much data, you should post here for help any time you get a preshot you haven't shot before. We can work with you to stall until the BG comes up.

--you are missing critical data by not getting any nighttime data. Cats often go lower at night so we encourage you to always get a before bed test at night; if you are up by +10 or +11, I'd grab one of those, too, before his AMPS.

Please let me know if you have any questions.
 
Thank you! Yes part of my problem is that it is so hard to read the needle. The .5 was partly in response to the low insulin scare the day before. But the fact is that it's hard for me to tell the difference between .5 and .75, it's always somewhere in between those two I think.

I will try to get a night time reading. Thank you so much.

So we want to keep him in the green numbers, so under 130 but above 80 all the time. Wow, I hope I can do that! I am just scared of it going too low!

Anna
 
Oh, I'm so glad you wrote that. I just checked at +3 and he is down to 85 alpha trak. I need to check again in the middle of the night. Good thing he's eating a huge snack right now!

Thanks!
Anna
 
Hi Anna!

I'm just headed for bed but wanted to post the directions for you on how to handle Bruno's low numbers. I'm so glad you tested just now and caught him. There aren't any other members on right now, but people do pop on during the night regularly, so if you get in a panic, hit a 911 and hopefully someone will see it. If you do, post also on the Main Health - between the 2 boards often someone is on.

Marje gave you good advice on dosing - lantus likes consistency, so perhaps reading glasses would help you figure out where the plunger line is in relation to the syringe line. you can keep a sample syringe to compare to - use colored water (tea, coffee) so you can see it. you've got a tiny dose!

See you tomorrow! julie

DON'T PANIC! or HOW TO HANDLE LOW NUMBERS

First, try to not panic. Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
(If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

~ written by Sienne and Gabby
Click to expand...
 
Where's the big LIKE button? :)

There's an art to this. It's overwhelming when you're new to it.

To read the needle. To get the bubble out. To do a subcutaneous shot and not a fur shot. To prick the ear hard enough but not too hard. I know you develop a feel for it. But right now it is very tricky, dealing with all these tiny nuances. I have good eyesight, it's just that I'm not used to this. I know I will get a feel for .5 vs .75 as I do this more.

The good news is my vet is very optimistic that Bruno can go into remission. He has not been diabetic very long, less than 3 months.
 
Hi, Anna and welcome!

You've gotten some great suggestions. One suggestion I'm surprised that Marje didn't make is that you might want to get a digital caliper to help measure the doses consistently. Not only are the doses between the lines on the syringes challenging to read, the syringes themselves can be a bit "off." If you go the caliper route, Marje has a written set of instructions for using them.

As for low numbers, we make a differentiation between a symptomatic hypoglycemic episode and low numbers. The information that Julie quoted gives you some of the physical symptoms of hypoglycemia. It's rare that we hear about a cat that is experiencing hypoglycemic symptoms. However, our cats have dropped into low numbers. As long as you are paying attention to where numbers are heading, you are in control of the numbers because you are testing and using food to steer the numbers. If you've been at this for any length of time, you'll know that our kitties can surprise us with a lower than expected (or desirable) number. That doesn't mean that they are hypoglycemic. It does mean you need to intervene. It's why we encourage everyone to have high carb food and some form of syrup (Karo/corn syrup, honey, maple syrup, etc.) on hand.
 
Background on Anne/Bruno http://www.felinediabetes.com/FDMB/viewtopic.php?t=115525

Hi Anna!! Bruno's looking pretty good so far!

Remember a few things we talked about. If you'll put that you're using the AlphaTrak on your spreadsheet, that'll help to let people know too (you already have it in your signature, so if you add it directly above the "Remarks" area in that big white space, you can also then go to the little icon that looks like a can of paint tipping over and choose a background color to make it "stand out")

Have you gotten the half unit marked syringes yet? If you have, it's not so important that you're giving exactly .75 as long as where you think .75 is remains consistent. A lot of people use an old syringe and decide where .75 is, and fill it with colored liquid of some kind, like coffee, tea, Kool-aid or just water with food coloring in it. You can then check each shot against your "model" syringe. If it's helpful, the bottom picture here shows what .75 looks like Fine Dosing

As we've said, it is important to keep the same dose every shot unless Bruno "earns" a reduction. That's how you work towards going OTJ! You want him to "earn" those reductions until he's not getting any insulin at all and staying in those normal numbers!

While getting those numbers close to 80 can be very scary, especially when you first start seeing them, they're actually very good. The pancreas in our cats can heal sometimes, and the more time they spend in those "pancreas healing" numbers, the better! When they get down close to that "breaking point" of 80, just stay calm, maybe give a teaspoon of their regular low carb food and keep testing! You're in total control as long as your home testing! The first time China dropped to 22 I really freaked out, but she didn't have a single symptom of being too low other than being very hungry. Our cats are just like us...when a diabetic's blood glucose goes too low, they usually go looking for a candy bar and a Coke! Our kitties almost always start driving you crazy for food if there isn't any down. Unusual hunger at unusual times is a good tip off to grab a test!

I've had to get used to the fact that China seems to like riding right on the line...she'll spend hours and hours in high 40's and low 50's (your high 70's-80's) but because I have almost a year of testing, and I know her well, when she does drop to those numbers, she just gets a teaspoon of her regular food and retested. If Bruno happens to need to be on insulin long enough, you'll learn those kinds of things about him too...as well as how to best get him up a little, without sending him through the roof by over-feeding. It just takes time and testing.

You really are doing great for being so new to this dance. Take some pride in the fact that you're successfully testing, he's doing well, and that you CAN do this!
 
Sorry, I did put Alpha Trak in the title of my spreadsheet. I didn't know it should be in the Remarks. I'll fix that. Thank you.

I do have the half unit syringes now, and that helps a lot. I also ordered a magnifier from Amazon.

I understand about the consistency, got it!

Thanks for all the info! I understand he will earn a reduction if his numbers stay all green for a week. But if they are green and blue, like now, just keep him on the same dose. But if he ever goes under 80, then immediate reduction (And stay there? Or just reduce the following dose?)

Thank you for China's story. And for your kind words. I am really hopeful to get him into remission. Then we'll only have the lymphoma to worry about, LOL.

THANK YOU Chris !! :)
 
If Bruno goes below 80, it's a reduction of .25 and you hold that same dose for at least 6 cycles (unless he drops below 80 again)

If it's really soon after you just reduced, you'll want to ask for advice, because we don't usually like to do reductions really close together. They fail more often than not.

The other way to "earn" reductions is to stay in normal numbers for a week. Using the Alpha, that means if he stays between 80-150 for a whole week, you reduce by .25 and start a new week. If he continues to stay in normal numbers, you reduce again....with the idea being that eventually, you'll reduce all the way down to OTJ!

Glad to hear you got the half unit syringes. They will make it easier, as will the magnifier! I'd love one, but my budget doesn't allow it, so I just eyeball it..but I have a little more experience figuring out where those half unit doses are at this point too! I did buy me some of those "Granny glasses" from WalMart though! Every little bit helps!

Keep up the great work!
 
OK, your last comment about 80 - 150 alpha trak for a whole week was really the answer I was looking for (see my original post at the top). The language in "Phase 4-- reduction" is not clear and I was not sure whether all his numbers needed to be under 150, or 130, or what. Your answer was different from Marje's answer above. So perhaps opinions vary on this. It really isn't clear in the literature, which says:

"Phase 4 -- Reduction" section, both sources say "When the cat regularly has its lowest BG in the normal range of a healthy cat and stays under 100 overall (130 for Alpha Trak) for at least a week, attempt to reduce the dose."

But I understand that either interpretation is probably fine. It does seem tricky to stay above 80 AND below 130.

PS I just ordered this: http://www.amazon.com/gp/product/B007WW ... UTF8&psc=1
Recommended by another user. It is not expensive! I will let you know how it works. :)
 
We PREFER to see all numbers below 130 (so for those of us using human meters, they'd all be green numbers) but the protocol allows for up to 120 for us (150 for you) on pre-shot tests

We wouldn't want to see those higher numbers mid-cycle at all.

We want a strong remission...Once they go OTJ, if they come back out, they're much harder to get back (if at all), so the lower the numbers are for those "weeks", the better

Make better sense now?
 
Typically, we are looking for under 100 on a human meter and under 130 on an AT. It's better to hold off on the reduction, when it is earned by staying in those numbers for a week, as long as you are able so when you do reduce the reduction sticks.

Sorry about not including the info on calipers :roll: It was my bedtime, too, and I just wanted to be sure someone responded since it was late. I'm glad Sienne gave you the link.
 
Thanks Marje! I see the link. Do you have a written set of instructions for using them? It's all mysterious to me :)
 
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