dosage confusion (AlphaTrak numbers)

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shadycat

shadycat

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Hi everyone, I have posted a few times on the main board, but thought this board might be helpful for insulin issues. I actually posted this question there also, but wasn't sure if this may be a better place for it (hopefully double posting isn't too frowned upon :)).

My cat Shady was diagnosed about 3 weeks ago. After doing some reading and looking at spreadsheets here, I am a little confused about insulin dosing. Initially my vet said wanted to administer a set amount (3 units PZI twice daily), then when I started home testing and Shady's BG was up and down a lot, she sent me a scale (under 200- no insulin, 200-300: 1 u; 300-400: 2u, over 400: 3u). After I did a 12 hour curve and Shady's BG seemed to be dropping a little, she said to still follow the scale up to 2 units, but not to give over 2 units (wouldn't have needed to anyway because it has been going down). I do tweak it a bit to include quarter and half units.

My confusion and question is, most of the spreadsheets I have looked at here seem to administer the same amount of insulin regardless of BG reading. I think I have seen some that still give a unit of insulin even when the cat tested at 100 or even below PS! I am still giving insulin based on the scale and was wondering if there is any reason that most here seem to not use that method. Which method is preferable and what are the differences in how in manages diabetes? Seems like shooting the same regardless of BG, on some days kitty would be a little high all day, and other days in danger of dropping too low. ??

Another question, Shady's glucose readings have been dropping (maybe due to diet changes?), and several times lately he has been under 200 so I haven't given him a shot. But then the next reading is usually higher (upper 200s-300ish). Tonight he tested 176, so I gave him a half unit to see if maybe tomorrow morning he might be a little lower. Do you all think this was appropriate? I was a little nervous shooting when he was under 200, just a half unit I figured would be ok. Do you think shooting a small amount when he is at 150-200 would keep him more on an even keel and better regulated? Spreadsheet is attached with am/pm PS readings.

Also, any general opinions on the SS are welcome. He seems to be steadily decreasing, which I feel like is a good sign, but then he still has the occasional 300 reading. I would love for it to somehow go into remission or be diet controlled but I know that isn't always possible.

Thanks!
 
Re: dosage confusion

Welcome! Glad you made it over here. I replied to you on Health. You might check out the spreadsheets of kitties here. Some use a sliding scale; some don't. Not that you can assume your kitty will react like theirs, but just good info.

Ours is a smaller friendly forum - not as big as Health, busiest in the am and pm. Come back often to see replies.
 
Re: dosage confusion

HI, glad you came over to PZI,
I responded in the thread you posted on Health, but look forward to seeing future threads here in pzi-ville.

Carl
 
Re: dosage confusion

Welcome, Shady and (What shall we call you?)

We are still fairly new here, too, but sometimes it's hard to remember before we met these great new friends! You have found a wonderful resource with SUPER people! Our little group is usually busiest first thing in the morning and later at night, but there are some of us who are home during the day or check in from work, so you can usually find someone around if you need something.

Our kitty, Hershey, is one who uses a sliding scale. The scale has undergone a lot of changes, but you're welcome to take a look at it to see what we've been trying for him. Today, we started a TID trial, so you might not want to look at the last couple of days to avoid further confusion. ;-)

Great to hear that Shady's BG has been dropping; I wish you much success in treating your sugar kitty!

Libby (and Hershey, too!)
 
Re: dosage confusion

Welcome!

The first thing that jumps out at me when reading your post, is the significant variance of the doses suggested by the vet. While many do use a sliding scale, to increase a whole unit on a higher BG is A LOT! Technically, if Shady is 280 he gets 1 unit and if he is 310 he gets 2 units---according to the Vet's scale-- That is A large increase on a range like that. The meter variance can be off that much. So, my thoughts are, a sliding scale is fine.....BUT, the scale the vet provided you is too wide. I am glad she revised it, but it still seems wide.

Also, you referenced people giving insulin if the cat is below 100. That might be true with different insulins, but NOT with Prozinc. Some of the other insulins build up a shed and they are dosed very differently than Prozinc, but with Prozinc you should not dose insulin under 100. In fact, "most" new users are encouraged not to shoot when BGs are less than 200. Some do dose Prozinc into BGs under 200, after months of gathering data and learning how "their" cat will respond. But, you 200 no shoot number is very reasonable. Though, your conservative approach to shoot half doses when Shady is between 150 and 200 probably is okay-- it just is a little aggressive early on. BUT, sometimes that aggressive approach will help your cat go into remission. Just always test and be prepared for low numbers. Be sure to read up on how to handle hypos in the event Shady goes low--- then if you get low numbers, you will know how to react.

Diet Change can have a BIG impact on BGs. I have a cat Chewy that was on dry food and is diabetic. When he first was dx his BGs were in the mid 300 range and I started him on 1 unit. I gradually increased to 1.5 units, but after a week I started decreasing his dose as his preshots got lower and I knew the food change was having a impact. After 4 or 5 weeks (can't remember!) he was OTJ--off insulin! He is now diet controlled and has not had any insulin for 6 weeks. His SS is attached in my signature if you would like to reference it. I am still checking him and his BGs are consistently in the 70s. He is still a diabetic and without low carb food, his BGs would rise again!

Shady is doing Great and it is obvious he is in very capable care with you! Good Luck and it is never "frowned upon" to double post in PZI...WE are VERY Relaxed in this forum!

I do hope you will revisit the sliding scale your vet provided!

Kim
 
Re: dosage confusion

Hi and Welcome to our group,

Wow nice numbers. The vets scale is too broad and given the fact that the food change has lowered the bg's I don't think that it is a good fit anymore.

You have had 3 blue PS's and he was without insulin for 24 hours before the .5u last night, is that correct?

It looks like the .5u did a good job last night. What was his AMPS today?

You can double post in Health any time you want to, sometimes PZI is a little quiet and if you need an immediate response Health is where you should go.

Welcome aboard.

Robin
 
Re: dosage confusion

Thanks, all!

Doug N Libby said:
Welcome, Shady and (What shall we call you?)...Our kitty, Hershey, is one who uses a sliding scale.
Click to expand...
Thanks! I'm Sheri, should've used Sheri and Shady as my username! I will check out your SS, thanks for the heads up.

kse said:
The first thing that jumps out at me when reading your post, is the significant variance of the doses suggested by the vet. While many do use a sliding scale, to increase a whole unit on a higher BG is A LOT! Technically, if Shady is 280 he gets 1 unit and if he is 310 he gets 2 units---according to the Vet's scale-- That is A large increase on a range like that. The meter variance can be off that much. So, my thoughts are, a sliding scale is fine.....BUT, the scale the vet provided you is too wide. I am glad she revised it, but it still seems wide.
Click to expand...
I do adjust to smaller increments than the vet's scale because I had the same thought as you... 299 gets 1 unit and 301 gets 2 just didn't make sense. I do approximately, 200-225: 1, 225-250: 1.25, 250-275: 1.5, 275-300: 1.75, etc. I also will give a little less if he ate less than usual.

kse said:
Also, you referenced people giving insulin if the cat is below 100. That might be true with different insulins, but NOT with Prozinc. Some of the other insulins build up a shed and they are dosed very differently than Prozinc, but with Prozinc you should not dose insulin under 100.
Click to expand...
Thanks for clarification on that, that is good to know, I had been pretty confused to see that.

kse said:
Diet Change can have a BIG impact on BGs....
Click to expand...
Yes, the first few days, Shady was still eating Hills TD and FF flavors with gravy. Since I switched TD to Wellness core, and FF gravy to FF Classics, his numbers have gone down quite a bit.

Rob & Harley (GA) said:
The vets scale is too broad and given the fact that the food change has lowered the bg's I don't think that it is a good fit anymore.
Click to expand...
What are your suggestions on dosing? Go lower overall and use smaller increments?

Rob & Harley (GA) said:
You have had 3 blue PS's and he was without insulin for 24 hours before the .5u last night, is that correct?
Click to expand...

No, he was at 308 and got 2u that morning. The last few days he had tended to be higher in the morning and low enough at night to not need a dose.

Rob & Harley (GA) said:
looks like the .5u did a good job last night. What was his AMPS today?
Click to expand...
Last night the lowest I saw him get was 87, which I know is ok but was low enough to make me nervous. Today AMPS was 188, and he didn't eat much breakfast and I couldn't come home at lunch to check on him, so I didn't continue the small dose on 150-200 trial, just to be safe. Tonight PMPS was 228 (gave him 1u), which I guess is good since he has only had .5u in the last 24 hrs, plus I think he ate more dry food today than usual.


Any thoughts on how to interpret these results so far or suggestions on tweaking his doses? Of course there isn't much data yet. Maybe go a little lower? Now I am second guessing giving him 1u tonight, when last night he was just 50 pts lower and .5u dropped him pretty low. :/ I am a bit of a worrier if I hadn't mentioned it. :)

Also wondering if it is worth getting him off the dry Wellness Core, if it might be enough to lower his BG enough to have the potential to go OTJ? (fingers crossed) He already had a big drop from switching from TD to Core, and FF gravy to Classics (assuming that's what caused the drop).
 
Re: dosage confusion

I just noticed that your sig says you are using an alphatrack meter?
That makes a difference! Is that still the case or have you switched to a human meter?

If you use an AT, can you put that in your subject line so everyone giving dose advice is more aware of it?

Carl
 
Re: dosage confusion

Hi Sheri,

Yes, I would try to get him completely off the dry, if you can. Every cat is different, but some react to any dry with higher numbers. And dry just isn't a great food for any cat. Have you seen this website by a vet? www.catinfo.org.

Can you get some day time midcycle numbers this weekend? That will give us a much clearer picture of what is happening and how the dose is really working. He was going into the blues at night. If he is doing the same during the day, maybe he is bouncing a little.
 
Thanks again. I am still using the AlphaTrak, but once I finish this box of strips I may switch. But, yes, these are all AT numbers. Was the 87 Shady hit still ok? I kept reading 40 is the cutoff for hypo, but is that on human or animal meters?

This weekend's project will be to eliminate the dry food and do some mid cycle testing. I have looked at the catinfo site, but there is so much there, I haven't read all of it. I just saw the Core as a transition between Hills and now hopefully go to all canned. I wish I could find some good low carb treats for post testing treats. Got some freeze dried salmon (not sure of the brand) and neither of my cats would touch it.

Sheri
 
I replied on your Health thread also. Carl is probably a good one to research why the numbers would be different. He loves that stuff. :-D

We tend to err on the side of caution so operate on the idea that the number is 30 lower on your meter. So your 87 could have been 57. The usual way to deal with low numbers is to watch any number 50 and below, particularly if it is coming early in the cycle, because it might drop lower. So a 50 at +3 is more worrying than a 50 at +6. If it is 40 - 50, we generally say feed regular food and retest in 15-20 minutes. We want to see if the food will make the number rise into safer territory and often that works. If it doesn't rise, and the number is dropping, then we say to feed higher carb food (good to have some gravy cans in your pantry marked as high carb just in case) or put some Karo syrup on his gums. The goal is to keep him above 40 until the insulin starts wearing off and his body starts to rise naturally.

If he ever gets into lower numbers and there is no one around in PZI, go to Health. Put a 911 on your post to attract eyes. It is nice to have someone with you to help you go through the process, as it is easy to forget what to do when you are worried.

Our hope is to keep good track of his numbers and monitor him so he won't go into low numbers. That's what all these darn tests are about. Few cats hypo and the vast majority of those do fine with food/syrup intervention. Our goal is not to have him there at all, but they do like to throw curves.
 
Re the treats - do they like chicken or tuna? You can offer a small chunk of tuna (packed in water not oil) or a piece of baked chicken (no spices) cut into small pieces. Lots of people bake the chicken, cut it up and freeze it in a baggie. Then bring it out to thaw for a minute and use for the tests.
 
I love numbers!

OK, the technical line for "hypoglycemia" is 50 on a human meter. But we all get caught up in that word "hypo". Hypoglycemia, literally, is "blood glucose below the normal range".
The ranges I have seen are these:
On a human meter, normal is 50-120
On a pet specific meter like the AT or the IPet, normal is 80-150.
The difference is that pet meters are calibrated to read dog and cat blood, so they are actually the "accurate" ones. But like you said in the Health thread, it really shouldn't matter. Blood is blood, numbers are numbers. The important thing to understand is that as long as you are aware of what "normal" is on YOUR meter, then you know when Shady is above or below normal.

There is a big difference between hypoglycemia, and showing clinical signs of hypoglycemia. Probably every cat treated with insulin goes hypoglycemic, and probably a lot more often than we think or "see" when we happen to catch the number on our meters. I only saw sub-50 numbers twice in 10 weeks of testing. I am 100% positive that Bob was lower than 50 a lot more than twice, but I never observed any "clinical signs" that he was in trouble. They may have happened and I was either working or sleeping which was what I was usually doing when he was nadir-ing.


So, if you see anything below an 80 on the AT, that is when you really pay attention and look for any signs that Shady is in trouble. Sue has already outlined the "what to do" steps, and why it matters when in the cycle you see the low numbers. At nadir, not that huge a deal as long as it doesn't keep dropping. Early in the cycle? Much more of a concern, because logic says that if you don't intervene, the number will most likely continue to drop. The key is not to panic and not to overreact. As long as you have a hypo kit handy, and you've read "how to deal with low numbers", you should be okay. You want the numbers to come up, but not too far and not too fast.

I have seen very few "real" hypos happen in the past year. There have been some kitties who have not survived. But those cases were not cases in which the lows were detected early. They were cases where usually someone came home to a crisis that was already underway. I haven't seen any cases (and there may have been a couple that I didn't see of course) where somebody had a cat that didn't respond to karo or gravy. There have been a couple of "stay up all night with the bean" hypo watches that I have done, but they all turned out fine. The important thing is to be prepared, have your hypo kit handy, have plenty of test strips, have the ER/Vet phone numbers where you can get to them without taking your attention away from kitty. And always hop online and post a 911 (In health if all else fails and it's the middle of the night). If you don't get immediate help when you post a 911, go to the main index page, look at the bottom, and see "who is online". Click on it. It tells you which forum everyone is currently on. Go to that forum, or click on a name and send them a PM. I have only been on the board one time in a year when I looked down there and found that I was the ONLY person here. There's ALWAYS somebody on the board that can help in an emergency.

This PSA was brought to you by the numbers geek!
Carl
 
Hey, Sherri -

Re: treats - We read one of Dr. Lisa's notes about avoiding fish, so we went with freeze dried chicken and turkey. We tried the beef liver (just as a change of pace for occasional use) but it didn't agree with his tummy. We buy the ones from PetSmart http://www.petsmart.com/product/index.jsp?productId=12243347. I read a couple of people's posts that they used the freeze dried dog treats (also 0% carbs) and cut them in smaller pieces.

If you peek at Hershey's SS, you'll see he's pulled low numbers on me several times (including a (31) at shot time once) and we enjoyed some all-nighters. We have only used Karo syrup once and that was early on. We have used higher carb food a few times, decreasing the amount each time as I became more familiar with how his BG would react. He never exhibited any symptoms and without testing I wouldn't have had an early warning. YAY! for home testing!

Libby (and Hershey, too!)
 
If you peek at Hershey's SS, you'll see he's pulled low numbers on me several times (including a (31) at shot time once) and we enjoyed some all-nighters.
Click to expand...

lol, looking back, I would have to say that I have enjoyed the "all nighters", at least from where I was sitting. I was the one saying "yeah, this is okay, everything is going to be alright" which is the easy part. I wasn't sitting on the floor turning kitty into a pin cushion every 15 minutes while juggling a bottle of karo and a teaspoon of gravy while poking his ears and trying to type (with my toes, I'm assuming?) :lol:
 
Thanks for the replies and explanations, I love numbers too! Can't say I would enjoy those all nighters, I was freaked out enough by 87, if it was in the 30s I would be a nervous wreck!

Sue, Shady is kinda iffy on canned tuna and chicken. Oddly, what he really likes is the water that drains out of canned chicken and tuna, so that is a possible treat too. Then I can make tuna salad or chicken salad for myself. ha. Baked chicken or fish he likes better, so I may try that, and will check out the freeze dried treats, Libby.

Is milk or cream ok as an occasional treat for diabetics? Shady doesn't have digestive issues with it, I just give him a couple tablespoons anyway, but I know milk has sugars in it.
 
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