Dosing advice, please!

Status
Not open for further replies.
mariko

mariko

Member Since 2011
Hi everyone!
I haven't visited here for some time since she went in remission last year, but unfortunately we are back and hoping you could help us.
Lucy was first diagnosed in June 2011, put on Lantus, went in remission in Feburary 2012, and recently became diabetic again.
If you could please take a look at her spread sheet (I know I haven't tested regularly enough), her numbers vary but never too low.
We tested her fructosamine 3 times since last month, and 1st result was within the normal range and the 2nd and 3rd result was below normal.
This had made it difficult for the vet to decide whether to put her on insulin or not, and we still don't know why her fructosamine is low when her blood glucose does not seem to have gone too low.
This is what's been going on and how her does has changed.
April 15 - BG tested at the vet was 504 mg/dL (28 mmol/L), but the fructosamine was within the normal range. Started insulin 0.5 unit twice a day. Assumed fructosamine was normal because she hasn't been diabetic long enough.
April 27 - BG tested at the vet was 252 mg/dL (14 mmol/L). Fructosamine was below normal range, so we stopped insuline.
May 4 - I did some home testings since April 27 and her BG was high, so we put her back on insulin but only 0.5 unit once a day.
May 18 - BG high, but fructosamine was again below normal.
I did a curve last night, and besed on the result, the vet and I decided to start giving her 0.5 unit twice a day from tomorrow.

Does anyone have any idea or similar experience about high BG & low fructosamine?
Even her lowest number is not that low..... so I really hope that deciding to give her insulin twice a day rather than once a day is a good idea. But Why... Why her fructosamine is low????

Some additional information about my kitty.
Lucy is a 16 yr old cat, has some other health issues - IBD, chronic pancreatitis, gallbladder stones, early stage of kidney disease.
Her Spec fPL test value has been particularly high recently, over 50 both time tested on March 31 and May 18.

Any comment/advice will be very much appreciated!!
Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Guesses: She may be an easy food spiker and/or the renal disease may be flushing the glucose out of her system fast enough the fructosamine doesn't get high.

Can you eyeball 0.25 units? Lowering to that may allow you to shoot more frequently and keep her more stable.

Remember that as you get data to show it is safe, you may gradually lower the no shot number to 150. If you follow the tight regulation protocol, there are some folks who shoot lower when they have data to show it is safe.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Yep, I also would like to know what the vet considers below normal etc. her blood glucose levels certainly are high enough to merit insulin currently but maybe she is bouncing up and down.. Did you start the 0.5 twice a day yet? I would like to see tests from then to see how low she is going..
 
Re: Blood Glucose HIGH but Fructosamine LOW

Lucy is getting 0.5 unit twice a day starting today, so I updated the SS.
I think her numbers are better and seem more stable. In fact her BG started getting better since last nigh even though she didn't have the morning shot yesterday. I am thinking her pancreatitis improved because her mood is also much better.

BJM - Thank you for your suggestion, but I have a question. If she is flushing the glucose out of her system too fast, wouldn't I get lower BG as well? Shouldn't BG and fructosamin results support each other?

Larry&Wendy: Thank you for your reply also.
The report from the lab that did the blood work indicates that normal range of fructosamin is between 191-349 umol/L = 11-20 mg/dL.
Lucy's values were: April 15 - 242 umol/L = 14 mg/dL
April 27 - 147 umol/L = 9 mg/dL
May 18 - 165 umol/L = 10 mg/dL
What do you think about these numbers?

My biggest question is, if the BG and fructosamin disagree, is it OK to go by BG as long as I test often?
I am going to check at least 5 hrs and 8 hrs after the evening shot as her BG seems to be the lowest at these times, and on weekends I am going to do a curve - something like every 2 hrs for 12 hrs.

Please let me know your opinion!
Thank you again - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Good idea on the testing. Do your syringes have 1/2unit markings in them? Reason i ask is that lantus is a depot insulin which means it builds up a bit in the cats system. Which makes me wonder if you are getting nice blues now, how low she will go in a day or two. Try and watch and see how low she goes, if she drops below 50, then I would reduce to 1/4unit instead.

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Yes, I use syringes with 1/2 unit markings.
I just tested her and she was 234 - yellow.... 3 hrs after shot. Is this because I let her steal the other cat's snack!?
I will test her again in 2 - 3 hrs, and one more time before the next shot.
And I will pay close attention to how low she will go in the next couple of days. Thank you for your advice!
Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

mariko said:
...BJM - Thank you for your suggestion, but I have a question. If she is flushing the glucose out of her system too fast, wouldn't I get lower BG as well? Shouldn't BG and fructosamin results support each other? My biggest question is, if the BG and fructosamin disagree, is it OK to go by BG as long as I test often? ...
Click to expand...

That was just a guess and it would depend on when you test. The spike possibility might make the most sense. After eating, the BG might go up high (about 2-3 hours after eating), then go down fairly fast, so overall, the average looks good, either because the kidneys flushed out the glucose, or the insulin allowed it to be used. Is she gaining or losing weight?

Visualize the profile of a mountain, right next to a valley, and draw a straight line across from start of the mountain to the far side of the valley. The line straight across (fructosamine) looks great, but in reality there was a big climb and then a slide down before returning to the next starting point. The trick is make sure the valley isn't too low (nadir), and the mountain is not too high (food spike). If you feed multiple small amounts, in may help keep that food spike from getting too high by matching the food intake to the insulin onset. Then you check your nadir to see how low it is going. You don't want it any lower than 50 mg/dL.

Note: a blood glucose is a point in time, while a fructosamine more closely reflects an average over time, wo they aren't measuring the same thing.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Another note: many cats go lower overnight, so if you were only to give 1 shot, morning might e a better time.

Lantus really works better if you do 2 shots, of the same amount, every 12 hours. You were giving 0.5 just in the evening. Switching to 0.25 morning and evening might work better.

With that low amps of 124 mg/dL, do you have your hypo kit ready? Please check around +2 to +3 hours after the shot to see how low he is going. You may need to support him with some higher carb food, if not today, then within about 3 days of twice daily dosing.
 
Re: Blood Glucose HIGH but Fructosamine LOW

My biggest question is, if the BG and fructosamin disagree, is it OK to go by BG as long as I test often?
Click to expand...
I think that BG testing is going to show you much better what is going on with the blood glucose levels than the averaging that the fructosamine test does.

Since you are using our standard spreadsheet format, we can see what is going on and help advise better.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you all very much for your advice!!!
And thank you very much for explaining to me about fructosamin so patiently - BJM.
Mountain and valley explanation really made me understand much better.

I give both my cats a small amount of better quality canned food as snack - a couple pea size for Lucy and a couple table spoon for the other cat Ginger.
By the way, Lucy eats Wellness, and Ginger eats raw. Unfortunately Lucy didn't do well on raw (thickened intestinal walls and weight loss) when I tried some years ago.

As my hypo kit, I have a bottle of corn syrup and some cans of cheapy food such as fancy feast/friskies (I though these kinds have higher carb. Are these good enough?

She gained weight over the past couple weeks. She lost some weight when she was sick and wasn't eating well in March (before insulin), but she is gaining back.

She has been on Lantas 0.5 unit twice a day since yesterday.
I tested +3 hr this evening, and am planning to test again at +5 and +8.
But so far, do you think she is doing OK by looking at the spreadsheet?
I think Lucy's energy and mood are better, and she seems generally happier.
Please let me know what you think!!!

Thank you again - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Those numbers you got yesterday, 5/22 Wed, look really good.

I would definitely recommend getting a pre-shot test this morning before you give the insulin, especially since you got those wonderful green numbers later last night.

If you are able to also get a +11 before the pre-shot test, that will help us see if the pre-shot test is a rising or falling number. That is important to know if you are going to be shooting those low numbers.

It would be a good idea to test, post and hold off on feeding until you get advice from us here. Ok? Tell me when your test,shot cycle is in your local time and what your local time is Eastern Central, Pacific, etc.

p.s. Those look like healing pancreas numbers. :mrgreen:

As my hypo kit, I have a bottle of corn syrup and some cans of cheapy food such as fancy feast/friskies (I though these kinds have higher carb. Are these good enough?
Click to expand...
Which of the fancy Feast/Friskies do you have? The pate styles are usually lower carb but the other styles with gravy are higher. Tell me exactly what you have and I'll look it up in the food chart. food chart Or you can look it up. It would be a good idea to label the cans with a black magic marker and write the percentage of carbs right on the can. You don't want to be scrambling during a hypo to figure out the carb percentage. :shock: :o :shock:

You can always add a drop or two of Karo to raise the carb content of any food.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you, Deb&Wink.
I was just writing a SOS message (little panic) when you posted your message because I thought the number I got last night at +10 was too low.
Is 68 not a good number?
I did give her a couple table spoons of her regular food because I got scared!

I will test as you suggest, so please let me know what I should do about today's morning shot.
I am in Vancouver BC Canada, Pacific time, so now is 5:13 am.
I am going to test her now as 5 am is her +11.
I start feeding them at 5:30 am & 5:30 pm, Lucy takes a while to eat, so she gets shot at 6 am every morning.
I will post her +11 number as soon as I successfully get it (sometimes not easy, she resists).

I feed & give a shot. "pre-shot number" is supposed to be tested even before feeding?
I wasn't sure if it's supposed to be the number after eating or before....
I will be back! Thank you - Mariko & Lucy.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Yes, please get that +11 now and then another test before you give the insulin, what we would call a pre-shot test.

I feed & give a shot. "pre-shot number" is supposed to be tested even before feeding?
Click to expand...
Pre-shot number testing is supposed to be before you feed. if you have fed already, please let us know.

Do NOT give any insulin until you hear back from us here on the board. Ok?
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you so much for staying with me, Deb & Wink.
I just posted +11.
She is up, probably because I fed her 2 tbsp of food after seeing the +8 BG.
Today's +11 value is more accurately +11.5.
I will wait to hear from you before giving her next insulin shot, but can I feed her breakfast before I test the pre-shot BG?
Or, should I hold both breakfast and insulin shot until pre-shot testing?

Breakfast --> pe-shot test --> insulin after hearing from you
OR Pre-shot test ---> Breakfast ---> insuline after hearing from you

Which pre-shot number would be useful for you to see? Or doesn't matter?

Thank you again, Mariko & Lucy.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Please hold breakfast until after the pre-shot test.

pre-shot test, wait to hear from us, then maybe breakfast or another test, then maybe insulin, then breakfast

Are you going to be around this morning or do you need to go to work?

ETA: What meter are you using for testing?
 
Re: Blood Glucose HIGH but Fructosamine LOW

OK, I will test her again in about 30 min or so, and wait to hear from you.
I usually give her breakfast/dinner before each shot because sometimes she refuses to eat, but today I will hold both breakfast and insulin until I hear from you after pre-shot test.

I normally do in the order of meal --> shot, not shot --> meal, because sometimes she refuses to eat and I don't want to give her insulin without food, but these days her appetite has been good. In fact she is starting to beg for food just now.

I do have to go to work, but today I will try to be at home as much as possible, although I would have to leave home at least for 5 hours or so at some point. I will consult you again when is the better time to leave her alone after a couple more tests this morning, but I am thinking if her pre-shot & +1 test give safe number, I'd better go to work early and come home mid-afternoon to test her around +7 to +10 since these seem to be the time she goes lowest.

The meter I am using is one tough ultra mini.

Could you please stay with me and Lucy to give further advice?
Thank you - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Mariko, I'm not going anywhere. Don't have to work today, errands can wait.

I'll add more to this post later but wanted to reassure you I'm not going anywhere.

ETA: Here is what I am thinking and why I had you do that +11, asked for the pre-shot, and had you hold on feeding breakfast and the shot.

Lucy went low last night with that 68. She may go low again today. I do not want her to go below 50 unless you will be around to support her with food or can leave some extra higher carb food out for her to eat.

I see 3 options for this morning.
1. stall. wait to see rising numbers and then shoot the full 0.5U dose you have been giving. leave out some extra food for Lucy to eat.
2. reduce. Since you need to be away today, giving a smaller dose would be safer than a full dose. She may still go low so I would want you to leave out some extra food, restricted from the other cat eating it.
3. skip. do not give the insulin. This is the safest way to go since you will not be around to monitor all day.

Our motto is 'Better too high for a day, than too low for a minute'. I'm not sure you have enough test data to shoot low this morning. We really need to have that pre-shot test before every insulin dose, AM and PM.

It's your choice, you hold the needle in your hand. What do you feel like you want to do?

Also, would you go back to your very first post in the this topic, click on the edit button and change the radio button from none to 911. It's not a health emergency yet but I'd like to get some other folks opinions on this.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Hi,

What we usually do with our FD cats is to not feed them for 2 hours before the shot. The reasoning is that if you feed your kitty less than 2 hours before his/her shot is due, the BG you are getting is influenced by the food (which makes BG's higher).

We use this order--->withhold food for 2 hours--->test--->shoot--->feed immediately after shot.

For example, if you feed at +11 and test at +12 (when shot is due, if you are using Lantus), and get a 90, that number is influenced by the food you fed at +11. If you feed at +10 and get a 70, that is more likely the actual BG aka "shot number".
 
Re: Blood Glucose HIGH but Fructosamine LOW

I just posted her pre-shot.
She is slightly higher than +11.
Please let me know what I should do. Can I feed her breakfast now?

I have an idea about why she went unusually low last night, and would like to know what you think.
I gave her sub-Q fluid at +5 last night, and I thought it might have changed how the insulin was absorbed.
It maybe a coincidence but I think she went low (not as low as last night) previously too when I gave her sub-Q fluid, and that's why I tried to space out as much as possible.
Do you think that might be the reason?

Thank you, TheBowHuntress, for your explanation.
In that case, I may have to adjust her feeding & shot schedule a bit.....
Is that what everyone else does too?

Anxiously waiting for your next advice - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

I had posted this earlier:

I see 3 options for this morning.
1. stall. wait to see rising numbers and then shoot the full 0.5U dose you have been giving. leave out some extra food for Lucy to eat.
2. reduce. Since you need to be away today, giving a smaller dose would be safer than a full dose. She may still go low so I would want you to leave out some extra food, restricted from the other cat eating it.
3. skip. do not give the insulin. This is the safest way to go since you will not be around to monitor all day.

I suppose the sub-q fluids could affect the absorption of the insulin, especially if you are giving them in the same area. I have no experience with that though.

You did get a nice rising number from your +11 to your pre-shot test.

If this were my cat, I would shoot the 0.25 to be safe, feed, leave out extra food for Lucy to munch on while you are gone, test as soon as you get home.

It's not my cat, so you may feel more comfortable with option 3, or feel confident and want to go with option 1. You have already stalled, so you could give the full 0.5u dose.

ETA: let us know what you decide. I think it's safe to take the 911 down from your first post in the topic now.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you again.
I am going to take the option 2.
I will check her again in 1 hr, leave for work, and come home to test as soon as possible in the afternoon.
Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Ok. Thanks for letting us know what you decided to do. Have a good day at work.
 
Re: Blood Glucose HIGH but Fructosamine LOW

mariko said:
...I have an idea about why she went unusually low last night, and would like to know what you think.
I gave her sub-Q fluid at +5 last night, and I thought it might have changed how the insulin was absorbed.
It maybe a coincidence but I think she went low (not as low as last night) previously too when I gave her sub-Q fluid, and that's why I tried to space out as much as possible...
Click to expand...
Lantus, which has a slightly acidic pH, precipitates after injection, when it meets the more neutral pH of the body. These tiny clumps are supposed to slowly dissolve. A guess: by adding the fluid which has a more neutral pH (closer to 7), if it was in the same location, the dose may have precipitated completely, been spread out, and then absorbed in approximately the same time period, maybe resulting in more of a bolus effect. This is a guess.

In general, you want to do sub-Q fluids on 1 side and the insulin on the other. You may want to move the insulin a bit more towards the hind end, too, if you can get a decent tent of skin for injection.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Before I leave for work, I wanted to thank you again for staying with me and Lucy for hours this morning.
I was quite scared....
I gave her 0.25 unit, was hard to measure but did the best I can.
I don't know how important the +1 BG is in today's case, but I just checked her anyway and she was 171.

Thank you, BJM, for your comment about sub-Q fluid. It is helpful.
I did not do them in the same spot, but maybe it was too close - about 4 inches or so apart.
When I give sub-Q fluid next time (probably on Saturday), I will do as you mentioned and see how it goes.
I think I can make a tent towards her bumbum.

Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

No problem staying with you this morning Mariko.

That 171 is probably at least 30 points higher from the food. You're good to go to work.

When you get a chance, I'd like you to add a couple more things to your signature.

1. Go to user control panel in upper left of screen, click on those words.
2. Click on Profile tab
3. From the list of options on the left hand side of the screen, select Edit Signature.
4. In the free form text box, where you already have the link to your SS, please add the meter you are using, the insulin, the food you usually feed, any complicating health conditions, any additional medications (like those sub-q fluids).
5. Click on submit to save the changes.

So it would look something like this:

Mariko & Lucy
One Touch Ultra Mini, Lantus, Wellness food, sub-q fluids every 3 days because ????
Lucy's SS

This helps to provide a quick snapshot of your cat and helps us to help you better. You didn't have all this information this morning so I had to ask a few questions and that delayed the response.

When you have some extra time, it is nice to have a bit more information. To do this, there is another google doc called a profile to tells us more about you and your cat Lucy. I believe these are the most up-to-date directions on creating a profile to link to your signature. You can make it as free form as you like, no reason to stick to the standard format. profile instructions
 
Re: Blood Glucose HIGH but Fructosamine LOW

Hello again.
I came home from work as quickly as possible, and have been checking Lucy's BG since +5.
I will check pre-shot before the evening shot, but I am wondering if 0.25 unit may be more appropriate for her....
She got 0.25 unit this morning because she went quite lower than usual over night, and her lowerst BG was at around +5.
Her full does is 0.5 unit, and her lowest point seems to come at +8 ~ even +10 with the full does.

I heard that normally the lowest is at around +5.
Is that what I should aim for? To adjust the does so she will have a peak at +5, rather than +10?

I am trying to decide whether I should give her 0.25 unit again this evening rather than 0.5 unit, and see how she does with the reduced dose.
I am beginning to think that 0.5 unit may have been too much for her since now her pancreas seems to be better.

I updated the signature with a big more info (hope it worked).
I will do a sheet of profile sometime soon (Lucy has one of the thickest files at the vet, a lot of medical history).

Thank you - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thanks so much for adding that info to your signature. It helps us to see that Lucy and you are dealing with quite a few medical issues.

With the BG numbers you got today, those were good "healing the pancreas" numbers. Anytime we can see those blue numbers and some greens, it means the pancreas is working to heal, probably making some insulin on it's own to help out. I would consider that 68 you got last night a good healing number, not too low, but scary for you since you had not had a number that low before.

Any number below a 50 is a cause for concern. That is hypo (hypoglycemic) territory and needs support with food and karo syrup. If you ever get a low number, put that 911 icon on the post and scream for help. Lots of people can walk you through a hypo event.

If you are more comfortable shooting the 0.25U, certainly you could do that.

Some of the numbers you are seeing may be because the lantus depot still has some extra insulin to be slowly released and help keep the BG's low. Once the insulin depot is drained, you may find the numbers going up high again.

Lantus usually peaks somewhere between +5-+7. But every cat is different. My Wink always nadired around +4.

I have to tell you that I will not be around later this evening or even tomorrow morning to help you with advice. Fridays are my really early morning this time of year, up at 4:30 am EDT so I'll be going to sleep early tonight, up early tomorrow, no time to look at the board, and not back until late afternoon, 1pm EDT or so. Unless it rains here in Massachusetts. Then my adventure is cancelled and I'll be around. But you shouldn't count on me is what I'm saying.

You could go back to your first post and edit it again, change the subject to dosing help? or something similar.

At some point, we should have you look for a low carb, low phosphorus wet food to feed Lucy to help with the CKD. There are other members here that have diabetic and CKD kitties and have food lists and can help out with that. I can also do a search. This is not something we need to do today or even in the next week. Keep it in mind and make sure we come back to this in a week or so.

ETA: Would you add one more piece of info to your signature? user control panel, profile, edit profile, location field - enter where you live, province/state and country would be good. City if you like is nice to know.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you so much again for the info.

Lucy's pre-shot was 175, so I ended up giving her a full does of 0.5 unit, but I made it a skinny dose.
I'll check her BG at around +5 and +9 or something like that tonight.
Hopefully she'll let me sleep a little better tonight.......
I want to give her a break until +5 - she is getting more irritated at being poked.
Also her ears are red.... sad..... are everyone's diabetic cats being home tested have red ears at the edge?
I do hold the poked spot for about 10 sec to prevent bruising, but she hates that part sometime more than poking.
I am worried about damaging the tissue permanently.....
I do alternate right ear / left ear, and try not to poke on the same spot, but her ears still look painful - heart-breaking.

Thanks - Lucy & Mariko
 
Re: Blood Glucose HIGH but Fructosamine LOW

Hi there

Don't worry about the ears, they won't be permanently damaged, just make sure they are nice and warm before you poke so you don't need to poke more than once. As you get better and the ears learn to bleed better, they won't bruise as much. Although my cats have a few red bits sometimes, and I have been doing this over a year. Put a little polysporin complete pain relief ointment on afterward,that will help too.

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you very much for your information about red ears.
About polysporin, doesn't it contain antibiotic? Is it safe if she licks it?
She can't lick her ears of course, but when she grooms, she repeats licking her paws and rubbing her ears.
Thank you - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

It does, but its a very small amount you put on, very sparingly. I use the polysporin complete triple with pain relief. I smear a pin drop on and wipe it off so its very little and I only use it occasionally maybe once or twice a wek. Many of our US members use neosporin and some use it every time. It seems to be safe for cats, I just use it less to be on the safe side.
 
Re: Blood Glucose HIGH but Fructosamine LOW

OK, thank you so much again.
Good to know there is something I can do to help with sore ears.
And you are right, it seems her ears are bleeding more easily.
In the beginning, I really wanted to stomp on the meter screaming, but it has become much less stressful for both Lucy and me.

I have a question, not about Lucy's condition, but about this forum and posting etiquette.
I would like you more experienced people to keep an eye on Lucy's SS (please!) for a little longer while since she hasn't been on insulin for long yet, and I am constantly worried if the dose and numbers are right.
I do not have the experience to interpret the home test results yet, so your advice/opinion is very valuable to me.
Also, Deb, I would really like to talk about the low carb low phosphorus food to help with CKD at some point in the near future as you mentioned in your last comment.

My question is: Can I keep this topic going even though the subject may no longer reflect the contents, or would it be better if I start a new topic?

Thank you! - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

We can help as little or as much as you like. If you want more experienced eyes looking at her SS, I would start posting daily ( or as often as you can) on the Lantus Tight Regulation board. Its a strong sense of community and very active. There are many very experienced people there who will look at your posts every day and advise on what you should do and answer questions.
http://felinediabetes.com/FDMB/viewforum.php?f=9

Deb and I visit (and post!) there too.

heres how it works
1. every day you open a new topic - we call them "condos"
2. in the subject line you put the date.cats name and blood readings i.e. 05/23 Lucy AMPS 140 +1 171 +5 119 +7 122.. PMPS 175 ... you can add a ? icon if you have a question. You can update this subject with every reading or at the end of the day. whatever works for you.
2. in the content you give a short update on how Lucy is doing regarding the 5 PS ( playing peeing pooping purring and preening) and a link to the previous condo and any questions etc. ie Today Lucy was so happy running around and attacking my feet. But she is still peeing a lot, should I increase her dose?

For your first post put "newbie" also in your subject line so people can welcome you!! I have been on that board since Tiggy and Bailey were diagnosed, and since they arent OTJ, I still post every couple of days to get advice and eyes on them!
Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Mariko, you can keep this topic going as long as you want. After it goes to a second and third page, it starts to get too big to track, so we often suggest someone starts a new topic, but provides a link to their old topic.

If the subject does not meet your needs any more, you can always change it. To do that, you need to go back to your very first post in the topic, and look over towards the right. There is a little rectangle with the word "Edit". Click on that little rectangle and your first post will be opened and the subject line pops up. Change the subject line to whatever is your current concern.

Please, do not change any of the text in your first post, we probably will not notice it. Most times, I will open a topic to read, and click on the "First Unread Post" over on the right hand side above the first post, and then start to read from there. I will only go back through a topic, if there is some information I am hunting for, that I need so I can answer any questions better.

This is a good website to learn more about Chronic Kidney Disease in cats. http://www.felinecrf.org/

Dr Lisa Pierson's food chart lists the phosphorus content of many commercial foods found in the US. See here catinfo food chart You want to keep the phosphorus numbers low ( I forget the number) and also select a food with < 10% carbs.

You may want to write a topic asking if someone has a shortcut list for the low phosphorus foods already. It is likely that someone does, but I don't remember who has this list.

I would like you more experienced people to keep an eye on Lucy's SS (please!) for a little longer while since she hasn't been on insulin for long yet, and I am constantly worried if the dose and numbers are right.
I do not have the experience to interpret the home test results yet, so your advice/opinion is very valuable to me.
Click to expand...
As Wendy said, you can stay here in the Feline Health forum, or you can decide to go to one of the Insulin Support Groups. Lantus TR tends to be quite hectic and fast paced. If you are not ready for that, stay here in health and we can either PM other members to come over to give advice or post over in Lantus TR to ask for 'more eyes' on someones topic.

People stay here for months, years if they need to. We aren't going anywhere. We will not abandon you. Did anyone mention that when you joined and started posting here, you gained a whole new family? Well, welcome to the FDMB family. We try to help each other the best we can.

There is so much traffic over in Lantus TR these days, that I no longer can find the time to read every post. I do read the ones with questions and chime in if I feel I can add some value and additional information. So, be sure to put the question mark radio button on your post when you need an answer to a question, ok?
 
Re: Blood Glucose HIGH but Fructosamine LOW

Fortunately it's not a requirement to read all the other posts on the lantus tr board so you don't need to worry about the pace, that's more for the experienced members who go on to read all the posts and advise. And there are a lot of very experienced people here, way more so than myself or deb, who are always available to advise on that board so I wouldn't worry! lastly, they keep track of all members on that board so will be better suited to watch over you.

FYI the way you can tell experienced members is the have over about 3000 posts.

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you very much, Wendy & Deb!
I will visit the Lantus TR forum sometime this weekend, and see if I can post there too.
I may post here and there at the same time, that's OK right?
But first, I'd like to get Lucy's profile done as Deb previously suggested.....

I updated the SS with yesterday's & this morning's AMPS numbers.
Yesterday, between AMPS PMPS, she went down, up and a little down again, so her PMPS number was lower than +8.
Is this not strange?
I gave her only 0.25u yesterday night because of late shot.
Overnight, her number went down, up and down again.
Fluctuation is not big, but is it OK how her 5/24 PMPB is lower than AP+8 when her AM+6 was the lowerst?
She did the similar thing again after 5/24's PM shot.....

I ended up giving her 0.25u again this morning instead of her full 0.5u.
I can stay at home most of the day today, but will have to go out around +2 ~ +3.
Maybe I shouldn't have given her the morning shot.....so worried if I'm doing it right....

Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Since the doses have fluctuated over the past couple of days, it'll take about 3 full days (6 shots) for the dose to stabilize enough to evaluate if it should be adjusted. Stick with 0.25 for at least that amount of time, unless he goes too low (<50 mg/dL).
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you very much, Wendy & Deb!
I will visit the Lantus TR forum sometime this weekend, and see if I can post there too.
Sure - you can post on both.. maybe post on Lantus TR all your questions etc but put another post here with just a link to the TR post and then people can hop over and keep the discussion on one thread.

I would love to see a profile - more pictures! she is such a cutie..

Yesterday, between AMPS PMPS, she went down, up and a little down again, so her PMPS number was lower than +8.
Is this not strange?
Click to expand...
and
Fluctuation is not big, but isn't it supposed to go in one direction, down - nadir - up, between shots?
Click to expand...
Nope because meters vary by 20% so those numbers are actually pretty much the same. If anything she was kinda flat blue. She did do more of a curve overnight.

I ended up giving her 0.25u again this morning instead of her full 0.5u.
Click to expand...
Interesting - lets see how she does on this dose like BJ says - if she starts to head back up to yellow ( I think she might - the 0.5s was working pretty well but lets see) you probably will want to move her back to the skinny 0.5IU but give it a few more cycles. Can you put 0.5s in your dose column so we know you gave a skinny 0.5 the other day?

Wendy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Mariko,
There a couple of items I wanted to make you aware of.

First, giving a late shot acts like a reducion in dose. It's nothing to worry about, but you may see slightly higher numbers the next day when you need to give a late shot, an hour or so later than your normal schedule. Giving an early shot, acts like a dose increase. Again, nothing to worry about, but you may see slightly lower numbers if you need to give a shot an hour or so early.

Yesterday, between AMPS PMPS, she went down, up and a little down again, so her PMPS number was lower than +8.
Is this not strange?
Click to expand...
Even if you took two tests, at the same time, off the same blood drop, you would not likely get two numbers exactly the same. This is because of meter variance.

Blood glucose meters are allowed to vary by as much as 20% and still be considered to be accurate. This means that a number + or - 20 percent, is for all practical purposes the same number. Falling within that 20% variance range up or down,we consider that number to be the same.

I'll give you an example from your spreadsheet. On 5/24, your PM +7 was 133 and the +10 was 112. These two numbers are so close to each other taking into account the meter variance, that we consider them the same number. Same thing with those morning numbers on 5/24. Meter variance is playing a big part in what you are seeing as different numbers.

So where your SS shows a little down, up,down from the PMPS, I see a nice drop into a wonderful green number at +5 ( around nadir), then a very slight rise at +7 and a 'surf' or maintaining the same range of numbers for +7 to +10.

You don't have to test so much at night unless you want to or are concerned that Lucy may drop too low. More data, especially, at the beginning of this journey with your cat Lucy, will not help. I'm only saying you do not need to test as much if you are staying up at night to do so. There may be times when you want to do that. I'm just letting you know you do not always need to do that.
 
Re: Blood Glucose HIGH but Fructosamine LOW

mariko said:
Hi everyone!
I haven't visited here for some time since she went in remission last year, but unfortunately we are back and hoping you could help us.
Lucy was first diagnosed in June 2011, put on Lantus, went in remission in Feburary 2012, and recently became diabetic again.
If you could please take a look at her spread sheet (I know I haven't tested regularly enough), her numbers vary but never too low.
We tested her fructosamine 3 times since last month, and 1st result was within the normal range and the 2nd and 3rd result was below normal.
This had made it difficult for the vet to decide whether to put her on insulin or not, and we still don't know why her fructosamine is low when her blood glucose does not seem to have gone too low.
This is what's been going on and how her does has changed.
April 15 - BG tested at the vet was 504 mg/dL (28 mmol/L), but the fructosamine was within the normal range. Started insulin 0.5 unit twice a day. Assumed fructosamine was normal because she hasn't been diabetic long enough.
April 27 - BG tested at the vet was 252 mg/dL (14 mmol/L). Fructosamine was below normal range, so we stopped insuline.
May 4 - I did some home testings since April 27 and her BG was high, so we put her back on insulin but only 0.5 unit once a day.
May 18 - BG high, but fructosamine was again below normal.
I did a curve last night, and besed on the result, the vet and I decided to start giving her 0.5 unit twice a day from tomorrow.

Does anyone have any idea or similar experience about high BG & low fructosamine?
Even her lowest number is not that low..... so I really hope that deciding to give her insulin twice a day rather than once a day is a good idea. But Why... Why her fructosamine is low????

Some additional information about my kitty.
Lucy is a 16 yr old cat, has some other health issues - IBD, chronic pancreatitis, gallbladder stones, early stage of kidney disease.
Her Spec fPL test value has been particularly high recently, over 50 both time tested on March 31 and May 18.

Any comment/advice will be very much appreciated!!
Mariko & Lucy
Click to expand...


What are you doing for the pancreatitis, how are you treating it?

Pancreatitis is extremely painful and causes higher BG numbers. so your cat may not need insulin if you treat the pancreatitis.

You need pain meds for sure. Buprenex is best for the pain.
You need to give subQ fluids to flush the system. I was giving at least 100cc a day for a week.
You need something for nausea / upset stomach. Most often, people give 1/4tab Pepcid AC 10mg strength. Give 1/4tab about 30min before shot time / meal time so that the stomach is settled in time to eat.

What about B12 shots? One of my cats have frequent bad flares, and my vet had me start to give her weekly B12 shots, 25u. Within a few weeks, she had no more flares and only one minor one, and I was able to stop giving her the pepcid which I had been giving her daily for months.... the B12 helps to bring down the inflammation of the pancreas along with many other benefits to the cat's health.

Some cats have been known to come out of remission because of pancreatitis, so be sure to keep testing as you may not need to give insulin once the pancreatitis issue is better controlled.

Last, BG tests done at the vet office are often higher than normal because of stress from being there, so combine stress at the vet plus higher numbers because of ongoing, untreated pancreatitis and you have a cat that likely dose not need insulin.

Gayle
 
Re: Blood Glucose HIGH but Fructosamine LOW

Thank you, everyone, for your advice.
OK, I will keep her on 0.25u for the next couple days, and ask for your opinion again.
And thank you for the info on meter. I will stop worrying too much about small fluctuation.

I am a little confused about the late/early shot.
Can you please explain to me again?
Most likely on every Friday, I will have to give her a late shot, late about 1 ~ 1.5 hrs late.
I gave her 0.25u yesterday because of this, but wasn't sure if it was the right thing.
Can you please let me know how should I deal with a late shot?

Yes, I am getting up in the middle of the night two or three times to check her because I am just so scared of her going too low and not noticing, but it's tough! I am not at home during days on weekdays, so I have only night cycle to check regularly to understand her tendency. Last night, I saw her go green at +5, and didn't know if it's a safe number not to check again, so I got up again to check. I test because I'm scared her going too low, but I really don't want to have to get up at night so many times unless I have to, but I'm not really sure what are the "have to" circumstances, so I end up doing it every night....
Hopefully I will have a better understanding of her reaction to insulin over the weekend and start getting decent sleep from next week....

About her pancreatitis, when she is having an obvious flare-up, I give her buprenorphine.
If she seems nauseated, she gets an anti-nausea shot (serenia) at the vet.
And sometimes, appetite stimulant if she refuses to eat.
She now gets 0.05 ml of V-B12 once a month only, because the last test indicated she was getting a bit too much of it.
As a long term treatment, she is getting acupuncture regularly since April.
I think it's helping.

Today is the day I am giving her a sub-Q fluid, and that is partly why I gave her only 0.25u this morning (again, scared of hypo) because last time she had a sub-Q fluid, she went unusually low.
I gave her the morning shot on her left hind area, so will do the sub-Q around upper-right.
I will post how she does!
Thank you - Mariko&Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Think of pouring water through a funnel.

If you pour too fast the funnel overflows.
If you pour too slow, the water goes out as fast as it goes in.
If you pour a little fast at first, then slow down, you may keep a small pool in the funnel.
If you slow down a smidge then resume a constant speed, the level lowers; like a delayed shot
And if you speed up a little then resume a constant speed, the level increases; like an early shot.
 
Re: Blood Glucose HIGH but Fructosamine LOW

I am a little confused about the late/early shot.
Can you please explain to me again?
Most likely on every Friday, I will have to give her a late shot, late about 1 ~ 1.5 hrs late.
I gave her 0.25u yesterday because of this, but wasn't sure if it was the right thing.
Can you please let me know how should I deal with a late shot?
Click to expand...

The explanation that BJM gave with the funnel, was talking about the insulin depot. The depot is a storage area within the cat, that stores some of that insulin you inject for later use. There is supposed to be about 24 hours worth of insulin in the depot when it is filled. When you need to give a later shot because of your schedule, the body will have some extra insulin it can use, and will release some of that stored insulin from within the depot storage area. When you give the next shot, the late or delayed shot, some of that insulin from the new shot, will be used to fill up that storage depot again, leaving a little bit less for your cat to use in this cycle. That is why I was saying that a late shot is like giving a reduction, or less insulin. Because not all of it will be used up right away, some goes to rebuild the depot. Does that make sense?

It's perfectly ok to give a early shot or a late shot. Some people need to shot Lantus on a 11/13 or a 10/14 schedule instead of the more normal 12/12. You should keep to the 12/12 schedule when you can, but we know there will be some variability in that schedule. Management of diabetes in your cat, needs to be worked around the rest of your life. You need time to take care of you and all your other responsibilities.
 
Re: Blood Glucose HIGH but Fructosamine LOW

I test because I'm scared her going too low, but I really don't want to have to get up at night so many times unless I have to, but I'm not really sure what are the "have to" circumstances, so I end up doing it every night....
Click to expand...

You are currently shooting very low numbers. That is good, because it may mean that Lucy will go into remission again. A number below 50 needs more tests and more food. We say "feed the 40's" which means if the BG is in the 40-49 range, you should feed some food. If the number is in the 50's, you can also give a little bit of low carb food, maybe a teaspoon or so. Numbers in the 30's need karo syrup, higher carb food, testing every 30 minutes to make sure the numbers are going up, and posting a 911 on this board for support, and maybe staying up for several hours until Lucy has BG's higher than the danger zone. Numbers in the 20's or lower mean an emergency visit to the closest 24 hour emergency vet clinic.

Let's get some more information about your schedule and see if we can make some adjustments in when you test, when you shoot insulin. I'm looking for ways to make this process of caring for your diabetic cat easier for you.

If you could give me some information like the following list, I'll try to make suggestions on changing when you test, feed shoot.

For example, up at 6 am, test at 7 am, feed, 7:30 shoot. Leave for work at 8 am
Get home at 6 pm. Start your own dinner, maybe take care of your kids or other animals in your house.
Test Lucy at 7 pm, feed, 7:30 pm shoot
Relax some, talk to friends, catch up on your posts on FDMB, etc.
Go to bed at 11 pm.

Do you have other animals in your house?
Other family members to take care of?

We want to simplify this management of the diabetes so you don't feel so stressed out and can get a good nights sleep without worrying about Lucy going too low at night.

So far, I have not seen a dangerous low. Yes, that 68 you got with the last sub-q fluids administration was the lowest BG you have gotten so far, but not a dangerous low. We start to worry if the number goes below 50.

There are also ways to leave some food out at night. Cats will usually eat some food if their BG numbers are dropping too low. Have we mentioned making frozen cat food sicles?

When was Lucy's last pancreatitis flare up? That can make the BG numbers go up.
 
Re: Blood Glucose HIGH but Fructosamine LOW

Hey there

If you know you are going to be out late you can plan for it by moving the shot schedule by 30minutes a day or 15 minutes each time. for example say your normal shot times are 6am and 6pm
Sunday AMPS 6am PMPS 6.15pm
Monday AMPS 6.30am PMPS 6.45pm
Tuesday AMPS 7pm PMPS 7.15pm

and so on. Then move them back afterward!
 
Re: Blood Glucose HIGH but Fructosamine LOW

OOOhhhhhhhh, that makes a lot more sense..... Thank you all.
That explains why her PMPS wasn't higher even though I was late to give her the PM shot yesterday....
My (incorrect) logic was, her PMPS should be higher because I'm late, but it's not, so maybe she is using it too slowly and if I don't reduce the dose of a delayed shot, she may end up with too much and go hypo after the next shot....
Ah, I don't think I'm ready to go to Lantus TR forum yet, so many beginner's questions and errors. I'd better seek your help here at the Health forum for a while longer....

About the delayed/early shot, I think I understand better now that you both explained to me about the depot. (I was completely misunderstanding about that before. I though depot meant it stores and releases the insulin slowly during one cycle of 12 hours only.)
But I am still not confident if I got it right (sorry - please be patient with me!).
Do I now understand correctly as below?

Is this correct? #1) If I am late to give her a shot, her insulin storage starts releasing stored insulin she accumulated from the previous shots.
When she gets the next shot, some of it goes into her storage to compensate the lost insulin she used during the previous delay, so she will not get the full amount to be used for that particular cycle. I should not adjust (reduce) the dose just because it's a delayed shot or she will have even less to use during the cycle. Instead, I should give her her normal dose even late because excess will be used to fill the insulin storage.

Is this correct? #2) If I am early to give her a shot, the excess will go into her storage. Her back-up insulin volume will rise, and if too much, overflows, causing higher BG. But still I should keep the same usual dose because an early shot means she will have more than 12 hours until the next shot, and use of stored insulin will be needed.

Is this correct? #3) Since I have already given her a reduced dose of 0.25u for the past 3 shots already, I should keep this dose for at least 3 more shots to see what her storage does. If her BG increases, her storage is empty and probably needs an increased dose - back to 0.5u. If her BG stays at the same level, 0.25u is the right dose for her.

My cats start waking me up at 5:30am every morning using various very effective mothods, and I used to use them as my alarm clock and got up and fed them right away. But since Lucy is now getting insulin and it's more difficult to give her the PM shot at 5:30pm, I now try to ignore their morning calls until 6:30am. They expect to be fed right after I get up, and right after I come home. Lucy is a very difficult cat to feed, not only finicky but she needs to be fed while she is begging. If I make her wait too long, she will lose interest in eating all together and becomes harder to get her eat her normal amount. On top of that, she needs to be finger-fed. She started refusing to eat by herself when she was first diagnosed with diabetes in 2011. Since then she insists on being finger-fed, so that's how I'm feeding her, and on good days it takes 20 minutes, and on bad days it takes over an hour. Even when her appetite is good and she really wants to eat, she would eat only a few mouthful by herself, and then insist that I hand-feed her. At first, I struggled to fix it by ignoring her begging, but now I accept it as a part of being her mom.
This make it impossible to go on vacation, but it's a deal I made with Lucy, I don't go away, you stay happy, not sick.

So this is my schedule:
Get up at 6:30am, test, shoot and feed right away. Leave for work at 8am.
Come home between 5:30 - 6:30pm. Test shoot and feed at 6:30pm.
Every Friday evening, I have a volunteer duty that I'd really like to continue. So on Friday evening, I come home at around 7:30 - 8pm.
I don't have anyone else who needs taken care of (fortunately!) - Just Lucy, Ginger (healthy cat) and myself.
I usually go to bet at 11 - midnight.
Could you please let me know when I should schedule her regular test apart from AMPS and PMPS?
And of course if something happens and needs additional tests, I can go to work later or come home early or get up in the middle of the night, but when is the better time for scheduled tests for you to evaluate her dosing? Please let me know!

Lucy has had 2 major pancreatitis flare ups.
The last one was in March, when she had all sorts of symptoms, and that is how the vet realized she is back to be diabetic.
I believe she had a smaller flare up on 5/18 but she was over it by 5/20 afternoon.
How I guess if she is having a small flare up is usually her appetite. She starts taking a long time to finish her meal, and purrs less when brushed.
Small flare ups are not easy to tell sometimes like major ones, because she has so many other reasons (health issues) to feel a bit off.

Thank you - Mariko & Lucy
 
Re: Blood Glucose HIGH but Fructosamine LOW

Yup, you got the basics of the depot concept.
More precisely, Lantus is a somewhat acidic solution. When it enters the more neutral pH body, it precipitates. These small clumps slowly dissolve and that usually takes more than 12 hours, resulting in an overlap effect between shots. That overlap is the depot.

Testing around +5 to +7 hours after a shot will help you check the nadir, the lowest point between shots which guides dose adjustment.
Testing before bedtime let's you see if you might need to stay up and steer low numbers safely.
 
Status
Not open for further replies.
Back
Top