Dude, newly diagnosed blood glucose PMPS @ 143, 4th test

Discussion in 'Feline Health - (Welcome & Main Forum)' started by jmichaelp, May 6, 2024.

  1. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Hi, I cannot save profile info & no one has gotten back to me about it via the "contact" option.

    I last gave him 2.5 units of Lantus at Midnight last night. He had 39g of Hill's a/d + FF Salmon Feast Pate with a couple of drops of added salmon oil (for palatability/calories) at Midnight. I'm syringe-feeding him. This morning at 10 am he had 40g of the same food. I took his blood glucose at Noon & found 101 mg/dL. He was at 144 mg/dL on 4/27 @ 10:30 pm, 459 mg/dL on 4/29 @ 8pm, 268 mg/dL on 5/2 @ 11:30pm, 418 mg/dL on 5/3 @ 7:05pm. I fed him 18g of the same food at Noon (that's all he wanted). I SKIPPED the Noon Lantus injection.

    Is there anything I should do? vet hasn't been helpful.

    Dude is an 18 y/o neutered male indoor cat. I'm using 2.5 units of Lantus 2x/day. I'm testing every 2-3 days (vet originally told me to wait a week b/c there's a lag from starting until things settle down) using Contour next GEN. Medical history: Asthma diagnosed in 2009 Flovent every other day (EOD), IBD & a benign heart murmur both diagnosed via ultrasound in 2016, Prednisolone 2.5,mg EOD, UTI diagnosed 4/26 Zeniquin daily Pancreatitis, CKD

    Blood work anomalies (3/23/24):
    ALT (SGPT) 121 (HIGH) 10-100 IU/L
    BUN 50 (HIGH) 14-36 mg/dL
    Creatinine 2.7 (HIGH) 0.6-2.4 mg/dL
    SDMA 15.9 (Mild Inc.) <15.0
    AMYLASE 1,266 (HIGH) 100-1,200 IU/L
    PrecisionPSL 27 (HIGH) 8-26 U/L

    Blood Glucose was 148 64-170 mg/dL at this time

    Blood work anomalies (4/26/24):
    Glucose >686 (HIGH) 71-159 mg/dL
    BUN >130 (HIGH) 16-36 mg/dL
    Creatinine 5.8 (HIGH) 0.6-2.4 mg/dL
    Phosphorus 8.2 (HIGH) 3.1-7.5 mg/dL
    Potassium 3.2 (LOW) 3.5-5.8 mmol/L
    Sodium 144 (LOW) 150-165 mmol/L
    Chloride 100 (LOW) 112-129 mmol/L
    SDMA 37 (HIGH) <14.0
    AMYLASE 1,266 (HIGH) 100-1,200 IU/L
    PrecisionPSL 27 (HIGH) 8-26 U/L

    Urinalysis anomalies (4/26/24):
    Glucose 1,000 mg/dL
    Bacteria Cocci *Suspected prescence
     
  2. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hello and welcome here. Posting on the Feline Health forum is what we ask people to do first.

    Sounds like Dude is one complicated kitty. Good for you for looking after all his needs. Can you tell me how long ago he was diagnosed? What were the signs he was diabetic? There is a bunch of background information people like to find out about the cat, cause it influences how we can help you. That information we typically put in our signature. More information on that here:
    New? How You Can Help Us Help You!

    I'm suspecting that he might be on too high a dose of insulin, but need more information first. Are you giving the insulin with a pen or syringes?
     
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  3. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Thanks for the reply. I don't understand the forum system, from reading I thought this was the correct place to post. can you point me in the right direction or can I get this post moved?

    Diagnosed on 4/26 as shown in his blood work/urinalysis above. He started with increased water intake a couple of weeks before & a couple of weeks before that had the indication of mild pancreatitis & a little higher than usual BUN. He had been eating Hill's k/d. I weigh him weekly to monitor his IBD & though he had lost a couple of ounces, it wasn't until 3/26 testing that I found he had lost nearly 1 lb since my last weighing.

    I tried & cannot save anything to my profile as directed. No one has gotten back to me to help with that.

    What other information can I supply? Was I right to not give the Lantus? It's very difficult to get blood to test, about 1/2 the time it fails to draw blood or not enough despite using the tricks I've read about. The pricks aren't healing quickly either.
     
  4. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    This is the correct place to post.
    I was commenting on this.

    You can put information on both the signature and the profile. The signature is easily viewable at the bottom of each post - you can see the information I have below my post. To edit the signature, click on your name on the top right. There is a drop down and a Signature selection on the left side of the menu. Select it, and a editing box appears. Save changes when done.

    For the Profile, select your user name below your avatar on the left had side of this post. A pop up will appear that allows you to select the Profile Page. Similarly, a text box appears that you can enter information into.

    This post has a bunch of basics on how to use the forum,
    HOW-TO USE THE FDMB: The Basics

    Did he start at 2.5 units? Normally we'd start around 1 unit and increase from there. Seems like he might be on too high a dose. If you can fill in the spreadsheet - details in the link I included in post 2, we can have a better idea what is happening.

    Home testing is hard at the beginning, it takes practice. Some tips in here: Hometesting Links and Tips
     
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  5. jmichaelp

    jmichaelp Member

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    May 5, 2024
    He started at 2 units. He had a reading of 144 mg/dL after 3 days at that dosage. The 4th day at 2 units it went up to 459 mg/dL.
    The 6th day the vet told me to increase the dosage to 2.5 units. On the 7th day it registered 268 mg/dL. On Day 8 it was up to 418 mg/dL. On day 12 (today) it was 101 mg/dL at Noon & 210 mg/dL at 2:50 pm (4 sticks to draw blood).
     
  6. jmichaelp

    jmichaelp Member

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    May 5, 2024
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    The AMPS and PMPS cells are for the blood test we do before giving insulin in the AM and PM. We typically give insulin 12 hours apart, so it's the equivalent of the +12 or 12 hours after the previous dose of insulin. I presume for the days not on the spreadsheet, he still got the same dose (April 28 and 30th)?. You could add a line showing that dosing. Lantus is a depot style insulin so it's like it builds over time. If you skip a dose it makes a difference in how we look at things.

    When you skip a dose, could you put either Skip or NS (for no shot) in the units. By the way, skipping was the right thing to do. When people are new to this forum, we suggest skipping if under 200 at shot time, unless kitty has recently been through DKA or diabetic ketoacidosis, a life threatening condition.

    I presume you are using syringes to give the insulin? If so, do you have U-100 syringes with half unit markings on them? I think you need to lower the dose a bit. So you won't have to keep skipping. It's better to give insulin all the time, but with a lower dose.
     
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  8. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Thanks for letting me know I did the right thing. Still no reply from the vet, second email with no reply...

    I'm using U-100 syringes. I'll back off to 2 units tonight.

    The spreadsheet doesn't make any sense to me. I put the time for any a.m. test in the AMPS column & for any p.m. test in the PMPS column. I put the test result in the "+" column corresponding to the approximate time since the last insulin shot. How is it supposed to work?
     
  9. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Tagging @Bandit's Mom regarding the spreadsheet. She's usually online later in the evening.
     
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  10. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @jmichaelp

    About the spreadsheet to make it easier for you to understand
    AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

    Units is where you would put how much insulin you gave


    +1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
    +2 two hours after giving insulin. ditto
    +3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

    +1 same as you do for AM cycle

    We don't give times because we are all in different time zones that's why we use the + numbers



    You can look at any members spreadsheet to see what it looks like, it's at the end of everyone's signature just tap on it

    On your spreadsheet where you have


    04/29/2024 459 8.5 hours after
    You need to go back and put 459 @+8.5 in the 8 cell or square that means 30 minutes and color code it manually with the color listed for the BG numbers


    05/02/2024 268 5.5 hours after
    You need to put 268 @+5.5 in the 5 cell or square that means 30 minutes and color code it manually with the color code listed for the BG numbers

    05/03/2024 418 7.5 hours later you need to put 418 @+7.5 in the 7 cell or block than means 30 minutes and color code it manually with the color code listed for the BG
    These are how to list the BG numbers if you aren't testing exactly on the hour

    0.25 means 15 minutes
    0.5 means 30 minutes
    0.75 means 45 minutes

    Also about the U-100 syringes you are using do they have the half unit markings on them?
    We use these since we adjust the dose by 0.25 units at a time when an increase or decrease is needed. These make it easier to do that
    You want the ones on the left
    • Full and half-unit syringe scales:
    [​IMG]


    https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

    You won't need a doctors script if you order from Amazon
    This is the info we need for your signature about Dude
    Tap on your name up top then tap on signature and add this
    • Add info we need to help you:
      • Caregiver & kitty's name
      • DX: Date
      • Name of Insulin (do not include dose or frequency)
      • Name of your meter
      • Diet: "LC wet" or "dry food" or "combo"
      • Dosing: TR or SLGS or Custom (if applicable)
      • DKA or other recent health issue (if applicable)
      • Bexacat or Senvelgo (if applicable) and dates
      • Acro, IAA, or Cushings (if applicable)
      • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
      • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
    Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

    Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help
     
    Last edited: May 6, 2024
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  11. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @jmichaelp

    Hi Mike I see you put this in your profile/ information about Dude
    Signature
    Mike - Dude, 18, M - Diag 4/24 - Lantus - Human,Contour next GEN - PU, PD, Neuropathy, CRF - Phos-bind, Miralax, Potassium Citrate, Cerenia, B12 injection, Zeniquin, Flovent, Elura/Mirtaz/Cypro - IBD, Pancreatitis, Heart murmur, UTI, CKD, Asthma - Prednisolone - Syringe-feeding FF Salmon feast pate

    You actually need to link it with your spreadsheet

    https://docs.google.com/spreadsheet...97XeD3F81Uh_LNFCYvwnrxelI7CLo0Fw0jMF-/pubhtml
    Your spreadsheet should be at the bottom of every post you do , just not one post

    I'll Tag Bhooma one of our members to contact you to help you out
    @Bandit's Mom

    More of Dudes information
    Dude is an 18 y/o neutered male indoor cat. I'm using 2.5 units of Lantus 2x/day. I'm testing every 2-3 days (vet originally told me to wait a week b/c there's a lag from starting until things settle down) using Contour next GEN. Medical history: Asthma diagnosed in 2009 Flovent every other day (EOD), IBD & a benign heart murmur both diagnosed via ultrasound in 2016, Prednisolone 2.5,mg EOD, UTI diagnosed 4/26 Zeniquin daily Pancreatitis, CKD

    Mike you need to be testing Dude every morning and evening before giving insulin and additional tests after that ,not every 2 to 3 days
     
    Last edited: May 7, 2024
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  12. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    I'll get the spreadsheet figured out later. Dude's blood glucose jumped to 502 mg/dL, the highest I've measured at home so I gave him the 2.5 units I had been. This morning it is down to 58 mg/DL.
     
  13. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Wendy ,don't know if you saw his reply to your question
    He started at 2 units. He had a reading of 144 mg/dL after 3 days at that dosage. The 4th day at 2 units it went up to 459 mg/dL.
    The 6th day the vet told me to increase the dosage to 2.5 units. On the 7th day it registered 268 mg/dL. On Day 8 it was up to 418 mg/dL. On day 12 (today) it was 101 mg/dL at Noon & 210 mg/dL at 2:50 pm (4 sticks to draw blood).
    @Wendy&Neko

    Edit can you read his post #12 that he did today.
    I would stick around but just got home ,had to get hip and groin injections this morning and need to rest, in pain from the injections
    I made it easy for Mike to understand the SS in my post #10 seems like he didn't understand the link explaining it

    He does have a SS set up but it's not linked to his signature ,it's only in this post. His post #6
    I didn't find the spreadsheet to be very intuitive, please let me know how to correct it, thanks.
    https://docs.google.com/spreadsheet...97XeD3F81Uh_LNFCYvwnrxelI7CLo0Fw0jMF-/pubhtml
     
    Last edited: May 7, 2024
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  14. jmichaelp

    jmichaelp Member

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    May 5, 2024
    The glucose testing isn't working out. This last time it took 7 sticks - 2 errors, 4 no blood to speak of & the last plenty of blood. I don't know how to do this forever, it's very invasive.
     
  15. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    We determine how to change the Lantus/glargine insulin dose based on how low it takes the cat, not the highs. Try to ignore the high numbers. Some cats will go high before they drop low. 2.5 units is too much insulin. Please drop the dose back down to 2 units for Dude's safety.

    What really helped me with testing was putting a really tiny smear of Vaseline on the place I was going to poke. It allowed the blood to pool together instead of hiding in the black fur of her ears. Also, when you start out, you should be using larger lancets, 26 gauge would help. Typically smaller lancets come with the meters. Once kitty's ears learn to bleed, you can move to the thinner lancets.
     
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  16. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Sorry about your injections, just got back from pain Dr to evaluate my last injection in my lumbar/sacroiliac area.

    I looked at someone else's spreadsheet & it still doesn't click for me. It makes more sense for me to put the insulin dose times in AMPS & PMPS cells for each date & then the test results in columns representing "+" hours from the last insulin dose. The problem with that is when you have "no shot" there's not enough "+" slots & so you have to put the number in the next (AMPS or PMPS) section. That's what makes sense to me right now, but I'm new to this.
     
  17. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Since he's relying on me to syringe feed him there's a big gap from the last feeding. Due to pain my sleep is pretty fractured so that drives when I feed him. So his numbers decline with the lack of food. That forces me to miss an insulin dose. Then the glucose numbers ratchet up during the day due to the lack of insulin. I've got to try to get up early & feed him. if I can't do that consistently, should I give him 0.5 or 1 unit in the am if his blood glucose tests relatively low?

    Thanks, I've been rubbing his ears & putting Vaseline on them. The vet sent me home with "25g x 5/8" needles but I don't recall that they explained what those were for. I guess for sticking him?
     
  18. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    @Bandit's Mom can add separate columns for the times.
     
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  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Lots of tips and videos here: Hometesting Links and Tips It's also important to warm the ears before hand so they bleed better.

    Not sure what you'd use the 25g needles for. Typically Lantus syringes are 30 or 31 gauge needles. Lancets are much smaller (and cheaper) than needles for sticking.
     
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  20. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Thanks. I watched those in the link as well as many others. I'm trying all the tricks, but have not yet used the lancet pen. I thought it might scare him, but I have to become more successful so I guess I'll try tonight.
     
  21. jmichaelp

    jmichaelp Member

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    May 5, 2024
    The lancet worked. The 1st try on #3 failed, but on the 2nd try at #4 I got blood!
     
  22. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Well the lancet pen failed me this morning. Drawing blood after 5x but getting an error code before 2-3 more tries & getting a sample. Dude is at 151 mg/dL. I got up at 6 am & fed him 1/2 his usual amount. He had 2 units last night as @Wendy&Neko suggested I give. I'm not sure what to do, I thought I read not to give a dose if under 200 mg/dL?
     
  23. jmichaelp

    jmichaelp Member

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    May 5, 2024
    I found two protocols & not sure what to do but this one https://felinediabetes.com/FDMB/threads/start-low-go-slow-method-slgs.129446/ indicated going to 25%, so I gave him 0.50 units (as best I could, very hard to see). That took 1.5 hours of crawling around the shower stall & under the bed to get the test, dose the insulin & feed him. Now to get breakfast, feed the colony I care for behind my house, get groceries/cat food & rest my back before time to feed him again.
     
  24. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    @jmichaelp
    You don't need the times in the AMPS and PMPS cells, members probably won't understand and you are not putting in the BG numbers when you first test in the AM and PM .We need them to go in those cells. the AMPS and PMPS cells

    Then if you do another test 2 hours later you put that in the +2 cell
    If you test first thing in the AM ,record it and if you don't give insulin you put NS in the U cell
    The way you are doing things I don't think any member will be able to give you any advice on what to do or when you need to increase or decrease his dose to see how low his numbers are dropping

    I explained this in my post #10 how the spreadsheet works and how to enter everything :cat:
     
    Last edited: May 8, 2024
  25. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Last edited: May 8, 2024
  26. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I don't see where you gave 0.50 units on your spreadsheet was that this morning (5-8) ?
    @jmichaelp
     
    Last edited: May 8, 2024
  27. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Thanks , sorry about your pain too. Back pain is the worst.
    I had facet injections recently for my lumbar area and they really worked
     
  28. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Yep, Dude kept me up a lot last night & I was worn out. Just entered it.
     
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  29. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Doing my facets now due to arthritis. Next will be SI joints. Both will get nerve ablations.
     
  30. jmichaelp

    jmichaelp Member

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    May 5, 2024
    I'm not sure what to do. The SLGS method states "Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise." My vet had Dude on a very high dose, 2.0 units then 2.5 units. Dude is at 264 & his average value right before a shot is 278. Do I reduce it & to what level? I gave 2 units last night & only 0.5 units this morning.
     
  31. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Well, I tried 1.75 units.
     
  32. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Blood glucose down to 62 this morning. I don't know whether to give him 0.5 units or nothing.

    I bought some larger lancets & had only 2 failures before getting a reading, so at least that's a little better.
     
  33. jmichaelp

    jmichaelp Member

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    May 5, 2024
    I've updated the spreadsheet, trying to get it how you all want it. It has zero value to me right now, I keep a much more extensive spreadsheet detailing the timing of all of his food & carb intake, injections, meds, etc.

    I'm only able to take two readings per day. I've had so many failures that it takes awhile. I have to syringe feed him, which takes awhile to prep & clean. I have to administer the inhaler & other meds.He also needs sub-q fluids.

    Last night I worked myself to collapse. I have to crawl under the bed or the desk to get Dude every time I do something. I have an unrepaired torn left rotator cuff, on the right a delaminated bicep & two full-tear rotator tendons that were just repaired, my neck is fused C3-C6, I have arthritis in my lumbar facet joints, I have instability/laxity in my SI joints, I had a lot of inflammation from the covid shots that messed up my GI system so that I'm severely limited in what I can eat & that takes a lot of prep time. I can neither stand nor can I sit at the computer for long periods.

    My priority is on helping my cat, not a spreadsheet. I need help & am doing the best I can. This week it may come down to me no longer being able to care for him.
     
  34. jmichaelp

    jmichaelp Member

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    May 5, 2024
    I keep reading about ketones & am unsure as to whether anyone can tell me if I should give Dude a dose, perhaps 0.5 units, or not since his reading this morning was 62. If I give no shot his second test seems to be high.
     
  35. jmichaelp

    jmichaelp Member

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    May 5, 2024
    This was the worst attempt at glucose testing yet. It took about 17 minutes of restraint, which I hadn't needed to do, & rubbing his ears. Twice I was able to draw enough blood but he shook his head on one, two error codes & multiple without enough blood. I think the only way to get blood is to hit the vein & he's not liking this anymore.

    Tonight's reading was 298.
     
  36. jmichaelp

    jmichaelp Member

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    After tonight's episode he jumped into the bathtub. I didn't know he could still do that. He wants to be left alone. I'm not sure what this means.
     
  37. Don Degludec

    Don Degludec Member

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    Feb 17, 2024
    Hey Michael,

    There is a newly published, Moderate-Intensity Home-Monitoring Protocol written for Lantus users who are unable to test more than twice a day. Given your circumstances, and the myriad of issues both of you are dealing with, this may just be the one that you and Dude need at this moment in time. Once stability is achieved and the both of you are in a routine and in better spirits, a tighter protocol [SLGS or TR] could perhaps be considered.
     
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  38. jmichaelp

    jmichaelp Member

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    May 5, 2024
    No one on this thread provided help after last night's trauma. He was trying to hide/get away from me. I watched him to see if he'd want to be fed until I fell asleep watching at 1:30am. I didn't feed him or give a shot. Without any feedback I was resigned to take him in today.

    This morning we had a huge storm that prevented me from getting to the vet. I was able to check his glucose. It was at 373 so I fed him & gave him 1 unit of insulin (hopefully, it's such a small amount & I could've pressed it early, I wasn't sure).
     
  39. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    I hope they help :cat:
     
  40. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Michael when ever you need help you want to start your title off with a ? Then Help Needed then what ever you need help with .

    You might want to ask your vet about this since you are in so much pain with back issues
    About the Freestyle Libre
    Tap on the blue link , there is a discussion about it
    https://felinediabetes.com/FDMB/thr...-diagnosed-with-diabetes.274874/#post-3051322

    I found this written by another member
    I had the Libre it’s very easy to use but from what I know it’s a temporary use . The sensor is suppose to last for 14 days but rarely does , I got 9 days out of my first sensor before it had to be replaced . Here are you Pros and Cons
    Pros - Once on very easy to read . You can read anytime . You can you the reader or your cell phone . The sensor reads BG every 15 minutes on it own but you still have to wave your reader or cell phone to get a reading
    and your Vet can access through a computer watching day through the night .
    Cons - The sensor is put on with surgical glue some kitties can have a reaction to the glue .
    You have to cross your fingers your cat will keep the sensor on and not scratch it off .
    The sensor may not last for 14 days and are about $ 40.00 dollars to replace .
    If you can’t use your cell phone to read the sensor the reader is about $65.00 dollars

    Found this also posted by another member
    I made avideo in English about the FreeStyle Libre,which shows how to apply it (complete with built-in blooper, be warned) and gives some explanations as to the interest of such a device for a diabetic cat.

    Here are the situation in which I think the FreeStyle Libre can be a precious solution:
    • untestable cat (some really are, I have come to discover)
    • cat who requires a lot of medical care for other conditions or stressed out by medical handling
    • caregiver away at work all day
    • caregiver often away for travel
    • holidays with petsitter, or boarding
    • stressed caregiver
    Advantages:
    • less handling of the cat (you can read upto 8 hours of measurements in one swipe)
    • anybody can swipe the sensor as long as they can approach the cat, it's a much simpler gesture than an ear test
    • no need to stick to a "schedule" of testing (way less stress)
    • possible to go out (have a life!) or sleep without losing measurements
    • one sensor application lasts upto 14 days
    • closer monitoring means you never miss anything, takes the guesswork out of interpreting glucose values
    • great for observing trends
    • reader shows visual curve for the day, can be easier to interpret than raw numbers
    • non-stop monitoring can allow for more aggressive dosing with appropriate experience/supervision
    Disadvantages:
    • price!
    • need to go to the vet to have the sensor applied, orlearn how to do it (not rocket science but you need to be shown how to do it correctly)
    • sensors do not always last 14 days, some die early (have a spare and expect some failures) and can fail unexpectedly
    • LO reading under 40, so if you want more detail in those values you'll have to resort to ear testing
    • interstitial glucose means there is a 5-10 minute lag behind blood glucose (not a big issue, particularly with Lantus or Levemir, just be aware of it)
    • we are not certain what the safety thresholds for methods developed with human blood/plasma equivalent meters translate to for interstitial glucose readings from a sensor designed for humans placed on a cat (not necessarily an issue, if you are worried you can get some readings at low values with a meter you are familiar with -- I did that and got readings of 60 and 65 on an AT2 for LO on the FSL)
    Tips:
    • add superglue to the sensor glue before applying (make sure the chosen glue does not irritate the skin)
    • if needed, use acetone or baby oil to remove the sensor; worst case scenario, you can remove thesensor from the sticker that is attached to the skin, and leave the sticker in place if it is too firmly stuck
    • get a surveillance camera so you can monitor your cat when away and check behaviour during low values after the fact
    • try leaving the sensor bare: bandage or shirt will bother the cat more than the sensor
    Summary:

    If you can afford it, go for it! I've found it was a huge improvement on my quality of life as a caregiver, even compared to ear testing a very compliant cat likeQuintus. The amount of data allowed me to be much more confident and aggressive in my dose increases -- bearing in mind of course that this is not my firstdiabetic cat, that I've followed hundreds over the lasttwo years, and that I am at home most of the time these days and have a surveillance camera set up.

    You can always start a new thread and ask other members that use it
    @jmichaelp
     
    Last edited: May 10, 2024
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  41. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    There are way more experienced members on this forum to provide advice than I, who's only been dealing with diabetes for over a year, but...

    In my opinion [for what's that worth], and 'if Dude was my dude' - I would keep with the 1 IU twice a day for at least 3 days. Ideally we rather see consistent numbers [e.g. pinks] both AMPS and PMPS, rather than a 60 and a 400 like on the 7th of May. The key is to keep the cat as stable as possible, and it's not something that can be rushed, or you'll end up with inconsistent data which let alone will give you the struggle and dilemma to adjust Dude's dose constantly at every cycle, but you'll have a cat who's BG is all over the place, making him feel even more miserable and it'll endanger him greatly.
    If those pinks don't turn into yellow after a few days, then I would increase the dose.
    With not giving him insulin for a whole 24 hours [so two NS cycles], it is safe ish to assume, that majority of his insulin depot likely has drained, so that pink we saw at today's AMPS is not influenced by much leftover [if any] insulin in his body. Therefore, today could be looked at as a fresh start, or "day 1" for the both of you, and from here on you can slowly build him back up. The keyword here is slowly.

    These are my thoughts and observations, but if more experienced members are happy to give advice regardless of the lack of data and your inability to test him more often, then please feel free to ignore me.
     
    Last edited: May 10, 2024
    Reason for edit: *inability, not ability
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  42. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    I tried a dozen times over 25 minutes. E2 - Used Test Strip or E8 - Strip or Test Errors or no blood. I can't keep doing this to him.
     
  43. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Thank you for that. I don't want to take him to the vet unless I have to. The last time he was hyperventilating, drooling because of that, and his heart was racing. They had to put him on oxygen immediately. I'd have to do it myself, so I'll look into that.
     
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  44. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    I've used it before! :oops:
    Happy to share thoughts if and when it becomes applicable. Especially regarding application and materials I used for it - I always applied them myself [please stay away from superglue, there are better options :nailbiting:] and some discrepancies re: readings I've noticed.
     
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  45. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Well, before going to buy more strips I tested it on myself & it worked fine. If I can't get results right before time for insulin I guess I'll give 1 unit?
     
  46. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    Yes.

    But I'd still try to get in a second test for today, later on in the cycle after you've given insulin, like at +3 or +6 or whenever you can/before you go to bed. It would provide the more experienced members with a better overview, so hopefully they could be more confident in giving you slightly more specific dosing advice.

    Just double-checking: Are you aiming to the outside of the pinna [aka the "sweet spot"] when trying to test him and not in the actual inner triangle part, right?

    upload_2024-5-11_2-18-7.png
     
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  47. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Yep, it's mangled with punctures. I think I have to hit the vein to get blood but it causes him to sometimes shake his head, twice I've lost the blood because of this. I'm using a 26 gauge lancet now but it hasn't helped.
     
  48. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    First try! Blood glucose 189. From reading, it appears I should decrease all the way to 0.25 units??
     
  49. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    I went with 0.5 units since I'd given that amount before & since I can't really see 0.25 units on the syringe - I could've been giving no insulin at all if I tried 0.25. I syringe-fed him 57 calories, about 0.36g carbs.

    I can't believe the vet had me giving him 2.5 units! I'm lucky he didn't go hypoglycemic.
     
    Last edited: May 10, 2024
  50. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    I'm gonna be brutally honest with you, he probably did, we just don't know about it due to the lack of data/tests. But he's clearly been riding them out like a wee champion he is! ;) Their bodies know something is wrong, and when they drop to dangerously low levels they either
    a) intuitively seek food to bring their BG up [is there a possibility he'd eat on his own without your knowledge e.g. when you're asleep?]
    b) their liver "panic" and secrete extra glucose.
    The suggestion to lower his humongously high dose drastically was based on him giving very inconsistent BG values - to me it looked like he was "bouncing" - dropping low, then bouncing sky high as a result of his panicky liver.

    I'm incredibly happy for you have being able to get a test for first try! It'll become easier, once his blood is less concentrated/clogged with sugar, allowing for easier blood flow.
    Plus clearly your patience and persistence is paying off, too!

    You were meant to decrease by 0.25 IU, so his dose should've been 0.75 IU. Let's see what he gives you for AMPS. Hopefully it's another blue, then you'll know your judgement of injecting 0.5 IU was correct.
    However, looking at his sheet where you shot a blue with 0.5 IU, the following PRE was yellow, which makes me think he'll give you a yellow AMPS again.
    With that said though, Lantus likes consistency, so perhaps it would be best practice to keep with the 0.5 IU for the next at least 5 cycles.
    In these upcoming 2 days, could you perhaps buy a digital caliper, which would allow you to measure out 0.25 units?

    Well done Mike and little Dude, you've got this! :cat:
     
    Last edited: May 11, 2024
    Reason for edit: panicky *liver, not pancreas
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  51. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Another first time success! Blood glucose at 373. This is the same as the "no shot" value, so it looks like he needed 1 unit for the PM dose. I'm going to give him 1 unit, the same as yesterday's 373 & see if it moves blood glucose down as much as yesterday.
     
  52. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    This 373 reading is almost 2 hours since being fed while yesterday's was fasting.

    Whether he will live is still undecided. I discontinued the Zeniquin for his UTI, that seemed to bother him, when I stopped it before I wasn't sure now I am. He was more active this morning, even tried to jump up onto the bed with me.

    I see where it states reducing by 0.25 units but then references the FAQ & states:
    Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
     
  53. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    We don't feed 2 hours prior shooting, for the pre-shot number is being influenced by the food and it reads higher. We test, feed and shoot [usually while their heads are in the bowl]. His "actual" pre-shot value likely have been much lower than 373, probably in the yellows [or maybe even in the blues].

    I'd encourage you to stick to a consistent dose, or you'll end up in the exact same predicament where you were at the beginning.

    Lantus. Likes. Consistency.

    Dude needs 0.75 IU twice a day in my opinion. If you can't measure that, stick to 0.5 IU for the following 3 days. You can't keep dose-hopping, you're endangering him.
     
  54. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    I have to feed him when he seems hungry. Sometimes he doesn't want the syringe. The spreadsheet doesn't show food consumption, which is a reason it didn't make sense to me. So I assumed that food must not matter as much as I thought.

    As I'm interpreting the guidelines, they indicate that I should alter the dose according to his blood glucose level. I'm confused.

    With two straight 1st attempt successes, I'm going to try to get more readings during the day today. However since I'm syringe-feeding him throughout the day there's always going to be a food effect.
     
  55. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    I stand corrected, apologies. It's been a while since I've followed SLGS.

    I don't understand your thought process, Mike. First you state you wanted to give 0.25 IU, then you state he likely have needed 1 IU. Although the latter may be the case, due to the lack of monitoring and data, we cannot be sure. It takes time to see a pattern in a spreadsheet, and some experience and knowledge to understand how depot insulins work.

    E.g. you shot 1 IU on a pink yesterday AM. Nadir [the lowest point in cycle] can occur anywhere between +4 and +8 [as a rule of thumb we say usually at +6]. His PMPS likely reflects his BG curving back up already. Had you shot that number with 1 IU, in the PM cycle he could have dropped dangerously low while you're asleep. There is also an overlap between doses...

    That's why it's so important to get at least one more test mid-cycle. Also, please remember, we adjust the dose based on the nadir. If you're able to get in more tests mid-cycle, you have to adhere to those rules, for the safety of your cat.
     
    Last edited: May 11, 2024
  56. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    Sorry, we were posting at the same time.

    Food does matter, quite a lot. It is encouraged to feed the cat all day, or "feed the cycle" per se, so his BG stays stable or he's giving us a "flat" cycle - meaning he is in the same colour bracket throughout the entire cycle.
    The original [German] guidelines state to feed the cat at AM PRE +3 +6 +9 / PM PRE +3 +6 +9. I believe here is encouraged to feed the cat every 2 hours. Sounds like it's working out perfectly in your case, but I would definitely hold food off for 2-3 hours prior to PRE checks.

    We alter the dose based on the lowest point in cycle which is why it's important to spot-check the cat throughout the day. We only alter the dose based on pre-shots if it's too low for comfort. It is to ensure the cat doesn't go hypo mid-cycle - see my previous comment re: why it was wise to give him a reduced dose seeing that blue at PMPS yesterday.

    If you can, today try and check Dude at +6. Tomorrow at +4. The day after +7...etc. This way the "gaps" will be filled on the sheet, thus more accurate dosing advice can be given.
     
    Last edited: May 11, 2024
    Reason for edit: i can't bloody type lol
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  57. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    You can add food consumption in the "Remarks" block at the far right column of the sheet. Or can even type the food amount and type etc under the hour [e.g. +3, +6 etc] when you feed him.
     
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  58. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    I was able to get blood to test after only 2 tries! Blood glucose level at 225. I was antsy & took it early (2hr 45min), wanted to make sure if was before the next time I feed him.
     
    Last edited: May 11, 2024
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  59. jmichaelp

    jmichaelp Member

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    May 5, 2024
    From what I read "give a token dose (10-25% of the usual dose)". "The usual dose" is that which I was adjusting down to, 1 unit, from the earlier very high dose. So 0.25 units for the PM dose, but 0.5 units was the only value I thought I could reliably dose so that's what I gave. I also didn't want to give him much (i.e. 1 unit) and have him go hypoglycemic when I was asleep so I was unsure about how much to give.

    I went with 1 unit for the AM dose to give a consistent dose & because that's what I gave the previous day when he was at 373. I was going off the feline diabetes spreadsheet & forgot to look at my spreadsheet that has feeding time/amount on it.

    Due to my lack of knowledge, I'm asking before each dose & putting a "?" in the title. If I don't receive a response then I have to make a decision give him the insulin.
     
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  60. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    You're doing great Mike, and learning fast! You'll have this down to a T in no time ;)

    If you need dosing advice, start a new thread under Lantus/Levemir/Biosimilars, starting with the current day's date, whether you need help with AMPS or PMPS and the value. Can pop a question mark at the front as well, so it pops out to the mods/well-known members. You'll see there how the members write their titles.

    E.g.:
    [?] 11/05 Dude PMPS 190 - Do I shoot?

    Or 05/11, even. My mind is set to EU date format :smuggrin:
     
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  61. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Thank you so much for your help & patience!

    Really happy to report that Dude is doing so much better post-Zeniquin. He actually went exploring all over the house & all of the way out to the screened porch to look over his territory. He was able to interact with my other cat Lilli, which was good for both of them (she knows something is going on in my office & doesn't even come in anymore, never asked to her to refrain from doing so).
     
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  62. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    I'm glad I could help :bighug:

    That's wonderful news!!! I'm extremely proud of you, and over the moon that you didn't give up on your little dude, regardless of all the struggles you both are experiencing.
    Remember: ask for advice, but if something doesn't sit well, go with your gut - like I know you would, e.g. signing up to this forum and asking for dosing advice here and discontinuing Zeniquin. I am 100% sure your vet has Dude's best interest, but sometimes vets get overwhelmed too [they're only human after all] so they may overlook or misjudge things.

    Now if I can be cheeky enough to ask you to try and get in an additional test at the +6 or +7 mark please... :smuggrin:
    Provided that, once PMPS hits and Dude's BG is under 200 again, if you post in the Lantus forum, the experienced members will be able to help you hopefully, if they see how low 1 IU brought Dude down from the pinks/have a rough idea how the cycle progressed.

    Edit: If/when you're starting a new thread under Lantus, you may want to copy-paste this thread's link on the top [not the title, but on top of the conversation/post box] so others can have easy access to this sequence of conversation, to prevent questions repeated etc etc. Would eliminate probable confusion and speed up things both for you and the members who'll try to help you.
     
    Last edited: May 11, 2024
    Reason for edit: copy link suggestion
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  63. jmichaelp

    jmichaelp Member

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    May 5, 2024
    Blood glucose nadir test 173. 2.5 hours after feeding 57 calories. Do I need one more test before his PMPS?
     
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  64. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    Excuse me, where is the "I can't test my cat" Michael, and what did you do to him? o_O:D

    I was just going to ask whether you think you could get in another test before PMPS, but I didn't want to push my luck :nailbiting:

    Will you be able to monitor the PM cycle at all? If so, give your boy a break for now [and lots of pets for being amazing with the ear pricks] and perhaps test him during the PM cycle. If you won't be able to monitor that, then a +9 before a little feed would be great. And try to not feed him after that [so after +9.5/+10 - depending how long it takes for him to eat].

    I'm wondering whether your little champion will be giving us a blue as a PMPS again...
    Since you've shot last night's blue with 0.5 IU and the cycle wasn't monitored/tested, we can't be sure whether he gave us a pink AMPS today because
    a) the 0.5 IU wasn't enough, or
    b) the 0.5 IU was too much for a blue and he dropped low and bounced back up by the morning... or
    c) simply because you fed him before the AMPS test

    But I'm thinking way ahead already.

    Edit to add: if his PMPS is blue again, definitely post and ask for advice under Lantus, mainly because 1) more experienced members, but also 2) I probably won't be awake to see if you post under this thread.

    Edit #2: if his PMPS is yellow, I think you can safely give him the 1 IU. But if you're not sure, it's always better to ask.
     
    Last edited: May 11, 2024
  65. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    Luck be a lady tonight - was headed to Vegas after my recent success!

    I was slated to feed him @7:30 pm & then @11:30 pm. With that schedule, I could give a +10.5 but then I'd have to give another right after for PMPS.
     
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  66. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    Oh no, men of Vegas better be locking away their girlfriends tonight!!! :nailbiting::D

    Mike, I have absolutely no idea what time zone you at, I'm in GMT, so on my end it's 00:15 at the moment.

    We normally feed the cats with a main meal/bulk of their calories after testing their pre-shots/giving them the insulin. I inject mine when his head is in the bowl and he doesn't notice it, because I'm not willing to put up with his dramatic attitude. Then we feed them little amounts of food throughout the cycle, don't feed at least 2 hours prior to the pre-shot checks, and rinse and repeat.
     
  67. jmichaelp

    jmichaelp Member

    Joined:
    May 5, 2024
    So the PMPS was at 143. This is a continual decline from the AMPS of 373. Last night the PMPS was 189 & jumped to that 373 with 0.50 unit of Lantus. So it seems as if I should give more tonight since last nights jump. I didn't hear from anyone so I went with 0.50 since I'll be feeding him less than last night.
     
    Last edited: May 11, 2024
  68. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    Ummm... no?
    From what we know his nadir was at PMPS. You're injecting a still decreasing number...

    If you don't feed him during the night, this might be the case.
     
  69. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I'd like to kindly ask that you start a new thread. If you look at the top of the board, there are a couple of posts that ask that threads be capped at 50 posts. There's a lot to read! You can link this thread to your new one.
     
  70. Don Degludec

    Don Degludec Member

    Joined:
    Feb 17, 2024
    He did here, under Lantus.

    Sorry, it was my fault too - the # of each post doesn't show on my phone for some reason.
     
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