Feedback or help needed - after 12/26/13

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mfrancis69

Member Since 2013
I have been posting now for about two months and after looking at my spreadsheet I have been told that Sassy's numbers are doing good and the possibility of remission could take place.
My question is, what does that look like? If she were not diabetic what would her numbers be and how would I know that she is in remission.

My learning about her health and how to see the things that I am being taught has all been attributed to this forum.
I have learned much more than my vet ever told me, but still feel like I am in the dark of the knowledge I should know to help Sassy best.

Wendy and Tiggy, you have helped me the most and posted a lot of helpful comments on Sassy and her numbers.
One thing that confuses me is she will have a few days where her numbers are great but then her numbers will be higher that evening
and the next day and they will stay that way for a few days and then her readings are really good again.

I know she is feeling better, she is more active and she fights me when I try and do her testing, as if to tell me to leave her ears alone.
But she has transitioned into the whole process quite well and she actually comes when I call her at time for her testing.

A little more guidance on understanding the highs and lows of he numbers would be great, any feedback welcome.

Thanks
Melissa and Sassy
 
Re: Happy Holidays - feedback needed

You have some great looking numbers there! The longer Sassy spends time under 200 and in "normal" range (50-130), the more likely her pancreas has a chance to heal. If she is able to get into remission, then you're definitely on the right track. A good sign she's headed to remission is if you start having to drop her dose and she's able to hold the reduction. You might even be able to try a reduction now since she's been maintaining so well on this dose for so long. Eventually, her dose will drop to zero and that's when you start the 14-day OTJ Trail (Off The Juice Trial).

Some kitties might never go into remission; that's okay, too. Your numbers are really incredible either way. I wish I could get numbers like those for Mikey and he's been on insulin for over a year!

You're not having really disparate numbers, so it's doubtful Sassy is bouncing, at least not a lot. When you see her going higher on some days, what you're seeing is most likely just the fluctuations in the Lantus cycle, which might be due to the previous dose wearing off faster than the next dose kicks in (the "overlap" window is shorter so numbers have a chance to creep higher).

It could also be minute variations in the markings on the syringe, meaning you gave a slightly lower dose because the lines don't match up with the other syringes. This happens more often than you'd realize. Not a big deal for humans who take quite large doses, but can be very noticeable in our kitties who take much smaller doses so even a little bit of a discrepancy is reflected in their numbers. That's why some of us will dose with calipers to remove that possibility from the equation. It could even be caused by fluctuating levels of eating and/or the times she's eating at.

Either way, you're doing a great job with Sassy! :thumbup
 
Re: Happy Holidays - feedback needed

Remission happens when you follow a Lantus protocol and gradually have to lower the insulin dose because otherwise, the cat would go too low. "Ah! But what is too low?" you ask. They are noted below.

Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak.

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
 
Re: Happy Holidays - feedback needed

If I'm reading her spreadsheet correctly, you are not always testing and shooting 12 hours apart. That is crucial for Lantus. It carries over some from shot to shot and you want that carryover to be very stable. Too much overlap may result in unexpectedly low numbers (aka "crossing nadirs").

Also, whenever you can, you want to snag a test in the +5 to +7 hours after a shot. This is when the glucose level is likely to be at its lowest - the nadir of the 12 hour cycle between shots. With good control, you want it no lower than 50 mg/dL (see previous chart for mmol/L and AlphaTrac numbers). Some folks will set an alarm in the middle of the night to test around the nadir, as they work full time and can't test during the day. Others will test on weekends or days off. Whatever you can manage helps your kitty.

Have you read any of the sticky notes in the Lantus Tight Regulation forumyet? You'll find them quite helpful in terms of how to handle and store the Lantus to maximize its use, when and how to adjust the dose, and, if you want to post in the Tight Regulation forum, how they do their daily posts.
 
Re: Happy Holidays - feedback needed

Thanks for all the input so far, I always get very valuable information on the forum.
As I mentioned before, I didn't receive any of this guidance from the vet at all, they just wanted me to continue to come in and pay the fees and re-test frequently.
That would have cost me a fortune.

I will be doing more mid cycle testing and I have always tried to stay as close to the 12 hour time frame as possible.
There are times when I am not home and I may stretch that a little, but that is why I post my times in my notes area so that I can keep track of when she has had the shots.

I appreciate the feedback very much,I learn something new on here all the time. KPassa, your feedback was most helpful.

The chart that you posted BJM, I have seen it posted for me before and maybe because the vet didn't explain anything to me about what to look for and how to handle her day to day etc, the chart is like reading greek to me.
Being new to the forum, I will have to dig into the terms and familiarize myself better.

Thanks again
Hope everyone has a Happy Holiday this year.
Melissa
 
Re: Happy Holidays - feedback needed

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Re: Happy Holidays - feedback needed

As I mentioned before, I didn't receive any of this guidance from the vet at all, they just wanted me to continue to come in and pay the fees and re-test frequently.
That would have cost me a fortune.
Yes, this is another reason for home testing. With a human glucometer with inexpensive test strips like the Relion Prime of the Relion Micro or Confirm, you can do the testing at home for much, much less than at the vets. Also, the home testing is much less stressful on your cat and gives you more accurate numbers without that "vet stress" influence.
 
Re: Happy Holidays - feedback needed

She does have good numbers - but not quite good enough - as far as we can tell. We really need to see if she is going under 50 and you are missing some night data. But the testing you have been doing the last few days is very useful.

I usually recommend 3-4 tests a day

- always before the shots
- mid cycle - This is to see how low she is going. The low point "nadir" is what you base dose changes on - we are trying to see if she is going under 50.
- before bed (2-3hours after Pm shot) to get an idea of what her overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

I would definitely get mid cycle tests if her pre shot test is green. If we catch her going under 50 we drop the dose - which is a step toward remission.

Wendy
 
Re: Happy Holidays - feedback needed

All of this is very helpful.

Because of the lack of information given to me from the vet, I definitely decided this was something I needed to learn and take care of myself.
I don't need a vet to test her blood every week or two to tell me what is going on, especially at about $200 per visit.
This forum has taught me so much and I know I have a lot more to learn.

I did a curve on her the other day and I believe her number are a little higher than usual because it was the end of a insulin vial.
I will continue to test and do another curve in a week or two to see where she is with the new vial.

I appreciate all your input and feedback.

Happy Holidays to you all.
Melissa
 
Re: Happy Holidays - feedback needed

Melissa,
When I start fresh insulin, I'm always a little careful, just in case the old insulin was starting to give out and the new insulin gives an extra bit of push on the numbers. KWIM? I would test a couple of extra times when starting that new vial.
 
Re: Happy Holidays - feedback needed

Hope all of you have had a Happy Holidays with family and friends.

I need a little advice, Sassy's pre-shot number this morning was 48, I know that it a good number, but what I don't know is "Do I still give her a shot or do I wait, or what should I be doing?"

The vet didn't tell me how to read the tests and how to treat them, I have learned most everything I know so far from the forum only.
All the advice and guidance I get has been extremely helpful, but I know I still have a lot to learn.

Please let me know what I should do when this takes place, I don't want her to have too much but I don't want to deprive her if she is still in need of the insulin.

Thanks
Melissa
 
Re: Happy Holidays - feedback needed

No shot.

Stall - Wait 30 minutes without feeding and re-test. If still too low don't shoot.

Unless and until you have test data showing that you can "shoot low to stay low", don't.

Also, that pre-shot warrants a reduction of 0.25 units (eyeballed, since syringes don't mark that precisely).

It will be higher this evening. That's normal.

Please read the Tight Regulation Protocol for Lantus, then come back and ask questions. In fact, you might print it out and give a copy to your vet, who may be unfamiliar with it.
 
Re: Happy Holidays - feedback needed

Ok, I probably should have asked the question before I took action, so I gave the shot anyway.

Now the question is what do I do now. Should I monitor her more closely today, I haven't fed her yet, But I gave her the usual shot of 1.5 units.
I have never had a good number like this on a pre-shot yet, so I didn't know what to do and her numbers have been good the last two days.

Thanks BJM for your quick response.
 
Re: Happy Holidays - feedback needed

Feed her now! You have shot dangerously low with no data!

Have you got high carb gravied food on hand?
Have you got Karo syrup, honey, molasses or the like?
 
Re: Happy Holidays - feedback needed

Yes, I have Friskies Pate and I do have something sweet I can give her.

When should I test her next? right after she eats or within an hour or so?

Thank you
Melissa
 
Re: Happy Holidays - feedback needed

Retest now. If she is below 50 mg/dL, feed her 1-2 teaspoons of high carb gravy or mix some syrup in with some canned food and feed that.

Lowest levels hit around +5 to +7 hours after the shot.

Start feeding her now. You have set her up for a possible hypoglycemic episode which could kill her.

I've posted a 911 in Lantus to get some experienced eyes over here as I'm at work.
 
Re: Happy Holidays - feedback needed

Ok, I fed her and she ate more than half of what I gave her which is normal . I couldn't get her to have any of the Karo syrup though, any secrest on how to get then to eat that?

I will test her right now as well. Her number right now is 84, so I think things will be ok.

Thanks so much for all your help.

Melissa
 
Re: Happy Holidays - feedback needed

Lantus builds slowly and last a long time.

Check again at +2 hours after the shot; this is when it may start dropping. If she is below 100, I would keep testing about every 30 minutes. Do you have enough test strips?

Watch her like a hawk between +5 to +7 hours after the shot, when she is likely to be lowest and continue testing

Remain vigilant - here's what to watch for:

SYMPTOMS
Some cats may have NO symptoms whatsoever, but here are the most common ones:

MILD HYPOGLYCEMIA
Sudden ravenous hunger
Shivering
Weak or lethargic

MODERATE HYPOGLYCEMIA
Disorientation
Trouble with vision... bumps into furniture
Poor coordination, such as staggering, walking in circles or acting drunk
Changes in head or neck movements
Restlessness
Urgent meowing
Behavioral changes, such as aggressiveness

SEVERE HYPOGLYCEMIA
Convulsions or seizures
Unconsciousness

TREATMENT

During treatment for hypoglycemia, try to test every 15 minutes until you see the bgs begin to rise. Then continue to test until you are satisfied that the cat is out of danger.

VERY LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a very low number (under 40 mg/dL or 1.9 – 2.2 mmol/L) administer a tablespoon of corn syrup, liquid glucose, pancake syrup or honey, or INSTA-GLUCOSE and follow with food until the blood glucose numbers rise to acceptable levels. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If using liquid glucose, dilute with water for a thinner consistency.

LOW NUMBERS – WITHOUT SYMPTOMS
Retest glucose using a large blood sample to make certain you have enough blood, and if you still get a low number (40 – 60mg/dL or 2.2 – 3.3mmol/L) give food or treats until the blood glucose numbers rise to an acceptable level. If the cat refuses to eat even his/her favorite foods, you can syringe feed or administer a small amount of syrup.

LOW NUMBERS – MILD SYMPTOMS
Try feeding first or give a little syrup or honey followed by food until the blood glucose numbers rise to an acceptable level and the symptoms disappear. The syrup can be mixed with wet food or poured over dry if the cat will eat the mixture. If the cat will not eat, syringe feed. If your cat will eat dry, feed this first as the high carbs will help to increase his/her bgs quickly. You can then follow with his/her favorite canned food. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – MODERATE SYMPTOMS
Give a tablespoon of syrup, a teaspoon of liquid glucose, a tablespoon of honey or a tablespoon of sugar syrup followed by food and continue doing so until you see the blood glucose numbers rise to an acceptable level and all symptoms disappear. The syrup, honey, or glucose can be rubbed against the inside of the cat’s cheeks or on the gums for quick absorption. You can also mix the syrup with wet food or pour over dry if the cat will eat it. Continue to give syrup and food as needed and observe your cat for signs of recurring hypoglycemia. Keep in mind that giving syrup (Karo, etc.) or honey is not enough because the effects wear off quickly. You need to follow with food.
IF IN ANY DOUBT, TELEPHONE YOUR VETERINARIAN.

LOW NUMBERS – SEVERE SYMPTOMS
Rub syrup, honey, or glucose on the gums and cheeks if your cat will allow it. Another option for administering syrup, diluted liquid glucose, honey or sugar syrup to a cat who is seizuring is to fill a needleless syringe with the mixture and insert via the rectum.
NEVER TRY TO SQUIRT SYRUP, HONEY, OR GLUCOSE TO A CAT WHO IS SEIZURING AS THE CAT COULD CHOKE ON IT! RUSH TO EMERGENCY.

AGAIN! ANYTIME YOU CAT IS SEIZURING OR LIMP, RUB KARO, GLUCOSE OR HONEY ONLY ON GUMS OR ADMINISTER RECTALLY AND GET TO EMERGENCY OR YOUR NEAREST CLINIC IMMEDIATELY!!!

Remember that syrup or any other sugared syrup/preparation will spike the blood glucose ONLY for a short period of time, so food is really important with mild and moderate symptoms. Dry food (high carbohydrates) will keep the blood glucose numbers elevated longer, so it’s a better food to give during a hypoglycemic episode.

After a hypoglycemic episode cats may be more sensitive to insulin, so a reduction in dosage is generally required, especially considering too much insulin – whether due to dosage, inadequate food intake, or the cat’s changing insulin requirements – caused the hypoglycemic event in the first place. With moderate to severe episodes, your Vet may have you skip the next injection altogether.
IT IS VERY IMPORTANT THAT YOU DISCUSS YOUR CAT’S HYPOGLYCEMIC EVENT WITH YOUR VET, SO TOGETHER YOU CAN DECIDE UPON THE NEXT COURSE OF ACTION.

Always keep in mind that with low blood glucose and no symptoms, the BG you get is not as important as where it is headed. In other words, if you get a BG of 100 mg/dL or 5.6 mmol/L or less and there are still several hours or more before the insulin peaks, your need to watch your cat (and the numbers) carefully and take appropriate steps. With very low numbers and NO SYMPTOMS, a cat can be fine one moment and seizuring the next.

BE PREPARED! KNOW THE SYMPTOMS AND KNOW THE TREATMENT!


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Melissa & Popcorn (GA) & Sushi (GA)
Joined the FDMB: February 25, 1998
 
Re: Happy Holidays - feedback needed

Hi Melissa

You could be seeing a food spike, and her number could drop again before you know it. DO NOT become complacent. Fingers crossed everything will be fine, but don't quit testing!
Please recheck within half an hour of her last feeding
 
Re: Happy Holidays - feedback needed

Ok, thanks I will keep a very close eye on her today and test her again in another hour, and then every two hours after that throughout the day.

I should have asked the question before giving the shot but now I know, and I hope things will be fine.

I appreciate your quick response and concern for her.

Thanks again
Melissa
 
Re: Happy Holidays - feedback needed

When we have a kitty below 50, we try to just feed the gravy portions of a can of HC. This way kitty wont fill up on the solid food, and will keep eating if we need to keep bumping up the bg.
As for feeding the karo, mix a couple of drops into the gravy. If no luck that way, rub it directly on the gums
 
Re: Happy Holidays - feedback needed

Have you got an oral syringe? That is how we sometimes give Karo or other syrup when needed. They're handy for some meds, too.

You don't need it just yet.

If she gets back down to 50 mg/dL, its going to be
this pattern:
test
feed 1-2 teaspoons of high carb
wait 30 min

and repeat until the numbers are safe.
 
Re: Happy Holidays - feedback needed

Im going to stay with you Melissa, so please post your readings for me :smile:
 
Re: Happy Holidays - feedback needed

What would safe numbers be, what am I looking for to know she is out of the woods?
 
Re: Happy Holidays - feedback needed

Safe is above 50, and after the kitty reaches nadir. But, when giving food, lc, mc, hc or syrup it raises this number briefly. This is good for safety, but NOT safe...until they are doing it on their own without the help of carbs. Does that make sense
 
Re: Happy Holidays - feedback needed

Put a small amount of the Karo syrup on your finger, open up kitty's mouth, and rub on the gums. It'll absorb into the blood stream. You want to try and bring the #s up safely, and steadily. Also, give a small amount of the gravy from a MC or HC food (ie. Friskie's Chicken in Gravy) will help.
 
Re: Happy Holidays - feedback needed

What Angela suggested is perfect when we are bumping the numbers. And you may still need to do this, but lets see what that half hour test gives us
 
Re: Happy Holidays - feedback needed

She's in California and shot about 9ish (?) her time (3 hours behind Ohio).
 
Re: Happy Holidays - feedback needed

I am not sure if I can get her to eat more food right now, she has always eaten very independently.
Is there anything else I can give her to give her high carbs other than the food that might entice her to eat more?

I don't have an oral syringe, should I try a little Karo on the gums now or wait a little longer?

Right now I am at an hour and a half after the shot, I tested her last a half an hour ago.
 
Re: Happy Holidays - feedback needed

She's 2 hours behind me (Texas). As long as she can get a test 1/2 hour after her +1 that she got and marked on her SS, and then another 1/2 hour after that (+2) and then probably more afterwards, that would be ideal.
 
Re: Happy Holidays - feedback needed

Don't give her anything just yet. Let's get another test since it's been 30 min from the 84
 
Re: Happy Holidays - feedback needed

Go ahead and test her again, please. You may see a spike due to the food that she was given. You don't want to give her anything at this point unless she starts dropping.
 
Re: Happy Holidays - feedback needed

I am in California and that is about 3 hours from the Ohio time, my first test was at 9:30 my time and then again at 10:30 my time, it is now 11:00 am here.

Ok, I am testing her again now.
Her number right now is 107.
 
Re: Happy Holidays - feedback needed

Also, in Sassy's spread sheet, type the +1.5 # in the same box as the +1 #. What you'll want to do is type the first test # first, then add +1 (for example: 84 +1 (space) 84 +1.5). It'll list both #s and test times (+1 and +1.5) in the same box. Hopefully that doesn't sound too confusing, and I apologize if it does.
 
Re: Happy Holidays - feedback needed

She's looking good. On a steady climb. I would hold off feeding her, and personally if she was my kitty I would grab one more test in a half hour to make sure it is a climb. If she is still going up or surfing around that number, you could do the following tests an hour apart until nadir. We have seen some kitties decide to dive again towards nadir, when they were so low early in their cycle.
 
Re: Happy Holidays - feedback needed

Only 5 more hours of monitoring to go...

This may turn out to be a non-event, but I'd rather be safe than sorry.
 
Re: Happy Holidays - feedback needed

One other thing... Don't be alarmed if her #s are a bit wonky tomorrow. It's simply due to today's episode, and will clear up within a day or so. It's called a bounce, and we all deal with them. :-D
 
Re: Happy Holidays - feedback needed

Ok, I can keep an eye on her for another 5 hours.

I will test again in another 1/2 hour, but then should I change to every hour?
 
Re: Happy Holidays - feedback needed

Perfect. Retest and post for the half hour. Then if she's still going up or surfing, you can switch to the hour. If you feel more comfortable doing another one in the half tho it is up to you. I wouldn't wait longer than an hour tho.
And yes, you are doing a brilliant job! Hopefully she stays up and this is all just 'practice' for you ;-)
 
Re: Happy Holidays - feedback needed

You can test each hour after this next test, if you'd like. I think her next test in less than 1/2 hour will tell you that she'll be rising some more, though, due to the food. Since you'll be home, you can keep an eye on her.
 
Re: Happy Holidays - feedback needed

Ok, I just tested again and her number is 78.

She is acting her normal self, after her food and morning shot she sleeps for quite awhile and that is what she is doing now.

What do you suggest I do, since her numbers are starting to go down again instead of up?
 
Re: Happy Holidays - feedback needed

I suggest getting another test 1/2 hour from the last one, then we'll go from there. You may need to feed her more HC food and/or a small dab of syrup on her gums. Her next # will tell us.
 
Re: Happy Holidays - feedback needed

I would test again in half hour. Yes they are going down, but not crashing. You could offer her a small amount (tsp) of lc whatever you normally give, to help her surf. Don't give too much yet tho. Just keep an eye on her that she continues to act normal. When you get your next test please post it in your top (1st) post line of this condo.
 
Re: Happy Holidays - feedback needed

Hi, Melissa. It sounds like you're having an "exciting" cycle -- or Sassy is.

The instructions we use for handling low numbers are in the link. They will guide you as to when you can shift to testing every hour. For now, you really need to be testing Sassy every 30 min. That first test most likely reflected a food spike. Since the numbers dropped, that's probably where Lantus onset began and number may continue to drop. In this scenario, it's best to remain vigilant rather than get caught off guard with Sassy sitting in very low numbers.
 
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