? finally some blues with (challenges). Protocol guidance pls

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Arman Matin

Arman Matin

Member Since 2017
Progress:
Finally Raja is showing blues. His appetite is good. Shows more energy. Some improvement in his hind legs.

Setbacks:

Vet recommended lower dosage so being doubtful I had two cycles of low dosage before following board advice and protocol and bringing it back up (thank you)
Fur shots plagued me a few times
Walmart 2 day delivery turns into 5 and emergency 1 day delivery of alpha track strips doesnt come on time
Especially at this crucial point I didnt have enough strips to test
Work has me occupied twelve hours of the day

Today I decided to take a "safe" shot of 5U versus 5.5 as I dont have enough data during his nadir points and he is new to this low numbers.
Hopefully i get the strips today and continue monitoring and back to 5.5 depending upon his numbers.

Am I doing the right thing ?

thanks so much every one
 
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So far it looks pretty good. Glad Raja appears to approve as well! Lots of vets are not used to cats that need higher doses of insulin. My vet was a "no cat needs more then 5u" preacher until Jack came along, he has taught her a few things:smuggrin:.
I would think about sticking with the current dose for a few days to see where things stabilize at now that you are seeing some good blue on the Alphatrack. It looks like Raja bounced after the blues on 3/12 and cleared it sometime during the day yesterday. Bouncing is annoying, but usually gets better as the kitty spends more time in the good number ranges.

Fur shots happen to the best of us, all you can do is ride it out, never give more insulin.
Test strip fun, I've run low without realizing it as well. Many members have a backup meter and backup box of strips. When new strips come in, swap the old emergency box with the new one to keep them from expiring. I like to have a good 100 around at least. Cats love to pick the worst time to go low and having plenty of strips means I have one less thing to worry about.

A few notes on things I see:

It looks like a few days you missed a test before shot time, that is a critical time to get a test in to see where the starting point is. You can see quite a difference in AMPS from yesterday to today and knowing where you are starting at helps determine the plan for the day.

The safe shot of 5u is what we affectionately call a "BCS" big chicken shot. They are very useful when needed and I think you had the right idea. That said, 5.5 -> 5 isn't much of a reduced shot. The depot was still at 5.5u, so today's 5u won't do too much for her numbers. The depot can affect numbers for 6+ cycles. Some experimenting is needed to find what works best for Raja, some cats need a big reduction, think 50% or less of normal dose, some do better at 66%-75% of a normal dose. Your shot today was ~90% of Raja's normal dose.

Nice to see a couple blues on the SS, that is such a nicer color then red or black.
 
You might call around to a few vets to see if you could buy some alpha track strips from them or get a human meter and strips to use until you get the strips you ordered. You can get a ReliOn meter from Walmart for about $15 and strips are $35/100 (they have smaller quantities for less too).

Wish you were closer I have alpha track strips you could have. :banghead:
 
Awesome to see that much blue finally popping up on the almost 17 year old boy's spreadsheet. :cool: I agree with Wes, I would stick with 5.5 units, for at least 6 cycles consecutive in a row. That will allow the depot to build and let us see what this dose can do without any interruptions. I expect he may need to go up, but let's prove that first.

I would seriously recommend getting a backup human meter. The running out of strips for the AT when you need it most is one of the biggest strikes against it. You never know when a cat will show you some lower numbers and you want to be able to swing by a human pharmacy to stock up when that happens. The other alternative is to put together a "hypo kit" with a spare box of 50 strips that doesn't normally get used and is not counted on when you are looking at ordering more. Even with the human meter, I got nervous if I got down to 200 strips left.

If you do a fur shot (it happens :oops:), and you smell or see the insulin on him, then write FS or furshot in the units column. That helps us who look at spreadsheets know that there was a possible reduced dose that cycle. The night of the 21st might have been just a really bad bounce reaction to those blues he's not yet used to.

For continuity, here is the link to your last post here.
 
thank you so much. I have already ordered the relion and it should arrive very soon.. they said two days but alas i cannot just drive to a walmart as I live in NYC without a car.

Not sure I have a clear idea of what a bounce is..but I am slowly grasping it.

BCS shot eh ? So if it was a real BCS shot would the reduction be significant ? I am not used to dealing with "blue" numbers and as I am not home to monitor it makes me very nervous
 
Shooting a reduced shot at an unexpected low AMPS when you cannot monitor is a perfectly fine thing to do. Once you've got some more experience with what happens with blues, you can lower the number you feel comfortable shooting the full dose. Help remind me, do you have an autofeeder for Raja?

From the New to the Group Sticky Note:
Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

As an add on to that, if the blood sugar drops too fast, but still to a number they are used to, that can also cause a bounce. If you see unexpected higher numbers, count back a cycle or two and see if there was a lower number than he is used to, or a fast drop that might explain the sugar dump.

Due to the action of the depot, when you want to interrupt a cycle with a lower dose, aka the BCS, it usually has to be a significant sized reduction, like maybe a 1/3 or 1/2 off the dose. Otherwise the depot from the previous shots may control most of what happens in a given cycle. Another example, when Neko was running in numbers that were close to reductions, but I needed her to be safe for a particular cycle cause I couldn't monitor, I would reduce her dose a little bit for 3 cycles before hand. The larger depot can influence 4-6 cycles after a reduction. And possibly more as the depot is larger.
 
If you're not already using a timed feeder, having one may provide you with some reassurance that food is available if Raja's numbers do happen to drop when you're not at home to monitor.
 
thank you for explaining . Raja stopped eating dry food two years ago. Currently he only eats when fed mainly because he got really weak. I started using the human meter which just arrived and my alpha strips too.
 
Automatic feeders can be used for wet or raw food too. I used the Petsafe 5 feeder, a commonly one used here. There is a spot under the tray where you can store an ice pack, and you can always load the food slightly frozen or with an ice cube on top. The melting ice cube will add water which is a good thing.

I am glad the strips arrived today. :) Since the +2 is a little lower than the PMPS tonight, I might get at least a +4 test. Looks like it might be a more active cycle.
 
Wendy&Neko said:
Automatic feeders can be used for wet or raw food too. I used the Petsafe 5 feeder, a commonly one used here. There is a spot under the tray where you can store an ice pack, and you can always load the food slightly frozen or with an ice cube on top. The melting ice cube will add water which is a good thing.

I am glad the strips arrived today. :) Since the +2 is a little lower than the PMPS tonight, I might get at least a +4 test. Looks like it might be a more active cycle.
Click to expand...


active cycle you say ? Oh my.. the day I start using the human meter.. the numbers drop like I have not seen before. After dropping rapidly from 223 to 51 I decided to give him some MC canned food and a few drops of honey. So new to this.
I guess I will keep with the 5.5 dosage for now.

How do folks calculate reduction if they dont have nadir numbers for all cycles ?

thanks so much

arman
 
Arman Matin said:
the day I start using the human meter.
Click to expand...
Keep in the back of your mind that the human meters read lower then an Alphatrak does. There isn't a 1:1 comparison between the 2, but a common reference is a 68 on an alphatrak is roughly equivalent to a 50 on a human meter.

Good idea feeding last night with that big drop. A big drop and a test of 51 would have me feeding and testing a few times as well, those are both signals that get my attention. Test an hour after feeding to make sure the numbers are staying up. I like to get another test after another hour to make sure when I can. The food can raise their numbers temporarily, sometimes they stay up, sometimes they start going down again and more food is needed. Keep track of what you fed to bring him up, it is useful data to reference when he goes low again at some point.

You are on the right track and getting the hang of things. Hopefully the 2 meters will allow you to have some backup supplies so these low numbers and lack of strips don't happen at the same time again. Our cats always pick the worst timing!
 
Arman Matin said:
I guess I will keep with the 5.5 dosage for now.

How do folks calculate reduction if they dont have nadir numbers for all cycles ?
Click to expand...
Good plan on sticking with this dose for the moment. You will reduce if you see a number under 50. In the mean time, I hope Raja gets more used to those lovely blues and greens. It's impossible for us to find the lowest number in each cycle, so we just go by what we do see. It's also hard to guess what might have been so we go by the evidence we do see.
 
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