glucose tracking

Status
Not open for further replies.
tsteinbarth

tsteinbarth

Member Since 2014
It's been less than 24 hrs that I've been monitoring Skinny's BGL at home . . . Any feedback on the his numbers would be appreciated.
 
It is really hard to give an feedback as there are not any mid cycle tests listed....

Are you able to test throughout the cycle at all?

That would be the most helpful for people who are able to interpret the spreadsheets.....Also keep in mind, you have only been testing for 24 hours, so it will take time to be able to notice trends and such.....
 
I think you are entering your numbers in your spreadsheet wrong, left to right is 24hr period, up and down is day to day. (Look at my spreadsheet)
That 43 is a reduction number meaning the 2 unit are too much, I can't give dosing advice. Hopefully someone smarter then I will be along to guide you.
 
I'm at work so I do have to keep this brief...but WOW on that 43. Thank goodness you were testing and caught that...shooting that number would have been very dangerous, and is the perfect example as to why we need mid-cycle tests as well as pre-shot tests.

I assume you have actually been shooting insulin, right? We do indicate the amount we shoot on the SS. That 43 indicates that Skinny needs less insulin than he is getting.

I have to get back to work...hopefully someone else will come along and get into greater detail. But please do keep up with testing as much as you can. I'll try to peek ini whenever I can.
 
The 43 surprised me too especially after the 2 units the night before were the first since Sunday.

I'm going to try and do a curve throughout the day as it's a rare Saturday that I am around until 6 pm today. Should give me some good info.

Thanks everyone.

I tried to update Skinny's SS to follow the suggestions :smile:
 
The curve will give you great information! ;-)

Let me see if I can help you with the spreadsheet. They can be really confusing to set up.

You'll only have one line for each date. Let's say, for example, that you give shots at 6:00 a.m. and 6:00 p.m. each day. Under the AMPS column, you'll put the blood sugar reading you get before the morning shot (AM pre-shot). Under the "U" column, you'll put the amount of insulin you gave (units). The +1, +2, etc. you see after that are the hours after the shots. So, if you gave a shot at 6:00 a.m. and then tested three hours later, you would put that reading under the AM+3 column (because it's three hours after the morning shot). You'll then do that same thing for the PM. The PMPS is the reading right before the evening shot, then you'll put the amount given for the evening shot in the "U" column that follows it, etc. Let's say you checked Skinny's blood sugar at 11:00 p.m. - that would be five hours after the evening shot. So that number would go in the PM+5 column.

If you don't give a shot, you can always write the word "SKIP" under the "U" column. That makes it easy for people to see that you didn't give any insulin during that cycle.

I hope that helps. If you have any questions about it, don't hesitate to ask!
Shelly
 
Hi Toni!

Welcome to Lantus/Lev Land!

I've read through your previous posts, except for the one where your vial broke (kudos on the great craigslist insulin find!) and have a couple of thoughts.

one is to get rid of the dry food - that is very likely what brought Skinny out of remission. It can have as much as 50% carbs - a mouse has 3-7%, and that's a normal cat's diet, so that's what we're emulating.

about your crzay schedule - one thing we emphasize with new people is that a newly diagnosed cat has the best chance of going off of insulin if they get tightly regulated (BGs between 50-120) as quickly as possible. Having come out of remission once, he still might become diet-controlled again, which is infinitely easier than having to give insulin and monitor him for the rest of his life. It can be intensive short-term, but a huge pay-off.

So . . . i'm a parent of 3-4 kids, and i'm wondering what incentive you could offer to your son to be on time and give you a hand with Skinny? You know him best, so perhaps you can think of what would work with him. I'd prefer not to call it a bribe :lol: but if the shoe fits . . . ;-) :-D

can you bring Skinny with you on your overnights? you're not the only one with this situation, and i wonder if he could even have a bedroom or bathroom at house #2 for his use? As you caught that 43 today, that means his body is responding well to the insulin. Lantus dosing is based upon how low a dose causes the BGs to go, so it's really important to catch the low numbers, not only for dosing, but also to keep him safe.

It looks like you gave 1.0u at 1:45pm today. You don't want to give another shot until 12 hrs have passed - so the next shot would be due at 1:45am. I"m going to guess you won't want to shoot at 1:45am, so you can wait til morning if you want. How did the 2.0u dose get arrived at? There is a weight-based formula for starting a cat out on Lantus. You can stick with the 1.0u if you want and go up from there - sometimes that's less nerve-wracking than having the dose start out higher.


from the Tight Regulation Protocol:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit.
Click to expand...

We all understand schedules - and it sounds like you have some very long days. A timed feeder is the best friend of a person with a diabetic cat. When a cat has low numbers, we give them a little bit of carbs to bring up their numbers. So if you have a lower preshot than normal, you can set the timed feeder to open at various intervals to feed Skinny and hold up his blood sugar in a safe range. I routinely had our timed feeder open at +3 so that punkin always had a second breakfast. Most people do feed their cats at least twice in the first 4 or so hours after the shot. You've got 2 cats, so you might do best with 2 feeders opening simultaneously so that Fatty doesn't beat Skinny to all the good food. I'm guessing there is a story there behind their names! :lol:

Shooting as close as you can to 12 hr intervals is going to be the best for Skinny, regardless of whether you use Lantus or Lev. They are similar insulins and wear off around 12 hrs after each shot. Keeping a cat's blood sugar as flat as possible in that normal range is the typical path to getting a cat into remission again. The goal if remission is what keeps people here trying to follow the TR Protocol (which is the only dosing protocol for treating a diabetic cat that's been published in a professional veterinary journal.) People do it because they want remission if at all possible, and if not, to keep their cat's organs protected from the damage of high blood sugar.

I know you said you're a skimmer, so i'll stop there. I like to educate people but know it can be overwhelming.

So ask us questions and we'll do our best to help you.

julie
 
Julie & Shelly:

Thanks for the great advice and feedback about the SS. I'll be honest, I had a hard time following it and this is coming from a person with a master degree :) But I did comprehend that it's 1 line per day.

It looks like you gave 1.0u at 1:45pm today. You don't want to give another shot until 12 hrs have passed - so the next shot would be due at 1:45am. I"m going to guess you won't want to shoot at 1:45am, so you can wait til morning if you want. How did the 2.0u dose get arrived at? There is a weight-based formula for starting a cat out on Lantus. You can stick with the 1.0u if you want and go up from there - sometimes that's less nerve-wracking than having the dose start out higher.
I gave him 1 unit because it was what seemed right given the number. He was on 2 units AM and 1 unit PM per the Vet but with the gap i days without and the low AM number I wasn't sure what to do. Probably nothing. His PM reading was 3-something last night (forgot the exact) so I gave him 2 units knowing that I would not be testing him until early afternoon. It would of been nice to get the AM number to compare but I wasn't home and my son came over to feed them. He did not give him any insulin at the morning feeding. I was afraid it would be low number like yesterday. His 290 doesn't seem too bad. He is on schedule for 2 units tonight.

I'm going yo get a few days worth of numbers before I ask for any more feedback.

Thanks again!!! :-D
 
Hi Toni,

Please do NOT give 2 units tonight - at least not until you get some advice here. The night you gave 2 units, Skinny was at 43 the next morning. That tells me that 2 units is too much for your cat. We don't want a dose to take a cat below 50 - that's hypo territory.

I'm going to see if I can track down some of our most experienced users here to see if they can offer you some additional advice.

Shelly
 
I have to admit, I'm really confused.

I get that your vet had you giving a different dose at AM and PM times. It sounds like you understand that Lantus doesn't work well when you do that.

I'm not clear on when you're shooting.

Generally, if there's a lot going on and you're working on getting on a 12 hour schedule, adjusting food, etc., we suggest NOT going with your maximum dose. Tight Regulation is an aggressive approach to dosing. From what I can tell (and I really don't understand your spreadsheet), you need to go with a more conservative dose until you can get some spot checks -- in other words, tests at times other than pre-shot.

If you've been giving a total of 3u per day, I would suggest either giving 1.5u or 1.0u twice a day.
 
Shelly:

Last night when I gave 2 u @ 9:20 pm the reading at 1pm was 209 today which was the first time I was able to check BGL. He had no AM shot this morning. Also, that morning of the 43 was morning after he had insulin for the first time the first time in 4 days.

He seems to need the insulin mid day to evening?
 
i agree - if you're not able to get tests in, you want to be conservative. if your goal is remission and you're wanting to follow the Tight Regulation Protocol, you really have to get at least 1 test in every mid-cycle and 1 test before each shot.

It looks from the ss like you gave 2.0u tonight. You've really got to monitor tonight. Last time you gave 2.0u it got Skinny under 50 - so you know it can get there again. When a cat goes under 50 you have to be available and monitoring, giving them high carbs (the gravy from high carb food, honey, corn syrup) to pull up their blood sugar.

I think what you've got on september 6th on the spreadsheet is that each test has its own line. The way the spreadsheet works is that each day has one horizontal line and the numbers go across the spreadsheet. We count hours from the morning shot (+2, etc.) and from the pm shot. Then the next day gets a new line.

One really important bit to know about Lantus is that the dose is based upon how low it can get a cat's blood sugar. So when we see that Skinny got to 43 on the 2.0u, we know for certain that it is too much for him. You want to reduce his dose - i agree with Sienne's suggestion to give 1.0 or 1.5u shots for now. For his blood sugar to get under control, you want the same dose at both am/pm shots.

Diabetic cats are a whole new field for you! It doesn't take a master's degree, but it is different than anything else, including diabetic dogs. I'd encourage you to post regularly/daily so you can learn how to help Skinny and keep him safe. That's our goal.
 
lantus wears off after about 12 hrs, depending on the cat. you want to find a dose you can give every 12 hours, instead of waiting until the blood sugar rises and then giving a shot. it sounds like 2u is quite a bit too much.

does that make sense?

tonight, would you get another test 2 hours after you gave the shot, what we would call +2, and repost and let us know how he's doing? The +2 is a good test to help us know where he's going in the next few hours after the +2.
 
Hi Toni.

You're getting a lot of feedback and that can be overwhelming, but I just wanted to ask if you've looked at others' spreadsheets? It might help you to understand how to fill yours in if you do. We all have a link under our signature called something like: "Cinco's 2014 SS". Click on a couple and check them out.

I know it seems like we are asking you to ignore what your vet is telling you, and in a way, we are. Keep in mind that most vets treat a number of different species for all sorts of different conditions. Unless you are seeing a specialist, chances are your vet only know the basics about FD. The people on this board, while not vets, have trained in the trenches. Many have long term diabetic kitties, some have had more than one kitty with FD. Some have kitties that have gone into remission. We all share our knowledge and experience. I know for certain that my kitty would not be here today if I had followed the instructions my vet gave me instead of what the people on LL advised me to do. Please trust us. We care about you and your kitty.

Good luck.
 
Tricia:

I did take a look at Cinco's SS. I think looking at the SS helped answer some confusion I've had about how to document several readings. If I understanding what I'm reading on Cinco's chart, on 9/7, his AMPS was 103 and you then gave him 1.75 units; and you took readings at +3.25 and +3.75 and those are in the same box. . .

I actually am not convinced that my Vet knows what she is truly doing . . .

I think Skinny's numbers are leveling out since I've got him back on the "juice". I'm going to keep posting numbers!

Thanks for the patience and feedback.
 
Nice job getting all of the data for each day on one line. I am still really cocerned that you're giving Skinny 2 units. Remember - with Lantus, we don't base dosing on the pre-shot number. We basically just use that number to tell us if it is safe to give insulin. Instead, we base the dose on how low that dose can take a cat in the middle of the cycle (the nadir or low point). We don't want to give a dose that will take a cat down below 50. That's too low. And we know the 2 units you gave the first day took Skinny down beiow 50 because you woke up the next morning to that 43. That tells us the 2 units is too much right now.

Lantus is going to work best if you give the same dose every 12 hours. I know you're trying to follow your vet's advice, and it's frustrating when people keep telling you not to do that. We just want to help keep Skinny safe and get him better regulated.

Shelly
 
Hi Toni,

Shelly's absolutely right.

One thing that can be really hard to wrap your head around is that high numbers can be CAUSED by low numbers. The numbers you're seeing right now are high because Skinny got to 43, or possibly lower than that before that morning. He's bouncing - meaning that his liver reacted to the 43 by letting loose a storm of stored sugars and counterregulatory hormones. His liver knew that 43 is too low and it reacted to the danger by sending him high.

Here's another explanation of it:
BOUNCING

Here is an example of a bounce from someone's recent condo:

you can spot a bounce this way (this only took me 6 months to learn and a bunch of people explaining it! i'm a slow learner!)

yesterday morning you had a 215 - then it went 235, 271, 270, and then 308 this morning - basically straight up. no curve. and then look backwards in the ss and the night before was that sweet little 148 12 hours earlier.

if you imagine that night-time cycle, starting at 148, kitty probably went down in a nice little curve, hitting something under 100 mid-cycle. that lower-than-usual number would've shocked her body. they get accustomed to whatever range they're in, and any sudden dip lower can set this off.

"HELLO WE"VE GOT A 911 HERE- KITTY'S GOING DOWN!" yells Mr. Liver. Fortunately, mr liver has a storehouse of counter-regulatory hormones and stored sugar (in case kitty needs a little nommy sweets in the middle of the night) and when Kitty gets into a range of numbers lower than usual, Mr. Liver lets loose with the sugar and the hormones and sends Kitty on a rocket to the moon. this is the cat's body's protective mechanism to keep the cat from becoming hypoglycemic. unfortunately, mr liver doesn't seem to know that anything above 40ish isn't a crisis and it will do this regardless of the range of numbers, even at 200 if the cat has become accustomed to 400.

A second cause of a bounce is if a cat drops very quickly. 100 points in an hour, for example, regardless of the range the BG number is in, can cause a bounce as well.

So, what to do now? don't increase the dose because of these higher numbers. once this bounce clears, which can take up to 3 days of high numbers if mr liver is super-active, then if you had increased the dose, it would be too high. you are entering the phase of treatment that we say requires "Patience Pants." when you think you're seeing a bounce, you have to wait it out, then you can see what the dose really does. You will know the bounce has cleared when you start seeing numbers you were seeing before - like that 148 again.

edited for clarity.
Last edited by julie & punkin (ga) on Tue Apr 24, 2012 2:30 pm, edited 1 time in total.
Click to expand...

Skinny should be "clearing the bounce", meaning the sugars and hormones his liver released that sent him high should be clearing out of his system by tomorrow morning. That's 3 days following the "low numbers event." Things are a little wonky because you've got a lot of skipped shots and then one reduced dose shot as well.

You're going to see the best most-predictable results if you go to 1.75 and hold that dose, regardless of how high the numbers go, and let things settle. Because Lantus is a depot insulin (think timed release), everytime you change the dose or skip the dose, you're rocking the boat and the result will be crazy numbers that will go all over the place. Shooting once a day allows the Lantus to completely wear off every day, so it's like starting over all the time. To get the best blood sugar control, cats need shots every 12 hours.

I'd encourage you to take a look at other people's spreadsheets and see how they adjust doses. Typically, we hold the same dose for at least 6 consecutive cycles, regardless of high numbers, unless a cat goes below 50. Then we reduce.
 
Shelly & Julie:

Thank you for the feedback. The "bouncing" is making sense NOW . . . and helping me not panic. I'm going to give him 1.75 per Julie's advice and see what happens with his numbers. I'm a little concerned because I don't know if I'm going to be able to get BGL numbers consistently the rest of the week. I can get him fed and his insulin. I may have to take on the task of showing my adult son how to check his BGL.

I'll keep posting what I do get.

Thank you!
 
Nice job getting the SS straightened out. It makes much more sense.

If you can convince your son to test, that would be ideal. Shooting and testing are the best way to help your kitty stay healthy and safe.

(And we run into a lot of vets who are not up to speed when it comes to treating diabetes.)
 
Skinny seems good. He's been a trooper. I was able to get Skinny number tonight. But my son is open to me showing him how to do it which I'll need this weekend. Skinny numbers are still high-ish but seem to be starting to stabilize.

Thanks for checking in :)
 
uuggghhh . . . hhhmmmm . . . with a AM 31 I'm going to skip is morning shot. I'm going come home during lunch and check his numbers again.

Am I understanding things correctly in planning for his PM shot, to decrease down to 1.5?
 
Hi Toni,

Yes - definitely skip the shot. Can you feed some high-carb food and retest before you go to work? That 31 is considered way too low for a cat on insulin - it's hypo territory. We don't want to see them under 50. Here's some information from the sticky at the top of the TR page that describes handling low numbers:

DON'T PANIC! or HOW TO HANDLE LOW NUMBERS

First, try to not panic. Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:

staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
disorientation (yowling, walking in circles, etc.)
twitching
stupor
convulsions or seizures
coma

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
(If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
Test again in 15 – 20 min. Depending on the numbers, give more HC food.
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
Test in an hour and follow the same steps.

DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.
Click to expand...

Can you start a new post for today? This one is getting long, and people may miss your updates. Just click on the "New topic" button on the TR page. For your subject line, put the date, Skinny's name, and your test number. I would also put in there that you need some dosing help. For example: 9/10 Skinny AMBG-31 Dosing Question. That will let people on the TR page know at a glance what's going on and that you need help with dosing. This will get lots of experienced eyes on Skinny's numbers.

Skinny most likely went lower last night than that 31 you saw this morning. That's why we encourage getting in some testing in between cycles. We want to catch those dangerously low numbers to prevent hypoglycemia, which can be deadly. Normally, we would say to reduce the dose to 1.5 units since Skinny went below 50. Since you aren't testing mid-cycle right now, some of the experienced users might suggest dropping the dose even lower. Let's see what they have to say. Our first goal is to keep the kitty safe.

Shelly
 
I noticed on your spread sheet that on 9/8's pm cycle you gave shot at 8pm, then on 9/9 am cycle gave dose at 6:35. When a shot is given more then +/- 15min per cycle or +/- 30 min in a 24hr period, the + will act as a decrease in dose, and the - will act as an increase in dose.
I am wondering if that had anything to do with this AM's #.
A bounce will come from that 31, so if you see an extremely high number at tonights pmps or tomorrow's amps, know that a bounce can affect BG #'s for 3 days(6 cycles)
 
Toni - you may have mentioned this before, I but I can't remember....what type of meter are you using? It will help us to know if you are using a human meter or an Alphatrak.

That 31 is VERY low...dangerously so. I'm surprised you didn't see any sort of hypo symptoms, and remember that hypoglycemia can kill. Skipping was the right thing to do, I hope you gave him lots of high carb food to get him up into safer numbers.

You definitely need to reduce...but with numbers like this and given your work schedule, I'm not sure by how much . I've asked some others to check in on you, too, so hopefully we'll get a more solid idea of what you can shoot to keep SKinny both healthy and safe at the same time.

You may see a bounce into high numbers tonight, but that doesn't mean you don't need to reduce. Lantus dosing is based on the nadir, or lowest point in the cycle. So that is what you need to keep in mind.
 
Status
Not open for further replies.
Back
Top