hello~newbie here...dose increase?

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tomtom13

tomtom13

Member Since 2013
Hello all you helpful people...my name is Kelly and my sweet tabby is TomCat and we are both newbies! He re-homed himself upon me about 4 years ago from across the street.....and he is seriously thinking of going back to his original home....not too much fun around here lately! ;-) He is an indoor/outdoor cat.......not so much anymore though. I still let him out to lay in the sun when I know his levels are safe and at night I go out with him on a harness. I first noticed his increased drinking...laying in the bathtub for someone to turn on the faucet....and the non-stop eating....you all know what I am talking about. After a trip to the vet on March 21 this year, it was confirmed..diabetes. The vet started him off on Humulin N 2 units 2/day and prescription can and dry (yes dry!!!) and told me to only feed him one can a day divided into 2. Well, being a newbie....this is what I did. Well, I tried to do....Tom was having no part of being fed 2 x a day! After searching the wonderful internet and this site, I called the vet and asked about Lantus. He told me he had treated cats for 20 years and Humulin was the first choice. So we plugged away. Tomcat never ate the prescription food and I never opened up the dry. Unfortunately and fortunately Tomcat was never a big dry food eater and his diet was already typically FF canned. After about 6 weeks with no visual improvement and increasing to 3 units, I insisted on Lantus. We joined LantusLand 15 May. 2 units 2/day. After a week of visual observations only, I increased to 2.5. Here is my first "curve" done at home:

2.5 units
730-275
1015-258
1-182
245-222
545-194

Vet told me to increase to 3 units

one week later 2nd curve

7-360
1015-358
130-216
345-253

Vet told me to increase to 4 units


because I have been reading this site non-stop, I knew I could not increase based on one curve and very limited home testing. I did, however, increase to 3.25. I have started to do daily home testing as suggested by you all. I just finished my spreadsheet for suggestions. do you think he needs an increase? I certainly do, but am worried as there have been a few <100s. Last week was a week of hell of every other fur shots! he has finally been given consistent dosing for 5 days now. I still need to do a tighter curve to find his nadir. How often do i need to test for this? every 2 hours?


I do have a meter question: I have been using Freestyle lite this entire time......yesterday I switched to Relion and was shocked at his AM number.....it was way way way off from the lite model!!! later when his levels came down, they were more equal. I have never got a value in the 500's (nor has the vet on his meter) with the lite model. I am guessing you will all agree to just stick with the Relion model from now on????? I figured there would be a difference between meters but 150 points is hard to believe. I am now questioning both meters!!! Shall I buy a different meter? they are both new.


TomCat is 9 years old and has weighed 15 pounds...should weight 12 or so. He currently is at 10 pounds. He is a good eater most the time....no problem with ff and no dry. he is a free eater all day...we are both lucky that I am home all day. I do hold off 2 hours before test time.


I guess that is all for now.....thank you all so much for your input of an increase......this site has been a life-saver for me! as we all know, these times are very very very stressful and sad and worrisome~ we all want the best for our buddies. .......but being a part of this group has helped so much


Kelly and Tom
https://docs.google.com/spreadsheet/ccc?key=0At_tdGGqu-SgdEZpbHEwellsWWRzcW1WcmFQakMyd1E#gid=0
 
I have to say wow. You are very well organized and are doing all the right things... wet food, testing, lantus and even a spreadsheet!!! Its nice to see a newbie that well ahead so lets see what we can do..

1. food - you said FF. Many of the FF flavours are too high carb and can spike blood sugar. You want flavours under 10% calories from carbs - and even better if under 8% ie the classic pates .. so what ones are you feeding? Also see here column C http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

2. I cant see your SS - can you share it?



Thanks
Wendy
 
I do have a meter question: I have been using Freestyle lite this entire time......yesterday I switched to Relion and was shocked at his AM number.....it was way way way off from the lite model!!! later when his levels came down, they were more equal. I have never got a value in the 500's (nor has the vet on his meter) with the lite model. I am guessing you will all agree to just stick with the Relion model from now on????? I figured there would be a difference between meters but 150 points is hard to believe. I am now questioning both meters!!! Shall I buy a different meter? they are both new.
Click to expand...

Those freestyle LIte meters have a known problem in cats, They give a false low reading when the actual blood glucose reading is much higher. Ditch that meter ASAP. Have your vet ditch her meter too.

See here for reviews.https://docs.google.com/spreadsheet/ccc?key=0AjcBiiIVLby8dDUzZmMzUmNmVUtWWERST2xidWxnUVE#gid=0
 
It sounds like you're doing a good job already, and have done some research :)

Welcome to the best place you never wanted to be.
And, I'm glad you TomCat decided to have you be his bean.

I am not able to access your spreadsheet, so I can't help you there. Maybe someone more techy can help you with that.
 
Two units is a high starting dose for Lantus.

Increasing by 1 unit increments is too much at one time. You have probably bypassed the good dose for your cat.

10 pounds /2.2 = 4.5 kilos * 0.25U = 1.125 Units as a starting dose. Round down for ease of measuring in the syringe. 1Unit dose.

Do you have 3/10 cc syringes with 1/2 unit markings on the barrel?
 
Yay to hubby!!! Works great!

The freestyle meters tend to be inaccurate at higher numbers (anything over 200 they show as lower than they actually are). The relion is better so I would keep the freestyle as a backup meter and use the relion.

You are getting some great tests in , let's see what happens over the next few days now that you are using a better meter

Edited to add... Remember to let me know about the FF flavours you are feeding..

Wendy
 
1. wendy-tiggy-bailey: yes, on the food. all ff classic pate.......I have the food list printed out and only feed low carb. I notice you use the Bayer meter.....shall I try that?


2. deb and Wink: so you think I need to decrease dose? to what? what increments? yes, I am using the correct syringes.


thank you all for you input, I hope you are able to look at my SS when I figure out how to post it!!!
 
The SS link you provided worked great so all you need to do is

1. Copy that link your hubbie gave
2. Go into user control panel above
3. Click on profile
4. Click on edit signature
5. Paste the link in the box using the URL button and click submit

The relion is a great meter, I live in Canada and I would use it too if we could get it here!!
 
Looking at your SS. Which days do you think you might have given fur shots? Were these in the AM or PM cycles.

I certainly would not increase at this point. Maybe a reduction. Not sure yet.
 
All my fur shots last week are not recorded on my spreadsheet~~~I figured why bother?!!!! I would test Tom around +4 and if the number had not moved....I knew I blew it again.....and stopped testing. I realize now I need to record all shots even those awful fur shots as then I can look at the entire picture!!! such as today......I guess yet another fur shot....hard to believe though, I did not smell insulin at all?



It is probably a good idea to wait a few more days with this new relion meter (high values are so different than the freestyle) and continue to improve my shot technique before we can see a clearer and more accurate spreadsheet.


as far as shot technique suggestions??????????? I don't know what I am doing wrong. I had been using the grab and roll technique on his side, I liked that could see the skin.....I am 2 inches away from Tom, down on the floor, with a lighted head strap, and plus 3 magnifying eyeglasses on, I can literally see the needle go in, (and I wipe the needle dry so no lingering smell on needle) I wait to inject insulin, I wait to withdrawl needle, and then I can see the needle come out......., all is good......down my nose goes to smell and there is that awful smell burning my nose and my gut and I could cry...and have a few times too! I even say THAT IS IMPOSSIBLE!!!!! so I figured the needle went thru the other blind side somehow???? so then I started to aim straight down as to avoid blowing thru any other skin..........nope doesn't work. same problem. So I am back to the grab scruff (not much to pull up) and inject. I have been successful for 10 shots now...and then this morning......blew it again I guess...


I am using terumo 3/8th needles and have also used BD 8mm. And he is NOT DEHYDRATED! I think I just need to aim way further down from where I am tenting..........and if I had three hands......that would be the ticket! I know the problem is blowing thru the other side


very very very frustrating when you can't do something that is very simple really......I can't change what I don't know what I am doing wrong!!!!


the best lines I read on this site that I keep telling myself is: it is a marathon not a sprint AND better to be high for a day than too low for a minute


thanks all

https://docs.google.com/spreadsheet/ccc ... yd1E#gid=0
 
Hwo come the SS has an empty line between yesterday and today?

I dont think you gave a fur shot today - esp if you didnt feel wet fingers and didnt smell anything. I think what you are seeing is a "bounce" off of yesterdays greens. If thats the case you will see numbers start to drop within a day or two and then more greens again hopefully!

ie a bounce =
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
 
oh, I didn't know about the Bounce.....interesting! Thanks so much for that info. That makes sense.....much calmer now knowing what is happening.

the empty line on the SS from yesterday and today is because over in the comments column I had to use two spaces yesterday......still need to work on how to fill in SS info.

Last night when Tom had the greens, I did not freak....was so happy for him....but certainly kept a keen eye on him and numbers....I checked every hour....is that soon enough or should I be testing every half hour with a newbie on greens? He slept so sound when he was in the greens......I figured he would be running around feeling so good...but nope....snoozing.


https://docs.google.com/spreadsheet/ccc ... yd1E#gid=0
 
You did well to test every hour last night when TomCat went into the greens. He was still in the higher greens which were safe. If he ever gets down to the lower greens, especially under 50, you want to feed some food, 1t or so. Have your hypo kit on standby and keep the karo syrup close by in case he drops into the 40's. We have another saying here "Feed the 40's".

You can always post on here and ask for help. If it's late at night, the ISG Lantus TR usually has someone awake over there, if no one is on in Feline Health.

Do you have your hypo tool kit together just in case? Do you have a copy of the hypo instructions printed out just in case? http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 you don't want to be scrambling around when your cat has dropped to low numbers to find this document or find your hypo toolkit.

IN CASE OF EMERGENCY - YOUR HYPO KIT

Put together NOW the following items and put in an easily accessible place!

•Phone number of your vet
•Phone number, address and map/directions to your nearest emergency vet (or phone number of the cab company and some cash/credit card)
•Karo syrup, honey or corn syrup
•High carb canned food with gravy – 2-3 cans
•Some favourite treats
•Spare pack of 25 blood glucose strips
•Coffee for you ;)
Click to expand...

You might want too look at this topic. http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=97401Another new member, very low number at +2, needed to get the numbers up and keep them up. Please note, this person is using an Alphatrak. So the numbers for a possible hypo are 30 points higher than for a human glucometer.
 
Deb and Wink~ why such a tiny amount of food when in the low 50's? you don't want to waste a nice low number?

is it normal that he sleeps so soundly in the greens? why do I think he would be a ball of fire? feeling so good......

I do have my hypo kit but still need to print out directions......thanks


Wendy and Tiggy~ it is confirmed! a bounce. so thankful it wasn't a fur shot! I got another good shot in PMPS, curious what the numbers will show tonight......

So is a bounce a good thing or a bad thing....or just a thing? Does it mean his liver is not up to par? Or it is working well and may help with future possible hypos?

thanks all
https://docs.google.com/spreadsheet/ccc ... yd1E#gid=0
 
The tiny amounts of food are so you don't fill up the cat too early. If the numbers continue to drop, you need the cat to be hungry so they will eat more food later.

The bounce is a good thing and a bad thing.

Good because it is a protective mechanism in the cat's body to keep him from going 'lower than he is used to'. This does not even need to be a drop into the greens or blues. Only a drop that the body thinks is too low. Those higher numbers become the new normal. It's a balancing act to keep the numbers in a good zone without getting the bounce effect.

Bad because it take time to clear the bounce (up to 72 hours) and you are in a waiting pattern for the bounce to clear before you know if a dose increase or decrease is needed. It delays the sugardance, getting back to those better more normal numbers. I think of the bounce clearing interval as a sort of a time delay effect. Circling the airport.
 
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