High at 4am, give dose early or wait?

Hi Kathy, I'm CDT too! I'm glad you're here right away for Lewie. I just did what my vet instructed when Olivia was diagnosed in February and she nearly died in July. Since then I've received some excellent guidance here and while we're still trying to figure out what works, I feel much more confident we'll get it right. I'm glad to see that Lewie is already responding to diet and dose changes!
 
I'm sad Olivia almost died in July... and so happy that she is doing better now!

This group is amazing. My vet wanted me to rely only on readings from the vet's office because of discrepancies in meters, but he never saw the 600+ numbers... that's when I reached out to this group. I told the vet that with this long holiday weekend, I felt like a fish out of water. He said Lewie would be fine, but I just couldn't wait and hope. There is a possibility that Lewie's diabetes is stress induced from a surgery about a month ago so I want to be super careful to watch for a spontaneous remission... that's when I knew I had to learn how to test. I'm testing the pad of his back feet and he is tolerating it much better than his ear.

With this group's help, I too am feeling much more confident that I'll get it right. :-)

Thanks for writing.
 
One little correction - you're actually aiming for anything in the normal range, not just 80-100. :) That is in the protocol as a caution when reaching regulation. But remission is usually between 50-80.

Love seeing that great cycle today! And hooray for a yellow!!!
 
So the normal range, since I'm using a human meter, is the 50-120 as mentioned above? Being watchful for repeated values of 50-80 which may indicate remission?
 
Remission is anything under 120 without insulin (we usually say to test for 14 days to make sure it's really remission and not just a good day or two), with most numbers in the 50-80 range for a typical cat.

With insulin the protocol says to aim for 80-100 at nadir to offset any moments when a kitty has an unusual response. However, if you're monitoring and being careful with dosing, it's fine to let them hit nadir anywhere in the 50-120 range, and many cats feel their best in the lower 50-80 range. There are things to consider in that such as the bean's work schedule, but if you're keeping an eye on things, there's no need to try to keep them at the top of the range.

To anyone else reading this, those ranges are talking about a human meter, not a pet-specific meter. If using at AlphaTrak the ranges are slightly different.
 
I think the goal is to get them to spend as much time in the normal range, with insulin support, as possible. It’s not remission until they can stay there on their own for 14 consecutive days.

Cross-posted with Djamila. Hi there!
 
Lewie had a good day yesterday with yellows in his chart so I was going to sleep through the night and not check his nadir +8 (4am Central). Well I just happened to wake up at 3:50am. Drats.

So I check on him and I find him laying in the litter box. His glucose value was 271 which is good for him, so I let him eat 3 tablespoons of food.

When I checked his blood glucose at his morning shot time it's 421 so I gave him 3.5 units.

Do you think feeding him at PM shot +8 shot his reading up? Yesterday at his nadir PM shot +8 (4am Central), I only fed him 2 tablespoons of food.

He does have hip problems and heartworms so I don't know if the laying in the litter box is related to that or diabetes.

Thanks for your thoughts.
 
Assuming it's low carb food, then most likely the rising number is simply that the insulin ran out. It's not uncommon for a cat to rise a hundred points in the last hour, that's why when you get a low PS number, stalling for 20 minutes or so often gets it into more typical range. When a cat is at a good dose, the insulin lasts longer, when they aren't getting quite enough yet, it runs out early. It's all a balancing act.

I don't know anything about heart worms, but hip problems if they involve inflammation (like arthritis) can increase numbers. Hopefully he'll feel better as the day goes on.
 
I'm feeding him Fancy Feast Kitten Turkey. We are have terrible rains so maybe the damp and cooler weather is bothering his joints. Thank you.
 
I just checked Lewie's afternoon nadir at +8 and his blood glucose reading is 109. Looking at his spreadsheet from this morning I didn't expect such a drop, although I did bump his insulin up to 3.5 this morning. I went ahead and fed him now to prevent him from going too low.

Note: I already ran through my 1st box of test strips and bought a new box yesterday and they are reading 20 points higher so his comparable value to the previous strips is 89. :-0

Any thoughts? Should I go back down to 3.3 units of insulin tonight?
 
Wow! Well that's a really good number for nadir! It's actually not unsafe at all, and I would probably feel fine sticking with the same dose tonight if he was mine. You want them in those good greens at nadir time, so it's really okay if he was hanging out in that...and he still had room to drop. :)
 
Great! Thank you Rachel. So it sounds like I shouldn't have fed him... just let his body enjoy the low number for awhile?
 
Nothing wrong with a little snack, but it certainly wasn't necessary as far as safety goes. A cat is quite safe down to 50. That's the "take action" number, so they can even go below that and still be fine, we just don't really want them below that because at some point they can start to have a symptomatic hypo and that's to be avoided. So 50 is like the safety railing to keep them from going over the edge. :)
 
Thank you Djamila. My vet said if Lewie goes hypo he will most likely die with all the things going on with him... that's why I've been so nervous. Now that I know his nadirs, I'm getting a little more comfortable with this. My vet is out of town for the week so I'm so glad this group is here. Next time I take a nadir reading, I'll skip the snack and let his body enjoy the low reading. Thank you.
 
Since she's that medically fragile then yes, using greater caution is important. Given that, you might want to set your "take action" number a little higher so you have a bigger safety margin.
 
First of all, I'm so sorry for calling Lewie "she". My fingers got ahead of my brain :). I'd be hesitant to suggest one since he has conditions I'm just not that familiar with, and because the vet's prediction was so dire. It might be worth talking over with your vet and deciding what level he thinks Lewie can handle. Or maybe someone else might have some thoughts on it?
 
No worries about she/he. :)

My vet said nothing lower than 200. That seems high. My vet also was ok with reaching a height of 600. That seems high. I trust my vet and my vet is very smart and knows what he's doing... I just have to live with myself when this is all said and done. When I first started charting Lewie's numbers, there were just too many 600s for my comfort. Lewie seems happier at the lower numbers.
 
Kathy4Lewie said:
No worries about she/he. :)

My vet said nothing lower than 200. That seems high. My vet also was ok with reaching a height of 600. That seems high. I trust my vet and my vet is very smart and knows what he's doing... I just have to live with myself when this is all said and done. When I first started charting Lewie's numbers, there were just too many 600s for my comfort. Lewie seems happier at the lower numbers.
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The closer to normal you can keep him the better he will feel. 600 is way too high and puts him at higher risk of ketoacidosis. Low 200s is where glucose starts appearing in the urine (renal threshold), which means the kidneys are struggling to keep up. The longer you can keep him below that threshold, the better off he’ll be. If he were my kitty I would aim for low to mid 100s for a nadir (120-150), which gives you a bit of a safety cushion. I am only speaking of my own personal comfort level (if I had a kitty with multiple medical issues), so you may feel comfortable keeping him higher, but aim to give him as much time as you can under the renal threshold.
600?? Yeah.... that’s a no....... :banghead:
 
Thank you so much for telling me about the renal threshold! Information is power. :-) I am going to get up at his am nadir (yawn) and check, but not feed. He felt much better today and was all purrs tonight. He’s still a sick kitty, but it’s good to hear the purrs. Thank you for sharing your thoughts on his goal nadir. (And I love the emoji hitting the wall!)
 
I think your numbers will depend on where you are at in the cycle too. Like if you're at 100 at nadir, you might grab another test an hour later to be sure he's still rising or something...but if that is at an earlier time in the cycle, you keep a closer eye? It's hard to be sure of a number with his other medical issues.

In the end, you do have to be sure you can live with whatever you choose. As Djamila said, 50 is the take action number for a human meter, so you want something maybe between that and 100 as your take action number? And you could say you're going to set something for a take action number now and then lower that number as you get more comfortable and get a better idea of what Lewie is doing...whatever makes you most comfortable and keeps Lewie feeling good. :)
 
Good advice about your own take action number for Lewie. I'd say something around 100 at nadir is a good goal for now. You can see how she does if her BG gets to that level. You don't want 600s though. That is definitely putting her at risk of a DKA episode and that would severely tax her fragile body.
 
I give Lewie 150ml subq fluids everyday. Yesterday, I gave him his fluids in the afternoon because he was a little dehydrated... I usually give fluids in the evening. Can giving subq fluids lower the glucose value?
 
Kathy4Lewie said:
I give Lewie 150ml subq fluids everyday. Yesterday, I gave him his fluids in the afternoon because he was a little dehydrated... I usually give fluids in the evening. Can giving subq fluids lower the glucose value?
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My experience says yes it does lower BG values modestly. But I think it probably depends on how dehydrated they start out, and when you give the fluids in relation to the shot time. You may want to be a little more careful until you see how he'll react.

*Edit: sorry I answered this in a hurry and just realized you meant you just gave it to him a little earlier than usual yesterday. Are you wondering if that's what caused the lower than usual number? It is certainly possible.. though that would be a bigger drop than I would expect.
 
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Yes, I was wondering if it caused the lower AM+8 nadir value of 109. I'm waiting today to give his fluids after his PM shot as an experiment.

Thank you for your reply!
 
Ok, so his AM+8 nadir value just now is 101. So for him, the fluids didn't appear to have influenced his value today.

Yesterday, his AM+8 nadir value was 109 and I let him eat because I was a little unsure about that new low value.

Do you recommend for today NOT to feed him now, but let his body enjoy the 109 value? Maybe check his value again in an hour?
 
Post AM Shot +8 value is 101. No food given.
Post AM shot +9 value is 105. No food given.

He's going to want to eat at +10.
 
I'm sorry you didn't get a response earlier. Lewie's numbers look good today. The lowest blue was almost green. I'd keep the 3.5 u dose for a few more cycles.
 
Thanks... we are fine... just was looking for a little hand holding but it worked out great. :-)

I tested him at AM shot +10 and he is 134. I gave him his evening pills and a small snack. Since he is starting to climb, I'll go ahead and give him his fluids.
 
Those last two AM cycles look really good. It's nice to see him get time in those healing numbers!
 
I just took Lewie's PMPS and his value is 266. That's about 170 point below the previous 3 days. :confused:

I'm a little concerned about giving the 3.5 units now.

How much should I give?
 
I’m so sorry that I don’t feel qualified to advise! First, that’s a very nice PS for him! It looks like he’s been dropping about 70% or so during the day on 3.5 but about 30% or so at night...? If that’s accurate (I see math coming at me, and I duck!) and it holds, then 3.5 on 266 would still keep Lewie in the safe range, but I also see the concern in holding that dose on such a markedly lower (but still very nice!) PS. When I am nervous about a shot, I usually reduce by 0.25. I am then usually sorry ... but as they say, “better too high for a day than too low for an hour.” Esp given his other health issues.

I hope someone with more experience pops in to help. In the meantime, I would stall and test in 20 minutes from the 266 test to see if his numbers are climbing. I’ve read that there can be up to 100 point difference in the last hour of a cycle. Maybe his is still ending ?
 
Cool that you noticed the 70% during the day, and only 30% at night. I've been wondering about that.

It's been 35 minutes so I'll check now...
 
Aha! So that looks a lot closer to what's typical for him. If the 30% drop is accurate and holds true, that would bring him to the low yellows/high blues <--- check my math!!! -- and that seems good for him given his other issues.
 
Awesome. Thanks for teaching me that math. I've been wondering if he needs more insulin overnight and less during the day.
 
Kathy4Lewie said:
Give 3.5?
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Totally up to you. As they also say, the care-giver holds the syringe! I would probably do it, but there's not a whole lot of data, so I would definitely want to get at +3 if I did. He's just responding and moving down so much overall, it's hard to know, esp since I am new, still very much learning, and do not feel confident to advise someone on their kitty.
 
Kathy4Lewie said:
Kris & Teasel: Yes, I can take the +2 reading. If I gave too much, what will I see at +2?
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A +2 that’s significantly lower than PS can mean a more active cycle requiring more testing so you know if kitty is going too low. If +2 is similar to or higher than PS it usually means the cycle won’t be dramatic.
 
Kris & Teasel: That's interesting! How often do people test? I could see 6 times a day: AMPS, +2, nadir, PMPS, +2, nadir

I was trying to back off on stabbing him, but I'm not having much success. I'll buy the big box of strips this time!
 
I’ll chime in!

We try for four: AMPS, +6 (when work allows), PMPS, and then “before bed,” usually around +3 or +4, which gives a good indication of where the cycle is going once you have enough data. If that number is any cause for concern, then we’ll try to get a follow up before bed. I will get a +2 (or get what if I originally planned for +4) if I am a little nervous about the shot and want an early warning, as Kris describes above.

And them sometimes, since we have less data for nighttime, I one of us happens to be up later, we’ll grab an additional one just for data’s sake.
 
Kathy4Lewie said:
I was trying to back off on stabbing him, but I'm not having much success. I'll buy the big box of strips this time!
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I've had to get over my guilt about testing him so frequently... the data is just too valuable and there's NO other way to know what's going on. Are you using the pain-relieving neosporin? I try to put that on Romeo's ear at least once a day and it does help him heal up faster. The other thing that makes it more tolerable for him is a low-carb treat after EVERY stick. I use freeze-dried chicken liver or beef liver... but there's a list somewhere in here of low-carb treats. It's gone a long way towards making Romeo a happier camper at testing time. :)

For another reference point... I test at LEAST 3x/day amps, nadir (anywhere between +5 & +8), and then obviously pmps. Additional sticks simply depend on my schedule and how his numbers are trending.... and if I get a gut twinge that I need to. ;)

Your nadir #s are great, btw... I'm so impressed with how you've managed to get him down so quickly... I bet he's feeling so much better!! Yayy!
 
When I first started testing, I tried the ear but Lewie took it really personally! He's never been one to complain so I respected him on not stabbing the ear and took to the back paws, which he really doesn't mind at all. He's a real trooper. He seems to be really taking to the insulin. Today is the first day in a while that I can tell he is really feeling better, except he is getting dehydrated faster than before so I probably need to wean him off of the Fancy Feast Kitten and start feeding more Nulo, except my cans aren't labeled medal series... hum.. need to call the company.

This group has been so helpful and I really appreciate all the help! Yes, today he felt good!
 
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