Is it safe to take Cashew off of insulin till we are sure?

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cashewsmomma

cashewsmomma

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Hi,

I spoke with the vet today and she said to check my meter and make sure it is working properly. I called the Manufacturer's and have ordered the control solution for this. I am going to go out and buy another meter. The guy on the phone said I was using the wrong meter and should be using Alphatrak...I looked it up online and there are views that the two are very similar.

The vet said to take Cashew in to her clinic again on Saturday to check with their meter but in the meantime, is it safe for me to skip his insulin? He did not use his litter box as much today (hardly if you ask me!), his waterbowl was full, his appetite was there as ever and after his meal, he had enough energy to jump up on to my chest of drawers!! Normally after his insulin shot he becomes quiet, lies down on the ottomon or hides in the basement...(i think i have said it before i don't get a good feeling about this behaviour)...my overall feeling is he may be getting too much insulin and that i would be better of maybe reducing his dose until saturday when i see the doc? What do you guys think?

Please shed some light! ohmygod_smile
 
Hi :razz:
I just went back to find your last post so I could link it to this one...here it is:

viewtopic.php?f=9&t=12023

We link the previous day's condo to our first post of each day so that it is easy to go back to previous days. Lots of people like to read what has transpired the days before.
Now, i am going to check your SS...BRB
 
Maybe you could fill me in on some stuff....what kind of meter are you using?
What made you think it wasn't working properly?
Did your vet prescribe the starting dose for Cashew?

I apologize for not being up-to-speed on all the particulars....
Let me go back and see if I can find other posts...

ETA: ok...I"m back with a post from Monday... viewtopic.php?f=9&t=11828

So, if I understand correctly, you switched to canned food and saw some drops.....and the vet told you to increase by 1 unit increments. So, you did start out on 1u. Ok.

What we do here on the forum is increase mostly by .25u or .50u if the kitty is on a high dose. Has anyone mentioned to you about the stickies at the top of the Lantus page? There is much information to read and try to absorb. I congratulate you on all you have done thus far!!! :thumbup There is an awful lot to learn....getting up to speed it very tough in the beginning.

I am also going to say that you instincts seem to be in fine tune! :-D The question of the amount of insulin Cashew is getting is definitely something you need to focus on.

For now, if you would feel better since your meter is in question, maybe not giving any would be in order until Saturday. I am hoping that others will voice their opinion here as well.
My reasoning is: if he is getting too much and you don't feel your meter is correct, you are shooting blindly. My thought is that you can start fresh after your visit to check the meter. Maybe someone will be familiar with your brand. The human meters are fine to use....most of us use human meters. I use the Relin-on micro from Walmart. I find the test strips are more reasonably priced.

There are people who will stop by who have been on the board for a long time and they really know their stuff. They are very good at discussing the best doses and when we can raise or lower. You will learn a lot if you read the stickies too.

My male kitty, Shadow was prescribed 4units bid (2X a day) and my female, Raja was prescribed 3u bid. Both made it through the first week when i wasn't testing....I brought them back to the vet office a week later to be checked. Raja had gotten sick so we stopped her insulin at that time. I joined the forum here and learned to home test. You see, during the 5 days that I was giving her 3units bid, she was not the same kitty I knew. She used to hide and acted all spooky. I really didn't know about hypos or any emergency situation that could have arisen if i had continued overdosing her. It was only when I saw her numbers on my meter that I found the right starting dose for her. That was .6u Vetsulin! No wonder the 3u dose made her strange!!!

On the board, we usually suggest that people start with 1.0u bid and work up in .25u increments until a breakthrough dose is reached. But I am going on and on here....maybe it's best if you read the stickies and come back with questions for us. Please post a condo each day with Cashew's numbers....read a few so you will get the idea. Don't forget to link the previous day's condo to the first one. You will do just fine!!! You did a great job with the SS and you are doing the right things!
keep up the good work!!
 
The person you spoke with from the manufacturer is not well informed about the differences between human and animal meters. This is a link that discusses the AlphaTrack vs. human glucometers. Also, if you look at the Rand Protocol there is a comparison of values and dosing based on either the AlphaTrack and human glucometers (e.g., Bayer Contour), as well. If someone hasn't done the reading, it is typically recommended to get a meter that is calibrated for non-human blood. The reality is that the differences are not significant and the cost for strips is much greater with an AlphaTrack vs. other meters. The majority of people here use a human meter.

As far as stopping insulin, while it is possible that Cashew is getting too much, IMHO you don't have enough information on your SS to know whether this is the case. The difficulty is that Lantus dosing is based on the nadir, not on pre-shot numbers. You have almost exclusively pre-shot BG tests. Cashew could be reaching low numbers at mid-cycle and bouncing back into the pinks at shot time but based on what's on your SS, the cycles are pretty flat pink.Ordinarily, this would indicate a dose increase. I would be very hesitant to suggest increasing in the absence of more information. If you are uncomfortable with the amount you are dosing, you can always start over at 1.0u or reduce the dose to a level you are comfortable with. If you opt to do this, you still need to get more spot checks in order to guide your dosing decisions. If you decide to stop insulin, I would strongly encourage you to keep testing for BG and ketones and if numbers are out of the normal (50 - 120) range, start insulin again. Otherwise, you could put Cashew at risk for diabetic ketoacidosis. This is a life threatening condition and will cost you a small fortune (we're talking thousands of dollars) in vet bills.
 
hey no problem...im sorry i didn't drag on the last post....aaah i am still new at this.

Cashew's doses have been prescribed by the vet, we suspect there may be a meter issue because of the random low bg level last week ( 5mmol/L x 18 = 90 mg/dl) so ever since then i have been looking for signs he is actually doing a lot better with less or no insulin.

I am just heading out to get another meter...the vet was concerned because of consistent high levels and wierd drop so asked if the meter (freestyle light) was calibrated with the strips but it doesn't require any coding. I spoke with a pharamacist and he explained the same. The only way you can check if your meter is broken by getting control solution (ordered it over phone which will take 7-10 business days). His current reading was in the low twenties (22 x 18 = 396 mg/dl) I tested him about 3 hours after feeding him, unfortunately i did NOT test him right before feeding. I was too much in a rush to catch the pharmacist i had been dealing with and hoping i would get the control solution and he'd teach me how to configure this thing...

To save time I am going to go out and get another meter and see if there is a difference. The vet was using my meter when he was hospitalized first day for observation so i really don't know why she wants him in again (I cant afford all these visits!!!)..uhm, sorry i am just becoming bitter because i feel like i am running around in circles.

Please let me know if there is anything else you need to know. I may have to increase his dose again which i am really reluctant to do because it will make him all pissy and grumpy and miserable. :(
 
Well, your feelings are understandable. But,if you don't like the way he is acting...maybe you should just take a minute and think about that. You are observing what I saw in my Raja I think.....too much insulin. In her case, she only needed less than 1.0u.

I don't want to contradict your Vet....I am just saying that we have lots of success by starting LOW and going SLOW. We increase slowly and watch the numbers during each 12 hour cycle.

High AM and PM numbers can indicate that the kitty went low during the day. That's why mid cycle checks would be really informative.
It would be great if you could monitor and see where Cashew went during the day. If you are not home during the day, the night time checks are very important....a +2 or +3 and a before bed time check too. That fills in the picture of what is going on.

This is all a methodical process of dosing and upping the dose by small amounts. Many vets do start kitties off on very high doses. We hear that all the time and it happened to me and my two. So, it becomes something that you have to really think about. You like your vet and yet, you are not feeling too good about increasing. Cashew is your kitty and you have to do what you feel is best, right?

I think that once you are secure in the numbers that you are seeing from your meter, you will then be able to track the BGs during the day....maybe days off you could do a curve? Test at +3, +6, +8 along with the AMPS and PMPS and on the next day, do a +4, +7, +9 and so on until you can see the nadir and a pattern.

Don't hesitate to ask any questions you might have. You will make your own decisions about what you feel most comfortable doing of course. But whatever you feel in your gut. We are here to tell you of our experiences and what has worked for many in the past. Start low ~~ go slow. You will hear many people say that. Read the info in the stickies, k? They explain a lot! :YMHUG:
 
Best way to test your meter without the control solution is to test on yourself.. poke on your finger:

http://www.topnews.in/health/files/diabetes_0.jpg

If you aren't diabetic.. you'll probably be somewhere between 60 and 130 depending on how long it has been since you ate.

Kitty, human, cow, dog, mouse, etc.. really doesn't make a lot of difference with meters.
 
My vet tested both the meters I have here against the Alphatrack. Both human meters ran 10-20 points higher than the Alphatrack, with numbers being mid-200s. In other words, less than a 5% difference between all three meters. She still recommends that I get and use the Alphatrack, even though she knows I won't (d/t expenses and just unnecessary-ness). She can't find a compelling reason for me, so she just wiggles her eyebrows. LOL.

As for weird drops, Eeyore has the weirdest cycle on Lantus. In the beginning, he'd have a giant drop, and then shoot back up - totally not the "gentle curve" lantus is famous for. However, if you look at it now, it's a nice, nice curve...so it can and does take time for their bodies to get accustomed to a new dose/new medication. And Esse, my other sugarcat, has a penchant for tanking, too...once, she went from 441 at 6 am to the 40s by 11 am...talk about a huge drop. So weird drops can and do happen with lantus...

Hang in there - you'll get it sorted through.

Best-
Michele
 
I don't know if it would be a good idea to take Cashew off insulin, but instead continue with this dose and get some mid point numbers, like you did on 4/11/10 I think it was.
For Lantus, those numbers at ps, just before your shot times don't really mean much at all. It's the ones in the middle that tell you if the insulin is helping or not.
You need to base your dose decisions on what's happening around +6 or so because you need to know nadir for Cashew; you need to know what Cashew's lowest numbers are.
And remember: no food for 2hours before ps so that you get true numbers, not higher numbers because of the foods eaten.

Think of a bouncing ball. If Cashew is going low in the middle and bouncing right up again, by giving more insulin, you could make the low even lower and the high even higher.

If your numbers are correct and there is nothing wrong with your meter, it could be very dangerous for Cashew to stop the insulin because those numbers would go even higher on no insulin and you are increasing the chances of a whole bunch of health issues that will harm Cashew.d

I am hoping you are testing for ketones because with high numbers, the chances are higher of developing them. I test Shadoe frequently because she has had some high numbers for long times, and it's dangerous. You have ketostix, yes, from the pharmacy, to test? You really don't want any health issues that will cost you $100s or $1000s at the vets, and poor Cashew too. Best to test and keep getting negative, or knowing when even if a trace shows and you can take care of the problem right away.

I am not sure what method you are using for converting BG test results, but I used this convertor and made myself a chart.
http://felinediabetes.com/bg-convert.htm
Instead of converting every result, I made myself an Excel sheet with all mg to mmol numbers from 2.0 up to 25.5. I attached a copy of what I use; it saves me time.

My vets don't work from the values we are putting on our ss, so rather than keep two charts/ss, I have recently started putting both values on the same sheet. I can fill in the colors myself and it's simpler to have both on the same sheet so anyone can look and understand. I take an updated copy of my ss with me to the vets on every visit so it can be seen how Shadoe or Oliver are doing.

I should say that my vets don't say much on dosing because they are not familiar with Lantus or Levemir; I go by what works here based on protocols followed on this board.

If you look at my ss for Shadoe or Oliver, you can see how those mid cycle numbers are very very important. Often, I may get pink numbers for ps results but in mid cycle, there can be yellow or blue or even green values, so all pink tells me maybe we need more insulin, but lower number in the middle tell me maybe we need to wait a bit longer.

I test lots, so I can't really say the best ones for spot checks, but every 3 hours would be good and if you can on the weekends or some other time when you are home to do a curve, you can do ever 2hours. There is absolutely no need to have the curves done at the vet because you can do them at home and Cashew is in familiar surroundings!

Once you have done a few curves, you will be able to see Cashew's patterns, where Cashew's nadir is. I should say that nadir can change, move around over time, so if Cashew is getting nadir around +4 now, later on it could move closer to +6, so regular curves are a good idea to just keep an eye on how Cashew's pattern is adjusting.

I am afraid I've gotten too long winded here, even for me, so if you have any questions, be sure to ask every one of them. If anything I have said is a bit off, hopefully, wiser ones will be along to correct me.

I should mention that I am also in Toronto, so I am close by if you need any help. I am right downtown.
 

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You must be a wreck, worried about Cashew (awesome name for a gorgeous kitty!) and getting conflicting information from your vet and the folks here. I know I was when I first showed up.

Listen, it's pretty common for us to show up here with a new diagnosis in our hands and all this stuff the vet said (and in my case a LOT he didn't say) while we're pulling our hair out in frustration because we just don't.know.what.to.do. Once you've been here for a while (a few minutes, days, whatever) and start looking around, you'll see how many people show up daily in the same shoes you're wearing.

The thing is, unless you can find a specialist, most vets have to know a little bit about everything but can't know a lot about any one particular disease. He tells you the same stuff they've all been telling folks for years and sends ya home. Where, smart mama that you are, you google it and start educating yourself. Then you find that there are different ways to treat this problem but the vet didn't tell you to do this and he may have told you not to do that... and he went to school for years to learn to be a doc so he should know right? BUT. When you find a place like this, where you have hundreds of folks who deal with FD all day every day, you're going to find some pretty concentrated knowledge. You just found your specialists :-D They may not have medical degrees (Actually, I suspect a few of them do in some field or another), but look around and see how many people and their kitties they have helped. The best part about these specialists? They don't charge you anything expect your active participation in your kitty's health and well being.

Wanna know what convinced me? Sometime this morning, there will be a thread in this forum for a kitty named Max. It will have the word Party in the title. Click it. Have tissues. If you really want the backstory on Max, check his thread from yesterday The first post describes their journey. It was a party thread similar to this that convinced me that these people know their stuff better than the vet I am using. Along with the ten tons of information that they have made available =)

With their help Tugger has gone from Sick Kitty to Heathy Fat Kitty in a very short time. In that first picture he was not yet diagnosed but quite sick, he laid in the paper but couldn't even play in it and it's his very favorite thing to do. The second picture was taken just recently and shows how shiny his fur has become, how alert he is and how curious he's become. He hasn't jumped onto anything in a very long time but he jumped up there like he's been doing it daily his whole life :mrgreen: Less than 6 months between those pictures and the first four and a half I wasn't coming here. No improvement was made in Tugger's situation till we came here and they started working with us. Now, he's shiny and playful and talkative. I have my boy back cat_pet_icon
 
hello my darlings!

Good morning to everyone on the east coast here :razz:

So, I went out and bought another Freestyle light meter and tested Cashew again using BOTH meters. Old meter showed a higher reading than new. This, to me, means there was something wrong with the old meter and my feelings were hinting in the right direction. I am glad the vet brought this coding business up because otherwise I would still be scratching my head.

It is time for Cashew's AMPS now and I am going to follow my ''feelings'' again and give him a lower dose of 2 units of Lantus (this is given his bg levels are still in the high teens). I am going to then do a few more curves (over the weekend and then try to get some checks in throughout the night since day time is impossible).
This will hopefully give us a better idea of what his nadir really is because so far the old meter was not showing a very low drop (+5 to +7) so I feel like we have to retrace our steps here and tread more carefully?

I am going to call the vet today and tell of her this. I feel wierd because I am not a doc/vet but i can't ignore my maternal instincts now can i! O yesterday I was so excited at the possibility of cashew getting better that I cut my fingers with a fruit cutter by accident when washing dishes. LMAO!!

okay guys talk soon! TGIF!!!

xo
 
Hi...a new meter? GREAT! My suggestion would be to use the one with the lower readings....and stick with only that one, k?
We can drive ourselves crazy by comparing 2 different meters, so just use the one that you just got.

I like you idea of starting with the 2u....we usually start with 1u but if that is what you are doing now, that's ok. If you can log the numbers your get on your SS and open a new condo each morning for Cashew, linking the previous day's condo to the first post of the day. You can show the BG numbers you have gotten and then people can come back and take a close look, k?

This is a process of getting the numbers at +3, +5, +7, +9 and then at night, maybe a +2, +4, +6 and then the following day you can alternate the numbers again. We want to find the hour that Cashew gets his lowest BG during a 12 hour cycle. That time will generally stay around about the same each cycle....so you will know in the future ...that is the nadir or lowest point. It is important to discover when your kitty goes low....each cat is different. (my shadow seems to get low numbers at +8 in each cycle...so if he is low at +4 I know that even with food, he will be going lower in 4 hours....)

The numbers will fluctuate with each cycle and with each hour, but a pattern will be seen with your curve testing. You will be in control once you test and see when to expect his nadir and then you can fiddle with the meal times and the amount of food given ....there are many things you will learn while here. One thing that is important: please make sure you do get tests during the PM cycle too...especially before bedtime. Some kitties go lower at nights and that leads to some interesting sessions....

If you ever see that his number is <50, you should have plenty of cans of high carb food available. We give gravy only so it will raise the BGs to a higher number. I am just telling you this right at the getgo....go and get some gravy foods ....I assume you know about the janet & Binky food chart? Foods with gravy are generally very high in carbs and you will be able to bring lower BGs up with the use of some gravy and the kitties always love that. I don't want to overwhelm you ....have you read the stickies at the top of the page yet? Please read up....read a lot so you will understand....and any questions you have, post it in your daily condo...k?

Good job! Looking forward to seeing what data you get. Data is good! I LOVE data! Please feel free to go to other condos and visit....read about what is going on with other kitties too when you get a chance...Come to Shadow's and say hello! :razz:
 
Hi everyone,

thank you for the overwhelming response. I read through all of the Stickies, and will have to read them maybe a few times more to make sure I did not miss anything. I e-mailed Cashew's vet but have not heard back cat(2)_steam

Uhm, so please feel free to check his SS to see over the next few days. I am going to do spot checks throughout the night hopefully and then a blood curve this weekend. I want to take it a bit easier on his ears too because I know they are becoming bruised, I don't know I hope it goes well. I think I am just feeling overwhelmed with everything right now.

I also got a pack of Keytostix and stuck it in his pee right after he got out (I caught him peeing but was holding in the wrong spot the whole time!!) Anyway, I dipped it in and waited for it to change colours. It changed ever so slightly if anything and was light pink which means trace of ketones. What do I do next? His sugar level is fairly high so it makes sense or no should I take action? if so, what do I do next?

I appreciate all the guidance I am getting from here.

Thank you so much!
 
continue checking for ketones. add water to cashew's food. get as much water in him as you can to flush the ketones out of his system. call your vet first thing in the morning. i suspect he'll raise the current dose.
how is cashew's appetite? how's he acting?
 
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