Luna: intro + FreeStyle Libre adventure

Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
Hello! Some people from back end 2017 might remember me and old Quintus (still in remission and doing good).

I'm fostering a diabetic girl named Luna (see her photo/video album). She is very shy and I am making very slow progress in getting to test her, so I took the plunge and got her fitted with a FreeStyle Libre. I am loving it -- and loving having something else than water consumption to go by to adjust her dose.

She was in very bad shape when I got her, 1kg950, two months (without insulin) after her diagnosis. She has severe intestinal inflammation (IBD, the IM vet had never seen intestinal wall thickening this bad) so she is on a strict diet that I can't really touch. She has put on nearly 900g since I got her, weighing 2kg810 today (she is a small cat).

I'm doing OK regarding dosing.

However, based on what comparisons I've seen, it seems the FreeStyle Libre reads slightly higher than a "normal" glucose meter. This means that maybe I need to set an action threshold around 60 rather than 50? How much experience does the board have with the FSL? Do you use the same thresholds as with a normal meter, or not?

Interested in hearing experiences.

Currently I'm giving her 4ui and she seems pretty bouncy (not surprising also with the kibble she is eating). If you look at her spreadsheet you'll see I've added sheets for the FSL graphs -- trying to figure out how best to present them (for the time being all the days are bunched up in one graph, but that won't work long) and if I can find a way to autofill the spreadsheet with the values from the FSL.
 
AmandaE said:
@Crista & Ming and @J.J. and Phoebe Squeak Have both tried the FSL. Do you guys have any insights for Stephanie and Luna?

Luna is so lucky that you two have crossed paths, she must be feeling so much better these days :) I hope she will go OTJ quickly :)
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Hi, sadly the Freestyle Meter was not right for Phoebe Squeak. She scratched the first one off and then was VERY unhappy that we made her wear clothes to keep her from removing the second one. Getting the data was great, though. I was told by the doctor who put the sensor on that I should not do blood tests while she was wearing it. I did a few blood tests anyway, but I use a pet meter so our take action number is 68 instead of 50. What I remember was that the Libre was higher than my AlphaTrak2 early on, but then it read lower later. I was told the Libres read high at first so I guess that explains it. For us, it was more about finding patterns -- when was her onset, when did she dip etc. I was not able to find a way to auto load the Libre readings into the spreadsheet so I just did it manually. The Libre meter itself tells you to double check with a blood meter when things are out of range, so that's why I tested those few times -- to see if she really was too low. Based on what @Crista & Ming said, the fluid that the sensor tests is behind the blood anyway time-wise, so if your foster kitty is getting close to too low numbers, best to confirm with a blood test if you can.
Remember to scan at least every 8 hours if possible so you don't lose any data. I really hope it works for you & Luna. You are AMAZING to foster a diabetic cat!
 
How did you get the graph with all the points and numbers? I've only been able to get pictures of the graph and not actual numbers on the graph!

I decided if Ming was under 90, I was going to use my blood glucometer so I'd catch dives before they happened. But I think you could decide on a lower number for when to intervene with food.

And wowwwww!!!!! That water consumption website is impressive!! I can't read the language but I'm curious about what it says.
 
Crista & Ming said:
How did you get the graph with all the points and numbers? I've only been able to get pictures of the graph and not actual numbers on the graph!
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So, here's what I do. I export the data from the FSL application on my computer after importing it from the reader. Here is the export file. I have to do a search and replace to put periods instead of commas in the number (French vs Swiss formatting), that's pretty easy to do on my computer with any text editor.

Then, in Google Sheets, I import from the export file in a dedicated tab (in my SS it's "import"). Then I copy that over to the FSL data tab (I do it like that to save myself steps) and I created the graph you can see in the spreadsheet. I'm just wondering how to make this sustainable, for the moment I only have a few days of data so I'm squishing them in one graph, but at some point I'm going to have to find a better solution, or only show the last few days.

If you want I can set it up in your spreadsheet, send me a private message and we can arrange access.

Crista & Ming said:
And wowwwww!!!!! That water consumption website is impressive!! I can't read the language but I'm curious about what it says.
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Glad you like it! As I couldn't test her at least by monitoring her water I could have an idea if I was getting anywhere. I knew her diabetes was really bad (her fructosamine was sky-high in April and she was really skin and bones). Then I was able to get a few measurements with the AT before she became completely impossible to test (particularly if I wanted to be able to continue doing the injections!), so that gave me an indication of how her water intake related to her BG.

I have now started weighing her food, so that when I go blind again I have two things to rely on (water + food). The water consumption album comments don't say much, mainly indicate when I changed her insulin dose and what led me to do it. It's in French.

I have to say that one thing I've learned these 18+ last months managing the French support group is that for some cat/owner combos, BG testing is just impossible, or so hard to get to they don't manage. I really didn't think I'd find myself in this situation, to be honest. So I'm "glad" to have the opportunity to look for alternative ways to evaluate how the diabetes management is going.

Luna spent all night in HI values. So either she is a really bouncy cat (I'd already observed bounces in her water intake) or something is off with the meter. Fingers crossed... (I'm not sure what is worse.) But she emptied her water bowl again this night which is consistent with the high values I'm reading. And hardly ate anything (I guess the low values yesterday fed her cells!)

I've manually put the +1, +2 etc values in her SS so that it is more "readable".
 
J.J. and Phoebe Squeak said:
She scratched the first one off and then was VERY unhappy that we made her wear clothes to keep her from removing the second one. Getting the data was great, though.
Click to expand...
Damn... Luna really doesn't seem to mind, thankful for that! She's going around with a "naked sensor"... I haven't managed to put her shirt back on (or tried because she freaks out so much and I see she doesn't seem to be attacking the sensor). Here putting a sensor on costs about 1.5 times the price of a glucose curve at the vet. I figured even if I get only two days of data out of it, it's worth it. The sensors seem to be WAY cheaper in France, so I'm going to see if I can get them from over there for the future.
 
Stephanie & Quintus/Luna said:
Has anybody seen a cat bounce back up into the blacks and stay there for 18 hours?
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That seems excessive, but hard to know if it is a problem with sensor or truly that high? Without sensor I think people might be better able to advise. Is there any way to test sensor for malfunction? Any way to test sugar through ear prick? I am not familiar with how this works.

Any possibility there was a fur shot?

If this continues a call to vet and possible visit may be in order. Also checking for ketones, since you don’t know if meter or actually that high. Is she eating okay and seeming herself?

I am tagging a few people, albeit not Libre users, for their thoughts.

@Bron and Sheba @Wendy&Neko @Marje and Gracie

Also tagging @Ti-Mousse who was in high numbers for some time and may have a point of reference on how long some high bounces can last.
 
Also looking at spreadsheet again, that black reading is identical every hour seems to point to those may not be true numbers, even high numbers should fluctuate some from reading to reading.

Plus wondering if a reduction could have been taken with that green yesterday?

I am sure you also know from past experience that too much insulin can look like too little. Does not look like there was a lot of data to get up to 4 units. Was there data for the increases that just isn’t listed?
 
So, Luna is behaving fine. I had a shot at trying to get her BG but it's hopeless. I'll give it another go in her carrier later (I have to be careful not to freak her out in my attempts or it can jeopardize my ability to do the insulin injections). What I did is I made a vet appointment for tomorrow 17:00, so if the readings haven't gone down by then we'll draw blood or get a BG reading at the vet's (more people and different environment, we'll certainly manage something).

Normally if the sensor is malfunctioning there are error codes. It is still firmly in place. By tonight's injection time I'll know how much she drank and if it's consistent with being in super high values.

She was super high to begin with. Her fructosamine was 727 umol/l upon diagnosis (and no treatment thereafter for 2 months). The few values I managed to test early on with the AT was really quite high. So I wouldn't be surprised she is capable of doing a moon-high bounce. The FSL doesn't go higher than 500 so we can't see if anything is "happening" up there. Here are her medical files if anybody wants to poke around (but it's all in French, sorry).

She never showed any ketones (even when I got her), I poke a strip in her litter every now and again.
 
Julie and Honey said:
Also looking at spreadsheet again, that black reading is identical every hour seems to point to those may not be true numbers, even high numbers should fluctuate some from reading to reading.

Plus wondering if a reduction could have been taken with that green yesterday?

I am sure you also know from past experience that too much insulin can look like too little. Does not look like there was a lot of data to get up to 4 units. Was there data for the increases that just isn’t listed?
Click to expand...

So, it's always the same number because it's the highest the sensor can read. Increases up to 4ui were based on water intake, glucose in urine, weight gain (plus the few values I got initially which did give me a kind of baseline for water and urine glucose). I added 0.25 this morning a bit on a whim, because I suspect 4ui isn't quite enough (based on how low she went and how high she goes overall around that low value). My 4ui injections were already somewhat fat sometimes.
 
Stephanie & Quintus/Luna said:
So, it's always the same number because it's the highest the sensor can read. Increases up to 4ui were based on water intake, glucose in urine, weight gain (plus the few values I got initially which did give me a kind of baseline for water and urine glucose). I added 0.25 this morning a bit on a whim, because I suspect 4ui isn't quite enough (based on how low she went and how high she goes overall around that low value). My 4ui injections were already somewhat fat sometimes.
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I understand about the readings now.

I just re-read intro and see she is also a very tiny kitty, more reason I would be concerned with higher doses of insulin without more data. That is a high dose for even a larger cat.

Giving more insulin to counteract high numbers is not recommended without more data to justify it. It is possible she is on too high a dose at this point so you are not seeing true numbers and her liver might just be throwing out stored sugar to save her from going too low, hence the bounces. I am not an expert, I am just going on what I have seen here in the past. I am hoping you will get more guidance from people that are most familiar with dosing (people I tagged earlier).
 
Also the kibble will play a part, but if you decide to remove that it needs to be done carefully as that will cause a drop in sugar by itself.
 
Julie and Honey said:
Giving more insulin to counteract high numbers is not recommended without more data to justify it. It is possible she is on too high a dose at this point so you are not seeing true numbers and her liver might just be throwing out stored sugar to save her from going too low, hence the bounces. I am not an expert, I am just going on what I have seen here in the past. I am hoping you will get more guidance from people that are most familiar with dosing (people I tagged earlier).
Click to expand...
I'm not worried about her being overdosed at this stage because I would probably have ended up with no glucose (or little glucose) in her urine now and then had it been the case. There have been a few cycles where her water intake was low, so that shows she is coming down to "nicer" values. Although I didn't have BG to go by, I did keep a close eye on her signs and symptoms and increased quite gently, considering. Also, she was in a desperate state when I got her (I don't know how visible it is on the photos) and I decided I would rather err on the side of a bit too much insulin than not enough (knowing the risks, and having seen way more cats die from DKA than hypos these last two years).

Regarding the kibble, I'd love to change it but her digestive situation is such that I'm not touching it for the moment. Of course I understand it's going to make her BG swing up and down much more than if she were on a low-carb diet. I've already managed to introduce half a can of a/d (13%) into her daily ration, and her stools are great (she was producing hard little pebbles when I got her, and she had frightful diarrhea before she was put on the HA kibble). More a/d and her stools started becoming too soft.
 
Stephanie & Quintus/Luna said:
I'm not worried about her being overdosed at this stage because I would probably have ended up with no glucose (or little glucose) in her urine now and then had it been the case. There have been a few cycles where her water intake was low, so that shows she is coming down to "nicer" values. Although I didn't have BG to go by, I did keep a close eye on her signs and symptoms and increased quite gently, considering. Also, she was in a desperate state when I got her (I don't know how visible it is on the photos) and I decided I would rather err on the side of a bit too much insulin than not enough (knowing the risks, and having seen way more cats die from DKA than hypos these last two years).

Regarding the kibble, I'd love to change it but her digestive situation is such that I'm not touching it for the moment. Of course I understand it's going to make her BG swing up and down much more than if she were on a low-carb diet. I've already managed to introduce half a can of a/d (13%) into her daily ration, and her stools are great (she was producing hard little pebbles when I got her, and she had frightful diarrhea before she was put on the HA kibble). More a/d and her stools started becoming too soft.
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I hope you get some answers to get her in better shape. She is a beautiful little girl. :cat:
 
Hi Stephanie,
Stephanie & Quintus/Luna said:
Has anybody seen a cat bounce back up into the blacks and stay there for 18 hours?
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Yes, the cat’s name was Neko. :rolleyes: Also seen it in an overdosed cat.

You got to a 4.0 unit dose with no test data on any of those cycles since 2.5 units? Since she’s on HC kibble (can I ask which one), you shouldn’t have been increasing every three days. Much less based on water consumption. It’s just too unsafe. I know you will do what you will do, but I have to say this for any lurkers present too.

There are alternatives for cat’s with IBD. Have you seen https://www.ibdkitties.net/
 
Wendy&Neko said:
You got to a 4.0 unit dose with no test data on any of those cycles since 2.5 units? Since she’s on HC kibble (can I ask which one), you shouldn’t have been increasing every three days. Much less based on water consumption. It’s just too unsafe. I know you will do what you will do, but I have to say this for any lurkers present too.
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I've also been keeping an eye on urine glucose -- always ++++ or +++. Sometimes we don't have much of a choice -- not sure you realise how skin and bones she was when I got her. I'm not sure how much longer she would have lasted without some kind of regulation, so it was urgent to get somewhere fast.

Water is actually quite a good indicator if you measure it accurately. If you look at the album you can see the cycles in which she went low and the bounce cycles that follow. But yeah, this is definitely "advanced rules" and I wouldn't recommend anybody do this unless a) they are desperate and b) they have a pretty good idea what they are doing (both were the case here). The kibble she is on is HA, so way too many carbs, even I agree ;-)

Just putting out there that being a rescue foster, I have to clear things with the non-profit which is paying for her care, and given she nearly died of her IBD I'm only gingerly departing from the IM vet's instructions for her. I might do things differently if it were my cat. (I know of the IBDKitties site, great resource.) I tried adding more a/d to her diet as she seems to tolerate it, but beyond what I'm giving now I would start getting mushy stools.
 
A little extra info on how I went about increasing the dose, as most of the explanations are in French and in her photo album.

Given the super high fructosamine and her sorry state, I was pretty confident she wouldn't run much risk up to 1.5. I got a measurement at that dose, it was high, and her drinking didn't seem to have budged, so I went up to 2, and 2.5 -- that's where I got some tests in, all disastrously high. The values measured with 2.5 were high enough I could confidently raise the dose to 3, and I stayed with that dose for 12 days before going gingerly up by 0.25, and another 0.25 6 days after that.

This is when I started seeing results, clearly. Her weight gain shot up. Her drinking went down.

Then I had to skip two injections. When I got back, her drinking was worse than ever. She was emptying her bowls, which she hadn't been doing before. I stuck with 3.5 with absolutely no improvement (clearly glucotoxicity taking us for a ride) before moving up to 4ui where after 3 days or so things finally started improving.

Dosing without being able to do BG is of course not ideal, but it is better than not giving insulin or sticking to obviously too low dosages by excess precaution. This is a cat that was labeled unmanageable at the vet's (sedation to get a blood test). So even curves at the vet were not an option for her. Consider it unsafe if you must, but it probably saved her life.
 
Stephanie & Quintus/Luna said:
However, based on what comparisons I've seen, it seems the FreeStyle Libre reads slightly higher than a "normal" glucose meter. This means that maybe I need to set an action threshold around 60 rather than 50? How much experience does the board have with the FSL? Do you use the same thresholds as with a normal meter, or not?

Interested in hearing experiences.
Click to expand...
Attached is my comparison of Libre readings with my human meter.
BG comparison Libre JPG.jpg
 
Monday morning the reader told me the sensor was dead. I did get measurements until 4am, though I didn't get a "successful" reading since midnight (go figure). We'll put a new one on tomorrow. In the meantime I'm back to 4ui for extra safety. Her drinking is still up, but she's still doing fine overall.
Larry and Kitties said:
Attached is my comparison of Libre readings with my human meter.
Click to expand...
Thanks for this! Do you know if anybody did this exercise with an AT?
 
Crista & Ming said:
Oh no! What did the reader say exactly?

I had a moment where the reader told me to try again in 10 minutes and then it worked. It was after I picked Ming up for a cuddle.
Click to expand...
So, the reader first started saying "try again in 10 minutes", but after that said "sensor is finished, try a new one". We put a second one on Luna on Friday but the first one was still well stuck (superglue...) and we decided to leave it on until the fur grew back a bit more. But it seems this sensor proximity is preventing the new one from starting and being read correctly. So... back to the vet on Monday we go.
 
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