Max and Elise--Help Please

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tiffmaxee

tiffmaxee

Member Since 2013
I've been posting on the relaxed list but would love some extra sets of eyes to comment on what you think I should do in regards to dosing. I upped Max's insulin Saturday night and then got the okay to do so from his vet Monday. Now there is talk that I should go back to .25. Any suggestions are more than welcome. Thanks.

Elise
 
Hello Elise and welcome to Lantus Land. I hope we'll be able to help you help Max. You'll find that the group over here is quite data driven. We like to see at least two tests per cycle. One at PS and another somewhere after that. I notice that you haven't been getting any PM tests after Max's PS test. Is it possible to get a BG test before you go to bed? Some cats (like mine), love to go low at night and then bounce during the day. If I was to decide on dose based on her daytime numbers, I'd be giving her too much insulin.

Would it be possible to get a test sometime tonight after her PS? We realize we can't get middle of the night tests all of the time, but a test around +2 or +3 will give us a clue as to what is happening at night. We also suggest a test before every shot at PS, so we can tell if it's safe to give insulin.

The other thing to be aware of is that +6 is not always a cat's nadir. Some cat's here nadir at +2 or +3, so mixing up the mid day tests might also help.
 
I have to agree with Wendy. There's no way to adequately determine what may be going on with Max during the PM cycle. Many cats experience lower numbers at night so without any clues to what may be happening, there's no way to make a suggestion that could keep Max safe. In addition, I'd strongly encourage you to do whatever you can to get a pre-shot test. It's the only way to know whether it's safe to shoot. Were people suggesting you reduce the dose because you aren't testing consistently or did they make the recommendation for some other reason?

That said, please think about a before bed test or a test before you walk out the door, a test when you get home or a test at any point when you can. There are certainly people here who work nights or whose jobs make it hard to get a test during one cycle because of work and commute. However, they try to get some additional tests on weekends or holidays.
 
Hi Elise!

I think sometimes people don't realize that "Tight Regulation" is about keeping the cat in normal numbers so their pancreas can heal and to keep their organs healthy. just throwing that out there in case you don't know - when i hear "tight regulation" i think "pain in my life and i can't do it!" Fortunately, I started when there was just one "Lantus" support group and didn't get scared off by the "Tight Reg" name!

Back to Max, though. I don't see anything that says "reduce the dose." nothing. he's still on a very small dose. I'd hold this dose and see how he is after 6 cycles on it.

I would encourage you to do two things. i would vary the time of the am cycle test, like get a +3 or +4 or + 5 instead of always getting a +6. Some cats have their low point at +6, but many haven't read the manual and don't know that's what we're expecting! You don't have to get all of those times, just vary the time you test. don't know if you're home during the day, or can do that, but if you can't during your work day maybe you could do it on your days off.

I'd also encourage you to get a before-bed test. somewhere in between +2 and +5, depending on your life and schedule. Many cats go lower at night and sometimes they go low and then bounce high. That's probably where the advice to lower the dose came from - because we have an empty section at night, and cats do often go lower there, that could very well explain a high amps, like your 402 day before yesterday. the way to know if that is happening, and if it's a safe range of low numbers, is to grab a test or two.

a cat will bounce from any range lower than they are used to - so that 402 could conceivably come from a blood sugar of 120, for example, which would not call for a lower dose.

i think of the spreadsheet as a jigsaw puzzle. you don't have to have every single piece to see the picture pretty clearly, but if you only have a row of pieces down the middle, or only have the edges, it's pretty hard to see what is happening.

i've seen you posting and encouraging people, elise. that's really kind of you! glad to have you here!
 
Thanks everyone. It took me a long time to start to test at all. I was going to the vet once or twice a week and sticking him there. I have to be careful with Max as he is very skittish and prone to pancreatitis attacks from stress. He has high BP, at least at the vet's office and on med for that. He acts calm but he isn't. The only time he rebelled there was when he had a curve done there the day he started lantus. He hides from me to avoid his gel cap and I don't want to have him hiding all the time. That being said I'm hoping he is getting used to testing. I still have a knot in my stomach each time.

The reason I was told to decrease his dose was that I was told the numbers looked better when he was on .25 but to me the best was when he was on a dose of .75 a day or at least as close to it as I could get. I still have to help out with my elderly mom so can't always test like I would if I could. For example, tomorrow I need to leave at about 11 a.m. and won't be back until at least 3-5 as we have doctor appointments. I shoot at 7:30 a.m. I can test before each shot and at 11 a.m. though. It's so confusing for me I considered stopping posting and just keeping the ss going.

Sorry for the long post and thanks for the help.
 
do you give Max some kind of food treat every time you test him? i didn't think that would be enough to make punkin tolerate it, but it really made a huge difference. i boiled chicken breasts, diced them small (1/2" cubes) and froze most of it, leaving a couple of tablespoons in the fridge at a time. he LOVED it! he'd leap from the test and run to the kitchen for his treat. some people use freeze dried treats, too.

i think it's common for people not on the TR forum to suggest to lower the dose. his spreadsheet only starts January and your sig line says he was diagnosed in november. was he on 0.75u before, then?

like i said, you don't have to test every day at all of those times, just vary the times. so tomorrow when you go with your mom, just grab it before you go. it's just that no one wants to tell you to increase the dose if there are some hidden lows in there that we're not seeing, and then have a crisis is Max ends up overdosed! we're just thinking of his safety.

i hope you won't stop posting. it is such a steep learning curve at the beginning and can be so stressful - this group will be a wonderful support for you. we all get how hard it is and that you're working around the rest of your life too. all you can do is what you can do! hang in there - it gets infinitely easier as you learn more!

julie
 
I didn't have a ss when this all started. He started on l unit BID, then went to .75, .5 .25 and then was off for 3-4 weeks. When his numbers were up again at the vet's and weekly test off lantus, he started Max back on the .25 dose. His PS was just 287, not much different from his +6. I'll test him again in 4 hours. I actually thought his nadir might be +7 based on the few better results we got then. Thanks, Julie.

I'm starting to wonder if I should get a different meter. Is the Relion Micro a good one? Also, do you want me to reconstruct the few tests I have from the vet's office from 11/15/13-1/8/14? He was doing so well when we started I don't understand this.
 
Any extra data you have from the vets tests will help fill in the picture for us. But we find that the last two weeks data is the most important so don't worry about it if it's too much work.

I use the Relion Confirm and a lot of people use the Relion Micro. I think they are good meters.
 
i had a Relion Confirm and thought it was a good meter. you can use generic Arkray strips through American Diabetes Wholesale - i was getting the 5 boxes (250 strips) for the price of 4 for about $70. that makes the cost of testing more often a lot more doable.

It might be helpful if you even just copied the summary you gave above and put it in the first row comment cell. or if you have any test data, you can do an approximate reconstruction.

nadirs can move around. punkin's was almost always at +5.5, but once in a while it was later, and if he was clearing a bounce that sorta wiped out any curve and the low point could be anywhere in the cycle.
 
Can I use the generic test strips for the Relion Micro? I'm not understanding what you are suggesting I do with the summary.

Elise
 
i just mean to go to he summary you wrote above and highlight and copy it.

then go to your spreadsheet, row 1 and move to the right where the comments column is. Paste it in that column. That puts the history with the different doses and number that you have on the spreadsheet where we can see it.

if you're spreadsheet savvy and you want to add rows and insert the history date by date, that's awesome. i just was thinking of this as an easy option.

i think there are some generic strips for the micro, but i don't personally know about it. if you want to know about it, edit the subject line of your first post in this thread and put something like "micro strips - generic?" or something like that to get the attention of people who use a Relion micro. Ask and they will come! :-D
 
Thank you. I just ordered more syringes from them today. I'm going to see if I can add to my order right now. I am NOT computer savy at all. Marje did my ss for me. I'll see what I can do.

Elise
 
OMG you folks are right! I just tested Max +4 after his PM shot and he was 74. This is the first time I tested at night. Do I need to be concerned? Before going off insulin he was 70 at +6 or 7 in the afternoon.

Elise
 
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