?Meter Issues, bear with me I'm new

[KKL]

Ok, this is kind of duplicate, but bear with me.

Where I am at: Is it the meter OR is it the cat?

When I started testing (dx was 5/31/13, he came home 6/2/13) I started using the TrueResult meter. Our ranges were good, numbers seemed okay. I had done tons of reading and switched to ReliOn meter and things got funky fast.

We have had higher highs and lower lows with the ReliOn meter. Could my meter be bad, is it really his BG bouncing that much? If you look on my chart, I used TrueResult 6/6-6/22 AM then switched to ReliOn from 6/22 PM forward. I did have him off insulin for a good 10-11 day period (until the higher ReliOn reading on 6/22 I restarted it and have given him some if he was above 250 until today I stopped)

I gave him 0.2 unit yesterday morning, but due to fear that he was bouncing (we are now seeing 400-600 numbers we never saw with only a 0.1-0.2 unit dose once a day). I am stopping insulin right now at the vets instruction to see what happens.

I took three readings today, based on these it seems my ReliOn meter is the one with the wider variances?? I know typically it's the other way around with other users, but I have gotten wildly sporadic results with my ReliOn:

Time: ReliOn: TrueResult:
7:00 am 596 281
9:30 am 402 156
12:00 pm 154 156

If I can rule out which meter yields the most accurate and consistent results then we can figure out what is going on with Harley. He only gets a super small dose, 0.10 unit too much sends him super low (into the 30's). With and without insulin he does go down when he eats, never up. He always starts high in the morning (happens somewhere between 4-6am) and comes down after he eats and throughout the day. Rarely does he trend upwards. He only gets wet food and to our knowledge no known infections. He MIGHT have had a bout of pancreatitis two months back (4/15/13+/-), when this all started (suddenly not interested in food, weight loss).

 

[Frosty]

Re: Meter Issues, bear with me I'm new

Hi and welcome to LantusLand. Sorry I can't offer any dose advice. We have been using the Relion meter since PurrFace (PF) was dx (8/29/12) without a problem. I'm sure someone that has used both brands as you will be along to give you their perspective.

We have also found that for PF consistent doses work the best and when necessary we will only adjust his dose up or down by a max of .25U at a time. Every cat is different (ECID) but I would recommend that you read the starred post on the main Tight Regulation page.

Again welcome to you and Harley and have a great day.

 

[KKL]

Re: Meter Issues, bear with me I'm new

I have had a heck of a time with his dosing as by 0.1 and 0.2 I mean a fraction of 1 unit and the syringes have not been printed the same so even at the 1 unit line they yield different amounts (by what appears to be almost 0.25 unit). I try to give him 0.20 unit but it could range from 0.15-0.25 unit due to error of margin being greater with that small of a dose. At any rate, any higher than that and he drops really low and then comes up really high just before breakfast.

How long does it take the depot to clear? How does one try a OTJ trial? He was OTJ for 11 days with good numbers, but that was on the TrueResult meter, so hard to say if it was or was not accurate.

I just worry the meter might be off, all five of the boxes at Walmart were pretty banged up, I picked the best one they had I had ordered control solution but it isn't here yet.

 

[Frosty]

Re: Meter Issues, bear with me I'm new

Placing a "?" at the front of your subject line might help bring your question to the attention of those members with a lot more experience and knowledge than me. Go to your first post for today and click on the small dot to the left of the question mark icon located above and to the right of the subject line.

Don't get discouraged, you'll find things become clearer each day.

 

[Sienne and Gabby (GA)]

Re: Meter Issues, bear with me I'm new

There are a number of people who have had issues with the "True" meters despite the positive reviews by Consumer Reports. Someone here mentioned that the Targe tbrand meter has likewise gotten positive reviews. You may want to opt for a 3rd meter and see if you can get consensus. The other factor that may be in play is that strips use differing technologies -- either glucose oxidase or glucose dehydrogenase with nicotinamide-adenine dinucleotide. This may be the reason you are seeing such a wide variation in results.

In looking at Harley's spreadsheet, what I can tell you is that despite the numbers in the 100 - 200 range, by the standards we use here, we would not have suggested that you withhold insulin. We would have encouraged you to keep shooting until you were on a very small amount of insulin and the numbers were in the normal range. We consider normal range as 50 - 120. (We have a cat that is currently on an OTJ trial. You may want to look at Cain's spreadsheet for an example.) Once insulin is stopped, an OTJ trial lasts for 14 days before a cat is "officially" OTJ.

I don't know that there is a set number of days for the depot to be gone. It can take 5 - 7 days for the depot to form in a newly diagnosed cat. I suspect much of this depends on the cat and, in the case of Lantus, how much subcutaneous fat there is since Lantus forms microcrystals in the fat tissue when the depot is formed. The individual cat's speed of metabolism may also be a factor, etc.

It certainly looks like you are seeing bouncing. Meter issues aside, if this were my cat, I'd re-start the insulin at 0.1u twice a day. You may want to consider getting digital calipers so you can consistently measure the dose. One of the members here, Marje, has instructions for using digital calipers for measuring doses.

 

[KKL]

Re: Meter Issues, bear with me I'm new

Thank you, your info does help a lot. I have had people tell me to never let him get to 70 or below and that 100-150 was a safe range? I can tell you his behavior is lackluster between 30-100. At 100-200 he acts most like himself.

Is there a preferred time of day? He seems highest in the morning, both with and without insulin. Would evening injections be better, or not make a difference? I can guarantee I will be home for injections in the am, but due to our work schedules in the pm there are times a neighbor has to feed.

For these super small doses do they ever dilute the Lantus?

 

[Sienne and Gabby (GA)]

Re: Meter Issues, bear with me I'm new

The manufacturer does not recommend diluting Lantus. Dilution can change the effect of the insulin or render it inert. Lantus is acidic so adding a dilutant will change the pH. To get an even smaller dose, if you push the plunger in as hard as you can, insert the syringe into the insulin container and then release the pressure, you will probably get about a drop of insulin.

Also, you really need to shoot twice a day. There is no insulin for cats that's a once a day dose. A cat's metabolism is about twice as fast as a humans hence the twice a day dosing. (There have been a few cats that get that kind of duration but is is very rare.) Shooting once a day will produce the kinds of swings in numbers that you're seeing.

Many cats experience lower numbers at night. I'm not sure there's an explanation other than "every cat is different."

 

[KKL]

Ok good to know...I think the problem has been getting a low enough AM injection that will allow a low PM injection without plummeting him. I can try it and watch his numbers. I just wish they made "pet insulin needles" that were smaller and could accommodate 1/4 unit injections reliably.

He is down to 117 right now from 596 this morning (without insulin). Could he really be going off of 1x day 0.15+/- unit reserves from just a few days?

I am waiting to talk to my vet before we do anything. I don't know if she's going to want me to switch insulins? After buying the Lantus, syringes, testing kits, strips etc we are pretty tapped out. But, if u40 insulin is easier to measure than u100 it might help....

 

[KKL]

I have been playing with red dyed water and a few different syringes.

I find that pushing the plunger down does yield a good sized "drop". Not sure what it is in terms of units, but it's small and consistent....might be a good amount to start at 2x a day...whereas before I couldn't get a small consistent dose to be able to do it a second time, he was always already too low.

 

[Sienne and Gabby (GA)]

One question...

How are you feeding your cat? If you're not giving several small meals throughout the day, this may make a huge difference. Food causes the pancreas to produce its own (i.e., endogenous) insulin. This may be why you're seeing some of these drops without insulin. If you're feeding one large meal, it may be overwhelming your cat's pancreas for several hours.

I'm also going to ask a couple of very experienced Lantus users to take a look at your SS. They have worked on individualized dosing schedules with people and may have a valuable perspective.

 

[KKL]

I give him about 3oz of Wellness Turkey in the morning and again in the evening. I also started to give him about 1oz on a spoon as snacks 2x a day...provided I am home, which since I work from home is give or take (sometimes I am on the road all day)...so I try to make the bulk of his body rely on am and pm feedings that he can count on and the snacks be what they are.

He is still awful thin and I'd love to see him get a little more bloom on him. He was 13lbs at the vet, ideally for his size/frame 15+/-lbs would be a very healthy weight...he's a big cat. (Photo attached: Harley laying with Raven his 100lb Rottweiler sister)