? Nadir

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Ok so I only gave Booger 2 units last night and used the relion meter to check him from 12:30-2:30am as I am again, running low on Alphatrak strips ugh. I just got them Friday. Anyway, I should have some FreeStyle strips tomorrow. Anyway, I only gave him 2 units this morning and he was 560 (bc of the dry food yesterday I am sure) and at +4 he is only down to 415... is that normal?? He has never been this high at +4. @JanetNJ @Kris & Teasel @Bellasmom @JeffJ
 
He's in a bounce phase after those lime greens. It'll settle eventually and then you'll be able to assess the dose properly. He needed that reduction so keep that dose for a few days to see how it all plays out. Make sure you keep both spreadsheets up to date as you use them. It would be helpful to us if you say up front in a post:"please check ______ spreadsheet". It's confusing right now and could lead to errors in advice when you're in a tight spot.
 
Kris & Teasel said:
He's in a bounce phase after those lime greens. It'll settle eventually and then you'll be able to assess the dose properly. He needed that reduction so keep that dose for a few days to see how it all plays out. Make sure you keep both spreadsheets up to date as you use them. It would be helpful to us if you say up front in a post:"please check ______ spreadsheet". It's confusing right now and could lead to errors in advice when you're in a tight spot.
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Ok I understand. I know its confusing me using two meters. I hope to get it to where I am only using one. I mainly used the AT2 yesterday during the hypo and to double check lower numbers on the Relion. It confuses me too bc the Relion shows lower readings than the AT2.
 
LovemyBoogie said:
Ok I understand. I know its confusing me using two meters. I hope to get it to where I am only using one. I mainly used the AT2 yesterday during the hypo and to double check lower numbers on the Relion. It confuses me too bc the Relion shows lower readings than the AT2.
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Yes, the ReliOn will always read lower with a bigger difference at high BGs and a much smaller difference at low BGs. For example, at a high BG level you might get a reading of 450 on the ReliOn but 600 on the AT (just making up numbers for this example). At the low BG end of things where you're getting a sign that a bit of food is needed, you'd be looking at 50 on a ReliOn and 68 on the AT. Those are approximations but they're reference numbers we use here all the time to tell people what to watch out for. Somewhere, someone, sometime determined that a reading of 50 on a human meter is roughly equivalent to 68 on the pet meter. Those two numbers are the most important to know. They're the ones that warn you to take action because BG is on its way down to (possibly) hypo level. All the other numbers above that on either meter just tell you how well kitty is doing - OK or too high. Too high is too high on either.

It drives people bonkers to skip between meters if they're doing that. That's why we always say choose one and stick with it. If you can afford the cost of AT strips at the rate you have to test some days and you can keep a big stockpile of them for this purpose and stay on top of maintaining the stockpile use the AT. Most of us can't do that so we make the switch to a human meter and forget all about pet meters. It's a mind set and it can take some people a while to wrap their head around it.
 
Yes it is hard to wrap my head around. Because if the dose is based off the nadir number than if the relion shows he is 151 (like last night) he could very well actually be 200 something which is not that great. He may actually need a little more insulin but me seeing 151 makes me think his dose is ok or a little high so I take him down a notch and he goes up. Does that make sense?
 
LovemyBoogie said:
Yes it is hard to wrap my head around. Because if the dose is based off the nadir number than if the relion shows he is 151 (like last night) he could very well actually be 200 something which is not that great. He may actually need a little more insulin but me seeing 151 makes me think his dose is ok or a little high so I take him down a notch and he goes up. Does that make sense?
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I understand what you're saying. The nadir is very important to look at when dosing Vetsulin but we also pay attention to the pre shot numbers. It takes time and lots of SS data to learn your kitty's responses so that you can make good dosing judgments. If your meter is working properly and you're sure the blood drop was large enough and you get the business end of the strip well into it, take the reading at face value.

Ignore for a moment that we can convert between Fahrenheit and Celsius temperature scales. Let's say you're trying to decide what jacket to wear on a certain cold day. If you know the significant numbers on each thermometer - really hot, really cold, etc. it doesn't matter which thermometer you use. Let's say you choose the Fahrenheit thermometer: would a temperature of 35F make you choose a different jacket from a temperature of 5F? Probably - and what those temperatures are on a Celsius thermometer doesn't even come into the decision. What if you compare two different Fahrenheit thermometers on that cold day. The second one might read 38F where the first read 35F and the second might read 3F where the first read 5F. Would it change your outerwear decision? Not at all.

We all understand Fahrenheit here - to continue my silly comparison. We also understand Celsius. However Fahrenheit is much more popular.
 
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Here's more explanation:

EVALUATING PRE SHOT BG:
  • is it really high and what might be the reason? (dose too low, bounce going on, insulin duration is too short)
  • how high is it relative to nadir? (ideally you want a nadir that's about 50% of the PS)
  • is it high enough to give the full insulin dose?
  • is it close to the ideal of low to mid 200s? (for an in and out insulin like Vetsulin)
EVALUATING NADIR:
  • is it too low because dose is too high?
  • is it more than 50% lower than PS? by a lot?
  • is it too high because dose is too low?
  • is it too high because kitty has bounced
  • is it about 50% of the PS BG and in the low 100s or high double digits? (for an in and out insulin like Vetsulin).
Vetsulin if a stong acting in and out insulin that can drop BG quickly and low. It's best to aim for a nadir in the range I specified above so there's a bit of a safety cushion all the time. It's also important to be methodical and careful in changing the dose. That's what the testing routine is all about.
 
As reference, I have been using the FreeStyle Lite strips in the AlphaTrak2 tester for over a year. I have found them reliable. Even though I'm in high tech and make a good wage, I didn't like paying the high price for the AT2 strips.
 
Kris & Teasel said:
What if you compare two different Fahrenheit thermometers on that cool day. The second one might read 38F where the first read 35F and the second might read 3F where the first read 5F. Would it change your outerwear decision?
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This would tell me that I was living too far north, and that I needed to move back to Austin TX. Although I won't be bragging about it too much in July :D

Leo is enjoying it now....a good excuse as any for a gratuitous kitteh pic.
 

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JeffJ said:
This would tell me that I was living too far north, and that I needed to move back to Austin TX. Although I won't be bragging about it too much in July :D

Leo is enjoying it now....a good excuse as any for a gratuitous kitteh pic.
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Hey, Jeff, what's that green stuff Leo is lounging on? Winter here has been too long ... :confused:
 
So what would cause a cat to throw up? When booger was low yesterday he threw up some clear liquid. I have been watching him to make sure he is drinking water and of course he is getting it from his wet food too.
 
Throwup:
Some cats just throw up if they haven't eaten in awhile. Leo seems to throw up every night. It's mostly bile. There is food for him to eat, but he is picky and wants "fresh food".

Green stuff:
That green stuff is actually plants. Maybe a strange concept for those living near the friggin arctic! Anyhow we used to have grass in the backyard. Too many trees shaded it out. Now we get 6-8 weeks of a clover field every spring. It's pretty neat. And is sure beats that white stuff you guys have all over the ground.
 
Kris & Teasel said:
I understand what you're saying. The nadir is very important to look at when dosing Vetsulin but we also pay attention to the pre shot numbers. It takes time and lots of SS data to learn your kitty's responses so that you can make good dosing judgments. If your meter is working properly and you're sure the blood drop was large enough and you get the business end of the strip well into it, take the reading at face value.

Ignore for a moment that we can convert between Fahrenheit and Celsius temperature scales. Let's say you're trying to decide what jacket to wear on a certain cold day. If you know the significant numbers on each thermometer - really hot, really cold, etc. it doesn't matter which thermometer you use. Let's say you choose the Fahrenheit thermometer: would a temperature of 35F make you choose a different jacket from a temperature of 5F? Probably - and what those temperatures are on a Celsius thermometer don't even come into the decision. What if you compare two different Fahrenheit thermometers on that cool day. The second one might read 38F where the first read 35F and the second might read 3F where the first read 5F. Would it change your outerwear decision? Not at all.

We all understand Fahrenheit here - to continue my silly comparison. We also understand Celsius. However Fahrenheit is much more popular.
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Best description ever! Thank you for this! It’s so hard to explain and I was one of those instistant on the alphatrack too and this way of describing it really helps it sinks in!
 
JeffJ said:
Throwup:
Some cats just throw up if they haven't eaten in awhile. Leo seems to throw up every night. It's mostly bile. There is food for him to eat, but he is picky and wants "fresh food".

Green stuff:
That green stuff is actually plants. Maybe a strange concept for those living near the friggin arctic! Anyhow we used to have grass in the backyard. Too many trees shaded it out. Now we get 6-8 weeks of a clover field every spring. It's pretty neat. And is sure beats that white stuff you guys have all over the ground.
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Handsome dude is Leo! :smuggrin:
 
What code do you use on your Alphatrak with the freestyle strips. I just did a test and with the Alphatrak strip I got 563 and with the freestyle strip I got 619.
 
LovemyBoogie said:
What code do you use on your Alphatrak with the freestyle strips. I just did a test and with the Alphatrak strip I got 563 and with the freestyle strip I got 619.
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You’d leave the AT meter set at whatever the cat code was on your last vial of AT strips.
 
LovemyBoogie said:
What code do you use on your Alphatrak with the freestyle strips. I just did a test and with the Alphatrak strip I got 563 and with the freestyle strip I got 619.
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These numbers are within 20% of each other. Glucose meters are allowed a 20% variance in the readings they give.
 
@JanetNJ He did fairly well today with 2.25 units this morning. Got a little too low for comfort. I am using the Human meter sheet as I am using my AT2 meter with Freestyle strips so the numbers are running a little lower than what they would with AT2 strips. I would like your opinion on whether you think he went a little too low or should I keep him at 2.25? He has had FF wet food all day. He did have a little dry food in his wet food this morning to get him to eat.
 
It's low but not hypo. I just wish it lasted longer. Honestly I would either switch to a longer acting insulin or consider 3 shots.
 
JanetNJ said:
It's low but not hypo. I just wish it lasted longer. Honestly I would either switch to a longer acting insulin or consider 3 shots.
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It's a 12 he insulin I thought as its twice a day. Yeah I wish it lasted longer as well. Maybe I should do a glucose curve but every hour. May be able to get a better picture of the readings and how the insulin effects him through out the day. Should I consult the vet about 3 shots? I really can't afford $200 a month insulin :( especially not right now.
 
LovemyBoogie said:
It's a 12 he insulin I thought as its twice a day. Yeah I wish it lasted longer as well. Maybe I should do a glucose curve but every hour. May be able to get a better picture of the readings and how the insulin effects him through out the day. Should I consult the vet about 3 shots? I really can't afford $200 a month insulin :( especially not right now.
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Insilun lasts longer than a month. Usually 3-6 months.
 
JanetNJ said:
Insilun lasts longer than a month. Usually 3-6 months.
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Oh, well the Vetsulin says to dispose after 42 days of first puncture. This is from the vetsulin site --> "*In the US clinical study, glycemic control was considered adequate if an acceptable blood glucose curve was achieved (ie, reduction in hyperglycemia and a nadir of 60–160 mg/dL), however, the Technical Services department believes that a nadir below 100 mg/dL in cats may warrant a decrease in the dose." So should I take him back down to 2 units since he was under 100 at nadir? I think today when he was at 86 he was probably really in the 90's (if I would have used a AT2 strip). I am just afraid of giving him 2.25 right now (it's time for his shot) and then he drop even lower tonight possibly in to hypo. What do you think?
 
LovemyBoogie said:
Oh, well the Vetsulin says to dispose after 42 days of first puncture. This is from the vetsulin site --> "*In the US clinical study, glycemic control was considered adequate if an acceptable blood glucose curve was achieved (ie, reduction in hyperglycemia and a nadir of 60–160 mg/dL), however, the Technical Services department believes that a nadir below 100 mg/dL in cats may warrant a decrease in the dose." So should I take him back down to 2 units since he was under 100 at nadir? I think today when he was at 86 he was probably really in the 90's (if I would have used a AT2 strip). I am just afraid of giving him 2.25 right now (it's time for his shot) and then he drop even lower tonight possibly in to hypo. What do you think?
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I know that's what the packaging days but if kept refrigerated it lasts at least 3 months.
 
Something to consider - Levemir. I get mine directly from Alan Hamman in the subforum "Supply Closet", who is in the Dallas area. I never knew him before the first order. He is a cat owner and a nice guy. He has always shipped on time. An alternative supplier is Marks Pharmacy in Canada...which many people order from.

Let's assume you use 3.0 units/dose, which is 6.0 units/day. Here is a cost analysis for Levemir.

You can purchase individual pens, or a pack of 5 pens. A pack of 5 pens is ~$180 including shipping. Each pen has 300 units. I never bought a single pen, since I buy 5 at a time. Costs:
~$40 for 1 pen = 300 units
$180 for 5 pens = 1500 units

Their expiration is October 2019 if kept refrigerated. Let's assume you use 3.0 units/dose, which is 6.0 units/day. Those pens would last you:
~$40 for 1 pen
= 300 units
= (300/6) = 50 days
so that is $0.80/day ($40/50 days)

$180 for 5 pens
= 1500 units
= (1500/6) = 250 days
= 8.3 months
so that is $0.72/day ($180/250days)
 
JeffJ said:
Something to consider - Levemir. I get mine directly from Alan Hamman in the subforum "Supply Closet", who is in the Dallas area. I never knew him before the first order. He is a cat owner and a nice guy. He has always shipped on time. An alternative supplier is Marks Pharmacy in Canada...which many people order from.

Let's assume you use 3.0 units/dose, which is 6.0 units/day. Here is a cost analysis for Levemir.

You can purchase individual pens, or a pack of 5 pens. A pack of 5 pens is ~$180 including shipping. Each pen has 300 units. I never bought a single pen, since I buy 5 at a time. Costs:
~$40 for 1 pen = 300 units
$180 for 5 pens = 1500 units

Their expiration is October 2019 if kept refrigerated. Let's assume you use 3.0 units/dose, which is 6.0 units/day. Those pens would last you:
~$40 for 1 pen
= 300 units
= (300/6) = 50 days
so that is $0.80/day ($40/50 days)

$180 for 5 pens
= 1500 units
= (1500/6) = 250 days
= 8.3 months
so that is $0.72/day ($180/250days)
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Tthanks for the info. I can't just switch him right I would need to discuss with the vet.
 
No problem. Your kitteh's health and well being are fully under your control. When I was newer to diabetes, I ran everything by the vet. It's your choice.

However you are connected to multiple diabetes experts here. When I switched Leo to Levemir, I informed my vet about it. But it was mostly a courtesy.
 
LovemyBoogie said:
So this vial I have I can use safely past 42 days?? Which is April 2.
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Yes. My vet said they last 4-5 months if stored and handled properly although I usually only keep them three months just to be sure they are full potency. I've never noticed a change in numbers when switching to the new vial, so they must still work the same. I keep the old one as back up in case I drop and break the new one.
 
@JanetNJ @Kris & Teasel @JeffJ i hope one of you is up. I'm confused! Booger was 85 this morning when I checked him before feeding! Like say what?? So obviously no insulin this morning but what now? Check him in a little while and if he is high give insulin or wait until dinner time???
 
LovemyBoogie said:
@JanetNJ @Kris & Teasel @JeffJ i hope one of you is up. I'm confused! Booger was 85 this morning when I checked him before feeding! Like say what?? So obviously no insulin this morning but what now? Check him in a little while and if he is high give insulin or wait until dinner time???
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Delay without feeding for up to an hour. If it goes over 200 you can shoot (reduce the dose of its close to 200) or skip if it's still under 200
 
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Yes, don't feed, wait 30 minutes (from your post's time), retest and let us know. You can repeat this for up to an hour's delay as Janet said. If he doesn't get to 200 go with skipping because you don't have enough data yet to predict his response if shooting on a lower PS. If he's close but still under, post here for advice.
 
He is currently 133. I don't give his shot until 8:30. Its 8:09. I usually feed anywhere from 45min to an hr before because he pretty much snacks and I want to make sure he eats a good bit before his shot.
 
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