? Nadir

Status
Not open for further replies.
It is frustrating. For those of us in this thread...on the forum awhile, we have seen a lot of it. We just need to stick it out at the current dose and look for trends over time.

I went thru a period with Leo where we dosed based on AMPS or PMPS value. But that was slightly different because of his acro variations. But he was getting 20% and 40% different doses based on BG. The most you can do is try to also regulate with food. With all the good testing that you are doing, some of those values are likely influenced by food.
 
Here we go... Roller coaster ride lol Boogers AMPS is 242. Definitely do not feel comfortable giving 1.25 units this morning... I mean I'm here all day so I can check him often but afraid 1 unit will even tank him. Not sure what to do.
 
The evening of 31 Mar you gave 1.5 u on a lower PS. I'd try the 1.25 u because you can monitor. Your call though.
 
Last edited:
Ok so I did feed him this morning since his PS was not below 200. I waited close to an hour after he ate so technically 30 minutes past when I normally give his insulin to check him and he was 560. I went ahead and gave him 1.25 units as planned. Checked him at +2 and he was 441. So he is dropping nicely. Will continue to check though I am about to run out for a short trip to the store. Will keep you posted on his progress. Thanks so much for the support yall!
 
There were also some good nadir patterns since April 6. Can you please ask him to continue that trend? :smuggrin:
 
So Booger has been getting 1.25units for the past 4 days and has done well. I feed him 3 cans of FF a day. One in the morning, one at night and I half one as a mid-day and midnight snack. I think there the 500s numbers are coming in is waiting 12 hours to eat. He does get a mid-day snack that the insulin kinda counteracts him going up too much during that time. I think I am going to try feeding him a can in the morning, half a can at +2 (I hear it helps him drop slower) then feed him half a can at +7 and then a full can at PMPS time and so on at night. This morning I didn't hear my alarm so he ate an hour later than usual and I think that caused the 500 AMPS number. I have the half unit syringes and I basically gave him between 1.25 units and 1.5 units this morning. I am guessing that would be something between 1.35unit and 1.40 units. In the past 1.5 has been known to be too much so I didn't want to bottom him out. He is coming down nicely from the 530 he was this morning so far.
 
That sounds like a good strategy. I try to ensure Leo eats throughout the day. It allows him to soak up the calories over time. Then he gets an evening meal right before bed.

When you are trying to narrow down dosage, it is important to get a good nadir. So your plan supports that. Food influenced AMPS happens. And micro dosing is a challenge. I always wished they made a 5 unit syringe with quarter unit marks.
 
Been giving Booger a dose in between 1.25 and 1.5 and it seems to be a good dosage though I do have to check him several times in the middle of the day to make sure he doesnt go too low. I am thinking that 1.25 units is a safer dosage. Keep in mind that I am using the Alphatrak 2 meter with the Freestyle Insulinx strips and as I have said before and @JanetNJ can verify, these strips run alot closer to the Alphatrak strips than the freestyle. Booger goes in to give blood tuesday for the fructosamine test. Vet said that she will likely switch him to Lantus once the Vetsulin is gone... Problem is, that can be a while lol. I am still using the first bottle. It said to be disposed of on April 2 (42 days) but it is still working as you all can see. I have a brand new bottle in my fridge as well. @JeffJ @Kris & Teasel
 
Agreed on the "1.4 is too high", since the nadir today was so low at 61. In general the numbers for the past 7 days look pretty good, with some nice blue nadirs.

You know it's your choice to switch insulins. When I first started, I had not joined the forum and only relied on my vet. Having the forum available for advice is very handy. And most of the long timers buy their insulin online.
 
Need advice. Booger had to go to the vet to get blood drawn for the fructosamine test. He was in the 500s shortly after leaving. Has been in the 400 and 500s all day. Should I still keep him on 1.25u so he doesnt start his bouncing all over the place again since his numbers today are just due to stress?? @JeffJ @Kris & Teasel @JanetNJ
 
Booger's Mom said:
Need advice. Booger had to go to the vet to get blood drawn for the fructosamine test. He was in the 500s shortly after leaving. Has been in the 400 and 500s all day. Should I still keep him on 1.25u so he doesnt start his bouncing all over the place again since his numbers today are just due to stress?? @JeffJ @Kris & Teasel @JanetNJ
Click to expand...
Leave him at 1.25 u for another dose or two. He needs to settle after the vet stress.
 
Kris & Teasel said:
Leave him at 1.25 u for another dose or two. He needs to settle after the vet stress.
Click to expand...
That is what I thought :) Thank you. The vet visit was upsetting for both of us. I was under the impression that we would be taken to a room, she would do a quick exam and then take him to the back to take some blood for the fructosamine test. Nope... not at all what happened. When I got there, they assumed I was dropping him off, which I was not. They knew that he would be stressed and his BG would shoot up because I told them this and thats why they said they would just do a quick exam and just draw blood. The vet had just gotten to work at 9am when I got there. She wasn't too pleasant or seemed too thrilled to see me. They took him to the back for about 20 minutes (what the heck was up with that?) Made me nervous because I was just told they would withdraw blood and do a quick exam so what takes 20 minutes??? Booger is a pretty chill kid. There is no way he would give them a hard time. Never has. Honestly makes me wonder what they did to him back there behind closed doors without me.

I asked while we were there if they could also extract urine from him and run a urinalysis but they acted like extracting urine while they extract blood would be a big long process and just couldn't possibly do it. So I gave up and told them never mind. I also mentioned to them that I know he has urine in his bladder so I do not understand what the problem is and that he will pee in the carrier on the way home. Sure enough, as soon as we got to the car, he had soaked the potty pad in the carrier. They bring him back out to me eventually, tell me that his BG will be high due to him being stressed (well duh) hand me the paperwork and wish me on my way. No vet, no explanation of what was done, results of the exam, or what is to come once the results come back. If I will need to come back in, if they will call etc.

I don't know if I am just being oversensitive about this because I quit smoking on Friday or if this is something that would also concern someone else too. I am very protective of my babies. I mean I am only human. I may not be a perfect pet parent that is able to take their babies to the vet with every little thing etc but this just didn't sit right with me at all. I feel like when I first took him to this vet I was given great service and communication and now the last few times I have been in, I feel like I have been treated less than adequate.
 
Poor Booger. Not many cats like the vet visit times. My vet won't pull blood in front of me either. I'm sure it hurts and they always do it in the back room.

Our vet gives us a writeup if there was any work or analysis done. But if I had a few bad experiences in a row, I would definitely change vets. Maybe you could see how the next vet visit goes.

Just looked at the chart for today. Yep, high numbers from the vet visit. I'd give it a day or so to settle down.
 
Well thats all fine and dandy if they dont want to get blood in front of me but why was he back there so long?? lol Yeah I will probably look in to some other vets but see how it goes with this one next time but just have one as a back up in case.
 
So upset i could cry right now. Just got a call from the vet with Boogers fructosamine results. Basically his number is 635 and that's not at all regulated. She said based on my SS that i am checking him too much and changing his insulin too much so she can't even really evaluate that. She said I need to go back up on insulin and stop checking him everyday unless he is acting off. Said to just wait and do a glucose curve once a week. I told her that when I have gone back up on his dose he has dropped down in the the 40s and 50s mid day. She didn't seem at all too concerned with that at all. Asked what I do when he is that low. I told her that I give him food. Shes not here when it happens and sees how scary it is when he is 40 something and I feed him and 30 minutes later he is 150 and then 30 minutes later back in the 40s. I'm so frustrated. I told her how in the world am I supposed to just give him insulin without checking what he is before he eats. She said the food will push him up so the insulin doesn't shoot him back down. She said that I am just freaking myself out and told me I need to take him up to 1.5 units and leave him there for now. I guess she doesn't realize that I am not feeding him the 15% carb Pro Plan DM food and I'm actually feeding him low carb FF wet food. I dont know what to do. She said his numbers are just too much all over the place. Hes not regulating and its been this way over the past few weeks she said. He has been acting more like himself since I started working with you all on his dosaging and stuff than he has in a long time. @JanetNJ @Kris & Teasel @JeffJ
 
Last edited:
Here's something I found and posted on another member's thread when her vet did a fructosamine test and wanted her to raise the dose:
_______________________________________________________________________________________________


Feline Diabetes Mellitus
Claudia E. Reusch, in Canine and Feline Endocrinology (Fourth Edition), 2015

Serum Fructosamine Concentration
Fructosamine is the product of an irreversible reaction between glucose and the amino groups of plasma proteins. Its concentration mainly depends on the blood glucose concentration (e.g., extent and duration of hyperglycemia) and the lifespan of plasma proteins; it is generally assumed that fructosamine reflects the mean blood glucose concentration of the preceding 1 to 2 weeks. The reference ranges differ slightly between laboratories but are usually between approximately 200 and 360 μmol/L. To enable comparison between consecutive measurements, serum samples should always be sent to the same laboratory. Fructosamine is measured in serum using commercially-available test kits adapted to autoanalysis. Shipping should be on cold packs if samples will be in transit for more than 24 hours. Lean cats have lower fructosamine concentrations than normal weight or obese cats, whereas age has no influence. In two older studies, fructosamine did not differ between male and female cats, whereas in the most recent study, fructosamine was higher in male cats (Thoresen and Bredal, 1995; Reusch and Haberer, 2001; Gilor et al, 2010b). In the vast majority of newly diagnosed diabetic cats, fructosamine levels are more than 400 μmol/L and may be as high as 1500 μmol/L. Fructosamine is not affected by short-term increases in blood glucose concentration and thus is usually normal in cats with stress hyperglycemia (Reusch et al, 1993; Lutz et al, 1995; Crenshaw et al, 1996).
However, fructosamine is not a foolproof parameter, and certain aspects need to be considered. In cats with a very recent onset of diabetes or with mild diabetes, serum fructosamine may be in the normal range, rendering the differentiation between stress and diabetic hyperglycemia impossible. In a recent study, two groups of healthy cats were infused with glucose to maintain either a marked or a moderate hyperglycemia (540 mg/dL, 30 mmol/L; or 300 mg/dL, 17 mmol/L) for 42 days. In the group with marked hyperglycemia, it took 3 to 5 days until fructosamine exceeded the upper limit of the reference range; in the group with moderate hyperglycemia, fructosamine concentrations mostly fluctuated just below the upper limit of the reference range (Link and Rand, 2008).

Fructosamine is also influenced by plasma protein concentration and by protein turnover. It has been shown that cats suffering from hypoproteinemia or hyperthyroidism have significantly lower levels of fructosamine than healthy cats (Reusch and Tomsa, 1999; Graham et al, 1999; Reusch and Haberer 2001). It is possible that diabetic cats with concurrent hypoproteinemia or uncontrolled hyperthyroidism may have normal (or even low) fructosamine levels, which would then be misinterpreted as indicative for stress hyperglycemia. In those situations (e.g., cats with concurrent hyperthyroidism or hypoproteinemia), fructosamine should be interpreted only if it is increased, which then indicates diabetes mellitus. There are arguments for and against correction of fructosamine for the serum protein level. Correction, however, may lead to falsely high concentrations and is not recommended. In the majority of situations, fructosamine is a helpful parameter to differentiate between stress- and diabetes-related hyperglycemia.

After initiating insulin therapy, blood glucose concentrations usually start to decrease, which is followed by a decrease in fructosamine after a few days. We consider 50 μmol/L to be the so-called critical difference (i.e., the difference between two consecutive fructosamine measurements has to exceed 50 μmol/L to reflect a change in glycemic control; Reusch, 2013). Another study found a lower critical difference of 33 μmol/L (Link and Rand, 2008). Generally, fructosamine concentrations increase when glycemic control worsens and decrease when glycemic control improves. As mentioned earlier, serum fructosamine concentration is not affected by a short term increase in blood glucose concentration, which may be seen in cats in the hospital. It is also not affected by lack of food intake, which is common in hospitalized cats and often leads to much lower blood glucose concentrations than what is seen with food intake. Routine measurement of fructosamine is therefore helpful to clarify the effects of stress or lack of food intake (e.g., to clarify discrepancies between history and physical examination and blood glucose measurements). Most well-controlled diabetic cats are slightly hyperglycemic for some time during a 24-hour period, and consequently, fructosamine concentrations will not become completely normal during therapy. In cats that achieve diabetic remission, however, fructosamine concentrations decrease into the normal range (Fig. 7-17).

As long as fructosamine is elevated (even if only slightly), we do not consider cats to be in diabetic remission. In those cases, insulin therapy is continued under close supervision. Fructosamine concentrations between approximately 350 and 450 μmol/L reflect good glycemic control, concentrations between 450 and 550 μmol/L suggest moderate, and concentrations above 550 to 600 μmol/L suggest poor glycemic control. In the latter situation, fructosamine is not helpful to identify the underlying problem because the various possible reasons for poor regulation (e.g., application error, insulin underdose, too short duration of insulin effect, diseases causing insulin resistance, or Somogyi phenomenon) are associated with high blood glucose concentrations and therefore have the same impact. Generation of one or several BGCs and revision of the owner’s injection technique are usually the next steps in those cases. Fructosamine concentrations less than 350 μmol/L suggest diabetic remission, hypoglycemia or concurrent hypoproteinemia, or hyperthyroidism (Reusch, 2010). It is important to note that there are substantial differences in glycation between individuals. In healthy cats in which blood glucose was maintained at 540 mg/dL (30 mmol/L), fructosamine concentrations ranged between 400 and 633 μmol/L when the plateau was reached (Link and Rand, 2008). The study underscores that diabetic cats with similar quality of glycemic regulation may have quite different fructosamine concentrations. The ranges of interpretation listed earlier therefore should only be used as rough guidelines. Fructosamine is useful if followed in individual cats over time; however, it should never be used as the sole indicator of the quality of metabolic control. The parameter is less important than the evaluation of clinical signs and body weight and generation of BGCs.

DKA, dehydration, acidosis, and other unidentified factors may influence fructosamine concentrations. If a diabetic cat is hospitalized for any reason, fructosamine levels measured at the time of admission may be considerably different from concentrations measured a few days later. It is therefore reasonable to repeat the measurement at the time of discharge and to use this concentration as a reference point. See Serum Fructosamine Concentration in Chapter 6 for additional information.
________________________________________________________________________________________________

Ultimately, you have to decide which route you want to follow. Your vet's role is to give advice based on her level of knowledge of FD.
 
Thank you for that information though I didn't understand a lot of it. I don't want to do him more harm that good but I also can not afford to take him to the ER when he starts seizing or something from going hypo. I have had him on 1.25 for atleast 2 weeks with a short increase to between 1.25 and 1.5 when the 1.25 was showing to not be enough but 1.5 was dropping him below 68. I just do not understand how she can expect me to just feed him, give him 1.5 units and then hope for the best until his next feeding and only check him by glucose curve once a week. That just seems crazy to me. I actually am sleeping 8 hrs at a time again because I know that 1.25units is not going to tank him at his lowest. I had a feeling she was going to pretty much scold me for how I am doing things. My friend suggests going to another vet for a second opinion. Also does she not take in to consideration that at the time she withdrew the blood he was stressed due to being at the vets office? I'm quite sure that took some effect on the test as well.
 
It is pretty frustrating. On the forum we are giving you the best advice we know...and we have dealt with diabetes directly for years.

I certainly would not give more insulin and reduce testing. But it is up to you. After I ramped my diabetes knowledge on the forum, and after awhile....I stopped using my vet for diabetes advice. For one thing, most vets (including mine) have been out of vet school for awhile. Home feline blood testing was not very common 10 years ago. And feline blood testing at home was virtually non-existent in the mid 1980's. So sometime after ~2008, the BG testing became more common. That puts the capability of owning and managing feline diabetes in the owners hands...if they want that responsibility.

At this point, I do not take in a 12 hour curve to my vet...ever. There is no need. Leo is sufficiently stable, and I don't need more advice on it from the vet. And she understands that.

Based on your note, and your experience over the last 45 days, you already have a lot of diabetes knowledge. Otherwise you would not be questioning the vet's advice. Like you, I am also pretty conservative. I would rather Leo's nadirs be 120-150 than risk a hypo. He is similar to Booger. Just another 10% or 15% and his BG drops like a stone. With Booger, he has been a challenge to regulate. I suspect some of his numbers are food influenced. You could reduce the testing to 4 or 5 times a day and probably have about the same information.

Your spreadsheet note for 4/25 says "snack at 1:30am". Was that for you or for Booger :D:eek:
.
 
Lol that snack was for booger lol he was bugging me for food and was about 100 so I gave in. I mean I understand where she is coming from on the fact that his PM shot numbers are still in the 300-400s and that the should be coming down in to more of a closer curve like maybe high 200s and then lowest below 100 and then coming back up in to the 200s. But just like I have seen many say on here that most vets think 200s are normal. I have the optimal wellbess plan with petsmarts banfield so milking it on these tests are with what I am paying it for. With that being said, I am just concerned that if I stop listening to her advice or taking him in that she will stop allowing me to purchase the vetsulin. I would like to switch him over the the lantus but I do not have the funds at the moment and I have another brnad new bottle of vetsulin in my fridge I need to use. I am still using the first vial I got which "should" have been thrown out April 2nd but nothing is wrong with it and as you all can see, its still working. I'm sure it has lost some potency and using a fresh bottle at 1.25 units will probably push his nadir a little further down than it is right now. Just afriad she will stop giving me the insulin.
 
Before he was diagnosed, he was eating a food that had over 30% carbs in it. Then she put him on ProPlan Dm which has 15% carbs in it. I can see giving him 2 units or so for that much carbs. I guess she doesnt realize that I am feeding him wet food that is below 10% carbs which is why less insulin is needed. My dad was diabetic and I know that feline diabetes is not the same as human diabetes in a lot of ways but I do know that it is pretty much the same with the sugar/carb intake. Cats dont get sugar but carbs do turn in to sugar in the body. The more sugar/carbs you intake the more insulin that is needed to counteract the glucose. The less sugar/carb intake the less insulin is needed. I am going to go look at the food chart again but I am pretty sure the food I am feeding him is around 5% carbs.
 
Well, when you finally switch to Lantus or Levemir, you don't need to get it from your vet anymore. I don't know about Vetsulin, but you can probably get that off the web too.
 
JeffJ said:
Well, when you finally switch to Lantus or Levemir, you don't need to get it from your vet anymore. I don't know about Vetsulin, but you can probably get that off the web too.
Click to expand...
Dont you have to have a prescription for Lantus??? Here are some screenshots of the chart. These are the only FF flavors I feed Booger because they are the only ones he will eat lol The Tender Liver and Chicken is his favorite and eats this more than the others. He is barely getting any carbs compared to what he was before.



Screenshot_2.jpg
Screenshot_3.jpg
 
Booger's Mom said:
Dont you have to have a prescription for Lantus???
Click to expand...

Yes you do....I think Jeff meant that you wouldn't have to buy it directly from your vet. Since it's a human insulin, you'd get it at a human pharmacy.

You can also get Vetsulin from online pet pharmacies if it's cheaper.....Your vet should write you a script for you to get it wherever you want
 
Chris & China said:
Yes you do....I think Jeff meant that you wouldn't have to buy it directly from your vet. Since it's a human insulin, you'd get it at a human pharmacy.

You can also get Vetsulin from online pet pharmacies if it's cheaper.....Your vet should write you a script for you to get it wherever you want
Click to expand...
Yes but what if I stop consulting her or taking him in for these tests. What if she decides not to renew his script for the lantus?
 
Booger's Mom said:
What if she decides not to renew his script for the lantus?
Click to expand...

Well I buy my Lantus from Marks Marine Pharmacy in Canada.....I submitted a script 3 years ago and they're still sending me refills whenever I need them (without needing a new script)

If you get it in the US, then yes, you'd need to get a new script every year....but it's really important that a senior kitty be seen at least once a year anyway, so I'd think you could get your script then (but you may have to do what I did too....find a vet that uses Lantus in the first place or is willing to use it)

Our current vet has never treated China for her diabetes.....the first time she ever saw her was for a dental. I'd called around to find a vet that had the right equipment to do a complete dental (no vets around me have dental x-ray machines). Of course she knew she was diabetic because I told her, but I just tell her "she's on X units of Lantus and her blood glucose usually runs between Y and Z"....and that's the end of the conversation. If she does feel the need to give me some advice, I just nod my head, smile and say "I'll give that some thought".

When I needed a script to send to Marks, I just called her (since she'd had the dental, she was an "established" patient) and told them I was running out and needed a script faxed to 1-800-xxx-xxxx
 
You might want to start a new thread too.....this one is getting way too long. You can put the link to this one into the new one

We usually like to keep them under 50 so it doesn't take forever to go back and see what's been happening lately in each cat's life.
 
Chris & China said:
You might want to start a new thread too.....this one is getting way too long. You can put the link to this one into the new one

We usually like to keep them under 50 so it doesn't take forever to go back and see what's been happening lately in each cat's life.
Click to expand...
Ok will do. But one last thing. My vet suggested Lantus from the get go but I didnt have the $200 at the time to get it so thats why he is on vetsulin. I plan on switching him over as soon as I can though.
 
Booger's Mom said:
Ok will do. But one last thing. My vet suggested Lantus from the get go but I didnt have the $200 at the time to get it so thats why he is on vetsulin. I plan on switching him over as soon as I can though.
Click to expand...

Booger's Mom: One possibility is using Lantus pens (CVS stocks those and is willing to sell single ones -- they come in a set of 5 or something) which are about $81 each. One pen lasts Angel anywhere from 3-6 months, depending on how much insulin he needs. The vials are horribly expensive.
 
Last edited:
Angel's mommie said:
Booger's Mom: One possibility is using Lantus pens (CVS stocks those and is willing to sell single ones -- they come in a set of 5 or something) which are about $81. One pen lasts Angel anywhere from 3-6 months, depending on how much insulin he needs. The vials are horribly expensive.
Click to expand...
awesome thank you for the info!
 
Booger's Mom said:
awesome thank you for the info!
Click to expand...

Glad that's helpful! I also find myself less stressed using pens -- the vials are so expensive and last so long (for Angel) that I was constantly worrying about contaminating them and even more stressed about leaving them outside the fridge etc. Of course I'm equally careful with the pens, but even if something goes wrong $81 is not as awful an investment to lose as $200! Wish you the very best! I honestly don't understand why vets don't suggest we use pens for tiny kitty bodies! For some reason they just default to the vials <eyeroll>.
 
Booger's Mom said:
I didnt have the $200 at the time to get it
Click to expand...

For less than $200, you can get 5 pens from Marks Marine in Canada....that's enough to last most cats at least a year....and more like 2 years (I've never gotten any from Marks that expired sooner than 2 years later)....5 pens is 1500 units and a cat getting 1U twice a day would take 750 days (over 2 years) to use it up

Marks will also sell you just one pen for $50
 
Angel's mommie said:
I honestly don't understand why vets don't suggest we use pens for tiny kitty bodies
Click to expand...

I think it's mostly because they don't know they exist......Lantus is still relatively new in the world of feline diabetes and for many years, the only option was a vial.

Another thing about Marks....if your vet writes for the vial, all you have to do is call them and say you'd prefer the pens....they'll send you what you want
 
Chris & China said:
For less than $200, you can get 5 pens from Marks Marine in Canada....that's enough to last most cats at least a year....and more like 2 years (I've never gotten any from Marks that expired sooner than 2 years later)....5 pens is 1500 units and a cat getting 1U twice a day would take 750 days (over 2 years) to use it up

Marks will also sell you just one pen for $50
Click to expand...

Oooh, that's a really good price! I need to move to Canada.
 
I get my Levemir from Alan Hamman near Dallas. He is in the supply subforum. No prescription needed. He will sell single pens as well.
 
Booger's Mom said:
Ok will do. But one last thing. My vet suggested Lantus from the get go but I didnt have the $200 at the time to get it so thats why he is on vetsulin. I plan on switching him over as soon as I can though.
Click to expand...
I think this is a good idea. Get the script then fill it through Marks.
 
Status
Not open for further replies.
Back
Top