Need some timing advice - urine testing frustration!

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jkbank

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Hi all

I've started to test Gem's BG again when I can. If I'm not successful after one or two tries I let it go. I'm having a hard time with the timing of all this stuff. I know ideally you test, feed and then shoot. Here's my problem. In the morning, I get up around 7 - I have to give Gem all her medications (in pill pockets) and since she's hungry there's no way I could really test her first as she will be too antsy. So I give her the meds, try and test her, and then put her food down. If she eats right away, I will shoot right then. If she doesn't really eat, I wait til she does and then shoot, so sometimes that's around 8.

Gem's been a grazer these days, and with all she has going on, I pretty much feed her on demand. As we get closer to the PM med time, I try and hold her off on the food. But starting around 5, she starts to cry and cry for food. So I end up giving her her pills around 6. Sometimes the pill pockets will hold her off for another hour, so I can feed and shoot at the 12 hour mark. But sometimes she doesn't. So now I have a dilemma. I can feed her and wait an hour to shoot, but then the PM test will be off (as she's already eaten). Or I can do it all at once, but then her shot times will be off (so 11 hrs between AM and PM, and then 13 between PM and AM). Does that all make sense?

I'm making myself a little nutty here, but since I don't really have so many shots at testing her, I want them to count. Any thoughts, advice??

And how's her SS looking? Still seems really all over the place to me. I can't make heads or tails out of it.

Thanks so much
Karen
 
Re: Need some timing advice - test, feed, shoot

jkbank said:
Hi all

I've started to test Gem's BG again when I can. If I'm not successful after one or two tries I let it go. I'm having a hard time with the timing of all this stuff. I know ideally you test, feed and then shoot. Here's my problem. In the morning, I get up around 7 - I have to give Gem all her medications (in pill pockets) and since she's hungry there's no way I could really test her first as she will be too antsy. So I give her the meds, try and test her, and then put her food down. If she eats right away, I will shoot right then. If she doesn't really eat, I wait til she does and then shoot, so sometimes that's around 8.

Gem's been a grazer these days, and with all she has going on, I pretty much feed her on demand. As we get closer to the PM med time, I try and hold her off on the food. But starting around 5, she starts to cry and cry for food. So I end up giving her her pills around 6. Sometimes the pill pockets will hold her off for another hour, so I can feed and shoot at the 12 hour mark. But sometimes she doesn't. So now I have a dilemma. I can feed her and wait an hour to shoot, but then the PM test will be off (as she's already eaten). Or I can do it all at once, but then her shot times will be off (so 11 hrs between AM and PM, and then 13 between PM and AM). Does that all make sense?

I'm making myself a little nutty here, but since I don't really have so many shots at testing her, I want them to count. Any thoughts, advice??

And how's her SS looking? Still seems really all over the place to me. I can't make heads or tails out of it.

Thanks so much
Karen
Click to expand...

Lots can happen in 15min, so I was told here that you need to shoot within 15min of the test number; otherwise, you will be dosing to match an old number.

Using Lantus or Lev, or other insulins as well, you need to stick to the 12/12 for the best results; 11/13 is going to give you wacky numbers.

You can give meds at +11 and also give something like some FD chicken to tide her over and that's that. At ps, test and feed/shoot.
 
Re: Need some timing advice - test, feed, shoot

Gayle Shadoe & Oliver said:
Lots can happen in 15min, so I was told here that you need to shoot within 15min of the test number; otherwise, you will be dosing to match an old number.

Using Lantus or Lev, or other insulins as well, you need to stick to the 12/12 for the best results; 11/13 is going to give you wacky numbers.

You can give meds at +11 and also give something like some FD chicken to tide her over and that's that. At ps, test and feed/shoot.
Click to expand...

Thanks Gayle
I am using Lantus (I should add that to my signature), but right now I am not making any dose adjustments based on her test numbers, since she has so much going on. I am really still gathering information. What you're saying makes sense though, and I realize that my info may be a bit faulty then. I guess I'm not so concerned right now with the time difference b/w testing and shooting (since I'm not making adjustments) but more about the timing of testing and feeding. And the fact that she's getting 3-4 pill pockets for her meds.

I'm so confused I just don't know what to do!

Sorry, what's FD chicken?!
 
Re: Need some timing advice - test, feed, shoot

I like the way you got those urine test strips colors and what they mean, in your spreadsheet. Good job, you.
I think it does look like she may be bouncing a little from some lower numbers that she is not used to. I would prefer to be careful, and try to test before every shot. And, try to keep on a 12/12 schedule. Do you think she would learn that she gets fed or a treat after she gets tested? Or, I think some people give a treat while they're testing. I know J.D. gets all ansy if I have a treat that he can smell while I'm trying to test him. Some people I have heard (read), can even test their cats while they're eating. I don't know how that's done.

Cats are creatures of habit, I find. I often feed a meal, after a test. I wonder, if you fed her a meal after every test, or if she didn't eat, if she got a treat after every test, if she wouldn't sit still. Just a thought. If she's being free fed, I wouldn't think she should be that starving that she would get all ansy because she knew food was next after a test. I don't know.

I hope you figure something out. I know, that you can give some boiled chicken, sometimes as a small treat, at +11, I think. Maybe that would work into the equation, somehow.

I wish you the best. Hugs.
 
Re: Need some timing advice - test, feed, shoot

Hi Karen,

How did Gem's vet visit go?

I think the FD chicken that Gayle referred to may have been Freeze Dried chicken, which contains only chicken freeze dried into a crispy form, and would be low carb, and which a lot of cats around here really like.

I am not a SS expert, so I posted in the Lantus Tight Regulation ISG group in the hope that someone may stop in and help with your questions. Please feel free anytime you have questions, to post them there yourself. There are a lot of Lantus users there, some people with an eye for spreadsheets, and it is a pretty high volume board.
 
Re: Need some timing advice - test, feed, shoot

Dyana said:
I like the way you got those urine test strips colors and what they mean, in your spreadsheet. Good job, you.
I think it does look like she may be bouncing a little from some lower numbers that she is not used to. I would prefer to be careful, and try to test before every shot. And, try to keep on a 12/12 schedule. Do you think she would learn that she gets fed or a treat after she gets tested? Or, I think some people give a treat while they're testing. I know J.D. gets all ansy if I have a treat that he can smell while I'm trying to test him. Some people I have heard (read), can even test their cats while they're eating. I don't know how that's done.

Cats are creatures of habit, I find. I often feed a meal, after a test. I wonder, if you fed her a meal after every test, or if she didn't eat, if she got a treat after every test, if she wouldn't sit still. Just a thought. If she's being free fed, I wouldn't think she should be that starving that she would get all ansy because she knew food was next after a test. I don't know.

I hope you figure something out. I know, that you can give some boiled chicken, sometimes as a small treat, at +11, I think. Maybe that would work into the equation, somehow.

I wish you the best. Hugs.
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Thanks Dyana…glad those urine test results make some sense, seems the best I could do!

I'm not having such a problem testing before shooting, rather it's holding off on the meal for 12 hours. You're right, she shouldn't be that hungry, but she just meows and meows. I'm trying to get her into some expected routine - meds, quick poke, then meal and shoot. But she's starting to get a bit feistier about all this poking and prodding (this is a mixed blessing! I think it's a good sign of her overall well being, but makes my life a bit harder! Sad that she is now running away from me :(

I haven't had much luck with any of the lo-carb treats that have been suggested here. She doesn't seem to like any of them, though my civvie goes nuts for the dried shrimp!! I guess I could try some plain chicken - would that not impact her BG in theory?

Thanks for all your help, and for your post in the Lantus TR forum….your words move me beyond words….
 
Re: Need some timing advice - test, feed, shoot

Linda and Bear Man said:
Hi Karen,

How did Gem's vet visit go?

I think the FD chicken that Gayle referred to may have been Freeze Dried chicken, which contains only chicken freeze dried into a crispy form, and would be low carb, and which a lot of cats around here really like.

I am not a SS expert, so I posted in the Lantus Tight Regulation ISG group in the hope that someone may stop in and help with your questions. Please feel free anytime you have questions, to post them there yourself. There are a lot of Lantus users there, some people with an eye for spreadsheets, and it is a pretty high volume board.
Click to expand...

Linda - thank you so much. Like I posted to Dyana, your post on my behalf moves me beyond words.

Thx for clearing up the FD, brain freeze there! I got the FD chicken and shrimp, she's having none of it!

As for her visit, thanks for asking. I didn't post back as I didn't get much info…waiting for blood work results. The vet is pleased with how Gem presents, relatively speaking. As this is the dr that has seen her since all this started in March, she has a good eye for any changes in Gem (not the best in terms of diabetes management, but makes up for it in this!). She agrees that Gem's more alert and responsive, and her breathing is slightly less labored. As for the Cushing's, she has no idea, so I will wait to talk to Dr Peterson once he sees the blood work.

Gem is quite famous in the practice though - all the techs, nurses etc know and love her, and are all pulling for her. They sent me home with some little "shirts" for Gem to wear to protect her wounds (though they don't seem to be working so well as she keeps stepping out of them) and they actually cut out and sewed on different color hearts to make it pretty!! So sweet - I will try and take a picture and post it here.

Anyway, hopefully after seeing her results, Dr P will have some insight as to whether the trilostane is working, and whether any dosage changes are indicated, based on my numbers and the fructosamine they are running.

Thanks again, as always,
K
 
Re: Need some timing advice - test, feed, shoot

Can you leave some food out for her overnight, perhaps in a timed feeder, so she isn't so ravenous in the morning?
 
Re: Need some timing advice - test, feed, shoot

Linda and Bear Man said:
Can you leave some food out for her overnight, perhaps in a timed feeder, so she isn't so ravenous in the morning?
Click to expand...

The morning is less problematic than the evening. In the morning we have a decent routine - I get up, she is waiting at my door, I give her her meds, test her when she allows, then she eats and I shoot. On some occasions where she doesn't seem to eat much right away, I wait a bit for her to eat more and then I shoot, but it's within a half hour generally. It's the evenings where I run into problems. Like I said, I try and hold off on food so I can get a "clean" BG test. But she meows and meows, so I end up giving her the meds at +11, and then try and hold her off for an hour to test, feed & shoot. Sometimes it works, sometimes she just keeps crying so I forego the test in favor of feeding her.
 
Re: Need some timing advice - test, feed, shoot

Hi Karen,
I'm afraid that I can't be much help with your challenges except to add some words of support. You are doing a great job in a very difficult situation. I do want to say that Dr. Peterson is fantastic and that you are very lucky to be able to consult with him. I had hoped that my GA kitty, Stu, would have the I-131 treatment at Dr. Peterson's Hypurrcat Facility, but he wasn't strong enough. If anyone can help you with the Cushings, it is Dr. Peterson. He is an amazing doctor and very kind and caring.
I hope that some of the really experienced dosing people in the Lantus Forum will be able to look at Gem's SS tonight or tomorrow.

Best of luck to you both,

Ella & Rusty
 
Re: Need some timing advice - test, feed, shoot

Ella & Rusty & Stu(GA) said:
Hi Karen,
I'm afraid that I can't be much help with your challenges except to add some words of support. You are doing a great job in a very difficult situation. I do want to say that Dr. Peterson is fantastic and that you are very lucky to be able to consult with him. I had hoped that my GA kitty, Stu, would have the I-131 treatment at Dr. Peterson's Hypurrcat Facility, but he wasn't strong enough. If anyone can help you with the Cushings, it is Dr. Peterson. He is an amazing doctor and very kind and caring.
I hope that some of the really experienced dosing people in the Lantus Forum will be able to look at Gem's SS tonight or tomorrow.

Best of luck to you both,

Ella & Rusty
Click to expand...

Thanks Ella & Rusty - I was really impressed with Dr P. Of course his resume is amazing, but in person he is just what you say - kind and caring, compassionate and straightforward. In only wish I found him 6 months ago, but I try not to waste my time dwelling on that :)
 
Why urine testing is an exercise in futility:
This morning I catch Gem peeing, not in time to test midstream, but I know it's a fresh sample. So I test, and get a low. Just for kicks, I test again, in a slightly different spot, get a bit higher. I wait 15 minutes, test again and get somewhere in the middle. Do I even bother doing this???
 
I can see how frustrating this is. I am not sure what would cause this. Your sticks are fresh and stored properly? A lot of people also find variability in the blood glucose readings. You can do two tests right together and get two different numbers, because there is always some variance on the meter. It looks like the same might be true of the urine strips. Are you timing them exactly? They turn darker as they sit longer, and seconds can make a difference.

FWIW, I think that there is still value in doing this. It still gives you some information, and it may be one of your few tools to warn you when she is going low.
 
Linda and Bear Man said:
I can see how frustrating this is. I am not sure what would cause this. Your sticks are fresh and stored properly? A lot of people also find variability in the blood glucose readings. You can do two tests right together and get two different numbers, because there is always some variance on the meter. It looks like the same might be true of the urine strips. Are you timing them exactly? They turn darker as they sit longer, and seconds can make a difference.

FWIW, I think that there is still value in doing this. It still gives you some information, and it may be one of your few tools to warn you when she is going low.
Click to expand...

You're right Linda. Thanks for being a voice of reason! I guess it's understandable to have variance. This was just so surprising - the first test was close to negative and then the second started turning brown! So frustrating!
Yes, I do time it - I run over with the stick and my stopwatch!

For better or worse, I shot 2u this morning as her BG was mid-200s. I've convinced myself she's bouncing. Im curious what the fructosamine shows. I will keep testing both blood and urine when I can and take it a day at a time.
 
Linda and Bear Man said:
I like the reduction to 2 units. I think you might be right about the bouncing. Paws crossed that the new dose works well for her.
Click to expand...

Thanks, I hope so!

I've tried to read lots and lots about the bounce/shed etc… but it still hasn't entirely sunken in…what would a bounce curve look like? And ideally, what would a well-regulated curve look like? I guess I'm not sure what I'm aiming for. I;m not looking for her going OTJ with everything else that's going on, but in a regulated cat, is there still a curve, or is it more of a flat line in the blue?
 
I hope that more experienced SS readers can help with what too much insulin looks like vs. not enough insulin. There is a section in the Lantus TR ISG section of "sticky notes" or "stickies" about a typical Lantus curve:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

You can also look at Rusty's SS. Ella posted earlier in this thread. Her cat, Rusty, spends some nice time in blue and green numbers. Sometimes, due to illness or other causes he will stray out of his good numbers. Ella puts informative comments in her SS.

Edited to add: I don't know if Gem's Cushing's disease means that her response to insulin might be different from that of a "regular" diabetic cat. That would be a question to ask Dr. Peterson.
 
Linda and Bear Man said:
I hope that more experienced SS readers can help with what too much insulin looks like vs. not enough insulin. There is a section in the Lantus TR ISG section of "sticky notes" or "stickies" about a typical Lantus curve:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=18139

You can also look at Rusty's SS. Ella posted earlier in this thread. Her cat, Rusty, spends some nice time in blue and green numbers. Sometimes, due to illness or other causes he will stray out of his good numbers. Ella puts informative comments in her SS.

Edited to add: I don't know if Gem's Cushing's disease means that her response to insulin might be different from that of a "regular" diabetic cat. That would be a question to ask Dr. Peterson.
Click to expand...

Thanks Linda - I may have to accept the fact that I do not have an "eye" for reading these spreadsheets! I looked at Ella's, and while it looks good to me with all those blues & greens, I can honestly say I can't glean anything from it! Maybe this is just a shortcoming in my brain activity!!

I'm going to hold on with the 2u and see where she goes, and will speak to the doctors tomorrow about the blood work. Good question re: Cushing's, and I will ask Dr P. From what I know, it makes it harder to regulate them, but I don't know if it affect how her body responds in some physiological way.
 
Ugh, just got a 401 at +9…that's not a good sign with the lowered dose, is it? Or is this one result from one shot not enough to tell anything?!?!
 
It's so hard to tell looking at the urine tests. I mean a neg. could mean she was anywhere from 20s to mid 200s, depending upon where her renal threshhold is.
Is she acting normal for Gem? Maybe decreasing by 1/3 of the dose was a lot for her.
Lantus likes consistancy in dosing, so the way I see it you have some options: you can call the dose this morning a BCS (Big Chicken Sht) dose and go back to her regular dose again tonight, or you can stay with the 2 units and see how that goes for a few days, or you can try something in the middle like 2.50 units and stay with that for a few days and see how that goes.
She might have been doing okay on the 3 units, it's just hard to tell right now. I think I would go with the latter option, but it's up to you.
Good job on the testing, by the way.
Any news from the vet, yet?
 
Dyana said:
It's so hard to tell looking at the urine tests. I mean a neg. could mean she was anywhere from 20s to mid 200s, depending upon where her renal threshhold is.
Is she acting normal for Gem? Maybe decreasing by 1/3 of the dose was a lot for her.
Lantus likes consistancy in dosing, so the way I see it you have some options: you can call the dose this morning a BCS (Big Chicken Sht) dose and go back to her regular dose again tonight, or you can stay with the 2 units and see how that goes for a few days, or you can try something in the middle like 2.50 units and stay with that for a few days and see how that goes.
She might have been doing okay on the 3 units, it's just hard to tell right now. I think I would go with the latter option, but it's up to you.
Good job on the testing, by the way.
Any news from the vet, yet?
Click to expand...

Thanks Dyana - I know it's really hard to tell much from the urine tests. I was hoping to at least see some pattern, or sense of those matching up in some way with the BG now that I'm doing that again. But so far that doesn't seem to be happening.

When you say the latter option you mean 2.5?

Her PMPS was 467, and I managed to get a fresh urine sample at the same time and that was high as well. So my thought was go back to the 3u, treat this morning as an oopsy, and stay the course. However, because I was doing a million things at once with my kids, I honestly don't remember how much I drew up, 2 or 3??!! I had the debate in my head - try the 2 for a few days vs go back to the 3 since her BG was so high - and I can't remember what I did in the end!

I guess I'll just see where she goes. Behaviorally she's fine, same as always.

I did not hear from the vet today, though they said it might be Friday. I meant to call but got sidetracked….end of the school year get's pretty hectic with the kids. I will call tomorrow if I don't hear from them in the morning.
 
Yes, I meant 2.5. I really don't know what to tell you.
My cat is a bouncer, so I am used to bounces and they are very frustrating.

I would try when you can to get tests around her nadir time, that would tell us more about dosing.

Without more data, it's just not safe to say ..go with 3 units. I can't say. I would go with what you gut is telling you,
for right now.
 
Dyana said:
Yes, I meant 2.5. I really don't know what to tell you.
My cat is a bouncer, so I am used to bounces and they are very frustrating.

I would try when you can to get tests around her nadir time, that would tell us more about dosing.

Without more data, it's just not safe to say ..go with 3 units. I can't say. I would go with what you gut is telling you,
for right now.
Click to expand...

Thanks for all your responses, I hope I'm not making you nutty! I know it's hard for anyone to say what I should be doing right now.

Part of me wishes I could just get a do-over! Start over with her dosing and do it right. But I can't so my mind is all over the place. In reading the TR protocols, it seems as if I should be going up, if anything, as her lowest points are still >200 except for some very rare instances. So I don't know why I thought about lowering her dose….because I got some negative urine tests, or some lower BG numbers?? Like I said, I'm so confused and no matter how much I read, I stay confused. And I'm not confident the vet can guide me, as she seems very by the book i.e. Purina DM, hold the dose, increase if numbers are not coming down etc.

Perhaps Dr P can give me more guidance, though I get the sense he doesn't want to mess around with the insulin right now. Perhaps he's right. I just want to do right by my kitty, you know.
 
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