New Member: Sammy, need advice on shooting near 200

Status
Not open for further replies.
TokyoKitty

TokyoKitty

Member Since 2013
Hi,

Sammy is 17 years old and was diagnosed 5/28/2013. At the time, Sammy was on a low protein dry cat food for her mild CRF, and had also received a steroid shot for allergies several months prior. So it's possible that her diabetes is steroid induced.

I do home testing with the FreeStyle Lite meter. It's taking some time, but I'm finally getting the hang of it. I test AMPS and PMPS and try to get nadirs 3-4 times a week.

Our vet still believes in the old protocol (high fiber, low protein diet), and put Sammy on Hills W/D dry. He started her at 0.5 units of Levemir 2x/day. Her dose has slowly been adjusted up to 1.0 units 2x/day. Her numbers were still consistently in the 400 range for over 3 weeks, so I decided to change her diet to a higher protein canned food, against the vet's advice. Two weeks ago I transitioned her to 50% Hills canned M/D. Her numbers started coming down into the 300 range. 5 days ago I increased the canned to 75%, and yesterday I switched to 100% canned.

Last night Sammy's PMPS was 207. Yikes! That was the lowest number I've seen with her. She ate a full bowl of food, and I reduced her shot to 0.6 units (normally 1.0 units). At +6.5 she tested at 273. Now I'm wondering what I should do if Sammy tests at close to 200 this morning (due for her shot in 1.5 hours). Should I reduce her dose or skip a dose? What if she tests higher, around 280: stay at the same dose or reduce? Thanks for your help.
 
Good job on the food change and the testing. It's nice to see her blood glucose levels dropping a bit. And I think we can help a bit more.

As a newbie however I would not advise shooting if she is under 200. If she is over 200 then shoot and feed. However If she is close to 200 (say 150-225) I would stall.. Don't shoot, don't feed and test again in 30mins to see if she goes up, and let us know meantime.

A few things..
1. Don't feed two hours before the shot so that food doesn't impact the preshot test
2. Try and get a before bed test every night (2-3hours after the PM test) so you know what her nighttime plans are
3 hills m/d is a bit too high in carb as well, it's 14% calorie from carb when we want under 10%. Check here and see if you can find another food that will work..https://docs.google.com/document/d/1NSWUx2ak7wcs2_G5TXr7BhPMrU7CVmW_3ouKPTUQhhA/pub

Any chance you can get a different kind of meter, like the bayer contour? The butterfly strip freestyle meters, and the "lite" and "true " meters tend to be inaccurate over 200.. Ie they say the cat is lower than it actually is.

I will be here in 1.5hours so let me know what the reading is and we can go from there.

Wendy
 
Also If she is over 200 I think you can still give her 1 unit, she hasn't earned a reduction yet (needs to go under 50)

Wendy
 
Thanks for the advice! I will test and post her results. (Don't shoot under 225, retest in 30 minutes. Shoot normal dose if > 225.)

Being in Japan, it's hard to find US glucose meters, and I can't read the instructions for the Japanese meters. We just happened to have this meter (FreeStyle). Hubby is going back to the States next week, and will send me a new one. I was thinking maybe the Walmart Relion meter; is that one accurate?

Another problem is that I can't find needles with 1/2 unit marks here. I'm also planning to have hubby send me some, but not sure what to do in the meantime if I need to reduce Sammy's dose. The vet had instructed me to dilute the insulin with saline; e.g. pull 1 unit, dilute X 10, discard 3 and shoot 7 for a 0.7 unit dose. I did this for the first 3 weeks, but after reading the manufacturer's warnings against dilution, I decided to stop diluting. I'm still not sure if that has made any difference, since I transitioned her to wet food around the same time. I wonder if anyone has any direct experience with diluting levemir?

I'm looking for a better low carb canned food. Since Sammy has mild CRF, she needs a low phosphorus food. American cat food is hard to find here, but is sometimes available on the internet. No Fancy Feast. I have found EVO Turkey & Chicken Formula Canned Cat & Kitten, but that seems rather high in phosphorus (0.38%, 266mg/100kc).
 
Ok, I just took a test. Sammy's AMPS is 228. That seems awfully close to 225. Should I wait 30 minutes and retest?

A complication is that hubby needs to go to the doctor for his monthly visit, leaving in 1 hour, and I need to go with him to translate. We'll probably be gone 3-4 hours. I'm really nervous about leaving Sammy alone for that long...
 
Yes - stall 30 min without feeding. If rising its OK to shoot in most cases. Leave food out.
If concerned, estimate a smaller dose.

Have him get either the Relion Confirm or ReliOn Prime plus tons of test strips.

You might look for the Arkray Glucocard 01 which is the unbranded version of the Confirm. Arkray is a Japanese Company, so maybe you can find it online near you.
 
I know I replied to this!!! Argh.

Ok so yes relion is good. Prime is cheapest but needs more blood than confirm or micro. Stock up on strips too, you will need them. Also get urine ketone strips while he is there.

Calipers will help you messure doses under 1unit. Use the search box above and search for calipers and you can see how the members use them.

We can stay with the hills for now but check the lists I gave you to see if you can find anything else.
 
OK, will feed and shoot normal dose.

I should be back in 3-4 hours, maybe earlier if they are not too crowded. I will retest and post when I get back.

Thanks so much for your help!
 
Retested Sammy at +4. Result was 349. I'm thinking about retesting at +10 and then again prior to the PM shot. That way I can tell which way she's heading before shooting. Does that make sense? Should I skip the shot if she's at 15-225 range at PM?
 
Looking good. She probbaly went higher instead of lower because of the reduced dose of 0.06 emptying the depot. Can you get a +3 now? I am hoping/thinking she will come down this time.
 
Sammy's +7 just now was 250 (AMPS was 254). Couldn't get a +3 because I had to take my chihuahua Chico to the vet for a checkup this morning; diagnosed with stage 1.5 mitral valve disease :sad: I'll try to get a +3 after Sammy's PM shot, or if I fall asleep too early I'll try for tomorrow after her AM shot. Thanks so much for your feedback. It really helps to know I'm not in this alone. Sometimes feels so overwhelming.
 
So sorry to hear the your Chihuahua Chico is not well. Sending healing vines to Chico.

A test at +2 or +3 will often tell us which direction the cat is heading, up or down.

The tests between +5 and +7 help us to pinpoint the nadir.

I'd like to see more tests in that +5 to +7 timeframe to help us see when Sammy's nadir is.

That "last test right before you go to bed" helps us to see what Sammy is doing in the PM cycle. Many cats drop lower at night.
 
I agree with Deb - lets see what Sammy is doing at night because if she isnt dropping low, she will probably need a dose increase. Can you get a mid night cycle and/or before bed test for a day or two?

Are you testing for ketones?
 
Okay, I did a 3 hour test after the AM shot. Sammy gets her first meal right after her shot, and it looks her BG went straight up afterwards. By +5, it was coming down, and kept dropping until +12 (PPS). Not sure what to make of this curve.

I also got a +2 after her PM shot and evening meal, and it headed straight up again. Just did a +7, and her curve is looking similar to the day curve.

I finally found some ketone urine strips online and ordered them. Should have them in a few days. I haven't noticed any sweet fruity acetone smell on her breath, but it will be good to have the strips.

I'm still having a hard time finding a high protein, low carb canned cat food here. I found Purina's version of Fancy Feast in Japan, called Mon Petit here. But the label doesn't list the amount of carbs or phosphorus. Tomorrow I plan to make an extra effort to find something online.
 
Sammy's AMPS was 192. This is her first test below 200. She tends to spike after eating, then has a long slow curve downward, reaching the lowest point at around +12. So I went ahead with her AM shot at the usual 1.0 unit. She's been trending downward after switching to the canned food, so I'm a little nervous about increasing her insulin at this time. Could the spike after eating be due to carb sensitivity? The M/D food she's eating is about 15% calories from carbs.
 
Good point, she is continuing to drop, you might want to hold off on a dose change right now, the food may be making a difference even though its higher than ideal for a diabetic cat ( we want <10%)

Cats can tend to surprise us, so please get a +2. If the +2 is higher then you should be ok but if its the same or lower you might want to get more tests as that implies an active cycle.

let us know, I am here to keep an eye on you if you need me.
Wendy

PS yes many cats have a food spike after eating.
 
Looks like Sammy is spiking 70-75 points. ECID but Wink only spiked maybe 30 points with food.

Only way to know for sure, would be to feed a lower carb food. Not sure what commercial foods are available in Japan. Look for foods with no grain, no wheat, rice, corn, soy, tapioca, potato, peas, no vegetables or fruit, no gluten. These are the higher carb ingredients in most foods. If you can find a commercial food without any of these ingredients, it would be worth trying.

You could also try a raw food diet with supplements for the vitamins and minerals.

Sammy could be carb sensitive. You can try to find some lower carb foods. Perhaps EVO or Bozita are available for order online?
 
Status
Not open for further replies.
Back
Top