Newbie home tester do I need to be concerned? 98 at +4

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Jen&Eddie

Jen&Eddie

Member Since 2013
Brand new home tester here. Eddie and I (and DH) had our first home test successfully tonight. I've tested twice since then although Eddie has had to suffer through my fumbling inexperience both times. We are currently on 3U ProZinc, having been increased pretty rapidly.

PMPS was 300 which we were excited about (first successful test, yay!), was 200 points lower than the last 500+ that Eddie checked at the vet's on Monday. Before that, his initial test was just over 400, then it climbed to just over 415, and most recently, it was just over 500. Second reading tonight at +2 was 308 presumably from his supper which was fed shortly before his insulin, and maybe a bump from testing treats. We do freeze dried shrimp (which Eddie will kill for) to help facilitate testing. At +4, we're at 98. I don't know whether to be concerned or not. I have been a little suspicious that he might be dipping low and that's what really made me determined to do home testing, regardless of how awful I feel clumsily stabbing away at my poor baby. Thankfully, he has a very forgiving heart.

Since he was upped from one to two, and even more so after upping from two to three units, he gets extremely hungry at roughly 4-5 hours after his dose. Hungry enough to start eyeballing the counter tops and trying to get into the garbage. The last couple nights I gave him a tablespoon or so of LC wet food, being suspicious that he was going a bit low. After that, he's sleepy. Not really lethargic, but sleepy.

My vet and particularly my vet tech are wonderful and caring and helpful and encourage home testing. That said, I'm concerned that perhaps Eddie's vet numbers have been reflecting a bounce or something, since he is usually seen about an hour before his PM shot. Is 3U too much? Do I need to panic about hypo yet?

Should I stay up and test him again? After relaying the 300 PMPS number to our vet, was instructed to continue the 3U and test in 2 hours, and to reduce to 2U if he hit 100 or less. Obviously, he went down significantly more after the 2+ mark.

Thank you so much for your patience and help!
Jen and Eddie
 
I was excited about my first home test too! I'm hoping it gets easier. :roll: I haven't been doing this very long either but 3 units seems like a lot for a 300 bg. The last day at the vet I think Skipper was at 548 and didn't even get 3 units. I'm sure there are other factors to consider though. You are looking for the BG number to drop about 50% about halfway between the AM & PM shot. If you go too low then this could cause a bounce which makes higher BG levels. Your post said that if he goes below 100 then you will give 2.0 units? If they are below 200 then you shouldn't be giving them insulin.
What food are you feeding?
 
Thank you for replying!

I'm pretty certain the dosage was based on the assumption that Eddie was actually in the high 400s or low 500s, so seeing starting 300, but seeing two numbers below a hundred, I'm assuming the 3U is too high. The recommendation of the vet was that if he went below 100 at 2+, to reduce to 2U, but obviously he has continued to drop since that point so I'm not confident at all in that recommendation.

I'm not sure whether to maybe feed him so he doesn't drop lower during the night or what to do for his morning dosage?
 
From what I understand 5 1/2 - 6 1/2 hours is going to be the low point. So your 79 might be as low as he will go. You might get another test in a couple hours just to make sure that he is rising again. After we brought our cat home from the vet, I would text the vet Skipper's BG levels and the vet would adjust the dose based on the new reading. No I have been playing with the dosage on my own. I can't really say what you should change it to, but for an example look at some other spreadsheets. Skipper's PMPS was 347 and I only gave him 1 unit. IF you have started with the low carb food you need to watch the numbers close because that will also reduce the amount of insulin needed.
 
Jen,
Congratulations on your first test! If you haven't been already, remember to get everything you need to test Eddie ready before you test him. You'll fumble less and Eddie won't notice your nervousness. I even have the strip in the meter too. They go for quite awhile and even if you feel you need to you can pull it out and put it back in to give yourself more time. Also designate a testing spot. Make sure you give him a treat after testing even when unsuccessful. Eddie doesn't know the difference. My cat actually jumps up on the testing spot now even [because he equates that spot with a treat] when I'm not going to test him. So I oblige him. :) Good luck with testing. Let us know how you are making out.
 
So far so good. We're doing better with the testing already. Seeing how low he's actually getting freaked me out a bit last night. He's at 350 this morning, but I'm going to do 1U to see if we get less of a swing.
 
For safety, he should not go below 50 mg/dL on a human glucometer (these read a different scale than lab equipment) or 80 mg/dL on a pet-specific glucometer (numbers are closer to what a lab gets).

You may leave food out all day until 2 hours before the next shot. This will let him eat a bit if he is dropping too fast or feels too low and just may prevent a hypoglycemic attack.

Do you have Karo syrup or other sweet syrup on hand if he should go too low (become hypoglycemic)?
How about some high carb food with gravy?

If he is ever below 50 mg/dL while on insulin, we have a protocol in place to bring him up safely using high carb foods.

Short version:
Test is < 50
Feed 1-2 teaspoons of high carb gravy.
Wait 30 min
Repeat test and evaluate again.

High carb gravy doesn't last long, so you must keep testing until far enough past nadir and numbers are steadyily rising.
 
Thank you!

Eddie was up to 350 this morning, so I wonder if this is a bounce in response to his lows last night. We're scheduled for a vet check tonight, but I intend to get a reading at home before we go so we can see how much he elevates at the vet's office.

We do have both Karo and hi carb gravy food and I have studied the protocol. I read and re-read it several times last night and it's still open in my tabs.

You may leave food out all day until 2 hours before the next shot. This will let him eat a bit if he is dropping too fast or feels too low and just may prevent a hypoglycemic attack.
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This is precisely what I'm most concerned about. DH and I are both at work when he'd be hitting his daytime peak, and theoretically sleeping during his nighttime peak. For several years, we have fed everyone (including our other three kitties and normally at least one foster cat), twice a day on a pretty consistent feeding schedule. I saw some stuff about freezing food to make sure some is available over an extended period of time. Is that how one goes about making sure some food is out and available when we're not around to give him some food if he is hungry? If we just left wet food out, Eddie would probably gobble it all up in one sitting, or the others would clean it up pretty quickly.

Thank you!!
 
I am wondering if your vet might agree to restarting at one unit, now that you are testing at home and the food change is kicking in. (It is so much safer to increase by a small amount, based on home numbers, rather than try to react to sudden low numbers if the dose is too high) You could start at one unit, hold it a few cycles, catching the nadirs whenever possible. If he is above 200 at preshot and not dropping down into the blues or greens at nadir, then increase by .25
 
Sue and Oliver (GA) said:
I am wondering if your vet might agree to restarting at one unit, now that you are testing at home and the food change is kicking in. (It is so much safer to increase by a small amount, based on home numbers, rather than try to react to sudden low numbers if the dose is too high) You could start at one unit, hold it a few cycles, catching the nadirs whenever possible. If he is above 200 at preshot and not dropping down into the blues or greens at nadir, then increase by .25
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This is what I'd like to do so we're hopefully not going up and down quite so dramatically.

Thanks!
 
I agree; I think going up in dose a little more slowly and by .25 units at a time might also help level out his bouncing. :-D Please let us know how it goes over the next couple of days!
 
I spoke with a tech who was someone other than the person we usually have been dealing with, rather than taking Eddie in tonight, and went through the numbers we've collected. They were not receptive to starting with one and gradually increasing after we have a better feel for what his numbers were doing. I don't think they understood my concern about the rather dramatic dip (at least in my newbie view) that we saw last night and characterized those numbers as "normal" and, therefore, "good." I expressed my concern about feeling safe with the dosing. We agreed to try a reduction to two and see how that goes. Not quite sure how to approach this with our vet if we want to try something different than what's being prescribed.
 
It is very hard to go against your vet, especially if you like him. But he is your cat and you are his best advocate. The vet will not be there at 2 am if he drops too low.....

You can try two but monitor carefully. Or try one and see how he does over the weekend. Don't tell the vet yet. If it works well, then just say that you were frightened by the low number and went with the lower dose. (it is hard for a vet to chastise an owner who says they were scared for their animal's life)

Your 98 would have been a good number at +6, though even then lower than we would expect for a new diabetic. But to get that number early in the cycle can be dangerous. If you hadn't been around and he couldn't eat to bring himself up, he could have dropped too low at nadir.

Did you just change the diet? That will also lower the numbers and is another reason we like the start low, go slow approach.
 
Here are some glucose reference ranges used for decision making using glucometers. Human glucometer numbers are given first. Numbers in parentheses are for non-US meters. Numbers in curly braces are estimates for an AlphaTrak. There are some examples following at the bottom of how to use them.


< 40 mg/dL (2.2 mmol/L) {< 70 mg/dL for an AlphaTrak}
- Treat as if HYPO if on insulin
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL (2.8 mmol/L) {< 80 mg/dL for an AlphaTrak}
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50 (2.8).
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL (2.8 - 7.2 mmol/L) {80 - 160 mg/dL for an AlphaTrak}
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s (1.7 mmol/L){60s for an AlphaTrak}; if not on insulin, this can be safe.

= 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- no shot limit for ProZinc, PZI, or other non-depot insulins

> 150 mg/dL (8.3 mmol/L) {> 180 mg/dL for an AlphaTrak}
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

200 mg/dL (11.1 mmol/L) {230 mg/dL for an AlphaTrak}
- no shot level for beginners; may slowly reduce to 150 mg/dL (8.3 mmol/L) {180 mg/dL} for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL (10 - 15.6 mmol/L) {may be 210 - 310 mg/dL for an AlphaTrak}- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL (15.6 mmol/L) {may be >=310 mg/dL for an AlphaTrak}, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.

* * * * * * * * * * * * * * *​

How to use the glucose reference values chart:

When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)7
 
Thank you so much!!

I'm probably worrying too much, but way better safe than sorry. I was really worried that we were going to be dipping too low and I'd have to be testing repeatedly with very, very shaky beginning testing skills. We completely stopped the small amount of remaining transitional dry food about a week and a half ago, so that probably does account for Eddie's lower PS numbers. Two of our civies are not pleased with eliminating the dry crunches all together, although we've fed a 1/2 wet, 1/2 dry diet for years. So those two do still get small amounts of dry behind closed doors, to make sure they're eating enough, until we can convince them they don't need it. After reading up on the carbs in dry (which we were feeding Science Diet not knowing any better), I think of dry food as being basically like potato chips.

After doing a couple 2U's with Eddie the dips look less dramatic. We'll keep on that for a couple days and get more data on his numbers. My DH didn't test PS this morning, which would have been nice to see his AMPS number this morning. He doesn't quite understand the testing rules yet.

That said, DH has been awesome! Growing up on a farm, shooting was super easy for him, and he helped me gain confidence in administering. DH does most of the insulin shots. He also does ear tests with me. When we were initially haplessly stabbing our poor guy, DH got the first successful test. We've been testing for less than a week but we get a usable test result on the first poke about 50% of the time now, and we get faster and better at it with each test. Eddie's also tolerating it much better too. We keep his treats inside his test kit, so everything smells like his favorite ever freeze dried shrimp. I sit down on the floor with his kit, and he comes running over to get his test and treat. Maybe in a couple months, we can do one of those how-to videos demonstrating on a super-cooperative cat, too :)

Last night Eddie was hanging out on top of one of the cat stands, that used to be his favorite spot, which was wonderful to see. This morning he was being goofy and flipping toys around, which was also great to see. His coat looks better, and he is slowly putting weight back on, so I think he's starting to feel better :)

Our normal vet tech is wonderful. She cat-sitted for us when we were out of town over the holidays and were freshly diagnosed. She really has gone way above and beyond for us. Our vet has been good too but we've worked most with our tech in terms of advise, discussing diet, etc. Maybe after we have more data, our vet will be more receptive to us making the decisions on the dosage.

I'm not 100% clear on the protocol for Prozinc, but from what I've been studying, with it seems like we're aiming for approx. a 1/2 reduction between PS and nadir and, so smoother curves, rather than the more dramatic highs and lows, and then pushing him slowly downward with increased doses....if that's not right, please let me know!

Thank you to everyone who has so thoughtfully responded, and to everyone who has contributed to the amazing wealth of information here!
Jen and Eddie
 
We spoke with our normal vet tech today who we love and she was frustrated by the way we were treated yesterday. She agreed that his numbers on Thursday night were scary, and that he very well could have gone down into the 50's. She is going to monitor our spreadsheet herself and work WITH us for managing his dosage. I feel so much better about our vet guidance on this now.

Thanks!!

P.S. I just wanted to say for anyone out there who is starting home testing and is feeling frustrated by ear testing, it can be done! I'm shocked by how quickly DH and I have gotten better at it, along with Eddie. Probably the tips that helped us out were 1) keeping his very favorite treats in the testing kit. The kit comes out and he comes to the testing spot because he knows he's going to get his treat and the testing materials all smell delicious, 2) the clear lid that came with the lancet. DUH! I didn't see the clear tip that came with the lancet at first and/or realize what it was, but WOW, actually being able to SEE where we were poking made pretty much 100% of the difference, 3) watching (several times each) all of the very helpful videos demonstrating how to do it. We were not poking in the right place when we made our first attempts, and 4) heating the ear first. Eddie's ear already seems to be "learning" to bleed better, so we're barely having to warm his ear to get a sufficient sample.
 
He's still pretty low at +8. Either he will surf longer and may be too low to shoot at +12. (if this happens, you might post and ask for advice) or he'll bounce back up for pmps.
 
He's still pretty low at +8. Either he will surf longer and may be too low to shoot at +12. (if this happens, you might post and ask for advice) or he'll bounce back up for pmps.
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Looks like a bounce is probably where we are going. Big upwards jump between +8 and +10.5 from 106 to 273.
 
Sue and Oliver (GA) said:
Looks like it. I wouldn't increase tonight, even if he jumps up.
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That's what I'm thinking too. I'm going to guess that my tech will agree as well. She's asked for his PMPS to help guide us.
 
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