Newly diagnosed -first curve-dosing help needed-AlphaTrak 93

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Re: Newly diagnosed -first curve at home- help!

MommaOfMuse said:
I believe that normal on an Alpha Trak is between 70 and 150 so 63 at +6 (6 hours after injection) is a nice safe number. Too low would be around 50 and still dropping.

With Lantus the lowest point when it is most effective is right around +6 to +7, she should start rising again after that. You're doing great!
Musette is on Lantus I test her before every shot to make sure she is high enough to safely give insulin too, and then get spot checks through out the day and a few every now and then in the evenings. I usually try for at least the preshot tests and because I am home all day at least her +3 which is about where her onset is, and then again at about her nadir (lowest point), but again its because I'm home with her.

Mel, Maxwell, Musette & The Fur Gang

The occasional weekend day I can be home for hours at a time with her, but not ussually. This would certaintly be easier for families with multiple caregivers!
 
Re: Newly diagnosed -first curve at home- help!

Then just do it on the weekends. :-D The really important ones are the ones right before the shots, and when you can get it the nadir. Then just catch the others when you can. Then every couple of weeks run a curve. I use to do like a +2 one day, maybe the next I would get a +9 then the following day grab a +5, so I have a rough idea of what she was doing at different times throughout the day.

Oh and the nadir does matter if it's between the day to evening shot, or the evening to morning shot, you could even set your alarm, get up test and go right back to bed, done that a couple of times myself.

Mel, Maxwell, Musette & The Fur Gang
 
Re: Newly diagnosed -first curve at home- help!

Her latest number is 162. I am supposed to feed her and give her another 4 units now.


Is the nadir a time or a number?
 
Re: Newly diagnosed -first curve at home- help!

Angela, I do test before every shot. That way I know that Smokey's sugar is high enough for me to give insulin. I also try to test before I leave for work (ends up being about +1.5) and that way I know that there isn't something weird going on (dropping too fast) while I'm at work. I try to test around +5 to +7 over the weekends, that way I'm getting a test closer to the Nadir fairly often. I also try to test before I go to bed at night (usually ends up being +3 to +5) and if I think that the number is too low I'll set an alarm to test at +6 to make sure he doesn't go too low. It's a lot but it has gotten easier and I've adjusted to it for sure. Plus, Smokey likes it- he gets a freeze dried shrimp treat (be sure that your treats aren't high carb- most are (like temptations, greenies...)- Purebites, sold at big box pet stores, are just freeze dried protein- no carb) so he loves it...
 
Re: Newly diagnosed -first curve at home- help!

Nadir is the time point when the insulin is "most active" and the blood glucose is lowest during a cycle. It varies for every cat and every type of insulin. For most cats on Lantus, nadir is around +6 hours. But every cat is different (ECID). As you start to test regularly, you'll figure out when Josie's nadir is.
 
Re: Newly diagnosed -first curve at home- help!

Hi again, Angela,
You don't have to do a bg test every hour. A mini curve is: AMPS, +3, +6, +9, PMPS (in other words, every three hours). A more extensive curve is every 2 hours: AMPS, +2, +4, +6, +8, +10, PMPS. Most people do a curve about once a week. But any readings you can get are helpful. It is most important to get AMPS, PMPS and something in mid-cycle (+5 or +6; the lowest bg number usually comes close to mid cycle--this is the nadir. Lantus dosing is based on the nadir, not on the pre-shot numbers; the reason we always get the pre-shot numbers is to determine if it is safe to give a shot). The other important test is a bedtime test, so that you can see where Josie might be heading in the evening cycle. Whenever you can do tests of other hours, put them into your spreadsheet. You don't have to get all of the numbers for every cycle. Fill them in when you can. Patterns will begin to emerge as you get more data.

Since the Alpha Trak generally reads 30 points higher than a human meter, 93 on the Alpha Trak would correspond to about 63 on a human meter. This nadir is considered safe, but it is a pretty low "safe" number, especially in a newly diagnosed cat experiencing large swings in blood glucose. I hope that one of our experienced dosing people will be along to help you decide what dose to give the next time you shoot. Please post this number (Alpha Trak 93) in your next subject heading (go back to your first post of today and edit the subject line there, so that people will see your question).

You are doing well and you are asking important questions.

Ella & Rusty
 
Re: Newly diagnosed -first curve at home- help!

Her latest number is 162. I am supposed to feed her and give her another 4 units now.

BUMP (bumping your post up).

You should edit your first post and change the subject - to newly diagnosed, dosing help needed. If you edit your first post it changes the subject line so people can see you need help.
 
Re: Newly diagnosed -first curve at home- help! AlphaTrak 93

Posted on the Lantus forum that you need dosing advice- eyes are coming...
 
Re: Newly diagnosed -first curve at home- help! AlphaTrak 93

Angela:

Just saw this and am jumping in. Is the 162 her PMPS (PM preshot)? If so, that is a 132 (approximately) on a human meter. Let me look at your SS and your day and I'll brb. It's ok to stall a few minutes on the shot. DO NOT FEED :-D
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

yeah, the 162 is her pmps. it has been almost 12 hours since her morning shot, and she hasnt had her evening one yet.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Ok....you don't have the data to shoot this number. You have a few options:

1. Skip the shot.

2. Stall and test every 20 mins or so (do not feed) until you get a pretty good rise and then shoot. In order to do this, you'll have to be able to delay your shot tomorrow morning as you will shoot 12 hours from when you shoot tonight and then slowly work your way back to your regular time....which we can deal with in a bit. Stalling acts like a reduced dose.

3. Shoot a reduced dose on time.

Personally, for it being your first day, I'd probably go with door number 1 or door number 2.

If you stall and shoot after she comes up, you still need to be prepared by having HC food, karo, plenty of test strips, etc. Do you?

eta: I really am leaning towards door number 1. What do you think?
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Here is the info on shooting low from our Stickys in the Lantus ISG:

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

I cant change her shooting schedual, I have already messed my schedual up to accomodate hers, and I cant just cancel my plans to stay home with her again tomorrow.


I dont know what Karo means.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Karo is light corn syrup. You can use any kind of syrup or honey to bring a cat up when their numbers are low. She is coming up from her 93 which is good.

You can't stall at all....if you can stall even 30 minutes, you could easily make it up tomorrow. If not, then I would consider just skipping and getting back on track at your normal time tomorrow.

You can also just shoot 1 or 2 units but you will need to monitor her very closely for the next several hours and make sure she continues to rise.

eta: my other concern with you shooting much of a dose is that if she does drop, all you have on hand is dry food...correct? Dry food takes a while to kick in and bring the numbers up and then it tends to linger. Karo or other honey or syrup will wear off quickly and the kitty's numbers could turn around and come back down.

There is a link to "Handling Low Preshots" in my signature block that gives additional info.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

FWIW, I don't think you have the data to shoot this low of a number. I have no doubt that Josie's numbers will be high in the AM but in this situation, that's OK.

What this is telling us is that you may need to reduce Josie's dose. The goal is for you to be able to safely give 2 insulin shots every day. From what you've seen today with Josie's numbers, my guess is that she has been dropping into lower ranges and then bouncing back up. That's not abnormal but now that you're home testing you are able to see the pattern.

Also, the "normal" range on an AlphaTrack if 80 - 150. Below 80 earns a dose reduction (an 80 is equivalent to a 50 on a human glucometer).
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Angela, Don't forget that your Alpha Trak reads about 30 points higher than a human meter. The guidelines Marjorie cited are based on the human meter. So your reading of Alpha Trak 162 corresponds to 132 on a human meter. She is correct that you don't have the data to shoot this low of a number (especially since you are giving a rather large dose).

Ella

p.s. I see that Sienne is here. Follow her advice. She is very knowledgeable.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

So what do I do now? Feed her her dry food, or feed her corn syrup? It is 11:30 at night I cant stay up much later to test her, I am exchausted and have to get up in the morning.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

I'm sorry I confused you. Feed her as you regularly would at this point. Since you aren't giving insulin tonight, just give her shot to her tomorrow morning at the regular time. Please read through Sienne's post regarding dose and what to shoot tomorrow morning after you test her.

The corn syrup is only if their numbers are really low (below 80 on your meter; below 50 on a human meter). We just like to know a caregiver is prepared if the kitty goes below those numbers.

eta: she may be high in the morning from skipping a shot but that's ok.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

In all honesty, I think you should skip the shot. She's not sufficiently low that you need to intervene with corn syrup. You just feed Josie they way you usually do.

I would suggest lowering her dose in the morning. I do think 4.0u is too much insulin based on what you've seen today. Would you be comfortable with reducing the dose back to 3.0u?
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

ok, no dose at all tonight, then in 11 hours, test her again, and then depending on the number, shoot either 4 or 3?
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Sienne is suggesting you might want to shoot 3 units at your regular time tomorrow. We don't raise the dose by 1u as your vet did (from 3 to 4). You can miss the correct dose that way and end up like you have today. It's possible she has already been in low numbers and the high numbers are from her bouncing up.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Hooray!! you'll be able to sleep tonight!

I'm another one who follows Sienne's advice like she were a messiah :lol:

(sorry, Sienne)

sounds to me like she feels 3u would be safer tomorrow...

rest well, angela...you deserve it!

and good job, girl!

celi
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

ok, i fed her 30 minutes ago, then did one last check just now and she is 198. Still too low to shoot?
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Angela:

The issue is, once you feed her, then you would be shooting a food-induced number. That means the 198 might not be a "true" number but just a food spike. Shooting a food spike can be risky.

Having said that, it is not possible to know with the dry food if this is actually a food spike this soon or it's just her normally coming up. IMHO, I'd skip as has been suggested.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Ok, well I guess I am going to bed then.
Missing a dose worries me, dont know what it will do to her, but sounds like it is better to have too little than too much.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

It's ok. It would be the same if you gave her a fur shot....which happens, too. Yes, she will probably be high in the morning. But everyone either has to skip a shot or accidentally gives a fur shot. The kitty always gets back on track.
It's better to spend a day at high numbers than an hour at really low ones.

It's most important now to find the correct dose for her. You are welcome and encouraged to join us in the Lantus ISG. There are alot of eyes on each kitty each day and we can help you with dosing, low numbers, low preshots, etc.

Hope you get some rest.
 
Re: Newly diagnosed -first curve at home- help!

eccentricfuzzyme said:
I have never heard of EVO- is that available at normal stores, or online only?

I live in Ottawa Canada- I think that is eastern time?.

I have seen EVO products at regular pet food stores in Canada. You can use the following link to locate stores carrying EVO products.
http://wtb.evopet.com/?new=true
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Her reading this afternoon is much higher than yesterdays midday reading, but last night I didnt inject at all, and this morning gave only 3 units instead of 4 so I assume that is why.


Also, I went and bought some EVO food. It is only a little cheaper than the vet stuff (32 instead of 38 for a 3kg bag) but it has less carbs and more protein. I am going to start mixing the two together to switch them over. Will this effect her numbers or dosage?


(xposted to the other thread, hope thats okay, wanted to make sure the people who mentioned the EVO to me saw this)
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Yes, you can expect the bg to be higher when you have skipped. Hopefully a consistent dose and your testing to see how it is working will help make this dance easier.

Unless you want to, you probably don't need to mix the two. Usually tummy upsets are only with the switch from dry to wet. I don't know if you will see a change in numbers. There is a definite correlation with most cats when they are switched to wet lo carb but you may not see a huge difference with the EVO. Every cat is different.....
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Hello! Welcome!

I second the opinion to ditch the alphatrak and get a cheaper, human meter. You need something affordable that allows you to test multiple times a day. I don't know if you can get the Relion meter at Walmarts in canada, but if not the Aviva Accuchek is a very good meter, and while the strips are expensive in the store you can get them on ebay and amazon for about half the price.

I also adding my voice to switching to canned food. If your cats eat their meal all in one sitting like most cats do, then you won't have to worry about bugs. The smell doesn't bother me but it did my boyfriend at first, but he got used to it. It's only at meal times anyway. Also, because he complained about the smell for a while I refrigerated the food before I opened it--it doesn't smell at all when it's cold. You can get big cans (13oz) of inexpensive food like friskies or Special Kitty to feed all of your cats, and keep it in the fridge. It will still work out to be cheaper than the more expensive dry food.

You do need to do things at your own pace though, but this is just something to think about for the future! The EVO dry is way better than the prescription stuff so that's a good first step.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

To those who mentioned the relion metre- are you all american? they didnt have them at any of the places i have checked here in ottawa canada.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Relion is sold exclusively at Walmart.

hope you're doing well... :-D

celi & binks
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

in canada too?
i went to walmart today and there were none on the shelves, and so asked at the pharmacy if they have any others, and specifically mentioned relion and they didnt know what i was talking about. said any metres they had were on the shelves.
maybe it is just an american thing. or maybe my store just doesnt carry it.
they only had the big name ones.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Yes - you are correct. Walmart in Canada does not carry the Relion metre. I use the OneTouch Ultra and have found the least expensive strips at Costco $74 for 100. And you do not need to be a member to buy at the pharmacy. I also buy my insulin there - again least expensive. The other thing some members do is shop at Shoppers Drug Mart and collect points with the Optimum card (their loyalty card). Every few visits there are enough points to get strips or insulin free.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Just thought to add that the metre is free if you buy a box of strips - just don't say its for a cat. This is at any pharmacy and most if not all metres.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Just-As-Appy said:
Yes - you are correct. Walmart in Canada does not carry the Relion metre. I use the OneTouch Ultra and have found the least expensive strips at Costco $74 for 100. And you do not need to be a member to buy at the pharmacy. I also buy my insulin there - again least expensive. The other thing some members do is shop at Shoppers Drug Mart and collect points with the Optimum card (their loyalty card). Every few visits there are enough points to get strips or insulin free.


Have you looked into buying online? 74 cents a strips is still almost twice the price others have quoted finding online. But all I can find is american sources that charge too much to ship.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

Can you use ebay? I had a brand name meter and always bought my strips on ebay for less than half the price of stores. Just be sure to check the seller's rep and the expiration dates. (The sellers seem to be retired people who are selling off their excess Medicare supplies....)
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

i have never used ebay before, as i dont have a credit card. can you use the prepaid ones on there? do you have to bid?
i will have to check to see if .com ships here and if so if it is expensive, because .ca never has as many things.
 
Re: Newly diagnosed -first curve-dosing help needed-AlphaTra

eccentricfuzzyme said:
i have never used ebay before, as i dont have a credit card. can you use the prepaid ones on there? do you have to bid?
i will have to check to see if .com ships here and if so if it is expensive, because .ca never has as many things.

Yes you can use the prepaid ones. Payout for ebay is thru Paypal.com. Paypal will also allow you to set up an automatic payment from your checking account too. It takes 4 days for a check to 'clear'...most sellers ship as soon as the 'clear' notice is received.
 
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