Not sure what to do

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casanovasmom

casanovasmom

Member Since 2010
Casanova went the vet about a month ago now and had a fructosamine that came back at 285. I've been testing him regularly since and his numbers are just plain confusing me. Today when I got home I tested him and got a reading of 31. I immediately feed him his regular food and 30 minutes later his number went up to 46. He seems fine, but this BG is pretty low. If anyone would please take the time to look at his spreadsheet and give me any feed back I'd appreciate it. I feel like I should lower his dose but am not sure by how much.

The other question I had was the vet thought we should come in once a month to test fructosamine but is that really necessary when home testing?

Thanks,
Laura
 
The most important numbers for evaluating the dose and whether to alter it are ones taken around the possible nadir - so between +5 to +7 hours after the shot. Any test below 50 automatically gets a 0.25 unit decrease in dose; you've met that criteria, and may reduce the Lantus dose from 5.5 untis to 5.25 units (you'll need to eyeball quarter unit increments at 0.25 or 0.75)

The next most important numbers are the pre-shot numbers - for someone not doing a lot of mid-cycle testing, you are shooting pretty low and could run into trouble without monitoring around the nadir. I'd be happier if you'd do one or more of the following a
) get more mid-cycle tests,
b) set a no shot limit about 100, or
c) reduced the dose down to 5.0 units
if you aren't able to do that level of monitoring. The most important thing is to be safe.

It is possible what you perceive as erratic numbers are due to lack of test numbers to fill in the gaps - without the context, the numbers may not make sense - an unrecorded low may generate a bounce to high numbers, for example.
 
Here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- 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, 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.
 
On days that I work, doing the midday testing is impossible. Do you think it would be wise to go lower than 5 units?

Laura
 
You don't need to get mid-day testing everyday. You do want to get it about 3 days after you've increased a dose, so you can see if its taking him too low. That means you should hold off on increases until you're able to check the nadir by that 3 day time.

Given the low today, you might drop to 5 units tonight to drain the shed a bit faster, then resume tomorrow at 5.25 units.

Any other tests you can squeeze in can help - before bed to see if he's heading too low, if you get up for a pit stop in the night, whatever.
 
And, since BJ didn't answer- if you are home testing you really don't need to pay the vet for a test to see how he was the last two weeks- you can take the average of your home testing and do that.
 
I agree, your home testing should be fine. This is a great thread, I think I need to print it and add to my notes.
 
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