QUESTION for BOOTS (This is Gabe, Jade's boyfriend)

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Jade77

Member Since 2013
Jade is at work and I have a question

at 445am this morning boots' BGL was 525
gave him some food and @ 515am gave him his .5 dose
i returned at 1115am during my lunch and tested him again...BGL was 150
after work today i retested him @ 515pm his BGL was 317 (gave him some food)
again i tested @ 6pm and it had dropped to 293 BGL so i immediately retested and it said 278 BGL!

i don't know what to do? any suggestions...at this point i aim to retest at 630-645 and if its higher than 350 give him his .5 shot....
 
Important note about glucometers: the FDA allows them to vary 20% around what a lab would get.

100 -> 80 - 120
200 -> 160 - 240
300 -> 240 - 360

Etc.

If the ranges overlap, the numbers may be considered the same.
To check:
Take the low number and multiply by 1.2
Take the high number and multiply by 0.8
Do the results switch which is high and which is low? If yes, they overlap and may be considered the same.

293 * 0.8 = 234.4
278 * 1.2 = 333.6
Yup, they overlap and may be considered the same number.
 
aLso, 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.
 
So with that BGL should i give him the .5 dose now? its been over 12hrs since his last shot
 
We're still getting data on his response to insulin, so I would be conservative and give 0.25 units

You'll have to eyeball it as best you can.
 
Hi Gabe! I'm sure Jade appreciates very much your being able to help with the testing and shots for Boots.

Those numbers are essentially the same, within meter variance.

What is your evening looking like? Will you be home or do you need to leave again?
Do you have some HC (high carb) food on hand? Plenty of test strips? Can be around to monitor?

You have basically 3 options:
1. give the full dose. You might want to be home to monitor if you do this. Depends on the BG number you get.
2. give a reduced dose. Say half the normal dose. That would be 0.25U. Depends on the BG number you get.
3. Skip the shot. Not recommended since this would make Boots very high for the evening.

I'm leaning towards options 1 or 2. But you hold the needle. What would you like to do?

Boots had 80- 100 more points to drop from that 150 you got at +6 for this AM cycle. He could have been a bit lower early in the day, but there is room to go down more without endangering him.

I'd like to see that one more test you were talking about before my recommendation. If it's a dropping number after the food, then lower the dose would be my first choice.
 
BJM said:
We're still getting data on his response to insulin, so I would be conservative and give 0.25 units

You'll have to eyeball it as best you can.
Click to expand...

thank you so much for your help. after calling jade , we decided to give him the .25U.

she will be home in an hour or so....we could retest then

thanks again
 
Deb & Wink said:
Hi Gabe! I'm sure Jade appreciates very much your being able to help with the testing and shots for Boots.

Those numbers are essentially the same, within meter variance.

What is your evening looking like? Will you be home or do you need to leave again?
Do you have some HC (high carb) food on hand? Plenty of test strips? Can be around to monitor?

You have basically 3 options:
1. give the full dose. You might want to be home to monitor if you do this. Depends on the BG number you get.
2. give a reduced dose. Say half the normal dose. That would be 0.25U. Depends on the BG number you get.
3. Skip the shot. Not recommended since this would make Boots very high for the evening.

I'm leaning towards options 1 or 2. But you hold the needle. What would you like to do?

Boots had 80- 100 more points to drop from that 150 you got at +6 for this AM cycle. He could have been a bit lower early in the day, but there is room to go down more without endangering him.

I'd like to see that one more test you were talking about before my recommendation. If it's a dropping number after the food, then lower the dose would be my first choice.
Click to expand...

Thank you so much for all your help! I didn't read this post until after i had talked to jade and we decided to give him the .25U dose and retest at some point once she has gotten home in about an hour..
 
Thank you all so much for helping Gabe. I was at work, and couldn't really do much from there. I just got home and we will be re-testing shortly. I cannot WAIT til I can switch the insulin.
 
Jade77 said:
Well we retested again at 830 and it was 534 BGL isnt that too high?
Click to expand...
Yes. That's one of the problems with N insulin. It hits hard and fast and we don't have a lot of data on how Boots responds, so we need to be cautious.

He might have been fine giving 0.5 units ... but if it was too much, at best you'd have several anxious hours testing, feeding 2 teaspoons of high carb, waiting 30 minutes, and repeating until the numbers were safe. At worst ... you wouldn't have a cat.
 
It's jade again. Yes, we will retest in another hour. I have been trying to find time to update it, I'm now training a mgr at work and am gone more like 12 hours til she's ready. Im going to try and update it tonight. It's all written down on paper, but Deb is who helped me get that spreadsheet up there..I still have to figure out how to enter data. I'm pretty computer-illiterate.
 
I'm actually not even sure how to get back to the spreadsheet Deb got started for me, now that I am trying..
 
Go to http://docs.google.com
You may need to login with your password.
From the list of files, find the spreadsheet.
Click on it to open it.
It may open in a new browser tab or window.
Start typing where you need to
Google will automatically save your changes
 
I found it. Im organizing in on paper before I start putting it in...but I noticed that Gabe didn't pay attention to when he had his last shot a few days ago and kind of changed the schedule Boots was on, and from there the numbers just make no sense to me. I am considering moving his shot time to when it is most convenient for us to be home about the same time. I work nights, so early AM is something I cant do every day, Gabe does it if I sleep thru it. But he's half asleep and still has to get ready for work...then most days Im working til around 10pm, so he has to do most of the PM stuff too. And I think it's to much to put on just him. Is it safe to change when I start testing and giving him his shots?
 
Humulin N is an in and out insulin, so unless you overlap the timing by more than 2 hours, you should be fine if the glucose is high enough.

Another thing you can do with N is develop a sliding scale, where higher glucose levels get higher doses and lower glucose levels get lower doses. That is partly what you did previously - the pre-test was a around 200 mg/dL lower than the morning pre-shot, so we suggested 0.25 units, not wanting to risk someone having a sleepless night staying up and checking him. And then the food hit and he zoomed up again, so it might've been OK to give 0.5 after all. But better too high for a day than too low for a moment. The latter can kill quickly.
 
You can see very clearly the food spike of 534 followed by the Humulin N dropping to its nadir by the next hour and hitting 277, with the subsequent glucose starting to rise again.

So now we know that if the pre-test is around 300, he eats and keeps it down, then it is safe to give 0.5 units.
 
BJM said:
You can see very clearly the food spike of 534 followed by the Humulin N dropping to its nadir by the next hour and hitting 277, with the subsequent glucose starting to rise again.

So now we know that if the pre-test is around 300, he eats and keeps it down, then it is safe to give 0.5 units.
Click to expand...

Food spike - increase in glucose levels about 2-3 hours after eating
Nadir - lowest point between shots

You got a pre-shot test around 300 mg/dL.
You fed the cat and the food stayed down.
You gave 0.25 units insulin.
You observed a food spike up to 500ish mg/dL, despite the incoming insulin. <- this showed it would have been safe to give 0.5 units
You observed the glucose come down due to the insulin.
You saw the glucose start to climb back up due to the insulin wearing off.
 
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