Relatively new diagnosis and frustrations

Sarah Neelix

Sarah Neelix

Member Since 2020
My kitty, Neelix, was diagnosed with diabetes last summer. I've been giving him Lantus twice a day but still can't seem to get his dose right and I'm getting frustrated. He's been getting canned food only since his diagnosis - Friskies and 9Lives pate style which are both on the food analysis as very low carb. For the past month-ish I've been supplementing his food with raw chicken liver. I'm finding the vet not very helpful (not entirely unhelpful, but not great, either, with constant suggestions to buy Purina DM, no ideas on how to get insulin from Canada, which I figured out for myself, etc.). I've been doing regular BG curves but I just don't have time right now to convert all that data into the spreadsheet (which I've copied and linked per the instructions). I just don't know what to do and am getting fed up. His weight is steady around 12 lbs and on 2 units 2x/day he was clearly not feeling well. He's now on 3 units 2x/day and is feeling so much better but his BG is still too high, and not much lower than when he was on 2 units 2x/day. I'm using the AlphaTrak2 with the PetSure strips on setting 4, the turbo setting. What gives? Can you help? I'm happy to share the BG data I have but I find it rather daunting to convert what I've got onto the spreadsheet - it's just so much data entry. I hope you can help anyway or can somebody help me move my data from spreadsheets in a word doc?
Thanks, Sarah
 
Hi-

Welcome to the group! This is the best place for you and Neelix to be. I am going to be honest, though, it is really hard to tell for sure what is going on with the numbers not being in spreadsheet form. The spreadsheet is color-coded, and that makes it super easy to track trends. I know setting it up sounds daunting. Others may chime in with different info, but I would suggest getting it set up with maybe the last week or two of data - that could be enough for us to start seeing trends.

First a couple quick questions:
Are you testing before every shot, and getting at least one test in per 12-hour cycle? If not, I strongly recommend that you do for Neelix's safety.
Are you consistently shooting 12 hours apart?
Have you had a chance to read the stickies at the top of the forum that explain the two different dosing methods we follow here - Start Low Go Slow (SLGS) and Tight Regulation (TR)? If not, reading those are loaded with lots of helpful info.

I see on October 18th that Neelix and LO readings. I just want to mention these up front, because that means he was in very dangerous numbers. Fortunately he seems to be OK, but if you get readings like that again, you want to intervene with high carb food and or karo, and then continue testing every 20-30 minutes until you start seeing safer numbers. Additionally, numbers that lo require an immediate dose reduction, again for safety.

Do you have syringes with 1/2 unit markings? In this group, we adjust doses (usually) in 1/4 unit increments. That allows us to safely arrive at an ideal dose. 1/2 unit markings make that much easier to measure.

I also see that Neelix has had some "bounces", where he has hit low numbers, and then a few hours later was quite high. That is not an unusual reaction, especially with a newly-diagnosed kitty. His body isn't used to the lower numbers, so it over compensates in an attempt to protect itself from hypoglycemia, and that results in the higher numbers.

All of this can be overwhelming, but we are here to help. If you're able to get the spreadsheet set up, that would be a huge help to us, so we can better help you. Please keep asking as many questions as you need!
 
Hi Trixie, thanks for the reply... I knew there would be more questions but I couldn't think what they would be.
I test his BG before his first shot, but only on curve days, not every day. The shots are very 12 hours and I'm consistent on that within 15 minutes.
Yes, I've read through a bunch of stuff on the forum and other places. I feel pretty well versed in things and I thought I was doing things right but his BG is still so darn high.
And funny, on that day when he had super low readings in October he didn't show any signs of hypo. I can't help but wonder if it was the meter being set at 22 (as is recommended on AlphaTrak2 for the PetSure strips, but then they also have that "turbo" code of 4. It's all so confusing). Anyway, I have karo and maple syrup on hand, although last Friday when he had a low reading I gave him some vanilla ice cream, which he loved.
Mostly I'm frustrated at the fact that I thought I was doing all the right things but his BG is still high. And the vet has been not very helpful. I feel as though it's been a rather solo journey.
In the meantime, I'll work on entering the latest numbers so there's a start for folks who are familiar with that format.
Oh, and Neelix is 12.5 years old.
Thanks, Sarah
 
Welcome to the group.

I agree with Amy. We tend to be pretty numbers driven here. While curves are great, they are only a small piece of the puzzle. They are a snapshot and we need a bigger picture. Getting more test data and having it on the spreadsheet will help us to help you. As Amy noted, it's very important to get pre-shot tests every single time you give a shot. Like you pointed out, cat's don't always look like they may be in lower numbers. No one wants to deal with a symptomatic hypoglycemic episode and one of the best ways to prevent that from happening is to know whether it's safe to give insulin.

Also, the AlphaTrack manufacturer does not recommend using other company's strips in their equipment. I have no clue how reliable your meter readings are. Would you consider switching over to a human meter? The strips for a human meter are far less expensive than an AT or other pet meter.

Not all of Neelix's numbers are high. Again, with only a snapshot, we can't reliably interpret what's going on. My hunch is that the high numbers you're seeing are the result of Neelix's numbers having dropped during a previous cycle.

Please let us know how we can help. There's lots of information on Lantus in the sticky notes at the top of the Board. We're more than happy to innundate you in information. And, this is one place where you will not be alone in managing your cat's diabetes.
 
Thanks, Sienne and Gabby. I'd consider changing glucose meters but I've already got the AlphaTrak2. And of course the manufacturer recommends not using anything but their own strips! At $1/each, why wouldn't they? I've done some research on the PetSure strips and they seem to be just fine. I'd really prefer to work with what I've got at the moment. In the meantime, I've entered a row of data but I have no idea what AMPS means or that blue U as I can't find a legend key. Nor do I understand SLGS and TR and I can't find information about them on this site. There is so much information here - I'm struggling to learn where to find stuff and then end up getting confused and lost. I thought it might be easier for me to get some answers if I just posted and started a thread.
So, if I'm understanding you, the suggestion is to test his BG before every shot, which means twice a day? Is that correct?
Yes, I've read through the stickies and tried to understand as much as I can, but it is so much information. I feel pretty well-versed in the facts, but my particular case is confounding, as are they all, I'm sure. There are the facts, then there is the real experience of feline diabetes. My main frustration is that I feel as though I'm doing all the right things (low-carb food, injections on the 12-hours, glucose curves, etc.) and yet I haven't been able to get to an insulin dose that seems to work for him. His numbers on 3 units 2x/day are not much lower than his numbers from 2 units 2x/day.
I'll keep plugging away at that data entry...
Oh, btw, I was confused about the information on the profile and entered *my* birthday, which it says I can't change without contacting a moderator. So, since I see you're a moderator can you help me with that so I can change it to Neelix' birthday?
Sarah
 
Great job getting started with the data entry! "AMPS" = "AM (morning) pre-shot" and "PMPS" = "PM (evening" pre-shot). "U" is the dose in units. If you click on the links for spreadsheets for other kitties here, it will help you see what is going on and how we use it.

As for testing...yes, we strongly, strongly recommend testing before every shot. As you saw the one time, Neelix hit "lo" on the meter. (BTW, You did the right thing and retest, to be sure it was an accurate reading.) Now imagine if that "lo" was right before you gave insulin, but you didn't know he was low because he was acting normally and you didn't test. The results could have been, well, bad.

Additionally, we really recommend getting an additional test in during each cycle, so you have a feel for where his BG is and if he needs intervention with karo or high carb foods. So with preshot tests and one test per cycle, that would be 4 tests a day. We do understand that it can be hard getting those mid-cycle tests, especially if you work out of the house, but those numbers are very helpful in seeing what is going on.

Here are links go the two dosing methods. (They are both at the top of this forum):
Start Low Go Slow
Tight Regulation

We understand that the information is overwhelming...we were once standing right where you are now. We are happy to break down any information you need help with...folks here are very generous with their knowledge and support.
 
Thanks for the response. I've updated the spreadsheet and added a few more lines. My basic question is how can I get his BG down? I can see that it's been too high for too long. I've jumped around with his insulin dose (following the vet's recommendations), and yet his BG is all over the place - mostly just too high. He's only getting low carb wet food. I'm diligent about his insulin doses every 12 hours. What more can I do?
 
Here's a link to the PetSure strips https://www.petsureteststrips.com/
Here's what they say, "Due to differences in manufacturing, PetSure!® test strips tend to produce lower readings on codes 20 and 22 than the AlphaTrak® test strips. Using the AlphaTRAK®2 Turbo code yields a higher reading which will more closely resemble the results of the AlphaTRAK® test strips. While both readings are accurate and fall within the accuracy range of at-home testing equipment, the AlphaTRAK®2 Turbo code option allows for a smooth transition from AlphaTRAK® test strip use to PetSure!® test strips.

(This does not mean that the results from testing with the assigned codes are any less accurate. It simply means that PetSure!® results seem to be negatively biased while AlphaTRAK® results are usually positively biased to the true glucose level.)"
 
Sarah Neelix said:
My basic question is how can I get his BG down?
Click to expand...

I've been using a Relion Prime meter & strips for 2 yrs now & have never had a problem. 100 strips cost under $20 & the meter is about $10. Most of the people here use a human meter because of the cost.
I understand how frustrating those High #'s are but you need to be patient. Insulin is a powerful hormone & your Neelix's little body is trying to adjust to it. It just takes time. It's important not to keep changing the dose. (Unless he drops too low & then needs a decrease.) You must check him before each shot, Am & PM. Every day.

Most kitties drop the lowest during the night. so it's important to get some night time readings also. Think of the spread sheet as a puzzle. You're trying to gradually fill in the boxes over time. Different readings lets you know when his BG usually is the lowest.

Any #'s below 50 are dangerous. My cat Ravan does not show signs of Hypo either but I've seen kitties rushed to the Emergency Vet due to such low BG.
You can check out some of the other cats spread sheets & see that especially in the beginning a lot of Kitties have High BG untill they adjust.Look at Ravan's SS for 2018 He was high for nearly 6 months until he finally start coming down.

If you listen to your vet it will be confusing. The people here who have been giving advice for a LONG time really know what they're doing. Some of them have been dealing with this for many years & are a lot more knowledgeable than most Vets about Diabetes.

In the beginning I was overwhelmed also. I knew nothing about diabetes. I spent many hours reading & re reading all the info here. The more you know the easier it will be.

Try to post every day. Put the date first & Neelix's daily BG readings. This is important . Every one that wants to help Neelix will want to see his SS first. In your information,put the day he was diagnosed, his age ,what type of insulin, his food & anything else that may be wrong with him.

Take several very deep breaths & try to relax. Our emotions really do affect our Kitties. Ask a lot of questions. When you post put a ? first & others will try to answer.

It will get easier! Just be patient & read as much as you can. We've all been right where you are Sarah! Best of Luck to you & Neelix!:bighug::)

images
 
I just saw on his SS that you didn't decrease the PM dose? Neelix had a low BG today you should have decreased the PM dose. It's important that you check his BG during the night .You didn't decrease his dose, & he might drop too low again. ( I forgot ,you're using a pet meter & a low reading is higher than on a human meter.)
 
Sarah Neelix said:
And of course the manufacturer recommends not using anything but their own strips!
Click to expand...
The manufacturer actually has a separate quality control step they use with their AT strips. I personally would feel uncomfortable using third party strips in the Alphatrak. Human meters are really cheap, their strips even cheaper. Having a second meter around is a good thing, for those days when you accidentally microwave it with the rice sock, or the cat's tail flicks it in the water bowl. Yes, both of those have happened here! :p The added bonus of a human meter is that our dosing methods were written using those types of meters, so it's easier for us to know how to change the dose.
Sarah Neelix said:
My basic question is how can I get his BG down?
Click to expand...
You have to get to a good dose. Not too high and not too low. Note, the dose Neelix needs can change over time, but the one you are giving him now is too high. Any time your AT meter gives you a number under 68, the dose is too high. That's what you got on the 21st. I would reduce the dose to 2.75 units. If kitty is on too high a dose, he is periodically seeing those too low numbers, and bouncing. If you aren't testing all the time, you aren't seeing those low numbers that create bounced and you could be testing just during cycles he's bouncing. If you aren't familiar with bouncing, here is the definition.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

So moving forward, you need to reduce his dose now to 2.75 units, and try to find those low number events. That is how Neelix tells you the dose is too high. 2.75 units might even be too high. Don't forget to do the odd spot check test at night. Many (probably most) cats go lower at night. We determine how to change the dose based on how low it is taking the cat.

@JoyBee&Ravan The low event was on the 21st. The spreadsheet is only showing days of the curve. There is no data, blood sugar tests or doses, listed for the other days.
 
@Wendy&Neko , thanks for the info about the bouncing - that's good to know. I've had trouble doing doses on the 1/4 and have been doing, say, 3 units am, then 2.5 units pm to make 5.5 units. The Lantus pen only goes to whole doses and while I have U-100 syringes those only go to half doses and it's super fiddly trying to get something in between.
I've only been doing curves because that's what the vet said! Being my first contact with feline diabetes that's all I know. Right now I'm out of strips (more on the way) so I have no more data. But he's been getting the higher dose in between curves. For example, when I started he got 1 dose 2x/day for two weeks. Then I did a curve. We increased his dose and in another 2 weeks I did another curve, etc. Basically, every time his dose changes, I do a curve after he's been on that dose 2-3 weeks. It's what I was told to do.
@Wendy&Neko How can I change the birthday in my profile? I thought it was for my birthday but now I realize it is the cat's birthday and it says I have to contact a moderator to change that.

So, thanks everybody. Sarah
 
Your last note gave a bit of a clue that may be contributing to Neelix's bouncing. Lantus likes consistency - in timing and in dose size. Giving different doses at AM and PM can definitely cause bouncing and other issues with regulation. The link below has pictures of various insulin amounts in a syringe, including 1/4 unit.
Dosing Sticky

You mentioned that you have u100s with 1/2 unit markings. That's perfect - they don't make them with 1/4 unit markings. Yup, getting 1/4 unit doses is a bit tricky, but that's OK...it's something everyone goes through. But those 1/4 unit changes are very helpful in getting a kitty regulated. Kitties are tiny, and 1/4 unit can make a huge difference in their response. We really don't recommend using the needles for the pen - they are not a good way to dose a cat. Instead, use the pen as a mini-vial and draw the insulin from it with the u100s. Many of us add readers to our diabetic kitty testing supplies!

As Wendy mentioned, getting a back up meter is a good idea. I understand wanting to use what you already have, but the strips for human meters are SO much cheaper that you will save so much money, so quickly, it will make up the difference. I'm not going to lie, it does make me nervous that you are shooting blind until the new strips come, since you did catch Neelix at "LO" during one of the curves.

I wouldn't worry too much about the birthday in your profile, although I'm sure one of the mods will help you when they have a chance. What is more helpful to the group here is if you set up a signature block. You can put Neelix's birthday in there, along with other helpful info: the type of meter you use, the food he eats, any other health issues he may have, etc. That way we can all see at a glance any info that we may need to help answer your questions.

Your vet is actually a tiny step ahead of some others. Most don't encourage even doing curve at home, much less any other testing; instead, they either want the cat back at the vet for a curve day, or they just want to do fructosamine tests. But, like many vets, sounds like s/he doesn't have the diabetic experience that this group collectively has. That is nothing against your vet, or any other vet. They just have to know so many things about so many different types of animals, and they don't get a lot of time learning about feline diabetes while in school. The folks here live and breath diabetes.
 
I use a Walmart Relion PREMIER Classic(non-Bluetooth) meter - $9. 100 test strips cost $18 so its cheap to do lots of testing which is important so you can fill out the spreadsheet and learn how your cat deals with long-acting insulin over time, where the low BGs occur, how BG is impacted by food, “exercise” and more. The SS will make you a ninja mom of a sugar cat. :cool:

I get blood samples from my cat’s foot pads with a fine gauge lancet.... ReLion Ultra-Thin 30 gauge. Easy.

I used the ReLion PRIME Compact meter for years and it is my backup meter especially for low BG.

Note: I find the ReLion PREMIER CLASSIC to read high once BG is under 100 (sometimes 20-30 points higher than the PRIME). This is where I use a second meter.. usually the PRIME but I have other meters...... because the low PRIME bg numbers better match MY cat’s food-seeking behavior when his BG is too low or the BG drop is too big. It was Nutty’s behavior that let me know the PREMIER meter sucks <100. Each cat is different so do your own science.

If my cat is food-seeking then I know I should check BG. Period. Every cat is different. —- Know your cat. :):cat:

You’ve got this!
 
Thanks for the Dosing Sticky. I work as an electrologist and have surgical loupes. I never thought to try those to read a syringe for 1/4 marks! D'uh - why not?
As for the glucose strips, the PetSure brand is quite reasonable and I just ordered 60 for $11.95, free shipping, no tax, for "damaged box" (which means they've got a sealed box of 30 but put a sticker on the box that says 60). Even at their normal price, the PetSure strips are $17.95 for 60, or $16.95 per box of 60 for 2+ boxes (via the PetSure site. They might be slightly cheaper elsewhere). Which is way better than AlphaTrak. It seems people strips are even cheaper so I'll keep that in mind.
In the meantime, I've sent my latest BG curve to my vet only to be told that he's out until next week. They said they'd have another vet look at the numbers but I'm just feeling meh about that. They mean well but I've feel rather adrift. They'll probably just tell me to change his dose again. *sigh*
It helps to chat about this so thanks again!
 
Yes, a loupe would be perfect for reading the syringe - awesome. Great getting your signature set up as well. Also, if you could add the meter you're using into the signature block that would be awesome, as the "normal range" is different between pet and human meters.

We're here to help as much as we can. Many vets are just too busy and don't have the FD knowledge. With this group, you have help - including dosage guidance/suggestions - just about 24/7. Ultimately, most of us have made our own dosing decisions based on daily testing results, because our vets left us feeling adrift.
 
Sarah --

No matter what the cost of the strips, they are worthless if you don't have any. We've also had discussions about using other strips in the AT meter. Most of us who have been involved with feline diabetes would not take the risk of using someone else's strips in a different manufacturer's meter.

I routinely purchased strips for my Bayer Contour online. However, if I ran out, I could head to Walgreens and get strips even if I was paying double (or more) what they cost online. We are a bit rigid about safety here. Yes -- we get a bit nuts if you don't test before every shot. You will also get a lot of people mentioning the lack of PM testing. You are missing half of your data. In addition, many cat's numbers are lower at night which may go far in explaining why Neelix's numbers seem like they are all over the place.

I've been on this board for a while. I would be very hard pressed to give you useful suggestions given 13 cycles of data over an almost 7 month period. Take a look at other people's spreadsheets. (You may not want to look at Gabby's -- I was a testaholic). You're going to need to be testing a great deal more in order to have a solid grasp on Neelix's numbers and how to get those numbers in a better range.
 
Sarah Neelix said:
How can I change the birthday in my profile?
Click to expand...
Most people have their own birthday in there, and out the cat’s age or DOB in the signature if they want to, or you can put it in the profile. Here is a post on how to edit the profile http://www.felinediabetes.com/FDMB/threads/creating-a-fdmb-profile.159626/

Some people use digital calipers to measure small dose changes. It varies by cat, but at one point my girl noticed a difference in a 0.125 unit change. Calipers saved me. http://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/
 
+1 on getting strips asap.
Walmart meter + some strips.... even if you don’t use the meter daily it’s there for times when your regular strips run out — like now. $28 insurance against low BG plus easy to get more strips — Walmarts are everywhere. If you get a wonky number with your regular meter you can test with a second meter -whatever brand you choose.

The SS is an awesome tool! :cat: Neelix’s BGs will make more sense re once you populate the SS with some testing data.
 
OK, so I can order the Relion Prime and some strips, throw in some cat food and get free shipping. So, then what should I look for in numbers for that meter?
 
The AT reads higher than the Relion in higher numbers. But that doesn't really matter, cause high is just high. They are closer together in lower numbers where it counts. Normal cat blood sugar range on the human meter is 50-120.
 
You can walk into Walmart pharmacy and get a ReLion meter and some strips. No need to order. Is there a Walmart near you?

The PRIME meter some of us use was discontinued. There’s PREMIER on the shelf at Walmart now plus other brands. Strips in 50 or 100 count.
 
Well, I just ordered a Prime so if it's been discontinued then maybe it's existing stock. Anyway, there's a WM reasonably nearby but it's quite high on my list of least favorite places to go, plus I live in the sticks and work from home so it's easier for me to just order and have it delivered. I got the Prime because of what you said about the under 100 readings, which is where things get critical.
 
Sienne and Gabby (GA) said:
Sarah --

No matter what the cost of the strips, they are worthless if you don't have any. We've also had discussions about using other strips in the AT meter. Most of us who have been involved with feline diabetes would not take the risk of using someone else's strips in a different manufacturer's meter.
Click to expand...

Thanks for the information. I looked through that discussion and it seems to be about the Freestyle strips being used in the AT meter. I'm using PetSure! strips which are made for the AT meter. "Our PetSure!® test strips are designed for use with your favorite AlphaTRAK® or AlphaTRAK®2 meters." https://www.petsureteststrips.com/ PetSure! doesn't even have a meter, although there are some other brands on the website.

​
 
Walmart will not tell you a meter has been discontinued. They will still let you order it and then keep you waiting for delivery.
Sarah Neelix said:
"Our PetSure!® test strips are designed for use with your favorite AlphaTRAK® or AlphaTRAK®2 meters."
Click to expand...
Marketing tool.
 
Oh I see the ReLion Prime on the website. I should have written “ReLion Confirm MICRO meter” when I mentioned it being discontinued. My bad. At least you have something coming soon? If you have no meter/strips at all for tonight I’d just go to WM and pick one up so you can keep your kitty safe. That’s just me and I get triggered by this stuff. ... lol :rolleyes:... but as said upthread, we’re very safety conscious and for good reason. :)

I’m not a diehard WM fan but I am grateful that if needed, I can easily get a whole glucose metering kit without breaking the bank. My other meters require online ordering for strips so WM serves a purpose for me and I’ll put my opinions aside for my cat’s sake .... .and my own sanity and quality of sleep. Insulin is potent and once injected you can’t take it back.

I live in the sticks too. The veterinary ER is a terrorizing 35 miles away from me. :eek: I’ll combat crawl to WM for supplies to avoid that trip.

Make sure you have a hypo kit assembled too and know how and when to use it. Search the stickies for info. Very important to have and you’ll need it eventually. We’ve all endured a hypo event or three. If it happens get back on the forum and post for help if you need or want support.

Welcome to the forum. :)
 
Yes, I meant the MICRO. I’ve had to research too many and now own too many with similar names. Ugh. Sorry!
 
You must log in or register to reply here.
Back
Top