Ricky AMPS (500), +2 (495) Insulin not working?

[PamJV]

I had posted yesterday the numbers I was getting from a home glucose curve after Ricky being on 2.5 Units of Lantus for 12 days. The numbers were no better than when he was on 2.0 units. There was no curve. My vet actually had told me to go right to 3.0 units 12 days ago, but instead I was more cautious and only went to 2.5 units.

Last night and this morning I started giving him 3.0 units. I know you here say to only increase by .25 each time, but I think it would be so hard to see 2.75 on the tiny syringe and getting a consistent dose is important too. Any way if today I would have seen that Ricky's BG was dropping too much on 3.0 I would then try to go for 2.75. Instead of that this morning his AMPS was 500 and then +2 (495). Now I am wondering if this insulin bottle is just bad. This bottle was just opened in April. Ricky hasn't even eaten since preshot today. Shouldn't his BG have dropped by now? He is drinking more, but he looks calm and friendly.

What does this mean? Could it be a different insulin is what he needs? And to think that the first month of treatment on 2.0 units he was doing much better. Then he was eating only Purina DM. I wasn't trying to home test then, I relied on the vet's Fructosamine test that told me everything was OK. Ricky didn't have plantigrade back then either.

So what do I do now? I can test him every two hours today to check in case there is any bounce. But if his Blood sugar stays the same all day then what? Do I just stay on this dose for a week and reassess or take him to the vet tomorrow?

Pam

 

[Gill & George]

Pam, forgive me I'm not familiar with your situation.

Could you tell me if you are able to get any tests midcycle on a regular basis?
If you are out all day, do you think you would always be able to get a before bed test, for me as I shot at 7am 7pm, I could always get a +5 before I headed to bed at 11pm.

Looking at the ss you are doing a good job of getting those tests, I remember how daunting that was in the beginign, but, if I may be frank, there is not enough data to be able to tell how well he is doing on the dose.
It is possible he is running high and flat all the time, but it is equally possible that he is dropping low one cycle then bouncing and remaining high for a number of cycles. (bounces can last up to 6 cycles), if you run a curve and he happens to be in a bounce cycle, you will see high numbers but that doesn't gaurantee that he is always doing that.

The way we try and decipher what a good dose is, is by getting spot checks when we can, you want to be able to answer the question, How low is this dose taking kitty?
Right now, with no data at all in the pm cylces, please note often kitties go lower at night, you are essentially missing half the information that would help you decide on dosing.

I don't think there is likely to be any milage in running a full curve today, with that +2 he doesn't seem to be going anywhere in a hurry, I would probably get a +5 +6, if he is still in red/high pink then it should be ok to leave him be till pmps. If he drops into yellow you might want to get +8/+9.

What I would strongly recommend, if your schedule allows it is the following
1) always always get a PS
2) try and get a +1 or +2 every cycle
3)always get a before bed test.
4) apart from that, if you are able to grab spot checks when you can, like a +5+6, to try and see where his nadir might be landing.
5) if work/life commitments make the above difficult, do what you can and run curves, or test more often when you are able to.

 

[MJW]

My Yum got worse before she got better. I couldn't understand it. My vet couldn't explain it. I would increase her dose and her BG kept rising---until we finally crept up on a good dose. I also thought her insulin bottle was bad. I went out and bought a new bottle just to be sure. I hope you find a good dose for Ricky soon.

 

[MJW]

I didn't explain that last thought very well. For us it wasn't the bottle of insulin---it was the dose.

 

[PamJV]

Pam, forgive me I'm not familiar with your situation.

Could you tell me if you are able to get any tests midcycle on a regular basis?
If you are out all day, do you think you would always be able to get a before bed test, for me as I shot at 7am 7pm, I could always get a +5 before I headed to bed at 11pm.

What I would strongly recommend, if your schedule allows it is the following
1) always always get a PS
2) try and get a +1 or +2 every cycle
3)always get a before bed test.
4) apart from that, if you are able to grab spot checks when you can, like a +5+6, to try and see where his nadir might be landing.
5) if work/life commitments make the above difficult, do what you can and run curves, or test more often when you are able to.

Gill, What exactly is meant by "cycle" ? Is that each 12 hour period after a shot?

I have been giving the shots at 9am and 9pm. I'm new to testing and Ricky is skittish about it, but getting better. As things are I would much prefer not testing every two hours but to test at what would be the important times and help establish the right dose ASAP.

I was wondering about doing PS tests and then a +6, and a +8 because we haven't been able to tell when his nadir is. What is the importance of a +2 shot? Is that to safeguard in case he had a rapid drop?

Pam

 

[Gill & George]

I was wondering about doing PS tests and then a +6, and a +8 because we haven't been able to tell when his nadir is. What is the importance of a +2 shot? Is that to safeguard in case he had a rapid drop?

The +2 can often be a good indicator of how active a cycle (12 hour period after a shot) you might expect.
If the +2 is higher than the ps there's a good chance that you won't see an active cycle. On the other hand if the +2 is about the same or lower, then the cycle will likely be active.
The lower the +2 is with respect to the ps, the more 'exciting' the cycle is likely to be.
Take a look in the new to the group sticky, there's an example of an active cycle, and good explanations on Nadir/onset/duration .

If he were to drop significantly by +2 then you know you need to be watchful and you may need to get more tests in, on the other hand if he didn't you can probably ease up on the testing.

I don't think it's necessary to be testing every two hours, some cycles might require it, the numbers will be your guide, if he is indeed running high and flat, then there is no need to be testing frequently.
If you are home and able to, I think the +2 and +6 would be useful tests to get at least as a starting point if he is high and flat, you may not need to test anymore than that, but if he were to drop then you might need to up the frequency of testing.

It's preferable not to always get tests at the same time, vary it a little, that actually helps build a better picture of what;s going on.
So some days you could get a +2 and +6 other days maybe a +1 and +5 /+4, try scattering the tests about so over time you cover all the different points in the cycle.

I have been giving the shots at 9am and 9pm.

I started of shooting on a 9am/9pm schedule, but I ended up changing it to a 7am/7pm schedule, it meant that I could get a +5 in before bed, and in the mornings I would test feed shoot and if I was still tired, I went Back to bed for an hour or two, I found it easier that way in the end, and I'm not a morning person.

 

[PamJV]

The +2 can often be a good indicator of how active a cycle (12 hour period after a shot) you might expect.
If the +2 is higher than the ps there's a good chance that you won't see an active cycle. On the other hand if the +2 is about the same or lower, then the cycle will likely be active.
The lower the +2 is with respect to the ps, the more 'exciting' the cycle is likely to be.
Take a look in the new to the group sticky, there's an example of an active cycle, and good explanations on Nadir/onset/duration .

If he were to drop significantly by +2 then you know you need to be watchful and you may need to get more tests in, on the other hand if he didn't you can probably ease up on the testing.

I don't think it's necessary to be testing every two hours, some cycles might require it, the numbers will be your guide, if he is indeed running high and flat, then there is no need to be testing frequently.
If you are home and able to, I think the +2 and +6 would be useful tests to get at least as a starting point if he is high and flat, you may not need to test anymore than that, but if he were to drop then you might need to up the frequency of testing.

It's preferable not to always get tests at the same time, vary it a little, that actually helps build a better picture of what;s going on.
So some days you could get a +2 and +6 other days maybe a +1 and +5 /+4, try scattering the tests about so over time you cover all the different points in the cycle.

I started of shooting on a 9am/9pm schedule, but I ended up changing it to a 7am/7pm schedule, it meant that I could get a +5 in before bed, and in the mornings I would test feed shoot and if I was still tired, I went Back to bed for an hour or two, I found it easier that way in the end, and I'm not a morning person.

Gill, OK I see. Yes, I was just doing every two hours today because I was nervous about increasing the dosage up to 3.0. I bumped the dose from 2.5 units up to 3.0 and I know everyone says to only bump up .25 increments. Now my result today so far is AMPS (500), +2 (495), +4 (437), +6(422), +8 (502). I am very surprised BG would shoot up that much at +8. And Ricky hasn't been eating either.

So are you saying if your +2 reading was hardly any change you wouldn't see a need to test the rest of that cycle?

The only other variable I can think of is that Ricky has gained about half a pound from when he was first diagnosed. When he was first diagnosed it seemed 2.0 units was enough. I feel guilty giving Ricky EVO grain free when the Vet was warning me to feed only Purina DM dry. (Ricky won't eat wet food) He loves the EVO, so far he won't touch the Young Again.

Pam

 

[DebG]

Pam is it possible Ricky has some other issue with his health? Are you testing for ketones? I don't know what the carb content is in the food your feeding him but it might be playing into the higher numbers. I suspect something else is keeping his numbers that high.

 

[Gill & George]

Yes, I was just doing every two hours today because I was nervous about increasing the dosage up to 3.0

I thought as much, if you look at how much I tested, you'll see I couldn't help myself, I was on the edge of my seat waiting for his BG to plummet. You can test as often as you like or want to to feel comfortable.
If he is read at PS and red at +2, I think you would be alright to just get a test a little later in the cycle +6+7 say, ECID, for George his onset was at around +1 +2 so if I saw significant movement then I learnt to recognize that it was going to be an active cycle. Some cats might onset between +2+3 or even later, with not much data at the moment, I would suggest you try and get a couple of tests in each cycle one in the early part of the cycle and one mid to late cycle, if that's feasible for you.

So are you saying if your +2 reading was hardly any change you wouldn't see a need to test the rest of that cycle?

It's likely you want see much action if the number is higher, if it's about the same or lower then more action can be expected, and so you may need to up the ante with testing. If the +2 seemed to suggest a flat bounce cycle, I would probably still get a test later in the cycle between +6 and +11, if you can, kitties are known to throw curve balls an there were times when I didn't think much was happening only to be surprised by a lower than expected PS, then I would be kicking myself for not getting another test.

warning me to feed only Purina DM dry.

I think that's around 13%, so a little high in carbs, I believe the EVO is around 8% so a little better according to janet and binkys chart
http://binkyspage.tripod.com/dryfood.html

Have you read the info on Dr Lisa's website on how to try and transition cats onto a wet diet, she has lots of great tips
catinfo.org
She recently posted regarding wet food versus dry, makes an interesting read
http://www.felinediabetes.com/FDMB/threads/dry-food-please-consider-more-than-just-carbohydrate-content.175004/

 

[PamJV]

Pam is it possible Ricky has some other issue with his health? Are you testing for ketones? I don't know what the carb content is in the food your feeding him but it might be playing into the higher numbers. I suspect something else is keeping his numbers that high.

DebG, Ricky is about to turn 14 years old, and he has a mild case of HCM. He has also has refused to eat wet food his entire life. I have always feed him the higher protein ones he likes. Most recently he was eating EVO Chicken-Turkey which I think is 12% carb and 50% Protein. When Ricky was diagnosed with Diabetes his vet told me to switch him to Purina DM which I believe is 18% carb and 51% Protein. The vet said that the Purina DM has more complex carbs which he says matters more than total percent. Well I did switch Ricky to Purina DM and he liked that food. It was only recently in April when I thought Ricky was starting to look a bit worse because of his neuropathy plantigrade gait that I decided to let him eat the EVO again. He immediately preferred that one and began eating more....and gained a half a pound.

On this site members have said that of dry foods the best choices are EVO and Young Again. I did buy Young Again but so far Ricky does not like that one. Ricky hardly eats during the day, so it would be surprising to me that food is the culprit. He's not overweight. The other puzzling thing is that a week after diagnosis his numbers in his glucose curve done at the vet officer were much better than his numbers now. That is strange given that cats are supposed to have higher numbers under stress at vet offices. Also one month after his diagnosis a Fructosamine test was done, and he came out with a good number so after one month it was thought he was doing perfectly fine on just 2.0 units of insulin. For some reason right after that is when he started to have pronounced Plantigrade gait and then I started testing at home. Ricky had a full blood work up at the end of April and he also had a cardiac ultrasound and was said to be doing well then.

I am puzzled ! Pam

 

[PamJV]

I thought as much, if you look at how much I tested, you'll see I couldn't help myself, I was on the edge of my seat waiting for his BG to plummet. You can test as often as you like or want to to feel comfortable.
If he is read at PS and red at +2, I think you would be alright to just get a test a little later in the cycle +6+7 say, ECID, for George his onset was at around +1 +2 so if I saw significant movement then I learnt to recognize that it was going to be an active cycle. Some cats might onset between +2+3 or even later, with not much data at the moment, I would suggest you try and get a couple of tests in each cycle one in the early part of the cycle and one mid to late cycle, if that's feasible for you.


It's likely you want see much action if the number is higher, if it's about the same or lower then more action can be expected, and so you may need to up the ante with testing. If the +2 seemed to suggest a flat bounce cycle, I would probably still get a test later in the cycle between +6 and +11, if you can, kitties are known to throw curve balls an there were times when I didn't think much was happening only to be surprised by a lower than expected PS, then I would be kicking myself for not getting another test.


I think that's around 13%, so a little high in carbs, I believe the EVO is around 8% so a little better according to janet and binkys chart
http://binkyspage.tripod.com/dryfood.html

Have you read the info on Dr Lisa's website on how to try and transition cats onto a wet diet, she has lots of great tips
catinfo.org
She recently posted regarding wet food versus dry, makes an interesting read
http://www.felinediabetes.com/FDMB/threads/dry-food-please-consider-more-than-just-carbohydrate-content.175004/

 

[PamJV]

Gill, I am not going to try to switch Ricky to wet food. He's been very definite his entire life even at the age of 6 weeks that he would not eat wet food. I have too much going on with sick humans at home and 4 other older animals with ailments etc. It seems logical to me that if Ricky eats more carbs because of eating dry food, then getting a higher insulin dose should compensate. The first month he was diagnosed he had a curve and numbers down in the 200's. My vet said that was good. So if the insulin was working then, why isn't it now? What I mean is even if he gets higher starting numbers wouldn't he still get a curve that brings his numbers down?

It makes me nervous that my vet preached so much about Purina DM being the best dry food. Actually on the bag it states it has 18% carb and 51% protein. I'm not sure if there is a formula for calculating absolute value by factoring in moisture and maybe that's how Janet got the 13%.

Ricky is a Maine Coon mix and used to weigh about 17 lbs - 18 lbs when in his prime and healthy. So now at 16.5 he looks slim but he did gain a half a pound last month which brought him up to the 16.5 lbs. If he started to eat better since the insulin started, could this be one factor as to why now his numbers are high?

Pam

 

[Gill & George]

Actually on the bag it states it has 18% carb and 51% protein. I'm not sure if there is a formula for calculating absolute value by factoring in moisture and maybe that's how Janet got the 13%.

The discrepancy in the numbers is because of two things
1) You have to use the as fed values as opposed to the garanteed analysis
2) Yes there is a formula that takes the moisture into consideration.

I believe that the Evo is better from a carb point of view than the purina, and the YA is even lower in carbs, maybe you can continue to try to mix it in with his evo, I had to swap george on to a low phosphorus food, I've never had any problems with food with him I thought it would be a breeze, wouldn't you know it he refused point blank to eat it, I tried mixing it 50/50, still no luck, tried 25/75, still no luck, in the end I tried 10/90 he went for it, so then I kept that ratio for a week, the following week we went to 20/80, kept that for a week and so on until he would eat it.

It's important that he eat so if he likes the Evo then that's great, at least it is lower on carbs than most dry foods, so hopefully it will have minimum impact on his BG.

Just wanted to point out (for the benefit of any lurkers) that going to wet is not just about the carbs though, it's about avoiding chronic dehydration that can lead to other health issues as this post by Dr Lisa explains
Dry Food (low carb) in the Diet, by Dr. Lisa, DVMhttp://www.felinediabetes.com/FDMB/...r-more-than-just-carbohydrate-content.175004/
I do understand though that you have a lot on your plate Pam and making the transition is not feasible, but when I post I am always aware that there are folk reading not posting and don't want anyone to get the wrong idea.

It does seem that things weren't goiing well with the purina, ie the weight loss and the plantigrade worsening, would suggest that BG's were not really great. George lost weight before diagnosis, but once we started seeing better numbers he but muscle mass back on and though he didn't have plantigrade difficulties, he had become less agile, anyways he soon started to improve.
Are you giving anything for the neuropathy? Numerous folk have had great success with Zobaline supplement.
@Gussie's mom @Tricia Cinco(GA) & Harvey are a couple of folk I can think of that used it.

 

[PamJV]

Gill, As for water, I think if the right insulin dosage is found then dehydration isn't an issue. It's only if unregulated that they pee too much and loose fluid. Since some have reported remission by putting a cat on Young Again, this is my hope to get him to switch to that food. Also I wonder if I can work toward withholding the food at night so that he would be motivated to eat right after his insulin in the morning? As it is I almost never see Ricky eat in the day time.

In the beginning I pointed out to my vet that EVO grain free had fewer carbs than the Purina DM, but he said that it's not all just about the carb percentage, but also about complex carb vs simple carb. That is beyond me as far as being able to look at ingredient list and know which has the more complex carbs. I do see EVO has fruits and vegetables.....is this bad ? The Purina DM has corn gluten. The best I could hope for is to switch Ricky to Young Again by mixing slowly as you say.

EVO Ingredient List:
Turkey, Chicken, Chicken Meal, Tapioca Starch, Chicken Fat, Herring, Pea Fiber, Salmon Meal, Natural Flavors, Potassium Chloride, Apples, Eggs, Carrots, Menhaden Oil, Peas, Cranberries, Alfalfa Sprouts, Pumpkin, Tomatoes, Cottage Cheese, Dried Chicory Root Extract, Minerals....etc

Purina DM Ingredient List:
Poultry by-Product Meal, Soy Protein Isolate, Corn Gluten Meal, Soy Flour, Animal Fat, Corn Starch, Animal Liver Flavor, minerals...Calcium Carbonate, Phosphoric Acid, Fish Oil, Potassium Chloride, and others....etc

Young Again Ingredient List:
Pork Meal, Chicken Meal, Chicken Fat, Tomato Pomace, Chicken Liver Flavor, Guar Gum, Herring Meal, DL Methionine, L Lysine, Fish Oil, Psyllium Husk, Potassium Citrate, Fructooligosaccharide, Brewers Yeast, Potassium Chloride, Calcium Carbonate and other minerals....etc

Pam

 

[PamJV]

It does seem that things weren't goiing well with the purina, ie the weight loss and the plantigrade worsening, would suggest that BG's were not really great. George lost weight before diagnosis, but once we started seeing better numbers he but muscle mass back on and though he didn't have plantigrade difficulties, he had become less agile, anyways he soon started to improve.
Are you giving anything for the neuropathy? Numerous folk have had great success with Zobaline supplement.
@Gussie's mom @Tricia Cinco(GA) & Harvey are a couple of folk I can think of that used it.

Gill,

Yes, I give Ricky Zobaline every day.

I don't think Ricky has lost any weight since he was diagnosed with diabetes He had lost about 3 pounds this year prior to the diagnosis. There were complicating factors in that at first we thought his apparent deterioration was possibly due to his HCM and his blood pressure pills. Then a resorptive lesion tooth was discovered and removed and that really made him sick. He could hardly walk and couldn't eat after that for a week. Now I think it was a difficult recovery because of diabetes. This was a different vet.....she ran a CBC for him prior to dentistry but did not check blood glucose so diabetes was still not detected. When even after the tooth healed he still was not gaining weight I took him in again and that's when the diabetes was discovered.

Once the 2 units of insulin started twice a day he really started to look great and was playing and seeming much better. For that first month we thought it was a total success. The vet did a glucose curve, and a fructosamine test and said everything was on track. He also had a good check up regarding his heart. Right after good news he started to go down hill ! He began to start showing the plantigrade gait, lethargy, and worsening of dandruff. So what changed? Was it being on the Purina DM for a month ? Or was it that he gained weight and just being a heavier cat increased his need?

Pam

 

[Tricia Cinco(GA) & Harvey]

Hi Pam.

Welcome to Lantus & Levemir Land, the nicest place you never wanted to be.

It's great that you are home testing. That is the best way to keep Ricky safe. Gill has given you some great advice. I would like to reinforce what she said about ALWAYS getting a test before shooting. That's the only way you will know it is safe to shoot. I would also highly recommend getting at least one mid-cycle test at night. A "before bed" test is the way a lot of folks do it. Many cats go lower at night than in the daytime, so that's why we emphasize testing at night. Think of your spreadsheet as a jigsaw puzzle. If you only fill in one side, you can't see what the picture is. As you begin to fill in more pieces, the image becomes clearer.

Has your vet said anything about testing for ketones? With the high numbers Ricky's been giving you, and the fact that you say he doesn't seem to be doing as well, I would recommend picking up some test strips at your local Walmart or pharmacy and checking him once a day if you can.

Something to remember about insulin is that it is not a drug. It is a hormone. It doesn't act like an aspirin - you take it and feel better. Especially with the depot insulins, you have to let the depot build up before you will see the effects of the dose. Also, you can't really tell how big a dose a cat needs until you get to it. Some cats need only a half a unit twice a day, other cats need 5 or 6! Some cats have other conditions that cause them to need a lot more - we have cats here on 30 units twice a day! I'm not saying Ricky needs a lot more insulin, or even a little more. I'm just saying that you can't expect to see results right away by increasing, because you might not be at the right dose for him yet. Or, you might have skipped over it.

Last night and this morning I started giving him 3.0 units. I know you here say to only increase by .25 each time, but I think it would be so hard to see 2.75 on the tiny syringe and getting a consistent dose is important too.

Are you using syringes with 1/2 unit markings? If not, I'd recommend you get some. Using a magnifier can help, too. You are correct about consistency being important. We tell people to guesstimate where they think the .25 (or .75) mark is, then just try to get that same amount every time, as consistency is more important than accuracy. You can try drawing up a dose with colored liquid and using it to measure against.

I know .25 units doesn't sound like much insulin, but for a cat, it's a lot. That's why we recommend making your dose adjustments by .25 units. It is way too easy to skip over the purrfect dose by making larger adjustments, and too much insulin can actually look like too little!

I understand your reluctance to try to transition Ricky to moist food at this time. I would still recommend reading Dr. Lisa's post about it, though - really good info to have. You should be aware that cats need more water when they eat only dry food, and not getting enough water can lead to serious health issues. Cats usually don't drink much water. That's why we harp on getting it to them in their food. I agree that you made a good choice switching to EVO from the DM and trying the Young Again.

How long have you been giving the Zobaline? With Cinco I found it took about a month to see any real positive improvement. It really made a difference for him. Don't give up on it.

It sounds like you have your hands full, but I'm glad you came here and are trying to do your best for Ricky. We will do all we can to help you. Here is a post we put together to help new members get acclimated to the Board: http://www.felinediabetes.com/FDMB/threads/updated-tips-for-new-members.173572/ It's kind of like an FAQ list.

Keep reading the stickies here, and keep asking questions! We love to help.

 

[PamJV]

Tricia, Thanks for replying.

I've been giving Zobaline for over a month.

I spoke to the vet today an he suggests just staying on the 3.0 units for a week with no testing in case Ricky's higher readings on the 3.0 units have to do with nervousness anticipating the testing. Testing is new for Ricky and I just did two days with testing every 2 hours. Maybe that was too much for him. The vet said based on the fact his BG went 100 points higher when on 3.0 units, it could be more about the anticipation of the testing that caused this. There was no bounce, so that's not the answer. He's not going low at any time. The vet says to give this dose a week and then test. If the readings are the same with no curve, the vet says he may be insulin resistant, and perhaps a different insulin should be tried. I will give this a try and see where we are next week. I will also try to get Ricky to like Young Again food.

I don't think ketones are an issue, since Ricky gained weight. Also if ketones are found what does one do? My understanding is all you can do is give insulin and fluids if needed. He's already getting insulin. He looks hydrated. I have 3 other cats, and could not manage to get Ricky's urine sample as a separate urine.

Pam

 

[Gill & George]

The vet said based on the fact his BG went 100 points higher when on 3.0 units, it could be more about the anticipation of the testing that caused this. There was no bounce, so that's not the answer. He's not going low at any time. The vet says to give this dose a week and then test. If the readings are the same with no curve, the vet says he may be insulin resistant, and perhaps a different insulin should be tried. I will give this a try and see where we are next week. I will also try to get Ricky to like Young Again food.

Though it is true that stress can increase BG, and I have certainly experienced that with George when he's gone to the vet's and his BG was 120pts higher than it was just 30min earlier at home, I haven't come across anyone on the board who has experienced that when testing their kitty at home.
If Ricky is a particularly nervous cat, then the way I see it, overtime if you continue to give him treats and lots of love whenever he gets his ear pokes I am certain that he will soon become used to them and may even look forward to them. George has been in remission (OTJ) for a year now, I still test him daily, first thing in the morning, he won't let me get out of bed till he get's his ear poke and treat (Freeze dried chicken, and lots of scritches under his chin), he purrs contentedly all the while, granted he is an easy going cat, and not difficult to test, but I know of many others where it wasn't easy in the beginning but who got there in the end, I remember @Tricia Cinco(GA) & Harvey talking about her Harvey being a bit of a handful (am I rememebering right Tricia?)
I don't think you need to be running curves every day, but with all due respect to your vet, there is not sufficient data to support that he is or isn't bouncing, you have no tests at all in the pm cycle, he could be dropping at night (our experience on the board is that many cats go lower at night) and bouncing up high by the morning. In fact the black amps on 5/7 makes me wonder whether he did drop low the previous evening, by low, please understand I mean lower than Ricky's body is currently used to. Another thing that we have noticed on the board is that some cats react to a dose increase with higher BG, we call this New Dose Wonkiness NDW
From the new to the group sticky

• Also worth noting: "Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations." http://www.tillydiabetes.net/en_6_protocol2.htm. Here in the Lantus and Levemir Insulin Support Group (ISG), we've affectionately dubbed this unexplained phenomenon "New Dose Wonkiness" (NDW).

Here's an explanation of bouncing from the new to the group sticky

• Bouncing - 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). (note that some kitties clear bounces sooner than others)

Going forward this week since Ricky is stressed by the tests, how about always getting amps and pmps and one other test in each cycle(ie morning and night), you can vary that to suit you and Ricky, in fact it might be preferable to. I really think it is a very bad idea to shoot blind, I've not been on the board as long as some, and have been witness to kitties being lost because their vets recommended no testing, I wouldn't want you to have to experience that. Someone once asked me, would I give insulin to an infant without knowing what their BG is?


I know that he had a reabsorptive lesion and had a dental/extraction, is there any chance a bit of tooth got left behind? Did they do xrays to confirm they got it all? I'm wondering if his mouth is still giving him problems, that could affect his BG.

As far as the insulin resistance goes, Ricky is not on that high of a dose, we usually suggest testing for acro/IAA when kitties get to over 5u, if your vet suspect that for other reasons, then you could get the test and at least you would know one way or the other. You may be running into a problem with glucose toxicity, because you are holding on to a dose that is not getting Ricky into a good BG range for too long (truthfully I can't say if that is the case without the data) The fact that his neuropathy has worsened, may be a sign that BG is not where it should be. Are there any other signs his BG is not controlled? Still drinking loads? Peeing more than normal.
The way to break the insulin resistance, if it does indeed exist, is to take the dose up more aggressively until you hit that break through.

If it were me, I would continue with the testing at home, at least to the level I suggested above (though, I would probably get 2 tests in each cycle rather than 1, so that there are less data holes in the ss, and I could increase with confidence should the numbers warrant it), if you did that you could follow the Tight Regulation Protocol, and if the numbers warrant it you can take the dose up more quickly, but safely.

I have 3 other cats, and could not manage to get Ricky's urine sample as a separate urine.

LOL yes it can be challenging, ask Tricia, she had 5 cats, two diabetic kitties among them. The way I got a urine sample from George, is by doing the Litter Box Lurk, I found he would always pee in the morning, halfway through his breakfast, so I would wait, follow him to the box and once he squatted and started peeing, I would scoot the ladle under his butt, he would look at me indignant, but he never stopped peeing, result
Ketones are a concern if numbers are persistently high, especially if kitty is off their food, and if you then throw an infection in the mix, the situation can quickly develop into DKA.

I've included hyperlinks (the blue text) to relevant info on the board, I would suggest you read those and the stickies, (if you haven't already).

 

[Sienne and Gabby (GA)]

Gill has provided a very good explanation of behavioral desensitization and extinction when it comes to any form of anxious apprehension around testing or even shots. The more you expose your kitty to the situation (testing) and there is a positive outcome (i.e., you provide treats, attention, whatever) and over time, your kitty starts to feel better, the situation is normalized. It's common to see this scenario with cats and with humans who are attempting to overcome an anxious or phobic response. What your vet is recommending is avoidance. The only thing that avoidance accomplishes is an increase in apprehension and/or more avoidance. There is tons of information on this in both the animal and human literature. Despite the literature, some vets seem to think that testing will produce a negative response in cats (or other animals). It's unusual to see this. Given that testing is the only way to insure that your cat is safe, I'd encourage you to opt for the desensitization route.

I've looked at a lot of spreadsheets. Gill and Tricia have provided you with a great deal of information for your consideration.

 

[Sandy and Black Kitty]

Gill, I am not going to try to switch Ricky to wet food.

A question for your consideration-

If there was even an outside chance that a change to an all wet low carb diet could get him into remission and keep him there, freeing you both from the demands of safe insulin use, would it not be worth going for it?

Being newly diagnosed (<1year) is in his favor, a potential advantage . Make the most of it.

I know that he had a reabsorptive lesion and had a dental/extraction, is there any chance a bit of tooth got left behind? Did they do xrays to confirm they got it all? I'm wondering if his mouth is still giving him problems, that could affect his BG.

I am wondering the same.

 

[PamJV]

Gill, I will do the best I can. I have a particularly bad stressful situation with a 94 year old father with Dementia who gets up several times a night and fights with me and he falls and all sorts of arguments about crazy things he says he sees that aren't there. He's been living with me for 10 years but now I have to commit him as soon as possible for all our safety. I am totally exhausted. I don't have the energy to follow Ricky watching when he pees right now. The good thing is that Ricky looks like he's getting bigger. His normal weight would be 17+ pounds. I don't see muscle wasting.

I never intended to go for tight regulation. I always hoped to just find a good dosage and stay with that watching how he looked and test only if there was a problem. I had a cat 20 years ago that was diabetic and I never tested her. She was fine on one set dose. But that was a different cat....who was younger, and she ate cooked chicken. That was easier !

Pam

 

[PamJV]

A question for your consideration-

If there was even an outside chance that a change to an all wet low carb diet could get him into remission and keep him there, freeing you both from the demands of safe insulin use, would it not be worth going for it?

Being newly diagnosed (<1year) is in his favor, a potential advantage . Make the most of it.

I am wondering the same.

I would have a better chance of getting him to eat Young Again. That's closer to the kind of food he likes.
Pam

 

[PamJV]

Gill has provided a very good explanation of behavioral desensitization and extinction when it comes to any form of anxious apprehension around testing or even shots. The more you expose your kitty to the situation (testing) and there is a positive outcome (i.e., you provide treats, attention, whatever) and over time, your kitty starts to feel better, the situation is normalized. It's common to see this scenario with cats and with humans who are attempting to overcome an anxious or phobic response. What your vet is recommending is avoidance. The only thing that avoidance accomplishes is an increase in apprehension and/or more avoidance. There is tons of information on this in both the animal and human literature. Despite the literature, some vets seem to think that testing will produce a negative response in cats (or other animals). It's unusual to see this. Given that testing is the only way to insure that your cat is safe, I'd encourage you to opt for the desensitization route.

I've looked at a lot of spreadsheets. Gill and Tricia have provided you with a great deal of information for your consideration.

The only food treat Ricky would appreciate is condensed milk which is high in carbs. So I can't give him that. If Ricky acted like those cats in videos who don't appear to even know the test is happening I'd be all for testing 4 times a day or more. If it's making him worse just from testing then I think the testing would have to be only as needed based on his appearance and symptoms. Some people never test, and just rely on when the vets test. The first time Ricky had a curve done in the vet office he was in the 200's. So I wonder if the vet office made him less nervous?
Pam

 

[Tricia Cinco(GA) & Harvey]

The first time Ricky had a curve done in the vet office he was in the 200's. So I wonder if the vet office made him less nervous?

If you are stressed when you do the test, that can convey itself to Ricky and cause him to be stressed, as well.

Was your other diabetic cat on a long-lasting insulin like Lantus? I have a friend that also had a diabetic cat she rarely tested, but I believe he was on an "in and out" insulin. That cat lived for several years post diagnosis and died of other causes. HOWEVER, In the six years I have been on this board, I have seen multiple cases of people who shot blind or did not test mid cycle at all and ended up having to rush their cat to the ER with a symptomatic hypo. Most of those incidents did not end happily. Even in a couple where the cat survived, some permanent damage occurred. In my opinion, you are playing Russian roulette by not testing. That is just my opinion and Ricky is not my cat.

Harvey was a huge challenge at first. He was a very muscular Abyssinian, and I could not hold him if he didn't want to be held (and he usually didn't). I had to put him in a cat sack just to pill him, and it took a couple of weeks to get him comfortable with getting into the sack, but he did. After a while he climbed in on his own when I put it in front of him. Because he knew he got lots of love when he went into it - Harvey didn't like treats, either (except bits of tri tip, but I didn't always have that around). When he became diabetic, I thought we would never survive it, but because I'd already gotten him used to the sack, I was able to test him in it. Of course, he still didn't want to hold his head still, so that took practise and training. By the end of his life, I was able to walk up to him at any time and test without his batting an eye. Not because he was old and sick, but because he was accustomed to it and it was no big deal. But it took patience and persistence to get to that point.

Here are some tips that might help make testing easier for you and Ricky: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

I have had otherwise very knowledgeable vets tell me I was testing too much and that I should be able to tell if my cat was running low by his behavior. However, at some point each of my boys hit the 20s without a single solitary sign that anything was off. Had I not been testing and intervened, I shudder to think what might have happened.

Pam, we can only give you the benefit of our considerable experience. What you do with the info is up to you. No one will judge you, or question your love for your cat, no matter what you do. We just want to help.

I understand you are facing multiple challenges. I'm not trying to discount that at all, but you should know that a lot of us here have had similar barriers, so we know that life can get in the way. As was mentioned above, I had four cats that all were diagnosed with cancer in one year, two were diabetic, one was blind, one had CKD, etc. I also had a house and a husband to take care of. Somehow, we all kept going. You can only do what you can do. Just let us know how we can help.

 

[PamJV]

Tricia, My other cat was on Humulin L back then. I appreciate your info and kindness to help. I can't comply with everything suggested, please don't get frustrated about that. It's a trial and error process so far. Ricky doesn't fight me, but I guess he must have huge emotion inside that he's not showing on the outside. I wonder if anyone gives a calming agent to help get over the hump ?

I lost two cats to an unknown disease one in 2015 and one in 2016. Those were horrible loses. My husband is an invalid. I have been beaten down, so right now this is all I can do. I'm sensing what works for Ricky and I hope we get there.

Pam

 

[Tricia Cinco(GA) & Harvey]

Tricia, My other cat was on Humulin L back then. I appreciate your info and kindness to help. I can't comply with everything suggested, please don't get frustrated about that. It's a trial and error process so far. Ricky doesn't fight me, but I guess he must have huge emotion inside that he's not showing on the outside. I wonder if anyone gives a calming agent to help get over the hump ?

I lost two cats to an unknown disease one in 2015 and one in 2016. Those were horrible loses. My husband is an invalid. I have been beaten down, so right now this is all I can do. I'm sensing what works for Ricky and I hope we get there.

Pam

Pam, we all understand. We'll keep making suggestions, and you just do what you can. You've had a rough time, but you've got people to help you out with Ricky now, so just hang in there. It's a trial and error process with all of us!

Just FYI: I see you use an Alpha Trak meter. The strips are ridiculously expensive. Have you considered switching to a human meter? The strips are much more reasonable, and if you get one of the Relion meters, you can get strips at any Walmart easily. Contrary to what some vets say, human meters are just as effective as vet ones. All our guidelines here are written based on human meters.

 

[PamJV]

Tricia, I will keep that in mind. The meter I have is one the vet gave me with supplies for free to start because someone donated the kit. Are the numbers the same regardless of either meter? This has been a bad week, I hope next week will be better.
Pam

 

[MJW]

The discrepancy in the numbers is because of two things
1) You have to use the as fed values as opposed to the garanteed analysis
2) Yes there is a formula that takes the moisture into consideration.

I believe that the Evo is better from a carb point of view than the purina, and the YA is even lower in carbs, maybe you can continue to try to mix it in with his evo, I had to swap george on to a low phosphorus food, I've never had any problems with food with him I thought it would be a breeze, wouldn't you know it he refused point blank to eat it, I tried mixing it 50/50, still no luck, tried 25/75, still no luck, in the end I tried 10/90 he went for it, so then I kept that ratio for a week, the following week we went to 20/80, kept that for a week and so on until he would eat it.

It's important that he eat so if he likes the Evo then that's great, at least it is lower on carbs than most dry foods, so hopefully it will have minimum impact on his BG.

Just wanted to point out (for the benefit of any lurkers) that going to wet is not just about the carbs though, it's about avoiding chronic dehydration that can lead to other health issues as this post by Dr Lisa explains
Dry Food (low carb) in the Diet, by Dr. Lisa, DVM
I do understand though that you have a lot on your plate Pam and making the transition is not feasible, but when I post I am always aware that there are folk reading not posting and don't want anyone to get the wrong idea.

It does seem that things weren't goiing well with the purina, ie the weight loss and the plantigrade worsening, would suggest that BG's were not really great. George lost weight before diagnosis, but once we started seeing better numbers he but muscle mass back on and though he didn't have plantigrade difficulties, he had become less agile, anyways he soon started to improve.
Are you giving anything for the neuropathy? Numerous folk have had great success with Zobaline supplement.
@Gussie's mom @Tricia Cinco(GA) & Harvey are a couple of folk I can think of that used it.

Do you think the usually high phosphorus diabetes diet caused George's kidney issues? I had Yum on a low phosphorus high carb diet (because her mother had kidney disease) and she got diabetes. Now I am worried the high phosphorus FF classic which is good for her diabetes will hurt her kidneys.

 

[Tricia Cinco(GA) & Harvey]

Are the numbers the same regardless of either meter?

There is no direct correlation, but vet meters run higher the higher the BG gets. A noted endocrinologist told me that. He gave me a range of numbers as examples, but I can't recall his words verbatim, so I removed them from this post.

As long as you pick one meter and stick with it, the difference really doesn't matter, because you are making decisions knowing which meter you are using. The only time people get confused is if they switch back and forth between the two.

The downsides of the AT meter are that the strips are so expensive and you can't just run out to a pharmacy and buy some - you have to order them, which can be an issue if kitty throws a PJ party (that's when they drop low and you have to constantly monitor and feed to bring them up) one night. Also, as I mentioned, the parameters of TR and SLGS are written using a human meter, so you have to make some adjustments when using a vet meter. We have people here that use them and are happy with them, but most people eventually switch, largely due to the cost. It's purely a matter of personal preference, but I just wanted to let you know about the drawbacks, since it sounded, given you situation, that cost could be a consideration.

 

[Marvin's Mom - Nat]

Hi Pam, I know how you feel. I also have a tall long cat who where is BG is just running flat at the moment. I am at 5U 2x a day. He also has sever neuropathy which at first just kept getting worse which landed me on this site. I was an emotional wreck that day. Even though is BG isn't getting better yet, he started walking a bit more this weekend, I finally got zobaline for him last week. I was giving him a b12 supplement prior to that. One piece of advice someone here gave me which seems to also help for the neuropathy is to also give him some arthritis medication.

Since I am also new don't want to give to much advice more support. I am wondering though if larger cats do end up in most cases requiring higher doses. From what I hear, Lantis is one of the better insulin. For me I plan on waiting a bit longer before looking into changing Marvin's insulin type. It is hard to be patient as I also want him to get better, and wish it was faster. I have also noticed with my baby that his numbers do go up a little when the dose changes, after a few days it goes back to what it was.

Everyday I hug him and beg him to get better.... I know silly me, I just want my kitty back. Patience isn't my strong suit, but I do my best. As for testing I also don't have the time to test very often. He is getting use to it, I have been giving him freeze dry chicken after the test, and I think this week he's caught on that he get a treat after. Just as an FYI, my vet has a cat with diabetes that is in remission, and was feed dry Purina DM. So hopefully that mean the most important part is to get our sweeties regulated and see where it goes. I am lucky Marvin likes wet and transitioned easily.

I think that what helped me the most were the posts I put up with after my initial one, there was so much feedback and information at first, which also differed with my vet and one important fact, well two... 1. Every Cat is different, and 2. acknowledging that I am doing my best. Our best is different every day depending on what we have on our plates. So days where I am able to take more BG test I do, and silly me again I tell him I love him all the time now, I know that is more for me but makes me feel better...

I hope everything works out, with your kitty, and your family responsibility. It is good that you are trying to balance all of that as you do have alot on your plate. Remember you don't have to be perfect, you are doing your best and it's one day at a time at the moment. You are doing great.

Nat

 

[PamJV]

There is no direct correlation, but vet meters run higher the higher the BG gets. A noted endocrinologist told me that. He gave me a range of numbers as examples, but I can't recall his words verbatim, so I removed them from this post.

As long as you pick one meter and stick with it, the difference really doesn't matter, because you are making decisions knowing which meter you are using. The only time people get confused is if they switch back and forth between the two.

The downsides of the AT meter are that the strips are so expensive and you can't just run out to a pharmacy and buy some - you have to order them, which can be an issue if kitty throws a PJ party (that's when they drop low and you have to constantly monitor and feed to bring them up) one night. Also, as I mentioned, the parameters of TR and SLGS are written using a human meter, so you have to make some adjustments when using a vet meter. We have people here that use them and are happy with them, but most people eventually switch, largely due to the cost. It's purely a matter of personal preference, but I just wanted to let you know about the drawbacks, since it sounded, given you situation, that cost could be a consideration.

Tricia, I have a human meter here at home that my husband had been using. Are you saying I could use that meter. How does one calibrate that for a cat?
Pam

 

[Marvin's Mom - Nat]

You don't need to calibrate for a cat. Just use as is. There is not much of a difference and alot of people here use human one... my vet does too.

 

[Tricia Cinco(GA) & Harvey]

Tricia, I have a human meter here at home that my husband had been using. Are you saying I could use that meter. How does one calibrate that for a cat?
Pam

Just start using it. Remember what I said about the difference between a human meter and a vet meter and don't try comparing them to each other. Just look at the readings from the human meter on their own. Your reduction point, since you are feeding dry and therefore following SLGS, would be 90 on the human meter, as opposed to 68 on the AT.

If you do decided to switch to the human meter, please skip a line on the spreadsheet and make a note that you changed, so people looking at the sheet will know they are now looking at numbers from a human meter.

ETA: My mistake. 68 on the AT is when you are doing TR. Because SLGS is written with the assumption one is using a human meter, there isn't a separate reduction point for AT.

 

[Gill & George]

Do you think the usually high phosphorus diabetes diet caused George's kidney issues? I had Yum on a low phosphorus high carb diet (because her mother had kidney disease) and she got diabetes. Now I am worried the high phosphorus FF classic which is good for her diabetes will hurt her kidneys.

I think it's more likely that the stress on his kidneys from being diabetic was the culprit. In Georges case, Some of the food he was on low phosphorus anyways, about 80% of his diet. I just had to eliminate a couple of varieties, and found some that were even lower p.

I'm in Europe so don't use ff.

 

[Sienne and Gabby (GA)]

Pam --

There is a huge amount of information to absorb at the beginning of the journey. Given all that you are juggling, please let us know if you have questions. We can not only answer your questions but direct you to the sticky notes that contain the information you're looking for.

 

[PamJV]

Just start using it. Remember what I said about the difference between a human meter and a vet meter and don't try comparing them to each other. Just look at the readings from the human meter on their own. Your reduction point, since you are feeding dry and therefore following SLGS, would be 90 on the human meter, as opposed to 68 on the AT.

If you do decided to switch to the human meter, please skip a line on the spreadsheet and make a note that you changed, so people looking at the sheet will know they are now looking at numbers from a human meter.

ETA: My mistake. 68 on the AT is when you are doing TR. Because SLGS is written with the assumption one is using a human meter, there isn't a separate reduction point for AT.

Tricia, I don't understand what you are saying. What I meant was would the human meter need to be calibrated for a cat? The AT meter does have to be calibrated with a code for either a cat or dog. and the code changes each time you get new strips.
Pam

 

[Tricia Cinco(GA) & Harvey]

Tricia, I don't understand what you are saying. What I meant was would the human meter need to be calibrated for a cat? The AT meter does have to be calibrated with a code for either a cat or dog. and the code changes each time you get new strips.
Pam

No, you don't calibrate the human meter. You just use it. Unless you are comparing it to a vet meter, it doesn't matter that it reads a bit lower. All the guidelines on this site are written for someone using a human meter.

 

[PamJV]

No, you don't calibrate the human meter. You just use it. Unless you are comparing it to a vet meter, it doesn't matter that it reads a bit lower. All the guidelines on this site are written for someone using a human meter.

Tricia, Today this morning, using AlphaTrak Ricky AMPS (388). Gave him 3.0 units. Then 2.5 hours later I tested with AlphaTrak and got (369), and with the Human meter got (175). I don't think this is a slight difference. What does it mean? The Human meter is a "Trueresult" brand. I just put a new battery in, as it hadn't been used in a long time.

OK just checked and the "Trueresult" meter's test strips expired in 2015 ! So maybe this is way off. Do you think that's it?

Pam

 

[Gill & George]

Tricia, Today this morning, using AlphaTrak Ricky AMPS (388). Gave him 3.0 units. Then 2.5 hours later I tested with AlphaTrak and got (369), and with the Human meter got (175). I don't think this is a slight difference. What does it mean? The Human meter is a "Trueresult" brand. I just put a new battery in, as it hadn't been used in a long time.

OK just checked and the "Trueresult" meter's test strips expired in 2015 ! So maybe this is way off. Do you think that's it?

Pam

The test strips being out of date may well be an issue.

 

[PamJV]

The test strips being out of date may well be an issue.

Are you using a TrueResult Meter? I am wondering if I should stick with this meter and buy new strips? Don't even know if they still make the brand test strips it says one must use. In the booklet it talks about checking the accuracy by applying a solution. Just wondering if one has to do that? We don't have the solution.

Or I was wondering if I should buy the Relion meters people seem to use a lot. There are also different models of that.

Pam

 

[Gill & George]

The relion strips are among the most, if not the most economical. If you are able to get the strips for the one you have you could check prices. I'm in Spain, so I use a European branded meter. The relion is certainly popular with our us members, not familiar with the other one.

Fyi, at higher numbers there is a bigger difference in BG between the pet and human meters. But the way i look at it is, high is high. If kitty is 350 or 550 either reading tells us they are hyperglycaemic.

At the lower end a 50 on the human meter equates to a 68 on the pet meter. (This is the reduction point for TR)

 

[PamJV]

Gill, Just to remove all doubt I'll switch to the Relion meter. Ricky has been on 3.0 units now for 6 days. I haven't had a chance to do another curve, but his plantigrade gait is worse. Pam

 

[Tricia Cinco(GA) & Harvey]

As Gill said, the higher the BG is, the bigger the difference between the meters. Over 300 there is such a difference there is no point in comparing - high is high.

I'm glad you're going to switch to the Relion. Aside from everything else, the strips are cheaper and much easier to get.

 

[Gill & George]

Hi Pam,
I'm sorry Ricky's plantigrade is worse.
How is he otherwise? Is he still drinking excessively? Have you noticed if he is using the lb more? Is he lethargic? How's his eating?

Just looked at the SS, is it all updated?
If that's all you have numbers wise, it's really hard to know what to do with the dose. As we are all mostly lay people, we rely on bg data, and the SS to allow us to safely adjust doses.

I know you have a lot going on at the moment and your plate is overfull, so I hate to ask, but do you think you would be able, at least over the next 3 days, to be able to get amps, pmps and one other test in both am and pm cycles (4 tests daily/24hrs),it doesn't matter what time, whatever works for you. And if you can find the time to run a curve on one of those days, that will be most helpful in terms of knowing what to do next.

How are you getting on with the testing in general? Anything in particular you are having trouble with, that we can help with. Hope you find the relion works for you.

I wish I could do more to help.

Fyi I'm busy this next coming week, we have visitors staying, so I apologise in advance if I don't get back to you promptly, I will try and check in, but it won't be as regularly as I normally do.

 

[PamJV]

As Gill said, the higher the BG is, the bigger the difference between the meters. Over 300 there is such a difference there is no point in comparing - high is high.

I'm glad you're going to switch to the Relion. Aside from everything else, the strips are cheaper and much easier to get.

I see there are at least 4 different models of Relion meters at Walmart. Looks like the Relion Prime is the cheapest one with the cheapest strips. Not sure in the long run which one would work the best.

This morning AMPS was 314 using Relion meter. This test was about two hours later than my usual time.

Pam

 

[PamJV]

Hi Pam,
I'm sorry Ricky's plantigrade is worse.
How is he otherwise? Is he still drinking excessively? Have you noticed if he is using the lb more? Is he lethargic? How's his eating?

Just looked at the SS, is it all updated?
If that's all you have numbers wise, it's really hard to know what to do with the dose. As we are all mostly lay people, we rely on bg data, and the SS to allow us to safely adjust doses.

I know you have a lot going on at the moment and your plate is overfull, so I hate to ask, but do you think you would be able, at least over the next 3 days, to be able to get amps, pmps and one other test in both am and pm cycles (4 tests daily/24hrs),it doesn't matter what time, whatever works for you. And if you can find the time to run a curve on one of those days, that will be most helpful in terms of knowing what to do next.

How are you getting on with the testing in general? Anything in particular you are having trouble with, that we can help with. Hope you find the relion works for you.

Gill, Ricky does not drink a lot or use lb a lot. As for lethargy, I think his whole life he has been one to hibernate during the day, so that's hard to judge. He loves to sleep under the blankets all day, and he's always done that. I think the Plantigrade is one thing that would stop him from walking that much. I have noticed he walks better first thing in the morning, then after the insulin he gets a little worse. I am trying to figure out why this would be.

Just moved my father to a memory care facility and have things to do with getting him comfortable. I think when Ricky had his 500's was when my father was still here and was very combative and difficult and there was a lot of yelling. So I really hope that now that things are quiet in the house Ricky may get some better readings just from less nerves. Will have to see.

I am going to try to get a few measurements this weekend. My biggest problem with that is Ricky's apparent sensitivity to the needle touching his ear. I just get it to touch and he flicks away so I don't get a true prick. I have to try several times before I can actually prick the ear because his reflexes are so fast. When I do get a true prick into the ear he cries. He is very good in that he will just sit calmly and does not try to get away, but he does appear to feel the needle and anticipates pain. Also since Ricky hibernates during the day I think it's more of an upset for him when I pick him up from a nap and take him to the counter to test him in the kitchen. If the testing were so smooth that I could get the blood quickly without even moving him from his sleep spot (just let him stay in bed etc) then it would be less intrusive. I wonder if others have this issue of a cat seeking out hiding places, and sleeping under blankets all day?

Another variable is that since I let him free feed I would not know if he just ate 1/2 hour before an AMPS. During the day, he hardly ever eats. I have to think he eats mostly at night.

Thanks, Pam

 

[Tricia Cinco(GA) & Harvey]

This test was about two hours later than my usual time.

Did you also shoot two hours late? Remember, your next shot should be 12 hours later. You can move the time back 15 minutes per shot or 30 minutes once a day.

Another variable is that since I let him free feed I would not know if he just ate 1/2 hour before an AMPS. During the day, he hardly ever eats. I have to think he eats mostly at night.

Have you considered getting him a timed feeder so you can set the last dish to be empty and to turn two hours before shot time? Lots of people here do that. The cat can still free feed all day except for those two hours twice a day.

My biggest problem with that is Ricky's apparent sensitivity to the needle touching his ear.

Have you tried rubbing Neosporin with pain relief on his ear? Not only does it dull the pain, it helps the ear heal, and also it makes the blood bead better.

I think when Ricky had his 500's was when my father was still here and was very combative and difficult and there was a lot of yelling. So I really hope that now that things are quiet in the house Ricky may get some better readings just from less nerves. Will have to see.

I would not be at all surprised if this is true. Most cats don't like loud noises and react to stress in their humans with higher BGs. Paws crossed that was part of Ricky's issue and he'll start to calm down now.

 

[PamJV]

Did you also shoot two hours late? Remember, your next shot should be 12 hours later. You can move the time back 15 minutes per shot or 30 minutes once a day. Have you considered getting him a timed feeder so you can set the last dish to be empty and to turn two hours before shot time? Lots of people here do that. The cat can still free feed all day except for those two hours twice a day. Have you tried rubbing Neosporin with pain relief on his ear? Not only does it dull the pain, it helps the ear heal, and also it makes the blood bead better. I would not be at all surprised if this is true. Most cats don't like loud noises and react to stress in their humans with higher BGs. Paws crossed that was part of Ricky's issue and he'll start to calm down now.

Yes, the shot was two hours late as well. The Neosporin sounds like a good idea. So do you mean I rub that on the ear prior to pricking the ear? And that does not after the BG reading? Are you talking ointment or creme?

I'm going to try working on things being calm in the house and ease into testing. I won't over load him today trying to test every two hours. Maybe just test at the +6 and +8 hour and PMPS If I'm lucky
Pam

 

[Tricia Cinco(GA) & Harvey]

Get the Neosporin ointment with pain relief. Most of us rub a generous drop in at night after the last test, then wipe it off in the morning before the first test. That way there isn't enough left to affect the test result (the little that remains shouldn't be a problem).

 

[Gill & George]

Fwiw, I know a lot of folk test their kitties in a particular spot, though o would often test George Street on my lap on the sofa, at times if he was in his basket sleeping often I would just test him there, often he wouldn't even move.


Ricky sounds lot like George, it's hard to tell if a kitty that usually sleeps all the time is lethargic

They are very sensitive to their surroundings,things quietening down may well help the overall situation.