Sammie 12/18 amps 617 advice?

Sarah & Sammie

Sarah & Sammie

Member Since 2017
http://www.felinediabetes.com/FDMB/...s-451-8-69-8-5-106-9-180.223068/#post-2494705

Sammie’s numbers are all over the place. She was 69 mid cycle yesterday, i have a reduced dose and this morning she is 617. The vet has no explanation for the drastic swings and wants me to take her to an internal medicine specialist. I’d be going into debt in order to take her, do testing, etc. Has anyone experienced these highs and lows? What can I do to regulate her?
 
I think you might be seeing a combo of a reduced PM Dose last night and a bounce from the nice visit Sammie made to the lagoon yesterday, fairly typical. In my opinion I don't think there is a need for an internal specialist :).

Have you read about bounces here? to sum it up very briefly: When your cat commonly has high BG levels, it's body adjusts to those numbers as if they are normal, because of that, when insulin brings your kitties BG levels down to even a normal safe number their body panics thinking that they might be experiencing a hypoglycaemic event. When this 'panic' happens their little livers release glycogen( a form of glucose) to raise their bodies BG to what it now considers safe and normal, in Sammies case his bodies perceived normal numbers are very high!

I was wondering about why Sammie has to be on the hills dry prescription diet? Switching to a low carb wet food like Fancy Feast pates would help to regulate her, is she on prescription food because of her IBD? I definitely can understand that individual cans of prescription food are just a little too pricey... I have read here that members have had success managing IBD and Diabetes by introducing a raw food diet, you can make it from scratch at home which can save a lot of money, maybe something to consider? I know Dr. Lisas website (catinfo.org) has info on feeding a raw diet along with the recipe she uses so make sure that her kitties are getting all of the nutrition they need if you're interested :)

I think if you want to regulate Sammie definitely try and stick to the protocol you're following (SLGS right?) according to SLGS Sammie earned a reduction to 2.50u when she went below 90 yesterday, we want to keep seeing her in those nice blues and greens so keep that dose for a week and then do a curve to see if you need to increase or decrease. the only exception to the holding the dose for 7 days is if Sammie goes below 90 again, then you would reduce again another 0.25u... does that make sense?

Additionally, since you're a little stressed about costs ( I hear you there!) have you considered a human glucosometer for your typical daily testing? you could just use the alpha track for when you need to communicate BG levels to your vet... You will really save a lot of money on strips if you do! The alpha track is soooo expensive.

AND just so you know, MANY of us have experienced these highs and lows! for example, last night Mowgli went all the way down to 40! today at +3.5 he was 319!!! it was a bounce!!! I think if you stick to SLGS I think you will definitely see an improvement in sweet Sammies numbers :joyful:
 
SammieCat said:
The vet has no explanation
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Typical vet.

Amanda has told you everything you need to know about bouncing numbers! Just read up on the stickies (as she suggested)...and forget about depending on your vet for answers. I don't mean to vet-bash...but your vet just doesn't have the depth of knowledge about feline diabetes as many members on this forum. You might as well stop calling them and spending money on vets for FD. Just keep reading here - you'll learn a lot more than your vet could even have time to learn.
 
@AmandaE
Thank you for your detailed response!

I have seen the term “bounce” thrown around here but I didn’t know exactly what it was. I appreciate the explanation.

As far as Sammie’s diet is concerned, she is on the Hills for the IBD. She used to throw up multiple times per day and rip her fur out until she bled. After trying a number of different foods and steroids (which I’m convinced caused the diabetes,) z/d has been the only thing to work. I will check out the website you mentioned, but I am concerned about switching anything up in her diet.

I have a relion meter that I was using when she was first diagnosed but I got my wrist slapped by my vet at the time. At this point I haven’t switched to a human meter because I’ve grown accustomed to the alphatrak. Perhaps I can use both for a period until I learn the appropriate numbers on a human meter.

Is there a low number at which I wouldn’t shoot or would drastically reduce? I’m worried about low numbers and I’m not always able to stay up with her and can’t delay work in the morning.

Thank you for all this useful information.
 
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Sue and Luci said:
Typical vet.

Amanda has told you everything you need to know about bouncing numbers! Just read up on the stickies (as she suggested)...and forget about depending on your vet for answers. I don't mean to vet-bash...but your vet just doesn't have the depth of knowledge about feline diabetes as many members on this forum. You might as well stop calling them and spending money on vets for FD. Just keep reading here - you'll learn a lot more than your vet could even have time to learn.
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I will revisit the stickies, thanks
 
SammieCat said:
As far as Sammie’s diet is concerned, she is on the Hills for the IBD. She used to throw up multiple times per day and rip her fur out until she bled. After trying a number of different foods and steroids (which I’m convinced caused the diabetes,) z/d has been the only thing to work. I will check out the website you mentioned, but I am concerned about switching anything up in her diet.
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I can completely understand! you have to do what is best for Sammie's health. Like I had mentioned, there are many members that manage both IBD and Diabetes, maybe you could post a question in the main health forum for tips and tricks on how to manage both conditions at the same time... just an idea :)

SammieCat said:
I have a relion meter that I was using when she was first diagnosed but I got my wrist slapped by my vet at the time. At this point I haven’t switched to a human meter because I’ve grown accustomed to the alphatrak. Perhaps I can use both for a period until I learn the appropriate numbers on a human meter.
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No pressure at all to switch meters, it's just that human monitors are SO much more affordable, I think that if it were me I would use the relion meter for my weekly testing and then at the end of the week I would do something like do a curve with both the alpha track and the relion. That way you can submit the AT numbers to your vet, and you will still have your Relion numbers for the board and for yourself. You will end up using way less alphatrak strips.

Additionally, if you get a value on the relion meter that worries you enough that you really want to reach out to your vet, you can test with an AT strip so you can communicate that number to your vet instead of the relion number. Again, there is nothing wrong with using an AT meter but its so expensive, If I were a vet I would just be happy my client wanted to test at all. I want to Stress though... YOU get to decide which monitor to use, even if your vet isn't happy about it, Sammie is your cat and you get to decide how to treat her :). Also another thing to consider is that you can ask for advice here for dosing, no one here is an expert but there are a lot of members with a variety of valuable experience :)

One other thing to consider on this front is that the methodologies here (including SLGS) were developed for Human meters not AT meters, so I might have been mistaken about the reduction point for SLGS being 90 using an AlphaTrak, in fact it could be a higher number(Sammie still earned a reduction though). An important thing to understand is that there is no calculable relationship between pet meters and human meters. @Marje and Gracie @Sienne and Gabby (GA) @Wendy&Neko are all very experienced members here, do any of you know if we have SLGS numbers for the AT that are used when following the SLGS dosing method?

SammieCat said:
Is there a low number at which I wouldn’t shoot or would drastically reduce? I’m worried about low numbers and I’m not always able to stay up with her and can’t delay work in the morning.
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I understand completely, I also work 10 hours away from home daily so it can be really stressful in the morning if Mowgli is low before I leave. I rely on foods with various amounts of carbs a LOT to help Mowgli stay safe ;) The absolute danger number for an AT is if Sammie goes below 68, even that 69 yesterday was a pretty low value. For myself, If I was going to work and not able to monitor I personally wouldn't shoot a number in the 60s, I may also be inclined to shoot a reduced dose in the 70-90s until I had more data on how Sammie reacted to that dose. I must say though, that I do not have any experience with the alphatrak, and what I mentioned I might do before leaving work is really just based on my gut... it would be better for you to follow the advice of someone with more experience :) @MrWorfMen's Mom I believe you use the AT... do you have any insight here? Do you know if there are AT value guidelines for SLGS?


SammieCat said:
Thank you for all this useful information.
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My pleasure, I hope you start seeing some great numbers soon, and I really hope that you can get some advice on food that is good for IBD that isn't dry, I think that would be a very big step in getting Sammie regulated ;)
 
We do not have a different reduction point for the AT2 vs. human meter. The reduction points are the same when following SLGS with either meter. There is no conversion between the 2 meter types so the "equivalent" pet meter reading to a 90 on a human meter is unknown and can't be established. The protocols here are based on human meter readings and so for best results, using a human meter is encouraged. While I was a diehard AT2 meter user for a long time, I made the switch and getting used to the human meter is pretty easy because you've got detailed instructions for exactly what to do in the documentation based on the readings you are getting.

I agree that what meter you use is entirely up to you. Human meters have been used on pets for far longer than the relatively new pet meters. Vets now have a new tool and encourage their clients to use it too but they also don't usually expect their clients to test BG as often as we advocate here. Cost definitely comes into play and if your vet gives you a hard time, then just ask if it's better to test with a human meter or not to test at all. If your vet thinks home testing is a good practice she should be happy with either meter. Tell her the AT2 is too expensive and you prefer to use the human meter. You should be commended by your vet for being a proactive pet parent, not berated for your choice of meter to do so. All your vet needs to know is that 50 to 120 is normal range for a cat on a human meter. Shouldn't be a big problem for her to make that leap.

If it helps, my vet initially looked at me like I had horns growing out of my head when I mentioned using a human meter. I provided her with a copy of comparison readings on the 2 meters and left it with her for review although I don't think she really wanted the human meter readings. Fast forward and I got an email from my vet wanting to know what the BG ranges for a human meter were because she had a client who insisted on using a human meter. I provided the normal range and "50" low BG action needed warning point and I believe she is now just fine with her clients using either meter.
 
An additional comment about diet and IBD. I have an IBD kitty. I don't know if Z/D is a novel protein an obviously, it depends on what you've tried in the past. (Looking at the ingredients in Z/D, it's likely high in carbs and chicken liver is the first protein.) It sounds like Sammie had a really tough time with the IBD and I can appreciate your reticence to change his diet. The website for IBD that I found helpful was Raw Feeding for IBD Cats. There's a great deal of information about supplements and health issues even if you don't opt to use a raw diet. They also have an active Facebook page if you have questions.

In addition to what everyone has said about meters, I also suspect that vets are unaware of what the cost for strips is with an animal meter and even less aware of the difference in cost between a human meter vs a pet meter. I see this a lot with MDs. They may want to prescribe the newest drug on the market and are gobsmacked when someone who doesn't have a good prescription plan tells them how much the medication costs. They are doing what they believe is good practice but unaware of the practicalities.
 
Sienne and Gabby (GA) said:
An additional comment about diet and IBD. I have an IBD kitty. I don't know if Z/D is a novel protein an obviously, it depends on what you've tried in the past. (Looking at the ingredients in Z/D, it's likely high in carbs and chicken liver is the first protein.) It sounds like Sammie had a really tough time with the IBD and I can appreciate your reticence to change his diet. The website for IBD that I found helpful was Raw Feeding for IBD Cats. There's a great deal of information about supplements and health issues even if you don't opt to use a raw diet. They also have an active Facebook page if you have questions.

In addition to what everyone has said about meters, I also suspect that vets are unaware of what the cost for strips is with an animal meter and even less aware of the difference in cost between a human meter vs a pet meter. I see this a lot with MDs. They may want to prescribe the newest drug on the market and are gobsmacked when someone who doesn't have a good prescription plan tells them how much the medication costs. They are doing what they believe is good practice but unaware of the practicalities.
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Thank you for this information
 
I won’t be too repetitive except to say when following SLGS and using a pet meter, you use the same numbers as if you were using a human meter.

Also, if you look at Gracie’s SS in my signature, you’ll see a tab of Micro/AT comparisons that I did just so members can see there is no equivalence.
 
AmandaE said:
do any of you know if we have SLGS numbers for the AT that are used when following the SLGS dosing method?
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Unfortunately yes. SLGS was developed by people using human meters. Using the AT is a relatively recent thing. Vets used to use human meters before Abbott ramped up their marketing.

Sammie earned a reduction down to 2.5 units with that 69 yesterday.

By the way, the numbers will look less all over the place with a human meter.
 
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