Took Boots to the vet

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Jade77

Member Since 2013
It was MUCH better than Banfield, but left me a little confused. First, the dr said the human meters are not accurate. She said I could get one specifically for cats, but they are close to or more than 200 dollars. Instead, they gave me a product called glucose chips, which I am to put in his litterbox and check daily for any color changing of the chips. And I did get a scrip for the lantus pens, but she told me not to give him his PM shot yesterday, and no insulin for today either. When they checked his blood at the clinic it was 76 with their meter meant for cats. The weird thing is we had just checked his blood 2.5 hours earlier and our meter said something like 250..? So Im unclear on when she wants me (if at all) to administer the new insulin..she told me that his number was so low he might not need insulin. Im just very confused and I think I will send the office an email to clarify what I am supposed to do now. They told me not to use the human meter anymore, to use these chips and see how his sugar levels are based on their color. Has anyone else ever heard of this?
 
1) they are accurate enough and we have reference values for using them in cats. See bottom of this post.

2) Purina Glucotest will tell you if glucose is spilling in the urine. This is urine collected since the last void and only reflects if the blood glucose was over about 240 mg/dL during the time the urine collected. It is less precise than home blood glucose monitoring!

3) He drops like a rock on the Humulin and was low enough that more insulin would send him into hypoglycemia. This is to be avoided!!!


Here are some glucose reference ranges used for decision making using a human glucometer:

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

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

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

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

200 mg/dL
- no shot level for beginners; may slowly reduce to 150 mg/dL for long-acting insulins (Lantus, Levemir, and ProZinc) as data collection shows it is safe

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
First, the dr said the human meters are not accurate.
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Bullsh*t! Another uninformed vet, trying to get you to spend hundreds of dollars on a pet specific meter. Until about 12 years ago, there were no pet specific meters. Only human glucometers. Everyone that tested used a human glucometer. Then Abbott Labs jumped into the lucrative marketing niche in 2006, and convinced vets that the human glucometers were not accurate and they and their patients all needed Abbott Labs brand new product, the Alphatrak.

IMHO, human glucometers work just fine. BJM gave you the reference ranges. Alphatraks are expensive and no more accurate (same +/- 20% accuracy) than human glucometers. My recommendation? Don't waste your money on the expensive Alphatrak with it's $$$$$ test strips. Use the money for cat food instead. ;-)

Would have been nice if you tested your meter and the vets side by side at the same time, on the same blood drop. A lot can happen in 2 and a half hours, and the Humulin drops Boots fast. I'm not surprised you got that lower reading at the vet.

The glucose chips work like the urine glucose/ketone test strips do. Checking for glucose levels hours after they have happened. How much did the chips cost you?
 
under 10 bucks. And they said I only had to use 10-15 of the chips per day, so the packets last a while as long as I keep it closed and in a sealed bag.
 
You know what? You got the insulin and they dont know what you are doing at home so I would ignore some of what they said

1. the relion is almost as good as a pet meter and cheaper. Many people use it here happily. So keep using it. Also its much more accurate doing blood than testing pee with those strips.

Blood test- gives you a detailed look what he is doing during the day. If he goes up and down like you have seen - for example down to 20 (way too low hypo!!) and up to 500 (high) then you will know that and because he dropped under 50 you would know to reduce the insulin dose. Or he could sit at 200 all day and you would see that - and you would think thats ok

Pee test- only gives a rough average over the day and depends too how much he drinks and how often he pees. So on a day he went to 20 and 500 it might tell you that today his sugar was mid range.. but it would say the same if he was 200 all day.. so its useless!

2. YAY on the Lantus. You want to give it twice a day - the 76 they got was probably the old insulin in his system. Remind me of his weight and we can recommend a nice safe starting dose. We will want to wait at least 12 hours from his last novolin shot before starting and you wont be shooting under 200 for now.

Wendy
 
That's exactly what I was thinking of doing lol! They are really nice people there though, so I will keep using them for check ups and in any kid of emergency situation where Boots needs to see a vet. They were really thorough, the dr took plenty of time to talk to me and charged me very minimally.

The thing that confused me about their blood test over mine is that he got the shot at 11am. WE tested him at +4 (at home, before the vet) and got 235. The dr tested him at +7 and got 76...I don't understand that at all?

Also, when I woke up this morning after not giving him insulin for a day and a half, the chips in the litterbox were the darkest color they could be, which means lots of glucose spilling into his blood. So we gave him a dose early this morning. No one was at home to test him, so we didn't get one til +10 unfortunately. But it was only 91. Gabe tested him 4 hours later and got 329. So everything is all screwed up now and I don't get why his numbers are coming out how they are.

My bills were higher than I anticipated so I have to wait til thurs to fill the lantus scrip, but I still have humulin N so I will use it til I can get to the pharmacy thurs, and I don't know if Im comfortable starting him on this during the week when we are both gone most of the day. So I think I will start him on it next saturday. I'll be gone most of the day, but Gabe will be home and can test and monitor throughout the day. Boots has gained a pound since I started the insulin (yay!!!) so he is now 12.76 pounds.
 
Ok am a little confused by the numbers - if 91 was at 4.30 and 498 was at 9.30 shouldn't the numbers be separated by more columns ie

+4 91 (4.30pm?)
+9 329 (9.30pm?)
PMPS 498 (11pm)
 
It's because his shot was at 530 am. We didnt get a chance to give him a test between then and 430 pm, and the test at 430 was 11 hours after his shot. He didn't get a shot 12 hours later, because his BGL was still so low. We waited to shoot til I got home that night at 11pm. There is no +16, and I considered the PMPT to be the 498 that we got at 11pm. Does that make sense?
 
I don't know how to do that. 91 was +11, which is the last column, the next one is for the PMPT. 329 would be +16, and there is no column for that. He didn't get his shot until 1130 pm, 18 hours after his last shot. 498 was what we got 30 mins prior to his PM shot.
 
Ok I am tired which doesn't help, how many hours passed between the 93 and the PMPS? 7?Then put the 93 at +5 and you should be fine. Just want to show that he didnt shoot up that high in an hour. Maybe document it all in your comments box,

Wendy
 
5 hours passed between those tests. I just documented it like you suggested. It hasn't happened since, I wonder if it was just wacky because he was off the insulin for a day and a half. Sorry it's so confusing. We are starting the lantus this weekend, so hopefully things will get a little less crazy.
 
Hi Wendy :)

Things are going the same. I was planning on starting the lantus yesterday but my day got hairy and I didn't get to the pharmacy in time, so I took it in today and will be picking it up shortly.

I'm unclear on when it's okay to start the new insulin though. Is it safe to give it to him as his PM shot? He had his am shot at 530 (too early for the pharmacy to be open) so he had a shot of humulin.

Also the scrip says to give him 1.5 units. Is that safe? He was only getting .5 of the humulin because 1 unit dropped him really low.

Thank you for checking on us!
 
What weight is he? We can work out a starting dose from there.

Since he is prone to ketones I would start him tonite IF he is over 200.

Wendy
 
Scratch that...won't be starting the lantus. I can't afford the syringes for it!! Gabe just went to CVS to fill the scrip and they wanted 65 for the pen and ANOTHER 50 for the needles you need :/ I was unaware of that cost and another 50 is not in my budget for this paycheck.
 
You DO NOT NEED and CANNOT USE those PEN NEEDLES! You will use the same syringes you're using with Humulin. When you open the pen, there's the same rubber diaphragm, just a bit smaller.

HUGS!!!!
 
I don't think they were willing to sell him the pen without purchasing the needles...I don't understand. If I can't use them why are they forcing us to buy them?
 
Gabe is telling me that the pharmacist told him the needles have to be used with the pen, you can't use it any other way. It doesn't have that rubber seal like the vial has, and you dial the amount you intend to give, which means I can't give him 1.5 units. I was under the impression that you could use syringes like with the vial. But this is something that I cant afford.
 
The pharmacist is wrong, if they take the lid off the pen there is a rubber end you can insert a syringe into. You don't use the dial. I do it all the tme. I will find a picture.

Wendy
 
Here is picture .. You can clearly see the grey end of the pen and the syringe being inserted.

4113.jpg
 
I see it. I just sent Gabe back out to get the pen, so we can use it for his 530 shot. Boots weighs about 12.5 pounds according to the vet.
 
what weight is he ? we need to work out the correct dose?

The idea is you test, shoot (if BG is over 200 for now) then feed. You can feed pretty much any time all day but no food for two hours prior to the shot to make sure his preshot level isnt influenced by food.

Let me know on the weight
 
it's 12.7. And I don't know if he needs to lose or gain, all the dr said was that the pound he's gained was good.
 
I gave him the 1.5 and we have been testing him hourly to see how it drops his BGL. PMPT 512, +1 HI (600 BGL or higher) +2 377
 
ok perfect. Please update your SS though ? Add the data to bring it up to date and add a line between yesterday and today saying "switched to lantus" big and bold so we can see it

Keep the lantus in the fridge (not the door). Do not shake or roll. Should last 6 months. Dont inject air into it either. Expel the air first then , hold the syringe plunger firmly and insert into the pen and withdraw the insulin.


Wendy
 
Updated. I did attempt to put that he started the lantus in bold letters in the middle but I wasn't successful, it's in the notes section. His +3 was 357, so the lantus is slowly bringing it down
 
Ok good. So you have a little learning to do on this insulin..

First.. Lantus is a depot insulin which means the depot slowly fills up or drains over time. That means it takes a few days to see the effect of a dose change.. Whether an increase or decrease. Patience is key.

In your case we have to initially build up the depot to a good level. This could take a week. So don't panic if the numbers are high to start. We give this first dose a week to settle. We will reduce it immediately though if he drops under 50. With lantus the lowest point of the day is most likely to happen 5-7hours after the shot. So that's a good time for a test.

I usually recommend four tests a day if you can manage it

- always before each shot.mandatory.
- 5-7 hours after the morning shot if/when your schedule allows
- before bed (2-3hours after evening shot). And if this number is lower than the preshot by more than 20% you might want to set the alarm for a mid night test as it can imply an active cycle.

Also for now don't shoot under 200.

Ask lots of questions!!!

Wendy
 
Gotcha. We are tring to test 4 times a day every day, but schedules aren't permitting that lately. We shoot at 530 am, but both of us have been doing AM shifts lately, so Gabe isn't home to do a test til about 330. And Im not home til after the next shot :/ This shouldn't last more than another week or two though.
 
Whatever works with your schedule . Just make sure at least you get a test before every shot and maybe one before bed..

Wendy
 
We understand that life gets complicated sometimes and you can't always get the suggested tests when your schedule changes and leaves you no choice. You do the best you can, maybe testing at odd times like when you get home or Gabe gets home and that helps to fill in the SS.
 
I don't understand anything that it going on with my cat. He got a shot at 530 last night. I checked his BGL every hr for the first 7 hours. Now, right before his next shot, the meter says 119!? Im not giving him his shot because I have no idea what will happen and no one will be home for a good chunk of the day, so if he drops too low no one will be here to do anything. I don't know how much longer I can keep doing all of this :/
 
Jade77 said:
...He got a shot at 5:30 last night. I checked his BGL every hr for the first 7 hours. Now, right before his next shot, the meter says 119!? Im not giving him his shot because I have no idea what will happen and no one will be home for a good chunk of the day, so if he drops too low no one will be here to do anything. I don't know how much longer I can keep doing all of this :/
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We do suggest newcomers not shoot below 200 mg/dL as there isn't enough test data to show it would be safe for your cat. As you home test between shots and gather data on your cat's response to insulin, you may gradually reduce the no shot number.

Be patient with yourself. There is a lot of information here, plus each cat is different (ECID) and may need tweaks to the process because of them.

With Lantus, the effects are cummulative. You've just started using it last night at 1.5 units and this mornings pre-shot was barely above 100 mg/dL. I think a decrease of 0.5 units down to a 1 unit dose makes sense.
 
You made the right call Jade, skipping the shot of insulin. Since you're not home to monitor and don't have much data yet with the Lantus insulin, skipping was the right choice to keep Boots safe.

You were giving Boots 0.5U of humulin insulin, but your SS says 1.5U for the first dose of Lantus last night. That may be why he dropped low this morning. I know Wendy said 1.5U starting dose but we may rethink that.

It will be ok Jade, really it will. You can do this with our support and your love for Boots.

When you get a chance, would you please update your signature and cross out the Humulin ( s edit command) and put in Lantus. Thanks.
 
Wendy&Tiggy said:
I think drop to 1unit. Deb/BJ - thoughts?
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Yes. With the cummulative impact of Lantus, dropping to 1 unit makes sense for this evening. If the pre-shot glucose is still low, between 100-150 mg/dL, I'd be inclined to take it down to 0.5 units.
 
okay, so when he gets his evening shot, I should make sure he's over 200 and only give 1 unit? And if he is still under 200 only give .5? Sorry if there's a delay in my responses, I'm at work.
 
Got it. Gabe will be the one shooting tonight, Im pretty sure I will still be at work. I will keep you all updated. I know I've said it many times, but thanks for all the support and advice.
 
No problem. I am glad Boots is doing so well now. with he DKA he had a few weeks ago, it was touch and go!

Keep us updated and ask lots of questions!
 
I concur on the 1U dose. She was only giving Boots 0.5U of Humulin, so I think lowering the Lantus dose makes sense.

I'd rather we bring Boots up slowly if needed. We want to keep him safe and it looks to me like the 1U will help do that.
 
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