Took Boots to the vet

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Lets give it a few days. We might need to tweak it again if it doesn't work. There is a little fiddling with dose at first. Don't shoot under 200 for now and drop the dose again if he goes under 50 at any point,

What was tonites BG?
 
okay, I will. He drops so much slower on the lantus, should I still be testing at the 3 hr point or wait a little longer? So far at 3 hours he hasn't gone down much. Seems to be more around the 6/7th hour that there is a significant drop.
 
It's always a good idea to get a+2 because it does give u an idea of his nighttime plans .. If he is rising for example u might not even need a +6. However it would be good to get tests at slightly different times since not all cats nadirs are exactly at +6 so for example tonite get a +2 and +7..
 
Jade77 said:
well he was too low again to give the AM shot. I just don't understand hat I'm doing wrong.
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You may not be doing anything wrong. He may be getting better!
 
He was 170 this morning, 12 hours after his last shot. Getting better is a nice thought, but he still has numbers in the 500's and even higher on a regular basis, so I don't think so..I just got home from work, Gabe tested him at 530 this evening and he was at 355. Gabe gave him .5 to see what happens with that.
 
Probably because you skipped this morning. He still needs insulin right now but his pancreas may be healing or he might just need a lower dose of lantus.

lets see how you get on with 0.5!

Wendy
 
I just updated his SS if you want to check it out...that .5 doesn't seem to be as effective as it should be, but 1 unit was too much. I wish I could be home a full day to get a test every two hours, but it just isn't happening til this darn holiday is over.
 
No worries. Lets give it a couple more days to let the depot build up. If we dont see better numbers then we increase to 0.75. So please keep your SS up to date if you can so we can decide when that should be. when do you think you can get day tests in?

Are you checking his pee for ketones?

Wendy
 
I am off work (so far, I was called in the other day on my day off) monday, so I should be able to do some better testing that day. And yes, Im checking his pee with the strips and they say no ketones. He is acting like his normal self still, eating well and drinking well but not excessively. Im considering investing in one of those alphatrak meters in the next couple of months, when I can fit an extra hundred bucks in my budget. What is your opinion on that meter? My vet says they are more accurate.
 
Its a little more accurate but the strips are more expensive too --- and the Relion is more than good enough. Honestly its not worth the extra money in meter cost and strips which you use more!

Wendy
 
IMHO, save your money and buy cat food or some toys for Boots instead of the more costly Alphatrak meter and it's pricey test strips. The human meter you are using is good enough. It accurately measures the lows, which is where you really want the accuracy. Anything really high, is high and it doesn't make a big difference if the high is 300 or 400. You know at the high numbers, to keep up the testing for ketones and that the cat needs to still be on insulin. High is high.

You can look at Wink's SS to see some parallel testing between the Alphatrak and the Relion Confirm. The only reason I started with the Alphatrak, was the shelter gave it to me to use. Then, they did not want me to test much. So I bought a Relion Confirm myself, so I could be more comfortable with using more test strips and not worrying about the cost so much.
 
Its like reading temperature in Celsius vs Fahrenheit. Both have reference values for freezing (0 Celsius, 32 Fahrenheit) and so forth.
At the lower end, the difference between an AlphaTrak and a human meter is about 30 mg/dL.

ALL meters sold in the US are permitted to test within 20% of what a lab would get.
A test of 50 mg/dL means the true glucose value is somewhere between 40 - 60 mg/dL, a span of 20 mg/dL.
A test of 500 mg/dL means the true glucose value is somewhere between 400 - 600 mg/dL, a span of 200 mg/dL.

Note that as the test values go higher, the range in which the real glucose level lies is much wider. At high numbers, it really doesn't matter - high is high. You have to figure out what you are going to do about that, following the insulin dose adjustment protocols and recommendations for food.

We're more concerned about numbers at the low end, due to the risk of hypoglycemia. Whenever you have an unexpectedly low number, test again and maybe test yourself. If the 2 test values are within 20% of each other, they may be considered the same.
 
okay, that makes sense. I just realized that I am NOT off on monday, wrote it down wrong. Im off tues but Im going to be gone for 2 hours in the AM for a managers meeting. But if Im only testing every two hours to do a curve, I can test right before I leave and test as soon as I get home.
 
We have been starting to get numbers that are higher 3 hours after his shot that the preshot test...not way higher..I think today he was 14 higher. But it's still weird. Anyone ever experience that? Does it mean the dose needs to go up?
 
When do you think you can get a test during the day? He could be bouncing, although these readings are all within 20% of each other which is within meter error... Essentially making him flat pink.

End tomorrow we don't see anything but pink then maybe its time for an increase.
Wendy
 
A small spike about 2-3 hours after food at shot time is common.

Fast or large glucose drops may provoke compensatory hormones to release stored glucose and elevate the level. We call it bouncing.
 
I won't be home all weekend...retail is brutal on holiday weekends. But if Gabe isn't out working I think I will ask him to get a test every two hours tomorrow, so we can try and figure out what's going on.
 
Even if he can get 1-2 midday tests that would be great. If we dont see any yellow (at least) by end today I am thinking you may want to increase by 1/2 unit to 1 unit.

General" Guidelines:
Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (green blue) before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red black) increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.
If an attempted reduction fails, go right back up to the last good dose.
Try to go from 0.25u to 0.1u before stopping insulin completely.
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Wendy
 
I know about those holiday weekends when you work retail. That was what I was up to all day today.

I'm still thinking that Boots needs an increase too. He needs an increase real soon, with all those stinky pinkies I see on his SS.
 
Okay, so Gabe got a bunch of results after Boots' AM shot, I have updated his SS (almost all pink numbers) so if anyone is up and wants to review it and give me opinions That'd be appreciated :)
 
Good job on the dose increase - and all the testing!

I think if she is pink/red you can test every 2 - 3hours instead of hourly.. give her ears a break. But if you start to see low yellows and dropping then increase to 1-2 hours.

Same routine. 3 days and increase to 1 unit if she is still not showing any blues or greens. Keep me updated though!

Also you might want to go over to the Lantus specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. check it out - its full of Lantus only users and very experienced members who advise on dose. I post there for my cats every day or so too. It has a great sense of community: http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Wendy
 
Thank you for checking up on us :) I am still discouraged by all the pink I see everywhere, though I did get a yellow at +6 today. I have actually attempted to check the lantus groups out a couple of times but I am being overloaded at work and I haven't been home for more than a few hours a day in..I don't even know anymore. Something like 2 weeks, possibly more. I am hoping that when my meeting is done at work tomorrow I can look them over, and while my little one is down for her nap as well. I noticed that there are two diff groups, tight regulation and relaxed..whats the difference? I'm assuming I would be a part of the relaxed group, since I am not home nearly enough for tight regulation.
 
Really the difference between the protocols is how aggressive you want to be - I like tight as it gets them into better numbers faster and makes the most of the narrow 6 month window that is for remission. Thats how I have been guiding you so far..

Anyway I am thinkingB oots may need another increase soon as per the tight protocol... To decide if a dose is needed you look at the "nadir" or low point of the day. And kinda do an average over how they are on the current dose . So in your case because you are seeing some yellow I would probably increase by 0.25 on Wednesday morning if you dont see blues and greens by end tomorrow. If you see either of these we would give the dose a couple more days. Or if you see a number under 50 we would drop the dose.

Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 (blue green) before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 (yellow) increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 (pink red black) increase the dose by 0.5 unit.

Reducing the dose:
If kitty drops below 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit immediately. If an attempted reduction fails, go right back up to the last good dose.
Click to expand...

Wendy
 
Yeah, I'm thinking he needs an increase too, doesn't matter what time we test him, he seems to almost always be in the pink, I think we have only gotten two yellows since increasing him to .75. Once my little one goes down I will start reading in the lantus groups. Is there a certain time I should or should not be feeding now that he is on lantus? Since we are home so sporadically lately I have just been making sure there is plenty of food out because my other cat, Freya, looooves wet food, and she sometimes eats a bunch of it before he even gets to it.
 
Its up to you how you feed as long as you dont feed for 2 hours before the shot time so that your preshot test isnt influenced by food. I like mini meals through the day or free feeding as its less stress on the pancreas than a couple of big meals.

Time an increase to 1 unit.

Wendy
 
Oh, I didn't know he shouldn't eat for two whole hours before the preshot..well, I know now. Should we increase tomorrow?
 
Well...we increased the dose this morning and +6 Im getting a way higher number than I did at preshot. I'm at a loss. I don't know what is going on or why I can't get his BGL to drop. :/ I'm very frustrated.
 
Remember that lantus is a depot insulin and takes 3 days to build up in the cats system. So you won't see the impact of the dose change for another day or two.... Patience! It's important not to rush things as you can skip past the good dose.

Did you check out the lantus board yet?
 
Yes, I checked both out. It's a lot of info and difficult for me to try and remember all of it. I don't really understand the difference between the tight reg group and the relaxed group though.
 
Well I would recommend you go onto the tight group . Its more active and more experienced members there. I am on there myself for my boys. I would like their eyes on Boots. They will also help guide you are regards the protocol as long as you keep asking questions!


Here’s how to post:
Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report, or the home you live in and the cat trees some people have)

Subject line: The subject has the date/cats name and BG readings ie 09/6 Boots AMPS 429 +5 335 You add a ? icon if you have a question. You should update your subject line in the very first post for the day as you get a reading, or whenever you have a question. For your first post put "newbie" also in your subject so everyone can welcome you!

Contents: The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today Boots was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?


Wendy
 
For those of us with erratic schedules, difficult to monitor cats (ex - a feral, working with someone else who has a diabetic cat but can't test) the Relaxed forum is where we hang out.
 
With my erratic schedule, would I be better off in the relaxed group? I do test quite often..so it's erratic but I'm on top of testing most of the time..
 
Its up to you. Tight is more active but if you can post every few days they will happy - they get worried when they havent heard from you for a few days.. like me.
 
I'm starting to think he may be getting into the dry food that my non-diabetic kitty eats :/ I noticed these random spikes in his blood sugar, then I caught him creeping up on the dry food bowl I keep in the bedroom for Freya. But I live in a pretty small apt, so I have no way of keeping him from the food, aside from locking one of them in a bedroom while the other roams. And I can't keep a litterbox back there or they will ruin the carpet.
 
You might put the civvie on a low carb dry so that becomes a non-issue. Evo Cat and Kitten, Young Again 0 Carb (internet only), Stella and Chewy's freeze dried (meant to be rehydrated) are some options.
 
Feeding them both the wet food would be kind of pricey. 5 bucks a day really adds up when you don't have much extra money. Is there a low card dry food out there?
 
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