Trixie's numbers are all over - help?

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KittyPurry

KittyPurry

Member Since 2014
Hi all. I need some help/opinions about Trixie. You can view her spreadsheet from the link in my signature or clicking here. She's on Lantus and eats Fancy Feast classics exclusively (all flavors happen to be 4% carbs).

Her numbers are all over the place from reds to blues and even one green. More often than not, her numbers are low enough that I don't feel comfortable giving her insulin in case she were to head too low while I was at work or asleep (shot time is ~2 hrs before momma bean's bed time). Since I'm new, my "no-shoot" number is under 200 mg/dL (but every time I didn't shoot she was actually under 150 mg/dL). Since I don't have many tests mid-cycle (only one at potential nadir, +6) it's hard to know how how low she is generally going.

Because she doesn't always get the AM shot, her numbers jump right back up in the PM. Since this jump was happening on a 0.25 u dosage, at the suggestion of some board members I took the dosage down even further. I wanted to find a level I could consistently give her morning and night without constantly skipping a shot. I'm eyeballing it the best I can and trying to be as consistent as possible. Of course, this is hard since there are no markers lower than 0.5. I'm not sure if 'human error' in the dosage is the most likely culprit in her bouncing all over, or if there are other factors at play too. Am I hurting her or damaging her by not giving every shot? I don't want to be unintentionally hurting my cat.

I'm still working on trying to grab more tests during the cycle. Trixie is cooperating much more with testing, so at least that working in my favor :) It just seems like the times I'd be around to test more often usually coincide with the times when she didn't get a shot. *eyeroll* I can keep working on trying to get tests at potential nadir time when she's had the shot to see how low she gets, but will those readings even be typical/generalizable? IIRC, I was told it takes 5-7 cycles for Lantus to build up (sorry not sure the right words to use for this) to a consistent level. She is skipping a shot almost every other day, so she's never even BEEN on lantus for 5-7 cycles at a time.

(I originally posted this on the main board but thought I'd stand a better chance asking Lantus users if they had any ideas. I've edited the original post and responses into this one new post.)
 
If you have to skip almost every day, try reducing the dose 0.25 units to see if that helps. You can't shoot low to stay low if you are skipping frequently ... and that supposes you want to get to that point.

If you're not able to do the monitoring for Tight Regulation, take a look at the Start Low Go Slow protocol, which may work better for you.
(she is using SLGS and already down to 0.25 units)
 
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@BJM If I'm reading this correctly, she doesn't have room for a .25u reduction--she's already down to a skinny .25u. (Correct me if I'm wrong, @KittyPurry.)

Do you work weekends? If not, this weekend would be a good opportunity to get some mid-cycle tests, now that you and Trixie have gotten the hang of that (congrats, btw!). As you probably know, Lantus dosing is based on the nadir, not the preshot number. I understand that you're new and have a no-shoot of 200, but assuming she's still hanging in the yellow/pinks/reds tomorrow morning (or even tonight if you're up late and can get a +3 or +4), you could start to fill in some of the data gaps in her spreadsheet. That will be tremendously helpful for people weighing in on Trixie's progress. (Glad you made it over here, by the way...there are super knowledgeable folks here who can translate everything into plain English and will be able to help you figure out a strategy that works for your specific situation.)

As to your other question about whether human error is having a major effect on her numbers, I am too new to answer definitively but more experienced members will surely chime in. I will say that I was giving Henry .25u and then .10u right before he went OTJ, and I know there was no way he was getting the exact same amount every day given that the syringe markings were sometimes not totally straight, I wasn't using magnifiers or calipers, there were probably tiny air bubbles, etc. For him, though, at that tiny dose, any variation on my part did not seem to make a difference in his numbers. That said, I know some people measure out a certain number of drops (practicing with colored water or coffee first) so they can be more exact; have you read about that? It seems more likely to me that Trixie's numbers are all over the board not because of any slight variation in amount but because you haven't reached a point yet where you feel comfortable consistently giving insulin to her at all. (And because she keeps stealing her brother's food! :p)

ETA: posted at the same time you did. Glad I interpreted her dose correctly.
 
@ramonaghan Yes you are correct on her dosing. I'm glad to hear your experience with skinny dosing -- that incidental variation didn't seem to effect his numbers too much. I worry about the darned air bubble that I can never get out, too.

I work M-F so the weekends are my best chance at getting mid-cycle numbers during the day or an extra late night test in. This past weekend she was low both mornings (once in the green!!) and didn't have insulin, so it seemed pointless to test her. As I'm writing that out now, I'm realizing it probably wouldn't have been POINTLESS -- just wouldn't have been an on-the-juice number. Monday was a holiday which is why I was home to grab that +6 at all.

I'm doing my best to keep their food separated, but every once in a while I forget to move his food and she's already had a few crunchies!! It's not like she's eating his whole portion or even half of it, but it's still too much for her sugar cat blood :) I started putting his food up on the fridge because I had never seen her get up there before. Well, she learned real quick that was some place she wanted to be too.
 
Hi and welcome to L/L Land. BJ's suggestion of looking at the SLGS protocol may help for you. However, I don't think she looked at your SS to see that you are only on .25u. There are a couple of things I noted though. the "5 to 7 days" is for the original shed build up when starting Lantus, when doses are adjusted it is "up to 3 days."

Also if you decide to stick w/ TR here in LLL we use 150 as the point to get on the board and ask for help, but not as an absolute "no shoot" number. Someone here can keep an eye on you and walk you through the first few times you shoot lower numbers. Lantus likes consistency and you are right, frequent skipping causes a lot of resets for the shed. "Shoot Low to Stay Low" is our mantra in TR. After building up a solid amount of data, many of us shoot as low as 50. I know it's scary at first, but you will learn how to read Trixie's responses to insulin and food manipulation when she does go low.

At these tiny doses consistency may be a problem. Many of us use a digital caliper to measure the amount in the barrel of the syringe and don't rely on the markings on the syringe, which can be quite inaccurate. Here's a step by step guide to using calipers to accurately measure the dose. Depending on what syringe you use you will need to find a syringe that looks very accurate ( the plunger lines up w/ the 0 lin when fully depressed). measure that in mm w/ the caliper and divide that number into .5u, .25u even .125u measurements and make a chart. Set the caliper and hold it up to the syringe to draw the dose.
 
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A couple of thoughts...

Will your civvy consider being transitioned to LC, canned food? Having both cats eating the same food will make your life much easier.

Is altering your shot time at all feasible. If you were to shoot earlier, you would be able to get another test or two in before you leave for work and get tests past +2 during the PM cycle.

The difficulty in interpreting your SS is that when you get a lower number you skip the shot and then the numbers shoot up. It would be very helpful if you were able to get tests during the PM cycle when you do give a shot so we have some means of knowing how Trixie is responding to insulin. On top of the testing, every time you skip, especially if you are skipping more than one cycle in a row, you are depleting the insulin depot. I think the goal right now might be to find an amount of insulin you feel like you can shoot consistently. I think BJ was on the right track regarding reducing the dose. If you look in the New to the Group sticky, toward the bottom are photos of measurements of small amounts of insulin. It may be that you need to push very hard on the plunger of the syringe, insert the syringe into the Lantus, and allow suction to pull up a drop or two. (I'd try this a couple of times to make sure you're getting some insulin.) That may be the best route to go for the moment so you can get Trixie's dose stabilized and consistent.
 
Cross posted!;) It sounds like you have a dry food addict on you hands. Is it possible to get your other can to eat the same thing as Trixie? It would really be better for him too, preventitive measure, as it were. Dry food can cause a lot of health problems for cats and YES, just a few crunchies can really mess up the BGs for a diabetic cat.
 
Someday I'd like to get my civvy eating better food. I 100% agree, preventative measures and all that. Right now, cost is the prohibiting factor. I can barely afford to feed Trixie all wet, which is why we're doing fancy feast... Diego is getting half his portion in wet, half in dry. It's the compromise I can make right now. He likes to munch the wet right away then graze on the dry so I just need to be better about getting it somewhere only HE has access to. It would be better if they were both on the same thing so that if I have these moments when I forget it's not a big deal, but until then it is what it is.
 
If you can manage to pay up front for full cases, buying online is much cheaper! Chewy.com has the best prices I've found.
 
Can you manage Evo Cat and Kitten dry? It is about 8% calories from carbohydrates.

Also, Friskies is less expensive than Fancy Feast. I can get a 13 oz can for around $0.80 ti $1.08 per can.
 
@Ann & Tess At these tiny doses, you are probably right, I should go the way of the calipers. *sigh* One more thing for me to stress over doing wrong. I say that light-heartedly, but you know what I mean... the learning curve on this disease is STEEP. The difference between my local store and ordering from chewy.com is $0.02/can so it's about the same either way.

@Sienne and Gabby shot time is kind of at the best time it can be for my life... I really don't want to move it at this point. It's the time that gives me the most ability to be flexible in my life :-\ The dosing method you suggest is pretty much what I'm already doing, so that's cool! Might give calipers a go, too.

I don't know when I'm going to get all this testing done or have a trial "shoot low" day... I can probably get a +3 in tonight. During Saturday/tomorrow's AM cycle, we have plans from +2(ish) to +8(ish). Starting to freak out over this a little bit again... :(
 
Lots of people work and get the tests when they can. No freaking out allowed, we've got your back! Read the sticky at the top of the Board "Can I do TR w/ a fulltime job?"

This is the caliper many of us use.
 
KittyPurry said:
I don't know when I'm going to get all this testing done or have a trial "shoot low" day... I can probably get a +3 in tonight. During Saturday/tomorrow's AM cycle, we have plans from +2(ish) to +8(ish). Starting to freak out over this a little bit again... :(
Click to expand...

Please don't freak out! Other than your normal AMPS/PMPS tests tomorrow, try to get a test before you leave (+1.5 or +2) and when you get home (+8 or +9), and that's two useful data points right there that you don't currently have. Then do what you can Sunday. Next weekend: lather, rinse, repeat. It's all about filling in the blanks, and that doesn't have to be done in one day, or one weekend. That's the only way some people can do "curves" at all--over a period of several days--and that's totally fine. Any test you can get is a helpful piece of the puzzle.

It was hard for me to get PM mid-cycle numbers for Henry too because we were on basically the same schedule as you, with bedtime at PMPS +2 or +3. Henry did his part by throwing me low numbers at +2, making me unable to sleep anyway! You'll have to get up to pee or won't be able to sleep one night, and you just grab a test then if you can.
 
The learning curve is very steep - we have all been there and it can be very overwhelming. But before you know it you're going to have the hang of it. really! In the meantime, lean on us and we can help teach you what you need to know to help Trixie. There are all kinds of little things that makes this Sugar Dance easier.

One thing that can be a powerful incentive for new members is understanding that newly diagnosed cats have the potential to have their pancreas heal and begin putting out insulin again. that doesn't happen to every cat and we have no way to know which cats will have it happen. However, the path to that is to get a cat's blood sugar back into normal numbers (50-120 on human glucometers) as quickly as possible. That's why people are trying to help you figure out how to be able to shoot consistently, because that's how to get the blood sugar to flatten out.

Rachel's got the hang of it - some people drink a big glass of water before bed and that's their wake-up call to test their kitty in the pm cycle! :smuggrin:

Before Punkin became diabetic he ate dry food and Felix, our other kitty also had dry food. However Felix had weight-loss food and Punkin had easy-on-the-bladder food, so i had to feed them separately. I fed them twice a day - put one in one room the other in the next room. Left them there for 5 minutes, open the doors and picked up the food. That way no one ate the wrong food. That might help you.

I'd start with making sure Trixie doesn't get any dry food - we know from member's trials that some cats can go up 100's of points from 3 pieces of kibble. It's hard to overcome that with insulin. That alone might make a huge difference in her blood sugar.

I hope you'll keep posting - there is a wealth of experience here and people will be happy to help you figure out next steps. Hang in there - it gets infinitely easier. Really!
 
Good news: I was able to grab some extra tests this weekend, and I gave insulin 7 cycles in a row. She definitely didn't get into any of the dry food. Trixie has been very lovey this weekend :) The symptoms that prompted me to bring her into the vet for initial diagnosis seem to be nonexistent (she's not drinking like she hasn't had water in weeks, no pee bricks in the box, no begging for water at the sink, coat looks 100x better, etc.)
Bad news: The reason I was able to give insulin all weekend was because she kind of high, and was in the pink quite a bit. :(

Nothing has changed from the way I was doing things before, and no known fur-shots or other mishaps... I haven't yet picked up a caliper, it's on the agenda for my next paycheck. I keep waiting for her to throw a number in the blues like she did ALL LAST WEEK but nada. What now?
 
Following the SLGS method, you do a curve once a week. If nadirs are between 90-150, you continue to hold the dose.

Sometimes higher numbers don't mean the cat needs more insulin. the symptoms sound like she's doing better.

Good job getting those spot checks in!
 
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