Trying to get a Curve for Jack. Numbers are low

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Thebudster77

Thebudster77

Member Since 2014
Hello All,

I have started a new thread for discussion of Jack's numbers and dosage. Original post with complete history under post ->New Members - Jack, Samantha and Dad

Last night PMPS (Actually +11) was 143. Vet's orders were if between 100 and 70, then only 1 unit. Regular dose was 1.5.

Because of the really low numbers in the AM (39 @+4), I did only 1u.

At +4 it was 40. Karo and chows and in 50 minutes it was 117. Fed a couple more chows and karo @ +6 to hold him over till morning.

This morning his AMPS was 126.

I am concerned that giving him the 1u is going to do the same thing to him. Contemplating on .5u or skipping. I am now +30 minutes and still trying to decide.

I am working on the SS and hope to get it up shortly.

Thank you.
 
Hi,
(Quick message, just going to re-read your post and your other posts, then will be back..)

NO SHOT at that number.
126 is a normal blood glucose number for a cat.

Eliz
 
Hi again, Kevin,

Thebudster77 said:
Vet's orders were if between 100 and 70, then only 1 unit
Click to expand...
Okey dokey... I'm wondering if there may have been some confusion with what the vet said...
The normal blood glucose range for a non-diabetic cat is approximately 45 - 130 (Some cats will run lower than that, and some a smidge higher).
These are not numbers that require insulin. Therefore I'm baffled at your vet suggesting that you give insulin "between 100 and 70". (Or could it be that your vet was referring to 'nadir' (lowest number of the cycle) rather than 'preshot' (number immediately prior to insulin shot)?

Eliz

PS. Kevin, could you possibly add 'Lantus' and 'Alphatrak' to your signature, so folks can see at a glance which insulin and meter you're using?
 
Hi Eliz,

Thank you for your suggestions. Information is now (I hope) in my signature..As well as his SS? Please let me know as Shelly gave me directions on how to publish his SS.

You make a good point about nadir vs. pre-shot and she did initially say that I could test at peak +4, +5. I then asked about Pre-shot test and she said "Sure you can monitor that". That would make more sense I suppose in light of the numbers and information that I am getting here.

So if it was nadir she was talking about and his was way low last night The orders were if <70 - no shot. And that is what I will most likely do. It is +1.5 hours from when he should have gotten shot..So I guess the decision is made and is what I will go with. Even though I work from home and can check it, I do not need any additional stress today. The accumulation plus last night has been quite enough thank you.

Kevin
 
Good to see you this morning! Since you're off track with your shot time, skipping isn't a bad idea at all. It will help the depot drain a bit, too.

Great job getting your SS in your signature, although I wasn't able to open it. I think we need to do one more thing:

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box.
Click to expand...

I'm off to work but will check back in later to see how it's going. We'll find a dose that you can safely give twice a day so that you don't have to deal with those low numbers. I'll also give you some more info about human meter numbers vs. Alphatrak numbers. I don't think anyone had a chance to fully explain the difference between the two last night.

Shelly
 
Good Morning,

Thank you for the feedback on signature and oh, on the setup of sharing:


6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box.
Click to expand...

In order to "change that to “anyone with the link can see"" you have to click words "Get Shareable Link", at the top right of the pop-up box. . Then it appears...as if by magic.....Oh Shelly, this one step might need a couple of words added....Like, click words "Get Shareable Link", at the top right of the pop-up box, this is what then brings the option to "Anyone with the link can see"

Please check to see if you can get to it.

I am a computer professional and the there is a quote "Sufficiently Advanced Technology is Indistinguishable from Magic". It is not magic, let alone "Rocket Science", but unless you can communicate the information accurately and have THAT person understand, Then it is pretty useless.

So back to the business at hand.

I gave no shot this morning based upon a very low nadir last night.

When should I test him again? At like +4 (when the food he ate at 6 AM has now converted to BG and his raising his numbers) ? +6 (1/2 way), +9 ? Please help me here. I know they are going to go up. How high, I have no clue. The past 2 time I skipped, they went well in the 400's.

Thank you.
 
If you're home, then testing every two hours to get a complete look at hoe his body behaves through the entire cycle (a full curve) would be what I would personally do. Obviously something unexpected is going on and I don't like voids of data that could be filled, especially when knowing could lead to either death or remission in equal measures!

I also got the exact same advice about shooting my cat (under 80 on an Alphatrak was my directive). It scares me so much now wondering how many times she almost died and I had no clue. She's also asymptomatic with low blood sugar.

But, she's off the juice now! And all thanks to switching to trusting these folks around here and ignoring what turned out to be pretty outdated advice from my seemingly fabulous vet (up until the diabetes diagnosis).
 
Hello there,

Thank you for the information.

I just took his BG and it was 203 @+5 (but no shot). As expected..more or less.. I will take at +7, +9 and do a pre-shot. I am just wondering if you might have some advice on what I might give him for a dose this evening?

I am not sure that I want to give even 1u. I am thinking maybe a .5. (marked on syringe so its easy) It is almost starting at the beginning again but if that is what it takes, so be it.

Learning about how Lantus can crystalize and release at odd times, provides me no comfort but maybe going through what we have gone through has provided some conditioning of the body and with sustained equal dosage starting maybe low would be the right course of action.

Jack appears to be asymptomatic as well. He was alert, able to eat and was grooming himself. That scares me too but at least we have a meter to tell us so that we can act accordingly.

I have been trying to get curve for 3 weeks. Each time I take a Pre-shot and get a number I am not familiar with. I skip a shot, his numbers go up etc. etc.

The Vet has been pretty good. She has told me I am doing a good job. But I do not think she may be accustomed to someone who has done as much research as I have and as fast.

She has indicated that she thought I was testing a little too much..Like a comment...Is there a reason (visual/physical) why you tested here when we said we would let him be for a while?

My thoughts and feelings are that I need to know the numbers to see how the insulin is being processed in Jack. As far as I have read, testing is the only way. I do not like sticking him any more than necessary but if he is ever to get OTJ, I feel it is a must.

Great news about her being OTJ, Congratulations.

It gives us all hope that it can happen.
 
I am a computer professional and the there is a quote "Sufficiently Advanced Technology is Indistinguishable from Magic". It is not magic, let alone "Rocket Science", but unless you can communicate the information accurately and have THAT person understand, Then it is pretty useless.
Click to expand...

I’m sorry if I gave you useless information. I went back and checked my directions. I still see the little blue “Share” button on the right-hand side of my page. I’m certainly not a computer professional, so I have no explanation for why our screens apparently do not look the same. I’m just someone who tries to volunteer here to help other diabetic kitties.

Here’s the information I promised you about the differences between numbers from a human glucometer and the AlphaTrak (AT). I took this from a post written by Julie (& Punkin), who is one of our most experienced users.

Most people use a human meter. In lower numbers, a 68 on an AT is equivalent to about a 50 on the human meters. As the blood sugar is higher, the difference between human meters and the AT increases, to somewhere about 30-40% when you're in higher numbers.
Click to expand...

I don’t generally give dosing advice; I leave that to those who have much more experience than I do. However, it will be important for anyone who is giving you dosing advice to know/remember that you are using the AT. As you can see, the numbers can vary widely between the AT and a human meter. Most members here use human meters, so we tend to automatically look at spreadsheets with those meter ranges in our minds. You added the AlphaTrak to your signature line, which will help. It’s also often a good idea to write somewhere on your spreadsheet that you are using the AT. The more reminders, the better.

About the dose/shot this morning – Wendy (& Neko) and I are part of the Lantus Tight Regulation (TR) forum. The TR is a pretty strict protocol based on published research. With TR, we test a minimum of four times a day (each pre-shot and at least one mid-cycle number) re-evaluate doses every 6 cycles (3 days), and “shoot low to stay low.” On the main board, we tend to be more conservative and encourage individuals not to shoot below a certain number. On the Lantus TR board, that can be quite different. If you are interested in TR, I would encourage you to visit that board and read some of the sticky notes that are posted at the top. It explains TR. If you decide that’s the approach you would like to use, you can start posting on the TR board. If you visit there, I think you'll quickly notice how we set up the daily post (“condo” as we call it) - date, cat’s name, numbers that are updated throughout the day. There are experienced users there who can help you with shooting lower numbers and finding that perfect dose.

Shelly
 
I agree with Shelly that I think it may be time to try presenting your situation to the folks in the Tight Regulation board since they're also the ones who gave me the bulk of my dosing advice. With the luxury of being home and able to test, you'll be able to get a great set of data quickly for getting the best advice and results possible.

I have no idea how/why vets would ever discourage testing. I wonder if it's because testing cats in the vet's office artificially inflates the numbers due to stress, so they can't fathom that it doesn't do the same thing at home? I think the standard notion around here is that a doctor would be criminally negligent if they suggested to a parent that they blindly inject insulin into their human child without doing a blood test first, so why wouldn't the same be true for our furred kids?

Also, there are essentially two "curves" talked about around here. One is functionally a verb, to "do/get/take a curve," which is doing BG tests at periodic intervals throughout a full 12-hour cycle. It is strictly a data-collection activity, and not necessarily anything related to any particular action or expectations around the results, though obviously the data could lead to changes in dosing/feeding/etc... The other "curve" is a noun and describes the shape of the data points from taking a curve, which in a regulated cat on insulin, makes a swooping curve.

So, you can do a curve at any time, whether or not the data points make a curve. :-D
 
Hello Shelly,

That quote had absolutely nothing to do with your posts. I was just trying to indicate WHY or what qualifications I had, to be suggesting adding that to the directions.

For anyone else using them, it might be helpful. Not always are people receptive to critique. But trust me, that was the only reason.

I have done more documentation than I care to admit to in my life. I can spot good and bad, usually with ease, especially is I have some level of expertise in the are. In this case, I really didn't know what I was doing, so I followed it step by step and got to a point where I said.. I am missing something or there is something missing. With my expertise in computers, I was able to look around without fear and find what it was that you were trying to tell me to do, or it appears in this case, your setup is different than mine.

About Jack today......

I got a 203 @ +5 and 189 just now at +8.

I just spoke to the other vet and said I wanted clarification on whether the orders of "<100 and >70 give 1 unit, <70 No insulin" were nadir or pre-shot. That vet got in touch with mine and the feedback was that at ANY time, pre-shot or nadir, if I get those numbers follow those directions. I really think it was nadir and am taking it as such. That is what I feel it is from what I got back in a response here.

I am still trying to grapple with what to do tonight. Since it came down a little from +5 to +8 and no food, it might end up at like 140. I really don't know if I would even shoot then but I would get at least 3 readings tonight either way and fill in some gaps.

Thank you for the information about the TR. I think I will stick here for a bit. I need to stabilize what I am doing and hopefully the numbers will accommodate me. I just want to get a curve (noun, pronoun, adjective or verb) I don't care what kind of curve it is! ..a curve, just a curve, with numbers that I do not have to react to a life saving event in obtaining.

ATAJEV, I understand completely what you said about the Curve and the other Curve, just adding a little of my dry English wit humor to the equation. Shelly, do watch out for this and please, please, please, ask me to clarify anything I may have said before making a determination of ANYTHING other than, I was being (in that case it would be that I was trying to be) funny.

Thank you all...appreciate it....
 
Hello All,

I gave no shot this morning and he was @ 200 for most of the day. Went up to 283 by PS.

I got a PMPS of 283. I decided to do 1u and I will test at +1 - +5 to see if I can better determine how his food and insulin react over time.

He needed something,most likely not the 1.5, so I opted for 1 and will work with that until I can get some consistent results.

Thank you for all the help, it is greatly appreciated.
 
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