Update meeting with vet

Status
Not open for further replies.
NancyJac

NancyJac

Member Since 2013
Met with Hairy's vet today to go over his symptoms and dosage. He is not terribly concerned about the numbers still being high and pretty much all over the place. Hairy has only been on insulin for 2 weeks and he said it could still be some time before he levels out. He was very encouraged by his improvement in symptoms. Hairy has gained about 1/2 pound of his weight back and is not as boney along his spine as he had been. Coat is much improved. Eating and drinking well and urine is clean. Upped his dose to 2 units which I will start tomorrow morning. Hairy still fights like crazy with the ear pokes but has gotten better with the insulin injections themselves. He is still nervous whenever I approach him, but I can give him the shot where ever I catch up to him as oppose to it taking two of us to wrangle him for the ear sticks.
 
So looking at your ss, I see you are missing some really key data...

Pardon me if you've got difficulties and I haven't read up your history....
I would very much like to encourage you to get some pm tests.... especially the pm preshot.....
just from the few bits you have, I see a possibility that your cat may be experiencing some big bounces.... because he goes down low to the greens and blues and then goes way high.
And if so, that could indicate you should be taking smaller increases....
you just don't know unless you can see the numbers and see just how low and how high your cat is going during a cycle.
I am going to go back and read up all your previous posts to familiarize myself with your story.
 
Okay... I'm reading some of your history and see that you aren't comfortable pushing him with the testing so I understand. This is a brave new world ...we all understand how you feel.

Because of that, I don't think you should follow your vets advise and increase yet. I think you should stay at the dose you are on.
This is my opinion because you aren't testing yet in the pm cycle.
Most cats tend to go lower in the pm cycle than they do during the am cycle.


My gut tells me that the black 572 you got on 9/9 was a bounce response from a lower number the night before.... much like that 89 you got early on....but probably even lower.
I can't prove it.... without numbers.... that's why I qualify this statement with this is My opinion.
Without test results, the situation is like driving with a paper bag on your head.


I don't want to make you feel pressured to test more than you are ready for....
I'm just stating the possibilities.....
If my gut is right, you would put yourself and your cat in a situation of needing to test a lot, because you could suddenly find yourself in some low numbers if you were to increase
tomorrow morning by that big of an increase. I don't want to see you in a hypo situation where you need to test every 30 minutes.

But I'm certainly willing to help you in any way and do so at your pace ...I'm heading to bed but I'll look for you in the morning....
 
That is why I never start a dosage change at night. Doing midcycle testing for the night time dose would mean I would have to get up at 3 in the morning and wake up my 77 year old husband (it takes both of us to test Hairy). And doing a PMPS isn't going to tell me anything about the effect of his evening dose. So at this time, there are no plans to test in the PM cycle. If and when Hairy become a bit more regulated and he gets greens or even blues on a regular basis, then I may need to consider some tighter monitoring of the numbers. And I don't really have anyway to increase at less than .5 units. I can barely see the 1/2 unit marking on the syringe let alone anything in between. So I could say I'm doing 1.25 or 1.75 but I really have no way to know if I am or not.
 
I couldn't sleep. I was thinking too much.
I understand about trying to see the markings on the syringes.... I have various magnifications glasses and a magnifying glass and extra lighting back when I was shooting.
And I would have to check and re-check.
I am one of the lucky ones to be in remission now.

The reason we test before the pm shot is sometimes you might find a number lower than you would want to shoot. Their cycles aren't predictable until you have enough data
to see their patterns.... and even then... they can change it up on you.
the nadir isn't always at +6... each cat is different .

There are certain times in the cycle we test that help us learn the patterns....or even whether they are going to have an active cycle that you need to monitor closely.
You learn a lot by reading other condos and looking at other spreadsheets....
There are numerous examples .

I believe your vet may be approaching the insulin you are on as if it were caninsulin. That is what most vets were schooled in and they are more familiar with treating dogs, not cats.
The old way was to shoot based on the pre-shot numbers..... and each shot wore off by a specified amount of time.
Lantus doesn't work that way. I saw where there were some explanations in some of your previous posts. Lantus has a cumulative process and it builds up in their system. And that's why their cycles can change.

So I just think that your cat may be getting too much insulin ....and you are getting these huge swings ... because of that.
The 1.5 u may be too high... thus going up without more bg tests isn't a good idea. ( in my humble opinion)
I don't think his numbers are staying in the high zone. I think those are spikes ( what we call bounces) after he goes down.


This site was a huge blessing to me because there is so much collective experience. People who deal with feline diabetes ever day and night, every hour.
I had a vet who didn't think testing was necessary, and just wanted me to shoot blindly and I chose to listen to the folks here instead and I aggressively pursued trying to get
my girl in remission. I couldn't sleep anyway worrying so I would read and read everbody else's experiences so I could learn everything as fast as I could.


It would be beneficial if you could get the evening pre-shot test and then a +2....... some of the time........
 
rhiannon and shadow said:
The reason we test before the pm shot is sometimes you might find a number lower than you would want to shoot. Their cycles aren't predictable until you have enough data to see their patterns.... and even then... they can change it up on you.
the nadir isn't always at +6... each cat is different . There are certain times in the cycle we test that help us learn the patterns....or even whether they are going to have an active cycle that you need to monitor closely. You learn a lot by reading other condos and looking at other spreadsheets....
Click to expand...

That is exactly what I am finding and have been told often by folks on this board as well as my vet. However, my conclusion from that finding may be a little different. Since it is unpredictable and changeable, there is no fixed testing pattern that will guarantee predictability. The degree to which you monitor doesn't change the readings, it just gives you more of them.


rhiannon and shadow said:
I believe your vet may be approaching the insulin you are on as if it were caninsulin. That is what most vets were schooled in and they are more familiar with treating dogs, not cats.
Click to expand...

My vet owns a cat only practice and he is the President of the American Association of Feline Practitioners.
 
Give it time.
If you find yourself in a scary situation.... we will all be here for you and still willing to help.
And we won't charge you $1000 bucks...
We'll also be here on the weekends and odd hours....
I've seen so many vets who huff and puff and pat their clients on the head and say come back in 2 weeks.... and the cat hypo's because of their bad management.
Sometimes the vet saves the cat, sometimes not.
And all of us here shed tears for the lost ones.
I'm sure you think we are a bunch of crazy cat ladies ( and gents) and we may very well be.... but we really do have your back.


They actually do become quite predictable after you get that data.... we call it Know Thy Cat.


My vet owns a cat only practice and he is the President of the American Association of Feline Practitioners.
Click to expand...

Sorry... I find that absolutely meaningless...

I would ask him how many cats he has actually gotten to remission status.
Your cat has an excellent chance at remission but I don't think your vet will get you there or even try. ( just my own experience )

I am sending you a pm with my email in case you have a day where you need attention here and there are few online.

This website is a very special community and we all become friends and will walk the extra mile or two for strangers because of our common predicament.
We call it paying it forward after receiving so much help ourselves.

I really hope you will decide to join us. :-D
Something made you post.... so many just lurk and never do.
 
NancyJac said:
That is exactly what I am finding and have been told often by folks on this board as well as my vet. However, my conclusion from that finding may be a little different. Since it is unpredictable and changeable, there is no fixed testing pattern that will guarantee predictability. The degree to which you monitor doesn't change the readings, it just gives you more of them.
Click to expand...

I wanted to give you an example off Michelangelo's spreadsheet as to why pre-shot tests (and additional tests as you're able) are considered necessary around here. If I were to go by the tests you're getting, Michelangelo would show:
9/9
AMPS - 260
+5 - 266

9/10
AMPS - 357

Why the heck did he shoot all the way up to 357 in one day? :o

Because he bounced from his low PM readings the evening before. Here's the testing I actually got:
9/9
AMPS - 260
+5 - 266
+9 - 319
PMPS - 173
+2 - 53 <--I caught this steep drop early and was able to keep him from dropping even farther into hypo territory (in this case, his regular food worked)
+7 - 162

9/10
AMPS - 357

The reason I wanted to share this with you is that prior to raising Hairy's dose, he had never topped 500 in all the times you tested him. Once you raised him up to 1.5, he started hitting over 500. To me, this looks like a reactionary bounce to lows going on at night, similar to the example I used above with Michelangelo.

You might want to see if your vet would be willing to do a night-time curve for you at their office to catch if he's going low (cats are notorious for dropping lower at night). There's no guarantee, however, that when you take Hairy in, they will be able to catch the low (especially if Hairy is still bouncing). This is why we always recommend pre-shot tests (both AM and PM) and some spot checks. You've been doing a great job on getting the day tests so far. :thumbup Would you be willing to attempt adding in a PM pre-shot test over the next week or so as you're able?
 
KPassa said:
The reason I wanted to share this with you is that prior to raising Hairy's dose, he had never topped 500 in all the times you tested him. Once you raised him up to 1.5, he started hitting over 500. To me, this looks like a reactionary bounce to lows going on at night, similar to the example I used above with Michelangelo.

You might want to see if your vet would be willing to do a night-time curve for you at their office to catch if he's going low (cats are notorious for dropping lower at night). There's no guarantee, however, that when you take Hairy in, they will be able to catch the low (especially if Hairy is still bouncing). This is why we always recommend pre-shot tests (both AM and PM) and some spot checks. You've been doing a great job on getting the day tests so far. :thumbup Would you be willing to attempt adding in a PM pre-shot test over the next week or so as you're able?
Click to expand...

Actually, the 500 readings started when I tried to use the Relion meter. Each time I got a reading in the black was when I tried to test him with the Relion meter. Each time I got "not enough blood" error readings after poking him twice and then had to poke him a third time with the AlphaTrak to get a reading and by then Hairy was just going ballistic, so I suspect the reading were higher due to stress.

My vet does not stay open 24/7 so a night time curve at his office is not an option. I could do a PMPS in lieu of an AMPS or daytime mid-cycle but that wouldn't tell me anything about the effects of the night time dose since it would be taken just before he gets that dose.
 
Well, your spreadsheet doesn't say a thing because there is way too much data missing.
At a minimum, a test must be done before each shot, but you are testing either before the am shot or mid-cycle and never before the pm shot. Why?
It looks like you are testing once a day and absolutely nothing can be determined with that little amount of data.

The dose of 1u got you a green, a number in the non-diabetic range, so why was the dose raised?
This cat's most probably bouncing all over the place... go back to 1u and test before every shot.

Gayle
 
Even with the change in meters, I'd expect the number to be lower if anything because of the difference between pet and human meters (hypo territory is around 70 on an AlphaTrak and 40 on a human meter). What test(s) did you use the ReliOn? Another thing I thought of with the meter is if you're putting in the strip and waiting for the sound of the first beep that says it registered the strip and is ready for blood? That's another thing I screw up on whenever I switch meters because my Prime is instantly ready for blood whereas my Micro needs a few seconds to "warm up."

The PMPS will at least let us know if he's one of those kitties with a late nadir. Since he's remaining mostly flat throughout the day, he might be having a nadir at around +10 or +12. Mikey's been pulling that one with me lately (as shown by the example I gave above :lol: ). Because of the way Lantus works, a "cycle" is not really 12 hours from shot to shot, but more like overlapping cycles where you're giving a shot while the previous shot is still working a little bit. Yes, some cats metabolize the Lantus faster and some cats metabolize it slower. The majority of cats, however, fluctuate between the two. This is why the minimal testing needed to get a full picture on how the Lantus is working is a test before each shot and a test at some point during each cycle (4 tests total). The AM cycle can be very different from the PM cycle, which is why it's suggested to make sure both cycles are included each day (especially accounting for the overlap in doses).

Since I know you've been struggling with the testing, that's why I suggested you try starting with just adding another pre-shot test each day, if you're able. Still, take your time and give each other breaks as necessary, but try squeezing in that third test when you can. ;-) Eventually, we'd like to see you testing at least four times a day, but that's a long way off still and only when you feel you're both comfortable enough getting to there. :mrgreen:
 
If you still don't feel like you can get more than two tests a day in at the moment, I might suggest swapping out either the AM test or the nadir test and start getting a PM test so we can at least see how he's doing at night since we don't have any data yet as to his nighttime cycles.
 
KPassa said:
Even with the change in meters, I'd expect the number to be lower if anything because of the difference between pet and human meters (hypo territory is around 70 on an AlphaTrak and 40 on a human meter). What test(s) did you use the ReliOn? Another thing I thought of with the meter is if you're putting in the strip and waiting for the sound of the first beep that says it registered the strip and is ready for blood? That's another thing I screw up on whenever I switch meters because my Prime is instantly ready for blood whereas my Micro needs a few seconds to "warm up."
Click to expand...

None of the reading are from the Relion because I can never get enough blood. Each time I tried twice with the Relion (2 lancets, 2 pokes, 2 strips) and got an error message so did a third poke (another lancet and strip) with the AlphaTrak which produced the readings in the 500s. By then Hairy was absolutely ballistic and stressed out. The instructions I have say nothing about waiting for a beep to register the strip. The meter comes on as soon as I put the test strip in, just like with the AlphaTrak. The difference is that the AlphaTrak doesn't beep until it has enough blood where the Relion beeps as soon as you make contact and then several seconds later gives an error message that there isn't enough blood. By then the blood has already dried up, both on the test strip and Hairy's ear, so I have to start all over again.

Right now my testing is also limited by the availability of test strips. I shouldn't have waited so long to find out that the Relion meter is crappy and now I'm in a position where I only have a couple of the AlphaTrak test strips left and the order I placed tonight could be a week in arriving. So I may have to go some days without testing at all. But once I get the test strips and I guess I'll alternate between AMPS, daytime midcycle and PMPS.
 
I have the Micro, which is almost the same as the Confirm. Mine does beep when the test strip is ready for blood and I'm constantly wasting strips with it because I get the blood on the strip before it's registered in the meter. ohmygod_smile Someone mentioned on your other thread that you may have a batch of bad test strips. You might also find it easier switching from the Confirm to the Micro. I've used the Confirm before and it seemed much more difficult for me than the Micro. They take the same strips (and the same small drop of blood) so you wouldn't have to waste those.

Sounds like a good plan with alternating the testing.

One other thing a lot of people do is swipe the blood drop onto a fingernail or a piece of foil so they don't have to worry if the meter returns an error on the first test; they just dip back into the blood pool on their fingernail with a new strip. This also might help with Hairy's "impatience." :lol:
 
Nancy,
I used the Micro, not the Confirm. But when I inserted the strip, the display lit up. But I had to wait for the meter to be "ready". It indicated it was ready to test when a flashing "drop" appeared on the screen and it beeped. That took about 3 or 4 seconds. Then I had two minutes to get a sample. If the meter timed out, the strip was wasted, but that happened rarely. Once I got a drop, and put the strip in it, it took about 5 seconds for the meter to beep again, at which time it displayed the reading (or once or twice gave me an error message). I wish I had experience with the Confirm to see what you are seeing. I like the Micro just because it was easy to hold, a little smaller than the Confirm.
 
Now that you mention it, I think that is exactly why I got the Confirm instead of the Micro, so I wouldn't have to wait for that extra beep. I put the strip in before I poke Hairy's ear and by the time I do that and milk the poke to get blood to come up, takes more than 10 seconds, so the meter is defintely ready, and it beeps as soon as it makes contact with the blood, whether it has enough blood or not. The problem is in the time it takes from that point to decide it doesn't have enough blood and beep again and give me an error code.

I really have to squeeze a lot just to get a small drop to bead. If I were to transfer that to my fingernail first and then to the meter, there would be even less blood and as I have said, by the time the meter gives me the error, the blood has already dried up so I can't use it even if there is any left.

As for faulty test strips, the instructions say the meter "reads the strip" and displays a code that should match the code on the container to verify that the test strip is good. It has been doing that and the codes match.

Edited to add: I just did a test using the Relion meter/test strip with the testing solution that came with the AlphaTrak. It did register a reading with that so the test strips aren't faulty. So I'm back to my original premise. They just flat out lie about how much blood is needed to do a reading. Each time I have tried to use this meter on Hairy, it has been at least as much blood as I've used with the AlphaTrak meter and have gotten the not enough blood error every time with the Relion where I have never gotten an error with the AlphaTrak. The drop of solution for the test I just did is way more than the amount of blood I usually get.
 
Nancy,
I would recommend the Bayer Contour Next EZ meter. It uses 0.6 ul... a tiny sample. I know because I have one.

I was just looking and amazon has them cheap. I would happily mail you 100 strips if we could get more bg readings from Hairy. ( send me your address by pm and I'll go put a brand new sealed box
in the mail )
The meter is available most everywhere... walmart, walgreens...etc.... strips are cheapest bought online... like ebay .... although amazon has better deals at the moment.
I don't live near any stores like that or else I would go grab one and mail that to you too. :-D

If you are having trouble getting Hairy's cooperation and a blood sample....
We all have numerous little tricks to help.


My cat hated testing at first too.... and after a few weeks, she started purring because she associated getting a treat with testing.
Some people here have a cat who will come running to get tested.... the cat will go to their testing spot when they hear the beep.
The stress some cats feel is more from being held down unless your technique is bad enough to cause pain such as hitting the larger vein in the ear. The edge of the ear doesn't have much sensitivity.
 
rhiannon and shadow said:
Nancy,
I would recommend the Bayer Contour Next EZ meter. It uses 0.6 ul... a tiny sample. I know because I have one.

I was just looking and amazon has them cheap. I would happily mail you 100 strips if we could get more bg readings from Hairy. ( send me your address by pm and I'll go put a brand new sealed box
in the mail )
Click to expand...

Actually that is twice as much blood as the AlphaTrak requires and that the Relion claims to require.

Thank you for the offer, but I ordered more of the AlphaTrak test strips last night. The only problem is that they are not sold in retail stores so I will be out of them before the new ones arrive by mail. But ordinarily, lack or cost of test strips has nothing to do with my decision to not test more often.
 
Hi Jackie,

Sounds like you have a defective meter. Just a thought, but if you purchased it at Walmart, I bet they would swap it out for you, with or without a receipt. They are so easy like that. I used the Bayer Contour at first, but when I ran out of strips I switched to the Relion Confirm. It uses much less blood than the Coutour, and I order the strips online. They usually arrive in two days. The Contour is my back up.

Good luck to you!

Jane
 
Yes, with the amount of difficulties you're having, I'm definitely thinking you might have a defective meter. You might not be able to return it to Walmart (you can't return blood products by law), but many people have contacted the manufacturer directly and they are very accommodating and will replace the meter for you. (Just don't tell them it's for a cat.)
 
KPassa said:
Yes, with the amount of difficulties you're having, I'm definitely thinking you might have a defective meter. You might not be able to return it to Walmart (you can't return blood products by law), but many people have contacted the manufacturer directly and they are very accommodating and will replace the meter for you. (Just don't tell them it's for a cat.)
Click to expand...

Many of the things I don't like about this meter and the accompanying tests are not defects but on purpose. The two things that are most aggravating about this meter are:
1. The test strips are packaged so that you cannot take out a single strip without touching the "blood window" since they are packed with that end up. The only other way to get them out is to shake several into your hand or the counter which isn't very sanitary either. The AlphaTrak stips come in a container that you can reach in a grab a single strip by the middle or the back side so you never have to touch any part of it that either comes into contact with blood or that goes into the meter.
2. The meter beeps as soon as you put the test strip in contact with blood, whether it receives enough blood or not. The AlphaTrak meter doesn't beep until it provides a reading, which is pretty much immediately after you touch the strip to the blood. The Relion has a 7 second processing delay after the first meaningless beep until it either displays a test result or an error code. By then, if you get an error code, it is too late to do anything except start all over again. With the AlphaTrak because it doesn't beep until it has enough blood, I know that right away and can go back and milk the poke for more blood without having to repoke or replace the test strip.

I don't think the meter or the test stips are defective since it works as designed with the test solution. It is just a poor design and requires more blood (or solution) than advertised. Or let me rephrase that. It is possible that the AlphaTrak actually requires less blood than advertised. But I do know that the AlphaTrak will work with less blood than the Relion. So even if the manufacturer agrees to replace the meter for me, that won't make me like it's design or utility to me any better.
 
There actually may be a good thing that has come out of all the problems with the Relion meter. Those days that I had to repeatedly stab Hairy to try to get enough blood for that meter and then still had to go back to the AlphaTrak to get a reading really stressed him out. The last 3 tests have been with a single stab and by comparison, he is not fighting it quite as much. I actually did two tests today, AMPS and mid-cycle. His BG is still quite high though regardless of when I test. Nothing but black and red for the last week, even at mid-cycle.
 
In my experience the Confirm required very little blood. However, you can put the blood on top of the window. You have to touch the end of the strip to the blood drop and let it "sip" the blood up.
 
Nancy,

Are you doing urine ketone testing with Hairy while he is in these high numbers? We suggest that when the numbers are above renal threshold, or the cat isn't eating enough, or there is an infection or inflammation present, that you ketone test daily. Ketones can develop quickly and can develop into life threatening DKA (diabetic ketoacidosis). This is another safety measure we like to suggest for our sugar kitties. Noting on your SS what the ketone test results were is a good way to track it.

Remember, a cat is more than a set of numbers. Yeah, no fun to see those reds and blacks though. How are the 5 P's, peeing, pooping, purring, preening, playing, and his appetite today? Those give us a lot of information, those clinical signs and tell us how Hairy is feeling.

Would you be willing to add the insulin and meter you are using to your signature? It would help us to be able to see that information at a glance. Since the Alphatrak 2 is your primary meter, if you bold that and change the font size from normal to large, it will stand out. It's important to know which meter you are using whenever you get really low numbers, under 80 for the Alphatrak is headed a bit low where as under 50 for a human meter is headed a bit low.

The ears actually form new capillaries in the area that you poke. It's called angiogenesis. That is why we say 'the ears learn to bleed'. With those additional capillaries, it gets easier to get blood from the cat's ear. It usually takes a couple of weeks for that to happen.

What is Hairy's favorite treat before/during/after testing? Wink absolutely loves freeze dried chicken, either the Pure Bites of the Halo Liv-a-Littles are 2 that I have tried. Whole Life freeze dried liver was another one that he'll gobble up.

Hope your day is going well and Hairy is feeling great.

ETA: When I was testing with 2 different meters, I put the information for the Alphatrak in one row, and the data for the human meter on a separate row and labeled it. Less confusion for me, and others reading your SS. Just a suggestion for you to think about.
 
Yes, I have been using the ketone test strips for a little over a week. Haven't tracked them, but have done it 3-4 times and it was neg each time (no color change). All of his symptoms have improved since starting on insulin. His eating is good but not constantly ravenous like it had been. His thirst/urination have been a bit variable, some times normal, sometimes a bit excessive. His skin and coat have improved dramatically, his eyes are clear and alert. He had gotten very matted this summer but lately he has gone back to grooming (sometimes a bit excessively from stress) and has taken care of the matts. His poop is normal, but it was even before insulin so no change there. He has never been much of a purrer, but his has been a bit more active, talkative, and playful.

I am using Lantus. I have 2 meters, and AlphaTrak2 (which I much prefer) and a Relion Confirm which I don't like but the test strips are cheaper. Right now I am using the Relion because I am out of strips for the AT but have them on order. I will add Lantus to my signature and I note on his SS in the comments section if it was with the Relion. If no note, then it was with the AT. I only tested with both meters at the same time once just to get a % difference, and may do that once in a while, but will not be using both meters for the same test regularly.

Hairy has never particularly cared for treats but he does like to eat (his regular wet food) after testing or a shot, so I make sure some is available. I've tried giving him a treat right after testing, but he was more interested in getting away from me and left the treat untouched.

Is it possible for a cat to build up a tolerance to insulin? It seems like after the first 10 days that he was on insulin his BG is staying high regardless of when I test it, almost as if he weren't getting insulin at all. I don't think the insulin is bad. Have only had it for about 3 weeks and it is in the fridge other than the less than a minute it takes to draw up a shot. It is clear and has no particulates in it.
 
Hi: Late to this party.

My Reli On Confirm meter pooped out, literally, and I'm not sure what happened. I mean, it works, but Mick's numbers suddenly dropped from 300 to 60, and then to 22. Kay had graciously given me a Prime, but I was out of strips at that moment and fell back to the Confirm meter, which worked fine...until...

I raced to WalMart for another supply of strips.

And sure enough, Mick's numbers were still high.

This could have been problematic, as I didn't inject him the morning of the 60 number...

Steph
 
That's kinda scary Steph. Glad you caught it fairly quickly. Another case that makes me very leery about using Relion products. I also bought their lancets figuring they would be the same as the ones that came with the AlphaTrak meter. They're not. They are smaller making it even harder to get blood and they are very tricky to get the plastic cover back on for safe disposal.
 
Hey, a little bit of his regular food sounds like it works fine as a treat. Non-food rewards or treat ideas also sometimes work. Ear or chin scritchies, brushing, petting, talking to him and telling him "What a good boy you are Hairy! Such a good boy".

From your description of Hairy's behavior, it does sound like there has been some overall improvement. Yeah! :RAHCAT

It's unlikely that the insulin has gone bad already. Some people keep it 4-6 months in the fridge. Sounds ok from your description.

It's difficult to tell what is going on with Hairy. Some possibilities are;
1. the dose was increased too quickly, in too large increments and you bypassed a good dose.
2. you haven't found the correct dose for Hairy
3. you could have given a fur shot. Have you been running your hand through the fur to check for a wet spot? Or smelled the insulin, like a bandaid smell after shooting?
4. Hairy could be bouncing off some low numbers. bounces can last up to 72 hours. The body panics seeing lower numbers than it is used to, and pumps out counter regulatory hormones and some glycogen to raise the numbers back to what it considers normal. It can overcompensate when doing this, hence the bounce.
5. Any access to higher carb food for Hairy? Another animals?

It's very common for cats to drop lower overnight. Is there any way you would consider getting a mid-cycle test at night sometime?

Cats can be resistant to insulin. More common in male cats and overweight cats, per this article. http://www.uq.edu.au/ccah/index.html?page=43391&pid=0 Cats can develop insulin resistance with inconsistent dosing and other factors, I don't know them all. Cats can also develop IAA or have agromegaly, but we do not usually consider that until you are at 5U or more of Lantus or any insulin.
 
Thank you for that article, Deb, it was very informative. I did Hairy's test earlier today, at +3 instead of +6 or +7 and it was a bit lower. Of course with just that one test, there is no way to tell if that was just coincidence or if his nadir is earlier than mid cycle.

I do always check for fur shots by running my finger over where I just shot for any wetness. There has been only one time that I think might have been a partial fur shot and that was a night time shot almost 2 weeks ago.

I feed all of my cats low carb (under 10%) wet food. I mix canned (mostly Friskies pate with cooked chicken, liver, or gizzards (or a combination). This ups the protein without adding any additional carbs, so as a % of calories, the protein would be higher and the carbs lower than the straight canned (which is already less than 10%). I have a small dish of dry kibble up on a counter for my younger guy who is toothless (stomatitis) but loves his kibble, and my younger female who eats it once in awhile. My told older cats (Hairy and a female Bengal) can't jump up on the counter so they are 100% wet food.

A mid cycle test for night time dose would be 3 AM. If/when I am able to test Hairy by myself, I would consider it, but I won't wake up my 77 year old husband who has breathing and sleep problems in the middle of the night to hold Hairy while I test him. He may be going lower and night, but it would have to be by several hundred lower at night before he would be hypoglycemic.
 
That certainly does make it more difficult for you to test at night, since Hairy is a two person job to test right now.

Hypoglycemia wasn't why I suggested testing at night. I suggested a mid-cycle test in the evening, to see how far Hairy's BG is dropping and thinking perhaps that is causing the high bouncing up in the numbers by morning.

As I said, many cats drop lower at night. Some people think it's because they don't eat as much or sometimes they are more active and playing at night. That is why I suggested doing a later night test.

Wink never did conform to the standard nadir at +5 to +7. He always nadired early, around +4 usually. ECID.
 
Hairy isn't really active at night. There is a chair with an ottoman in our bedroom and he pretty much spends all night every night on that ottoman. He gets his last feeding right after his 9PM shot and his breakfast around 7:30AM so that probably is the longest he goes without food. But even if he were say 100 less at midcycle during the night, that would still be in the 300-400 range compared to his recent daytime midcycle tests. Doesn't seem likely to be a big enough drop to cause a bounce every night.

For now I am trying to vary his testing back and forth from the midpoint (+6) to see if he reaches a lower point before or after that. I know that isn't conclusive but even if I were to test him every hour on the hour for one day only makes it conclusive for that one day, not the next day and any other days. And the one night I did a PMPS, it was virtually identical to the AMPS the next morning. Again, not conclusive, but nothing to indicate that his PM cycle hits a lower nadir than his AM cycle either.
 
Hairy's BG has finally come down a little bit the past couple of days. Don't know if that is the higher dose finally kicking in or if it is because I have been varying the time of day of the tests and maybe he tends to be lower before +6. He was 273 at +5 today. First time he has been yellow since 9 days ago. He's been feeling pretty frisky today. Has approach the other cats to play a couple of times today which is something he doesn't do very often.
 
Status
Not open for further replies.
Back
Top