Updates on Marley! +6 at 2.7 Freestyle, 4.5 AT

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Marleysgirl13

Marleysgirl13

Member Since 2020
Hello again guys!

I just wanted to thank everyone who reached out yesterday in my fit of panic about my newly diagnosed boy Marley. This has truly been an amazing community of people working together and I'm so so so thankful.

I'll add the link to the post yesterday if you're interested.

So, I skipped a dose last night and Marley was more himself. This morning when I tested him he was quite high, so I gave him his prescription of 3u of cansulin.

It's now +6, this is when he hit his lowest yesterday and his results are:

Freestyle Lite Meter - 2.7
AlphaTrak - 4.5

With the human meter, he is close to the danger zone again.

Obviously I'm keeping an eye on him as usual. He's not been left alone all day. He hasn't shown any weird symptoms and isn't running around looking for food yet. Or do any of you think I should be feeding him something high carb?

As some of you said, I think his dose is way too high and is causing him to dip too low. I'm curious whether his numbers in his PMPS will be too low to give a shot. If that true for the second day in a row, I think it's safe to assume he should go on a lower dose, so he's still getting insulin every 12 hours.

Does anyone know why in the spreadsheet that the Alphatrak and Freestyle have been in different colours all day? Or is this normal and I can trust both meters?

Thanks for any advice!
 
He's actually below the danger zone on the human meter. I'd give a bit of medium-carb food if you have any on hand, and test again in 30mins.

Marleysgirl13 said:
Does anyone know why in the spreadsheet that the Alphatrak and Freestyle have been in different colours all day? Or is this normal and I can trust both meters?
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Pretty normal. There's no consistent conversion between the two meters (essentially, they are doing different biochemical assays and making different assumptions about the location of glucose in the blood, so they're just not measuring the same things), which is one reason people tend to just pick one and stick with it. The only hard-and-fast number equivalent we use is the "too low" cutoff: 2.7 on a human meter and 3.8 on a pet meter, but as you've seen there's no guarantee that those are going to be measured that way in the moment. Plus you have a certain amount of meter variance that is allowed.
 
Nan & Amber (GA) said:
He's actually below the danger zone on the human meter. I'd give a bit of medium-carb food if you have any on hand, and test again in 30mins.

I dont have med carb wet food, but I'll feed some treats. I'm on the phone with the vet cause I'm very concerned and will post an update here soon.


Pretty normal. There's no consistent conversion between the two meters (essentially, they are doing different biochemical assays and making different assumptions about the location of glucose in the blood, so they're just not measuring the same things), which is one reason people tend to just pick one and stick with it. The only hard-and-fast number equivalent we use is the "too low" cutoff: 2.7 on a human meter and 3.8 on a pet meter, but as you've seen there's no guarantee that those are going to be measured that way in the moment. Plus you have a certain amount of meter variance that is allowed.
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Marleysgirl13 said:
So, I skipped a dose last night and Marley was more himself. This morning when I tested him he was quite high, so I gave him his prescription of 3u of cansulin. [...]
As some of you said, I think his dose is way too high and is causing him to dip too low. I'm curious whether his numbers in his PMPS will be too low to give a shot. If that true for the second day in a row, I think it's safe to assume he should go on a lower dose, so he's still getting insulin every 12 hours.
Click to expand...

Couple things to note: first off, Marley definitely needs a lower dose. All of the dosing methods we use would have recommended at least a 0.25U decrease from the numbers yesterday, and Marley's numbers today are reiterating the point-- he wants less insulin than he's getting! The only question is how much less. The 0.25U reduction assumes that he got to the 3.0U by a similarly-slow process of 0.25U dose increases from a much lower start (1.0U, typically), but that's now how he got there. He may actually need a lot less insulin!

Second point: his high numbers this morning were very likely a reaction to the lows he saw yesterday (we call this a 'bounce'). It's not an indication that he needs more insulin to bring the numbers down. He'll likely bounce again tonight or tomorrow, but please don't shoot 3.0U again!

Hoping a Caninsulin/Vetsulin person can make a specific dose recommendation...
 
Nan & Amber (GA) said:
He's actually below the danger zone on the human meter. I'd give a bit of medium-carb food if you have any on hand, and test again in 30mins.



Pretty normal. There's no consistent conversion between the two meters (essentially, they are doing different biochemical assays and making different assumptions about the location of glucose in the blood, so they're just not measuring the same things), which is one reason people tend to just pick one and stick with it. The only hard-and-fast number equivalent we use is the "too low" cutoff: 2.7 on a human meter and 3.8 on a pet meter, but as you've seen there's no guarantee that those are going to be measured that way in the moment. Plus you have a certain amount of meter variance that is allowed.
Click to expand...

I don't have any med carb wet food but I'll feed some treats. I'm on the phone with the vet now and will update here soon.
 
Marleysgirl13 said:
I don't have any med carb wet food but I'll feed some treats. I'm on the phone with the vet now and will update here soon.
Click to expand...


Treats are good, they usually have carbs. You can also give him a couple drops of honey or maple syrup, either drizzled on treat or a bite of food or else rubbed on his gums. That will bump up the numbers quickly.
 
Marleysgirl13 said:
I don't have any med carb wet food but I'll feed some treats. I'm on the phone with the vet now and will update here soon.
Click to expand...

So I just got off the phone with the vet. I gave him some dry food and he ate it like a starving man. I explained all the info that everyone gave here to the vet and told him I wasn't very pleased. He surprisingly didn't fight me using a human meter and more importantly gave me new dosing recommendations.

He basically said, no shot if he's under 8.
2u if he's between 8-16
3u if he's over 16.
And all these are using numbers from the human meter.

Personally, I'm gonna do the 2u.

What do you guys think about that?
 
Marleysgirl13 said:
He basically said, no shot if he's under 8.
2u if he's between 8-16
3u if he's over 16.
And all these are using numbers from the human meter.

Personally, I'm gonna do the 2u.

What do you guys think about that?
Click to expand...

We don't usually dose in this way (according to pre-shot numbers), instead we dose by how low the cat goes during the day. We find it's easier to interpret patterns when the cat has been getting a consistent dose morning and evening than when it changes from cycle to cycle.

Not sure about the 2U, I think I'd probably drop back even more after these scares. @Deb & Wink , what do you think?
 
NB: All values in this post are for readings taken on a human meter.

Marleysgirl13 said:
[Vet] basically said, no shot if he's under 8 [144].
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I'd suggest initially setting the no shot threshold at 11.1 (200) per FDMB guidelines for recently diagnosed cats with only a little BG data gathered to date.

(It may be possible in time when you have more data showing how Marley responds to Caninsulin to lower the 'no shoot' limit to some degree, but nowhere near the preshot levels that are OK for data-ready cats on gentler insulins like Lantus and Levemir.)

2u if he's between 8 -16 (144 - 288)
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Per FDMB Caninsulin guidelines and based on the 3.00IU dose and Marley's readings over the last 2 days, the current dose should be reduced by 0.25IU to give a maximum dose of 2.75IU. Nan makes a very astute observation above that the 3IU was not arrived at through gradual increments so a reduction of 0.25IU in this situation may well be too small an adjustment.

Choices:

1. Drop back to 2.75IU: Absolute maximum dose - 3.00IU has proven to be too high (twice in as many days) and I suspect that 2.75IU may also be too high (based on general principles and my own experience with this insulin since there's not much data upon which to base such a suspicion but see (3) below).

2. Drop back to the 2.00IU: Maximum starting dose recommended by manufacturer, sanctioned by your vet. (May still be a bit on the high side.)

3. Drop back lower than 2.00IU - again something to consider given Marley's current response to the insulin, the completion of the diet change and antibiotic course, plus his better clinical signs last night when you skipped the dose.

Should you elect to go for the third option, other than recommending that you test daily for urine ketones as a general safety precaution I'm not sure what to suggest dose-wise so I'm tagging @Deb & Wink and @JanetNJ to ask them to weigh in on this when they're next online.


3u if he's over 16 [288]
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I disagree strongly with your vet's guideline here. Based on your testing yesterday and today, 3.00IU Caninsulin is categorically too high a dose for Marley at this time. This morning's AMPS was 16.5 (298) and the 3.00IU dose dropped him down below the lower bound of the normal range. The FDMB nadir threshold for signalling dose reductions with Caninsulin is 5.0/90 so a dose that drops the cat below 50 is way too high.

In general I am not a fan of dosing on a sliding scale for Caninsulin - certainly not for a newly diagnosed cat - reason being that there typically doesn't tend to be a cast iron relationship between the preshot BG value and the size of the drop. As you can see from just two days' worth of data, the 3 unit dose dropped Marley right back down into the too-low numbers you saw yesterday after a much lower AMPS, i.e. just because a preshot BG is higher, there's no guarantee that the nadir will be correspondingly higher even if the same dose is given, never mind a larger dose. (Caninsulin is pretty good at yanking down numbers in general, and also preshots affected by bouncing - as looks to be the case for this morning's AMPS - can often be brought back down very quickly when using this insulin.)

Sorry if the above is a bit disjointed (and apologies for any proofing howlers). Had a bad day trying to feed my civvie, Lúnasa, and I'm kinda shattered.


Mogs
.
 
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I think the 2U your vet recommended is still too much for Marley.

I would not recommend any more than 1U of Caninsulin/Vetsulin at this point.
Any drop into the neon green colors on the SS says the dose is too high, and needs an immediate reduction.

It's even possible that Marley is even more sensitive to insulin now, since he dropped into those VERY low numbers.
One saying we have here is "Feed the 40's!" So any BG reading that is below 50 mg/dL (<2.7 mmol/L), means you should be feeding your cat until the BG levels are back to safe levels. Safe being >90 mg/dL (>5 mmol/L) for at least 2 hours, without food. You want to keep feeding until the BG is > 90 mg/dL (>5 mmol/L), and then taper off the food and testing. Let's keep your cat safe.

Even then, with a reduction of the dose to 1U, the pre-shot BG level on the human meter should be at least >200 mg/dL (>11 mmol/L).
Please, please, please do not continue to give Marley that high 3U dose that your vet prescribed. It's way too much.

"Better too high for a cycle, than too low for a moment."

We are trying to help you find an insulin dose, where you can safely give Marley the same amount in both the AM and PM cycles. It's a major reason I'm suggesting you drop the dose down so much, to 1U only. We have found that a sliding scale dose, like your vet suggested, does not work well for cats.

What was the fructosamine test result? That is the test your vet probably did to measure the BG levels over the last 2-3 week period.

With the recent change in diet, that alone can drop the BG numbers by 100 basis points speaking in mg/dL terms. (5.5 basis points in mmol.L terms).
Steroid induced diabetes can usually resolve quickly. Within 1 to 2 months. We've seen it happen here on the message board plenty of times.
Antibiotics added to the mix, getting rid of the infection/inflammation, can also cause the BG levels to drop quite a bit.
No vet stress, meaning that Marley is not at the vet where the BG levels spike due to fear, can cause the BG levels to drop significantly.
Marley likely dropped low somewhere overnight, and you didn't see it because you weren't testing. Bouncing as Nan said, gave you the high pre-shot test this AM.

So you have a "perfect storm" situation of at least 5 reasons for the BG levels to be so low right now.

p.s. When I saw Marley's SS today, I GASPED in shock at those too low numbers.
p.p.s. Even our "Sticky" post on https://felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/ has the starting dose recommendations wrong. It's still using the outdated information to base the dose on the weight.
 
Marleysgirl13 said:
I don't have any med carb wet food but I'll feed some treats. I'm on the phone with the vet now and will update here soon.
Click to expand...
I don't know if you have these in Canada, or you can Get Friskies in Gravy
I'll post the food chart for you


This is what you need to feed if he ever drops to low, don't have want a hypo
Such as

You should always have a few can of these on hand in case you need to bring up


Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs


Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs




Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs


Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs




https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-chart.174147/
 
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