What are we aiming for in BG levels?

[Mousse]

Hi everyone, there is something I do not understand, I feel that I want my cat to go into the blue numbers, and he's not been there for a long time

Can someone please tell me were we aim for? I do understand that blue numbers can go to remission, if they stay steady for 2 weeks, but do we aim for that in a diabetic cat that is not in remission, so for nadir, do we want to see blue or is it better if that number is higher in a diabetic cat, in the yellows for example, I'm guessing that pink nadir numbers mean you need to up the dosige?

My cat has been in the pinks mostly pre shot and an occasional red and yellow, but I have to say that I mostly don't get to have him fast for 2 hours, for a variety of reasons but when I do fast him for 2 hours he's mostly also high, it's not like if I do it's lower

Tonight he did not, and he was in the red (433), I took 3 and a half hours later and he was 259. Does this mean the insulin is working? I feel I should be giving more but that's based on nothing because although I've tried to inform myself as best as I can, when you're relatively new to this it's not only all this new information you'll have to grasp but there's a lot of emotion interwoven with the situation and that can make it kind of messy for me

I'll have to say that I'm not making it easy for him because of my work situation, I have to walk him back and forth often, because I work 2 days from 5 in the morning till 1 pm, then 1 pm to 9 pm and then 9 pm to 5 pm. The worst is from morning to evening, because then I'll have to do it at 4am, and on the day I can do it at 4 pm but when I move the shift to evening I'm not home at 4pm so this is really complicated en more then the 2 hour window they say you can take from time to time. And there is just really nothing to do about that but adapt and go with it. But I don't know if this is what keeps him high. The whole of August I was home on vacation and could do the 12 hour window, but that didn't change anything, he was even hospitalized with ketoacidose in the last week

Anyway, if someone could explain what we are aiming for in numbers and maybe give some dosing advice I would be much obliged

Thank you all you lovely people, sending you all my love

With a special thanks to Marje and Gracie who has been patiently helping me set up my spreadsheet

 

[Marje and Gracie]

Hi everyone, there is something I do not understand, I feel that I want my cat to go into the blue numbers, and he's not been there for a long time

Can someone please tell me were we aim for? I do understand that blue numbers can go to remission, if they stay steady for 2 weeks, but do we aim for that in a diabetic cat that is not in remission, so for nadir, do we want to see blue or is it better if that number is higher in a diabetic cat, in the yellows for example, I'm guessing that pink nadir numbers mean you need to up the dosige?

My cat has been in the pinks mostly pre shot and an occasional red and yellow, but I have to say that I mostly don't get to have him fast for 2 hours, for a variety of reasons but when I do fast him for 2 hours he's mostly also high, it's not like if I do it's lower

Tonight he did not, and he was in the red (433), I took 3 and a half hours later and he was 259. Does this mean the insulin is working? I feel I should be giving more but that's based on nothing because although I've tried to inform myself as best as I can, when you're relatively new to this it's not only all this new information you'll have to grasp but there's a lot of emotion interwoven with the situation and that can make it kind of messy for me

I'll have to say that I'm not making it easy for him because of my work situation, I have to walk him back and forth often, because I work 2 days from 5 in the morning till 1 pm, then 1 pm to 9 pm and then 9 pm to 5 pm. The worst is from morning to evening, because then I'll have to do it at 4am, and on the day I can do it at 4 pm but when I move the shift to evening I'm not home at 4pm so this is really complicated en more then the 2 hour window they say you can take from time to time. And there is just really nothing to do about that but adapt and go with it. But I don't know if this is what keeps him high. The whole of August I was home on vacation and could do the 12 hour window, but that didn't change anything, he was even hospitalized with ketoacidose in the last week

Anyway, if someone could explain what we are aiming for in numbers and maybe give some dosing advice I would be much obliged

Thank you all you lovely people, sending you all my love

With a special thanks to Marje and Gracie who has been patiently helping me set up my spreadsheet

Someone has given you incorrect information because to go into remission, a kitty needs to consistently be in BG levels between 50-100 on the lowest dose of insulin (usually a drop) for a week. But in dosing, our goal is to get the kitty into the range of 50-120 and if remission eventually happens, that’s great.

What the difficulty is here is we don’t recommend, generally, increasing a dose if we can’t tell how low the current dose is taking the kitty. So the more data you can get when you are at home, the better. I wonder if a continuous glucose monitor (CGM) like the Freestyle Libre might be more helpful. But, if not or you can’t get it, the more data you can collect when you are home, the better we can advise you.

Sometimes, if the BG drops fast or lower, the liver will release counterregulatory hormones which drive the BG back up into what we call a bounce. If you are only catching those high BGs, then it looks like he needs more insulin. But I’ve seen many, many cats, including my own, start the day in the 300s, be in the 70s by nadir and back in the 300s by next shot time. If I didn’t have the midcycle test, I would have thought she was high all day.

PZ is certainly more forgiving when it comes to shot times being off than Lantus is. That schedule must also be very hard on your own body clock. Do you have anyone who can help you test his preshot and then give the insulin shots to keep him on a better schedule? If you had a CGM, they wouldn’t have to test him but just check with you on what his BG was before giving insulin.

I’m going to suggest you increase his dose to 1.75u bid in the hopes you can get more tests when you are at home. That doesn’t need to be every hour but as often as you can around sleeping. Getting him off all dry food and making sure his canned food is low carb will help but be sure you take him off dry or any higher carb canned slowly so his BG doesn’t tank.

I also need to show you how to correctly enter the data because, right now, it looks like you shoot every 12 hours so that adds another layer of difficulty in dosing advice but let’s start at 1.75u bid and a little more testing. And perhaps you can see if there is anyone who can help with more consistent shots.

 

[Mousse]

I can look into getting a libre but I'm so afraid of him taking it off and it being a waste of money because this situation has been emptying my bank account, I had saved some money and that's gone, and I haven't been able to save since so my budget is precarious at the moment. But I can try maybe, next salary, and hope it's not a waste because these things are quite expensive, certainly if he rips it off

I really have no one, I live alone, in a small village where I don't really know anyone, besides saying 'hi how are you' with a few people, no one comes to my house, I have no friends here

There is really nothing to do about it, it has to be me, and I have to work where I work, because of the shifts it pays very well in comparison to regular jobs, easily a difference of 600 euros, so I could say, I'll look for another job but then I can't afford to take care of him anymore, or so much harder, that is just not something I can do either, I'll have to buy heating oil soon and I don't know how I'm going to do that for the moment but I'll find a way of course, only hope he doesn't need urgent care soon or I'll be completely f*cked...

I'm a bit hesitant to buy things that are relatively expensive and might be a waste of money if you will

So another job is not an option and I have no one, it's just the way it is

I will go to 1.75 from tonight, thank you so much!

 

[Marje and Gracie]

I can look into getting a libre but I'm so afraid of him taking it off and it being a waste of money because this situation has been emptying my bank account, I had saved some money and that's gone, and I haven't been able to save since so my budget is precarious at the moment. But I can try maybe, next salary, and hope it's not a waste because these things are quite expensive, certainly if he rips it off

I’m tagging @Staci & Ivy as she uses a Libre and can perhaps help you with how she manages to keep it on Ivy. Once the vet shows you how to do it, you can do it at home but I don’t know the cost of it versus the cost of strips. If you can figure out how to keep it on, the data you get will be really helpful.

I was just asking questions just to brainstorm but each member has things they must deal with and it just helps us to know if there is anyone who flexibility. If there isn’t, then we need to make suggestions for what fits your needs,

Let me see if I can figure this out:
Day 1 work 5am till 1 pm; shoot 4:30 am and pm
Day 2 same as above
Day 3 work 1 pm till 9 pm; shoot 6:30 am and 9:30 pm
Day 4 same as above
Day 5 work 9 pm to 5 am shoot 8:30 am and 8:30 pm
Day 6 same as above
Day 7 shoot 6:30 am and 6:30 pm

That has you shooting every 12 hours on Day 1, 2, 4, 5, 6, 7 and shooting 2 hours late on Day 3 am and 3 hours late Day 3 pm, shooting one hour early on Day 5 am, shooting 2 hours early Day 7 am and Day 1 am of the next weekly cycle.

@Suzanne & Darcy has used PZ and is another of our very experienced members so I’m tagging her to see if she can check that schedule over and make any tweaks to improve it.

 

[Staci & Ivy]

I’m tagging @Staci & Ivy as she uses a Libre and can perhaps help you with how she manages to keep it on Ivy. Once the vet shows you how to do it, you can do it at home but I don’t know the cost of it versus the cost of strips. If you can figure out how to keep it on, the data you get will be really helpful.

I was just asking questions just to brainstorm but each member has things they must deal with and it just helps us to know if there is anyone who flexibility. If there isn’t, then we need to make suggestions for what fits your needs,

Let me see if I can figure this out:
Day 1 work 5am till 1 pm; shoot 4:30 am and pm
Day 2 same as above
Day 3 work 1 pm till 9 pm; shoot 6:30 am and 9:30 pm
Day 4 same as above
Day 5 work 9 pm to 5 am shoot 8:30 am and 8:30 pm
Day 6 same as above
Day 7 shoot 6:30 am and 6:30 pm

That has you shooting every 12 hours on Day 1, 2, 4, 5, 6, 7 and shooting 2 hours late on Day 3 am and 3 hours late Day 3 pm, shooting one hour early on Day 5 am, shooting 2 hours early Day 7 am and Day 1 am of the next weekly cycle.

@Suzanne & Darcy has used PZ and is another of our very experienced members so I’m tagging her to see if she can check that schedule over and make any tweaks to improve it.

HI Nicolette,
As Marje explained, using a Freestyle Libre CGM sensor can be a help, especially if you can’t be home with Mousse.
I use one with my cat, Ivy, all the time since she won’t tolerate being poked all the time. ( I am able to ear prick and test her if the Libre reads LO (which is under 50).
Usually, the Libre reads lower than the handheld meter does with a blood test.
But, the Libre is better than having no data for sure!

The Libre has an adhesive backing, which attach to your kitty’s skin after you shave an area on his skin on his back. I use a thin covering called a tegaderm to protect the sensor and I use a tube top on Ivy to cover the Libre so she cannot pull it off. Most people use a little tee shirt to cover the sensor. (Some cats will leave the Libre alone, but not my cat).
(Human’s wear a Libre CGM on the back of their upper arm).

I am going to put a link here with lots of information we have put together for anyone interested in using a Libre sensor.

https://felinediabetes.com/FDMB/thr...ucose-monitors-cgms-for-diabetic-cats.301950/

I hope this helps, feel free to ask any questions. Wishing you lots of luck with your sweet Mousse

 

[Marje and Gracie]

HI Nicolette,
As Marie explained, using a Freestyle Libre CGM sensor can be a help, especially if you can’t be home with Mousse.
I use one with my cat, Ivy, all the time since she won’t tolerate being poked all the time. ( I am able to ear prick and test her if the Libre reads LO (which is under 50).
Usually, the Libre reads lower than the handheld meter does with a blood test.
But, the Libre is better than having no data for sure!

The Libre has an adhesive backing, which attach to your kitty’s skin after you shave an area on his skin on his back. I use a thin covering called a tegaderm to protect the sensor and I use a tube top on Ivy to cover the Libre so she cannot pull it off. Most people use a little tee shirt to cover the sensor. (Some cats will leave the Libre alone, but not my cat).
(Human’s wear a Libre CGM on the back of their upper arm).

I am going to put a link here with lots of information we have put together for anyone interested in using a Libre sensor.

https://felinediabetes.com/FDMB/thr...ucose-monitors-cgms-for-diabetic-cats.301950/

I hope this helps, feel free to ask any questions. Wishing you lots of luck with your sweet Mousse

Thank you, Staci

 

[Mousse]

I’m tagging @Staci & Ivy as she uses a Libre and can perhaps help you with how she manages to keep it on Ivy. Once the vet shows you how to do it, you can do it at home but I don’t know the cost of it versus the cost of strips. If you can figure out how to keep it on, the data you get will be really helpful.

I was just asking questions just to brainstorm but each member has things they must deal with and it just helps us to know if there is anyone who flexibility. If there isn’t, then we need to make suggestions for what fits your needs,

Let me see if I can figure this out:
Day 1 work 5am till 1 pm; shoot 4:30 am and pm
Day 2 same as above
Day 3 work 1 pm till 9 pm; shoot 6:30 am and 9:30 pm
Day 4 same as above
Day 5 work 9 pm to 5 am shoot 8:30 am and 8:30 pm
Day 6 same as above
Day 7 shoot 6:30 am and 6:30 pm

That has you shooting every 12 hours on Day 1, 2, 4, 5, 6, 7 and shooting 2 hours late on Day 3 am and 3 hours late Day 3 pm, shooting one hour early on Day 5 am, shooting 2 hours early Day 7 am and Day 1 am of the next weekly cycle.

@Suzanne & Darcy has used PZ and is another of our very experienced members so I’m tagging her to see if she can check that schedule over and make any tweaks to improve it.

The schedule you posted is roughly what I do, but on the second day, when I go to a different hour I'll split the difference so for example I tested and injected him at 4.15 day one, afternoon 4.15 as well, next morning to, but that night I'll start to walk him forward, because the day after at 4.15 pm I'll be at work, I'll be back 9.30 pm. So that afternoon I'll do around 6 pm, the next morning I'll go 8, for that night it won't be before 9.30. Then I'm going to have to walk him back, but not a lot, I'll have to go to 8, because I'll start working at 9 pm. And when the nights are over I have a couple of days off (3 or 4) to walk him back to 4/4.15 am ... And that's how we keep going back and forth. I can imagine this is not good, maybe even a problem, but as I said there is really nothing to do about it, and I'm guessing it's better than no treatment at all...

I still don't know is I understand... When Mousse had blue numbers on his sheet they've told me to go down on insulin so I'd have to inject him all the time, not half the time because his numbers were blue. It had to be in balans i guess? You can see on my sheet exactly how and when this happened, and after that his numbers were never low again, they even kept going up... Honestly I still don't really understand, but I can say that this did not feel good at all, and Mousse was much better when he had blue numbers interspersed with higher numbers where I had to inject him. I hope you understand what I mean, it seems hard to explain what I want to ask... I feel you've explained what I also thought, but I'm still not sure if I understand that really right? So sorry, I feel a bit dumb really...

 

[Mousse]

HI Nicolette,
As Marje explained, using a Freestyle Libre CGM sensor can be a help, especially if you can’t be home with Mousse.
I use one with my cat, Ivy, all the time since she won’t tolerate being poked all the time. ( I am able to ear prick and test her if the Libre reads LO (which is under 50).
Usually, the Libre reads lower than the handheld meter does with a blood test.
But, the Libre is better than having no data for sure!

The Libre has an adhesive backing, which attach to your kitty’s skin after you shave an area on his skin on his back. I use a thin covering called a tegaderm to protect the sensor and I use a tube top on Ivy to cover the Libre so she cannot pull it off. Most people use a little tee shirt to cover the sensor. (Some cats will leave the Libre alone, but not my cat).
(Human’s wear a Libre CGM on the back of their upper arm).

I am going to put a link here with lots of information we have put together for anyone interested in using a Libre sensor.

https://felinediabetes.com/FDMB/thr...ucose-monitors-cgms-for-diabetic-cats.301950/

I hope this helps, feel free to ask any questions. Wishing you lots of luck with your sweet Mousse

Thank you so much! Funny thing is Mousse lets me do anything with him now, so earpricks are no problem at all for us. What holds me back is I don't like to, no, I hate to bother him... So he's there, sleeping nicely and relaxed with his brother, and hop, there she is, wake him up, pick him up, and go to our prick place... I hate it. And because he's unwell, well, we can say sick, and I want him to heal, I want him to relax and repare his organs

But I do try to get more tests in, I'll do a day of it next time I'm off or working night, it just is very bothersome, for me in the first place, he lets me do anything like a trooper, I just wish he didn't have to be a trooper and just be happy and relaxed...

The freestyle is something I could try, but with the financial strain right now a risk I can't take, it can so easily be money down the drain, and I can't afford that now

Thank you for your help!