Wider swings with insulin than not

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KKL

KKL

Member Since 2013
As I continue to give him a 0.2+/- unit of insulin I am seeing a higher swing in numbers than the 11 days I had him off of it. I am so hesitant to add a second dose since he's usually low 100's in the evening already. But now we are seeing low 100's until 3-5am then high 400's and even low 500's at 6-7 in the morning, with a 0.15-0.25 unit dose (all my syringes are off by a 0.05-0.1 unit) so super accurate dosing without a micrometer (on its way!) is near impossible.

I passed forward my chart to my vet and she had me enhance it with exact feed times to see what we might try differently. She is not fond of numbers below 100 with him and doesn't mind numbers 250-300+/- as long as they are only for a few hours. He does drop (both with and without insulin) on his own once he eats his low carb wet food. I am hesitant to add a higher carb food since he shoots up pretty fast. Might he just be "carb sensitive"?
 
What he may be doing is bouncing. This occurs for a number of reasons
1) sudden drops in short time periods
2) large total drops
3) drops to unusual levels for him

Some of those numbers suggest to me that you might try an off the juice trial.
ie take him off the Lantus, feed a low carb diet spread out across the day, and just monitor. If he doesn't need insulin, he should stabilize in a couple of days as the Lantus works out of his system.

If he is having sporadic function of his pancreas, it may work better to use a non-depot insulin such as Prozinc, which comes in a U-40 concentration and may be easily measured in 0.2 unit increments using a U-100 syringe with a conversion chart.
 
I would tend to agree with this.

This morning I got a reading of 596 with the Relion...I took another reading with my other meter (TrueResult) and it was 286. How can there possibly be over a 300 pt spread? :(

When I was using the TrueResult meter without insulin he got great numbers, but I switched to the Relion and it had higher numbers so we put him back on a small dose of insulin and he started this scary roller coaster with numbers...from high 500's to below 70 in a few hours. Is it possibly just the meter? Do I have to switch to the AlphaTrak?? I'd rather pay more IF it will give me better readings...and thus save my cats health, insulin and false reading test strips :(
 
True Result may not be when it comes to cats. I'd trust the ReliOn model over the True any day. You can always test yourself and see how it works on you.
 
KKL said:
...This morning I got a reading of 596 with the Relion...I took another reading with my other meter (TrueResult) and it was 286. How can there possibly be over a 300 pt spread? :(

When I was using the TrueResult meter without insulin he got great numbers, but I switched to the Relion and it had higher numbers so we put him back on a small dose of insulin and he started this scary roller coaster with numbers...from high 500's to below 70 in a few hours. Is it possibly just the meter? Do I have to switch to the AlphaTrak?? I'd rather pay more IF it will give me better readings...and thus save my cats health, insulin and false reading test strips :(
Click to expand...
Hi. In my experience, the TrueResult is nothing "true" in the higher-number range. Many other members have found this out as well. When Gobbles was first diagnosed, I was using the TrueResult. If you look at his SS, you'll see that he was diagnosed 11/17/12. Up until 1/8/2013 his numbers looked pretty good. When I switched to a ReliOn meter, well, his numbers started looking higher (and they were!!!) I had my vet test his AlphaTrak against both the TrueResult and the ReliOn: (1/7/13) TrueResult read 343 and AlphaTrak read 419 and then (1/ReliOn read 203 and AlphaTrak 234. My advice and opinion: Use the ReliOn exclusively and keep the TrueResult as a backup. Also, at lower numbers, it seems the TrueResult is more accurate (when ReliOn was about 125) and much more accurate at very low numbers (40-100 range). I can't name dates specifically without going over Gobbles entire SS, but I remember a few times when Gobbles was in the 50-70 range, I tested the same drop of blood between each meter and there was about a 5-10 point difference. You'll also see by looking at Gobbles SS that he went OTJ on 5/17/13; 6 months after his diagnosis. I contribute this to the fact that we started following the Protocol for the Lantus Tight Regulation on 1/5/13. I hope this helps you out. I would certainly NOT spring for the AlphaTrak: too expensive and the cost of strips is astronomical! Most members here use a human glucometer (probably ReliOn being used more than any other meter).
 
Also, with regard to the cost of meters, here is something another member put together:



Cost of test strips and the meter are big factors. For example:

Relion Confirm meter $14-17.
1. Test strips, box of 50 $19.98, box of 100 $36.
2.Only available at Walmart but online and at a store. Interchangeble test strips with Relion Mini and Arkray Glucocard 01. Arkray glucocard 01 test strips available on-line at ADW, our shopping partner for a good price. Use the link at the top of the screen and the board gets a little money to keep it going.

Alphatrak test meter $120-200.
2.Test strips, box of 50, $49.99 to $100. Box of 100, $97.98 to ??? Alphatrak test strips from your vet may have a large markup. I've heard from one member her vet office prices are high, a vial of Alphatrak test strips is $100 for 50, $2 each. At 4 tests a day, that is $8. Alpahtrak test strips from ADW are about $0.96 each in bulk.

ReliOn makes a few different models. I use (I still test Gobbles, even though he's not receiving any insulin now) the ReliOn Ultima model and the strips are only $49/250 strips if ordered from ADW.
 
Just to clarify, it's the ReliOn that has yielded significantly higher and lower numbers for me than the TrueResult.

This morning:
ReliOn: 596
TrueResult: 286

The second part of my chart was using only the ReliOn, the first part was using the TrueResult. I am skeptical as to the 400-500+ readings I am getting with the ReliOn. I had ordered their control solution, it hasn't come yet.
 
KKL said:
Just to clarify, it's the ReliOn that has yielded significantly higher and lower numbers for me than the TrueResult.

This morning:
ReliOn: 596
TrueResult: 286

The second part of my chart was using only the ReliOn, the first part was using the TrueResult. I am skeptical as to the 400-500+ readings I am getting with the ReliOn. I had ordered their control solution, it hasn't come yet.
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IMHO, the ReliOn is the number I'd go with especially since you've had to skip shots--thus higher numbers due to lack of insulin. And with the fact that there is a 20% variance on all meters, the ReliOn number COULD be much lower, or higher. If you take into consideration of Gobbles' SS numbers with the ReliOn vs. the TrueResult, you'll see it is similar to yours. Those red and black numbers are probably big bounces. On which days which meters were used? I suspect that on the most, if not all, days with all the green and blues, you were recording the TrueResult readings? If if makes you feel any better, Gobbles bounced and ran some high numbers for many months before he went OTJ....but I stuck to the Protocol. When cats run high, there is little you can do....
 
I'm just a little confused here: do you mean that from 6/22 to present, you are using the ReliOn exclusively and all those numbers are from the ReliOn only?
 
Yes :(
I first started with the TrueResult from 6/6 through morning of 6/22. Then starting +10 on 6/22 forward is the ReliOn meter. I seem to be having the opposite luck with the Relion vs the TrueResult meters. The ReliOn is showing swings of 300-400 pts in just a few hours...which both my vet and I are very skeptical of. When I double check with the TrueResult the results are significantly less..such as this morning, by 310pts. I find it very hard to believe that it's accurate when with only 0.2+/- unit of insulin he was at 67 at dinner yesterday and 596 at breakfast today :(
 
Also to clarify the higher numbers were with Insulin, the lower were when skipping shots. We've only done 1x day due to the super low dose and that 2x day was too much for him.

On the TrueResult meter it appeared he did not need insulin. We only resumed when the ReliOn meter showed high numbers. I am wondering if my ReliOn meter is off.

Now:
TrueResult 158
Relion: 402
 
KKL said:
Yes :(
I first started with the TrueResult from 6/6 through morning of 6/22. Then starting +10 on 6/22 forward is the ReliOn meter. I seem to be having the opposite luck with the Relion vs the TrueResult meters. The ReliOn is showing swings of 300-400 pts in just a few hours...which both my vet and I are very skeptical of. When I double check with the TrueResult the results are significantly less..such as this morning, by 310pts. I find it very hard to believe that it's accurate when with only 0.2+/- unit of insulin he was at 67 at dinner yesterday and 596 at breakfast today :(
Click to expand...
I'm so sorry that you're having a disheartening time with all of this. Meters, by I believe the FDA, can be 20% higher or lower. So even your 286 TrueResult reading could be 343 on the high end, and the ReliOn could be 483. With Lantus, doses are given every 12 hours, around the clock UNLESS you get a reading of 200 or less; then we strongly advise you to NOT give the shot and please post on this forum for help. A cat can easily swing 300-400 points in a few hours; a few times Gobbles swung from blue numbers to black numbers in a few hours (once in just one hour). Please understand that your cat is very "newly diagnosed"; a cat is considered "newly diagnosed" in their first six months of diagnosis. As I stated, those high numbers are Harley bouncing off low numbers, especially when a shot is missed--though sometimes, especially with numbers 200 and under, a shot should be held until an Advisor here helps you...shots sometimes have to be given late, reduced or skipped.

A suggestion: Just for the heck of it, and to make you more aware of the problems with the TrueResult, you may want to post some sort of new posting about the TrueResult accuracy. Explain your situation a little, even copy & paste from your posts, and get some opinions on that meter. Also mention the inaccuracies with the ReliOn. I am sure you will get a lot of the same information that I'm giving you about the TrueResult. I see BJM had commented on this post and also mentioned the inaccuracy of the TrueResult. My vet even agrees and he does have a good knowledge of feline diabetes....

I bet you are really sad about Harley being in high numbers? Maybe still in shock and perhaps some denial of him being diabetic? Sweetie, I use to cry, cry, cry about it, but I received such an outpouring of care, comfort, support, education and advice from the members here, that I hung in there. The best advice I've ever been given? Patience :-D

Another factor (and I'm sorry as you have probably answered this question but I've not read your other posts): What are you feeding Harley? How often? Food can play a huge factor in diabetic cats. Health issues can also play a huge factor.

We want to give Harley the best care possible and start the road to recovery, and to hold your hand through the diabetic journey. And to educate and support you.

I hope I've not overstepped my bounds here. I'm concerned about you and Harley; I've been there and done that. And remission is very, very possible because Harley's been prescribed an excellent insulin and you've come here for help.

OT: With regard to vets: Say I go to my primary care doctor, he sends me for a stress test, and the results are not good--my primary doctor wouldn't treat me because he is not a cardiac specialist; he would refer me to a specialist. And I would want to go to a specialist because I know my doctor surely is not a cardiac specialist. In that scenario, your vet is the "primary doctor", has done a blood panel and finds out that your cat has feline diabetes. Most vets don't treat feline diabetes exclusively unless your vet they are strictly feline diabetes specialists who knows the disease in and out and is up to date on the treatment of feline diabetes. While we aren't experts, the combined knowledge and experience of our members is staggering. Once I got a grip on that, well, Gobbles was on the road to recovery. And his vet did has some knowledge of diabetes, but very few patients with diabetes.
 
KKL said:
Also to clarify the higher numbers were with Insulin, the lower were when skipping shots. We've only done 1x day due to the super low dose and that 2x day was too much for him.

On the TrueResult meter it appeared he did not need insulin. We only resumed when the ReliOn meter showed high numbers. I am wondering if my ReliOn meter is off.

Now:
TrueResult 158
Relion: 402
Click to expand...

I'm not a super-experienced member and don't feel confident giving a good answer to you regarding your readings with regarding to dosing..skipping shots, 1x day.... Would you mind if I contact a Lantus Advisor to read through this post and take a good look at Harley's SS? I'm sure an Advisor can help shortly...
 
I certainly do not mind you posting to an advisor.

Just to give a background, the vet I am working with is not my "routine visit vet" but the specialist vet that I deal with when things go more awry. She has always been very knowledgeable and honest while helping to keep things as manageable as possible. We have a good working history together and she deals with a lot of diabetics.

Not denial, he went in with a 427 blood sugar and had symptoms-loss of weight, peeing a lot and some hind end weakness-he definitely is diabetic...just to what degree I am not sure. Unforunately, we thought the peeing was our other hyperthyroid cat that we had changed his medication and that Harley's hip arthritis was flared up with the weakness...we didn't realize all the pieces right away until he started losing a lot of weight fast and looking "off".

I am just more concerned that this Relion meter shows higher highs and lower lows than the TrueResult meter. He seemed more "stable" when he wasn't on insulin and/or when we were using the other meter. We never saw 400-500 readings while both on or off insulin. Which begs the question, is the it the meter or the cat. Unfortunately he doesn't travel well and it's a 20+/- minute stressful ride into the vet to get his BG levels tested there. But I might have to do that with both meters to get an idea of which is closer to what their results are.

He is usually only at "dosing range" once in the day, typically in the morning. At any other point he is usually well under 200. She advised me unless he's at 250 or above not to give him insulin because even 0.10 or 0.20 unit shoots him very very low very fast. He does get a low carb wet food 2x day with a spoonful of it as a snack 2x day. Due to his prior health history I am hesitant to add any other food or change things around too much.
 
Hi :)

I've posted over in Lantus for a more experienced members to help. I am literally walking out the door as I type this.

Someone will be here shortly:

I'll check back in a little later.
 
Use the ReliOn Prime, not the True Result meter. The True flattens the swings FOR CATS and isn't showing you anything accurate.

As mentioned, the FDA allows meters to be sold in the US that are within 20% of what a lab test would get. This means that
test -> range where actual value falls
50 --> 40 - 60
100 --> 80 - 120
etc
Here's a graph
Notice how that range gets wider the higher the numbers go? It just means that high is high and the actual number really doesn't matter, you need to take corrective action. So don't get stuck on "numbers" per se.

My signature link Secondary Monitoring Tools provides tips on testing urine ketones and more. Those indicators may support your glucometer results - increased drinking and urination, increased eating, and behavior.
 
Part of the problem is we have 3 cats and 3 litter boxes. One cat is hyperthyroid (on meds). All three drink well, two pee a lot. Who is who, I cannot tell :( They are all discreet pee cats.

But Harley is acting like Harley. Grooming, eating, etc.
 
That's what we will have to do, I feel horrible since it's sheer torture for the guy he damn near has a panic attack and pants with his mouth open the whole way there, especially if I have to do it alone and stuff him in a crate to make the trip. But at least I will know which one gives me more accurate readings.
 
I like the idea of calibrating both meters against the vets although i must say I had a meter that did the same as the true result and kept giving me wonky numbers too.

I do think these high blacks are a result of you skipping the PM shot .... and now that you are giving 0.2IU in the morning and not the night you are messing up the insulin depot and making the issues worse. We look at tons of SS every day and are fairly confident its the lack of shot and not the meter. BUT Every Cat Is Different and we can easily be wrong this time. There could be something else going on or unusual.

So... how about you humour us for a day or two and give the PM shot too and see what happens? But only 0.1IU. It will give us a ton of information either way. If we are right then great! If we are wrong then we look to other issues that might be causing a morning spike

? Deal?

Wendy
 
Sounds good by me...I have been practicing with red fluid and used syringes to perfect the "depress the plunger for one drop" method.

I'll try doing that and see where we go. We only never did the evening because he was always in the 100's. Right now he's at 127.

Funny my wonkier numbers came with the Relion, but is that because the TrueResult was off...only one way to know. I can tell you they are both spot on when he is in range, with both human, sugar cat and civie cat blood. But once you go south of 80 or north of 200 all bets are off and I've gotten some wild numbers.

I'll just keep a close eye on him. He's acting just fine, he actually jumped up on the bed the last two mornings, the last few weeks he would use the night stand to come and go (our bed is very high). I put some "steps" on the other side because I was so worried he'd not make it and spill on the hardwood...so I also put padding down...yep I am that overprotective :)
 
KKL said:
Just to clarify, it's the ReliOn that has yielded significantly higher and lower numbers for me than the TrueResult.

This morning:
ReliOn: 596
TrueResult: 286

The second part of my chart was using only the ReliOn, the first part was using the TrueResult. I am skeptical as to the 400-500+ readings I am getting with the ReliOn. I had ordered their control solution, it hasn't come yet.
Click to expand...
The TRU2GO and TrueResult and also the Freestyle with butterfly strips are all no good.
The Relion meters are all just fine and trustworthy for numbers.

Gayle
 
You havent shot under 200 before right? how is your supply of

1. strips and lancets?
2. Got syrup and/or HC food in the house with gravy?

Are you able to get some night tests in? If not , then save this for a night when you can.

Wendy
 
I could do it now or in an hour (it's 6pm right now). I have lots of lancets, 50 strips, caro, gravy, 20 cans of wet food....I think I am prepared LOL

He was at 120 an hour ago...should I still do the 1 drop aka 0.1 unit?? Seems so scary :)
 
Wait till normal shot time.

Quick question though.. those readings today were with the relion right? And you didnt shoot this morning?

Wendy
 
Sounds silly, but is there a particular regimen I should follow tonight,for the next 12-18 hours? Such as test PM, feed, insulin 0.1, then what times do I retest? Do I give wet food "snacks"? If so, what time?
 
Yes, unless specified TR those are Relion readings.

I usually feed him about 7PM EST. I haven't given any insulin since yesterday morning and it was roughly 0.2+/- unit
 
Crap, I just got a new order so I will be on the road tomorrow morning/afternoon. Should I still shoot tonight the 0.1 unit and hold tomorrow morning depending on his numbers???
 
Ay "fun" will be over by 1am.. can you stay up that long?

If so, at 7pm, test him. If over 200 go ahead and give him 0.1IU and feed as normal. Get a test in 2 hours and let me know.

If under 200 - dont shoot or feed and come back here. Take another test in 30. Based on that we will see if we are going to shoot or not. We will go from there.

Wendy
 
Ok I usually test by 6:45 so I can feed the herd by 7...

He is at 150 with the Relion...
and he is wondering where the #$% his dinner is "Ok Mom, I got poked now where is my meal?" He's galloping up and down the hallway and digging crinkly things out from the trash :)
 
Ok looks like he is on the way up but lets stall 30 minutes to be sure. So wait 30 mins.. no food and no shoot... retest in 30 and let me know

Wendy
 
Ok, VERY interesting, he's now at 182....which normally by now I have fed him and he's on his way down...but he's gone up, which I find interesting...so now what?
 
Now you shoot. Give him the 0.1iu, and feed him dinner. Measure again in 2 hours and Please come back and let me know otherwise I will worry. That +2 will tell us what his plans are for the night.

See you in two hours.

Wendy
 
Shoot before or after he eats...usually I do after, but the way you worded it I just wanted to make sure :)
 
Ok, at 7:45 I fed him and at 7:50 I gave him 0.10 unit (by doing the 'depress the plunger' trick)

So test him again at 10:00?
 
Sounds good! I will "see" you then..

FYI if the number is higher we are good, if its the same or lower we will need more testing to keep an eye on him as it implies an active cycle..
 
OK I fear the pull the plunger might be too small of a drop, but we shall see. He is at 215, which is higher than normal at this time of night...with or without insulin, interesting huh. Let me know what to do next...I can test in another hour or two....
 
He missed two doses so his depot is probably empty and he is using this dose to fill it. Plus he was already on his way up when you shot and of course there may be an impact of food.

Maybe get a +4? I will check on you again then so let me know.

We want to keep doing this dose for a few days unless he drops under 50. 3 days gives the dose a chance to settle..

Tomorrow morning, I won't be around at 7am so same plan as tonite

1. Test, shoot 0.1 if over 150. Feed. Get another test in 2 hours.
2. If under 150, don't shoot, don't feed, wait 30 minutes and retest. Meanwhile post on the tight regulation board for help. Shoot 0.1iu if goes over 150. Again test in 2 hours.

Make sense?

Wendy
 
Okay perfect, thank you!
What do I do if I retest in the am and he's still not over 150? Of course I think he will be...but just incase?
 
It depends. If he has dropped then you probably should skip. If its the same or gone up a little you could wait another 30minutes and retest again as long as it doesn't throw you too much off schedule... Since your next shot is 12 hours after that.

The people on the tight regulation board will be able to help advise. They might have you shoot anyway (if over 100) and just steer the curve with higher carb food. They are pretty good and I will be around by 9am to check on you anyway.

Wendy
 
Alright, he is at 245. I did give him a 1/2 oz of his wet food for his snack. This usually tends to bring it down some if it's higher. Though the drop is probably the smallest dose I've given him yet...I just hope I did it right. We'll have a better picture tomorrow.
 
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