Woody BG!

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Need to sort out some food for my little one. Will be back in a while.

You're doing a phenomenal job with the home testing. :)

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I know I have Caninsulin experience but never having used Novolin I would very much like to see suggestions and comments from other members for MO2F to consider.

@MrWorfMen's Mom, @Chris & China, @manxcat419, @Squalliesmom -

I'd be grateful if you could review my earlier post to see if there is anything out of place in my suggestions for an overall approach to treatment in this situation or whether there is anything better you could suggest to MO2F? I don't feel comfortable being the only person chiming in here.


Mogs
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He got 4 oz of canned w/d at 7:00 this morning. He has had nothing else. I didn't mix any friskies for him. But, he did
Have a very good appetite this morning.
 
Be sure to log when and how much you feed every day. Between the food log and the BG tests you get when you're able to monitor it will give you a much better guide to how Woody's BG might go when you're away from the house.

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I wonder if his increase in food this morning helped keep his BG up and he didn't eat that much yesterday morning when he dropped so hard and fast. But they haven't been eating a lot until today.
 
Critter Mom said:
Novolin is same as Humulin N (different manufacturer).
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Not really true:
Humulin is Eli Lilly's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two. Only N/NPH is OK, but not that good, for cats.
Novolin is Novo Nordisk's trade name for a family of Recombinant DNA origin insulins. They include N (sometimes called NPH), and R (very fast actions) and mixture of the two. Only N/NPH is OK, but not that good, for cats.
Novo Nordisk's Novolin insulin is typically less expensive that Eli Lilly's Humilin
Walmart also the same insulin under there house brand of Relion and it less expensive than Humulin and Novolin
 
I don't have direct experience with anything except Lantus for cats (I do know Novolin in humans, but it doesn't translate across very well I don't think). Your suggestions look good to me - I agree that it's definitely vital to keep Woody running in safe numbers any time he can't be monitored but without losing the overall control. 0.75u could very well be something that would work for him if it can be measured but you'd probably want to try it on at least a couple of cycles where you can monitor before using it on a day when you can't be home with him. I'm sure at least one of us will already have mentioned this, but for all we like to have cats as carefully regulated as possible, you have to be able to survive this too...there are going to be nights where you're too tired to monitor as well as days where you can't be home so finding a safe option for those times is really going to help. It may well be that the 0.5u will be the best option for that for now - so far it doesn't seem to have got him into ideal numbers today, but I'd rather see him run in the 300s when you can't monitor than have the possibility of him getting down to the 20s and 30s when you're not home.

The infection also concerns me - of course it's concerning that it's there and checking for ketones, if you can do it, would really help to make sure it isn't causing him issues there. But given that that is quite possibly making him run higher, there is the possibility as Mogs says that he will drop quickly once it resolves. I'm not sure exactly how you get around that - as you have some physical signs of the infection, monitoring for those to start resolving and knowing you may need to be alert for lower numbers at that point may be the only way of managing it.

If the urine catch is only for testing ketones, would there be any possibility of just sticking a ketone test strip under him when you see him in the litter box? I have been able to do that a few times and it is sometimes easier (and definitely quicker) than any of the other options.

Critter Mom said:
Before I can dish up Saoirse's grub or set out her treatment accoutrements I have to make sure there's absolutely nothing containing any carbohydrates on the same surface.
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I thought it was only me who did that! And if I've cooked anything with onions or garlic or anything else that's bad for cats in it, I can't prepare Rosa's meds or food until every last thing is cleared away, all the surfaces wiped down (even if nothing touched them) and all the pots and dishes in the dishwasher. I'm not sure exactly how I think the onions are going to jump from one side of the kitchen to the other, but I have it in my head I'm going to make her sick if I'm not that careful!
 
Critter Mom said:
If kitty is going too low ([author didn't] like Bunny to be anywhere under 100 [NB: HUMAN METER VALUE - Alphatrak equivalent BG would be HIGHER than this] and [author], personally, [did] not “shoot” under 250 [HUMAN METER - again, Alphatrak equivalent BG would be HIGHER than this]), definitely decrease your dose. [@mrworfmen's mom - any idea on possible Alphatrak guidelines for these thresholds?]
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I knew being anal about this stuff and testing with both human and pet meters would all be worth it at some point;). I just checked my spreadsheets for multiple readings in the 245 - 270 range on a human meter and on my AT meter the range was 365 - 405. So from that I would personally think I'd set the limit about 375 as a no shoot limit on the AT meter if Woody were my guy. I think that still provides a little cushion.
 
Mum of two felines said:
Ok, the 300's aren't too high?
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The composition of cat blood is different from human blood. Most human meters now read plasma equivalent instead of whole blood. Most of a human's glucose is carried in the blood cells whereas a cat carries most of theirs in the plasma so that's why the readings are different. The AT is programmed to count plasma glucose based on cat blood whereas the human meter extrapolates based on human blood composition. So the readings for a cat on a human meter are lower than their actual levels. So while you don't want kitty sitting at 300 all the time on either meter, it's not as "worrisome" a number on a pet meter as it would be on a human meter.
 
I am not aware of anyone using one here but I did see someone selling some strips for it in the supply closet not long ago. I'd expect any differences would be minor between that and the AT....somewhat like no two human meters will ever read exactly the same but they'd be relatively close. You could always do a comparison in the vet's office next time one of the boys has blood drawn.
 
Critter Mom said:
Before I can dish up Saoirse's grub or set out her treatment accoutrements I have to make sure there's absolutely nothing containing any carbohydrates on the same surface. I can't even use the microwave because I need that to warm up the water for her tests or to take the 'chill' off her grub.
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That's not OCD. That's being technically perfect and you are to be commended for your diligence in my books! I have a hot water dispenser but if I needed the microwave I'd probably buy Menace a small one for her birthday.:rolleyes: I'd be lost without mine! :)
 
MrWorfMen's Mom said:
I knew being anal about this stuff and testing with both human and pet meters would all be worth it at some point;). I just checked my spreadsheets for multiple readings in the 245 - 270 range on a human meter and on my AT meter the range was 365 - 405. So from that I would personally think I'd set the limit about 375 as a no shoot limit on the AT meter if Woody were my guy. I think that still provides a little cushion.
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The vet upped his insulin to 15 at 226 at +9:(
 
Mum of two felines said:
The vet upped his insulin to 15 at 226 at +9
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I'm going to have to say it one more time - I don't think your vet has much of a clue how to handle insulin dosing. +9 on Novolin is usually well after nadir and I don't think that number warranted an increase from a single reading like that. Linda, I don't suppose you have comparison figures for your AT for the low 200s by any chance do you? I can get a rough idea with the 30% although I know we can't take that as being accurate, but a real comparison would be good to see.
 
Mum of two felines said:
Ok, the 300's aren't too high?
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The characteristics of the insulin one is using has a huge bearing on the range in which it is safe to keep the cat. With harsh insulins like Novolin and Caninsulin they can drop blood glucose levels very hard so it tends to be necessary to work in higher BG ranges for safety. In comparison, insulins with gentler action (e.g. Lantus, Levemir) they don't tend to produce the steep drops so there is greater opportunity to keep a cat in more tightly regulated numbers.


Mogs
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manxcat419 said:
I'm going to have to say it one more time - I don't think your vet has much of a clue how to handle insulin dosing. +9 on Novolin is usually well after nadir and I don't think that number warranted an increase from a single reading like that. Linda, I don't suppose you have comparison figures for your AT for the low 200s by any chance do you? I can get a rough idea with the 30% although I know we can't take that as being accurate, but a real comparison would be good to see.
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I was being sarcastic :) lol I get myself in trouble sometimes.
 
manxcat419 said:
I'm going to have to say it one more time - I don't think your vet has much of a clue how to handle insulin dosing. +9 on Novolin is usually well after nadir and I don't think that number warranted an increase from a single reading like that. Linda, I don't suppose you have comparison figures for your AT for the low 200s by any chance do you? I can get a rough idea with the 30% although I know we can't take that as being accurate, but a real comparison would be good to see.
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Unfortunately I don't have a lot of lower readings YET but I'll peak at my data and see what I can find. Hopefully if things keep progressing I might start getting some more data in that range in the near future. Fingers crossed!

I have to agree re: the vet. It doesn't appear he knows much and his wife's claim that he researched anything seems very questionable to me.
 
manxcat419 said:
And if I've cooked anything with onions or garlic or anything else that's bad for cats in it, I can't prepare Rosa's meds or food until every last thing is cleared away, all the surfaces wiped down (even if nothing touched them) and all the pots and dishes in the dishwasher. I'm not sure exactly how I think the onions are going to jump from one side of the kitchen to the other, but I have it in my head I'm going to make her sick if I'm not that careful!
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The very same here! :oops:

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Critter Mom said:
I'd be grateful if you could review my earlier post to see if there is anything out of place in my suggestions for an overall approach to treatment in this situation or whether there is anything better you could suggest to MO2F? I don't feel comfortable being the only person chiming in here.
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I don't have any experience with Novolin or any of the faster acting insulins but FWIW, based on what I have learned since joining, I think your recommendations make logical sense and are sound.
 
Thanks for the review, Linda. All I have to offer are general principles, not anything specific to Novolin as I've not used it either. It's even harsher than Caninsulin.
 
Excellent news! Happy dance!
hapydafhf.gif
 
Critter Mom said:
I know I have Caninsulin experience but never having used Novolin I would very much like to see suggestions and comments from other members for MO2F to consider.

@MrWorfMen's Mom, @Chris & China, @manxcat419, @Squalliesmom -

I'd be grateful if you could review my earlier post to see if there is anything out of place in my suggestions for an overall approach to treatment in this situation or whether there is anything better you could suggest to MO2F? I don't feel comfortable being the only person chiming in here.


Mogs
.
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I think you're right on the money, Mogs, it sounds good to me. I know Novolin and Vetsulin aren't exactly the same but they are very similar, and that's probably how I would handle a similar situation, using Vetsulin.

ETA: I will always err on the side of caution. Better to make small mistakes you can recover from rather than HUGE ones that could be irreversable!
 
I can relate to the kitchen OCD. I have pretty much given up coffee because I have to basically clean and disinfect the entire kitchen before I can make a pot. I can't even begin to describe what feeding raw and having it out in the kitchen and handling it does to me!
 
manxcat419 said:
I don't suppose you have comparison figures for your AT for the low 200s by any chance do you?
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I've scoured my data and to my surprise I did have a lot of readings in this range (YEAH! that's good news for me). I guess I pay more attention to my AT numbers and of course I use mmol. so not as attuned the US equivalent on daily basis!

For readings between 198 and 225 on a human meter, my spread of readings on the AT was 274 to 398. Averaged out it's roughly 300-337. I think this gives us a ballpark but it's important to note I had only one or two comparisons for some human reading numbers and a dozen for others so these numbers are certainly not precise.

OF INTERESTING NOTE: Although just supposition at this point........there appears to be a pattern of a higher difference between the readings when Menace is having a very obvious bounce and the AT meter appears to pick this up sooner than the human meter. Same seems to hold true when her numbers have gone lower than her usual. Looks like the AT picks that up a tad earlier too. Got to pay more attention to see if this continues to hold true or is just an anomaly or my imagination. :woot:

Thanks for asking me to do this April. It has been an enlightening exercice!
 
MrWorfMen's Mom said:
OF INTERESTING NOTE: Although just supposition at this point........there appears to be a pattern of a higher difference between the readings when Menace is having a very obvious bounce and the AT meter appears to pick this up sooner than the human meter. Same seems to hold true when her numbers have gone lower than her usual. Looks like the AT picks that up a tad earlier too. Got to pay more attention to see if this continues to hold true or is just an anomaly or my imagination. :woot:
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I know you've written before about exactly how the glucose is measured in various meters, Linda, but PTSD won't let me remember it properly so forgive my following question: Could a difference in the way the Alphatrak meter process the blood sample account for the (apparent) increased sensitivity?

MrWorfMen's Mom said:
Thanks for asking me to do this April. It has been an enlightening exercice!
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That's the trick with data: it only becomes really powerful when finally fathoms out the right questions. ;) (Same goes for the information on the intertube. :rolleyes:)


Mogs
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Critter Mom said:
Could a difference in the way the Alphatrak meter process the blood sample account for the (apparent) increased sensitivity?
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I think that may be the reason or possibly it's because the glucose in a cat's blood is carried mainly in the plasma and most human meters are providing a plasma equivalent by doing some computations based on the whole blood human sample where the majority of glucose is in the red blood cells. The AT meters are simply old human meters with new programming so if the meter is still providing a plasma equivalent reading (and I think this is a safe assumption given we think the strips are same as the FS strips and they work in the AT meter) could it be that the cat's ratio of blood cell glucose goes up before it's plasma level and this is being accounted for by the algorithm in the AT meter in such a way as to make the increase look more apparent. Just a guess!

I'm going to pay more attention to this and see if the trend continues. Menace doesn't have seriously pronounced bounces but as I went through the numbers I noticed a few times when I had multiple comparisons that the difference between the meters was more apparent when her numbers were on the way up or down. For example at a reading of 11.8mmol (212 US), I had readings from 15.6 (281 US) up to 19.7 (355 US) with the majority being in the 18's (324 - 338 US). Happened to notice a notation regarding thinking she was bouncing and the lights came on. It would be really interesting to be able to test a cat on one of the faster acting insulins where there are more dramatic changes in BG throughout a cycle to see if that showed any similar trend.
 
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