Depressing

I have been thinking about posting for the past few days but the whole situation over here has me feeling pretty down. Wilson is very unhappy here and I don't see any way to change things for the better. He does NOT like to live with dogs, he does NOT like the coming and going of new cats all the time (I do cat rescue). He's stressed, unhappy, tense, and I don't see any way to remedy this since he is not exactly an adoptable cat.

He's definitely dog aggressive and will actually burst out from under a chair, or jump up from the couch, etc., just to run after the dog and slash at his rear legs. The dog gives him a wide berth but Wilson is constantly on the offensive. This isn't cool for all of the obvious reasons but topping it off is the fact that my dog is getting older and was recently diagnosed with liver failure. Awesome, right? After Wilson gets all hot and bothered about the existence of the dog, he will occasionally pick a smack-fight with one of the other cats. There are two other cats that live here, and I have one extra right now who is looking for a home. Wilson is aggressive towards this extra cat as well.

So what to do? Try to find a home for a grumpy (but often loving) diabetic cat....

Wilson is holding steady

And there is (therefore) not much to report. I actually haven't even written his numbers down though they are stored in his BG meter. He is on 2-3 units a day and I consistently get pre-shots in the 200s. We've had little wobbles in his numbers--a few days of numbers in the 300-400 range led me to take him to work for a urine culture--but it is actually quite consistent as long as there are no illegal activities undertaken like ripping open the dog's dry food bag or scarfing down some unattended pasta (why, Wilson, why???).

I should copy down his numbers at some point ... it's on my to-do list...

Insulin needs are lessening ...

But true to the caveat in the Rand protocol, if you back off too much at first you will mess up the process.


8/5
7:21a 105, 2u
8:25p 83, 1.75u
8/6
6:54a 133, 2u
7:57p 127, 1.5u
8/7
8:19a 306, 2.5u
9:48p 234, 2.5u

Major annoyance

I just realized now that my Elite has the wrong date and time setting. Sigh.

Last night his BG was 86 @ +12 (dinnertime). I tested again and it was 104 @ +15. So I left it alone... Since I took it 3 hrs after his meal, I wanted to see what would happen without insulin.

This morning, of course, his BG was 310. Gave 3u.
This evening 195, gave 2.5u

I just heard from two other lantus users that their cats also got a duration that was over 12 hrs but less than 24. . . .

The week in review

Not that the week is over yet, but whatever.

For the meter comparison thing that I'm doing, I had been keeping my Elite at work so Monday I still used the mini:
7/30/07
7:00am 72
8:00am 162, 2u
8:25pm 130, 2u
10:38pm 146

7/31
7:23am 215
8:51am 257, 3u
Brought home my elite from work:
9:40pm 249 (by Elite), 3u

8/1
5:43am 233 (Elite)
8:30am, didn't retest, shot 3u
8:31pm 59 (Elite)
10:17pm 72 (Elite)
1:00am 162 by mini b/c the Elite is apparently out of batteries (aargh), 1.5u

8/2/07
9:27am 206, 2.25u
Got more batteries for the Elite. Actually have just stolen them from my old Contour whose inaccuracy makes it worthless (to me)


stay tuned.

Lantus has apparently settled (or something)

The following numbers and my insulin-amount decisions may make me look crazy. Whatever my decisions or results were, I STRONGLY and VEHEMENTLY advise against using them as a guide to how to treat any other diabetic cat. Got it? Ok here goes:

7/26
8:27am 52! FED, ate well
9:00am 65 FED MORE, ate well (he always eats well)
9:24am 87, 2u
Yup, I gave him 2u at that number. It's dangerous to do that so I strongly advise against it. However there was someone that was going to be home all day with him and feed him and observe him.
8:14pm 304, 3u
Ah, the effects of gluttony and/or mild rebound. He was fed only low-carb (less than 9%) wet food but he did have quite a bit of it. And he got four little greenies.

7/27
6:11am 236, 3u
4:49pm 245, 3u
Shooting early was a stupid thing to do, esp. given the events the previous day. Lesson learned:
12:00am 50! FED, ate marvelously
12:31am 63 FED, ate well
1:00am 75 Left food out and went to sleep

7/28
5:30am 119
10:15am 204, 2.75u Trying to get him back towards his 8am/8pm schedule
5:24pm 188
10:20pm 156, 2.75u
12:45am 164

7/29
8:00am 244, 2.5u
8:16pm 157, 2.5u

Notes for this week are a lessening of his pu and I also note that I just can't afford all of the OTU strips. Since his ears have learned to bleed better and my tests at work continue to show the Elite to be the most accurate, I am switching back.

UPdate

Ok, I can't figure out why it's so hard to write new entries; the letters don't appear on the screen immediately, I type away but the text doesn't follow it, the words appear in chunks. This is really, really annoying but I tried all of the little things I know that could have fixed it and none of them work so I hereby blame it on blogspot. I knew I should have started this blog on wordpress.com :( Oh well.

Ok, last number I mentioned was the 7/19 shot where the +8 was 287 (ick). I said was going to try to keep at two you before moving up, but I was unable to resist and did 3U that night. These numbers are all with the OTU mini which I was using because I couldn't get enough blood sometimes for my favorite meter, the Elite XL. I am also using a new cartridge of Lantus.

Here are my updated numbers:
7/19
8:33am 274, 2u
+8 = 287
8:41pm 254, 3u
[I know, I should have done just a half unit increase but I couldn't help myself; I felt like he was going to fall into DKA if he was really spending all that time in the high 200s!]

7/20
8am 166, 3u
7:30pm 250, 3u

7/21
8:48am 282, 3u
7:45pm 232, 3u

My notes for that past week: mild pu, behaviorally +++ -- playful, affectionate, etc.

7/22
7:55am 248, 3u
7:45pm 270, 3u

In my limited experience, Lantus takes a bit of time at the same dosage to show progress so I am holding steady here.

7/23
7:25am 239, 3u
8:25pm 265, 3u

7/24
8:40am 250, 3u
8:57pm 179, 3u

7/25
7:57am 254, 3u
7:30pm 210, 3u

Made some changes, got some better numbers

Although my nerd-scientist self would have prefered to make one change at a time to calculate its effect, my scared-of-DKA self kicked me in the ass and forced me to implement a whole new plan in order to get him out of the danger zone he was in with those 400s. So I made three changes:
1--restricted feeding and treats. I was using a lot of treats in attempts to get him used to the testing/shooting process; now, the food reward is his own post-test meal. He is fed a fixed amount, twice a day, and eats it all within a half hour. I *had* been giving him large amounts of food to both offset the food-thievery of his feline housemates and to have some extra on hand in case he went low, BG-wise, since I have worked crazy hours in the past month or so.
2--opened a new vial of lantus in case my current bottle was crapped out. It doesn't appear to be, visualy, but even so.
3--changed from a sliding scale to a fixed 2u dose. It's conservative in case the first two changes make a huge difference, and also to address the possibility tht the former craziness was caused by rebound.

Results so far??
Tuesday 7/17 8am 292, 2u from fresh Lantus bottle
9:44pm (late because of work) 426, 2u
Wednesday 7/18 8:22am 253, 2u
8pm 219, 2u
Thursday 7/19 8:33am 274, 2u
+8 = 287

It is so very tempting to move up to 3u but I will hang in there for a few days at least. I also plan to get a urine reading if at all possible.

One other note: I am using the OTU mini now. Again, I like the Elite the best and it is the most accurate IMO but since Wilson is somewhat resistant to testing and it requires the most blood (2x the amt of the mini, and 3x the amt of the contour), I have switched to the mini to save some angst and time.

Quick numbers update from the past week

Again, fluctuations in times of shots are due to work.

7/9/07
7am 266, 3.5u
7:40pm 141, 2u

7/10/07
8am 501, 4.5u
10:20pm 226, 3.5u

7/11/07
8:25am 273, 3.5u
8pm 443, 4.5u

7/12/07
7:30am 389, 4u
9pm 424, 4.5u

7/13/07

8am 228, 3.5u
6pm 318, 4u

7/14/07
7:20am 436, 4.5u
7pm 244, 3.5u

7/15/07
7:40am 286, 3.5u
8pm 403, 4u

7/16/07
7am 254, 3.5u
8:30pm 265, 3.5u
+3 390!!!!!!
+4 399!!!!!!

7/17/07
8am 292.
Pulling hair out now, dunno what to do.

Back after a forced hiatus

Ugh, computer was messed up and then internet was down completely. The worrds are coming up super slow as I'm typing, so this doesn't bode so well either. AARGH. hang in there, I have stuff to report, I'm still trying to fix this thing. If not, that tremendous CRASH noise you hear will be my computer hitting the sidewalk outside.

Starting a TR protocol

I've decided to start Dr. Rand's tight regulation protocol for Lantus. It's written out here. More info to come later.


PS Wilson is so CUTE! Check out the gianormous paws!

Diabetes accessories that I like

First, the most accurate meter I've tried is the Ascencia/Bayer Elite XL. But it takes a ton of blood, hence me trying out the Contour. We'll see how that goes.

Other stuff: the little lancet devices that come as part of the meter kits usualy work pretty well. The one that comes with the mini is quite compact and uncomplicated and I like it. I also use the microlet lancet thing that comes with Bayer meters. I haven't found any differences in the lancets themselves so I usually buy the cheapest ones.

The best place online to order from, price-wise, is usually Hocks.com. The best urine strips are the Keto-Diastix which measure urine glucose and ketones. The syringes I like to use for my U-100 insulin (all insulins are U-100 except for PZI and Vetsulin, both of which are animal-specific insulins) are the short-needled, 3/10cc syringes with half unit markings. Since most cats receive just a few units of insulin at a time, these syringes are worth getting because they make those small measurements a little easier.

For testing the ear, I use these cheap cotton squares. I fold one and put it on the other side of the ear so that I don't poke myself accidentally and also because it gives me something to press the ear against. The cheapo brand that I use isn't good enough to use for removing makeup or anything but it is perfect for ear testing.

Another thing I do is put my insulin bottles in pill vials like this:


so that I can't drop and break them. I wrap the bottle in one or two of the aforementioned cotton squares:

Pre-shot BGs in the 300s

Sigh. I am pretty sure that the main problem here is that I am not shooting on a regular schedule. That should straighten out, though, since my work schedule has changed.

This morning I gave him his shot late, at +15 rather than +12, and he was OVER 500. So I have to work well within the overlap in order to keep him at good numbers. I feel really bad that I have been doing such a lousy job.

Wilson and I got in a huge argument last night

:(
He's been high for the past two days and it seems to make him a bit grouchy. He became very irritated when I started our ear-pokey routine and despite treats (he looooooves treats) and happy talk we ended up having a wrestle. I wasn't willing to wait to give him his shot because not only was I super tired but he seems to really skyrocket if his shot is delayed and with all these high numbers I'm afraid of him developing ketones. So we argued, I got a 344 and gave 3u Lantus and 1u R.

Amazingly, this morning he's been a real snugglebear ... of course, I haven't attempted to test him yet, but I'm hopeful that he is feeling much better and will be much less naughty. *fingers crossed*

+9 BG=395 (Elite), 3u Lantus, 2u R

Because I am tired of this hyperglycemia, and I'll be home all day, I didn't wait till +12 and I am giving a bigger dose of R.

The BG was 379 on the Contour2 and 440 on the Mini.

I think Wilson has been such a grouchy little SOB because he feels crappy when he's so high. Hopefully this will push him back into sweetiepie territory. Already, he seems to be a bit brighter today.

AM BG=425 (Elite), 3u Lantus, 1u R

It was 425 on the Elite, 451 on the Contour2, and 531 on the Mini. When it gets to be this high, I don't know if those differences actually matter :(

Yup, last night was a total fur shot

Even though I don't see how it happened. I took a BG when I got up this morning at +10 (from the shot-that-should-have-been) and it was 575 on the Elite :( UGH. It was 529 on the Contour2 (I have a more recent model that I have started testing) and HI on the Mini.

I gave him 1u R and 3u of Lantus. I tested again 5.5 hours later and got 240 on the Elite. I gave 1/2u R. I'll test again at midnight, 12hrs after the first R booster.

In other news, I have used the lancet device that comes with the Mini and I kinda like it.

Meter comparison/review

I am going to chuck the Ascensia Contour. The Ascensia Elite XL that I have is awesome, and incredibly accurate. I have tested it dozens of times against the lab machines through work and it is reliably accurate. Unfortunately, it requires a much larger blood sample than the Contour. The OTU requires a sample that is in-between sizes. Since the Contour is a Bayer meter as well, I thought that it would be just as good and have the additional benefit of requiring a mere speck of blood. Not so, it sucks. It seems to read somewhat accurately at really high numbers (300s) but anything under 150, it reads a good 30-50 points lower than the OTU and Elite. I can't say this is true of all Contours or if I have a bum one. I may just get another one and test that one since I'd like to think that Bayer kept up the quality somewhat with their meters!

So, here is my BG reading comparisons. These are all within the past week from animals at work. Most animals were not diabetic and these are all using venous blood. When possible, I compared the BG meters to one of our lab machines called an i-Stat, using it as a gold standard. It measures blood electrolytes, blood gases, and pH. I tested an OTU-2 (the newest version), OTU Mini, Elite, and Contour. Results:
OTU-2/Mini/Elite/Contour/i-Stat
54/59/60/35/X
74/76/75/44/84
76/79/81/X/X
75/78/81/X/93
X/121/108/83/X
143/155/139/116/154
211/229/200/179/X

I actually have a re-designed Contour, a more recent model than the one I was testing, so I am going to bust that one out and continue testing. I'll keep you posted ...

AM BG=331 on OTU mini, gave 3u, FUR SHOT??

Okay, I'm upping the dose because I am tired of seeing pre-shot numbers in the 300s. I was trying to stick to his vet's advice but I'm getting stressed about this. Wilson was also real stinker tonight about his test & his shot :( I'd like to do a curve tomorrow but don't know if I should ... some more behavior mod may be in order first. On the other hand, I REALLY need to know what is going on with his BG during the day. Is the lantus is keeping him in euglycemic or near euglycemic range for the vast majority of the day?

Dammit, I may have given a fur shot. I would swear that I didn't--I drew back before shooting and didn't pull back any air so I know I was under the skin, and he didn't move so I dont' think it was yanked out at the last minute, but I just pet him and there was a teensy wet spot on his back and it smells like insulin. Aaarrgh. Did I mention that he has been a real punk about being tested? I am not sure what to do. I wish I didn't have two other household wolverine-cats who stuff themselves with his food, so that I could at least give him another token dose before bed and just leave lots of food out in case he feels low.

How annoying :(

Re-tested 2 hrs later, 237/225, 2.5u

6/19 +10=446 (!). Gave 2.5u
6/20 AM BG=163/143, gave 2u
6/20 PM BG=351/393, gave 2.5u
6/21 AM BG=337 on the OTU mini I just got. Wilson was not being a good boy and I was unable to get more blood so I went with this. Gave 2.5u.
6/21 PM BG=371, gave 2.5u