Robby's BG curve

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maggie

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Hi, this is my first post. My cat Robby (brown tabby, 7 yrs old) was diagnosed with diabetis in late November. The vet told me to administer 2 units of Lantus insulin twice a day. A week later Robby became very sick, not eating, not drinking, not peeing or defecating. I became alarmed one night and took him to the emergency clinic. He stayed there for 3 days and regained his normal functions. Since then he has had occasinal diarrhea and vomiting but otherwise seems fine. His insuline has been reduced to one unit twice a day.
From the beginning my vet has encouraged me to do a BG curve on Robby, but I only got the courage to start doing it yesterday. I used a One Touch Ultra 2 glucometer and a Terumo sterile needle to prick his ear. I should have done the first test at 5:30 AM before his first insulin injection but unfortunatly I only got the courage to start testing at 3:30 PM and continued the testing today. It actually was not as bad as I thought, though Robby clearly does not approve of being pricked in the ear :smile:
I live in Canada and my readings are in mmol/L. These were my readings so far: Yesterday: 3:30 PM - 18 mmol/L (nibbling @ his food prior to testing); 5:30 PM - 17.7 mmol/L (food & insulin after testing) Today: 5:30 AM - 17.6 mmol/L (food & insulin after testing); 7:30 AM - 16.2 mmol/L; 9:30 AM - 17.4 mmol/L. To complete the curve I am planning to do 2 more testings today, at 11:30 AM and 1:30 PM. But I am concerned because the numbers seem to be very high. Maybe stress from the unusual prick in the ear might have played a role? Also, I have another cat and normally leave food out for both of them to nibble during the day. I know that's not good for diabetic cats. Also, Robby recently had some diarrhea and vomitting and is currently taking Tylosin 50mg and Purina Forti Flora with his food. Could this effect his readings? Thank you for any advice or suggestinons,
 
Yeah for you for testing and what a great vet to actually support it. That is rare. So you are going in the right direction. 1 u 2x daily (that is known as BID) is widely considered to be the best place to start. One thing you have to understand is that patience is necessary (easier said than done, I know).

Since they reduced the dose, it sounds like it was definitely a hypo situation? The blood sugar went too low? How long ago was this? For the most part, you are just going to have to keep getting numbers for now. There is a great google docs spreadsheet template in the tech section that you can start using. It really helps you visually see what is going on (I need to update mine! It was a busy week.) Leaving food out is fine, but leaving *dry* food out could be keeping your cat's numbers high. What do you feed? Have you read about wet and dry food yet?

Just keep getting those numbers. On the prick part, I know I like using the lancet device better because I think it is less painful. A lot of people freehand, but I find it hard and that I am too slow. So you might consider trying that.

One last thing is that we find it is easier because of the different time zones, to post numbers like this (XXX=blood glucose reading):

AM pre-shot XXX (right before feeding and shot) Amount of insulin (i.e. 1u)
+2 (meaning two hours later) XXX
+4 (meaning four hours after shot) XXXX
+6 XXX
+8 XXX
+10 XXX
PM pre-shot XXX 1u
+2 XXX
+4 XXX
+6 XXX etc

Try formatting your numbers this way. You can see what is going on much more easily.

This is a two hour curve (readings every two hours) you could probably do a 3 or 4 hour curve and it will be just as good. Or, even get a +2 +5 +7 +10. Just so it is throughout the day. So don't get worried if you haven't gotten zap on the 2 hour spot. One thing with lantus and levemir, we find that it is very important to try to give shots as exactly close to 12 hours apart as possible. Because of the nature of the insulin, that is really most effective. YOu can learn more about that later. I think you have enough on your plate right now!
 
You can convert your "Canadian" numbers to a format that most of the people on this board use by multiplying them by 18. In my experience, using Tylosin and Fortiflora don't affect BG values, but if there is an illness present which is causing diarrhea and vomiting, that could. Also, as Karen mentioned, food plays a large role. Please keep posting. There are a lot of new people coming on board, so it may take a while for people to read everyone's new threads.
 
Okay, your numbers are telling a pretty typical story for a newly-diagnosed cat.

That 'curve' is basically high and basically flat, at about 305 for our American friends.

There are a few possible reasons for this lack of response, all of them pretty common in a new diabetic kitty.

1. You're feeding too much carbohydrate in your food, or your cat is eating treats or other cats' food. See Janet & Binky's Non-US foods list and look for something lower-carb. Even your vet's prescription food is not likely to be a winner, so check the list carefully. About 10% calories from carbohydrate or less on this list will help a lot. There are few or no 'dry' foods that will help, so you will quickly see you need to move away from them. See http://www.catinfo.org/ by Dr. Lisa Pierson to see how to transition.

2. 1 unit of Lantus twice a day might be too much

3. 1 unit twice a day might be too little.

However, 1 unit twice a day is just about right for an unknown food, so it's best to begin with the change of food and then move to this lovely Lantus protocol for fixing the dose:

http://tillydiabetes.net/en_6_protocol2.htm

Expect things to improve over the next 2-3 weeks if you do all this, and welcome to the FDMB!

Cheers,
Steve
 
Thank you everyone for all the information and advice! I obviously have a lot to learn. I have added the websites you suggested to my favourites and will look into the food question. Robby is pretty picky with his food and the last time I changed his eating habits he became really sick and stopped eating and drinking altogether. Now he seems pretty happy with his food; he's having Purina's DM dry food to nibble during the day and Hill's i/d prescription diet (cans) in the morning and evening with his insuline. I'm happy that he's not drinking the unbelievable amounts of water that he used to drink and has already began to gain some weight (he had lost a lot prior to diagnosis). I'll keep you posted on how things evolve. Thanks again.
 
Sounds like you have some of the stuff already in hand...........good for you


Welcome to our FDMB family and be patient with yourself. You sound like you really love your cats, so you have come to the perfect place. Get some chocolate, sit back and get ready to read. Also, remember Every Cat Is Different. (ECID) Also, remember opinions may vary sometimes on this board, so you may get different views. Unfortunately, that is human nature.
Sorry this is very long, but there is a lot to say! Also, remember we were ALL newbies once and are feeling just like you are right now! :) OK……..breathe………. :RAHCAT

This disease is very manageable and by no means a death sentence. There is just some learning we all had to do. You do not need any type of prescription food or “special” diabetic food. Janet & Binky’s chart is on the top of this page! Low carb is best for diabetics. I try to stay around 10% or under. I feed Whiskas, 9-Lives and mostly Friskies. If you are giving a high dose of insulin and feeding dry, be careful with switching to canned food. You MUST reduce the insulin at the same time you switch to canned food.

Please create a profile if you have not already done so. It will help us to help you. We need to know what kind of insulin you are on, what needles you are using (U-40 or U-100), what are you feeding, how much insulin you are giving and when, BG test results, etc. There are many people on this board from all over the world, so it will be helpful to know what area and time zone you are in. ~O)

Remember that your cat is YOUR cat, and YOU are paying your VET to help you take care of him; diabetes was probably a day or two worth of notes when the vet was in college; it is probably NOT a day-to-day existence with his own cat trying to maintain a quality of life. Sorry to say, but I would have overdosed my guys on insulin if I followed my vet's advice. Vets, unfortunately are not as knowledgeable as they should be on diabetes.

Sometimes, as I did, you have to take a leap of faith and trust these people on this board who deal with diabetes day in and day out. Trust me. You will not be disappointed. OK………..breathe again……….get some chocolate…….. cat_pet_icon

Also, please realize that it takes insulin about a week to settle. START LOW AND GO SLOW!! The usual starting dose from our experiences is 1u twice a day for at least a week. Insulin in cats is NOT and I repeat NOT based on weight. This is a misconception that a lot of us have gotten from our vets here. pc_work

You have to be patient, as I also had to learn!! Do not adjust the dose upwards based on one test. Don’t freak out based on one test result. As long as the levels stay on the high side, keep the same dose twice a day for at least the initial week period and you should see improvements. When you have some time (hee hee), read my profile.

If you are not hometesting already, you really need to start!! Hometesting is VERY important. Think of it as a human diabetic does. *If it were you or a child of yours, you'd be testing blood glucose levels at home prior to each shot; you'd be working with your doctor to determine a proper dose based on those shot results, correct?* Some vets do not agree with hometesting and I cannot for the life of me understand why. Most vets, sadly are not knowledgeable enough in feline diabetes. Insulin is a VERY powerful drug and you NEED to hometest before giving a shot. This is very important. The vet would rather have you bring the cat to them, stress it out more, which may spike the levels anyway and then they can charge you $$. Hometesting saved me a lot of money and it is VERY important for you personally to know the cat’s levels and how it is reacting to the insulin before you shoot so you do not pass up your ideal dosage.
Thanks to everyone's help here I learned to home test 2 cats and they both got off insulin within 3 weeks with diet change…but of course, they reacting both DIFFERENTLY with the process. If I can do it with 2 cats twice a day (and more on curve days), ANYONE can do it. It does NOT hurt them as much as you think it does. It just stings for a moment and then it is gone, you can try it on yourself. Also, put pressure on the ear after poking and it should minimize the nub. They won't mind it once they start feeling better. I use the True Track meter (CVS or Walgreens brand) which I love. And, the strips are also reasonable. Also, remember to give them a treat after the test. Here is a link to a member videos on hometesting:

http://www.youtube.com/watch?v=_zE12-4fVn8
http://www.youtube.com/watch?v=cZ6iXetR398

I would not feed DRY food if at all possible. Of course, it is better than nothing – you MUST get them to eat if you are giving insulin, but if there is any chance, get them off the dry. I took my guys off dry and within a month they were off insulin. Again, remember that switching from dry to wet can cause a drop in blood sugars, so you MUST reduce insulin at the same time to make sure you are not giving too much insulin. I truly believe also that I saved some of my many others from developing diabetes. I also saved so, so much money changing them all to regular canned cat food.
When Blackie and Jackie got diagnosed, I was afraid to start shots. The people on this board made me realize it was no big deal. (They went on PZI insulin around 3-25-06 and went off on 4-18-06! :) Please also realize that diet plays a BIG, BIG part in insulin needs. I switched my cats off dry food to all wet and I was never so happy. It was a challenge to try to regulate 2 cats at once.


Welcome to the Sugar Dance. flip_cat
Welcome to the Vampire Club.

If I can do it, ANYONE can!!!
It does get easier. Trust us.

You need to test BEFORE you shoot. It usually goes: Test, Feed, Shoot



There's a saying something like "better the sugar level is too high for a day than too low for a minute".
 
Hi Maggie

Where in Canada are you? There's lots of us Canucks on this board...personally, I'm in Calgary...

Jen
 
Jen, I live in Toronto. Next time I test Robby I'll try the lancet device instead of the Terumo needle. Can anyone tell me what number I should use? Maybe 2 or 3 ? Robby really trusts me but he's very timid and scared. I'm at work right now so I'll leave my other questions for later. I'm really happy to have found your group :smile:
 
GTA Folks?

THere are lots of folks in GTA and I'll try to flag this post for you

Defintely use a lancet device; for some people (me included) it is way easier and there is less hesitation. And I much prefer ears vs feet for various reasons including sensitivity, hygiene, etc.

Don't project fear or worry as your Robby will catch it...pretend you are a matter of fact vet....
 
Well, I don't know if it's OK to mention his actual name here. But that name is similar to my vets name, his office is on Queen Street East in the Beaches.
 
ok, i was asking cuz my vet mentioned a client with a diabetic kitty and I was hoping she would find this board.

either way - welcome to the FDMB!!

there's about 4 of us here in Toronto (that I know of) I'm in the west end -
if u need any help I don't mind helping out - u can send me a private message (PM) if u like.

I think there is someone else closer to u - she was on this morning.

let us know if we can help ok?
 
Hi Maggie,
I am also in TO, but I am right downtown, by Bloor and Yonge, so you have plenty of people around who can help you with guidance and assistance.

Welcome to the site.
 
Hi Maggie, welcome to the FDMB! Ronnie told me to come take a peek in, I'm downtown on Queen West not too far from you.

From what I am gathering, you are feeding dry food which you want to stop doing and there's alternatives to the Vet Brands of food that, Steve gave you a link to Janet & Binky's guide so take a look at that. My kitty eats Fancy Feast and it's working great for him (though by his weight, it's costly since those tins are so teeny!). If you can get both cats eating wet food, it'll make it easier on you.

If you need any help, send me a PM or Ronnie who will hunt me down!
 
Please remember if you remove the dry food from kitty's diet his BG #'s *could* drop drastically (my Bubs dropped almost 100 points, just with diet change alone) . Please always test before EVERY dose of insulin.

Jeanne
 
Hey Maggie -- just a quick note to help with something that a lot of people take some time to absorb.

Diabetes is *all* about diet. Some feline diets, like "light" or "low ash" diets, have dubious or unproven benefits to the cat. The burden on the cat food companies to actually prove their efficacy is very light, and in general it's hit or miss.

But with diabetes, you *will* have to become an expert to some extent on feline diet, which means you'll start learning which cat foods are really good for cats and which just claim to be, on the basis of actual ingredients and actual feline nutritional requirements. You'll find that vets actually don't know these things, mostly, since they are for the most part educated by pet food companies, who of course have an interest in their bottom line. Not evil, just not really motivated to give kitties what they need most.

So when we're talking about which diet we feed like it matters, it's because it really truly does, more than for any other condition your cat might have. And we're all pretty much in agreement that what matters is not if the food is 'natural' or 'organic' or 'low ash' or 'prescription' or even 'vet recommended'. What matters is that it be very low in carbohydrates, which raise blood sugar dramatically in cats.

When you switch to a lower-carb food the effect you'll see in blood sugar readings will be immediate (within hours) and in most cases dramatic. Usually not dramatic enough to let you stop insulin altogether, but certainly likely to lower the dose. Gia and Quirk were here when this was first shown and it was apparently a huge revelation.

More on feline diabetic diet (and baseline feline diet, which turns out to be about the same) at http://www.catinfo.org/ And please check the foods you're feeding on Janet's list I linked to above, stop feeding all the ones higher than 10% calories from carbohydrates, and watch blood sugar carefully as you do. If it starts to drop below about 4.5 on your scale, start reducing that insulin dose!

Keep reading and learning and you'll see for yourself!

Best regards,
Steve
 
To my fellow Torontonians I want to say that I live in the East end in the Main & Danforth area.I came to this website because I met someone at the vet who mentioned your group to me. This person was also kind enough to give me her name and phone number in case I needed help. So thank to her and to you all!
Now I have a lot of work ahead of me. I have to update my profile with all the relevant info, think about the food question, set up a spreadsheet from google docs (and try to understand what all the column headings mean), read the Lantus protocol website, re-read your tech page etc. By this weekend I hope to have made some progress and I'll let you know.
 
Hi and welcome! I was very hesitant about testing Rascal at first, and he never has learned to like it, but he does tolerate it quite well. The only time he seemed to become annoyed was when I was having difficulties getting a good drop of blood and he was getting tired of all my attempts. Check out youtube for some good videos of how it's done. I sit on the floor with him and wrap my legs around him to hold him still and try to get a drop on the first prick so he can leave quickly.
And I try to remember to give him a little treat after for being such a good boy.

Rascal has been OTJ (off the juice) for almost a year now - but I remember some pretty harrowing times when he was on it - I was so scared I was going to screw it up! Fortunately, he's a fairly patient kitty and things got easier as we went along.

I'm up in Vaughan, btw - not far from Canada's Wonderland.
 
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