New Diagnosis, I'm massacring my kitty's ears and need bg curve advice

Status
Not open for further replies.
Martha and Lolly (GA)

Martha and Lolly (GA)

Member Since 2015
Hi Lolly was dx'd two weeks ago, I've started trying to get bg curves. My vet is trying a tightly regulated protocol with Lantus that is supposed to help the cat into remission.

I'm not having trouble with the insulin injections, but I'm having trouble with lancing. I've been trying to hit the ear capillary, and each time I either miss and get nothing or I get a huge blob. And the capillary shows a huge blood spread/bruise. I am hating this! Is the lancet supposed to go all the way through? I can't seem to get blood without it going through.

Two kind people have suggested I use a sock with rice warmed in the microwave, as well as getting a lancing device. I have the alpha track 2, and their lancing device did not work for me at all.

I tried two curves last weekend, but the numbers were wildly inconsistent. I don't feel like I'm getting the best info out of my vet, but I tried two other vets, and they both told me to just give insulin shots twice a day and get fructosamines at the office. They said that feline BG values are "all over the map" and can't really be regulated. This doesn't make sense to me, so I am with a vet who wants to regulate, but she even told me she hasn't done it before, as no client wanted to. So here are some questions:

- When I do a curve over 12 hrs, when should I feed her? My vet said to free feed, but how I can a determine the nadir then?

-Should I feed, do bg test, then do insulin, continue every 3 hrs with bg tests, and not feed till final bg test (12 hrs later) then feed, and give night insulin?

-Or feed midway and somehow account for it? Normally she eats at 7am and 4:30pm.


Thanks for any help from still in shock cat mom
 
Aim for a spot between the edge of the ear and the vein which runs just inside the edge.
Test, feed, and shoot within about 15 minutes, if the pre-shot test is over 200 mg/dL on a human glucometer (230 mg/dL on an AlphaTrak).
Its OK to let her graze for up to 10 hours after the shot.
Pick up the food 2 hours before the next pre-shot test (if all is going well) so you get a number not influenced by food.
Some folks feed mini-meals to reduce meal spikes. A timed feeder such as the PetSafe 5 may be helpful if your cat scarfs. Or, you can freeze part of the food to be eaten as it thaws.
Nadir means lowest glucose post-shot. It often happens in the +5 to +7 hours after injection.
See my signature link Glucometer Notes for some feline reference ranges when using a human glucometer.
See the link Secondary Monitoring Tools for some additional assessments you may wish to make, such as dehydration checks and urine ketone testing.
 
Last edited:
Don't worry about Lolly's ears they will recover. My cat remi 's looked terrible for the first few weeks but they would actually heal up within one or two days. After you prick the ear and get the blood are you holding some cotton wool to the spot? By applying pressure straight away it can prevent the blood travelling in the ear and so no bruise. Make sure you alternate the spot/ear. I was able to do it both on top or the ear and on the inside but it took a few weeks to get it right. Just keep trying, it does get easier.

Have you set up a spreadsheet yet? It is a great way or keeping track of your kitties blood glucose results and a way or allowing other members to see what is happening.
http://www.felinediabetes.com/FDMB/...te-a-ss-and-link-it-in-your-signature.130337/

With regards feeding I split remi's food up into small mini meals as it is better for his pancreas and helping even out the blood glucose levels. As BJM said I didn't feed two hours before the next insulin shot because I didn't want the the blood glucose result to be influenced by food. Then as long as the test result was not too low I would go ahead and feed a small meal and then give the insulin. Then I would take at least one other test during the early part of the cycle to check remi wasn't falling too low and if need be up the testing.

During the cycle I would feed at shot time, + 2, +4 and +6. And then repeat in the evening cycle.

To answer your question when I was doing a curve I would do this (just my experience not any sort of definitive way or dosing it). Food is meant to affect the blood glucose for 2 hours so I would feed straight after a test and then wait 2 hours).

Am cycle
Test, feed, insulin
+2 hours- test and feed again
+4 hours- test and feed again
+6 hours- test and feed again
+8 hours-test
+10 hours -test
+11 hours - test

I would get too caught up in doing lots of cycles. I would say it is equally as important to get in those daily readings. So each day you always do a preshot reading and then at least one other during the cycle. Over a few days this data can help to fill in a lot of info. Then do a curve when you can.

Lolly has been prescribed lantus hasn't she? If you are changing food to a low carb one it is very important to regularly test and the amount of insulin may drop dramatically.
 
Last edited:
BJM said:
Test, feed, and shoot within about 15 minutes, if the pre-shot test is over 200 mg/dL on a human glucometer (230 mg/dL on an AlphaTrak).
Its OK to let her graze for up to 10 hours after the shot.
Pick up the food 2 hours before the next pre-shot test (if all is going well) so you get a number not influenced by food.
Click to expand...

Yep,
Ideally, a curve should give you a picture of what's going on in a typical day. So, if you normally let your cat free-feed, it's fine to do that throughout the day of the curve.
But it's helpful to pick up the food a couple of hours before the pre-shot test so that the pre-shot test isn't influenced by food if possible.

Doing a curve can help you to understand the pattern of how the insulin works in your cat's body. In particular it can help you to identify; when the insulin starts working ('onset'), when the blood glucose is at it's lowest (insulin 'peak', or blood glucose 'nadir'), and how long the insulin is having an effect in your cat's body ('duration'). It will also tell you - crucially - how low your cat's blood glucose may be dropping on a given dose. That's vital information for making dose adjustments.

Curves do have their limitations though.
A curve done on one day almost certainly won't be exactly the same as a curve done on another day. You may see high numbers one day and lower numbers the next. There are all kinds of factors that affect the result (the cat's appetite, how the cat is feeling, how the cat's body utilizes that particular insulin shot, and many other things...) But don't worry about that. At this point you're just trying to work out the pattern of how the insulin is working, and seeing how low your cat's blood glucose drops.
Are you able to identify any pattern at all from the curves that you've done so far?

Once you've identified the point at which the insulin starts working, and when the blood glucose is at it's lowest, doing complete curves becomes less important. It becomes possible to target your testing toward certain key points in the insulin cycle.

The type of insulin used can also affect the cycle quite a lot. You're using Lantus which is a 'depot' insulin. With depot insulins it can take a little while to see the full effect of any given dose.

Martha, you are doing just fine. But it is OK to slow down a bit. Relax. Breathe....
We have a saying here that managing feline diabetes "is a marathon and not a sprint". ;)

Best wishes,

Eliz
 
How often are you doing a blood sugar curve? You can really stress your cat with too many sticks. That increased stress just raises the blood sugar all the more. I have a small baby sock with rice that I heat and place onto the ear to dilate the capillaries. A quick stick and it's over. I also don't use restraint with my cat...that too stressed her out. I do a blood sugar before each insulin delivery twice daily. Granted, it was more frequent in the early stages of treatment. Just be patient and gentle and supportive...and, don't panic or beat yourself up. It will get better! Good luck from Jane and Stewey
 
Hi everyone,

Thank you for all this information, it's really helping. I think I'm getting the blood draw down. The warm sock makes a big difference, though I'd say that's the part she likes least. I don't think I'm making it too hot, she just doesn't like something next to her ear like that. I also started using the accu check softclix lancet, I've been experimenting on the proper setting. It has 1-11 depth settings, 3 didn't get anything, but 3.5 seemed like too much, go figure. She's always been a very sweet tempered cat and is incredibly good about this. I can lift her onto the kitchen table and do all this without her trying to get off. I also managed it while we was on my lap, but that was harder, she shook the droplet off. I don't think she is stressing now.

BTW, I use bonito flakes as a treat. All my cats go crazy for them. You can buy them at an Asian market, they're dried shaved flakes of the Bonito fish.

So my vet didn't have much to say about my curve results from last weekend, one looked like a curve, the other was all over the place. She's asked me to try two more this weekend. I''ve done 3 readings so far. The readings are really low compared to what I've been getting during the week. I will post the readings as soon as I can figure out the spreadsheet and how to attach, etc. Elizabeth, maybe the "Depot effect" you mention about lantus could have something to do with her readings going down? Or cat orneriness.
 
Hi

That's good you are managing up get readings. Yes please post up the results. When you say really low compared to before they aren't below 50 / 2.8 are they?

With my lancet I think 3.5 was the depth that worked for me too. You could try heating it for a second or two less and see if that helps but remi acts the same. One day I thought I had broken his ear because he kept it flat for a whole evening.

Once the lantus depot builds up it was hopefully help to bring those blood glucose levels down. This is why it's so important to monitor because once under control you might get the opportunity to decrease the dose lower and lower.

Have you been transitioning onto wet food aswell. As this will have an affect.
 
If you just started Lantus last week, it does take about 5-7 days after starting to see the full effect of the dose on BGs so that's probably why you're seeing lower numbers today.

Here's something I wrote up about finding a good testing position that might be helpful for you. I've discovered it's easiest to come at the ear from slightly behind and to the side than it is to come over from the front or the back of the cat.

I did want to comment on your vet's sense of urgency to start TR. While it's true that the study showed ~80% of cats achieve remission within the first 6 months of diagnosis when following TR, there are also other factors at play, like how long they might have been diabetic before diagnosis, if they have any comorbid issues, etc.... The key is making sure you're giving the "right" dose to keep those numbers euglycemic.

Some cats are incapable of achieving remission regardless of which protocol you follow (like my Mikey). Other cats achieve remission with just a diet change and maybe a week or two of insulin. Some cats need 6 months; some cats need a year or two of insulin support. We have a saying around here that Every Cat (and Caretaker) Is Different (ECID). If strict TR is too much for you to tackle straight out of the gate, then that's okay! Most people end up slightly modifying the protocol to fit their unique situation anyway so you do the best that you can do. Everyone here will help you with each step of the way. It might not be immediate (that's just the nature of the Sugar Beast) but we'll get you where you need to go. :bighug:
 
Has anyone linked you to this photo...the 'sweet spot' you want to aim for? http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

It helps to have something behind the ear when you are poking, like a folded up tissue, for example..something to help hold the ear firm. Also besides the warmed rice sock, if you rub the ear between your thumb and forefinger that also helps with blood flow. I found my kitty also seemed to love this part. Wonder where you are located, and if perhaps we have a member nearby that might be able to demonstrate and help you with your technique? Someone above mentioned applying pressure after you lance, you just pinch the ear for 30 seconds or so. Many will also apply a dab of neosporin w/ pain relief which helps.

here are some other tips in case you haven't found them http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

It is overwhelming at first, but really does all get easier and becomes quite manageable. You have come to the right place..there is so much wisdom and support here and we can help you get your kitty on the right track.
 
Last edited:
Sounds like you are doing a great job and I am so impressed that your vet is up on tight regulation :) there is a sticky (post stuck to the top of the board) over in the lantus/levemir board about tight regulation that you may want to read. That board is where most of the people doing tight regulation hang out too, some do daily posts and others pop in for dose advice so have a look around there when you get the chance.

Most kitties do not get stressed from home testing if you're doing it right and giving treats. Although Vyktor has been in remission for a couple of years (thanks to tight regulation) I still test him once a week to be sure he's staying on track and he starts purring as soon as he sees the meter. When we were in the midst of his diabetes he would often sleep through his tests. My mum's cat was diagnosed about a month ago and already he hears the alarm and recognises that it's test time and runs to their testing spot.
 
I would for sure spread the feedings out into several small meals throughout the day, it is easier on their pancreas and also helps to level things out with their BG's. We usually fed anywhere from 5-8 meals a day, depending on the days activities, when you are home or when they are hungry. the only real time to withhold food is the appx 2 hour window prior to their shot time, so your pre-shot test will be clean and not food-influenced so you know it is safe to shoot. Beyond that it won't matter in terms of the curve, it is all helpful data for you, as you can see how much her numbers respond to food, how long that lasts, etc.. all info is good info. We end up using food to manage curves at times if the numbers are running low, for instance, just like a human diabetic would. I always fed my kitty one of his small meals late just before bed to tide him overnight which seemed to help us both!
 
KPassa said:
If you just started Lantus last week, it does take about 5-7 days after starting to see the full effect of the dose on BGs so that's probably why you're seeing lower numbers today.

Here's something I wrote up about finding a good testing position that might be helpful for you. I've discovered it's easiest to come at the ear from slightly behind and to the side than it is to come over from the front or the back of the cat.

I did want to comment on your vet's sense of urgency to start TR. While it's true that the study showed ~80% of cats achieve remission within the first 6 months of diagnosis when following TR, there are also other factors at play, like how long they might have been diabetic before diagnosis, if they have any comorbid issues, etc.... The key is making sure you're giving the "right" dose to keep those numbers euglycemic.

Some cats are incapable of achieving remission regardless of which protocol you follow (like my Mikey). Other cats achieve remission with just a diet change and maybe a week or two of insulin. Some cats need 6 months; some cats need a year or two of insulin support. We have a saying around here that Every Cat (and Caretaker) Is Different (ECID). If strict TR is too much for you to tackle straight out of the gate, then that's okay! Most people end up slightly modifying the protocol to fit their unique situation anyway so you do the best that you can do. Everyone here will help you with each step of the way. It might not be immediate (that's just the nature of the Sugar Beast) but we'll get you where you need to go. :bighug:
Click to expand...

Thank you KPassa, I am feeling a bit overwhelmed with the TR. I was feeling guilty that if I didn't do it, I wouldn't be giving Lolly the best chance at remission. I did get a fully curve yesterday, but I don't know how I'm going to get those daily nadirs when I'm at work. My husband wants to help, but taking kitty BGs isn't for everyone. More below on my first curve.
 
bettyandhank said:
Has anyone linked you to this photo...the 'sweet spot' you want to aim for? http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

It helps to have something behind the ear when you are poking, like a folded up tissue, for example..something to help hold the ear firm. Also besides the warmed rice sock, if you rub the ear between your thumb and forefinger that also helps with blood flow. I found my kitty also seemed to love this part. Wonder where you are located, and if perhaps we have a member nearby that might be able to demonstrate and help you with your technique? Someone above mentioned applying pressure after you lance, you just pinch the ear for 30 seconds or so. Many will also apply a dab of neosporin w/ pain relief which helps.

here are some other tips in case you haven't found them http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

It is overwhelming at first, but really does all get easier and becomes quite manageable. You have come to the right place..there is so much wisdom and support here and we can help you get your kitty on the right track.
Click to expand...

Thanks for the photo! I am in South Jersey, 20 min from Philadelphia, thrilled if anyone is nearby.
 
Can I ask which city?... I am far away so won't be familiar but can put some feelers out to some who are nearer and will be
 
In an ideal world, we would be able to get those nadir tests every cycle. In the actual world, we have jobs, volunteer, have children or parents to look after, and all other sorts of commitments on our time. Plus, we need to keep ourselves healthy and sane so we can keep our kitties healthy and safe.

So, we step back and reevaluate and think about other options. You know you can't get the nadirs on those days that you work. Perhaps you have time on the weekend to get a few other tests in. Perhaps you get a test first thing when you walk in the door. A regular test nightly just before you head off to bed is a good option. By testing at random times, this data gathering helps to fill in the spreadsheet on how your cat is doing.

Just because most cats have a nadir (lowest BG) reading on Lantus around the +5 to +7 hour time frame, doesn't mean that every cat is average. My Wink had an early nadir on Lantus, around the +3 to +4 hour time frame. ECID Every Cat is Different.

As time goes on, you'll learn to read the little signs your cat is giving you on how they are doing.

We have a nice way of reporting progress, that doesn't focus strictly on the BG numbers. The WCR or Whole Cat Report. Your cats appetite along with the 5 P's (peeing, pooping, purring, preening, playing) give you and us a nice way of evaluating progress.

Yes, we get hung up on "the numbers" around here a lot. They give us some very needed and useful monitoring of how the insulin is affecting our cats. But those subjective evaluations are important too.

ETA: I mentioned a spreadsheet, but see that @Martha does not have one up and linked to her signature yet. Directions for copying our google spreadsheet template and saving your own version to link into your signature are here. This aforementioned link is to the post over in the Suggestions, Tech Support and Testing forum with how to directions.
 
OK, I haven't figured out how to post the spread sheet yet, and I wanted to get you all these numbers, so I attached a spreadsheet. <sorry!>

I have a difficult work schedule, (some late shifts, some Saturdays) so I can't always feed her on the same schedule. I know this is a problem. Anyway, last weekend's numbers will look odd timewise..

She started lantus Jan 2, at 1 unit. On Jan 8 she was increased to 2 units. The first readings are before her first shot, immediately before her first meal. 1/10 makes sense, though it's 7 hrs until the nadir. I don't know what happened on 1/11. Yesterday it looked like her levels went down quite a bit. I was nervous when she hit 55.

I couldn't get am and nadir readings today. Her evening bg is 61. My Vet's protocol calls for me to decrease the insulin by .5 to 1 units if pre insulin bg <180. I decreased tonight to 1.5 I will do a curve tomorrow. BTW, is there anywhere I can get syringes that have an even more narrow barrel, so .5 units is easier to measure?

Any comments welcome! Thanks good folk.
 

Attachments

Have you read through the TR protocol (Roomp and Rand) pinned at top of Lantus forum for comparison/consideration?
 
Perhaps this will help for getting into our spreadsheet.

Using our grid to record your glucose tests will help us give you better feedback. Instructions are here.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
Heads up: At 3 days on the same dose, she is down as low as 55 mg/dL. She could go lower over the next 2 days and may need a dose reduction.

Lantus works best by keeping a consistent dose and adjusting it based on the nadir, the lowest glucose post-shot, not the pre-shot numbers. Because of carry over effects, the dose stabilizes after 5-7 days on the first dose and 3-5 days on later doses, after some carryover has built up.

You want her to stay safely above 50 mg/dL on a human glucometer.
 
BJM, I have an alphatrak glucometer set for cats. What is the equivalent then to the 50 mg/dL on a human glucometer? Also @betty, BJ, I did look over the Roomp and Rand protocol. My vet's protocol seems to be the same idea, but she is more conservative about decreases. She cites the recent article in Journal of Feline Medicine and Surgery as basis for the protocol she gave me (I just learned Roomp and Rand was basis for this study)

I'm a little nervous right now. Her nadir was 55 yesterday, pm before shot was 63 at 9pm, so decreased insulin from 2 to 1.5 (very approx- syringe impossible to measure intervals) . Just did bg at 12am, it's 59. Should I stay up and monitor all night? What's happening?
 
ALERT: possible hypo/low numbers in progress

Feed 1-2 teaspoons of high carb gravy or add a couple of drops of syrup to 1-2 teaspoons of regular food.
Wait 30 min.
Re-test.
Repeat if below 68 mg/dL.
Continue until past +7 hours post shot, and numbers are rising.
 
Last edited:
Did you shoot a 63 tonight? Is 12AM your +3#?.....as in 3 hrs after you shot? Do you have any high carb gravy type food should you need it?
 
Please feed a couple teaspoons of just the gravy off high carb food if you have it....don't feed too much so she will still eat if you need her to. Bj, unless I'm reading wrong she is well below that... Needs to test 20 minutes or so I am going to try get some more eyes as I can't stay up... But Martha you DO need to monitor this cycle. Be back to check in a few
 
Last edited:
bettyandhank said:
Can I ask which city?... I am far away so won't be familiar but can put some feelers out to some who are nearer and will be
Click to expand...
I live in Pennsauken, NJ. Best known nearest town is Cherry Hill, Nj. NJ is so small we have a tendency to say
bettyandhank said:
Is the 59 on an Alpha track you said?....and is this your +3 number?
Click to expand...
Yes 63 on an alpha track before shot at 9pm 59 at 12 going to to another now
 
I'll stay up as long as I can with you. (I have a sleep disorder, but the prednisone I'm on right now may help me stay awake.)

You may want to put on a pot of coffee.
 
Last edited:
Bj...I posted in LL for more eyes. I can't stay up much longer.... 59 is close to 40 on human, yes? She still has at least couple hours to go.
 
Last edited:
Yes, too low on the AlphaTrak.
Going back downstairs to my laptop as phone battery almost out.

OK, on my laptop now.
 
It's up to 86 at 1am. 63 at 9 before pm shot, 59 at 12, now 86 at 1am. She was sleeping, she just woke up, stretched and is sleeping again. She seems fine. Her numbers were low on the curve from Sat. :
Time BG Value
8:40 83
11:40 66
1:45 55
4:40 72
6:00 87
8:30 93
 
How are you doing Martha? Do you have high carb canned food in the house? If not we can find something you can use instead, but that is best for steering numbers if you have it. The 63 you shot was very low but also doesn't seem to be dropping much. You are fine as long as you are monitoring and feeding the number up if needed. Can you tell us your next Bg number you get...and clarify how long after the shot it was?
 
numbers so far:
PMPS of 63 at 9 pm
+3 of 59 at 12 midnight - too low.
+4 of 86 at 1am - high carb gravy wears off fast

No, the AlphaTrak 2 still has the same 68 mg/dL as a threshold for intervention.
 
So 12am was +3? And 1am +4 since the shot? (We go by hours since shot...makes it clearer with us in many time zones). Can you also list what you fed, when and how much? Have you fed close to these BG tests?
 
+3 of 59, +4 of 86. She last ate at 7:30, but free feeds for now. I feel like an idiot- I have kayro, but I don't have high carb food except for some dry. Would she be going into a hypo? if she's sleeping? She really seems OK. I'll keep testing.
 
Martha for now let's focus on this one cycle.... Was her +4 test 84? Had she had food? Its low but coming up a little which is good. Still warrants monitoring as you have a way to go til nadir and may need to steer with food. And yes, the distinction of Alphatrack is VERY impt. The 86 is = to appx 55 on a human meter. Not dangerously low, but needs watching to be sure it is rising
 
We have a small buffer at 68 mg/dL, plus kitties vary in how sensitive they are to low numbers. They can be fine 1 minute and seizing the next.
 
numbers so far:
PMPS of 63 at 9 pm
+3 of 59 at 12 midnight - too low.
+4 of 86 at 1am - Note: if you gave high carb gravy or syrup, it wears off fast.
 
Last edited:
You can mix a couple drops of Karo into a teaspoon of low carb canned for similar effect. It will slow down the drop. Dry stays in system too long. It would be a good idea to coax a little teaspoon of that into her now... She is not at a dangerous low, but could drop back.. It would just be a bit safer with some food on board to bump her up a little
 
I'll be up for a while yet and can jump in if need be. How are you holding up Martha? Nothing like a trial by fire....:eek: You're doing a great job!
 
Bj, the +4 I don't think had food behind it. Doesn't sound like she ate since 1 1/2 hours prior to shot??? If so she may have been on rise already at +4, but now next test will have food influence, so won't be sure
 
Betty asked me to check in on you but I am fading fast as well.

First...we do not recommend members shoot below 68 on an AT and especially not new members. You are dealing with some very low numbers early in the cycle and HC can wear off quickly. So while she might be up right now, she could easily come back down. If she does, I would suggest you get to an ER. Lantus can have a very long duration and it's possible to be fighting numbers for 16 hours.

Please stay on the testing and give HC syrup for any number below 50. You might be up most of the night.
 
Last edited:
Understood; just noting that high carb can wear off fast. Edited to clarify.
 
Status
Not open for further replies.
Back
Top