Poncho's 3rd curve attempt tomorrow. Advice welcomed

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christoph

christoph

Member Since 2015
I'm trying this again tomorrow. I'll be going 12 hrs, testing BG with Relion Confirm (used up the Alphatrak strips Sat/Sun) every 2 hrs, feeding 20-25ml Hills AD (force feed) and keeping Fancy Feast Classic within Poncho's reach in case he self feeds. Given the late low numbers last time, I think I'll make 0.75 unit the base/starting dose. Any advice will be very appreciated. I need this to be as successful as possible. Should I bug the vet for some more Alphatrak strips and use the Alphatrak (for low numbers)?
 
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@Mogmom
Poncho has a history of being very sensitive to insulin. The first vet nearly overdosed him. Christoph knows this and is being appropriately cautions. Better too high for a day, than too low for a moment.
 
If you'd feel that you'd have more peace of mind with the Alphatrak if Poncho goes lower then go bug the vet! ;)

What are you hoping to learn from doing this curve, Chris? If you have a clear objective, maybe we could suggest some things of note.
 
Mogmom said:
What was the dose recommended by your vet? I'd go with that unless Ponchos numbers are too low.
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My old vet back in St Louis (who curved Poncho's sister Tiny several years back), who I contacted last week for advice, instructed me to try starting with 1 unit. Looking back over the SS, 1 unit in pm usually brought down his BG very low. I figured 0.75 unit tonight should bring it down to around 200 in the am to start the curve, and start curve with that dose. If so I will stick with it to begin trying to regulate Poncho. I'd like to finally arrive at a fixed dose and keep both numbers between 150 and just under 200.
 
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Critter Mom said:
If you'd feel that you'd have more peace of mind with the Alphatrak if Poncho goes lower then go bug the vet! ;)

What are you hoping to learn from doing this curve, Chris? If you have a clear objective, maybe we could suggest some things of note.
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I think I'll be ok with the Relion. If I start to doubt I'll have some time to run to the vet's office and pick some up. What I'm trying to establish is a fixed dose eventually. The vet said to focus on the BG number @ nadir and go from there. There is a big urgency here because I've been following the attending vet's guidance and she seemed to be focused on the pre shot numbers to arrive at dose, which has been swinging wide and poor Poncho has been sliding backwards in the meantime. I've learned enough from this forum and working with Poncho to know we have to take a different path. I think she's ok with me taking the reigns.....at least I hope so since Poncho needs other supportive prescribed care. Since I need this to go well, I'd feel better having forum members with more experience, give their thoughts/guidance esp with resulting numbers at curve's end. It's crunch time! Thanks, Aine.
 
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As I'm sure you already know, Chris, you will get fluctuations in BG on a day-to-day basis even on a fixed dose of insulin, hence the value of keeping the BG history in Poncho's spreadsheet. I know it's tricky feeding-wise with Poncho at the moment, but if you're looking to use the data you're gathering to make things more manageable, if there's a roughish schedule you try to work to everyday with his mealtimes try keeping to those times for the curve tomorrow so that you can see how the feeds and the insulin work together during the cycle. Remember to record the mealtimes and amounts fed. I found it handy to put that sort of information into the Remarks column in Saoirse's spreadsheets so that I'd have the food and BG information side by side in case I needed to refer back to it.
 
Aine, Poncho is normally a grazer but lately/presently I have had to assist feed, although he does eat on his own but not much....he's grazing I guess. Once he's regulated I'm assuming he will go back to grazing. Before all this he ate mostly dry food and I think this wet food takes getting used to, but he's getting there. I read somewhere a diabetic cat can eat dry food if it is grain free (some grain free is low carb high protein I think) and mixed with water. Do you know if this is true? I think the most important data I want to get today is the nadir, which seemed to come late in last two curves and I missed it.
 
So far this is what I got (Relion Confirm):
9:30am BG 394 Gave 0.75 unit
10am fed 25ml Hills ad
11:30am BG 332 +2
1:30pm BG 180 +4
1:35pm fed 25ml H. ad
3:30pm BG 177 +6
5:30pm BG 165 (1st stick on the vein got BG 127, second stick between vein and edge of ear got BG 165) +8
5:35 fed 25ml H. ad
7:30 BG 165 +10
9:30 BG 208 (Relion Confirm) 278 (Alphatrak) Tested 1st with Relion, 2nd test w/AT and needed a second stick. Poncho was not pleased.

Vet was not pleased I was using the Relion. I'll have to appease her and do the curve again with the Alphatrak.
 
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My vet wasn't thrilled about me using the ReliOn either until I brought it in and left it with Bud while he had his dental. Every time they checked his blood sugar, they would check it with both meters. Once she saw the Relion was consistently reading an average of 50 points lower, she was fine with me using the ReliOn.
 
Do you know if the Relion Micro reads lower than the Confirm? When I curve again with the AT I'll test with the Relion also and show her the results.
 
Most people on here believe all wet food is the way to go, I'm having trouble doing all wet right now, so I do still use some dry and may always use some dry, but only the young again zero carbs, for diabetic kitties. Your numbers look pretty good.
 
I wish they were the Alphatrak meter readings, but I guess He's settling right around 200 (Alphatrak). PM pre shot is coming up and I'll test with both meters. I'm assuming I need to test the same droplet of blood with both meters.
 
When I go to test the blood droplet, after the meter gives me a number, I'll try and catch any remaining blood from the ear with the test strip. That way if I want to retest, I use the blood droplet from the used strip. Works out great so I don't have to poke him twice, or get him to sit still long enough to try and get through 2 readings.
 
I'm not sure, but I wonder if the confirm and micro would test close since they use the same strips.
 
See my signature link Glucometer Notes for feline-specific reference ranges using a human glucometer. In fact, print it out for the vet or send the link. The numbers are based on the work of Dr Rand, an international expert in feline diabetes, from the University of Queensland.
 
Done with curve....resulting #s listed reply #12 and SS. PM test used both Relion and Alphatrak to compare. Tested first with Relion....needed 2nd stick for Alphatrak.....Relion Confirm 208 and Alphatrak 278
So how did we fare? 0.75 unit look good for starting base dose or wait until am pre shot test? His food intake was very controlled @ every 4hr feedings and always after test.
 
BJM said:
See my signature link Glucometer Notes for feline-specific reference ranges using a human glucometer. In fact, print it out for the vet or send the link. The numbers are based on the work of Dr Rand, an international expert in feline diabetes, from the University of Queensland.
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I'll make sure she is informed. She can't argue with an expert. Thanks BJM. By the way, how fast and how far can stress push up BG level? I tested using both meters but needed a 2nd stick on the AT meter.
 
I think the 0.75 looks really good right now. Expect that the next coupe cycles might be a little lower because yesterday he was pretty high. It will be interesting to see what happens the next few days. Hope the good numbers continue. Once you have a good dose, if his sugars start to creep up or down, you can then adjust again.
 
BJM said:
Vet office stress may increase the glucose 100-180 mg/dL.
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Wow! The original diagnosis was based on 359BG, and he was very stressed when they took him back to check him out, then gave him 1.5 Vetsulin SQ according to my copy of the vet's notes.
 
Meya14 said:
I think the 0.75 looks really good right now. Expect that the next coupe cycles might be a little lower because yesterday he was pretty high. It will be interesting to see what happens the next few days. Hope the good numbers continue. Once you have a good dose, if his sugars start to creep up or down, you can then adjust again.
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So I should continue 0.75 for around 5 days? I can't remember if the advising vet told me an exact # days....or 1 week.....just that his body needs time to adjust to a specific dose. He also said when testing BG to test nadir rather than pre shot. Does that sound right? Or maybe he meant to use the nadir to determine dose rather than pre shot. When he curved Poncho's sister I never home tested her.....or even had a vet test BG for several years. I think her dose was 1.5units Prozinc until she died from complications with her enlarged heart meds and the diabetes (and an incompetent vet).
 
Since both the Confirm and Micro use the same strips You will get eventually the same BG with both meters. The difference wold be due to the tolerance/inaccuracy of the individual meters and the tolerance/inaccuracies in the strips. If both strips are from the same lot then the difference between due to strips wold be very small. I would not expect much difference between to the two meters since they are from the same manufacturer and thus I would expect the electronics to be the same. The difference would be to the tolerance on the electrical components of the meter.
 
You probably want to hold the dose for at least 3 days, so you can see the effect when you are shooting lower numbers. His PS values were so high sometimes, that he was just hard to contol. You might see his nadir go down a little more in the next couple days.

For prozinc, you use the nadir to determine dose, but you should consider preshots as well, because prozinc can wear off faster and leave a cat without insulin for a time.

Preshot values should be up to the low 200s. Nadir, lowest I'd go if it were my cat was 80 (due to the hypos you had). If values are much higher -consistently-, raise the dose. If you see a nadir below 80, you might want to reduce. If preshots remain high (in the 300s+) and your nadir goes below 80, then this insulin is not the right one.

(numbers above are for human glucometer)
 
Well, here we go again. Pre shot BG this am was 480 on Alphatrak. I don't get it.....does the Prozinc wear off sooner at night? His last feeding was 1am and I left a tablespoon Fancy Feast for him.
 
In the early AM, in order to wake up, maintain wakefulness, cortisol is produced. This can elevate AM blood sugars. Lots of things can contribute. Maintain the dose, and get a "bigger picture" the next few days. A couple readings in the night once in a while will help you see whats happening at night too, and if the insulin is effective then too.

As the numbers become more stable, you might start seeing lower values, because his pancreas will produce more of it's own insulin.

If the next couple weeks or so, holding a steady dose doesn't improve values, please ask your vet about lantus/lev. That being said, your numbers looked really good yesterday.
 
That's reassuring.....thank you! Do you think the curve showed his nadir @ +8-10 hrs daytime, +6-8 nitetime?
 
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It's hard to say yet on this dose where his lowest point will be time-wise, but yeah, the duration might be shorter at night because of the "dawn phenomenon" or spike of cortisol in the early AM. So far +8-10 looks about right for the daytime nadir. That's a good place for it too be, cause the insulin is lasting long enough and not letting him get too high for the PM shot. <8 hrs and you are more at risk for ketones again because his body doesn't have the basal insulin.
 
Another lower #.....doesn't make sense to me. I was afraid to give 1unit so gave 0.75 again. I think I may need to re-establish Poncho's old feeding routine so I'm not stressing him out 5-6 times a day force feeding and that will mean putting dry food (low carb) back in his diet so he can graze (he can't graze on the wet food and never liked it much). When he's regulated I'll gradually try to transition him to wet food only. Right now I have to get this back end neuropathy reversed asap. and some weight back on him. Make sense?
 
The general rule here is to treat underlying problems and work the insulin requirements around the treatments. I think your choice to focus on Poncho's nutritional needs at this point has great merit, especially as he is quite underweight, but that's just one opinion from someone who has no experience of the insulin you're using so I recommend waiting for other experienced members to chime in on this. My reasoning would be that Poncho needs to build himself back up to a reasonable weight and that's not going to happen without enough food.

Will Poncho eat more of the low carb dry, Chris?
 
If he's eating dry by himself, and not wet, I think that for nutrition and also comfort of you both, it's best to just give whatever he'll eat himself. If this requires more insulin, then you'll just have to give more insulin. When he is feeling better, then you can try half and half for a while or transition him.

Someone mentioned to me that there was a low carb dry food (Evo? - can't remember). Maybe he'll eat this. Also, there is a food called "Fresh pet" that I used for my dry food addicted cat, and she gobbled it up. It's kind of in between wet and dry, and is refrigerated.

Also, were you able to get labs done for potassium. Neuropathy doesn't really come on quick, but low potassium does, and they may look similar.

I'd stick with the 0.75 U for a few days. You gotta give his body a little time to even out. After 3-4 days if his sugars are still high, then increase. Sometimes when you change a dose (up or down) the body reacts funny for a day or two.
 
A thought on feeding, Chris. If you do switch to feeding low carb dry, it may be less stressful for both of you. If feeding becomes less stressful for you both, that may be reflected somewhat in Poncho's numbers. If he were mine, I'd keep a close eye on his numbers for the transition to the new feeding technique so as to catch any potential BG 'surprises'.
 
Critter Mom said:
The general rule here is to treat underlying problems and work the insulin requirements around the treatments. I think your choice to focus on Poncho's nutritional needs at this point has great merit, especially as he is quite underweight, but that's just one opinion from someone who has no experience of the insulin you're using so I recommend waiting for other experienced members to chime in on this. My reasoning would be that Poncho needs to build himself back up to a reasonable weight and that's not going to happen without enough food.

Will Poncho eat more of the low carb dry, Chris?
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I don't know. I haven't really tried to introduce dry food back into his diet, but need to try something. At least 80% of his intake is assist fed, and I'm not sure he isn't getting dependent on that even tho he hates it. I'm trying to figure out how to deal with his weight and neuropathy as I'm getting dosing figured out. I keep getting these high numbers and when I don't expect them. I don't want any feeding routine to hamper him getting regulated but not sure how long it will take and I need to ward off the neuropathy from moving to his front legs. I know neuropathy reversal is dependent on regulation, so I'm stuck in a corner.
 
Meya14 said:
If he's eating dry by himself, and not wet, I think that for nutrition and also comfort of you both, it's best to just give whatever he'll eat himself. If this requires more insulin, then you'll just have to give more insulin. When he is feeling better, then you can try half and half for a while or transition him.

Someone mentioned to me that there was a low carb dry food (Evo? - can't remember). Maybe he'll eat this. Also, there is a food called "Fresh pet" that I used for my dry food addicted cat, and she gobbled it up. It's kind of in between wet and dry, and is refrigerated.

Also, were you able to get labs done for potassium. Neuropathy doesn't really come on quick, but low potassium does, and they may look similar.

I'd stick with the 0.75 U for a few days. You gotta give his body a little time to even out. After 3-4 days if his sugars are still high, then increase. Sometimes when you change a dose (up or down) the body reacts funny for a day or two.
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I was hesitant to give a full unit when BG was 163. I'm not sure when to draw the line and looked at the SS and tried to estimate a reasonable reduction. At some point I have to reduce the dose in the low # range but how much is partially cautionary guesswork at this point. The vet didn't feel a need for testing potassium, but gave me some beef flavored potassium pills to crush and put into food. His fluids have some also. I'll look into Fresh Pet. Thanks Meya
Fresh Pet semi dry has 3.3% carbs, their moisture free dry has 8.4% carbs
 
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Critter Mom said:
A thought on feeding, Chris. If you do switch to feeding low carb dry, it may be less stressful for both of you. If feeding becomes less stressful for you both, that may be reflected somewhat in Poncho's numbers. If he were mine, I'd keep a close eye on his numbers for the transition to the new feeding technique so as to catch any potential BG 'surprises'.
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I'm going to try it. Thanks Aine.
 
First and foremost, Poncho needs food. If a cat is eating steadily and reliably, it can make regulation easier to achieve. (The insulin dose can be adjusted and members here can help you with that.)

Again with the caveat that I have no experience of treating a ketone-prone cat, maybe if he is eating enough then it may also reduce his risk of throwing ketones again. I hope other members will say more about this aspect of Poncho's treatment.
 
yeah, ketones can develop from overall lack of calories as well. Hepatic lipidosis can also develop. Food is important.
 
I think the Hills AD has everything he needs. I'm just wanting to get back to his normal feeding pattern to speed up some weight/strength gain, reduce force feeding stress while still keeping with good nutrition. After reading up on low level potassium he has all the symptoms. We have another appt with vet tomorrow and I will ask again about getting a blood test. I bought some Fresh Pet and I think he likes it.....hope he continues to but with Poncho variety is the spice.....
Interesting BGs today. AM was 163 gave 0.75 unit, +7 hrs was 241, PM was 228 gave .075 unit. Is it strange to get a nadir higher than 1st shot BG and +12 pre shot? I was using Alphatrak
This am BG 533 0.75 unit Overnight /early am good self feeding Freshpet and Friskies pate
Going back to 1 unit....
 
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