First Curve, worried for my boy.

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Amy Dobson

Amy Dobson

Member Since 2015
Today I completed Murphy's first proper curve.
In context, he was diagnosed 12 days ago, then spent a few days in hospital due to having DKA.
Since being home he's been having 1.5u caninsulin twice daily.

I will fill in a spreadsheet, hopefully tomorrow, but can't at this moment. So here are results, taken every two hours, aside from one extra reading taken due to my concern he was going hypo.

7am - 19.4 (349.2)
9am - 14.2 (255.6)
11am - 5.4 (97.2)
12pm - 10.5 (189)
13.20pm - 18.1 (325.8)
15.00pm - 22.4 (403.2)
17.00pm - 24.8 (446.4)
19.00pm - 24.7 (444.6)

Poor boy. He obviously needs a longer acting insulin. Ill be emailing the curve results to my vet tomorrow. Which longer acting insulin are available in the UK?

I've been so miserable all week, due to Murphy being miserable. He's also got what we think is seasonal allergies. His temples and eyes are so irritated and sore.. He's constantly in a homemade e-collar at the moment as without one he's damaging himself by scratching so much. He's already got two corneal ulcers, and now a corneal sequestrum in one eye. He's on tramadol and has eye drops six times a day. He's the sweetest, most tolerant cat in the world, but I can tell he's miserable and beside himself/tormented with itching. I want to get his blood glucose more stable so that we can help more with his allergies.

Any help and advice would be appreciated. Thank you.

Amy and Murphy.
 
IMG_20150525_083134.jpg
Here Murphy is today in his favourite spot.
 
Amy Dobson said:
Today I completed Murphy's first proper curve.
In context, he was diagnosed 12 days ago, then spent a few days in hospital due to having DKA.
Since being home he's been having 1.5u caninsulin twice daily.

I will fill in a spreadsheet, hopefully tomorrow, but can't at this moment. So here are results, taken every two hours, aside from one extra reading taken due to my concern he was going hypo.

7am - 19.4 (349.2)
9am - 14.2 (255.6)
11am - 5.4 (97.2)
12pm - 10.5 (189)
13.20pm - 18.1 (325.8)
15.00pm - 22.4 (403.2)
17.00pm - 24.8 (446.4)
19.00pm - 24.7 (444.6)

Poor boy. He obviously needs a longer acting insulin. Ill be emailing the curve results to my vet tomorrow. Which longer acting insulin are available in the UK?

I've been so miserable all week, due to Murphy being miserable. He's also got what we think is seasonal allergies. His temples and eyes are so irritated and sore.. He's constantly in a homemade e-collar at the moment as without one he's damaging himself by scratching so much. He's already got two corneal ulcers, and now a corneal sequestrum in one eye. He's on tramadol and has eye drops six times a day. He's the sweetest, most tolerant cat in the world, but I can tell he's miserable and beside himself/tormented with itching. I want to get his blood glucose more stable so that we can help more with his allergies.

Any help and advice would be appreciated. Thank you.

Amy and Murphy.
Click to expand...


Amy and Murphy....first of all, Murphy is such a cutie! :) He looks quite at home in the outdoors there. :)

I'm not an expert as my kitty, Morrigan was only diagnosed last month (April) and she's been on insulin for only about 36 days now and I'm sure more experienced members will have more info for you.

You've done a GREAT job in getting that curve. :) Congrats on that! You're becoming a pro at managing Murphy's condition and taking your baby's health into your own hands. (APPLAUSE) :)

From what I'm seeing, (other more experienced members may disagree or have another viewpoint on this) but, it seems that the Caninsulin *may* be a shorter acting insulin where he's getting a powerful "punch" in it then, a quick raise again to an even higher number.
There could be 2 reasons for this (without being a vet/doctor)

1) It *may* be a "reaction" to the insulin as some cat's bodies do sometimes, become "threatened" by the insulin and tries to override what it perceives to be a sort of "need" to produce more glucose and release it into the blood stream to kind of "counteract" the lowering effect. Or....

2) ALTERNATIVELY...it *could be* that the Caninsulin is too short acting and you're seeing a sharp spike in its action where there's a "plummet" in the glucose levels then, a sharp rise again.

(***Please also remember that numbers in cats can raise and lower from day to day as well, depending upon foods eaten, when, how much and how much exercise they are getting. Also, when a cat has something going on that is "agitating" such as an illness/physical issue, which seems to be Murphy's case with his eyes, glucose levels *can* go up as well. This may especially be true if poor Murphy is irritated by the collar...which I know is necessary for him given what you're describing.***)

Most (not all though so, some may be able to answer to the Caninsulin more specifically) people in here are using longer acting, human insulins like Levemir or Lantus (more the Lantus though).
If I'm not mistaken, either one can be gotten from a human pharmacy with a script from your vet. (I'm sure more U.K. members may chime in on this and where they get it, cost etc.)
This may give a more consistent curve where you're not getting those BIG drops then those big rises again...even higher than the beginning levels.

What foods do you have Murphy on? Are you feeding the lower carb foods? If not, you may want to switch over slowly. That will also bring down levels. If you are....then, you would be doing the right thing by talking the idea of switching insulins to a longer acting one like Lantus or Levemir. :)

Basically, I'm trying to say that Rome wasn't built in a day and a lot of us are out here, scratching our heads, trying our best to figure out what (all put together) gives our Sugar Kitties the best levels. You're not alone and 12 days on insulin is a short period of time in the long run. Be patient with yourself and Murphy and don't get too frustrated with everything. In time, you'll balance things out. We're all trying to do the same thing.

Sending you a hug and a pat on the back for your hard work, dedication and love for Murphy. More members will chime in too. Hang in there! You're doing great! :)

By the way, I forgot to add (thus edited)...is Muphy on prednisone for his potential allergies? If so...that *may* be causing a rise in his numbers as well.
 
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Good job getting the curve! And yes, it certainly looks like CAnninsulin isn't working long enough, giving him his lowest point around +4. That could lengthen as he adapts to the insulin, but may not. A few more days should give you a clearer picture

I am not in the UK but my understanding is that you have to demonstrate that it doesn't work. Your vet would have to give you a timeline. And any and all data you can get will help.

I think Lantus is available in the UK. There also is ProZinc available. Elizabeth and Bertie will have more info
 
Thank you, Louellen :)
I used to feed Murphy bozita wet and dry food. Since being in hospital, he stopped the dry (thankful they were monitoring his BG closely). I've continued that and he only has wet food Bozita as the mainstay , Lilly's kitchen kitten and chicken parfait, and almo nature green for variety.

Thankfully he doesn't mind the collar , only gets so frustrated that he can't scratch. Just realised the collar looks like a heavy tyre (it's not, it's very light!)
Thank you so much for your reply.
 
@Elizabeth and Bertie I think is in the UK if I remember correctly, I know there are others that are in the UK that might be able to give some advice as well.....Just for context, was his shot at 7am?

Since everyone is from all over the world, to help everyone understand where you are in a cycle we label the PRESHOT either AMPS or PMPS and then everything is + how many hours from the shot time....so if you shot at 7am, the AMPS would be 1.4 and +2 would be 14.2.....it sounds stupid and like a tiny thing, but it really helps everyone with the context of where in the cycle the readings were taken....

@Sue and Oliver (GA) was one of the first people to greet me when Skooter and I joined almost a year ago...I must say, you are waaaay further along than I was at this point in the diagnosis, you are doing awesome!
 
You're most welcome, Amy. :)

Sounds like Murphy's diet is good...though I am not familiar with U.K. foods but, since they had him on it in hospital and he's off the dry food, that's the best that you can do in that arena.
Given that...it's a measure of the insulin and dosing then. :) Work on that with your vet and these numbers. You're going to get to the right mix for him. :) Hang in there.

As for the collar....oh, I didn't mean to imply that it was heavy....not by a long shot. I see that he's got his head up and looks quite comfortable. We used a "victorian plastic collar" on Morrigan and I saw that she was agitated by it. She laid and wouldn't move. Poor thing walked into doors! So, this is by far, a lovely collar! You should consider marketing those to vets and pet stores! :) Seriously.

That aside, I was also thinking of the agitation of having itchy eyes/skin around her face. Those itches can get intense (I am actually allergic to poor Morrigan...whom I love dearly and put up with it). Even I get irritated with allergies! Grrrrr!!!

But, keep on trying and talk to your vet, listen to the wise words that others will chime in with and remember that we can only do what we're doing. You're doing fantastic!!! :)
 
Ahh yes ok.. I'm going to fill in a spreadsheet as soon as I can so will hopefully get to grips with the way things are written asap.
So the first reading was just pre morning injection. And the last reading was just pre evening injection.
Thank you for saying that I'm going along OK. I feel like I'm wading in mud.
 
Amy Dobson said:
I feel like I'm wading in mud.
Click to expand...
I felt the same way when Skooter was first diagnosed. There is so much to learn and its not like you can just learn different parts at a time. You gotta just jump head first and wade through all the information. For me, it felt like trying to learn a college level PhD honors class lolol.....but you will get through it and you are doing awesome!

Everyone here is super awesome and will answer any questions you may have....
 
Hi Amy and extra sweet Murphy!! Glad to see you posting over here from the Facebook group.

Lantus IS available in the UK, but I know with your system over there, you have to start with Caninsulin. If you can prove it doesn't work, your vet can prescribe Lantus.

What it looks like is that the Caninsulin took him down too fast today and his liver responded by releasing stored sugar and hormones that caused a "bounce" back higher than he'd been in the first place. Bounces happen for several reasons....getting into a number their body isn't used to, getting into numbers too low, and dropping numbers fast....Looks like Murphy had two of these going on today.....Not only is his body probably not used to being in normal numbers anymore (so even though the 97 isn't too low, his body has gotten used to living at higher numbers so acted like it was and released those stored sugars/hormones) but he dropped quickly...and that can trigger a bounce too

Hopefully with the data you have, you'll be able to get your vet to switch to Lantus. There's also a Feline Diabetic Remission Clinic in the UK you might want to check into
 
Can we get you started using our grid to record your glucose tests? It 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.
 
Amy Dobson said:
Which longer acting insulin are available in the UK?
Click to expand...
Morning, Amy,

The longer lasting insulins in the UK are Lantus/glargine, Levemir, and Hypurin Bovine PZI. All have long durations, but work slightly differently. If your vet does prescribe one of these it's most likely to be the one they have some experience of.

Actually, I don't think your numbers are too bad for this stage of the game! Murphy was diagnosed less than 2 weeks ago. And those are Alphatrak numbers, so on a human meter (which most of us use and 'think' in) those numbers would be a little lower.

It could be that Murphy isn't getting enough duration from the Caninsulin (not uncommon; that can be one of the issues with it). Or it may be, as Chris says, that there is also an element of 'bouncing' involved. When a cat's blood glucose drops lower than it's got comfortable with, it's body can respond by releasing stored glucose to raise the blood glucose level.

I'd be interested to know what happened between four and five hours after the shot.
(Alphatrak numbers)
+4, 5.4 (97.2)
+5, 10.5 (189)
Did you get any other tests during this time? Did you give food?

A couple of things come to mind. One is that reducing the dose of insulin a little may help to level things out a bit.
The other is that, if you can give some food 2 - 2.5 hours after the shot that may slow the drop.

Are you home and able to monitor today?

Eliz
 
Amy, regarding changing to longer lasting insulin, vets in the UK vary enormously in their willingness to do this. Some are keen to help (or may even encourage a change of insulin), other vets may doggedly refuse.

But quite a few of us have managed to get our vets to prescribe something other than Caninsulin. It certainly can be done!
In persuading our vets, hometesting data has proved invaluable. So, if you can get a spreadsheet up and running that could be an advantage.
Also, you may want to take note of any symptoms you see Murphy experiencing. For example, does he seem affected by the steep blood glucose drops/rises; and if so, how is he affected?

Another thing to consider is Murphy's history of DKA. You could point out to your vet that with a longer lasting insulin Murphy would have insulin in his system for more of the time and therefore possibly have better protection.

Edited to add: Are you checking Murphy's pee for ketones?

Chin up, sweetie. It's early days. And you're doing just fine. :bighug:

Eliz
 
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Thank you so much, everyone. I so appreciate your replies and help.
Eliz, good point between 4 and 5 hours post shot.. I was worried about the low reading so gave him some of his food with more carb in it. So I've actually contributed to the spike :( He was suddenly lethargic so I panicked.
I've emailed my vet, hoping he doesn't take offense at me asking outright about longer acting insulin. Here is a copy, for you information:

Hi M,

I'm going to put the values into a spreadsheet to produce a graph, but here are the BG values for the curve I did yesterday.

7am -19.7 (insulin given after)
9am - 14.2
11am - 5.4
12pm (extra reading as was concerned he was low) -10.5
1pm - 18.1
3pm - 22.4
5pm - 24.8
7pm - 24.7

He still seems to be bouncing and hits the Nadal point 4 hours after, which seems very quick. And again, his body compensates and it shoots up again. Do you think he would benefit from a longer acting insulin so that it's in his system longer and BG more stable? I'm wondering if it would therefore also be more protective against DKA.

Just observing him, he's definitely at his happiest mid-cycle, where he's anywhere between 10 and 19. At his lowest and highest points, he becomes very lethargic and sleeps with lots of dream twitching.

I've been reading up lots about diabetes in cats and came across the the cascade process, whereby if a shorter acting insulin is shown not to be working, then a longer acting one may be prescribed. I read that Lantus and ProZinc brands may be prescribed in these cases where BG shoots up and down so markedly. Is this something that would be possible?

Hope yourself, Julie and family had a good bank holiday weekend.

Many thanks,

Amy.
 
Hi Amy,

My Cat Molly was recently diagnosed and as am I am in the UK was given Caninsulin, I to was concerned with the big drops it gave and thought it did not last long enough, and I was considering changing Insulin, or at least trying to, but with regular BG testing, and great help from members here, I began to understand how the insulin was working with Molly, and when to give a small meal generally + 3 to slow the drops down, and we gradually was able to reduce Insulin amount, and we got into a regular routine of mini meals which definitely helped with controlling the way Caninsulin was working with her, and 8 weeks approx. since diagnoses, Molly is now on day 12 of no Insulin, I am not saying this will happen the same way but it is early days, and I have been at the place you are where you think you may need to change Insulin, but stick with the GB testing and you will see the pattern of how it works on Murphy.

So keep doing what you are doing, it does take a bit of time, but you are doing great!!!!!

Lorraine
 
That's brilliant, Lorraine! How fantastic.. and reassuring! Perhaps I've been too quick to ask the vet about longer acting insulin. Oh dear :nailbiting:

Eliz, ketones are fine.
 
I am at home today, but I've a 5 year old girl and twin 3 year old boys to look after.. they're very good, but consistency might not be on my side today :confused:
 
Oh how lovely but yes you have got your hands full, we can only do our best, I just wanted to give my experience of Caninsulin, and let you know that I have been where you are in thinking about changing Insulin. If Murphys eating ok, it may be more manageable to balance the insulin with food. Also Molly definately seems to be more active in the 7s even now, if she sleeps all afternoon then she normally is in the 4/6 GB levels this is without insulin.

Have a great day, and see what response you get from your vet regarding changing Insulin, but if they don't want to change it, I hope you will feel a bit more positive going forward with the Caninsulin for a while.:)
 
Thank you Lorraine.
Your experience has already made me feel more positive, which is great.
If anyone knows any tranafol/insulin/blood sugar interaction, I'd be interested to know.
His happiest times seem to be just post insulin in the morning, then again at about 11pm - 1am.
 
I had a reply from my vet. I think at this stage, it's good advice:

Dear Amy,
Its nice to see that Murphy is responding to the insulin. It is far too early to say that the insulin is not acting long enough. He could be over-swinging to compensate for his glucose dropping low and hence the afternoon hyperglycaemia. This reflex bounce would mask how long his insulin is lasting. Personally speaking I have never had the need to change to one of the human insulins. PZI is useful in some cases were it is impossible for the owner to inject twice daily but even in these cases it invariably has to be injected twice daily to gain adequate control.
Please reduce his insulin to one unit twice daily. It will take 3-5 days for his body to stabilise on this new dose so please can you do another curve in 7 days time. On the next curve please could you sample him HOURLY between 10 and 1pm with an additional sample at 11.30am. I also need to see his evening glucoses upto 11pm.
Please remember it could take a few months for us to be happy with Murphy's control.
Regards
Mike
 
Hi Amy,
I agree I think that is a great response at this time, and with the specific BG testing requested, they seem to be on the ball, so at least you've got a plan going forward now. Keep us updated, thinking of you both Lorraine
 
Amy Dobson said:
I was worried about the low reading so gave him some of his food with more carb in it. So I've actually contributed to the spike :(
Click to expand...

Don't think of this as contributing to a spike, but as data collection. It is important to see how everything works together. If you notice that after you give him a little bit of his normal food and he spikes all the time, that tells us he may be carb sensitive, which can be very valuable information when his numbers go low. You may be able to get away with feeding him maybe a medium carb food and getting him to come up and surf, vs a high carb food that may make him spike/bounce. Even seeing how they react to skipped shots, reduced dose shots, everything.....It is all great information to have on hand. The more we know how the insulin works in our specific cat, the more we will be able to do for them. The "ECID" - Every Cat Is Different rule comes up so often that having as much data about what is going on, will help you and those of you who are assisting you tell where your cat is different in this wonderful sugar dance that we do
 
Amy Dobson said:
I had a reply from my vet. I think at this stage, it's good advice:

Dear Amy,
Its nice to see that Murphy is responding to the insulin. It is far too early to say that the insulin is not acting long enough. He could be over-swinging to compensate for his glucose dropping low and hence the afternoon hyperglycaemia. This reflex bounce would mask how long his insulin is lasting. Personally speaking I have never had the need to change to one of the human insulins. PZI is useful in some cases were it is impossible for the owner to inject twice daily but even in these cases it invariably has to be injected twice daily to gain adequate control.
Please reduce his insulin to one unit twice daily. It will take 3-5 days for his body to stabilise on this new dose so please can you do another curve in 7 days time. On the next curve please could you sample him HOURLY between 10 and 1pm with an additional sample at 11.30am. I also need to see his evening glucoses upto 11pm.
Please remember it could take a few months for us to be happy with Murphy's control.
Regards
Mike
Click to expand...


Your vet sounds very informed and I for one really like his approach. I really like the fact that he is listening to what your concerns are and responding to them..plus he is totally on board with home testing. There is a good plan in place and your vet will be updated as things go. You are off to a great start, both with your home testing and with a good vet.

Good luck!!
 
Can we get you started using our grid to record your glucose tests? It 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.
 
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