? Adjusting insulin

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nfcatlady44

nfcatlady44

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I've read many posts here by cat people who have so much experience on adjusting their cat's insulin according to the readings. I'm new at all this and need some kind of education on when to change the dosage and to what. For the past 2-1/2 months since diagnosis, I've been used to just taking Mr. Black into the vet for his sugar check with the vet advising me on dosage. I just started home testing yesterday. At 2 p.m. (his peak time) his numbers were 59, 84, then 106, but I wasn't too confident I was doing the correct method of getting blood on the test strip... I really don't think the numbers were accurate. Then, last night at 8 p.m. just before feeding and shot, his number was 346, which is more what I was expecting, plus felt in my heart I did everything exactly right. He's currently on 3 units of ProZinc, which I haven't adjusted at all. I've been so nervous about being more in charge now and also because I’m changing his diet slowly to all canned and no dry. I’m keeping the Karo syrup handy just in case. I need to learn more asap re: figuring what the numbers mean with respect to insulin dosage. I need to know more about the "curve" people do also. Please advise.
 
Nancy

Congratulations on starting home testing. This will be much less stressful for Mr. Black as well as cheaper for you. The first thing that you need to do is set up a spreadsheet with the glucose numbers that you have. Here is a link to setting up a spreadsheet:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

You need to test before each shot then again once or twice (depending on what your time is like) between shots. This will give a good picture of how well the insulin is working and how low the doses are taking him.

Also here is a link to information of Prozinc/PZI if you haven't already read it:

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

I see you are transitioning Mr B from dry food to low carb wet food. Great!! and good for you to be doing it gradually. Some kitties can drop 100s of numbers just from the switch from dry food to wet low carb.

Once you have your spreadsheet set up it will be much easier for members familiar with Prozinc/PZI to give dosing advice. If you have any problems with the spreadsheet just post for help and there are several "techie gurus" who can help you (unfortunately not myself..I needed help setting mine up initially :) )
 
Hi Nancy! Mary Ann is absolutely right that getting your SS set up will be a huge help. We are all used to reading the data in that format...plus it helps us spot patterns. I see she gave you the protocol we put together for ProZinc too...thanks Mary Ann!! Check that out when you can...it's good info.

Based just on what you have told me, I think Mr. Black bounced. Basically, he probably had a higher AMPS (like in the 300 or 400 range) and dropped pretty low...then bounced back up tonight. That happens when a cat drops low or just lower than they're used to. Their body releases extra glucose I think which causes their numbers to jump up.

That 59 is pretty low. If you're in the process of transitioning to lower carb food, I'd be concerned about continuing on 3 units. Make sure you test before each shot, and mid cycle too if you can. 59 is getting close to hypo range...and low carb food can help him drop further.

The curve is where you test every 2 hours or so for 12 hours. That way, you can see where he drops, what his nadir (mid cycle) is, and how he goes back up. That info is extremely helpful to have every now and then!

We're happy to help advise you on doses. If you set up the SS, we can help a lot. Feel free to post every day and we'll take a look and help out!

Also, just so you know, this is a small but friendly forum. However, we're not super active all day and night...so if you have an emergency post both here AND on health so you get more eyes.
 
nfcatlady44 said:
I need to learn more asap re: figuring what the numbers mean with respect to insulin dosage. I need to know more about the "curve" people do also. Please advise.
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Rachel said:
That 59 is pretty low. If you're in the process of transitioning to lower carb food, I'd be concerned about continuing on 3 units. Make sure you test before each shot, and mid cycle too if you can. 59 is getting close to hypo range...and low carb food can help him drop further.
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Greetings, Nancy, from a "neighbor!":D (I'm right outside of Prescott.) Was wondering how Mr. Black is doing today, and wanted to "second" Rachel's comment re: testing before every shot, as it may be possible that 3 units is too much insulin for him. I say this because it's not uncommon for cats to have some "stress hyperglycemia" going on during a vet visit (my cat can spike #s more than 100 pts. higher than she will at home where she's not all freaked out). So if vets base their dosing on only the blood glucose #s that are collected in-clinic, they can start them out on more insulin than is actually needed by your cat - this is why it's so great that you've decided to home-test your boy's BGs!
nfcatlady44 said:
At 2 p.m. (his peak time) his numbers were 59, 84, then 106, but I wasn't too confident I was doing the correct method of getting blood on the test strip... I really don't think the numbers were accurate. Then, last night at 8 p.m. just before feeding and shot, his number was 346, which is more what I was expecting, plus felt in my heart I did everything exactly right.
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I use the same meter you're using, and if you're saying you were getting a 59 at nadir (time when insulin's effect is at its peak * BG can drop to its lowest point), then it's entirely possibly that he did drop that low. And what you may have been seeing at his pre-shot test (PMPS) last night was a bounce, as Rachel said.

I hope you can get a spreadsheet up & running for Mr. Black asap - this will really help us to help you. (Let us know if you're having trouble with that, and we can tag one of the spreadsheet gurus to help with the setup.:)

What did you get for a preshot # this morning?
 
Robin&BB said:
Greetings, Nancy, from a "neighbor!":D (I'm right outside of Prescott.) Was wondering how Mr. Black is doing today, and wanted to "second" Rachel's comment re: testing before every shot, as it may be possible that 3 units is too much insulin for him. I say this because it's not uncommon for cats to have some "stress hyperglycemia" going on during a vet visit (my cat can spike #s more than 100 pts. higher than she will at home where she's not all freaked out). So if vets base their dosing on only the blood glucose #s that are collected in-clinic, they can start them out on more insulin than is actually needed by your cat - this is why it's so great that you've decided to home-test your boy's BGs!
I use the same meter you're using, and if you're saying you were getting a 59 at nadir (time when insulin's effect is at its peak * BG can drop to its lowest point), then it's entirely possibly that he did drop that low. And what you may have been seeing at his pre-shot test (PMPS) last night was a bounce, as Rachel said.

I hope you can get a spreadsheet up & running for Mr. Black asap - this will really help us to help you. (Let us know if you're having trouble with that, and we can tag one of the spreadsheet gurus to help with the setup.:)

What did you get for a preshot # this morning?
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Hi neighbor!
Yes, I've considered 3 units could be too high, and last night and this morning I changed it to 2-1/2 and hope to give even lower than that - we'll see what the vet tells me today. We're on our way there in 2 hours, to compare my meter with their reading, so I'll know once and for all how accurate my meter is when I test.

I'm aware of the stress adding to the number at the vet, but I don't know HOW MUCH the number can go up because of it - 50, 100 or ??? Any way to find this out in Mr. Black's case?

I haven't tested before his shots (except the first day) as you mentioned because I really don't know what to do with the info once I get a reading...I'd just be guessing on what to do with his dose (I know - not good!). I hope to have the spreadsheet done soon, plus some answers from the vet today.
 
Vet stress may cause the glucose to jump 100-180 mg/dL according to a study one member posted.

There are some notes on glucose numbers in my signature which you might find useful.
 
nfcatlady44 said:
I'm aware of the stress adding to the number at the vet, but I don't know HOW MUCH the number can go up because of it - 50, 100 or ??? Any way to find this out in Mr. Black's case?
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Yes: In-home BG testing, both before every dose of insulin and at other times during the 12-hour cycles.

Frankly, in our collective experience, there are lots of vets out there who are not all that well-versed in the most current "best practices" in treating feline diabetes - which is why I - along with countless others who have joined FDMB - have found FDMB's forums to be such an incredibly reliable resource in helping me get my cat's diabetes well-regulated. All too often vets rely on in-clinic BG#s only to determine insulin dose. (This often turns out to be an error in judgment on the part of the vet, unfortunately.) Many vets do not encourage in-home testing, either - opting instead to tell the cat owner to bring kitty in for an expensive (!) fructosamine test every couple of weeks. But home-testing of blood glucose makes such added expense generally unnecessary; and consistent testing at home provides you two things:

- Added assurance that you are keeping your kitty safe from a hypoglycemic event (the pre-shot BG test both a.m. & p.m.)
- Lots of good data that, once you plug all those BG#s into a spreadsheet, provide you and others here who help you with your cat's individual pattern of response to the insulin. This is what guides your hand where dosing is concerned, and helps you in getting your cat well on the way to better health.

Will be interested to hear how your your conversation with the vet went today.:)
 
nfcatlady44 said:
I'm aware of the stress adding to the number at the vet, but I don't know HOW MUCH the number can go up because of it - 50, 100 or ??? Any way to find this out in Mr. Black's case?
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Hi Nancy,

With Bertie, on a couple of occasions, I tested his blood glucose before going to the vet and then when got home again. (I guess I could have tested his blood glucose at the vet's but I didn't think of that. Duh!)
Anyway, his blood glucose remained pretty much the same, so in his case the stress of the vet visit had no impact at all on his blood glucose levels. But there are cats here whose blood glucose has been raised quite dramatically by a trip to the vet....

nfcatlady44 said:
I haven't tested before his shots (except the first day) as you mentioned because I really don't know what to do with the info once I get a reading...I'd just be guessing on what to do with his dose (I know - not good!).
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The main reason we test before giving insulin is just to make sure that the cat's blood glucose is actually high enough to warrant being given that insulin shot. (Sometimes they can surprise us! ;) )
For folks new to dealing with diabetes we recommend that NO insulin is given if the blood glucose (at the time of the shot) is below 200. That's just until the caregiver has got comfortable with hometesting, and has gathered a little bit of data about how their cat is responding to the insulin.

Has anyone given you the link to our Prozinc 'user guide'? Just in case they haven't, the link is here:
Protocol for ProZinc/PZI

As others have said, it is really useful to be able to record your blood testing data on a 'spreadsheet', so that you can keep a track of the info, and others here can look at that data if you need their help.
Don't be put off by the idea of the spreadsheet. There are some techy people here who can set that up for you if you need help.

Hoping all went well at the vet. :bighug:

Eliz
 
Robin&BB said:
Yes: In-home BG testing, both before every dose of insulin and at other times during the 12-hour cycles.

Frankly, in our collective experience, there are lots of vets out there who are not all that well-versed in the most current "best practices" in treating feline diabetes - which is why I - along with countless others who have joined FDMB - have found FDMB's forums to be such an incredibly reliable resource in helping me get my cat's diabetes well-regulated. All too often vets rely on in-clinic BG#s only to determine insulin dose. (This often turns out to be an error in judgment on the part of the vet, unfortunately.) Many vets do not encourage in-home testing, either - opting instead to tell the cat owner to bring kitty in for an expensive (!) fructosamine test every couple of weeks. But home-testing of blood glucose makes such added expense generally unnecessary; and consistent testing at home provides you two things:

- Added assurance that you are keeping your kitty safe from a hypoglycemic event (the pre-shot BG test both a.m. & p.m.)
- Lots of good data that, once you plug all those BG#s into a spreadsheet, provide you and others here who help you with your cat's individual pattern of response to the insulin. This is what guides your hand where dosing is concerned, and helps you in getting your cat well on the way to better health.

Will be interested to hear how your your conversation with the vet went today.:)
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The visit with the vet turned out informative. His reading was only 135! However, my meter said 60 points less at 75. I'd understand if it was 20 or 30 points difference, but 60?? The vet of course wants me to come in again in a week or so and we'll try it again. If it's consistent around 60 points, then I'll know to keep that in mind when I home test. So many people on here use the same RelioOn Confirm with no problems like this. What's really good though is Mr. Black is now on 1-3/4 units of ProZinc, plus his excessive peeing has decreased quite a bit! Yaay, finally some signs of improvement! I'll be testing him again mid-day today, then before his evening shot. The spreadsheet is on my "to do" list, so hopefully today.
 
nfcatlady44 said:
The visit with the vet turned out informative. His reading was only 135! However, my meter said 60 points less at 75. I'd understand if it was 20 or 30 points difference, but 60?? The vet of course wants me to come in again in a week or so and we'll try it again. If it's consistent around 60 points, then I'll know to keep that in mind when I home test. So many people on here use the same RelioOn Confirm with no problems like this. What's really good though is Mr. Black is now on 1-3/4 units of ProZinc, plus his excessive peeing has decreased quite a bit! Yaay, finally some signs of improvement! I'll be testing him again mid-day today, then before his evening shot. The spreadsheet is on my "to do" list, so hopefully today.
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Those numbers sound about correct. Pet meters will always read higher than human meters. I used to do side by side comparisons with my Alpa Trak 2 pet meter and my Freestyle Lite human meter. I have some examples on Tuxie's spreadsheet but they are all in the world units of mmol/L.

I converted one of of mine that was in numbers close to yours to US numbers. My comparison:

AT2 pet meter 137 Freestyle Lite human meter 83. The differences are greater when the numbers are high and closer together as the numbers get much lower.
 
Tuxedo Mom said:
Those numbers sound about correct. Pet meters will always read higher than human meters. I used to do side by side comparisons with my Alpa Trak 2 pet meter and my Freestyle Lite human meter. I have some examples on Tuxie's spreadsheet but they are all in the world units of mmol/L.

I converted one of of mine that was in numbers close to yours to US numbers. My comparison:

AT2 pet meter 137 Freestyle Lite human meter 83. The differences are greater when the numbers are high and closer together as the numbers get much lower.
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The 135 was the "lab test" result from the vet, and 75 was from my ReliOn Confirm.
 
Hey there and welcome and to say again that I am so glad that you are home testing and especially since you are transitioning to lower carb food which can drop numbers significantly ! Once you get the SS up and going it will help those here to help you with the pre-shot numbers and what the dose should be.

The method is to always test before you shoot insulin so you know if it is safe to shoot. And as many more test as you can get through each cycle to determine how low the insulin took Mr. Black. The nadir, or lowest point of the cycle is somewhere around 5-7 hours after the shot.

You can do your own curves at home and as BJ mentioned, vet stress can have the numbers jump as much as 100 higher and then the vet is having you dose up according to that inflated number. All the test that you get and plug into the SS will help this forum to help guide you.

Keep asking questions and posting as that is how we all learned.
 
nfcatlady44 said:
The 135 was the "lab test" result from the vet, and 75 was from my ReliOn Confirm.
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The readings on the pet meters such as the AlphaTrak 2 are supposed to be closer to the lab machine tests, both of which are higher than the human meters. I took my AlphaTrak 2 meter is when I was having blood work done and did an ear test right before they did the blood draw. The glucose readings between my AlphaTrak 2 pet meter and the lab machine were within 3%.

Because many of the people here use human meters and the TR protocol was based on testing with human meters the information on the stickies and such is based mostly on readings from human meters. For instance with Lantus/Levemir the dose decrease level with TR is 68 on a pet meter but 50 on a human meter since there is a difference in readings. However whichever type of meter you use it is a tool to see trends and changes in readings. All meters can have a variance of + or - 20% so no meter is exactly dead on.
 
PS I wanted to say also, that I think that 1.75 units twice a day could be too high especially since the dosing was based on stress inflated numbers from the vet office and that you are transitioning to lower carb food. Let's see what everyone else thinks.
 
Yes, I worry about his 1.75 units 2x daily, but the vet yesterday actually wanted me to give him 2 units 2x daily. I'm so tempted to take him off insulin to see what happens (as you did). I have changed his diet in the past couple of months to FF Classic little by little, and in the past week he's been eating FF I'd say 85% of the time. He still craves his DM dry, which I give him a little once a day. And, when injecting, I have to bring out the Temptations treats and give him 2 of those so he can be distracted and still for his shot. All 3 of my cats (2 healthy) won't touch freeze dried, which is so unfortunate. My search goes on for a tasty-enough low carb treat.

Also, another thing I was thinking that could be part of the reason Mr. Black's numbers are so good right now could be because of opening a fresh bottle of ProZinc a week ago. I've read many times not to use the bottles over 50 days, and I used the other bottle for 2-1/2 months. Is it true that insulin can weaken after approx. 50 days or so? Could the new insulin, along with the low carb food be the reason for his numbers lowering dramatically? (His last lab test reading was 276 on Apr. 16th. Lab test yesterday was 135.)
 
We find that when properly handled and stored the bottles can last up to 6 months. When you start a new bottle, it can be more potent and skinny up the next few doses is a good idea.

Have you tried Bonita Flakes? Dried fish? You did say they didn't like freeze dried but wasn't sure if you tried fish too.

Let this forum do some brainstorming and see if we can get you a dose that will be safe before you just take Mr. Black off insulin just yet. Meantime could you get the SS up and going? If you need help with it, holler and someone will help get it going. It won't be me because I am a tech mo-m0.
 
nfcatlady44 said:
Is it true that insulin can weaken after approx. 50 days or so?
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As long as you keep your vial of ProZinc refrigerated, it should remain potent for about 6 months; I have even pushed mine to 7 months.
nfcatlady44 said:
Could the new insulin, along with the low carb food be the reason for his numbers lowering dramatically? (His last lab test reading was 276 on Apr. 16th. Lab test yesterday was 135.)
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Could be any number of factors/ changes you've made along the way. But as you only just started home-testing, it's all guesswork until you are testing consistently at AMPS/ PMPS time, as well as some tests around the time frame of when cats usually nadir (roughly between about +4 and +6/+7 hrs. after the shot.

I am glad you intend to home-test on a regular basis from now on - this really is essential, not only to make certain you're keeping Mr. Black safe, but also so that you can look at those numbers in a spreadsheet and SEE his pattern. As mentioned earlier, this will provide you with a much clearer picture of how Mr. Black is processing the insulin. And based on the numbers that we can see, it will make it easier to determine how/ when/ how much to adjust his doses of insulin.
nfcatlady44 said:
Yes, I worry about his 1.75 units 2x daily, but the vet yesterday actually wanted me to give him 2 units 2x daily. I'm so tempted to take him off insulin to see what happens (as you did).
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Having seen what can happen when a cat gets too much insulin injected into his body, I am more than a bit concerned about your vet's current assessment of Mr. Black's insulin needs. A 135 BG reading on lab equipment is a pretty low number. So was that 75 that you reported you got on your Relion meter. (I don't think that was any type of meter "error.") But I don't think just going "cold turkey" on the insulin at this moment in time is a wise idea either. You could end up losing all the ground you've gained - and with nothing but the in-clinic BG#s to go by (up to this point where you're finally home-testing), we would only be guessing about his overall history since we don't have enough data yet.

What time will you be doing his next pre-shot BG test? PLEASE post that number on a new thread with a title that reads something like: "Need Dosing Advice ASAP." Depending on the number you get, you may want to reduce the amount of insulin. You do not want to shoot insulin if that number is too low. I would recommend that you read through this doc now, before your next pre-shot test time: Protocol for ProZinc/PZI
(It's the same one that @Elizabeth and Bertie sent you earlier.)

It disturbs me that your vet wasn't having you home test. Please look at it this way: If your Mr. Black were a human child, would you shoot him with insulin without first checking his blood glucose level? Of course you wouldn't! Nor would your child's doctor tell you it was okay to skip that essential step! So why some veterinarians think it's "ok" to skip the pre-shot BG tests that would keep our cats safe is beyond my comprehension ...

Bottom line here is: You're probably going to end up knowing more about treating feline diabetes than your current vet does. (Just sayin.';))
 
Robin&BB said:
As long as you keep your vial of ProZinc refrigerated, it should remain potent for about 6 months; I have even pushed mine to 7 months.
Could be any number of factors/ changes you've made along the way. But as you only just started home-testing, it's all guesswork until you are testing consistently at AMPS/ PMPS time, as well as some tests around the time frame of when cats usually nadir (roughly between about +4 and +6/+7 hrs. after the shot.

I am glad you intend to home-test on a regular basis from now on - this really is essential, not only to make certain you're keeping Mr. Black safe, but also so that you can look at those numbers in a spreadsheet and SEE his pattern. As mentioned earlier, this will provide you with a much clearer picture of how Mr. Black is processing the insulin. And based on the numbers that we can see, it will make it easier to determine how/ when/ how much to adjust his doses of insulin. Having seen what can happen when a cat gets too much insulin injected into his body, I am more than a bit concerned about your vet's current assessment of Mr. Black's insulin needs. A 135 BG reading on lab equipment is a pretty low number. So was that 75 that you reported you got on your Relion meter. (I don't think that was any type of meter "error.") But I don't think just going "cold turkey" on the insulin at this moment in time is a wise idea either. You could end up losing all the ground you've gained - and with nothing but the in-clinic BG#s to go by (up to this point where you're finally home-testing), we would only be guessing about his overall history since we don't have enough data yet.

What time will you be doing his next pre-shot BG test? PLEASE post that number on a new thread with a title that reads something like: "Need Dosing Advice ASAP." Depending on the number you get, you may want to reduce the amount of insulin. You do not want to shoot insulin if that number is too low. I would recommend that you read through this doc now, before your next pre-shot test time: Protocol for ProZinc/PZI
(It's the same one that @Elizabeth and Bertie sent you earlier.)

It disturbs me that your vet wasn't having you home test. Please look at it this way: If your Mr. Black were a human child, would you shoot him with insulin without first checking his blood glucose level? Of course you wouldn't! Nor would your child's doctor tell you it was okay to skip that essential step! So why some veterinarians think it's "ok" to skip the pre-shot BG tests that would keep our cats safe is beyond my comprehension ...

Bottom line here is: You're probably going to end up knowing more about treating feline diabetes than your current vet does. (Just sayin.';))
Click to expand...

Yep, I already feel I know more than my vet!

I checked Mr. Black's sugar at 1:45 pm and it was 53. According to what I'm reading and heard from the vet, my ReliOn Confirm tells me a lower number than the actual, so I'm keeping that in mind. But, I'll for sure test again tonight pre-shot and post here right away before he gets the shot - if there is one. Thanks so much!
 
How many hours after the insulin was that 53? If you have a while to go till shot time, you might want to give some Low carb food to have Mr. Black surf and not drop further till shot time. If he goes below 50 then he will earn a reduction. Do you need help setting up the spread sheet. That is going to be helpful for us to help you with dosing.
 
We have to get a spreadsheet for you so when you need help, we will have your history of levels and dosing. @Marje and Gracie, can you help? 50 is our level on a human meter to pay attention. As Bobbie says, give him a little regular low carb food and retest in 20 minutes. You want that number to go up, not down.
 
Bobbie And Bubba said:
How many hours after the insulin was that 53? If you have a while to go till shot time, you might want to give some Low carb food to have Mr. Black surf and not drop further till shot time. If he goes below 50 then he will earn a reduction. Do you need help setting up the spread sheet. That is going to be helpful for us to help you with dosing.
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What's the link again for the spreadsheet please?
 
Great! Now, go to your signature and paste the URL in there so it comes up each time you post, updated.

So, you have a lot of midcycle/nadir numbers. Are you testing before each shot? You want to do that, so you can be sure the number is high enough to shoot( over 200) and that your dose is appropriate for the level.

He is definitely in low numbers midcycle. I am concerned that your dose may need to be reduced.
 
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