Smiffy's progress (: Friday 29th April

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Looby, you are asking some valid questions here. Yes, Mary Ann meant 4.6 not 46 (just a typo) - do you understand how the US uses a different "scale" to the UK and rest of the world? ie multiply by 18 to translate one of "our" numbers for the benefit of the US readers, and divide "their numbers" by 18 to translate it to the figure we use. And yes, +3, for example, followed by a number is the BG reading three hours (for example) after insulin was given. These are the very basic issues you need to get your head round - recording BGs accurately at each stage of the insulin cycle is the only way you will know how the insulin is working and if it's as expected or is too low for comfort, etc etc.

I strongly recommend that you read other members' threads on this forum so you will become familiar with this sort of thing. Other members may have similar issues to you and their experiences and the responses to their threads may well help you a great deal too. As you know, the vast majority of people here are in the US and their responses are exactly the same as those from any of us in the UK... There are only a tiny handful of us here these days and we are by no means able to be here 24/7... Work, family commitments, personal emergencies, holidays etc mean that there may be not only hours on end but days on end when we aren't able to spend time here, so it is well worth acquainting yourself with overseas members - they are incredibly helpful.

Good luck with the meter this week.

Diana
 
Diana&Tom said:
Looby, you are asking some valid questions here. Yes, Mary Ann meant 4.6 not 46 (just a typo) - do you understand how the US uses a different "scale" to the UK and rest of the world? ie multiply by 18 to translate one of "our" numbers for the benefit of the US readers, and divide "their numbers" by 18 to translate it to the figure we use. And yes, +3, for example, followed by a number is the BG reading three hours (for example) after insulin was given. These are the very basic issues you need to get your head round - recording BGs accurately at each stage of the insulin cycle is the only way you will know how the insulin is working and if it's as expected or is too low for comfort, etc etc.

I strongly recommend that you read other members' threads on this forum so you will become familiar with this sort of thing. Other members may have similar issues to you and their experiences and the responses to their threads may well help you a great deal too. As you know, the vast majority of people here are in the US and their responses are exactly the same as those from any of us in the UK... There are only a tiny handful of us here these days and we are by no means able to be here 24/7... Work, family commitments, personal emergencies, holidays etc mean that there may be not only hours on end but days on end when we aren't able to spend time here, so it is well worth acquainting yourself with overseas members - they are incredibly helpful.

Good luck with the meter this week.

Diana
Click to expand...
Is there one place that will tell me when I am supposed to home test her , when the numbers are too loo .... I understand now that the same low numbers on insulin are worring but are not worrying if the cat is off insulin so Maxie for example would have been OK at 4.6 if she was not on insulin so her owner would have tested her but not taken any action ..... Initially I thought I was to take action only if her BG was lower than 2.2 but that is not the case it seems ....... If I take a pre-shot reading of 4.6 I wouldn't give insulin but would I take action like give her higher carb food? Where are the boundries?

I give her the Caninsulin when she is three quarters her way through her food and she is still a littel anxious to eat as she knows there is a shot coming but doen't run away now so I would find it nigh on impossible to take a BG before I gave her her food ....... I am so dopey in the morning from the drugs that I am on as well .............. I remember somebody saying test, feed, shoot (or not shoot) ..... so if you test before you shoot and the BG is low, then you would give her maybe honey but then followed by higher carb food or do the food first .... I know if it was very low then you would HAVE to do the honey first? Is there one place where I can find a short clear guide to all of this? Things are sinking in from here and there ad from the refereneces that @Elizabeth and Bertie has given me ....

Just given Smiffy her shot and she just moaned a bit ... still have to feed her two steps up the stairs from her normal eating place though!

Thanks for the clarification .......... perhaps you could direct me to the next stage of understanding if there is such a document
 
Hi Looby,

Looby & Smiify said:
Is there one place that will tell me when I am supposed to home test her , when the numbers are too loo
Click to expand...
No, there isn't a single document that covers all of the above, but do have a read through of the Caninsulin/Vetsulin user guide which has quite a lot of helpful info.
Vetsulin/Caninsulin user guide

As a general rule, for those new to dealing with diabetes (and new to hometesting) we recommend that NO insulin is given if the blood glucose at the time of the shot is below 11 (200).
That's just until the caregiver has got comfortable with hometesting, and has gathered some data to show how the insulin is working in the cat's system.

If the number is too low to shoot, you can either skip the shot completely, or wait without feeding for a little while to see if the blood glucose rises on it's own to a shootable level.
Later on, when you've learned a bit about how the insulin is working in your cat's body, you might also decide to give the shot but to give a reduced or 'token' amount.
Ultimately whether you give the shot or not is your decision. You're the one holding the syringe.

Regarding preshot tests: I crumble a few freeze dried treats for Bertie and test him while he's munching on those. These seem to have no impact on his blood glucose. This might work for you, too..?

Caninsulin usually does 'most of it's stuff' in the first 5 hours after the insulin shot, after which the blood glucose will rise.
A cat may see the lowest number of the cycle at around 4 - 5 hours after the insulin shot. But some cats will have the lowest number a bit earlier than this, and some may have the lowest number a bit later.

It can be helpful to test the blood glucose during the first hours of the cycle to see how low the blood glucose is dropping, and also how fast the blood glucose is dropping. If it is dropping too low or too fast then giving food can help to slow down the drop and/or to reduce the amount of the drop.

The Caninsulin user guide suggests that, in most cases, the aim should be to not let the blood glucose drop below 5.6 (100) at the 'peak' of the cycle.
So, if you see a '5.6' earlier in the cycle, and there is still some time to go until the peak (lowest number), you may need to give food (or glucose if there's a very steep drop) to raise the blood glucose level, or to stop it from dropping any further.
That '5.6' is a perfectly safe number, but aiming to not go below that gives some 'buffer of safety'.

Hoping this helps.

Eliz
 
Looby & Smiify said:
You describe an episode 3 days ago with your cat ... Do you mean three hours after the preshot by 'at +3'?

Do mean therefore you gave Maxie her shot but then three hours later she was 4.6 not 46 as you have typed - sorry just want to be clear? You started giving her high carbs HC? Because there was too much of a drop within 3 hours of her shot? 4.6 is within normal range under normal circumstances isn't it?

So first course of action was HCs and then as she was dropping further you introduced syrup too but still she was dropping until 6 hours after shot down to 1.8 so you contained with more syrup AND HC? At what reading were you happy not to have to take her for ER and what does that mean? Emergency what?

If she is on a more gentle insulin than Caninsulin, why did her BG drop so quickly within 3 hours of you administering it?
Click to expand...

Others have already explained some of your questions. Sorry the 46 mmol/L should have been 4.6 mmol/L.

Yes the 4.6 is in a normal range but because she is on insulin and there was such a fast drop, especially when she is on a gentler, long acting insulin such as Levemir, that was a warning sign. I use the AlphaTrak2 meter which gives higher readings than a human meter. According to the AlphaTrak manual normal ranges are 4.0-9 for a kitty on insulin. Because my type of insulin usually has the low point (nadir) around 6 hours after the shot, I knew the glucose levels would be continuing to drop further. That was why I started with high carb food, which still did not keep the numbers from dropping further, so I added in syrup as well.

Because I use a pet meterI wanted to make sure Maxie's numbers stayed higher than 3.8 (68 US). On a human meter that would have been 2.8 (50US). With Caninsulin/Vetsulin these "take action" numbers would have been even higher since those insulins bring glucose down much quicker. If I had not been able to bring the numbers up with what I was doing then I would have taken her to the Emergency (ER). Not all kitties show signs of a hypo but when the numbers get too low and can't be brought up, the possibility of a kitty going into a serious hypo is more possible and as I explained in my other post a serious hypo can be deadly.

Even on the gentler insulins the glucose levels can drop. Because insulin is a hormone it can sometimes have different reactions. A dose that has been working fine for days or weeks can still cause glucose to drop too low. That is why home testing is important. A random test done at the vets office cannot tell what is happening on a day to day basis and even a glucose curve done at the vets will not always be accurate, especially if it is done on a day when the kitty is "bouncing". As well many kitties are prone to stress when at the vets office which can show higher numbers.
 
Tuxedo Mom said:
Others have already explained some of your questions. Sorry the 46 mmol/L should have been 4.6 mmol/L.

Yes the 4.6 is in a normal range but because she is on insulin and there was such a fast drop, especially when she is on a gentler, long acting insulin such as Levemir, that was a warning sign. I use the AlphaTrak2 meter which gives higher readings than a human meter. According to the AlphaTrak manual normal ranges are 4.0-9 for a kitty on insulin. Because my type of insulin usually has the low point (nadir) around 6 hours after the shot, I knew the glucose levels would be continuing to drop further. That was why I started with high carb food, which still did not keep the numbers from dropping further, so I added in syrup as well.

Because I use a pet meterI wanted to make sure Maxie's numbers stayed higher than 3.8 (68 US). On a human meter that would have been 2.8 (50US). With Caninsulin/Vetsulin these "take action" numbers would have been even higher since those insulins bring glucose down much quicker. If I had not been able to bring the numbers up with what I was doing then I would have taken her to the Emergency (ER). Not all kitties show signs of a hypo but when the numbers get too low and can't be brought up, the possibility of a kitty going into a serious hypo is more possible and as I explained in my other post a serious hypo can be deadly.

Even on the gentler insulins the glucose levels can drop. Because insulin is a hormone it can sometimes have different reactions. A dose that has been working fine for days or weeks can still cause glucose to drop too low. That is why home testing is important. A random test done at the vets office cannot tell what is happening on a day to day basis and even a glucose curve done at the vets will not always be accurate, especially if it is done on a day when the kitty is "bouncing". As well many kitties are prone to stress when at the vets office which can show higher numbers.[/QUOTE
Elizabeth and Bertie said:
Hi Looby,


No, there isn't a single document that covers all of the above, but do have a read through of the Caninsulin/Vetsulin user guide which has quite a lot of helpful info.
Vetsulin/Caninsulin user guide

As a general rule, for those new to dealing with diabetes (and new to hometesting) we recommend that NO insulin is given if the blood glucose at the time of the shot is below 11 (200).
That's just until the caregiver has got comfortable with hometesting, and has gathered some data to show how the insulin is working in the cat's system.

If the number is too low to shoot, you can either skip the shot completely, or wait without feeding for a little while to see if the blood glucose rises on it's own to a shootable level.
Later on, when you've learned a bit about how the insulin is working in your cat's body, you might also decide to give the shot but to give a reduced or 'token' amount.
Ultimately whether you give the shot or not is your decision. You're the one holding the syringe.

Regarding preshot tests: I crumble a few freeze dried treats for Bertie and test him while he's munching on those. These seem to have no impact on his blood glucose. This might work for you, too..?

Caninsulin usually does 'most of it's stuff' in the first 5 hours after the insulin shot, after which the blood glucose will rise.
A cat may see the lowest number of the cycle at around 4 - 5 hours after the insulin shot. But some cats will have the lowest number a bit earlier than this, and some may have the lowest number a bit later.

It can be helpful to test the blood glucose during the first hours of the cycle to see how low the blood glucose is dropping, and also how fast the blood glucose is dropping. If it is dropping too low or too fast then giving food can help to slow down the drop and/or to reduce the amount of the drop.

The Caninsulin user guide suggests that, in most cases, the aim should be to not let the blood glucose drop below 5.6 (100) at the 'peak' of the cycle.
So, if you see a '5.6' earlier in the cycle, and there is still some time to go until the peak (lowest number), you may need to give food (or glucose if there's a very steep drop) to raise the blood glucose level, or to stop it from dropping any further.
That '5.6' is a perfectly safe number, but aiming to not go below that gives some 'buffer of safety'.

Hoping this helps.

Eliz
Click to expand...
Yes that makes sense thank you but when is the 'peak' lowest number - would I have derived that from doing a home test curve? Or would it be half way between shots or would it be approximately four hours after giving Caninsulin ... how so I know when the peak is?
Click to expand...
 
Looby & Smiify said:
Yes that makes sense thank you but when is the 'peak' lowest number - would I have derived that from doing a home test curve? Or would it be half way between shots or would it be approximately four hours after giving Caninsulin ... how so I know when the peak is?
Click to expand...

Hi Looby,
The peak (lowest blood glucose number) will depend on the individual cat's response to insulin.

You may well see the lowest point at around 4 hours after the insulin shot. This is quite common. Or it may be a bit earlier or later. I've seen a few cats that have had the lowest point at 4.5 or 5 hours after the shot. And there is also a cat here who had the lowest point at just 3 hours after the shot.
This is something you will find out by testing Smiffy's blood glucose. Doing a 'curve' can help to determine when the peak of the insulin cycle is.
But be aware that the peak isn't necessarily a permanent fixed point, it can move around a little bit... :rolleyes:

Eliz
 
Diana&Tom said:
Looby, you are asking some valid questions here. Yes, Mary Ann meant 4.6 not 46 (just a typo) - do you understand how the US uses a different "scale" to the UK and rest of the world? ie multiply by 18 to translate one of "our" numbers for the benefit of the US readers, and divide "their numbers" by 18 to translate it to the figure we use. And yes, +3, for example, followed by a number is the BG reading three hours (for example) after insulin was given. These are the very basic issues you need to get your head round - recording BGs accurately at each stage of the insulin cycle is the only way you will know how the insulin is working and if it's as expected or is too low for comfort, etc etc.

I strongly recommend that you read other members' threads on this forum so you will become familiar with this sort of thing. Other members may have similar issues to you and their experiences and the responses to their threads may well help you a great deal too. As you know, the vast majority of people here are in the US and their responses are exactly the same as those from any of us in the UK... There are only a tiny handful of us here these days and we are by no means able to be here 24/7... Work, family commitments, personal emergencies, holidays etc mean that there may be not only hours on end but days on end when we aren't able to spend time here, so it is well worth acquainting yourself with overseas members - they are incredibly helpful.

Good luck with the meter this week.

Diana
Click to expand...
Yes I understand the readings are on a different scale in the States .... I have just read a good response by Elizabeth but I need to know how I find out what and when Smiffy's 'peak' (lowest number) is in her cycle .... I am guessing I would have to test her throughout the day one day and draw a curve for her .... I am learning a lot here ... maybe it would also be useful for me as Elizabeth says to go back to the Caninsulin Guide and read it again .... thanks for your help and support .....
 
Yes, Looby, it all comes down to being able to test Smiffy's BG at ANY point in the cycle. That's the ONLY way you'll have the information you need to treat effectively and minimise the risk of hypo.

Diana
 
Tuxedo Mom said:
Others have already explained some of your questions. Sorry the 46 mmol/L should have been 4.6 mmol/L.

Yes the 4.6 is in a normal range but because she is on insulin and there was such a fast drop, especially when she is on a gentler, long acting insulin such as Levemir, that was a warning sign. I use the AlphaTrak2 meter which gives higher readings than a human meter. According to the AlphaTrak manual normal ranges are 4.0-9 for a kitty on insulin. Because my type of insulin usually has the low point (nadir) around 6 hours after the shot, I knew the glucose levels would be continuing to drop further. That was why I started with high carb food, which still did not keep the numbers from dropping further, so I added in syrup as well.

Because I use a pet meterI wanted to make sure Maxie's numbers stayed higher than 3.8 (68 US). On a human meter that would have been 2.8 (50US). With Caninsulin/Vetsulin these "take action" numbers would have been even higher since those insulins bring glucose down much quicker. If I had not been able to bring the numbers up with what I was doing then I would have taken her to the Emergency (ER). Not all kitties show signs of a hypo but when the numbers get too low and can't be brought up, the possibility of a kitty going into a serious hypo is more possible and as I explained in my other post a serious hypo can be deadly.

Even on the gentler insulins the glucose levels can drop. Because insulin is a hormone it can sometimes have different reactions. A dose that has been working fine for days or weeks can still cause glucose to drop too low. That is why home testing is important. A random test done at the vets office cannot tell what is happening on a day to day basis and even a glucose curve done at the vets will not always be accurate, especially if it is done on a day when the kitty is "bouncing". As well many kitties are prone to stress when at the vets office which can show higher numbers.
Click to expand...
Is the Nadir the same thing as the 'peak' of the cycle ie the lowest number of a cycle? @Elizabeth and Bertie can you answer that as you are about? I understand exactly what you mean Tuxedo Mom (:
 
Elizabeth and Bertie said:
Hi Looby,
The peak (lowest blood glucose number) will depend on the individual cat's response to insulin.

You may well see the lowest point at around 4 hours after the insulin shot. This is quite common. Or it may be a bit earlier or later. I've seen a few cats that have had the lowest point at 4.5 or 5 hours after the shot. And there is also a cat here who had the lowest point at just 3 hours after the shot.
This is something you will find out by testing Smiffy's blood glucose. Doing a 'curve' can help to determine when the peak of the insulin cycle is.
But be aware that the peak isn't necessarily a permanent fixed point, it can move around a little bit... :rolleyes:

Eliz
Click to expand...
Is the 'peak' the same thing as the 'Nadir"?
 
Elizabeth and Bertie said:
Yes!
It's the insulin 'peak' (strongest effect), and the blood glucose 'nadir' (lowest number).
.
Click to expand...
I have read the notes on Caninsulin ..... all the normal ranges are different ..... in British numbers I mean ... my Vet says normal is between 5 and 8, you say 2.7 - 7.2 and the paper here that you referenced for me gives another number so it is a bit confusing .... I will take your numbers to be the normal range I think as they are the average between the two ...... have just read the bumph that comes with the Caninsulin pen again and there is NO information about home testing or the cycle - ABSOLUTELY NOTHING - just says to expect frequent visits to the Vet initially! I wonder if they are tied up financially! They did though give a specific quantity recommendation for the amount of glucose syrup to give a cat depending on their weight but the Vetenary nurse I saw just said rub Smiffy's gums with honey - she didn't say how much - do you think it matters how much? I would try to feed her some higher carb food first (which I only have in biscuit form if that matters) .. I have the gravy one that you suggested - can't remember now why the gravy from a tin of gourmet gold is good for her if she is hypo - is that high carb the gravy? I am going to read a bit more ......... have lots to discuss with the Vet!!!
 
It's true that it is not the perceived 'norm' for care-givers to test their cats' BGs at home, and it's not something that vets - other than the really enlightened kind - seem to even suggest. There seems to be an unspoken assumption that owners would simply not want to do so or not be able to do so. We on FDMB say RUBBISH (in polite mode ;-) ) The fact is though that there is absolutely nothing stopping us testing our cats in order for us to treat them so much more precisely. Knowledge is power. We may be in the minority but who cares. The bottom line is that our diabetic cats will probably have a longer and healthier life if we home-test their BGs effectively.

Most foods in gravy are higher-carb because there are sugars in the gravy.

Diana
 
Diana&Tom said:
It's true that it is not the perceived 'norm' for care-givers to test their cats' BGs at home, and it's not something that vets - other than the really enlightened kind - seem to even suggest. There seems to be an unspoken assumption that owners would simply not want to do so or not be able to do so. We on FDMB say RUBBISH (in polite mode ;-) ) The fact is though that there is absolutely nothing stopping us testing our cats in order for us to treat them so much more precisely. Knowledge is power. We may be in the minority but who cares. The bottom line is that our diabetic cats will probably have a longer and healthier life if we home-test their BGs effectively.

Most foods in gravy are higher-carb because there are sugars in the gravy.

Diana
Click to expand...
That's good I am well stocked in Gourmet Gold food in gravy ... just little tins so perfect ...... I also have some clear honey so all I need to know for the moment is how to use the meter that I bouht which is the AccuChek Avviva ... but I am hoping that the Vet may have a Alphatrak meter in stock which is what he used on Smiffy last time we were with him ...the click of that meter was much quieter than the one I have ....
 
@Looby & Smiify please read the last post of this thread that you started a few days ago. http://www.felinediabetes.com/FDMB/threads/smiffys-personality-changed.157133/ where i gave some information you will find useful around getting started and how to take blood from the paws if you can't do the ear testing. You also need to set up a spreadsheet and put the link to your signature. The spreadsheet is colour coded to help you understand the numbers and get some idea of what they mean, don't get too hung up on the actual numbers yet. For the AccuCheck meter you need the world spreadsheet for human meters and select the tab mmol/l for entering the numbers. If you are struggling with the spreadsheet someone can help you set it up. You just need to ask.
 
Alexi said:
@Looby & Smiify please read the last post of this thread that you started a few days ago. http://www.felinediabetes.com/FDMB/threads/smiffys-personality-changed.157133/ where i gave some information you will find useful around getting started and how to take blood from the paws if you can't do the ear testing. You also need to set up a spreadsheet and put the link to your signature. The spreadsheet is colour coded to help you understand the numbers and get some idea of what they mean, don't get too hung up on the actual numbers yet. For the AccuCheck meter you need the world spreadsheet for human meters and select the tab mmol/l for entering the numbers. If you are struggling with the spreadsheet someone can help you set it up. You just need to ask.
Click to expand...
I will have a look tomorrow - thanks Alexi - sorry I missed your post first time round xxx
 
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