Glucose home monitoring and interpreting results

[Raewyn]

I just got my glucose monitor today, and the first try at testing newly diagnosed Tim went smoothly. I had hubby home to hold him while I did the testing and he was pretty compliant. He didn't even seem to notice the prick, he was just concerned about getting food. Tomorrow I'll have it go at doing it by myself, that might not go so smoothly! He tested at 25.8 mmol/L (just before his insulin shot), which from the spreadsheet colour coding I'm guessing is pretty high.

I wonder if someone can direct me to information on what I should be expecting from the monitoring, eg. when I should be doing it and what I should be looking for in the readings?

Thanks.

 

[Becki and sox]

Tomorrow I'll have it go at doing it by myself, that might not go so smoothly!

Hi congrats on your first testing. It can always be a little scary but it soon gets part of your daily routine.
I find it easier when in my own to sit sox in the table back towards me and then sort of lean over him... Gives him less wriggle room. Or I test him when he's chilled out on the settee.

when I should be doing it

You always want to test before shooting any insulin. So for sox I used to test and feed at 7am (check his BG and line his stomach) then feed and shoot ah 7.30am. same routine at the evening then.
If I could test then a couple of times through the day I would.
Id try and test at around +5 hours as this when Sox would seem to reach his lowest point. And then a few hours after to see if his sugars were starting to increase again.

If you look at my 2018 spread sheet you will get an idea of how the numbers react after insulin.

All the best

 

[Raewyn]

Cool, thanks for your help!
I managed to get one blood test done today a couple of hours after his shot. I tried another couple of times but ended up giving up both times because I couldn't get enough blood (the second time I got the blood out but he moved and smudged it, so annoying!)
Hubby helped me do another one just before his second shot today. It is lower than yesterday (now in purple not red) which seems like a good thing.
How low would it have to be before I should worry about giving the insulin shot? I think I've seen that somewhere but now I can't find it again.
Another question - is there a reason to wait half an hour between the test and shot?

 

[Becki and sox]

the second time I got the blood out but he moved and smudged it, so annoying!

Ahh yes Sox's loves to do that... Or even flick it off his ear

is there a reason to wait half an hour between the test and shot?

I was always told to feed half an hour before shot to line kitties stomach so you know that there's something in there for the insulin to work with.

How low would it have to be before I should worry about giving the insulin shot?

I think to start with I had a no shoot number of 200 untill I knew how his body reacted to the insulin after a few weeks on the insulin and getting used to number I started to shoot on lower numbers if some one was there to monitor him.

I'll tag @MrWorfMen's Mom who might be able to give you more guidance about shooting on low numbers.

You may also want to post on the lantus forum too as all the guys in that forum will be used to working with lantus

 

[Raewyn]

Thanks for that, I'll check out the Lantus forum to see if can find the info.

 

[MrWorfMen's Mom]

Hi and welcome to FDMB.

Kudos and congrats on testing Tim. Testing is by far the best tool we have to keep our furry kids safe.

One tip for you when you get a sample but Tim gets antsy and doesn't want to wait for you to get the meter into position..........grab the blood bead on a clean fingernail and test from there. Saves a lot of frustration for both of you.

There is lots of great information in the stickies at the top of the Lantus/Levemir forum and I encourage you to read through those documents to understand how Lantus works and our dosing methods. I notice Tim is on 2u which is a bit higher than what we would normally recommend as a starting dose. While we would normally recommend no shot unless BG is over 8.3, given the higher starting dose and lack of data as yet, I'd suggest using 11 mmol as your cut off point until you get a bit more data. Once you get more data to understand how Tim is reacting to the insulin, then you can gradually lower your no shot limit. That said, if Tim has a history of ketones or DKA, then skipping shots is not usually the best idea and I would encourage you to post for assistance.

Lantus is dosed based on how low a dose takes the BG at nadir (peak action of the insulin). Lantus' action usually onsets around +3 post shot and peaks between +5 and +7 but every cat is different, the nadir can and does move and some cats will reach nadir earlier or later. Random testing allows you to figure out your cat's usual pattern.

Getting tests before shots tells you it is safe to give insulin and tests taken during each 12 hour cycle tells you how Tim is metabolizing the insulin and how low his BG is going. We recommend a minimum of 4 tests daily whenever possible. If you are working full time, it can be difficult to get mid cycle tests every day but grabbing tests whenever you can, still provides useful data on which to make dosing decisions. We also encourage getting a before bed test every night as many cats tend to go lower overnight than they do during the day.

With Lantus, you need to know Tim will eat but you do not need to wait between feeding him and giving his insulin shot. Your routine should be test, feed, shoot and it can all be done within 5 to 10 minutes.

 

[Raewyn]

Thanks for your help. I'm gradually getting more confident with the testing. His glucose levels are no where near 11 mmol even after the insulin at the moment, so hopefully that won't be an issue for the time being. And he is eating very well (constantly hungry). The vet didn't say anything to us about ketones or DKA. He has lost a lot of weight but has a good appetite. He's going back to the vet for another blood curve on Wednesday. I'm hoping to get some good data at home before then.

 

[Bron and Sheba (GA)]

Hi Raewyn and Tim. Well done home testing !!
There is absolutely no need for you to have to take Tim to the vet for a curve when you are home testing. Tests at the vet are typically higher than at home because the cat is stressed so the readings can be falsely high. And the dose could be increased when it shouldn't be because of the falsely high readings. Also you are getting readings throughout the day.....if you do a curve at home just test before shot then every 2 hours until and including the next shot. It will save you money too!
I notice you are not getting any readings at night. Cats often drop lower at night so it is a good idea to get a 'before bed' test at least to see that Tim is going to be safe.
Don't forget to use the remarks column in the SS for information about food, how kitty is feeling, urine output, bowels etc
Are you testing for ketones? If I were you I would go to the pharmacy and buy a bottle of Ketostix and test the urine for ketones. Anything above a trace needs vet attention. It is advisable for all unregulated diabetic cats to be tested regularly for ketones as they can lead to DKA which is a serious illness. If caught early they can be treated successfully.
Bron

 

[Raewyn]

Since he is already booked in I will take him this this appointment, but discuss with the vet about doing future blood curves at home. It's kind of intimidating contradicting their advice! They didn't even mention home testing as a possibility so I'm not sure that this would be something they would recommend or even have heard of.

I'm not sure how I would go about doing the ketone testing since Tim doesn't have a litter box and always does his ablutions outside. I don't even know where he usually goes, possibly under the deck! I guess I could put a litter box down for him on the deck to to see if he would use it. I don't want to keep him inside as he is much happier outside where he can get away from our dog.

 

[Idjit's mom]

Raewyn, there are meters that can be used to test the blood sugar and for ketones. They just use different strips for each purpose. I am not certain that you would be able to find them in NZ, but the brands I am coming up with are: Keto Mojo and Nova Max Combo. There are other brands that just test for the ketones. Hot on the market here in the US because of the popular ketone diets going on here. This might be an option for you.
Additionally, you don't have to have permission to home test. You are Tim's caretaker and the one who loves him. You need to know, real time, how the insulin is affecting him, and most importantly if it's safe to inject the insulin every time. If there is any objection, which I would wonder at, you can just nod and smile, then continue to keep your boy safe.

 

[Raewyn]

I just did a search and the brand of monitor I bought does another model that also measures ketones. Kicking myself that I didn't do the research on that before I bought it!
It is not too expensive though, so I could consider that. Thanks for the info.

 

[Bron and Sheba (GA)]

Lou is right, you don't need your vets permission to home test. A lot of vets discourage it but it is far safer for your kitty to be testing. Remember you are paying the bills and you are the cats advocate. I know it can be hard to go against vet advise but you can calmly say that you have looked into it and decided that home testing is the best thing for Tim and smile sweetly at the vet and you are quite happy to share the blood sugar results with him..