New Member: starting Glucose Curve today; any tips?

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Cat Caregiver

Cat Caregiver

Member Since 2020
My 13 yr-old, 7-pound, neutered, indoor male, OLIVER, was diagnosed 9/28/20 and started on 1U bid Vetsulin. Vet said keep food the same, eating whenever he wants, and come back in 2 weeks. I immediately set up a Breeze litter box without a pee pad so I could measure his urine which is about 400 mls/day. I measure his water intake: avg. 500 mls/day. He eats about 3 ounces of dry Kirkland (Costco) cat food throughout the day. Looks as if the Vetsulin has had no impact on his polyuria so I bought an AlphTrak2 and plan to measure a Blood Glucose Curve today. (Hopefully the vet will accept my data.) The meter arrived yesterday so I tested his blood as a practice run (which was 4 hours after his morning Vetsulin, 1 U) and got 586. I set up a Spreadsheet and put the link in my signature box and will add data today. I read everything I could and took away his food just now (2 hours before the morning Vetsulin will be given). I will measure BG then feed him 1/2 hour before the morning shoot (10 am). I will then test BG every hour thereafter. Is this correct? Any advice?
 
Cat Caregiver said:
I will measure BG then feed him 1/2 hour before the morning shoot (10 am). I will then test BG every hour thereafter. Is this correct? Any advice?
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Hi, well done you for wanting to do this curve at home. :bighug:

With Vetsulin, yes, it is helpful to test hourly if you can, until the blood glucose is past the peak of the cycle and is rising. Then you can space tests much further apart, or even not test again until the evening pre-shot test (especially if your kitty has already had enough of the testing...)
The lowest number of the cycle 'often' happens around 4 - 4.5 hours after the shot with Vetsulin, but 'your kitty's mileage may vary'. On FDMB the lowest number has occasionally been seen as early as 3 hours after the shot, and as late as 7 hours after, but this is quite unusual.

Good luck with the curve!

Eliz
 
Welcome to FDMB we are so glad you found us! First I want to say WELL DONE! You have your spreadsheet up and signature done!
Eliz has already given you fantastic advice. I'm sure you will follow with questions. Theres a wealth of information here with good people to help you navigate it all.
WELCOME TO OUR FAMILY:bighug:

You've landed in a safe place, that happens to be the best darn site on this planet, to learn everything you need to know, about feline diabetes...and then some!
jeanne
 
Thanks Eliz and jeanne! It's 1/2 hour until his morning shoot, so I measured BG at 627 and gave him his food, which he's eating now. It took several free-hand pokes to get his ear to bleed. Is it OK to poke several times with the same lancet? I found that poking directly into the blood vessel that runs around the perimeter of his ear worked well. Is that OK to poke? He is a fawn-colored cat ad his skin is pink so it's very easy to see the vessel.
 
Hello and welcome, and let me echo what others have said, well done to you for getting all of this up and running!

Cat Caregiver said:
Thanks Eliz and jeanne! It's 1/2 hour until his morning shoot, so I measured BG at 627 and gave him his food, which he's eating now. It took several free-hand pokes to get his ear to bleed. Is it OK to poke several times with the same lancet? I found that poking directly into the blood vessel that runs around the perimeter of his ear worked well. Is that OK to poke? He is a fawn-colored cat ad his skin is pink so it's very easy to see the vessel.
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We usually try to avoid the vein-- it's a little painful to poke there, and it bruises easily. If that's the only place you're able to get blood from today while doing the curve, though, it is what it is. My cat had one ear that bled easily, and one ear that I could never get enough blood from, so perhaps if you switch ears you'll have a different situation! Wherever you end up doing most of the pokes, just make sure to apply some pressure on the poke site for several seconds after you get the test, to stop bleeding and help reduce bruising.

What size lancets are you using? We recommend using the larger size lancets (26 or 28 gauge) when starting, rather than the smaller 30 or 31 gauge that often come with the meter. After you've been poking a while, the ears will naturally grow more capillaries and bleed more easily so you can move to the smaller lancets, but using the bigger ones definitely helps at first.
 
I'm guessing they are 28 gauge because they came with the meter. I can't find the size listed anywhere. The lancing device drew no blood on any setting so I am free-handing. His ears are VERY THIN so I go straight thru so far when poking. I will try poking at an angle next and see if that helps. Thank you for the tips.
 
+1 Poke: I put a dish of coconut oil on the floor for him to lick while I poked his ear. I tried a non-vein area and poked at an angle but the blood sample was too small and gave an ERROR meter reading. So I poked again with a new lancet and scooped the blood off with my thumb nail. It was a bit clotted by the time I got it to the test strip but the meter read it.
+2 Poke: Covered a round cork with a paper towel and held it inside his ear to have something to poke against. Got a good drop to read.
+3 Poke: Used covered cork again and even though the drop was small, the meter read it!
+4 Poke: Used cork again but poked INSIDE of ear and was perfect!
 
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Ah, I was just checking the spreadsheet to see if you had any more numbers; I see you've added the +2 to your message (side note: it's usually better with this forum software to add a new message rather than updating an older one, as the update doesn't show up as "new" to readers otherwise)

Could have been a bad reading on the +1, or it could just have been meter variance-- it can be quite large for the higher numbers! You may start to see some real movement soon, so keep going with the curve for a while and let's see what Oliver has to show us :cat:
 
I tested the meter on my other cat who is not diabetic and hadn't eaten since breakfast (about 6 hours ago) and his BG was 100. So I know the meter is working. I'm really glad HE's not diabetic; my daughter helped me test him and said she felt like she was wrestling an alligator in the outback! With Oliver however, she said she felt like she was a child playing "doctor" on a stuffed animal. Oliver is half Ragdoll, thank goodness. Joking aside, looks as if Oliver's Vetsulin has maxed out. His +4 is back up to his AMPS. And yesterday's test-run taken at +4.25 was comparable. I will be contacting the vet tomorrow (or maybe late today) and appreciate any advice! Should I be testing his urine for ketones?
 
Definitely a good idea to test for ketones with a kitty who is running high. Should be easy for you to get a sample, if I understand your litter box arrangement (unless your civvie uses the same box? or do you just wait until Oliver goes in to measure volume and keep things separate that way?)

Your vet will probably suggest a dose increase based on these numbers, and that very well could be what Oliver needs. A couple things to keep in mind, though:

1) we would probably want at least another day or two of pre-shot tests and spot-checks before increasing. This is because of a phenomenon called 'bouncing', in which a kitty's body reacts to a low number by skyrocketing BG. Unfortunately, BG can be elevated in a bounce for up to three days, so it'll take another day or two before we can be reasonably sure that the numbers you're seeing today aren't just a bounce. Besides your data, the fact that he's still drinking a lot of water suggests that he is still spending a lot of time overall in high numbers, it's just a question of why.

2) sometimes vets suggest dose increases in full units. We've found that big jumps like that can miss the perfect dose, and usually recommend dose changes in units of 0.25U.

3) now that you're up and running with testing, you have another angle to work to try to improve Oliver's FD status, changing food to all low-carb. That's not a safe thing to do while giving insulin if you aren't testing, because the food change can have a really dramatic impact on some cats' insulin needs, but you can do it safely if you are monitoring. The Kirkland dry food is going to be pretty high in carbs, so switching to a low-carb pate (less than 10% carbs from this list: http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf) will help a lot.
 
Thank you for your excellent and detailed analysis. Today's BG Curve demonstrated very little impact from the Vetsulin. Would it be OK to just stop the insulin (or cut it in half) and change the diet? This way I could compare the two (Vetsulin vs. Diet) independently. When he was diagnosed two weeks ago, I wondered why the vet didn't just start with a diet change.
 
Hmm, I wouldn't just stop insulin to do a food transition like that, especially with him running high. The risk there is ketones, which can develop in a diabetic when they aren't getting enough insulin and not enough food (and many cats are finicky eaters during food changes). There are other factors that go in, not least of which is whether or not a cat is ketone-prone, but it's one of those things that is serious enough that you don't want to risk it if you don't have to.

I think I'd just stick with the insulin and start a gradual food change. You'll want to make sure you're getting pre-shot tests (to make sure it's safe to shoot) and at least one in-between test to see how low he goes during the transition. Does that sound possible?
 
I like your plan! Your points are very compelling. I will keep the insulin the same and gradually change the food, all the while doing pre-shot tests and some in-between tests to discover his lows. When I asked the vet two weeks ago about food, she sold me a bag of Royal Canin Glycobalance (dry) but said not to use it until we see what the insulin does. The best I can tell is that his Kirkland food is 36% carb., 14% fat, 32% pro., 3% fiber. The Royal Canin Glycobalance is aprox. 30% carb., 10-14 % fat, 44% pro., 6.7% fiber. So that would be a gradual shift in right direction. Or do I need a lower carb. food?
 
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New Question: I opened the RC Glycobalance bag and Oliver went nuts over it!!! I thought it would be a nice treat to give him a few pieces since he'd been so good about the ear pokes all day. But he decided to stop eating the old kibble and hold out for the new stuff! He spent the rest of the afternoon following me around begging for it. I just measured his PMPS at 566 (lower than the AMPS, probably because he's holding out for the new food). My daughter just tried to give him his PM insulin shot but he wiggled out from under the needle while she was shooting so we are going to have to skip tonight's insulin dose and the pm glucose curve. He is refusing to eat the old food now and is stalking us to get the new food. Any advice? Should this be a new post?
 
Uh.... well, I guess I would say that Oliver has made his feelings clear on this! The carb difference is not that big between the two foods so I don't think you'll need to go gradually on this switch for that reason. You do want to watch out for digestive issues when doing a rapid food switch.

You'll want eventually to get him eating food that is less than 10% carbs, so it's a bit of a bummer that he likes the Glycobalance so much, as he may not be on it for long. Hopefully he'll find that he likes truly low-carb foods just as much!
 
Cat Caregiver said:
The Royal Canin Glycobalance is aprox. 30% carb., 10-14 % fat, 44% pro., 6.7% fiber. So that would be a gradual shift in right direction. Or do I need a lower carb. food?
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Absolutely not! All dry food is packed with carbs . Carbs feed diabetes.
note there ARE lower carb, dry food on the market but they are just "lower" in carbs. I just dont get why vets push dry food as an acceptable meal for a diabetic cat. Any human doctor would NEVER do this.:rolleyes:
 
Amber's SS,

THANK YOU so much for guiding me through this first glucose curve. Because of Covid-19 my vet was very nervous about instructing me and my daughter inside the clinic. She was swamped with drop-off pets. I think the clinic was short on staff due to Covid-19. This website was a godsend. The wealth of information and real-time, in-person help was more valuable to me than the diagnostic service provided by my vet.

I went on Google Scholar and read PubMed articles about feline diabetes and was shocked by the dearth of studies. I found more information on this website.

You are so right: "Oliver has made his feelings clear on this!" This morning he sat for two hours in front of his food bowl, refusing the old food. So, I appreciate very much that you took the time to answer my question about switching him over to the RC.
 
jt and trouble (GA) said:
Absolutely not! All dry food is packed with carbs . Carbs feed diabetes.
note there ARE lower carb, dry food on the market but they are just "lower" in carbs. I just dont get why vets push dry food as an acceptable meal for a diabetic cat. Any human doctor would NEVER do this.:rolleyes:
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I agree and will follow any advice on how best to switch him off the RC ASAP!
 
All those "good things" manufacturers put into their dry food is quickly cooked out in the process (massively high temps), If you ask me its pushes the truth in advertising beyond its limits. :mad:
 
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