Newbie Curve/BG test inquiry

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Diane Tyler's Mom GA

Diane Tyler's Mom GA

Member Since 2018
Newbie Curve/BG test inquiry
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  1. Anjee
    Joined:
    Monday
    Hello again, I posted this question recently, but then thought I might get a faster reply if I asked a helper from my very first post here instead since I'm trying to get my sugar baby started on her insulin asap & soon I'll have to go back to work (so can't Curve), but I can't find how to delete posts here so it's still there until I can figure that out. At any rate, here it is and much obliged if you can assist:

    Trying to compile all the scattered, overwhelming info I received from my very first thread this week (although extremely grateful) plus located on this website into a sensical, easily accessible physical format in case of emergency while trying to learn to navigate this very intricate website (at least it is for certain newbies), but can't even get past the first step because I can't locate how often/when to Curve once starting the Insulin. Is it Curve every 2h for 8-12h just the day before, then on your first day of starting Insulin: Test BG before the AM shot, then test BG again (if not at home/working) before the PM shot, then repeat this daily? Then how soon do you Curve again & how often? And in case of a hypo emergency: is a vet ER visit always required once they drop to 50 or less BG or only with certain symptoms?

    Thanks again


  2. Anjee, Yesterday at 7:41 PMReport
    Reply


  3. Diane Tyler's Mom
    Joined:
    Sep 21, 2018
    New
    Hi it's not that I don't want to answer you questions but the group prefers you post your questions on the feline health board.
    I will move your post for you
 
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First how many units are you going to start with?
You would test the BG first thing in the morning to be sure it's safe to give insulin. For newbies we suggest not to give insulin if the BG is under 200. You can stall for 20 minutes ,do not feed yet and test again to see if the BG comes up on it's own.
You can always post for help in your title
If it's 200 you would then feed and then give insulin
So test, feed and give insulin, lantus usually starts to work @+2. 2 hours after giving insulin.
I don't know what hours you work but it's best to get a test at +2 to see if the BG is dropping ,if so that means you should test again @+3.
If it is dropping a lot you might have to feed med or high carb food .
We won't know until you start testing , are you going to set your spreadsheet up soon?
Did you read the dosing methods , I think we suggested you go with SLGS
You would stay with the same dose for 7 days ,unless the BG drops under 90, you would then reduce the next dose by 0.25 units
So after 7 days you would do a curve
After giving insulin you would then test every 2 hours until you get the test at PMPS


On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up , always ask if you're not sure about something

What hours do you work

We suggest after AMPS test , get a +2 test, +4 and a +6 , even for the PMPS cycle, cats often drop lower at night
Then the next day maybe get a test +3. +5 +7 both cycles
You want to test at different times , like filling in pieces of a puzzle
What time to you plan to test for both cycles AMPS and PMPS?

Do you want someone to set up your spreadsheet for you?
 
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From the
START LOW, GO SLOW (SLGS)

The Start Low, Go Slow Method (SLGS) with Lantus, Levemir, or Biosimilars for Diabetic Cats has been adapted from the FDMB's original 5 Steps to Regulating Your Diabetic Cat. Adaptations were necessary to accommodate the action, nuances, and exceptions of the newer Lantus, Levemir, and their Biosimilars insulins.

Requisites when following the Start Low, Go Slow Method:
  • Learn the signs of and how to treat Hypoglycemia and prepare a Hypo Toolbox.
  • Test regularly for ketones and know about Diabetic Ketoacidosis (DKA).
  • Use a meter calibrated for humans, not a pet-specific meter. Reference numbers given are for measuring blood glucose with a human meter.
  • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
  • Most kitties are easier to regulate when fed small meals throughout each cycle. Others adapt well to free feeding.

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Please read all the yellow stickys from the Lantus link
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
@Anjee
 
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Diane Tyler's Mom said:
First how many units are you going to start with?
You would test the BG first thing in the morning to be sure it's safe to give insulin. For newbies we suggest not to give insulin if the BG is under 200. You can stall for 20 minutes ,do not feed yet and test again to see if the BG comes up on it's own.
You can always post for help in your title
If it's 200 you would then feed and then give insulin
So test, feed and give insulin, lantus usually starts to work @+2. 2 hours after giving insulin.
I don't know what hours you work but it's best to get a test at +2 to see if the BG is dropping ,if so that means you should test again @+3.
If it is dropping a lot you might have to feed med or high carb food .
We won't know until you start testing , are you going to set your spreadsheet up soon?
Did you read the dosing methods , I think we suggested you go with SLGS
You would stay with the same dose for 7 days ,unless the BG drops under 90, you would then reduce the next dose by 0.25 units
So after 7 days you would do a curve
After giving insulin you would then test every 2 hours until you get the test at PMPS


On a human meter, 50 is your “take action” number meaning it's time to intervene with food to bring the BG up , always ask if you're not sure about something

What hours do you work

We suggest after AMPS test , get a +2 test, +4 and a +6 , even for the PMPS cycle, cats often drop lower at night
Then the next day maybe get a test +3. +5 +7 both cycles
You want to test at different times , like filling in pieces of a puzzle
What time to you plan to test for both cycles AMPS and PMPS?

Do you want someone to set up your spreadsheet for you?
Click to expand...
 
Thanks again for that info. In order of sequence: Vet says 1U twice a day, but I'm so scared that I figured 1U once a day should be the starting dose for a cat new to this, no? Next, I'm sorry, I keep reading this info elsewhere as well: Why would you stall (I assume that means to wait & not FDMB terminology?) and not feed if the BG is under 200 if you want the BG to rise? Next, Re: Dosing methods - Yes, I think I read & printed out every info page here on the site bc I've been reading every day for a week now (just so wish I had them to memory) & now my phone just died this morning (ordered new one by mail), so I only have access via a 13 y/o slow, overheating laptop until I rtn to work Tues. Next: I read it's not safe to post your work sched here. Should I DM you it? Next, I would only be able to test when I'm off work of course so I have no idea how anyone here who works fulltime does multiple tests (just 2 days off is ok?) nor how I will when I ascertain a FT job, which terrifies me for her sake. But for now, I will do it on my days off when I'm not cat /grocery shopping (once biweekly). Update: I'm sorry, I'm wondering if I misunderstood your last msg. Does everything after "So after 7 days you would do a curve" apply to the curve? So i.e. I would only have to test at +2 (& +3 if BG is dropping) on a work morning?
 
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You don’t give insulin once a day only. It only lasts for 12 hours so if you do that, your cat is unprotected for the next 12 hours. In addition, Lantus requires consistency which means same dose at the same time. If you’re worried about 1 unit, start at .5 unit x2 a day.

as for the work schedule, you should be able to do the preshot tests at home since you can pick the shot time that works best for your schedule. If you’re going all day, you should try to get a +2 at least before leaving for work and another one at night before going to bed. Can you do that?

Not sure I understand your curve question. A curve is different than daily testing. A curve means testing every 2 hours for 12 hours. You do that after 7 days. However, you need to test at least 4 times every day so the preshot tests and an additional 2. Does that make sense?
 
Ok, got it, thanks! Yes, I can do that. I didn't know it was only 1 test before & 1 test +2 on work days. I'd read: "We suggest after AMPS test , get a +2 test, +4 and a +6 , even for the PMPS cycle, cats often drop lower at night. Then the next day maybe get a test +3. +5 +7 both cycles" and I didn't know if that applied to just a curve or every day.
 
Yes that would be great if you were at home but if you’re not, and a lot of people who work aren’t, than at least get that second test before leaving the house.

do you understand about giving Lantus x2 a day and not only once?
 
abt Lantus: Yes, but I was hesitant as well because vet's email a couple days ago said "1U/twice day, if she responds well then we may drop her to once a day in the future". She only mentioned BG spot checks if I was nervous, besides a curve 3 days after starting insulin, then every 2 wks. I'm just the messenger. Want to do what's safest for Celia, but don't know how she's going to go for that many pricks in a day based on the last curves she's had but I will try my best, plus she has an ear tip so not sure if I just aim for under the tip when I run out of room around the perimeter of that ear or what & can't do paws because she's the type that won't let you lift one for anything.
 
Your vet is not well informed and sadly most vets aren’t. I think there are other things he’s told you that we said are incorrect in some of your other threads if I remember correctly. You never want to give insulin once a day only because it does not last 24 hours. You’re much better off splitting the dose and giving it twice a day. Given all your anxiety around a potential hypo, I really think it’s best if you start her on .5 unit x2 a day. We actually do suggest a smaller starting dose like .5 unit anyway. Start low go slow (SLGS) is the protocol you’re going to follow so it just makes sense.

Tagging some of the folks here who answered your other thread for more advice @Sienne and Gabby (GA) @Bron and Sheba (GA)
 
Did you answer @Bandit's Mom PM about the spreadsheet? We can’t really help you with dosing unless you set up a spreadsheet so we can see the data.
I agree you would be much better to give 0.5 unit twice a day than 1 unit once a day. It not only give coverage for the 24 hours, it is safer, as you are giving a smaller dose more often, than giving a bigger dose less often.
To keep your kitty safe you need to be testing before every dose to see it is safe to give the dose.
Then try and get a test in between the cycles, sometime between +4 and +7 to see how low the dose is taking your kitty.
Lantus dosing is based on how low the dose is taking the not the preshot.
 
Bron and Sheba (GA) said:
Did you answer @Bandit's Mom PM about the spreadsheet? We can’t really help you with dosing unless you set up a spreadsheet so we can see the data.
I agree you would be much better to give 0.5 unit twice a day than 1 unit once a day. It not only give coverage for the 24 hours, it is safer, as you are giving a smaller dose more often, than giving a bigger dose less often.
To keep your kitty safe you need to be testing before every dose to see it is safe to give the dose.
Then try and get a test in between the cycles, sometime between +4 and +7 to see how low the dose is taking your kitty.
Lantus dosing is based on how low the dose is taking the not the preshot.
Click to expand...
She can’t do +4,+7 because of work schedule. That’s why I suggested at least a +2 in both cycles. Maybe she can do more tests when she’s off?
 
Bron and Sheba (GA) said:
Did you answer @Bandit's Mom PM about the spreadsheet? We can’t really help you with dosing unless you set up a spreadsheet so we can see the data.
I agree you would be much better to give 0.5 unit twice a day than 1 unit once a day. It not only give coverage for the 24 hours, it is safer, as you are giving a smaller dose more often, than giving a bigger dose less often.
To keep your kitty safe you need to be testing before every dose to see it is safe to give the dose.
Then try and get a test in between the cycles, sometime between +4 and +7 to see how low the dose is taking your kitty.
Lantus dosing is based on how low the dose is taking the not the preshot.
Click to expand...
Yes, I answered her about spreadsheet but haven't heard back yet & have no idea where to find it either. Sorry
 
Anjee said:
Yes. Did it already but not sure I can get off tomorrow to test her +2,+4,+6 so that's what I'm worried. Also not even sure I got it in her, the needle is so short & thin. I guess only the numbers will tell.
Click to expand...
Make sure you feed her well before the shot and leave food for her while you are at work.
Ae you hometesting yet?
 
Bron and Sheba (GA) said:
Make sure you feed her well before the shot and leave food for her while you are at work.
Ae you hometesting yet?
Click to expand...
Yes, fed her breakfast right before shot &:have been testing for a mth now when vet requested curve every 2 weeks. Just don't know if safe to leave her for @8 hrs on only her 2nd day on it tomorrow. Just did a +2 & she lowered around 100+/- points to 334 after staying in the mid 400s for weeks. Will try to figure out how to fill in spreadsheet once I can find it. Its probably right in front of me & I don't even know it! Thanks
 
Bron and Sheba (GA) said:
Did you answer @Bandit's Mom PM about the spreadsheet?
Click to expand...
Anjee said:
Yes, I answered her about spreadsheet but haven't heard back yet & have no idea where to find it either. Sorry
Click to expand...

Hi @Anjee, I don't know how I missed your below reply. I will send you a private message (PM) with the details I need. Look for it in the Inbox at the top right corner of this page.
Anjee said:
Omg, please, because I can't even decipher them just by looking at them so anything would help, plus am juggling food shopping for my 7 cats plus TNVR colony today while fighting fatigue & focus symptoms from A D.D. & Depression symptoms so I am at my wit's end here. THANKS!
Click to expand...
 
Anjee said:
Yes. Did it already but not sure I can get off tomorrow to test her +2,+4,+6 so that's what I'm worried. Also not even sure I got it in her, the needle is so short & thin. I guess only the numbers will tell.
Click to expand...
Make sure you use a light or flashlight and part the fur so you can see the needles going in. When you have a fur shot you’ll know because the fur will get wet and the insulin smell will be super strong. But you want to see so you’re not wondering if you got it all in or not.
 
Thanks . I think I got it in (started with 0.5U instead of 1) because now at +4, she's down to 227 (was 334 at +2) & she usually stays in the 400s (before starting insulin). Now I'm scared if she'll be too low to give her the evening shot. I can't find that info (the BG limit) in all my notes. Update ~ Found it: 200.

Also regarding marking the HC & MC cans, how do you know which ones (MC vs. HC) to give during a hypo?

Thanks again.
 
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Anjee said:
Also regarding marking the HC & MC cans, how do you know which ones (MC vs. HC) to give during a hypo?
Click to expand...
I think I gave you this information before
Such as

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.
@Anjee
 
Anjee said:
Will try to figure out how to fill in spreadsheet once I can find it. Its probably right in front of me & I don't even know it! Thanks
Click to expand...
I see Bhooma just told you to look at your inbox , she sent you a message about setting up your spreadsheet

Will this help you understand the spreadsheet
About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

Take a look at other members spreadsheet to see what it looks like.
Look at the end of members posts tap on their blue links at the end of their posts underneath their signatures
@Anjee

Take a look at Ale and Bobo's spreadsheet
Bobo's Spreadsheet
You can look at mine also but you won't see many tests because Tyler has been in remission since 1-24-21 so I don't need to test that much
 
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Ale & Bobo & Minnie (GA) said:
You keep them separate. Anything that is not pate is either MC or HC like gravy lovers. You can look them up again in the food chart.

she won’t be too low. The peak of the insulin hits around the times we told you to test and after it starts to
Click to expand...
No, I have the MC & HC cans in my Hypo Kit ready to go, but I mean do you give MC if they hit between certain numbers and give HC if they hit others? If so, what is the range?

Btw, Celia just hit her lowest ever tonight (after a couple meter glitches): 191 at +4 after her PM shot. She appears happy, climbed in my lap which she rarely does & purring.
 
HC for anything below 50 and MC I’d say between 70 and 50 but every cat is different so you’ll have to see how her numbers are influenced by food first. Some cats will go up with even LC food. I think if she hits under 90 but over 70 and you’re worried, try LC first. If they go low and you give food to bring them up, you need to test again in 20 minutes to make sure they are going up and don’t continue to go down.
 
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Anjee said:
No, I have the MC & HC cans in my Hypo Kit ready to go, but I mean do you give MC if they hit between certain numbers and give HC if they hit others? If so, what is the range?

Btw, Celia just hit her lowest ever tonight (after a couple meter glitches): 191 at +4 after her PM shot. She appears happy, climbed in my lap which she rarely does & purring.
Click to expand...
That’s really great for her first day on Lantus :bighug:
 
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