? BG Testing & Curves Advice

[Cassia & Miss Kineta]

Here's the intro thread for some background on us so far.

I've noticed a lot of you guys test frequently throughout the day. I work a 9-5 job M-F and am not close enough to run home during lunch for a quick BG test. The regular hours do, however, keep our feeding times and insulin shots quite regular! It's been about a month since Kineta's diagnosis, we struggled with a few health issues early on, but have recently started to get into a regular routine with feeding, BG checks, and insulin doses and back to our normal selves. We are finally off other medications and it's been about a week since we've held all the variables consistent (food type & quantity, meal times, BG check times, insulin dose & injection times). This weekend I'm doing our first curve at home to see how her BG tracks throughout the day. I have been home with her every weekend since her diagnosis so I could keep an eye on her for any changes - she seems to be ok and I haven't noticed any signs of hypoglycemia on those days so I'm not too worried about that right now. I know Lantus dosing is based off of the nadir so I'm curious to see what we come up with. Her BG has been high mostly, but I think it is from a food spike??? We usually test and dose 30 min to an hour after she eats. Since I'm unable to test her throughout the day, I was planning on doing curves every weekend to see how she's tracking and then adjust her dose from there (maybe curve on a Saturday then I could keep an eye on her on a Sunday when I change the dose? then hold it for a week until the next curve). I could do additional tests in the evening which I'll start doing this weekend/week. What's a good time range to do spot checks? I've seen some charts have every hour/every other hour/random/etc. Kineta get's her insulin between 7:30 and 8 AM and PM every day, so I could check in the evening anywhere between +1 and +3 before I go to bed. I thought about changing our times to 6am/6pm which would allow us to check her morning BG at+2 right before I leave for work, but I can't always be home in time for 6pm. So the 7:30-8 seems to be working for us. Our vet had recommended we not go over 3u, that maybe we'll try a different insulin if we're not responding. Our next appointment is in 1 month, so until then I wanted to get some good data and curves so we can evaluate how things have been working over the long(ish) term. If she's still quite high in the next week or so I'll see if we can get in earlier to try another insulin. I believe her body is still recovering and adjusting to all the changes, so I'm trying to be patient with the process and not expect immediate changes!

Any thoughts or suggestions here? Is this a good starting strategy? We are still learning & figuring out what works best for us! Thanks all!!


Quick side note/question: we currently use Vet One u100 3/10cc 29G 1/2" (12.7mm) syringes. She is a little finicky when we do shots... I was thinking about changing the needles/syringes we use - shorter ones and possibly finer gauge? Which ones do you guys use???

 

[Wendy&Neko]

Hello and welcome here. Read all the yellow starred Sticky Notes if you have not already.

I have a lot of questions and comments, and will ask more when I am at the keyboard instead of iPad. First, you have been increasing without knowing how low a dose is taking her. Since she saw green somewhere around 1.5 units, I suspect she is overdose now. Mid cycle spot checks are essential. We dose based on how low the dose takes the cat, not the high points which tend to be the preshots. The lower points are usually somewhere in the middle, so I am glad to see you are starting to get more tests in.

What is “combo” food? What brands? Low carb wet or raw is best for diabetics. It can make a huge change in insulin needs.

As for syringes, something with 31g needles are better. Where do you live? That might help us point to a better place to get syringes. You should be able to get them at human pharmacies.
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[Cassia & Miss Kineta]

Hi Wendy, thanks for the reply, I appreciate your input! I believe we started out with the tight regulation protocol - our instructions from the vet were to increase dose 1/2u if she was above 250, keep it the same if she was 100-250, decrease dose 1/2u if she was 50-100, and do not give insulin below 50 and also reduce the next dose by 1u.

Her green number was on a day after she had not been eating for a couple days. We also had a vet appointment in the afternoon that day (3/18) because she wasn't eating and was not doing well. At that appointment our vet recommended:
1. continue to follow the insulin dosing instructions (as above, which I believe is TR??) - we were at 1.5u at that time.
2. stop taking metronidazole that we got from the emergency vet (figuring that was making her feel unwell enough to not eat)
3. start on an appetite stimulant until she would eat again (and since she wasn't eating I was offering her anything and everything since she was losing a lot of weight and the vet said the most important thing right then was to get her to eat)

After a couple days, she did start eating again, but our diet was unregular (different types of food) as we tried to find something 'good' for her that she would eat. Through all this she was also on antibiotics, which may or may not affect her insulin needs?? We just finished our last dose of that 1 week ago.

We had another vet appointment about a week later (3/23) for a check up.
1. I brought up the insulin dose (currently at 2.5) and the vet recommended to continue what we've been doing for now, but if she gets to 3u and is not responding, then we'll take a look at why that is/consider a different insulin. She thought 4u was a high dose and didn't want us going over 3u until she could see Kineta.
2. I asked about food - at this point she would not eat ANYTHING from a can. She did start eating both prescription dry foods (we have Purina DM that we got initially after her diagnosis and also Hills W/D which we got at the vet appointment on 3/18 to see if she'd eat that. I went to the store and looked through all the wet food in pouches to see which would be the best for her, settled on Natural Balance Platefulls, our vet said that if she wanted to eat that, that would be ok for now.

Currently she eats a combination of the prescription dry food and the Natural Balance platefulls wet food. ** I am trying canned food here and there - she still will not touch it (we have Purina DM chunky and friskies shreds in different flavors - the friskies is what she ate before our diagnosis) I'm hoping she will eventually take to the canned food again, but I'm doing what I can in the mean time. It was important that she gain her weight back, so we found a balance in food that would be better for her and food that she would actually eat. She is nearly back to a good weight so I can be a little more strict on her food now.

I unfortunately am unable to test mid-day, which is why I am trying to do more testing this weekend. It took a while to get into a routine, and since we have been on a steady routine for a week now I figured the numbers won't be all over the place, although it seems like they have anyway. I am going to test again soon and continue through tonight. I will do the same tomorrow.

 

[Sienne and Gabby (GA)]

Welcome to the group.

You may want to take a look a look at this post on managing diabetes and working full time. Like you, I worked the entire time I was managing Gabby's diabetes and I was following the Tight Regulation (TR) protocol. I did move my shot time to 5:00 AM and PM. This gave me time in the morning to get some tests in. before I left for work. Gabby had an early nadir so I have a way of knowing if her numbers were dropping and I could bump up her carbs before I was out the door.

One observation, with Lantus, you can test, feed, and shoot all within a few minutes. I would give Gabby her shot when her head was in her food. You do not have to wait 30 - 60 minutes after a meal to give Kineta her shot. Lantus onset is generally at around +2 whereas with shorter acting insulin, you must have food on board before giving a shot. If your vet told you to wait before shooting, I suspect your vet in not well versed in how Lantus works.

The instructions your vet gave you are not for TR. With TR, you adjust the dose based on nadir. If nadirs aren't in normal range, you increase the dose usually by 0.25u and at most, by 0.5u. Doses are evaluated every 3 days/6 cycles. You decrease if numbers fall below 50 in a cat within a year of diagnosis. One of the basics, though, is that TR is not recommended if your cat is on a dry food diet. The research on TR is based on a low carb, canned food diet. I'd encourage you to read over the Start Low Go Slow (SLGS) approach to dosing given that Kineta is still eating dry food.

The majority of the prescription diabetic dry foods are very high in carbohydrates -- the last thing in the world your cat needs. If your kitty is a dry food addict, Young Again Zero Carb is a reasonable option. It's about 5% carb. The company will send you a sample if you get in touch with them. Lisa Pierson, DVM has a website on feline nutrition. She has a section on how to transition a cat to a canned food diet. She also has a food chart that has information on the carb count for most canned foods. (I've linked the section on transitioning your cat.)

Please let us know if you have questions. The people here are very generous with their information and time.

 

[Cassia & Miss Kineta]

Thank you Sienne, the first post was encouraging! It's good to know there's others out there who aren't able to test throughout the day but make it work! I will start doing feeding, testing, and shooting all at once and see how that goes. The initial instructions were to feed her, wait until she finished, test, and then give insulin based on those numbers. I did suspect that her numbers would be naturally a little higher when I was testing after meals simply from food intake, so I was wondering why I was basing the dose off those numbers, but I just kept doing what the vet recommended .

Today her nadir was at +9 or possibly before at +7 or +8? Don't know since I didn't test at those times. So following SLGS I decreased her dose this evening. I don't have half units on our syringes so I just went with about half a unit decrease somewhere in the middle of the 2nd and 3rd lines. I did order different syringes with 1/2 unit markings so I'll switch to those when we get them. I planned on testing her all weekend, so I'm going to continue every 2-3 hours tonight and tomorrow.

Still working on the canned food... tried again tonight with Purina DM chunky canned and FF pate and she wouldn't eat it. Tried putting a little in with her dry food and she just eats around it. We'll keep trying... she eats the stuff in the pouch which is basically the same texture as the stuff in the can, so not sure what the problem is, maybe a smell? no idea! I haven't heard of the Young Again Zero Carb, but I'll look into it if I can't get her eating canned food, thanks for the recommendation.

Thanks for linking everything - I feel like I find a helpful page on here and then when I try to find it again I forget where I saw the information and start clicking through everything again trying to find what I'm looking for

 

[Wendy&Neko]

By the way, 3 units is not "too much insulin". Cats need what they need. My girl needed 8.75 units Lantus to turn her around, and that was on low carb raw food. She did have a couple secondary conditions that meant she needed more insulin than most. We have seen a cat on as high as 5.5 units on what was supposed to be low carb wet, but sneaking another cat's dry food. When dry food was removed from the house, he very suddenly went into remission. There is nothing magic about the number 3, especially with high carb dry food in the picture. Dr. Elsey's clean protein is supposed to be another low carb dry food. I don't know much about low carb dry food, I am in Canada and the options aren't available here.

I see you caught a 66 today! As I suspected, the dose was too high. SLGS would only have you reduce by 0.25 units, but given you were overdose, plus the lack of markings on the syringe, reducing by 0.5 units was fine. Are you in the US? Walmart's Relion syringes have 1/2 unit markings. I think the Sticky Note on Insulin Care and Syringe Info lists some other brands available in the US. The rest of the world, it's basically either the BD Ultrafine II or BD Microfine syringes.

Good luck with the food transition. It can take a while, but will be worth it. Don't transition without being able to monitor.