Controlled BG range

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NancyJac

NancyJac

Member Since 2013
So in theory at least, is the objective to get to a point where BG stays in the normal range throughout a cycle or will the numbers always be high preshot? Hairy has only been on Lantus for 5 days and his numbers are all over the place, Can I expect the range (from low point at mid cycle to high point just before next shot) to get smaller once he has been on insulin for a couple of weeks?

Nancy
 
Hi Nancy! Since Hairy has only been on it for 5 days, it's way too soon to expect to see much in the way of results. Lantus take at least 3-5 days to "build up" the depot so you're just now getting to that point where the depot could "kick in"

Since you've had trouble doing BG tests as often as we're used to seeing before we can give a LOT of advice on dosage, we just don't know at this point if he might need more or not. We sure don't want to blindly say "yes, go up" and risk that the dose is too high and could cause permanent damage (or worse) to your dear Hairy!

We really DO understand cats can be difficult when it's time to test, but those are tests that are so very important when using any insulin. Lantus is an excellent insulin for cats, but without knowing where his numbers are before each shot, and where they go somewhere mid-cycle, we just can't know what the "whole picture" looks like.

To specifically answer your questions
is the objective to get to a point where BG stays in the normal range throughout a cycle
Click to expand...
Yes..with "normal" being anywhere between 50-130 for a diet controlled diabetic

Can I expect the range (from low point at mid cycle to high point just before next shot) to get smaller once he has been on insulin for a couple of weeks?
Click to expand...
Generally, the way Lantus works would be like a big smile at first. Preshot numbers at the top of the smile...the nadir at the bottom, then headed back up to the other "top" of the smile. :-D (like the bottom curve of this smile..very pronounced)

As the Lantus starts to kick in, and the doses are adjusted, that "smile" starts to even out a little...so the "top" of the smile isn't so high, the bottom isn't so low, and then it goes back up at the end of the cycle to complete the "smile" :smile: (like the bottom curve of this smile..more flat and gentle)

However, it can take weeks, or months to start seeing any "flattening" of those curves. Bouncing also occurs, so there's just no easy, quick answer to give you on this one. Lantus is a marathon, not a sprint, and it just takes time to learn what dose is best (but safe) as well as how each cat reacts. Every cat is different, so there is no "one size fits all"

The more information you can get on how Hairy reacts to each dose, the better and sooner we'd be able to advise you when it was time to consider increasing to try to get better control. I do know you're trying and from what I remember, he IS getting better about the testing, so hopefully you'll be able to get a few more tests in per day soon and we can REALLY start helping! Even 4 tests a day would be so awesome! One before AM shot, one somewhere between +5 and +8 during the day, one before PM shot and one before you go to bed (no matter what time that is)
 
That's the idea. It may or may not happen quickly, as you can see if you look at Papaya's spreadsheet in my signature! Cats don't always play by our theories :lol: but Hairy is very new to this so hopefully he will level out for you sooner rather than later. In any case he will no doubt be feeling much better with the insulin, and the more data that you collect as time goes on with the hometesting will help you get the dose just right, which should also help level things out. Good job with doing the hometesting, by the way, sometimes it's not easy but it's so important!
 
Hi Chris,

Chris & China said:
However, it can take weeks, or months to start seeing any "flattening" of those curves. Bouncing also occurs, so there's just no easy, quick answer to give you on this one. Lantus is a marathon, not a sprint, and it just takes time to learn what dose is best (but safe) as well as how each cat reacts. Every cat is different, so there is no "one size fits all"
Click to expand...

Hairy started bouncing the first day. This being day 5 it's hard to tell if he is still bouncing or depot loading or both. Are the bounces basically random event that can occur anytime, even once BG is better controlled?

Chris & China said:
I do know you're trying and from what I remember, he IS getting better about the testing, so hopefully you'll be able to get a few more tests in per day soon and we can REALLY start helping!
Click to expand...

It's not really that Hairy is getting better, it is that my husband and I are getting a little bit better at being able to get blood out of him. But Hairy still fights us all the way.
 
Wow Amy, Papaya's range is still pretty wide after quite a long time even with frequent dosage and diet changes.
 
If you click on the link to Chris's spreadsheet, you'll see a lot of bounces and numbers all over the place at first. But scroll to the bottom, and look at how things have improved lately.
It's easier if you just look for colors rather than specific numbers... But you'll notice that the reds and pinks have just about disappeared? The spreadsheet has become mostly blue and green, right? China still may be bouncing occasionally.
But now, it happens less often, and not as "high". And while it used to take a few cycles for the bounces to go away, now they aren't lasting as long before China returns to the blues and greens.
China's spreadsheet is a pretty good example of how things improve over time. I'm guessing Chris is pretty happy with how things have been going lately :smile:
 
Uh hmm....HEY HAIRY....KNOCK IT OFF!! BE A GOOD KITTY! <<shakes finger sternly at Hairy>>

There...let's see if that helps :lol:

Bouncing...since Hairy was probably diabetic for quite some time before being diagnosed (we don't generally get the diagnosis until we see something else going on like weight loss, lost energy, rough looking coat, lots of drinking/peeing) By then, his liver has gotten "used to" higher blood glucose numbers.

When you had the low number the other night, Hairy's liver "panicked" and sent out counter regulatory hormones and glucogen to quickly bring his glucose back up to what it thought was "normal"....the "Bounce"....It's totally normal for kitties to bounce, and if there has to be a silver lining, it's that at least we know Mr. Liver is working the way he's supposed to!!
Bouncing can also happen without going TOO low...if the numbers drop drastically, you can expect a bounce. A drop from (for example) 390 to 189 is over 200 points...the liver thinks there's a problem!!
Bounces can take up to 72 hours to clear, so we don't want to increase the dose during this time.

As Hairy gets better controlled, and his numbers start to come down, his liver has to "re-learn" what's normal. As this happens, bounces will gradually not go as high, and will clear faster. When China first started this dance, if she'd go into the 100's (even fairly high 100's), she'd "bounce" into the 400-500's and take pretty much the full 72 hours to come back down. Now that she's better controlled, she still bounces, but not as high, and she clears them faster.

Unfortunately, as long as they're on insulin, there's a possibility of a bounce, but as their liver is re-trained, they'll be less and less severe and will clear faster. It just takes time to get Mr. Liver to understand it doesn't have to work that hard!

Edited to add...that last sentence wasn't exactly what I meant. Cats that aren't on insulin can "bounce" too, but that's because there's something else going on that's dropped their blood glucose too low, and the liver's job is to "kick in" those hormones and sugars to bring them back up...and attempt to bring things back to normal. It is a valuable part of how things work in the body
 
I've looked at China's SS several times. In fact I'm thinking we should arrange a play date between the two of them because they have a lot in common. Hairy's BG and weight at diagnosis were about the same as hers (which is down from the 10 pounds he had weighed from the time I got him until a few months ago. And from your notes, Chris, I take it China wasn't always a happy camper with the ear sticks either. I'm hoping over time that their spread sheets look similar too since China seems to have improved rather dramatically and seems pretty stable now.
 
Hi Nancy..and Happy Labor Day!

Heck NO!! China was not a happy camper when we first started ...we had several huge battles (which I always seemed to lose by the way) before I backed off and took the time to desensitize her. She didn't mind the poking part...she just didn't want me touching her ears to do it! :lol: :lol:

Once I found her Achilles heel though, things got much easier...she loved deli chicken (and at $5/lb, why wouldn't she???) Eventually, I got her to eat home-boiled chicken though (more work, but a lot easier on the budget!)

The tips I gave you were the things that worked for us..Always using the same spot, always rewarding no matter what the outcome and I think the biggest hurdle for me was realizing it HAD to be done..My feeling sorry for her, or letting my fear that she'd hate me forever and run every time she saw me get in the way weren't going to help her.

We'll have to consult on that play date....Texas in early September??....nahhh..been there, done that...LOL Maybe mid-November? :-D
 
NancyJac said:
Wow Amy, Papaya's range is still pretty wide after quite a long time even with frequent dosage and diet changes.
Click to expand...

Since ECID, there are a lot of factors at play that might keep you from seeing the BGs level out lower and flatter. I've been doing this dance with Mikey going on 11 months now and he still gets high pre-shots (usually from growth spurts because he has the added "benefit" of being diagnosed at 6 months :lol: ). Other cats may have other issues that bring their BGs up: ultra-sensitivity to carbs, co-morbid conditions, infections, dental problems, lack of activity, too much eating, too much activity, it's a full moon, who knows! Not to mention some cats' nadirs move around from cycle to cycle. Mikey is about half the time right around the "typical" nadir of 5-7 hours after a shot. The other half the time he nadirs at his next shot or even past his next shot and I end up with a "double-nadir" cycle. He definitely keeps me on my toes.

The ultimate goal is to keep them below renal threshold (~220-240) for as much as possible and get them into safe double-digits at least around nadir as much as possible. So, if it takes a while to happen (or it rarely happens like in Mikey's case :YMSIGH: ), don't get discouraged. You're still doing a fine job, even if your "smiley-face" cycle looks a bit "happier" than others. :lol:
 
Hi Nancy,
I'm new at this too. I have gotten much better at testing Bandit over the last few days. He's been so patient with me, I was just not very good at it and had to try over and over again... so he had to suffer through the learning curve with me. I was having a really difficult time getting blood from Bandit and still sometimes do... I remember reading your "New Diabetic Cat Mom" post, so I thought I'd try to offer my experience. Sometimes when you've just learned something, it's easier to describe than if you've done it everyday for a long time...
Everyone here is so helpful and I received so many suggestions. Here are a couple of things that really helped me the most:
- small warm bottle of water and lots and lots of face and ear rubs (do this when you're not going to test as well)
- really make sure there is a good amount of pressure on the other side of the ear (I use half of a paper towel folded up really small and put it between my finger and Bandit's ear. It is helpful for me to line up my finger with the hole in the lancing device. Just in case that's really confusing... finger, folded paper towel, ear, lancing device... Line up the lancing device and finger and use more pressure than you think you should... )
- Bandit does better when I take it from the furry side of his ear because then I can be behind him or at his side instead of in front of him. He's very particular about how he receives his attention... Did you try having Hairy facing away from you? Also, Bandit does not like to be held by someone else while I do it. He'd prefer to be semi-free...
Hope some of this helps you get testing more often...
Good Luck!
Samantha
 
Thanks Samantha. I have been using rice in a sock, both to warm his ear and to have something solid behind where I am poking. I have to do it from the inside of his ear because the outside of his ear is black and I can't see the blood, so I have to have him facing me. And unfortunately, if somebody else isn't holding him, I wouldn't stand a chance. I need both hands to prick his ear, hold the sock on the other side and hang on to his ear so he doesn't shake it and put the test strip to it when I do get blood. There is no way I can do all that holding him in my lap or on the counter. He would be long gone before I even got near his ear.
 
Nancy..I had trouble with the rice sock too...first, I was using WAY too much rice....it only needs to be a small amount and I probably had 2 cups of rice in a sweatsock :lol: :lol:

Then I tried a small pill bottle with warm water instead. It worked better for us. I just run my hot tap water, fill the bottle and test it against my wrist to make sure it's not too hot. (sometimes it does leak a little, so I have to try to keep it upright)

You don't have to hold the rice sock or pill bottle at the same time you're poking. Just use it to warm the ear, put it down and then you'll have both hands free to poke. I put China up on a counter facing left (since her left ear bleeds much better than her right). I'm not looking straight at her, or have her looking away from me. I come at her "from the side". I use my left hand to hold her ear, and my right to poke, and then put the lancet down. Sometimes it bleeds like a gusher but occasionally I have to kind of "milk" it to get that tiny drop to form. Once I have that, I grab the meter and suck up the sample.

Just adding tips as I think of them that MIGHT help you with Hairy!!
 
Chris brings up a good point: "from the side." Don't come in over their head or from the top, but come up from the side and from the back.
 
I'm not having trouble with the rice sock, it helps quite a bit. It warms his ear and forms a block to put behind his ear to make it easier to poke and get blood all at the same time. As, I said, I have to poke on the inside of his ear because I can't see or get the blood droplet from the back of his long haired black ear, so coming from the back or the side is not an option.
 
I do China on the underside too...the "furry" side smeared things too much.

I know it's really hard to describe with the written word what I mean...maybe someday I'll figure out how to make a video and post it on YouTube
 
Trying something for the first time...don't know how it'll work


China's head in bowl of food...left hand holding top of left ear. the black spot isn't really black...that's the "sweet spot" to poke that I superimposed on the picture. She is facing left perpendicular to me

(my right hand, instead of poking/testing, was holding camera and clicking....LOL
 

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If I even touched Hairy's ear while he was eating he would run. That is pretty much the same location I use though.
 
Hairy's being what I call "contrary"...( in other words, a pain in the butt)....lol

I just thought the picture would help clarify considering trying to describe how I was doing China's using just the written word could be pretty confusing. I'm also a horrible photographer, but at least it shows what I wanted to show :-D

Keep working with him. I'm sure he'll come around with time and patience....and I know you understand how cats can be...and that in their own homes, they can be much more difficult than they'd be anywhere else.
 
My foster Wink had long black hair on his black edged ears. I shaved a tiny patch of hair on the top side of his ear so I could see the blood drop better through all that fur and dark background. I used a safety razor, and very lightly ran it over the sweet spot.

I got better at the poking and finding the blood on his black ear and the fur grew back very quickly. I don't bother to shave the ear anymore, but it sure did help there at the beginning. You people with lighter haired cats have no idea how tricky it can be for aging eyes to see that blood drop in the black hair.

Just another option for you to consider.
 
Deb,
You just made me giggle.
I have been teaching my husband how to take care Bandit. Kevin really butchered poor Bandit's ear last night! He really felt awful about it too. Especially since he hit the vein and he got too much blood on the test strip, so he had to try again. Unfortunately Bandit shook his head and splattered the blood everywhere before we were able to get another strip ready and so we had to start over. Kevin was so upset that he had to "hurt" Bandit again.
Bandit has dark fur on his ears and Kevin needs to get his eyes checked. He definitely needs glasses and just won't go. Poor Kevin felt so bad about hurting Bandit but won't go get his eyes checked because he doesn't want glasses.
Thank you!
 
Don't call 'em glasses, call 'em magnifiers for fine detail work!

Visor magnifiers are available through our shopping partner Amazon.
Clip on magnifiers if you already have glasses (I like the Carson Clip and Flip - they were wonderful!)
 
Samantha,

Glad I could make you laugh. Wink has even longer hair on the inside of his ears, I mean like two inch tufts poking out of his ears, so the suggestions from people to test the inside of his ear really did not work for me either. Plus, I still had the black ear edges and my aging eyes to contend with.

I occasionally test my civies. Little Delta also has those black ear edges but thankfully is missing the voluminous ear floof. Civie Monet is easiest of all to test with white ears! Yeah, easy to test.

ECID and I have 3 very different cats.
 
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