Did a curve. Can someone tell me what's going on ?!!!

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christoph

christoph

Member Since 2015
Last night BG was 470 (Alphatrak) gave 1 unit Prozinc insulin force fed 30 ml Hills ad (9:30pm)
This am BG was 206 gave 1 unit force fed 25 ml (9:30am)
+2 BG 179 f. fed 25 ml
+4 BG 156 f. fed 25 ml
+6 BG also 156 f. fed 15 ml
Evening +12 BG 99 no shot
I only have 1 AT strip left so used Relion...BG 62
Did the insulin kick in way late today?
 
I live in Australia. We have a different way of recording BG readings.
For example:-
7AM = 18BG (is considered high blood glucose)
11AM = 23BG (is considered very very high)
3PM = 25 BG (is considered very very high)
7PM = 27BG(is considered very very high)

Anything over 16BG is considered bad news for cats here in Australia.
There is no ideal BG range but if a cat's BG reading is under 10BG then we consider that to be purrfect BG for any cat on Glargine Lantus insulin.
 
Well, the 10 that's considered the maximum internationally is the equivalent of 180 in the US, which is considered a good target by many vets but is still much higher than the normal levels for a cat and so we tend to consider it too high to be ideal. The equivalent readings of the ones Poncho got in international readings are
AMBG 11.44
+2 9.94
+4 8.67
+6 8.67
+12 5.5

Also the AT meter reads higher than the Relion (by design as the AT is specifically for animal use). The 62 on the Relion would convert to 3.44 on the international scale.

It does look as though Poncho may have nadired late today.

Ideal range on the international scale would be approximately 2.78-6.67 (50-120 in US terms) if you're looking for the sort of readings you'd get from a non-diabetic cat.
 
So, could it have been due to too frequent feeding or too much food at feedings, then not feeding much after +6 until +12? I guess he could have dropped into hypo range and I couldn't have helped him since he was in his covered crate out of sight. Well, that was a wasted curve......
 
Information you get is never wasted. He may just nadir late sometimes - some cats do. I don't think feeding frequently would do any harm - little and often is good for most cats as it helps to keep their BG level. You can see how level he is for a lot of the day from the readings you got. His readings are below the high risk levels all day which is good to see. It looks as though overall he's doing pretty well - if he can just level out the highest of those numbers he'll be looking great! :D
 
I guess I'll do a new curve and keep testing after +6.....feed same amount every 4 hrs or 1/2 less food every 2 hrs up to the +10th hr. Thanks!
 
No problem - and good luck with the new curve! I curve or partially curve Rosa just about every day - not really by design, just because a lot of days she needs that much testing. It might feel like you're not getting good information from the first one or two, but the more tests you get at different times of day, the more you'll get to know how Poncho reacts to insulin, food and a combination of the 2 at different points in the cycle. Then you'll be able to start predicting when he's going to need a closer eye kept on him and you'll know the days when you can relax a bit because you know he's not likely to drop low. That really helps because there will be times when you'll need all the rest you can get. I agree, a couple of tests between +6 and PM pre shot would help you to see where he did drop and if that 99 was a rising or falling number. You likely don't even have to do the +6 to +12 on the same day as the shot to +6 if you don't want to, or not every time - either way you'll get more numbers on your spreadsheet to help you work out what's happening on the days you can't monitor so closely.
 
All data is precious, Chris. :)

When you finish the next curve with the different feeding schedule, if you compare the two curves afterwards, the comparision may yield valuable information to guide you towards optimising Poncho's feeding pattern to suit the way his body tends to use the insulin. Use of such comparisons helped me to better regulate Saoirse, initially while she was on Lantus, but also now she's diet-controlled. Indeed, I now use dietary manipulation to actively control her regulation (she has impaired fasting blood glucose).
 
Prozinc peaks at about 6-10 hours, but can have residual effects for up to 24 hours. Without feeding, and starting at a lower BS, this might be what you are seeing. Since you are giving a set dose (1u) rather than a sliding scale, you aren't having the big swings, so his sugars might be more stable, which improves his PS values. This is a good thing, but you might have to lower your set dose as his BS stabilizes. As blood sugar stabalizes, sometimes the pancreas starts kicking in too, so this can lower sugars as well. It's a good thing.

If you get an unshootable preshot value, you might want to lower the whole dose by 0.25U at the next shot time and start over with the new dose. Its better to do this than to hold ever other or every 3rd dose which leads to really high sugars 12 hours later.

Also, because he really needs insulin, you can feed a higher carb food, or mix some sugar into his food so you are able to shoot, instead of no shot. Even if you shoot half the dose at a low number. He really shouldn't be going 12 hours without insulin when he has ketones. It's hard, I know, with all the testing and watching for hypos.
 
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Thanks Meya. I thought the insulin had peaked at 156 so was very surprised to see the 99 instead of a shootable number. The vet who set me on this new course said to keep the dose no higher than 1u and adjust dose according to the nadir.....but to give Poncho's system a week to adjust to any change in dose. I agree no shot is not an option given he has had so many high BGs, so I'm glad to know I can adjust the food to allow a small dose. His BG this am was over 500.
 
Critter Mom said:
All data is precious, Chris. :)

When you finish the next curve with the different feeding schedule, if you compare the two curves afterwards, the comparision may yield valuable information to guide you towards optimising Poncho's feeding pattern to suit the way his body tends to use the insulin. Use of such comparisons helped me to better regulate Saoirse, initially while she was on Lantus, but also now she's diet-controlled. Indeed, I now use dietary manipulation to actively control her regulation (she has impaired fasting blood glucose).
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Thanks Aine. I hope I can get him eating on his own asap. Since he was always a grazer it's difficult to measure daily intake. I started to weigh the food cans as he feeds.
 
I think giving a steady dose at each shot is a very good idea at this point (ie. no sliding scale), so your vet is on the right track. Just keep a very close eye on the blood sugars if you shoot low, and steer them up with carbs if necessary. You'll get a good sense of how much the carbs will do after a while. Aim for mid 100s-200s for your blood sugars during this time for all readings, steering if necessary. If using the carbs to steer isn't working, lower the set dose. Your vet is right about holding the dose for a few days, it sometimes takes that long for the swinging to settle down.
 
christoph said:
Thanks Aine. I hope I can get him eating on his own asap. Since he was always a grazer it's difficult to measure daily intake. I started to weigh the food cans as he feeds.
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I set up a spreadsheet to track Saoirse's food intake. I'd just weigh the food I gave her at each meal, enter it into the spreadsheet, then let the spreadsheet add up how much she ate that day.

You could also use the Remarks column in Poncho's spreadsheet to record his meals relative to the time of injection. (See Saoirse's spreadsheet entries for November of last year to give you some ideas.)

I hope your little fella gets his appetite back very soon.

Sending :bighug: for you and gentle scritches for Poncho.
 
Poncho's BG at the vet's +6 hrs was 251 I think ( am BG was 548 1 unit), 9pm shot time BG was 258, so I gave 1 unit. I think I'll be up all night monitoring him. His last feeding will be midnight but I might give one more and I have some high carb Friskies chicken w/gravy and a bottle of honey. In retrospect I think I should've given 0.75 unit. I'm on edge now and probably thru the night. I'll check @ +3 BG and every 2 hrs until nadir, feed and steer if necessary.
+3 BG 230
+5 BG 155
+6 BG 133
+8 BG 141
+12 BG 132.........not what I expected again.
 
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christoph said:
Does it matter if a curve is done in pm instead of am?
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It's highly valuable to perform curves in both cycles, Chris. Some cats run lower in one cycle than the other (Saoirse ran lower at night, for example). Knowing how Poncho's body's own natural rhythms interplay with insulin treatment will better inform your dosing decisions and thus help you keep him safe. :)
 
Critter Mom said:
It's highly valuable to perform curves in both cycles, Chris. Some cats run lower in one cycle than the other (Saoirse ran lower at night, for example). Knowing how Poncho's body's own natural rhythms interplay with insulin treatment will better inform your dosing decisions and thus help you keep him safe. :)
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Thanks Aine. I'm not sure that Poncho lately hasn't been the same in both am and pm. Anyway at +8 his BG was 141, up from 133 at +6 so I assumed it was going back up and went to sleep. I just tested at +12 and BG is 132.....I expected it to be going up to a shootable number in the last 4 hours and instead it went back down......then maybe it's going down or went further down and is going up. I went ahead and gave him a can of food which he is tearing into on his own. Now again I'm wondering what to do. Retest in 1/2 an hr to 1 hr to see if it's rising? Will the food I gave him start raising BG that soon?
 
Food usually raises the sugar starting 30 minutes after a meal. I'd wait 30 minutes, see if it has held steady or went up, then shoot. At 132, I wouldn't give the full dose. Maybe half the dose, then steer with food.

Great to hear he's eating on his own a little.

Might be a good time to recheck ketones and make sure they are going down.

I'd lower the whole scale to 0.75 starting with the dose after this coming one. That way you can give a consistent dose at each shot time. The 1U is probably just a little too high.
 
Meya14 said:
Food usually raises the sugar starting 30 minutes after a meal. I'd wait 30 minutes, see if it has held steady or went up, then shoot. At 132, I wouldn't give the full dose. Maybe half the dose, then steer with food.

Great to hear he's eating on his own a little.

Might be a good time to recheck ketones and make sure they are going down.

I'd lower the whole scale to 0.75 starting with the dose after this coming one. That way you can give a consistent dose at each shot time. The 1U is probably just a little too high.
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I just gave him 1/4 unit.....so give another 1/4 unit? I just tested BG 1.5 hrs after 1st test/food and BG is 177.
 
Meya14 said:
Food usually raises the sugar starting 30 minutes after a meal. I'd wait 30 minutes, see if it has held steady or went up, then shoot. At 132, I wouldn't give the full dose. Maybe half the dose, then steer with food.

Great to hear he's eating on his own a little.

Might be a good time to recheck ketones and make sure they are going down.

I'd lower the whole scale to 0.75 starting with the dose after this coming one. That way you can give a consistent dose at each shot time. The 1U is probably just a little too high.
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So what might have made his BG start to go up to 141 +8 then end up lower at +12......the food he got +7?
 
BJM said:
Or the insulin may have handled it.
Or his pancreas might have some residual function (the food trigger)
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He had the test Wed to see how his pancreas is doing and it has healed. I forgot the name of the test....will have to find the receipt.
 
Too late to shoot another 1/4 unit or could the 1/4 unit I gave be adequate to keep from another high pm BG. I'm wondering if his pancreas it starting to kick in a bit.
 
If the pancreatitis has resolved, his insulin needs may decrease somewhat. The inflammation is what seems to raise the glucose levels.
 
When blood sugar is high for long periods of time, the beta cells of the pancreas are damaged by the high blood sugars. These are the cells that secrete insulin. Once your blood sugar starts to be consistently in the normal range, these cells begin to regenerate, and begin secreting insulin again. The damage to the cells is known as glucose toxicity. The thought about diabetic cats is that high carb food is the cause of the initial hyperglycemia, but then the toxicity from hyperglycemia creates a cycle that continues the diabetes. This is also the reason why remission is possible once blood sugars are under control for a period of time. It allows the pancreas to regenerate.

It's all very interesting, and I wonder if humans had the same control over food/insulin as we have over our cats care, would more humans go into remission?
 
At this point, I'd just see what that 1/4 unit does to the BS. Then start at 0.75 tonite, and hold that dose for a few days (unless he goes low).

Expect he'll be high tonite, and it may take a day or two to settle into the new dose.
 
I was just assist feeding Poncho who was wrapped up in a towel when he started distress meowing and he started to struggle, eyes dilated....I freaked, unwrapped the towel and went straight for the honey, cramming it into his mouth. He struggled against me and soon I stopped and he stood up and assumed his pooping posture and went. I tested BG and it was 227. Now I'm wondering if he was going hypo or just had to poop really bad. I'm about to lose my marbles here. I'll test BG again..... if he actually was hypo his BG wouldn't have gone to 227 that fast, could it have?
 
No, even the honey takes a few minutes. He probably had to poo. This morning max was jumping on me with his "screaming" meows. I immediately took his BS and he was fine. He -loves- having his blood sugar taken (???), and began purring immediately when I pulled out the glucose meter. He's learning how to get my attention I think.

Cats can sure make us crazy huh?
 
So I don't really know for cats, but in comparison, for humans anecdotally when I've had someone go low at work, we give 15G of carbs (usually juice or glucose tabs). We retest at 15 minutes. Generally I've only seen these people raise from <60 and after the carbs I usually expect them to be at 80-100 after the carbs. Now a cat is much smaller, and this is just my own anecdotal experience, but I don't think you'd go from <60 to >200 in less than 15 minutes.

227 and 221 is really the same number because the glucometer can be 20% different on each reading.
 
Regarding the leg weakness, you'll probably find a faster response with the injectable B-12 methyl-cobalamin. Grayson was on Zobaline, and it was probably a few weeks to a month before we started seeing improvement. There's another B-12 - cyano. It's less expensive and will work, but the body has to convert it to methyl. Not sure timing on cyano.

One other thing, when you're using Karo Syrup or honey, keep checking. Grayson would climb quickly (20 min), but an hour later might be back down in the lower numbers.
 
When I gave Poncho the honey it was a lot....and also a bit of high carb food mixed with honey in the syringe. Would that cause nausea later on.....not to mention I fed him quite a lot over night and yesterday. He threw up some food that had crushed beef flavored potassium in it this afternoon while I was force feeding so maybe all of it was finally too much. We have some catching up to do food wise tonight as a result.
 
The potassium is very irritating to the stomach. Sometimes giving smaller amounts at one time helps.
 
NB Chris - if you do give Pepcid, it needs to be the right one. There's definitely at least one Pepcid variety that is unsuitable for cats. I'm not sure which is the right one. Can someone post the right type for Chris, please?
 
I tried a smaller amount of the potassium with no problems. I'd like to have the pepcid on hand tho. Thanks for the tip.
 
Grayson & Lu said:
Regarding the leg weakness, you'll probably find a faster response with the injectable B-12 methyl-cobalamin. Grayson was on Zobaline, and it was probably a few weeks to a month before we started seeing improvement. There's another B-12 - cyano. It's less expensive and will work, but the body has to convert it to methyl. Not sure timing on cyano.

One other thing, when you're using Karo Syrup or honey, keep checking. Grayson would climb quickly (20 min), but an hour later might be back down in the lower numbers.
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Are the B12 injection in a series....like 1 per week for a month?
 
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