Doing Pixie's curve today...can you take a look

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pixiesmom

pixiesmom

Member Since 2013
First time doing the curve and I hope it won't throw it off too much, but I will have to give him small bits of tuna
so he will let me test him.
Looking at his numbers right now I would imagine that I will be increasing by .5
Can you take a look and tell me what you think?


And this is the guideline for interpreting the curve and adjusting the insulin, correct?

If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
 
No, I don't think increasing by .50 is correct or a good idea--with Lantus, we usually increase in .25 increments AND Pixie is very newly diagnosed...hold on a minute and I'll check the dosing scale and BRB :-D
 
General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Note the bolded area. A .50 increase is just way too much of a jump from 1.0 units. I don't give dosing advice, but someone will jump in here...I'm going to locate an Advisor, though you may get a response from one in the interim :-D
 
Morning... ~O)
Will you be doing a curve (every 2 hours) or a mini curve (every 3 hours)?
The tuna is good for a treat/reward for testing. Make sure and read your can and make sure it doesn't have any soy in it.

Do you work during the days? If so, I would adjust in .25 units....
you don't want to miss the right dose by jumping too much.
It would be great if you can get some more nighttime tests.... maybe set an alarm once or twice to see if he's dropping lower at night. Many cats do.

I also pulled up the guidelines for you from the TR protocol.

"General" Guidelines:
•Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).
•Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).
•Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose:
•Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
•After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
Can you give me the link where you found the guidelines for the .25 increase?
The one I found was the .5 and this is why I am here and so thankful that all of you are here
as well.
During the summer I don't work.
I will go back in September.

I am doing the +2 curve and will keep posting results....
thanks so much!
 
First, it looks like Pixie if following SLGS and not Tight Regulation so the guidelines are a little different.

However, the guidelines for SLGS are meant to cover any insulin, not just Lantus or Levemir.
Step 3. After 1-2 weeks at a given dose, you or your vet should perform a serial blood glucose curve (blood glucose tests every 2 hours, starting at shot time and continuing until the next shot). Follow the cat’s normal feeding schedule during the curve. The curve should be evaluated by someone experienced at interpreting feline blood glucose curves, in order to check for signs of rebound and other possible problems. If no rebound is present, follow these guidelines for dose adjustment (smaller adjustments may be appropriate for cats on PZI or Lantus):

a) If the lowest point of the curve is above 150 mg/dl (8.3 mmol/L), increase the dose by 0.5 unit.
b) If the lowest point of the curve is between 90 and 149 mg/dl (5.0 and 8.2 mmol/L), keep the dose the same.
c) If the lowest point of the curve is below 90 mg/dl (5.0 mmol/L), decrease the dose by 0.5 unit.
Click to expand...
Please note the section I put in bold. With Lantus (I can't speak for PZI), they typical dose increase is 0.25u. There are times when you may want to increase by a larger amount but I would not do so in Pixie's case. It looks like the nadir is below 300 so you would want to increase by 0.25u.

I'd also encourage you to try to get at least a before bed test every night. Right now, you're missing half of your data and you could easily be missing a dose reduction if you don't get any tests during the PM cycle.

The information that people were providing was taken from the Tight Regulation Protocol that we use on the Lantus Board. There are a series of starred, sticky notes at the top of the Board that you may find helpful. You are also welcome to post there if you think you want to follow the TR protocol.
 
The PZI/ProZinc folks have been using 0.25 unit adjustments, too, so as not to miss an optimal dose.
 
Lauri,

If you are going to follow the SLGS (start low, go slow) protocol, it would be a good idea to put that in your signature in large letters. Should look like this SLGS.

That SLGS protocol is here Start low, go slow
 
Ok so you have a choice given what people said above - tight regulation ( get him regulated fast - more aggressive method) or Start low and go slow (slow and steady towards regulation). Many of us prefer the former since the window for remission is narrow and it seems to offer good results - plus the support network on this board for it is much more extensive.

Looking forward to seeing todays curve!

Wendy
 
Since you said you don't work in the summer, you might consider the Tight Regulation protocol. Just a thought.


Off-topic: Do you ever get down to Allegany State Park? I remember when they first formed it and flooded the area to form the lake.
 
We camp at Allegany every year. We used to camp Red House before we got a camper. Now we go to Quaker.
I live about 45 minutes north of there.
This year we will be camping in Cooperstown for a week in the beginning of August. I will have my neighbor to
shoot but not do readings.
With that said...I will SLGS....I just hope I can hit that .25 mark correctly.
Pixie is back to his normal self...bringing up 4-5 articles of clothing a day from the laundry room...why he does this???
That was one key indicator I knew he was so sick....
I can continue doing some readings after his pm dose as well....
I am thinking am number is highest maybe due to the fact he is not getting a snack midway like he is for the daytime.

Also, yes, my tuna has soy...so will do that no longer. What is the problem with soy?
 
Red House and Quaker Lake! I haven't been there since I was a kid, 40+ years ago. We used to camp in the cabins there. Cooperstown and the Baseball Hall of Fame. Used to live in that town many years ago. Have fun on your vacation there.

Ok, so you picked the SLGS protocol and have that in your signature. Great! So if Pixie's BG drops below 90, that is a dose reduction.

Pixie is back to his normal self...bringing up 4-5 articles of clothing a day from the laundry room...why he does this???
Click to expand...
That is so darn cute! :o Does he make a pile of the clothes? Or ask you clean or dirty pile? Whites or darks? Or say, mommy, you forgot to fold this one. :lol: :lol: :lol:

Two reasons. 1. Soy can be an allergen in cats. 2. It can also affect the thyroid gland so is not recommended for cats.

From catinfo.org
Soy contains phytoestrogens and soy also negatively influences the thyroid gland. Given how common hyperthyroidism is in the cat, soy has no business being in cat food. Unfortunately, soy is a common ingredient used by many pet food manufacturers - especially Purina - because it enhances their profit margin.

When considering allergies, the ingredient list is useful since we don't care how much of the offending ingredient is in the food. The bottom line is that we don't want any of the ingredient to be present. Fish/seafood, beef, lamb, corn, wheat, and soy tend to be the most hyperallergenic ingredients for the cat - especially fish/seafood.
Click to expand...
 
I just finished Pixies curve...unless I am suppose to continue it going longer.
Now the only thing I did different today was give him about 1tsp. of tuna so I could do his reading each time.
Seems like his numbers were at the highest today.

I will try to get a reading at +14 as well.

So if I am thinking correctly, I should start a .25 increase tomorrow am.
 
We call a +14 , a PMPS +2. That would be a good idea too. Assuming its still yellow and pink then a 0.25 dose Increase tomorrow would be good unless someone disagrees.

Edited to add, it's just the low carb fancy feast versions ie classic pâtés, that he is getting right?
 
Yes, I do believe it's time for a 0.25U increase. Up to 1.25U dose for Pixie.

No more need for any tests to fill out the curve. Those +2 tests are nice to see which direction the BG's are headed.

We do still always like that 'one last test before you go to bed' test. If you would please.
 
It would be great if you could get a night cycle curve... or mini curve.... or even something like a +2 ( you said +14 but the cycle starts over when you shoot)
am cycle... and pm cycle...

I know it's hard to get up... but having the data to see what Pixie does will help you down the road when you need to shoot lower numbers.
So even a +2 and another random test somewhere in the night is better than no info at all.
I often tried to get pm tests every 4 hours in the early days .... since I didn't have to get up so much.
 
Do that night cycle curve another day. Pixie has already had plenty of pokes for today.

An occasional test at +5 to +7 timeframe at night would be good to have. You may need to set your alarm to wake you for these occasional nighttime tests.

You need your sleep too.
 
I must be way too optimistic because I thought raising Pixie's dose to 1.25U would improve
his numbers.
They are higher than I like them to be.
391 this am was the highest am reading since starting the Lantus.
I am expecting to make another change this weekend. Will I need to do another curve on Saturday before
increasing the dose to 1.5U or by looking at the numbers can you pretty much just tell he'll need an increase?
I would love some expert advice if you could look at Pixie's SS.
And I already know I am expecting too much too fast....I am trying to take the whole SLGS approach myself, but ya know
how it is when one of your babies are sick....you just want to fix it!
 
There is often something we call New Dose Wonkiness ( ndw) and that is where they go up with a new dose before they go down.
It's a bodily reaction.

You've also got a night time cycle there last night with out any data. Kitties tend to go lower at night , You might have had more yellows or even a high blue and this mornings
number could be a reaction to that.

Try to get a before bed test at least.... And if you can pick other random times.... maybe if you get up to use the bathroom in the night....
It really helps to have that data to decide on dose increases in a few days.
 
Ok Lauri, here is where I ask you what your favorite color is. It's important.

p.s. the SS link works, but it is a direct link, not the correct one to open the SS in a new window. You need to copy the link code from the "publish to the web" pop-up box, not the one in the internet web address block. Then paste that into your signature between the link code goes here brackets

Directions here, starting at step B for clarification. ss setup and link to your signature
 
How's the link? Think I got it now.
Just when you think you're computer savvy....

I will try to get a before bed reading and a during the night reading tonight.
 
Your SS link is perfect now! Thanks so much for doing that change. Appreciate it.

At least the before bed test would be great. If you wake up and think of it, a later test is great too. In these early days, we need a bit more data to fill out that SS . "If you aren't testing at night, you're missing half your data" as another person here says.
 
Pixie was at 475 this am.
I really want to bump him up to 1.5U tomorrow.
I will be home all day with him.
I don't have a problem with SLGS approach if the numbers are going lower or at least holding steady, but he has been
increasing.
I did manage to get a before bed reading and it was 331.

I really want to get him down before I go on vacation..in about 3 weeks.
I have a friend who will give him his insulin but no do readings.

One thing I did yesterday was give him a treat of Salmon in a pouch...I couldn't find any tuna without soy.
Could this have spiked his numbers?
He gets 3 cans of FF a day. I usually do 1.5 cans at am feeding and 1.5 cans at pm feeding. Maybe I need to give a little
FF as a treat to test instead of Salmon....
What wll give better numbers...1 can FF am, 1 can pm, and 1 can during day OR 1.5 am and 1.5 pm without a "snack' during the day?
 
Spreading out the food over several mini-meals during the day can put less pressure on the cat's body to process all the food at once. I would suggest spreading out the meals a bit more. I'm sure Pixie will love that! :o :shock: :o

Let's see how Pixie does today before you bump him up again. It looks like the food may have spiked his number or he is bouncing. We want the bounce to clear and that can take up to 72 hours. Time to put on those patience pants. Pick your favorite color.

Did that salmon in a pouch have any gravy in it? Look for any grains in the ingredients or gluten. Probably some flour in the gravy which would have been like feeding him some HC (high carb) food. A teaspoon of LC (low carb) works great for a little treat at testing time.
 

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Tomorrow sounds good for an increase.

What brand/type of salmon was that? was it cat food? It could well spike his numbers depending on what it was and what was in it. FF makes a salmon feast pate in a can that would be better. You have to be real careful about what you feed since some cats are more carb sensitive than others.

Can you feed more mini meals through the day? Or free feed? It helps some cats, especially if they are carb sensitive.

Edited to add :what other flavours/types of FF do you normally feed?
 
Morning. ~O)


here's a list of low carb treats
Many of us use freeze dried treats, they can be crumbled on top of foods to help when they don't want to eat their food too.

You may have to hunt to find the brands of human tuna that don't contain soy... there are some. If that's Pixie's favorite treat....
I'll go ask Dyana.... she knows at least one brand.
 
Hi Lauri! I agree that you should wait just a bit longer to bump up the dose. It takes a few days to really see the effects of a dose change on BG. I also agree with splitting up the meals so that he's eating more frequently--cats' metabolisms are about twice as fast as people's, so they really do best with at least 4 meals a day, and it has a good leveling effect on a diabetic's blood sugar. When I'm not home to feed Bandit, I stick a frozen chunk of food in his auto-feeder so that he's eating about every 6 hours (not counting treats :smile: ).

Do you have a Petsmart close by? I get these treats for Bandit, and they work great (they come in both Chicken and Salmon). If there isn't one close by, another good treat option is Fancy Feast Appetizers--Wegmans carries them, and they're all diabetic safe.

I would post here for dosing advice before you leave--depending on Pixie's numbers, you may want to reduce the dose a little bit before you go just to be safe if your cat-sitter is unwilling to test him.
 
The Salmon was human salmon in a pouch. No gravy. Only ingredient was salmon and I think water.
I feed him FF Savory Salmon 90% of the time, sometimes he gets oceanfish and another one that is from the list.
He HATES freeze dried treats so just giving him the FF during the day is a treat for him.

I can't free feed. My other cat has CRF and I also have 2 labs. But for the most part, there will be someone here mid-day to give
him some food. This way it will hold him better until that pm feeding.

If I still see readings in the 400's tonight and tomorrow I think I will go to 1.5U and be home all day.
I think my "patient pants" would be fitting better if he was in the 200's...right now I can barely get these pants zippered!!
 
Well, if the salmon was only salmon and water, that is not the culprit in these higher numbers.

I can't free feed.
Click to expand...
I can't free feed either. I have two glutton civies, Delta and Monet, that hoover up their food in about 3 minutes flat. Wink takes at least 10 minutes and if I'm not watching, the other cats will chase him away from his food. ohmygod_smile

I think my "patient pants" would be fitting better if he was in the 200's...right now I can barely get these pants zippered!!
Click to expand...
Yeah, I know. It's really hard sometimes to let those bounces clear. How about some music while you are waiting? http://www.youtube.com/watch?v=r1f4DywTtLg&feature=c4-overview&playnext=1&list=TL9PFonl10Idw
 
Can he get into any of the dogs or other cats food? Does he go outside where he might get food?

Hows the teeth? Any sign of infection? What about in the ears? Clear and clean inside?

Wendy
 
He used to get into the dog's food before the diabetes.
now i am extra careful...if the dogs don't eat right away, the food goes up.
He's an indoor cat and everything else looks fine with him.
 
I increaded Pixies dose to 1.5U yesterday. Numbers were slightly better, nothing in the 400's.
(Vet wanted me to go to 2U...he obviously has never met all of you ;-)

So Pixies +6 was 134 today, brand new package of test strips, so i checked it with my accucheck nano as well and that
came back at 190.
(This is also his midday meal/snack time)

I am assuming 134 is good from what I know about human diabetes.
 
Yes, 134 is a good BG number. Just a hair over normal non-diabetic numbers (40-130). Let's see how this dose works out as the depot fills and starts having more of an effect on Pixie.
 
134 isnt bad at all. Lets give this dose 3 days (6 cycles) to let it settle unless he drops under 50. Also you might want to do a spot check between PMPS +5 and +8 to ensure he isnt dropping low at night.

Are you testing for ketones?
 
I am going to pick up Ketone strips tomorrow when I get out.
I NEVER see him use the litter box. I tried to "follow" him all day once and
it wasn't until I turned my back that he went. He usually goes at night.
Will see what i can do, though.
I will need to keep him at this dose until mid next week. I will be camping Sun-Tues but
will be home to do am and pm shots for him. Just don't want to make any changes until then...if needed.
 
Ok...this is weird and I am wondering if it is coincidental or not.
The other day when Pix had a spike in his numbers the only thing I did different was to
give pouch salmon (ingredients salmon, water, salt)
This morning he was over 500 and last night before bed I gave him a treat of pouch salmon.
Thinking I am going to stay away from the pouch salmon.

Also had my husband test and shoot last night.
Let's just say that it is a work in progress....

I told him that you test first and you won't shoot if the numbers are too low.
How low is too low?
At what point would I not shoot pixie?
I am pretty sure I would not see that anytime soon, but i would like to know that if he reads a low number I will wait.

BTW...finally figured how to get his avatar up...isn't he a cutie?
 
He is a handsome boy!

I wouldnt assume the black today was the salmon. In fact I think a bounce may have gone on last night.. ie he may have dropped lower than used to since it does look like his numbers were dropping a little overnight. But on he safe side, I would stop the salmon for now. And get some spot checks in around PMPS +6 to PMPS +10 especially when the before bed test is lower than 30 points than the preshot.

Bounces:
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.
Click to expand...

If it is a bounce it should clear soon and his numbers will come back down. As they do you might want to get more tests in as he goes yellow to see how low he goes.
Wendy
 
Wish we could see more pictures of him and bigger ones :sad: Don't suppose you use photo bucket or flickr where we could see some more pictures?

I think the dose may need an increase again. I'd like to see a +6 nighttime test before saying yes or no on that.
 
if it's salmon for humans... it should be low/no carb...

I would say you probably had your lowest number thus far and didn't catch it in the night.... and that is a bounce from it.
But he didn't stay up there for long.....

He is quite the bungy jumper.
He can change floors rapidly so you should not assume he doesn't go lower... I'd be checking for a +8 or +9 just to see where he is. That was his lowest point on 7/14
when you did the curve.
 
Deb & Wink said:
Wish we could see more pictures of him and bigger ones :sad: Don't suppose you use photo bucket or flickr where we could see some more pictures?

I think the dose may need an increase again. I'd like to see a +6 nighttime test before saying yes or no on that.
Click to expand...


I will try to get some PM readings tonight since I am back from camping.
He used to be a free feeder. Now that he is scheduled to eat he is quite nasty.
I know it's just because he is hungry. But he is attacking our legs if we walk past him and not feed him
or not let him near the dogs when they are eating.
I can bend down and pet him and talk sweet to him and he is sweet right back.
IS there anything you can give in between that won't disrupt his BG at all. He won't eat freeze dried
treats.
He is just a hungry little guy :cry:
 
He used to be a free feeder. Now that he is scheduled to eat he is quite nasty.
I know it's just because he is hungry.
Click to expand...
We don't want that. ohmygod_smile Pixie, be good please for your mommabean and no attacks.

IS there anything you can give in between that won't disrupt his BG at all. He won't eat freeze dried
treats. He is just a hungry little guy :cry:
Click to expand...

You can give him a teaspoon or so of his low-carb food. Take his daily food portion and spread it out over the day.

You can actually still almost free feed the wet food. Take it up 2 hours before the pre-shot tests only. Add water to the wet food to keep it from drying out. I add about 1 tablespoon per ounce of wet food for my cats until about applesauce to soupy consistency. Helps to fill them up and make them feel fuller as well as keep them well hydrated.
 
some here boil/bake chicken or turkey and give a little of that as a treat.
You have to experiment to find just what it is they like. Just think of ways to give pure protein.
 
Deb & Wink said:
I think the dose may need an increase again. I'd like to see a +6 nighttime test before saying yes or no on that.
Click to expand...

His nighttime numbers are up and I also think he needs an increase.
Do I need to do a 12hr. curve each time before an increase? Or is it safe to say there's enough data to go up .25U?
I will not be able to do another curve until next week sometime.
 
Yes ... I think it's time to increase if today's numbers continue as they have been....
try to get something like a +4 and a +8 .... comparison numbers.... nadir's don't always hit exactly at a +6. It would be nice if they were that predictable.

And if you increase tonite, do something similar in testing....
 
You dont need to do a curve before you increase - just enough data over the previous few days to know that he isnt dropping into blues and greens which may make you hold the dose longer.

I think you are good to increase too - 1.75?

Wendy
 
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