Feedback on curve results requested

I just did Howie’s first curve at home today and would love to hear some feedback on what you think of his results and his daily tests overall since I started. He seems to be relatively consistent in staying in the 200s all day. He’s had 2 curves at the vet previously and his nadir has been about the same results but were at +4.5 and +6. I find it a little strange his nadir today was at +8. I did give him 1 Hills Hypoallergenic dry treat at +4, +6 and +8 but got a chewy treat (fewer carbs) at +10. Would the 1 dry treat throw off his BG that much that he would never go below 200? He gets a mini meal at +2 and +5 per recommendations I’ve gotten on this forum. We go back to the vet on Wednesday for his first fructosamine test so would like to give him all these results and talk about anything you all see that warrants discussion. Howie was such a good boy today and I don’t want to run another curve for a few weeks if I don’t have to so his ears can heal. THANKS!
(I am cross posting this on the Prozinc forum as well. I hope that’s OK.)

 

@Deb & Wink might not be on tonight anymore but I've heard her say that flat yellows often indicate a bounce breaking. I think we'd need more testing to see though, with just the pre-shots it's hard to say.

Please refresh my memory - we've had so many new Prozinc members this month I can't quite remember the details to everyone specifically. What was the reason why you're not able to get any mid-cycle tests? Work schedule?

What's the reason for flip-flopping between 3 and 6 units? The fact that he stays in yellows with both doses makes me think 3u is better. When cats get to 6u we usually recommend testing for high-dose conditions such as acromegaly or IAA. I suspect he's being overdosed though. @Chris & China (GA) @Nan & Amber (GA) thoughts?

 

I can’t do mid-cycle tests as I work all day out of my home. As for the flipping between 3units and 6units, my vet told me to give a half dose (3units) if he’s between 200-250 and a full Dose (6 units) if he’s over 250. We started him at 2 units when he was first diagnosed and the vet moved him up incrementally to 6 Units base on increasing water intake/urine output and the curve results done at the vet office. He’s never had big bounces with all the testing I’ve done and at the vet office.

 

Gotcha. Are you able to test in the evening cycle any? A couple hours after shot-time or before bed perhaps? That would help.

Okay, that's a weird way to judge dosage ... do you have the numbers from the vet curves to share?

One thing you should note, is that meters are allowed an up to 20% meter variance. That means a 250 and 300 are considered the same number, for example. The pre-shot from this morning (243) and this evening (263) are not even 20 points apart, yet there is a 3 unit difference in dosage. I would honestly stop doing 6 units, that is way, way too much.

Here is the Prozinc Start Low, Go Slow guide for pre-shots:

Basically, if pre-shot is over 200, give full dose.
If pre-shot is between 150-200, skip the dose OR do a token dose. A token dose is 10-25% of regular dose, so for 3u it would be .30 - .75 units.
If pre-shot is below 150, skip entirely.

If pre-shot is below 200, it is recommend to stall feeding 20 minutes and re-test to see if the number is heading up, maintaining, or dropping. You can make a decision on whether to skip or give a token dose then.

Are you testing for ketones any? You can buy ketostix at a pharmacy or Walmart, they're around $6 and you just stick them under Howie while he's peeing.

 

So if you’re saying 6units is too much, then what do I now say is his full dose? 3units? That seems a drastic change. When he was at 3units as a full dose before, he was consuming upwards of 8-9 oz of water/day. I don’t want to backtrack (but don’t want to overdose him either!) as his water consumption is now normal per my vet. Obviously I’m getting some very different info on here compared to what the vet is saying so it’s hard to decipher everything right now. I don’t have all his curve #s from the vet, but I know they were skewed (400+ At +1 but nadir was down to 230s) due to the stress of being at the vet. He’s never had a reading that high while I’ve tested him at home. Thanks for the help. I just don’t know how to backtrack and cut down Insulin now.

 

It is drastic. Your vet has been having you flip-flop between 3 and 6u which is very drastic. Most cats don't even need 3u and the way your vet has bumped the dose based on water consumption isn't an appropriate way of determining the dose. However, if Howie IS a high-dose cat, he needs tested for high-dose conditions.

Why don't we wait for more input? You hold the syringe after all so you need to be comfortable with any changes.

 

I agree with Elizabeth....6 units is a huge amount of insulin, especially considering he was just diagnosed 2 months ago.

We find that a lot of vets start out at too high a dose to begin with and then raise it too much, too quickly. When the dose is too high, it can also look like it's not enough! (strange but true!) In an attempt to save the cat's life, the liver will release stored sugars and hormones to bring it back up to where it feels is safe. We've also seen cats that could go from 400 to 40 and back to 400 in the same cycle. If you only got the pre-shot tests you'd think the cat needed more insulin when in fact, it needed less.

The vast majority of cats should be started at between .5 and 1 unit twice a day with increases in .25 to .5 unit increments depending on the test results and while it's not true in all cases, keeping the dose consistent usually works better. Going from 3U to 6U never gives his body a chance to settle down and see what that dose is really going to do.

It'd be really helpful if you could get at least 1 test other than the PS on the PM cycle, especially since you say you can't test during the day due to your work. Most cats go lower at night so it's important for safety so you don't wake up to a tragedy.....and anytime you can, grab a test or two on the AM cycle

 

I have to agree with Chris and Elizabeth about dosing, my vet had me doing sort of the same sort of dosing instructions as yours. Same dose AM and PM , meaning if it was between such and such amount either increase or decrease, which got me no where with Tyler. Thanks to the experienced members here Tyler wouldn't be where he is today.
Sorry to say but most vets don't know what they are talking about
Can you do more testing on weekends or do you work weekends also

 

just to be sure: do you use U40 needles ? Or do you dose with U100 needles?

 

U40 needles

 

I 100% agree with everything Elizabeth, Chris and Diane have said.

I don't post often (my sister got the writing skills in the family ) but when I see something that concerns me I'll chime in too.

 

Thanks for the help! I can start getting at least 1 test before bed but that’s usually around +2. I’m a young old lady here!!

 

The weekends just depend. Trying to get a full 12 hour curve I’d hard but I can get partial cycle tests. Something is better than nothing! Thanks for your feedback! I LOVE my vet but he admits that diabetes is difficult in their profession as there are so many variables. I love this forum and all the help you all provide!

 

I'm impressed that your vet agrees that the profession doesn't know a lot about feline diabetes. Like you, I loved my vet, and I still do. (Unfortunately, he's not working many hours now because he's getting old - probably in his 80s now). But had I listened to his advice on how to dose Jack, I honestly don't think Jack would have survived. Turns out that Jack never needed too high a dose, as even low doses put him into remission in 4 months and that was 14 months ago now. (He does have other health issues, but he's still in remission!) In the beginning, it was really difficult for me to follow the advice given here because I thought my vet knew what was right to do. It was uncomfortable, early on, for me to go against what he said to do and to trust the collective wisdom here. I'm so glad that I did! I'm glad that you found your way to this message board too.

 

Hi you don't have to get a full 12 hour curve on weekends just a couple during the day cycle and night

 

I agree with Diane! It's easier AND better to get a couple mid-cycle tests a day rather than dedicating an entire day a week to testing. Plus, what if Howie had (ahem) gotten into something that spiked his BG and you didn't know? Then the whole curve day would be ruined!

 

Randomize the testing a bit. A +2 one cycle a +5 another cycle. Doesn't have to be the same time always.
You want to fill in the missing places in the middle of the SS. Put books (mid-cycle tests) between the "bookends" (the pre-shot tests).

With such a big difference in dose, between one cycle ( a cycle being a 12 hour period) and the next, Howie could be dropping really low during the cycles where you give him 6U and you wouldn't even know it.

AND that bag of bread last night, 8/29/20 didn't help his BG pre-shot this morning. He may have been running with a low BG level, and naturally sought out food.
You may hate to do it, but setting an alarm to wake you at night is another possibility to get a BG test in around the middle of the cycle. Most cats on Prozinc have their nadir around the +5 to +7 hour time frame. Right now, you have no idea when he hits those low points.

I had Wink chew through a bag of dry food in only a couple of minutes. It was being taken out to the trash, since he was finally eating lower carb wet food. So don't feel bad. All food had to be behind cupboard doors. I even got a simply hook and eye, to put on my bifold doors to keep the door closed from prying cat paws.

The vet should be able to email you the curve test results done there at the clinic. Then you could enter them on your SS. Give the clinic a call and see.