First Curve Day

Status
Not open for further replies.
Shirls

Shirls

Member Since 2016
Hi All,

My vet has made it very clear that he doesn't believe in one reading testing, he believes there is no value in them, the vet techs at the clinic call him "new school" if that gives an indication of his treatment plans. Instead he is a big believer in curve tests and wants me to do a 12 hour curve every two weeks, testing every two hours.

Roo has been on insulin, 2 units, twice a day now for two weeks so today is my first day of curve testing. This morning 12.5 hours after Roo's insulin shot last night and before being feed his number was 3.5 at 6:15am (I think that is 63 American style) and then I feed him, gave him his 2 units of insulin. I had called the 24 vet clinic to confirm if I should give insulin with such a low number but they told me to go ahead because after eating his number would go up, so I did as instructed.

I just tested again 2 hours later at 8:15 am and his number is 3 (54), he is showing no signs of being too low, he is acting perfectly normal if anything he has a touch more energy than he has in weeks.

So I guess what I'm asking is it possible that Roo is recovering? Seems crazy to me that 2 weeks ago his number was 35.9 (646) at the vet and then 21.1 (380) and then 17.2 (310) and then today its at the low side of the normal range.

Love to hear your thoughts on this. In the meantime I'm going to keep going with the curve testing today, every 2 hours.
 
I would definitely start testing every 30 minutes. 2 units on a 63 preshot (which is a normal number) is a very large dose. If he drops below 50, you want to give him a teaspoon of the gravy off high carb food. If you don't have that, then a small bit of honey mixed into a teaspoon of his regular food. You want to give small amounts so he will eat if you need him to bring up his numbers.

Your vet gave you very poor advice. I am concerned that he is dropping so low early in the cycle. If he drops below 40, you need to take him to the vet so they can give him intravenous glucose. Hypos do not always have symptoms until the cat starts to seize so don't be lulled by the fact that he seems to be acting okay.

What kind of insulin? Please retest and post again. If you don't have honey or karo syrup, have someone go get you some.
 
My advice is the same. Test every 20-30 minutes and keep an eye on his levels, intervening with food if he drops below 40. How long as he been on insulin?
 
If you have an alpha trak meter, then he has earned a dose decrease at his next shot time.
And you do need to monitor him more today than every 2hours....



reductions are taken with a drop below 50 (on a human meter or 68 on an Alpha Trak meter)
 
I have an alpha track 2 meter and he honestly seems perfectly fine, no signs of anything but a regular day. Next test is in 45 minutes. I don't want to stress him out by testing every 1/2 hour when he is not even use to testing at all, every 2 hours is a big deal for him and for us. I really appreciate all the concern and advice but I'm super conflicted between the panic that you all seem to have and what the 24 hour emergency vet clinic is telling me, they have no concern at all. So I'm more confused than ever. However all I can do is keep testing him today.

I guess what I really wanted to know, is it actually possible that a cat can start to go into remission with only two weeks of insulin?
 
It is possible. But I would say the likely scenario is that the insulin is working.... now his pancreas needs support to continue healing....
If you click on Shadow's spreadsheet.... her beginning was much the same..... she went to good numbers right away and stayed
there.....


We aren't trying to stress you just want you to stay on your toes.... in case you need to intervene....
often by the time they show signs of a hypo , you don't have a lot of time so you need to know what to do.
I added that information so you have it.... you should print it for future reference.


On your next shot, he needs to go down to 1.75 units because 2 units is too much.....He has earned a reduction
in dose with that low number. ( not too low , just low)

There is a lot to learn and without overwhelming you.... many things you can do to manage his diabetes.
I think you have a high chance of remission.

For your information:







DON'T PANIC! or HOW TO HANDLE LOW NUMBERS
The following guidelines apply to those following the Tight Regulation Protocol only.

First, try to not panic. Post to the Lantus & Levemir Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 prefix to the first post in your thread. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range.

ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.

If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
  • staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
  • ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
  • disorientation (yowling, walking in circles, etc.)
  • twitching
  • stupor
  • convulsions or seizures
  • coma

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.
 
thanks for all the tips everyone, Roo is still symptom free of being too low and I'm continuing with the every 2 testing for a curve
 
Not all cats show outward signs of hypo. Rover only showed signs once. You can't always judge by external signs. Please test often.
 
I just did a calibration test on my alphatrak2 meter and its reading correctly in the range listed on the bottle, and coded correctly to match the bottle specs.
 
just called the urgent care centre again and spoke with the ICU nurse and she is not concerned about his number being roughly at 3 all day. Going to continue with the testing and making sure to test after he eats tonight and then call the centre with the number before making any decision about insulin tonight.
 
I hope you are going to reduce his next dose, as experienced Lantus users have suggested, as blood sugars often run lower at night and a level of 3 for a cat on insulin is risky territory, and you may be heading for a bounce or an early morning trip to the ER vet.
 
10 attempts to get a freaking blood drop and didn't get a damn thing, except 2 stressed out humans and 1 angry cat. I can't tell you how much this stuff makes us feel like such a big failure and that we aren't doing our best for him.
 
Shirls said:
I have an alpha track 2 meter and he honestly seems perfectly fine, no signs of anything but a regular day. Next test is in 45 minutes. I don't want to stress him out by testing every 1/2 hour when he is not even use to testing at all, every 2 hours is a big deal for him and for us. I really appreciate all the concern and advice but I'm super conflicted between the panic that you all seem to have and what the 24 hour emergency vet clinic is telling me, they have no concern at all. So I'm more confused than ever. However all I can do is keep testing him today.

I guess what I really wanted to know, is it actually possible that a cat can start to go into remission with only two weeks of insulin?
Click to expand...
I have had two cats go into remission at 7 and 8 weeks. I think this was in a large part due to a change of diet. Time for a dosage decrease more than likely.
 
Shirls said:
10 attempts to get a freaking blood drop and didn't get a damn thing, except 2 stressed out humans and 1 angry cat. I can't tell you how much this stuff makes us feel like such a big failure and that we aren't doing our best for him.
Click to expand...
It happens sometimes, give yourselves a little break then try again. Make sure you warm the area well, a little rice in a sock for 30 seconds in the microwave, or warm water in a pill bottle helps to get the blood flowing. You are doing great with all those readings today. You can do this.
 
I found the first month or so of testing very stressful for both of us, and then it just started to come right. One thing I did was change the angle of the needle (I free hand). Pricking at about a 30 degree angle worked best for us.
 
Shirls said:
10 attempts to get a freaking blood drop and didn't get a damn thing, except 2 stressed out humans and 1 angry cat. I can't tell you how much this stuff makes us feel like such a big failure and that we aren't doing our best for him.
Click to expand...
Oh god i so know that feeling. If it helps, know you are not alone!

It took a few weeks before i started getting the hang of testing. I still have the occasional screwup.

Always always always give treats after testing, even if its a fail.
 
oh it's not the 3 that was so scary.... it's that we don't want him going lower.....
I'm so glad that he surfed there all day.... that's a wonderful curve....

if you would like a spreadsheet like the rest of us have.... here is the link...

I had to have help getting mine set up so there are some here who can do that for you quickly..... just ask....

congratulations on your dose decrease..... that's good progress!!:woot:
we have picture of those in between whole unit marks ( and half unit markings) if you need ....
the most important part is that however much you shave off of his dose.... that it's the same each time until he earns another dose reduction.
 
thanks for the support it really does help. Its just frustrating when your are doing something that seems painful in order to be helpful. Gave him, his evening meal waited 45 minutes and got a successful test of 9.5
 
we all like to pay it forward....
we don't forget how scared, frustrated, anxious, and worried we all were when were first started out..... and our great community here
is here to listen, advise, give virtual hugs.... whatever is needed.....
we even share supplies when we can for those struggling....
FD is very overwhelming.....
 
I'm an experienced Lantus user and I will tell you that your vet is just plain wrong. This is all we do here on FDMB - feline diabetes 24/7/365. I have to wonder how many diabetic cats your vet has had - so often people euthanize cats upon diagnosis that it isn't uncommon for vets to not have that much experience managing the dosing.

Cats are the only mammal that can have their pancreas heal and begin putting out insulin again. The results of the study that resulted in the Tight Regulation Protocol for Lantus and Levemir, which is the only protocol for dosing diabetic cats using Lantus or Levemir that has been published in a professional veterinary journal, showed that cats who have their blood sugar brought into normal range (68-150ish or so on an Alpha Trak meter) can have their pancreas heal. It is especially likely if the cat is newly diagnosed and the damage to their pancreas (from high blood sugar) has not been too extensive. That healing happens when the cat's blood sugar is in the normal range - so Roo's long hours today spent in those low numbers would allow that healing to happen.

If the pancreas does heal, it will begin putting out insulin again. The dose that was ok before will become too large now. As it sputters back to life, you need to reduce the dose you are injecting. The only way to know if that is happening is by testing. If the pancreas puts out insulin and you don't know and don't reduce the dose you are injecting, the result will be an overdose.

You're having such an awful time testing because it takes a couple of weeks for capillaries to grow in his ears. As you poke his ears, that stimulates the growth of more capillaries. In a couple of weeks you'll get blood with every test. In the meantime, your struggles are promoting the growth of those capillaries, so it's not for nothing. You are trying desperately to keep Roo safe - and he will understand if you tell him that. Here are some Testing & Shooting Tips: here and here ; Preventing Overdoses

It also will help his feelings if you always give him a treat after you've poked him. ;) We cooked chicken breasts, diced them in 1/2" cubes (yes, that small - it's a treat, not a meal) froze most of it and kept a couple of tablespoons in the fridge. Punkin would've tolerated anything for his beloved piece of chicken after he'd been tested.

Diabetic cats are different than treating dogs or people. With dogs, the vet can run a curve one day, decide on the dose, and the dog can stay at that dose for years with just occasional checks. It's simply not that way with cats.

We've had very sad stories here with cats who were not being tested. It is the single most important thing you can do to keep him safe. This diagnosis is overwhelming for everyone - it's like you have to take a college crash course in Feline Diabetes 101 in a very short time.

But we have all been in your shoes and people here will do everything to try to help you. I'm glad today turned out ok, but truly, it could've been different. You haven't seen it, but we have. By the time a cat has hypo symptoms on Lantus it's more than a small problem - a hypo can last as long as 16 hours. Lantus is a depot insulin - think of it as a timed release med. It builds up in the body and keeps on releasing.

I'm truly not trying to freak you out or scare you, I want to help you help Roo to be safe.

With the tests you got today, you would definitely reduce the dose. If I knew you were testing consistently, it would be a dose reduction of 0.25u. If you are not going to test daily, I'd reduce the dose more than that. Those were extremely low numbers on an Alpha Trak. I can't encourage you enough to test your cat before every shot, and to try to get another test in before bed. Your vet may be giving the advice, but Roo is your cat and the choices are yours to make.

Please keep posting and keep asking questions - we'll do our best to help you understand how to help Roo.
 
Ok, I'm totally confused and overwhelmed between what you are saying and what the several 24 hour pet care centres I've called have been telling me, none of it matches. I just don't understand how those in the vet profession are constantly telling me something different. Aren't they supposed to be trained in this, isn't it what I'm paying them excessive amounts of money for recently?

Regardless, I've given Roo's curve results to his normal vet this morning and I'm waiting to hear if the vet has a new recommendation for his care. I'm also going to do some research and see if I can find a vet in my area that is rated as the best for diabetic care. I'm trusting these people and I feel like I'm being let down. I am not an expert and I'm relying on them.

on another note, on the articles and info posted I keep seeing a reference to "when your cat bumps" what is that?
 
from our collective experience here....
there are vets who often only tell their clients to change doses in whole units at a time. We find that to be too much when it is increased for many cats....
but vets tend to think we can't do dosing in 1/4 increments.

even the so called vet experts often give this advice.... and this is their bread and butter so most of them insist you bring the cat to them for curves where
they charge $30 + a test.
If you hang out with us, you basically only need the vet to manage FD for true emergencies or for writing the prescription but all the day to day stuff
is right here for free if you are willing. We will help you on a daily basis, you can even tag several of us that you want help.
There are some who will share emails/phone numbers so you can say, I need help now..... but all advising is done on line for peer review.... so we can
add a different perspective or correct something that isn't said clearly. We don't give advise over the phone or by email or really even over on facebook,
we try to get it all right here.
Some of us even get to meet each other in person , becoming friends for life.

There are vets that think we are just some internet site and get offended when their clients quote something we say but the people here have been doing
this for years ( the veterans who hang out) and often go and adopt more diabetic cats because they know what they are doing and what they are committing too. Those folks get great admiration for doing this repeatedly!!
Some of us have taught our vets many things that they were highly doubting and when we showed them an improving cat going into remission.....
that's the best. We feel vindicated after having to argue with them that we hire them and we can choose their advice or not.

The proof that we know is in our spreadsheets..... where we record dosing, foods, health issues.... everything because it is a extremely valuable tool
for evaluation..... we see patterns, and what we have done that succeeded or failed.....
we look at this like a puzzle..... and there are several pieces that factor in .... it's not just the insulin.... it's diet, it's timing, it's following protocol
(and the protocol we are following is proven by someone who really knows FD) plus all the members here have proven it over and over.

Most vets seem to think they know what they are doing because they have done caninsulin with dogs for years.....
Lantus and the other depot insulins are more recent medical developments and it can't be used on dogs....
And we see time and time again, that vets send clients home with lantus ( altho' they've never used lantus before) and then give directions as
if it were a canine insulin.
Depot insulins behave differently and it can even vary from one cat to another in how they respond.
Afterall, insulin is a hormone, not a drug.


just this part right here, made me compelled to post:

I had called the 24 vet clinic to confirm if I should give insulin with such a low number but they told me to go ahead because after eating his number would go up, so I did as instructed.
Click to expand...

imho, they could not know for sure that his bg number would go up.... with a depot insulin, it could very well have dropped which is why it was said
to test more frequently so you would know he wasn't going lower.
That clinic is acting like they have given you a non-depot insulin.... which wears off after a few hours.....

We have witnessed people who have come on site for help.... conflicted by what the vet says, vs us telling to do something different.

We do increases and decreases more conservatively so that we don't miss the optimum dose....
it's very easy to go up too much....

and my heartbroke so much for one lady years ago, her cat Cleo, she had to go on a trip so she boarded her cat believing they would monitor
and take proper care of her cleo.... but they continued shooting the usual amount and didn't test and the cat was overdosed and died.
I tried to warn her and all I could do was cry.
As Julie said, we've seen vets do this more than we can stand.


bottom line, is they aren't as expert as they pretend.... most only get about a one hour course on diabetes for both dogs and cats combined.

I hope i've said this coherrently....i'm kinda getting scatterbrained in my old age. :rolleyes:
 
@rhiannon and shadow (GA) on the Tight Regulation Protocol page that @julie & punkin (ga) posted - "if a bounce" (sorry not bump but bounce)

KNOW THY CAT. Shooting early or late is a practice best reserved for those who have a full understanding of the insulin used and it's effects on their kitty.
  • Because of the cumulative nature of Lantus and Levemir, please be aware: Shooting an hour or two early *could* act like a slight dose increase. Shooting an hour or two late *could* act like a slight dose reduction. How your cat will react has a lot to do with what kitty is doing that day. For instance, if a bounce is breaking shooting early probably isn't the best idea because you'll have a little extra action on the dose from both the early shot and the bounce breaking simultaneously. The next shot is due 12 hours after the time of the early or late shot if you're shooting twice a day. Oftentimes the effects of an early or late shot will not be seen until the next cycle. Please monitor carefully when shooting early. Ask for guidance if you're unsure.
 
bounces are hard to understand at first.

basically, when a cat's bg drops too fast ( say from 500 to 250 in one hour) or if a cat has been in high numbers for a long time and finally
the insulin pulls down the number to a good number ( such as between 100 and 200 ) but the cat's body is no longer used to lower numbers....
the liver will dump counteregulatory hormones ( glucagon) for the body's protection.....
so you'll see
amps ( am pre shot ) 500
+2 ~ 250 big drop two hours after morning shot
+6~ 200
+8 ~ 450 boing... right back up
pmps ~550

sometimes that bounce will last a while.... numbers stay high.....
each cat is different

some clear the bounce fast others take 3 cycles ( 12 hour period -each shot time)
 
All the information we've been giving you here is coming from the Tight Regulation Protocol, because it is the published protocol for dosing a diabetic cat with Lantus, as I mentioned above. We have another dosing guide we use that was developed by people here many years ago. It's called Start Low Go Slow.

A cat's blood sugar is never constant until they are tightly controlled. That takes time in most cats and it can't be rushed. By the time a cat has been diagnosed, they likely have been in high numbers for a while. A cat's body will get used to whatever level their blood sugar is at over time and it will begin to recognize that as normal. If a cat is constantly at 300 or higher, the body will begin to think that's normal.

When insulin is begun, the cat's blood sugar is now dropping into a lower range because of the insulin. The body often perceives that as a hypo - even if it's well above hypoglycemic range - and the body will release counter-regulatory hormones and stored sugars to save the cat's life from that perceived hypo. So a cat used to 300+ might react to 200 as though it is a crisis, releasing those chemicals and bringing the cat's blood sugar back well over 300. That's what we call a "bounce." The cat typically will go nice and high - maybe 500 or HI - if it's been in the 300's. It can take the cat's body as many as 3 days to clear out that flood of stored sugars/hormones and for the cat's body to return back to 300.

A persistent person will stick with things and continue giving insulin to bring the cat's body back in normal range, where that healing can occur. The longer the cat's body spends in normal range, the sooner the body will "remember" that this IS normal. It's a process, and as it happens the cat will lessen its bouncing - now if it's regularly getting to 75, it might only bounce to 200 and the bounce might only last a few hours. Eventually most cats will stop bouncing - although not all.

If you were to take Roo to the vet today, without the information from yesterday's curve, and the vet took his blood sugar today, it is extremely likely that he would get a nice high number. Then the vet might suggest increasing the dose. But we know from the curve you did yesterday that he got very low, and he absolutely does not need more insulin - in fact, he needs less insulin. Consider though, if you hadn't tested yesterday and this scenario had played out with tests today likely being high. That's why we hometest.

It's also possible Roo isn't bouncing today, although I would expect it. If you test him and he isn't in high numbers, but is again under 100, that would tell us that he has spent enough time in that range that his body is used to it and not reacting. That can be either a good thing or a bad thing, depending on whether or not he's being tested. If he's being tested and you can be sure he's not going into hypo range, then it's a great thing. If he's not being tested and he could potentially get into hypo range like he did yesterday, it's a good thing if he does bounce. That's a cat's survival mechanism.

Here is a post that talks more about bouncing - take a look at the second post in the thread.

We base Lantus dosing on answering the question "how low can the current dose drop this cat's blood sugar?" We basically ignore the high numbers that occur with bouncing and try to catch the low points. People with experience can help new members figure out when is a likely time to test to catch the low points. That not only helps with making dosing decisions, it also helps with keeping the cat safe. All cats have patterns, and with tests, we can see those patterns emerge and often be able to make predictions - although cats are notoriously unpredictable!

Don't be too hard on your vet. Lantus is a human insulin and while many vets have gotten enough information to learn that it's a good insulin for cats, many don't have the extensive experience with dosing. Your experience is common. So FDMB is a very popular, busy site and we teach people who find us how to use their particular insulin with their particular cat. We also know that most vets only have less than 1/2 day in vet school spent on diabetic animals - not just cats, but all of them. They can't be experts on something that they haven't been taught or had experience in.

One question I'd ask your vet: Knowing that you are using a pet glucometer for testing, at what number would s/he suggest that you intervene and give carbs? If the vet says wait for symptoms - that's too long. You want to prevent a crisis, not wait until one happens and then try to deal with it.

I used a human glucometer and followed the Tight Regulation guidelines and intervened at 50 - in other words if my cat went below 50, I treated it as a hypo and gave him high carbs (gravy, corn syrup, maple syrup or honey) to bring him back up over 50. A 68 on an Alpha Trak or other pet meter is the equivalent of a 50 on the human meter. That's why people were jumping up and down yesterday about your tests that were under 68 - to us, even following the Tight Reg Protocol, which is an aggressive dosing method, those tests were signalling a potential problem for Roo.

People following Start Low Go Slow intervene at 90.

I'd be very curious what number those 24 hour vet centres would tell you to use.
 
Shirls said:
Ok, I'm totally confused and overwhelmed between what you are saying and what the several 24 hour pet care centres I've called have been telling me, none of it matches. I just don't understand how those in the vet profession are constantly telling me something different. Aren't they supposed to be trained in this, isn't it what I'm paying them excessive amounts of money for recently?
Click to expand...

Save your money and let the folks here at FDMB help you. Boo is my 2nd diabetic cat. The folks here have been my lifeline through both of them. Please trust them.... they know what they're doing.
 
one of our favorite saying is go with your gut.
So many vets send their clients off with insulin, instructions, and say come back in a week or two.....

we will help you thru every single day and night .... at least we try.....
 
so here's the link to set up a spreadsheet

if you are less savvy at such technical stuff ( as I am), there are a few here who will do it for you.... just ask.....

and you might want to come post over in the lantus forum
at the top of this forum are several sticky's which you will want to read as soon as you have time.... lots of good info there......
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/
you will have lots of support on that forum...
you will want to post each day ( we call that a condo)

starting out like

7/11 Roo amps __ +2 ___ and so on.....
you can edit the title of your condo several times.... there is an arrow at the top right of your post where you can do so...
you will see how others do it and you can learn a lot reading other condos....

when i first got here in 2012, i couldn't sleep for worrying, so i sat up a lot and read and read....learned others stories and
extracted a lot of information from their examples.....

you can also stay in the main forum if you want but you will find more lantus users over in the other one.
hope to see you there!
 
Status
Not open for further replies.
Back
Top