First curve with ReliOn meter

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ryanms3030

ryanms3030

Member Since 2013
Hello all,

My cat, Whitey was diagnosed about 18 months ago. I originally got a AlphaTrak meter but due to cost of strips I have decided to buy a ReliOn since they are highly recommended here. He just had a check up and the vet found ketones in his blood and his and BGL was over 400.

I have upped his insulin last week and am doing the first full day curve since then today. The first test I did before his morning shot was over 400. How accurate is it with this meter? Does it get more innacurate with the higher readings? I want to know how I should interpret the curve. ...on that note, I will post the results when I am done.


When he was diagnosed I switched him over to fancy feast classics and did 1 unit lantus twice a day and was eventually down to 1/2 unit once a day and his BGL was between 100-200 all day using the AlphaTrak. Now I am starting to think that meter is junk and the readings were not as accurate as they should be. He does not seem to be drinking a ton of water or urinating a lot right now but he has started coughing up hairballs every day it seems. They are pale logs, they don't seem like they have a lot of hair but I wouldn't call it vomit since they are solid but it concerns me considering the ketones in his blood. He definitely has neuropathy in his back legs. He is still pretty active and can jump up onto furniture and perches and otherwise seems healthy. We also moved into a new house 2 months ago with a new person and new cat and he started spraying in the house and crying a lot and I just started him on prozac after trying everything under the sun to avoid that. So beyond the diabetes, he has stress/anxiety/emotional issues going on but I don't know if those are effecting his BGL or vice versa. Anyway, I just needed to rant little. I would love feedback on the curve and using this new meter. Thanks
 
Do you have the numbers on your curve? It would be helpful if you can post the number at shot time, the dose, and then all the tests plus the times that you have until the next shot.

You mentioned giving insulin once a day? There is NO insulin which lasts 24hours for any cats, so right there, your numbers will be like a roller coaster.... if you found that the 1 unit twice a day was too much, and you were getting too low numbers, then you would reduce the dose to .5unit but still give a shot every 12 hours. The Relion meters are just fine.

For the neuropathy, give him B12 pills; they work.

The recipe for ketones includes not enough insulin, not enough food, and infection.
If you could set up a google spreadsheet with your test numbers, people can guide you to better dosing.
 
The spreadsheet is a little complicated. Here is a quick recap of the BGL during the curve:

8:30 am 406
8:35 am 1 unit Lantus
9:00 am fed 1 can FF Classic mixed grill
10:30 am 214
12:00 pm 135
2:00 pm 144
4:00 pm 253
5:30 pm fed 1 can FF Classic kitten turkey
6:00 pm 367
8:00 pm 338
8:05 pm 1 unit Lantus
10:00 pm 341

My first concern is his BGL is going to high, my second concern is two hours after his second shot his BGL was slightly raised.

One big caveat is that this vial of Lantus is almost a year old. It is not expired and I was under the impression from the pharmacist that it would be good until expiration as long as it's refrigerated but as I read more it seems that it loses potency after 6 months?

Also, about two months ago when I moved into my fiance's house he had access to Instinct grain free chicken kibble because the other cat was free fed that and I know he would eat it. That lasted about 3 weeks before I switched all 3 cats in the house to the same diet of FF classic (beef, chicken, mixed grill or kitten) and Friskies special diet turkey and giblet. He has had nothing but wet food for he past 5 weeks so I would think any effect from adding dry food to his diet would be gone by now. Any suggestions would be greatly appreciated. He is having lots of behavioral issues now on top of the diabetes/ketones so I want to get the diabetes under control quickly. Thanks
 
- I would increase the dose to 1 1/4 units.
- You said you are concerned with:
8:00 pm 338
8:05 pm 1 unit Lantus
10:00 pm 341
The 338 and 341 are really the same since the meter accuracy is +/- 20% (+/- 68 points)
- You also said "One big caveat is that this vial of Lantus is almost a year old. It is not expired and I was under the impression from the pharmacist that it would be good until expiration as long as it's refrigerated but as I read more it seems that it loses potency after 6 months?". The manufacturer says to discard the insul 28 days after you puncture the rubber stopper even if the insulin is refrigerated. Many users can get up to 6 months on a one pen/vial of Lantus. A year is pushing it. Thus, the insulin may be getting weak.
 
For the daily vomiting, it might be a food allergy. I would try an elimination diet and stop feeding them beef for a week and see if it clears. If not, stop feeding them poultry for a week and see if it clears, etc....

Blue said:
For the neuropathy, give him B12 pills; they work.
Click to expand...

It's methyl B12 you want (the cat version is called Zobaline). If you buy the human version, make sure it doesn't contain sugar or xylitol (which is poisonous to cats).
 
Do you have ketone test strips? If you don't please go out and buy some, tonight.
Please test for his ketone readings as often as possible, and take him to the vet if the results are over a trace, or if he starts to not want to eat or become lethargic. My kitty is a DKA survivor, and I don't want you to have to go through that.
 
Thank you. I will get ketone strips tonight and new lantus. Any advice on getting urine onto strips?
 
If Whitey is more of a private pee-er, you can try a long spoon or ladle, switching out the litter with aquarium rocks, or even plastic wrap over the litter. Others may have more suggestions for you. I'm lucky in that all I have to do is wait for Mikey to visit the litter box and then I just shove a ketostrip under his bum. :lol:
 
Some people are lucky and they can put a spoon into the cat's stream and get a sample that way. Sometimes you can put a piece of saran wrap in the litter where they usually go and collect enough there. Our Oliver would not let anyone watch him go. We ended up putting a clean litter box filled with aquarium gravel in a room with him. He'd want to "christen" the new box and we could get a sample because it didn't get absorbed into the gravel.
 
I got a fresh vial of lantus today and ketone strips. Just tested ketones and it looks like it is in small/15. He was at 280 bgl before his first 1 unit injection. Can I do anything other than insulin to get rid of ketones? I know with people low carb diets cause ketotosis but I don't understand it in cats. All his food is under 6% carb wet food other than a one month period where he had access to dry food which was about 1 mk month ago. Thanks
 
Did you inspect the strip at the specified time after getting it wet? If you look at it longer the color will continue to change in the direction of showing ketones.
 
Larry and Kitties said:
Did you inspect the strip at the specified time after getting it wet? If you look at it longer the color will continue to change in the direction of showing ketones.
Click to expand...


Yes. And I checked it again a few minutes later and it didn't get any darker. I am going to try to test him whenever I see him going to the bathroom. Luckily he let me stick it under him while peeing.

I tested his BGL 4 hours after his evening shot and it was 180 but before his morning shot today he was up to 480. I want to give it a week on the fresh vial of Lantus before considering upping his dose.
 
When starting out, the best times to test BG are pre-shot and between 5 to 7 hours after a shot when the typical Lantus nadir occurs. The nadir, being the lowest point, lets you know whether or not the dose might be too high or too low.
Example of a typical Lantus curve:
+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
Click to expand...

You also don't want to change doses too quickly (unless it's a mandatory reduction due to low numbers).
"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.


Reducing the dose:

If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

If an attempted reduction fails, go right back up to the last good dose.

Try to go from 0.25u to 0.1u before stopping insulin completely.
Click to expand...
**Note: you do not have to follow the Tight Regulation Protocol, but this still holds true across the board for adjusting doses when using Lantus.


Spreadsheet-specific terminology:
  • Fur shot: when the syringe needle pokes through almost like a sewing needle through fabric and it is unknown how much, if any, insulin actually made it inside the cat. Usually detected by wet fur or the smell of insulin (it smells like band-aids or scotch or antiseptic). IT IS ALWAYS ASSUMED THAT THE CAT GOT THE INSULIN AND YOU NEVER GIVE ANOTHER SHOT. It is always better to miss a shot than to give too much insulin.
  • AMS/PMS: morning (AM)/evening (PM) shot
  • AMPS/PMPS: morning pre-shot test/evening pre-shot test (it's assumed the shot is given within 15 minutes or less of this test).
  • +1, +2, +3...: How many hours after a shot, i.e. +1 would be one hour after their last PS (pre-shot) test
  • BG/BS: Blood Glucose or Blood Sugar (numbers). Usually used in relation to testing and dosing and what "level" or "point" the cat is at. Used in a sentence: "Michelangelo's BGs have been high so I've been increasing his dose."
  • AMBG/PMBG: morning/evening Blood Glucose. Used when no shot has been given at the regular shot time.

Once you get your spreadsheet set up, I suggest you come join us over in Lantus Land! Most people there post daily (or as often as possible) on their cat's status. We call these threads "condos" and start a new one each day with a link to the previous condo. Feel free to view a couple of them to see what people write and how they format them. Again, you don't have to be following Tight Regulation to post here (if you're not, just mention it in your signature), but it helps to get some more Lantus-specific eyes on your spreadsheet to help answer any questions or problems you might have.

Have I missed anything you might still be having difficulties with? If so, my apologies and feel free to ask again. :-D And, as always, feel free to ask any questions or if you need any clarification. You're doing a great job so far! :thumbup
 
Thanks for everyone's help. Specifically regarding the ketones, should I consider adding some higher carb food to his diet? I know with humans lack of carbs creates ketones. But since years of high carb food led to his diabetes I don't know if that is a good option. I just want to reverse it before it gets worse
 
Cats (all obligate carnivores, really) process protein differently than humans, other omnivores, and regular carnivores (like dogs) and actually turn protein into glucose. That is the biggest reason why they can't have very many carbs. There's also a difference between ketosis (as seen with a high protein diet like Atkins) and ketoacidosis (specifically diabetic ketoacidosis). So, that would be a "no" on feeding higher carb foods. ;-)
 
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