First Home Glucose Curve Today

Lomo

Lomo

New Member
First off, I hope I uploaded the SS in my signature correctly. If not, please let me know. Basically, my kitty Lomo was diagnosed on 10/25/19 and we've been working on her dose with her vet. She started at 1 unit of Prozinc 2x daily and after a glucose curve done at the vet on 11/12, she has eventually been raised to 2.5.

Been getting familiar with the Alphatrak2 and dealing with a kitty who doesn't even like to be pet, much less getting her glucose tested every 2 hours! It has been challenging. :arghh:

We tried to ease her into her first home curve test day today. I've sent these numbers onto her vet. Would love any advice, as it seems her dose still isn't high enough (we've been slowly increasing it per discussions with the vet).

She's lost a ton of weight but FINALLY seems to be reversing that trend. We got a home scale as well, and she seems to have gained about 1/4 of a pound. She was down to 8.59 lbs on 11/12 at the vet. She had lost approx. 4 lbs this year.
 
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Hi. It is usually best to increase the dose in 1/4 unit (definitely not more than 1/2 unit) increments. (Having syringes with 1/2 unit markings makes that possible.) A tiny bit of insulin can make a big difference in a cat, so larger increases can result in you zooming right past the correct dose. It becomes difficult to tell if a dose is too low or two high. Did your vet jump from 1 unit to 2 units or were any doses in between tried? Were dosing decisions always made based on one curve?

The first test on 11/21 was at +8 which is pretty late in the cycle, and it was 204. If no tests were done earlier, we don't know how low the 2 unit dose took his glucose that day. When a cat's glucose goes lower than their body is used to, it can cause a reaction in them that sends their glucose even higher - we call it 'bouncing'. That can send them high and can cause them to then stay rather high and flat for a few cycles. If you don't have the full picture and a dosing increase is made based on the higher numbers that happen because the cat actually had a drop in glucose, you can end up giving too much insulin. That creates volatility and makes it difficult to figure out what is going on.

To really know what is going on, you have to have more data than just an occasional curve. I have personally seen a curve not reflect what I have seen from daily monitoring (especially if the curve just happens to be when the cat is bouncing). Periodic curves are helpful since they help you determine when the insulin begins working (onset) and when in the cycle the cat's glucose is the lowest (nadir), but daily monitoring is important. Testing before every insulin shot allows you to know that it is safe to give the planned insulin. While numbers are high, it may not seem like a big deal, but a low number can come out of nowhere, and if you give insulin without realizing that, it can be very dangerous. Mid-cycle tests show you what impact the insulin has which is important data to have when making dosing decisions. ProZinc is usually most active in most cats between +3 (3 hours after shot) and +9 with the lowest point usually occurring between +4 and +7, so somewhere in those time frames is good for doing md-cycle tests. Doing more regular testing also allows you to build a routine with the cat that makes testing easier.

Based on the VERY limited data we have here, I wonder if the 2 unit dose was really given a good chance. It clearly had some impact since we see that 204, but we don't have enough data to see the full impact of it. If no doses between 1 and 2 were tried, it is possible something less than 2 may also have had impact. But, based on what we have here, I would be tempted to drop to 2 units and start getting in tests before every shot and during each cycle (at least one, preferably two right now) to see the impact. It takes at least 3 days at a dose, and often more like 4 or 5, to really see the impact. If a cat drops too low during that time, the dose should be dropped by 1/4 unit from that point forward. If they remain too high over that time, the dose should be increased by 1/4 unit and the process started again. Being very gradual and systematic in dose increases/decreases allows you to focus in on the right dose (and dosing needs to fluctuate over time, too).
 
Thank you for replying! Here's some answers to your questions:

Our vet had us go from 1 to 2 with no increments in between. We then tried 2 1/4 and eventually, they had us go to 2.5. We are going to get into the habit of testing before feeding. We just started using the glucometer this week. The first curve was done at the vet. We were trying to spare her from that. The middle tests were just readings from me trying to get kitty accustomed to it. Lomo has been on the 2.5 for 5 days as of today.
 
There are two posts on this (http://www.felinediabetes.com/FDMB/threads/first-home-glucose-curve-today.222173/) I am replying to a comment on the other post but am doing it here in hopes that we can get the full conversation to happen here instead of in two different places.

Lomo said:
Now I'm wondering if I should go back down to 2 units in the AM and see how she reacts. It couldn't hurt to do that for one day, could it? Just to see?
Click to expand...

You don't want to do it just for one day. As I mentioned before, it takes at least 3 days and often 4 or 5 to really see the impact of a dose. If you think you will be able to start getting in a test before every shot and a couple during each cycle so we can really see what impact the dose has, then I think it is worth trying 2 units. You may have others come along today and give their thoughts as well. I would hold the 2 units at least 3 days - if she unexpectedly drops too low during that time, decrease the dose by 1/4 at the next shot time and hold that dose - if she remains too high for the 3 days, increase the dose by 1/4 and try that one for a few days following the same process. You are always welcome to post for input/advice as things progress.
 
I agree with FurBabiesMama. The 2u dose seemed to have a decent impact on BG but wasn't held long enough to really know if that dose is "ideal" or still needs some adjusting. Slow tiny adjustments of 0.25u at a time along with a little more monitoring will ensure you don't jump over the "ideal" dose and keep kitty safe.
 
Thank you both. I'm on Pacific Standard time so kitty isn't scheduled to get her insulin for about another hour and 45 minutes. I will do preshot readings today and do the midday testing you suggested as well as lowering her dose to get more thorough readings on the 2 units. We had previously done 2 units for several days, but she was still ravenously hungry, so our vet suggested we bump her up when he spoke to us about kitty's bloodtest results. At that point, we didn't have the home glucose monitor figured out yet, so we didn't do much testing at that range.
 
@FurBabiesMama @MrWorfMen's Mom Numbers from testing today are all over the place (see SS) or:

AMPS--502 (first time she's ever been in the 500s)
+ 5 was 285
+9 is 606 (her highest levels at home or at the vet)
She received 2 units of Prozinc this AM.
This is a new bottle of strips, but the code is set for the right numbers and I also checked with the control solution and it's within range.
Our vet emailed today that based on her readings yesterday, we should raise to 3 units. Thoughts, now that you've seen these numbers?
 
You have no data to know how low Lomo went last night and with that higher AMPS, there is a real possibility that BG dropped to lower levels than you are aware of and what you are seeing now is a bounce. Your data shows Lomo's BG dropping to yellow on 2u but staying in higher range on 2.5u. I'd still go back to 2.0u for a period of at least 6 cycles (3 days) and then if numbers are not improving, raise the dose to 2.25u. One day on a dose is not long enough to know if it will work or not and dose increases of 0.5u make it more likely you will skip over the best dose for Lomo. It already appears the 2u dose was better than 2.5u so increasing to 3u may just set you back progress wise in finding the right dose for Lomo.
 
Thank you for getting back to me, @MrWorfMen's Mom . I've had so much information to take in the past few weeks that today I'm just learning how important the nighttime readings are as well. I will make sure to get at least one or two for her this evening in addition to her PMPS. I know that stress can affect her numbers and her good yellow number from today (+5), I was able to get her when she was asleep. The other 2 readings thus far today were huge struggles and fights and took several times to get a reading bc she was fighting so hard. I've tried both the ears and paw pads. Only had one successful paw pad reading thus far and that was when she was basically asleep.
 
Another thought to mention is that your data does show a significant drop today on 2 units, so there was some action there. Even getting into the 200s could cause her to bounce some since her body is not used to it. It will adjust over time.

Can you share some info with us on when you feed her? Also, your signature says 'Fancy Feast Shredded White Chicken Garden Fare (Carbs: 4.545%)'. I am not sure if I have the right food, but in the cat food database (link in my signature), I found FANCY FEAST - Medleys Shredded - White Meat Chicken Fare and it is 11% carbs. Is this the food? If so, you will probably want to try a lower carb option. That may help with those high numbers.

I hate to hear that she is struggling when you test, that could impact the numbers some. Have you tried the testing tips found here? I will look for the link. UPDATE TO ADD LINK: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/
 
Make sure to offer Lomo a low carb treat every time you test even if not successful. Sing to yourself or Lomo to relax. If you get uptight she will get uptight too. They are like little sponges when it comes to emotions. Make sure her ear is warm and if you haven't already, get lancets that are 26 or 28 gauge to make it easier to get a blood sample.

And fuss with her ears every time you give her a pet or pass by her. It's not the poking they object to....it's having their ears manipulated and handled.

Be patient with yourself and with Lomo and testing will be much easier in the near future. :)
 
On little bit of housekeeping....... Can you please rename your spreadsheet to include Lomo's name? Sometimes when we are helping folks, we have more than one spreadsheet open on our PCs so avoid confusion it's best to have your kitty's name on their spreadsheet. Let us know if you need any help to do this. Thanks.
 
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