Glucose curve results - any thoughts?

[jennw]

So, Malachi has been on insulin for just over a month now (Lantus, 2 units twice a day). After the first two weeks, he spent the day at the vets for his first glucose curve, and then I did one yesterday at home.
I'm just going to summarize his results from yesterday, and if anyone has any thoughts, I'd love to hear them!
(The first number is mmol/l and the second is mg/dl)

7:45 am - before meal 10.4/187.2
8:45 am - after meal, and 2 units 9.3/167.4
10:00 am - 5.8/104.4
12: noon - 5.4/97.2
2:00 PM - 5.8/104.4
4:15 PM after food- 7.8/140.4
6:20 PM - 6.7/120.6
8:20 PM - after dinner - 6.9
8:30 PM - gave only 1 unit of Insulin.

At the last meeting with my vet (after his first curve), we discussed my schedule and Mal's eating schedule. I don't get home from work until around 6, and he likes to eat in the afternoon, around 3 or 4. We couldn't pull all the food up because we have fosters who graze during the day (two are semi-feral and only come out when we're gone). In light of that, since Mal was eating only a light meal at 6, the vet was ok with me only giving him 1 unit at night. We moved those semi-feral cats to a different foster home and are going to try picking up the kibble left out so Mal can't get at it (I totally forgot this morning) and then hopefully he'll be hungrier when I get home at 6 and will eat more wet food.
He had some neuropathy at the start, lots of trouble walking, and his hind legs would flop out to the side. That was the only symptom he displayed, which is why we took him to the vet in the first place, and she checked his sugar there. It was 29.47 that first test. His legs are MUCH better. A little bit of floppiness, but he's hopping into boxes again and can support himself when he sits. He's also MUCH happier and looking better.

So, any thoughts or questions or things I should be watching for now? We're really hoping he gets to the point he doesn't need insulin anymore, and his numbers (I think) are really coming down.

**Edited to add the notes from his vet from his curve on Jan 31:
Admit for glucose curve. Did not eat much this am so owner only gave 1 unit of insulin. ate at 6 am had insulin at 6:45. BG on admit at 7:45: 17.4 mmol/l.
BG at 9:45: 18.9 mmol/L
BG at 12PM: 18.5 mmo/L (left ear prick)
BG at 2pm: 15.9 mmol/L (right ear prick)
4pm: 16.7 mmol/l

 

[KPassa]

Great job on doing your first curve at home! :thumbup The double-digits are very nice to see as well as the lowish pre-shots.
Let me recap to see if I understand:
- 2u of Lantus twice a day but have lately been giving 2u AM and 1u PM
- Still eating dry but you're planning on taking it up soon
- What wet food are you feeding him?

First, Lantus works best when a consistent dose is given twice a day, so if you're having to reduce the PM dose in half, what you want to do instead is decrease the dose across both cycles. So, 3u a day works out to 1.5u AM and PM. I think you'll see much more stable numbers doing it that way.

Second, if you're picking up all the kibble, I would recommend doing a preemptive dose drop to 1u twice a day to see how he reacts to no longer having dry food available (which will lower numbers even further).

I also wanted to link for you how to get a spreadsheet like the ones we use. It's helpful because you can keep track of the numbers, spot patterns through the color-coding, and share with us here. And here's how to fill out the spreadsheet:
Questions on understanding how to use the spreadsheet get asked a lot, so I thought I'd share a quick run-down of 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.

 

[Deb & Wink]

I think you and Malachi are making some very good progress! The suspected neuropathy is already better. His numbers are coming down nicely at mid-cycle to a healing range. His nadir seems to be a bit early, which can mean the dose is a bit too high.

When you do get rid of the dry food, you'll want to be sure to be home testing before every shot. With the removal of those extra carbs, Malachi could drop much lower. Looks like he's a good candidate for remission.

I concur with a consistent dose both AM and PM. It keeps the depot full instead of constantly filling and draining by giving him 2 different doses. Here's someinfo on how the depot works, from over in the Lantus TR forum. It's one of the stickies at the top of the page.

 

[jennw]

- 2u of Lantus twice a day but have lately been giving 2u AM and 1u PM
- Still eating dry but you're planning on taking it up soon
- What wet food are you feeding him?

-I want to take up the dry, but we need to put kibble somewhere so our foster kittens have access. They need to eat more often, they're only 16-20 weeks old, so we're going to try and put it up high where they can get it while we're at work, but Malachi can't.
-he doesn't *always* get 1 u PM, only depending on how much he eats for dinner. Sometimes he eats almost a whole can, other times he just picks at it. His wet food is the Tiki brand Tuna.

Now that I can test at home confidently, I'll be doing it more often. And yes, for sure with any diet changes I'll test pre-shot, and that preemptive dose drop is a good idea once the kibble is up.

I saw the spreadsheet, and hope to use my notes from the other day to fill it out. I just hadn't had time to really look at it, and while I'm pretty tech-savvy and computer adept, I *despise* Excel. Just a quirk, I'll have to get over it and start using this spreadsheet, I know.

Also, as for fur shots, Malachi is a VERY long haired cat. Like, crazy amounts of hair - I've been keeping a patch at his scruff shaved, along with a patch on each 'hip-ish- area to give him his shots in. The vet originally shaved it to make it easier for us to give him the shot in the right spot, and it's been helpful, so I'll just keep it trimmed.
This is him:

Here's someinfo on how the depot works, from over in the Lantus TR forum. It's one of the stickies at the top of the page.

Oh, thanks for that link!


Thanks again for ALL the help and advice. I really wish ALL forums could have as many articulate, level headed members as those I've seen here so far. My vet is very good, so I'm lucky in that regard, but I know lots of people don't have the same relationship and there is a LOT of information that could be helping them and their pets here. I'm sure not all vets know some of this stuff, either!

 

[Deb & Wink]

I saw the spreadsheet, and hope to use my notes from the other day to fill it out. I just hadn't had time to really look at it, and while I'm pretty tech-savvy and computer adept, I *despise* Excel. Just a quirk, I'll have to get over it and start using this spreadsheet, I know.

Well, although our standard formatted, color coded SS looks like Excel, it's actually just a bunch of columns and rows with some conditional formatting for color behind the scenes. It's just a tool for data entry. No math involved. We don't all have access to Excel on our computers, so we came up with this "document" to use for data entry. Anyone can set up a Google account and then with the share options, you can let "anyone with the link" view it. Having it available does give other people here some sense of what may be going on and helps to get more suggestions on the dosing.

Also, as for fur shots, Malachi is a VERY long haired cat. Like, crazy amounts of hair - I've been keeping a patch at his scruff shaved, along with a patch on each 'hip-ish- area to give him his shots in. The vet originally shaved it to make it easier for us to give him the shot in the right spot, and it's been helpful, so I'll just keep it trimmed.

Yes, I know where you are coming from. Fortunately for me, Wink had lost so much hair, had so many bald patches and giant dandruff flakes, when I first started to foster him, it was extremely easy to find a bare spot to inject the insulin. What gave me trouble was the long black hair on his ears and the black ear edges and the long hairs inside his ears that just wanted to get in my way and my poor eyesight. ohmygod_smile I ended up shaving a tiny patch on his ear so I could find that blood drop. The blood color just blended into his fur so well, it was almost impossible for me to see, even with bright light. :YMSIGH:

 

[jennw]

Oh, ok, when I downloaded it, it opened in Excel. I can't upload to google drive here at work, but I was poking around the spreadsheet and then my head exploded. Hah, kidding, I know it's simple enough if I just look at it. I'm still getting familiar with the terms and stuff, and am crazy busy, but will work on filling it out.

I never thought of shaving the hair on his ear. Good idea. There were a few ear pricks that were troublesome because of the hair, I'll give those ears a little trim, too!

 

[KPassa]

Check out some of the spreadsheets linked in other people's signatures and it'll give you an idea as to why we find them so useful. If you think of it as collecting data in an easy-to-read format, it removes the whole "maths iz hard" from the equation. :lol:

 

[KPassa]

Also, as for fur shots, Malachi is a VERY long haired cat. Like, crazy amounts of hair

OMG! I thought both of my long-haired boys were hairy beasts, but what a beautiful lion-kitty! So fluffy and look at that mane and the tufts of hair between the toes! (My Mikey has the toe tufts, too. :lol: ) Do you know what breed he is?

 

[BJM]

Understanding the spreadsheet/grid:

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +5 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.

 

[jennw]

Understanding the spreadsheet/grid:

Thanks!

OMG! I thought both of my long-haired boys were hairy beasts, but what a beautiful lion-kitty! So fluffy and look at that mane and the tufts of hair between the toes! (My Mikey has the toe tufts, too. :lol: ) Do you know what breed he is?

Haven't got a clue. Just a big orange guy. Our vet had told us about a cat that one of their clients needed to rehome, so we went to go see him. He was a beautiful all-white boy, 8 years old. The woman said she couldn't handle three cats and a new baby in a tiny apartment. We agreed to take the white cat, and then she said 'can you take this guy, too? I just want him gone'. She was pointing to this monstrous orange dude. We (obviously) took him too. No idea where she got him or what breed he really is, but he's always been gigantic. (We've had them both for almost 10 years now.)