gluose curves or patterns

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joanngold

Member Since 2014
I am noticing some slight trend in my cat, Big Shot's BG tests. On a number of days, there is no curve, just a downward slope.
It concerns me.

Some people might say that it doesn't matter when the nadir appears. It matters only that one evaluates the nadior according to its BG number.
So I try to ignore the other sample results. But I'm still a little concerned.

Over the last 4 to 5 days, I've changed the injection location from the scruff of his neck to his hind leg. I read that the Lantus is absorbed more quickly when given in the hind leg. But my numbers may suggest that the lantus may be absorbed or activated late and keeps on working bypassing a nice little curve. Curious.

I classify myself as a tight regulation person, so I stick to my dosage amount and injection schedule. I want to wait at least a week before changing the dose unless an urgent situation arises such as hypo.

I may have asked too many questions. But I'm relatively new and uncertain about what to ignore and what to pay attention to.

Thank you

Jo Ann and Big Shot
 
Hi Jo-Ann, and welcome to you and Big Shot to the Lantus TR forum. For those wanting some background, here is one of Jo-Ann's previous posts on Health: viewtopic.php?f=28&t=128700

Cats only sometimes follow what looks like a traditional curve. It's very common when cats are breaking a bounce, that their numbers slide down all cycle. For more information on bounces, check out the second post here. Big Shots spreadsheet does not look that unusual. I'm wondering, what do BAR and AQR mean from the Remarks field?

My first observation when looking Big Shot's spreadsheet, is that you do a reasonable job testing during the day, although you did miss some preshot tests. But the biggest issue is that you are missing half the data by not testing at night. Getting a +2 test and hight or even testing just before you turn out the lights to go to bed will help tell us what the cycle looks like. When Neko was on Lantus, she earned almost all of her deductions at night, and then she bounced during the day. If I had no night time data, that would look like she needed an increase, when in fact she had earned decreases. Many cats go lower at night. By looking at Big Shots spreadsheet, there are several days where he was much higher at AMPS, then slid down to his PMPS test. That is very indicative of him going lower at night, then bouncing, then getting over the bounce during the day. For example, the night of the 23rd, he had a PMPS of 65, there were no tests after that, then up to 230 the next day.

Getting at test at +2 is a good test to get on Lantus. If the +2 test is similar to the preshot value, then you'll likely have a normal Lantus cycle (curve). A higher value means likely a bounce and you can safely go to sleep. If that +2 test is lower than the preshot, you are likely to see an active cycle where more testing is needed, and possibly intervention with high carb food.

I just inject Neko below the shoulders, alternating left and right side.
 
Hi Jo Ann!

welcome back! You've gotten good advice already - I think BigShot looks like he's doing pretty well, overall. I agree with Wendy about getting one test in the evening cycle - and if you can only get one, i'd probably get that one just before you go to bed. If you can get two, I'd get the +2 and a before bed. The +2 is helpful for being a little bit predictive about what might be coming.

You're doing a super job during the day - I'd just add that if you get a test in the 40's, give high carbs and retest within 30 minutes. You don't want to ignore the 40's test because you don't want him going lower than that.

There's nothing concerning about his spreadsheet other than what Wendy pointed out. It looks like he's likely going lower in the evening cycles and that can be dangerous if you're not catching it and he goes too low.

Diabetic cats have what is called Dawn Phenomenon and it will raise the blood sugar in the mornings. Often that is the highest number of the day. If it's low, like the 71 on 11/16, you have to wonder how low it got to the night before. Adding that extra bit of information from the night cycle is really going to help figure out what's going on with mr. big shot. :-D

I always gave punkin his shots in the scruff. No problem with it.

Glad to have you here!

julie
 
Hi Jo Ann-

Glad to see you back in LL!

I agree with the others about night time testing...getting that data will really help fill in the blanks. Likewise, I would definitely not skip pre-test testings, just so you know you are starting with a reasonably safe number (that's not to say Big Shot won't drop low even from a really high number, though!).

One other question, which you may have answered elsewhere...what kind of meter are you using? It does make a big difference if you are using an alphatrak vs. a human meter, so that's something we need to know when looking at Big Shot's spread sheet.
 
Thank you for your recommendations. I've got some good assignments/links and tasks ahead of me and will get back with the data.

As an aside I'm using the AlphaTrak II and I'm very satisfied with it. I will read up on your recommended sites and do at least +2 night tests.

Big Shot is in a somewhat unusual situation because there is always someone who is awake and at his side for close to 24 hours. It has been especially helpful when those low BG numbers appeared. His night companion knows what to look for in case of hypoglycemia and will sound the alarm if he sees anything that is the slightest bit unusual.

I've got some good assignments ahead. Again thank you so much. We all love our buddies more than we can say. And, I'm out to do all that is possible to help him along this rough road.

Jo Ann
 
Hi again Jo-Ann. Good question by Amy. The reduction point for a Alphatrak is a little higher than for a human meter. If you are using an AlphaTrak, you should reduce if you get under 68. Since Big Shot got a couple of numbers in the 60's the other day, that means he earned a reduction. His new dose should be 1.0U.

Could you do a favor and add "AlphaTrak" to your signature? That way we'll remember to keep that in mind in the future.

By the way, we've had kitties here go into the 30's (on a human meter) which is hypo territory, but still not show symptoms. Testing is the best way to know when they are low.

Good luck with your assignments.
 
i'm glad Amy asked that - it's a really important distinction. Most of us use human glucometers because the strips are so much cheaper.

You'll want to keep in mind that the numbers you are getting are going to be higher than the equivalent blood sugar that you'll be seeing on other people's kitties. Most of the numbers being reported in the subject lines are in human meter numbers. AT measures roughly 30% higher than human meters.

Here is the link to the protocol that uses AT numbers: http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf One update has been made to that and they now suggest using the number 68 as the trigger for a dose reduction, and for giving carbs. In the document linked above they refer to 80 as that cut-off. The most recent document uses 68, however. So you want to keep him over 68 on the AT, giving him carbs if necessary to do that. If he goes below 68, that means a reduction of 0.25u in his dose. When you're looking at the yellow-starred stickies on this forum, you'll see 50 referred to as being the line for dose reductions and giving carbs.

The 50 on a human meter is considered to be roughly equivalent to the 68 on the AT.

Ask if that doesn't seem clear. The 29 on his ss is a scary low number - especially since it was using an AT.

Because of the way Lantus works, a hypo can last 16 or more hours, and often people won't see symptoms even with very low blood sugar. We encourage people to rely on testing data, not observations. By the time there are symptoms it's a serious situation.
 
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