? Help analyzing the curve and deciding on insulin dosage.

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Aliona

Aliona

Member Since 2020
Hello guys. Our kitty Sulls was diagnosed about two weeks ago. We used these 2 weeks to change his diet (he's on FF pate now - nothing else) to see how it affects his BG BEFORE we started insulin. So he has been doing this new diet for 2 weeks now (no insulin). Yesterday we did a curve and recorded our results here.
https://docs.google.com/spreadsheets/d/1nZKC_SaXU84HMSbvY_1lki2qUm9FLfURB0q-F4n13xQ/edit?usp=sharing

Could I please get some help analyzing these results and deciding on insulin dosage. We use Relyon Prime.
Thank you
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Numbers don't look horrible for not having insulin but he looks like he's going to need a little insulin therapy still, hopefully for just a little while to help nurture the pancreas and get it up and running on its own. Was he on any steroids that caused the diabetes? What insulin are you discussing using?

Tagging some people that might be able to suggest a small starting dose. @Wendy&Neko @Deb & Wink @tiffmaxee @Sue and Luci
 
Not bad numbers at all for a new sugarcat!!

What type of insulin do you have?

It will also help us to help you if you'll go ahead and fill out your "Signature". Up along the top right of the page is your sign on name. Click and choose "Signature". When the new box opens (where you currently have Sulls Spreadsheet) add the following information:

Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or meds? and then the spreadsheet link.

Save it and you're done! Keeps people from having to ask the same questions over and over!

Great job getting the spreadsheet up too!
 
Panic said:
Numbers don't look horrible for not having insulin but he looks like he's going to need a little insulin therapy still, hopefully for just a little while to help nurture the pancreas and get it up and running on its own. Was he on any steroids that caused the diabetes? What insulin are you discussing using?

Tagging some people that might be able to suggest a small starting dose. @Wendy&Neko @Deb & Wink @tiffmaxee @Sue and Luci
Click to expand...

Thank you! No, no steroids or any other health issues. Just realizing he ate too much dry food before and was overweight.
We're thinking to use lantus for insulin.
 
Panic said:
That would be an excellent insulin of choice! Not sure if you're in the US or not - if you are we get it cheap from Marks Marine Pharmacy from Canada.

Hoping just a little bit of TLC will give him a strong diet-controlled remission very soon! :)
Click to expand...
Yes, we're in the US, California. I'll check out Marks Marine Pharmacy from Canada.
 
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Chris & China (GA) said:
Not bad numbers at all for a new sugarcat!!

What type of insulin do you have?

It will also help us to help you if you'll go ahead and fill out your "Signature". Up along the top right of the page is your sign on name. Click and choose "Signature". When the new box opens (where you currently have Sulls Spreadsheet) add the following information:

Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or meds? and then the spreadsheet link.

Save it and you're done! Keeps people from having to ask the same questions over and over!

Great job getting the spreadsheet up too!
Click to expand...

Thank you. I updated my signature with all the info.
 
I did just hear that Mark's said their orders were taking 2-3 weeks for shipping though ... I don't think you'll need a 5-pack of pens, maybe just one? @Chris & China (GA) have you heard of anything about their shipping delays?
 
Those yellow color coded range BG readings on your SS do say that Sull's will need some insulin.
You want to see BG levels down in the blue and then the green ranges.

Lantus is a good choice.
 
Deb & Wink said:
Those yellow color coded range BG readings on your SS do say that Sull's will need some insulin.
You want to see BG levels down in the blue and then the green ranges.

Lantus is a good choice.
Click to expand...

Quick update and a question. So we're trying to get a lantus prescription from our vet. But since we did our curve using human meter he is giving us a hard time and tells us that we need to bring the cat back in to retest him on cat meter because the vet doesn't understand human meter numbers. We really don't want to do that. So what do I tell him to get our prescription?
@Deb & Wink @Chris & China (GA)
 
Hi Aliona,

My first suggestion would be to ask your vet whether you could borrow a pet meter from the practice to run another curve at home. Home BG readings aren't influenced by vet/travel stress and thus provide better information upon which to base dosing decisions.

If that's not an option then another suggestion would be to compare the price the vet will charge to run a curve with the cost of a pet meter (e.g. Alphatrak 2). It may be cheaper to buy the meter and run the curve at home. If you did choose to get the pet meter, you could also use it to run future curves that your vet will be happier with. (It would pay for itself in very short order if your vet were to insist that they were only willing to accept pet meter values as a basis for their treatment recommendations for Sulls.)

A third suggestion would be to use the attached peer-reviewed published study on treatment of cats with Lantus and other long-acting insulins as a basis for further discussions with your vet. Have a look at the tables in the document. They contain information on how to set starting doses and make dose adjustments based on human meter values.

Aliona said:
Also if he asks how pet meter numbers compare to human meter, what should I say?
Click to expand...
Per my vet, the normal feline blood glucose reference range for readings taken on pet meters is:

70-150mg/dL (3.9-8.3mmol/L).​

Per the attached study, the normal feline blood glucose reference range for readings taken on human meters is:

50-120mg/dL (2.8-6.7mmol/L).​

There is no defined formula for converting the readings from one meter type to equivalents on the other, you simply use the reference range appropriate to the meter you test with.


Mogs
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Attachments

I would remind him that pet meters are still a fairly new invention and human meters were being used in cats long before the Alphatrak came on the market. Say that while you would like to use a pet meter, you can't realistically afford to use it at $1 per strip, or do vet curves because of the stress factor inaccuracy + cost. Indicate you really can't afford it so are making due.

As for comparison - a pet meter will run higher but if you ran a curve on both meters, the pattern would be the same. Same rises and falls, and the pattern is really what matters, not the numbers much. Think of it like holding two pencils in one hand and drew a curve. One pencil line would be slightly higher than the other, but they follow the same pattern.
 
Aliona said:
Also if he asks how pet meter numbers compare to human meter, what should I say?
@Deb & Wink @Chris & China (GA)
Click to expand...
Pet meter numbers are higher. Wider spread at the high BG ranges. Difference in the BG numbers narrows as the BG levels get close to normal for a cat. So at 500's, 400's, 300's, 200's, the BG numbers on a pet vs human meter are too high. Really doesn't matter what the difference is. Too high is too high, no matter what the meter.

Your vet should know what the renal threshold is for a cat. Anything over the renal threshold is too high, and Sull's is over the renal threshold.
Needs insulin.

Hopefully, your vet is aware of the (2018) AAHA Diabetes Management Guidelines for Dogs and Cats and will pick a good insulin for CATS, which is NOT NPH insulins or Vetsulin/Caninsulin.
 
@Deb & Wink @Panic @Critter Mom Thank you everyone for your insights and advice. After much conversation and back and forth with the vet, he made us come in again for a quick glucose check (I know it was totally pointless but he was not giving us a prescription otherwise) and now $60 later we have our lantus prescription (YAY!).

So we'll be starting Sulls on lantus tomorrow. I guess an overall question is as we start this process should I continue asking questions on this post or should I make separate posts for questions as they arise (kinda like what I would do on Facebook)?

Another thing is dosing. The vet prescribed 2units twice a day. I know based on our SS everyone here suggested 0.5 to 1 units per dose. Can I please get a confirmation on that since we'll start injecting Sulls tomorrow and we want to stay consistent and do the right thing.

I also keep hearing about a "protocol" to follow when it comes to insulin dosage, etc... Is there some document i need to refer to or how do I start this protocol.

Also just for reference... in case it makes a difference on your dosage advice:
after todays vet's visit numbers are
1) we tested him on human meter right before going to the vet and he was 311.
2) vet tested him on our human meter and SAID he was 248
3) vet tested him on their alpha trak reading AND lab strip and got 389.
4) THEN we tested him again as soon as we got home and our human meter reading was 357
..... So I don’t know what was going on.... Like how could it go from 311 to 248 to 357 within 1.5 hours without food or drugs on our human meter. But when we did a curve he mainly stayed in 200s on human meter with nadir at 180.


Thank you guys!!!
 
He charged $60 for a BG test? :eek: Well, pick your battles I guess.

So since you're on Lantus you can actually start posting over on the L&L forum! You can still post here or ping any of us of course, but if you look you'll see the L&L forum works a little differently than Main Health. Most members make a new post every single day - even if they don't have questions - just to keep track and other members can pop by and see how kitty is doing. The forum prefers that you make one thread a day with a specific thread title (L&L is the only section here that does this, you don't have to do it in Main Health). It would be something like this:

9/23 Sulls AMPS: 200

Throughout the day if you're active, you can update the title to add more tests, so +2 180 +3 140 etc. You can also ask questions at the end of the title. They do prefer that you do DATE - CAT NAME - AM/PMPS first though, it makes it easier for them to read it. Here's an article on their posting preferences, but I've summed it up for you for the most part.

2 units is a huge nope. Sulls has good numbers off insulin already, 2 units would ruin it. He just needs a little bit of TLC before hopefully sliding into remission. I would make a post on the L&L today that is simply something like:

Yellow curve off insulin, starting Lantus tomorrow - starting dose advice?

I'm not sure how low they'd like you to start him. Perhaps 0.50 units, maybe even less. Sulls numbers are too good to be starting on a full unit, much less two.

As for the meter, two things to note - meter variance is 20%. You can take two tests at the same time and get a different number up to 20% off and it will still be considered the same number. Another thing, pet meters are going to run a bit higher than the human meter. ANOTHER thing ... stress increases BG. Vet visits are very stressful. Sulls BG was up a bit but with meter variance it wasn't that much higher than at home. Then when you went home it went up - probably due to car ride/vet visit stress. None of that appears concerning, in fact it's expected.

Good luck! :)
 
[QUOTE="

As for the meter, two things to note - meter variance is 20%. You can take two tests at the same time and get a different number up to 20% off and it will still be considered the same number. Another thing, pet meters are going to run a bit higher than the human meter. ANOTHER thing ... stress increases BG. Vet visits are very stressful. Sulls BG was up a bit but with meter variance it wasn't that much higher than at home. Then when you went home it went up - probably due to car ride/vet visit stress. None of that appears concerning, in fact it's expected.

Good luck! :)[/QUOTE]

Thank you! I'll make a post L&L today. As for the BG numbers up and down, it just seemed super weird that his number went DOWN to 248 at the vet (it was 311 at home pre-stress). I'd think because of stress at the vet they'd go UP. Maybe you are right it's just the variance, but I wish we could've seen it when the vet did his test. But I guess it's not very important in the grand scheme of things.
 
Ah, knew I was forgetting something.

Protocols. Lantus has two dosing methods: Start Low, Go Slow and Tight Regulation.
SLGS: Reductions earned when BG drops below 90, maintain the dose for 7 days (unless dropping below 90), then increase if nadirs are consistently over 150.
TR: Reductions earned when BG drops below 50, maintain the dose for 3 days (unless dropping below 50), then increase if nadirs are consistently over 150.

If you are posting every day you'll probably get advice from members commenting when they think it's time for an increase as well.

Normally I recommend new members to start on SLGS ... TR is kind of aggressive, you need to be testing at LEAST once per cycle (excluding pre-shots, and preferably at least 2 midday tests and one before bed test), you cannot have any dry food (even low-carb) in the diet, and you need to be prepared for lower numbers because TR essentially forces the BG to stay low. If it's not low, you increase quickly to get them low. Because it's aggressive and you have to test often it can be kinda overwhelming for a newbie ... but you seem to already have a handle on testing and Sull's no-insulin numbers are soooo good the likelihood of getting him into remission faster on TR is high. Personal opinion. I think a bit of time doing aggressive treatment will really help, and obviously save you time in the long-run getting him off insulin quicker. If a cat is regulated within six months, ideally on Lantus TR protocol, there's a very high remission rate.

Here is the link to the dosing methods.
Here is the Roomp and Rand protocol study that was done in case your vet wants to know what you're up to. Most of us do not take dosing advice from our vets. Those that do tend to struggle lol.
Should your vet get fussy about starting dose (and honestly I would just ... not tell him hahah I'm terrible) you'll want to point out that every cat is different and starting doses need to be done conservatively ... just because a cat is 15 lbs doesn't mean their pancreas is damaged enough to receive 1-2 units of insulin. Alternately, a 8 lb cat may have a LOT of damage to the pancreas and need a considerable amount of insulin to start repairing it.
 
Aliona said:
So I don’t know what was going on.... Like how could it go from 311 to 248 to 357 within 1.5 hours without food or drugs on our human meter. But when we did a curve he mainly stayed in 200s on human meter with nadir at 180.
Click to expand...
It's called "vet stress", a well documented phenomena, where the BG numbers go UP at the vet.

Also, unless the vet tested both meters using the exact same blood drop, the BG numbers can be very different.

If you would please add those BG readings you got to the SS, before vet, at vet, after vet, that is more data and more data is good.

I can't see starting Sulls at more than 0.5U. Doses of the depot insulin don't go to work right away, as the depot has to fill first. So it can take several days to see the full effects of starting your cat on Lantus.

Good luck! You've "graduated" from the Feline Health forum to the ISG group.
 
Deb & Wink said:
I can't see starting Sulls at more than 0.5U.
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Aliona posted in the ISG already about a dose - they said for SLGS do .5u and TR do 2u. I for one am wondering why TR starting dose was based off of weight in the Roomp/Rand study, especially since Sulls is in yellows without insulin. Wouldn't that be wrong, in theory?
 
Panic said:
Aliona posted in the ISG already about a dose - they said for SLGS do .5u and TR do 2u. I for one am wondering why TR starting dose was based off of weight in the Roomp/Rand study, especially since Sulls is in yellows without insulin. Wouldn't that be wrong, in theory?
Click to expand...
It's been so long since I had a kitty start on lantus, I couldn't say either way.
 
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