? Help with understand BG levels

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CLS

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I'm Nayeli - My mom Chris - May 18 I was diagnosed with diabetes - BID 1 unit of PZI insulin - high blood pressure L. Amlodipine once daily. Started home testing on 7/8/16.



Nayeli’s last BG curve started at 622, drop to 474, rise to 540, then never below 454, is this normal? First BG curve we did, better levels.


8/15 vet checked her blood, BUN – 61.0 & creat – 2.3. Now receiving sub q fluids daily. Would a high BUN affect her BG levels? Is she headed to becoming a CRF Kittie and diabetic?
 
Hi Chris and Nayeli!

Was the curve done at home? Yes, those are high levels. One possible question is food. What is he eating? Are the Fancy Feast and Friskies pates? Is the Authority wet or dry? The food chart we use is here:

http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf

We try to feed under 8-10% carbs.

We put together a protocol for ProZinc. It is my signature in blue.

I don't know about BUN levels. You might post that specific questions on Health.
 
Hi Chris and Nayeli! I don't know that a high BUN level would affect BG, but I know that Sometimes when you get kitty regulated the kidney levels can improve. Just in case though, you may want to look into feeding low carb, low phosphorus food such as Wellness Grain Free Turkey or Wellness Core Beef, Venison & Lamb.
 
The two curves I did were at home using the AlphaTrak 2.
I do select her food from the food chart.
She is totally off dry food for close to two years now. She does like to eat every 2.5 - 3 hours, and not a big eater, usually no more then a TLB at a time. She is only 7 lbs, I dont think she is absorbing all the food nutrients, been losing weight , but holding at 7 lbs.

Thank you for your thoughts. Sorry I did not answer back sooner, just not finding my way around here fast enough.
 
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No worries! It takes some time to find your way around this place and it can be challenging for sure!

If she isn't absorbing all the food nutrients, that's fairly common. As she gets better regulated, her body will be able to use the food better. Quick question: I see that she free feeds. Do you pick up the food 2 hours before AM and PM tests? We do that so the preshot numbers we get are not food influenced.

Her numbers are interesting....high numbers and then those yellows yesterday. Was anything different yesterday? What was her AMPS today?
 
once she is done eating and walks away, that is her signal I am done, so I do pick up, her food dish.... normally, she wont go back and eat food that has been sitting out. Fri (8/19) her AMPS was 289 and the PMPS was 268, I was very happy to see those numbers. I was also confused about do I give her insulin or not. Thought about 1/2 unit, not sure about that either, so did not give her insulin, knowing she would pay for it Sat morn, which she did, 594.

I was expecting her evening numbers to be going up and not down, & thought if I give her insulin will that drop her into a hypo state, don't need that. This time I left her bowl of food out wanting her to eat more before going to bed. I wanted to re-check her BG at around 4 am just to see where it was going, but I totally forgot about the food, and of course there she was at 4 am eating.

On the last BG curve I did with those high numbers, I went back over all my notes about her food, how she was feeling, walking, what if any thing did she eat differently, nothing. Then I was wondering if I was not giving her insulin correctly. Shorty after that is when the vet checked her blood and the BUN levels were high and started the sub q fluids. I am wondering if not feeling good because of this high BUN level that might have had something to do with it. Sure the vet will run the test again when she is done with this bag of fluids. Maybe now too, if her BG levels come down the fluids are helping to clear her kidneys of the toxins. (she started fluids on Mon, 15th).

Nayeli has had other health issues in the past three years off and on. Her BG levels usually showed in the normal range, but towards the high end, never told to keep an eye on that. The vet would think maybe it is this, run tests, nope everything returns normal values, well it could be IBD, so treating her for that with budesonide, not now any more. She would also run high white blood cell counts, never could find a reason to explain that one. The answer to most of the problems from the vet was to give dexamethasone, which she had been receiving off and on since 2013. I believe the lack of information on my part and the vet about long term use of these med's, the budesonide and dexamethasone are why she is a diabetic today.

The beginning of 2016 she slipped off the bed and down onto a tile floor, could not move for a short time, helped her up and it ws like she walked it off. Day or so later I noticed she was walking like she was drunk or dizzy. Went to the vet, I believe these blood test came back in normal range, however they checked her blood pressure it was very high, so started the blood pressure medicine. The weak hind legs problem has never gone away. From day to day it changes a little as to the difficulty she has in walking, getting up, standing to eat, in and out of litter pan.

I do have some light at the end of the tunnel, because I do see parts of her personality coming back out, trying to wash herself after eating, not sleeping in the closet or box all the time, awake for longer periods of time. Activity level is not there yet. Her movements are to come and let me know she is hungry, eat, drink, litter box and back to lay down. She will lay in the bedroom doorway, and then she can see what is going on. Just not back to the point of wanting to sit up on the couch again with me or sleep with me. Sorry about going on, I just would like to see more of that little girl come back out to me. I had one other vet beside her current vet that thought she should be put down.

Questions: what is the sliding scale for insulin and when giving her insulin is there a certain window of time it needs to be given before you should just let it pass and not give the shot? Sometimes when I have to take her in to the vet and because of the time they open I have to give her shot almost two hours earlier. Vet is like an hour away.
 
Questions: what is the sliding scale for insulin and when giving her insulin is there a certain window of time it needs to be given before you should just let it pass and not give the shot? Sometimes when I have to take her in to the vet and because of the time they open I have to give her shot almost two hours earlier. Vet is like an hour away.

It sounds like you two have had your hands full with health issues, but have been doing the things necessary to keep her safe and happy.

Generally we say that ProZinc can be given 30 minutes early with no issues, as long as the number is above your no shoot number and rising, not falling. Giving insulin later than normal, because the number is below your no shoot number, is up to you and your schedule. If you don't give food (which raises the level, meaning you wouldn't be shooting a "true" number) you can shoot as soon as the number is right. If you have to feed, then it's best if you wait 2 hours and retest (so again there wouldn't be a number food influenced). But doing that messes up your schedule because the next shot would need to be 12 hours from that shot.

Make sense?
 
Hi Sue and Oliver,

My instructions by the vet technicians: poke for BG check then wait 30 minutes and give insulin, using this range of 150-250, above - give insulin after eating, below - do not give insulin.

Usually when I have appointments in the morning I have to leave 45 min to an hour before our “normal” time we check her BG. So, that does screw us up at times, especially when she has to go to the vet more than once a week. I try my best to schedule appointments after her morning check.

I understand now that food will alter her BG number, but not sure what you mean by I can shoot as soon as the number is right. Are you just referring to the nothing to eat 2 hours before so we don’t get a number influenced by what she has eaten.

Now this gets me to thinking about the food she is eating during the day. Do you every find a pattern in the BG numbers that will tell you it is best to have your cat eat between 1 pm and 7 pm and 2 am – 5 am and not to eat during times outside these ranges. Maybe that is some of our problems with her numbers, she is eating during the wrong time of day, even if she is not feed 2 hours before her BG check time (9:30 am – 9:30 pm). I hope that makes sense to you. Boy if she can only eat during certain times this opens a whole new can of worms for us to work with.
 
At this point, I think a number you could establish as one not to shoot below could be 230. Once you see that she does okay with that no shoot number, and if you can monitor, you can lower it. I would not shoot at 150; that is lower than I'd be comfortable with, even later on, as you are using a pet meter

People feed differently. Some free feed, pulling the food up 2 hours before the shot. Some give 2 meals daily, after the shot. It depends on your cat and your schedule. Food may affect mid cycle numbers but you just work with it
 
I'm with Sue on this. I wouldn't ever advise giving insulin at 150...if she was my cat, I wouldn't do it. It's just lower than I would ever feel comfortable with.

I free fed and just took the food up 2 hours before preshot. It worked for us. Gypsy would always eat when I put food down...not all of it, but enough to get her shot. Then she'd eat more later.
 
I am so happy I wont have to change her feeding routine and sure she would tell me the same thing.

By monitoring her if she does have a 230 reading, do you mean I should watch her for any signs of hypoglycemic problems?
 
I think what Sue is saying is you could lower the no shoot number to 230. So if she's at 230, you shoot. But then grab some tests that day to see where that dose brings her on that number. Then, if she isn't going too low at nadir when you have been shooting at that number, you can lower that number to say....215.

By monitor, we usually mean keep an eye on things, grab some tests, be prepared IF she goes hypo...not that she will. The mid cycle data helps us figure out if shooting a certain dose at a certain preshot number works or brings her too low.
 
Rachel, that sounds just like Nayeli, eat take a break and come looking for more. Forgot to ask, is there a certain amount of food they should have in their tummy before receiving their insulin, I try to get two tablespoons into her.
 
K, I follow you, but here is another newbie question. How will I know this nadir, will it just be her lowest number during the mid cycle. When the day comes that I can drop the 230 to 215, will be great, but to be clear, I will not go below 150 ever. If I get a 150 she would still receive her shot of insulin.
 
If she's getting 2 TBL in, I think you're good.

The nadir is usually between +5 and +7 but it can be earlier or later. Best way to find out is to run a curve every now and then. Other than that, try to get tests in during that range when you can...you'll figure it out through that.

Correct! I wouldn't ever be able to suggest giving below 150, especially on a pet meter.
 
Thanks Rachel. Sometimes we get in the 2 TBL before the shot and sometimes 1 to 1.5 before and then she eats more right after her shot. I can only remember back maybe 3 years, and in those 3 years, she has never eaten over 2 TLB at one time.

I am hoping to move over to the Relion Confirm pretty soon and just use the AlphaTrak as a stand by, too costly.

I will probably have a question or two when it comes time to do another curve with the new spreadsheet. Maybe in another two - three weeks.

Thank you again for the information,
 
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