Home Testing Advice

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My 10 year old Tabby, Sonic, was Dx 1 month ago. Began on 1U PZI BID and is now on 5U PZI BID. His #s range from 321-445. I need some advice on a testing site other than his ears. Poor guy sees me coming with the equipment and folds his ears down :( My tears are not conducive to a calm testing time. Any thoughts are appreciated.

Also, I'm getting very concerned about those #s not coming down. Feeding him Evo.
 
Some people do use the paw pads for testing. You can look up how to do that, I always used maui's ears and when she would fold them down, I would hold the ear to keep her from doing that.

Are you able to get blood from testing the ears? Can we help you with technique? Is the ear warm when you test - do you know about using a "rice sock"?

It's where you take a sock, put uncooked regular rice, dried beans or oatmeal in it (about 1/4 cup), knot the sock so it doesn't come out, then place in microwave for 15-30 seconds until warm to touch.

What I would then do, is place it behind Maui's ear and use it as a brace, so I wouldn't stick my finger and then test that way.
 
Hillary & Maui said:
Some people do use the paw pads for testing. You can look up how to do that, I always used maui's ears and when she would fold them down, I would hold the ear to keep her from doing that.

Are you able to get blood from testing the ears? Can we help you with technique? Is the ear warm when you test - do you know about using a "rice sock"?

It's where you take a sock, put uncooked regular rice, dried beans or oatmeal in it (about 1/4 cup), knot the sock so it doesn't come out, then place in microwave for 15-30 seconds until warm to touch.

What I would then do, is place it behind Maui's ear and use it as a brace, so I wouldn't stick my finger and then test that way.
Thanks :) I didn't know about the rice-sock. I'll try it for Sonic's PM shot. Just did a curve yesterday and Sonic is a bit irritated. Perhaps I'll try a paw as well!

So glad I've found this forum!
 
What size lancet are you using? It may help to use a 26-27 gauge lancet over a 31-33 gauge lancet (these are super fine and may not make a big enough hole).
 
The other thing that helps a lot with making them look forward to testing time is TREATS! is there a low carb treat that Sonic really loves, I know for my girl it is fat free cream cheese, but others use plain boiled chicken, fresh shrimp, sardines in water or even bits of water packed human tuna, as well as things like freeze dried chicken, shrimp, fish etc. Really just about anything that is pure meat works well.

Cats are pretty smart they catch on pretty quickly that a small pick to the ear equals a yummy treat that they only get when they get tested. Musette comes running when she sees me pull out the testing kit because she associates test with Cream Cheese and she would do anything for that cream cheese. My other diabetic Maxwell has been in remission for over a year and he still comes to the testing spot as well because he also knows that it means he is getting kisses and brushing his two favorite things in the world.

Mel, Maxwell, Musette & The Fur Gang
 
BJM said:
What size lancet are you using? It may help to use a 26-27 gauge lancet over a 31-33 gauge lancet (these are super fine and may not make a big enough hole).
It's a 33. I hadn't even considered that so thanks for mentioning it. I am quite new to having a diabetic cat (as is Sonic) so we need all of the help we can get.
 
MommaOfMuse said:
The other thing that helps a lot with making them look forward to testing time is TREATS! is there a low carb treat that Sonic really loves, I know for my girl it is fat free cream cheese, but others use plain boiled chicken, fresh shrimp, sardines in water or even bits of water packed human tuna, as well as things like freeze dried chicken, shrimp, fish etc. Really just about anything that is pure meat works well.

Cats are pretty smart they catch on pretty quickly that a small pick to the ear equals a yummy treat that they only get when they get tested. Musette comes running when she sees me pull out the testing kit because she associates test with Cream Cheese and she would do anything for that cream cheese. My other diabetic Maxwell has been in remission for over a year and he still comes to the testing spot as well because he also knows that it means he is getting kisses and brushing his two favorite things in the world.

Mel, Maxwell, Musette & The Fur Gang
Oh WOW I hadn't thought about treats! I've been so focused on diet that an extra goodie seemed inconceivable. I made low-carb tuna treats (recipe via my mother who makes them for her dogs). I'll try that :)
 
Oh yeah, testing time should not be a stressful activity. Otherwise neither you or the cat will get anything out of it.

Maui loves brushing, so that was her treat. And if I would walk away without giving her brushes, she would sit there and look at me until I remembered.

Once you are relaxed and calm about the process, your cat will be too, as he feeds off your energy.

What color are your cat's ears? If they are dark, you want to get a handheld flashlight to shine on the ear, like a spotlight, so that you can see where you are poking. I used to hold it with my teeth.

Also, if you find you have problems being quick enough, or he may flick his head, put petroleum jelly on the ear, prior to poking. The blood will pool on the jelly and you can test from that.

and for ear bruising that you may eventually see, neosporin with pain relief is a good thing to have on hand and rub onto the ear after testing is complete.
 
Prefering to err on the side of caution, does anyone else see anything wrong with this statement?

My 10 year old Tabby, Sonic, was Dx 1 month ago. Began on 1U PZI BID and is now on 5U PZI BID

Just thought I'd better say something, sorry if I'm over reacting,
jeanne
 
Now while I have never used PZI that also looks to me like a dose that is being raised way too fast as that would be an increase of a full unit in less than a week each time. I'm thinking there is a good chance that the ideal dose has been missed and not the kitty is in rebound from too much insulin....Hopefully more exerienced PZI users can weigh in here. But 5u bid or 10u per day seems like a whopping dose for a newly dxed kitty.

Mel, Maxwell, Musette & The Fur Gang
 
Hi, nice catch, Jeanne and Mel!

It looks like you've gotten some great tips on testing, and hope that they will make this easier on you and Sonic.
I was wondering and more concerned about the doses of insulin...
I see that Sonic was started on a good starting dose of 1u BID, and that was about a month ago? And now you're up to 5u BID? Can you give us some idea of what kind of numbers you have been seeing along the way? Were the numbers that the dose increases were based upon the preshot numbers, or have you been able to collect numbers during the mid-cycle hours?
That is a very fast climb in dose over that period of time, and there's a very good chance that Sonic is getting too much insulin currently.
We need to get you set up with a spread sheet....

When the doses were increased, did that take place after the vet ran a curve of Sonic's BG, or have the increases been based on numbers you have been getting at home?
My vet also was very aggressive when Bob first started getting insulin, and I also went up too soon and too fast. It wasn't until I came here that I came to understand the logic of the "start low, go slow" protocol. But it probably helped save Bob's life, and once I "got it", I began dropping his dose. A few weeks later, he went OTJ...

Any feedback you can give us on his test numbers and when/how his dose went up so quick and so much will help us to help you and Sonic make sense of his numbers.

Carl
 
Carl & Bob in SC said:
Hi, nice catch, Jeanne and Mel!

It looks like you've gotten some great tips on testing, and hope that they will make this easier on you and Sonic.
I was wondering and more concerned about the doses of insulin...
I see that Sonic was started on a good starting dose of 1u BID, and that was about a month ago? And now you're up to 5u BID? Can you give us some idea of what kind of numbers you have been seeing along the way? Were the numbers that the dose increases were based upon the preshot numbers, or have you been able to collect numbers during the mid-cycle hours?
That is a very fast climb in dose over that period of time, and there's a very good chance that Sonic is getting too much insulin currently.
We need to get you set up with a spread sheet....

When the doses were increased, did that take place after the vet ran a curve of Sonic's BG, or have the increases been based on numbers you have been getting at home?
My vet also was very aggressive when Bob first started getting insulin, and I also went up too soon and too fast. It wasn't until I came here that I came to understand the logic of the "start low, go slow" protocol. But it probably helped save Bob's life, and once I "got it", I began dropping his dose. A few weeks later, he went OTJ...

Any feedback you can give us on his test numbers and when/how his dose went up so quick and so much will help us to help you and Sonic make sense of his numbers.

Carl

When Sonic was Dx he was 435 and was put on 1u PZI BID. We didn't home test during the 2 weeks he was on the 1u every 12 hrs. He went to vet for a curve and was 375 before his 9am shot. 2hrs later he was at 321 then 312 2 hrs after that. We were told to increase to 3G BID. That's when the home testing began. Didn't do any curves at home but was testing 350-370 just before shot and 300-320 an hr later. Two weeks later (4/13 the day after we lost our lady Spooky to bladder cancer) he was 435 before shot (3u). Then 365 2 hrs after shot and 320 2hrs after that (all at vet). We were told to increase to 5u PZI BID (that was 4 days ago) #s range from 321-420 before shot and 300-350 an hr after. Going to do a curve Thurs when we are home all day to do it (we both work full time). I am so scared for him that I am having nightmares :(
 
^^Posted while at work^^ so I took #s from memory (which is faulty). Have put nearly all of Sonic's #s into my phone so here are those #s

Date/Time Bs(mg/dL) Notes
04/16/2012 07:00 425 1/2 can Friskies canned 2hrs prior
04/15/2012 21:03 321 1 can FF/ 5U PZI
04/13/2012 15:30 372
04/13/2012 12:30 401
04/13/2012 10:30 478
04/13/2012 09:00 439 3U PZI
04/13/2012 08:30 439
03/30/2012 14:20 322
03/30/2012 12:20 314
03/30/2012 10:20 389
03/30/2012 08:20 356
Dx 3/16 435
 
OK, here's where I think things took a wrong turn....
When your vet upped the dose from 1u BID to 3u BID. That's an insane increase. It's triple the amount of insulin. The correct adjustment would have been up by .25, or at most .5. What has probably been happening since then is that his system is fighting like hell to offset the insulin every day. His BG will start to drop (and as far as he's concerned, it is falling too quick and too far), and it tries to "self-preserve". His pancreas tells his liver to dump "sugar" into his bloodstream to push his BG up to safe levels.
You may not see this happening. It can be happening between tests, even if you are testing at AMPS and +6. It's all instinctive. Here's a simple "what happens":
Glycogen is the storage form of glucose - think of it as a bunch of glucose molecules stuck together in a form that's too big to escape into the bloodstream.
Glucagon is a hormone produced in the pancreas and it's "job" is to increase blood glucose by triggering the conversion of glycogen back to usable glucose that can enter the bloodstream from the liver. It also stimulates the liver to make "new" glucose from protein sources (gluconeogenesis).
That's from a "think tank" topic that took place 4 years ago.
http://www.felinediabetes.com/phorum5/read.php?15,675616,1196248#msg-1196248

And it doesn't even have to be what we would consider a low number. It's what his body thinks is a low number. Right now, to him, 300s and 400s are "normal". This reaction can happen if he drops into the 200s or lower. As long as the dose is doing "too much", it will continue to happen. At some point, what can happen is that the liver just can't keep up, so there's nothing except for your intervention, if you happen to catch it, to stop his BG from falling to unsafe numbers.

The easy way to avoid this is basically to "start over". Go back to 1 or 1.5u per shot. Test before every shot, and keep the dose the same for a few days. Test at different times between shots. Like one day you can check at +3 and +6, the next day at +4 and +8. Eventually you will have a good picture of what that dose does to his BG. Then you can evaluate the data, ask for advice if you feel it will help, and adjust the dose if needed.

Increasing the dose by 200% is just not a safe way to treat the condition. Jumping 2 units at a time, same thing, not safe. And you can't adjust a dose based on a curve run at the vet's office. First off, you never adjust your dose based on a single 12 hour period. ACtually, from looking at the data, the vet determined to increase the dose based on one seven-hour time period. From 3u to 5u because his cycle that day was not a good one and the 3u didn't drop his BG much. That's crazy. It's just not a big enough sample size to judge how a dose performs. Also, when most cats are at the vet, they are stressed. Unfamiliar noises, smells, people, etc. It raises their BG numbers, sometimes they can be 100 points higher than they would be at home. You have to have days or weeks worth of data to logically make dose adjustments. You have to see what today's dose does for 3 or 4 days to draw any conclusions as to if it is "right" or not, and that conclusion can't just be made looking at preshot test results. Yes, they tell you a snapshot in time of what the BG is. But they don't tell you how high or low the BG was the rest of the day.

Please understand, I sure as hell am not a "know it all". And you are getting advice from a trained professional who you are paying damn good money to. But the way you have described it is just not the way that insulin doses are safely determined. Your vet may be a super fantastic vet and you might feel comfortable with his advice on every condition or illness you have ever needed him to help you with. But as far as feline diabetes, I'm sorry, I don't think he's on target. If nothing else, see if you can find a 2nd opinion for your sake and most importantly for Sonic's sake.

Carl
 
I agree about the dosage increase because I am now dealing with the results of the same problem. My cat was diagnosed February 4th and was started on 3 units PZI once a day. After 2 weeks he became ketoacidic and ended up in the vet hospital for a few days. They changed his insulin and started him at 3 units of Humulin N twice a day, it was eventually upped to 4 units twice a day. After having some more problems he was switched back to PZI at 3, then 4, then 5 units twice a day. This was all over a 2 month span. My cat was never started at a small dose and had consistently high BG numbers.

This past Saturday he had two hypoglycemic seizures. He's ok but Monday morning we went to a new vet who said based on his home testing numbers and his file from the original vet we needed to drop him down to 1 unit of PZI twice a day. They also did a fructosamine test and called yesterday to say he may have actually been hypoglycemic the last two weeks as he appears to have started producing his own insulin again. They told us for right to stop giving him insulin and continue home testing and to let them know if he spikes.

We went from 5 units a day to potentially none - If we had gone to the new vet originally I feel like the last two months would have gone very differently. Thank goodness for these boards making me realize I needed to switch vets!
 
Tami,
The truth is, not many Vets are well trained in this field. I was incredibly lucky with mine. She was not that up to date with FD, even though SHE herself had a diabetic kitty. I went home found this AMAZING site and took matters into my own hands (with the wonderful help and support of everyone here). The lucky part is that my Vet jumped right on board and encouraged me to become proactive.

I would write every shot time and info into the little book you get with a store bought meter. (This was way before spreadsheets). Every time Trouble went in for his monthly rechecks I would take our little book of test numbers, dates and times for his Vet to examine. She was so thrilled she would take that little book around the office for the other Vets to see. Again I was very lucky. Sadly a lot of Vets feel threatened for whatever reason by this proactive stance. I KNOW it made Troubles Vets' life MUCH easier. I cant understand WHY Vets dont see this as a blessing.

At any rate, you have found us, we are here to help and support. We ALL faced the same worries and learning curver you face now and you know what? We all were able to do this. Diabetes is NOT a death sentence. It IS the beginning to a whole new bonding with Sonic. Embrace it.
jeanne
 
jt and trouble (GA) said:
Tami,
The truth is, not many Vets are well trained in this field. I was incredibly lucky with mine. She was not that up to date with FD, even though SHE herself had a diabetic kitty. I went home found this AMAZING site and took matters into my own hands (with the wonderful help and support of everyone here). The lucky part is that my Vet jumped right on board and encouraged me to become proactive.

I would write every shot time and info into the little book you get with a store bought meter. (This was way before spreadsheets). Every time Trouble went in for his monthly rechecks I would take our little book of test numbers, dates and times for his Vet to examine. She was so thrilled she would take that little book around the office for the other Vets to see. Again I was very lucky. Sadly a lot of Vets feel threatened for whatever reason by this proactive stance. I KNOW it made Troubles Vets' life MUCH easier. I cant understand WHY Vets dont see this as a blessing.

At any rate, you have found us, we are here to help and support. We ALL faced the same worries and learning curver you face now and you know what? We all were able to do this. Diabetes is NOT a death sentence. It IS the beginning to a whole new bonding with Sonic. Embrace it
jeanne

Thanks, Jeanne <3 Certainly is frightening but finding all of you wonderful, understanding parents makes it easier :)

Due to the wonderful testing advice & suggestions Sonic's ear-pokes are going a LOT more smoothly! His #s have been below 375 for the past 12hrs (tested 8pm last night, again at 11:00 two hrs after his injection, 4am and again at 8:30am). So IMO we are progressing (still high, but I am cautiously optimistic)
 
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