How often do you test?

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tripp

Member Since 2015
my vet wants me to test Tripp once a week three times a day. First thing in morning before food and first shot, four hours after that and then before evening meal and shot. I do this for first time tomorrow. Nervous but will get it done. Using accutrak. One unit of lantus twice a day for now. Only diagnosed last Friday.

My guestion is how often does everyone else test? It sounds like everyone else here is testing everyday? Should I be testing more? Or does vet have it like this in the beginning?
 
Most of us on the boards test before every shot at a minimum to make sure it is safe to give insulin. Humans don't take insulin without first finding out if it is safe, our kitties deserve just as much. Many of us also get more tests during the cycle looking for "onset" (when the insulin starts to work) and "nadir" (the low point in the cycle, also called the peek of the insulin activity) so that we know how well the current dose is working so we know how to adjust the dose.
 
Lantus Insulin (aka Glargine)

Lantus/Glargine is human analog insulin that comes in U100 strength and requires the use of U100 syringes. Because it cannot be given any sooner than 10 hours after the last shot, it is the best insulin for those folks who are gone for extended hours during the day. Lantus is not a good insulin to use for a cat with a history of ketones or DKA. It is sold in either 10ml vials, or 3ml cartridges (in 5 packs) that are designed for use with injection pens that are purchased separately. We recommend purchasing Lantus cartridges, but do not recommend buying the injection pens as it is impossible to measure part unit doses. Lantus cartridges look very much like "mini" vials, with a rubber stopper at the top. Purchasing cartridges will be more expensive at the outset (about $25-$30 more than a 10ml vial of Lantus) but there is much less waste compared to purchasing 10ml vials. Lantus expires approximately 28 days after opening, so it's likely that even a 3ml vial would not be empty by the time Lantus loses its potency. We recommend storing Lantus in the fridge. Depending on how it has been handled, we have found that Lantus can remain potent well past 28 days.
Lantus is clear, just like water. Should you ever see any crystals in the vial or cartridge, the Lantus has been damaged and should be discarded. If bubbles appear in Lantus, it will start to lose potency. Unlike when filling a syringe with PZI, it is recommended not to draw air into the syringe to express into the vial when measuring a Lantus dose, nor to back the insulin out of the syringe while it is still in the vial in an effort to avoid creating air bubbles. Draw more than your required Lantus dose into the syringe by at least a unit, remove the syringe from the vial and express the extra insulin onto a paper towel or tissue to avoid creating bubbles.
Lantus is available at any drug store as it is commonly used in humans. In some countries, like Canada for example, Lantus is available over the counter and does not require a prescription. If you are purchasing Lantus through your vet, you may wish to check pricing with your local pharmacy first in order to save yourself the extra cost of vet mark-up. Prices differ greatly – for example, premier drug stores charge $30 to $40 dollars more, where well-known stores such as Wal-Mart and Costco charge a lot less for Lantus.
When giving insulin shots, particularly with Lantus, you want to slowly push the plunger of the syringe in completely and with the syringe still inserted under the skin, slowly count to 10 before removing the needle from the injection site. You may have to hold your cat gently while you wait. Remove the syringe and very gently apply pressure for several seconds. DO NOT RUB THE AREA to avoid damage to the Lantus molecules.
Lantus is long lasting insulin, remaining in the system for 12 hours or more. It typically drops the BG slowly, has an extended nadir, and begins to slowly leave the system after approximately 8 to 10 hours. These are the norm, every cat is different. It is very important to maintain overlap on Lantus – meaning that the remnants of the prior shot are still working to keep the BG as close to normal range as possible, while the next shot is coming to onset.
Lantus is insulin that cannot be dosed any sooner than +10 hours after the last shot, and only to a rising BG over 150/8.3. It is imperative that your cat is curved on the first three or four shots when starting out, or when making even very minor dosing changes. The first curve starts with the preshot test, continues with testing every two hours afterwards to determine onset, nadir (peak insulin activity) and when the insulin starts to leave the system. The timing for tests on the second curve is dependent on the first curve’s results.
When using Lantus, rather than starting with a static dose every 12 hours as is typically prescribed, TR requires the use of a three rung sliding scale, with dosing at approximately every 10 hours as determined by the cat’s progress. When compared to PZI, a tighter dosing scale is used with Lantus and we find that the scale becomes almost "static" over time, with only very small adjustments made to doses. Eventually the Lantus scale is reduced to two rungs, and then possibly to one rung as the cat becomes better regulated.
Unfortunately there is a big challenge to using Lantus. It is released over time and does not result in the instant gratification that is seen with all of the other insulin types. In humans, Lantus crystals are still present in the system 24 to 48 hours after dose. In cats, due to their much faster metabolisms, Lantus lasts approximately half that time.
It takes approximately three shots of Lantus before you know if the dose is doing what it is supposed to do, such as reaching ideal numbers at nadir. If ideal BG is not reached after two to three doses, increases should be made by either "fat" increases or a maximum increase of 0.25u increments only.
Using Lantus requires PATIENCE
 
That makes so much more sense then once a week. I'm not sure why vet has me testing once a week? I test for first time tomorrow. I will post results. On Monday when I picked him up from being there four days it was 363 six hours after his shot. He is on lantus 1 unit twice a day.
 
Testing:
1) Always test before giving insulin to make sure it is safe.
For now, your no shot level is 200 mg/dL on a human glucometer (230 for pet-specific); this will lower as you collect data around the middle of the cycle to know how low he is going.

2) Mid-cycle tests between shots - whenever possible, test around the nadir (lowest glucose level between shots) for your insulin, to see how low he's going. For Lantus, this often falls between +5 to +7 hours after the shot. Some folks do this on weekends or set a clock for the middle of the night to get this test done as it helps determine dose adjustments. This number should be at or above 50 mg/dL for Tight Regulation depot insulin protocols, 90 mg/dL for Start Low, Go Slow depot insulin protocol, and 100 mg/dL for Vetsulin/Caninsulin insulin protocol on a human glucometer (68 mg/dL for pet-specific meters on Tight Regulation).

3) A before bed test is helpful in determining if you need to break out some higher carb food and steer the glucose level or go to bed with some peace of mind. Steering means giving 1-2 teaspoons of high carb gravy, waiting 30 minutes, and re-testing (repeating as needed) to make sure the glucose stays above 50 mg/dL for Tight Regulation depot insulin protocols, 90 mg/dL for Start Low, Go Slow depot insulin protocol, and 100 mg/dL for Vetsulin/Caninsulin insulin protocol.
 
tripp said:
That makes so much more sense then once a week. I'm not sure why vet has me testing once a week?
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Glad you will be testing more often! My vet told me the same thing, and I know a lot of vets I've heard are the same - some of them don't even talk about home testing at all. My dad is a diabetic and there is no way he would shoot insulin without knowing his blood sugar, so it just makes sense for safety's sake.

I genuinely believe that most vets are very afraid that someone faced with a Dx of diabetes will opt for euthanasia if they don't provide the simplest treatment regimen possible. When I showed my vet my spreadsheet, he was delighted I was testing and doing my own curves. He did tell me that too many cat parents didn't want to invest even the barest treatment and it was sad how many he'd had to put to sleep. :(

Good for you coming here, Tripp - you will find this a very informative, friendly and supportive place.
 
I've always tested am and pm, before feeding. Then, gave the shot after Goof was finished eating. I've done a few curves over the past year just to get a good picture of how his body reacted to the insulin. He's in remission now. :cat:
 
Brashworks said:
Glad you will be testing more often! My vet told me the same thing, and I know a lot of vets I've heard are the same - some of them don't even talk about home testing at all. My dad is a diabetic and there is no way he would shoot insulin without knowing his blood sugar, so it just makes sense for safety's sake.

I genuinely believe that most vets are very afraid that someone faced with a Dx of diabetes will opt for euthanasia if they don't provide the simplest treatment regimen possible. When I showed my vet my spreadsheet, he was delighted I was testing and doing my own curves. He did tell me that too many cat parents didn't want to invest even the barest treatment and it was sad how many he'd had to put to sleep. :(

Good for you coming here, Tripp - you will find this a very informative, friendly and supportive place.
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I agree with you on the vet thing! My vet told me that some will say " I'll do whatever I have to", but many will say," I guess we'll just have to put him down". So sad.
 
i tested today for first time. Before food or insulin. It was 308. That's twelve hours after his evening shot. On Monday when I picked him up at vet and they showed me how to test it was 363 five hours after his morning shot. So I guess it's coming down some. Does lantus take longer maybe? He only weighs 8 lbs. half can of DM in morn/night. I test again at 11, I'll post that. How soon into therapy have others seen levels come down

Testing was not as easy as was in vet obviously. One ear I could see vein but nothing coming out. Right now that vein looks bigger? I hope I didn't hurt him. I got out of other ear. The ear that gave me trouble was ear that had frost bite and had tip removed from the rescue org vet. My vet said it was ok to test from that but doesn't seem to work. I guess I just have to get right spot. And yes I pricked my finger too. He's so fidgety and he probably senses I'm nervous. It will take time, we'll get it.
 
I think that most vets under estimate our abilities to care for our pets. My vet's office has taught me how to home test, give fluids and give shots. However, whenever they have a new vet join their practice and I see them for the first time, they do not seem to believe that I know how to do all of that. I have had them tell me not to hometest or think that I do not know how to give fluids. You can guess how well that went over with me. :banghead:
 
I left my last vet largely over disagreements on feeding and home testing of my diabetic kitty. My new vet was surprised but delighted to find that I was feeding him appropriate foods, regularly home testing, and doing my own curves. He said most of his patients don't home test! I emailed him the link to my spreadsheet so he can look at it whenever he wants to, or I need him to; it works out great and saves me the cost of lots of trips back and forth to his office.
 
tripp said:
That makes so much more sense then once a week. I'm not sure why vet has me testing once a week? I test for first time tomorrow. I will post results. On Monday when I picked him up from being there four days it was 363 six hours after his shot. He is on lantus 1 unit twice a day.
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A lot of cats experience "vet stress" which can cause their BG to be a good bit higher at the vet's, sometimes as much as 100 pts higher, so don't be surprised if his numbers at home are a bit lower.
 
I would recommend testing at least 3 times a day with Lantus--once before each shot to make sure it's safe to give insulin, and at least one test in the middle of one of the cycles to see how the insulin is working to lower BG. Of course, the more tests you get, the more information you have to safely adjust the insulin dose, so getting other tests in when you are able is always a good thing when you can, but 3 times a day is the minimum that's needed for good BG control. Typically, I've found that I've tested more frequently when Bandit was unregulated (5-8 times a day), and then once he was well regulated we dropped down to 3-4 times a day unless we saw an unusually high or low number.

A couple tips that might help with testing! I would back the ear with a piece of tissue or a cotton ball before you poke...this not only helps prevents pricked fingers, but it provides something firm behind the ear so that the lancet pokes through instead of glancing off the ear. And you can immediatly use it to to put some pressure on the poke spot to stop the bleeding and prevent bruising (I usually count to 20). Also, you're not aiming for the vein, but the spot between the vein and the tip of his ear. Here's an awesome picture that shows you where to aim: http://s106.photobucket.com/user/chupie_2006/media/testingear/sweetspot.jpg.html

Also, what size lancets are you using? I made the mistake of starting with the ones that came with the meter, and they were way too small to get a good drop of blood (ultra thin 33g). I would recommend trying out 26g or 28g lancets instead.

I've never been able to get blood out of Bandit's right ear easily, but his left ear bleeds great. So if one ear works better than the other, there's nothing wrong with sticking with that ear while you're learning.
 
I only test between shots when beginning insulin and when only periodically if the PS BGs are as expected . If I get unexpected PS BG I will test between shot to see what is going one.
 
I am going to test three times again tomorrow. Today readings were 308 first in morning, 291 five hours after food and insulin and 378 before food and shot which was 12 hours after morning insulin. Called vet with numbers and she said to up his dose to 2 units twice a day. He does get a tiny pice of chicken about size of walnut mid day because he is soooooo hungry he is always at my feet meowing and then he sits in front of cabinet his food is in paws at it. Could that chicken be affecting numbers? It's all chicken nothing else. He gets half a can of DM morn and night but that is about can less then he got before I knew he was diabetic. He was always on canned to start with no dry.
 
Meliane~~ off topic ....the cat in your profile looks EXACTLY like my cat named Smokie, even down to the beige coloring. I am no kidding EXACTLY, and the same name!
 
How often do I test? That depends on the cat (I've had 5 FD cats) In the very beginning I tested like a fiend usually every 3 hours for about the first 6-8 months or until I could see them falling into some kind of a pattern. When I first start working with a new cat (mine have all be adopted as diabetic) at first my focus isn't so much on what their numbers are, unless they are headed for below 40 on a human meter but I'm looking for when their numbers stop rising after injection and start heading lower, and where they seem to hit bottom or the lowest point before they start heading back up again towards their next preshot. Once I have those points kind of identified, and roughly is about the best you can do since they do move around some that gives me a good idea when I NEED to test and when I am just adding other points of data to fill in the complete picture.

With my girl Autumn who recently passed away at about age 20 she had been insulin dependent for 4 years. With her I always made sure to get her preshots, and a +3 especially in the evening because I had learned that her normal pattern because she was on Levemir was that her preshot and her lowest point were within just about a hour or less apart, then she would start back up and her numbers would continue to rise until +5, then start back down again until right before her next shot was do. By grabbing a +3 on her if she was still rising all was good and she was right on track, but if she was starting to dip already at +3 then I needed to start testing more frequently that day because she was setting up for what is referred to here as an active cycle and I might either need to feed her a few extra snacks to keep her from dropping too fast or too low.

But on average I would say most days I have tested them all while they were actively on insulin about 4 times a day, which just became habit as I also feed my entire crew 4 times a day so my sugar cats now associate being tested with mealtime. And my current remaining 2 I test Maxwell once a year on Nov 1st as he has been in remission and off insulin for 6 years and Cassanova I tested once a month as he is also in remission but only a little over a year.

Mel and The Fur Gang
 
Good job Tripp! Keep up the testing. It's a lot of work but in the long run (as it can be a long run) it is LESS effort in the end because you'll know how your cat is reacting to the insulin. I think most cats (like mine) get used to the testing and it is NO BIGGIE to them...just like human diabetics.

Keep this in mind...as I have read so many times here and was true in our case x2....it is a marathon NOT a sprint. Don't be too quick to up the dose or you'll end up overdosing which can throw things in a confusing and frustrating place...too much insulin can cause fatal hypoglycemia OR can cause high BG, huh?

I'll say it again...keep up the testing...every day...before injections and at least once between shots. Good for you for getting this far in the process!!
 
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