Just starting insulin. Unsure if I'm dosing right

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fbrunner6

fbrunner6

Member Since 2015
My cat was diagnosed on 6-30-15 with diabetes. Her level at the vet was 337 at the time. He wanted her to start Novolin-NPH insulin 1 unit every 12hours, and change her dry Meow Mix Indoor Formula to canned Fancy Feast Classic. I decided to get the glucometer and monitor her on just the food change before i started the insulin, and then i only started her on half a unit when i did. Now im usnure if i should move up. Here is what i have so far:
6-30-15 11pm: 217 before food
7-1-15 11am 190 before food
1pm 245 two hours after food
11pm 271 before food
7-2-15 1am 217 two hours after food
11am 253 before food, then fed and gave 0.5 unit Insulin immediately after feeding
1pm 192 two hours after feeding/insulin
3pm 84 (but it took so many pokes & the machine was glitching, so feel this couldve been human error
5pm 206
7pm 299
9pm 257
11pm 265 before dinner, immediately fed, then gave 0.5 insulin
7-3-15 1am 205 two hours after feeding
3am 171
5am 234
7am 239
9am 321
So now... my conclusion is that she hits her lowest point about 4hours after the dose. Should i increase her dose to the 1 unit ever 12 hours? Should i try to do every 8 hours on 0.5 for a few days? im not sure my work schedule is going to allow me keeping up with the 8hour dosing
 
Hi. I am new here myself. I am not able to advise you in any way. I noticed your post and wanted to say Welcome to you and that you are doing a great job of keeping track of your test results! I'm impressed. There is a spreadsheet link on here that will help you so,so much and other experienced members can see and advise etc.
Although EVERYONE here is fantastic & caring & knowledgeable, I will tag the few members I am familiar with so that you can either grab the link, or they might contact you. @BJM @Sue and Oliver (GA) @Elizabeth and Bertie I'm so new I don't even know for sure if this is what you do! But I am concerned no one had answered you yet & I felt you needed help soon.
 
Welcome to FDMB.

I just got up and got some caffeine, so let me put your numbers in a spreadsheet and get back to you.

What is your name and your cat's name?

OK, I've set up a spreadsheet for you here. Take a look and you'll see it is color coded. I will send you a private message, so look in the upper right corner of the screen for a read flag over the Inbox. I will make it so you can edit the spreadsheet, and save a copy in your own Google account so you can track the numbers.

Please read over our Humulin/Novolin primer and always feed 30 minutes before you give the N. As you can see from your curve (great job!! you only needed to do it for 12 hours!), the N can drop the glucose quickly and quite a bit. Feeding and waiting 30 minutes will help buffer that drop. This will be more comfortable for your cat, plus reduce the chances of bouncing. Bouncing happens when the glucose drops suddenly and/or to an unfamiliar level. This triggers compensatory hormones which release stored glucose (glycogen) and raise the glucose levels right back up. A bounce may take up to 3 days to settle.

You don't want the glucose to go lower than 50 mg/dL at the lowest (the nadir) which is about +4 hours after the shot. You got pretty close to that with the immediate feeding at shot time. Lets see what happens if you do the feed +30 minutes and then shoot. It may be possible to slightly increase the dose if that helps smooth out the curve a bit.
Also, please do not shoot below 200 mg/dL, as the glucose may drop too much - we don't have enough data to know at this time.
 
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My name is Flo. My cat's name is Wrecka. She is 10
Thank you so much!
I have someone trying to help me from online, but I feel bad for bugging her so much. :( So I figured I would try to learn some on my own in this group
 
ahhh this could be part of my problem yesterday. I gave the insulin as soon as she was done eating, so that I wouldn't have to catch her. I already gave her this mornings dose at 11am. I will have to change it for the 11pm dose. The dr. wanted her on 1unit twice a day. Do you think she is ready to go to a full unit? It takes me almost 20minutes to feed them and get everything ready. I know it is going to be so simple once i get the hang of it. But right now, I'm running back and forth (forgetting the needle, forgetting to put the insulin in the fridge, etc.) I'm still working on my rhythm I guess. How often do I do a curve? I am lacking sleep. Luckily, every time my alarm went off, she immediately got up and came to me, before I even had a chance to call her. I think she knows the drill already
 
Only do a full curve every week or two. Getting the mid-cycle tests around +4 will help you make sure she doesn't go too low or that you can intervene to get her numbers up if they are below 50 mg/dL on a human meter.

Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
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 meters); 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. For NPH (N, Humulin NPH, Novolin NPH) this is around +3 to +4. 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 on a human glucometer (68 mg/dL for pet-specific).

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.
 
And finally, your signature:

If you add a few tidbits to your signature, it will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as
your name,
cat's name,
date of Dx (diagnosis)
insulin
meter
general location
any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.
 
Thank you for all of the information! I will work on this later today after I am done working. So I have tested her sugar for the past 24hrs (every 2 hours). I know that she is at her lowest point 4 hours after i give her the shot. So, if i understand correctly, I now should test before i give insulin, and 4 hours after (which would be her lowest point), to make sure it isnt too low?
 
Testing anywhere in the +3 to +5 hour period is fine. The nadir can and does move around. Shifting the shot to 30 minutes after eating may move it some, too.
 
fbrunner6 said:
My cat was diagnosed on 6-30-15 with diabetes. Her level at the vet was 337 at the time. He wanted her to start Novolin-NPH insulin 1 unit every 12hours, and change her dry Meow Mix Indoor Formula to canned Fancy Feast Classic. I decided to get the glucometer and monitor her on just the food change before i started the insulin, and then i only started her on half a unit when i did. Now im usnure if i should move up. Here is what i have so far:
6-30-15 11pm: 217 before food
7-1-15 11am 190 before food
1pm 245 two hours after food
11pm 271 before food
7-2-15 1am 217 two hours after food
11am 253 before food, then fed and gave 0.5 unit Insulin immediately after feeding
1pm 192 two hours after feeding/insulin
3pm 84 (but it took so many pokes & the machine was glitching, so feel this couldve been human error
5pm 206
7pm 299
9pm 257
11pm 265 before dinner, immediately fed, then gave 0.5 insulin
7-3-15 1am 205 two hours after feeding
3am 171
5am 234
7am 239
9am 321
So now... my conclusion is that she hits her lowest point about 4hours after the dose. Should i increase her dose to the 1 unit ever 12 hours? Should i try to do every 8 hours on 0.5 for a few days? im not sure my work schedule is going to allow me keeping up with the 8hour dosing
Click to expand...
 
This does not answer your q (but several people, thankfully have already done so) but, instead, I have a q for you.

I cannot seem to get a bg (because I cannot get blood from my poor boy’s ear) reading and , clearly, you have mastered the art. Can you tell me, as a fellow newbie, just how you have become so proficient so quickly?
 
It must be my reticence because I am doing this and can’t get a drop from his ear.
Got some from paw pad but he shook it out of my hand and he flew off. Since the pad AT LEAST produced something I guess I should try this site again.

Pathetic (me)…..I can stick other people and myself……and Salt ends up being a pincushion for my ineptitude !

Thanks for your help, Rhonda.
 
Try this. Once you get the drop, scrap it off with your fingernail, then test it from there. Shiloh likes to shake her head, so I have done it myself on occasion.
 
toreishi said:
This does not answer your q (but several people, thankfully have already done so) but, instead, I have a q for you.

I cannot seem to get a bg (because I cannot get blood from my poor boy’s ear) reading and , clearly, you have mastered the art. Can you tell me, as a fellow newbie, just how you have become so proficient so quickly?
Click to expand...

It is really about being warm. I was microwaving socks for about 15seconds then holding them on her ear but that was scaring her. Now I wash and warm my own hands and just pet and rub her ears. They warm up faster when she is relaxed. I've also noticed that i get less blood towards the tips... SO i try to stay with the thickest area. After you prick the needle, you IMMEDIATELY need to start rubbing and working that blood to the surface where the poke was. It doesnt require alot of force, but you want to get it up there before it clots back up. We have a little bendable light right beside the chair that i use. It helps me to see more clearly and aim, because I can see where the vein is. Also, I manually use the needle, i dont use the machine that triggers it. I wasnt have much luck with the machine. It seamed to prick her too quick and not get the blood
 
toreishi said:
It must be my reticence because I am doing this and can’t get a drop from his ear.
Got some from paw pad but he shook it out of my hand and he flew off. Since the pad AT LEAST produced something I guess I should try this site again.

Pathetic (me)…..I can stick other people and myself……and Salt ends up being a pincushion for my ineptitude !

Thanks for your help, Rhonda.
Click to expand...

I'm new, so i wont offer advice but will just state my opinion on the paw pad... My thing is, they walk on dirt with those and i dont want to lead to infection. Also, I dont want to irritate or make the pad sensitive from continuous pokes. Others have had issues on here with their cat's ears becoming scabby, etc. If I do something wrong, i would rather mess up on her ear, than her paw pad. Again though, I'm very very new at this
 
If it is absolutely imperative to get a blood test, aim directly for the vein. Be prepared to collect the drop on a fingernail and then blot, as it may bleed profusely and your cat is likely to shaker his head and spatter it all over.
 
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