Need feedback on cat's glucose curve

[MayL]

It looks like Milo hits nadir rather late. Would it be possible to get a +8ish test early in the morning to get a feel for the night cycles? It's not uncommon to have very different AM and PM cycles, I just want to check if he's going lower during the night.

Good idea @Djamila! I just posted an update on Milo's green nadir today (please check the thread) and think I should definitely check him after his PM shot.

 

[Rachel]

Wow! What a GREAT number! I think you'll have to base it off what the PMPS is. Maybe 2.5 for a yellow and 3 for a pink or higher? Or if you're feeling comfortable with it, you could hit 2.75 for a yellow. That's not as conservative though, and you may want to go to the lower dose if you need to get some sleep, as we often do at nighttime.

If it was me, I'd try to get a +2 if you CAN (to tell you if you're going to see an active cycle) and then you can decide what other test you want through the night if he isn't dropping too fast.

 

[Kris & Teasel]

Well, heck! Here you are - and I just suggested you post over here.

 

[MayL]

Maybe we got too hopeful too quickly I went down to 2.75 units from 3 units because his PMPS was 221 and was afraid I was going to see too big of a drop at night and won't be awake to catch it BUT instead the complete opposite happened. He was high all evening. I don't normally test after PMPS (so we don't have much prior data to work with) but at +2 he was at 418 and then +6 he was at 571 and now right before his AMPS he is at 573. It's like he didn't even get a shot, but I know he did

Was last night a bounce from him being so low yesterday? What are some of the reasons why his night numbers be so different from his morning numbers?

Any words of encouragement would be appreciated!

 

[Kris & Teasel]

Yes, a huge bounce from that green. This is a very common phenomenon and it can take a couple of cycles to settle. As you accumulate more data you'll be able to "stand back" and see trends more easily. Reacting to individual numbers is very stressful so try hard to look at the big picture.

 

[MayL]

Milo continues to surprise us! Yesterday his PMPS was 167 so I cut down his insulin to 2.5 units and I just tested him for his AMPS and it's 112! I am going to stall and retest in a hour, but at this number I have no clue what insulin amount to give him? 2 units? no units? Help please! @Djamila @Kris & Teasel @Rachel

Thank you!!!

 

[Djamila]

Will you be able to do a couple of mid-cycle tests? It looks like on a 169 last night the 2.5 worked well, so fingers crossed you get that much of a rise and can just do it again!

 

[MayL]

Will you be able to do a couple of mid-cycle tests? It looks like on a 169 last night the 2.5 worked well, so fingers crossed you get that much of a rise and can just do it again!

Yup, someone is home with him and can watch him and do mid-cycle tests. I guess if we see he's dipping too low we can try to get some food in him and consider reducing the units even further? I am really nervous he's going to get to hypo levels

 

[Kris & Teasel]

Yup, someone is home with him and can watch him and do mid-cycle tests. I guess if we see he's dipping too low we can try to get some food in him and consider reducing the units even further? I am really nervous he's going to get to hypo levels

Try the stall and if he doesn't get above 150 maybe drop to 2.25 u. It's great to see nice numbers but scary too. Yes to a snack if at +2 he's dropped 50+ points.

 

[MayL]

After stalling for an hour plus he got up to 144 and we decided to shoot a 2.25 and will monitor/test the little guy closely throughout the day. Keep you all posted!!!

 

[Kris & Teasel]

After stalling for an hour plus he got up to 144 and we decided to shoot a 2.25 and will monitor/test the little guy closely throughout the day. Keep you all posted!!!

Exciting! These experiments where you push the envelope a bit are great learning experiences and excellent reference for later on.

 

[Rachel]

Ohhh this is exciting! Can't wait to see what happens!

 

[MayL]

Did I push the envelop too far?! I noticed Milo did not do well with the 2.25 or 2.5 units so I have been monitoring him on 2.75 and today at +8 I got a 52 on the ReliOn. I didn't see any clinical signs but I did panic I gave him some feed, treats, and when he wasn't eating much (he doesn't like me to force anything on him), I rubbed a little karo syrup on his gums. I tested 15 mins later on ReliOn and got a 60 and Alphatrak a 93. I tested him again at +9 and he's at 110 on ReliOn. I'll keep testing him before the PMPS and then after his PMPS, but wow I am still shaking from the experience.

 

[MayL]

And a huge bounce at PMPS 533 we also gave him insulin late (about 1.5 hours because he went hiding after today's ordeal). Poor guy.

 

[Kris & Teasel]

And a huge bounce at PMPS 533 we also gave him insulin late (about 1.5 hours because he went hiding after today's ordeal). Poor guy.

I think you did the right thing in right thing in going back to 2.5 u for now. He's a bouncy kitty and it often works better for them to keep a dose a bit longer. If changes are too frequent it can send them off into space. Speaking from experience here ...

 

[Rachel]

Poor thing! And poor you! You both deserve a break and a treat today!

 

[MayL]

Thanks everyone! Milo is getting some greens but then bouncing back up. It's a wild ride - doesn't seem like much I can do but be mindful and keep collecting data

 

[Djamila]

As long as you're still getting those greens, I agree you just keep doin' what you're doin' and collecting data.

 

[MayL]

Hi @Djamila, @Kris & Teasel, and @Rachel,

Today I didn't give Milo his morning insulin. Last night he was hanging around the 100s and when he got up to 156 I gave him 2.25 units which is down from his 2.5 that he's been on for awhile. He's had quite a few nice greens and then some bounces along the way.

This morning his BG was not moving up. His first AMPS at 8:33 am was 100; second AMPS at 9:25 am was 87; third AMPS at 10:09 am was 117; fourth AMPS at 11:22 am was 107; fifth AMPS at 11:55 am was 111. Unfortunately, I had to leave and would not be home to monitor him and did not feel comfortable giving him any insulin when he's sitting this low for over three hours in the am.

I just got home a little bit ago and at 2:50 pm he's at 195. Today was a first for me so I am not sure if I did the best thing for Milo

Is the dosage too high and that's why the duration lasted passed 12 hours? What are thoughts if this happens tomorrow again?

And I guess for tonight if he's doing 200 and up, I'll just shot the 2.25 units (and go on as usual)? This am was really strange and I am a little baffled!

Thank you!!!

 

[Rachel]

Wow! Well first you did absolutely the right thing this AM. With those numbers, I would never advise giving insulin.

The dose COULD be too high...that might be why. It could be the pancreas too. Did he eat after his first test this AM? Numbers going down or staying low after eating is a sign the pancreas is kicking in, and I think that's most likely what is going on. Which is exciting but nerve-wracking!

Yes, tonight, if he's over 200, I'd give the lowered dose you mentioned and just make sure to grab a +2 if you can...and go from there. If he is low again, you could try the stall without food and retest strategy and see what happens. He might raise enough to give insulin, and if he doesn't, then at least you know.

 

[MayL]

Wow! Well first you did absolutely the right thing this AM. With those numbers, I would never advise giving insulin.

The dose COULD be too high...that might be why. It could be the pancreas too. Did he eat after his first test this AM? Numbers going down or staying low after eating is a sign the pancreas is kicking in, and I think that's most likely what is going on. Which is exciting but nerve-wracking!

Yes, tonight, if he's over 200, I'd give the lowered dose you mentioned and just make sure to grab a +2 if you can...and go from there. If he is low again, you could try the stall without food and retest strategy and see what happens. He might raise enough to give insulin, and if he doesn't, then at least you know.

Thanks @Rachel! He had breakfast a little before 7 am and then we tested around 8:30 am because he was hungry again and wanted to eat and we got the 100. He then had some food and then we got the 87 so maybe the pancreas was working then. At 9:30 it would have been close to 12 hours since his PM shot. Then we stalled for about two hours hoping the food from 9:30 would pass and got the 107. We gave him some food around 11:30 or so and right before we left at noon we got the 111.

It's hard to predict what's going to happen next for Milo!

 

[MayL]

Also, I was also wondering if no shot is the right decision because I wasn't sure if I should have given him at least something like a token shot. Like 1 unit? I wasn't sure if it made sense for me to go from 2.25 to 0 units. I know we want to make small changes to dosage and going to zero was a big change, but I guess his numbers were so low, did I really have any other option besides zero?

 

[Rachel]

I don't think so. The other option we sometimes suggest is feeding, waiting 45 minutes, then giving a reduced dose. BUT that's only if the number is rising. Since you know for sure the number was still so low after eating, we wouldn't have suggested any insulin at that point.

Honestly, he stayed in normal, non-diabetic numbers all day, even with food on board. That really signals pancreas to me. And if that's the case, giving insulin could have been really dangerous since his pancreas was putting some out too. Even if you had been home to monitor, I wouldn't have felt comfortable with you giving ANY at all. And since you WEREN'T...nah, you had no real choice. You made the absolute safest decision for Milo and I think every single person here woul dhave done the same.

We do want to do small dose changes, but that's because we want to be sure we don't skip over the ideal dose. When it comes to lowering doses, or skipping them, that's a different story since we have to be sure they stay safe.

 

[Kris & Teasel]

I don't see today's numbers on your SS yet.

 

[MayL]

I don't see today's numbers on your SS yet.

Hi @Kris & Teasel, I just have the numbers in the notes. I am going to move it into the cells now. It felt weird to put a number into say +7 for an imaginary shot of zero haha.

 

[MayL]

I tested him at 6:11 pm and he jumped all the way to 525. Gave him his 2.25 units after I tested him again and got 515. I will see what direction he is heading in a couple of hours when I retest.

 

[MayL]

Hi ladies @Kris & Teasel @Djamila @Rachel,

I continue to scratch my head!! Milo ran high all day 4/3 so I gave him 2.25 units after his PMPS of 405. I didn't get a chance to test throughout the night, but this morning AMPS he was low (105). We stalled for a hour but he was hungry and had a little bit of fancy feast broth and Isla Bonita Werura (not much) but he's at 89 now. I will try to test again in a hour to see where he's at.

I have a new question. When should I give him his next insulin when I skip a dose? Since I am at home today, I can keep testing him until I get a reasonable number and then give him a shot. Or should I just wait it out until we get to the 12 hour mark?

The issue is I can't always be changing up his shot times on a daily basis, i.e., if I notice his numbers are high and I give him the shot at 3 pm, there is no way I can give him his next shot at 3 am (when his typical shot is around 9 am / 9 pm). It's probably not practical to keep changing the 12 hour marks of when to give him his shot, but I also don't want him to go too many hours at a high number. Thoughts? Strategies? Thank you so much!

 

[Kris & Teasel]

When you skip a dose give the next one at the usual time. ProZinc allows up to an hour's dose timing flexibility so you could give it an hour early. It's best not to scramble your dosing schedule.

 

[Rachel]

Wow! That’s quite a number...and looks like he is staying low so far. I’m very interested to see where he is tonight!

Warning: he may be high since no insulin onboard. That’s okay and expected...you don’t want to increase even if he is.

 

[MayL]

Wow! That’s quite a number...and looks like he is staying low so far. I’m very interested to see where he is tonight!

Warning: he may be high since no insulin onboard. That’s okay and expected...you don’t want to increase even if he is.

Nailed it @Rachel! He came in at 458. I stayed with our 2.25 units and let's see what happens tomorrow!

 

[Djamila]

My hunch is that you need to reduce the dose a little. For each of the last five days, one cycle has been a zero or reduced. You really want to be able to shoot both cycles, so I wonder if you drop back to 2.0u if you'd be able to be more consistent.

 

[MayL]

My hunch is that you need to reduce the dose a little. For each of the last five days, one cycle has been a zero or reduced. You really want to be able to shoot both cycles, so I wonder if you drop back to 2.0u if you'd be able to be more consistent.

I will try this for a few cycles and see what happens!

 

[MayL]

Hope everyone had a good weekend!

I tried to do a curve for Milo's internal specialist this weekend so I switched back to Alphatrak (which is what the vet office uses) and Milo's BG has been running super high

I had him on 1.75 units for a few cycles and then 2 units for a few cycles and he hasn't dropped down to some of the lows I saw earlier in the week. Not sure if he needs more time to settle down or we need to go back to 2.25 units. But as you remembered at 2.25 units I was getting nadirs at the 12 hour mark or getting PS at 100 (see ReliOn tab 4/2/18 and 4/4/18). Those days I gave no insulin.

Because I am doing the curve with Alphatrak sometimes I checked with ReliOn to see what I am getting. The numbers are much higher on Alphatrak. Now I am wondering for 4/2/18 and 4/4/18 would the Alphatrak have given me a BG of 200 plus (instead of low 100s per ReliOn) and I should have given him a shot? What are yours thoughts on this? @Djamila @Rachel @Kris & Teasel

Thank you!

 

[Djamila]

Yes, at high numbers the human vs pet glucometer difference can be quite dramatic. Try not to stress about it too much. It does look like he can handle an increase, so if you're home to do some spot checks, I'd say to go ahead and move up to 2.25.

When you get a number that seems too low to shoot, you could do a second test and see how it looks on the AT2. The other option is to stall without feeding until the number starts to rise, although listening to a hungry cat crying for dinner can be tough.

 

[Rachel]

I agree...it's time for an increase I think. I know that before you were getting a cycle that was too long on the 2.25 but insulin needs can and do change. It's very possible that the dose was too high at one point in time, but now it will be perfect. That's part of what makes this sugar dance so tough...things can change so quickly!

 

[MayL]

Things continue to change rapidly! I gave Milo 2.25 units yesterday because the 2 units on many cycles was keeping him pretty high. Well, the 2.25 units was a long cycle again. 12 hours would have been roughly around 9/10 pm and at 11:30 pm he was 104 on ReliOn and 178 on Alpha Trak. I decided to go very conservative because it was a PM shot and I won't be up watching him. I only gave him 1.5 units.

At 2 am, he was restless wandering around the house. I decided to test him and he got a 121 on Alpha Trak so he was going down. I decided to be safe and wake up at 5 am and tested him and got a 67 on Alpha Trak!!! I didn't really see any symptoms but he seemed agitated and restless so I rubbed some karo syrup on his gums and syringed him some fancy feast broth. He didn't want to eat anything. I got 72 on Alpha Trak 30 mins later. So not much changed. I brought out a high carb gravy fancy feast and he ate about 2 ounces and at 7 am he was up to 111 on Alpha Trak. We have been feeding him all morning and he's sitting at 242 Alpha Trak at 9 am.

Wow! I am just shocked. He was running high on 2 units and one cycle of 2.25 and this happened? And a reduction to 1.5 units and I get the lowest nadir I have seen with Milo. Help!

 

[Kris & Teasel]

I gave Milo 2.25 units yesterday because the 2 units on many cycles was keeping him pretty high.

Unfortunately you've been shooting partially blind because you missed two AMPSs and have no evening data for those four recent days at 2 u. He might have dropped low enough overnight on 08/09 April to justify staying at the dose.

the 2.25 units was a long cycle again. 12 hours would have been roughly around 9/10 pm and at 11:30 pm he was 104 on ReliOn and 178 on Alpha Trak. I decided to go very conservative because it was a PM shot and I won't be up watching him. I only gave him 1.5 units.

An overly long cycle can be a sign of a dose that's too high. Looking only at the 104 from the ReliOn, that's too low a dose to give insulin. At most a very small token dose would be given. Even with a 178 on the AT that's a sign to skip or greatly reduce. A token dose might have been 0.5 u at the most.

He was running high on 2 units

Not really if you're looking at those recent days at 2 u. I recommend you stay at 2 u both AM and PM for a few more days. Post here for advice if you're unsure of what dose to give.
______________________________________________________________________________________________

http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

This is an excerpt from this guide:

• The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.

• IMPORTANT NOTE: Do not feed your cat within the two-hour window right before the scheduled dose time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should.

• FDMB has general BG references for use with human meters: A cat is considered regulated if BG is in the mid-200s mg/dL {mid-11s mmol/L} for pre-shot and in low 100s mg/dL {low 5.6s mmol/L} or double digits (U.S. mg/dL) for nadir. (BUT not below 50 mg/dL {2.8 mmol/L} which is approaching hypoglycemia range, which is too-low blood glucose - we commonly call this “hypo.”) If you are using an Alpha Trak2 (pet meter) your hypo range starts at 69 mg/dL {3.8 mmol/L} and below. Again: You may want to consider raising your No-Shoot number to as much as 250 mg/dL {14 mmol/L} in the beginning of this sugar dance when using a pet-specific meter. That’s your and your vet’s decision.

 

[MayL]

Unfortunately you've been shooting partially blind because you missed two AMPSs and have no evening data for those four recent days at 2 u. He might have dropped low enough overnight on 08/09 April to justify staying at the dose.

Thanks Kris - I'm sorry if I weren't cleared. I switched between AlphaTrak and ReliOn so between the two tabs I should always have a AMPS and a PMPS. I never shoot now without testing 2 hours after no eating.

 

[MayL]

An overly long cycle can be a sign of a dose that's too high. Looking only at the 104 from the ReliOn, that's too low a dose to give insulin. At most a very small token dose would be given. Even with a 178 on the AT that's a sign to skip or greatly reduce. A token dose might have been 0.5 u at the most.

I must got the wrong impression that a reduction to 1.5 from 2.25 unit was enough. I considered prior 100s on the ReliOn and saw that a zero shot ended up too high at the end of the cycle and that I should really try to shoot 2 shots every day so that's why I made the decision to give him insulin. How does one decide between a token 0.5 units vs 0 units? Or maybe 1 unit would have been okay?

 

[MayL]

Not really if you're looking at those recent days at 2 u. I recommend you stay at 2 u both AM and PM for a few more days. Post here for advice if you're unsure of what dose to give.

On Alphatrak he was in the high 200s to mid 300s on April 7 and 8 - I thought 200-300 was considered high? And that I needed a dose that kept him in the 100 range?

 

[Kris & Teasel]

I should have checked both SSs. If I could put in yet another plug for using only one meter ... Using both and going back and forth can confuse us or cause us to miss info (puts hand up ...) and it has to be burdensome for you. You test with one or the other, try to evaluate numbers on each and can feel OK or not OK depending on which meter reading you're looking at. If you can afford the AT strips by all means stick to that. If you're concerned about BGs that are close to vet measurements use the AT. I guarantee that we all know how to interpret human meter numbers here if you're game to try that. You'd get very comfortable with it yourself in time.

Here's another thing to consider: one of the best ways to get a feel for how your kitty is doing overall is to sit back from your computer screen and get a "forest" view - colour concentrations, increase in blues/greens over time, etc. This is impossible when you have some data on one SS and other data on the second. All you're looking at are the individual "trees" and really can't see trends over time.

When I suggested staying at 2 u for now I was looking at your ReliOn sheet because you have more data there over a longer period of time.

 

[Kris & Teasel]

On Alphatrak he was in the high 200s to mid 300s on April 7 and 8 - I thought 200-300 was considered high? And that I needed a dose that kept him in the 100 range?

I'll talk in human meter terms for now to make it clearer. BGs in the 200-300 range aren't high. High is high 300s and up. You won't likely find a ProZinc dose that will keep him steady in the 100 range because of the action the insulin has. An ideal ProZinc curve is a smile shape. The high ends of the smile are the AM/PMPSs. After the AM dose the insulin gradually lowers BG until it's at its lowest at nadir, the lowest part of the smile shape, and from there the BG will gradually rise again to about the level it started at as the dose finally wears off at the end of the 12 hour cycle. A good ProZinc dose will be one that gives PSs (on a human meter) in the low to mid 200s and a nadir in the high double digits to low 100s. If you're using a pet meter you might expect PSs nearer 300 and nadir around low to mid 100s. These are all approximations.

 

[MayL]

Wow! Well first you did absolutely the right thing this AM. With those numbers, I would never advise giving insulin.

The dose COULD be too high...that might be why. It could be the pancreas too. Did he eat after his first test this AM? Numbers going down or staying low after eating is a sign the pancreas is kicking in, and I think that's most likely what is going on. Which is exciting but nerve-wracking!

Yes, tonight, if he's over 200, I'd give the lowered dose you mentioned and just make sure to grab a +2 if you can...and go from there. If he is low again, you could try the stall without food and retest strategy and see what happens. He might raise enough to give insulin, and if he doesn't, then at least you know. [/QUOTE]

I should have checked both SSs. If I could put in yet another plug for using only one meter ... Using both and going back and forth can confuse us or cause us to miss info (puts hand up ...) and it has to be burdensome for you. You test with one or the other, try to evaluate numbers on each and can feel OK or not OK depending on which meter reading you're looking at. If you can afford the AT strips by all means stick to that. If you're concerned about BGs that are close to vet measurements use the AT. I guarantee that we all know how to interpret human meter numbers here if you're game to try that. You'd get very comfortable with it yourself in time.

Here's another thing to consider: one of the best ways to get a feel for how your kitty is doing overall is to sit back from your computer screen and get a "forest" view - colour concentrations, increase in blues/greens over time, etc. This is impossible when you have some data on one SS and other data on the second. All you're looking at are the individual "trees" and really can't see trends over time.

When I suggested staying at 2 u for now I was looking at your ReliOn sheet because you have more data there over a longer period of time.

Thanks Kris! I was only using the AlphaTak to do the curve for the vet so I have numbers consistent with the vet. Otherwise I am sticking to ReliOn. But I thought why not get some ReliOn numbers for comparison and then realized that if I used the AlphaTrak number instead of the ReliOn I would have given an insulin on some days instead of zero. I plan to stick to ReliOn

As for approximates, sounds like the protocol you copied earlier is that for human meters don't shoot if BG is around 200 and pet meter is probably 225 or 25o. But it sounds like some folks would still shot a token shot with these numbers. How do you decide maybe just give .5 or 1 unit instead of the zero? Is it better to have a little vs. zero or does it all depend on the PS number and each cat?

 

[Kris & Teasel]

As for approximates, sounds like the protocol you copied earlier is that for human meters don't shoot if BG is around 200 and pet meter is probably 225 or 25o. But it sounds like some folks would still shot a token shot with these numbers. How do you decide maybe just give .5 or 1 unit instead of the zero? Is it better to have a little vs. zero or does it all depend on the PS number and each cat?

OK. I understand it better now. Vet wants AT curve numbers.

Yes, that protocol is for human meters because the majority of people use them. It does give reference values for pet meters as you've seen. Those "no shot" guideline numbers are meant for people who are new or haven't collected a lot of data yet. As you get further down the road you can experiment with giving a full dose on a lower number - eg. a 180 PS on a human meter or a 200 on an AT. Over time you push the envelope to see how low a PS you can give a full dose on and then you try slightly reduced doses on an even lower PS. It's this collection of experimental results (the BGs on your SS) that you can refer to because they'll be specific to your cat. Learning whether you can give 0.5 u when a PS is quite low (eg. low 100s) is yet another experiment. There's a lot of judgment required on the part of the owner and a SS data base is what you need for those judgments. Early on, you might have to post here for help quite often but over time you'll get more confident in looking at your SS and making good dosing decisions most of the time.