New person with questions

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KKL

KKL

Member Since 2013
Hello!
I have a 13 yo cat we rescued several years ago and we found out a few weeks ago he has diabetes. He was hospitalized for a few days to straighten out his dosing, he only required 1 unit of Lantus in the evening when he left. I got a TrueTrak meter (thinking of changing) and we did a glucose curve after one week (at home) and his numbers were good. Then a few days later they started dropping so we went to 1/2 unit in the am and pm. He dropped lower. The vet advised that we stop his insulin for now (that maybe the new wet food only diet was helping control his glucose levels). I have been tracking it and he seems good....IF it is accurate. I am concerned about that part. I did try testing two of my other cats and they are much lower....which leads me to two questions.

Has anyone done a side by side comparison of their diabetic cat along with a non diabetic cat?

Which is the most accurate cost effective human meter?

We are presently feeding Wellness Turkey to all three of our cats (including our diabetic), they eat it readily...any pros cons to this, or a better food?
 
Re: Hello from Newbie

Hello and welcome!
I can tell you that your choice of food is good and it it good to have ALL kitties diabetic or not on a low carb wet diet. Dry food - bad, bad, bad!! I also add a bit of water to the food in order to get a little more water in their system.
The most cost effective human meter that I have found in the WalMart brand ReliOn Prime. I paid around $17-$20 for the meter however a box of 50 test strips is only $9. That is a BIG savings for me because I was paying around $50 for a box of strips and I use a lot of strips! The only thing is that it is a WalMart brand and that is the only place you can get the strips. I buy 2 and 3 boxes at a time because I have gone in to get them and they would be sold out and I'd have to go a country mile to another WalMart.
There are a lot of others here that are more experienced than I and Im sure that they will be along shortly to help more.
Welcome aboard!!
Terriy
 
WELCOME to the best place to help you, help your kitty. I cant give you dosing advice but can say, you seem to be doing all the right things and are ahead of the learning curve. GOOD FOR YOU!
I'm sure others will be here soon to answer your insulin questions. Until then, there is MUCH to read and absorb here and again WELCOME .
jeanne
 
Has anyone done a side by side comparison of their diabetic cat along with a non diabetic cat?
Click to expand...

Sure, I've testing both my civies ( non-diabetic cat) on occasion. One of them runs in the low 40's most of the time. The other one tends to be in the 50's to low 60's.

Which is the most accurate cost effective human meter?
Click to expand...

Accurate in what way? Repeatability? Or being able to get a test with the blood drop?

We have found that human glucometers with True in the name and the Frestyle with the butterfly strips do not read accurately at the high numbers, often giving a false lower value. Here is the CR report with our added comments. http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=70140

It's not the cost of the test meter that will strain your budget. It's the cost of the strips. That is why so many here use the Walmart Relion line of meters or their Arkray equivalents. You can easily go through 100-200 test strips in the first month or two. Depends on how much testing you do and if you do your own curves and how many bad strips/failed tests you have and if you have to manage a hypo event or two.

With 4 tests a day, that's 124 strips a month. Relion Prime needs a bigger drop of blood, 0.5 microliters. Relion Confirm needs smaller 0.3 microliters. It's a balance to get the lower cost, availability of strips, size of blood drop, accuracy, repeatability.

Since meters are allowed to be off by 20% by government standards, accuracy is more of a 'close enough' issue than an exact number you can take to the bank and earn interest on.

Maybe list a few of your numbers here in the post since you do not have a SS (spreadsheet) set up.

AMPS = test in the morning before shot AMBG = test in the morning with no insulin given
PMPS = test in the evening before shot PMBG = test in the evening with no insulin given
Replace the xxx with your actual numbers. Replace the ?U with the number of units you are giving. 0U if not giving insulin right now.

6/16 AMPS xxx ?U +2 xxx PMPS xxx ?U +6
6/17 AMPS xxx ?U PMPS xxx ?U
6/18
6/19
6/20
 
When you said your other two cats tested much lower, how much lower? And were the tests roughly about the same time in terms of "how long after they last ate"?

Normal BG range for cats is between 40 - 120. Were all your numbers in that range?
 
Thank you all!

I am a researcher by job/nature so I have done TONS of reading :) I'd been looking into the Relion, just wasn't sure which one to go with. Got the TrueResult just to get me something ASAP.

I have been keeping a log, spreadsheet but have also done a graph. Yep, I am that "particular". The last time he got insulin was 06/11 7:20pm (1/2 unit). (attached-though the graph was too big but the spreadsheet data is on there)

My "normal" cats were at 45 and 49 before meal. Today my "sugar cat" was at 150. His initial blood sugar when he was hospitalized was 427.

He has a history of "hepatic lipidosis" (had to feed every 4hrs via a tube in his neck for 8 weeks) so we had him on a 3x day dry food diet to try to control his intake--which is a real fun thing to do with 3 cats with different needs :) Now all three cats are 2x day on the Wellness Turkey, seems decent food for a good price (the 12.5 oz can is $2.35-$2.88).
 
We have a standardized color coded 'spreadsheet" that we use here to track the BG numbers. It's nice to have to share with the people here on the forum so they can see what is going on with your cat.

Creation instructions and how to link into your signature are here:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

(attached-though the graph was too big but the spreadsheet data is on there)
Click to expand...
No attachment came through in your post.
 
A hundred points is a fairly significant difference, but 150 is right at the high end of normal. And that's after ten days of no insulin.
I think I might try the "what happens after he eats" thing...
Take it before food, then an hour later to see if/how far he rises. Then an hour or two later to see if it drops on it's own. That can at least show you if his system is trying to function normally.

He might need a short stint of tiny (like .25u or less) doses to get him down into lower levels of normal? There isn't anything else going on like an infection or dental issues that might be elevating his BGs?
 
Is the TrueResult a Walgreens brand?

If so, it may be giving you incorrect numbers.

Before I got my AlphaTrack, I had a TrueResult. When my kittie was at the vet, we tested his BG with both my meter and the vet's. My TrueResult was about 100 points lower.
 
It is a CVS brand, I am going to pick up a Relion Prime in a little bit because recently I read the TrueResult wasn't as accurate with cats.

I had been testing before breakfast and dinner, then about an hour or two later. His glucose levels seem to come down after he eats if anything. No known infections either.

Here is our track so far:
06/10    4:56pm 172
06/11    6:54pm 161 (last time insulin was given 1/2 unit)
06/11    11:17pm 95
06/12    7:52am   105
06/12    12:59pm  70
06/12    2:05pm  75
06/12    4:25pm  174
06/12    7:43pm  204
06/12    10:46pm 164
06/13    8:06am  213
06/13    12:51pm  136
06/13    6:43pm  197
06/13    9:38pm    175
06/14    6:59am   198
06/14    8:41pm  170
06/15    12:16am  178
06/15     9:02am 202
06/15    7:00pm  193
06/16 2:30am 145
06/16    9:03am 196
06/16    12:46pm   170
06/16    8:00pm  108
06/17    8:36am 218
06/17    6:30pm   104
06/17    10:46pm 98
06/18 8:02am 228
06/20 8:39am 194
06/21 8:46am 150

This is his initial 24hr Glucose Curve from two weeks ago (he had been on 1 unit of insulin a day for a week):
6/6/13 7:17 PM 265
6/6/13 7:20 PM Fed dinner
6/6/13 7:45 PM 1 Unit Insulin
6/6/13 11:05 PM 158
6/7/13 3:10 AM 110
6/7/13 7:21 AM 112
6/7/13 7:25 AM Fed Breakfast
6/7/13 11:30 AM 152
6/7/13 3:15 PM 169
6/7/13 7:23 PM 240
6/7/13 7:28 PM Fed Dinner
6/7/13 7:48 PM 1 Unit Insulin
 
When you are listing values, it is helpful to do it with reference to the shot time, like this

AMPS - morning pre-shot glucose test
+1 hour since the shot
+2 hours since the shot
etc
PMPS - evening pre-shot glucose test.
 
It's definitely time for some insulin support again. Those numbers are creeping higher and higher towards the renal threshold.

Wikipedia has this to say about what the numbers mean. Table formatting lost in the cut and paste. See here for more readable version. http://en.wikipedia.org/wiki/Diabetes_in_cats

For general guidelines only, the levels to watch are approximately:


mmol/L mg/dL(US)
<2.2 <40 Readings below this level are usually considered hypoglycemic when giving insulin, even if no symptoms of it are seen. Treat immediately[26]

2.2-7.5 40-130 Non-diabetic range[27] (usually unsafe to aim for when on insulin, unless your control is very good). These numbers, when not giving insulin, are very good news.
3.38-6.88 61-124[28]
This is an average non-diabetic cat's level,[29] but leaves little margin of safety for a diabetic on insulin. Don't aim for this range, but don't panic if you see it, either. If the number is not falling, it's healthy.
5 90 A commonly cited minimum safe value for the lowest blood sugar of the day
5.5-10 100-180 Commonly used target range for diabetics, for as much of the time as possible.
7.8 140 According to the American Association of Clinical Endocrinologists (AACE), threshold above which organ and pancreatic damage may begin in humans.[30]

<13.33-15 240[31]-270
Feline Renal threshold for glucose, when excess glucose from the kidneys spills into the urine and roughly when the cat begins to show diabetic symptoms. See Hyperglycemia for long-term effects of high blood glucose on cats.

16.7 300 Approximate maximum safe value for the highest blood sugar of the day, in cats, to avoid neuropathy and complications. Some cats can go on long-term at this level or higher, but there will be side effects eventually. Check for ketones.

>20 >360 Check for ketones frequently, be sure you are giving insulin. Cats are much more resilient than dogs or humans at these high levels; nevertheless, the blood sugar should be lowered. The cat can feel any of numerous ill effects both short and long-term, see hyperglycemia for details.

 
Yes, he hasn't had insulin in 10 days...AND the TrueResult meter (which just read 150) is not reading even close to the Relion meter I just got (which read 215 at the same sitting).

I am going to start with a 1/2 unit tonight and monitor him with the new meter...any recommendations on just how often to test. I was testing right before feeding and two hours after, then sometimes randomly four hours after that. How long after feeding or giving insulin should I retest?
 
Stick with the Relion... all the TRU track or results meters have proven to be unreliable at low and high ends, and many just toss them. Any of the Relions are decent and affordable, and the pet meters are nothing special for the huge diff in cost. Stick with the Relion for the economy and the reliability.

You want to be giving your Lantus every 12 hrs, and you need to test before each shot... if you test but get delayed by about 15min, it's best to test again as you want to know what the number was at shot time and lots can happen in just 15min. Curves, testing every 2hrs between 2 shots, is the best way to work at determining your cat's nadir... the nadir, lowest point in the cycle, will help you decide if your dose is not enough, too much, or just right.

So, a few people have done graphs for their data but other than look pretty and show you trends, they are not as details as the google spreadsheets used by most people here. With the sheet, you can go back months or even years to compare data, but on a graph, well, where's the precision in a graph for the last 3 yrs?

How often to test? Well, a test before each shot and then just before you go to bed are the 3 most important tests. After that, whatever fits your life. I used to test when I got up, then just before shot time and those 2 numbers would tell me where my cat's numbers were headed. When I got home from work, I would test again, then at shot time and maybe once or twice in the evening. On the weekends, I'd try to do a full curve, every 2 hrs between 2 shots, and also a mini curve, testing every 3 hrs between 2 shots, on another day. I am sure you already know that each new piece of data adds to the whole picture.

For the feeding, most people try to pick up the food for the 2 hrs before a shot because food could cause the number to rise and give you an artificially high number at shot time. so if your shot times are 8am/pm, don't feed between 6-8am and 6-8pm. Test the cat, then if you have decided to give a shot or not, then give the meal. Don't feed until you have decided on the shot and the dose.

I don't know if anyone showed you this info:
How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.

Now, your cat may not follow this pattern, and neither of mine did.
One of mine had her lowest point around +5, but my other guy would rise until about +5 and then his lowest point, his nadir was maybe around +11. Only by my testing here and there to gather data for my picture was I able to learn their nadirs.

To explain the +numbers, it's just how many hours since the last shot, so if you give a shot at 8am and then don't give the next shot till 9pm, that shot is at +13, and you then reset your counter... your next shot at the +12 mark would be at 9am the next day.

Gayle
 
THANK YOU!!
I did fill out and make my chart shared...though not positive I did it right :)

I'll use this chart and see how things go the next few days...since the Relion meter showed him at 315 (sigh) I did give him insulin this evening. So testing 2 hours after insulin is a good idea? I only feed him 2x a day wet food, so he does not have access to food before/after that point. We also have a multi cat household so that is always fun.
 
Low carb food is good for all the cats and may be left out from pre-shot to +10 hours later. Some diabetics do better with mini-meals or grazing.
 
Please don't confuse the Lantus cycle "Curve" that you were given with a testing curve. That Lantus cycle example shows what typically happens for each hour of a 12 hour cycle.

A testing curve is taking a BG (blood glucose) reading every 2-3 hours over a period of 12 hours.

Thank you for the SS (spreadsheet). I can read it just fine. I would ask you to make note of the name of the meter you were using and then the name of the meter you are using now in the SS.

Since you are just restarting the insulin this evening, the +2 number might be a good idea. To see what direction your cat is headed.
 
I am going to take this conservatively going back to insulin with the new meter. When he was in the vet they kept him at 1unit in the PM only because the AM and PM were too much. I am going to try 1/2 unit this evening which is what the vet had suggested we try doing before they suggested to pull him off it and watch. Last night he dropped to 33 seven hours after the insulin so I gave him a little wet food and a few crunchies to bring him up so he didn't go down further. His vet said the sweet spot would be between 125-175 for managing him and that between 100-200 is acceptable, so depending on his levels the next morning I will see if he needs another 1/2 unit. He was managing very well last week without the insulin, BUT that was with the old meter which seems to have been reading lower. I'll just clock his BG levels into the handy chart and we will see what works best for him...any input appreciated of course!
 
We treat glucose levels less than 50 as hypos using these instructions.
Dry food takes too long to bring the glucose up, plus if too much is eaten too rapidly, the cat may vomit, making the potential hypo worse.
 
Ok thank you!!
He did eat readily and wasn't showing any signs of being low...but I do have a hypo kit all set just in case with Karo syrup and a small dosing syringe just incase.
 
Some cats show very few symptoms ... until they are actively seizing, at which point it may be too late. We'd rathe be proactive when the glucometer tests low. Its OK to test twice to confirm an unexpected low number and go with the average of the 2.
 
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