No significant curve in nadir

Kelsey R

Kelsey R

Member
Hello.
This is my first week after diagnosis and the start on insulin.

I took my first nadir mid cycle testing today and it was only 23 pts lower than early morning. Has anyone had experience with this? Does it mean he needs more time on insulin to see results, or that the insulin isn't working??

I haven't created a chart yet. Plan on doing a full curve cycle reading on sunday. But in the meantime, here is what I've gotten off him

11/8 - BG 380 at vet
Gave 1 unit 2x a day

11/11 was able to start testing. Evening +12 testing (before food or insulin) was 290.

11/12 - evening +12 BG: 260
vet told me to go to 2 units 2x a day

11/14 - evening +12 BG: 432. gave 2 units insulin & food, retested +1, bg was 328

11/15 - am reading was 276. i went down to 1.5 units & wet food. Retested +6 and bg is 253. Only a 23 pt drop.

Any suggestions? This small curve doesn't sit well with me. My vet's not much help, so really hoping for some guidance before I give myself an anxiety attack.
Thank you
 
This is very confusing at first. Your best path forward is to set up the spreadsheet we use here and log all the test results you get. We wouldn't recommend an increase from 1 to 2 units after only 4 days on insulin.

This is a great guide to ProZinc: http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.165103/ Read it over and ask a ton of questions. We're here to help.

In a nutshell I would recommend:
  • staying at 1 unit AM and PM for at least the first week while you get your testing routine smoothed out and a spreadsheet set up
  • reading the ProZinc guide carefully and posting your questions here
  • trying not to overreact to numbers and change doses right now - it's far too early in your kitty's FD journey.
 
Hi. Two tests is not enough to call it a curve. Normally, a curve means testing before an insulin shot then every two hours after. They are usually done for a full, 12-hour cycle. This allows you to see when the insulin begins having an impact (onset) as well as when the lowest point in the cycle occurs (nadir - which, by the way, does not necessarily occur at +6). If the only tests that have been done are the ones you listed, there is not enough data here to really determine the impact of the insulin dose being given.

I am surprised the vet doubled the dose just 4 or 5 days into treatment, and if I am understanding this correctly, that was done based on a single point-in-time glucose test which is not really a great idea. Normally, the starting dose of 1 unit is held for a week then a curve is done to determine whether to change the dose or not. From there, you generally want to hold doses at least a couple of days before changing, and it is usually best to make dose increases in amounts of just .25 or at least no more than .50 unit.

Data is so important in enabling you to really know what is going on and to be able to make informed dose change decisions. You do not have to do full curves all the time, but if you could grab a mid-cycle test or two as many cycles as possible, and vary the times you do it, you can begin to fill in gaps and get a picture of things. It would be very helpful (to us and you) if you would set up one of the spreadsheets we use here. This gives you a place to record the tests, and with the color coding, it helps you see patterns more easily.
 
I will definitely start a spreadsheet. Thanks for the reaffirmation that the 1) i'm overreacting and need to take a step back (i hardly slept last night worrying about his copious water drinking after that high number!) and 2) that the vet jumping to double dosing so quickly, without full data, wasn't the right way to go. He was doing better with the 1 unit 2x a day. So I will go back to that number and give it a week WITH spreadsheet tracking! Work is crazy tomorrow, but I will get a sheet started tomorrow and will have time to do a full curve on Sunday.

Thanks for talking me through these first few weeks... I'll calm down soon! :)
 
It is so difficult at first when dealing with this diagnosis and learning everything, but I promise it gets easier and you're already over the biggest hurdle - learning how to test. Hang in there and deep breaths. Please ask as many questions as you have. We've all been new here at some point and are happy to pay it forward for all the help we received!
 
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