Penny's Values

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Bex and Penny (UK)

Bex and Penny (UK)

Member Since 2020
Hi all,

Sorry for the essay! Please not that I'm in the UK therefore values are in mmol/L. Link to spreadsheet: Penny's spreadsheet

I adopted Penny (she's around 15ish at a guess) in March and she was showing symptoms of being diabetic (eating a lot, drinking a lot, weeing a lot) from when we got her. I asked but apparently the vet didn't seem too concerned (I didn't speak to them) and we sort of put it down to a behavioural thing due to her living on the streets for the last few years/all her life. We took her to the vets around June as she was super lethargic, wasn't interested in food - very unlike Penny - and had diarrhoea and had been sick (probably her BG was all over the place, I feel awful that we didn't diagnose the diabetes earlier). The vets did bloods and gave her antibiotics but no urine check. The antibiotics did the trick and all her bloods came back fine and she was back to her normal (hungry, thirsty) self. Obviously the hunger and thirst didn't go away and we took her back a couple of weeks ago because she wasn't putting on weight despite being on double the amount of food she should have been. And finally she was diagnosed with diabetes. I'm frustrated we didn't check for it as soon as we adopted her, my gut was telling me it was diabetes or hyperthyroid, but we didn't and I can only learn from it! Anyway, long story short, she's likely been diabetic for quite some time but was diagnosed on the 11th September and started on Caninsulin on the 14th September.

She started on 1U twice a day; this got upped to 2U twice a day (aware this is quite a fast change in levels based on what I've read since and will push for smaller increases going forward) and she's been on 2.5U twice a day since Friday the 18th. She was going in every 2 days to get her BC read +5 after her morning insulin and the values were gradually dropping - from 36 to 31 to the 20s and her last vet reading on Wednesday (23rd) was 17. She's looking so much better, her eyes are brighter, she's drinking way less and she has so much more energy <3

I've now got a GlucoNavii human meter and started home testing on Saturday. We did a full curve Sunday and from this morning I will now be starting to test her every pre-shot and probably around 12pm and 1pm (i.e. +4 and +5 hours) to detect her lowest reading.

I need to email the vets today with her values. I was going to let them know about using a human meter and say I've been doing my research on this forum and send a link to her spreadsheet showing her curve from Sunday. She's still on her original food (which I worked out is around 15% carb calories) pre-insulin. I've found a suitable low carb (6%) food I want to try but I'm a bit nervous about making the transition.

I was thinking of telling the vet that I don't want to change her dosage at the moment while we are transitioning her. But what values do I need to be looking at/for when I change? Should we change suddenly on a weekend so we can do her curve rather than doing it gradually like you normally would if you changed foods? Should I be reducing the insulin dosage or keeping it the same? And how do I know how much to decrease it by? I will be asking the vet the same question but they hadn't really mentioned moving her to a lower carb diet so I'm not sure if they are fully informed on the effect of the food on her BG/insulin requirements. I'm terrified of sending her hypo. Are her curve values high enough that this is unlikely? Is there anything else you think I should be asking my vet?

Thank you if you've stayed with me this far! I keep going in waves of feeling like I'm on top of things (to be fair we've got the insulin injections and the testing sorted now so that's progress!) but other times I feel totally overwhelmed! We are also trying to sort out our hyperthyroid foster cat's dosage at the moment too so there's a lot of learning going on and everything seems to be happening at once! Thank you for your help <3 Penny and I really appreciate it, I'm so grateful for this community already!

Bex and Penny xx
 
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Hi Bex.

Bex and Penny (UK) said:
I keep going in waves of feeling like I'm on top of things (to be fair we've got the insulin injections and the testing sorted now so that's progress!) but other times I feel totally overwhelmed!
Click to expand...
Oh, that's a very familiar refrain round these parts. Welcome to the early days of feline diabetes! :)

You're spot on about the need for caution when doing the food transition. It's better to do it slowly to avoid digestive upsets because if a cat's appetite gets iffy it obviously complicates matters enormously when she needs insulin.

I can't see your spreadsheet at the moment because the sharing permissions need to be set to allow people with the link to view it. Here's how:


Spreadsheet Sharing Permissions

To set spreadsheet sharing permissions:

* At the top right of the spreadsheet screen click on 'Share'.

* In the pop-up dialog box click on the 'Get Link' section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click 'Done' to save the changes.​


Please post again on this thread when you've changed the permissions. I'll keep an eye out for your post and then I'll have a look at Penny's readings for you.

I think it's absolutely wonderful that you've given Penny a forever home. She is very lucky to have found you to be her Person. :bighug: I'm glad to hear that, thanks to your love and care, she's already starting to feel better. :)


Mogs
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On human meters and possible vet objections:

I've attached below a published, peer-reviewed study which provides evidence from veterinary professionals that human meters are perfectly acceptable tools for monitoring of blood glucose levels in cats provided the appropriate reference range is used. Although the study concerns treatment with insulins other than Caninsulin, the principle of using a human meter to safely monitor a cat is independent of the type of insulin with which the cat is being treated.

The reference range used with a human meter when monitoring a feline diabetic is:

2.8-6.7mmol/L

(FYI, the reference range my vet gave to me for use with a pet specific meter like the Alphatrak 2 is 3.9-8.3mmol/L.)

The attached document may be of assistance to you in discussions with your vet.

The key advantage of using a human meter is cost: the Alphatrak strips are expensive.

Some vets are uncomfortable when presented with curves run using a human meter. Some members get around this sticking point with the following compromise:

* Purchase both a human and a pet meter.

* Use the human meter for day-to-day monitoring.

* Use the pet meter to take readings for curves that are to be submitted to the vet for review.


Mogs
.
 

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WELCOME TO FDMB Bx and sweet, sweet Penny. We are glad you've found your way here! You are way ahead with your learning curve lets see if we can take that one step further. If you look at the bottom of everyones pots you see a couple of lines with a light gray printing. THAT is everyones "Signature" we want you to have one too! :)
Heres how you go about it:
  • On the left, under Settings, Click on Signature. This is where you will put information that helps us give you feedback.
    • There is a limit of two lines which may include two links; you may separate pieces with commas, dashes, | etc. This is where you paste the link for your spreadsheet, once it is set up.
    • Add any other text, such as
    • Caregiver & kitty's name (optional)
    • DX: Date
    • Name of Insulin
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

All this gives everyone an at a glance information of all Penny's particulars. Thats just so we dont have to search long threads to find out things like insulin type... It actually will serve you and Penny in the future.

We are a community of dedicated cat lovers ready willing and able to help you and anyone else learn how to navigate this disease .

WELCOME TO OUR FAMILY:bighug:
jeanne
 
Critter Mom said:
Hi Bex.


Oh, that's a very familiar refrain round these parts. Welcome to the early days of feline diabetes! :)

You're spot on about the need for caution when doing the food transition. It's better to do it slowly to avoid digestive upsets because if a cat's appetite gets iffy it obviously complicates matters enormously when she needs insulin.

I can't see your spreadsheet at the moment because the sharing permissions need to be set to allow people with the link to view it. Here's how:


Spreadsheet Sharing Permissions

To set spreadsheet sharing permissions:

* At the top right of the spreadsheet screen click on 'Share'.

* In the pop-up dialog box click on the 'Get Link' section.

* Change link access from 'Restricted' to 'Anyone with the link' and make sure that the permission on the right hand side is set to 'Viewer'.

* Click 'Done' to save the changes.​


Please post again on this thread when you've changed the permissions. I'll keep an eye out for your post and then I'll have a look at Penny's readings for you.

I think it's absolutely wonderful that you've given Penny a forever home. She is very lucky to have found you to be her Person. :bighug: I'm glad to hear that, thanks to your love and care, she's already starting to feel better. :)


Mogs
.
Click to expand...


Thanks so much for your reply! The spreadsheet should now be visible.

I was thinking about suggesting we get a pet one for submitting results to the vet. How often do people generally undertake full 12h blood curves / submit these to their vet? I'll give the article a read now! :)

Bex
 
Bex and Penny (UK) said:
Hi all,
Click to expand...
Hi Bex and Penny, waving to you from Surrey! :bighug:

Well done for getting started with hometesting so promptly. That is the best way to be able to see how the insulin is working in your kitty's body. And it will also help protect against (or help you deal with) any low number situations that might crop up along the way.

I second Mogs' caution about the food transition. Just take it slowly, and monitor carefully during the transition. Some kitties have a pretty immediate drop in blood glucose as the higher carb food is removed. But some may take a few days or even a week or more to see the effect of the change in diet.

Bex and Penny (UK) said:
How often do people generally undertake full 12h blood curves / submit these to their vet?
Click to expand...
It depends...
How often you do curves will depend on how often you can get tests at other times (on a day to day basis), and/or how often your vet wants to see the results from a glucose curve.

Curves add to the data that we get from day to day testing, but they can't reliably replace that data.
Curves can be useful for showing us the 'pattern' of how the insulin is working in the cat's body. They can give us valuable clues to things like; how soon the insulin starts working after being injected ('onset'); how fast the blood glucose drops; when the lowest blood glucose of the cycle might typically occur (insulin 'peak'/blood glucose 'nadir'); and how long the insulin lasts in the cat's body ('duration').
Getting this kind of information can be very helpful in clueing us in to the best times to do 'spot check' glucose tests on other days. The data we get may also show us whether this insulin type is lasting long enough in our kitty's system. So, curves can be useful things.

A limitation of curves is that they are only a snapshot of a particular day. And that day may or may not be representative of what 'typically' happens on other days. Every day will be different to some degree, sometimes just a little, sometimes a lot...
For this reason it is never a sound idea to increase insulin dosage purely on the basis of a single curve (the cat may just be having a day that's higher than usual.)
However, if the blood glucose drops low on the day of the curve it absolutely is important to reduce insulin dosage.

If you are getting pre-shot tests every day, and at least one other mid-cycle test during either the morning or evening cycle, then that will give you quite a lot of useful information. If you can get a test during both cycles, then that will give you even more. Quite a few kitties do drop a little lower at night. So it can be helpful, where possible, to get a quick 'before bed' test just to see how things are going.

The more tests you get on a daily basis, the less relevant curves become. But the data from curves is something that many vets like to see, so sometimes people will do curves just for that reason.
It's also possible though to send the vet the link to the cat's spreadsheet, and then they can see what's going on. Some vets really like to have this information, and can be pretty impressed! But less progressive vets may think that the caregiver is testing too often, or there may be concerns if they see a change in insulin dosage, etc, etc... You know your vet, so you know best how your own vet might respond...

Eliz
 
Hi again, Bex.

I can see the spreadsheet fine now.

As you're only starting out collecting data for Penny, it's only possible to give a rough interpretation of her curve of 27.09.20.

* Penny had a quite early onset for Caninsulin. (BG drops to general nadir level by +2 instead of +3.)

* Penny had a relatively good duration for this insulin. (BG stayed roughly at nadir level right through to +8. Some cats start rising on this insulin from +6.)

* Penny is running fairly high at nadir on the current dose.

You may have to start reducing the dose when starting the food transition from the 16% carb food to the 6% carb food, but the adjustments may need to be done in moderate steps with each change in the proportion of high to low carb foods. Please discuss a strategy for dose adjustments during the food transition with your vet.

Here is a link to helpful information on safely transitioning a cat receiving insulin treatment to a lower carb food (vet-authored site):

catinfo.org - Feline Diabetes page

It is a wise safety precaution to regularly test cats running in higher numbers, doubly so when adjusting the dose during a food transition. Here are helpful links:

Testing Your Cat for Ketones

Tips for Collecting Urine Samples


Mogs
.
 
Thank you very much for your replies! Sorry for the super slow reply, I was off work last week so wasn't using my computer and was trying to limit my time on my phone.

We have now successfully transitioned on to her new food (Integra Sensitive Intestinal) and it's clear that her values have dropped after changing food. It's nice to see no more red and blacks!

We've been regularly testing ketones in her urine too; so far so good!

Before we transitioned the food, my vet was keen for me to increase from 2.5U of Caninsulin to 3.5U. Although they recommended that it wouldn't make much of a difference to her values, I told her I would wait until I'd transitioned the food in case it dropped considerably. I'm quite glad I did.

As the Caninsulin is shorter acting than some of the other insulins (and based on the curve I did had worn off by around +10; I need to do some more curves the next couple of days!), I'm a bit unsure as what values I want to be getting. Presumably, her AMPS and PMPS values will always be higher than cats on 'better' insulins? (I do want to talk to my vet about changing insulins as some point for a longer lasting one).

So I guess 2 main questions I have currently;
1) Is the 2.8-6.7mmol/L range what I want all my BG values to be? Or is that what I want my post-shot values to be?
2) What dosage would you recommend we increase to? She was on 1.5U then 2U and has been on 2.5U for two or three weeks now, with a decrease in values after we transitioned to a lower carb diet.

I'm going to email the latest spreadsheet to my vet later (they were happy with us using a human meter and sending the spreadsheet readings which was great!); I'm basically going to tell the vet what I'm doing rather and asking her I think! The 3.5U would likely have been too high with the food change.

Thank you so much for your help! I finally feel like we are sort of on top of things now. Penny's right ear bleeds nice and easily on the first attempt (although the left ear is like getting blood from a stone!) and she's so much brighter than pre-insulin. It's so great to see <3 xx
 
Hi Bex,

Glad to hear that you're safely through the diet transition and that Penny's numbers have improved. Also good to hear that you're doing so well on the testing front. :)

Just had a quick gander at Penny's spreadsheet. I think you're correct that the 3.5IU Caninsulin dose would have been too high with the switch to low carb.

Since switching diet, you've already seen a nadir of 6.4/115 on the 2.5IU dose. With this particular insulin it is advisable to keep quite a large 'safety buffer' so it is wise not to let nadirs go below 5.5/100. According to the FDMB Caninsulin Guide, the dose should be reduced immediately upon seeing a nadir below 5.0/90. From the aforementioned guide:

Changing the Dose

Hold the starting dose for at least a week UNLESS
  • your cat won’t eat or you suspect hypoglycemia
  • your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12-hour curve (i.e., testing every 2 hours) OR perform an 18 hour curve (i.e., testing every 3 hours). Note: Random spot checks are essential in order to "fill in the blanks" on your kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

The general guidelines for making dose changes are:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • HOWEVER, there are some situations which signal that a larger than usual dose reduction is needed. If you are unsure, please post on this forum or in the Health forum and ask for input about your dose.
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], lengthen the waiting time between dose increases. If you decide to change another factor (e.g. diet or other medications), don't increase the insulin dose until the other change is complete but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change.

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may race past the right dose for your cat.​


Looking at Penny's pattern of response thus far, it's possible that she might be metabolising the insulin quickly (lowest BGs tend to be earlier in the cycle). I'd suggest grabbing +3 tests to see what she's doing there as some cats can nadir quite early on this insulin. Also, many cats run lower at night so it's possible that Penny might have lower nadirs during her PM cycles. (It's possible that the pink AMPS readings you're seeing lately may be a little bit 'bouncy' following a lowish nadir overnight, but no way to be certain without test data.) I'd recommend trying to get some night time tests as best you can (some people set alarms, grab a quick reading, and then go back to bed). It would better inform your dosing decisions.


Mogs
.
 
Hi Mogs,

Thanks! Our AMPS and PMPS readings are taking around 20-30mins after we've fed her, just before shooting; is this why they appear slightly high? I re-read the Caninsulin FAQ and saw it said to test, feed, wait 20-30 mins then shoot. Should our post-food, pre-shot values still be tending towards 16.6? I think some of the variations in her readings might also be to do with how much of her food she has eaten before we test (sometime she eats all of it, sometime maybe half and then finishes the rest after her shot). Does the BG tend to rise so much 30 mins after food?

I will start testing her overnight too, thanks!

If we have a week or so where the nadir isn't dropping into the blue, would we look to increase the dosage by 0.25? As long as we are pre-testing before shooting?

Thank you!

Bex and Penny xx
 
Bex and Penny (UK) said:
I think some of the variations in her readings might also be to do with how much of her food she has eaten before we test
Click to expand...
Hi Bex, ideally the sequence is Test, Feed, Shoot (or, Test, Feed, Wait, Shoot). But sometimes my girl will be a bit wriggly first thing in the morning until she's had something to eat. So I test her as soon as she's had a little breakfast, and before the food has had a chance to impact her blood glucose.
If you're testing 20 - 30 mins after feeding then it may well be that the food is starting to have an effect in her system at that point... ...It would be interesting to know if that is the case, so, if you get the chance to test prior to feeding, and then test 20 - 30 minutes later, that could give you some useful info....
 
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