Pre shot question

[David - coco]

I just need quick help to understand the pre shot test. Is this test done AFTER feeding them or BEFORE feeding them? I was told by the vet that if the pre shot test was <150 to not give the insulin but she said this test was 20-30 after feeding. Just want to clarify.

Thanks

 

[Chrispooky12]

I just need quick help to understand the pre shot test. Is this test done AFTER feeding them or BEFORE feeding them? I was told by the vet that if the pre shot test was <150 to not give the insulin but she said this test was 20-30 after feeding. Just want to clarify.

Thanks

You always want to test first to make sure kitty is safe to give insulin. Then you feed & give them there shot while there eating. Unless you are using an insulin other than Lantus or prozinc. What insulin is your kitty on & what dose?

 

[David - coco]

You always want to test first to make sure kitty is safe to give insulin. Then you feed & give them there shot while there eating. Unless you are using an insulin other than Lantus or prozinc. What insulin is your kitty on & what dose?

Prozinc doing 2U at the moment. So the pre-shot is the number you get BEFORE feeding? I know the food will raise the glucose a bit. Basically I was told that as long as they eat, should be safe to shoot. But I'm "trying" to get into testing at home but I was told to feed, wait 20 minutes, then test, if under 150 don't shoot. Sounds like I'm backwards (or the vet is?). Why test before feeding since the food will impact glucose?

 

[Chrispooky12]

Prozinc doing 2U at the moment. So the pre-shot is the number you get BEFORE feeding? I know the food will raise the glucose a bit. Basically I was told that as long as they eat, should be safe to shoot. But I'm "trying" to get into testing at home but I was told to feed, wait 20 minutes, then test, if under 150 don't shoot. Sounds like I'm backwards (or the vet is?). Why test before feeding since the food will impact glucose?

The preshot number is the number you get before giving insulin AMPS is am pre shot PMPS is pm pre shot. You want to with hold 2hrs before shot time so the number won't be influenced by food. I'm going to tag Melissa for you on your other questions. I'm not experienced enough to give you dosing info. @FrostD

 

[Chrispooky12]

Prozinc doing 2U at the moment. So the pre-shot is the number you get BEFORE feeding? I know the food will raise the glucose a bit. Basically I was told that as long as they eat, should be safe to shoot. But I'm "trying" to get into testing at home but I was told to feed, wait 20 minutes, then test, if under 150 don't shoot. Sounds like I'm backwards (or the vet is?). Why test before feeding since the food will impact glucose?

With hold food * I'm going to tag @Diane Tyler's Mom so she can give you some links to help you get a signature & spreadsheet set up. It's great that you are home testing & keeping your kitty safe.

 

[Bron and Sheba (GA)]

Hi David…here is your first post for continuity https://felinediabetes.com/FDMB/threads/wet-food-for-diabetes-and-kidney-disease.272102/
2 units Prozinc twice a day is a lot to start off with. Most cats start off with 1/2 to 1 unit Prozinc. See what @FrostD thinks as she is a Prozinc user and I am not.
Did you get the food sorted out for Coco?
In the beginning we suggest not giving the dose if the BG is below 200 until we get more data. In the SS.
So you test first, then feed, then give the dose of insulin. If the preshot is not high enough to shoot we suggest you stall, don’t feed and the west again in 20 minutes to see if the BG is rising. Also post and ask for help.

 

[Diane Tyler's Mom GA]

Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
The link will also tell you how to create a spreadsheet and understanding the spreadsheet. If you need help with setting it up just ask we have a member who would be glad to set it up for you

 

[David - coco]

Hi David…here is your first post for continuity https://felinediabetes.com/FDMB/threads/wet-food-for-diabetes-and-kidney-disease.272102/
2 units Prozinc twice a day is a lot to start off with. Most cats start off with 1/2 to 1 unit Prozinc. See what @FrostD thinks as she is a Prozinc user and I am not.
Did you get the food sorted out for Coco?
In the beginning we suggest not giving the dose if the BG is below 200 until we get more data. In the SS.
So you test first, then feed, then give the dose of insulin. If the preshot is not high enough to shoot we suggest you stall, don’t feed and the west again in 20 minutes to see if the BG is rising. Also post and ask for help.

hmm, not sure why the vet would have told me to do pre shot check after feeding. Maybe I misunderstood. I’ll double check with them tomorrow to make sure.

They initially started her on 1 unit for two weeks. They did a fructosamine test and it came back over 700, so they upped the dose to 2 units yesterday.

I guess my main question for curiosity is why do you determine whether to shoot based on pre-feeding numbers? Is it just to be sure the number is high enough to give the insulin and not relying on food to be enough to raise BG? Is it typical for BG to be rising so late in the cycle if I need to stall? How long should I wait after feed to give insulin? She is a slow eater so I’ve been waiting about 20 minutes or so.

Still working on a food, vets are pretty adamant about keeping her on a kidney diet. However one vet said I could change to Hills WD which is lower in carbs vs the KD but still high. I'm getting another opinion next week from an internist so we'll see. Thanks, I'm learning

 

[Bron and Sheba (GA)]

However one vet said I could change to Hills WD which is lower in carbs vs the KD but still high. I'm getting another opinion next week from an internist so we'll see. Thanks, I'm learning

Did you look at the Weruva site that I sent you. It has some new low phosphorus low carbs food that is very suitable for diabetic cats that have crd. I would feed that before I would ever look at prescription foods. They are just a money making racket for the big companies.

They initially started her on 1 unit for two weeks. They did a fructosamine test and it came back over 700, so they upped the dose to 2 units yesterday.

The fructosamine test is an average of the last 3 weeks BGs. It doesn’t tell you if the BG dropped really low or if it went really high. I would strongly recommend you think about hometesting the BG to take the guesswork out of it. If an increase was needed it should have been to 1.25 units not 2 units. I would go back to 1.25 units if I were you. But unless you are willing to hometesting the BGs and setup a spreadsheet we can only help you so much.

guess my main question for curiosity is why do you determine whether to shoot based on pre-feeding numbers? Is it just to be sure the number is high enough to give the insulin and not relying on food to be enough to raise BG

We always check the BG before the shot to see that the BG is high enough and safe enough to shoot the dose. The way we decide the dose is the nadir or lowest point in the cycle. They only way to find that out is to home test.

it typical for BG to be rising so late in the cycle if I need to stall? Still

The BG will normally rise late in the cycle because the insulin is wearing off

 

[Sienne and Gabby (GA)]

It sounds like your vet is not factoring in the pharmacology of the better insulins for cats like Prozinc. With shorter acting insulin (e.g., Vetsulin, Novolin), you want to have food on board prior to giving a shot because those types of insulin act much more quickly and can cause a sharp drop in blood glucose. However, if it were my cat, I would still want to know what the numbers looked like. It's a very different matter to get a pre-shot number of 150 vs a pre-shot test of 50. You want to be sure it's safe to give your cat insulin or know what to do if the pre-shot number is lower than is either safe or below your comfort level for injecting. Your pre-shot number is just that -- the test result you get prior to giving a shot.

I know the food will raise the glucose a bit. Basically I was told that as long as they eat, should be safe to shoot.

Well, that's not always the case. If your cat is on a low carb diet, the food may not cause a large rise in blood glucose. And keep in mind you're feeding AND giving insulin. The insulin will then cause numbers to lower. If you haven't tested, you don't know where those numbers are or if they've changed since your previous test. The food may not cause a large change in numbers and then the insulin you're giving will drop the numbers. Depending on what that pre-shot number is, you could be scrambling to get the numbers back into a safe zone.

There's a wonderful website for information on feline kidney disease -- Tanya's site. We do not typically recommend renal diets because they are too high in carbs. Diabetes is hard on the kidneys. Getting your cat's diabetes under control will benefit the kidneys. I'd encourage you to take a look at the ingredients in the prescription renal diets. They are routinely awful (Hill's KD chicken: Water, Pork Liver, Chicken, Egg Product, Brewers Rice, Sugar, Chicken Fat, Chicken Liver Flavor, Modified Rice Starch, Powdered Cellulose, Fish Oil, Calcium Sulfate, Potassium Citrate, Guar Gum...) My favorite on that list is the powdered cellulose -- in common parlance, it's sawdust to say nothing of brewers rice and sugar. The major issue with diet for a cat with CKD is phosphorus. A low phos food is key. If your cat's CKD is advanced, Tanya's site has information on phosphorus binders that will allow you to feed your cat pretty much any canned food as long as you add the binder to the food.

 

[FrostD]

2U is a little high but not unreasonable for a high carb diet and kidney issues. Testing near nadir will be your best bet, on ProZinc that's usually 4 to 8 hours after the shot. Fructosamines aren't always an accurate picture - he could very well be dropping low then shooting back up as a protective measure (we call this bouncing).

 

[David - coco]

So I don't know if i should start a new thread or not but had a question.

I've tested a few times today. psam/210 - +6/259 - +10/118. For reference shes on prozinc - 2U

I tested her at +10 because I noticed she was twitching every so often when she was trying to rest/sleep. I've noticed this the last couple evenings but haven't tested until today. Its just a slight twitch of her head or paw every so often or sometimes looks like a muscle spasm where you see her skin twitch. Not bad, noticable. It was a little worse 2 nights ago. I'm still learning so I'm not sure if the 118 is bad?? What about the other numbers? Should I test again in an hour? Her shot is normally at 7:30.

Yes, i'm working on getting my sig. and spreadsheet set up. Thanks

 

[David - coco]

Did you look at the Weruva site that I sent you. It has some new low phosphorus low carbs food that is very suitable for diabetic cats that have crd. I would feed that before I would ever look at prescription foods. They are just a money making racket for the big companies.


The fructosamine test is an average of the last 3 weeks BGs. It doesn’t tell you if the BG dropped really low or if it went really high. I would strongly recommend you think about hometesting the BG to take the guesswork out of it. If an increase was needed it should have been to 1.25 units not 2 units. I would go back to 1.25 units if I were you. But unless you are willing to hometesting the BGs and setup a spreadsheet we can only help you so much.



We always check the BG before the shot to see that the BG is high enough and safe enough to shoot the dose. The way we decide the dose is the nadir or lowest point in the cycle. They only way to find that out is to home test.


The BG will normally rise late in the cycle because the insulin is wearing off

So I don't know if i should start a new thread or not but had a question.

I've tested a few times today. psam/210 - +6/259 - +10/118. For reference shes on prozinc - 2U

I tested her at +10 because I noticed she was twitching every so often when she was trying to rest/sleep. I've noticed this the last couple evenings but haven't tested until today. Its just a slight twitch of her head or paw every so often or sometimes looks like a muscle spasm where you see her skin twitch. Not bad, noticable. It was a little worse 2 nights ago. I'm still learning so I'm not sure if the 118 is bad?? What about the other numbers? Should I test again in an hour? Her shot is normally at 7:30.

i will say its tough because she does tend to twitch when shes sleeping good and deep. But i can tell thats not the case because you can tell she cant get comfortable and shifts her position a lot.

Yes, i'm working on getting my sig. set up and spreadsheet set up. Thanks

 

[David - coco]

Hi David…here is your first post for continuity https://felinediabetes.com/FDMB/threads/wet-food-for-diabetes-and-kidney-disease.272102/
2 units Prozinc twice a day is a lot to start off with. Most cats start off with 1/2 to 1 unit Prozinc. See what @FrostD thinks as she is a Prozinc user and I am not.
Did you get the food sorted out for Coco?
In the beginning we suggest not giving the dose if the BG is below 200 until we get more data. In the SS.
So you test first, then feed, then give the dose of insulin. If the preshot is not high enough to shoot we suggest you stall, don’t feed and the west again in 20 minutes to see if the BG is rising. Also post and ask for help.

So I don't know if i should start a new thread or not but had a question.

I've tested a few times today. psam/210 - +6/259 - +10/118. For reference shes on prozinc - 2U - AlphaTrak meter

I tested her at +10 because I noticed she was twitching every so often when she was trying to rest/sleep. I've noticed this the last couple evenings but haven't tested until today. Its just a slight twitch of her head or paw every so often or sometimes looks like a muscle spasm where you see her skin twitch. Not bad, noticable. It was a little worse 2 nights ago. I'm still learning so I'm not sure if the 118 is bad?? What about the other numbers? Should I test again in an hour? Her shot is normally at 7:30.

i will say its tough because she does tend to twitch when shes sleeping good and deep. But i can tell thats not the case because you can tell she cant get comfortable and shifts her position a lot.

Yes, i'm working on getting my sig. set up and spreadsheet set up. Thanks

 

[Bron and Sheba (GA)]

It’s fine to stay with this thread for now. Once it get up around 50 responses we like you to start a new one.
Remind me what type of meter you are using to test the blood glucose. We really need all this type of information in your signature so that we don’t have to ask questions each time you want an answer.
If you think you will need help, there is someone who is willing to help you get set up. @Bandit's Mom , she can do it in less than 5 minutes!

118 BG shouldnt cause twitching, but what was the BG in the previous couple of hours?
Are you still feeding a high carb diet? the other BGs are OK you mention, but we really do need to see them in the spreadsheet with all the other numbers to get an overall picture.
If she was 118 at +10 she may not get high enough to shoot at the next dose.
You can get a +11 if you want to but we will also need to see a +12 ( preshot BG)
It is very possible that 2 units is too high a dose.

 

[FrostD]

The 118 is good, I'm glad you got the +6 before it.

She may have a later nadir than most cats, perhaps around +8. For now, if she drops below 90 that's when you'll take a 0.25U reduction in dose. It's possible she went lower before that 118 (my experience says unlikely she went below 80s, probably close to 90), so it's up to you if you want to proactively take a 0.25U reduction until you get a little more data.

 

[David - coco]

It’s fine to stay with this thread for now. Once it get up around 50 responses we like you to start a new one.
Remind me what type of meter you are using to test the blood glucose. We really need all this type of information in your signature so that we don’t have to ask questions each time you want an answer.
If you think you will need help, there is someone who is willing to help you get set up. @Bandit's Mom , she can do it in less than 5 minutes!

118 BG shouldnt cause twitching, but what was the BG in the previous couple of hours?
Are you still feeding a high carb diet? the other BGs are OK you mention, but we really do need to see them in the spreadsheet with all the other numbers to get an overall picture.
If she was 118 at +10 she may not get high enough to shoot at the next dose.
You can get a +11 if you want to but we will also need to see a +12 ( preshot BG)
It is very possible that 2 units is too high a dose.

I updated it but we're using the alphatrak.

at +6 she was at 259.

So 118 shouldn't be low enough to cause twitching you think? Maybe its a sort of diabetic neuro issues? But to be perfectly honest, the last couple weeks shes been watched like a hawk so its entirely possible its a bit normal and I just never noticed but i dont think so. She has visible restlessness when its happening.

Should i test at 7:00 and see if I need to stall till her normal 7:30 shot?

UPDATE; as of 6:57 we're now at 148. So I guess I'll test again at 7:30 and see

 

[David - coco]

The 118 is good, I'm glad you got the +6 before it.

She may have a later nadir than most cats, perhaps around +8. For now, if she drops below 90 that's when you'll take a 0.25U reduction in dose. It's possible she went lower before that 118 (my experience says unlikely she went below 80s, probably close to 90), so it's up to you if you want to proactively take a 0.25U reduction until you get a little more data.

Should I test again at 7 and see what it is? Her shot is normally at 7:30

 

[Bron and Sheba (GA)]

Should I test again at 7 and see what it is? Her shot is normally at 7:30

Normally with Prozinc you test, feed and shoot within a few minutes. There is no need to wait 30 minutes. How long does it take for her to eat? If it takes 15 minutes, I would test at 7.15, feed her and shoot at 7.30.
I would defer to @FrostD about the dose and if you should stall/skip as she is a Prozinc user and I am not. Hopefully she will be around for that. Let’s see.

 

[David - coco]

Normally with Prozinc you test, feed and shoot within a few minutes. There is no need to wait 30 minutes. How long does it take for her to eat? If it takes 15 minutes, I would test at 7.15, feed her and shoot at 7.30.
I would defer to @FrostD about the dose and if you should stall/skip as she is a Prozinc user and I am not. Hopefully she will be around for that. Let’s see.

As an update i just tested again a few minutes ago and it was 148. She is a slow eater, 15-20 minutes usually to eat most of it.

I called the vet and she doubled down on saying to test AFTER feeding to determine whether to shoot. So I'm not sure

UPDATE: PSPM - 171. Ok to shoot??

 

[David - coco]

Normally with Prozinc you test, feed and shoot within a few minutes. There is no need to wait 30 minutes. How long does it take for her to eat? If it takes 15 minutes, I would test at 7.15, feed her and shoot at 7.30.
I would defer to @FrostD about the dose and if you should stall/skip as she is a Prozinc user and I am not. Hopefully she will be around for that. Let’s see.

As an update i just tested again a few minutes ago and it was 148. She is a slow eater, 15-20 minutes usually to eat most of it.

I called the vet and she doubled down on saying to test AFTER feeding to determine whether to shoot. So I'm not sure


UPDATE: PSPM - 171. Ok to shoot??

 

[Bron and Sheba (GA)]

You must test before food otherwise the Preshot is food influenced.
I am sorry but your vet does not know much about FD if she is saying test after food.
Is the 171 before or after food?
And have you given a dose before when the Preshot was around 172?
And are you going to give 2 units or reduce the dose to 1.75 U?

 

[David - coco]

You must test before food otherwise the Preshot is food influenced.
I am sorry but your vet firs not know much about FD if she is dating test after food.
Is the 171 before or after food?
And have you given a dose before when the Preshot was around 172?
And are you going to give 2 units or reduce the dose to 1.75 U?

Test was Before food. She just ate most of her food. The only other PS I got was this morning and was at 210 (before food also). just started testing yesterday. I would give the 2 U I suppose. My syringes dont do 1/4 U, only halves. i was told to skip altogether if it was <150. I called an ER vet (since my vet was closed) to verify and she suggested to skip <170. Was never recommended to reduce dose, only skip so not sure how i feel about that.

 

[Bron and Sheba (GA)]

Test was Before food. She just ate most of her food. The only other PS I got was this morning and was at 210 (before food also). just started testing yesterday. I would give the 2 U I suppose. My syringes dont do 1/4 U, only halves. i was told to skip altogether if it was <150. I called an ER vet (since my vet was closed) to verify and she suggested to skip <170. Was never recommended to reduce dose, only skip so not sure how i feel about that.

I’m sorry you just fed her because it would have been better to stall and not feed for 20 minutes and see if the BG is rising.
The reason I asked were you going to reduce the dose was because Melissa suggested that was an option as the 2 units could be too much. And I agree with that.
The Prozinc protocol recommends in the beginning you don’t shoot if the BG is below 200. And that is what I would recommend. And because you have now fed her, the option of stalling is not possible either.
Has she ever had ketones? Did the vet ever mention them?
Your options are to skip the dose if there were no ketones, or give a token dose of say 0.5 U
David… to be able to help you properly we need you to set up your SS and signature otherwise we are working in the dark. Would you like me to ask @Bandit's Mom to help you with that? let me know what you decide to do about the shot

 

[David - coco]

I’m sorry you just fed her because it would have been better to stall and not feed for 20 minutes and see if the BG is rising.
The reason I asked were you going to reduce the dose was because Melissa suggested that was an option as the 2 units could be too much. And I agree with that.
The Prozinc protocol recommends in the beginning you don’t shoot if the BG is below 200. And that is what I would recommend. And because you have now fed her, the option of stalling is not possible either.
Has she ever had ketones? Did the vet ever mention them?
Your options are to skip the dose if there were no ketones, or give a token dose of say 0.5 U
David… to be able to help you properly we need you to set up your SS and signature otherwise we are working in the dark. Would you like me to ask @Bandit's Mom to help you with that? let me know what you decide to do about the shot

Well at 6:55 it was 148 and at 7:25 it was 171 so I would assume its rising.
We did not talk about ketones but per the blood work/urinalysis it says Ketones - 0. So I think no ketones.
She ate all her food and I made the decision to give her normal dose so now I'm a little worried. Would you recommend to test again soon to see where things are at?

 

[Bron and Sheba (GA)]

If you gave the normal dose of 2 units I would get a + 1 and a +2 to start with so we can see where the cycle is going. After the +2 we can decide when to test after that
How does that sound.?
Do you have some high carb food and honey or karo in the house in case it is needed?

 

[Bron and Sheba (GA)]

Any updates on the +1?

 

[David - coco]

If you gave the normal dose of 2 units I would get a + 1 and a +2 to start with so we can see where the cycle is going. After the +2 we can decide when to test after that
How does that sound.?
Do you have some high carb food and honey or karo in the house in case it is needed?

Any updates on the +1?

Sorry for the late update.
Yes i have Karo on hand. The food is already high in carbs - this is something I'm working on do try and get better.
I unfortunately did not get the +1 but I did just get +2 and it was 295. So I think we'll be fine?

Thanks for the help. This has been a frustrating and extremely anxiety filled last 2+ weeks. The tough part has been the lack of information given to me to start. I've already gotten a second opinion from another vet and has help a little but seems to have gotten possibly miss information (ie when to PS test). Also, the way my brain works is I want to use the internet as a tool but I have a hard time trusting. So I mean no disrespect to anyone on here. I have an appointment next week with an internist for a consultation so hopefully I can get some more answers on a few things such as her kidneys and food choice.

 

[Bron and Sheba (GA)]

Yes 295 is fine. If possible I would get another test a bit later in the cycle if that is possible.

 

[David - coco]

Yes 295 is fine. If possible I would get another test a bit later in the cycle if that is possible.

How much later would you recommend? Also I have a question. For testing, I should be using the outside of the ear? I feel bad because I've been doing it on the inside so hopefully I'm not hurting her.

 

[Lauren and Loki]

How much later would you recommend? Also I have a question. For testing, I should be using the outside of the ear? I feel bad because I've been doing it on the inside so hopefully I'm not hurting her.

Hi David, I’m new here too, so not an expert by any means. I just wanted to say that we are also ProZinc users, trying to get my Loki regulated. So far, his nadirs have been in the +4 - +8 range. It’s not exact yet, but based on the experience so far, I would keep watching Coco’s numbers till at least +4, if not longer to +6. Especially if you gave 2U with BG under 200. Am I correct in this thinking @Bron and Sheba (GA) ? @FrostD ? Not trying to butt in, or scare anyone, just wanting to help

 

[Bron and Sheba (GA)]

Yes correct Lauren. A +4 and +6 would be good.

How much later would you recommend? Also I have a question. For testing, I should be using the outside of the ear? I feel bad because I've been doing it on the inside so hopefully I'm not hurting her.

Use the outside of the ear near the edge. Hold a cotton ball or tissue on the prick after you have finished for a minute to stop bruising

 

[Lauren and Loki]

Use the outside of the ear near the edge.

Does it make a difference if you prick with the point going in to the back of the ear, like from behind, or from the front of the ear?

 

[David - coco]

Yes correct Lauren. A +4 and +6 would be good.

Use the outside of the ear near the edge. Hold a cotton ball or tissue on the prick after you have finished for a minute to stop bruising

We're at 202 @ 4.5. Should i be concerned for the night?

 

[Bron and Sheba (GA)]

We're at 202 @ 4.5. Should i be concerned for the night?

He is dropping so I would get a + 6.
Are you feeding during the cycle as well as the Preshot meal.?
Please do try and get the spreadsheet and signature done. I want to help you but it is hard without those two things.

 

[David - coco]

He is dropping so I would get a + 6.
Are you feeding during the cycle as well as the Preshot meal.?
Please do try and get the spreadsheet and signature done. I want to help you but it is hard without those two things.

typically feed only twice at each shot times. She will nibble on the wet food she doesn’t eat during the meal a while after.
What am I looking for at the +6 test? And what should I do depending on the number I get?
Signature and spreadsheet are both there now.

 

[Lauren and Loki]

We're at 202 @ 4.5. Should i be concerned for the night?

In situations like this, you may want to try to get some sleep and set an alarm to wake you up to test. Or try to stay awake and set an alarm to test in case you fall asleep. It’s like having a newborn baby lol The BG seems fine now, but you’re still trying to gauge how Coco reacts to this dose. Last night, Loki went from 223 to 44 (granted he’s on a Libre and he mostly likely wasn’t that low but still lower than comfortable) in an hour and fifteen minutes. I was at work and had to have my dad help over the phone, and was posting here throughout. I would definitely try to get a +6 reading even if you have to wake yourself up. You don’t want to wake up to a crisis later on if you could’ve prevented it by checking earlier.

 

[David - coco]

In situations like this, you may want to try to get some sleep and set an alarm to wake you up to test. Or try to stay awake and set an alarm to test in case you fall asleep. It’s like having a newborn baby lol The BG seems fine now, but you’re still trying to gauge how Coco reacts to this dose. Last night, Loki went from 223 to 44 (granted he’s on a Libre and he mostly likely wasn’t that low but still lower than comfortable) in an hour and fifteen minutes. I was at work and had to have my dad help over the phone, and was posting here throughout. I would definitely try to get a +6 reading even if you have to wake yourself up. You don’t want to wake up to a crisis later on if you could’ve prevented it by checking earlier.

To what end though? Why not +8 or +10? She ended up being pretty low at +10 today (118). What number would be good at +6 to be comfortable for the night? Should I give a tablespoon of food to hold her over? I’m still learning though. I don’t know what the numbers should be at certain times of the cycle. Is there like a graph showing where numbers should ideally be?

 

[Lauren and Loki]

To what end though? Why not +8 or +10? She ended up being pretty low at +10 today (118). What number would be good at +6 to be comfortable for the night? Should I give a tablespoon of food to hold her over? I’m still learning though. I don’t know what the numbers should be at certain times of the cycle Is there like a graph showing where numbers should ideally be?

Good questions! Since this is the beginning of treating Coco, I suggested the +6 because you want to stay ahead of any issue that may arise. But I was just looking at your SS, and you’re right about her going lower at +10 (closer to shot time). Because of that, I would also suggest to keep checking +8 & +10. I also suggest doing this because you did dose her last with 2U while her BG was under 200. You just want to make sure she doesn’t go too low late in her cycle tonight, and when next shot time is approaching. Dosing while at a lower BG may cause a lower nadir if the dose is too high, from what I understand. I believe above 90 is okay. I do think others here will tell you she should eat more if possible. I’m just not familiar with how CKD affects diabetes. And don’t worry, I’m still learning too! @Bron and Sheba (GA) @FrostD can you correct me if wrong? Thanks.

 

[Bron and Sheba (GA)]

Signature and spreadsheet are both there now.

Fantastic thank you.
Looking at your SS it looks to me as if she was probably bouncing from some previous low numbers when you were not testing and this morning she was coming off the bounce, hence the lower numbers at the end of the am cycle. This is how bounces typically end…they keep on going down at the end of a cycle instead of going back up again as the insulin wears off.
Here is an explanation of bouncing from The yellow sticky The Basics:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

We test so that we can preempt any problems, that is why I suggested a +6. It will tell us if she is levelling out or still dropping. If she was still dropping and you didn’t test until +10 you might get a much lower number….not always but keep in mind…we have no data for Coco yet so we don’t know how she will react to the dose.
Normally with a normal cycle you see a preshot BG of say 300 and then over the course of the next seven or so hours it drops to say 120 and then it starts going back up again as the insulin wears off. But with a bounce breaking cycle the preshot can be lower (as it is the your current cycle) and then the BGs in that cycle can look like they are not following the usual pattern but they are in fact going back to what they would normally be if the bounce had not happened. Not sure I am explaining this very well …does it make sense?
If you get any BG under 90 you need to give some higher carb food to bring her up again over 90 and a reduction is earned.
Re feeding….we recommend giving some snacks during the first half of all cycles as well as the 2 main meals
A snack is a teaspoon or two of wet food or if you only have dry, a small amount of that.

 

[David - coco]

Fantastic thank you.
Looking at your SS it looks to me as if she was probably bouncing from some previous low numbers when you were not testing and this morning she was coming off the bounce, hence the lower numbers at the end of the am cycle. This is how bounces typically end…they keep on going down at the end of a cycle instead of going back up again as the insulin wears off.
Here is an explanation of bouncing from The yellow sticky The Basics:

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

We test so that we can preempt any problems, that is why I suggested a +6. It will tell us if she is levelling out or still dropping. If she was still dropping and you didn’t test until +10 you might get a much lower number….not always but keep in mind…we have no data for Coco yet so we don’t know how she will react to the dose.
Normally with a normal cycle you see a preshot BG of say 300 and then over the course of the next seven or so hours it drops to say 120 and then it starts going back up again as the insulin wears off. But with a bounce breaking cycle the preshot can be lower (as it is the your current cycle) and then the BGs in that cycle can look like they are not following the usual pattern but they are in fact going back to what they would normally be if the bounce had not happened. Not sure I am explaining this very well …does it make sense?
If you get any BG under 90 you need to give some higher carb food to bring her up again over 90 and a reduction is earned.
Re feeding….we recommend giving some snacks during the first half of all cycles as well as the 2 main meals
A snack is a teaspoon or two of wet food or if you only have dry, a small amount of that.

Good questions! Since this is the beginning of treating Coco, I suggested the +6 because you want to stay ahead of any issue that may arise. But I was just looking at your SS, and you’re right about her going lower at +10 (closer to shot time). Because of that, I would also suggest to keep checking +8 & +10. I also suggest doing this because you did dose her last with 2U while her BG was under 200. You just want to make sure she doesn’t go too low late in her cycle tonight, and when next shot time is approaching. Dosing while at a lower BG may cause a lower nadir if the dose is too high, from what I understand. I believe above 90 is okay. I do think others here will tell you she should eat more if possible. I’m just not familiar with how CKD affects diabetes. And don’t worry, I’m still learning too! @Bron and Sheba (GA) @FrostD can you correct me if wrong? Thanks.

At +6 we’re at 272 now. Does that seem right or possible?

 

[Bron and Sheba (GA)]

At +6 we’re at 272 now. Does that seem right or possible?

Yes it looks like the 202 @+4.5 was the nadir and now he is on the way back up again.
Safe to go to bed. Just leave a snack out for her overnight.

 

[Sienne and Gabby (GA)]

It's understandable that you may not be comfortable trusting all information on the internet. There's some bad information out there about feline diabetes to say nothing about other topics! FWIW, this message board has been around for 25+ years. It was established by an MD (Rebecca) who had a diabetic cat and had a very difficult time finding resources or a community of other feline diabetes caregivers. The fact that this group has existed for as long as it has is noteworthy and (IMHO) speaks to our providing solid information. Many of the experienced members do their homework. We read about feline diabetes and have access to medical and veterinary libraries. Some of us have been paying it forward for a long time.

Not to throw a brick at vets who have the impossible job of trying to know about disease processes across any number of species, they do not get a huge amount of training in feline diabetes. They get some but unless they are going into a feline specialty practice, the information is limited. Unlike with human medicine, vets do not have to do residencies. They can join a practice as soon as they are out of school. They do have to complete continuing education to maintain their license but the content of that education is up to the vet.

Despite newer insulin like glargine having been used for some time, many vets treat the newer insulin the same way as the shorter acting insulins. The pharmacology is very different. Vets also get next to no training in nutrition (nor do MDs). Most of their information comes from the pet food manufacturers. Recently, those manufacturers were the subject of a class action suit (and lost) because there is nothing prescriptive in the "prescription" foods they have foisted off on consumers for years. (If you read the label on some of the diabetic foods, there's nothing in there that's vastly different than any canned food and some of the food is horribly high in carbohydrates.)

By all means, retain your skepticism. Ask questions. We truly want you to be an educated caregiver.

 

[tiffmaxee]

Welcome. I tested poking the inside of Max’s ear because his ears were all black and I could see where I was poking much better. Either inside or outside is fine.

 

[Chrispooky12]

Hi there I also test on the inside of Panzer's ear because he is also black. I've never test on the outside, but whatever works for you & your kitty works. Testing is very hard & stressful at first but once you get it down it's like second nature. It gets easier I promise!

 

[David - coco]

FWIW as an update her amps was 322 and her pmps was 326. Is this about normal?

I did end up testing her twice for the PM shot. The first one didn't have much blood on it but still registered at 343. I decided to test again at that's when I got 326. Is it normal to have a discrepancy like that in a matter of a minute?

Also, when I gave her the shot, she jumped slightly and let out a small meow. This is the first time shes done that for me. Is it possible I hit a nerve or muscle or something?? The injection went in since I didn't have any wet fir. Should I be concerned that maybe it wasn't a good injection if it went into muscle? It was done on the scruff of the neck and afterwords, I realized I may have done it a little higher up on the neck then normal.

She did strain a bit when pooping this morning then right after threw up a little clear liquid (before eating and shot). That's the 3rd time in the last 7-8 days that's happened. She pooped twice yesterday and were normal so I don't suspect constipation but something I'll need to watch.

Is there any stickies I haven't come across that explains the glucose numbers and what to expect or how the numbers should change throughout the day? Basically explaining the numbers a little better and what's good and bad? Graphs or charts?

Thanks everyone for the help last night.

 

[Bron and Sheba (GA)]

It’s possible you could have hit a muscle but don’t ever repeat an insulin injection.
Not much difference between 326 and 342 when you take into account meter variance.
See if either of these links help

The prozinc basics

Prozinc dosing methods

 

[David - coco]

It’s possible you could have hit a muscle but don’t ever repeat an insulin injection.
See if either of these links help

The prozinc basics

Prozinc dosing methods

Yeah definitely know not to give another! If I did hit a muscle, is the injection usually still effective? I'm a little worried I hit a bone or something in the back of her neck.

I've read both of those. I guess I was more/less looking for something that explains maybe ideal numbers?

Are the AM and PM PS numbers I had today good, bad, so so?

 

[Bron and Sheba (GA)]

Remember it is very early on in your FD journey and you are just gathering data at the moment. The two Preshots today are fairly normal for a newly diagnosed FD kitty. Getting some tests in during the cycle will tell us a lot more than just the two Preshot tests. Try and get at least one test in each cycle if you can.

GENERAL INFORMATION

 

[Sienne and Gabby (GA)]

What can be considered, "ideal" numbers is normal range blood glucose. We use 50 - 120 as normal range. However, until a cat is regulated, numbers may be all over the place.

What you're seeing is a bounce. Coco isn't used to spending time in lower numbers. This is the case for most of our kitties since we rarely know how long they have been diabetic prior to diagnosis. As a result, when their numbers are in a better range, their liver and pancreas overreact by releasing a stored form of glucose along with counterregulatory hormones that cause the numbers to spike upward. Those pre-shot numbers in the 300s are reflecting the drop into the 100s on 12/30. It can take roughly 3 days for a bounce to clear although the duration of the bounce varies. The more time Coco spends in better numbers, the less frequently she will bounce.