Some advice on extreme glucose curves

zenworm

zenworm

Member
Hi all — been dealing with a recently diagnosed diabetic part-Siamese (it's a long story, but we have an idea of how he became diabetic). Going on 2ish months and dealing with a doctor who doesn't know much about diet (tried to prescribe him a high-carb dry food) and keeps trying to get him in for an in-office curve.

We've been doing the PetTest glucometer and drawing blood from the pads of his front paws, which he tolerates quite well.

A few weeks ago we took him in to get a Freestyle Libre put on, and after we sent some curves to the vet she increased his dose to 2.5u of Prozinc.

I wanted to share some of the most recent data because we've been having a hard time getting his levels down to a decent number, and I'm a little concerned how extreme his falloff and rise is.

I would appreciate any general advice for those who have seen cats dealing with this same kind of curve. I'm attaching a link to our spreadsheet (grouped by days, most recent first) and some screenshots from the Freestyle. Happy to provide any other data as needed.

One weird thing I'll note: when we first started tracking in Notion, he did hit very low of 78 (see screenshot). Granted, we were brand new to the glucometer at that point so the readings may not be trustworthy, but I do find it interesting he has never gotten back to those levels.

I just found these forums... sorry for the novel but I'm finding comfort in reading through all the threads and knowing so many others have gone through this.

Notion spreadsheet: https://zenworm.notion.site/Sid-Diabetes-Adventure-23704613d44440e9ba979791bc39249a?pvs=4
 

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Thanks! We have some good news tonight, his PMPS (I’m learning from this forum!) was 364 and we haven’t had that low of a number since we started. I’m thinking about doing a glucometer curve tomorrow since we’ll be at home all day.
 
zenworm said:
Thanks! We have some good news tonight, his PMPS (I’m learning from this forum!) was 364 and we haven’t had that low of a number since we started. I’m thinking about doing a glucometer curve tomorrow since we’ll be at home all day.
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This will be awesome and also I would like to see data from what happened last night.
 
Hi there. What are his shot times? I'm on eastern time in Georgia, so just curious. Generally, we don't use times here since we are all on different time zones and it's much easier to use the hours after shot times (+1, etc.) like on the spreadsheet. It's great that you have started your google spreadsheet. This will really help us here to see what's happening. Today, it looks like he's bouncing from that 284 last night (and he probably went a bit lower than the 284 since it was still a bit early in the cycle, although I do see some cats nadir early at about +4. The more test data we can get the better. In general, what is your work schedule and when would you be able to get tests. If you put another Libre on, it won't matter so much because you can just input the Libre data into your spreadsheet.
 
What does he eat? Is it low carb wet food? What kind of a feeding schedule does he have. It's best for our diabetic kitties to have multiple small meals spread out over time. I do not recommend feeding after the typical nadir (once we find out when that is) because it can shorten the duration of the insulin and cause BG to rise more than it ordinarily would prior to the next shot time. So let's say, for now, no more snacks after +6, unless it's just a very low carb treat that you give after an BG test using a handheld monitor. He's very beautiful by the way!

So a good feeding schedule for starters is to just feed and test (or scan Libre) at shot time and then let him eat his normal meal. Then at +2, you give a small snack of about 1-2 tsp. low carb wet food. At +4, you can do the same. People who are not at home usually buy the times automatic feeders to dispense snacks at pre-set times.

As for extreme drops in BG or extreme rises, I will know more when we have more spreadsheet data. I would not be too concerned unless you see a drop of 100 points in BG in an hour. If so, you need to feed to slow it down (this is part of the reason for the feeding schedule I've mentioned above -- multiple small meals throughout the early portion of the cycle help to stabilize BG and prevent steep drops.) We don't want steep drops because they can trigger a bounce into higher BG. Also, anytime the cat's BG drops into territory that his body isn't used to, it will most likely trigger a bounce. It's a frustrating, but very common part of managing feline diabetes. As for steep rising BG, that is very likely a bounce that you've been seeing, but I will have to have more data to know for sure.

When he had that 78, at what time in the cycle was it? How many hours after the shot? Also, what was the preshot number that you got before shooting the dose of insulin? How many units were given? There are several reasons I can think of where this scenaria could happen, but again, I don't have the data from that day's cycle or the previous cycles to give me more clues. Remember, a 78 isn't a bad number (although alarming considering the usually numbers on your sweet cat!) It's not dangerous, but if it was a steep drop and he seems to be in a free fall, you would want to feed (starting with a spoonful of low carb food first and then re-scan/test in about 30 minutes to see if the BG is stabilizing or rising on it's own.)

I've already dumped a lot on you.

It would be great if you could get your signature set up with the kind of information that we need to know (and so we won't have to keep asking you over and over... like what he eats!
 
Here's some information about how to set up your signature. See mine above.
Make sure your signature is up-to-date.
  • 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 info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • 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.

Thank you!
 
Have you been testing for ketones using either keto stix and putting them in the urine stream when he uses the litter box or using a blood ketone meter (I have a Nova Max Plus blood ketone meter.) Any history of DKA for your cat?
 
Thank you @Suzanne & Darcy, I've updated my signature, hopefully I captured everything.

Diet
He was raised on raw food (homemade) with his step-brother, until step-brother was diagnosed with kidney disease and we mistakenly put them both on Hills K/D for over a year. We believe this is what contributed to the diabetes, as that food is extremely high in carbs.

We now have them both on low-carb versions of Rawz and Weruva, after carefully looking at protein/carb contents of many foods (my Notion sheet is here for anyone curious).

Shot times
We feed at 7am/pm and shoot at 7:15ish, try to keep it like clockwork as much as possible.

When he was 78/84 early on, that was tested at feeding time so at that point we did not administer the 1u dosing (he was just 1u at that point). After that, he just shot back up and stayed extremely high for a long time until we recently went to 2.5u.

I'm attaching a curve I did on December 1 where I believe he was still at 1u. While he did get very low here, you can see another curve on December 10 where he was staying high. These were with the PetTest. Also attaching more recently data from the Freestyle Libre.

Ketones
We have not been testing for this and we haven't asked the vet about it yet. I can research this, I am not as familiar.

Thank you so much for the thorough reply. Very appreciative for this forum and being able to read through everything.
 

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So if you still want to feed raw food, a lot of our members feed raw and use a premix completer mix such as EZ Complete. I feed some of the Weruva BFF PLAY pate foods to my cats because they are low phosphorus. I haven’t fed the Weruva WX food yet, but I will try it if my cats need even lower phosphorus.
 
zenworm said:
After that, he just shot back up and stayed extremely high for a long time until we recently went to 2.5u.
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How did he get up to 2.5 units? Were the dose increases made gradually, or did he go from 1unit to 2.5 units without any intermediate doses?
 
@Suzanne & Darcy It was the Hills wet but still 38% carbs dry matter basis. Just crazy. We try to keep the carbs around 1% now.

I will look more into that premix. It says it’s made with eggshells which may help with the phosphorous situation with the other kidney diseases cat.

Should we start testing for ketones? I haven’t looked too much into this.
 
@Suzanne & Darcy After a quick read (will dive more into it tomorrow) he shows a lot of signs of DKA. Ketones smell on breath, excessive water drinking and urination, vomiting more than usual. The water intake has been going on for awhile, it’s why we originally brought him in for diagnosis in November.
 
Oh, and sorry, but since you’ve started a spreadsheet we need to somehow differentiate between the Libre readings and the Pet Test readings. It’s important to pick one meter that you will use most of the time and record those on the spreadsheet and then have a way of noting which numbers are from the PetTest meter. Pet meters tend to read a little higher than human blood glucose meters, and I have found Libres to read lower when cats are in the lower BG numbers (under 100).
 
zenworm said:
@Suzanne & Darcy After a quick read (will dive more into it tomorrow) he shows a lot of signs of DKA. Ketones smell on breath, excessive water drinking and urination, vomiting more than usual. The water intake has been going on for awhile, it’s why we originally brought him in for diagnosis in November.
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Okay. Then it is worth picking up some keto stix and trying to get a reading. Some of the things like drinking a lot and urinating a lot all go along with the high BG numbers. The breath smell and the vomiting are concerning. Is he eating well still? Lethargic at all? Did he have bloodwork done in November or more recently?
 
@Suzanne & Darcy Bloodwork in November but not sure they tested for ketones. I can call tomorrow and ask. Will go ahead and order sticks.

Spreadsheet and my notion page so far are only PetTest numbers, I never entered any Libre in there so we should be good.

Vet went from 1 to 2 and then to 2.5 because she wanted to try half steps going forward.
 
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