Surprise Glucose Curve

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The Liz

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So, my cat is very difficult at the vet. To the point where they will not perform a curve on him and want me to do it at home. I haven’t done a ton of testing with him because I am new to the idea and was taking it slow. He’s very difficult with me as well and I am stressed that I have to do a curve without a ton of experience. I plan to dose him with gabapentin to make life easier for us both but am worried about having to test him so much in one day. Does anyone know a way to handle a difficult cat that isn’t used to testing and is going to have to get a lot of tests quickly? I’m guessing there aren’t a ton of shortcuts but any help would be appreciated
 
Lizzie, if you could get your spreadsheet set up it will make it much easier for us to help you. Here is a link to how to do this
HELP US HELP YOU. I will ask @Bandit's Mom to look in to see if she can help you with it.
This is what you wrote in your first post

I have just started testing him and not as regularly as I should because he’s so difficult. Once he gets more used to (less stressed) I will update with a spreadsheet. He’s had two hypoglycemic episodes in the last few weeks. The first he had a seizure and the second he kept his head down and was unsteady on his feet. Both times I took him to the ER vet who diagnosed hypoglycemia. They want me to take a break from insulin until we can get a curve. He since has stopped throwing up, so I assumed it was related to being hypo.

You can see the importance of hometesting, if your kitty has had a seizure and another symptomatic hypo. This should not happen if you are hometesting becasue you will be aware of where the blood glucose is up to and can take steps to stop the blood glucose from dropping further. Here is a link to HOMETESTING. Please read through it and ask questions. We are happy to help you with this.
Now importantly
  • did the vet tell you to reduce the dose after both the symptomatic hypos?
  • What is your current dose?
  • What dose were you giving when the symptomatic hypos happened?
  • Do you have a hypo box set up in case of further hypos?
  • What food are you feeding?
  • Are you giving a good meal before the dose and waiting 30 minutes before giving the dose? Vetsulin hits hard and fast and it’s very important your kitty has food aboard to counteract this.
  • Are you giving 2 or 3 snacks during the first half of all the cycles?
We are here to help you :)
 
Methos doesn’t mind needles but hates anyone touching his ears (always has. I get it. I hate anyone touching my feet). He also really hates being restrained. So when I started in April it seemed insurmountable. FWIW (and ymmv) I get everything ready (including 2x2 opened and lancet uncapped, I kneel on the floor with him sitting in front of me so backing isn’t an option. I loop my left arm loosely in front of his chest, grab lancet in right hand while picking up 2x2 quickly in left, bringing both to his ear for a fast prick. I put down lancet and grab meter in right hand while still not directly holding onto him (if it looks like he will shake his head I may scratch under his chin and he usually holds still then). Only if I must and only at the last second as I bring strip to blood drop will I hold his ear. once test done I do hold some pressure on ear but he’s getting a treat at that point so is more tolerant.
treats were a big part of it—he loves freeze dried chicken breast more than anything—he gets some after a test and sometimes when he’s hungry he will walk to where we test (and I keep his meters) and sit looking at meter then me then meter. It took him about 4-6 days to make the association.
Making sure he’s warm also helped since I can’t do the ear warmer trick. So I don’t turn on AC (or I turn it off) in time to make it toasty for testing. Sometimes I run hot water on my hands (which are usually cold) before testing to help.
Last but not least, from his Cushing’s my cat is weaker on his non dominant right side. So I test his left ear preferentially because he’s too weak to hold himself up on only his right front and both back legs. If I test his right ear he can be a tripod on his left front and use his huge right polydactyl paw to interfere. So if your kitty has a weaker side test the ear on the stronger side.

Good luck. I thought I’d never succeed but with each test it got easier. It will for you also

ps gabapentin didn’t make a difference for Methos. Edit: I should also say I’m ambidextrous so if I make it sound too easy sorry but I think even right or left handed this system would work for a cat that hates restraints
 
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Bron and Sheba (GA) said:
Lizzie, if you could get your spreadsheet set up it will make it much easier for us to help you. Here is a link to how to do this
HELP US HELP YOU. I will ask @Bandit's Mom to look in to see if she can help you with it.
This is what you wrote in your first post

I have just started testing him and not as regularly as I should because he’s so difficult. Once he gets more used to (less stressed) I will update with a spreadsheet. He’s had two hypoglycemic episodes in the last few weeks. The first he had a seizure and the second he kept his head down and was unsteady on his feet. Both times I took him to the ER vet who diagnosed hypoglycemia. They want me to take a break from insulin until we can get a curve. He since has stopped throwing up, so I assumed it was related to being hypo.

You can see the importance of hometesting, if your kitty has had a seizure and another symptomatic hypo. This should not happen if you are hometesting becasue you will be aware of where the blood glucose is up to and can take steps to stop the blood glucose from dropping further. Here is a link to HOMETESTING. Please read through it and ask questions. We are happy to help you with this.
Now importantly
  • did the vet tell you to reduce the dose after both the symptomatic hypos?
  • What is your current dose?
  • What dose were you giving when the symptomatic hypos happened?
  • Do you have a hypo box set up in case of further hypos?
  • What food are you feeding?
  • Are you giving a good meal before the dose and waiting 30 minutes before giving the dose? Vetsulin hits hard and fast and it’s very important your kitty has food aboard to counteract this.
  • Are you giving 2 or 3 snacks during the first half of all the cycles?
We are here to help you :)
Click to expand...

Thank you for your help! In answer to your questions
-the vet said to reduce insulin after both episodes. The first was at 3 am, about 8 hours after a dose and the second was at about 3:30 pm about 8 hours after a dose.
-the current dose is 2 units in a U40 syringe
-For the first episode he was at 4.5 units. For the next he was at 2 (which is why the vet said to lay off insulin until we got a curve)
-I have maple syrup and those feeding syringes
-His food is Royal Canin Satiety Support
-I give the dose right after the meal typically
-I had been giving him dry food snacks but the vet said to be consistent and I can’t with the hours I work
 
Hey another possible option might be using a 24/7 monitor like the freestyle libre. It’s pricey but otoh I haven’t compared price of 2 weeks worth of lancets, test strips and 2x2 to its cost. That may make it seem more reasonable. I can’t use them on Methos because of the Cushing’s but o/w I could see an advantage of this at least on curve days. The drawback is it’s a human meter so the readings will be off and there’s no way to definitively calculate the feline numbers, but I suppose you could use a 24/7 monitor and then use the alpha trak at 0, and some point between 4-6 (wherever the libre seems to indicate you’re at the lowest point)
 
The Libre is such a good option if it can work out. Raj had a Libre installed a year or so ago and he pulled it out as soon as we got home. If this curve at home doesn’t work out, we are going to try the Libre again. Raj really is a stinker
 
My initial thought was to suggest a Freestyle Libre, as well. The Libre is a continuous glucose monitor (CGM) that was developed for use with humans. Vets have been using it with cats, as well. The sensor is "glued" to your cat's skin and will provide a blood glucose level you can read on your phone. One way to prevent a cat from detaching the sensor is to get your cat a onsie like you would use on an infant. The Libre isn't a perfect solution in that it tends to give falsely low readings when your cat's blood glucose is in the lower end of the range. However, if you need time to build your home testing skills, it's a reasonable solution. Also, just as an FYI, it takes several weeks for the capillaries to build up so it's easer to get blood when you test. I'm also wondering whether it would be easier for you to test your cat on his paw pad.

I don't think Bron included the link to our info on home testing.
 
The Liz said:
The Libre is such a good option if it can work out. Raj had a Libre installed a year or so ago and he pulled it out as soon as we got home. If this curve at home doesn’t work out, we are going to try the Libre again. Raj really is a stinker
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He sounds like my Tammuz, who is the funniest cat I’ve ever met and smiles just before he does something destructive like he’s aware of the joke.
Perhaps a T-shirt over the libre? Because of his bare belly and fragile skin I used those for a while with Methos but he had such an embarrassed look over them, even the one that said “chick magnet”. Edit: rather than infant onesies I bought medium dog Tshirts bc a) more open near the boy bits for litter box use and 2) methos is about the size of a Maine Coon/Siberian
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I was wondering about testing on the pad as well. I haven’t tried to get a reading on his pad before and I feel like he would hate that even more than the ear. Luckily my mom is coming to help me get the readings so that she can hold him and I can do the sticking. We’ll see how it goes
 
The Liz said:
I was wondering about testing on the pad as well. I haven’t tried to get a reading on his pad before and I feel like he would hate that even more than the ear. Luckily my mom is coming to help me get the readings so that she can hold him and I can do the sticking. We’ll see how it goes
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I’ve read you should use a non-weight bearing pad. I feel like it must be more sensitive than an ear (but like I said, it’s not the needles that bother Methos it’s being restrained that made him fuss—when I stopped doing that he was cool). My bigger concern would be infection—they do walk on those feet including the litter box, and diabetics are more prone to infection…I’d be interested in others’ experience
 
To the best of my knowledge, and I've been on the board since 2009, no one has ever mentioned that their cat developed an infection as a result of testing on a paw pad. That said, not many people test using their cat's paw. The information is anecdotal. The likelihood is that the edge of the ear is less sensitive to being pricked given that there are fewer pain sensitive nerves located there.
 
The Liz said:
For the first episode he was at 4.5 units. For the next he was at 2 (which is why the vet said to lay off insulin until we got a curve)
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I am concerned you are now not giving any insulin until you do a curve. Just stopping insulin in a diabetic cat can cause ketones to develop if the cat still needs insulin. Please go out and buy a bottle of Ketostix from a pharmacy and test your kitty’s urine to see if there are any ketones. follow directions on the bottle and read the results exactly 15 seconds later. There should be no ketones. If there are then insulin needs to be restarted.

The Liz said:
I give the dose right after the meal typically
Click to expand...
With Vetsulin you need to feed then wait 30 minutes before giving the insulin. This is because Vetsulin hits hard and fast and your cat needs food aboard before the insulin hits.
The Liz said:
had been giving him dry food snacks but the vet said to be consistent and I can’t with the hours I work
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I would think about looking into an automatic timed feeder. Lots of us use them and it allows us to leave food out for our kitties when we are not there. He needs to have snacks available for when the blood glucose drops during the cycle. If you are in the US petsafe has a couple of good timed feeders.
 
Okay I can go get the ketostix. My vet said he would be okay as long as his behavior and clinical signs don’t indicate any changes. So far he’s been okay thankfully. But I understand the need for testing
 
Still no ketones. We’ve tested him 3 times since his breakfast (once every 1.5 hours) and his numbers are going up. Is this typical for a curve or something I should be worried about? So far the readings are 477, 494, and 523 in order. He at his food 10 minutes before the first reading.
 
The Liz said:
Still no ketones. We’ve tested him 3 times since his breakfast (once every 1.5 hours) and his numbers are going up. Is this typical for a curve or something I should be worried about? So far the readings are 477, 494, and 523 in order. He at his food 10 minutes before the first reading.
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I’m neither a vet nor an expert. I do know glucose will go up after they eat and since he didn’t get insulin it will only come down if he is making some himself. Since all three numbers are diabetic level numbers I don’t think they’re going to come down but that’s just a guess on my part
Does your vet have an after-hours number you could call for advice?
 
Also fwiw the Alphatrak has a 10% precision standard so all three of those numbers could be essentially the same but they are all high and seem to be trending high so if it were me (because I’m easily made anxious) I’d call my vet (who thankfully has an after hours number)
 
SmallestSparrow said:
I’m neither a vet nor an expert. I do know glucose will go up after they eat and since he didn’t get insulin it will only come down if he is making some himself. Since all three numbers are diabetic level numbers I don’t think they’re going to come down but that’s just a guess on my part
Does your vet have an after-hours number you could call for advice?
Click to expand...
They should be open and I can call for some advice about the curve. Thankfully they have weekend hours.
 
I called the vet and they were not concerned by the numbers, especially since they have gone down a little since. They said to call in tomorrow with the curve and we can establish the new insulin dose
 
It would help us a lot more if you could set up a spreadsheet…without it we really can’t help you as we need BG data to give help safely. Just a few BGs given to us in text is not enough. We need to see the whole picture. I gave you the link to our spreadsheet in post 2. If you would like help in setting it up I will ask @Bandit's Mom to contact you.
You should be able to do a curve and give the normal snacks you usually do without having to worry the food will ionfljence the curve much. Your kitty needs to eat. im glad there are no ketones. I would keep getting a daily test atm.
 
Sorry for the delay. This curve is my first time doing consistent BG readings for my cat. I am working on becoming more consistent but that is why the spreadsheet has not been forthcoming.
 
Hi Lizzie—I just read the alpha trak booklet and HI is over 750! @Bron and Sheba (GA) are you out there?

edit: it says to consult a veterinarian and to do a control solution test (if you haven’t done that I can explain how ) to be sure strips and meter ok but consult a vet
 
The Liz said:
called the vet and they were not concerned by the numbers, especially since they have gone down a little since. They said to call in tomorrow with the curve and we can establish the new insulin dose
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Just so you know, you don’t really want to choose a dose based solely on how high the numbers are in a given curve. I know vets tend to do that, but it’s not at all like “my car is a quart low on oil so I’ll just add a quart.” Some cats can go from 500 to 50 on a half unit (0.5u) of insulin, others require much more. That’s why BG testing is so critical. Every cat is different, and ideally you start at a low, safe dose and methodically work your way up in dose while gathering the BG test data. Anything else is just guessing (which can be dangerous, especially with an insulin that tends to be harsh in cats such as Vetsulin), and can slow down progress toward regulation.

If you haven’t done so, you might want to read the following Vetsulin links:

Introduction to Cansulin/Vetsulin and N/NPH

Beginner’s Guide to Caninsulin/Vetsulin
 
JL and Chip said:
Just so you know, you don’t really want to choose a dose based solely on how high the numbers are in a given curve. I know vets tend to do that, but it’s not at all like “my car is a quart low on oil so I’ll just add a quart.” Some cats can go from 500 to 50 on a half unit (0.5u) of insulin, others require much more. That’s why BG testing is so critical. Every cat is different, and ideally you start at a low, safe dose and methodically work your way up in dose while gathering the BG test data. Anything else is just guessing (which can be dangerous, especially with an insulin that tends to be harsh in cats such as Vetsulin), and can slow down progress toward regulation.

If you haven’t done so, you might want to read the following Vetsulin links:

Introduction to Cansulin/Vetsulin and N/NPH

Beginner’s Guide to Caninsulin/Vetsulin
Click to expand...

Turns out the vet wants to switch the insulin to Prozinc, starting at the lowest dose possible tonight. I have read the link about Prozinc that was posted to bone up on what to expect. I mentioned changing his food and meal time to more than twice a day but the vet said to keep everything else the same so that we know it’s the dose of the insulin making a change and not another factor.
 
The Liz said:
Turns out the vet wants to switch the insulin to Prozinc, starting at the lowest dose possible tonight.
Click to expand...
Prozinc would be preferable to Vetsulin. And it's a good idea to start at a low dose and increase gradually so that you don't bypass a good dose.


The Liz said:
-His food is Royal Canin Satiety Support
-I give the dose right after the meal typically
-I had been giving him dry food snacks but the vet said to be consistent and I can’t with the hours I work
Click to expand...
Btw, you also want to try a change in diet to a low carb one. I don't think the RC is low carb and most dry food is too high in carbs
 
Bandit's Mom said:
Prozinc would be preferable to Vetsulin. And it's a good idea to start at a low dose and increase gradually so that you don't bypass a good dose.



Btw, you also want to try a change in diet to a low carb one. I don't think the RC is low carb and most dry food is too high in carbs
Click to expand...

I mentioned changing the food to the vet and she wants to change only one thing at a time since we’re changing insulin
 
The Liz said:
I mentioned changing the food to the vet and she wants to change only one thing at a time since we’re changing insulin
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I understand, but feeding carbs while giving insulin is like trying to put a fire with one hand while adding fuel to it with the other! The switch to a lower carb could make a big difference to his numbers and greatly reduce his insulin requirements. Like with humans, diet is an essential part of treating diabetes.

If he has never had ketones and you can test for ketones every day, you could even take a break from insulin for a few days (a week or less) and try a diet change. Or start at a really low dose of Prozinc (like 0.5U) and gradually change the food over a week or so (that will also prevent tummy upsets from overnight changes in food).
 
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