TESTING BG FOR FIRST TIME, HELP NEEDED

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phlika29

phlika29

Member Since 2014
Hi everyone I am starting to inject my cat remi with caninsulin for the first time tonight and would love your help, advice, observations.

Remi was diagnosed on Monday with a BG of 25.12 (452.16) this week and I spent a couple of days transitioning him onto wet. He went in today and had a BG of 22.7. The vet wanted to start him off on 1 unit of caninsulin twice a day(he weighs 4.9 kg). I bought a accu-chek meter and have started the dosing tonight.

I took a reading at 19:00 tonight and it was 23.2 mmol/L (417.6)
He ate a little bit-injected 1 unit at 19.20
+ 2 reading 15.06 (271.08)

I will take another reading in abit but in the meantime any suggestions or observations gratefully recieved
 
I've just tried for 15 minutes to obtain an ear blood sample to no avail. I have now used up all the lancets and nearly all the strips that came with the pack and don't know what to do. Remi is eating just now. Should I try again tonight before we go to bed (everyone is very stressed!) or just try again in the morning.

I managed to get more blood from the top of his ear and got quite good drops but the meter said E-6 error-not enough blood was applied. Yet it seems the same as before. So I've wasted the last six lancets and most the test strips. I do have a couple of sterile needles from when I had to give subcutaneous fluid. They are sterile but perhaps a little big. I am worried I can't seem to get the blood onto the strip correctly. If I can't do it tomorrow morning how will I know its safe to give remi his insulin? I have to go to work tomorrow.
 
First question: are you getting enough blood from the prick? If not, you might want to try warming the ear first. And yes, you can free-hand with a syringe needle or lancet if you want to try it that way.

Phlika29 said:
I managed to get more blood from the top of his ear and got quite good drops but the meter said E-6 error-not enough blood was applied.
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The method that works best for me is I angle the strip just above the blood drop and then gently tilt it down till the end of the strip hits the drop of blood and it sucks up the blood. You can try testing it out on yourself first to see if you can get the technique down.

For tonight, if you are able to and it won't be too stressful, I'd say try grabbing another test. Every test you're doing (whether successful or not) is just more practice. And practice makes perfect! :lol:
 
Thanks for the tips. I think we are all a little stressed to do anymore tonight and it is mid night and I have to be up at six.

What worries me more is that if I can't get it right I only have two strips left. If I do it wrong I won't be able to do a BG test before I give him his next shot. What should I do if that happens?

The blood goes on the thin end not the top doesn't it? I touched the strip on the blood once the meter beeped and the kept it there until it came up with the error or beeped. I just not sure what went wrong and deeply worried about not getting a reading tomorrow morning. He has just eaten now and it 5 hours post injection so going to have to assume his levels aren't too low.
 
Taking a break from testing tonight sounds like a good idea. That way you'll be fresh again in the morning. ~O)

Phlika29 said:
What worries me more is that if I can't get it right I only have two strips left. If I do it wrong I won't be able to do a BG test before I give him his next shot. What should I do if that happens?
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Buy more test strips? :lol: ;-) Since you just started giving insulin, I would be hesitant to tell you to give the shot without testing. BUT, since he seemed to have responded well with the testing you did get in today, it might be safe for you to give it if you think you'll be around to visually monitor him and/or buy more test strips for tomorrow's cycle.

Phlika29 said:
The blood goes on the thin end not the top doesn't it? I touched the strip on the blood once the meter beeped and the kept it there until it came up with the error or beeped. I just not sure what went wrong and deeply worried about not getting a reading tomorrow morning. He has just eaten now and it 5 hours post injection so going to have to assume his levels aren't too low.
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Right, on the end and not on the top. You should be able to see it "suck" up the blood. You might be holding the strip on there for too long and are getting too much blood on the strip, which is causing the error. Next time, watch as the blood gets sucked up and remove it when either the blood reaches the top of the strip or the meter screen changes from a "waiting for blood" symbol to a "processing" symbol. Sorry; I don't have any strips left for my Accu-Chek (I use a different meter now) so I'm using generic terms since I can't test this out in practice for you. ;-)
 
I agree with KPassa, you may well be getting too much blood on the strip. Just touch the very end of the strip onto the blood and watch it suck up the blood. Slowly does it. I do know how difficult and stressful it all is at first but congratulate yourself on making an excellent start. If you're worried about giving insulin this morning, perhaps give a half dose. And get some more strips when you can.
You will soon get the hang of it and will be on your way to treating Remi's diabetes.
Keep posting.
 
Thankyou Kpassa

Your comments have been very helpful. I am going to give it ago this morning with the two strips I have left. I haven't managed to look at the screen as I have focused on the blood ball :smile: will get some more strips today.

Diana&tom

I like your idea of a half dose as no one is around to watch him this morning. I am about to try to lance him with a unopened needle! Using the drums is going to be too expensive. Can I buy the little individual hand held lancers at Boots?
 
Ok just got a reading but poking the top of his ear with the sterile syringe. Got a lot of blood this time.

The reading was 7.7 mmol/L at + 12 hours. This is before his breakfast. I did leave some food down and so he probably ate 3 hours ago.

I don't give the shot do I? But give him his breakfast?

Also the ear I kept bleeding last night is very hot and red. Is that ok? I did the different ear this morning

Finally I haven't mentioned that remi is on prednicare 5mg eod. He is next due tonight. How will this affect readings? And what does it mean for tonight?
 
Hmmm,,that's an interesting reading for +12 and shows that that 1 unit dose has had a good effect. No, I wouldn't give insulin at this point, without other data to see whether Remi was lower than this during the cycle and is now going back up, or whether the Caninsulin has a gentler effect in him than it does in a lot of other cats and he is still dropping slightly. It is probably safe to say that the insulin has now 'run out' but it's better to be safe at this very early stage of the process.

As you are already adept at the needle prick, you probably don't need the lancet device in future, just the lancets. I'm afraid I don't know much about their availability but as they are essential (human) diabetic supplies I would guess that they are sold at pretty much all chemists, including Boots.

Keep us informed!
 
PS just looked at the Boots website and they have boxes of 100 lancets for around £5, so you should find them in stores.

And ref Remi's poor ears - just remember to apply gentle but firm pressure on the spot, using a little cotton wool or similar. I used to cut up tiny pieces of wet wipes and fold the piece over the part of the ear that had been pricked.

Not sure if any of us has also mentioned the importance of treats, for both Remi and you. Seriously! A little low-carb nibble such as a piece of chicken or ham to reward Remi for being a good boy will mean he associates the procedure with something nice. Give him lots of fuss and cuddles too. And for you, reward yourself with wine, chocolate or whatever cheers you up a bit, according to the time of day ;-) you too need to see the procedure as stress-free.
 
I think that the 1.25 mg steroid that I give eod must be out of his system and this in combination with the insulin has bought his level down to where it is now. Will come back at lunchtime and retest BG then but will leave off the insulin shot this morning.

Just tested his urine and this shows much lower numbers too:)

Many thanks
 
Phlika29 said:
The reading was 7.7 mmol/L at + 12 hours.
Click to expand...
NO INSULIN,
That 7.7 is at the higher end of the normal blood glucose range for a cat. :smile:
So, either Remi is getting long duration on the Caninsulin (unusual) or his pancreas is producing some insulin of it's own....

Eliz
 
Given the response that Remi has shown to that dose of Caninsulin, it might be a good idea to watch out for carryover effect. Saoirse didn't respond as well to Caninsulin as Remi seems to be doing. Her numbers rose at the end of each cycle, but there were a few times when she didn't get any Caninsulin for over 24 hours. Her BG levels held relatively steady for quite some time before rising further.

You'll be able to monitor all of this now that you're able to home test, and that will give you great peace of mind.

Well done! You're doing great. :thumbup
 
You're doing great!!! I remember the first time I tested I did ok then not so well and felt like giving up..Eliz recommended the Thrive treats from Zooplus and Angel loves them, they have no carbs.
If you have a lot of blood, just touch the strip to the blood and let it suck it up, rather than dipping the strip. Do you have the alphatrak on order still? The reason I asked is that the lancing device is easier to use than the one that came with my first glucometer. I did offer my spare (human) glucometer and strips and lancets to another girl on here as a long term loan, but if she doesn't want it maybe I could meet you somewhere Thurs and you can have it. The only reason I would want it back is if I'm still testing Angel regularly after next July. I have an alphatrak and get free strips until then, but after that I'd need something with more affordable strips.

Once you're comfortable(ish) with home testing and able to do a test in between as well, you can start giving Remi a very low carb diet, can let you know what food is good.

7.7 is a brilliant response to Caninsulin. I think you said Remi had other health problems too but he may still be suited for the trial Angel is on with the RVC. You would get a better insulin, free alphatrak, free insulin and food for a year. Here's the details
https://www.facebook.com/RVC.Diabetic.R ... linic/info
and if you go to the timeline you see a pic of Angel!!!

If you have a look at Angel's first spreadsheet, he was on caninsulin then, it will give you an idea of home testing results. Have a look at his latest one too, it shows how much better he is on the other insulin. If Remi isn't suitable for the trial and doesn't seem to be getting much better, ask your vetif he can go on Lantus.
xx
 
Thankyou for the encouragement

I've come home at lunchtime and tested his blood glucose at +17 hours and the reading is now back up to 20.8 mmol/l. I have to wait for his tea time now before I can give him his shot. This is a shame as he is now out of control until then.

So not sure what this implies if anything. He probably last ate 3 hours ago. So was it the caninsulin helping him still this morning or the lack of food. I guess you need more readings. I've bought some more strips and and for now still using the syringe but that leaves a cut rather than a little hole.

Sweet angel-I actually just cancelled the order for the alphatrak purely because I have spent a small fortune in the last few days but plan to buy it in a month or so. I ended up with the acu-chek aviva. If you have any strips for that machine that I could borrow from you that would be great as they are pretty expensive. I am still wasting three for every reading I get.

I am so pleased that you managed to get angel into remission. Do you know what caused her diabetes? I love the idea of that trial but am not sure about getting remi up to Hertfordshire. It might stress him out too much and his pancreatitis play up. You have to physically go? They won't speak to my vet? I will study your spreadsheets tonight. I would be interested to hear about the medication she was on and. Also the food.

Critter mom when you say carry over effect what do you mean? So Saoirse levels would rise before her next shot of caninsulin?
 
Another reason for the unshootable number is too high of a Caninsulin dose. The idea is to have a dose you can give safely twice a day at roughly 12 hour intervals. You might drop it to 0.5 to 0.75 units next shot.

And speaking of skipping - any time you have too low of a number to shoot at pre-shot, stall for 30 minutes without feeding and re-test. If it is a rising number, it can be safe to shoot something.
 
Hi bjm

What I don't understand is if the insulin is to given after food and the food makes the BG rise why don't we test the BG after they eat.? Also if the low point is about 5 hours post shot why was it lowest 7 hours afterwards?

I think I will give 1 unit again tonight as he will also be having his steroid dose tonight and if the same happens again maybe lower the dose.

Many thanks. Sarah and remi
 
We test before giving insulin to make sure it is safe. For new folks, we recommend you not shoot a glucose under 200 mg/dL or 11.1 mmol/L on a human meter.

We test mid-cycle whenever possible to see how low the glucose level drops. That number should go no lower than 50 mg/dL or 2.7 mmol/L on a human meter.

The nadir can vary, so randomly checking in the +5 to +7 time period is a good idea.

Caninsulin/Vetsulin is a mixture of 2 different insulins that last different lengths of time. It is possible to have 2 different nadirs with 1 for the shorter acting insulin and 1 for the longer acting insulin.

The steroid will have an impact on the glucose levels, generally increasing it. If it is not given every day, you may need to develope a scale where you give lsightly more insulin when the steroid takes effect and slightly less insulin as the steroid wears off. Frequent data collection will help you identify what works for your cat.
 
Phlika29 said:
Using the drums is going to be too expensive. Can I buy the little individual hand held lancers at Boots?
Click to expand...
Not sure how much they cost in the UK, but here, a box of 102 lancets (17 drums) costs me about $10 and lasts me 6 months or longer. The ease and convenience of the lancing device makes it worth the cost for me.

I have really shaky hands so I was never able to do it free-hand but I do know quite a few others here do it that way so they should be able to give you suggestions on how to do it without "cutting" the ear.

BJM said:
The steroid will have an impact on the glucose levels, generally increasing it. If it is not given every day, you may need to develope a scale where you give lsightly more insulin when the steroid takes effect and slightly less insulin as the steroid wears off. Frequent data collection will help you identify what works for your cat.
Click to expand...

Which specific issue are the steroids being used for? Any other alternative for treatment besides steroids? If steroids are needed, then you will simply work around that as BJ mentioned above.
 
Hi Kpassa

I have worked out that unless you move the indicator around the drum doesn't reset itself and so I can get 2 goes with the same needle. Yes this morning with the syringe I ended up cutting poor remi. Have just used the drum tonight and had to do it three times before getting a reading. My hands were shaking so much!

Re the steroids. I have reduced the vet in half since Monday and both the vet and I think we should wean him off completely. He was originally given it for his IBD and then when he had his cholangihepatitis flair he had both a steroid and antibiotic. He just never came off them as his tummy seemed to play up when we reduced the dose. I ashamed that I didn't get him off them earlier but I am also very nervous about him not having them and changing the food at the same time.

On that note I am transitioning him onto applaws chicken in jelly because it was limited ingredient and low in fat and carbs but it is incomplete. How long is it safe to leave remi on an incomplete food? I have got the thrive food in but don't want to rush too many changes at once.

I have taken remi reading tonight and it was 23.0 mmol/L (414). It has been 24 hours since his last caninsulin dose (because he was 7.7mmol/L (138) this morning and so didn't give the shot). He has had 1 unit of the insulin and I will take another BG reading at +4 hours to see what is happening. This is the night he has his steroid dose so I was wondering what I would see? Will it not control it as well?

Should I start a new thread or amend this thread title?
 
It sounds as if a bg of 23 is Remi's 'default' number (not an official term, but some unregulated diabetic cats do sometimes stick around a particular number when they have no insulin in their system).
Yes, take a +4 reading and if you can, a +2 would be useful as well. The more data you can collect the better. Or perhaps with the weekend coming up you can take a few more readings then? Remember the treats!
Yes, always a good idea to start a new thread when an existing one starts to get a bit unwieldy or goes off topic. Try to think of a heading that sums up exactly what you want to say, so you attract the most appropriate and helpful replies.
 
Thanks

I think tonight I might do just a +4 as both me and remi got pretty stressed with the last ear shot.hi poor ears look a mess. I will take more I think tomorrow and Sunday when I am home more.

I have been reading lots of threads and links and think I am beginning to understand a little more. The aim of treatment is to get them back with in both the normal BG and renal whatnot range for as long as possible each day. So my concern is that the caninsulin has big curves that go above these ranges at the beginning and maybe end of the cycles. Which insulin available in the uk avoids this?

What should I do if his BG levels are as low as 7.7 mmol tomorrow but then raised by lunchtime. I didn't like having him back out of control again. I could wait half hour to see if they rise but it seemed to me that they probably only really raised when I gave him his breakfast.

Sorry lots of questions.
 
I don't blame you for just going for a +4, I think I'd feel the same as you :-)
Yes, the action of Caninsulin is not always ideal for every cat, but it is rather early days yet to worry about what you have read. Every cat is different and it may be that Caninsulin suits Remi - we will only know when we see more data, and at that point you can start thinking about changing the dose (with the ok of your vet, but you will get good technical advice on dosing on this board).
So as for what to do tomorrow, I think it's a question of taking it one step at a time. Post here with as much info as you can (dose given, time, food eaten, bgs at intervals you are able) and sooner or later someone here will be along to help. I know it's not nice seeing Remi go back up after that nice 7 number, but as I said, these are very early days. Unregulated diabetics are most likely going to be outside normal numbers for periods of time so soon after diagnosis. After a few days you will start to see a pattern forming, which will make things easier. People here will help, and that's what the vet's there for, of course.
Easier said than done I know, but try to relax a little and take heart that you have made a really good start to treating Remi's FD.
 
Ok so I know I said I wouldn't go for a plus 2 but I did.

I will start a new thread but his +2 is 12.4 down (223.2) from 23.0 mmol/L (414)

He had his 1.25 prednicare about +1 and also ate some more wet food.

Diana/tom

Thanks for the reply. Very reassuring. I am desperate for it to be under control straight away. I get myself very overalls stressed when remi gets unwell. I think I have probably lost more weight than remi has :smile:

What is your opinion on feeding remi an incomplete food for a few more days? Before transitioning onto the new wet one?
 
Mmmm, that's what you'd call a fairly steep drop. The good news is that Caninsulin definitely works for Remi. If you can get any more tests done - sorry, I don't want to nag, but this is what will help - post on a new thread and ask for people's opinions. It may be a question of tweaking the dose and/or food to achieve more of the cycle in lower numbers.
As for incomplete food, I suppose most of us on this board would want to get our kitties on the optimum diet asap, but if Remi likes what you are giving him that's at least one 'constant' while you are discovering how the insulin works in him. A variation of food at this point could distort the pattern of bg numbers you're getting, so I would say try to collect some more bg data over the weekend and then think about a change of food. Others may be able to add more on this point...?
 
Phlika29 said:
I will start a new thread but his +2 is 12.4 down (223.2) from 23.0 mmol/L (414)
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Hi,

As Diana said, that is a steep drop for +2.
Remi's blood glucose level has dropped by almost half in just 2 hours post shot. And it will probably continue to drop for (typically with Caninsulin) maybe another 2.5 hours (give or take half an hour maybe). Are you able to get another test during that time..?

Caninsulin/Vetsulin often has steep drops early on in the insulin cycle. For this reason it can be helpful to feed a second small meal (or half of the main meal) 1 - 1.5 hours after the insulin shot. This puts a bit of glucose into the system and can help to counteract that steep drop and balance things out a bit.
If you're not home to give a second feed then you could just leave food out for Remi (or do you have other cats who might eat the food?) or set a timed feeder to open up and provide a tasty mini meal.

Feeding an 'incomplete' food for a little while should not do any harm. Did I read that you're feeding Applaws? (I can't find where you posted what you're feeding...sorry...). If that's the case then it will be probably be lower in fat than is optimal and also may not have taurine and other vitamins/minerals added; but short term I think this would be unlikely to cause any issues. (And if you're concerned you could consider giving a vitamin/mineral supplement in the interim).

We all really do understand how stressful this is for you at the moment. But you really are doing incredibly well. You've accomplished a tremendous amount in a very short space of time.
Do look after yourself too though. And remember to breathe..... ;-)

Big reassuring hug,

Eliz
 
Hi Diana

Yes I am going to try to get another shot at +4. It's a bigger drop than yesterday yet he has had his steroid tonight.

Hi Elizabeth

Since his original dose he has eaten two small meals and seems much more perky than earlier this afternoon. I do tend to feed little and often as he has acid reflux and pancreatitis. The wet food is much bulkier than the dry and I do find that even small meals can make him seem a little uncomfortable. You are right it is applaws. I wanted a food that had no more than 45% of calories from fat and over 50% from a single source of protein. Although there are lots of good quality ones out there now most seem to have too high a fat level for remi as he appears sensitive to fat. I was going to transition him onto a Thrive complete food starting next week. Unless you can think of a food that might fit the bill.
 
Hi Sarah,

Are you feeding Remi exclusively on low carb now? Or are you still transitioning? I ask because with a 12-point drop like that you could end up with a very low reading very soon, esp considering Remi's low number this morning. If you're still feeding a mix of low and high carb be very careful when you increase the proportion of low carb in Remi's diet because his numbers may go lower still. And test as frequently as you can. It's the best way to keep him safe.

If you have the time available, I'd suggest you run a 12-hour curve over the weekend. It would give you a much better picture of how the Caninsulin is working in Remi's system.

If' Remi's numbers are low at pre-dose time, I'd suggest asking your vets or some of the experienced members here for advice before giving the next dose of insulin.
 
Okay I just did a + 4 and it is now 3.7mmol/L ( 66) that's a little low isn't it?

I did give remi some a mix of of the dry and normal food but tonight you are right it has been just the wet food. I am a little all over the place and didn't even think about the wet.

I shall give him some food mixed with his old stuff.

Thoughts? Will start a new thread
 
Start a new thread with a 911 flag, Sarah. Post the BG value in the thread title.

That is VERY low.

I'm not experienced enough to advise you through this.

I'd recommend giving Remi some of his high carb food IMMEDIATELY. Don't let him eat too much at one time in case you might need to feed him again shortly.

Have you glucose handy?

Edited to add:

Don't give him too little either.
 
No glucose. I have honey. I don't think there was much difference in today's and yesterday's food. But to be honest my head is fried with all this so maybe not. But I dint put any dry food in the wet tonight.

I have given him his biscuits a minute ago and some of his low carb food. I think I make up his royal canin convalescence liquid food as it is full of carbs.
 
Suggest reposting the food info in your 911 thread. Honey's fine.

I won't post on this thread anymore. Better to keep to the new thread.
 
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