Today's Glucose Curve

Hi

I am in the process of completing a glucose curve today. Looks like Douglas' lowest point was 10.2. Any advice before I go back to my vet? I am anticipating that he will want to raise Douglas' insulin to 3IU.

I have some Thrive Complete and Wild Freedom food on its way (hopefully arriving by the weekend) as Douglas is not a fan of the Purina DM.

I have one more BG test to go at 5.30pm (in about 1.5 hours) and then just his standard PMPS

Many thanks in advance as always!

 

There's not a lot of data to go by ... it looks like he was trying to clear a bounce today. He miiiiight be ready for a 0.25u increase but I personally can't tell, not enough data. Tagging @Deb & Wink , she won't be online for several hours though probably. Have you discussed switching to Prozinc with your vet? Are you able to get in some earlier tests each cycle (+1 to +4 perhaps)? You're probably fighting against bounces and short duration.

 

Thanks. So is testing just before the shots and on curves not enough? Should I be testing every hour?

I can do a +1 and +4 tonight after the PM shot and can do testing over this weekend. I will hopefully have the GlucoNavii by then so I may be less conservative with the test strips.

 

Pre-shots are necessary for making sure the kitty is high enough to need insulin. Most of us actually don't do curves, we do mid-cycle spot checks 2-4 times daily instead. I think curves are more intended for people who work a day job and aren't able to get mid-cycles until the weekend.

Caninsulin is a little bit tricker than Prozinc or Lantus because it usually only lasts 3-5 hours after shooting. You wouldn't really need to do every hour until +5, but you could alternate. Say +1, +3, and +5 one day and +2, +4, and +6 the next. After a few cycles of doing this you should have a pretty good indication of where Douglas drops the lowest, and test accordingly.

Ahh yes, definitely understandable with Alphatrak strips.

 

Douglas got a relatively late nadir for Caninsulin (usually comes between +3 and +5). The too-short dose duration is classic Caninsulin.

Your vet probably will recommend a dose increase but that's only likely to budge the curve down a little, not extend duration of effect.

I second Elizabeth's suggestion to talk to your vet about switching to a longer-acting insulin. It should help to keep Douglas in better numbers for longer each day.


Mogs
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Thanks @Critter Mom and @Panic

So is my understanding that we are looking for more of a low dip as oppose to an actual curve and would Prozinc, being a slower but longer insulin help with not having such large number drops/highs throughout the day?

Sorry if I have repeated what you are both saying, just want to make sure that I understand so when I speak to the vet I at least sound like I now what I am talking about

 

Yes! On a curve Caninsulin tends to make a "check-mark" shape, with a sharp drop and then steep incline up quickly. Prozinc makes a "smiley-face", with a gentle dip that rises back up gradually.

 

So this may seen a silly question, why do vets prescribe Caninsulin. Wouldn't we prefer to avoid such a sharp drop and steep incline?

 

I would definitely suggest putting up a good case with your vet for Prozinc. Caninsulin is always going to have the same action - fast onset and short duration - and a gentler, longer-lasting insulin is just a better bet.
If Douglas could talk he would tell you that the fluctuations in his bg don’t make him feel great; a gentler “smile” of a curve rather than a big cheesey “grin” will make him feel better.

 

Ideal curve of a cat on Caninsulin/Vetsulin:





As you can see, today's curve is pretty much textbook for this insulin.

Lantus curves are typically shallower (don't drop BG as hard) and wider (longer-lasting), a bit more of a smile than a saucepan.

I don't know much about Prozinc curves, but the insulin is longer lasting in cats.


Mogs
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The difficulty with curves is that they are just a snapshot of a single day. For example, if your curve had been done two days ago, when you got a PMPS of 11.3 we might be drawing very different conclusions to what we'd draw now when only looking at today's data.
Because there were no other tests during the AM cycle on the 1st Sept we don't know what happened in the run up to that 11.3 PMPS. The blood glucose may have dropped slowly toward that number, or it may have dropped much lower and be rising at that point. But, because of Caninsulin's 'typical' short cycles, the lower PMPS of 11.3 does raise some questions which we currently can't answer... (And he may still be clearing a bounce today...)
Because we don't know what happened prior to that lower PMPS I'd suggest holding off from any dose increases at this point.

I'd suggest trying to get some mid-cycle tests for a few days in addition to preshot tests (at least one mid-cycle test each day if possible). That could give a lot of useful info whether Douglas does or doesn't switch to Prozinc. It's always useful to be able to identify 'exactly where we are' before moving on to somewhere else.

And Anna - well done you for doing that curve! Great stuff! I hope you gave yourself some nice treats for doing that...

 

I think it's something to do with the cascade system in the UK? Haven't done updated research but from my understanding Prozinc has only recently been approved for regular use in the UK. They need "proof" that Caninsulin is not working before moving on to Prozinc.

Lantus would be better - it puts the BG into low numbers and keeps them there, making the BG curves low and flat. I think it's difficult getting Lantus approved though, someone local will have to give details on that.

 

Not a silly question at all!

Currently only Caninsulin and Prozinc are licensed for use in cats in the UK. Vets are required to prescribe one or the other first. If the first one doesn't suit, then the other must be prescribed next. Only when both of these insulins have been found wanting is a vet free to legally prescribe other insulins under drug cascade rules.

Prozinc only received its licence a few years ago. Prior to that vets had to start with Caninsulin because there was no other option available. Even though Prozinc now provides an alternative, I suppose that vets are as likely as any of the rest of us to be creatures of habit and reach for the familiar option first.

Another reason why a vet might prescribe Caninsuiln/Vetsulin because it's the only insulin a cat can tolerate (not all insulins suit all cats).

It must be noted that some cats do well on Caninsuiln/Vetsulin, some achieving remission. Also, like any other insulin, it can really disagree with some cats.


Mogs
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In addition to the reasons suggested above, the recent temporary breakdown in Prozinc supply may well have been a factor for some vets.

 

And what is the current situation on supply of Prozinc in the UK?

 

This is going to sound really pathetic but my last few BG tests with Douglas have been pretty easy so that to me is my treat. Although I'll have some ice cream in a mo!!

Ok, so my gameplan is test test test especially over the weekend!

 

It is here again! ...Initially supplies were sporadic but vets should be able to access it easily enough. And it's also currently available in a few places online for those who want to buy it with a prescription from their vet.
Apparently the laws changed (I suspect due to Brexit), and supplies had to be ordered from the US instead of the EU...

 

That's a bit troubling. I am fearful of American drug pricing coming here. I hope that doesn't happen.


Mogs
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Could NOT sign on Thursday 9/3/20 to the message board. Just catching up now.

 

My vet started Mac on Cansulin as his first insulin on 15th Aug. When I saw him for the first check up after a week I mentioned in passing that I had heard about prozinc (after reading about it on here I was a bit concerned which was best). He said he would usually have prescribed that ad first insulin but this was at the time of the UK shortage so he didn't want to prescribe something that we may not have been able to get and so have to change immediately off it.
Luckily Mac seems to be doing well on the caninsulin and his first curve after 10 days was so symmetrical over the 12 it was strange to see - almost an exact mirror image before and after the +6hr point.
Whether we end up being swapped eventually who knows but I assume it must suit some cats long term if they still make it ? I hope - fingers crossed.
Gill

 

Caninsulin is still made because it works better in dogs.
Canine + insulin = caninsulin