Why are they asking me for all these tests!!!!

[Wendy&Tiggy(GA)]

As a newbie here, or as a lurker, you may see that we routinely ask for blood tests. And you might be wondering why these are necessary and how many do you really need to do?

I would say at least 4 and heres why:

1. Preshot tests - before every shot. these are critical because the worst thing that you can do is shoot when the cat is low. For most insulins the preshot blood reading is the highest of the day (except when the cat is bouncing, see below*). So if you shoot when the cat is, say for example under 60, you can trigger a hypo as the insulin kicks in. So preshot tests are an absolute must. Its like driving with a blindfold on if you dont test. Russian roulette with your cats life... especially as easily 40% of cats go into remission with a good low carb wet diet and insulin .. and so low preshot numbers will happen.

2. Mid cycle test - After you give the shot, the insulin kicks in to bring the cats blood glucose down. Sounds great! However if the cat goes under 40 then he is moving into hypo territory. Hypos can kill fast.. the cat can go from showing no symptoms to seizures and dying within an hour or less. Also if the cat does drop under 50, it shows that the insulin dose is too high and needs to be reduced. How will you know this if you dont get a mid cycle test?? The mid cycle test can also tell if the cat is bouncing *. The ideal mid cycle test varies by which insulin you are using but its best to vary the mid cycle test time since cats low points (nadir) do vary.

3 Before bed test - unless you are a night owl you dont want to have to stay up to get that mid night cycle test. So a test 2-3 hours after your PM shot will tell you how your kitty is trending and whether you need to stay up.

So thats it! four tests a day. Its not a lot to keep your cat safe healthy and watch for remission or dose changes!

Wendy

* Bounces - what are they and is my cat doing them?
When a cat is first diagnosed, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down.

If a cat is bouncing it means that at some point in the last day or so he dropped low/ lower than he is used to. When trying to see if there is a bounce I look for pinks, reds and blacks which hold for a good day or more, but that were preceeded by a time where there could have been a low.. I look for gaps in testing where there could have been a low - especially where there was a trend downward before that.

A problem with bouncing is that it means the insulin may be too high, yet your cat is in high numbers as a result. High numbers can also mean your cat isnt getting enough insulin. this is why testing is important as otherwise you wont know!

Think your cat may be bouncing? Get the tests above, set up a spreadsheet (http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207) and let us take a look.

 

[Libby and Lucy]

While I agree that many of the points here are good ones for new members, it is important to understand that they do not apply to every caregiver, every cat, and every insulin.

1. Preshot tests - before every shot. these are critical because the worst thing that you can do is shoot when the cat is low. For most insulins the preshot blood reading is the highest of the day (except when the cat is bouncing, see below*). So if you shoot when the cat is, say for example under 60, you can trigger a hypo as the insulin kicks in. So preshot tests are an absolute must. Its like driving with a blindfold on if you dont test. Russian roulette with your cats life... especially as easily 40% of cats go into remission with a good low carb wet diet and insulin .. and so low preshot numbers will happen.

Sorry Wendy, but I have to disagree. Of course I believe preshot tests are important, but I disagree with the reasons you give.

the worst thing that you can do is shoot when the cat is low.

So if you shoot when the cat is, say for example under 60, you can trigger a hypo as the insulin kicks in.

Those following the Tight Regulation Protocol for Lantus and Levemir routinely shoot low once we have gathered the data to allow us to do so. I strongly disagree that this is the "worst thing you can do" and saying so makes it really difficult to transition people to the Tight Regulation frame of mind when they are otherwise ready to do so. Lantus and Levemir, when dosed properly, can result in a long, flat curve. Of course, we do work toward gathering enough data to know when we can safely give insulin to our cats, and it's not recommended for a new caregiver to shoot low, but it is also not necessary to scare them away from something that can be a very effective technique when used properly.

2. Mid cycle test - After you give the shot, the insulin kicks in to bring the cats blood glucose down. Sounds great! However if the cat goes under 40 then he is moving into hypo territory. Hypos can kill fast.. the cat can go from showing no symptoms to seizures and dying within an hour or less. Also if the cat does drop under 50, it shows that the insulin dose is too high and needs to be reduced. How will you know this if you dont get a mid cycle test?? The mid cycle test can also tell if the cat is bouncing *. The ideal mid cycle test varies by which insulin you are using but its best to vary the mid cycle test time since cats low points (nadir) do vary.

Again, I appreciate that you are trying to instill respect for low numbers. Some of us tend to get too cavalier about lows after a while. However, under 40 does not necessarily mean the cat is moving into hypo territory, and 50 doesn't necessarily mean the dose needs to be reduced. There is a distinction between "HYPO" and low numbers. Usually on FDMB we tend to reserve the word Hypo for a cat that is showing symptoms, or a cat that is in extremely low numbers. It's sort of like crying wolf - reserve the scary word for situations that are truly scary, so you can be sure to get the proper attention on that thread. Good guidelines for people without data, but this might be a bit too much hype to use as a generalization.

3 Before bed test - unless you are a night owl you dont want to have to stay up to get that mid night cycle test. So a test 2-3 hours after your PM shot will tell you how your kitty is trending and whether you need to stay up.

I'm a BIG fan of before bed tests. However, for some cats the +2 or +3 don't give enough information to truly know if the cat will drop low overnight. Levemir, for example, tends to onset later than that. Some cats do with Lantus too. Know thy cat. But yes, get the before bed test because it's a great way to start to learn thy cat.

So thats it! four tests a day. Its not a lot to keep your cat safe healthy and watch for remission or dose changes!

I tend to encourage 3-4 tests a day, plus more on the weekends. It is important to gather other spot checks whenever possible so you can begin to put together the data picture on your cat.

If a cat is bouncing it means that at some point in the last day or so he dropped low/ lower than he is used to. When trying to see if there is a bounce I look for pinks, reds and blacks which hold for a good day or more, but that were preceeded by a time where there could have been a low.. I look for gaps in testing where there could have been a low - especially where there was a trend downward before that.

Some cats bounce off of numbers that aren't anywhere near too low. I've seen cats bounce off of 200s before, if they aren't used to 200s. I wouldn't want to reduce the dose just because my cat is bouncing from a 200... Or a bounce can be caused by a fast drop, even if the cat doesn't drop very low. Again, that probably does not require a dose reduction. Bounces aren't necessarily pin/red/black either. A number like 110 can be a bounce, if a cat is normally tightly regulated lower than that. Most of the time, for cats following the Tight Regulation Protocol, we won't reduce the dose just because of a bounce. It depends on WHY they bounced.

Think your cat may be bouncing? Get the tests above, set up a spreadsheet (http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207) and let us take a look.

I just wanted to note that spreadsheets are VERY helpful, and you will likely find that you receive more (and hopefully better) dosing advice when you have a spreadsheet, but a spreadsheet is not required on FDMB. ;-)

Wendy's point is good overall, though. Filling in those blanks and getting data whenever you are able is extremely helpful to those who are trying to help you, and it's not that hard to do.