? Help reading Minnie’s 1st curve

Hello All,

I’m new to this forum, so thank you for accepting me. My 11 year old cat Minnie was diagnosed with diabretes earlier this year. The vet thinks it was secondary to pancreatitis or IDB. It’s been a tough road to get her stable and I’ve seen an internal specialist and a nutritionist who has done wonders for the IDB. I thought she was finally at the right insulin dosage but at the last vet check up she was at 86 at 4pm, 3 hours before her next 12 hour shot and the vet thought it should have been higher that time a day, especially with the stress of being at the vets office. I already noticed she’s drinking a bit more water, not a lot, and is peeing 3 times a day instead of 2. I’m tired of guessing and want to get setup to check her at home. I was apprehensive about doing it myself but I feel like a bad mother for not doing it sooner. Can you all recommend the best glucose meter to get? I hear alpha track may be as good as freeline? What about ReliOn?

PS - she’s developed pretty advanced neuropathy in the back legs and I’ve got her on b12 methyl as well as Thorne small animal antioxidant to help with that. I’m going to start her on Gabapetin in the new year as the nutritionist thinks it may help. If anyone has any additional tips for it, I’d appreciate it!!!

Thank you and Happy Holidays!!! ☃️❄️

 

Chosing the best glucose meter is always a tough choice. You should look for the fast ones only needing between 0.6 to 0.3 in tiny blood drop.
I was lucky to get Simba's first meter Bayer Contour free from our Animal Hospital and his Abbott Precision/Xceed for the Blod B-ketones for free from Abott Sweden themselves.

Here you have a meter link collection to reaf through
http://www.felinediabetes.com/FDMB/...r-ratings-comparisons-recommendations.156388/

 

We used to use the Alphatrak 2 but the strips were way too expensive to continue, plus all of the information on this board is geared to using a human meter. Once you decide on a glucometer, do an internet search to see if you can get a coupon as many companies will provide a free meter when you buy the strips.

We use Freestyle Lite meter and many on here use Walmart's Relion (cheap strips). You will be testing a lot and it's the test strips that can end up getting quite pricey so keep that in mind as well.

 

I’m new to this and my cat has only been on insulin for a few days, but I got the AlphaTrak pet meter because I feel more comfortable knowing the numbers geared for pets. I’m sure all the other meters are great choices, but there is so much to wrap my head around I didn’t want to be doing compatibles with the human meter because frankly, I am exhausted. The strips are ridiculous price wise, but I am sticking with it for now. It gives me peace of mind and that is worth the cost right now as a newbie.

 

I totally understand as I did the exact same thing when Freckles was diagnosed in Sept. of 2019. The learning curve is not as steep anymore and I'm not panicking anymore if I miss her shot time by 5 minutes. My Alphatrak has become one of my back up monitors now.

One step at a time. From one newbie to another, it will start coming together. My DH thinks I'm addicted to this forum now, but there is a lot to learn and the first few times I read things, I don't think I retained much.

 

Yes, I noticed the comments about the alpha track strip test price. So if I get the Freestyle or ReliOn, I have to convert the human numbers to animal or is there a way to recalibrate the meter? Is there a resource for the convention, like a chart online somewhere? I regret trusting the vet because I feel a lot of what I know now is different than what she told me to do and it may have helped Minnie get stable sooner and have less neuropathy now. I need to be on top of it instead of trusting the vets. Thank you all and Merry Xmas!!!

 

There is no conversion or comparison online. Everything you see on this site will be in reference to human meter numbers so you'll have an easier time understanding readings if you stick to human. Human meters run lower than pet meters typically, with very low numbers being more accurate and higher numbers more far apart. As a rough example, a 400 on a human meter may truly be a 500 on a pet meter, but a 70 on a human meter is probably going to be about the same reading on a pet meter. The important thing to remember is that the low numbers are what really matter (too high is too high, so it doesn't really matter if your cat is 400 or 500, they're both too high).

 

Hi Alessandra, I just tagged you. @Alessandra Franco

Any information specific to your cat or situation we may help you with?

Simply change the title on your post if you have a new question.

Upper right hand corner, edit post, drop down list for editing options, change the title to something more of current concern to you. Put the ? prefix on the post to get a question answered. Start typing away in the text box at the end of your "thread". Save changes.

What would you like to know to help your Minnie more?

 

She's posted since this post was made. Here's her last thread but she's commented on several other people's too

 

Thanks Chris. Search function only gave me her first thread, from back in December 2019.

 

I've been using the alphatrak since 2016. It is pricey but I like that it is the same readings as my vet.

 

Lots of little questions, but the main one right now for me is diet. I agree with most people here that a lifetime canned diet is probably not the best we can do for our feline companions. It wouldn’t work for humans, I’d think it’s also not great for animals. When we were suspecting pancreatitis before the diabetes, I did some digging online and found the Smallbatch rawfood here in Cali that seemed like a good option. I also tried freeze dried, many brands like Sojos and Stella, but Minnie would only eat the smallbatch. I transitioned her completely to it 100% and I was thrilled but she gained weight (I probably didn’t portion it correctly since I followed the instructions on the food urghhhh) and developed diabetes about 3 months later so the vet had me put her back on can food. Fastforward to end of last year, I took her to an internal medicine vet because I wanted answers. He did all the tests and a new ultrasound that ruled out pancreatic cancer and pancreatitis, although she was on the low end and could have had it previously, so the diagnoses was IBD. I also took her to a nutritionist referred by a friend and she put her on basicallly everything she’s one now as far as food and supplements and even the gabapentin but does not believe in the Smallbatch raw food because of salmonella. I tried a few different diabetic canned foods like hills and the Royal Canin is the one Minnie likes but the transition has been hard. She won’t eat just that so I’m still supplementing with fancy feast. I want to try raw again or at least a combination of raw and the Royal Canin. The only raw food the nutritionist recommends is Instinct. I read about Hounds & Dogs in another thread and I’m going to ask her about that. What do you guys think diet wise? I’m also afraid of changing the diet and negatively affecting the diabetes which is regulated right now.
Thanks!!

 

@Veronica & Babu-chiri feed raw. I'm sure there are others.
@Wendy&Neko feed raw.

Canned is usually better than dry.
Raw can be better for some cats than canned.
Vets need more education in feline nutrition.

Have you ever considered making your own raw diet?

 

Sorry, forgot the raw food/making your own cat food diet link to Dr. Pierson's site.
https://catinfo.org/making-cat-food/

Raw Feeding for IBD Cats

 

Nature’s Variety has several novel protein canned foods, such as rabbit, venison and lamb, that are also low carb. Ziwipeak is another good source. Novel protein plus a good probiotic are how you want to treat IBD. If it is IBD - you cannot diagnose IBD with just a ultrasound. Leaving that aside for now, we will assume IBD. And by the way, episodes of Pancreatitis are not uncommon with GI disease.

If you want to do raw, there are some commercially available novel proteins. A number of us used the EZComplete premix and made our own, less fuss than the Dr. Pierson recipe and cheaper than premanufactured raw. The premix is available on the FoodFurLife website. It was made by a bunch of folks who have IBD cats.

 

I’m a vegan so I don’t think I could make it myself. It’s already challenging handling the made stuff, but if it’s what’s best for her I’ll suck it up and deal with it. Okay, so it’s good to hear from others. I do want to at least get her away from fancy feast. I never fed them dry anyway so that’s not an issue. I’ll look into Nature too.
Btw, I know IBD is an educated guess for now but the ondansetron keeps her nausea/vomiting at bay and I think the probiotics help a ton too. Just want a healthier diet for her.
Thanks!

 

No one here has used Smallbatch then huh?

 

I do remember someone using SmallBatch, but don’t remember who. It’s not as widely available as some of the others.

 

I wouldn't call raw what I feed is more like Dr. Lisa's recepy home cooked wich is slightly cooked for safety reasons since I really can't trust the freshness of the proteins I have access where I live and is actually what Dr. Lisa recomends wich I think is a good midle point where I keep the food safe and avoid loosing too much of the raw properites and nutrients

I prepare my own mix of supplements since none of the premixes are available here

I've feed Natures variety instinct canned food and and I think is quite good and they have a fairly good selection of novel proteins that could help in this case, grain free, low carb and with the actual meat as their main ingredient no by products but it can be pricey

 

Hi All,

Happy Saturday!

Taking baby steps here but I have Minnie’s spreadsheet set up. I did 2 spot checks this week and both were under 300 but in the middle of doing the curve today and her first numbers were over 300 even after the insulin shot. I’ve noticed she’s been waking up nauseated since Wednesday this week and it’s a struggle to get her eating in the morning. I have to pill her the ondansetron and wait about 20-30 minutes for it to work and for her to finally eat. As a result, her shot this morning was almost an hour late. I’m not sure if I should just have given her the shot anyway and fed her 20-30 minutes after since she will always eat but a part of me is afraid that what if I do and that’s the day she doesn’t eat at all? I’ll keep plugging in the numbers but just wondering if there’s enough there to get some feedback. Let me know and thank you!!

 

Couple questions. First, are you giving one or two shots a day? Spreadsheet shows nothing given at night. Second, how are you measuring 0.4 units. Syringes only have half unit markings. Can you get up 1/2 hour before morning test and shoot routine and give the ondansetron then?

 

I give her a shot every 12 hours I just haven’t gotten to the pm shot yet. I’m not sure I understand the question. Most days she eats right away without any issues. It’s hard for me to know when she’s gonna wake up and not want to eat. Most mornings they’re both dying to eat as soon as I’m up. I give them their food and Minnie gets the ondansetron with her first feeding then the shot, but today she wouldn’t eat so I had to pill her and wait. I was waking up earlier every am this week except for today

Here’s a pic of the syringe. It’s one mark before the 5. Is that not .4?

 

No, that is 4U, not 0.4U of insulin.

 

Okay, I fixed the spreadsheet. She gets 4 units twice a day. She was on 5 and 4 units back in December but when I took her to the vet her BG was 85 so we lowered it. 2 weeks ago when the vet tech showed me how to test at home she was at 144. I should add that I’ve been trying to get her weight up because she initially lost a lot and was at less than 14 pounds. She was at 15.8 at the last visit and today I weighed her at home and she’s 16. This is the good weight where she should be, but I’m wondering if the insulin needs to be raised because of the weight increase. Any thoughts?

 

On the syringe, I think you are giving 4 units. Each line is a whole unit. Which brand of syringes are you using? It would be good to use ones with half unit markings, as we make changes by 0.25 units at a a time.

Is it possible for you to get any tests at night, say just before you go to bed? Many cats go lower at night, we determine how to change doses based on those lows. We change the insulin dose based on blood sugar values, not weight. We have small cats on large doses and large cats on small doses.

 

So the last test I did was 325 at 6pm. I’ll do one more at 8:30 right before the pm shot. Should I do one more after the pm shot?

UltiCare UltiGuard Safe Pack Insulin Syringes U-100 29 Gauge x 0.5-in, 0.3-cc, I can get different syringes I’m running out of these on a few days.

 

In the US, ADW on line is a good source of syringes. The Lantus forum Sticky Note on Insulin Care and Syringe Info lists some of the brands of syringes that come in 1/2 unit markings.

If you can get a test before bed, maybe two hours after the PM shot, that's a good one to get. With may cats on Lantus, if the +2 test is quite a bit lower than the preshot, it'll be an active cycle with lots of downward motion.

 

okay do I did one last test about an hour and 15 after the pmshot. I’d really like to get some feedback on her curve numbers please. Anyone? @Deb & Wink @Sienne and Gabby (GA)

Thanks!

 

SS skips from the 18th to the 22nd of February. Please have one row for each day on the SS. Even if you did not home test, you still gave insulin. At least, I'm guessing you did.

TR or SLGS protocol for Lantus? SS does not say. Neither does your signature.

Yes, we need a bit more information.

 

So do i. I don’t know what TR and SLGS are hence the question mark next to it

And should I be posting this in the Lantus forum...?

 

I just found the sticky note that explains that. I suppose SLGS. Please understand she was diagnosed almost a year ago and I didn’t find this forum until late last year. I haven’t been doing everything y’all have been doing since the beginning. I had never ever done a curve until yesterday and I had also never home tested her until last week. She was seeing a vet who told me that cats on Lantus did not need home tests or curves because it’s a long lasting insulin and would only adjust her dosage once a month. Once she was below 300, she told me I didn’t need to bring her in monthly anymore. That’s when I knew I needed a new vet. Her dosage has been increased in full units each time and she is now at 4 twice a day. All of this is new to me and I honestly don’t want to feel more overwhelmed that I already do with all her conditions and medications. I don’t have the half unit syringes and since I don’t have all the info y’all are asking me for, it may just be easier to discuss her numbers with the new vet tomorrow. Thanks and enjoy the rest of your weekend.

 

Sorry Alessandra. Entirely my fault thinking you knew what SLGS and TR stood for. My apologies.

Please read this document I've linked for you below first. And see which dosing method you think would work better for you. EDIT: See you already did. SLGS or Start Low Go Slow, it is.
Sticky Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

If you have not been over there in the Lantus Insulin Support Group (ISG) yet, it does get very busy. Read the stickies at the top of the Lantus/Levimir ISG first. Especially the one titled
Sticky The Basics: New to the Group? Start here!
Before posting over in the Lantus forum.

Which direction to go with the dose is still the same, with either lantus dosing method. Up. By 0.25U increments for now. Reevaluate at next curve or if the nadirs drop low.

Nadirs are greater than 200 but less than 300. (>200, <300) if using TR - Tight Regulation
Nadirs are > 150 if using SLGS - Start Low, Go Slow.

Talking things over with your vet is always a good idea. Getting that vet opinion on what we would recommend is always a good idea.

 

Alessandra take a big breath we know is not easy especially for cats with multiple issues, and if we made you feel overwhelmed we are sorry sometimes we can be a bit pushy but is because we care about you and Minnie, specially about her safety that is why sometimes we insist so much in testing before shooting.

Also we want to make suggestions based on information, but since each cat is different that information has to come from Minnie and you so we ask a lot of questions

Trying to understand all of this is complicated but just keep asking and hopefully the new vet is willing to work with you good luck

 

Hi All,

Happy Saturday!

Taking baby steps here but I have Minnie’s spreadsheet set up. I did 2 spot checks this week and both were under 300 but in the middle of doing the curve today and her first numbers were over 300 even after the insulin shot. I’ve noticed she’s been waking up nauseated since Wednesday this week and it’s a struggle to get her eating in the morning. I have to pill her the ondansetron and wait about 20-30 minutes for it to work and for her to finally eat. As a result, her shot this morning was almost an hour late. I’m not sure if I should just have given her the shot anyway and fed her 20-30 minutes after since she will always eat but a part of me is afraid that what if I do and that’s the day she doesn’t eat at all? I’ll keep plugging in the numbers but just wondering if there’s enough there to get some feedback. Let me know and thank you!![/QUOTE]

Sorry I’ve been MIA. I had a lot of other overwhelming things going on in my life and, of course, we are now all going through covid19 and I hope you and your kitties are all safe!!!

I’ve been filling in the spreadsheet, but I had to re-save it and make it public again so please let me know yon have the latest with today’s date 3/16. Minnie has been have a lot of nausea and morning vomiting. I’ve been spot checking her to see if the numbers have gone up and they did. I’ve been running things by my vet, but she is against changing dose if she has no symptoms like more peeing and drinking water. She says she doesn’t want to be “chasing numbers” I don’t know that I agree I think changing the dose is necessary to keep her regulated through the flare ups, so I upped her by 1/2 unit (got the half unit mark syringes) 2 days ago. Her nadir today was 67 then 135 2 hours later. I couldn’t get her to eat well in the morning so maybe that explains the lower than usual nadir? Anyway, would love some feedback. Let me know if I left anything out and you have any questions. Thank you!!

 

I can see the latest spreadsheet. I don't see any tests before giving her shot though. You were right to go back to 4.0 units. If you are following SLGS for dosing, you keep the same dose as long as nadirs are between 90 and 149, and that's what you were getting on that dose, so you wouldn't have increased.

 

Yes, appetite can affect the BG (blood glucose) levels.

Hard to tell how much the 4U dose dropped Minnie, without those pre-shot tests.
Those pre-shot tests are the most important ones of the 12 hour cycle.

Hope Minnie feels better. Sounds like she is experiencing a bout of pancreatitis.

Even if your life wasn't overwhelming before, it is now.
p.s. Hanging in during this covid-19 scare. Stay safe yourself Alessandra.

 

We do recommend that all adjustments in the dose are made depending on the test results and not in symptoms, those can be different from one cat to another and even in the same cat depending on circumstances but we do made them considering the protocols either Tight regulation (TR) or Start Low go Slow (SLGS), given the fact that it appears you are not testing very often I'm guessing you are following (SLGS) so as Wendy mentioned you keep the same dose as long as nadirs are between 90 and 149, but with either one the preshot test is VERY important to keep him safe, so you will need to test him at least every 12 hours before giving insulin, do a curve each week and any other test you can get in between will help you get a better picture of how she's really doing

It seem's she's getting some morning nausea, it could be because there's too much time between his last night meal and breakfast, sometimes giving them mid night snacks can help or giving them some anti nausea meds before bed too with one of my civies (non diabetic cat) what I do is give her SEB (slippery elm bark) just before I go to bed to avoid stomach acid causing nauseas during the night

 

I agree with that. No sure why most vets care more abou true symptoms. I knew 233 was too high then I got a 67 yesterday and her pre check before night was 244 I think. So I adjusted to 4.5 in the am abs 4 in the pm. Today her nadir was 130 which is good. I give her the ondansetron at night and I’m pushing that to closer to bed time. She hates SEB. She eats at 10pm then again at 7:30am. I wonder if I should try again omeprazole again. I can put that in a pill pocket so she’ll eat it. Thanks!

 

One important thing about Lantus is that it needs consistency so you need to find a dose you can give both am and pm, (you don't have much data yet to make an assesment but maybe consider 4.25 am and 4.25 pm) and keep the dose unless she gets a test result lower than 90 at any time, if that happens you lower the dose by 0.25 units on the next shoot, and you have to keep it even if you see some high numbers to allow the depot to form properly.

What was her am preshot today?

From 10 pm to 7:30 am is a very long time with out any food for a cat that's having stomach acid problems, with too much time with out any food acid starts building up and it can cause nausea, maybe you can try and give her some midnight snacks , you could try a time feeder so that you don't have to wake up in the middle of the night

 

She won’t eat overnight. Sometimes she won’t even eat her last feeding at 10pm. I leave food out and I know it’s Bobo who eats it because she sleeps in my bedroom the entire night. When I was working, I’d feed them at 8:30am then not again until 5:30pm and she was fine...urghhh I’ll ask the vet about omeprazil

omg it went up so much! My laptop froze so I couldn’t add to the sheet. Pre shot was 395 and at the 7th hour mark she was at 293. That’s a very high nadir so I’m taking your advice and sticking to the same dosage am and pm. Going back up to 4.5 for the next few days to see if it goes back down. If my computer works, I’ll add the later numbers. The low 67 nadir also alarmed but I guess that’s better than 293, right? Should the nadir be at 80 or higher always?

The good news is she hasn’t been nauseated or vomited the last 2 days, so yesterday and today.

Thanks!

 

Low numbers is what we are aiming at but you have to get there slowly diabetes is a marathon not a 100m race and even though low is good if she doesn't get there in a slow controlled way is VERY DANGEROUS please read these so that you are aware of hypos and how to deal with them http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/ with that in mind the 293 is not so bad is actually ok because the insulin is starting to work a bit you will get to better numbers eventually. So I don't think giving 4.5 is the way to go right now

Right now and with the little data that you have I think keeping her at 4 both am and pm for a few days would be a good idea, and wait till the depot is formed and see how she reacts, is always better to be safe than sorry

I'm wondering if maybe she's going a bit too low during the night and we haven't caught it try and get some day maybe during the weekend a test at night

 

I had posted previously about the entire ups and downs since she was diagnosed last March. She was on 4.5 before then the new vet wanted her done because she tested at 85 during the visit. This was last December. She’s been on 4 x2 day since then. I’m also using the half unit syringes that are 8 in length versus 12 in length on the previous syringes. Does the length of the needle makes any difference. It feels weird to me because I was used to the longer ones...

 

85 at the vet seems a bit low because usually cats have higher number at the vet because of stress (each cat is different and she may not be affected but that would be very uncommon)

I can see that in your SS and she was seeing good numbers at 4 that is why I think going back to 4 is a good idea and stay there for a few days for the depot to get formed at that dose, and see how she's doing, with diabetes there's not one magic dose that you get there and stay in there you will have to change doses periodically and sometimes go back to the previous dose or lower

Once she's been on 4 for at least 3-5 days you could make another curve, and depending on the results you get, maybe (big maybe it will depend on the results) raise the dose to 4.25.

I think 4.5 is too high for her right now because that dose has taken her dangerously low very fast

No the length of the needle is more a matter of preference when shooting I used 6mm ( for me the smaller the better chances of not getting a fur shoot)

 

Okay this all makes sense. I get what you’re saying. I know that readjusting is probably a constant especially since her number will vary when she has IBD flare ups. I’ll go back to 4. How do you measure 4.25? That seems tricky. It’s hard already even with the half measure for me ha! Just to give you some backstory, her first vet, I now know, took too long to make the adjustments. When she was first diagnosed she had me change the diet but no insulin at all until a month later. She lost a ton of weight in that month which likely want good for her. Then we started with 1 unit twice a day and went up to 2 than 3 but her rechecks were monthly so a lot of time went by in between. I stress because I don’t want her neuropathy to worsen and I’m still hoping she’ll recover from it 100%. She walks fine but going up the stairs is hard and also when she pees and poops she can’t hold her weight on the back paws only and she uses the entire leg. It gets messy poor baby. I still need to use the urine strip but I can’t seem to catch her when she pees urghhhh

thank you for all the super explained info and guidance. I know a lot about certain things and not so much but others.

In addition to all of this, we now need to hunt for their food and ours

Stay safe!!!

 

You can be super precise and use calipers or you can more o less eyeball it, placing the plunger between 4 and 4.5 which is ok as long as you keep the dose consistent and always place it in the same spot

I have a photo of where the plunger is when measuring 0.25 (it says unidad that would be unit sorry I have it in spanish and I'm at the office ) you can have an idea you can place it more o less the same but instead between zero an 0.5 between 4 and 4.5



Stay safe yourself too please be very careful

 

Keynote & urine test from tonight

 

That looks negative to me for ketones. But high (1 or 56) for the glucose in the urine. That glucose reading is what you would expect from a cat that is above renal threshold and spilling glucose into the urine.

Please try to get a blood glucose test before every shot, the pre-shot test. That is so you know your cat's blood glucose (BG) level is high enough to give the insulin in the first place. Or if you need to stall, reduce dose this cycle, or skip the shot entirely. With lantus, you want to avoid skipping doses as much as possible, because the "depot" or storage area will drain a bit.

p.s. This thread is getting long. We try to limit the length of threads to 50 posts maximum. Would you please start a new thread here and link this post into the top of the new one please? Thank you.

 

It shows high glucose as was to be expected since she's still unregulated, and it appears negative for ketone in the photo but sometimes there are some color changes in the photos from what it actually looks in real life so you can probably get a better look at it, just keep monitoring her

Did you decided to keep the 4.5 dose ?

Please do a blood test before every shoot and if you can one mid day because that dose has already gotten her a bit too low so is better to keep an eye on her to avoid any dangerous surprises