Blaze's first home curve and questions

Since I seem to have mastered the knack of getting a BG sample (and my boy has gotten more used to my sticking his ears), today I decided to do a curve. A single can of food a day isn't satisfying Blaze's hunger; last night he woke me up repeatedly, prodding me and crying for food. Can't have my kid starving, so I wanted a better idea of what's going on. And I'm not happy.
At 8:30 BG was 542 (fasting level; then he got his shot and half a 5.5 ounce can of poultry pate), at 1:30 PM it was 414 (2 ounces of poultry pate), and at 5:30 PM it's 538, and I'm about to feed him again (another half-can). His next shot isn't for a few hours, but I'll test again before I give it to him, and he'll want some more food (he'll get some ground turkey). And, given last night, he'll get a midnight snack, too.
When the vet did his very first curve on 3/9, they started him on 2u (for a 595 initial reading) and his numbers dropped nicely, although they released him before they knew the bottom of the curve. Our rx is for 1u twice a day. Tomorrow I'll email the numbers to the vet and ask for an adjustment.
I was told to feed him (Blaze, not the vet) at about the same time as I gave the shot. Is that okay? Should I feed first and wait a bit, or vice versa? Does it matter?
Also, do I have to use One Touch Ultra strips in my One Touch Ultra meter, or will other brands work?
Thanks to all for helping me better my skills!

 

Regarding strips, you can only use the strips that go with the a particular meter.

It is better to represent th a curve via the following notation:
AM PS is the BG in the morning before the shot. PM PS would be the evening preshot BG
Use a + to indicate things that happen after the shot. In your case these would result in:
AM PS 542
+5 414
+9 538

You can probably safely go up to 1 1/2 units bid but, as you are doing, I would ask your vet.

 

Does your vet have you restricting him to 1 can a day? It is my understanding that when they are just diagnosed and still showing the signs of diabetes we should feed as much as they want because the disease is not allowing him to metabolise that food correctly and will stay hungry all the time. Unless there are other medical issues involved, you may want to increase the food.

He should be fed at shot time to make sure he doesn't go down to fast. I think the preferred is before the shot (test -feed - shoot). One of my vets said yes, they need to be fed first to make sure they are going to eat, that way you don't shoot and then find out they won't eat. My other one didn't seemed to think it mattered. We test - shoot -feed only because that is what works best with Smokey (she will sit still for us once, we better get our stuff done then) and we know she will eat for us.

 

Real quick here, excuse shortness.

Is chicken pate on Janets list at top of page (you know carb%)
Feed as much as kitty wants. He is literally starving to death as body can not metabolise the food (so you might think overkill bt actually he won't put a lot of weight on right now and amount he wants will decline as you get better bg numbers for him)

Try and set up chart for him-info in tech forum, helps you and us to help you.

Not sure what insulin your on, but most insulins it is better to make sure they eat something just before shot (some insulins are fast acting).

how long you have been giving 1u?
It does look from the couple numbers you give an increase is in order, however if it's been less that 5 days might be worth holding out. Can take bit of time for insulin to start working.
We usually recommend an increase of .25u. This is so you don't miss the ideal dose for kitty. Does mean have to guesstimate between the markers.

Well done for mastering the testing-it was the hardest part for us!!! :mrgreen:

Keep asking q's always someone arond.

 

Thanks to all for the feedback. His last level last night was HI (>600). I gave him 1.5u last night and tested again at 8:30 this morning, for a reading of 542. I gave 1u this morning as prescribed. No reply yet from the vet, but they often wait until after-hours.
I'm feeding him as often as he wants. He's already had a full can today; I'll give him another tonight (in 2 measures, so he doesn't barf) and supplement with the ground turkey to give him some extra protein.

 

Okay, just heard back from the vet...they're increasing the insulin to 2u b.i.d. and want me to repeat the curve in a week. I sure hope that stabilizes him!

 

HUMULIN USERS-Input please

Hi Jean,

I'm sorry I don't have the knowledge/experience with Novolin but what your vet has said is not the way to do this.

Please cross post in the insulin support group for your insulin too.
As far as the protocol on here goes, a dose needs to settle before increasing again. You have only just gone up to 1.5u.
I know it didn't come down a lot but a dose needs time to settle. Also we advocate increases of .25u, so you don't miss the ideal dose. As kitty is in the 500's the increase to 1.5u is probably o.k, but I think you need to let it settle before increasing again.

It's also no good doing a curve once a week.

Again the ethos here is test before each shot, then around +1-2 (when trying to identify onset in your cat), +4-6 ish (peak, again depends on insulin and cat)
You then get to see what impact food is having on bg's and how insulin is working in your cat, also keeping your cat safe as you know their not going to bottom out on you.

Insulin is a really powerful drug.

I can't recommend hometesting and caution enough.
Please keep asking q's.

 

I gave the 1.5 on my own, without veterinary approval, because his numbers were so consistently high. Last night he got 2u, and again this morning, but I wasn't able to get a good BG sample before the AM shot. I'll test again before the evening shot, but he had a decent day: ate a big breakfast, and was ready for more about 5 hours later.

 

I'm going to disagree with Kate's advice here....

There is no writen rule on how often to curve; once a week is more than adequate and for most people all that they can manage. What is more helpful is preshot tests and spotchecks because a curve day may not go as usual.

For humulin N, you need a few days settling time. It doesn't work like lantus or PZI but you need a bit of settling time, so please try to wait a few days inbetween dose changes. High numbers ARE alarming but overdosing can cause a host of complications. Ensure that you are testing his urine for ketones, get spot checks between 2 and 5 hours post shot, and see where things go.

Jen

 

Can tell I'm outta practice here! :roll:

Jen is right about a curve. I meant a curve once a week isn't enough on it's own. I.e that your not testing before shots and getting spot checks where you can (even an hour or two after the evening shot).

Hope that clarifies it.

Any update?

 

His morning numbers are still high (528 today, for instance), but lower than they have been, so I'm (perhaps naively) optimistic. It's only been a couple of days since we changed the dose. My schedule's been crazy this week, so I haven't been able to do mid-day levels. I've been giving him all the food he wants, so he's not constantly starving. He appreciates it, and I definitely appreciate not having to wake up to fix him a snack in the middle of the night (plus, then everybody wants one). He's being such a sweetie with all this testing and the shots -- comes right to me when I say, "C'mon, time for your shot"! I figured by now he'd be trying to hide when he sees me, but he doesn't, even when he sees me setting up the test kit. Still doesn't like his ears fussed with, but we're adjusting.

 

If it has been 3-5 days, then you are safe for an increase of approx 0.5 units. But how low is he going between shots?

 

Good update.

That 528-it is before he eats?
Agree with Jen on a .5u increase because he is stillshowing such high numbers (usually recommend .25u)

Lovely to hear he doesn't mind coming for his shots. I considered shot time as cuch time too :mrgreen:

 

I don't yet actually know the low at the new dosage. Between grad school (second time around) and Holy Week, things have been crazy this week and I haven't been able to collect mid-day samples. His PM preshot numbers are in the 500s, high but an improvement over >600. This morning his AM preshot level was 499 -- lowest it's been in the morning since he was diagnosed! The preshot numbers are also pre-feeding numbers.

 

With N it is really important to know how low he's going and how quickly he goes back up because you don't know if those high numbers are from underdosing or rebound....I know life is hectic but testing at approx 4-5 hours post shot would be very helpful when possible.

Jen

 

Easter Sunday at 5 PM he was at 145. That's the lowest number I've seen so far. Still giving him as much as he cares to eat, but he's still thin as a rail. Drinking less, peeing less, no vomiting, good spirits. Doing the second curve today and will post a new message with results.

 

Thats a start!

 

It gets better! His 8 AM, preshot, prefeeding BG was 471, and his 12:15 level was 87!! (He got lunch after that.) I'm freakin' ecstatic!

 

Well.....

I'm not certain you should be totally excited.....but I am very happy you were able to get some succesful info

The good news is that the N is working
The bad news is that that is a bit of a rollercoaster ride

N is known for sharp 'curves'. Lantus or levemir or even prozinc would provide a smoother curve which is healthier and feels WAYYY better.

What do you think?

 

I agree about the erratic levels, but I was happy because 87's the lowest number I've seen since we started this strange trip. My problem is that I'm unemployed and have been for two years (!!!) and so have had to make decisions with major financial consideration. My vet would have preferred PZI (which I understand has been discontinued), and would have charged me nearly $40 more for it than the Humulin cost, which I could get through a regular pharmacy. So for the time being I have to find a way to make it work.