? Confused whether to do a curve

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Sue484

Sue484

Member Since 2015
Today is the 5th day of a dose reduction for Frankie from 4 units to 3.75. Trouble is he seems to be bouncing every day to the slightest sniff of a yellow number and he's not doing much better at night. True, the bounces aren't going into the blacks (touch wood) any more, but I am due to do a curve on him on Sunday as per the SLGS protocol. Is it worth it if he is still bouncing? Should I just increase his dose back up to 4 units and see where that takes me, if the curve can't be done? Maybe the low he got on 4 units before was just a reaction to the depot in his body, as he had two reductions in 2 days. Any help is appreciated.
 
If bounces last up to 3 days, then this would be the 3rd day. Can you do a curve tomorrow?
 
The best answer I can give you is to ask a question: Do you know where Frankie's onset and nadir fall and how much duration you're getting? If you can't answer those questions, then getting a curve will help. Also, it looks like when you're getting a curve, you're testing every hour. A curve is typically testing every 2 hrs and a mini-curve is testing every 3 hours.

While I realize it's a matter of personal preference, I'm curious as to why you're following SLGS? You're certainly testing enough to follow TR.
 
@Sienne and Gabby I was following TR but I'm too chicken to carry on with it. It says for a long term diabetic if he falls below 40 to decrease the dose (that's 2.2 on Alphatrak!!) . I really don't want him going that low, I would love him to be in the 5-10 (90-180) range. Frankie's onset is +2 or +3 depending on what day of the week or his mood it seems. I have no idea about his nadir as he is all over the place numbers wise and the same for duration. Sometimes he is going up at +11 sometimes down. I will try and do a curve tomorrow, I was testing every hour as that is what my vet told me to do, admittedly that was when he was on Caninsulin. As I can't test much during the day usually, I will do every hour until I have a bit more of an idea of his patterns, if he has any.

@Dyana his bounces seem to clear with the yellow numbers and then immediately increase again. Is this classed as one bounce then or lots of smaller ones?
 
I'm sorry, maybe I was wrong before. I was thinking he was bouncing from the 185 and it's been two days in bounce, but now I see the 144 from 2 nights ago, and I'd say he is bouncing from that. You can see how he slowly got higher after that. Maybe, he'll come down from the bounce today, or tonight. I would try to do the curve when he is not doing the bounce but has come down to lower numbers.
 
I'm starting to wonder whether the few yellows in the last few days and solitary blue was a fluke and he is just running high again. Thoughts anyone?
 
Just a note about where your target is at: Some cats really don't ever get nice flat curves in the blue numbers (on human glucometers) without also a lot of numbers in the greens as well. My cat is like that, he's either in the 300s or has a lot of green. I was nervous at first to let him get lower, but he came down the dosing scale so fast after his dental, that I didn't really get a choice.

You'll get more comfortable with it after you see how the lower flat cycles pan out. It's hard at first.

The longer he stays in the 250+ numbers, the greater amount of insulin he'll probably need over all to overcome the glucose toxicity.
 
Well he's had over a year of very high numbers so it looks like an increase is on the cards. I will still do a curve tomorrow just to see what happens. Not expecting miracles though. I think he's just a complicated case.
 
Hi Sue,
I understand your frustration. My cat Sheba is a notorious bouncer. She came out of remission 18 months ago and I have struggled to get her regulated, let alone OTJ. I joined FDMB in Feb and have made steady progress since then.
I was also not happy to let Sheba drop below 40. However I was told there were other ways to gain a reduction for a long term diabetic cat.........you can let him drop below 50 three times or you can have him stay in normal numbers for a week. Both of these will gain a reduction.
But first you have to get to that point, so I wouldn't worry about that yet. (I am now comfortable to let Sheba drop to below 40 because I can manage the drop. I never thought I would be able to do it but I can.)

I think the TR would suit you better and get results much faster. You want to get Frankie out of those black and red and pink numbers and to do that you will probably need to increase the dose. BUT I am not experienced to give you advice on dosing but there are several people who can.

I now have Sheba in mostly blue and green numbers and a couple of yellow. To get there I was guided by Wendy, Julie and Chris.
I had to find out why Sheba bounced. Was it: not used to low numbers, fast drop in numbers from onset, or dropping to a very low number. For Sheba it was too fast a drop from onset to nadir, so I was taught how to feed the drop and stop it going too fast and causing another bounce. It took time, but we are getting there. If you look at Sheba's SS and comments on the side re feeding you will see what I mean.

It all takes time and patience, which I had to learn, but it is worth it to see a run of green!
Don't be afraid of TR. If you think you could give it a try you could tag one of the ladies I mentioned above for guidance.
Good luck
 
Thanks @Bron and Sheba. Trouble is I work all week, so could not feed any drop during the day, so for now I will do SLGS. I only recently stopped TR as he went too low and it scared the hell out of me. What are the ladies you mentioned user names in case I need help? I am doing a curve today, and fingers crossed, so far it's looking good. From what I can make out, Frankie bounces just because of a low number (well, low for him anyway!!) He's been in very high numbers for over a year now, so I guess it will take just as long to wean him back into normal numbers. I only joined here last month, but I too am already seeing progress, he has decreased his dose from 5 to 3.75 units and today him and his brother were play fighting, something which hasn't happened in a long while and chasing each other round the house. Ok Frankie was bunny hopping because of his neuropathy, but he was going quite fast and I'm very happy.
 
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Sue484 said:
today him and his brother were play fighting, something which hasn't happened in a long while and chasing each other round the house. Ok Frankie was bunny hopping because of his neuropathy, but he was going quite fast and I'm very happy.
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Very positive news! (And that exercise will help Frankie's neuropathy too). :)
 
Hi Sue.

You mentioned Frankie has neuropathy. Are you giving him anything for that? My Cinco was walking on his hocks when he was first diagnosed. I was advised here to start him on B-12, so I ordered some Zobaline, and within a few weeks he was walking normally! His back legs are still a little weak, and he doesn't like them to be touched, but he's sooo much better than he was.

The ladies that Bron referred to are @Wendy&Neko, @julie & punkin (ga) and @Chris & China. There are others here that are as experienced and helpful. When you have a question. Use the ? icon in your subject line and you'll get answers!

It's great that you're already seeing improvement. Hopefully you'll see more and more as Frankie begins to feel better. I was lucky enough to take Cinco to see a noted expert on diabetes in animals, and he told me to be careful not to get so fixated on the numbers that I lost site of the whole cat - in other words, quality of life is as important as tight regulation. So when you're frustrated at not getting to the numbers you'd hoped, look at Frankie and ask yourself if he feels good? Is he happy? The numbers will come. Let him guide you on how intense you need to be.

Welcome to L&L Land. The nicest place you never wanted to be.
 
Hi Tricia. Frankie has been on Zobaline for about 2 months now but is getting worse. I suppose I need to get him in better numbers first. What a wise man you saw. I am fixated on the numbers as I want his legs to improve, but he has no clinical signs now, his weight is stable and he is happy and affectionate as always. He is so right. Thanks for that advice.
 
Sue484 said:
Thanks @Bron and Sheba. Trouble is I work all week, so could not feed any drop during the day, so for now I will do SLGS. I only recently stopped TR as he went too low and it scared the hell out of me. What are the ladies you mentioned user names in case I need help? I am doing a curve today, and fingers crossed, so far it's looking good. From what I can make out, Frankie bounces just because of a low number (well, low for him anyway!!) He's been in very high numbers for over a year now, so I guess it will take just as long to wean him back into normal numbers. I only joined here last month, but I too am already seeing progress, he has decreased his dose from 5 to 3.75 units and today him and his brother were play fighting, something which hasn't happened in a long while and chasing each other round the house. Ok Frankie was bunny hopping because of his neuropathy, but he was going quite fast and I'm very happy.
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Hi Sue,
You may not have to feed the drop if that is not your problem. Frankie could be bouncing because he is not used to low numbers. If that is the case, the more he sees these lower numbers the more he will get used to them and not bounce from them. I see that Tricia has given you the names of the ladies I mentioned, that is good. If you do not have someone helping you with doses and ideas of how to improve things, it would probably be good idea to do so. They will help you find the problem areas and suggest solutions.

I fully understand how hard it is to work all week and have a FD cat. Do you have an automatic feeder you could use each day and put food into for the hours you think Frankie needs food during the day. I find the auto feeder invaluable. Having two cats makes it more difficult. Can you separate them or have two feeders?
Sheba also had neuropathy and I gave her Zobaline. It really was not until she started to get out of the really high numbers and began to stay in the lower numbers that she started to improve to any agreed extent. She has now fully recovered and can jump up on things again and run up stairs.
 
I'd give you a different set of names. Myself, Marje/Gracie, Julie/Punkin, Wendy/Neko, Amy/Trixie, Dyana/J.D. and Sandy/Black Kitty. Some of us are around more than others. However, there are lots of people with good experience and solid instincts that are here and can help out if you have a question or you think there's the potential for an emergency. For example, sending a PM to moderators like Jill/Alex or Libby/Lucy if they are available will get you considerable expertise. Tricia/Cinco has been here for a while and she should have included herself in that list. Anyone can lend a hand and certainly can lend support. It's what makes LL such a wonderful community.

Sue --

I've been using TR since we got here about 6 years ago. I work full time. Gabby has dropped into impressively low numbers and has worn the crown for Bouncing Queen. There were, admittedly, times that I went in late when her numbers were making me nervous. Part of how I've adjusted to managing her FD is to get early tests. It gives me some warning if her numbers are dropping and I won't hesitate to "over" carb (or abort the cycle) if I have to get into the office and her numbers are dropping. In my previous job, I had more flexibility with my schedule and could get in late or run home. It's really not feasible for me to do that since I changed jobs. Bron is also correct -- you don't have to let Frankie drop below 40 in order to reduce the dose. Three drops under 50 or a week in normal numbers also qualifies for a dose reduction.

My preference for TR is based on it's having a foundation in published research. SLGS has been used here and cats have been successful. I'm a science nerd so I like data. (Look at Gabby's SS, especially from the early years, if you have any question about my love of data. I'm a testaholic.) Either approach can be modified once you know your cat. They are guidelines not rules that are carved in granite.
 
I have 6 cats, two diabetic, so I a can't really separate. The second diabetic would eat anything and everything. Not because of the diabetes because he's regulated, but he's always been greedy. I don't have an automatic feeder because of this. I do have a pet sitter who comes in at lunch time to give Frankie a snack and do a spot of crowd control because they all want some!!! Frankie is definitely bouncing because he is not used to low numbers. I just need to try and get him to stay low. The trouble is his bounces last so long. I may have to put his insulin up after the curve today, he did well last time on 4 units when I was told to reduce.
 
Sienna is quite correct. There are many others who could help you. I just mentioned the ones I did as they have helped me.....so has Sienne helped me I must add.
No the three drops don't have to be in a week. It is just a week of normal numbers.
ETA: Sheba's bounces used to last three days as well but as they get used to numbers they bounce less. Sheba was a huge bouncer. Lately she has been bouncing in lower numbers and only for about half to one cycle.
You are correct, you do need to get Frankie into lower numbers.....they don't have to be green numbers yet just ones in the 100s and 200s and get him used to those. The more he is in them the less he will bounce, but it will take time
 
Thanks everyone. He started off so well today. Now I think he is starting to bounce again. Sigh.
 
Nope. It's three drops in different cycles. If they were 2 months apart I don't think I'd say go ahead and reduce but there's no hard and fast rule as to how close together those drops need to be.

(If you widen the columns on your SS, the numbers that are showing on the US side as #value will read as actual numbers.)

One thing that helped to flatten out Gabby's numbers was for me to do what I could to prevent her from getting a reduction while at the same time, trying to maximize her insulin dose. I know you're apprehensive about Frankie dropping low so now may not be the time to consider this approach. A different strategy might be to spread out Frankie's food over the pre-nadir period if you're not already doing this. Sometimes experimenting with your feeding cycle helps to level things out. Food type of interventions are very individual. I'm currently feeding Gabby at pre-shot, +1 and +2 although during the PM cycle and on weekends, she gets a +3 snack. If I have to be out of the house, I may double up a portion. Often what I see is that by giving her a double portion at one feeding time, it's not what she's used to and it props up her numbers giving me an extra measure of safety. You may need to test out different options with Frankie, keep good notes and see what works.

 
And longer term, Sue, if it turns out the Frankie does keep bouncing then there are other insulins you can try to see if that makes a difference. Some folks here have found that their cat had less bouncing on Levemir, for example. And in the UK we also (uniquely) have Hypurin Bovine PZI (though very few FDMB'ers use that at the moment so you wouldn't get the support that you'd get with Lantus/Levemir).

I'm not suggesting that you do change insulins. I just wanted you to know that are other options you can try if it turns out that Lantus doesn't suit.
 
I can spread his food out in the evening cycle, but with work I can't do it in the mornings as I have a 90 minute journey each way as it is. That's why I have the sitter come in. Maybe I should get her to come about 11 rather than 12.30.
 
There is not a huge difference between 15.1 and 16.7. See what the next few numbers are. I would still do the curve. He might just need a bit more insulin. One of the experienced ladies will tell you. In SLGS you decrease if it drops lower than 5 don't you? Frankie might do better if he uses the TR and keeps the dose longer.
I thought Sienne made several good points for you to think about.

Yes I can see having 6 cats would complicate things. But if you have a sitter come in at lunchtime she could feed Frankie some food to keep his numbers in a safe range, couldn't she?
 
Sue484 said:
I can spread his food out in the evening cycle, but with work I can't do it in the mornings as I have a 90 minute journey each way as it is. That's why I have the sitter come in. Maybe I should get her to come about 11 rather than 12.30.
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Wow, that is quite a commute each day!
If you do a few curves, you will be able to see where Frankie would benefit with getting food. And then you could think about changing the sitters time.
Elizabeth suggested there are other insulins ....I use levemir and it is very good but it has a later onset and nadir compared to lantus. But it is worth remembering if this doesn't work out.
 
The sitter does come in to give Frankie a snack as I got so scared when he dropped to 2.5 that I wouldn't be able to get to him quickly. She also tests his blood just as a reassurance too. I am off this week so hopefully can get a bit of data from him so we know where to go next. I think an increase at the minute, but we shall see. I will remember the other insulins if no luck with this one. But it certainly miles better than Caninsulin.
 
My only concern for Gabby with Lev is the late nadir. Gabby is (usually) an early nadir kitty. This means if her numbers are dropping, it's before I leave for work and it allows me to get some HC into her before I leave. With Lev, it could push her nadir substantially later and not afford me the margin of safety I'm used to. This is another example of ECID and how you need to think about adapting what you know about the insulin you're using to what you know about your cat along with your own lifestyle needs.
 
Sue484 said:
The sitter does come in to give Frankie a snack as I got so scared when he dropped to 2.5 that I wouldn't be able to get to him quickly. She also tests his blood just as a reassurance too. I am off this week so hopefully can get a bit of data from him so we know where to go next. I think an increase at the minute, but we shall see. I will remember the other insulins if no luck with this one. But it certainly miles better than Caninsulin.
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You are very lucky to have a sitter who will test his blood and a great idea for her to give him a snack. When you say 11am and 12.30pm, where is that in the cycle?
If you are off this week you might be able to get something sorted out. It all takes time. You are doing a great job.
 
12.30 is roughly +5.5 amps, therefore 11 am would be +4. Which time would you think is more suitable for his snack?
 
It depends when his nadir is? Looking at his SS there is no consistent time that I can see for the nadir. Once he gets better numbers it should became clearer.
Do you give a snack before you leave the house in the morning after his breakfast?
The +4 might be a better time for the snack but the +5.5 is a good time to test for the lower blood sugars. While you are home this week try out a few times and see if any seem to be better than the others.
I can see he is bouncing again in the curve. Don't get dispirited though. Sheba was a terrible bouncer and she has all of a sudden almost stopped doing it (anti jinx) and gone into really good numbers.
 
No, in the morning it is breakfast, shoot and out the door. If he has left anything from his breakfast then he will go back to it later. Maybe I should put extra down before I leave and then the sitter just test? I will try different times for feeding his this week his midday snack and see if that helps, but he needs to stop bouncing first!! I did give him a very small amount today at amps +2 and +3 but that seemed to trigger the bounce.
 
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If your schedule allows, maybe you could change it to shoot earlier and have time for a couple of extra tests before you leave for work? I used to shoot at 6, and that gave me an hour and a half before I left the house. That was the best I could do, as I often didn't get home from work until 6:00pm.

It looks like you can stop testing until PMPS.
 
Don't the other cats eat his food if he doesn't eat it all at once?
I think I would still get the sitter to give him some food. That way you know he has got something later in the cycle in case he is running lower.
 
Trouble is I don't get in from work until 6pm depending on transport, and I have another diabetic cat too. I get up at 5.30 as it is to get myself ready and see to all the cats. Hopefully the other cats wouldn't eat his food. They normally snooze the morning away until the sitter arrives and then stir themselves ready for lunch!!

@Dyana ok. I stop the curve as he is bouncing. Should I increase to 4 units this evening as per SLGS instructions? The sitter is coming several times tomorrow as I will be out from morning to late evening. Should I wait until Monday to increase when I can monitor?
 
Sue, just out of curiosity, what does the #VALUE mean on your spreadsheet?

I am not 100% sure about where the numbers should be on Alphatrak, but based on the colors of your spreadsheet I think Frankie has room for an increase. Whether you do it now or later it really up to you, only you know what you can handle in regards to the possibility of treating a low if it should occur.

I do think that the 45 that he had on the 4.0u dose before was the work of the depot, although you were not on the 4.25u dose for very long, so maybe that isn't the case. I do know that sometime a cat will go low on a dose, but then after the reduction they don't do as well and have to go back up again, and the second time the don't go too low on the same dose. It is a huge frustration of mine, and I am sure many others, that FD isn't more predictable.
 
@Tina & Sammy if you look at the world spreadsheet, where it says #value on the US version is where I have entered something like 19.2 @ 10.5. Meaning 10.5 hours after shot he was 19.2. (I wish!!!) The sheet does it automatically. I have been colouring it in with the appropriate colour so you could see the range. I think Alphatrak run 30% higher than human meters, so I might get the sitter to inject 4 units tomorrow night. I will be back about +3 after that, so I could monitor then.
 
Sue484 said:
@Tina & Sammy if you look at the world spreadsheet, where it says #value on the US version is where I have entered something like 19.2 @ 10.5. Meaning 10.5 hours after shot he was 19.2. (I wish!!!) The sheet does it automatically. I have been colouring it in with the appropriate colour so you could see the range. I think Alphatrak run 30% higher than human meters, so I might get the sitter to inject 4 units tomorrow night. I will be back about +3 after that, so I could monitor then.
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Gottcha! I thought that might be what it was.
 
Hi Sue.

If you highlight the cell on your World SS that correspond to the ones that say #value on the US, then click on "Wrap Text" up on the toolbar, it will fix the problem. Any time you enter that much data in a cell, it will need you to wrap the text.

As you have observed, there are lots of people here who can/will help you. Sienne was one of those that was here when I started, and she was VERY instrumental in helping me save Cinco's life. You couldn't be in better hands than hers, as well as all the others she and Bron mentioned.

I know you already have some experience with a diabetic cat, but it sounds like you used a different insulin, so this experience will be somewhat different - maybe a little more overwhelming. Just don't forget to breathe!!!
 
Hi @Tricia & Cinco I just checked and wrap text is already enabled. Everyone has been so helpful and friendly here, and it all thanks to them that Frankie has made as much progress as he has. Yes, Lantus is completely different to Caninsulin and took a while to get my head around it, now with two diabetic cats on two different insulins then it's a challenge to remember sometimes!!
 
By the way, Jill has updated the SLGS sticky to include information on how to handle a lower preshot, for example, and some other information. If you haven't looked at it this week, it would be worthwhile.

So you've done a curve - now to decide what to do with the dose compare your data with the SLGS guidelines (listed in human meter numbers, approx 30-40% less than AT):

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
​
The lowest number you've had on this dose is actually not on the curve, but on 5/20 pm cycle he got to 144AT; the lowest in today's curve is 185AT. These would suggest you would maintain the same dose, since that number translated into human numbers would likely be in the 90-149 range of the second bulleted point.

The best way to get experienced people to help you is to do exactly what you did - put your question in the subject line, or use a ? icon. The folks Sienne mentioned mostly check on the board at least once a day and look first for those with questions. There are also plenty of others who give a hand - Elise (Max), Marilyn (Polly) and Serryn (Purrdy/Vyktor), Ella (Rusty), Ann (Tess), Rhiannon (Shadow) all help a lot - and of course even by naming them i'm no doubt leaving out others that help when there is a need. If you rely on tagging, then if those individuals aren't on, a question may get missed. It's fine to tag, but I really think the best way to get a question answered is just to use a ? icon or put the topic of your question in the subject line - then anyone with experience in that area will come and help.
 
julie & punkin (ga) said:
The best way to get experienced people to help you is to do exactly what you did - put your question in the subject line, or use a ? icon. The folks Sienne mentioned mostly check on the board at least once a day and look first for those with questions. There are also plenty of others who give a hand - Elise (Max), Marilyn (Polly) and Serryn (Purrdy/Vyktor), Ella (Rusty), Ann (Tess), Rhiannon (Shadow) all help a lot - and of course even by naming them i'm no doubt leaving out others that help when there is a need. If you rely on tagging, then if those individuals aren't on, a question may get missed. It's fine to tag, but I really think the best way to get a question answered is just to use a ? icon or put the topic of your question in the subject line - then anyone with experience in that area will come and help.
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Thank you, Julie!

Yes, the best way to get questions answered is to use the question mark prefix on your thread (as you did). Tagging people to take a look is fine, but if they're not logged in to the FDMB the persons have no idea you're looking for them. When looking for help, one also wants to tag judiciously because sometimes tagging only certain people will make others feel like they're excluded... or worse yet, like chopped liver. Those who routinely offer suggestions, advice, and help make it a habit to scan the group/board for 911s and question marks as soon as they log on. They'll see the problem or question.

Not too long ago, our webmaster made it very clear there are not any specific "advisers" on the FDMB (it's a legal issue, folks), so let's refrain from the using the word as well as listing sets of names or using sets of names of experienced members in posts or documents because doing so does not honor her wishes. Listing only certain people also tends to exclude those who may have something worthwhile to add... not what we want to have happen on an open, peer reviewed message board.

Hope you all are having a nice weekend!
 
Sorry, I never meant to offend anyone. I'm new here so still getting to grips with things, but everyone so far has been very helpful and friendly, so I'll always use the question mark.
 
Hi Sue.
It is not your fault. It is probably mine as I was the one who first mentioned others helping you.

Sorry Jill. Thank you for clarifying that. I will be mindful of that in future.
No offence was meant to anyone by just mentioning a few people. I know there are many many wonderful people here on the board who are helping people in need every day as well as giving much needed support
 
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