Doing our first curve and everything going wrong! Help!

Hey!

We're doing our first curve today, so naturally everything is going wrong.

A bit of background
- 11 year old male cat
- diagnosed with diabetes after extreme weight loss. Diagnosis 3.5 weeks old
- on a controlled diet of 300 calories (goal is 200 calories) wet diabetic management food
- Using Bayer Contour Next monitor and strips
- gets 2 units of Lantus twice a day

- We usually aim for his insulin injection between 10 and 11, and were late today (12:30pm)
- Forgot to do a test just before injection, rather did one just after
- took forever to get enough blood on the strip, and used the needle to "spread" the blood over the strip as it asked for more (think it just hit the wrong part of tip)
- reading was 1.7 mmol/L which seems really low

Should we be worried that it's that low? Or would it be that low because of right after the insulin? He seems fine, heading back to bed now.

Any advice would be awesome

 

You need to re-test right now! That number seems way to low & can indicate your kitty is hypo.

Please re-test immediately & post the numbers, it's very important.

 

Yes, that is an extremely low BG number (and one of the reasons we really stress not giving insulin without a test before hand, yikes!)

How long has it been since you gave insulin? Instead of giving time in hours like 12:30PM, on the boards we express time in relation to the shot - a test prior to shot is PS, a test 1hr after is +1, 2hrs, after is +2, etc.

You should get a test ASAP. If still under 50, you should feed a little bit of high wet carb food (gravy) or get a little karo syrup on his gums. If his number remains low, you should repeat testing every 15- 30 min (depending on how low) until you see him safely into higher numbers for 2 tests in a row.

 

Thanks all!

Are we talking in the same measurements? My documents from my vet say normal is 4 to 8 mmol/L.

The first test was immediately after his insulin shot. I just did another test now (+2.5 hrs) and he's at 12.5, Plan to test again in 2 hrs.

 

1.7 is dangerously low and you should never give insulin that low. The Americans use a different system to the rest of the world, to get their readings, multiply your figure by 18.

 

How is your kitty doing now, what are his numbers?

 

so right after insulin earlier today he was 1.7 (30.6 for my US friends ) — I stupidly didn't measure before.

+2.5 hrs he was 12.5 (225) and +5hrs after he's 10.9 (196.2)

Long story short — he's now 10.9 (196.2)

 

Glad his BG came up without incident. I would suggest you might want to try another day for a curve, since you had so much happen today. Don't feel bad about it, all of us have had days like that, and curves that went wrong, more than once!

Hi Xtian, welcome to FDMB, the best place you never wanted to be, lol!

I'm glad your kitty's BG came back up without incident. Did your vet give you a "no shot" BG number? For American human meter values, we use 200 as a "no shot" number, unless you are very experienced. Also, did your vet or anybody tell you to put together a hypo kit, and what to do if your kitty has a hypo event? Here are two links, one for putting together a hypo kit and one on how to handle a hypo:

http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Both of these are very important! You can never know when you might need this information. My kitty has had at least two non-symptomatic hypo episodes, and it is scary, so best to be prepared (and hope you never need it)!

It is also very important to test your kitty's BG before you administer insulin. Here, we suggest test, feed, then shoot. That way your BG readings are not influenced by food, and kitty has some food in his tummy to buffer the drop in BG.

We have a spreadsheet here that we recommend you use to chart kitty's BG and insulin dose, along with anything else you might want to add, such as medications, foods, other tests, vet visits, etc. It is incredibly handy to have all your info in one place and be able to see it at a glance! It is also very helpful to other members to refer to if you have questions or need help. Here is the link to it:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/WE

I don't know what type of diabetic management food your vet put your kitty on, but a diabetic cat's carb intake should be under 10%. Here is a list of most of the widely-used cat foods and their analyses, showing % of carbs: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf A lot of vets, really through no fault of their own, are not well-versed in the nutritional needs of our sugarcats, and when sales reps visit them with promises of "the best food" for diabetic cats, it ends up being what the vet tells us to use. The majority of these foods are not good for our cats, as they are high in carbohydrates. They are also usually pretty expensive! Most of us feed Fancy Feast Classic pates, or Friskies or 9 Lives, based on the catinfo.org chart, but there are many other choices as well.

If you switch your kitty to a low carb food (providing he isn't already on one), you will need to do it gradually, and you absolutely MUST be home testing. Kitty's BG can drop a great deal from the change to lower carb food, and you may need to adjust his insulin dose accordingly. It is vital to monitor his BG during this time to prevent hypoglycemia!

Last but least, could you please update you signature to include some info about yourself and your kitty? Just click on your name at the top right in the blue bar, then click on Signature in th drop-down menu. Most of us put our cat's name, Dx date, type of insulin, type of meter we use for home testing, type of food we're feeding, and some of us also put our name there, as well.

ETA: This is also where you link your spreadsheet!

I hope I haven't overwhelmed you with information, and that you will find at least some of it helpful! It gets easier and less complicated as you go! And always feel free to ask for help, or for answers to questions, any time you need to. Everybody here is happy to help you!

Lucy

 

You have also earned a .25 reduction in insulin too, although he may well bounce tomorrow from that low reading.

 

Thank you Sue and Lucy! Much appreciated. I'll update my signature and start a spreadsheet later tonight.

He's on Purina Pro Plan Veterinary Diets Diabetic Management. about 3 weeks in. Prior to that he was on a mostly wet food diet, but not controlled (we fed him when he was hungry

Our vet did give us information about a hypo kit. We're very fortunate to have our vet — she's Ontario's (Canada's largest province) only fully feline certified vet, owns two cat-only hospitals, and is an editor for Cat Fancy. Her and her team are excellent. If anyone is in Ottawa, go see her!

We were told to only do his curve weekly — should we be testing in addition to that?

I'll call my vet tomorrow with my results as she was really explicit to not change his dose without consulting her first.

I'm about to do another test now (each time is easier, thank god!) and then one just before giving him insulin near +12 hrs.

You're all wonderful! Thank you

 

Added my signature

 

You should certainly be testing before each and every shot. Also at least one mid cycle test in the day and at least a before bed test at night. Lantus is dosed on how low it takes your cat's BG. If my vet had his way
Frankie would probably be on at least 6 units twice a day, when actually he just earned a reduction yesterday to 2.25. If you are feeding dry food too, that is way to high in carbs. He needs a low carb canned diet. No need for expensive prescription food. If you switch his food you will need to monitor his BG closely as it can cause a huge drop in BG.

 

Purina DM canned food is okay as far as carbs go, it's only 3% carbs. If you ever decide to change, there are less expensive options that are just as good.

I'm glad to hear you have such a wonderful vet! Some of us have looked high and low before we found ours!

Yes, you absolutely should be testing before every shot, at the very least. It can be very dangerous to Datura to give insulin without knowing what his BG is! If his BG is low, like it was today, he could become hypoglycemic, which can be fatal. Not too long ago there was a new member who was not home testing his cat. He had been having some issues and posted for help; we convinced him to go out right away and buy a meter, and come back and test his cat. It saved his cat's life. Literally. He was giving 4 units of insulin, which would have killed his cat as it's BG had already dropped very low.

Your vet is right about not changing his dose without consulting her, at least until you have more experience. Our most experienced members will give dosing advice here, also, especially if a lower dose is indicated. We stress that we are not vets, but some of us do have years of experience in treating diabetic cats. I have looked to the members here for dosing advice several times, and I'm sure I will again, lol.

Yes, it does get easier every time, before you know it it'll just be routine.

 

Thanks Sue. He is on wet food only.. other than the occasional Temptations crunchy treat.

So I should be testing every single day before his insulin shot?

 

Yes, before every single shot. You really should not have shot tonight with that 1.7, as he was hypo then although he had no symptoms, but this can be fatal. Luckily all has turned out well, but you can see now why it is important. If you had been testing more regularly, you could have averted this with food and slowed down the inevitable bounce that will happen tomorrow.

 

Thanks

"You really should not have shot tonight with that 1.7, as he was hypo then although he had no symptoms, but this can be fatal." I should mention again this was the result after administering insulin — I don't know what it was before (my mistake! Glad it went ok)

I'm going to test him again in 2 hours, as that's when he's due for another insulin shot. If he's still 10.9 or higher, it's ok to give him the shot?

 

I sincerely apologize. I was doing a few different things at once and did the conversion, but didn't type it in. Totally my bad. US numbers = international mmol X 18.

Glad things look safer. After a really low number kitties can bounce - their bodies react to low numbers by producing glycogen. You should be safe to give tonight's shot if he is that high. But do make sure to keep an eye on things because if he is bouncing, when that clears you could see some really low numbers again. Bounces can last a day to a few days, so make sure to get your preshot test in a try to catch some mid-cycle tests to see how low you are getting.

Good catch today!

 

HELP! In doing this prick on his ear, the needle slid as he squirmed and I sliced his ear a little. like a small millimeter slice, but through. I'm overwhelmed with guilt. He's bot longer bleeding, and doesn't seem to have noticed, but I'm so upset.

For the record, he was 11.6 (208.8) and insulin time is about 30 minutes away.

Is he ok? He's not bleeding out. Has anyone else accidentally sliced their cats ear during their first curve?

 

Just gave him his shot. How long should I wait before testing again?

 

Hi from a fellow Canadian. If there is no further bleeding and Datura (what a neat name!) seems fine, I wouldn't worry. Just stay away from that spot for a day or so to let it heal up. If you have any Neosporin handy, you could put a dab on there for good measure but it's not necessary.

I am thinking that the 1.7mmol you got this morning was a false reading especially given you were having issues getting enough blood on the strip. At that level, I'd expect there to be signs of hypo!!

I see you just posted that you gave Datura his shot. Given he was over 11 mmol (200 in US measurements) that was fine. We suggest that as a cut off point for whether to give the shot or not. If you can stay up, it would be ideal to get a reading in at +2 after the shot. If he is reading about the same or up a bit, then you can call it a night as that usually signals a pretty flat cycle. If his number is down, give him some food for overnight and set an alarm to check again around +5 or +6. I think it best to check tonight just so you get a better idea of how he is reacting to the insulin.

If there is any question about how to proceed when you do the +2 test, post here and there's usually someone around because there are folks here in all time zones. While I seriously doubt this will happen, if his number has dropped a lot, you can put a 911 on your post title (prefix box on the left side of the title box) to get attention.

 

Thanks Mr! 1.7 felt false as well.. we were trying to get the blood "on" the strip rather than absorbing blood through the tip. All is good now. Monster just had his injection and is devouring some wet food — then a test. He was 11.9 just before his insulin.

 

When you test at +2, please post the reading. I'll probably still be up as I assume you'll be testing in about 40 -45 minutes.

Just for future reference, should you get a low number again, do a second test to confirm the reading. This morning you had issues you were aware of , but it is also possible to get a bad strip so retesting to confirm is always the best move when you get an unexpected reading.

If per chance, Datura does goes lower tonight, you should discuss lowering his dose when you call your vet tomorrow.

While a lot of vets do not tell their clients to test their cats before each shot and some even discourage it, it has been our experience here, that it is safer to do so as it has saved many cats from having a hypo event.

 

Sorry, I never meant to offend, but Lantus does not start working in most cats until +2 ( although with Frankie it's +4) if you shot him straight after food, that would have made no difference, but as you feel it was a false reading, then I again apologise. It was very late at night for me (early morning actually) and probably I wasn't reading everything properly.