Here's our Curve

Previous threads detailing our story here:

1) http://www.felinediabetes.com/FDMB/threads/5-months-in-desperate-for-help.179060/#post-1980335

and here 2) http://www.felinediabetes.com/FDMB/threads/newbie-first-day-of-testing-results.179124/#post-1981870

...Today we did our first at-home curve. Abby's spreadsheet is available in my signature below and I stuck an image in it of the curve in graphical form. I was able to nicely locate her nadir, at 4 hours today, so that answers that question.

Wondering where to go with this next? Since she's only been on the 3 unit dose for two days, I'm tempted to keep her at this level for another week or so to let her body continue to adjust down from the 7 unit level where we were with our vet for the past month. The lowest numbers we get are mid-200s though, so we've clearly got work to do. Just not sure what. Any insight greatly appreciated.

 

Very nice curve. I would stick with 3 for now for a few more days.

 

That was indeed a nice curve. I agree you should hold the 3u for a few more days. Is there any way you can get some tests in the evening cycle to see what Abby does then? Many cats go lower at night and getting a test in early in the evening cycle will give some clues as to the evening activity. Snagging a test before bed and when/if you get up to use the facilities, gets you more pieces of the puzzle to see what is going on.

 

This is very nice. I can't believe you were at 7 u!! Too many vets take the approach of throwing more insulin at a cat if the numbers there are high ...

 

I will do that!

 

It's really a shame! And frighteningly similar to my human experience when I had gestational diabetes. For how common it is, it's scary how deficient and uninformed standard protocols can be.

 

Too many medical professionals tend to treat insulin like a drug rather than a hormone. Vets don't get much training time on diabetes and many treat cats like dogs. Dogs don't tolerate high BG as well as cats so vets tend to think they have to rush the kitties along as they do their canine patients raising doses in alarming fashion. We get a lot of folks joining here whose cats' dose has been increased too quickly and far too much.

 

Great job, Meg

 

Well thank you!

 

So we've been at the 3 units for a week now. Unfortunately I haven't been able to get AMPS and PMPS every single day as I've not been home, although I'm thankful to have had a great sitter who could at least give Abby her shots each day. Anyway, based on the readings I did take (see spreadsheet in my signature), I think our next step will be to switch her over from her current wet food (Purina Pro Plan Entrees) to the Friskies type recommended on this board. I plan to do that this weekend while I'm home to watch her, probably mixing it 50% with her current food at first and then swapping it in entirely. Plan would be to watch her measurements again then for a few days. Her numbers are still too high.

Does this sound about right in terms of what we should be doing?

Hope everyone is having a nice summer!

 

The plan to get Abby on the Friskies is a good one. It might be a good idea to start off with less than 50% of the new food as switching too quickly can cause GI upset. Maybe start with 15 - 25% rather than 50% and gradually increase the portion of the Friskies over a few days to a week. Doing it this way also gives you a bit of a cushion for watching the BG change which can be dramatic if the carb difference between the foods is substantial or even if the carb difference isn't large but Miss Abby is particularly carb sensitive. Hard to tell exactly what the reduced dose is doing just yet but if you monitor this weekend and get some more readings, it will help start putting the pieces to the puzzle together.

 

Sounds good.

 

Linda, Janet, do you think she should reduce the dose again when diet change is 50/50? I'm suspecting 3.0U might still be too high. The accidental 2.0U from pet sitter gave a nicer AMPS

Meg, how many hours after her PM shot do you go to bed? Could you squeeze in a before bed test? *paws crossed* it's like +3

 

I'll fit in some post-PMPS tests this weekend. I should theoretically be able to do this more often, it's just been a bit of a trick with hubby out of town and both kids refuse to sleep without Mom physically touching them, lol.

 

One conclusion I feel comfortable making at least is that the reduced dose is certainly not producing any worse numbers than the crazy 7 unit dose was!

 

@Yong , you might be on to something there. It's hard to tell for sure what's been happening, but it never hurts to be conservative when making food changes.
@megmonger I take it you will be working again come Monday and unable to test regularly?? If so, it might be an idea to take the dose down to 2.0u while doing the food change just to add a bit of extra caution. You may not see a lot of change immediately if Abby is bouncing. The real change in BG as a result of diet change may not show until she's been on the new diet fully for a few days. It easy enough to increase the dose if Abby needs it but knowing how far to back up the dose if she does start showing much lower numbers is a little trickier.

 

Could do that or meet half way and do 2.5.

 

I'm excited to see the results of the food change

 

Normally I'm able to get at least an AMPS and PMPS during the week. This week was unusual. But I don't see her for the middle portion of the day so I like weekends for making more significant changes. I'm going to research more to confirm her current food carb content and how much it differs from the one we're switching to and likely decrease the insulin as well. Trying to walk that line between not wanting to change too many variables at once and not wanting to cause Abby's BG to go crazy by changing too few. Thank you for all of the advice!

 

Random question - what's the difference between the different types of insulin used for cats? I see the other boards like for Prozinc here. I have no idea why our vet started us with Vetsulin. Is that the first one folks usually try? What are the appropriate criteria for looking at one or another?

Anyway, I was just curious. It has been a hard week for us here with Abby. Trying to distract myself with research.

 

Usually Vet's recommend what they're familiar with. The differences are in Absorption, Onset, Peak, and Duration. The best one for your cat is the one that works . As for criteria to look into changing, there is no broad general answer.

 

Insulin is a hormone rather than a drug but like drugs, the different insulins are made with different ingredients and therefore one may work well for one cat and not so well for another. While we all focus in on the BG numbers there are other clinical signs that you should pay attention to as well and use as part of the criteria to decide if a change of insulin should be considered.

Things like appetite, amount of water intake and urinary output, is kitty still preening, purring, peeing, pooping and playing (the 5Rs) and whether their general demeanor is different than it was before insulin. With some cats, an insulin may get the cat into good BG range but the cat still seems to be feeling poorly while others may have still have erratic BGs but clinically be acting as if they feel wonderful. It's the full picture you need to consider.

You've been dealing with Abby's diabetes for a few months now but she's been on a large dose of insulin that was not controlling her BG and possibly making her roller coaster between low and high BG numbers. The dose being lowered may help improve her numbers and how she is feeling. Your observations of both her general well being as well as her BG numbers should be your guide.

 

Thank you for the helpful reply!

Abby's behavioral issues ALL started not when we got the diabetes diagnosis, but a month or two later after she had been on the insulin (at that point only 1-2 units), which seemed very odd after presumably at least a few months with uncontrolled diabetes and on a high carb diet but with no behavioral issues or outward signs other than a very wet litter box.

We will continue to work to get her BG under control and hope that that will resolve the behavioral aspects. But now I know to keep this in mind as well. If all else fails, we'll look (potentially with a new vet) into a different insulin before we give up hope. We have been feeling pretty hopeless lately, although with bright spots thanks to the help we have received here which had allowed us to feel a bit more in control and aware. Her behavioral issues continue to be severe though.

 

The food aggression will improve once her BG is better regulated. I know you dropped her dose a bit because of the food change. After a couple of cycles to see its effect, I'd try raising the dose by 0.25 u (eyeball it) every 3 cycles and try hard for at least one mid cycle and before bed test every day. We don't have much info yet on how low she goes but the SS data you do have suggests that her dose is too low. The longer they sit in high numbers, the harder it can be to shift them. The extra testing will demand more of your time and so on but it's the way to find a dosing range that will get Abby feeling better.

 

Have the food aggression and/or the peeing problems changed at all since you lowered the dose of insulin? I take it you have had Abby checked for a UTI (sorry if this has been covered before).

As Kris mentioned, the more data you can get the better to determine what is going on with Abby and right now we don't have enough data to determine exactly what any dose is doing for her and is therefore a guess. Snagging a test whenever you can will help put more pieces to the puzzle into play and help you see patterns that will guide you as to whether she needs more or less insulin at any given time. The dose of insulin can change from time to time for unknown reasons so testing is your best tool to get Abby feeling better and get the behavioural issues under control.

 

She has been peeing outside the litter box, limited to the basement, since about Feb-Mar, so it started shortly after we first started her on the insulin (1-2 units at that time). In the past two weeks, so same timeframe when we have reduced the dose, she has begun peeing upstairs in our living space. We have had her checked numerous times for UTIs although it's been a month or two. Each time came up clean.

And fitting in more tests now that I'm home for the weekend. Just got another +4. The delta between her pre-shot tests and her nadir seems to be decreasing, meaning I think her curve is smoothing out. All still high though.

 

Oh man! I feel for you with the peeing issues. Been having some periodic issues with my 19 yr. old recently which I think are senility related and it's very upsetting to say the least. If you have the litter box in the basement have you tried putting another upstairs somewhere? I'm not aware of any specific reports of Vetsulin causing inappropriate elimination issues but that is certainly something to factor in when deciding if a different insulin might be in order. I agree with Kris that holding doses too long is not ideal and wouldn't hold any longer than 3 days if numbers are not improving.

Are you using syringes or the Vetpen? If you are using the Vetpen, I'd suggest you get some U40 syringes with half unit markings so you can make 0.25u dose adjustments at this point. With the higher doses, it's often OK to make dose adjustments of 0.5 to 1u at a time but when in the more normal ranges, quarter unit changes ensure you don't skip over the best dose.

 

OK, I'll plan to watch her numbers and adjust up by a small increment assuming nothing changes in the next day or so. Previously I had been holding for about 5 days prior to adjustments.

We use the U40 syringes. A bit frustratingly, we always buy the same brand and color of box from our vet but half the time they have the 0.5 marking and half the time they don't. Our current box does not... If anyone knows of an online source that always has those markings, I'm looking to switch.

 

Whoops forgot to answer this. Not yet but I'm switching our second box to upstairs this weekend. I have a separate post on the main board working through suggestions to help with this. Needless to say, the peeing issues have been less than enjoyable. :-/

 

Some people have success with Dr. Elsey's Cat Attract litter.

 

A lot of US folks order from adwdiabetes. Here's a LINK to one brand. They have several different brands available.

 

Yep we have that

 

Thank you!!!

 

I used to use these: https://www.adwdiabetes.com/product/16363/carepoint-vet-u-40-syringe-29g-half-unit

 

Numbers are slowly coming down! We're in the mid-300's pre-shot pretty consistently and while I don't have enough data points for +4s yet they're looking like they're in the low-mid 200s. I believe I am aiming for 200-300 pre-shot and 80-100 at the nadir. So we've got about 100 points to go for each (a bit more for the nadir). I slept through last night's alarm for the nighttime +4 but I'm confident I'll get more of them this week. Also trying to talk hubby into doing the daytime +4 on days when he works from home.

 

Tests don't always have to be at +4. Testing anytime between +2 and +6 randomly will give you more data and a picture of how quickly the insulin is starting to work and how quickly. I know how hard it is to get up with those test alarms in the middle of the night (slept through mine last night ) but if you can get a test just before you turn in for the might, it will provide a clue to how active the cycle may be. Nadir's don't always occur at exactly the same time every day so shuffling test times a bit gives you a broader picture of how cycles are going. The more data the more complete the puzzle making it easier to figure out how to proceed.

Abby's cycle has smoothed out considerably and looking much better but she's still running a bit high so if you can get those half unit marked syringes and increase her slowly by 0.25u, I think you'll find her pre-shots and nadir will continue to come down.

 

Slow but steady is good . One little thing, we try to hold a dose for at least 3 cycles (each cycle is 12 hours, so 3 shots). Only mentioning this because I noticed 2.75U was only done twice . Seeing improvements are good but we don't wan tot rush the process as it can cause issues in the long run. Remember, complimentary patience pants are available

 

Yep, that was an accident! I thought I had done 3 cycles and didn't realize it until I filled out the sheet. The days are blending together... >.<

 

Got our first blue reading ever! (celebrating the small victories...)

 

It took me about 3 months to get a blue.... And look how much that dose had gotten reduced! I'd say that's two victories!

 

Excellent!!