In home testing

Hi all. Started testing Frank's BG today at home. We got a 383 reading right before his 730p shot and I just checked again, about 5.5 hrs later, and it was 353. I'd like to stop giving him the royal canin glycobalance that was prescribed and stick to just Friskies pate. With these high numbers, do you think I'd be safe to do that? (I'm using a Relion prime for testing.)

 

How much insulin are you giving? How much of the dry food is he eating? You'd have to pay close attention to his numbers when you cut out the dry food. If he's on a big portion of the dry you'd have to do it slowly. 353 at +5.5 seems like he's not doing well on the dose he's getting but without more tests it's not really possible to determine if it's too high or too low of a dose. If you can I'd do a mini curve when you can. Which is testing preshot- 2 hours without food before test, then feed and shoot. Then test again +3, +6 and + 9. This will give you a glimpse of how the dose is working. If you can you can also do a regular curve which is every 2 hours after his shot.
Setting up the spreadsheet here will help others here see how he's doing and is very helpful for you to help determine dose in the future.

 

I missed the dose info in your signature! I see he has had DKA. There are others here who have been through it with their cats that can give you more info on how high is too high for a DKA prone kitty. I suggest getting Keto-strips to test his urine for ketones if he's staying high like today. They can come on quickly. I saw your post in the main health area. I think cutting out the dry is a good idea. Usually they like to hold the dose for 6 cycles or 3 days before increasing dose but with DKA prone kitties it might be a shorter hold. There will be much more knowledgeable people on here, usually start getting on around morning time.

 

To do testing every 2 hours, does that mean I withhold food all day? Or just no food at the 5-7 hours post-shot, and food the rest of the time?

 

CONGRATS Sarah on testing! It's probably the biggest hurdle most have when treating FD and you're already doing it like a champ!

Just withhold food the 2 hours before the shot on curve days...it's okay to let him eat the rest of the time.

Sounds like things are staying high and flat. Those numbers aren't really TOO bad, but we definitely want to bring them down. I'd love to see you switch to a wet food only diet. It MAY be best to do that slowly...over a week or so...to avoid any possible GI issues that the sudden change could have. But I think getting him off the dry is the first step.

Second step is continuing the testing and setting up the SS so we can take a look at your patterns and see what's going on. If you need help getting it set up, we have some great members who can help...just let us know!

Once you've ditched the dry, if needed, we can start to work on upping the dose. DKA is definitely dangerous and once a kitty has had it, they are more likely to have it again (NOT trying to scare you...just watch for any symptoms and test urine, especially when he's high). Getting the numbers down will help make it less likely.

Again CONGRATS!

 

I'll be doing the spreadsheet in the next day or 2. In the meantime, he's been getting about a cup of dry a day and about 2 cans. Started testing yesterday without withholding food and got 383 right before the 730P shot, 353 about 5.5 hours later, and 374 this morning right before his 730A shot.

 

Congrats on getting a home testing routine going. It's the essential tool in keeping Frank safe. Here's the regular testing routine we recommend:

• test AM and PM before feeding and giving insulin (no food for at least 2 hours before these tests) to see if the dose is OK or maybe too high
• at least one other test part way through the interval between shots and/or just before bed time to see how low he's going
• extra tests scattered at other times when you can to fill in the picture
• a full curve when you want to see exactly what a dose is doing over the course of a cycle (the 12 hours between shots) - this means testing every 2 hours
• a mini curve occasionally (testing every 3 hours)

The scattering of tests at different times over many days tells the best story about how he's doing. I think of it as being a BG movie. The curve days are more like snapshots and can be deceiving if they're done on a day when he's bounced high and stayed there.

Here's something I wrote before about bouncing. You might find it helpful:

Here's how bouncing works:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
7. Many vets have little/no understanding of the bouncing phenomenon.

 

So no food from 5:30-7:30 a and p on curve days, and test before shot's plus ever 2 hours between shots? I thought I also needed to hold food for 2 hours at the 6-8 hour mark as well, but I must have misunderstood. I'll have to wait for Sat to get a curve. Is it better to get it during daytime hours or nighttime hours?

 

Also I dosed with a very slightly heavy 1U this morning. Just on the other side of the mark. I feed 1/4c dry (which I'm sure he has eaten already), 1/4 can wet for breakfast, and 1 1/4 can for day eating.

 

Are you planning to reduce the dry? That could impact his BG numbers. Re feeding when doing a curve: I used to test my guy just before feeding his lunch mid day on curve day. That test would be 2 hours after the previous one and because I feed scheduled meals, it gave me a non-food influenced curve number.

 

I will be reducing the dry, but probably not until I can do a full 12 hour testing. I'm trying to avoid any hypo episodes, but also don't want DKA again. Maybe I won't give dry tonight, so I can keep an eye on him, and just give it in the morning when I'm not able to be there to watch him during the day in the case of a hypo.

 

The curve can be done during the day or night...whichever is best for you.

 

Also, whenever you do the curve, keep the same feeding schedule so you know how that is influencing him as well If you are feeding him 1/4 cup of dry right now, I suggest reducing it rather than just stopping it. I noticed a change pretty quick when I reduced Maury's DM dry from 1/4 cup each cycle to 1/8 cup.

 

Ok, I definitely need help setting up the spreadsheet. I guess I'll start with...what do you set it up on? Is that a google doc, or an excel file? And then how do I link it to my signature? I'm looking at other people's and I *think* I can set it up based on theirs.

Here's how our testing has gone so far:
Yesterday 7:18p, preshot without witholding food: 384 (gave 1U prozinc at 7:30p)
Today, without witholding food: 12:49A 353, 7:25A 373 (1U at 7:30a), gave 1/4 c royal canin glycobalance and 1/4 can Friskies pate for breakfast, left out about a can and a half for free feeding all day. Fed 1/4 c royal canin glycoblance and maybe 1/8 can Friskies pate at 5:30, then pulled food. Test BG at 7:36 and it was up to 439. Dosed with 1U at 7:40. Now I'll randomly check for the next few hours and see.

His urine output is still high...so much so that tonight when I went to scoop the box, there was a puddle that wasn't absorbed just sitting on top. :-( Still drinking a lot of water, too. We're dropping to 1/8 c dry starting tomorrow morning, and may skip it entirely tomorrow evening when I see where the numbers are.

What should I be looking for, ideally, with his BG? I had it in my head that he was at 199 when diagnosed, but now I'm thinking it was probably 299.

 

We set it up in a google doc. @Marje and Gracie is our SS guru...she's helped tons of people set them up.

Ideally, the BG you want is yellows (in the 200s) at preshot, and high double digits (like 80s or so) at nadir...which is the mid point of the cycle.

Your numbers aren't terrible, but they don't go down much at all...basically he stays high and flat. I do think your first step is drop that dry food and see where he goes...then we can mess with the dose. I just don't want to suggest going up on dose if you're dropping the dry. So if you plan on lowering it tomorrow and maybe dropping it in the evening, we can see what that does and go from there?

 

Here are the directions for setting up the spreadsheet. You will need to have a Google account, if you don't already. All of the color coding and formatting is already done for you, so once you start, it's super easy.

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

 

He does go back to the vet on Thursday for his first week's BG there. I plan on taking my monitor with me then and comparing our 2 numbers, to get a good idea of what I'm reading. I'm really thinking they are going to raise his dose, but I want him off dry food by then so we can get "true" numbers, since I want to drop the dry food diet anyhow. Unfortunately I can't pull his food 2 hours before the appt because I'm working, and already adjusting things to get him to the vet at 3.

When he initially went in last week, he hadn't been eating, and because I was busy, it may have been a full day since he had eaten before I noticed how off his behavior was. He was hiding under furniture, not being vocal, letting me cart him around (which he never does)...so I think maybe while his number then was high, it was a low high because of not eating. IDK if the DKA lowers BG numbers as well? He was fighting an infection, had a fever and high WBC as well.

This is stressful. I'm going to test as much as I can tonight to get numbers, and hope that at some point we have a good drop. And I'll be getting the spreadsheet going momentarily.

 

It is stressful but it gets better ...its a learning curve is all and you'll learn fast.

 

He's up to 558. I feel like I'm going to have an anxiety attack.

What are the chances that I'm testing "wrong"? I mean, there's nothing to it, right? I put a cotton ball behind his ear, try to lance it towards the outer edge, although it's hard to get it there exactly. And let the testing strip suck up the blood. Not hard, right? I hope I'm doing it right. I'm going to check again in an hour and hope it's coming down. He's 2 hours post shot...why is it still rising? :-( I'm terrified he's going to get horribly sick again.

 

Where are you giving him his shot?

 

Shot in the scruff, which is where the vet told me. Should I be doing it somewhere else?

 

Scruff is usually fine as long as your not shooting into the muscle. You should be making a "tent". Found a picture . Note: That picture is a left handed person but should help get an idea of what the tent looks like minus fur.

 

Yep, I pull his scruff up, put the needle in, pull back the plunger a bit to check for blood (and there hasn't been any, so I'm thinking that means it's not in muscle) and inject.

 

Try to breathe . He is still on a low dose and will probably need an increase before you see his numbers improve. If it will make you feel better, look at Maury's February numbers, covered in red and black .

 

Great job getting your spreadsheet going, and starting testing!

One thing that may help is to know that for many cats (mine included), their numbers will often rise for two to three hours after the shot because they just ate. I generally won't even bother to test before +3 for exactly that reason. It takes a little while for the insulin to kick in, and that's what we're really trying to measure. And like Yong said, he's on a pretty low dose right now, so those numbers, while high, are not reason to panic tonight. This is a process, and the numbers will come down. It's just going to take some time (as in weeks, not hours). You will likely see at least a little improvement as you get him off of the royal canin as it's a bit high in carbs for most of our sugarcats.

I don't think you're testing wrong. Remember to breathe, and know that you don't need to test every hour, especially right now. Generally the nadir (lowest point in the cycle) will hit around +5 or +6, although that varies for every cat. You would only need to test every hour when he's in danger of a very low number.

Also, when you compare with the vet's meter you will find that they are usually quite different. When i did that at the beginning of this journey, our meters were off by about 30%. That may seem troubling, but remember that the protocols here are written based on human meters, so the numbers and advice given here are based on those numbers. It bothered my vet at first, but he's slowly come to see that this system works.

Whew! There is a lot to learn at the beginning. Just remember that you're not alone, and it's going to get much much easier. The beginning is the hardest part. Sending you lots of love!

 

Awesome job getting the spreadsheet set up! If you ever have any issues with it, please just send me a private message.

 

Hey Sarah...I promise you aren't testing wrong. Those numbers, while high, aren't one bit surprising for 2 hours post shot. You can see at +3 and +4, he started to go down...that's normal. When you feed, as Djamila said, you will see the numbers go up for about 2 hours. And that +2 is just 100 points higher than preshot, which is about right. It's really not that much of a jump.

Getting rid of dry food will help. Are you planning on doing that today still? If not, we can start looking at raising the dose. If so, let's get that out of the way, and then talk about going up in dose.

Remember, DKA comes when you have a combo of things usually: not enough food, not enough insulin, and an infection of some sort. He's eating and getting insulin...DKA doesn't happen overnight. Are you able to test for ketones in his urine? That might help reassure you.

It's going to be fine...we're here to help and you're not alone with this.

 

You've had great advice from the folks here. I'll add my encouragement to theirs. It really does get easier and you'll have peace of mind from knowing what's going on with Frank. We're always here to help and/or commiserate.

 

I finally got a below 300 reading this morning, before his breakfast and AM shot.. I felt like having a celebration. I really think it's the dry food, because he had 1/4 c at about 5:30, then only a few pieces here and there that I used as treats to check his sugar. This morning he'd been hours without it and it dropped drastically. I only gave him 1/8 c this morning, so we'll see where he is come 5:30 when I get home.
I wanted to change him to an all canned diet back in January, and got some negative feedback from a rescue group that I belong to that said diabetic cats have to have access to dry food all the time (this was pre-diagnosis and pre-insulin) to keep their sugar from going too low, that I'd make him sick, etc. I really wish I would have listened to my gut then, and the advice I got from lurking on this board when I was researching things on my own. So...the moral of this story is...I think no more dry food. Which is a shame, because I have the better part of a $25 bag of prescription food left. (Maybe I'll just keep it as "treats" when testing and shooting.)

 

It is hard with so much information out here on the internet, and trying to sort through which advice is the best for you and your cat. I do think it's a good idea to give them access to food all day (except for the two hours before the shot), but if you can just leave out wet food, it's going to be the better option for keeping Frank healthy beyond just his diabetes. Interesting to see the difference in numbers this morning, and what happens as his kibble-consumption drops over the next few days.

I keep some kibble on hand to give Sam a boost if his numbers get too low (into the hypoglycemic range) because I know that even if he's not hungry, he would never pass up the chance to eat it! and your idea to use it as a treat seems like it would be fine too - that way you don't have to just toss the bag.

It seems like testing is going well for you! Congrats! Numbers often drop pretty dramatically when carb consumption goes down, so hopefully you'll be seeing more of those yellow numbers!

 

GREAT preshot! You see that it dropped him 100 points from yeterday's AMPS! Looking forward to seeing how this helps.

 

Just got my 2nd under 300 reading. Just over 24 hours with no dry food...but he's eating A LOT of canned food...and I'm letting him bc of his need to gain about 2 pounds. This time last night we were in the 500s, so I feel like this is a HUGE victory! I think I'm going to become obsessed with testing. I see now why everyone says you go through tons of strips.

 

Wow! That's a big drop by +3. How is your schedule for this evening? Do you go to bed soon?

 

It's 11:35 right now. Just starting an episode of Game of Thrones, so I'll be doing at least 1 more test. I should do one right now, then again in an hour....hmmm...let me go do that....

 

Eh...back up, just a bit. I'm going to chalk it up to the 5 or 6 pieces of kibble he had for treats at the last testing time. Holding steady at under 300...I'm happy with that!

 

Frank's looking good tonight! The 245 and 272 are really close to the same number since there is some variation in the meters. We don't tend to get too fussy about the exact number when they are within 20% of each other. If you do two tests right in a row, even from the same drop of blood, you'll usually see some variation in numbers. So he had a steep drop, but now he's flattening out a bit. A good cycle usually looks like a smile if you were to plot the numbers: a drop from the PS that usually shows around +2-3, nadir around +5-6, and then a slow rise to the next PS. It's great to see those yellows popping up so quickly. Amazing what a change in food can do!

 

Hahaha you're turning into one of us!!! Data is a lovely thing...and as you collect more, you'll see how useful it is to make dosing decisions!

Frank is looking wonderful!