? Just started home testing, high numbers - bouncing?

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Kelly Howard

Kelly Howard

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Hi everyone,
I just got a meter (AlphaTrak) and have started testing this week. I don't have a lot of data yet, but I'm trying to understand the numbers I am seeing. The spreadsheet link is in my signature.

Maggie was diagnosed on 8/31. Her initial dose was 2U Prozinc. She had one curve done at the vet's office a week later (it's in the SS) after which they decided to raise her to 3U.

On Saturday, I tested for the first time and her AMPS was 329. Not great, but not abysmal. We were busy that day and I didn't have a super easy time of the first test (more on that in a second) so I didn't test again that day. I started trying to test again on Sunday, Monday, and Tuesday. For the life of me I could not get the strip to collect enough blood. By Tuesday night I was at my wit's end and was about ready to make a post here with a pic of my strips saying "How is this not enough blood?!" Then, I decided to watch some videos on testing a cat. And I realized... I was trying to put the sample on the end of the AT strip rather than the side! I felt like such an idiot. Some of you probably saw my FB post about it :D Anyway, I had really been manhandling my poor Maggie and I'm sure she was super stressed. I felt so bad, I also let her have some treats, and the only ones we had in the house were normal high carb treats. When I finally got a sample, the number was sky high - 670!

The next day I worked from home so I was able to do a full curve. Her number was really high again in the morning, but it dropped extremely fast. Since then all her PS numbers have been really high. I was able to do a +3 test last night and it was about 250pts lower than the PMPS test. These numbers just seem all over the place to me and I'm wondering if the 3U dosage is too high and causing her to bounce.

The other possibility is that it's due to food. I've been giving her wet food twice a day for about 3 weeks now, but we've still had dry food out for the other cats. I'm sure she was having some in between wet servings. On Wednesday afternoon, I got a bag of Nature's Valley Instinct and replaced all the dry food in the bowls with that. That's the only dry food the cats have had available since then. Could the old food just still be working through her system?

I'll be home all day tomorrow so I can do some mid cycle readings. I just got 100 new strips too, so I'm all set :)

Sorry for the wall of text. What do you guys think? Bouncing, food, or too little data to tell?
 
I think it's totally possible that you've increased the dose too quickly....Most of the time we start cats at 1U and slowly increase while testing to find out how they're doing

It's also very important to get tests on the PM cycle....most cats go lower at night and without testing, you're missing half the picture

You don't have to do a full curve every cycle...think of your spreadsheet like it was a puzzle...if you only put one line in, it's impossible to see the picture, but if you sprinkle pieces (tests) all over, the picture becomes clearer

Dropping from 600 to 200 that quickly IS too fast and is one of the main reasons for bouncing. We see bouncing when they 1. drop too low 2. drop too much, too quickly or 3. drop lower than their body is used to being (or any combination of all 3)

If the Natures Variety Instinct is dry, it's still too high in carbs....there are only 2 dry foods that are low enough carb for a diabetic....Young Again Zero and Evo Cat and Kitten. As long as there's high carb food in the picture, it's a lot like trying to put out a fire while continuing to pour gasoline on it...just don't work.

I don't use ProZinc, but what I'd do is hold this dose for now and get those tests in...Always before shooting and at least 1 mid-cycle on the AM cycle and at least a "before bed" test on the PM cycle

@Sue and Oliver (GA) @Rachel have more experience with ProZinc so hopefully they'll chime in....You might also want to start posting over in the ProZinc forum to get the best advice possible

And congratulations on figuring out the AlphaTrak!! I saw your post on the Facebook group and know how happy you were to finally figure it out!!
 
I agree with Chris. We usually suggest increasing by 0.25 or 0.5 and holding the dose for 6 cycles in the beginning. I think she is bouncing, may be getting too much insulin and yes, getting all low carb in the picture can make a huge difference (for us -100 points overnight). As long as you are on higher carb, I think I'd try 2.5 for a few cycles, get some midcycle numbers and see if the cycle flattens out and drops a little. Once you get high carb out of the picture, you'll need to watch her numbers especially carefully.

We have a protocol and beginner's guide for ProZinc. They are in blue in my signature. They may be helpful. And yes, come over to the ProZinc forum, look at other people's threads and spreadsheets and get some help with daily dosing.

http://www.felinediabetes.com/FDMB/forums/prozinc-pzi.24/
 
Thank you both. Her numbers were a little better this morning (at least out of the black). It does seem like it's the food driving her up so high. The other cats (we have 4 total) are getting used to the new food now and I think they're emptying the bowls earlier in the night. It was probably longer this morning between her last kibble and the AMPS.

I think the dose is too high too. Since she lost a lot of weight before her Dx, she is only 10lbs. This is a new vet we're seeing, and while I do like him a lot, I'm not sure how knowledgeable he is about FD. He didn't even tell me to switch her off the high carb science diet dry we were feeding exclusively before all this started.

It looks like the Evo is on Amazon with same day shipping so I think I'll order that and bring her down to 2.5. I will be home all weekend so I can do some extra tests. I can do PM+3 any day, but I leave for work right after her AM shot and don't get home until about +11 (long commute). Luckily I work from home every Wednesday so could get an extra test or two on those days.
 
Question? How do you handle testing at home if you have to work? My vet gave me these weird schedules that are basically spaced out through the day, I'm currently on a 3 day weekend but once I go back to work, not sure how to handle it!
 
Generally, insulin doses are given twice a day 12 hours apart. Occasionally, people will do every 8 hour dosing but it's very difficult to fit into a person's schedule long term. What insulin are you using? What dosing schedule did the vet give you? Was there an explanation for this schedule? Is it possible to have the vet rework the schedule so that you are able to fit it into your work life?

As far as blood glucose testing goes, we recommend testing before AM and PM feeding/dosing. Extra tests can be done into the late evening if you are at work all day or on weekends. This works with twice a day insulin dosing. More frequent dosing would need more frequent testing.
 
Most days I am only able to test before her morning and evening shots. These are the most important tests, because you have to make sure your kitty's BG level is high enough to receive insulin. If the levels are too low and you give insulin, he could go into hypoglycemia which is very dangerous. But if you don't test beforehand, you have no idea what his level is.

When you are trying to figure out if the dose you're giving is working right, then it's very helpful to do some tests mid-cycle. These can be done on your days off from work. You can do a full curve, which is taking a test every 2-3 hours throughout the day. Or if you just want to do a couple extra, you could do every 4 hours. You might miss the lowest point of the cycle, but it still gives a good picture of how the dose is working for him.

Also, depending on the time you give his shots, you might be able to get another test in right before you go to bed. For me, we give her PM shot at 7 in the evening and I go to bed around 10:30/11pm. So most days I can get a test in at +3 (meaning 3 hours after the insulin shot) or +4 depending on how late I stay up. While most cats haven't reached their lowest level of the cycle yet at those hours, it's still helpful info to see how the insulin is affecting them for that cycle.

I am definitely still learning but the people here are so knowledgeable. You may want to start a thread in the insulin support forum for the insulin you are using. Every insulin works differently so by posting there you can get advice from the people who are most familiar with the insulin your kitty is on.

The home testing seems really difficult and overwhelming at first, but you will get good at it very quickly. And hopefully your kitty will too!
 
I think your vet was wanting you to do a curve. This gives an idea of how your cat is responding to the insulin. Curves are not done every day. Your vet will probably start with curves 1 week apart and then increase the spacing over time. The most important tests are the ones done every 12 hours, before feeding and giving his shot. Don't worry, you will work it out.
 
Right now my cat is takins insuline every 9 hours, but today he didn't need the shot until after 12 hours, but it has been going like this: insuline every 9 hours, feeding two hours after insuline, I'm testing 4 times a day, before shots and six hours after. He has new food today with less calories so we're going to be starting all over again. After how many hours after insuline do you feed yours?
 
Mariana.Mnez said:
Right now my cat is takins insuline every 9 hours, but today he didn't need the shot until after 12 hours
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Lantus (glargine) should be given every 12 hours, not every 9...it's a long acting insulin and except under very special circumstances does best on every 12 hour dosing. It's also almost impossible to do more frequent dosing and have any kind of life for yourself!

Mariana.Mnez said:
After how many hours after insuline do you feed yours?
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What most of us do is Test/Feed/Shoot....all within about 5-10 minutes....You Test to make sure they're high enough for insulin, Feed to make sure they're willing to eat and Shoot.

Most cats do better with multiple small meals instead of 2 big ones, so most of us feed every 3-4 hours (or use an auto-feeder). The only time we don't want them to eat is the 2 hours immediately before Pre-shot tests so that the number you get isn't influenced by food

It will really help if you'll fill out your signature for us so we don't have to keep asking the same questions. Go to the top right of the page and find your sign on name. Click and choose "Signature" and a new box will pop up. Enter some basic information there like:

Your name/Cats name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health problems, general location of where you live.....and then "save".

You also need to try to get our spreadsheet going. We really depend on seeing the spreadsheet to be able to give you the best advice possible. Here are the Instructions for getting the FDMB spreadsheet. When you have it, you can put the link into your signature too. If you can't figure it out, let us know. We have people who can help set it up for you!

It's best for you to start a new thread for yourself instead of asking questions on someone else's. We wouldn't want to lose track of you!!

Mariana.Mnez said:
Question? How do you handle testing at home if you have to work?
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Here's some great ideas on how to deal with things if you have to work full time
 
@Mariana.Mnez -

You need to give food BEFORE giving the insulin injection.

For each dose:

1. Test BG to make sure it's safe to give insulin.

2. Feed Taro.

3. Give the insulin dose.

4. Do a mid-cycle test to check how low the dose is taking Taro's BG. (At least once a day. If you're out at work during the day then get the PM 'before bed' test.)


Mogs
.
 
Thank you, I just tried to update as best as I could because most information is new. Just today he will begin to eat a different food, he was eating normal Diamond food and was on 9 units of insuline! He did gain almost a pound, now he will be eating w/d dry food 3/4 of a cup, and we lowered insuline to 3units. I shot him 3units at 11.00pm CT (he was at 349), will feed him 1/4 of a cup at 1:00am CT and will check his levels at 4:00am CT. Specialist switched to regular glargine after he was for the first week on his first clinic on Lantus, and he was on 3.5units of the regular one and was very stable so we're trying to go back to that.
 
W/D is very high in carbs and not a good choice for diabetics....it's like trying to put a fire out while continuing to add gasoline to it. It's also got horrible ingredients...One of the ingredients is "powdered cellulose".....that's a nice way of saying it contains sawdust!

There are only 2 dry foods that are low enough in carbs for a diabetic and I doubt if you can get either one in Mexico.

It will really help if you can get Taro onto a low carb canned or raw diet. I'm not sure what brands you have available, but Fancy Feast Classics, Friskies pates and 9-Lives ground are good choices and affordable....BUT....if you do change Taro's diet to a low carb food you need to be sure you're able to test because he could drop as much as 200 points just from being on a low carb diet.

Also, Glargine is Lantus...Lantus is Glargine.....Lantus is the brand name for insulin glargine

There is a new insulin glargine with the brand name Toujeo but it was just released in the US a short time ago. It's a U300 insulin instead of a U100
 
Mariana, I don't mind sharing this thread with you :D But I think you will get much better info if you start a new thread of your own. Then everyone can focus on you and Taro.

I think in this case the high carb food is intentional as Taro is coming out of DKA. Here is a link to one of Mogs' posts in Mariana's other thread: http://www.felinediabetes.com/FDMB/threads/vets-cant-stabilize-glucose-levels.165787/#post-1793960

From that post:
When there are no fat stores left in a diabetic the liver has a very hard time compensating for insulin doses. This in humans is referred to as "brittle" diabetes. What happens is that the blood sugars go very high, then insulin is given, then you get dangerously low sugars, and back and forth. The solution is actually to increase the amount of carbs you are feeding, so that you can give larger insulin doses - this will allow her to gain weight faster and for her sugars to be less "brittle". Once she is more stable, slowly reduce the carbs in the food, and monitor weight closely. The only way she'll gain weight and be healthier is with larger insulin doses than what she's been getting and that's going to mean increasing intake.
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Kelly, I'm so sorry, I'm all over the place, I'm just trying to get as much information as possible, it's all too new and I'm a bit scared!
 
Chris & China said:
W/D is very high in carbs and not a good choice for diabetics....it's like trying to put a fire out while continuing to add gasoline to it.
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@Chris & China -

Hi Chris,

As Kelly mentions above, Taro has just been in hospital with a DKA episode and he is very much in need of weight gain hence the current high carb diet. (FYI, Chris, the quoted text above was originally posted by Meya in one of the earlier posts on Taro's thread about the non-standard carb/insulin needs for a brittle, underweight diabetic with DKA.)

@Mariana.Mnez -

As Kelly suggests above, it would be very helpful for you to start a new thread for Taro on Feline Health so that members will be able to get a clear picture of his history and give you information specific to Taro's special requirements. That way we'll be able to help get you up and running with the day-to-day aspects of treatment, and hopefully help you set up a spreadsheet for Taro so that you can monitor him and track his progress more easily.

While the information Chris provided above is correct for UNCOMPLICATED cases, it's not really applicable to Taro's current status. Taro's is a complicated case because of his recent DKA episode and his being underweight. At the moment he has special treatment requirements and needs extra carbs to match his current - specialist - insulin requirements.

Don't change Taro's food at the moment, Mariana. Stick with what the specialist has prescribed; it is helping Taro to recover and start gaining weight. You need to keep things as stable as possible so as to avoid any DKA relapse. (Be sure to test for urine ketones every day!) Diabetes treatment is a marathon, not a sprint. When Taro is well clear of the DKA episode and has regained weight you can always discuss food choices with your specialist at that time. In the meantime we can help you learn more about how to care for Taro's diabetic needs. We'll hold your hand all the way. :bighug:


Mogs
.
 
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