New curve help

New here, have been lurking and reading a bit. Just diagnosed about a week ago on 3 units of prozinc twice a day. Have switched to a low carb wet food and cut out dry food. I did my first curve today. Can anyone help me interpret before I can get ahold of vet on Tuesday? Thank you! Used alphatrak 2

Thursday 1/16: Food/insulin at 6:45AM reading of 200 at 4pm 10 hours after morning dose.

Friday 1/17: Food/insulin at 6:45AM reading of 96 at 4pm 10 hours after morning dose.

Saturday 1/18 Curve:
7:45AM. 408
7:50 Food/morning dose insulin
8:45. 364
9:45. 173
10:45. 79
11:45. 78
12:45. 76
1:45. 122
2:45. 169
3:45. 254
4:45. 284
5:45. 328

 

Dose is too high. Need to reduce. Food change has made a difference already. You don't want your kitty to go much below 100-120 on an Alphatrak at mid-cycle. (+4 to +7 timeframe)

New? How You Can Help Us Help You!

Get a signature and SS set up and we can help you better.

p.s. Thanks for coming over here instead of in the Prozinc ISG group. Not enough people over there to help.

 

Here you have the blood glucose chart to help you interpret and in learning
http://www.felinediabetes.com/bg-convert.htm

3.9 to 5.9 (70 to 105) are good normal bg numbers

6.0 to 9 (110 to 160) are okay numbers

13 (245) is were the renal threshold goes and no bg above it is any good

 

Except she is in the US so she needs to multiply those numbers by 18 that you got from Ann & Scatcats.

 

Ah it's the Alphatrak

The bg's on the bg chart are all from human meters

As far as I know we don't have a similar bg chart for Alphatrak but I could be wrong.

 

There isn't a BG chart for using a pet meter like the Alphatrak.

 

I have added the American values now to that post.

 

I am he not a she lol. Thank you both, I will have to look into making a signature. I was actually reading some posts how a lot of you use the relion I might try that or get both and use the alphatrak while doing curves and or to compare. Currently using the vets for this curve was nervous to use a human meter seeing see is not regulated yet etc. When I brought her to the vet she stayed a couple of nights due to being dehydrated/pancreatitis. Hoping this is all a by product from the pancreatitis and she will start producing normally after it settles down.

 

Once a diabetic, always a diabetic.

Sorry about the mistake in pronoun. Probably 90% of people that post here are women. I was going with the odds, since your Username gave no clue.

p.s. You might want to change that user name to something else more unique. Or we may be calling you Newcomer for years.

Look at your user profile. All sorts of fun stuff you can change.

 

If there was any time when Simba's blood glucose went all bonkers and very hard to regulate and very high no matter if I tried to increase his insulin, it was when he got his very first and very severe pancreatitis. It was like that for the long months his pancrea was so very swollen.

I hope it goes better for you. What is your kitty's name?

 

Very kind of your vet to loan you an Alphatrak meter for testing. Test strips are pricey for the Alphatrak, $1-2 each. And you'll go through a lot of them. Relion Premier line of glucometers get some good reviews.

ADW Diabetes is a good website for diabetes supplies in the USA. Did you get the syringes that had the 1/2 unit markings on the barrel?

Saturday 1/18 Curve:
AMPS 408
7:50 Food/morning dose insulin
+1 364
+2 173
+3 79
+4 78
+5 76
+6 122
+7 169
+8 254
+9 284
+10 328

 

Name is Midnight awesome cat. Plays fetch better than most dogs LOL. The vet is great she is a very scared cat so they wanted to get a curve at home while she is relaxed. With a newborn and now a diabetic cat at home hectic weeks ahead to say the least! Yes I have the 1/2 unit on my barrels. I’m really hoping with diet and possibly catching it early we can achieve some of these great remission stories I read about on here. She is a relatively young cat 6 years or so.

 

Hello Midnight and welcome Sweet Midnight!

 

Update with new curve dropping to low.

Thursday/Friday woke up to vomit. Not sure which cat can only assume midnight. Decided to test levels.

Both cats current food schedule of ~2.75oz(1/2 can each) morning and night. 9lives low carb pate(~6% carb or less) mixed with water. No dry food.

Friday 1/24
7AM 107MG 10 minuets after eating/3 unit dose
5PM 58MG called office said to still dose if going to be eating that night at 1.5 units. Still hesitant to dose since blood sugar already low.
6:30PM 77MG 11.5 hours after morning dose
6:43 Feed/dose 1.5 units.
8:21PM 58MG
9:53PM 49MG Gave food to raise sugar.

Saturday 1/25 Curve
7:30AM 115MG before food/dose ~11 hours after dose of 1.5 unit
7:35 food/dose of 1.5 units
8:30AM 117MG finished food 10-20 minuets prior
9:30AM 48MG
10:30AM 52MG
11:30AM 59MG
12:30PM 77MG
1:30PM 76MG
2:30PM 103MG
3:30PM 140MG gave about 1.5 oz 9lives no dose
4:30PM 149MG
6:30PM 75MG 3 hours after eating with no dose
6:45PM Dinner feeding no dose
7:45PM 86MG
9:45PM 96MG 3 hours after eating dinner with no dose given

1/26
8Am 126MG before food no dose

Since her numbers are staying in the normal range even after eating with no dose, and going hypo while dosing does that mean I should discontinue the insulin?

 

If you are still dosing 1.5u of insulin, you do NOT want to discontinue the insulin. The dose needs to be reduced but an abrupt discontinuation will mean that Midnight's healing pancreas will not have the support it needs to keep recovering. Basically, you want to follow Midnight's lead and reduce the insulin dose as the numbers dictate. I would suggest reducing the dose to 1.25u.

Also, we don't consider numbers as "hypoglycemic" unless there are symptoms of hypoglycemia present. Cats can drop into low numbers and be completely asymptomatic (and hopefully, you catch the numbers and bumps them up with food). Also, it's not really possible to have a symptomatic hypoglycemic episode if you've not given insulin. FWIW, there are some cat's whose normal BG levels are in the 40s.

It would also be very helpful if you could take a look at this post and follow the instructions for setting up a spreadsheet and your signature. We tend to be very numbers dependent and the spreadsheet will help you track Midnight's progress and see patterns. Likewise, your signature gives us information at a glance (e.g., the insulin and meter you're using, when your cat was diagnosed).

 

Are these BG values from a human meter or an AlphaTrak?

 

These are from alphatrak

 

Thank you, have been reading all the posts about people that will not shoot below a certain reading. Since I was getting normal/low numbers before dose/food I thought it was best to not dose. If that is the case I will start her back on her schedule later tonight as she has already eaten for the morning.

 

Looking at the thread you linked me to, it says the no shoot number is 200MG so that confuses me?

 

Seeing your BG (blood glucose) readings in our standardized SS would really help us to help you better.

Directions on how to do that are in this link
New? How You Can Help Us Help You!

Only takes a couple of minutes of your time, good sir.

 

@Deb & Wink and I were thinking along the same lines --we provided you with the same link!!

You were fine to skip. Until you get the hang of managing lower numbers, it's fine to do what's safe. Generally, we encourage new members to post and ask for experienced eyes to oversee shooting lower numbers until it's comfortable for you. Generally, numbers in the range of 150 - 200 are when we urge folks to ask for guidance. Shooting lower numbers can be hard on the caregiver's nerves!

 

Holy crap. Those are definitely hypo numbers on an AlphaTrak.

Does Midnight have any history of ketones?

I don't usually give dosing advice but, unless there’s a history of ketones, I personally would NOT shoot insulin again until the dust settles here or you see a pre-shot over 200 on the AlphaTrak. Even then I’d be conservative and start at something like 0.5 u and work up as the data dictates.

Your cat is newly diagnosed. You were on 3u Prozinc and shooting blind, then switched to a low carb food and cut out all dry. Do I have that correct?

On Friday 1/24 you shot 3u into an AMPS of 107 and Midnight was only at 58 (on an AlphaTrak) at +10. Who knows how low he went during that 10 hours. You also fed a +8 140 and he dropped on his own to 75 by +11, which might mean that his pancreas is trying to pitch in.

After hypos, a cat can be more sensitive to insulin.

Also, if you were using Lantus or another depot insulin, I might consider shooting. But Prozinc, though it can have some “hang time” in some cats and carry into the next cycle, is more of an in-and-out insulin (meaning it’s pretty much all used up after 12 or so hours).

Counterregulatory hormones and the cats natural biological defenses can head off hypos up to a point but will eventually fail if pushed too far.

Just my two cents.

 

Yes you are correct, i have linked the spread sheet. as of today
AMPS 126 MG No dose
+2 86MG

https://docs.google.com/spreadsheet...7oEgmJAU_DZSC9ZNz89k0GWiT0EseeC3E0JAA/pubhtml

 

Hi Mike, Thanks for introducing yourself with your user name change.

Yes, his signature now says cat has had DKA. So he should be testing for ketones at least daily.

How long ago was the DKA?

Spreadsheet (SS) can be linked directly in your signature. That way you don't need to re-post it every time. Look back at the how to set up your spreadsheet instructions on how to do that. Please and thank you.

 

I did that as well I was just in the middle of replying. To be honest this is all new to me I am not sure exactly what DKA means. on 1/13/20 she was hospitalized for high readings and dehydration. Dr did ultrasound while there diagnosed pancreatitis because it was inflamed. Sent home with insulin prescription then things have improved significantly. In my opinion in the last two weeks per numbers on spreadsheet. But my opinion does not mean much LOL

 

DKA is an abbreviation for Diabetic Ketoacidosis. Not really treatable at home. Most cats need to stay several days at the vet receiving 'intense care' on a glucose drip, lots of blood tests to check electrolytes, etc.

"Ketones in the urine, as detected by urine testing stix or a blood ketone testing meter[1], may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels combined with certain other systemic stresses. DKA can be fixed if caught quickly."
http://petdiabetes.wikia.com/wiki/Ketones

Some more info for you on DKA is here: Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

I would still point out that unless your cat was experiencing symptoms of hypoglycemia, the low numbers are low numbers. You don't want to leave Midnight sitting in that range -- and you didn't.

I agree that skipping this morning made sense. It especially makes sense given that you fed Midnight and numbers dropped. Numbers dropping when you feed your kitty is a signal that the pancreas is working. Let's hope that it was the pancreatitis that was the cause for the FD diagnosis.

DKA is a life threatening condition. It occurs when there is an infection, not enough insulin (either the pancreas can't produce enough or a dose is too low) and the kitty isn't eating enough calories. As a result of not eating, the cat starts converting stored fat to meet nutritional needs and that metabolic process causes ketone bodies to develop. Basically, this throws the cat's metabolism out of whack and there are electrolyte changes. You do not want electrolytes to be outside of normal ranges. Usually, it takes several days of ICU treatment with insulin and glucose IVs along with other medications to stabilize a DKA kitty. You would know if your cat was in DKA.

 

On spread sheet for yesterday at +8 I gave food and her numbers started dropping on their on down to 75 an pmps at which time i fed but did not shoot

 

Ok I will remove DKA

 

Although I am still confused because today AMPS 126MG no dose given along with eating and at +2 she is down to 86MG. So if she is normal for PMPS should I shoot or no? You recommend not ending abruptly but if I do not see number over 200MG or she is at normal should I shoot? it has been +27 hours with no dose and no high readings.

 

Please continue to work closely with your vet. Your girl Midnight was very sick and needs your vet's input.

Pancreatitis can flare and there may be additional episodes of pancreatitis.
Do you know if your vet ran a specific blood test for pancreatitis? Either the SNAP fPL or the Spec fPL?

You may find this link useful to you: Pancreatitis: A Primer On Pancreatitis

 

It depends. We are still unsure if your cat Midnight had diabetic ketoacidosis (DKA) or not. Did your vet say anything about that? Do you have any written records from the vet about Midnight's overnight stay at the vet clinic? Is your vet available by phone in case of emergency? Or via email or text?

 

Hello Mike and Midnight

I usually don't post because it takes me entirely too long to write anything, but I wanted to say I completely agree with @JL and Chip ; when I saw the numbers you posted for your curve using an AT2 meter, I panicked! I used an AT2 for over a year -- and those would be panic numbers for me. I see that you're only feeding twice a day? When you got the reading of 48 did you give any food at all? If I'm remembering my AT2 literature right, the manufacturers consider any reading below 65 a hypoglycemic reading. I'm not sure if you've put your hypo kit together yet; the numbers you got on your most recent curve really needed to be boosted by food. (Personally, I would have broken out the karo syrup ) It looks like Midnight's pancreas is absolutely kicking in with that drop from 126 to 86 this morning.

I can't give any dosing advice, but I can't help wondering if breaking down Midnight's meals to several feedings through the day and night might not be beneficial. I know when my Sammi's pancreas finally decided to lend a hand, feeding multiple times a day really made a huge difference in control.

Okay, basically just wanted to write because seeing those low AT2 numbers without any attempt to bring them up scared the jeebers out of me I've been extra cautious since a 2018 presentation that showed 75% of hypoglycemic events go unrecognized because they're associated with no clinical signs, but can still lead to increased risk of neuroglycopenia (full presentation here). This contradicts FDMB, however. I'd rather stay out of that range completely when using an AT2 since there's been no safety cushion established for it, as there has been with human meters. Just my two cents... and it's taken me an hour and a half to write this. Drat, I'm slow...

 

Can you or a friend or family member go to a drugstore and purchase some ketostix? They will measure the presence of ketones in your cats urine.

Since we are unsure if your cat Midnight had DKA as well as pancreatitis, we are being cautious.

Infection/inflammation + not enough food + not enough insulin are the classic situations for developing ketones which can lead to diabetic ketoacidosis.

Your situation is not a simple one to answer. Plus you have a newborn boy or girl at home.

 

Initial Blood test at vet:
GLU 556MG
CREA 1.4MG
BUN 34MG
BUN/CREA 24
PHOS 2.2MG
CA 9.6MG
TP 7.9g
ALB 3.5g
GLOB 4.4
ALB/GLOB .8
ALT 210U
ALKP 42U
GGT 0U
TBIL 1.1MG
CHOL 344 MG
AMYL 684U
LIPA 614U
Na 148mmol
K 3.1mmol
Na/k 48
CI 112mmol
Osm Calc 323mmol
WBC 19.74K
NEU 14.87K

 

Correct I only feed twice a day. 2.75 oz each bowl. They usually do not finish in one sitting so I leave out to free graze on that set amount. On Friday night when I first saw the 48MG I fed to boost that number up as it was late and we were going to bed. Yesterday’s curve I did not feed when they dropped that low to try and get an accurate curve. Although I did give a snack around 8+ with no dose to see if her pancreas was kicking. So 140MG Pre snack and 75MG post snack at +3 definitely suggests that it is indeed producing. By the way 1.5 hours you did not have to go through that trouble. But I greatly appreciate it!

I will have to look into the strips and see how to test etc!

 

Which lab? In house equipment from IDEXX, sent out to IDEXX or another lab like ANTECH or TrueNorth? Makes a difference, because different labs have different reference ranges.

I'm going to tag someone that is our best person to interpret lab results. She may not be around today. We all have busy lives and other responsibilities. @Marje and Gracie

I also don't have personal experience with pancreatitis or DKA in one of my cats. Other people do. Let's see if @Sienne and Gabby (GA) have another moment to drop in and make recommendations on your situation.

 

Mike --

Having the lab values is a great help. We need the reference ranges to know if any of the values are out of range. Labs sometimes differ as to what they consider normal range. There's a tab on your spreadsheet that is already set up with reference ranges. If you vet's lab has different ranges, you just need to make that change. I know you're busy. Would it be too much trouble to enter the information on the tab on your SS?

It looks like both phosphorus and potassium were low on the labs. That might be indicative of a metabolic imbalance. Do you know how your vet diagnosed the pancreatitis? The current method of diagnosing pancreatitis is either a Spec or a Snap fPLi. The latter is done in the office (it looks like a pregnancy test with a +/- value) whereas the Spec is sent out to a lab (IDEXX).

If the vet gave your cat fluids, it may have helped to get things normalized quickly. I'd also point out that there's a huge difference between having ketones that are at a trace level and DKA. The former is manageable at home with the vet in the loop vs DKA which is an emergency situation.

 

It was the IDEXX in house I believe they had it within about 10 minuets. I will try to upload the photo or post ranges

 

Hi Mike

Even if you're doing a curve, if you get numbers that low again, please feed to bring them up. Blood sugar can go from low to emergency room in a matter of minutes, especially considering how early in the cycle you got that reading. It truly scared me, seeing your curve's numbers without any notes of feeding to bring the numbers up. The other thing that concerns me is that usually, when a cat's blood sugar dips low, the liver will release glycogen to raise blood sugar -- and usually overcompensates, resulting in a 'bounce'; a high BG#. Your curve on the 18th looks like it shows a bounce to me -- and at a 3u dose then, I wouldn't be surprised if Midnight was dipping and bouncing constantly that first week. That the highest reading you got on your second curve on the 25th was only 149... If that was a bounce, it wasn't much of one. There's a chance that Midnight's liver has no more reserves, and if she goes into low numbers again (if/when you give insulin again) she won't be able to bring her blood glucose back up on her own. It makes the low BG a bit more dangerous.

I could be interpreting wrong, I do not have the experience that other members do. But please do not be too casual about low numbers Wishing you and Midnight the best of luck!

 

Mike — just wanted to toss in that the reason there’s so much focus on whether Midnight had ketones or diabetic ketoacidosis (DKA) is that it can affect opinions about dosing.

The saying “better to high for a day than too low for a minute” is something I was taught when I first joined this board and is still my mantra to this day. If a cat is ketone-prone or has a history of DKA, we have to weigh the risks and trade offs when deciding how aggressive to be with dosing. Hypoglycemia kills fast, DKA kills slower, but the net result is still the same.

The other consideration is that if you shoot insulin and Midnight drops down into hypo numbers again, feeding low-carb food in an attempt to bring up BG can actually backfire and cause the BG to go even lower (pancreas contributes insulin to offset the food). It’s not a given, I won’t even say it’s common, but we’ve seen it happen, so sometimes have to go straight to high-carb food or Karo/honey to offset the double whammy. And no, it’s not better to withhold food. You want to get the BG back into a safer range ASAP.

Many cats will seek out food when they feel their BG dropping too low so you can also consider leaving food out when you’re not home or in bed.

I know it’s confusing. Everyone’s trying to sort out the facts to give you the best info possible. Check back in with some BG values later and we’ll go from there.

edited to add: How is Midnight acting? I’m not sure anyone asked, but that’s important too.

 

This is the only way I could figure out how to get the photos of her lab results. They are IDEXX
https://imgur.com/a/KXfYuWz?desktop=1

I do have some high carb food fancy feast in gravy stuff that I can give next time. She has normal as of lately. After eating today she was even running and zipping around the house with her toys. She is currently at 113MG +6 food/no dose and +30 since last dose of 1.5u

 

Well alphatrak came in today so I compared it to the vets. 78MG on one 80MG the other at +9.5 after food/no dose. Will check my pspm right before dinner. But if she is still in the 80-120MG zone I am not going to dose again. Thoughts?

 

Hello again Mike

The 78 and 80 are basically the same number, so it's nice to see the Alpha Traks agreeing

Were you able to get ketone test strips by any chance? My Sam wasn't on Prozinc long, but I personally would not have dosed him with Prozinc at those low of numbers -- as long as there were no ketones present, or a history of ketones/DKA.
From the BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS:
"You may want to consider raising your No-Shoot number to as much as 250 mg/dL {14 mmol/L} in the beginning of this sugar dance when using a pet-specific meter. That’s your and your vet’s decision."

Midnight is far, far below the recommended no shoot for newly diagnosed cats. Plus it looks like her pancreas is kicking in hard after food. You might want to consider feeding more than two times a day
My thoughts (not actual advice ) would be to keep monitoring Midnight on her low-carb diet, monitor ketones, and see what range her blood glucose settles at. If her numbers start to trend up hopefully an experienced Prozinc user will be able to advise you on a safe dose of insulin to restart her at. If ketones appear, seek advice immediately! And if pancreatitis symptoms reappear, also seek advice

With luck, Midnight will be a diet-controlled diabetic

 

We are headed out for a hike but I’ll be around tonight and will be glad to take a look. Thanks, Deb.

 

Unfortunately I was not able to get the keotones reads because I was reading I need special litter etc. Can she have keotones and normal BG? Anyone have good info I can reason on them? Tested before dinner 101MG did not shoot. She is currently playing around the house after eating will test again to see what she does after eating. Thank you all much sorry to be a pain

 

There are other ways to get a urine sample, if Midnight doesn't mind you lurking around when he's peeing. For example, some folks hold a big spoon or ladle under them as they are peeing. Others have used plastic wrap in the litter box. One can also get a blood meter that tests for Ketones, which I had to do for my shy pee'er, but the test strips are pretty costly.

I wanted to agree with the other posters than mentioned you may want to try several small meals a day instead of only two. You just have to pick the food up 2 hours before test time to get a more honest BGL reading and make sure they will be hungry enough to eat when they get their dose.

 

Not really feasible to feed more as we both work days. And I would rather not leave dry food out graze on. Unless I was to feed at 6:30am/pm and feed again before bed. I thought I would be in the clear if her BG got into the normal range and was not spiking anymore. So what does remission actually consist of normal BG levels and no ketones?

 

For what it’s worth, you can leave canned food out for them to graze on. Many of us do. I leave a plate down all day then toss any leftovers and put down fresh. I would NOT go back to dry food — that could very well spike Midnight’s BG and put you back at square one. Not worth the risk.

I encourage you to keep monitoring Midnight’s BG. Sometimes hypo events seemingly “jolt” the pancreas into working again but that can be short lived. Or it might be that all Midnight needed was a change to low-carb canned food. One never knows, but the fact that she’s currently active and playing and her BG is staying in a normal range is great. Just stay vigilant. If I were holding the syringe, I would not shoot insulin unless those BG numbers rose significantly.

Ketone tests might or might not be a big deal. We headed off down that path because you initially indicated she’d had DKA. I’m not clear whether she’s ever had either one; it sounds like maybe not, but since you’re not certain, it’s never hurts to get a few ketone tests in to err on the side of caution. That’s true for any diabetic but we tend to be extra cautious with those who have a history of DKA or ketones. It’s also important to test for ketones if she starts acting punky or goes off her food.

I’m not clear whether the vet diagnosed pancreatitis based on a specific test (i.e., a snap or fPLI) or whether he/she was using that term generically. Pancreatitis isn’t uncommon in diabetics and can be painful and impact BG numbers, so just be mindful of that going forward. If you start seeing the same symptoms that drove you to the vet in the first place, pay attention.

In addition to the numbers, it’s also important to consider the “whole cat report” when evaluating how Midnight is doing. The “5 P’s” are a good guide — peeing, pooping, playing, purring, and preening.

It sounds like you’re on the right path. If Midnight’s numbers start trending up again, you can look at restarting insulin then. Until then, here’s hoping Midnight is a diet-controlled diabetic and continues to be active, playful, and happy.

 

Her labs do show an electrolyte imbalances because her sodium, chloride, and potassium are too low. Her hematocrit is also low trending towards anemia. In addition, her phosphorus is low and her ALT which indicates damage to the liver cells, is mildly increased.

If she seems to have improved, you might want to have her labs done again to see if those parameters are back in balance.