new to forum, somogyi effect?

Hi, just registered. Here is Milo's chart, the vertical gey lines are 12 hours apart, the top of the vertical axis is 25mmol/L


He is currently on 4 units Lantus twice a day (the larger light blue blobs). The small light blue blobs were 3 units injections

I haven't given his injection today as lately every injection seems to push him higher not lower. Am I seeing the somogyi effect?

Also have I got the graph zones about right?

Thanks

 

Not the kind of format I am used to looking at .. whats the vertical scale? I cant read the numbers.. I see 25 at the top.. is it increments of 5?

Do you think you could put this into our spreadsheet format so we can take a better look?
How to: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

It does look like he bounced high (above max safe) and then slowly came down after that. The bounce was triggered by him dropping into "normal" levels - which his body wasnt used to. Is he dropping below 2.8 at these times? ( I cant tell from the image). Depending on how long he has been diabetic, anything below 2.8 indicates a dose decrease of 1/4unit is needed.

What food are you feeding? And how long has he been on insulin?

thanks
Wendy

 

Before we start trying to analyze a graph, it is going to help us if we know more about the situation.

What food are you feeding?
How much and how often?

Were you on another insulin before Lantus?
When did you start giving Lantus?
What was the starting dose?
How much does your cat weigh?
What should your cat weigh?

What are you observing in terms of water drinking and hunger?

 

Adding to BJM's questions:

In what increments was the dose raised? Looks like bumped by 1U at a time - too much
Based on what criteria?
Who made the decision to raise the dose?

I know we haven't answered your question, "Is this a bounce?" But there are so many factors involved in determining that.

We are looking for more insight.

 

Thanks for the replies. More info:
He's 9 years old, has a twin sister Pixie (who is the occasional maroon dot on the graph)
He's a domestic shorthair - standard non pedigree cat
He weights 6.2kg (slightly overweight)
He eats Hills science plan mature dry cat food twice a day, boths cats have always had this type of food.
He had ketoacidosis and a urine infection mid Jan this year and nearly died. This was the first time he had been ill and was when we discovered he was diabetic.
He had caninsulin twice a day until beginning of March dropping from 4 units twice a day to 1
He was in remission all of March, back on caninsulin in April.
He went onto Lantus in May at increasing amounts up to his maximum 4 twice a day
He appears very healthy, very slight 3rd eyelid showing but has always had that. His eyes sometimes appear very slightly cloudy but this is almost imperceptable and it may just be the light.

I see why you have a standard template, but I do find a graph much easier to interpret. The vertical scale as I said goes to 25. It starts from 0 and so goes up in units of 5 mmo/L. The graph was trhe highest resolution I was allowed to post for some reason (the image is hosted on photo bucket, so do I need a pixel restriction?). It is unfortunate that I graph in mmo/L (my gluocometer actually measures in mg/dL and I have been converting because everyone here and my vet uses mmo/L.). I'm sure you know to multiply by 18 to get back to mg/dL. I can redo the graph if necessary.

As both cats eat and drink from the same place it is difficult to judge water consumption. Ditto urine testing, so I have a blood ketone tester and Milo, since his ketoacidosis, always shows up as 'lo' i.e. too low to measure.

I did raise from 4 to 5 BID admittedly a large leap but you can see why in the middle of the graph - he went above 17 on 3 BID. I now decide the dose, the vet got it rather wrong with the caninsulin at 4BID which was way too much.

As I write he has shot down to 2.8 (51mg/dL) just after another 4 IU lantus injection.

I know about the wet hp food recommendation but would like to try with dry if possible.

 

Here are all the readings for milo from 16th Feb when I first got a glucometer to 5th June. Ignore the comments on the graph, the coloured dots and the recent gap when we could not measure. The maroon line is his sister for comaprison.


Interestingly the first significant spike you can see where both cats spike was entirely due to a 2 hour car journey - boths cats went over 8. So stress elevates BG a lot more than I thought.

 

Hi, how long after the shot did you get that 2.8 (50.4)?
And which glucose meter are you using?

Eliz

 

You may be seeing some food spikes, since you are meal feeding a medium carb diet. The Hills is not 10% calories from carbohydrates or under.

You are home testing, so the first thing I will point you to is Cat Info. Written by a vet, it discusses appropriate feline nutrition ... and dry food is not recommended due to the additional strain on the kidneys (increased risk of renal disease), the risk for obesity, and the risk of urethral blockage in male cats. That said, Young Again 0 Carb, Evo Cat and Kitten, and Wellness Core in the gold and tan bag are the 3 dry cat foods that are 11% calories from carbohydrates or less.

I leave canned food out all day, put down fresh food every 12 hours, and use Friskies 13 oz canned Pates. My obese cats lost weight on low carb canned without restricting intake. Their coats look better, too. No one has become ill doing this.

 

Hi, about 6 hours after; here is the latest graph


He's due another 4 IU Lantus in two or three hours but with the graph at present it will be less than 4 units I think. However the bright light green line is what I was aiming to keep him below all the time. His sister who doesn't have diabeties (the maroon dots) is always below that.

I have a B|Braun Omnitest3 for these measurements (both cats) and a GlucoMen LX plus+ which gives 20% lower BG readings for some reason but I use that one mainly for ketone-in-blood tests.

 

Young Again 0 Carb, Evo Cat and Kitten, and Wellness Core in the gold and tan bag are the 3 dry cat foods that are 11% calories from carbohydrates or less.

 

Thanks I don't think any of those are available in the UK where we live but there is a huge range of dried food here, eg:
http://www.petsathome.com/shop/cat/cat-food-treats/dry-cat-food/?pag=1&rpp=340

This is what Milo is on at the moment: http://www.hillspet.co.uk/en-gb/en-...dult-7-plus-active-longevity-chicken-dry.html

 

here is the dry food Hills are recommending for diabetic cats

http://www.hillspet.co.uk/en-gb/en-gb/products/pd-feline-prescription-diet-md-dry.html

As Fed
Dry Matter
kcal/100g

Beta-carotene
1.5 mg/kg
1.6 mg/kg
0.04 mg

Calcium
0.92 %
0.98 %
236 mg

Carbohydrate (NFE)
18.6 %
19.8 %
4.8 g

Fat
18.8 %
20 %
4.8 g

Fibre (crude)
3.6 %
3.8 %
0.9 g

L-Carnitine
521 mg/kg
555 mg/kg
13 mg

Magnesium
0.06 %
0.06 %
15 mg

Moisture
6 %
-
1.5 g

Omega-3 fatty acids
0.18 %
0.2 %
47 mg

Omega-6 fatty acids
3.14 %
3.34 %
803 mg

Phosphorus
0.69 %
0.74 %
177 mg

Potassium
0.73 %
0.78 %
188 mg

Protein
47.5 %
50.5 %
12.1 g

Sodium
0.33 %
0.35 %
84 mg

Starch
15.5 %
16.5 %
4 g

Taurine
0.28 %
0.3 %
72 mg

Total sugar
< 0.2 %
< 0.2 %
< 0.1 g

Vitamin A
9590 IU/kg
10202 IU/kg
245 IU

Vitamin C
70 mg/kg
74 mg/kg
1.8 mg

Vitamin D
410 IU/kg
436 IU/kg
10 IU

Vitamin E
550 mg/kg
585 mg/kg
14 mg

 

Would you please update your user control panel, Profile tab, Edit profile, Location field and put in UK, maybe more county info. Submit to save.

There are folks here like Elizabeth and Bertie and Dr. Schroedinger that can suggest foods available in the UK that would be good for diabetic cats. But they need to see your are located in the UK before they will think to chime in on your topic.

The Hill's M/d is still rather high in carbs, 19%. We look for those under 10%. It's probably lower in carbs than the food you are feeding which is 35% carbs according to the Hill's UK website.

I'm sure you'll get some suggestions on another food. In the meantime, switching to the M/d would be better for your diabetic cat than staying on that other Hill's high carb food.

 

Maybe check this
Canned cat food for EUROPEANS and International buyers

 

Profile updated.

I'v ordered the Hills m/d dry food.

It's not straightforward to calculate the '% calories from' figues but I think they are:

Current food, Hill science plan mature
carb 46%
fat 16%
protein 38%

Hills prescription m/d
Carb 12%
fat 12%
protein 76%

Anyway thats a little diversion I am still trying to work out Milos Lantus dose for tonight

 

He's now up at 7.8 (140) 12 hours after the 4 units so I've given him 3 units (not 3.5 as he went into the hypo danger zone briefly, 6 hours after the 4 units)

 

I am glad you changed the dose because since he is a fairly new diabetic, we would consider a dose reduction earned when he goes under 2.8. And you will likely see a bounce after that.

Lantus works best on consistent dosing because it is a "depot" insulin which takes time to build to optimal levels in the cats system. So its best to hold it for 3 days to see how it works before changing it.. unless the cat drops below 2.8.

Its unfortunate you won't do a spreadsheet because the many experienced members who could advise you will find that easier to read and interpret in order to give advice. This chart is also small and my eyes arent that great. I cant tell what the dose has been or when it was changed.

Wendy

 

Waving 'Hi' from Surrey, UK,

If you're in the UK and need help with food suggestions just let me know! :smile:

Eliz

 

There's a really natty little carb calculator here:
https://secure.balanceit.com/tools/_gac ... /index.php?

 

I fed my cats Hills Science Plan for years until Bertie became diabetic at the age of 8. And afterwards I could have kicked myself for not realising sooner that I was feeding my carnivorous cats a diet laden with carbohydrates. My vet had recommended Science Diet (Grrrr...!)

In terms of dry food in the UK, the best are generally considered to be 'Acana' and 'Orijen'. These Canadian imports are available online from Zooplus (and probably elsewhere too). Orijen is slightly more expensive than Acana, and is higher in protein and slightly lower in carbs. I think Acana is around 23% carbs, and Orijen around 17%. So, these are similar in carb content to the food that you've just ordered, but are grain-free, and are considered to be considerably better quality.
Details of these are here:
http://www.zooplus.co.uk/shop/cats/dry_ ... ijen/45156
http://www.zooplus.co.uk/shop/cats/dry_ ... ana/132343

However... The food you're currently feeding seems to be over 30% carbs, and even switching to another lower carb dry food could lower your cat's glucose levels. As it is you're seeing nadirs of around 2.8.... So, you may well need to lower the insulin dose even when switching to a different dry food...

Also, to echo what others have said, there are huge advantages to switching to a low carb wet/canned diet. And quite a few cats go into remission after just a short course of insulin and a switch to low carb wet/canned food.

Maybe you could consider getting a timed-feeder that your neighbour could use for your cats when you're away? Some of those will keep the food cool as well.

Eliz

 

One precaution for you. When you switch the food from the high carb food, the blood glucose numbers can drop dramatically, as well as the need for insulin.

When you do switch the food, if you switch all at once, the BG's can easily drop 100 points. Even a gradual changeover to help with any intestinal upsets when changing over from a high carb food to a low carb food can have a dramatic impact.

I switched my foster cat Wink from high carb dry Hill's w/d 37% to low carb Fancy Feast wet 5% carb, gradually, over a 3 week period. I had to keep dropping the dose and dropping the dose. One day, he hypoed because the food change had dramatically dropped his BG numbers 100+ points. He was still on 1/4 dry and 3/4 wet at that time.

I ended up stopping the insulin until he stabilized. He only needed a tiny dose for about 4 weeks and then went OTJ.

My recommendation when doing a food switch like this is to cut the dose at least in half.

As far as weather this is a bounce or not, I can not say because I quite simply can not read your graph. I do not know waht the doses were. I do not know when your test times were. I do not know when the doses were changed. You may be able to read your graph but not many of us here have been able to.

I realize it is more work for you to create the spreadsheet we use, but that is what is needed in order for us to give dosing advice. I'm uncomfortable giving advice without being able to see what is going on. With thousands of users, you probably realize why we have come up with this standard format spreadsheet. There may also be more tests required. Can't tell this with your graph.

Spreadsheet creation directions from the Tech Support forum: http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

 

Yes I have looked at the spreadsheet template. Unless I'm missing something I believe 'spreadsheet' may be too grand a term for it, it looks like a table to me. I could cut and paste the table that my graph is derived from, which is similar to the template table, but for lots of reasons I don't take readings every hour or every two hours, on the hour. So I don't believe it would help. I am much happier with the graph as a way of displaying such data it is surely easier to read and much harder to misinterpet. All expalnations of Somogyi I have seen use a graph.

To be brutally frank if anyone cannot intepret the graph I would not be happy with them trying to interpret my raw data, given my readings are not hourly. However not being able to read the figures (due to the pixel restriction on this forum?) is a different issue. I did enlarge them so they are clearer. The vertical axis is mmo/L. The horizontal axis is time, each vertical line is 12 hours apart. Every other vertical line is 11:30pm. The light blue dots are the injections, large ones 4iU, small ones 3 IU. The small dark blue dots within the curve are the readings.

 

I have vision issues and had great difficulty seeing the details, so it helps you've made the graphic larger (and that I'm on my office PC with a 24" monitor!)). A few more tick marks on the horizontal axis to mark 6 hour periods (5:30,11:30,17:30) would be helpful, since the nadir would be easier to identify with the vertical lines. Note, many cats will go lower at night than during the day.

Glucose levels from pre-shot to nadir to pre-shot may swing as much as 200-300 mg/dL (11.1-16.7 mmol/L). If I saw your numbers, I could check if the swing was within that range.

As an FYI, the renal threshold depends on what source you use. I've seen estimates of 200 md/dL (11.1/L), 240 mg/dL (13.3/L), and 280 mg/dL (15.6/L) on the web. Another posted found a reference to 180 mg/dL (10.0 mmol/L). A very rough determination of the renal threshold being exceeded would be a positive urine glucose test. Of course, this only determines if it was exceeded in the time since the last void and may depend on other renal issues the animal is experiencing, such as renal failure, hypertension, and so on.

The charting template we use is in Google Docs, and they call it a spreadsheet file, so everyone is calling it a spreadsheet. Its a useful tool for the majority of folks here. And for those of us who are so inclined, it becomes very easy to do averages down a column with the same insulin dose and time, or get a graph across a particular day. Unless needed by the vet, most of us don't do graph the numbers; it isn't necessary for the day to day management. (BTW - I'm an epidemiologist, so I have graphed it.)

Because of the different time zones folks are in, we reference glucose readings as
AMPS or PMPS - preshots before giving insulin
and if taken, any subsequent readings are in relation to when the dose was given
+1 hour since shot
+2 hours
+3.75 hours <- yes, you can use fractional hours. I've merged cells together when I've done that. Others put a note in the notes column, or in a separate row.
etc
This avoids any confusion over different time zones, etc. That's really important if we're helping someone's cat through a hypoglycemic episode as it helps us judge if we're heading into more monitoring, or can let up due to the hours since the shot was given, without having to convert for time zones.

Finding the nadir for one's cat on a specific insulin is usually within a specific period post shot - Prozinc may be 5-6 hours after the shot, Lantus 12 +/- an hour, and levemir tends to have a later nadir than Lantus. Seeing numbers in the chart in the columns around those times lets us know if the person has any nadir tests pretty quickly. As dose adjustments are based on the nadirs, thats important.
ex. going below 50 mg/dL [2.8 mmol/L] using a human glucometer; or 80 mg/dL [4.4 mmol/L]) on a pet-specific glucometer is usually cause for a dose reduction, barring other issues (steroid meds starting, vomiting, inappetance, and so on).
- I see you were at or near that recently and may wish to check around the nadir for that reason.

 

.
Edited to add: Sorry, cross-posted with BJ who is a lot smarter than I am.... :roll:

Hi,

Please don't lose faith in our ability to help you. That would like 'throwing out the baby with the bathwater'... There is a lot of experience of feline diabetes on this forum. (IMHO nothing else in the world compares with this site...)

All that has happened is that folks here have found it hard to understand the format of your data. No big deal... Some of us - like me - are old and a bit knackered and find it hard to see fine detail. And my tired old brain has only just realised that there were 10 days worth of data in the graph above....(Duh!) But we have no problem with graphs per se. We're just used to seeing a smaller sample of data in one hit.

OK, our 'spreadsheets'/tables may not be 'state of the art' but they are in a format that people here are used to reading. They show a day's data at a time, and the format makes it easy - and fast - to compare one day's data with another day's data.

Another way of writing data would be this:

For example...

AMPS: 15 (ie, morning pre-insulin blood glucose number, 15)
+2.5: 18 (ie, two and a half hours after the insulin shot, 18)
+4.75: 12 (ie, four hours and 45 mins after insulin shot, 12)
etc, etc, etc...

And tests don't need to be given hourly. I test as and when I think of it... (But it is especially useful to get a test around the middle of the cycle to see how low the insulin is dropping the cat's blood glucose.)

Best wishes, Eliz

 

This quote above is from BJM's post. The nadir for Lantus is usually somewhere around the +5 to +7 time frame, not +/-12. But every cat is different. Some nadir early on Lantus, like my Wink who nadired at +4. Some cats nadir later on Lantus. It can change over time also.

I said I could not read your graph, not that I could not interpret it. It was too small to read. Thank you for the larger version which at least has the numbers large enough to be visible now.

We use our standardized format spreadsheet for the simple reason that we do not want to have 7000+ versions of the data to look at and interpret. The standardized spreadsheet was developed to create a single version of the data. Certainly there are variations of that data. No one tests every hour. The +1 thru +11 columns are there for those that do take a certain test on a certain day. People enter the numbers they have in the appropriate columns.

From your graph, it looks like you are changing the dosing times around since you upped to 4U. Why is that?

A jump from 3U to 4U is considered to be a big jump per the Tight Regulation protocol. Dose changes are best done in 0.25U increments, so the appropriate dose for your cat at that point in time is not bypassed.

Why the 1U jumps?

4U of Lantus is also starting to be a high dose. Think IAAA, Agromegaly. Or you have raised the doses too quickly and have bypassed a good dose.

Yes, where you live in the UK uses mmol/L but us backwards folks in the US still use mg/dL. Yes, I can multiply by 18, but our world version of the SS does this automatically. All I have to do is select the US tab and get the numbers translated for me.

 

My bad - I was thinking duration when writing about nadir! That'll teach me for posting @ work!

 

Usually the few injection time changes are when I am closely monitoring him and trying not to inject him on a falling curve. I don't change them much.

I absolutely cannot read 0.25IU on a 0.3ml syringe. I'm surprised you can if you struggle with the graph numbers. Are you using a different syringe? U-100 0.3ml is the smallest I can get here. Hence the larger change.

Is 4IU BID a large dose for a 6.2kg (14 pound) cat? I didn't think it was.

No sign of Agromegaly that I can see (though I appreciate it may not be apparent), is his diabeties not under control? I am successfully keeping him below 10 (180) most of the time. It's just that I would like to keep him below 6 as I thought this was the aim of the tight Lantus regime.

What is IAAA?

 

Lastest graph below, he'll be on 4 IU BID now until Sunday at least as we are away and someone else is injecting and he won't be tested.

 

Hi,

Are you using the syringes with the half-unit markings? My close vision isn't great at all (and I DO really struggle with the numbers on the graph) but I can just about 'eyeball' a .25 unit with these, and couldn't manage without them. But I do need to hold the syringe against a light source to see it clearly. The syringes are available from vetuk here:
http://www.vetuk.co.uk/veterinary-suppl ... demi-p-296

If you scroll down this page you'll see pics of syringes measuring different dosages. I think the third pic down is showing .25 unit.
viewtopic.php?f=9&t=18139

Eliz

 

Hi,

If it were my cat - and given the lowest reading on your latest graph (touching the "danger line") - I would reduce the dose while there is nobody there to monitor the blood glucose, just to be on the safe side.

Cats often eat less when their people are away from home, and if a cat does eat less than is typical the usual insulin dose can be too much and the cat could become hypoglycemic.

Eliz

 

Insulin Auto Antibodies (I think!). There is more info on the following page (you need to scroll down a little way):
viewtopic.php?f=12&t=375

 

Various magnifiers have been helpful for some of us to view the syringe markings.
I have used Carson Clip and Flip which clip on my existing glasses.
There are visor magnifiers if you don't wear glasses.
There are syringe magnifiers which clasp the syringe barrel.
And of course free-standing magnifiers.

 

There is no struggle with the graph numbers, but graphs are vague, whereas the google spreadsheets used for recording BG test numbers are much more specific. If you click on the links in many people's signature for their cats' ss, you will see how most record their numbers on this site.

When using Lantus, the important number to know is the nadir.... on the dose you are giving, 4u Lantus am and pm, what number does the cat get down to..at the lowest point in the cycles?
Your graph may be fine, but it's best if you provide the actual number values for your turquise, blue, and red dots. As well, it would be good to know the values for every horizontal line on your graph....
What are you considering as the red Max safe value and what are the orange lines? Renal threshold is what value on your chart? Finally, what is the value for your 'danger' line at the bottom of the graph.

The majority of people here are accustomed to a diff scale for their readings.... you can use the BG Conversion Calculator
What you call a 5.0, others here will call it 90, your 10.0 is 180, your 15 is 270,and so on.

As for measuring small doses, it can be done easily using a drop method if you don't want to eyeball an amount. If you measure a 0.5u amount on your 3/10 syringes, you can squeeze out a drop at a time..... I can get 4 drops easily .... and you get the following amounts:
0.5u
0.375u = 3 drops
0.25u = 2 drops
0.125u = 1 drop

Graphs are a fine picture, but without the numerical data, you have no specifics.
https://docs.google.com/spreadsheet/ccc ... XdYREFUc2c

On the above, you can see that there is much more details on a spreadsheet than on a graph.
My Oliver tested positive for acromegaly and IAA, but is currently off insulin.
Your current dose of 4u is fairly high, but since you have done very large increases, you may well have better numbers on a lower dose.

As has been posted, increases are based on the nadir of the cycles, not the preshot numbers. Increases up to a 10u dose are done in 0.25u or 0.5u increments. No one should be making full 1u increases until they are past 10u twice a day. By then, if you are feeding low carb wet food, and still don't have a regulated cat, you likely have an acromegalic cat.

So, if you can provide the number values for the graph dots, it will be easier to give some feedback.

Gayle

ETA: About the weight and the dose.... they are not connected at all. Sure some people may initially base the dose by weight, but it's not right from what's been seen. There are cats who are large that are just fine on a 1u dose twice a day.

My other acro cat weighed less than your cat when she was diagnosed with acromegaly. She was not large, had no acro 'signs', but she was on a highish dose of insulin. Later on, her signs became more apparent, like the weight gain and the pot belly.
Oliver weighed 15lb when I adopted him, but he ended up needing a great deal more insulin. He was a largely built cat and his head was very large, plus his paws were also big..... signs of acro.
Some of the signs of acro are hidden, silent. The heart is a big one. When was the last time you had your cat get an echo to see what's up with the heart? Not many people do, but it's the first thing that should be checked if you suspect your cat is acro or has tested posiitive.

If you could provide the times for shots, the test numbers at shot times, and times and numbers when tested between shots, it would be most helpful.

 

Thanks thats safe advice and is exactly what I did when we were away for 10 days. However this time as we we only away a weekend and I wanted to persevere with this dose for a while, I left the dose as is with instructons not to inject if he didn't look his usual perky self and call us instead.

 

Thanks but in my case it is not a problem reading the graduations it is that there are no 0.25 graduations. I assume there are none because already the difference on my syringes between 0.5 and 1 is very small and any more fine printing would not help.

 

I don't think we're going to agree on the subject of graphs. I guess some people think in graphs and some in numbers. Personally I find the forum 'spreadsheets' very difficult to read, and also easy to make a mistake reading. I don't find my graphs vague at all - the values and times of all the dots can easily be read from the vertical and horizontal axis scales.

Perhaps the problem is I am not using mg/dL but mmo/L? To assist the horizontal 'max' red line is 300mg/dL, the orange 'renal threshold' line 250mg/dL, the beige 'target' line is 180mg/dL and the 'normal area is bounded by green lines at 135mg/dL and 43approx. The area marked danger is below 43mg/dL. So looking at my recent graphs the lowest nadir was 43mg/dL.

 

It may drive you crazy. It did me, anyway as I've got several courses on tests and measurement theory. We eyeball it, much the way experienced cooks eyeball measurements. There are some photos for reference. A few folks use calipers to be extra consistent.

There are lab syringes that can measure those; they require autoclave type sterilization, are quite expensive, and are generally unavailable for the lay public.

As an fyi - each batch of syringes should be checked for inconsistencies in markings as sometimes they are inconsistent and not caught by quality coltrol checks.

 

Communications requires the sender to send in a way that is understood; otherwise, the receiver says "HUH?"

You may well be fine with reading the graphs, but if others on this board cannot, you will lose out on their input.

For measuring, it is really quite simple to measure doses with .25u or .75u endings using the twisting drop method which may be much simpler for most people and no caliper is required.

I am quite familiar with the mg and mmo measurements because the most people on this site use the US one whereas I use the World one being in Canada. The issue is no numbers on your graphs.
Click on anyone's signature that has a link to a ss.... you will see what form is most used by people here.
I would put renal at 240 or lower, normal non-diabetic numbers are 50-120, and danger would be under 50.
Gayle

 

Now my turn to say "HUH?" The numbers are on the axes.

Milo spiked to 314/17.4 last Sunday evening but is now on the low carb food and there seems to be a significant improvement. He is staying around 100/5.5 and has done so for 24 hours.Fingers crossed.

I cut the dose from 4 BID to 3.5 BID Lantus to allow for the food change.

When I have more data I'll regraph in US measurements with more numbers in the scales and less clutter. Then I'll start a new topic with 'graph' in the title.

Maybe I'll also re-look at how to get better than 600x400 pixel images linked into posts on this forum.

 

Depending on the software, you could just add a second axis on the right with the mg/dL.

 

Hi,

Do you mean that he's been 24 hours on a single shot? That would be good news indeed.

Re the graphs/spreadsheets issue which seems to be continuing; in the meantime it would just be really helpful if you could post the preshot (before insulin) blood glucose readings, and any other readings you get (and especially the lowest reading of the cycle (nadir)) in good old ordinary numbers. That would enable people to be able to help you more...

Eliz

 

No he's still on 2 shots a day 3.5 IU Lantus - as mentioned I cut the dose from 4 BID to 3.5 BID Lantus to allow for the food change.

I've actually published every reading, to find a nadir level simply look at the lowest points on the dark blue curve and read across to the vertical axis. All the preshot figures are there too, simply read across from the light blue blobs to the vertical axis. Doing that myself now the nadirs range from 2.5 (45) to 7 or 8 (135) recently and the preshots 6 (100) to 11 (200). On the very recent new food the range is much tighter, nadirs 4.5 (80), pre shot 7.5 (135) or less.

I don't understand the problem about reading figures from a graph. Frankly I would be worried about anyone interpreting my figures if they didn't find the graph easier, it would indicate to me they don't have an understanding of what the figures mean and are just applying some rigid learnt-by-rote interpretation.

 

Thats a very good idea, I can do that in Excel.

And normally I would but in this case I think it might add to the confusion my graph seemsto be creating. Instead I will cut the graphs to the absolute minimum - a curve, two axis with scales and the shots marked. In fact it migth be worth removing the curve and just having the data as dots, that's as close to the forum 'spreadsheet' as I can get!

 

Per the tight regulation protocol, if you are following it, a nadir of 2.5 (45) earns a dose reduction of 0.25 units in the new diabetic.

Up to you whether or not you do. If you do not, be on alert for symptoms of hypo at those times - with enough insulin, the pancreas gets a rest and may start to regenerate (unlike humans). This could result in endogenous insulin production and a much lower glucose than anticipated, with hyp symptoms.

 

Huh?

 

Dan,

You want to reach as wide an audience as you can. On this forum, Feline Health, you find a lot of new people who have no idea what the BG numbers should be, let alone how to interpret them, say 7 out of 10. Then you have the people with more experience, that have been here a bit longer. Many of them do not give dosing advice, say 2 out of 10. Now you are down to the few people that do give dosing advice, 1 out of 10.

For those of us that do give dosing advice, we have learned how to interpret the ss we use. You may not be used to it, but we are. It has it's limitations, but we can glean an awful lot of information from the data.

The Spreadsheet may not be as robust as you would like, but it is a compromise for the wide range of people on this forum, with varying abilities and computer skills. Some people are more visually oriented. Some people are more verbally oriented.

I know of at least two other diabetic cat forums. They each have their own way of requesting the data to be presented. The spreadsheet is our way.

We have people here that help set up the spreadsheet and link it to your signature. Ask if you would like some assistance.

What did your vet say about the insulin dose after viewing your graph?

 

Hi,

We really do want to help.

Please DO consider Deb's excellent advice and suggestions.
As Deb says, if you can provide some basic data it's very likely that someone else here may be able to set up the SS for you, and then you'd only have to update it along the way! Now that is a good offer, isn't it?
So, what do you think..?

Eliz

 

I find the graph hard to read because what is important is the change from one shot to the next shot. The FDMB SS allows one to scan down to see how each cycle changes. Some cats have exhibit different AM and AM cycles and thus the FDMB also allows one to compare only AM and PM cycles.

 

As promised I've re-done and simplified the graph and started a new thread http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=97640

Here are Milos last 6 1/2 days starting at 3.5 rising to 7 IU every 12 hours. I hope the graph is easier to read, the left vertical scale is mg/dL, the right is mmo/L, the dark blue dots are readings and the light blue are injections and readings at the same time. The bottom scale is time with marks every 12 hours.

 

Seems to be getting ber (lower BGs). Yes, the graph is easier to read/interpret now.
Did say: From the graph it looks like sometimes there is more than an hour between a reading and the injection. Is that true?
Now I understand the light blue dots are both a BG reading and shot

 

Here is Milo's latest data, sorry I haven't put it into a table yet. As you can hopefully see I have got him into a tight range by giving up trying to cut his dose and instead putting it up to 10 IU twice a day. Unfortunately we are away for a week from Saturday so he will be in the care of our cat sitter. She is willing to dose twice a day but isn't able to monitor his BG as I have been doing. So I don't plan to leave him on 10 BID because of the danger of hypo if unmonitored. I haven't worked out the best dose yet but probably around 6 or 7 BID. Its a trade off between getting him better with the tight regime and just keeping him safe until I can resume it.


That graph covers 4 days, for reference below is a longer period (19 days):


Nb I haven't updated this second graph with the latest injections, for those please refer to the 4 days chart.

 

Although it's scary for me to think of a dose that large (Bob topped out at 4u), it sure does seem to be working for Milo.

The brown horizontal line - appears to be at 180? Is that a "line in the sand" of sorts you are trying to stay below? Just curious.
edit to add - nevermind, I just figured out it says "target".

Also, when is he eating in relation to the shots? The past few cycles, it appears that there's a slight increase just after the shots. Is that a food spike?

 

What weight is Bob? Milo is quite a big cat at 6.8kg/15 pounds. So per kg is 10iu still a lot? I'm now over thinking it is too much, though he used to be on 1 unit BID Caninsulin.

Milo is fed around 7:30am and 7:30pm, so just after half way between each vertical line. However he grazes most of the day, some food is often still in their bowl until close to the next feeding time.

 

Bob weighed 12.8 lbs at diagnosis. The vet felt his ideal weight was 14. He'd been at 18 six months earlier.

 

Milo was 5.68kg (12.5 pounds) at diagnosis (during ketosis).

I am now putting up thge latest graph as an attachment but it still seems to be subject to the 600x400 pixel restriction.

 

I'm currently using a tablet. I can zoom the image so it's larger than my 10 inch screen and the resolution is fine. Even I can see it with my aging eyes and bifocals

 

You can't see the '9' and '8' sitting inside the last two light blue dots though.

This is me reducing his dose prior to being away for a week. Along with delayed shooting it accounts for the slight rise.