Newly Diagnosed - Need help with BG curve interpretation

My name is Pamela and my nearly 7 yr old kitty Lightning (who yes, does have a brother named Thunder ) was diagnosed with diabetes a few weeks ago. I think it runs in my family (or we are just cursed) because both my sister and mom each had cats with diabetes as well. And unfortunately due to other complications, both kitties have since passed on. (Sending love to Simba and Bosco). So luckily or unluckily I suppose, they have been amazing at helping me deal with this since they've had to go through it themselves.

I'm a few weeks into treatment and doing home testing and giving canned food (which from all the posts I've read on here, looks like I'm on the right track). My concern is that even though I'm doing the testing, I really don't know how to interpret the results and don't know how to adjust Lightning's insulin or food intake based on the numbers.

I don't know the exact number when he was diagnosed, but the vet said it was over 400. She prescribed Lantus and thought I should start with 2mL 2x per day and my sister/mom both thought that might be high to start out. So the vet was ok with me starting at 1mL 2x per day. I did that for 1 week, and was unfortunately out of town for most of it so I didn't want Lightning to get stressed by having my mom or sister take his blood. So I only have a few days of BG data at 1mL, and his numbers were in the 400-250 range. So I talked to my vet and we decide to move to the 2mL 2x per day. That seems to be going well....and he's now getting numbers in the mid 100's and even got as low as 84 yesterday! I nearly fell over when I saw that number. But once I got the number, I really wasn't sure what to do with the information. I got the reading at +9 hours after his shot in the morning. I gave him a treat for being a good boy and letting me take the blood and then I gave him a 1/8 cup of HIlls M/D dry food because I was worried he could hypo (which i have no idea is right or not, but I'm so nervous about it that I figured I would rather be safe than sorry). I waited 2 more hours (which would be the normal time of +12) and it had doubled to 168. Since that number was still very low I was worried that giving him 2mL would be too much so I knocked it down to 1.5mL and kept an eye on him. I tested later that night, +2 hours and it was doubled again at 337. So here's where the real question comes in....should I have stuck with giving him 2mL even though he was only at 168 and I was about to feed him? This is where I'm lost and I don't know what the best choice would've been. This morning when I tested him, he was at 364 so I don't know if the number dropped at any point in the night and then came back up or if it only went up.

Is there anywhere I can find information about what to do based on what BG reading I get? I just really have no clue what to do and don't want to do anything to jeopardize his health. Any help anyone can provide is very much appreciated!!

Thanks,
Pamela and Lightning

 

HI Pamela and Lightning,

There are stickies over on the Lantus Insulin Support group page that will help you understand exactly how it works: viewforum.php Everyone on that page uses Lantus and will be able to help you get started. Check it out.

 

Sounds like you are doing a lot of things right so far. A lot of us keep track of our kitty's numbers by entering them in a spreadsheet and posting it online. Here is a link for you if you would like to try that: viewtopic.php?f=6&t=16 It also helps to have it so others can take a look at your numbers in an easy to read format.

A number in the 80's is not in hypo range yet, so I would not have worried about it especially so late in the cycle (+9). I wouldn't give high carb food or syrup until numbers are around 40 or below, or kitty is showing signs of a hypo. 80-something is actually quite a nice low point! You were right to wonder about giving insulin at a 168 - without lots of data, it is hard to predict what kitty will do. The number over 300 within 2 hours after is probably what we call a rebound number. If kitty's body is not used to seeing numbers below 100, then the liver panics at those low numbers and sends glucose into the system to protect itself. This can happen even if the body is not going hypo. The only way around it is to hold the dose steady and give the body more exposure to those same numbers. If you get a value below 50, then that is reason to decrease the dose. Only give a full dose of insulin on a preshot value below 200 if you have done it before and know what to expect or you will be home most of the day to test him and catch a hypo if it comes up.

High protein, low carb food is very very important - so it is good to hear that you have already made the switch. Keep up with the hometesting and good food choices! cat_pet_icon

 

Saying hi. I have civi named Lightning (all white) and the diabetic is one is Thunder.

 

Wow, I've never met another Thunder and Lightning pair but glad to see someone else shares my sentiment! My Thunder (who is gorgeous and all black with yellow eyes) has his own issues with ulcers in his mouth and has gained A LOT of weight since getting on steroids....I really hope he doesn't end up with diabetes as well!!

 

Thank you for the info....I think I figured out the spreadsheet thing and hopefully it works for everyone. I will do some more reading up and hopefully can get better at this. Thank you for the help so far!!

 

Nice job! Works well over here. Only thing I forgot to mention before - the insulin is dosed in units and not milliliters

 

Hi Pamela and Lightning
Welcome to the FDMB!

I've copied a previous post (with some editing) here for you with info on what you're looking for during a cycle on Lantus.

First, you'll want this info nearby should you need it.
A good idea to have handy, maybe on the kitchen wall or near your desk.
How To Treat Hypo
Jojo's Hypo Tool Kit

This is the protocol the Lantus forum uses. Tilly's Protocol: Modified Version A modified version of the Tilly Protocol.
When you are ready, and if you like, the Lantus forum is a very active insulin forum and you'll receive tons of guidance while using Lantus.

Please note, the protocol advices increases in .25 increments rather than a full unit. If you are raising dose per vet advice, I strongly urge you to keep an eye on Lightning's number.

Also, Lantus dosing is not based on pre-shot numbers., but rather the PEAK (see above) so it is - and I will repeat, very important to get spot checks during a cycle. If you work - that's ok, lots of us do....this is why we have evenings and days off and weekends to collect the data.

You'll need this. Read it if you haven't seen it yet. Very important to store your insulin properly so it doesn't damage.
Proper Handling & Storage of Lantus/Levemir


Now, if you are home testing regularly, use the chart below, if you like, to follow your kitties cycles.
I will tell you, the Lantus forum is a test-happy :lol: forum. And a lot of the guidance given there is based on your data collection.

In the meantime, you are more than welcomed to continue posting here in the main Health forum and include your daily spot check BG numbers. We have members all over the board with diabetes experience and quite a few of us on Lantus or have used it, spend some time in the Health forum.

This chart might help you with a curve and spot checks....please read about Onset, Peak, Duration etc...(click on those words in bold blue)
You can find the complete link in the Lantus forum information stickie New To The Group


Learn how YOUR kitty is responding to insulin:
Onset ---> the length of time before insulin reaches the bloodstream & begins lowering blood glucose
Peak/Nadir ---> the lowest point in the cycle
Duration ---> the length of time insulin continues to lower blood glucose

How to do a Curve: you don't have to test every hour. This is just a guideline.
Typically curves are every 2 hours in a 12/12 cycle. Or a mini-curve, about every 3 hours.
Depending on where the numbers are, you may have to re-test frequently and offer food to help steer numbers.

Example of a typical curve:
+0 - PreShot number/ AMPS (a.m pre-shot)
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle). please note, nadir can fluctuate. Spotchecks are essential to finding out when you kitty will hit the lowest point in each cycle.

+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number/ PMPS (p.m pre-shot)

Carryover ---> insulin effects lasting past the insulin's official duration
Overlap---> the period of time when the effect of one insulin shot is diminishing & the next insulin shot is taking effect
Insulin Depot ---> (aka "storage shed" in Lantus Land) "spare tank" of insulin, which has yet to be used by the body
More on the Shed (or bank) ---> Lantus & Levemir Insulin Depot AKA Storage Shed

One last thing....Lantus requires patience. You will like it, but you need your patience cap on.


As others suggested, head over to the Lantus forum and read the information stickies on Lantus. You are welcomed to open a thread there when you are ready.

Good luck!

 

Pamela looks like your off to a good start. Now with your spread sheet up I think Introducing yourself over on Lantus would be the next step since you are dealing with dosing questions.
You will likely get expert and caring advice there as that is there specialty.
Best of Luck to you and Lightening.
lori

 

Welcome Pamela!

You are really already doing a lot of things right. I'm hoping that the canned foods you're feeding are low carb. It looks like the couple of links that Ronnie didn't provide were related to food. Dr. Lisa Pierson is a vet who has a wonderful site devoted to feline nutrition. She also has an interest in feline diabetes. Janet & Binky's food charts will give you the carb counts on most canned (and dry) food. We consider low carb anything under 10% -- although I suspect that most of us feed 5% carb or less.

Once you've had a chance to look at the modified dosing protocol or the formal versions that are in the link that Ronnie provided, I think you'll notice a couple of things. Lantus dosing is based on the lowest point of the cycle, the nadir, and not the pre-shot value. With certain exceptions, we don't reduce the dose. It's also important to get spot checks during each cycle. Since many cats have lower numbers in the evening, it's important to get tests then, as well. The dosing protocol that we use recommends dose changes in much smaller amounts than your vet has suggested. These changes are in the amount of 0.25 - 0.5u. By making changes in smaller increments, you don't risk missing an ideal dose or giving your cat too much insulin. The Tight Regulation Protocol that we use is backed up by published research.

As far as interpreting the BG tests, normal BG is in the 50 - 120 range. For those cats on the Lantus protocol, a dose reduction is earned by a BG level falling below 50. This is safe as long as you are monitoring and know how to steer numbers with food. Numbers in the 80s are not overly low. They are, however, numbers that Lightening is probably not used to any more. For example, you had a number in the 80s yesterday. A few hours later, Lightening's numbers were in the 300s. He bounced -- his body had forgotten that the 80s are normal and reacted as though the level was way too low and his liver dumped stored glucose into his system and drove the numbers back up.

 

Lightning is on the Hill's M/D food, so its low carb and high protein. I also have it in dry form and give him an 1/8 of a cup or less if I have to go to work during the day or right before bed time. He'd been throwing up in the morning prior to the diabetes diagnosis and the vet recommended giving a bit of food to get him through the night...its been working out well, but not sure if now that's what's causing the high numbers in the morning.

I just bought some syringes and was very pleased to see they have 1/2 unit marks. If I/my vet decide we need to change his dose, I will definitely use your advice and go up in smaller increments.

I'm VERY glad to hear that the 80's aren't a terrible number!! But watching the number drop from 400 to 80 was a major shock and I guess I just wasn't ready for it. The same thing happened today as well....he was at 85 an hour before I normally test him (he threw up white watery foam and that's what prompted me to test him). So I gave him food and he ate it and 2 hours later I tested him again and he was up to 168. I'll test him again in a few hours, not sure what I'm expecting to see, but at least it will help me figure out what his body is doing.

 

Welcome and it sounds like you are off to a great start. The numbers might not mean a lot at first, but gathering is what's important now. Getting numbers when there is something off (like throwing up) is a great idea because it will give you information to form a pattern that will help you know what to do in the future.

And yes, 80s are beautiful numbers (if you look at us, that's about all Smokey ever wants to give me :mrgreen: )

 

One thing to note from the Janet and Binky food lists is that Hill's M/D dry is 13% carbs and wet is 14% carbs. Many here are most successful feeding 6% carbs or less, though technically we state 10% or less. With either cut off - both varieties of the M/D are above the recommended carb content. On top of that - read the ingredients list on that food - all filler, grains, and by-products with very little muscle meat in there at all. Not good. The real reason that these foods are called "prescription diets" is because they are fixed batch foods. Meaning that the exact same ingredients in the exact same quantities, from the exact same sources are used each time. It has nothing to do with the quality of the ingredients. Typically you can find better ingredient foods that better match the target as fed values for less than the prescription if you check out local higher end pet stores or buy from petfooddirect.com.

 

Thanks for the info Kelly...I'm still trying to figure out how to read that spreadsheet and I think I have it figured out now (finally printed it off and now it makes more sense than just continuously scrolling). So if I were to look into getting another food (which I'm definitely up for), I need something 10% or lower in carbs, but then what about the fat content? I notice that alot of the low carb ones are very high in fat, higher than the protein content in most cases. Is that ok? Also, looks like a lot of the REALLY low carb ones include seafood and I thought that wasn't good to give cats all the time either?

Agghhh, so many variables, it makes my head spin!! I just want to give him something that's healthy for his condition and its seriously BLOWING MY MIND how many things I need to consider. I don't want to say that I'm overwhelmed, but I'm just afraid that every choice I make could hurt/help him and its scary to think that I have so much power. :shock:

 

Most people here don't have an issue with fat content, although personally I'd prefer protein over fat. There is another site that says that fat plays a bigger role than carbs in feline diabetes but she's not convinced anyone over here of that.

Your best bet is to look for a range of 3-10 % calories from carbs; ensure there is little or no fish or at least not too frequently (high phosphorous and possible metals and not good protein source for cats); look for muscle meat (i.e. 'chicken') over bi-products and no grains if possible.

Hope this helps

Jen

 

I just want to add one thing (not to overwhelm you more, but it is important). If you are going to change Lightning's diet to lower carb food, you will need to reduce his insulin dose also. Less carbs will mean lower BG #s, so you need less insulin. Yes, you should give him lower carb food, AND reduce the insulin dose too!

You're doing great, really! I know it's a lot to learn and it's overwhelming, but you really ARE doing great. It will get easier, I promise. :smile:

 

Yes, and I even (accidentally) ordered syringes and they have 1/2 unit markings so that was a welcomed surprise when I opened the box!

I'm doing to do some research to find out what food to switch to, I have some time since he still has about half a case left of the M/D and then I'll start the phase out of the old and phase in with the new. He's usually not too finicky when it comes to changing food, but I figure I should do it somewhat gradual so I can get some numbers and figure out how to adjust the insulin.

Does anyone have a recommendation on a good treat? I haven't heard of the freeze dried stuff I read about on a link from Binky's page. I haven't heard of any of those brands either....guess it's because I'm a bad mom and don't usually give my kitties treats But now I feel like I should so Lightning has incentive to me good for me....and then of course Thunder thinks he deserves one just for being around

 

For treats, I find freeze-dried meat to be the best. Once kitties figure out it is food, they will jump through hoops for it!

PetCo in my town has started carrying PureBites. PetSmart has PrimeBites, which I understand is the same thing, just a different brand, though I can't say first-hand as we use PureBites. My kitties (all three) just adore the chicken pieces. They are sold as dog treats, but they are pure meat, no other ingredients, so there is no reason not to give them to cats. If the pieces are kind of big, just break them up.

Halo Liv-a-Littles is another brand of freeze-dried meat treats. Some of us have found the pieces to be a little too hard sometimes, but the brand is an option. Sometimes this brand is easier to find than the others.

 

Phasing in the new food is a good plan, I'm glad you are considering everything and going about it carefully. :smile: How fortunate that the new syringes have half unit markings!

We use boiled chicken breast, cut into small pieces, for treats. I also keep the freeze dried chicken treats in the house...Prime Taste Treats (for dogs) from Petsmart.... and they do LOVE them!