Question about my BG curve - Newbie here

Hi,

My cat Prudence, was diagnosed late last week. My friend told me about this site and I have been reading and reading everything. Thank you for all the information & help everyone gives.

I’ve just ended my BG curve for 24 hours. My question is about finding the midpoint. Do you only take the highest point and the lowest point, add the numbers together then divide by 2 ?… to get the midpoint? Next question – You do nothing with the lowest point back up to the high point, right?

I’ve attached my chart. You will notice that when I started 9am her high point was 296, dropped to 126 = midpoint 211 – but two days prior to doing the BG I was having trouble giving her shot, so she was only getting one shot per day not two two shots every 12 hours.

9am that morning until 9am this morning she has been given 1unit of ProZinc 2xday and I’ve only fed her before both shots. At 9pm to 3am her numbers were 427 (highest) 132 (lowest) = midpoint 279.5

Am I doing this right? Should I continue the curve until mid day? When I took her BG at 9 this morning… it was 534.

I need sleep confused_cat Michelle

 

Oh wow! A 24 hour curve! You are ambitious! And definitely deserving sleep

Not sure where you got the midpoint idea from'; what you want to see is preshot values, nadir or lowest point, and next preshot. Also good to see when things start to wear off, etc.

What I see is quite a rollercoaster with pretty high preshots and decent nadirs (for early stages anyways). That rapid rise to today's preshot likely doesn't feel too good...

So, questions - how was she diagnosed? Simple BG test or fructosamine? And what food are you feeding?

Somehow we need to help you figure out why today's preshot is so much higher, and how to smooth out that curve because today it isn't a curve so much as jagged peaks

Jen

 

Actually it is not the "midpoint" that you need per se...

The important number is the lowest BG also called nadir or peak -- which usually occurs sometime between the two shots (perhaps where the "midpoint" idea came from -- midpoint in TIME or 6 hours after injection)

Different cats hit the peak insulin action time at different times during the cycle -- hence the need to do curves and record the data.

Based on your curve, your low points occur at +6 hours after injection -- when you have time, it would be good to test at +5 hours after injection and +7 hours after injection to confirm when the low point occurs.

Usually for a curve, we test every 2 hours for a 12 hour period. (sleep!!!!)

phoebe

 

I'm the friend she mentioned, and I can answer some of the questions

She's using ProZinc and feeding Science Diet kibble. She's planning to switch to all-wet, but she's going out of town for a week on Thursday and the cat won't be tested while she's gone, so she's looking for a safe dose for the cat until she comes back and can test/change food. She did just decide to board the cat at the vet's while she's gone, so maybe she can make the changes--upping insulin or switching food sooner, but I don't know if her vet will test pre-shot or not.

That curve is wild!

 

Hi Michele & Prudence and welcome to FDMB. I remember Kira & Max posting about you. From that post, it said that you started on ProZinc at 1 unit BID. Is that still correct? I'm afraid that I'm not very good at dosing advice, but you might find some more help if you post on the Insulin Support Group for PZI/ProZinc. You can get there here: viewforum.php?f=24

Those really are steep curves. I'm going to translate your chart the way we usually post numbers here (amps means morning preshot test). I put in 1 unit, so please correct me if that's wrong:
amps 296 1u
+3 249
+6 126
+9 317
pmps 427 1u
+3 330
+6 132
+9 364
amps 534 1u

For PZI we usually don't want drops of more than 60% - that usually means too much insulin. But those high preshot numbers are throwing me. Hopefully others with more experience will be along soon. And I hope you get some sleep. :razz:

(Edited to correct my stupidity.)

 

With those high preshot numbers, it is possible that 1 unit is too much --

--- maybe between hours +3 and +6 or +6 and +9, the kitty is dropping down to 30 and rebounding to high numbers.

A longer-lasting insulin like Lantus or Levemir would help that curve (flatter - not jumping from 400 to 120 and back like a roller coaster ride)

 

Hi Michelle and Kira,

Michelle, I'd like to applaud you for all your hard work! Great job...keep it up. It just shows how much you love your baby.

Kira, maybe you can help Michelle enter all the info on one of the spreadsheets we use around here. I think it would be a lot easier for everyone to read, and also to help with dosing. Your sheet looks great, and Max's numbers look absolutely fabulous!

Good luck everybody!

 

I would think that the dry food may be causing the #s to be so high when the insulin is wearing off. My guess would be that once you can switch to canned food, you will see a lot of improvement. It's actually pretty astounding to me that you are getting a good nadir on 1u on dry food, so I think that is a pretty good sign overall. Just guessing, but I'm thinking her pancreas may be doing a good bit of work, and LC will really help a lot. When Bix was on dry food his swings were big like that too (though with him it took 4u to see a good nadir), it's just fighting a losing battle with the carbs. Once he got on LC canned, he got good duration and reasonably flat curves on PZI. Of course ECID, just sharing what I see from my cat's experiences.

I remember the post too from Kira. I am in the camp of go ahead and start switching foods now, let Prudence stay at home with the DH (dear hubby), and just skip the insulin for that week, having DH check for ketones daily. If he sees any sign of ketones, or she isn't eating well, or her behavior/how she seems to feel worsens, then he could always take her to be boarded at the vet at that point. Just my 2c, and of course I understand that might not work with your circumstances.

If you do end up boarding her, I would put in writing what you want. They will test PSs if you pay them to I bet!!!! Boarding can elevate her stress as well as affecting her eating patterns, so I would be sure to speak personally with the vet who will be in charge about exactly what they will do, what level of care (will they monitor how much she is eating and adjust the insulin if needed? will they check for nadirs at least some days, or run a curve one day to be sure she isn't going low? etc.)

On the dose, one way to see if it might be rebound adding to the high #s is to try maybe 0.75u and see if that steadies things out. The nadirs may be a bit higher, but if you start seeing flatter curves with lower PSs, that might be an acceptable compromise until you are able to lower the carb intake.

Hope your trip goes well! Keep us posted on things, and as others said, feel free to join us over in PZI Land, and if the DH can be enticed to visit, we are happy to help him out while you are gone if he has questions.

 

Wow! Thanks for the replies & big thanks to Kira!!!!

I am going to keep up with the BG curve since her 9am was 534. I took it again at 1:30, it's at 233, so I will take again both at 6 and 7 hours into the curve and make sure it goes to it's low and back up. I will then take BG at 9pm so I have an idea again.. vs. the 534 number. gonna skip the 6pm test cause I feel bad for my baby confused_cat

I am feeding Fancy Feast as of Sunday night. She normally eats Science Diet Hairball dry... but I've switched to wet since I need to make sure she eats before her shot. I can not leave her with my DH, but I will tell the Vet what to do. I am thankful that I know him well I've had one weird thing happen since all of this - yesterday at 3pm I noticed that her fur seemed damp. Can kitties sweat? She's fine today, but it was kind of weird.

 

Seriously? Wow. Wouldn't you think getting off dry food and onto low carb wet food [and letting the carb toxicity wear off] and figuring out if the cat has any other issues going on would be the first step before starting in on the L&L proselytizing?

 

[/quote]

On ProZinc, low point will be +6 after the shot, no matter when you start the curve [/quote]

OK. :? +6 today was at 3pm BG at 211. I just took it again at 4pm and its at 205. I sure hope its not still dropping? I will take again at 5pm nailbite_smile

 

Just some clarification notes:

- Looks like you have already switched to LC canned, awesome!!! That could explain the good nadirs. It can take a couple days for the dry effect to really clear their systems, so you may see more improvement over the next few days, or this could be where she lands, it's hard to really say (since it's already been a couple days now that she if off the dry, that is if she is 100% off vs. in the midst of a gradual transition).

- The low point on ProZinc is by no means guaranteed to be at +6. For Idexx PZI the bracket is somewhere around +5.5 to +8 I think for the nadir, and every cat will nadir a little differently. I think the jury is still out on ProZinc, and we've seen some cats who seem to get an early nadir, although that could be from the dose being too high. For testing, I wouldn't worry about it too much, just try to get something in that mid-zone to give you a ballpark. At some point, maybe after your trip, you can try to isolate the nadir by testing a couple subsequent times in the same cycle, like maybe +5 and +6 one day, +5.5 and +6.5 another day, etc., to try to pinpoint it. Honestly, I never figured out for sure where my cat's nadir was . I had plenty of spot tests along the way though to have a decent idea that his +6 or +6.5 were usually lower than the #s on either side, so that was close enough for me to feel comfortable with.

- For curves, it is really up to you what you do. Most people that I have seen rarely do a full curve, but instead do maybe one or two spot checks a day, or every few days. It really depends on people's schedule (many can only do much testing on the weekend, for example), and the cat (some balk after a few tests, so full curves are out of the question). There is also a mini-curve you can do that is every 3 hours rather than every 2. But really, it is up to you what data you want to collect. It's all good info!!!

- When you are noting the times, it will be easier for people to follow if instead of the actual time (9 a.m. or whatnot), you use AMPS or PMPS for the pre-shot test, and the +n for spot tests after that. I think I'm repeating what someone else said, sorry. :smile: My brain is too fried (or something, maybe it's the rain!) :roll: to get my mind around connecting all the dots on the times. "n" is then the # of hours after the last shot, so you can say for example at +3 I got a reading of 250 and I plan to check again today at +6. (but do include the actual time & time zone if you want to post & get feedback then, so people will know what time to be on the lookout for your post!)

Sorry to sound fussy, just wanted to clear up a couple points that seemed confusing to me! You are doing an awesome job getting good data, and making the food change so fast, great work!

 

p.s. that is fine if it is still dropping! it could be that she nadirs later than some other cats, and it's also a good sign that you are getting good duration (and so far no appearance of rebound this cycle). Sometimes they even drop pretty late in the cycle on PZI - at times it is a sign the dose is too high (like if they drop down at +10 or later), but not always.

Just keep posting your info and we can help you try to decipher the data. It's fine to test at the next hour, but personally I would probably skip it if you think she could use a break from testing. You are no where close to low #s that would be a safety concern, and you can test something like a +7 & +8 on another day to see which is lower. That's only a slight difference between the +6 & +7, so that suggests to me she is probably in the nadir zone.

With Bix for instance, his rate of drop was fastest between +3 and +5, then it would ease off some, then flattish for an hour or two in the middle, and then start climbing. 211 & 205 are statistically about the same #, so looks like a nice ride for now! Certainly get any more tests in that you want to, I just wanted to be sure you know that you don't *need* to at this point.

 

Thank you so much for all the advice and help. My goal right now is to have an idea where she's at since I am going away in two day. I know she will be somewhat stressed at the Vet while I'm away, so again.. for peace of mind and her sake... wanted to do that curve. I know it can get dangerous when switching the diet, so I will have to give 100% on that when I get home next Tuesday. I was just wanting to see if she was in a safe zone before I board her on Thursday... which kills me that I have to do that to her, but she's a trooper cat(2)_steam

I will have to do the spreadsheet when I return. I am so thankful that there are folks on this board that will take the time to help. Thank you xoxoxox

 

did you mention that you are only feeding twice a day, before shots. at this phase in her diabetes she may be hungry just becuase of the diabetes but for other reasons if you could feed at least 3 times i think it would help. perhaps amps, pmps and bed time meal. that helps her pancrease to stay producing as well as keeping her tummy happy.

 

I second what Lori just said. Free feeding [or the closest possible approximate] is the best with PZI [ProZinc]. Unless one is using a short acting insulin than PZI, cats should eat 10-20 smaller meals during the course of every day [24h]. I add a little water to the wet food and this keeps it from drying out and getting the crusties.

 

yes, i did put the dry food down again... just enough in case she's hungry.

thank you all again for your support! Thanks too Gator for the info about PZI o

 

I have not made my spreadsheet yet, but looking at how you layed it out for me here.... I think I did this right?

Feb 22 BG Curve 9am – 9pm
amps 296 1u
+3 249
+6 126
+9 317
pmps 427 1u

Feb 22 – 23 BG Curve 9pm – 9am

pmps 427 1u
+3 330
+6 132
+9 364
amps 534 1u

Feb 23 BG Curve 9am – 9pm

amps 534 1u
+4 233
+6 211
+7 205
+8 204
pmps 292 1u

Prudence pmps was really taken at +11, but I didn't have the heart to stick her one one time. confused_cat It probably went up a little more than 292. I did switch from Friskies wet food to the Fancy Feast yesterday, so maybe the change in the type of food messed her numbers up? I hate that I have to go away, but I will be ready to get this under control when I get back.

Love & light to all :YMHUG:

 

No worries - her #s look really good and it sounds like she will be in good hands while you are gone! Enjoy your trip! You are really doing an awesome job being so proactive and staying on top of things! She is a lucky kitty to have you looking out for her.

 

Hi, Prudence didn't do to well at the Vet while I was away. I do want to completely switch her over to canned food by morning. My question - I know she was very hungry last week when I had her on canned food only for a few days. Her numbers were kind of all over the place, so I was wondering if it's safe to feed her 3 times a day? My goal is to get her off of insulin, but I am still learning all of this. Kira was successful with Max and she's given me some guidelines to go by. One question I keep asking myself... is it around 6 hours after her shot I need to make sure she doesn't go Hypoglycemic? I am trying to figure out if she's on 1unit of PZI twice a day. How will I know if she's getting too much insulin? If her numbers start getting into the 100 -200 AMPS/PMPS is that when I stop giving insulin? I will amps in the morning and start her spreadsheet again. I will test at +5 & +6 to get her low point and of course pmps. I am guessing that I won't see much of a change until Sunday and Monday. I took away the free feed dry food and will only give canned food.

 

It is definitely OK to feed her 3 times a day, if not more....Just make sure it's lo-carb canned. NO MORE DRY! :razz:

When Tida was first diagnosed and not regulated, I free fed her all the LC canned she wanted. From my experience, cats will usually stop when they get full.

If you are not going to be home, you could put extra out. Some people have had success with timed feeders also.

 

Free feeding [or the closest approximate possible] is best with PZI. Cats should eat 10-20 times throughout the day [24h]. I add a little water to H's food do it does not dry out and get the crusties. Folks who have overweight cats depend a lot on timed feeders. If the cat was hungry on canned food maybe Prudence did not like the flavor you had selected? There are many choices in J&B's tables. If your goal is to get her off insulin the the best thing yo can do at this point is to get rid of the dry and move to low carb [less than 9% as %Kcal] wet food ONLY. PZI tends to peak at around +5 - +7 so you should be testing to first learn when that low point or "nadir" of the curve happens most. Sometimes if I'm worried I'll test and hour or two before I expect the nadir just to see how things are going so I could potentially head off any trouble before it happens. The beginner "no shoot" PS is usually 200 or even 150. Once you get more experience and more data then you can and will probably want to lower that "no shoot" level.

You may want to start a new topic over in the PZI Insulin Support Group.

 

I will start a new topic as suggested. First I'd like to ask if anyone can view Prudence's spread sheet. I just took her +6 number and it was at 68. I am feeding canned Friskies low carb. I just gave her some more to eat.

 

The best place to get attention for folks to check your SS is in the PZI ISG...

 

Thank you! I did post over there.