Pls help interpret this curve

Hi everyone, the sheet finally in my signature. I know there are holes in the tests, but he is really difficult to test. I'm slowly getting the hang of it, and quite happy I got as many as I did yesterday. The vet wants to see this curve tomorrow to check dosage. I couldn't believe he went as low as he did, but absolutley no symptoms of hypo, eating happily and just being Max. I tested at +3 again today and he was at 17.6 (316)??? Did I give him a fur shot??? I don't think so, but maybe I did? Couldn't get an AMPS number. Now, I'm really confused? I'm not at home during the day when he peaks, and I can't afford to let him go so low when no one is around. Pls help, do I reduce the AM dose, he is on 1.5 BID. The low numbers really scare me?

I'm getting him off kibble slowly. He is eating only low carb FF from his morning feed right through, but he gets about ten pieces of kibble before we go to bed (that's what I'm trying to reduce every night, he used to get a bowl of kibble before bed)

I'm no dosing expert here and I don't claim to be a SS expert either, but I'm guessing what happened is supermax went into the lower number range yesterday and this is simply rebound, when a cat isn't used to going down into the lower normal number range and they tend to over panic and numbers go back up.

I hope someone can come and clarify this for you better then what I just typed out!

Hi. I'm new to Lantus b/c they're not making Sammy's insulin anymore but he was dx in January 2006 and has been tightly regulated since then to keep his numbers under 150. Back then when I found out about all this lc/hc stuff Sammy and two civvies went "cold turkey," so to speak, and on to lc (no wheat glutin) FF and everybody survived. I didn't even hear complaints. The people who can help you manage better will be along soon but they're going to tell you that you need more data and that Max probably had a rebound from the low numbers.

Max's Yesterday Condo

Generally we don't worry about hypo until they get into the low 30's-20's. However Max did have a very big drop from 317 to 59 within 3 hours. My first inclination is to say that perhaps the 1.5U dose is too much. Most start off at a 0.5U-1U dose. But do not make any changes based on what I just said. Let's see if we can get some more experienced people to take a look.

How did you come to start Max at 1.5U Lantus bid?

The numbers that you are seein on the SS are rebounds BG's from the low green numbers that Max got yesterday. When their bodies are not used to seeing lower BG's the liver can react by releasing stress hormones that will bring the BG up again. This is normal and takes time for the kitties to get used to the lower numbers and not react immediately. Generally rebound can take up to 72 hours to clear. Some cats can clear faster. I would strongly recommend that you get some spot checks in today to see if he drops again into the blue or green range. The more you can fill in the spreadsheet the better. Data is always good when trying to decide how Max reacts to the insulin dose, when he may need an increase or decrease. We recommend that when possible, try to get a couple of spot checks during the days and evening.


Congratulations on your first curve! You have come a long way in such a short period of time!!!


ETA - I see now that you are not able to get spot checks during the day. I am going to talk with some others and see if we can help you with some of your questions.

What do we call you other than Max's mom (or dad)?

First, I would suggest you read this information on how to do a curve. A curve involves BG readings every 2 or 3 hours. It will give you a baseline for how Max's numbers typically go and when his nadir/peak falls. Understand that this will not be the same every day. Any number of factors can influence how the curve looks on any given day. An ideal day's worth of BG tests should look like the following:

+0 - PreShot number.
+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).
+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.

All of this information, including the links, are in the New to Lantus/Levemir sticky above.

Paige is generally correct with respect to starting dose. The dosing protocol that we use stipulates that the initial dose of Lantus can be based on weight - 0.25IU per kg of your cat's ideal weight. This generally works out to somewhere in the 1.0 - 1.5u range. I would be more concerned about Max's dose if you were seeing big swings in his numbers. At this point, there's not a great deal of test data to really interpret his curve or conclude that his dose is too high.

I'm wondering what kind of meter you're using. Some meters require considerably more blood than others. It's recommended that you use a meter that requires no more than 0.6uL of blood. You may also need to use a lancet that's a bigger gauge. The thinner the lancet (higher gauge # is thinner), the smaller the poke and until you've poked a lot, Max's ears may not bleed easily. You probably want a 28 or 29 gauge lancet.

You do need to collect more information. If you cannot get anything other than an AMPS test in during the day on workdays, it's imperative that you test at night. Further, if you don't test in the evening, you are losing half of your data. Max can go low just as easily during the night as during the day and many cats do tend to have lower numbers in the evening. If you can get an out the door test and an in the house test in the AM cycle, that would be helpful, as well.

The numbers in the 50s and 60s are not dangerous in the least. Also, unless a cat is symptomatic, even numbers in the 20s or 30s are not a hypo. Please read the link about having a hypo kit -- you need to have high carb food, not dry, at home to manage numbers. This is the FF flavors that have gravy. The stuff works wonders at raising numbers!

One way to offset lower numbers when you aren't home is to leave food out or to get a timed feeder that will provide food every couple of hours. Most of us work or are in school and these two methods work admirably.

You can take a fistful of rice and sacrifice one of your socks. Tie it off and stick it in a microwave for a few seconds (seconds not minutes when it burns it's an awful stink) and when it's warm hold it against Max' ear to get the blood closer to the surface.

Hi everyone, thanks for your replies. The data is sparse not through lack of trying. I was committed to doing the curve every 2 hours, but couldn't get a reading in some of them. His ears bruise a lot. I will try to fill the SS more, he was not a happy cat yesterday with all the ear pricks.
I am using the sock, and I think that it's definatley helping, I have gotten almost all the readings I attempted, now of course, I get the blood, but have a wriggly cat that smears the blood on everything but the meter.. (which is a One Touch Ultra2)...getting there one day at a time.
I sacrificed a pink sock, hubby says that if I was using a pink sock on him, he would also take offence
Max was started on 1 unit BID, they did his first mini curve at the vet and mid numbers were in the pink range, hence dose went up to 1.5. He has been at 1.5 for about 3 weeks now. I finally convinced vet that I won't take him in every second week to curve and I would do it myself. Max HATES the vet and he was just being stressed out.
Got a blue number +3 this PM, will keep you posted.

One the face of the data I have (which I understand is little) if vet tmr says I must lower the dose...should I? or should I stick it out? Help...

Sandra

Ah, the old pink phobia. I am familiar with it.

Are you applying mild pressure to the ear (squeezing it between yr fingers) after you get the blood and counting to 20 or 30? I don't think it matters if you slurp the blood up off the wall if necessary as long as it's Max' and not yours. The pressure keeps the bruising down. Somebody also suggested to me the other day (I'm in the middle of a practically every hour curve and even Sammy, who's a GREAT patient, is sick to death of it) that I try Neosporin with Pain Relief. Neosporin is one of those over-the-counter antibiotic ointments used mostly on kids, animals and clumsy husbands. I didn't even know there was a pain relief one. I have yet to get out of the house long enough to get it what with doing Sammy's curves. I'll let you know if I ever get out of here how it works. I have only used the One Touch Ultra (zero I guess not 2) but they changed the strips the last delivery. They now require less blood. Even I have to adjust to it. I HATED the lancets that I guess came with it. I use Accu-Chek Multiclix now and it's sooo much better. Personally I think you're doing nobly. You should be very proud of yourself. I too have doubts about his dose but there are experts in dosing on this board and they will help you out. They are sure helping me out. It all depends on the data.

Yup, I do apply pressure, but maybe I'm not doing it for long enough. I can't get neosporin here over the counter. I'm actually going to ask my pharmacist this afternoon if there is a topical aneasthetic that I can use.
My strips are one touch ultra, so I think we are using the same strips. I go and have a look at the Accu check lancets. I suppose I also don't know any better only have used the lancets that came with the meter.

So this morning he was sky high. Husband mistakenly gave him an octopus snack before testing, that I have been forgetting to throw away. I got it from an Asian store, whilst trying to find stuff that I could use for treats. I would have thought it was all protein. Also he is still having about 8 little pieces of kibble at night, they don't seem to have affected him , but maybe that just threw him over the edge last night....of course today I'm back at work so can't do a thing!

I'd drop the kibble. It's just gratuitous at this point and might be making a difference. This has turned into a shrimp-addicted household over here. And Sammy loves turkey (nothing processed only real off-the-bone white meat). I'm beginning to suspect that real beef sends him up but not buffalo tartar. The plastic MultiClix whatever you call it that you stick the lancets in is much more durable than the other one and more practical for a little tiger like yours.

I actually freehand the lancet as the pen was causing him to jump with the noise, even with the clear top, it was hard for me to see where it would prick. Hope his numbers are not sky high again on the PM shot. My poor cat, he really is quiet miserable about all the testing, there is very little super about supermax right now ...

Hi Sandra
I am glad to see that you made it over the the LL board.
Too make things easier, you should open a new condo for Max today,
5/3 Max AMPS #

You can link this condo to it as well as the one you had the other day.
We need to keep one condo per day for our kitties so it makes it much easier to
follow him.
You copy and past yesterday's links into your first post of the day.

When I would test my Max I gave him a lttle bowl of his treat while I was testing him.
He was so busy eating his treat, the noise or test never bothered him. It's worth a try.
Keep at it, it will work out.