Smiffy's mini curve

[Looby & Smiffy]

Hello!

I am in the UK ..... I usually post on the main forum so I don't know any of you here but I would like one or some of you to look at Smiffy's first mini curve on Caninsulin on her spreadsheet please ..

She was diagnosed nearly three months ago .... she was initiallly on 2 units twice a day but she had two hypos which her Vet questioned and asked me to video the next one so we sacked him!

He wanted Smiffy who is 15 and nearly 6 kilos to lose weight so he put her on a slimming diet but with the Hill's prescription m/d low carb dry food for Diabetics (Smiffy won't eat wet food - still trying to get her to like it so please don't make this post about her diet!) but only allowed her two meals a day with her shot.

After her two hypo epidsodes I decided to reduce her dose to one unit twice a day and to let her have snacks of her biscuits throughout the day as well as her main meals againt the Vet's advice. He also mentioned PTS twice so that was another reasong to sack him politely!

Her new Vet Roberta agrees with me and after over a month now on one unit twice a day and the ability to graze when she is at her lowest BG of the day and night, she is back to her normal self and doing really well ....

However, her last Frucstosamine on one unit was 436 as opposed to 405 on 2 units.

I have from the start had difficutly treating Smiffy as she is a bit of a tinker and doesn't like to be touched that much ... she is adorable and loving just now touchy feely so I have only recently been abe to home test her.

I did a mini curve for the first time this weekend just gone and I was a bit surprised by the results and wondered if any of you could tell me what you think .... she doesn't appear to have a very low Nadir at about +3 or +4 as one would expect and her pre-shot number is not that high either ........ I know all of her readings could be lower in general but here I am wondering why she is pretty level throughout the day .... I was told she would dive at +3 as Caninsulin is fast working and then start to rise again after about +8 as the insulin wore off.

Maybe she is one of those cats for whom the Caninsulin lasts a bit longer ...what do you think?

She is very well - no keytones but a little glucose in her urine the last time I tested and no neuropathy .. she is bright, talking and playing and coming for walks just like she used to .... she was very poorly when she was diagnosed and had diarrhea .....

Look forward to hearing from you about her mini curve - the best I can do for the time being .....

Looby&Smiffy UK Smiffy is 15 diagnosed April 2016, on one unit Caninsulin twice daily, Hills m/d prescription dry food left to graze for 7 hours after each shot ...she WON'T eat wet food, still getting used to testing, negative keytones, coat in good condition and no neuropathy, lastest fructosamine 436. Possibly change to Glargine at later date. url = https://docs.google.com/spreadsheets/d/1csTpTNFFv2OjLvyCwr2WTlmBsH4cNctPfH-I9WnXmfk/edit?usp=sharing Smiffy's spreadsheet

 

[BJM]

To me, it looks as if the insulin dose could be raised slightly. To do this, you need one of the following:
1) Syringes with 0.5 unit markings, or
2) Some sort of ruler to use as a guide for pulling up the same dose each time (a short firm ruler with millimeter markings can work), or
3) callipers, or
4) A conversion chart to use with U-100 syringes ( an advantage in. using these is the ability to shoot in 0.2 unit increments)

I would increase by 0.2 units if you can use U-100 syringes and by 0.25 units for any of the other options. (You'll be eyeballing it somewhat, so the key is to be as consistent as you can.)

 

[Looby & Smiffy]

To me, it looks as if the insulin dose could be raised slightly. To do this, you need one of the following:
1) Syringes with 0.5 unit markings, or
2) Some sort of ruler to use as a guide for pulling up the same dose each time (a short firm ruler with millimeter markings can work), or
3) callipers, or
4) A conversion chart to use with U-100 syringes ( an advantage in. using these is the ability to shoot in 0.2 unit increments)

I would increase by 0.2 units if you can use U-100 syringes and by 0.25 units for any of the other options. (You'll be eyeballing it somewhat, so the key is to be as consistent as you can.)

I don't use syringes - don't know how to and Caninsulin doesn't come in philes but a cartridge for her Caninsulin pen that only has increments of 0.5 which might be too much I know ...

I was wondering why her numbers are so more or less level throughout the day? I was expecting her to be higher pre-shot and lower at her Nadir ... Caninsulin is supposed to 'hit hard' and then wear off at about +8 so maybe it lasts the full 12 hours in Smiffy?

 

[BJM]

If you have aan empty cartridge, you can check if it is possible to remove the top and use an insulin syringe to pull out the insulin.
Do you have to have a prescription to get diabetes syringes?

 

[Looby & Smiffy]

If you have aan empty cartridge, you can check if it is possible to remove the top and use an insulin syringe to pull out the insulin.
Do you have to have a prescription to get diabetes syringes?

No prescription for syringes and they would not be covered on the insurance nor would any further treatment if we took things into our own hands to that extent ..... it would have to be with the Vet's collaboration .... plus if I were to start self dosing I would have to be able to guarantee that I could home test preshot numbers every day and I can't guarantee that every day ....... I'm pretty sure the Caninsulin cartridges are designed just for the pen ....

What I was wondering was why Smiffy's numbers are so more or less level each day as I say ... Taking into consideration what I have been told about Caninsulin one would expect more of a difference between preshot numbers and Nadir, and say +8 numbers and preshot ....

 

[Looby & Smiffy]

@BJM just checked and Caninsulin syringes even if I could get a script for them give only the same increments as the pen ie ie units and we would have to pay for them ourselves anyway and then probably the philes too whereas we get the cartridges on insurance and hopefully the expensive needles too at the moment .....

It's possible the Vet will recommend a dose increase of 1/2 unit .... Will have to wait to hear from hear having sent her the numbers ... Or I will call tomorrow ...

My query is on the curve itself and what is happening to Smiffy .... Was hoping somebody here who is familiar with Caninsulin (like yourself?) might recognise or be able to explain the strange trend of Smiffy's curve knowing how Caninsulin is supposed to act ...

 

[BJM]

What you need to get are U-100 syringes with half unit tick marks which you would use with a conversion chart.

U-100 syringes have 100 units marked per milliliter
U-40 syringes have 40 units marked per milliliter

It works out to every U-100 syringe 0.5 unit tick mark equals 0.2 units of a U-40 insulin (it is only 40% of the concentration).

 

[Looby & Smiffy]

What you need to get are U-100 syringes with half unit tick marks which you would use with a conversion chart.

U-100 syringes have 100 units marked per milliliter
U-40 syringes have 40 units marked per milliliter

It works out to every U-100 syringe 0.5 unit tick mark equals 0.2 units of a U-40 insulin (it is only 40% of the concentration).

We missed each other then! Please read the above posts from me ..... syringes not an option nor the query for us ... query is about the nature of the curve ......

 

[Alexi]

Hi @Looby & Smiify well done for getting those numbers. I agree her dose could go up but I understand the limitations of the pen. Smiffy is free feeding which might explain why the curve is flatter, so she is topping herself up through the day. The numbers are nicely in the yellow range. If you do increase her dose then you have to be prepared to do a full curve and to monitor her closely to make sure you are not overdosing. This means on a single day doing APMS and hourly readings in the middle of the curve and a PMPS. Do you think you could manage this? We know 2 units is too much and one not quite enough. As you are with her during the day it will be easier to monitor her. I think if your vet agrees it may be worth trying the 1.5 units but you will need to do the full curve on this dose. I did a full curve on 12/6 so if you look at Cappuccino's spreadsheet you can see how many readings are needed.

 

[Looby & Smiffy]

Hi @Looby & Smiify well done for getting those numbers. I agree her dose could go up but I understand the limitations of the pen. Smiffy is free feeding which might explain why the curve is flatter, so she is topping herself up through the day. The numbers are nicely in the yellow range. If you do increase her dose then you have to be prepared to do a full curve and to monitor her closely to make sure you are not overdosing. This means on a single day doing APMS and hourly readings in the middle of the curve and a PMPS. Do you think you could manage this? We know 2 units is too much and one not quite enough. As you are with her during the day it will be easier to monitor her. I think if your vet agrees it may be worth trying the 1.5 units but you will need to do the full curve on this dose. I did a full curve on 12/6 so if you look at Cappuccino's spreadsheet you can see how many readings are needed.

I am not around all day .... I can't guarantee that I will be able to do the readings .... I feel so inadequate ...... so what do yellow readings mean? Below the renal threshold? She is allowed to eat about for about 5 or 6 hours after her main meal but tends not to much ... she doens't have the appetite that she used to have .......

I know what you are saying ..... I am in bed for her first Nadir ... difficult to explain but that is the way I survive and then I am up late at night so can watch her at her Nadir in her second cycle ......

I will have a look at your spreadsheet .....

I still haven't heard from the Vet ...... they have alwasys told me that cats don't spike when they eat but they obviously do go up when they eat and hence her numbers levelled out right? ....

So her numbers are not bad but I need to move her onto the next stage ...... wish I COULD go up by 1/4 unit ..... she seems to know when she needs to eat ...

It is early for me 10am so I am not quite with it because of my drugs for anxiety so I will have to get back to you later .... have to think and have to get back to you and I am going to have to speak to her Vet ... as least she is well at the moment and not in danger .....

Thanks Alexi

 

[Alexi]

The easiest way of explaining the colour coding on the spreadsheet for a cat on insulin is:
Black - high
Red - high but ok depending on insulin (ok for caninsulin, but aiming for lower than this)
Purple - ok
Yellow - not bad at all
Blue - good - getting into normal range for the cat
Dark Green - in normal range but not too low
Pale green - low and risk of hypos

I am aiming for blue/dark green at nadir, not there yet as I am slowly tweaking doses to see if I can find the ideal without initiating a bounce. I am also having to deal with unexpected lower numbers, Smiffy seems to be pretty consistent so far, more so than Cappuccino. So yellow is not bad at all but blue numbers would be better. Some Lantus users seem to get into the low ranges and stay there but the variation in numbers during the day is not as big as for Caninsulin because Lantus works very differently.

The main thing is to avoid hypo numbers or bouncing and it seems to be an art form. The good thing is Smiffy is back to her normal self, and doing her normal stuff, she doesn't care what her sugars are doing, she just wants to be a cat.

 

[Looby & Smiffy]

The easiest way of explaining the colour coding on the spreadsheet for a cat on insulin is:
Black - high
Red - high but ok depending on insulin (ok for caninsulin, but aiming for lower than this)
Purple - ok
Yellow - not bad at all
Blue - good - getting into normal range for the cat
Dark Green - in normal range but not too low
Pale green - low and risk of hypos

I am aiming for blue/dark green at nadir, not there yet as I am slowly tweaking doses to see if I can find the ideal without initiating a bounce. I am also having to deal with unexpected lower numbers, Smiffy seems to be pretty consistent so far, more so than Cappuccino. So yellow is not bad at all but blue numbers would be better. Some Lantus users seem to get into the low ranges and stay there but the variation in numbers during the day is not as big as for Caninsulin because Lantus works very differently.

The main thing is to avoid hypo numbers or bouncing and it seems to be an art form. The good thing is Smiffy is back to her normal self, and doing her normal stuff, she doesn't care what her sugars are doing, she just wants to be a cat.

Thanks Alexi that is really helpful and makes me realise how well she is doing ....... will try to get some more readings today ..... still haven't heard from the Vet after my e-mail on Monday afternoon so a bit disppointed about that ......

Will let you all know if I can remember what she has to say about it all .... yelllow and well is good enough for me for the next week or so anyway until she sees Roberta again .....

Don't understand how I can use a syringe with Caninsulin from the cartridge and if I could how I would get the dose right - too risky and in any case we can't afford to do this all by ourselves and I am not sure that Smiffy and I are ready for syringes just yet ..... I think Glargine comes with a pen or can do but again only 1/2 units ... I see the advantage of a syringe but I am not so confident about using one ...

 

[Alexi]

It takes some getting used to but it's not that difficult. I am just about to start using syringes with half unit markings as I'm going to have to change doses in smaller increments now so need to find the 0.25 unit point. I think if the cartridge has a rubber stopper you can put the needle on the syringe into that to draw up, the needles are fixed to the syringes so it is easy. If you not not confident drawing up you could practice using coloured water until you hit the markings just right. The vet can show you how and also how to do the injections, if you can do it with a pen you can do it with a syringe as you are used to knowing when the needle is in the right place. With Caninsulin you need U40 syringes with a red top, the orange topped are U100 which can be used as BJM says for very small increments but you have to do the conversion.

 

[Looby & Smiffy]

It takes some getting used to but it's not that difficult. I am just about to start using syringes with half unit markings as I'm going to have to change doses in smaller increments now so need to find the 0.25 unit point. I think if the cartridge has a rubber stopper you can put the needle on the syringe into that to draw up, the needles are fixed to the syringes so it is easy. If you not not confident drawing up you could practice using coloured water until you hit the markings just right. The vet can show you how and also how to do the injections, if you can do it with a pen you can do it with a syringe as you are used to knowing when the needle is in the right place. With Caninsulin you need U40 syringes with a red top, the orange topped are U100 which can be used as BJM says for very small increments but you have to do the conversion.

To be honest it is a change too much for me at the moment ...... I have such a lot in my head as I am getting over my illness .... as you say Smiffy is in OK numbers for the next week or so until I see the Vet but I will definitely bring it up or when I speak to her hopefully soon .....

 

[Looby & Smiffy]

It takes some getting used to but it's not that difficult. I am just about to start using syringes with half unit markings as I'm going to have to change doses in smaller increments now so need to find the 0.25 unit point. I think if the cartridge has a rubber stopper you can put the needle on the syringe into that to draw up, the needles are fixed to the syringes so it is easy. If you not not confident drawing up you could practice using coloured water until you hit the markings just right. The vet can show you how and also how to do the injections, if you can do it with a pen you can do it with a syringe as you are used to knowing when the needle is in the right place. With Caninsulin you need U40 syringes with a red top, the orange topped are U100 which can be used as BJM says for very small increments but you have to do the conversion.

Have just heard from Roberta Smiffy's Vet and we decided between us that I will give her 1 1/2 units Caninsulin in the evening and 1 unit in the morning (was my idea rather than 1 1/2 twice a day ......... she said that her numbers are OK but she would like to see them between 4 and 12 throuhout the day .... she has asked me to try to get her Nadir reading most importantly to make sure she is not dropping too low so I will be about at night at 1.30 am to test her if I can ...... she said that she is not worried about the shape of the curve as long as we can get her numbers down a bit to between 4 and 12 ..... we are going to see her on the 13th for a check up .... she LOVED the spreadsheet that I can e-mail her whenever I want so that is great so thank you to @BJM for that ...... she said that if we can't get her numbers down with Caninsulin and regulated then we will be looking at starting her on Glargine which would be with a syringe but she is looking into whether we can get a pen as I think I have seen it on line and I really do like the pen to use with Smiffy but if I have to changet to syringes with Glargine then I will ... the good thing is that Smiffy is well in herself so far so we have done (I have done!) a good job so far .......

 

[Alexi]

[QUOTE=" she LOVED the spreadsheet that I can e-mail her whenever I want [/QUOTE]

If you send her the link she will be able to read it in real time.

To set sharing on the spreadsheet click file, share, add in the email address for your vet in the second box, change the 'can edit' box to 'can view' and press done. The vet will then get an email with the link from your google account.

 

[Looby & Smiffy]

[QUOTE=" she LOVED the spreadsheet that I can e-mail her whenever I want

If you send her the link she will be able to read it in real time.

To set sharing on the spreadsheet click file, share, add in the email address for your vet in the second box, change the 'can edit' box to 'can view' and press done. The vet will then get an email with the link from your google account.[/QUOTE]
I told her that would be possible but she wasn't keen but I could do it anyway .... she is one of the more busy Vets there but thanks for the instructions as I want my husband to have the link ......

 

[BJM]

Or just copy and send the link in your signature.

 

[Looby & Smiffy]

Or just copy and send the link in your signature.

Thanks but the Vet didn't want me to give it to her live but it is easy for me to just send her the link in an e-mail ...... it ended up as an attachment for some reason but that is fine - she could see it that is the main thing ..... I will send it to her before every trip we make to see her and whenever there is something to report ..... I mentioned to somebody on Facebook that you had helped me with the spreadsheet as she was completely at a loss like me .... should have asked you first sorry about that .. she may or may not contact you here ...

Smiffy is really well today - so bright it is lovely to see ...... she wouldn't eat at her supper time last night so I couldn't give her the 1 1/2 units (rise of 1/2 unit just for the evening dose) and aad to resort to just one unit an hour or so after her supper time once she had eaten something ....... better luck tonight .......

Are your cats in remission? Gracie and Sptizer?

 

[BJM]

The link in your signature should be the read-only link for sharing, not the one you need to edit and add data.

Also, I commented on your other post about the curve. indicating thhat an increase would be good if youcoul make it a small one, but your pen won't let you do that, hence the explanation about the U-100 syringes.

I can think of 2 ways to match the glucose to her levels better.
The first is to slightlyy increase the carb level so you can shoot the 2 units again.
The second is more complicated, so I won't post it for now. It takes a lot more testing and the timing has to be very consistent.

(GA) means Guardian Angel or Gone Ahead and indicates the animal is deceased. Spitzer had a saddle thrombus, a blood clot to his hind legs. These are excrutiatingly painful. Recovery is uncertain, and the cat is likely to have another clot within the next year.He had numerous other problems - IBD, pancreatitiis, exocrine pancreatic insufficiency - and I made the decision to have him euthanized because he was in agony. Gracie passed away after several days at the vet for not eating. we never discovered why.

 

[Looby & Smiffy]

The link in your signature should be the read-only link for sharing, not the one you need to edit and add data.

Also, I commented on your other post about the curve. indicating thhat an increase would be good if youcoul make it a small one, but your pen won't let you do that, hence the explanation about the U-100 syringes.

I can think of 2 ways to match the glucose to her levels better.
The first is to slightlyy increase the carb level so you can shoot the 2 units again.
The second is more complicated, so I won't post it for now. It takes a lot more testing and the timing has to be very consistent.

(GA) means Guardian Angel or Gone Ahead and indicates the animal is deceased. Spitzer had a saddle thrombus, a blood clot to his hind legs. These are excrutiatingly painful. Recovery is uncertain, and the cat is likely to have another clot within the next year.He had numerous other problems - IBD, pancreatitiis, exocrine pancreatic insufficiency - and I made the decision to have him euthanized because he was in agony. Gracie passed away after several days at the vet for not eating. we never discovered why.

Oh I'm so sorry to hear about your two puss cats ....

I spoke to Roberta our Vet and we agreed to up Smiffy's dose to 1 1/2 units at night and leave her morning dose at one unit and she how she goes ......she says she wants to get Smiffy's numbers to between 4 and 12 and is not bothered about the shape of the curve if Smiffy is well in herself ......If that doesn't make a difference then we will go up to 1 1/2 units twice a day and if that doesn't make a difference then think about Glargine .......

She wants me to at least get her evening Nadir number and I am continuing to try to get preshot readings and any others that I can .... Roberta loved the spreadsheet and it's great that I can send it to her whenever I like and especially before trips to see her ...

I will take one step at a time .....and if Smiffy needs me to use syringes I will be right back here for advice but so far Caninsulin seems to suit her well so let's hope we can make it work for her

She is licking some wet food at lunchtime now ..... Just licking the jelly off but it's available to her each day to try so just a mixture of the two would be great but I'm not going to starve her into swapping to wet food .....I can't promise to preshot test her each day as she is such a tinker with her eating habits and as you know she needs to have some food on board before I inject Caninsulin unlike other insulins

She has been her lovely old self recently