First time curve questions

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Jenna & Kitsu (GA)

Jenna & Kitsu (GA)

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Hello everyone, I hope you are all doing well!

Tomorrow is Kitsu’s big day – my first time doing a curve. I just have a couple of questions:

1. Do I need to change the way I feed her for the day? She is a grazer and likes to eat frequently throughout the day, not big meals. I figure I shouldn’t change it just for a curve, but thought I would check in to see what other people do, and to make sure it isn’t going to throw the data off in any way.

2. Since it’s her first curve, is it recommended that I do her BG tests every 1.5 hours, or every 2 hours? I’d rather do every 2 hours to minimize her stress levels, but I can do every 1.5 hours if that gives more accurate results.

Thank you for your time! I’ll post my data here when I get everything finished up tomorrow.
 
Thank you, Janet!

Question for anyone: I just tested Kitsu for her PMPS and she came back at 93, which is unusual for her. She did have some low PMPS numbers earlier this week, in which case I just didn't shoot at all and waited for her AM test. Since I'm doing the curve tomorrow after her AMPS, should I shoot tonight or just wait until the AMPS test first?
 
Jenna & Kitsu said:
Question for anyone: I just tested Kitsu for her PMPS and she came back at 93, which is unusual for her. She did have some low PMPS numbers earlier this week, in which case I just didn't shoot at all and waited for her AM test. Since I'm doing the curve tomorrow after her AMPS, should I shoot tonight or just wait until the AMPS test first?
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Hi Jenna,
What is the current situation? Did you give the shot?
Will read your other posts...

Eliz
 
Jenna & Kitsu said:
Since it’s her first curve, is it recommended that I do her BG tests every 1.5 hours, or every 2 hours? I’d rather do every 2 hours to minimize her stress levels, but I can do every 1.5 hours if that gives more accurate results.
Click to expand...
With Vetsulin it can be helpful to test more frequently during the first half of the cycle, and then relax a bit....

In some cats Vetsulin can start working quite early on (within an hour) and can drop the blood glucose quite fast, so testing more frequently in the first hours of the cycle can give a lot of important information about how the insulin is working in your cat.
So, I'd suggest testing after maybe 1.5 hours after the shot, and then hourly until the blood glucose starts to rise (if Kitsu will let you....). After that 2 - 3 hourly is fine. It's more important to know how it's dropping than how it's rising.

I'm sorry if I've posted this too late. We're all in different time zones and it can get a bit confusing.... :confused:

Eliz
 
Elizabeth, thanks for the information! It is a little too late for this time, unfortunately, but still good to know for future reference. Time zones are definitely fun to work around, haha.

So last night, I skipped the shot completely. I didn't test her again before bed. This morning, I tested her at 7:50am and got a 328. I gave her some wet food (Iams Winner Winner with Chicken Dinner) and when she finished eating a little bit of it and walked away, I gave her 1.5 unit shot at 8:00am. I tested her again at 10:00am and got a 336, slightly higher 2 hours into the cycle, which seems strange, but it may have been from her stress (the AMPS test took a little more ear poking than usual). She didn't eat much between 8:00am - 12:00pm, but that's nothing new, since she usually only digs into her wet food when I'm sleeping/out of the house since she knows she can't beg me when I'm not there. I did her next test at 12:00pm and she came back at 153, so that was 4 hours into the cycle. I gave her a teaspoon of YAZ Mature dry food after that, just so she would eat something. Doing my next test at 2:00pm, will update this thread with the data once I'm done with the curve. I can also do the test at 1:30pm if that would be more beneficial? Trying not to overwhelm her right now, but if it needs to be done, I can do it.
 
I guess I also kind of feel like doing a curve isn't as beneficial as it could be, because I haven't totally solved her eating situation. I'm still switching her food around because she quickly tires of anything wet that I give her (but she'll stay on dry just fine, of course). I've been doing the Iams Winner Winner for the last few weeks, but I can tell she's losing interest in it. Different foods do different things to BG levels, so I feel like until I get her on a canned food that she truly likes, my curve isn't going to give very useful information. Oh, the things we put up with for these picky cats... haha.

Anyway, I'm going to continue doing the curve today, I just feel hopeless with getting her regulated, I guess. I want to switch to YAZ Mature completely, as in stop giving her wet food, because she just doesn't care for it... but I know dry-only diets can cause urination tract issues and dehydration, so it's just really frustrating. And what's more frustrating is that I can't find a wet food that she'll consistently eat, so a curve is going to show weird data with her diet being all over the place.
 
2:00pm test shows 92 BG. Still won't touch that wet food, so I gave her a tablespoon of YAZ Mature, which she ate most of (left some behind, which is good, since it's so dense). I'll swap her old wet food with a fresh can at 5:15pm, since that's normally when I would do it on a regular day when I come home from work.
 
Jenna, I absolutely feel your pain. My buddy Lou ate the same dry food for years before his diabetes diagnosis. I switch him over to wet food and he suddenly becomes a picky Penny. I stopped worrying about the differing carb content of the food, because I have to have a ridiculous number of food flavors and types to keep him interested. He gets a different flavor each time. It's annoying, but as long as he's below the 10% carb mark (I try to stay under 6%), I don't worry too much about it. He loves his wet food, but he apparently also loves his variety.

So really, curves (full or mini) can help shed light on the situation as it is now, so don't give up on them. The biggest issue with diabetes is things can change, and we do curves to see how our kitties react to a certain dose. The 92 is a great sign!
 
Amanda, I wish variety would work with Kitsu, but it just doesn't... more often than not, she will either refuse a wet food completely, or eat it for 1-3 days and never touch it again. I've tried switching flavors, brands, consistencies, adding toppers, all kinds of stuff. I actually posted a whole thread about this issue, venting my frustrations about it, haha. So far, that Iams food seems to be the true Winner Winner, as the name suggests, but I need another wet food to switch her to that she will like as well. Until then, I have to keep giving her YAZ Mature, because this cat will literally starve herself if I leave only wet out. Picky girl! But yeah, thank you for the encouragement, I'll keep trying.

Alright, so here's the results of the curve today!

May 12, 2018
7:50am - 328 (last insulin dose [1.5 unit] was given at 7:50am on May 11, no PM shot because she was only at 93 at 7:50pm)
8:00am - 1.5 unit dose of insulin administered
10:00am - 336
12:00pm - 153
2:00pm - 92
4:00pm - 111
6:00pm - 149
8:00pm - 281
 
Jenna & Kitsu said:
Alright, so here's the results of the curve today!
Click to expand...
Jenna, nice work! And also a very nice curve.... :cat:
This may give important clues about when the insulin starts to work, how fast the BG drops, what the nadir (lowest number) is at the peak of the cycle, and how long the insulin lasts in Kitsu's system.
(Be aware that curves are, however, 'a snapshot' of a particular day; and curves will differ somewhat from day to day, sometimes only very little, sometimes a lot, depending on the kitty, the dose, and diet, for example.)

If I may I'll just write those numbers out in FDMB-speak, where we refer to the am preshot as 'AMPS', the pm preshot as 'PMPS'; and all tests in between in terms of how many hours after the shot. It's a 'universal' format that means nobody gets confused by times and time zones.

May 12, 2018
(no PM shot night before because she was only at 93)

AMPS - 328 - 1.5 units Vetsulin
+2 336
+4 153
+6 92
+8 111
+10 149
PMPS - 281

That is a really nice response to that dose of Vetsulin at that preshot number.
The drop was fastest between +2 and +4. Then it slowed down toward the peak of the cycle which looks to have happened (on this occasion) at around +6. That 92 is a nice number to see at around the peak of the cycle with Vetsulin.
Then Kitsu's BG seemed to rise quite gently until +10, after which it rose a bit more steeply. (Vetsulin can have a relatively short duration compared to other insulins, and so the increased rise in BG toward the end of the cycle is not at all uncommon.)

Initially with Vetsulin we advise not letting the BG drop below around 90 if possible. That is to allow some buffer of safety in case the BG does actually drop lower than that. So, if you start to see lower preshot numbers you may want to consider lowering the dose a little for safety's sake. Once you get more data, and have got an idea of how the Vetsulin is working in Kitsu's system, you will be able to adapt the dosage in whatever way seems to work best for her.

Can we get you set up a spreadsheet for Kitsu's numbers? We have a template here that you can use. If you want help, just shout out. There are some smart techy people here who can help you set one up (unfortunately I'm not one of them, haha!).
Here's the link to the spreadsheet info:
FDMB SPREADSHEET INSTRUCTIONS

Eliz
 
Elizabeth, thank you so much for analyzing the data! I've gone ahead and set up Kitsu's spreadsheet, it is in my signature now. What do you think of the data prior to May 12 (curve day, since you already talked about it)?

Also, I know stalling is an option, but it's one I haven't tried yet. Basically, if Kitsu's BG levels are low, I either skip the shot or just give her half or even lower dose of insulin than usual (0.5 or 0.75). Obviously, I don't have enough data to fully tell when her nadir is, but it looks like it's around +6 based on May 10 and May 12 results. My concern with stalling is something like this scenario:

PMPS - 112
Stall 1 hour. BG test shows 150.
Stall 1 more hour. BG test shows 236.
Administer 1.5 units of insulin (normal dose).
Normally, I give her AM shot about 5-15 minutes before I have to go to work. If I stalled 2 hours the night before, would that affect her morning shot time, even if she tested around 215 - 250 on the meter for her AMPS? Let's say I stalled 2 hours the night before, so then the next morning, her shot time would be +10 into the PMPS instead of +12 like it normally is. I know Vetsulin is a short-acting insulin, and that shouldn't be a huge issue, but I guess I'm just worried about giving her the shot and then leaving for 8-9 hours without being able to test her again until after work. Especially if her nadir is at +6 like I suspect (which may not be accurate, I'll get some more data next weekend).

I'll continue collecting as much data as I can on Kitsu for the next few weeks, to see if Vetsulin is something I want to stay with, or if I want to possibly switch to ProZinc/Lantus. I'm mainly thinking of switching because my Vetsulin vial has a little more than 1/3 left, and I don't want to re-order it if I can't regulate her on it. Anyway, that's to be decided after I get more data.

Again, thank you so much for your help!
 
And here we go, she just tested 90 on tonight's PMPS test. She only ate about 1/4th of her can of Iams this morning, I've been giving her small amounts of YAZ Mature throughout the day, since it gives her diarrhea if I give her too much. I feel like either she hasn't had enough to eat yet today, or the YAZ is keeping her low. I'll test again in an hour.

Assuming she shows better results in an hour, I have to decide between Iams or YAZ. I feel like YAZ barely does anything to her BG levels, whereas Iams raises it a bit, so if her nadir is truly at +6, it would be wiser to feed her some YAZ until I go to bed, then switch her to Iams... if she will eat it. *sigh* I plan to go wet food shopping again sometime this week when I get a chance.
 
Jenna & Kitsu said:
Tested 123 after 2 hours of stalling. Gave into her hunger demands, skipped shot, and will test her in the morning.
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Jenna, you're getting quite a few preshot tests that are too low to shoot.

There are a number of different reasons for low preshot numbers.
It might be, for example, that the dose is too high and so there is some 'carryover' beyond the insulin's typical duration. That being the case it might be worth trying a slightly lower dose. That could even out the numbers and make it more likely that she is shootable both am and pm.

Or it might be that Kitsu's pancreas is able to produce some insulin to extend the duration sometimes; sort of 'picking up the ball and running with it'. If that makes sense...?

Vetsulin has a relatively short duration; it's action is usually 'done and dusted' after 10 - 12 hours. So, low numbers at the end of a cycle have to be there for a reason.
Either the cat is getting longer than average duration from the Caninsulin (unusual but not unheard of); or the dose is too high and causing 'carryover'; or the dose is too high and causing 'bouncing' (and the low numbers late on are the result of dropping out of a bounce); or the cat may be producing insulin of its own...
.
 
Elizabeth, thank you so much for the explanation! I will consider lowering her dose soon. I felt like she didn't eat as much as she should yesterday, so I wanted to experiment today by giving her YAZ Mature dry food only, no wet food. This way, I knew she would be eating enough calories to not show up low on her PMPS.

So, today when I got home from work, she had a bit of kibble left in her bowl (good because I left out a tiny more than she should have eaten while I was at work). I put it away and didn't let her eat between 5:15 (+9) and 8:00 (+12, PMPS). I tested her at +10 and she was 164. At PMPS, she was 182, so not much change between +10 and +12, but still higher than she was last night. I'm thinking it is because she ate more food throughout the day instead of starving herself like she normally does when I leave wet food out.

This may have been the wrong decision, but I went ahead and gave her 1 unit of insulin at PMPS, even though she was at 182. I will test her again closer to bedtime to make sure her levels aren't too low. I did set her dry food back down and she did eat it before I gave her the shot, so her 182 should go up before the insulin hits her, since it seems to hit her later in the cycle. I also did a 0.75 unit PM shot last week when she was 169, so she should be fine.

Question for accuracy - When I come home from work, should I continue to put her food away until PMPS, or should I let her eat before her PMPS? I've read about withholding food for a certain period of time before the PMPS because food obviously makes BG levels raise, but she does cry for her food when I hold it back like that, and I'm not sure if it's making the results less accurate, since I don't do that for the AMPS (since I'm still asleep).

Thanks again!
 
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Jenna & Kitsu said:
Question for accuracy - When I come home from work, should I continue to put her food away until PMPS, or should I let her eat before her PMPS?
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She really shouldn't eat for the 2 hours immediately before Pre-shot tests so you're sure the number isn't influenced by food.

As far as the AMPS, you might want to consider getting an auto-feeder so you can make sure she's not eating right before AMPS while still offering her food overnight. The PetSafe 5 is a popular one around here and you can just set it to open to an empty space 2 hours before AMPS
 
Thanks Chris, I'll look into it!

So I took your advice in the other thread and dropped her dosing down to 1 unit. As I said last night, I gave her PM shot when her BG was 182, but I was worried about that decision after I did it. I stayed up late and tested her at +4 and she was 72. I've never seen her drop that low before. 72 is a great number, but if she is peaking at +6 like the first curve suggests, I was worried about her dropping too low while I was asleep. I gave her some higher-carb dry food (her old food) before I went to bed just because I know it spikes her BG a bit. I probably gave her like 10-12 pieces, not much. I set my alarm for 2 hours to give her a +6 test and she came back at 152, so that was a relief. I slept the rest of the night and she was back to 330 in the morning, which seems about average for her AMPS. I gave her 1 unit this morning and wasn't able to test her again until PMPS tonight, but she came back at 275, which is a shootable number for sure. I gave her another 1 unit and I plan to test her again at +3 or +4 again tonight and see how things are going.

If things go well, I might be able to do another curve soon, this time on her 1 unit dose instead of her 1.5 unit dose.
 
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