Need Curve Assistance

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Karen & Charlie

Karen & Charlie

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Charlie was diagnosed on 7/28/20 and 1st insulin (2u/day Vetsulin) was given 7/31/20. Per vet no BG testing until a curve tomorrow. I need help with the process! I've been reading, reading, and reading and it's not clear and very intimidating.

Can someone hold my hand and walk me through every test? The only thing I know for sure is that the first test is done after 1st meal.
  • Is the first test done after meal AND after insulin?
  • When am I giving his 2 insulin injections?
  • Do the day's remaining meals need to be precisely timed to hit a specific test?
  • What are other specifics related to each test or a particular test?
  • What should I be watching for, if anything, or am I just recording data

12 hr testing cycle, 6 tests every 2 hrs

1st - after 1st meal
2nd
3rd
4th
5th
6th

Grateful thanks to anyone giving up time on their Saturday to help me!

~K
 
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Actually that’s not correct. You need to test before the food not after. But Vetsulin acts fast and hard so you need to feed at least 30 minutes before giving insulin which means you should be testing about 30 minutes before the shot. Then feed, wait the 30 minutes and shoot. Vetsulin is also called caninsulin because it was designed for canines and it’s not always the best or most effective insulin for cats. It has a much lower rate of remission compared to Lantus or prozync so please keep that in mind.

I love ReliOn and I think it’s a great meter. Warm up the ear is key for me. Use an old sock, fill it with rice or orzo like me, and nuke it for 20-30 seconds. Apply to your cat’s ear and make sure it’s the ear gets warm to the touch. I use a few cotton ovals as a backing for the ear and I press it firmly against the ovals so I can prick it with the lancet. Here’s the spot your aiming for:
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  • Is the first test done after meal AND after insulin? I answered that above
  • When am I giving his 2 insulin injections? The insulin shots should be 12 hours apart you pick a time that’s best for you and your cat. I do 7:30am and 7:30pm
  • Do the day's remaining meals need to be precisely timed to hit a specific test? Cats tend to be grazers and it’s okay to give smaller meals throughout the day. It’s also easier on their pancreas. But we try to give the bulk of the meals around shot times. The important thing is that your cat needs to have food onboard prior to each insulin shot. Never give a shot if your cat hasn’t eaten especially with Vetsulin. Also, try to not give a lot of food after the insulin peaks, which with Vetsulin tends to be early on, unfortunately like +4 I believe. So then snacks after that but no large meals.
  • What are other specifics related to each test or a particular test? We recommend testing before each shot every day and trying a few spot checks during the day so you can learn when your cat’s nadir sets in - lowest BG at any given 12 hour cycle. So I’d start with the 1st am preshot test then maybe try a +4 and alternate so the day after maybe try a +3 instead and then a +5 and so on, so you can gather test data about your cat
  • What should I be watching for, if anything, or am I just recording data When it comes to dosing we here adjust by the nadir not the preshot numbers so that’s why it’s good go figure out when that is for your cat. Then you also want to watch for low numbers that indicate a possible hypo episode. Anything under 50 I’m ReliOn is a concern and you then need to treat it as a hypo with Karo, high carb food, etc to bring the number back up. I believe with Vetsulin the only dosing protocol is SLGS but I could be wrong, so check the forum for more info on that
 
Aleluia
So helpful! One FU question:

1. Try to not give a lot of food after the insulin peaks, which with Vetsulin tends to be early on, unfortunately like +4 I believe.

What do you mean by "early on?"
What is meant by +4 (or +X). In my reading, I've not seen (or registered that I'd seen) an explanation.
In this scenario does it refer to hours after the test?v

2. We recommend testing before each shot...and trying a few spot checks during the day so you can learn when your cat’s nadir sets in... I’d start with the 1st am preshot test then maybe try a +4 and alternate so the day after maybe try a +3 instead and then a +5 and so on, so you can gather test data about your cat.

Do you mean that I would do the preshot test, then X hrs later do another test, alternating each day?
I take if from your other comments that I wouldn't be doing only 2 tests (one preshot and then one X hrs later). So, sorry I'm still not clear on the periodic testing bit and their timing.

3. Does anyone ever test on the pad? I see little reference to it...seems it could be easier than trying to hit a "sweet spot...?"

Thanks so much for your help and your time!

~K
 
Exactly. So you test at 7am let’s say. Then 8am becomes your +1, 9 is +2 and it goes all the way to +11 which will be an hour before your next shot at 7pm. Makes sense? We use the + with a number because we’re all shooting at different times of the day and different time zones. This way we’re all on the same page as to when things happened. If you set up a spreadsheet using one of our templates, you’ll see that’s marked on the columns where you’d enter the BG numbers from your tests. Click on the link to my ss in my signature so you’ll see what I mean :cat:
 
Karen & Charlie said:
Charlie was diagnosed on 7/28/20 and 1st insulin (2u/day Vetsulin) was given 7/31/20. Per vet no BG testing until a curve tomorrow. I need help with the process! I've been reading, reading, and reading and it's not clear and very intimidating.

Can someone hold my hand and walk me through every test? The only thing I know for sure is that the first test is done after 1st meal.
  • Is the first test done after meal AND after insulin?
  • When am I giving his 2 insulin injections?
  • Do the day's remaining meals need to be precisely timed to hit a specific test?
  • What are other specifics related to each test or a particular test?
  • What should I be watching for, if anything, or am I just recording data

12 hr testing cycle, 6 tests every 2 hrs

1st - after 1st meal
2nd
3rd
4th
5th
6th

Grateful thanks to anyone giving up time on their Saturday to help me!

~K
Click to expand...
Hi Karen about the curve

Let's say you test Charlie at 9:00 AM ( that is AMPS AM Pre- Shot)
You would then feed Charlie
Then wait 30 minutes , then inject the insulin, so that would be 9:30 AM
No feeding 2 hours before any pre shots

During the curve you can feed him small snacks as usual, and during other days, we don't just feed our cats twice a day

So 9:30 AM is when you gave him the vetsulin
11:30 AM. You would test him
1:30 PM. You would test him
3:30 PM. You would test him
5:30 PM. You would test him
7:30 PM You would test him
Now Test him at 9:00 PM
Then feed him
Wait 30 minutes then inject the insulin so that would be 9:30 PM
That would be the curve, you are testing every 2 hours after the injection time

Now for normal testing , since Vetsulin is harsh and can drop BG quickly
Let's say you test him at 9:00 AM
Feed him. Wait 30 minutes
Then inject the insulin at 9:30 AM
Do a test @+2( that means 2 hours after you inject,) so that would be at 11:30 AM
Test again @+4. ( that means 4 hours after you inject ) so that would be at 1:30 PM
Test again @+6. ( 6 hours after you inject ) that would be 3:30 PM

Night time the same thing, cats usually drop lower at night so you want to make sure you test and see how the insulin is working .
The first test is called PMPS ( PM Pre- Shot)

You want to alternate testing times for example do a test @+3 ( three hours after injecting insulin, then @+5 ( five hours after injecting the insulin, then maybe @+7 ( seven hours after injecting insulin)
You want to scatter them to see when and how low he is dropping

Depending what his BG number is you might have to test sooner if his BG drops
below 50 on the Relion meter, you would then feed him about a tablespoon of high carb food , I see you feed Friskies Pate, , you can look at the food chart and see what high carbs and medium carbs are for Friskies.
I feed Fancy Feast so I would only know what they are for Fancy Feast
I'll show you after this post
Always have some Karo or Honey on hand

It all depends if he drops low , then you would have feed medium or high carb , wait 20 minutes and test again
You want to raise his BG to safe numbers two times in a row without feeding any food.
Always post if you need help if he ever drops low and you are not sure what to do
such as. Help Low BG Need Advice, put what his BG is

Why don't you take a look at my spreadsheet and you will see what I am talking about.
You should set up a spreadsheet so you can record his numbers in case you ever need advice on dosing so members can see what his numbers have been
That is the only way they would feel comfortable giving advice

I will give you the link to set up the spreadsheet, if you have trouble doing it we have a wonderful member who will do it for you @Chris & China (GA)
Just post you need help setting it up.

Keep the numbers for the curve tomorrow so you can then fill in the spreadsheet.
I hope this helped , good luck tomorrow
 
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Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy. 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy. 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef Feast in Gravy 15% Med Carbs

So just check the food chart to see what medium and high carbs would be for what you are feeding, it's really the gravy you would need to bring his BG up, you could give him a teaspoon of food, but you don't want to fill him up on food in case you would have to keep feeding him to bring it up, hopefully it will never happen
 
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Hi Karen!

I want to point out some things that haven't been mentioned about Vetsulin.
Vetsulin is a harsh, fast-acting insulin in cats. It hits hard and fast and rarely lasts the full 12 hours we are aiming for (usually only 4-6). It would benefit both you and Charlie if you switched to a longer-acting insulin such as Prozinc or Lantus (Lantus especially!). Vetsulin can be difficult to work with so if you get frustrated with Charlie's data, keep that in mind. We will of course help you if you stick with Vetsulin.

Onset (the time when insulin starts to take effect) for Vetsulin can start very quickly, so it is recommended to provide food 20 to 30 minutes before giving insulin. Peak action may occur between 3 and 7 hours after the injection, though it is typically seen between 4 and 5 hours after.

Recommended protocol for Vetsulin is to test blood glucose, give food, and after 20-30 minutes administer insulin. It is important to have food already on board before the scheduled shot. It is recommended to have food available 1 to 2 hours after giving insulin due to the fast onset of insulin, and continue to have a couple extra mini meals available until your cat’s typical nadir. I really recommend giving food 1 hour after giving insulin and testing at +1 (1 hour post-shot) because that is more than likely when the drop hits. If Charlie's BG drops too fast, he will be at risk for hypoglycemia and will more than likely "bounce", which is a phenomenon the body experiences when the BG drops too low. In order to protect itself, the body dumps excess glucose into the bloodstream and raises the BG up into very, very high numbers. It looks very scary in a reading!

Vetsulin has a fair amount of “wiggle” room when administering more or less than 12 hours apart. It is considered safe to administer insulin up to two hours early or late, though the more consistent the better.

For Charlie I would recommend testing, feeding, waiting 20-30 minutes, shooting, and then testing again at +1 (for EVERY cycle, so that means night-time too!). His BG will usually have started to drop and you'll want to give him a small meal at that time. Like the others have mentioned, you can alternate testing times each day to fill in the gaps on your spreadsheet, but I always recommend a +1, unless/until we have data that proves that his BG isn't affected until +2. It depends on the cat. You can absolutely start a thread for assistance when you test so we can offer advice depending on his numbers, as we want to keep Charlie safe. Feel free to ping any of us by typing in @Panic etc to get our attention (or you can message us directly, since tags aren't going through for everyone as of late).

Friskies Pate is a fine food to be feeding. You'll want to pick up a few cans of the Fancy Feast Gravy Lovers Diane mentioned as part of your emergency kit, in case Charlie's numbers drop too low. Higher carbs will bump up BG into safer numbers in a crisis. Pick up a few medium carb and high carb cans along with a bottle of Karo Syrup. Hopefully you'll never have to use it but it's good to have on-hand in case you do.

As for paw pad testing, you can do it but I think very very few of us do. The paws can get infected when using litterboxes/walking on dirt. I think the only person I know that used the paws was because her cat's ears had frostbite.
 
Panic said:
Hi Karen!

I want to point out some things that haven't been mentioned about Vetsulin.
Vetsulin is a harsh, fast-acting insulin in cats. It hits hard and fast and rarely lasts the full 12 hours we are aiming for (usually only 4-6). It would benefit both you and Charlie if you switched to a longer-acting insulin such as Prozinc or Lantus (Lantus especially!). Vetsulin can be difficult to work with so if you get frustrated with Charlie's data, keep that in mind. We will of course help you if you stick with Vetsulin.

Onset (the time when insulin starts to take effect) for Vetsulin can start very quickly, so it is recommended to provide food 20 to 30 minutes before giving insulin. Peak action may occur between 3 and 7 hours after the injection, though it is typically seen between 4 and 5 hours after.

Recommended protocol for Vetsulin is to test blood glucose, give food, and after 20-30 minutes administer insulin. It is important to have food already on board before the scheduled shot. It is recommended to have food available 1 to 2 hours after giving insulin due to the fast onset of insulin, and continue to have a couple extra mini meals available until your cat’s typical nadir. I really recommend giving food 1 hour after giving insulin and testing at +1 (1 hour post-shot) because that is more than likely when the drop hits. If Charlie's BG drops too fast, he will be at risk for hypoglycemia and will more than likely "bounce", which is a phenomenon the body experiences when the BG drops too low. In order to protect itself, the body dumps excess glucose into the bloodstream and raises the BG up into very, very high numbers. It looks very scary in a reading!

Vetsulin has a fair amount of “wiggle” room when administering more or less than 12 hours apart. It is considered safe to administer insulin up to two hours early or late, though the more consistent the better.

For Charlie I would recommend testing, feeding, waiting 20-30 minutes, shooting, and then testing again at +1 (for EVERY cycle, so that means night-time too!). His BG will usually have started to drop and you'll want to give him a small meal at that time. Like the others have mentioned, you can alternate testing times each day to fill in the gaps on your spreadsheet, but I always recommend a +1, unless/until we have data that proves that his BG isn't affected until +2. It depends on the cat. You can absolutely start a thread for assistance when you test so we can offer advice depending on his numbers, as we want to keep Charlie safe. Feel free to ping any of us by typing in @Panic etc to get our attention (or you can message us directly, since tags aren't going through for everyone as of late).

Friskies Pate is a fine food to be feeding. You'll want to pick up a few cans of the Fancy Feast Gravy Lovers Diane mentioned as part of your emergency kit, in case Charlie's numbers drop too low. Higher carbs will bump up BG into safer numbers in a crisis. Pick up a few medium carb and high carb cans along with a bottle of Karo Syrup. Hopefully you'll never have to use it but it's good to have on-hand in case you do.

As for paw pad testing, you can do it but I think very very few of us do. The paws can get infected when using litterboxes/walking on dirt. I think the only person I know that used the paws was because her cat's ears had frostbite.
Click to expand...
 
Karen & Charlie said:
Elizabeth, I am so very grateful for all your help. I'm still very intimidated and nervous, mostly about Charlie's health, but also about whether I can do this :nailbiting:. But, I have no choice.

I feel like I will want to swap out the Vetsulin at some point. I need to get these first testing steps under my belt first.:arghh:
Click to expand...
You're welcome! You've got this, you have decades of experienced members at your disposal. :) Take your time, don't feel like you need to learn everything in one night. Ask questions - ask the same ones over again if you need to.

I have used almost all insulin types with my cat and I will say switching off Vetsulin not only was better for her, but it put less stress/work on me as a caregiver. It's not always easy when you need to be there to watch the cycle but you also need to go to work/appointments/etc - the longer lasting insulins will give you some relief. :cat: Baby steps though!
 
Karen & Charlie said:
Diane, thanks SO much for the step by step schedule, the great information, and the spreadsheet link (I have it all set up and ready to go)--I can't tell you how helpful you've been!
Click to expand...
You are welcome, I know it was a long post but I found it easier to understand for me understanding it step by step
Great job setting up the spreadsheet.
You got this, I felt the same way you did in the beginning, but you will do great.
Just keep asking questions , that's what we are here for
Good luck with the curve today
I test free hand with the 28 gauge lancets, the ears will bleed better in the beginning with the 28 gauge, they will make a bigger hole, his ears will start to grow more capillaries and bleed better, if you want to you can switch to 32 or 33 gauge lancets. I stayed with the 28 gauge.
The lower size lancet the bigger the hole, higher size lancets the smaller the hole.
Get some cotton rounds and put the behind his ear so you don't poke your finger , then press gently on his earvto stop the bleeding, about 10 seconds to stop the bleeding
If his ears get a little red you can put a thin layer of Neosporin Ointment with Pain relief, make sure its the Ointment NOT The Cream
Charlie is such a cutie :bighug::cat:
 
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Diane,

Okay, 1st test done! It was so stressful (for me!), but Charlie was a champ. He tested 392. I set up his spreadsheet, but haven't read instructions on entering the numbers...so I'll do that now. I used a 28 gague lancet.

I have questions about overnight eating--both cats woke me up at 3:30 to eat, I didn't feed Charlie--so I'll have to read back through all the great info from you and Elizabeth and see if you addressed that.

Thanks, again for you help and thanks for checking with me today!
 
Karen & Charlie said:
I have questions about overnight eating--both cats woke me up at 3:30 to eat, I didn't feed Charlie--so I'll have to read back through all the great info from you and Elizabeth and see if you addressed that.
Click to expand...
I'll make it easy for you - snacks at night are encouraged! Cats tend to drop lower at night than during the day so it's important for night snacks. We do recommend not allowing food 2 hours before pre-shot testing, just because the food will bump up the numbers and not give you an accurate "safe shooting" number.

Good luck today! :D
 
Thanks, Elizabeth!

As I'm thinking about it, I'm concerned that Charlie may have eaten some of my other cat's food in the early AM hours before his test (the food I gave her when they woke me at 3:30 AM). He doesn't usually do that, but if he was hungry, as the early morning meows would indicate.... [I've transitioned Inky to the same food as Charlie, so there's no danger of him having had a high carb feast.]

I wonder if I should continue with the curve today, or do it again tomorrow.

I'd read that putting out iced food cubes before bed was a good way to provide snacks over night, but how do I know he hasn't eaten in the early AM before testing? When you were getting this under control with Tyler were you attending to him overnight?
 
The food from 3:30 AM (if he did eat any) would only affect his numbers if you did his AM pre-shot before 5:30 this morning. You're fine to continue the curve.

Most of us use autofeeders at night (Petsafe 5 is a popular favorite - and it's on sale on Amazon right now for $28, it's usually $45). It allows you to input up to 9 set times. It has 5 slots, 4 of which you can set a time for (since one is always going to be open) and what most people do is when the last/fourth slot is opened, they set the timer to go off again two hours before AMPS, so it rotates on a now-empty tray. No more food!
 
On more question for now. Here is the schedule so far this morning

7:45 AM AMPS
8:15 AM Feed (he wouldn't eat until then)
8:45 AM Inject

I assume my next test is always +2 from the injection...so, at 10:45?

Thank you!!
 
Karen & Charlie said:
On more question for now. Here is the schedule so far this morning

7:45 AM AMPS
8:15 AM Feed (he wouldn't eat until then)
8:45 AM Inject

I assume my next test is always +2 from the injection...so, at 10:45?

Thank you!!
Click to expand...
With Vetsulin I really recommend a +1. It hits faster than most insulin. It's possible that he won't dip until +2 but it's more likely to happen at +1.
 
So,
Panic said:
With Vetsulin I really recommend a +1. It hits faster than most insulin. It's possible that he won't dip until +2 but it's more likely to happen at +1.
Click to expand...

So, I'll be doing 12 tests instead of 6 in 12 hours, am I understanding that correctly?
Or, +1 only after injection and +2 as usual for the rest of the day?
 
He got/demanded a freeze dried snack.
As he’s snacking throughout the day, do I need to be aware of when he smacks in relation to each test? Like, can he snack and then immediately be tested? Or does there need to be a no snack space around each test?

Thank you!
 
Sorry, left for a bit.
You want this curve to be like a normal day. So feed/snack like normal, don't worry about feeding in relation to testing times during the day.
And yikes, look at that! Charlie's earned a reduction!

With Vetsulin we don't want Charlie dropping below 90. Any time below 90 (no matter what time of day it is), he earns 0.25 unit reduction. So starting tonight please only give him .75 for now on.

You also want to feed a LC snack and re-test every 20 minutes until he's above 90.
 
Thanks so much for checking back in! He's below 90. By LC food, I'm guessing you don't mean his regular low carb/high protein food? It's now been 20 minutes since I tested him...

AMPS 392
+1 352
+3 64
 
Whoops sorry, LC means low-carb. Could you please re-test him? I'll explain how to put it in the spreadsheet but right now we need to get his BG back up.
 
Hi Karen,

It's best to feed Charlie on the same schedule as any other day when you're running the curve. The purpose of running the curve is to give you an idea of how Charlie's insulin dose is working under normal circumstances. If you were to artificially alter his feeding schedule while running the curve it wouldn't give as true a picture.

It's a good idea in general to make a note in the Remarks section of Charlie's spreadsheet about the food type and time of meals/treats and it can help spot patterns or answer puzzles sometimes. For example, ingredients like beef or soy can spike some cats' numbers, even though the food in which they're contained is low carb. With the BG data in the sheet but no food info those patterns would have been harder to spot.
 
I feel like I suck at this so hard!

Okay --

AMPS 392
+1 352
+3 64 (after, ate freeze dried treat + mouthful of regular LC food)
+ 30 min 221 (ate freeze dried treat after)

I'm not on any feeding schedule with him. Being newly diagnosed, I haven't changed anything about his feeding except the food itself. He pretty much was able to eat whenever he wanted. I would welcome a regular suggested feeding schedule. I think enough info has been provided here to help with me feeding on curve day.

Clarification: I'm not allowing him to feed 30 minutes ahead of injections.
 
You're doing great, Karen!

Okay awesome, no more scary numbers. He has started to bounce which is completely expected. He dropped hard and fast and that almost always triggers a bounce. He's probably going to stay high the rest of the day. You can continue the curve if you like but we'll probably only see higher numbers now.

If Charlie is a grazer and not a scarfer you can keep free feeding him like normal. Just make sure no food 2 hours before AM/PMPS. We at least want to make sure he has snacks before nadir. Right now it's too soon to tell when that is.

In your spreadsheet under +3 please input it like this: 64 (+3), 221 (+3.5). The cell will have to be manually colored if you do this, just make it that green color with white font so everyone can recognize he dropped very low.
 
Panic said:
Sorry, left for a bit.
You want this curve to be like a normal day. So feed/snack like normal, don't worry about feeding in relation to testing times during the day.
And yikes, look at that! Charlie's earned a reduction!

With Vetsulin we don't want Charlie dropping below 90. Any time below 90 (no matter what time of day it is), he earns 0.25 unit reduction. So starting tonight please only give him .75 for now on.

You also want to feed a LC snack and re-test every 20 minutes until he's above 90.
Click to expand...

Okay, .75 it is. Thank you!
 
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