Need Curve Assistance

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Charlie just tested highest so far today. I'll continue testing for the curve--this is our 1st testing of any kind, per vet, and I'll be emailing her numbers tomorrow. But, this is just stressing me out! Charlie is getting wise and growled. I've had to poke him multiple times and use 2 tests strips on each of the last 2 tests.:( What should I be doing differently?

AMPS 392
+1 352
+3 64 (after, ate freeze dried treat + mouthful of regular LC food)
+3.5 min 221 (ate freeze dried treat after)
+5 423 (ate lunch of FP Poultry Platter within 20 minutes of testing, got FD treat after)
 
Karen & Charlie said:
Charlie just tested highest so far today. I'll continue testing for the curve--this is our 1st testing of any kind, per vet, and I'll be emailing her numbers tomorrow. But, this is just stressing me out! Charlie is getting wise and growled. I've had to poke him multiple times and use 2 tests strips on each of the last 2 tests.:( What should I be doing differently?

AMPS 392
+1 352
+3 64 (after, ate freeze dried treat + mouthful of regular LC food)
+3.5 min 221 (ate freeze dried treat after)
+5 423 (ate lunch of FP Poultry Platter within 20 minutes of testing, got FD treat after)
Click to expand...

I'd call it quits for today. Charlie sounds grumpy and you're in a bounce - bouncing numbers can take up to 6 cycles to clear, but for this cycle you've got all the useful data you're going to get. Send the numbers to your vet and explain that Charlie experienced a bounce. I have no idea if most vets know what bouncing is but oh well. :rolleyes: Charlie did good today, you don't want to push him where it's not needed.

As for the multiple pokes - totally normal. It takes a while for the ears to form capillaries that makes drawing blood easier. Warming the ear helps but in the beginning stages you just have to wait for the capillaries to develop and deal with the extra pokes. Were the test strips giving you errors? You may not have had enough blood - which brings you back to it just being part of the starting out process. You're doing exceptionally well honestly.
 
Are you giving Charlie treats after each poke? you want him to associate nummies with test and shot time.. You can start with having him in the spot you are going to test give a treat...let him go...try again with a treat and get all the supplies in front of him give a treat...let him go.. get where I'm going? eventually he will associate a little poke with nummies.
have you read here?
Hometesting Links and Tips
 
jt and trouble (GA) said:
Are you giving Charlie treats after each poke? you want him to associate nummies with test and shot time.. You can start with having him in the spot you are going to test give a treat...let him go...try again with a treat and get all the supplies in front of him give a treat...let him go.. get where I'm going? eventually he will associate a little poke with nummies.
have you read here?
Hometesting Links and Tips
Click to expand...

Thanks, JT...I had read the Hometesting tips a few days ago, but will peruse again. He is fed & sleeps on a counter in the laundry, so that's where I've been testing. He's in his bed, which I can sort of fold around him (which I did the last time) to contain him, without really trapping him. Plus, it's easy for me because it's counter height, easy on the knees. So, I believe his association with the spot is good--"I can get food here and TREATS here!"
 
Panic said:
I'd call it quits for today. Charlie sounds grumpy and you're in a bounce - bouncing numbers can take up to 6 cycles to clear, but for this cycle you've got all the useful data you're going to get. Send the numbers to your vet and explain that Charlie experienced a bounce. I have no idea if most vets know what bouncing is but oh well. :rolleyes: Charlie did good today, you don't want to push him where it's not needed.

As for the multiple pokes - totally normal. It takes a while for the ears to form capillaries that makes drawing blood easier. Warming the ear helps but in the beginning stages you just have to wait for the capillaries to develop and deal with the extra pokes. Were the test strips giving you errors? You may not have had enough blood - which brings you back to it just being part of the starting out process. You're doing exceptionally well honestly.
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OMG...thanks for the encouragement. I swear, though...

I'm heating his ear with a rice sock, so either I'm being a chicken and not poking hard enough (though I think Charlie would beg to differ), or it's a "new ear" problem, or both.

The times I had to use 2 strips were when there was not enough blood, and the 2nd time it seemingly wouldn't measure too much blood. I fumble pushing the strip into the meter, time spent which I'm sure Charlie doesn't appreciate. I locate it in the easiest spot for me to pick it up after drawing blood, but pushing it in one-handed...I need to practice.

Should I still go ahead and reduce injections to .75?
 
I'd wager just new ear trials! It took me like four days to consistently get tests in so you're doing better than I was! ;)

Yep, it does that. I don't know what the Premier strips look like but the Prime strips you could "see" the blood filling up the strip. If it doesn't fill all the way then it won't read. You'll eventually be able to eyeball a blood drop and tell if it's going to be "enough" for the strip to read.

I tried doing the little trick of keeping the strip halfway in the meter but like you, sticking it in one-handed and all that was way too difficult so I just started sticking it in all the way. What I did was insert a strip and count how long it took for the meter to time out - 2 minutes. Not sure what the countdown on the Premier is, you can check, but I bet it's also 2 minutes. If a meter times out, the strip is STILL GOOD as long as you haven't put in blood in it. If you can get in the swing of drawing blood and touching the strip to the drop in under 2 minutes you won't need to play the one-handed game.

Yes, Charlie has earned that .75 reduction. Do not be tempted to give more tonight if he is still high, that's the bounce talking. I'm going to tag @Deb & Wink to ask her if she thinks, based on the very big drop today, if she recommends dropping any more than .25 units. She may say the .75u is fine, but on occasion I've seen her recommend more of a drop for new diabetics.
 
I want to give a heartfelt thanks to each of you who has posted here, encouraging and offering advice. I'm not sure how to tag you in this forum, I hope you all see this and know what a huge help and comfort you have been. I couldn't have gotten through this without each of you! Thanks for all of the time you took to help out this nervous, stressed out fur mom!

jt and trouble (GA)
Aleluia Grugru & Minnie
Diane Tyler's Mom
Panic
Critter Mom
 
There simply isn't enough data to know if the dose should be lowered further.

Are you able to get a test or 2 in each cycle, after the pre-shot test?
Try to "sprinkle" those tests around at different times, like you are sprinkling jimmies on top of your ice cream. You don't want the jimmies in only one spot, but spread out so you get some with each bite of ice cream. Sort of the same idea with getting tests at different times during the 12 hour insulin cycle.

You do that, so you discover the onset, nadir, and duration for this particular insulin and this dose for YOUR cat.

p.s. Are you feeding Charlie at least 20 minutes before the insulin shot? That is important to do with Vetsulin (aka Caninsulin).
 
Deb & Wink said:
There simply isn't enough data to know if the dose should be lowered further.

Are you able to get a test or 2 in each cycle, after the pre-shot test?
Try to "sprinkle" those tests around at different times, like you are sprinkling jimmies on top of your ice cream. You don't want the jimmies in only one spot, but spread out so you get some with each bite of ice cream. Sort of the same idea with getting tests at different times during the 12 hour insulin cycle.

You do that, so you discover the onset, nadir, and duration for this particular insulin and this dose for YOUR cat.

p.s. Are you feeding Charlie at least 20 minutes before the insulin shot? That is important to do with Vetsulin (aka Caninsulin).
Click to expand...

Deb, thanks so much for adding to the conversation. I'm brand new at this and I'm sorry, I don't know what you mean.

Getting a test or 2 in each cycle -- what's a cycle?
Sprinkle the tests around at different times -- do you mean when doing a curve I should not do testing strictly 2 hours between tests? That I should vary the time in between tests? 2 hrs one time, 4 hrs the next, etc.?

I [now] am making sure that Charlie eats 30 minutes ahead of his injection. I learned it here, not from my vet.
 
Karen & Charlie said:
Getting a test or 2 in each cycle -- what's a cycle?
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A cycle is 12 hours - it starts when you administer insulin and ends when you administer again. So if you shoot insulin at 9 AM and again at 9 PM, the entire cycle was from 9 AM to 9 PM. There's two cycles in 24 hours. :) Deb is wanting you to test at least a couple times in each cycle.

Karen & Charlie said:
do you mean when doing a curve I should not do testing strictly 2 hours between tests? That I should vary the time in between tests? 2 hrs one time, 4 hrs the next, etc.?
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A curve is when you test every 2 hours in a cycle. "Sprinkling" the tests - or doing spot checks, as we call them - has you alternating your testing times. Like say one day you test at +2 and +4, and the next day you might test at +1, +3, and +5. That will fill in the gaps on your spreadsheet. Most of us actually don't even do curves at all, we do spot checks instead. Spot checks every day paint a bigger picture than doing a curve every once in a while. If you look at my spreadsheet below, you can see the "sprinkling" of tests every day.
 
Elizabeth, thanks for responding. I'm afraid I'm more confused than ever. I think I have information overload for my first testing day. I'll have to start fresh tomorrow.

But, if I understand right, tomorrow I should do random spot tests. Charlie is a grazer, not a set time eater. Earlier today, I'd asked whether I should pay attention to his food intake when doing my curve testing. You responded "feed/snack like normal, don't worry about feeding in relation to testing times during the day." I assume that advice is the same on a normal day, when not curve testing.

Do most people here still involve a vet in their cat's care on a regular basis? Or, have you all become such an educated community that it's not necessary unless something is out of control or becomes critical. Just curious.

So grateful for your help.
 
Karen & Charlie said:
I want to give a heartfelt thanks to each of you who has posted here, encouraging and offering advice. I'm not sure how to tag you in this forum, I hope you all see this and know what a huge help and comfort you have been. I couldn't have gotten through this without each of you! Thanks for all of the time you took to help out this nervous, stressed out fur mom!

jt and trouble (GA)
Aleluia Grugru & Minnie
Diane Tyler's Mom
Panic
Critter Mom
Click to expand...
Hi Karen been reading this post about you and Charlie who is a Cutie and I just wanted to say You are doing a Great job Your really learning and trying for Charlie what a Great Mom
You can do this Karen yes it’s Overwhelming and so much to process but this forum is Amazing and as you can see you will love this bunch you just met . I can tell you they all really do care . Keep asking questions and Welcome to you and Charlie even if you just need to talk or vent we are here
 
You've done a lot today, take a step back and let yourself recharge. :) There's a lot to cover, but the information above isn't going anywhere. Take your time.

You are correct. Spot checks tomorrow, get an early test (between +1 and +2) to see if he's dropping noticeably. It may take him a while to "clear" the high bounce numbers so if he's still high tomorrow don't be concerned. With Vetsulin you want to focus more on the early tests (between +1 and +5) so get at least a couple then if your schedule allows. As we saw today, that's when the most changes occur.

And correct again, let Charlie do his thing, if he prefers to graze let him. :) A "curve day" is supposed to mimic a normal day. Feed him like normal every day, whether you're doing a curve or not.

Karen & Charlie said:
Do most people here still involve a vet in their cat's care on a regular basis? Or, have you all become such an educated community that it's not necessary unless something is out of control or becomes critical. Just curious.
Click to expand...
Lol ... no. As long as kitty is happy and eating, we keep our vets out of it for the most part. Most of us just do the "smile and nod" (and maybe a bit of eyeroll) when our vets make suggestions and just keep doing our own thing. They just don't have the experience that the caregivers here do. Once I starting calling the shots for my girl's diabetes, I didn't take her back to the vet for almost a year. Just sent in spreadsheet numbers once a week and told them how she was doing. If you ever hear someone telling you to take your cat to the vet though ... it's something serious.
 
Dusty & Roe said:
Hi Karen been reading this post about you and Charlie who is a Cutie and I just wanted to say You are doing a Great job Your really learning and trying for Charlie what a Great Mom
You can do this Karen yes it’s Overwhelming and so much to process but this forum is Amazing and as you can see you will love this bunch you just met . I can tell you they all really do care . Keep asking questions and Welcome to you and Charlie even if you just need to talk or vent we are here
Click to expand...


Dusty, I'm so grateful for your encouragement. I've found this to be.the most knowledgeable, caring, helpful community I've been part of. SO glad I found it! And, my helpers today are all off the chart. Above and beyond. :bighug:
 
Panic said:
You've done a lot today, take a step back and let yourself recharge. :) There's a lot to cover, but the information above isn't going anywhere. Take your time.

You are correct. Spot checks tomorrow, get an early test (between +1 and +2) to see if he's dropping noticeably. It may take him a while to "clear" the high bounce numbers so if he's still high tomorrow don't be concerned. With Vetsulin you want to focus more on the early tests (between +1 and +5) so get at least a couple then if your schedule allows. As we saw today, that's when the most changes occur.

And correct again, let Charlie do his thing, if he prefers to graze let him. :) A "curve day" is supposed to mimic a normal day. Feed him like normal every day, whether you're doing a curve or not.


Lol ... no. As long as kitty is happy and eating, we keep our vets out of it for the most part. Most of us just do the "smile and nod" (and maybe a bit of eyeroll) when our vets make suggestions and just keep doing our own thing. They just don't have the experience that the caregivers here do. Once I starting calling the shots for my girl's diabetes, I didn't take her back to the vet for almost a year. Just sent in spreadsheet numbers once a week and told them how she was doing. If you ever hear someone telling you to take your cat to the vet though ... it's something serious.
Click to expand...

You're a saint. I feel like I've thanked you a dozen times today, and with all your responses when I needed help, I probably have. :cat:
 
Insulin -- switching from Vetsulin to ???

I thought rather than a new thread, I'd ask here first, since you've been my "trusted team" so far.

1. What do you recommend I should switch to from Vetsulin? My vet suggested Vetsulin & Prozinc, at twice the price of Vetsulin.

2. I'm not able to see insulin pricing on Marks Marine Pharmacy website. Do any of you purchase from Marks?

Thank you!

AMPS 437
+2 360

PS -- Panic, I found your reply to me on Lantus. Now that I'm paying attention to changing insulin, it's valuable info. Thanks!

I recommend looking into Lantus! It's outrageously expensive here in the US but if you can get a script for it you can send it to Mark's Marine Pharmacy - the upfront cost is higher but in the long run it's actually the cheapest insulin. One box of 5 pens (they are like mini-vials) is $169 plus $25 shipping, but because they are like mini-vials, you only open one at a time, use the entire pen to the last drop before opening another which extends the expiration date. Depending on kitty's dosage a box of pens will last 9 months to 2 years! In 9 months time you'll have purchased 2-3 vials of Vetsulin ($168) and in 2 years time 5-6 vials ($336). Cats respond better to Lantus than any other insulin out there too.
 
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Karen & Charlie said:
Do most people here still involve a vet in their cat's care on a regular basis? Or, have you all become such an educated community that it's not necessary unless something is out of control or becomes critical. Just curious.
Click to expand...
I happen to be one of the members that believes keeping a good relationship going with your vet is important.
Think of us as an "adjunct" or supplemental resource to your vet.

Plus, we have links to a lot of the more current feline diabetes vet journal articles and practical day to day advice you can share with your vet.
Most vets don't have the time to give that day to day guidance that many diabetic cat owners need. We do. We share what we know with you, and you can share that with your vet.
Vets are welcome here, and we've had a few over the years.

p.s. It really is time for a new thread. Simply link this old one at the top, for reference and history.
 
Karen & Charlie said:
Insulin -- switching from Vetsulin to ???

I thought rather than a new thread, I'd ask here first, since you've been my "trusted team" so far.

1. What do you recommend I should switch to from Vetsulin? My vet suggested Vetsulin & Prozinc, at twice the price of Vetsulin.

2. I'm not able to see insulin pricing on Marks Marine Pharmacy website. Do any of you purchase from Marks?

Thank you!

AMPS 437
+2 360

PS -- Panic, I found your reply to me on Lantus. Now that I'm paying attention to changing insulin, it's valuable info. Thanks!

I recommend looking into Lantus! It's outrageously expensive here in the US but if you can get a script for it you can send it to Mark's Marine Pharmacy - the upfront cost is higher but in the long run it's actually the cheapest insulin. One box of 5 pens (they are like mini-vials) is $169 plus $25 shipping, but because they are like mini-vials, you only open one at a time, use the entire pen to the last drop before opening another which extends the expiration date. Depending on kitty's dosage a box of pens will last 9 months to 2 years! In 9 months time you'll have purchased 2-3 vials of Vetsulin ($168) and in 2 years time 5-6 vials ($336). Cats respond better to Lantus than any other insulin out there too.
Click to expand...
Personally I spoke to my Vet about insulin and she highly recommend Lantus . It was my choice too . Is Charlie eating ? I think the rest of the crew will advise you to switch insulin too ...... your doing Great hang in there Karen Saying a prayer for Charlie’s BG to go down
 
Deb & Wink said:
Plus, we have links to a lot of the more current feline diabetes vet journal articles and practical day to day advice you can share with your vet.
Click to expand...
My vet ignores the articles I send her ... can you tell why I'm switching. :rolleyes:
I'm envious of all the members who DO have enthusiastic vets willing to learn and share. It's definitely a good thing to have a vet who will work with you.

Karen, there is this handy little guide we like to print out - 2018 AAHA Diabetes Management Guide. It's from the American Animal Hospital Association. They recommend a low-carb diet with Prozinc or Lantus for cats.
 
Dusty & Roe said:
Personally I spoke to my Vet about insulin and she highly recommend Lantus . It was my choice too . Is Charlie eating ? I think the rest of the crew will advise you to switch insulin too ...... your doing Great hang in there Karen Saying a prayer for Charlie’s BG to go down
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Hi Dusty,

Yes, Charlie is eating; he got very skinny before he was diagnosed...that was why I initially took him to the vet. Panic also recommended Lantus. Have a great evening!
 
Panic said:
My vet ignores the articles I send her ... can you tell why I'm switching. :rolleyes:
I'm envious of all the members who DO have enthusiastic vets willing to learn and share. It's definitely a good thing to have a vet who will work with you.

Karen, there is this handy little guide we like to print out - 2018 AAHA Diabetes Management Guide. It's from the American Animal Hospital Association. They recommend a low-carb diet with Prozinc or Lantus for cats.
Click to expand...

Thanks, Panic! It remains to be seen how my vet will be when I email my numbers to her. I wanted to try to get as many tests in today--after the disaster of yesterday--before emailing her. If you have nothing better to do tonight, would you take a peek? I did his PMPS and am waiting to do a +1 and maybe a +3. +3 was where he dipped so low yesterday morning.
 
Deb & Wink said:
I happen to be one of the members that believes keeping a good relationship going with your vet is important.
Think of us as an "adjunct" or supplemental resource to your vet.

p.s. It really is time for a new thread. Simply link this old one at the top, for reference and history.
Click to expand...

Thanks for you perspective, Deb. I will go ahead and abandon this thread where conversation is off the original topic.
 
Karen & Charlie said:
Thanks, Panic! It remains to be seen how my vet will be when I email my numbers to her. I wanted to try to get as many tests in today--after the disaster of yesterday--before emailing her. If you have nothing better to do tonight, would you take a peek? I did his PMPS and am waiting to do a +1 and maybe a +3. +3 was where he dipped so low yesterday morning.
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Sure I'll stick around! It'll be interesting to see what he does tonight. :) Looks like he was trying to clear that bounce earlier.
 
Morning, Karen. :)

Looks like Charlie might be bouncing a bit after yesterday's AM cycle green.

I think it was right to reduce the dose from 1.0IU to 0.75IU of Vetsulin. It's what I would have done if Charlie were my cat. That green was a low green, there was no bit of safety cushion in it at all on the 1 unit dose. Also, most cats run lower in their night time cycles so that 1 unit dose could have potentially taken BG lower again than the 64mg/dL that you saw yesterday.

You did a great job with the testing, Karen. It shows that Charlie is giving a textbook response to Vetsulin: dropping fast in the early part of the cycle, and the dose pretty much spent by +8.

Bon chance with the vetty bean today. :)


Mogs
.
 
Critter Mom said:
Looks like Charlie might be bouncing a bit after yesterday's AM cycle green.

I think it was right to reduce the dose from 1.0IU to 0.75IU of Vetsulin. It's what I would have done if Charlie were my cat. That green was a low green, there was no bit of safety cushion in it at all on the 1 unit dose. Also, most cats run lower in their night time cycles so that 1 unit dose could have potentially taken BG lower again than the 64mg/dL that you saw yesterday.
.
Click to expand...

Thanks, Mogs! Would you recommend I keep randomly testing Charlie every day, like I did yesterday? Is this how it goes? Just keep testing and injecting and hope something changes? Gah!

468 AMPS is highest since I've been testing (3 days).

I see you switched from Caninsulin to Lantus which is what I want to do! Do you syringe out of the pen or use the pen injector?

Thanks a million!
 
Karen & Charlie said:
Would you recommend I keep randomly testing Charlie every day, like I did yesterday? Is this how it goes? Just keep testing and injecting and hope something changes? Gah!

468 AMPS is highest since I've been testing (3 days).

I see you switched from Caninsulin to Lantus which is what I want to do! Do you syringe out of the pen or use the pen injector?
Click to expand...
Good job with the tests yesterday, Karen! :D
Keep an eye on those numbers between +1 and +5 mainly, that's where the action is for him.
You're experiencing bounce numbers AND the result of Vetsulin not acting long enough. Unfortunately he's probably always going to be unpleasantly higher at pre-shot simply because the insulin has run out a few hours before, thanks to the short duration.

We use the Lantus pens like mini vials, so you insert the syringe into the pen. When you use the pen injector it only allows full units, so you couldn't even draw Charlie's 0.75u dose. Plus you have to "prep" the pen, which means wasting 2 units every time! :eek:
 
Panic said:
Keep an eye on those numbers between +1 and +5 mainly, that's where the action is for him.
You're experiencing bounce numbers AND the result of Vetsulin not acting long enough. Unfortunately he's probably always going to be unpleasantly higher at pre-shot simply because the insulin has run out a few hours before, thanks to the short duration.

We use the Lantus pens like mini vials, so you insert the syringe into the pen. When you use the pen injector it only allows full units, so you couldn't even draw Charlie's 0.75u dose. Plus you have to "prep" the pen, which means wasting 2 units every time! :eek:
Click to expand...

Gotcha, thank you!!
 
Karen & Charlie said:
Thanks, Mogs! Would you recommend I keep randomly testing Charlie every day, like I did yesterday?
Click to expand...
Not all that randomly with Caninsulin/Vetsulin.

When Saoirse was on Caninsulin, in textbook response to this insulin her BG dropped hard and fast early in the cycle. For her safety, I did the following tests as a matter of course:

* AMPS
* AM+3 (earlier if she showed a marked hunger uptick at onset of the dose - anywhere from +1 onwards - and then the regular +3, as she tended to nadir early).

* PMPS
* PM+3 (so I could be as sure as possible she would be safe while I was asleep.)

I would check again later in the cycle if her +3 tests were uncomfortably low.

I would do occasional curves or spot checks to cover the +6 to +8 period to track the duration of the Caninsulin dose (or rather, lack thereof). This provided evidence for my vet to be able to prescribe Lantus under UK drug cascade rules, where it must be demonstrated that a treatment licensed for use in cats is not fully effective before other non-licensed treatments can legally be pursued.

I advocate ALWAYS getting a before bed check, regardless of insulin type, especially because most cats tend to run lower at night.

One night early in Saoirse's treatment, a before bed check saved her life. It was the only symptomatic hypo she had - and she was still ABOVE the lower limit of the normal reference range.

Is this how it goes? Just keep testing and injecting and hope something changes?
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Other than making dose adjustments as required, pretty much. :rolleyes:

Gah!
Click to expand...
I could not have put it better myself. ;)


Mogs
.
 
Karen & Charlie said:
I see you switched from Caninsulin to Lantus which is what I want to do! Do you syringe out of the pen or use the pen injector?
Click to expand...
Forgot this bit! :oops:

I used 10ml vials of both insulin types. I have PTSD and my hands get very shaky so I found the vials easier to manage. I did try the pen cartridge (as a sort of mini-vial) but I found it too fecky to use.


Mogs
.
 
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