24 hour curve

[Tina & Sammy]

I understand, both from my vet and from this website that a typical curve is 12 hours with an insulin dose at each end, and the lowest part of the curve between 6 and 7 hours post insulin.

Over a four day period I monitored my cats BG every two hours and found that without changing anything with diet, she was dropping up to 12 hours after her shot.

I am working on getting my spreadsheet uploaded, but here is an example from one of the days.

1/2/10 - 9:46 pm – 393 – two units given
1/3/10 - 1:57 am – 407 - +4 hours
1/3/10 – 8:08 am – 373 - +10 hours
1/3/10 – 10:05 am – 307 - +12 hours
1/3/10 – 11:56 am – 266 - +14 hours
1/3/10 – 2:01 am– 323 - +16 hours
1/3/10 – 3:46 am – 180 - +18 hours (not 100% sure if this was an accurate reading)
1/3/10 – 6:13 pm – 314 - +20 hours
1/3/10 - 8:12 pm – 349 - +22 hours
1/3/10 – 10:00 pm – 500 - +24 hours (3 units given at this point)
1/4/10 – 2:00 am – 392 - +4 hours
1/4/10 – 6:43 am – 342 - +9 hours
1/4/10 – 8:17 am – 409 - +10 hours
1/4/10 – 12:10 pm – 410 - +14 hours
1/4/10 – 5:17 pm – 508 - +19 hours
1/4/10 – 7:14 pm – 408 - +21 hours
1/4/10 – 8:00 pm – 391 + 22 hours
1/4/10 – 9:03 pm – 462 - +23 hours
1/4/10 – 11:04 pm – 594 - +25 hours
1/5/10 – 1:00 am – 589 - +27 hours
1/5/10 – 4:07 am – 600+ - +30 hours (1 unit given)
1/5/10 – 6:00 am – 563 - +2 hours
1/5/10 – 7:49 am – 479 - +4 hours
1/5/10 – 10:00 am – 400 - +6 hours
1/5/10 – 12:00 pm – 356 - +8 hours
1/5/10 - 2:00 pm – 342 - +10 hours
1/5/10 – 4:00 pm – 321 - +12 hours
1/5/10 – 5:00 pm – 343 - +13 hours
1/5/10 – 7:00 pm – 443 (1 unit given)

Understand that Sami is a grazer and eats throughout the day, which could explain some of the midpoint increases and then the drops again. I have started to try to get her on two feedings a day at the time of her insulin, but with 4 other cats in the house I don’t know how successful I will be. Also, as of last night I am trying to convert her to wet food over dry. I understand that this could be a contributing factor.

My question is should I still be dosing twice a day. Under the circumstances of her sugar being so high the vet recommended continuing with the twice a day doses at least until we get her under 200. But the fact that she doesn’t fall in the norm with her curve I am concerned that over time it might cause more problems. She has been on the two doses for over two months, and it seems like the more unites I give her per dose the higher the next value is. I understand that she could be having a rebound effect, but based on the numbers above she is definitely not going too low, unless of course she can drop too low and spike back up again with the time between checks.

I could use any advice you can give. As of this morning Sami was at 189 before her breakfast and insulin. An hour and a half after breakfast and insulin she was at 274.

Thanks in advance for any help that you can provide.

Tina

 

[Monique & Spooky]

Tina I am assuming you are using Lantus insulin.

Lantus does work best if dosed 2x a day (every 12 hours), it is a long acting insulin and generally lasts longer than 12 hours in most cats, it lasts 15-20 hours, however it has it's strongest working on the BG between +3 and +12 (usually upto +10) but we don't wait for the insulin to completly wear off before giving another dose because the BG will rise too much (as you can see from your curve) through the overlap that is formed by giving insulin before the last dose is completely finished we can keep the BG in an overall lower range. It is better to shoot a lower dose more often than to keep trying to shoot down a high number with larger and larger doses. With Lantus consistancy in both dose amount and time are very important. Please read the information in the perment post at the top of this forum, and have a look around the Pet diabetes site in Wiki that I have linked above. This can explain how Lantus works in cats and how these things overlap, duration, carryover all work.

 

[Barbara and tuffy]

Welcome to LL: This is an excellent site for sugarkitties. Reread all the stickies. Yes, dry food is "kitty crack". Too many carbs for the BG. I separate Tuffy from the other 6 when I am out so I can leave out some LC food and she can eat if she needs to. Read Janet & Binky's food chart at the top. There you can find all the carb values of the different foods. Hope to see you posting soon. Ask questions, read other condos (1 post daily and all your information goes in there). Look at some of the spreadsheets. You will learn so much checking out the forum. Good luck, and welcome aboard.

 

[Pat and Skipper (GA)]

Please get your spreadsheet up ASAP so that we can help you better.

The dry food is very probably adding to your skewed results. My cat is also a grazer; but she gets lo carb, wet food only and her curves don't bobble .

You have been doing some dose hopping - sometimes one, sometimes two, sometimes three unit shots. Lantus works best when the dose is allowed to settle before increasing or decreasing and adjustments are made on the basis of the nadir, not on the preshot values.

With Lantus, we start low and go slow. The usual starting dose is 0.5 - 1.0 unit twice a day.
Did you start in that range?

Again, please get you spreadsheet up and continue to post here so that we can help you.

 

[Tina & Sammy]

Please get your spreadsheet up ASAP so that we can help you better.

The dry food is very probably adding to your skewed results. My cat is also a grazer; but she gets lo carb, wet food only and her curves don't bobble .

You have been doing some dose hopping - sometimes one, sometimes two, sometimes three unit shots. Lantus works best when the dose is allowed to settle before increasing or decreasing and adjustments are made on the basis of the nadir, not on the preshot values.

With Lantus, we start low and go slow. The usual starting dose is 0.5 - 1.0 unit twice a day.
Did you start in that range?

Again, please get you spreadsheet up and continue to post here so that we can help you.

I hope to get my spreadsheet up this weekend.

We started with 1 unit. How is it that you can accurately measure .5 units? I have seen that they have a syringe that has a half mark, but where can I get those.

My biggest concern is letting her go to low, which is why I have skipped doses when I have seen a huge drop from the last reading, and a continual drop up to 12 hours. I totally understand about the settling and really need to stay more consistent. Right now she is on 1 unit in the morning and 2 at night. I guess I will continue with this dosing schedule for a few days to see where it goes.

What is your recommendation for dosage base on the nadir number. I can't always test at +6 because I work full time, but I do try to get up during the night to get a readying.

And why would the dose be based on the nadir number rather than the BG at the time of dose. I am just trying to understand all the specifics. This is still very new to me, and I am trying to get as much information as possible so I can get Sami regulated as quickly as possible. I see that some people on these board have been dealing with diabetes for more than a year, and based on some of the spreadsheets it isn't uncommon for regulation to take a few months. After the first bout and then OTJ (starting to learn the lingo), the back on insulin I have been concerned that I have been doing something wrong.

I can tell you in the two days I have been on this forum I have gotten more information here then what my vet has provided. She didn't even know some of the tricks to home testing, and really didn't encourage it. I found the information on my own and for my own piece of mind decided I was going to do the home testing. It has really saved me a lot of anxiety and money from not having to take Sami to the vet every other day for testing.

Thanks again for all the help.

Tina

 

[Sienne and Gabby (GA)]

Hi Tina and welcome to LantusLand (LL)

You're thinking in the right direction -- that the dose is based on nadir vs. pre-shot blood glucose (BG) levels. However, we do not slide the dose on a daily basis based on nadir. Rather, we typically shoot the same amount of insulin every 12 hours. If the BG at nadir, which can be at any time during the 12 hour cycle, is less than 50 in a newly diagnosed cat, then a dose reduction is earned. You might want to review the dosing protocol that we use to guide dose increases and decreases. Doses are held for a period of time in order that they settle and a consistent level is built up in your cat's system (aka a "shed" or depot)

I order my half unit syringes through Hocks. They have good prices and ship quickly. Walmart's brand, Relion, also has syringes that are calibrated in half units. These will be much easier for you than full unit syringes since dose changes are often in 0.25 increments.

Skipping shots when there is a drop isn't really necessary. Whether you need to delay a shot or skip is why getting pre-shot (PS) BG tests is important. Since you've been reading others' thread (we call them condos) here, you may have seen people asking what to do if they get a low PS reading. I'd encourage you to ask what to do if you get a lower than expected BG level. Generally, for someone who is new, a PS level of 150 might be a good time to ask for input.

One of the explanations for the variability in BG is that Sami is bouncing a bit. The 180 may have triggered a rebound since Sami isn't used to that low of a number. Some of the changes in dose may also be effecting your numbers.

Grazing is fine. It's especially important to know that Sami will spontaneously feed if his numbers are running low. But dry food, no matter how good of a food it is, inflates BG levels. If you have not seen Lisa Pierson, DVM's website on feline nutrition, it is a wealth of information. She is a big proponent of a canned food, low carb diet. Information about the carb content of most foods is available on Janet & Binky's food charts.

At this point, I would suggest giving the same dose (1 unit, preferably) twice a day unless one of our experienced members suggests differently. One way to approximate a good starting dose is by weight. What is Sami's ideal weight (vs. how much Sami actually weighs). Does Sami have any other medical problems? Is there a history of DKA (diabetic ketoacidosis), chronic pancreatitis, steroid use, etc?

If you are not already doing so, test for ketones. You can pick up Ketostix at any pharmacy. You may have to stalk Sami to the litterbox in order to dip the stick into Sami's urine stream, but it's one of the only ways to know if there are ketones present. Sami's numbers are high so we want to make sure that ketones are not an issue since DKA is a serious condition.

Open a condo every day so you can get input from everyone here. Do what you are currently doing -- testing, reading other people's condos (and start posting there), look at our spreadsheets, and ask questions. Ask lots of questions! And again, welcome.

 

[Tina & Sammy]

Hi Tina and welcome to LantusLand (LL)

You're thinking in the right direction -- that the dose is based on nadir vs. pre-shot blood glucose (BG) levels. However, we do not slide the dose on a daily basis based on nadir. Rather, we typically shoot the same amount of insulin every 12 hours. If the BG at nadir, which can be at any time during the 12 hour cycle, is less than 50 in a newly diagnosed cat, then a dose reduction is earned. You might want to review the dosing protocol that we use to guide dose increases and decreases. Doses are held for a period of time in order that they settle and a consistent level is built up in your cat's system (aka a "shed" or depot)

I order my half unit syringes through Hocks. They have good prices and ship quickly. Walmart's brand, Relion, also has syringes that are calibrated in half units. These will be much easier for you than full unit syringes since dose changes are often in 0.25 increments.

Skipping shots when there is a drop isn't really necessary. Whether you need to delay a shot or skip is why getting pre-shot (PS) BG tests is important. Since you've been reading others' thread (we call them condos) here, you may have seen people asking what to do if they get a low PS reading. I'd encourage you to ask what to do if you get a lower than expected BG level. Generally, for someone who is new, a PS level of 150 might be a good time to ask for input.

One of the explanations for the variability in BG is that Sami is bouncing a bit. The 180 may have triggered a rebound since Sami isn't used to that low of a number. Some of the changes in dose may also be effecting your numbers.

Grazing is fine. It's especially important to know that Sami will spontaneously feed if his numbers are running low. But dry food, no matter how good of a food it is, inflates BG levels. If you have not seen Lisa Pierson, DVM's website on feline nutrition, it is a wealth of information. She is a big proponent of a canned food, low carb diet. Information about the carb content of most foods is available on Janet & Binky's food charts.

At this point, I would suggest giving the same dose (1 unit, preferably) twice a day unless one of our experienced members suggests differently. One way to approximate a good starting dose is by weight. What is Sami's ideal weight (vs. how much Sami actually weighs). Does Sami have any other medical problems? Is there a history of DKA (diabetic ketoacidosis), chronic pancreatitis, steroid use, etc?

If you are not already doing so, test for ketones. You can pick up Ketostix at any pharmacy. You may have to stalk Sami to the litterbox in order to dip the stick into Sami's urine stream, but it's one of the only ways to know if there are ketones present. Sami's numbers are high so we want to make sure that ketones are not an issue since DKA is a serious condition.

Open a condo every day so you can get input from everyone here. Do what you are currently doing -- testing, reading other people's condos (and start posting there), look at our spreadsheets, and ask questions. Ask lots of questions! And again, welcome.

Sienne and Gabby,

Thanks for all the helpful advice.

Do they have syringes that go down to .25 units? I will try to find the .5 syringes, because that will really help if I have to adjust the dosage and I don't have to worry about guessing. Are the .5 units marked for 1.5, 2.5, etc.?

Depending on where she is tonight I will decide if I should do 2 units twice a day or 1 unit twice a day. Now that she is primarily on wet food that could change things, so I might have to back off to 1 unit just until I can see where she is.

I have been testing for ketones, since the first time she was diagnosed; because that was the only way the vet could provide me a way to monitor at home. That is when I found the information about home testing with the ear prick. When Sami went off the vetsulin back in October I thought I wouldn't have to worry about it, but as soon as she was re-diagnosed in November I purchased a meter and have been testing at home ever since. I only test for ketones occasionally now, if she is in the 400s for a few days. So far she has always been negative.

The spreadsheets are very helpful. Just seeing that I am not the only one having trouble getting my cat regulated helps to ease my mind that it is normal, although stressful at times. I hope with all the information I have collected over the past two days I will be able to be understand the dosing and will start to see some improvement with Sami's numbers.

You can definitely look for future postings on a daily basis as soon as I can get my spreadsheet uploaded.

Thanks again for everyone’s help.

Tina

 

[squeem3]

I hope to get my spreadsheet up this weekend.

Instructions here: viewtopic.php?f=6&t=16

We started with 1 unit. How is it that you can accurately measure .5 units? I have seen that they have a syringe that has a half mark, but where can I get those.

There are insulin syringes with half unit markings.

Here are close up pictures on how to measure small insulin doses---> http://romlin.com/jock/SyringeFineGradations/

Here's a thread on the old board with members' preferred brands of half unit marked insulin syringes ---> http://www.felinediabetes.com/phorum5/r ... 22,1959486 It may take a minute or two for the page to load. You can buy half unit marked insulin syringes online with no prescription. You can buy them at your local pharmacy with a prescription but sometimes the pharmacist will give you a hard time and insist that there is no such thing as a half unit marked insulin syringe :roll: