GENERAL INFORMATION AND IMPORTANT LINKS If you're new to the FDMB, please start on FELINE HEALTH: The Main Forum where you'll learn all about hometesting, the basics of feline nutrition, and feline diabetes. Please be sure you read “New? How You Can Help Us Help You!" *** IMPORTANT DOCUMENTS *** Symptoms of & how to treat HYPOGLYCEMIA - what to do if your kitty experiences hypoglycemia Jojo's Hypo Tool box - be prepared, what to have on hand in case of an emergency Welcome to this Insulin Support Group! We've put together information we think will be helpful. Most Stickys and Info posts have links (clickable, in blue font) to provide answers to many of your questions. Although, one of the first things you'll probably want to do is check out the Syringe & Insulin Info: Handling, Drawing, & Fine doses sticky to learn how to properly care for your insulin so it'll last as long as possible. Confused about our jargon? Don't let it scare you off! You'll catch on in no time. Until then, here's some help: FDMB Glossary - common abbreviations & definitions used throughout the Feline Diabetes Message Board Until you have a moment to read through the glossary, here is a short list of some key terms/acronyms that you need to know as you get started: BG: Blood glucose. Sometimes called blood sugar. Bounce: a sharp increase in blood glucose. There is more about this in a later section below. Curve: The shape that the graph makes when the BG numbers are graphed. Generally a full curve refers to mid-cycle testing every 2-3 hours throughout a cycle. Cycle: A cycle is 12 hours. It is the time between shots. There are two cycles each day. ECID: Every cat is different. While these guidelines will help you get started, ultimately you need to learn how your own cat reacts and learn to make adjustments to meet the needs of your cat. This takes time and data. Mid-Cycle: The BG tests that are done between the two shots. Getting tests at different times is important to creating a full picture of how your cat is responding. So some days you can get a +6 test, some days a +4 test, some days a +9 test, etc... Nadir: the lowest blood glucose number during the cycle. This is also the peak action of the insulin. The nadir can vary by insulin and cat. Normal BG: Normal BG for a non-diabetic cat is between 50-120 on a human meter. You will find different ranges listed throughout the internet, but this is the range we’ve found to be most accurate. No-Shot Number: Usually shortened to NS. This is the pre-shot number that you use as your cut-off. If the BG is below your NS number, you either delay, reduce, or skip the shot. In the first three months, we recommend using 200 as your NS number. As you collect more data and are confident in your cat’s response, you will be able to shoot on lower numbers. PS: Pre-shot. This is the BG number that you get right before you give the injection. It is used to make sure that the BG is high enough to safely inject the cat. “AMPS” is the A.M. PS (the test before the a.m. shot is given) and PMPS is the P.M. PS (the test before the p.m. shot is give). Keep in mind every cat is different (ECID). Data collection will offer you a better picture of YOUR cat's response to insulin and his/her onset, nadir, and duration. Initially, don't expect to see "active" cycles after every single shot. Chances are, your kitty had diabetes for some time before diagnosis. It requires time for kitty's body to become used to dropping into lower numbers than their bodies have become accustomed. Don't expect immediate results! Regulation takes time and patience! A full understanding of the following concepts will go a long way in helping you regulate your kitty's blood glucose: Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose Peak/Nadir - the lowest point in the cycle Duration - the length of time insulin continues to lower blood glucose How to do a Curve - a simple explanation Carryover - insulin effects lasting past the insulin's official duration Overlap - the period of time when the effect of one insulin shot is diminishing and the next insulin shot is taking effect. Bouncing Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce”. It should be noted that “bouncing” is a term we use in the FDMB and might not be recognized elsewhere. Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles). You cannot avoid all bouncing. It is normal and natural, and frustrating. There are some things to keep in mind that can help though: Following a bounce, a cat’s BG may stay high and flat for several cycles. Avoid the temptation to increase the dose at this point. If the BG does not return to normal in 6-8 cycles, an increase might be needed based on the method of regulation you are following. Some vets might have little/no understanding of the bouncing phenomenon. Consequently they will look at a single BG number or a single in-office curve and change the dose without realizing that they could be looking at a bounce number, or a high-flat cycle following a bounce, and increasing the dose will make it worse. There is also a common misconception, often by vets, that bouncing is caused by chronic Somogyi rebound. Michael Somogyi published one paper based on a very small number of human diabetic subjects on the topic in 1938 in a local St. Louis medical journal. There has been no replication of the research and, in fact, anyone that has attempted to replicate the research with humans failed to find similar results. The research has never been done with cats and, just as importantly, has never been done with cats (or humans) using a long-acting insulin. When it’s not a bounce: in general, during a cycle, the blood glucose should decrease for a few hours, and then begin to increase again. If you plot the numbers on a graph, they should look like a smile. This rise in BG towards the end of the cycle is normal. It is not bouncing. As a cat gets better regulated, the cycle will get a little flatter and the PS numbers will decrease, but in the beginning, it can feel like that rise at the end is a bounce. It often isn’t. It’s just the insulin losing duration. As you slowly reach a better dose for your cat, the insulin will last longer and the numbers will look better. 'What is Regulation?': There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald proposed the following "regulation continuum": Not treated - blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs Treated, but not regulated - often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs Regulated - generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia Well regulated - generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia Tightly regulated - generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin Normalized - 60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a glucometer calibrated for humans. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure. Links to more information and discussion: Blood Glucose Converter Calculator (metric to US value) (1 mmol/L = 18 mg/dL) Blood Glucose Meter Ratings, Comparisons, & Recommendations AlphaTRAK meters and AlphaTRAK 2 test strips: If AlphaTRAK users choose not to upgrade to the newer AlphaTrak 2 meter, you can continue to use your original AlphaTRAK meter with the new AlphaTRAK 2 test strips. Be sure and check for the correct code. For the most accurate AlphaTRAK® test results, upgrading to the new AlphaTRAK® 2 meter is suggested by the manufacturer. Suggestions for Advice Givers Vet Interview/Screening Topics & Check List - ideas for what to ask when looking for a new vet American Association of Feline Practitioners - find Veterinarians & Practices in your area INDEX: Health Links / FAQs about Feline Diabetes - Bookmark this forum! Answers to questions, tips, and articles on feline diabetes. Check it out. Hometesting Links and Shooting Tips - Tips, tricks, & videos from FDMB members. Find what works for you! Dosing with calipers (optional) Insulin ruler template for use with BD syringes: https://www.diabetes-katzen.net/insulinruler.pdf Preventing over doses - FDMB members share test-feed-shoot routines Calculating % Calories from Carbohydrates Using Food to Manipulate the Curve Feeding Low Carb vs Lower Carb Foods Carb sensitivity - thoughts Discussion: "Feed kitty as much as they want?" How much should I feed? How to Stimulate Kitty's Appetite How Low is Too Low? Cat on a Pogo Stick Discussion: Increase, maintain or lower the dose to stop bouncing? Rebound hyperglycaemia in diabetic cats.pdf Feline Diabetes and Glucose Toxicity links Ketones, Diabetic Ketoacidosis (DKA), and Blood/Ketone Meters Oldtimer Alex Update & Ketone Awareness thread American Veterinary Dental College Anesthesia Free Pet Dentistry: Know the Facts AVDC Veterinary Dentist Directory Medication Warnings - Certain veterinary medications for other conditions may seriously affect diabetic patients. Alternative Medication Warnings Metacam/Meloxicam discussions (Strength and Dosing for Cats): Metacam ! - Is it safe? Bronx's hypo & arthritis thread (begins around Post #80) A Primer On Pancreatitis ISFM Consensus Guidelines on the Diagnosis & Management of Feline Chronic Kidney Disease To vaccinate or not: That is the question Feline Diabetic Neuropathy (weak Back legs) Acromegaly - the basics Acromegaly - interesting posts from the past (2014) 39th WSAVA Congress Which Insulin in Cats Management and Monitoring of the Diabetic Cat Feline Diabetes Diabetes Mellitus and Quality of Life Acromegaly in Cats Insulin Resistance Medical and Nutritional Management of Diabetes Mellitus French Fry's FD Library Please be aware: There are not any "dose advisers" or "experts" on the FDMB. The FDMB is an open board subject to peer review where laypersons with varied degrees of knowledge and experience are free to share their own thoughts and opinions through explanation and by making suggestions. We are not veterinarians. It is not our intention to take the place of your veterinarian. Please discuss dosing, methods, medications, and care for your cat with your veterinarian. Hope this information helps ease your way through this journey... WELCOME to this INSULIN SUPPORT GROUP! ====================== This document was written by FDMB members Jill & Alex (GA) and modified by Marje and Gracie with contributions from Sienne and Gabby (GA) and Djamila.