Glucose Curve intepretation

Hi, I did my first curve 2 days ago. Would someone explain to me what's happening with my cat's glucose and insulin during the curve. Should I do anything differently? The next day, his numbers were great and low (I did not give insulin), but this morning they are slightly higher. Thanks!

 

I say Nacho is on the track to remission again. I say 0.25 unins Caninsulin is too much but some is still needed. Since you are using a U40 insulin, Caninsulin, If you use U1000 human syringes with 1/2 unit markings, you can easily dose 0.1 units of Caninsulin since each 1/2 unit mark on a U100 syringe filled with a U40 insulin is only 0.2 units of the U40 insulin and you can eyeball halfway between the 1/2 unit markings for o01 units of the U100 insulin. For full chart of conversion see:
http://www.felinediabetes.com/insulin-conversions.htm

 

Hi Marinachi,

Nice job with the curve.

For a kitty on Caninsulin, Nacho's doing really nicely. That's a really smooth, shallow curve for this particular insulin. He might be a little higher this morning due to the two skipped doses.

I see Larry has given you some pointers on dosing. I agree that he still seems to need a small amount of insulin but, looking at the spreadsheet as a whole, the overall trend is really good: better numbers now, and on a smaller dose.


Mogs
.

 

I unfortunately have a bunch of the U40 half marking syringes (Elimedical) 1ml/cc right now.

 

Would this be roughly 0.1 units?

 

Ive included a picture above, would that be roughly 0.1 units to give to Nacho now?

 

Just seen this. Looking something up. BRB...


Mogs
.

 

I'll prob buy a box of syringes with the other markings this week to get him into remission as it looks like he's close!!

The fees aren't fun! Haha

 

Here's a pictorial guide to measuring finer doses. The pics are for U100 syringes but the principle is exactly the same for U40s.





Does the above help enough?


Mogs
.

 

Thanks! What do you think of my picture? It was definitely less than the 0.25 I was giving.

 

Which syringes would you recommend from this list to make it easier to shoot 0.1 or 0.25?

https://wyserpetsupplies.ca/collections/syringes

 

Hi Marinachi,

Not ignoring you. Having problems with my laptop.

I've no idea about the syringes - I've only used the BD ones you can get in the UK. I'd suggest starting a new topic thread to ask for syringe recommendations from members on your side of the pond.

It looks to me to be definitely less than 0.25IU.

Tip: One thing to be especially careful of when you're down to microdoses is the position of the printed scale on each syringe. Sometimes they can be off by a significant amount. I used to keep a reference syringe with the markings in the correct place and I'd then check for any offset in the syringe I was about to use against it.


Mogs
.

 

I strongly feel Nacho got out of remission and his glucose must have spiked after eating Dr. ELSEY'S CLEAN PROTEIN dry food along with his fancy feast classic pates. Since I stopped feeding him the dry food, his numbers have been dropping as well. But it could also be the insulin haha

 

He was 10.1 this morning and with the roughly 0.1 unit, his number is at 6.4 (+3). That's pretty good!

 

Very nice.

If you're in a position to test, it might be helpful to see where Nacho is at +4.

I've read reports here recently about other cats whose BG levels improved when their caregivers withdrew that particular dry food, so your hypothesis has merit.


Mogs
.

 

Hi again, should I be increasing Nacho's dose again? 0.25unit maybe?

https://docs.google.com/spreadsheets/d/1wzhQVyyc2CtxBIIgJzeQ5fVCCdoUxtx_w1p8pPMLe5c/edit#gid=5

 

Hi Marinachi,

I'd be inclined to hold the current dose for another couple of days and then review again. There's not much of a muchness between his current numbers and where he was on the 0.25IU dose recently, and his preshot BGs are trending down a bit on the 0.1IU dose (very encouraging). Increasing to 0.25IU might possibly take him a bit too low. If you were to increase the dose in a few days' time, I'd be inclined to suggest just fattening the 0.1IU to see how Nacho did with a bare smidgen more insulin.

What do you think yourself?


Mogs
.

 

I will continue with the 0.1 roughly and see how it goes. I am always hesitant to shoot when the reading is in the 7.0-8.0mmol range like he was in the PM. At one point should I stop giving insulin completely? What are the pre-shot numbers/ +3/+4 numbers again that will show me he's gone into remission?

 

Good morning! Nacho went from 8.6 AMPS to 5.6 (+4) - I gave him about 0.1units. Is that ok?

 

Hiya.

Nice cycle today. Will be interesting to see where Nacho is at PMPS today. Would be good to see whether it's round the same as AMPS.

At the rate Nacho's going at the moment, I think you might want to consider reducing dose from 0.1IU down to a drop dose.

If any PS is lower or if you aren't in a position to monitor round nadir on ANY cycle, if Nacho was my cat I'd skip. Because his numbers are so good, I'd recommend to start testing at +2 latest on every cycle - possibly even +1.5 - if you do give insulin so as to catch any lower numbers earlier (and intervene with food if required).

Given that Nacho's numbers are mostly in the normal range now, and assuming Nacho is not ketone-prone, then it might be sensible to look at a remission trial to see whether he might drift down the rest of the way following suspension of insulin treatment.

What do you think yourself, Marinachi?

Is Nacho eating well? Do you monitor for urine ketones at all?


Mogs
.

 

His numbers at PM were much lower. I will be skipping tonight. He is eating quite well. I do not monitor for ketones, I was planning on taking him in 1-2weeks to see his urine. Is there a way of monitoring his urine ketones at home? I believe there are strips I can use but I think it would be challenging to catch him in the act?
Is a remission trail, not giving him insulin for 2 weeks?

 

Ace! That's what I was hoping you might see. I've noticed that sometimes when a cat's near remission giving insulin might bump numbers up a little and when the dose comes down (or if a cycle is skipped) the cat might start getting lower preshots.

Good that you're skipping tonight (I would!). Did you feed Nacho after doing the PMPS reading? If yes, it would be great if you could check his BG at the normal PM+1 and PM+2 times to see how his pancreas is handling BG levels round mealtimes unassisted. This would be really helpful in assessing whether Nacho might be ready for a remission trial (and yes, that's checking how BG goes without insulin and if a cat stays in normal numbers for 14 days the trial is considered a success).

Re ketones, you can get urine test strips at any pharmacy. Some helpful links:

FDMB ketone primer

Tips for collecting and testing urine

You can also get blood beta ketone meters (see primer). The strips ain't cheap, but you can test on demand in the same way as you'd test BG, with a blood droplet from the ear. Unless there were a problem, testing once a day is fine.


Mogs
.

 

Hi! I was wondering how do you do a drop dose exactly? I asked my vet tech friend and she didn't know what that meant.

 

Hi Marinachi,

- Push the plunger of the syringe as far down as it will go and hold it in while you insert it into the insulin vial.

- With the needle in the vial, release the plunger. This should suck a tiny droplet of insulin into the tip of the needle. Remove the needle from the vial.

- When administering the dose, insert the needle into the tent, push down the plunger as far as you can and hold for a count of ten.

- Withdraw the needle from the skin tent before releasing the syringe plunger.

You could try practising 'sipping up' the droplet dose with a used syringe and some water. After you've drawn up the droplet and removed the syringe needle from the water, squeeze down all the way with the plunger and you should see a tiny droplet of water appear on the needle tip.

Nacho's sooooooooooo close! (Anti-jinx!)


Mogs
.

 

Just saw Nacho's PMPS!!!

C'mon, li'l fella...

(((Nacho)))


Mogs
.

 

hahaha Thanks! I obviously skipped the dose tonight. It definitely made me very happy! but he's now at 9.8.

 

hi Critter Mom! not sure what is happening. Nacho's numbers have increased again. I decided to give 0.25units today. Not sure if that's the right thing to do but I will monitor today and see. He was doing so well!

 

Hi Marinachi,

As I mentioned before, with Nacho getting into a better and better range getting mid-cycle tests on BOTH cycles is much more important. If you don't know how he's doing at night (possibly dropping lower) it makes interpreting daytime numbers more problematic. I can only speculate here but the yellows you saw in the AM cycle yesterday could possibly be a bit of a bounce from a lower number on the previous PM cycle (or could Nacho possibly have got into some contraband?). It's usually better to give it a few days to see whether there's a marked upward trend in BG levels before increasing the dose, especially when your kitty can drop quite low on only a small dose of Caninsulin.

I'd suggest being very conservative and cautious about dosing. Given that you've increased the dose today to 0.25IU it's definitely highly advisable that you monitor BG very closely. I'd recommend starting to test from +2 because if the dose is on the high side for the cat's needs sometimes with Caninsulin you get really early nadirs at +2 (and Nacho's already done that once a few AM cycles ago).


Mogs
.