Nadir???

[Summer and Susie (GA)]

Can anyone tell when and what my nadir is? +4, +5, +6? It seems to be all over the place. I seem to have a lot of inter-day variablility. Does this ever get more understandable or more obvious? Isn't this the number you look at to determine the insulin dose? I'm trying to determine if I should increase to 1.5 units. My vet said it would be okay but I am concerned. I am a Vetsulin user currently at 1.25 units and I use a ReliOn Prime meter.

 

[Marje and Gracie]

Link to last Main Health post for history for members helping in this ISG.

 

[Marje and Gracie]

@Summer and Susie

The link I posted above is so that any members helping here and answering your question could see the previous posts and history. We always do that as a courtesy as it makes it quicker for them to find out what has already been said. I am not ignoring your question since I did answer it in that post (#43).

You are doing a better job of testing and that really helps others respond to questions. It can be difficult, at times, to pinpoint nadirs as they do shift but I’m glad you are thinking about it. I suggested you post here to get others’ opinions especially like @Elizabeth and Bertie who is very well versed on Vetsulin. She has used the insulin more than anyone I know. I’m hoping that by tagging her, she will pop in and start a discussion with you regarding Susie’s cycles and answer any other questions you have on Vetsulin.

It also appears I overestimated the number of people who post here. It looks pretty “sleepy” but I thought I’d seen Eliz around. It might be that you will have to continue to post on Main Health. I apologize for that inconvenience.

 

[Elizabeth and Bertie]

Can anyone tell when and what my nadir is? +4, +5, +6? It seems to be all over the place. I seem to have a lot of inter-day variablility. Does this ever get more understandable or more obvious? Isn't this the number you look at to determine the insulin dose? I'm trying to determine if I should increase to 1.5 units. My vet said it would be okay but I am concerned. I am a Vetsulin user currently at 1.25 units and I use a ReliOn Prime meter.

Hi Summer, sorry for delayed reply.

The numbers can be a bit 'all over the place' at first, for all kinds of reasons. (I've had the same thing with my diabetic girl recently, since she came out of remission and we've had to start over again (even though she's on a different insulin)). That's not uncommon at all.

But I thought that was a nice day for Susie yesterday. That was a lovely shaped Vetsulin curve. And Susie's preshot numbers have been quite consistent over the last couple of days too. So, 'maybe' her numbers are beginning to settle down a bit...
Sometimes it can happen that a cat can get really short cycles at first, and then the duration gets better over time; it sort of stretches out a bit more. And if/when the duration gets better then the preshot numbers can come down a bit as a result of that.
It may be too that she is getting a bit more used to being in lower numbers, and so her blood glucose levels are starting to be less variable.

Regarding the nadir, this is not a precisely fixed point, it can vary quite a bit; but once the blood glucose patterns settle down a bit it often becomes possible to see that the nadir will 'usually' happen between +x and +y.
With Vetsulin the nadir is 'often' between about +4 and +4.5. But on this forum there are cats who've had nadir as early as +3 or as late as +7. ...From looking at Susie's data so far it looks to me as though she may get a slightly later nadir than is most often the case as her numbers settle down a bit.
In the cycles where her nadir seems to have been quite early there often seems to be a possible reason for that; for example, the blood glucose dropped very early on, or quite steeply, or she may have hit a number early in the cycle that her body wasn't that comfortable with, and that may have foreshortened the cycle somewhat.

I saw the note in your 'remarks' about the numbers being lower with the Relion. Yes, numbers from human meters are 'usually' a bit lower than numbers from pet meters, and vice versa. They just read the blood glucose a bit differently, and it's a matter of understanding the range for the particular type of meter, human or pet.

If this were my kitty, and given that the numbers 'seem' to be settling a little, I'd be inclined to stick with the current dose for a bit longer, maybe a few days to a week, and then re-evaluate. That is, unless the blood glucose actually drops too low at any point, or you start seeing preshots that are too low to shoot.... Ideally, at this point (and while you're still getting comfortable with testing, and gathering data) it is prudent with Vetsulin to 'aim' to not let the blood glucose drop below about 90 - 100 at the peak of the cycle. That is to give some buffer of safety in case the blood glucose does actually drop a bit lower than that.
And the general initial advice is not to give insulin if the blood glucose is below 200 at preshot.

How is Susie coping with the testing?

Eliz

 

[Summer and Susie (GA)]

@Summer and Susie

The link I posted above is so that any members helping here and answering your question could see the previous posts and history. We always do that as a courtesy as it makes it quicker for them to find out what has already been said. I am not ignoring your question since I did answer it in that post (#43).

You are doing a better job of testing and that really helps others respond to questions. It can be difficult, at times, to pinpoint nadirs as they do shift but I’m glad you are thinking about it. I suggested you post here to get others’ opinions especially like @Elizabeth and Bertie who is very well versed on Vetsulin. She has used the insulin more than anyone I know. I’m hoping that by tagging her, she will pop in and start a discussion with you regarding Susie’s cycles and answer any other questions you have on Vetsulin.

It also appears I overestimated the number of people who post here. It looks pretty “sleepy” but I thought I’d seen Eliz around. It might be that you will have to continue to post on Main Health. I apologize for that inconvenience.

Thanks for your help.

 

[Summer and Susie (GA)]

Hi Summer, sorry for delayed reply.

The numbers can be a bit 'all over the place' at first, for all kinds of reasons. (I've had the same thing with my diabetic girl recently, since she came out of remission and we've had to start over again (even though she's on a different insulin)). That's not uncommon at all.

But I thought that was a nice day for Susie yesterday. That was a lovely shaped Vetsulin curve. And Susie's preshot numbers have been quite consistent over the last couple of days too. So, 'maybe' her numbers are beginning to settle down a bit...
Sometimes it can happen that a cat can get really short cycles at first, and then the duration gets better over time; it sort of stretches out a bit more. And if/when the duration gets better then the preshot numbers can come down a bit as a result of that.
It may be too that she is getting a bit more used to being in lower numbers, and so her blood glucose levels are starting to be less variable.

Regarding the nadir, this is not a precisely fixed point, it can vary quite a bit; but once the blood glucose patterns settle down a bit it often becomes possible to see that the nadir will 'usually' happen between +x and +y.
With Vetsulin the nadir is 'often' between about +4 and +4.5. But on this forum there are cats who've had nadir as early as +3 or as late as +7. ...From looking at Susie's data so far it looks to me as though she may get a slightly later nadir than is most often the case as her numbers settle down a bit.
In the cycles where her nadir seems to have been quite early there often seems to be a possible reason for that; for example, the blood glucose dropped very early on, or quite steeply, or she may have hit a number early in the cycle that her body wasn't that comfortable with, and that may have foreshortened the cycle somewhat.

I saw the note in your 'remarks' about the numbers being lower with the Relion. Yes, numbers from human meters are 'usually' a bit lower than numbers from pet meters, and vice versa. They just read the blood glucose a bit differently, and it's a matter of understanding the range for the particular type of meter, human or pet.

If this were my kitty, and given that the numbers 'seem' to be settling a little, I'd be inclined to stick with the current dose for a bit longer, maybe a few days to a week, and then re-evaluate. That is, unless the blood glucose actually drops too low at any point, or you start seeing preshots that are too low to shoot.... Ideally, at this point (and while you're still getting comfortable with testing, and gathering data) it is prudent with Vetsulin to 'aim' to not let the blood glucose drop below about 90 - 100 at the peak of the cycle. That is to give some buffer of safety in case the blood glucose does actually drop a bit lower than that.
And the general initial advice is not to give insulin if the blood glucose is below 200 at preshot.

How is Susie coping with the testing?

Eliz

Thanks for all the information. Susie does well with the testing accept for the pre-shot tests when she is very hungry and just wants to be fed. She is very fidgety at these times. I don't like the ReliOn meter as much as I liked the AlphaTrac 2. It was so much easier to get a test with AlphaTrac. I can go through several ReliOn test strips to get one test but I am learning how to use it so I will be patient. I will stick with the current dose. I need to have a more patience with all of this. I'm sorry to hear about your kitty falling out of remission. What insulin do you have her on now?

 

[Elizabeth and Bertie]

Susie does well with the testing accept for the pre-shot tests when she is very hungry and just wants to be fed.

Bonbon is like this in the mornings. She won't settle with an empty tummy. So I just have to feed her and then test her straight after that. Once she's eaten her brekkie she'll wash and then settles down. And then I test her. It's generally done within 5 - 10 minutes of her eating, and so doesn't impact significantly on the preshot blood glucose test.

I don't like the ReliOn meter as much as I liked the AlphaTrac 2. It was so much easier to get a test with AlphaTrac. I can go through several ReliOn test strips to get one test but I am learning how to use it so I will be patient.

Maybe post on the main forum to see if the Relion has any particular quirks that you need to know about..? Or....do you need to apply blood at a different point on the end of the test strip? Is it the very tip of the strip with the Relion strips (different to the Alphatrak)..?

I'm sorry to hear about your kitty falling out of remission. What insulin do you have her on now?

It's just the luck of the draw. According to research about a third of kitties will come out of remission. And I am grateful for the time we had in remission. I can't deny it's strange though to get back into the habit of testing and shooting.
Bonbon is on Levemir now. She was on a UK insulin called Hypurin, but that's been discontinued. Hypurin and Levemir are both 'depot' insulins, but have slightly different characteristics.

I need to have a more patience with all of this.

It does get easier, honestly. (((Hugs))) ...Deep breaths...and one step at a time....

Eliz

 

[Summer and Susie (GA)]

Bonbon is like this in the mornings. She won't settle with an empty tummy. So I just have to feed her and then test her straight after that. Once she's eaten her brekkie she'll wash and then settles down. And then I test her. It's generally done within 5 - 10 minutes of her eating, and so doesn't impact significantly on the preshot blood glucose test.


Maybe post on the main forum to see if the Relion has any particular quirks that you need to know about..? Or....do you need to apply blood at a different point on the end of the test strip? Is it the very tip of the strip with the Relion strips (different to the Alphatrak)..?


It's just the luck of the draw. According to research about a third of kitties will come out of remission. And I am grateful for the time we had in remission. I can't deny it's strange though to get back into the habit of testing and shooting.
Bonbon is on Levemir now. She was on a UK insulin called Hypurin, but that's been discontinued. Hypurin and Levemir are both 'depot' insulins, but have slightly different characteristics.


It does get easier, honestly. (((Hugs))) ...Deep breaths...and one step at a time....

Eliz

The ReliOn Prime strips require the blood at the very tip of the strip. It was easier when I could get blood from the side of the strip. They also require more blood than what the AlphaTrac required. I have also found that I can't push the strip half way in before getting the blood so I need two hands to push the strip all the way in before testing. Kind of hard to do when you are also trying to hold a cat. I did post about the switch from AlphaTrac to ReliOn. I received some information about needing more blood and the end of the test strip. Nothing about any quirks of the meter. My best to you and Bonbon. Thanks for the support.