New Member - Glucose Curves?

Hi Everyone,
My name is Caitlin and my 10 year old male kitty, Charleston (who I usually call "Mr. Cat"), was diagnosed with diabetes on April 27. It took me a couple months to recognize that he was showing symptoms of diabetes, but after his weight dropped very quickly I finally got him to the vet. I feel terrible that I didn't notice the symptoms sooner. At diagnosis, his blood glucose was 551 and his fructosamine was 445. We started him on 1U, 2x daily of ProZinc on April 30. Yesterday he went in for a check-up and the vet upped his dose to 2U, 2x daily. I've created my SS with all his info

Overall, Charleston has been a real champ about this whole process. I seem to be the one who is more stressed out by the diagnosis, treatment, monitoring, etc. When he was first diagnosed, I immediately started the process of switching him from his HC dry food to LC wet food. It took a couple weeks, but he seems very content eating FF at this point. He had diarrhea for a few days, but things are back to normal now. Administering the insulin shots has been fine as he seems totally unbothered by them. However, we've definitely been struggling with the glucose monitoring. I feel like his poor ears are becoming pin cushions. He does not like his ears messed with at all, but I've been bribing him with LC treats and we're making progress. Now if I could just stop accidentally stabbing myself in the process...

Question: His blood glucose feels like it has been all over the place. I'm a little surprised my vet hasn't suggested a blood glucose curve yet. I wanted to do a curve today, but I think I may have already messed it up. I measured him before his first meal (302) and shot 2U at 7:15am. Then I fed him and gave him his shot. I also just measured him again at 9:15am (404). Was I supposed to measure him after his first meal? Should I continue with the curve today or try again tomorrow?

Thank you! So glad I found this place!

 

Hi Caitlin and welcome!

What you’ve done so far is correct for the curve. You should now test him every 2 hours and you already did that at 7:15&9:15. Food doesn’t matter at this point it’s only important not to feed 2 hours before the preshot test so you get numbers not influenced by food and then 2 hours before the night preshot test as well.

have you found all the info about testing and tips on how to do it? I’m happy to post it here for you. My personal tip is I use a flashlight that I aim at the spot so it makes it easier for me to see the lancet going into the ear. Are you also warming up the ear? I find that makes a world of difference in getting the blood to just pop out. You can also try to milk the ear if you see a tiny red dot already and that can make more blood come out. It’s like gently poping a pimple to get that bigger droplet. And are you aiming for the sweet spot?

I totally understand how you feel I was there myself it took me a while to to get her diabetes regulated. Minnie also lost a ton of weight and even developed neuropathy but I’m happy to say she’s recovered amazingly well and is regulated now. You’ve come to the right place! I don’t know a lot about prozync but we do recommend that you only increase or decrease insulin by .25 increments not full units. I know that’s how vets do it but we feel you may miss the ideal dose that way. Anyway, let’s see what your curve tells us and I’m tagging @Deb & Wink who knows a lot more about prozync than me. She usually responds in the evenings so hang on!

PS - do you have 1/2 unit marked syringes, that helps with those 1/2 or 1/4 doses

 

And here’s some helpful reading reading on ear testing:
https://sites.google.com/site/michelangeloprofilefdmb/feline-diabetes/ear-testing-psychology

oh are you applying pressure to the spot on the ear after you test? I hold it for a few seconds with a cotton oval and that helps the ear not to bruise. It works like a charm!

 

Thank you! I'll keep going with my curve today. I haven't read the Ear Testing Psychology yet, so will do that now! I've been reading lots of tips on ear testing, but I need to start implementing more of them (e.g. warming the ear). I'm doing okay on getting blood, just getting kitty to sit still and not shake his head has been a challenge.

I was a little surprised that my vet upped his dose by a whole unit. Glad to be monitoring his levels closely today because it definitely makes me nervous. One good thing about this happening now is that I am home all the time working remotely, so I can keep a constant eye on him. Very very grateful for that.

My current syringes don't have 1/2 or 1/4 unit marks. Will look for those when I buy syringes again

 

I see you’re in the US. Walmart carries the 1/2 units. There are no 1/4 but it’s easier to guesstimate let’s say 2.75 with a syringe that has 1/2 unit marks.no prescription needed. See attachment.

For me, warming the ears is key for blood easily coming out. But if you’re doing okay with that, keep it up! Sitting still is a challenge. Make sure you hold the ear firmly. I’ve had many accidents with Minnie wiping her head and felt horrible as the ear gets slashed once the lancet is in I have to remind myself animals respond better to us being firm when handling them since that’s what their moms do. Anyway, do give a treat consistently after because that helps them get used to putting up with it and staying still since they know they’ll get a reward

 

You can use U100 syringes with a U40 insulin, like Prozinc, but that can get a bit complicated for new members.
We do have a conversion chart for measuring the U40 dose in a U100 syringe. Going the other way, with measuring U100 insulins in a U40 syringe is not possible. Different concentrations make it hard enough to measure.

Let us know if you are interested in using U100 insulin syringes with the U40 insulin.

BG levels will be all over the place at first. It took time for your cat to become diabetic, it will take time to get Charleston better.

Yes, our protocols here only make dose changes in 0.25U increments. Most vets raise the dose by 1U increments at a time.
Please see the "Sticky" or pinned posts at the top of the Prozinc ISG forum for more information on using Prozinc.

Charleston got a nice drop in the middle of the cycle with the 2U dose. Curve looks pretty decent so far, for a newly diagnosed diabetic cat.
You want to test in both AM and PM cycles, or else you are missing half your data.
So a "Before bed time" test is a good one to get in the PM cycle.
A cycle is 12 hours, to coincide with the shots given twice in each 24 hour period.

 

Thanks @Deb & Wink! I wish I would have pushed back with my vet more when they wanted to double his dose. If we get to a point where they want to increase again, I'm definitely going to ask to do .25U increments. I'll read through the protocols so I know better in the future. Do you think I should stick with the 2U doses or consider dialing back to 1.25U?

I have to admit, I got pretty nervous when I got the low 200s reading today at +7 since it was so much lower than I had been seeing. I called my vet because they previously instructed me to call them if he went below 250 on the AlphaTRAK, but once I finally got a hold of them, he was on his way back up. They seemed surprised I was doing a blood glucose curve, but asked me to share it with them when I was done and call tomorrow to discuss. For tonight, vet said to give him 1U if his PMPS is 250-300, but the full 2U if he is above 300.

Lots for me to learn still and appreciate everyone here for the knowledge sharing and help! Trying not to get too overwhelmed.

 

We actually don't dose based on strictly the pre-shot numbers with Prozinc. The mid-cycle nadir or low, is key to adjusting the dose for Prozinc, as it is for most insulins.

Charleston looks ok for now on the 2U dose. Hopefully he won't bounce too high after those drops into the yellow range ( low 200's). We like to see cats get even better and better control of the diabetes, than many vets like to see.

If you had more test data, to tell how Charleston does on a particular dose of the Prozinc, you could even shoot a BG number >200 safely. As long as you are around to monitor and have sufficient test strips and your hypo toolkit ready to go.

That 200 threshold for giving insulin gets lowered as you gain more knowledge about Charleston's onset, nadir, duration, etc.
Look at the Prozinc dosing protocols, and then ask questions.

There are options like stalling and giving a token dose, instead of skipping an insulin shot entirely.

So what if he is <250? What did your vet suggest you do then?

 

Okay, going to spend some time reviewing and absorbing the Prozinc dosing protocols and then will ask questions over in the Prozinc/PZI group. I'll also keep home testing and collecting data on how he's doing on his dose.

The vet's input was to skip the dose if <250, which I see contradicts the dosing protocols here. Charleston is back up to 409 at +10 though, so looks like a full dose is going to be appropriate under their guidelines. I'm definitely realizing I need to be more skeptical about my vet's advice.

 

when you test outside of doing a curve, we - and I love how I’m part of we now but Deb here is the one that got me to start home testing as frequently as I do now so she gets the irony because I was not a super easy one to convert lol - anyway, we suggest you get the amps and pmps always but also the day nadir - which could be at +6 or +7 or even + 5 so you can vary these - and the pm +2 so you can see where he’s headed overnight as you sleep.

You’re doing great and I’m happy the vet wants to see your curve data. I’m sure he/she was super impressed haha! You go girl!!!

 

If you could actually stay in the Feline Health forum a bit longer, that would be good. At least for a few days.

Not many people to help over in the Prozinc ISG, and Deb can't be on 24/7. But hopefully, there would be someone else to help you here in this forum.

 

@Aleluia Grugru & Minnie I will plan to check his amps/pmps, nadir, and pm +2 daily. I'm an easy convert And thank you!

@Deb & Wink Okay, will stick to this forum for a bit longer. Appreciate all your help!

 

Hi Caitlin I am a new member too and Bee is also on Prozinc. Welcome and hope to see you around

 

Hi @Lalkabee! Thanks for the welcome. So glad we found this place!