? Post #2 on Newly Diagnosed Nala

Good morning everyone. So we ended the day off yesterday with Nala being at the vet for her scheduled glucose curve. I had decided to transition Nala from the Purina DM script to ONP Wet. Yesterday with the vet was the first day on that transition since I am not yet knowledgeable or comfortable and I wanted her under the vets supervision. Until I decide on a meter (mine is so old I may just get a new one) I am uploading a pic of her glucose curve from yesterday instead of choosing a spreadsheet, I hope that's ok. While talking to the vet, she said to transition slowly from dry to wet, giving the wet for her two main meals with her shots, and letting her have the dry during her two middle feedings slowly transitioning to all wet. (Remember all my kitties are on a schedule for now, 8am, 12pm, 4pm, 8pm, and 9:30pm if there is anything left in their dishes from the day). She said that she wants to keep her at 2 units twice a day. She said that for Nalas age and body type, no higher than 250 is what we are aiming for so she was pretty pleased with the last two readings. With the food transition we are to watch her for the next week for any clinical signs that are staying the same (excessive thirst, etc) or if anything gets worse. I will update her Monday and we will see where we are going from there but she feels and hopes this has us in the right direction for remission as that is the goal. Gotta go feed everyone, give Nala her injection, and then head off to PetSmart to stock up on some canned foods. Busy day ahead. I hope everyone has a great day. I will be back on later to read any replies. Thanks!!
Ok, so Im on a new computer and can not get the photo of her GC to upload, so here it is just typed out.

Baseline 280, 8:18am;gave 2 units of insulin and fed
1st Sample 330, 10:27am
2nd Sample 284, 12:28pm
3rd Sample 251, 3:15pm
4th Sample 214, 4:41pm

 

Good morning!

For inputting numbers, most of use a shared spreadsheet template (you can see them linked in our signatures). That lets anyone reading your posts to be able to quickly check through all of Nala's history. FDMB SPREADSHEET INSTRUCTIONS, let us know if you have trouble, we have people who can help get things set up!

Interesting numbers. In our notation (we count hours from shot times, because we're all in different time zones), this would be:

AMPS: 280, 2U insulin
+2: 330
+4: 284
+7: 251
+8.5: 214

Those are pretty good numbers for a pet meter, though still definitely in the diabetic range. I'm interested in the fact that they seem to be (slowly) dropping or at least holding steady in the second half of the cycle. I'll let the Prozinc folks comment in more detail about this, but I'm wondering again if the 2U might be more than Nala needs. Really, though, we'll have to wait to see more data to know, but this is a great start!

For meters/home testing, the old meter is probably OK, you would just need new strips, but it's not a bad idea to look around to find the meter that will serve current needs best. The main things to look for in a meter to be used on a cat are: size of blood droplet, and (especially) cost and availability of test strips (you'll find that you'll sometimes have to do a lot of testing-- cats can't tell us how they're feeling!). Many in the US use the Relion Prime from Walmart for those reasons, but there are plenty of other options if that doesn't work for you. Good places to look for non-Walmart cheap test strips include Amazon and EBay, though of course there you have to plan ahead so you don't run out.

The other thing you'll need for testing a cat is lancets for doing the pokes. If you were testing yourself or another human earlier, you probably used thin lancets (30 or 31 gauge), and those will work eventually for Nala, but in the beginning you should get some thicker ones, (26 or 28 gauge). Much easier to get the blood droplet! Eventually, the ears "learn to bleed" as more capillaries grow in response to the poking.

OK, that's a lot of stuff, so I'll stop now!

 

Previous post: Newly Diagnosed...Im so confused but not convinced

 

I agree with Nan in that 2 units may be too much. One problem with vet curves is that vet stress can artificially raise BG.
"At-Home Blood Glucose Curves Obtaining a BGC at home is strongly recommended both for dog and cat owners, but even more so in the case of feline patients due to the chance of stress hyperglycemia in a hospital setting."
Above from: https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

I have no objection with maintaining 2 unit dosing and take BGs at home to see if they are different that the vet curve.

Regarding what meter to use, an old OneTouch is fine especially if you use third-party strips like the GenUltimate ones that I use. Real OneTouch strips are very expensive like $1 each. The only downside with the OneTouch (I use two 15 year-old meters myself with GenUltimate strips) is that it requires 1uL of blood. A lot of caretakers here use Walmart's Relion Prime or Premiere. Those only require 0.5uL of blood.

 

So Im adding Wamart to my places to venture into to see what they have on hand that I can purchase today(Relion meter, lancets, strips) If I can't get everything on hand there today I have an order on standby for Amazon to order the lancets and strips fro my One Touch Ultra Mini but they won't be here until Friday.

Boy, I thought we were doing good from what the vet said yesterday, and I wonder why the vet would say we are looking to be staying around the 250 range if normal range is in the 100's. Her words when I asked what number we were looking to stay around and she said no higher than 250 were "based on her age and body weight"...I wonder if she's talking about her current weight and not taking into consideration that she's not at her ideal weight. Ive read so much in so many places, but Im pretty sure I read somewhere that insulin amount should be based on the cats ideal weight, not current weight?? Am I understanding that right. I have still yet to make it out the door for errands. Going to try to head out now. Be back soon.

 

Walmart also has its own branded (ReLion) ketone strips

 

Oh, she is doing well, don't worry!

Most vets do not advise their clients to aim for the normal range of BGs, because (if you don't test fairly frequently) you run a risk of hypoglycemia, which can be deadly. It's perfectly safe to do it if you are testing frequently, though, and in fact really helps get you towards remission (the more time in normal BG, the more time for the pancreas to heal).

Not really sure about the business about age and body weight, on the other hand...

Anyway, when we're talking about the dose possibly being too high, we're kind of reading between the lines of the numbers you have so far, and guessing a bit. A typical nadir (low point) time for Prozinc is between around +4 to +7. To me, it looks like either Nala is a late-nadir cat, or else we're seeing something other than that day's response to insulin in that curve. One explanation for "something other" is that she was coming off of a bounce. A bounce is an extended period of high BG in response to a low BG, in other words, a sign of too much insulin. Not having any numbers after +8.5, I wonder if she kept going down, and where she was at the next pre-shot time?

That said: 1) impossible to really tell that from a single day's numbers, and 2) I'm not super-familiar with Prozinc per se. I'm going to tag @Deb & Wink, who is much more familar with the shape of Prozinc curves than I am, to see if she can fill in the blanks a bit and help explain.

 

Based on the second quote above, it sounds like your vet's treatment objective is for Nala to become well regulated. This means that all her readings should be safely above the hypo threshold (lower bound of the normal feline BG reference range) at nadir and below 250 at peak (on equipment calibrated for cat blood), i.e. below the renal threshold (estimated at 250-290 on a pet meter, per the Merck Veterinary Manual, varies from cat to cat).

Here's a helpful post from the Forum FAQs:

What is Regulation?


Mogs
.

 

Ok, just got home. I bought the Relion Premiere Classic meter, the test strips, and 26 gauge lancets. I also went on a canned food shopping spree with the foods list I found in the link from Dr. Lisa. She last ate at 4pm. So, now...should I check her blood sugar before giving her insulin tonight at 8:30? She is scheduled to eat again at 8ish and when she finishes her food around 8:30 she will get her injection. Am I doing that right? She is the best time to inject? Before, during, or after eating? And then I should check it again 2 hours later right? And now that Im starting a spreadsheet, I chose the one that says human meter correct?

 

No really. Sequence is test, feed and then shoot. It is OK and sometimes necessary to shoot when the cat is finishing eating.
One wants cat to eat all or most before injection since youo want to ensure that cat has eaten before shooting.

 

Gotcha. Im going to set up and try out the meter now to get in a practice poke. its been 2 1/2 hours since she ate. Ill be back to let y'all know what it said...

 

ok guys, got a drop at 7, 3 hours after eating, reading was 186. What does this mean??

 

How many hours since the shot?

 

8:30am this morning, she's scheduled for her next shot at 8:30pm

 

Oh, and congratulations on your first successful test! Whoo-hoo!

OK, so (in our notation), that would be 186 at +10.5. The reason I asked is because it's a great number in general, and would be fantastic in the middle of the cycle, but it's a tad low for late-cycle/getting near shot time (as it turns out to be). We generally say not to shoot numbers under 200 when new, so there's a definite chance she's going to be in that zone tonight!

Luckily, by testing now, you'll have some extra information at shot time. You'll be able to tell if she's rising or falling from where she is now, so you'll know if it's safe to shoot or not. Just don't feed her a meal between now and then-- we want that pre-shot "decision" number to be free of food influence.

And just to repeat: the 186 is a good number and perfectly safe (it's well above the usual range for normal cat BG on a human meter, 50-120), we just don't want to be adding more insulin to a number like that without more information. But she's looking good!

Deb usually logs on in the evenings, so I hope she is able to come by before you have to make a shot decision, as I'm not really comfortable with Prozinc dosing. I'm not sure who else to tag...

 

Totally facepalming right now bc she had a few bites if her canned as a treat for letting us poke her ear. So when you say not to shoot numbers under 200, are you meaning that she may not need an insulin shot tonight?

 

Until you get more successful and good at testing, our guidelines here in the Feline Health forum say not to shoot insulin if the BG pre-shot test is <200.
As you gain experience with testing, that pre-shot decision point BG becomes lower and lower. (It's 150 in the Prozinc ISG).

Especially since you are also transitioning Nala to low carb wet food, it's a bit safer to keep her at a slightly higher BG for now.

That last BG test of 214 done with the vet curve is a bit later than usual for most cats using Prozinc. But ECID, Every Cat is Different, so you have to test during the cycle to see how low a particular dose drops Nala. You will also learn with testing at home, when Nala tends to have her low or nadir point in the cycle. That nadir can be different, and vary with a 12 hour cycle. So don't get too worried if you see a nadir that moves around a bit.

Some cats rise quite a bit with their BG's towards the end of the 12 hour cycle. So please try to take another test, the pre-shot test, as you get closer to the actual shot time.

 

Hi Deb, thanks so much for coming on board tonight. So I will test her again at 8:30 which is shot time and then post the number here before shooting, with the thought in mind she did nibble about 7ish as a treat for letting me poke her ear for the first time. The vet has her on 2 units of Prozinc every 12 hours. Many have expressed that may be too high of a dosage, especially since I am transitioning her.

 

Just tested and about to feed her, its a 196, am I a go for her 2 units?

 

Urrggh... that is right on the line.... I don't think I would (she's basically flat, especially with the snack). Can you change your subject line and add a "?" in the dropdown?

 

Ok, so Ill skip the injection. When should I test again to make sure she is ok after a full meal? What am I looking for there to determine if she needs an injection? A drop or rise?
And this is probably a dumb question..lol. but do you mean the title of my thread as being the subject line? Ive been staring at this message board all day and everything is running together..lol

 

Ha! Yes, you can edit the subject line of your post, and there should be a drop-down menu at the left where you can put an icon ("?" for a question, "911" for an emergency, "GA" for "gone ahead"/"Guardian Angel", a kitty who has passed away).

If you skip, I'd test in a couple hours, to see how her pancreas has dealt with the meal.

 

Ok, thank you so much. Ill be up and Im thinking of the one to 2 hour mark. You and the others have been such an amazing help.

 

+1 reading 202, +2 reading 196...Im thinking she is going to be good for the night. What do you guys think? She is also having the last few bites of her left over evening meal as her night time snack. Poor thing, she's bled good for me each poke, but she is totally over it for tonight.

 

Yes, I think you can let her get her beauty rest tonight .

Are you applying a little pressure after the poke? And of course giving her treats each time? The pressure helps prevent bruising, and the treats reassure her that it's not all bad, lol! Actually, most cats soon learn to come running when the testing kit comes out, because test = treats!

She's doing great-- not zooming up yet, even without the shot. Will be interesting to see where she is tomorrow morning.

 

Thanks, and yes, I massage her ear a little before and def apply pressure after as we pet and love on her. I need to def pick up the Neosporin tomorrow as that's the one thing I forgot today. And she has gotten little morsels with most of the pokes but Ill make sure to have something on hand for each one. Im very interested to see where she is in the morning too. Thank you so much for keeping up with me and her today. I appreciate all your time so very much, as well as the time the others were able to put in.

Talk to you tomorrow, Ill probably sleep better tonight than I have the past week. I swear Ive been cramming so much info fro this board I dream this stuff..lol