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Diabetes in Pets

Curve

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A curve is the result of regular blood glucose readings taken over the space of 12 or 24 hours, on the same animal, with notes on timing and amounts of insulin and food. (For how to take a reading, see hometesting.)

The curve shows the action of the insulin on the animal's system, and can be used to adjust dosage. It's useful to find the highest and lowest blood-glucose readings of the day, the peak action time of the insulin, the onset time and duration of the insulin. See also Insulin for more information on how long your particular brand of insulin is expected to last.

Some people and even vets mistakenly try to base an insulin dosage on one or two readings. This is dangerously mistaken -- there's no way to know if that reading was at a high or low point in the day, or if the reading was skewed due to stress or even from being at the vet's. Any change in dose should be based on at least the information of a good mini-curve.

When and how to curveEdit

When first regulating, it's not unusual to take a curve or two every week. Later on, many people take a curve every few weeks, to obtain analytical data to help decide whether, and by how much, to increase or decrease the pet's insulin dosage. Some people take a 24-hour curve if their preshot and shot check numbers indicate that there may be significant differences between their pet's AM and PM cycles.

Keeping your curves, whether in written or graphed form, is an essential part of recordkeeping. Many glucometers come with an optional data cable for uploading readings to an excel sheet -- this can help tremendously too. You can help the Petdiabetes Wiki by copying or linking to your logs and curves in your pet's case study.

Readings are generally taken once every 2 hours, though it's possible to be more or less frequent. The minimum useful curve is the mini-curve.

Numerical CurvesEdit

Some people are adept at reading the numbers themselves, with notations like this:

Typical notes (US readings, divide by 18 to get int'l version):

PS 290 1.5U 1/4cup FF
+2 310      (food spike?)
+4 235
+6 187    1/4 cup FF
+8 159
+10 121
PS 287 1.5U 1/4 cup FF

How to read these notations:

  • PS: Pre-shot: test just before injecting insulin
  • 290: Blood sugar reading in mg/dL (US reading)
  • 1.5U: Injected 1.5 units of insulin
  • 1/4cup FF: Fed 1/4 cup of Fancy Feast (a low-carb canned food)
  • (food spike?): Note possible reasons for unusual readings.
  • +2: 2 hours after injection time
  • +4: 4 hours after injection time, etc.
Graphing Curves
Others find this information easier to interpret using a graph. Download the spreadsheet below[1] to make graphs like this one. Use the US or International version as appropriate for your country.
Curvesample1

Interpreting curvesEdit

This is likely to be the subject of a large article, but some quick tips to begin:

  • The most desirable curve while regulating is a simple dip, from about 250, down to around 90 or 100, then back up to 250. Ideally, most of the pet's time is spent with blood glucose levels below 200.
  • The lowest point on the curve (blood glucose nadir) is your peak, and you should remember the time this occurs. Use that same time for between-shot peak tests and mini-curves in future.
  • A typical difficult curve when you first begin regulating is high and flat, between 300 and 500. This can indicate either not enough insulin, or too much insulin and Somogyi rebound. It may also indicate insulin resistance due to glucose toxicity. Telling the difference is difficult, and requires looking at a full dosage and curve history. The best method is to avoid Somogyi rebound by starting low and going slow[2].
  • A curve that goes down below 90 may indicate less insulin is needed.
  • A curve that has a nice dip between shots, but rises too soon, may indicate that a longer-acting insulin is appropriate or that the pet needs more time to "settle" into the current dose.
  • A curve that has a nice dip between shots but doesn't rise in time for the next shot, suggests either changing to a shorter-acting insulin, or giving shots less often, or learning to work with overlap as discussed on the FDMB[3].
  • A curve that shows a significant drop between shots, but never going below 150, may indicate that a small dosage increase is appropriate. (Half unit or smaller increases are suggested as you get close to a perfect dose.)

Further ReadingEdit

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Wikidog3


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ReferencesEdit

  1. Spreadsheet for Curve Graphs Download
  2. Starting Low and Going Slow-a Guide to Regulating Cats
  3. FDMB--Curve Corrections Discussion

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