Lower than usual PMPS. What to do?

Butterscotch's Pawrents

Butterscotch's Pawrents

Member Since 2019
On Sunday 9/1, Butterscotch had an AMPS (159) that was significantly lower for her, and we had not collected much BG data on her yet, at that point. Not knowing what she would do throughout the day, we came to the decision of cutting her insulin decision in half for the AM (3 units reduced to 1.5 units). That evening, we resumed her insulin at a new reduced dose of 2.5 units, and have held that through today's evening dose on Wednesday 9/4. Her blood glucoses do appear to still be higher than they had been trending on the prior 3-unit dose, and we are considering increasing her dose back up to the original 3 units starting tomorrow, Thursday morning 9/5. I will be home all day to test. Looking for some seasoned advice if anybody has the time to review our spreadsheet data.

Below is a link to our previous thread which led to the dose reduction:
http://www.felinediabetes.com/FDMB/...er-dose-reduced-pmps-349.218833/#post-2435700
 
In your last post here you mentioned you were reading the SLGS descriptions. Is that the dosing method you are planning to Follow? If so, could you put SLGS in your signature. That'll help us help you.

If you are following SLGS, you hold the dose for seven days or 14 cycles before doing a curve then deciding what to do with the dose. You are halfway there. Provided of course, that she doesn’t earn a reduction before then. Getting some mid cycle tests, including one before bed at night, will help us determine how low this dose is taking Butterscotch. Those lows tell us how to change toe dose. Instead of increasing tomorrow, maybe you can get a curve done. The depot is full so it should be good data.
 
Wendy&Neko said:
In your last post here you mentioned you were reading the SLGS descriptions. Is that the dosing method you are planning to Follow? If so, could you put SLGS in your signature. That'll help us help you.

If you are following SLGS, you hold the dose for seven days or 14 cycles before doing a curve then deciding what to do with the dose. You are halfway there. Provided of course, that she doesn’t earn a reduction before then. Getting some mid cycle tests, including one before bed at night, will help us determine how low this dose is taking Butterscotch. Those lows tell us how to change toe dose. Instead of increasing tomorrow, maybe you can get a curve done. The depot is full so it should be good data.
Click to expand...

I guess we haven't really committed to a specific protocol yet, but I'm thinking it will be easier for us to start with SLGS.
On Sun when her numbers started out blue for the first time, we cut the dose purely out of newbie nervousness. I guess I thought it'd be ok to go back to 3units sooner because her numbers are now higher again. She's been so lethargic and uniterested in everthing for months and on Sun she was so happy and as close to herself as we've seen in months. After the dose cut she's back to laying around and not interested in cuddles or play. Feeling very impatient at the moment and dreaming for some blue numbers again.
 
We do dose increases by 0.25 units at a time. Your vet had you increase by too much up to 3 units. It is better to get data on this dose and evaluate how she is doing on it first. You don't want to deal with an overdose.
 
I'd love for some of the more experienced members to review our SS and share any thoughts about what you see there.
What do her number trends reflect, what do you think is happening?
I understand and agree that her dose was raised quickly by the vet. But here we are. Do you think this dose is still too high or do you think I'll need to raise it and why? If not enough data yet, then as I do get the data, what should I be looking for?
When people say she might bounce, or a cat is bouncing, can someone explain more what this looks like in terms of numbers? I understand the physiological process but exactly how big of a jump high/low do the numbers have to go to know it's a bounce?
I have read and reread all the stickys on the main forum and on the Lantus forum. I also try reading several posts from others and reviewing other SS to try to wrap my head around it all. But I feel like I'm just treading water in the dark still. I don't feel like I'm on a clear path as to what I'm looking for in terms of how to adjust her dosing. Obviously I can't rely on the vet because she wants her to go up to 4 units and doesn't even think we need to be testing this much, yikes!
 
I am by NO means an expert, but wanted to pop in and wave to you from Seattle! As Wendy&Neko said, dose adjustments should only be done 0.25 units at a time. I think you just have to be patient (I know, I know!) and keep to the SLGS protocol. The rest of her advice, about getting more nighttime data is also spot on. It is a "dance"....and we need to let Kitty lead. You are only a few days out from being able to do a curve again; that will give you more data and maybe a better idea of how Butterscotch's body is responding.
 
A lot of responses will depend on which protocol you're following. If you've decided, could you please add it to your signature?

For instance, we're on TR, so we feed no dry food and I increase every 6 cycles until I get a green number - then I test until she goes one way or the other (more greens, we hold the dose, no greens, we increase, lime greens x 3 below 50 we decrease OR 1 lime green below 40, we decrease)...For SLGS it's different as you hold the dose longer before increasing....that's why it's important to decide which protocol you're going to use. If you're new and uncomfortable with a lot of increases, you may want to start with the Start Low, Go Slow method - you can always change once you get the hang of it all...
 
Surprises as usual. PMPS is 173. I'm going to retest in 15min.
Last time she got a low preshot we cut dose in half but I felt like that caused some high numbers and I was kicking myself for cutting it so much. She didn't respond to the subsequent high numbers well and it took several days for her to improve. I don't want to back track with her progress.
Should I maybe reduce by 0.5 units tonight? Or be bold and stick with the 2.5 units?
Thoughts?
 
PlumsMom said:
I am by NO means an expert, but wanted to pop in and wave to you from Seattle! As Wendy&Neko said, dose adjustments should only be done 0.25 units at a time. I think you just have to be patient (I know, I know!) and keep to the SLGS protocol. The rest of her advice, about getting more nighttime data is also spot on. It is a "dance"....and we need to let Kitty lead. You are only a few days out from being able to do a curve again; that will give you more data and maybe a better idea of how Butterscotch's body is responding.
Click to expand...

Hello, waving at you from the South Sound. Thank you for the thoughtful encouragement. It is so hard to be patient when our little lady is so lethargic and not herself. It definitely is a "dance" and I feel like we're tripping a lot lol.
Where do people buy insulin syringes with finer measurements? Mine are in whole units and it's hard to measure anything smaller than a half unit when you're eyeballing on such a tiny scale.
 
Ah, sorry you didn't get advice on this in time to shoot. Let's see what she does with this!

Plan on getting at least a +2. If she's lower, you may need to monitor for a while tonight-- looks like you're able to get up to +6 at night, which is very good.
 
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