PMPS - Before food or after?

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Sergei

Member Since 2020
Hi, many apologies in advance but could not find this information easily: for a PMPS BG do I test before food or after prior to injecting? We had a nadir reading of 4,6 mmol/L today. This is the lowest we've been and I want to test him before proceeding with insulin. Sergei and I both send our many thanks, Scott
 
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Before.

The usual order with Caninsulin is test, then (if high enough to shoot), feed, wait 30mins, then shoot.

If he's not high enough to shoot at PMPS, post here for advice. Depending on how close he is to your non-shoot number, it might make sense to proceed, but it would depend on the circumstances, so it's best to get some input before going forward.
 
OK, a little more detail here: the reason to test before shots is (as noted above) to make sure he's high enough to shoot. That's why we don't want him to have eaten first-- there could be a food bump from that that makes him look high enough to shoot, even if he isn't really.

As for what's "high enough": generally, we set a "no-shoot" number of around 200 mg/dL (around 11 mmol/L) for the first few months, until the caregiver has a lot of data about their cat's patterns and is very comfortable testing and managing low numbers.

Again, "no-shoot" in this context usually really means "post and ask for advice". We'll take a look at the data in the spreadsheet and your description of the previous cycle and what you're prepared to do in this cycle, and help figure out what's the best course of action for that situation.
 
Nan & Amber (GA) said:
He sure is!!!!!

One more thing: that 4.6 today has earned Sergei a dose reduction, down to 2.25U!
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Thanks for that information, and on such short notice. So much appreciated. We tested pre-food PMPS and he was at 28.3 mmol/L / 509 mg/dL. I think we'll be okay tonight. I was hoping for a slightly lower number there but alas. Thanks for your time and insight. Very helpful and much appreciated. Will send an update after we see the vet tomorrow. Sergei is proving a tough customer to insulin. Today's number had us hopeful but the 28x felt a bit of a setback :|
 
Is there any reason you dont test more? (Not disparaging you just curious.) It really would be better for Sergei. You'd get a broader picture as to why you were surprised by today's reading.
 
Sergei said:
Today's number had us hopeful but the 28x felt a bit of a setback :|
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That could be a bounce triggered by the 4.6/87, in which case numbers may run a bit higher for a while and then drop back to lower levels again. There is no way to say when a bounce will clear so it's important to take dose reductions immediately.

I very much recommend you try to get 'before bed' tests because many cats run lower on the PM cycle and you're seeing some quite low nadirs for Caninsulin. It's impossible to say for certain because there aren't preshot BG readings but it is possible that some of the pink readings you're seeing mid-cycle may also be indicative of BG levels bouncing from lower numbers that you're not catching with your testing.

Per the FDMB Caninsulin/Vetsulin guide, any time BG drops below 5.0mmol/L / 90mg/dL (human meter) the dose should be reduced by 0.25IU immediately.


Mogs
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jt and trouble (GA) said:
Is there any reason you dont test more? (Not disparaging you just curious.) It really would be better for Sergei. You'd get a broader picture as to why you were surprised by today's reading.
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Thanks, I know you are not disparaging us and I really appreciate your help. I'm very open to feedback. Basically, my current testing regimen is based on the fact that the average peak for Caninsulin happens between hours four and five after injection, and since diagnosis we have had very few nadirs on our current dose that have fallen below the renal threshold.

This is supported by a host of data I collect every day such as Sergei's urinary output (I carefully weigh each 12 hours worth of sawdust from the box), appetite, and energy level. I predicted today's 12:30 nadir at 9:15 this morning, when I looked at my previous 24 hours of data on the cat box and his appetite and energy The first two had dropped -- the former significantly, the latter noticeably, and the third—his energy—had increased. This was a much more familiar version of my Sergei than the one of the last couple of months. Because the numbers have remained so high neither my partner nor myself, or our vet, has seen the need for a curve just yet. Once we get there, I have no doubt our need for testing will increase. I have thirteen alarms set every day for diabetes management, starting at 7:30am and terminating at 1:30am. So I guess I'm waiting until we get closer to a stable situation before I add curves to the routine. It's not perfect but we are moving in the right direction.
 
Critter Mom said:
That could be a bounce triggered by the 4.6/87, in which case numbers may run a bit higher for a while and then drop back to lower levels again. There is no way to say when a bounce will clear so it's important to take dose reductions immediately.

I very much recommend you try to get 'before bed' tests because many cats run lower on the PM cycle and you're seeing some quite low nadirs for Caninsulin. It's impossible to say for certain because there aren't preshot BG readings but it is possible that some of the pink readings you're seeing mid-cycle may also be indicative of BG levels bouncing from lower numbers that you're not catching with your testing.

Per the FDMB Caninsulin/Vetsulin guide, any time BG drops below 5.0mmol/L / 90mg/dL (human meter) the dose should be reduced by 0.25IU immediately.


Mogs
.
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Thanks, it's a great catch. That 5,0 mmol/L really resonated with me too when I read it on the Caninsulin site earlier today. I immediately contacted the vet after we got the 4,6 and she wanted us to test again this evening and if he was high then to stay the course. Sergei very obviously felt a little better today than he has in ages. We see the vet tomorrow so we can discuss the dose and increasing testing with her then.
 
I am thrilled to hear Sergei is feeling more like himself. I do hope this method works out the best for you. I dont understand it but if you are happy with it, THATS what matters. Will you be posting his curve when you do conduct it? I would be very interested to see the results.
AND...Dont be such a stranger...WE CARE. :bighug:
jeanne
 
jt and trouble (GA) said:
I am thrilled to hear Sergei is feeling more like himself. I do hope this method works out the best for you. I dont understand it but if you are happy with it, THATS what matters. Will you be posting his curve when you do conduct it? I would be very interested to see the results.
AND...Dont be such a stranger...WE CARE. :bighug:
jeanne
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jt and trouble (GA) said:
I am thrilled to hear Sergei is feeling more like himself. I do hope this method works out the best for you. I dont understand it but if you are happy with it, THATS what matters. Will you be posting his curve when you do conduct it? I would be very interested to see the results.
AND...Dont be such a stranger...WE CARE. :bighug:
jeanne
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Hi Jeanne, thanks. I very much appreciate the support. Because we were so low this afternoon and because he's been alternating between sleepy, restless, and hungry since about an hour ago I went ahead and did a third test, this one at half past midnight or +4, which is within the widow of the nadir. We are doing fine at 11,5. I'd like to see a safe number a little south of that. I dream of 6,5 to 7,5 but 11,5 is still under the renal threshold, and I can now catch a bit of sleep knowing we are probably not going to dip into the blues or greens anywhere on this cycle. I will post the curve once we do it (I'm planning to do it at home). I'm also interested to see the results.
 
I worry about the sleepy , restless, hungry ...do you think he could be too low? You know your cat. If this isnt usual behavior... would you mind adding those numbers to your spread sheet?
 
At +4 (90 minutes ago) during PM cycle he was 11.5 mmol/L (207 Mg/dL). This afternoon at +4 on AM cycle, by contrast, he dipped down to 4.6 (83), and at PMPS was at 28.3 (509). So, we’ve been on a bit of a ride today. Sorry if that did not appear on the sheet— thought I had updated it. ;)
 
I have to sign off for the evening . Need to start dinner.

Sorry but still cant see the additions to your spread sheet. :( I will check again first thing in the morning.
Sending best wishes for you, your partner, and for Sergei! :bighug:
 
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