1/4 Poppy PMPS 60 AMPS 367

Monica-Poppy

Monica-Poppy

Member Since 2020
Hi all! I really need your advice. So Poppy is on Lantus 2u twice a day (vet's advice). On some days the nadir started to be quite low and also the PMPS, but very rarely the AMPS. So in those days the vet told us to either reduce the insulin to 1u (if the BG > 100), or don't give the shot at all (if the BG < 90-100). After those episodes, I come back to the regular 2u shot and in a couple of days it happens again - nadir and PMPS low.

I keep her meals strict. She has 4 equal meals: AMPS after shoot (7AM), +5 (12 AM), PMPS after shot (7 PM), +5 (12 PM). Her meals consist of 1 can of low carb wet food (aprox 200gr) split between the 4 meals + a few grams of Hill's m/d dry at each meal (because I got to order a 5kg bag of dry Hill's m/d food before reading the advice on the forum and because she is still hungry after the canned food).

The vet told me that a normal trend would be the one on 12/29/2020, and the rest are quite strange with lots of highs and lows. He also suggested a pancreatitis test.

I was thinking of reducing her dose a bit, but I am not sure with how much, and also I really don't get how most of you manage to reduce the dose by 0.25u
1f642.png
Do you just approximate by looking at the syringe?

I have 100units / 1 ml syringes, with 1u line marks. In Romania I only found another type of smaller syringes the are 0,5 ml with 1u line marks (Insumed 31gx8mm) that I already ordered and I am waiting for the delivery in the next couple of days. Do you know if those would allow a better dosing?

PS: please ignore the middle part of the spreadsheet. I made the (very big) mistake to get Poppy checked by a pet diabetes specialist in Romania (the only one), that proved to be a big disappointment. Recommended 2 types of insulin: Mixtard in the morning, Lantus in the evening, and other strange advice and got her in hypo on Christmas when everyone was unavailable, including the vet. Now Poppy is supervised by our regular vet.

So my questions would be:
- should I lower the insulin dose and by how much?
- how much time do I keep the new lower dose and when do I know it's time to decrease even more (or increase)?
- if the AMPS and PMPS are low, what should I do? which are the casese (BG) in which I give her a lower the dose and which are the ones when should I not give the shot at all?
- are the feeding hours ok? I noticed that always the AMPS is higher than the PMPS.

I appreceiate any other usefull information that maybe I missed to ask.
 

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Hi Monica!

Glad you found your way to FDMB! Welcome! :)
I am really impressed that you figured out our Thread Title nomenclature, Signature and Spreadsheet on your very first post. :cool:

Let me try and tackle all your questions one by one.

Food - Is this the Hills m/d dry you are feeding Poppy? (https://www.hillspet.com/cat-food/pd-md-feline-dry). If yes, you want to stop doing so because it is high carb (HC) and that's like feeding cake to a diabetic and then giving her insulin. However, you want to make the change in her diet very very carefully since removal of the HC food can cause her BG to come down steeply - and she is on a high dose of insulin which seems to be too high for her even with the HC food.

You want to feed her a low carb (carb% less than 10%) canned food. Here is a carb calculator that can help you calculate the carb% (http://scheyderweb.com/cats/catfood.html). If your food label has only Guaranteed Analysis, you will get an approximation, but it is good enough to know whether it is LC. MC or HC.


Dose - The dose of 2U does seems to be too high for Poppy.

The higher numbers you are seeing every now and then are what we call a "bounce" - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". Usually, a bounce will clear kitty's system within 3 days (6 cycles).

We follow 2 dosing protocols here on FDMB and this link will explain both of them to you. We increase and decrease in multiples of 0.25U here and how long you hold a dose, when you increase or decrease depends on which protocol you choose to follow. If you can stop feeding the dry (which you should) and feed Poppy 100% wet food you could follow the TR protocol.
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/


Syringes - Almost everyone here use 0.3 cc/ml syringes with half unit markings. Which makes it easy to dose in multiples of 0.25u. I understand that you do not have those in Romania. Do you have 0.3cc syringes? Or is 0.5ml the smallest ones you have?


I am deliberately keeping this post short because I don't want to overwhelm you with too much information!

I am going to tag Elise (@tiffmaxee ) to help you with dosing. I have to once again caution you that with the removal of HC dry food, Poppy's dose would reduce even further.

Welcome again to FDMB! :)
Bhooma
 
Welcome to you and Poppy. She looks a little like my Chai. You have had quite the introduction to feline diabetes. I’m still trying to wrap my head around what that specialist had you do! Well that’s in the past.

I agree with Bhooma about theHills MD. Save it for when she drops low and you find yourself needing high carb food in a pinch. Her numbers are really not bad and if you get rid of the dry and follow TR she will do really well I think. As for still being hungry, just feed her more canned food around 10% carbs or less. Many of us find dividing the food into 3 meals each cycle helps even out the cycles. Before any dosing changes please tell us how you feel about eliminating the dry.

Next question, why does your vet suspect pancreatitis? My boy had chronic pancreatitis for a few years before FD. So he had it for about 7 years once diagnosed and it likely started sooner. What if any symptoms do you see? For Max inappetence started and then one night he just stopped eating completely. Of course it was Christmas Eve! Poppy has a good appetite. Does she appear to be in pain? Diarrhea or constipation?
 
Hi Monica!
Poppy is such a beautiful girl! Welcome and I'm so glad you're here. This is a very supportive place with a lot of knowledgeable people. You and Poppy will be in very good hands.

I went through several vets when Butters was first diagnosed and many were also less than helpful. So I empathize with what you went through with the "diabetes specialist". That is so disappointing. I've stuck with following the Tight Regulation protocol that Bhooma provided the link to, and with help of people here I have been able to keep Butters regulated. I don't know what I would've done without this board.

If you can't find syringes with 1/2 unit markings, there is another option. Many of us use calipers to dose. Instead of using the lines to measure insulin, we use digital calipers to measure each dose. It is much more accurate. You don't have to think about doing this right now, but something to consider at some point when you are feeling more settled in here.
 
Food - Yes that is the the dry food I am feeding her (about 10 gr/meal). I can slowly eliminate and only feed her low carb canned.

Dose - I see, I suspected that 2u was too high. I will read the info in the link you provided.

Syringes - I just ordered 0.5 cc/ml syringes but still with 1 unit markings, and I just found out that I could order BD Micro-Fine Demi 0.3ml Syringe 0.3mm (30G) x 8mm. Any idea if these have half unit markings? Here is a photo of the box: https://pharmacygreek.com/image/cac...-fine-0.3ml-30g-0.30x0.8mm-100-1000x1000h.jpg

Thank you for being so welcoming and for all the usefull information!
 
Monica-Poppy said:
Syringes - I just ordered 0.5 cc/ml syringes but still with 1 unit markings, and I just found out that I could order BD Micro-Fine Demi 0.3ml Syringe 0.3mm (30G) x 8mm. Any idea if these have half unit markings? Here is a photo of the box: https://pharmacygreek.com/image/cac...-fine-0.3ml-30g-0.30x0.8mm-100-1000x1000h.jpg
Click to expand...

Yes! They do seem to come with 1/2 unit markings. Do you order from the UK?
https://www.vetuk.co.uk/veterinary-...-0-3ml-u100-insulin-syringes-box-of-100-p-296

This is even cheaper
http://www.alldaypharmacy.co.uk/pro...3ml-Syringe-0.3mm-(30G)-x-8mm-Box-of-100.html
 
Monica-Poppy said:
Food - Yes that is the the dry food I am feeding her (about 10 gr/meal). I can slowly eliminate and only feed her low carb canned.

Dose - I see, I suspected that 2u was too high. I will read the info in the link you provided.

Syringes - I just ordered 0.5 cc/ml syringes but still with 1 unit markings, and I just found out that I could order BD Micro-Fine Demi 0.3ml Syringe 0.3mm (30G) x 8mm. Any idea if these have half unit markings? Here is a photo of the box: https://pharmacygreek.com/image/cac...-fine-0.3ml-30g-0.30x0.8mm-100-1000x1000h.jpg

Thank you for being so welcoming and for all the usefull information!
Click to expand...

I will think about the next dose too. Until the dry is removed we will work with SLGS. You are right to do this slowly.

Those syringes don’t have the half unit markings. It would say so on the box. I suspect the digital calipers will be the so,union. I used them even though I had what used to be the best syringes with half unit markings. The company stopped making them.
 
Bandit's Mom said:
Yes! They do seem to come with 1/2 unit markings. Do you order from the UK?
https://www.vetuk.co.uk/veterinary-...-0-3ml-u100-insulin-syringes-box-of-100-p-296

This is even cheaper
http://www.alldaypharmacy.co.uk/products/BD-Micro%2dFine-Demi-0.3ml-Syringe-0.3mm-(30G)-x-8mm-Box-of-100.html
Click to expand...


I found them here, apparently they ship them from Greece to Romania: https://pharmacygreek.com/bd-micro-...-9nbTJ3ZYqH9P1ReMTyd8usYAYfbdnZ3xvXmhe0ETZodk
Someone else from Romania orderd and she said they are ok and they are deliverred in a few days.
 
tiffmaxee said:
I will think about the next dose too. Until the dry is removed we will work with SLGS. You are right to do this slowly.

Those syringes don’t have the half unit markings. It would say so on the box. I suspect the digital calipers will be the so,union. I used them even though I had what used to be the best syringes with half unit markings. The company stopped making them.
Click to expand...

I read the SLGS. As Poppy was on 2u until now, are you suggesting decreasing with 0,25 from 2, so give her 1,75u for a week and see how it goes? Or start over from 1u and increase/decrease if necessary after 7-10 days? I am not sure which would be better, as she was on 2u until now.

Regarding the syringes, on the box it says 1/2u just under BD. The Romanian girl that orderd, confirmed me that they have 1/2 u :) so I am going to order a box.
 
Monica-Poppy said:
I read tge SLGS. As Poppy was on 2u until now, are you suggesting decreasing with 0,25 from 2, so give her 1,75u for a week and see how it goes? Or start over from 1u and increase/decrease if necessary after 7-10 days? I am not sure which would be better, as she was on 2u until now.
Click to expand...

Do you think you can eliminate dry right away? If yes, I would recommend restarting at 1U.
Then you can do TR and increase as soon as 3-5 days if 1U is too less.

@tiffmaxee?
 
Bandit's Mom said:
I am going to tag @Xara Kakarantza and @Melita & Chnoudi who are in Greece to tell you what half unit syringes they buy and where :)
Click to expand...
Hello @Monica-Poppy !! The syringes you found in the "Pharmacy Greek" are the ones that me and Xara use too! They are perfect! We don't order them via this online shop, we buy them straight from another shop with medical supplies. They are doing deliveries too, but I'm note sure if they can send packages to a different country. I can call them tomorrow and ask!
However, keep in mind that couriers have crashed, due to lockdown, and may be there is a delay in the delivery...
 
Hi Monica and Poppy :cat: Poppy is beautiful <3 and you are in good hands here. There is A LOT to digest so just take it one day at a time. Each day something else will make sense. So many kitties - including my own - are in a better place thanks to all the folks here. Keep asking questions :cat:
 
Melita & Chnoudi said:
Hello @Monica-Poppy !! The syringes you found in the "Pharmacy Greek" are the ones that me and Xara use too! They are perfect! We don't order them via this online shop, we buy them straight from another shop with medical supplies. They are doing deliveries too, but I'm note sure if they can send packages to a different country. I can call them tomorrow and ask!
However, keep in mind that couriers have crashed, due to lockdown, and may be there is a delay in the delivery...
Click to expand...

Thank you for confirming! No need to call your shop. I just managed to order from the website that delivers to Romania. Hopefully they will arrive in a few days.
 
So Poppy had 88 BG at PMPS, just added the value to her spreadsheet. Didn't give her the shot. Will probably have a high BG at AMPS, as she also had this morning, but I will give her 1u as you advised and see how it goes during the following days. It's obvious that 2u is too high for her.
 
Welcome Monica and Poppy, you can't be in better hands.
If it wasn't for the amazing members here my Tyler wouldn't
be doing as amazing as he is. The members here are so knowledge and caring.
I have always taken their advice and I'm glad I did
What a cutie Poppy is., We are happy you are here
Have a good night Monica :cat:
 
Hi Monica, I see that you have given Poppy 1U today as discussed. :-)

Have you decided to get rid of the HC dry food? I hope so! The other thing I wanted to mention is that you don't need to get tests at only +5 every cycle. Nadirs can and do shift. I would try and get test at different times on different days to understand how Poppy reacts to Lantus - her onset, nadir etc.

And if you encounter a lower PS number than you are comfortable shooting, do not feed her or shoot her and post here for advice. Someone will come along to help you. Lantus likes consistency, so we want to get to a dose that you can shoot AM and PM without skipping.

This thread is now quite long. We post a new thread here for a new day so people don't have to read long threads to get to the latest info. Hope to see another thread of yours soon, :-)
 
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