2/8 Maki PMPS 236

Hi Maki,

Just wanted to give a :bighug:
It is tough to start with, but you will get in the swing of things soon.

Because lantus uses the depot, it would be difficult to know what the 1.5U insulin is doing until you have given it consistently for a few days. More than my kids, it has been feline diabetes that has taught me patience!
 
Hi! Great job on a new condo (thread :)) for the day! We link to our last one for continuity - https://www.felinediabetes.com/FDMB/posts/2736374/

On SLGS, you are correct that you hold the dose for 7 days unless reduction is earned (a drop below 90 on a human meter) in which case you reduce the dose by 0.25u at your next shot.

If you get a pre-shot value <150, do not feed and post to the board for help. Test again in 20 minutes from the first test. As you gather more data, you'll eventually shoot lower numbers.

Hope that helps some :bighug:
 
Thank you, you both read what I am feeling. I needed those hugs, thanks and back at ya. (don't know how to insert emoji on laptop)
Ok, rewriting what I hear is how I know if I actually get something. I am trying to make 'rules' for myself so I don't have to figure out numbers or read a lot quickly.
Here goes:

150-300 AMPS or PMPS is the good range to feed and shoot
<150 is hold food/shoot until I post and get response, then mostly likely 1.5U
<90 is hold food/shoot until I post and get response, then mostly likely 1.25U
>300, umm. No matter what I read, I haven't figured this out???

>250 test for ketones through day
<150 test - stay with Maki and test frequently to avoid hypo

How did I do? Any of that right?
Thanks
 
Close!

This applies to preshot numbers only (AMPS and PMPS).
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), ask for help
  • Above 200 (11.1 mmol/L) give 1.5U

If any test at all is 90 or less, the next shot that is safe to give gets reduced by 0.25U. For example, let's say you get an AMPS of 85. Do NOT give insulin. If your PMPS comes back above 200, then you give 1.25U for that shot and every safe shot thereafter...until you qualify for another reduction or increase per the dosing sticky.

Carrying on from last night - since your +2 is lower than AMPS, you're going to see an "active cycle". This means Maki should continue to drop towards nadir, for most cats nadir is +4 to +7. So you'll want to be testing during those hours if you can. If Maki will let you, I'd test each of those hours...I suspect you may see a number under 90 and we might need to reduce the dose. It's hard to say with high carb food still in the mix.
 
As for ketones, I don't have experience. I just know that you for sure want to test for ketones any time you reduce insulin (either the dose, or by skipping a shot). Also if your cat is sick, or isn't eating as well as usual. Ketones can happen at both high and low BGs, so I wouldn't define it that way.

For Maki specifically, I think any time you start seeing numbers below about 125 I'd check hourly if you can to be safe. If she starts dropping below 90, I'd ask for help here. I'm just overly cautious given her past hypo and lack of data so far.

Did you manage to put together a hypo toolkit?
 
Ok, she just hit 101 and I would guess will go lower next three hours...will test hourly if not more.
She ate kibble (she is still hungry often and has lost another .6 lb) at 3+.
She had just been resting in the sun. Has not used litter box since early morning.
 
These are actually really good numbers for newly diagnosed, I'll tell you that. Especially with high carb food still in the mix. I'm glad we went with 1.5U...i really think 2U would have put you in another hypo situation (or close to it).

So since she had kibble, which is higher carb, don't be surprised if her numbers start to go up a bit or stay flat (called a "food spike"). But still test! This is also why we recommended having food available - shes doing exactly what she needs to to hopefully control the drop in numbers.
 
How was she diagnosed to begin with? What symptoms were you seeing, what tests did they do?
 
In December 2020, I noticed Maki was loosing weight and yet eating more and more. My partner does litter box cleaning. He said her pees were huge now. She was losing interest in playing (thought maybe it was weather). Looking back it was behavior clues building over time. That was 1/4. Vet came out to car and said all her labs were good including thyroid, but her sugar was 'through the roof". I didn't know a thing and didn't ask for any copies, will get those all this week. He said to stop her FF pate and Science Diet Urinary. Gave us a case of wet and bag of Glycobalance. Said feed every 12 and give her 2U Prozinc at mealtime. She was so hungry he said give treats sparringly but let her eat some dry kibble between meals to keep her from losing more weight.

We can all that that day and then I started crash learning from videos how to give injections. So 1/4-1/21 she was holding her own given my learning curve (missed with a few insulin injections, even got myself once). Then all of a sudden mid 1/21 afternoon

We went to pet her and her head was twitching. Then realized her gaze was fixed. Grab her, got the honey, rubbed on gums, called vet, raced to their office...She was 30 when she go there.
 
My Current Hypo Tool Kit:
2 cans Science Diet Ocean Whitefish Pate
2 Pouches creepy catnip Temptation Treats
Tupperware of Science Diet Urinary Dry Kibble
Tupperware with honey
Syringe without needle

Hypo Instruction - Print this sheet - for flight or fight mode
Er vet and regular on phone speed dial and programmed in GPS

Since we are rural we are 45 minutes in any direction to a 24/7 vet. We drove to the one in DE the night of her hypo episode.
 
Oy I'm sorry...at some point I'd look for a new vet, but I know options are limited when rural. But don't worry, this board will get/keep you in the direction!

I'm sorry if you mentioned before, why was she on the science diet urinary?
 
This vet put her on the SD Urinary when she developed a UTI (~4 years ago). So we kept asking and he said to just keep her there if it was keeping her from getting UTIs.

Yeah, the whole new vet thing. We are country vet communities here. So this is the best of the 4 local vets.
 
Hmm, interesting. Vets really do love all these prescription diets!

Good job with the tests! I'd say you're ok to give her ears a break until PMPS, but feel free to keep testing if it'll give you peace of mind.

Just for information - it's the higher carb food at +3 that kept those numbers up, which is why you're not seeing a true nadir. Had she not eaten or had it been a lower carb food, those numbers likely would have dropped a bit lower.

@JaxBenji I'm not sure who to tag for guidance on tonight's shot, do you know who could help? Given the mix of wet and dry food, I wonder if 1.5U runs the risk of dropping Maki a little too low for comfort tonight, should she decide to not eat the dry. It's probably ok, but knowing that cats tend go lower at night I'm not sure.
 
So should I not let her eat between meals? Should I force nadir to happen? This part really confused me no matter what I read.

She is actually in favor of her dry food cause it comes in a toy puzzle. She loves it and plays with it as long as kibble rattles around in it.

I have been sitting with her or bringing her wet food to her as she is less inclined to eat it these past few days.

Yes, I still have many questions. Again thank you for your patience and carefully watching over us.
 
Except for the 2 hr window before shot time, let her eat whatever she wants, when she wants it, especially since she's underweight right now. Remember, the combo of lack of food and insulin reductions/skipped shots increase risk of ketones. It's more important that she eats right now.

Right now during the cycle, we want test data to reflect a "normal day" for Maki. So if she grazes all day, we want to see what her numbers do while she does that. If she wants to scarf 90% of it down at shot time, we want to see that too. Until we have more data and switch to low carb food, we don't want to mess with her food or eating habits. Today was a great first step!

If you look at my spreadsheet from June 2020 - the drop in numbers and dose was SOLELY due to changing to a low carb diet. So for Mr Kitty specifically, eliminating the kibble and going low carb dropped his BGs by about 100+ points. Now imagine you did that to Maki, cold turkey, based on the numbers you saw today. She'd drop very very low at the current dose. This is why we don't want you to change food yet, we need to see how she reacts to the insulin on a typical day, so we know how to best switch over her food.

It would help if you could note what she eats and when in the Remarks column if you get a chance. So for today, you could put "+3 glycobalance dry, 1 tbsp" or however much she ate.

That was a lot of words, I hope that makes sense!
 
Once the depot builds and Maki is low carb, you'll start to see the "ideal cycle" Wendy mentioned in her post last night. We just have to be slow and safe in how we get there.
 
Ok. Maybe I am learning from all this. For Maki's sake I am studying.

I have been trying various spreadsheets but honestly having a tough time drawing any conclusions. I see a sea of numbers.

She normally had her toy once during the day and overnight. So I will put it back down. I been hiding it and she keeps going to the drawer begging for it.

I will keep her eating wet with water twice 12/12 just after AMPS and PMPS. I tried to look up the treats I have for high and low carb but I couldn't find them on the magic food chart.

Ok next check-in is PMPS and then 2+ before bed.
 
Ketones - you definitely want to test daily if the BG is high (over 300). Below that, test periodically, a couple times a week, or if she seems off/lethargic/has an infection/inflammation/lack of appetite. The suggestion on frequency to test would differ if the cat had been in DKA or shown ketones recently.
Patricia & Maki said:
So should I not let her eat between meals? Should I force nadir to happen? This part really confused me no matter what I read.

She is actually in favor of her dry food cause it comes in a toy puzzle. She loves it and plays with it as long as kibble rattles around in it.
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She can eat between meals, though it's preferable if she eats most of her food before nadir. Think of the insulin as stronger in the first part of the cycle before nadir, then it's effect starts to wear off. If you give carbs after nadir when the insulin is already wearing off, you can make it wear off faster, get shorter duration and thus higher preshots. Nadir happens when it happens, it's not in your control. For the treat toy puzzle, freeze dried meat treats work equally well, and are low or no carb. Some like the Orijen brand are pretty uniform in size. For testing treats or food toppers, you can get any pure meat freeze dried treat. They will all be safe. Sometimes they have the same in the dog aisle, just bigger size so more economical. Purebites is one brand available most places.

Anytime you are worried about how low she might be at PMPS time, get a +11 or +11.5 and post here if you think you'll need help with what to do at preshot time.
 
Got SS updated. Laptop died.
She is mixed on testing. Knows the whole fish flakes as treat but has yelped or growled a couple times.
Really, I am super proud of her for all she has been through and put up with. She's a trooper.

Thanks for all the help. I do feel like maybe I am getting it :) with lots of hard work from all of you here.
 
So my vet called late today to check on. It was a bit weird awkward. I explained I am doing 1.5U bid. He wanted me to go up to 2U in morning and stay at 1.5U evening. That makes me nervous.

He also said he wanted me to get a pet specific meter if I was going to be testing as human ones are not as accurate or scaled for cats.

So he said he would check in next week and wanted to run another glucose curve after that. I did explain that for Maki's sake I felt best if I test at home daily. I also mentioned that this became quickly expensive and more than I even make in a month of pay so I would think about the meter.
Suggestions?
 
Well folks. Tried A 2+ just now and Maki was done for the day. Just couldn't get the sick and she was unhappy. So gave up, but she still got her treat.

So no more data tonight. Will get up with her thru the night to make sure she is ok, not going low.

Her toy is down for play and eating.
Nite!
 
Patricia & Maki said:
So my vet called late today to check on. It was a bit weird awkward. I explained I am doing 1.5U bid. He wanted me to go up to 2U in morning and stay at 1.5U evening. That makes me nervous.

He also said he wanted me to get a pet specific meter if I was going to be testing as human ones are not as accurate or scaled for cats.

So he said he would check in next week and wanted to run another glucose curve after that. I did explain that for Maki's sake I felt best if I test at home daily. I also mentioned that this became quickly expensive and more than I even make in a month of pay so I would think about the meter.
Suggestions?
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I would NOT change the dose. You saw how low she went today at 1.5U, and was "propped up" by the food. If she didn't eat that food, my guess is she might have hit 80s. At 2U, that would be even lower and possible hypo territory again. If anything, i suspect we'll need to reduce the dose again in a few days... especially when going to low carb.

My vet said same thing about pet meter, but I respectfully told him I would stick with my meter. (1) cost and (2) literally hundreds of us here use the human meters and we do just fine. And the guidelines here take the accuracy into account.

I also would not pay for a curve. I would tell him you can do a curve at home and send him the results; this is what I do with my vet. My vet offered to "rent" me a pet meter and strips to do a curve ($20), that may be an option if your vet is really pushy and you don't want to push back. I understand the delicate situation of rural vets, don't want to burn bridges.

About the tests - they shouldn't be too painful for her. Make sure you're not hitting her vein, but rather right above it. I know it can be hard to do. If you can sneak a +5 or +6 that would be good; not all hypos are symptomatic. Usually by the time they're symptomatic, it's an emergency.

You're doing great! Look how far youve come and what youve learned in just a few days. I'd ask that you trust the people and methodology here; I've been here almost a year now, and I'm certain Mr Kitty would not be alive right now if I hadn't found this site, and went only by what my vet said.

Otherwise, same thing in the morning. AMPS above 200, give 1.5U. 150-200 post here for help. Below 150 no shot.

Edit: one other thing I'd like to double check, given the chaos of switching from ProZinc to Lantus - you are using U100 syringes, correct? It should be printed somewhere on the side of the syringe.
 
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