Low PMPS/ Dosing advice

[ida01]

Greetings! I hope everyone is doing okay . In these days I have been putting into practice everything I have been able to learn in this magnificent forum and I think that finally I am seeing improvements in my dear cat, as you can see in his SS, in the last two days his PMPS have remained relatively low as never before since I started to home test, what could that mean? Could his diabetes be finally getting under control? Also, since I don't feel confident enough giving him the insulin shots at such low numbers I decide to wait until it rises to a safer number... I have also noticed that in the afternoon his sugar is in the blues, which makes me very happy to know that it is possible that he can reach those numbers and I have noticed changes in his behavior, now he is awake during the day and he looks for affection as he used to do before, and you can see that he feels better, something that did not happen before. I feel confused since I was convinced that Vetsulin was not for him, but now I don't know what to think.. Also, these days he's been a bit constipated so I've been adding pumpkin to his food plus two tablespoon of water and he's gotten better! Anyway, right now I am a little anxious because his PMPS was 203 and I waited a few hours and it is 285 but I still do not feel safe. I would greatly appreciate any advice you can give me!

 

[smorgasbord]

Hi,

That's great news he is feeling more perky. It sounds like you are making progress.
I know I used to be scared to give a shot at 285, but I assure you it is safe with the guidance of the folks here.
You will get many responses if you repost this over in here: Caninsulin / Vetsulin and N / NPH
I suggest you post this again in the Vetsulin forum area because you will get more eyes on your query. Add a "?" tag to your thread title, and pose your question, " safe to dose 285?" in the title of your thread.
Good luck!

 

[Bron and Sheba (GA)]

I don’t think there is much traffic over on the vetsulin forum at the moment. You would be better staying on main health and I will tag someone to help you.
@JanetNJ
@FrostD
I would suggest you try and get in at least one test during the pm cycle as many cats drop lower at night. Get into the habit of getting a before bed test. If that test is lower than the preshot BG, set the alarm and get up and test again later to see Tabby is safe.
Looking at the SS I think he is dropping low during some of the cycles and bouncing up at the next preshot.
Also if you see a much lower BG during the cycle, try and get another test in to see it is not dropping lower.

Ae you feeding 30 minutes before the dose each cycle and giving snacks during the cycles as well?
No, he is not anywhere near under control (regulation) at the moment. Have you thought about a more suitable insulin such as Lantus or Prozinc?

 

[FrostD]

Welcome!

So remember that insulin is a hormone, it's not going to work the same every time. Just because drops him from 400s to 118 does not mean it will drop him from 200s to 0.

I suspect he might be bouncing, which is normal. But if it continues, will probably need to switch to a more gentle insulin. I also wonder if he's not getting good duration, can you get some +9/10/11 tests?

Completely low carb diet correct? Are you giving shots 12 hours apart, even when you delay shots? I see one day you stalled for almost 4 hours, do you feed him when that happens?. We recommend stalling without feeding for no more than an hour or so.

Generally we say it's safe to shoot above 200. If you're not comfortable, I'd work on lowering your comfort zone slowly. You've shot a full dose as low as 270, so perhaps try lowering your threshold to 250 and see what happens (provided you can keep an eye on him, have hypo kit, plenty of test strips). Then 225, etc.

 

[ida01]

I don’t think there is much traffic over on the vetsulin forum at the moment. You would be better staying on main health and I will tag someone to help you.
@JanetNJ
@FrostD
I would suggest you try and get in at least one test during the pm cycle as many cats drop lower at night. Get into the habit of getting a before bed test. If that test is lower than the preshot BG, set the alarm and get up and test again later to see Tabby is safe.
Looking at the SS I think he is dropping low during some of the cycles and bouncing up at the next preshot.
Also if you see a much lower BG during the cycle, try and get another test in to see it is not dropping lower.

Ae you feeding 30 minutes before the dose each cycle and giving snacks during the cycles as well?
No, he is not anywhere near under control (regulation) at the moment. Have you thought about a more suitable insulin such as Lantus or Prozinc?

Hi, I was suspecting that he might be bouncing too but this morning he surprised me with his AMPS that was 197 and I gave him his breakfast and waited 3 hours and his Bg is at 170! All this seems very strange to me but at the same time I feel hopeful that he is improving. Also, I was starting the habit of getting a test before bed but I have been forgetting about it, not gonna lie... And yes, I always wait 30 minutes after he finish eating and I give him snacks during the day. Regarding insulin, I have considered changing it to one that is more gentle with cats,but I haven't had the opportunity to consult it with his vet and now with these changes in numbers and his behavior improving, I don't know what decision to make. Right now I'll give him a snack, and about his insulin shot, what should I do?

 

[FrostD]

Hi, I was suspecting that he might be bouncing too but this morning he surprised me with his AMPS that was 197 and I gave him his breakfast and waited 3 hours and his Bg is at 170! All this seems very strange to me but at the same time I feel hopeful that he is improving. Also, I was starting the habit of getting a test before bed but I have been forgetting about it, not gonna lie... And yes, I always wait 30 minutes after he finish eating and I give him snacks during the day. Regarding insulin, I have considered changing it to one that is more gentle with cats,but I haven't had the opportunity to consult it with his vet and now with these changes in numbers and his behavior improving, I don't know what decision to make. Right now I'll give him a snack, and about his insulin shot, what should I do?

So his numbers are still too high overall...the insulin is bringing him down pretty well, but the overall numbers need to come down too. Nothing to be done about that until he either (a) gets used to lower numbers and stops bouncing, or (b) the Vetsulin is just too harsh (dropping too fast) and he will almost always bounce, in which case a change of insulin would be needed.

I'd say give it another 2-4 weeks and see how he does. If he keeps bouncing like this and you're not seeing more yellows, I'd consider changing insulin.

I'm sorry nobody was around to help earlier - what you can do in situations with a low preshot and you don't want to shoot full dose/stall is a reduced or token dose. A reduced dose is something like 30-50% of a normal dose, and a token dose is more like 10%. It's always better to give some insulin than none, provided numbers are high enough and you can keep an eye on him. With that 197 I'd have suggested something like 0.25U-0.5U to see what happens.

 

[ida01]

So his numbers are still too high overall...the insulin is bringing him down pretty well, but the overall numbers need to come down too. Nothing to be done about that until he either (a) gets used to lower numbers and stops bouncing, or (b) the Vetsulin is just too harsh (dropping too fast) and he will almost always bounce, in which case a change of insulin would be needed.

I'd say give it another 2-4 weeks and see how he does. If he keeps bouncing like this and you're not seeing more yellows, I'd consider changing insulin.

I'm sorry nobody was around to help earlier - what you can do in situations with a low preshot and you don't want to shoot full dose/stall is a reduced or token dose. A reduced dose is something like 30-50% of a normal dose, and a token dose is more like 10%. It's always better to give some insulin than none, provided numbers are high enough and you can keep an eye on him. With that 197 I'd have suggested something like 0.25U-0.5U to see what happens.

Well, after waiting several hours for his numbers to go up I finally decided to give him his insulin shot at 272, after giving him his food and waiting the 30 minutes I injected him with his usual dose which is 1.75, now after 3 hours he is almost hypoglycemic (76) . Right now I mixed his usual food with some of the RC glycobalance dry food hoping it will help him raise his bg levels, I think I will have to lower the dose.