? When looking at PMPS +2 what are we looking for?

[Sebastian’s mom (Lauren)]

I know it’s recommended to test 2 hours after their PM shot to make sure they’re not heading down too low, but WHAT would be alarming/ a cause for concern? What exactly am I looking out for?
What indicates it’s safe for me to sleep through the night?
Sebastian PMPS 363 +2 338 +4 215
Is it possible he keeps going down?
Can gabapentin be contributing to this?
Hasn’t happened before, but also not used to such big differences in his numbers.

I often feel like I need someone on speed dial to answer all of my questions because this is not getting any easier and I don’t think my mind will ever be at ease.

Dear Sebastian’s pancreas, please start working right again.

 

[Hendrick Cuddleclaw]

Hi Lauren I don't think I've seen one of your posts before. Great job with that curve yesterday!

I know it’s recommended to test 2 hours after their PM shot to make sure they’re not heading down too low, but WHAT would be alarming/ a cause for concern? What exactly am I looking out for?
What indicates it’s safe for me to sleep through the night?

Ok so the basic idea is, you want to see the number either leveling off or at least no longer dropping at such a fast rate.

The example you post, with his numbers dropping like that, some would recommend that if you go to bed you maybe set an alarm to get up again in an hour and test again at +5 or around there. And I see you did get a +5.5 at which point he had "flattened" as we say -- in other words, the BGs leveled off and were no longer dropping. Even rose just a tiny bit. And that is when I would feel comfortable going to sleep for the night. ECID of course and you know your cat best.

I don't know for sure about the gaba. I don't think it impacts the BGs from what I recall. If you search the forums there are many posts about people using it with their FD cats.

 

[Sienne and Gabby (GA)]

Lantus is a long acting insulin compared to some of the other insulin that has been used to treat feline diabetes. What this translates to is that onset and nadir are also later in the cycle. In a "perfect" curve, you would feed your cat and give an insulin shot and roughly 2 hours later you would see blood glucose levels begin to drop. (See the timeline in this sticky note.) It's helpful to have enough data to discern where onset and nadir fall for your cat since not all cats follow the expected pattern and nadirs can and do move around.

If you see a larger than expected drop at +2, it suggests that it may be an active cycle -- numbers are dropping faster than expected. You would want to get some additional tests especially if you are going to sleep or leaving the house. It is absolutely possible that the numbers will continue to drop unless you know for certain where nadir (lowest point in the cycle) will be and none of us can predict exactly where nadir will fall all of the time. Remember, onset is generally hours prior to nadir.

It would be helpful to have all of Sebastian's numbers on his spreadsheet.

Unlike Kyle, I wouldn't characterize the example you notes as a "sharp drop." The numbers are still in a safe range but without the context of what your cat's cycles typically look like, I'd be hesitant to draw any conclusions. I also would suggest that you stick with the SLGS dosing if that's what you're still following. I'm not clear on why you've reduced the dose and in all honesty, your cat's been sitting in high numbers. It would be better for his overall health if his numbers were in a lower range.

The only reason gabapentin might cause a drop in numbers is if your cat is in pain. Gabapentin may reduce neuropathic pain and if the alleviation of pain is causing less stress, your cat may have a drop in blood glucose levels.

 

[Sebastian’s mom (Lauren)]

Lantus is a long acting insulin compared to some of the other insulin that has been used to treat feline diabetes. What this translates to is that onset and nadir are also later in the cycle. In a "perfect" curve, you would feed your cat and give an insulin shot and roughly 2 hours later you would see blood glucose levels begin to drop. (See the timeline in this sticky note.) It's helpful to have enough data to discern where onset and nadir fall for your cat since not all cats follow the expected pattern and nadirs can and do move around.

If you see a larger than expected drop at +2, it suggests that it may be an active cycle -- numbers are dropping faster than expected. You would want to get some additional tests especially if you are going to sleep or leaving the house. It is absolutely possible that the numbers will continue to drop unless you know for certain where nadir (lowest point in the cycle) will be and none of us can predict exactly where nadir will fall all of the time. Remember, onset is generally hours prior to nadir.

It would be helpful to have all of Sebastian's numbers on his spreadsheet.

Unlike Kyle, I wouldn't characterize the example you notes as a "sharp drop." The numbers are still in a safe range but without the context of what your cat's cycles typically look like, I'd be hesitant to draw any conclusions. I also would suggest that you stick with the SLGS dosing if that's what you're still following. I'm not clear on why you've reduced the dose and in all honesty, your cat's been sitting in high numbers. It would be better for his overall health if his numbers were in a lower range.

The only reason gabapentin might cause a drop in numbers is if your cat is in pain. Gabapentin may reduce neuropathic pain and if the alleviation of pain is causing less stress, your cat may have a drop in blood glucose levels.

I’ve actually increased his dose! He just started 2.75 units lastnight after being at 2.5 for a week. There was a small period where I went down from 2.5 because when I made that increase is when all of his neurological/ seizure- like activity started so I got afraid. I didn’t know the reason that started and unfortunately I still don’t, but I’m going to continue to slowly increase for as long as he needs me to. With the help of all of you of course because I’m clueless and a nervous wreck.

 

[Sebastian’s mom (Lauren)]

Does anyone have any idea why his AMPS would be SOO high today? I thought that big jump would be reflective of him going too low and then bouncing back up.

 

[Sienne and Gabby (GA)]

I suspect the AMPS was a bounce from last night's numbers in the lower 200s. What you described is exactly what he did.

 

[Sebastian’s mom (Lauren)]

I suspect the AMPS was a bounce from last night's numbers in the lower 200s. What you described is exactly what he did.

I thought they just bounced when the numbers were low LOW so I was concerned that’s what happened even though logically it made no sense looking at his previous numbers. Thank you

 

[Sienne and Gabby (GA)]

Bounces can occur for a few reasons:

• Numbers dropping low.
• Numbers dropping fast.
• Numbers dropping lower than what your cat has grown accustomed to.

The last point is the one where most people new to managing their cat's diabetes get confused. If your cat's blood glucose is typically in the 300s, a drop into the low 200s, for example, may trigger a bounce. As your cat gets used to lower numbers, what triggers a bounce may change or the duration of the bounce may get much shorter.