11/13 Coco AMPS 376 +4.25 329 +6.25 303 PMPS 275 +2 219 +4 132 +6 79; 6.5 83

win&coco

Member Since 2026
11/12 Coco AMPS 354 PMPS 397

Good morning, we start the new dosis the endocrinologist recommended (you can read about it in the last post if you are interested).
The cone comes off today at night or tomorrow morning which is pretty good for him, actually.

Three pokes at +4 😵‍💫, pretty difficult. I wonder tho how much does the stress of the pokes changes the glucose values? 🤔 I just want him to go back to yellow 😣
 
Last edited:
Sorry about the bad advice you got from the endocrinologist vet. There are a few specialties within endocrinology, perhaps the one you talked to doesn't have much diabetes experience.

First, I'm glad you didn't listen to the part about increasing by a full unit. A half unit might be OK now, but as you get into frequent nadirs in the low 200's or under 200, you will have to go to 0.25 unit changes. I do agree with the vet about testing 4 times per day. I did typically at least 5. Look around at other people's spreadsheets, you'll see what can be happening between the preshots that night be surprising. The first time Neko went under 50, her AMPS was over 400 and her PMPS was over 300. Without that mid cycle test, I wouldn't have caught how low she was going. Just as I have no idea how low the 2.5 unit dose was taking Coco. Those extra two tests, one in the AM and one in the PM are for Coco's safety. Stress of pokes does not change blood sugar values, as long as you are relaxed too. Try singing to her. It relaxes you too.

Somogyi is not fake, it is different from a bounce, but it is also something that very rarely happens in cats on long lasting insulins when they are started on a low dose, increase by appropriate amounts, and the caregiver is home testing. Somogyi was a concept written for a local journal and was not peer reviewed. It was written almost 100 years ago, based on a small study of humans and old very fast acting insulins. There has been research on Somogyi in cats using Lantus - it is very rare. Unfortunately, it has been taught in vet schools and something especially older vets believe.

The process here is test, feed, then shoot, sometimes referred to as TFS. All within about 10-15 minutes. For the older fast acting insulins, you did have to make sure the cat has eaten well before shooting. Glad you aren't following the advice on this one.

The Lantus depot takes 5-7 days to build when you first start insulin. If you are following TR, you can increase as soon as 3 days later if the nadirs are above 200. Ignore the part about taking into consideration the bounce. TR, should you be able to follow it, has built in time frames for increasing based on possible bounces. For nadirs below 200, doses are held longer. If you are following SLGS, you hold the dose for 7 days, unless she goes under 90, regardless of the nadirs.

I am glad you are switching back to the DM food, but be very careful and monitor closely. The diabetic food is lower carbs and will impact her blood sugars. We suggest trying the new food for a new days, seeing how it impact blood sugars, then increasing if still needed. You can not feed the DM dry food if you want to follow TR for dosing, TR requires and all wet food or dry diet. The dry is too high in carbs for a diabetic. Both it and the wet food are called diatetic, not diabetic management. There is nothing special in that food for diabetics.

Please also ignore those dosing guidelines she gave. We dose based on the nadirs or how low the dose is taking the cat. As I said above, Neko (more than once) went below 50 about 7 hours after the shot when starting her cycle at 400. That would be extremely dangerous to have increased the dose by 1 unit as the guidelines the vet gave you said to do. The guidelines the vet gave you are yet another clue she is more used to the faster acting insulins which tend to have their low points or nadir around 4 hours after the shot. With Lantus, is is more commonly around 6 hours after the shot, with some variability by cat and cycle.
 
I’ve never dealt with it personally but I’ve read people say they can smell a change in their breath with ketones present. Not really sure how that works tbh.

Those guidelines frustrate me. I probably should even comment and you know what to do, but why do these practices feel the need to reinvent this stuff, ugh. Over 30 years here with people following actual research. I hope we can keep spreading the word about this forum.
 
Sorry about the bad advice you got from the endocrinologist vet. There are a few specialties within endocrinology, perhaps the one you talked to doesn't have much diabetes experience.

First, I'm glad you didn't listen to the part about increasing by a full unit. A half unit might be OK now, but as you get into frequent nadirs in the low 200's or under 200, you will have to go to 0.25 unit changes. I do agree with the vet about testing 4 times per day. I did typically at least 5. Look around at other people's spreadsheets, you'll see what can be happening between the preshots that night be surprising. The first time Neko went under 50, her AMPS was over 400 and her PMPS was over 300. Without that mid cycle test, I wouldn't have caught how low she was going. Just as I have no idea how low the 2.5 unit dose was taking Coco. Those extra two tests, one in the AM and one in the PM are for Coco's safety. Stress of pokes does not change blood sugar values, as long as you are relaxed too. Try singing to her. It relaxes you too.

Somogyi is not fake, it is different from a bounce, but it is also something that very rarely happens in cats on long lasting insulins when they are started on a low dose, increase by appropriate amounts, and the caregiver is home testing. Somogyi was a concept written for a local journal and was not peer reviewed. It was written almost 100 years ago, based on a small study of humans and old very fast acting insulins. There has been research on Somogyi in cats using Lantus - it is very rare. Unfortunately, it has been taught in vet schools and something especially older vets believe.

The process here is test, feed, then shoot, sometimes referred to as TFS. All within about 10-15 minutes. For the older fast acting insulins, you did have to make sure the cat has eaten well before shooting. Glad you aren't following the advice on this one.

The Lantus depot takes 5-7 days to build when you first start insulin. If you are following TR, you can increase as soon as 3 days later if the nadirs are above 200. Ignore the part about taking into consideration the bounce. TR, should you be able to follow it, has built in time frames for increasing based on possible bounces. For nadirs below 200, doses are held longer. If you are following SLGS, you hold the dose for 7 days, unless she goes under 90, regardless of the nadirs.

I am glad you are switching back to the DM food, but be very careful and monitor closely. The diabetic food is lower carbs and will impact her blood sugars. We suggest trying the new food for a new days, seeing how it impact blood sugars, then increasing if still needed. You can not feed the DM dry food if you want to follow TR for dosing, TR requires and all wet food or dry diet. The dry is too high in carbs for a diabetic. Both it and the wet food are called diatetic, not diabetic management. There is nothing special in that food for diabetics.

Please also ignore those dosing guidelines she gave. We dose based on the nadirs or how low the dose is taking the cat. As I said above, Neko (more than once) went below 50 about 7 hours after the shot when starting her cycle at 400. That would be extremely dangerous to have increased the dose by 1 unit as the guidelines the vet gave you said to do. The guidelines the vet gave you are yet another clue she is more used to the faster acting insulins which tend to have their low points or nadir around 4 hours after the shot. With Lantus, is is more commonly around 6 hours after the shot, with some variability by cat and cycle.

She does have experience with diabetes, she even has a book 🤔 but maybe more with dogs than cats?

I tecnically didn't listen yet but on Monday after the curve we perform on Sunday we will have to increase/decrease (or mantain) by 1u according to her instructions...
I did fail to measure how low 2.5u was taking him so that's why I am skeptical about the whole increasing in 1u, but she said in cats like Coco who seem to have insulin resistance increments like .5 or .25 may not work at all. That's why we also need to do all the bloodwork again and some hormonal panel to see if he has something that is making him resistant to it.

Thing is she didn't commend on dry food affecting values? She did say hydratation was really important and that we could add part of the wet food as a topper or add water but didn't mention carbs. I will change gradually but we need to save a little to buy a bag of the dry food so that means he won't be on Purina Pro DM yet on this week.

I think she got confused? When we talked she did said about the nadir being +6/+7; even in one of the other PDF she send kind of says that. But also one of the PDF includes:
Feeding schedule in relation to insulin:
1- Main meal: 1/2 hour after insulin administration
2- Second meal/snack (fruits, vegetables): 6–7 hours after insulin administration
Then, repeat the process at 12 hours with the second dose.


Which maybe it's for a dog? Because it says fruits and vegetables...
We have an appointment next week probably so I will insist on doing .5 increments rather than 1u. I really want her to treat Coco because of the whole other exams she requires for him but about his dosis I don't know what to do anymore. I keep searching for vets who can help us and yet I encounter more confussion and mess 😢
 
I’ve never dealt with it personally but I’ve read people say they can smell a change in their breath with ketones present. Not really sure how that works tbh.

Those guidelines frustrate me. I probably should even comment and you know what to do, but why do these practices feel the need to reinvent this stuff, ugh. Over 30 years here with people following actual research. I hope we can keep spreading the word about this forum.
I did read about that but I never smelt nothing different or wrong on Coco's breath. I also read that cats can't form ketones if they are eating well and having constant insulin but again, this was something I read by the google AI so it can be incorrect or correct. Either way that's why I don't like leaving Coco without insulin and why I was eager to get him on a 12 hour schedule.

I literally looked for an specialist because I wanted a verified guidelines but it seems like I keep encountering more confusing/incorrect ones 😣
She's from another country so maybe they get another type of guides? So yeah I do not know what to do exactly.
 
I had a cat with two types of insulin resistance caused by secondary endocrine conditions. She was sensitive to 0.25 unit changes, even when her dose was over 5 units. We don't suggest getting those extra hormonal blood tests until kitty is at 6 units total dose. Though there are occasionally kitties on lower doses that test positive for them. Right now I can't tell if Coco is on too low a dose, or too high a dose and bouncing.

The vet may have experience with Caninsulin and other older insulins no longer recommended for cats. At least in a lot of countries. Sad truth is that more people treat diabetic dogs than cats. My vet originally insisted I used Caninsulin, cause that is what she was used to and they used in the clinic. Again, mostly dogs treated for the dog insulin. A locum vet got us switched to Lantus. I still stayed with my vet as she was willing to learn along with me about feline diabetes, and those endocrine conditions (acromegaly and insulin auto antibodies). She was great on handling Neko's other issues. I just came here for dosing help, and also more knowledge about the conditions and treatment for the endocrine conditions.

Google AI is wrong about ketones - no surprise. We've seen cats that don't get above 300, eating well, getting insulin and still get ketones.
 
I’ve never dealt with it personally but I’ve read people say they can smell a change in their breath with ketones present. Not really sure how that works tbh.
Yes our vet said that too, she said when the breath smells a bit like acetone, like nail polish remover, than ketones could be present. And that some people are more sensitive in smelling ketones than others. Not sure if that is true....
 
I had a cat with two types of insulin resistance caused by secondary endocrine conditions. She was sensitive to 0.25 unit changes, even when her dose was over 5 units. We don't suggest getting those extra hormonal blood tests until kitty is at 6 units total dose. Though there are occasionally kitties on lower doses that test positive for them. Right now I can't tell if Coco is on too low a dose, or too high a dose and bouncing.

The vet may have experience with Caninsulin and other older insulins no longer recommended for cats. At least in a lot of countries. Sad truth is that more people treat diabetic dogs than cats. My vet originally insisted I used Caninsulin, cause that is what she was used to and they used in the clinic. Again, mostly dogs treated for the dog insulin. A locum vet got us switched to Lantus. I still stayed with my vet as she was willing to learn along with me about feline diabetes, and those endocrine conditions (acromegaly and insulin auto antibodies). She was great on handling Neko's other issues. I just came here for dosing help, and also more knowledge about the conditions and treatment for the endocrine conditions.

Google AI is wrong about ketones - no surprise. We've seen cats that don't get above 300, eating well, getting insulin and still get ketones.
Would these 3 days with meditions of AMPS +4, +6 and PMPS +2 be enough to determine if Coco is having a low dosis or too high?

Because the notes she added said that Coco's resistance to the insulin was multifactorial, mostly because of his FeLV+ (it can damage the pancreas), the environmental stress and the secondary infections that caused both obstructions and abscesses. And she wanted to rule out hyperthyroidism and evaluate calcium metabolism (whatever that means). But the summary also says: "Coco’s diabetes is insulin-resistant, as confirmed by a glucose curve and a fructosamine level >600 µmol/L." Even though the fructosamine test is from July and the curve is recent from November 7. And it says: "The insulin dose should be increased in whole-unit increments to overcome resistance, with 4.0 U serving as a realistic target—a common dosage for cats with comorbidities."

I chose her because I saw her IG where some of her patients were cats. I wanted to reach out to one of them to ask how was she managing the insulin but I decided not to do that because well she is a professional, so I kind of expected to have better guidance. Either way my dad is still saying poking him 4 times a day is much so having a professional helping didn't help in changing his opinion (but he does helped me with the +6 so i guess that's good).

I know some cats are more prone to ketones than others but could there be cats that are less prone to developing ketones? The urine test they did when we changed vets said negative ketones even when he was really high for a few days/week.

What I am about to do is probably do the hemogram (to see if that light anemia is still there), the blood chemistry test (to see his kidneys) and the urianalisis to discard infections, see if he has crystals and the type and to see if his ph is back to normal because the urinary food made it to 5.5 ph, which his vet (not the endocrinologist) said it was normal... and the stool analysis to look into the cause of his diarrhea too 😵‍💫 and see what the endocrinologist recommends with all this test; then depending on it I will see if I stop doing her guidelines/appointment.

Yes our vet said that too, she said when the breath smells a bit like acetone, like nail polish remover, than ketones could be present. And that some people are more sensitive in smelling ketones than others. Not sure if that is true....
That's good to know 🤔 just in case
 
Coco’s diabetes is insulin-resistant, as confirmed by a glucose curve and a fructosamine level >600 µmol/L."
I'm not an expert and I hope I don't say anything wrong here. But is a fructosamine test with that levels a sign of resistance or just a sign of a not well controlled diabetes? Coco was on 2.5 units until this morning, not sure if that could be a bit too early to say Coco is resistant.

Regs only had a little effect at 2.25 and 2.5 and then suddenly at 2.75 and 3 units he came down significant, sometimes even a bit too good
 
I'm not an expert and I hope I don't say anything wrong here. But is a fructosamine test with that levels a sign of resistance or just a sign of a not well controlled diabetes? Coco was on 2.5 units until this morning, not sure if that could be a bit too early to say Coco is resistant.

Regs only had a little effect at 2.25 and 2.5 and then suddenly at 2.75 and 3 units he came down significant, sometimes even a bit too good
Tbh I don't really think Coco is resistant to the insulin. The fructosamine test was made back in July (literally was our test to confirm the diagnosis) so he wasn't getting insulin before that at all which is why he had uncontrolled diabetes. No one has told us to repeat the fructosamine test not sure why but I suppose it's because we test at home maybe?

So I think the endocrinologist said that because the fructosamine test + the curve we did with the 2.25u we didn't get numbers under 200's (however he may have dropped after the PMPS but unfortunaly I didn't test him at night) and because Coco seem to be stuck in the 300s most of the time. But to me that just seems like he hasn't found the correct dosis yet (and I haven't been testing as much as I should 😓).
 
I’ve never dealt with it personally but I’ve read people say they can smell a change in their breath with ketones present. Not really sure how that works tbh.

Those guidelines frustrate me. I probably should even comment and you know what to do, but why do these practices feel the need to reinvent this stuff, ugh. Over 30 years here with people following actual research. I hope we can keep spreading the word about this forum.
When Jude was first diagnosed, I knew he was diabetic because I could smell a fruity smell in his breath (plus he had frequent urination and persistent thirst). I had smelled that before with people I knew who were on low carb diets (called keto breath). But when Jude was tested initially and since, he's never showed ketones. I made sure to ask the vet about it because the smell on his breath was so pronounced. So I'm not sure smelling is a test.
 
Okay so I have the worst timing when testing. I don't know if he went low in between +7/+11 in the AM cycle (and how low) and then the PMPS was just starting to go up as normal or what. But then we have the PM +2 219 being lower than the PMPS but idk if it's because of insulin cycle being active or if it's the same morning dosis that is making him go low? I should have checked at +8 or +10.

I'm really tired but if I have to check him should I check at +4 or at +6?? Should I leave food out just in case? He's still staying confined in my room but the cone is off so he is more comfortable this night.
 
Yes our vet said that too, she said when the breath smells a bit like acetone, like nail polish remover, than ketones could be present. And that some people are more sensitive in smelling ketones than others. Not sure if that is true....
Yes it is. I was posting on a new person's post on the Health forum, and she could smell something was off. I've even heard people say they smell something fruity. Also a lot of people can't smell, best to rely on urine or blood testing for ketones. Not all cats in high numbers show ketones. Neko being one such example. She was stuck above 300 for a long time, thankfully no ketones.
should I check at +4 or at +6??
Check at +4, then leave food out if he's still dropping a lot and you cannot get a +6. This looks like an active cycle to me.
 
He's gone down 56 points so far. A cat's blood sugar doesn't go down at a steady rate, but unfortunately we don't have a lot of data about when Coco likes to typically nadir (have his low point). Note that can change somewhat from cycle to cycle, based on things such as is he breaking a bounce, which leads to later nadirs. If he was down another 50 or so points at +4, I'd be interested in a later data point. You'd like to see him slowing down or stable before calling it a night.
 
He's gone down 56 points so far. A cat's blood sugar doesn't go down at a steady rate, but unfortunately we don't have a lot of data about when Coco likes to typically nadir (have his low point). Note that can change somewhat from cycle to cycle, based on things such as is he breaking a bounce, which leads to later nadirs. If he was down another 50 or so points at +4, I'd be interested in a later data point. You'd like to see him slowing down or stable before calling it a night.
He is 132 at +4.
So yes, I will stay awake to test at +6, didn't think he would go into blue but now that I see I will make sure to check him again.
 
If he goes under 90 tonight, the dose is too high. I hope he levels out now.
He went 79 at +6. However I'm not sure if it could be a meter error? Should I check again in 20 minutes? You can see the blood on the strip and I'm not sure if it probably read low because of not enough blood?

I don't plan on sleeping tonight just in case. I have hills urinary multicare c/d wet food which google says has 28% carbs. Coco didn't want to eat much of his kibble, just a few tiny bites. He doesn't seem lethargic tho nor wobbly.

I did checked again at +6.5 and it's 83. Not sure if I feel comfortable with those numbers despite knowing they aren't too bad per se. Will see if I can check at +8 just to make sure he is going up enough for his AMPS. Pretty sure he might bounce tho 😵‍💫
 

Attachments

  • IMG-20261114-WA0009.jpeg
    IMG-20261114-WA0009.jpeg
    330.4 KB · Views: 2
Last edited:
I see you got an 83 at +6.5?

A faulty strip or not enough blood can give a bad reading. When in doubt, you can test again right away rather than wait 20 mins.

Congrats on the green! Greens can be scary at first, but with time, both Coco and you will get addicted to them:-)
 
I see you got an 83 at +6.5?

A faulty strip or not enough blood can give a bad reading. When in doubt, you can test again right away rather than wait 20 mins.

Congrats on the green! Greens can be scary at first, but with time, both Coco and you will get addicted to them:-)
I did wait because I didn't want to poke him right away again because he was a little bit restless (and the second poke the blood did came out more easy) but I will keep that in mind if that happens again.

Thanks 😊 I do hope we can get used to them soon. Just not sure how I feel about a lower pre-shot number than the usual.
 
Back
Top