? ? 06/07 Jack AMPS 72, +6 22, +6.5 55” Advice on Dose Schedule in 1 Hour

Jack the Cat

Jack the Cat

Member Since 2019
Ok it's been a rough day for Jack the Cat.

He's been on 2 units LANTUS x 2 a day per vets advice. I just started home monitoring and the numbers today were frightening.


I've been reading through a lot of information, but the JAAHA. ORG Diabetes Management Hypoglycemia flow chart is telling me to not dose insulin until Jack's numbers get up to 250+.

But other documents say don't change insulin dosage without consulting the vet.
So now I don't know what to do...withhold the insulin based on his numbers today? Reduce to 1 unit. Withhold food? High carb food for his pm feeding or his low carb food for pm feeding?

Any advice is most appreciated...it's been a stressful day.
 
Hi, I posted on your other thread. If he isn't over 150 at PMPS test time, withhold food and stall and then retest in 30 minutes. We want him up over 150 for you to shoot the reduced dose of 1.75.
 
Here is what .75 of a unit looks like to help you dose the 1.75 units.

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Jack the Cat said:
Jack's PMPS reading was 256. I fed him and gave him 1.75-1.50 units. Will try and test before bedtime. Thank you all for your support.
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It was expected that his numbers would soar up ( bounce ) from seeing that lower number today. Bouncing happens when a kitty sees a number much lower that he is used to being in or dropping fast. I suspect that the 2 units is too much for Jack. As Carla said, please get some night time test in as a lot of kitties go lower at night time. A +2 test is a good test to get. IF that +2 is the same or lower that the pre shot number, it could be an active cycle and could require more testing to make sure that Jack is safe.

Do you have some higher carb food ( 11% and above ) for steering if necessary. If not, might be a good idea to get some to have on hand and keep in a separate place than your lower carb food so you don't get mixed up. Or, write on the lids the higher carb %.

Post again if you need help.
 
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Hi Jane,
Welcome to you and Mr. handsome Jack :cat:
Will you please consider changing your title? Keep the “?”, reword subject asking for dosing advice, need help, please look at Jack the Cat SS.
I don’t feel properly skilled to advise you- I believe you need to get attention from others who can/will :). More skilled eyes on you is kinda important right now for Jack the Cat :nailbiting: :cat:
 
Hi Jane,

I'm glad Bobbie and Carla were here to advise you on the PM dose and what to do next. If you can update your SS and post your +2 number, that'd be great.

It is most likely and obviously, as Bobbie said, 2 units is too much for Jack. You will find that the next few cycles, either Jack will bounce from going down to 22 as well as possibly be still influenced by the previous dose of 2 units so you might still see Jack experience low numbers. Tonight's cycle may produce high numbers as expected but the 2 unit depot is still in effect and could still bring Jack down. I would test as often as you can and stay alert.

It's also important you are clear on what dose you gave Jack and be consistent about it. Where ever the plunger ended up is your new dose unless Jack tells you otherwise (aka he goes under 50 again) or if you are advised to further lower the dose or drain the 2 unit depot.

I know you are reading up on multiple sources about FD. Of course, if you're here, we will encourage you to follow the methods used here on the forum. It will most likely go against advice of your vet but as you can see, many of us follow these methods and have success in managing diabetes in our kitties.

Jack the Cat said:
the JAAHA. ORG Diabetes Management Hypoglycemia flow chart is telling me to not dose insulin until Jack's numbers get up to 250+.
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We do still give insulin under 250. But for new diabetic cats, we recommend asking for help if you have a PS number under 150 as there isn't enough data to know what the cat will do.

From the Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR) sticky:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
I encourage you to read (yes more reading!) the stickies on this forum and click the links within all the stickies. After reading, take your time and make a decision as to what dosing method you want to follow and let us know so we can help you better.

You did a good job keeping Jack safe today. It was stressful but you did it!
 
So glad you got the help of the more experienced members here. You are now in very good hands. If in doubt about anything don't be afraid to ask questions it really is the only way to learn. The learning curve is a bit daunting but you've taken your first steps on the FD journey and are with a community that understands how stressful and rewarding it can be. The very best of luck tonight, hope that Jack the Cat stays safe for you. Best of luck.
 
Good morning. I don’t see a new thread for today, so I’m posting here. How did Jack do through last night’s cycle?

I also wanted to add to the good information that @Crista & Ming gave you that besides the depot of 2 units could still be affecting his numbers even though you reduced , but something else to be aware of is that after a very low number like 22 , kitties can become very sensitive to insulin. So, please be vigilant in testing to make sure he is safe.
 
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Thank you all for the guidance. I was not able to test yesterday's PMPS +2 nor this morning since I cannot get enough blood out of his ear for a successful test. He looked good this morning but didn't eat much. I did dose him 1.75 units and will watch him this morning and try another test in two hours.

And I will read the stickies this morning.
 
What a learning curve...I was the problem in the testing, not Jack's ears. Just got a successful test and he is at 115.

I will test again in three hours to see where he is then...

Thank you all again.
 
Jack the Cat said:
What a learning curve...I was the problem in the testing, not Jack's ears. Just got a successful test and he is at 115.

I will test again in three hours to see where he is then...

Thank you all again.
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Oh good. Glad you were able to test. How many hours after the insulin was 115? If you could update his SS , that would be helpful.
 
The 115 reading was 2.5 hours post shot. I've updated the SS. Will test again in an hour. Just checked on him and he looks good.
 
Jack the Cat said:
The 115 reading was 2.5 hours post shot. I've updated the SS. Will test again in an hour. Just checked on him and he looks good.
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The 115 should be in the 2 cell and put @ 2.5 Then you will have to manually color the cell. Go to top of the SS and find the paint can that is tipped. Click on that and with your cursor in the +2 cell click on blue color. If you have any problems, just yell.
 
37 is the reading post shot 6 hours. Gave HC food and corn syrup. I will test again in 2 hours. I have to be somewhere soon.
 
I didn't mean to sound so abrupt. I was multitasking and needed to make sure you understand not to leave him that low without knowing that the HC food and syrup brought him up. When a number is that low and you give HC food and/or syrup, you would test 20 -30 minutes afterwards to make sure it bought him up. Then you would test again in 30 minutes to make sure he is maintaining above 50. If not, more HC food and syrup. If he is maintaining over 50, you would not feed and test again. You want to see 2 tests, 30 minutes apart without food influence to know that he is out of danger.
 
I just looked up one of your past posts and see that your vet started you on 2u, decreased to 1 then back up to 2 after he tested high. That was too big a jump in dose based on one test or even one curve. I think you should start over at 1u and get some tests in and see where Jack is at. He’s had several very low numbers lately and that can make a cat more sensitive to the insulin too. Please check him again and let us know. We worry
 
Sorry all folks. I had to leave the house for an appointment this afternoon. I tested Jack at 9.5 hours from morning shot and his number is 84.

I will test again at 12 hours prior to giving shot and food and see what his number is.

From all I have read, I agree, Sharon 14, that I think 1 unit is what he needs. I will do that tonight, then test throughout the day tomorrow to see how his number react to a lesser dose.

Thank you all...
 
Jack the Cat said:
Sorry all folks. I had to leave the house for an appointment this afternoon. I tested Jack at 9.5 hours from morning shot and his number is 84.

I will test again at 12 hours prior to giving shot and food and see what his number is.

From all I have read, I agree, Sharon 14, that I think 1 unit is what he needs. I will do that tonight, then test throughout the day tomorrow to see how his number react to a lesser dose.

Thank you all...
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I agree with Sharon. Let’s do a “restart” of one unit and get as many test in as you can. Like I mentioned in a previous post , the + 2 is a great test to get. It will tell you if you need to keep testing. Besides that test , since we base the dose on the nadir, the lowest point of the cycle, try to get some test in between +4-7 when most kitties nadir. (The lowest point in the cycle ) and that said some kitties nadir differently, but that is a good starting point.
 
Jack the Cat said:
PMPS value is 58, so I am not giving insulin right now. Will try and get another test in before bed.
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I think you should skip the shot tonight and then in the morning start with 1 unit. I think a restart would be a good idea. He might be higher in the AM due to skipping and some bouncing.

Clearly , his dose is too high. Let’s play it safe and start over with 1 unit. Has Jack ever been DKA? That would be a consideration in lowering the dose. If no, then let’s resume tomorrow at 1 unit.
 
Jack the Cat said:
PMPS value is 58, so I am not giving insulin right now. Will try and get another test in before bed.
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Oh, please try, try to get another test in before bed. These low numbers Jack the Cat has experienced- nadir's below 50/ below 40 could potentially have a (grave), long term impact on his health.
I am going to tag a few peeps who have much more experience and knowledge than me @Sienne and Gabby (GA), @Christie & Maverick @Jill & Alex (GA) , @Tricia Cinco(GA) & Harvey :) :bighug:
 
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You will still have some depot in play, even with a skipped shot, he has shown very low numbers and a strong reaction. What % carbs are you feeding? Can you please get a +2, that will tell you if you need to continue monitoring. If same number as PS or less, please post.
 
OK I just joined last Monday so still working on understanding the lingo...Can you please explain what a DKA is? And what is "some depot in play" mean? Sorry, have been reading a lot but have not run across those terms.
 
DKA stands for Diabetic ketoacidosis which can be life threatening. It's when sugars are too high, the body doesn't have enough calories, and not enough insulin so the body starts breaking down its own fat. It can become an emergency situation and it's why testing for ketones when kitty is high is recommended.

If Jack has had DKA, we take this into account when considering dosing. For example, Ming has had a DKA event so I try my best not to skip a shot because I don't want to risk Ming having high blood sugar levels and not enough insulin. I do this by giving a reduced dose or giving insulin later.

Lantus and Levemir are depot insulins. Unlike Vetsulin or ProZinc which are in-and-out insulins that have a 12-14 hour effect. Lantus will continue to affect cycles that follow afterwards. To put it simply: the body "stores" insulin for later use. You'll read about it more as you read the stickies.

So since you've been giving Jack 2 units for the past few days, the 2 unit depot is still in effect. It will still continue to release insulin at the strength of 2 units. So even though you gave Jack 1.75 units last night, the 2 unit depot is still working it's magic. Its why cats on Lantus are able to achieve flat curves as opposed to cats on Prozinc which produce cycles that are shaped like a smile.
 
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Sorry, it is hard to remember being new, DKA is diabetic ketoacidosis. See here ... it explains further http://www.felinediabetes.com/FDMB/...oacidosis-dka-and-blood-ketone-meters.135952/

The reason why we ask whether Jack has had DKA is because ketones can build up quickly, and the recipe for DKA is insufficient supply of insulin +inappetance+Infection or other systemic stresses. If Jack had a history of DKA, skipping insulin wouldn't usually be a good idea.

Lantus is a type of insulin that is characterized as an insulin which is absorbed slowly in the body (unlike other in and out type insulins). Because it is slow to absorb, you get a cumulative affect...so even if you skip tonight, the previous doses will still affect his cycles, sometimes up to six cycles.

Does this make sense?
 
OK I understand the depot stuff. As far as the DKA he probably has had it. His drinking water volume has decreased in the last week. There was tremendous stress when he was diagnosed. His parter Rufus didn't recognize him, and there were cat fights galore. So he has now limited his movements to just my bedroom, the bathroom where he is fed and the litter box just outside the door. So is he depressed, yes I am sure. He stays under the bed most of the morning, then will come up an lay on the bed during the afternoon hours. I spend time with him on the bed, and the ketone odor has diminished in the last few weeks.
 
Jack the Cat said:
OK I understand the depot stuff. As far as the DKA he probably has had it. His drinking water volume has decreased in the last week. There was tremendous stress when he was diagnosed. His parter Rufus didn't recognize him, and there were cat fights galore. So he has now limited his movements to just my bedroom, the bathroom where he is fed and the litter box just outside the door. So is he depressed, yes I am sure. He stays under the bed most of the morning, then will come up an lay on the bed during the afternoon hours. I spend time with him on the bed, and the ketone odor has diminished in the last few weeks.
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If he had DKA , he would have been hospitalized for days maybe a week or so. You would know that term from your vet.
 
Do you have ketone strips? The best way to know is to test their urine.

I know you had to go somewhere when Jack got the 37 reading, but it's important you follow up after a lime green. Giving karo/honey will only temporarily boost up their numbers. Once that's out of their system, their numbers will go right back down and/or the depot/insulin is still doing its job and that will further influence numbers.

When a cat goes under 50, we usually feed (either more low carb food, high carb food, or karo/honey) and then test 30 minutes later. Repeat if number is still under 50. Once their number is up again, we continue to test until we know for sure that kitty is safe. It all takes a while and might take upwards of 2-4 hours. (This is also another stickie you'll be reading soon)

Ming always has a caregiver at home so that's where I'm fortunate enough not to have to think about leaving him during a low event. Perhaps some other forum members can share how they deal with being the only caregiver to a sugar cat.
 
Crista & Ming said:
Jack got the 37 reading, but it's important you follow up after a lime green. Giving karo/honey will only temporarily boost up their numbers. Once that's out of their system, their numbers will go right back down and/or the depot/insulin is still doing its job and that will further influence numbers.

When a cat goes under 50, we usually feed (either more low carb food, high carb food, or karo/honey) and then test 30 minutes later. Repeat if number is still under 50. Once their number is up again, we continue to test until we know for sure that kitty is safe. It all takes a while and might take upwards of 2-4 hours.
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Please don’t take this as my being harsh , I truly don’t want to sound this way.-
the last test you took on 6/5, PMPS showing 54 is a really low number for a PMPS. I don’t see any numbers recorded for 6/6- do you have numbers for this day (after PMPS 54, night before?).
Please, please don’t think I am being a mean jerk o_O... Jack nadir (lowest point in cycle) on 6/7-6/9, respectively 47,22 and, 37 were dangerously low. How would you know this? You wouldn’t without the guidance of experience :eek:.
There are many people of this caliber watching jack and you- wanting to help you... help Jack :bighug: :bighug: :bighug:
Please, hang in there- hang in there with us. This trip becomes more understandable and easy to ride :)
 
No I was not successful in testing on 6/6...my error in not know how to use the monitor and strips correctly and just so much stress on his ears.

I just tested he is at 98. I wouldn't know how dangerously low these numbers are -- now with the help of all of you!.

Jack and I have made significant progress over the last 2 days. He is now cooperative when poking his ears like he is when I give shots so he is beginning to understand the journey that both of us are taking to make him better...

I am conflicted though since I have to travel in 10 days (daughter-in-law's memorial service) and have the vet tech coming in twice a day. I plan to ask her to test (since I am paying her) and record in my paper log. I don't want to leave Jack but I have to!

Thank you for your education and support...I know we will be successful.
 
I do not have ketone strips. Unless you thing it is an emergency, I need to be able to master ear piercing and testing before stepping up to another kind of testing?
 
Jack the Cat said:
No I was not successful in testing on 6/6...my error in not know how to use the monitor and strips correctly and just so much stress on his ears.

I just tested he is at 98. I wouldn't know how dangerously low these numbers are -- now with the help of all of you!.

Jack and I have made significant progress over the last 2 days. He is now cooperative when poking his ears like he is when I give shots so he is beginning to understand the journey that both of us are taking to make him better...

I am conflicted though since I have to travel in 10 days (daughter-in-law's memorial service) and have the vet tech coming in twice a day. I plan to ask her to test (since I am paying her) and record in my paper log. I don't want to leave Jack but I have to!

Thank you for your education and support...I know we will be successful.
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Two days or 4 cycles before you leave , a reduction for safety would be in order. We can talk more about that then.

Jack is nice and safe now and since you did not shoot insulin tonight, you can relax and get a good nights sleep and resume tomorrow morning.

Unless he’s thrown ketones in the pass, I wouldn’t worry about that now. When you said “the ketone smell on his breath” , were you referring to the “acetone” smell that diabetes can sometimes have?
 
Yes there was an odor to Jack, a sweet kind of odor.

Thank you for your kind words...getting a good night's sleep has been rare in the last few weeks.
 
Great job, Jane :) It's so great to hear that Jack is doing well with ear pokes.

I think it's a good idea to ask the vet tech to test BG before she shoots. She should know how.

Yes, I wouldn't worry about DKA right now but having ketone test strips is a good tool to have at your disposal. They're dip sticks you test in pee to check for ketones. When you have the opportunity to get them, let us know and we can teach you how to use them.

I'm sorry to hear about your daughter. :bighug::bighug::bighug::bighug: When you need to leave, let us know again and we can help you draw up a plan on how to care for Jack when you're away. We might give a "vacation dose" which is a reduced dose to keep Jack safe.
 
DKA doesn''t really have a "sweet" odor. A cat's breath smells more like nail polish remover -- it's an acetone-like smell. Like Bobbi said, your kitty would have been hospitalized, on an insulin and glucose, drip, and it would have cost thousands of dollars to help Jack recover. You'd be quite likely to remember the term.

I think the suggestion of a start over is a good one. For right now, it's likely a much better strategy to have Jack's numbers sitting a little higher overall rather than having him drop into dangerously low numbers like that 22. It will give you a chance to see what his cycles look like -- and get some sleep without worrying if Jack was dropping too low.

FYI - you may want to change the color on your AM +2 from yesterday. The cell should be colored blue, not yellow.
 
Jack the Cat said:
Am feeling better with these numbers and maybe on a better path!
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I am feeling more comfortable too. It can take up to 6 cycles or 3 days for the new depot to fill. Let's see how it goes. :)

Could you start a new thread today with Jack's name and the date and his AMPS number and today's info? We do a new thread a day otherwise the threads get so dang long to get through and read. The last few days we've been dealing with Jack and low numbers so that was more important that the housekeeping stuff so no one mentioned it to you.

You are doing a great job!
 
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