? 10/19 - 10/20 PMPS 119, skipped dose, AMPS 575

Alli and Bub

Alli and Bub

Member Since 2022
Hello All!

This is my first time posting in this area of the forum so apologies if my formatting is off. I am currently having an issue where my cat Bub is showing low numbers on his 3u dose before his PM injection. To err on the side of caution, I called the vet's office for dosing advice. Both times this has happened I was told to skip the injection. However, both times I have done this, his levels are sky high come the next injection time.

I called the vet to schedule an appointment and told them what was happening. My usual vet who initially diagnosed Bub and has been in charge of his dosing was there and believes there was confusion about the type of insulin used (I use Lantus) and that I should not have been advised to skip the doses and should of given him his 3u dose since Lantus is a basal type insulin.

My question is this: When he gets low-ish (under 150 but above 90), should I give him the full 3u and watch for hypo or err on the side of caution and try a reduced dose?
 
Hi Alli, did you read the sticky about the two dosing methods used on this forum? One is called "tight regulation (TR)". It requires more testing to monitor BG since it's more aggressive in terms of dosing, but also offers the best chance of remission. You can only use it if you are already feeding wet food only. The other method is called "Start low, go slow (SLGS)". As its name indicates, it's a more cautious and gradual method, better if you are not able to test as often during the day. If you feed any dry food you'd have to use that one (but I don't think you do, based on previous posts?).

Here is a link to the sticky, so you can read the "rules" of each method and decides what would work best for both of you.
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Also tagging experienced members so they can advise you!
@Bandit's Mom @tiffmaxee @Wendy&Neko

Link to previous post in general sub: https://felinediabetes.com/FDMB/threads/new-member-need-advice-struggling-with-numbers.269823/
 
I'm thinking SLGS might be best since I can't test during the day due to work. I also feed him wet food, but it is high carb...

Reading the sticky, it says to skip a shot below 150, but his BG goes up super high without it. His nadir last time seems to be the 119 around PMPS, which says to keep the dose... I guess I'm not sure how to approach these lower numbers since this is the first time he's gotten this low since being diagnosed.
 
Hi again. Here’s your post from the main/health forum. We link the previous thread for continuity.

If you read what I wrote on main I suggested you read the link on SLGS and follow it. Thanks for reading. There are guidelines on handling low preshots. The first thing you do is stall, DON’T FEED, and recheck the bg in 20-30 minutes to see if it’s going up. The reason for not feeding is so you won’t get a food influenced preshot. Then post for dosing advice. Add a question mark prefix and put something like Ambg or pmbg ### should I shoot.

His bg will go up if you skip but sometimes it’s necessary for safety. As you gain data you lower the no shot or reduced dose number until eventually you can shoot anything over 90 PROVIDED YOU CAN MONITOR. We find with lantus for most cats it onsets at +2 so if that number is lower than the preshot more tests are needed.

I suggested you lower the dose for two reasons. The first is because lantus likes consistency so you need a dose you can shoot every 12 hours. The second reason is since it’s dosed based upon nadir, lowest point in the cycle, and you don’t have many tests to know what that’s been. A dose of 3.0 is quite high for a recently diagnosed cat and it looks like your vet upped the dose too quickly and was looking at amps / pmps to decide the dose.
 
Thanks for the tips!

When he tested low at 121 for his PMPS, I stalled 30 mins and retested which was 119 and skipped based off that. I don't think I want to skip again if he tests lower; I don't want this crazy up and down to be a regular cycle for him. If I reduce the dose next time this happens, is there a rule for how much to reduce? The SLGS method says to look at previous data, so maybe 2.5u seems safer?

The increases in dose were prescribed every 2 weeks based on a glucose curve taken all day by the vet. When a curve was taken at 2u, she said the nadir was 170, but when taken at 2.5u, she said he was in the 400s all day which led to the increase to 3u.
 
We increase and decrease in .25 increments. Curves at the vet have the added stress of being at the vet. The only curve Max had at the vet was the first one after his first shot. It will be more accurate if you can do one at home testing every 2 hours for 12 hours or every 3 hours for 18. If you can get some tests in when home between +4-7 and vary them a full curve might not be needed.

If you decrease by just .50 it most likely won’t effect the first half of the cycle. It could still be active unless there’s a bounce. So we suggest shooting no more than 25% of the current dose until you have enough data to know the response.
 
Ah ok I see, so according to the guide you recommend trying the token dose option. So if he gets low again, try .75 units and see how he does. I know my vet said to go ahead and give him a full 3 units if he is low again because the dose should fight whatever BG increase happens after feeding / giving his steroid pill, but a full dose seems so excessive...
 
You will need to experiment and see what works for Bub. If he doesn't bounce he could get too low even with a steroid. When is he getting budesonide? That is important information that should be added to your signature. I saw it in your comments but don't always look there. Many cats don't have a spike with it like often seen with pred.

BTW you left out his name in the subject.
 
I usually give it at night before bed or sometimes with his nightly meal given after the PMPS so I don't have to shoot the pill in.
 
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