10/23 Sev, AMBG 119 +.5 133, PMBG 138, 3 NS

[Sevytheking]

Previous Post (yesterday)

Hello, I was checking Severus’s AMBS and his number came in at 119. Last night his PM reading was 172, so I skipped the shot because my vet wants to be conservative with insulin right now due to several factors that could have affected his tests during diagnosis. The cheat sheet he provided, and what he confirmed (insisted) over the phone yesterday morning, says no insulin below 200. This is the second time his preshot number has been below that. Should I keep holding the shot? I’m currently stalling his AM dose.

Hello from the cute flower boy.

 

[Sevytheking]

The second AM blood sugar test was done with two meters. The Human meter, which I’m using to track his readings, showed 133. I also tested with the iPet meter, which my vet prefers, and it read 180. Both numbers are still below the level for giving insulin. Last time his numbers were below with a 191, and even though I gave him the insulin later, my vet told me afterward that I should not have.

 

[Sienne and Gabby (GA)]

It's interesting that his AMPS today is still fairly low. However, it looks like the numbers are heading upward (your +11 from the last cycle is lower than your AMPS). When you get a pre-shot number you're worried about, we suggest a couple of options:

• do NOT feed your cat and then re-test in 20 - 30 min to see where numbers are heading. You can repeat this process to see if numbers get to a place where you're comfortable. Keep in mind, though, that your next shot will be 12 hours later. Will your schedule be able to accommodate the shift in shot time?
• shoot a reduced dose of insulin
• skip the shot

Much of the choice depends on your comfort level, if you will be home to monitor, whether you have adequate supplies should your cat drop into lower range numbers, etc. We tend to discourage skipping unless you are still pretty new at managing your cat's diabetes since a skip has the most impact on numbers.

 

[Seth&Bell]

Johanna is brand new to this, and Sev is dealing with 3 new variables (new insulin, switch from kibble to wet LC, and antibiotics fighting a possible infection). She decided to skip this morning’s shot. I’m guessing Sev will rise throughout the day with two cycles in a row without insulin, but she’ll keep tabs on him (she’s doing great with the manual testing).

I think she’s looking for advice on the dose she should be using, and the preshot number above which she should shoot insulin being new without much data to go off of.

 

[Sienne and Gabby (GA)]

@Seth&Bell -
Not only is Johanna new to feline diabetes, all of us who are looking at Sev's spreadsheet are responding based on the limited data she's collected so far. He's new to us, too!! There aren't all that many hard and fast "rules" or even a history that can help guide any of us yet.

With Prozinc, if the cat is already on a low carb, canned food diet, we suggest 0.5u as the starting dose. If dry food is in the mix, 1.0u is the suggested starting dose. This is a link to the information on Prozinc dosing methods.
The following is in the dosing methods post:
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.

Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

@Suzanne & Darcy

 

[Seth&Bell]

Thank you very much, Sienne. That is super helpful.

I was talking with Johanna earlier today and describing a lot of these hard decisions early on as data gathering opportunities. We slowly gain confidence with decisions as we gather more data.

Sev has had two injections (one in the mid 200s and one in the upper 100s) and has responded with nice curves. He’s had two skips where he’s stayed (thus far) in the blues, which is very interesting to me.

Joha and I talked about the ketone concern as well, especially with the skipped shots. She’s having trouble catching him with a urine sample but she’s doing amazing with the manual testing, so she may just buy a ketone meter that reads blood samples.

She’s running into some of the same challenges a lot of us have (myself included) of antiquated advice from the vet (saying she needs a pet-specific meter, dosing off of BG readings at shot time instead of nadirs, etc). I can help guide a lot of that. I just don’t have experience with ProZinc so your roadmap above is very helpful to us!

 

[Sevytheking]

Thank you both so much! This forum and all the helpful answers have really been making such a difference! I took his PMBG before shot time, and he’s in the blue at 138. I’m going with the “no shot” decision again tonight and will test for ketones tomorrow just to be safe (hopefully everything’s fine!).

 

[Tim & Pookey]

Nice job so far! And welcome… I love his name too.