10-27 Delilah AMPS 363; last cycle was 80. Do I shoot?

ShilohVasquez

ShilohVasquez

Member Since 2016
I have a new kitty, Delilah. She is on Lantus and has been on .5 units for a while. She was in foster care at a few different places since May. I have had her for a week and a half.

I was feeding her Friskies pate and leaving Young Again Mature Zero dry food out for her all the time. She has thrown up a lot of water several times since I've had her, so a few days ago I stopped feeding the wet food and just left YAZ for her. She seemed extra thirsty and was drinking too much then throwing it up.

Her sugar went from 441 on Friday morning to 282 Friday night, then Saturday morning it was 245. Saturday night, I got a reading of 80. I didn't give her Lantus with that one. I have an AlphaTrak2 meter.

Now this morning, her sugar was 363. Is this a bounce? She is free fed YAZ right now, and we have a vet appointment for Tuesday. I'm just wondering if I need to give her the .5 units this morning or just wait and recheck. I'm new to Lantus and I have had a few diabetic kitties in the past but they went OTJ very quickly with diet changes. Any insight is appreciated!
 
Welcome to the forum.

One thing that will help us enormously is if you get some spot checks during the cycle. Lantus dosing is based on the nadir, not on the pre-shot number. Without those spot checks, you have no idea how low Delilah's numbers went earlier in the AM cycle to give you the 80 at pre-shot. It's possible that her numbers were very low -- or not. Most of us would be very reticent to provide any guidance about dosing without some tests that are closer to nadir.

You may want to read through the sticky notes at the top of the board.

In all likelihood, your AMPS is a combination of a bounce and your not having given insulin at PMPS yesterday. With the 80, if you are planning on following the Start Low Go Slow (SLGS) method, which is your only option since you are not giving your cat a canned food diet, Delilah's dose should be reduced to 0.25u. With SLGS, you will need to do a curve once a week.

The other thing you will hate me for is that we arrange the spreadsheet in the opposite direction than how you have your dates arranged. We work from the earliest date to the present date. It allows us to better see trends in your data. Is it possible for you to rearrange the data?
 
Thank you. I prefer to give her canned food, but the vomiting was getting out of hand so I stopped it for a few days until we see my vet. I do hope to get her back on canned soon.

I will rearrange the spreadsheet later today. Sorry about that.

I also will do some spot checks. I guess my question was in general, does keeping the same dosing schedule make bounces worse or is it worse to skip when it is low?
 
Bounces are inevitable. If your cat is relatively new to diabetes, you have a couple of choices when facing low numbers and following SLGS:
How to handle a lower than normal preshot number:

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.
Click to expand...
 
I am doing a curve today. I also have a vet appointment for Delilah at 2 p.m. eastern. She seemed like she felt bad yesterday, and today she isn't eating much. I suspect she may be building ketones. I appreciate any insights into the spreadsheet values I am collecting today, although I don't know if they are useful if she is heading for DKA. I will keep you all updated, and thank you again!
 
There was a nice nadir on the curve today. How did the vet appointment go? Are you testing ketones atnhome?
 
Wendy&Neko said:
There was a nice nadir on the curve today. How did the vet appointment go? Are you testing ketones atnhome?
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She had a high white blood cell count, and Delilah was given Metronidazole, Cerenia, and Fortiflora. We go back for a recheck on Tuesday. The vet seemed to think it was a GI infection. Right now I'm just testing twice a day before the Lantus injections (unless I have reason to check more often) and trying to let her recover. I'm guessing the meds and the fact that I have given her the wet Friskies pate back are making her numbers go back up.

What can you tell me about the nadir you mentioned on my spreadsheet? I'm very new to figuring out how to use it to determine how the current dose is working. Or how many hours after the Lantus I need to be testing to see her low point. Thank you!
 
ShilohVasquez said:
Right now I'm just testing twice a day before the Lantus injections (unless I have reason to check more often)
Click to expand...
We determine how to change the Lantus dose based on how low it takes the kitty. The low point, or nadir, is typically somewhere in the middle of the cycle, so it’s important to get spot checks between the preshot tests. Including at night, many kitties go lower at night. A test just before going to bed is a good one to get. I rather suspect she is going low, then bouncing high.
 
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