10/28 Comet PMPS @ 96 - Insulin question.

Amanda Comet’s Mom

Amanda Comet’s Mom

Member Since 2021
At what number do we consider normal for not needing to shoot any insulin?
Comet was at 103 this morning, so since I’m home for about 6 hours with him after shooting we just shot .5u. Tonight his PMPS is 96, but I typically can only get a +2 and +4 before NEEDING to sleep. I skipped his insulin tonight and seeing where he is in the AMPS. Is it bad to skip, or could we get to a point he would only need insulin in the AM? I get it only works for 12 hours and after food it generally rises. But he is almost completely off his Prednisolone. The day after we dropped him to 2.5mg once daily his numbers were great! This morning he was 103 but his appetite was not great from the Clavamox (which we stopped) so I only shot .5u because I was not sure if he would eat much more and didn’t want to risk a hypo but also not just skip.
Ahhh idk help lol. I’m tired and sick right now so want to do what’s safest.
 
With SLGS you can shoot any number over 90. When you get a number below 90, you stall without feeding and test in 20 mins - if it rises above 90, you're good to shoot.

The 96 tonight is not very different from the 101 you shot last night. Since you could test till +4, you could have shot. Comet is a very good example of the beautiful flat cycles that Lantus is known for. Some cats bounce and dive a lot and can be hard to predict/need more monitoring, but not so with Comet. Not that I am suggesting that you don't need to get tests after shooting!

When was the pred stopped? Could you add that to the comments on your SS?

Link to your previous post:
https://www.felinediabetes.com/FDMB/threads/10-26-comet-amps-101-then-20-min-recheck-98.254694/
 
Bandit's Mom said:
With SLGS you can shoot any number over 90. When you get a number below 90, you stall without feeding and test in 20 mins - if it rises above 90, you're good to shoot.

The 96 tonight is not very different from the 101 you shot last night. Since you could test till +4, you could have shot. Comet is a very good example of the beautiful flat cycles that Lantus is known for. Some cats bounce and dive a lot and can be hard to predict/need more monitoring, but not so with Comet. Not that I am suggesting that you don't need to get tests after shooting!

When was the pred stopped? Could you add that to the comments on your SS?

Link to your previous post:
https://www.felinediabetes.com/FDMB/threads/10-26-comet-amps-101-then-20-min-recheck-98.254694/
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We have not stopped him yet. Just went from 2.5mg twice daily to only once daily and noticed a pretty good drop after the second and 3rd day.

Im curious as to how you know your cat is in remission. Like what should his numbers be at without needing insulin? Also what is the lowest number you shoot at? From what I understand 80-100 or 120 is normal? So if he was in a normal range why shoot at all? I’m not questioning your judgement just curious about all of this! Any info is greatly appreciated. Also if I would’ve give him insulin tonight should I have given him 1.25u (his usual) or less? Lower numbers seem tricky
 
AmandaD said:
Im curious as to how you know your cat is in remission. Like what should his numbers be at without needing insulin? Also what is the lowest number you shoot at? From what I understand 80-100 or 120 is normal? So if he was in a normal range why shoot at all? I’m not questioning your judgement just curious about all of this! Any info is greatly appreciated. Also if I would’ve give him insulin tonight should I have given him 1.25u (his usual) or less? Lower numbers seem tricky
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Feel free to ask as many questions as you want. We have all had the same questions at some point! :)

A cat is considered in remission if it stays in normal numbers (50-100 mg/dl on a human meter) after 14 days of no insulin.

The lowest number you can shoot at depends on which dosing protocol you follow. With TR, you can shoot as low as 50 and with SLGS it is 90 (both on human meters).

If a cat sees normal numbers when it is on insulin, it just means that the insulin is bringing the numbers down to those levels. Not that the cat does not need insulin any more. The aim of tight regulation is to keep the cat at a dose where it spends as much time as possible in normal numbers.

Tonight you could have given the full dose. I see that you have dropped his dose to 0.5U for the last 2 cycles. It is possbible that with the pred being tapered, he needs less insulin, but we don't know what that amount is. Some cats race down the dosing ladder (especially when there is a food change from a higher carb to a lower carb diet, or something that was causing the higher numbers resolves - infection/inflammation/bad teeth/removal of steroids etc). With others, we take reductions is 0.25U (just like we do with increases) so that we don't bypass a good dose. Lantus is a depot insulin and it can take 4-6 cycles for the depot to adjust. It's possible that the 1.25U depot is still affecting Comet's numbers.
 
Bandit's Mom said:
Feel free to ask as many questions as you want. We have all had the same questions at some point! :)

A cat is considered in remission if it stays in normal numbers (50-100 mg/dl on a human meter) after 14 days of no insulin.

The lowest number you can shoot at depends on which dosing protocol you follow. With TR, you can shoot as low as 50 and with SLGS it is 90 (both on human meters).

If a cat sees normal numbers when it is on insulin, it just means that the insulin is bringing the numbers down to those levels. Not that the cat does not need insulin any more. The aim of tight regulation is to keep the cat at a dose where it spends as much time as possible in normal numbers.

Tonight you could have given the full dose. I see that you have dropped his dose to 0.5U for the last 2 cycles. It is possbible that with the pred being tapered, he needs less insulin, but we don't know what that amount is. Some cats race down the dosing ladder (especially when there is a food change from a higher carb to a lower carb diet, or something that was causing the higher numbers resolves - infection/inflammation/bad teeth/removal of steroids etc). With others, we take reductions is 0.25U (just like we do with increases) so that we don't bypass a good dose. Lantus is a depot insulin and it can take 4-6 cycles for the depot to adjust. It's possible that the 1.25U depot is still affecting Comet's numbers.
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Do you have any advice about PMPS numbers being low and giving full dose (1.25u) but only being able to check a +2 +4 before heading to bed when you are also not able to leave out food? I only ever shoot lower when I either can’t check him as frequently or because I’d be gone/sleeping and don’t want to risk a hypo and me not being there. I know how inconsistent things can be sometimes, and now lately his appetite has been bad. Hoping it improves with him getting off Clavamox.
 
AmandaD said:
Do you have any advice about PMPS numbers being low and giving full dose (1.25u) but only being able to check a +2 +4 before heading to bed when you are also not able to leave out food?
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Comet seems to be relatively flat and feeding just LC food might be enough. If there is a sharp drop at +2, you may want to feed slightly higher carbs and test at +3 and +4.

You can always post here and ask. One of us will be around since we are in different time zones, so please tag us.

@Bron and Sheba (GA)
@tiffmaxee
@PerfumedCatMom
 
Bandit's Mom said:
Comet seems to be relatively flat and feeding just LC food might be enough. If there is a sharp drop at +2, you may want to feed slightly higher carbs and test at +3 and +4.

You can always post here and ask. One of us will be around since we are in different time zones, so please tag us.

@Bron and Sheba (GA)
@tiffmaxee
@PerfumedCatMom
Click to expand...

Thank you! Comet was 103 this morning again. I decided to do the 1u instead of 1.25u as I again can only do a +2 and +4 and might miss a +6 going to see how he does with just a unit and see where he is at tonight. Since I’m off tomorrow I will try to give him insulin tonight even if he is lower because I can get a good few checks with him. Do you think it’s ok to just cut back to 1 unit and see how we do there? I know he was at 1.25u but his numbers seem to be dropping more after the pred decrease
 
AmandaD said:
Thank you! Comet was 103 this morning again. I decided to do the 1u instead of 1.25u as I again can only do a +2 and +4 and might miss a +6 going to see how he does with just a unit and see where he is at tonight. Since I’m off tomorrow I will try to give him insulin tonight even if he is lower because I can get a good few checks with him. Do you think it’s ok to just cut back to 1 unit and see how we do there? I know he was at 1.25u but his numbers seem to be dropping more after the pred decrease
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You do not want to keep keep changing doses based on preshots. Lantus is not based on preshots but on how low a dose takes the cat. Being a depot insulin, it works bets with consistent dosing. Changing the dose so frequently means you don't know which dose is working.

If you want to stay with 1U, shoot that consistetnly for a few cycles till he either earns a reduction or his numbers indicate that he needs more insulin.
 
Bandit's Mom said:
You do not want to keep keep changing doses based on preshots. Lantus is not based on preshots but on how low a dose takes the cat. Being a depot insulin, it works bets with consistent dosing. Changing the dose so frequently means you don't know which dose is working.

If you want to stay with 1U, shoot that consistetnly for a few cycles till he either earns a reduction or his numbers indicate that he needs more insulin.
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Could you explain a reduction a bit more and how he earns one?
 
Drops below 90 after insulin or just in general?
Like today I have a feeling when I check him in a few minutes here he is going to be in the 80’s. He was 96 this morning.
 
AmandaD said:
Drops below 90 after insulin or just in general?
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If you get a number below 90 - whether preshot or after the shot, he earns a reduction.

AmandaD said:
Also, at what point (number) would I want to feed HC food vs LC Food to level out his glucose number?
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We normally reserve HC only for drops below 50. Feeding small LC snacks every hour or two will help keeping them surfing.
 
Bandit's Mom said:
If you get a number below 90 - whether preshot or after the shot, he earns a reduction.


We normally reserve HC only for drops below 50. Feeding small LC snacks every hour or two will help keeping them surfing.
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He was at 125, he tends to go up a bit higher in the AM with his 1/2 pred tab. If I’m right, around his +4 he will creep down to like 110 and then his +6 he should be around 80/90
 
As Bhooma said, lantus is not dosed based upon the preshots. Those following TR shoot 50+. Si your pmps was fine to shoot. He might have earned a reduction since you follow SLGS but it was safe to shoot. I think even though not earned you should reduce his dose to see if you can shoot the same dose every cycle. Since you shot 1.0 this morning I suggest 1.0 tonight and hold the dose for a week unless a drop under 90. Just my take fwiw.
 
tiffmaxee said:
As Bhooma said, lantus is not dosed based upon the preshots. Those following TR shoot 50+. Si your pmps was fine to shoot. He might have earned a reduction since you follow SLGS but it was safe to shoot. I think even though not earned you should reduce his dose to see if you can shoot the same dose every cycle. Since you shot 1.0 this morning I suggest 1.0 tonight and hold the dose for a week unless a drop under 90. Just my take fwiw.
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Thank you that will be my plan tonight as the next 3 days I’m off to be able to test more frequently
 
AmandaD said:
Thank you that will be my plan tonight as the next 3 days I’m off to be able to test more frequently
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Well, that changes things a little. Since you can test more the next 3 days you could stick with 1.25 and see if a reduction is earned. It’s up to you.
 
tiffmaxee said:
Well, that changes things a little. Since you can test more the next 3 days you could stick with 1.25 and see if a reduction is earned. It’s up to you.
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My issue is we do 8am/8pm. I work at 2:30pm and don’t get home until 10-10:30. Hubby leaves at 9am and gets home at 7:30pm. We both need to be in bed by 12-1am. I have tons of time during the day to get in a +2/4/6 check but at night we only have time for a +2/4 never a +6 unless we just don’t sleep that night. Sometimes if I get up at 4-5am to go to the bathroom I’ll check but it’s rare. So checking at night is a bit trickier and therefor makes me nervous shooting lower numbers at night if that makes sense? I can’t shoot earlier or later, because it messes everything up. Lol
 
Makes sense. Go with 1.0 and see how that works. Our lives get in the way. Keeping him safe is the number one priority. Good luck. Do you have an auto feeder? That will help at night and when you are working.
 
We do not. He isn’t microchipped and he only eats wet food. He also has two brothers that would eat any food left out. So we schedule feed and that has made this all 10x trickier since. Also his lack of appetite from Clavamox put a wrench in a lot, so we stopped it. Going on day 2 and his appetite is getting better. (The Clavamox was for a hotspot that has since healed) we are coning him as well which makes everything even more difficult. My sweet guy is such a trooper.
 
The auto feeders work well with wet food. Many here use them religiously. No micro chip needed. With other cats you would need to lock him in a separate room. That would not go well with my two so I understand the challenges.
 
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