11/18 Peter need help with dosing again PMPS 68

Barbara and Peter

Barbara and Peter

Member Since 2019
Peter is doing well, but his numbers seem too low. He must have been quite low recently and I missed him (looked like he was sleepy) Gave him some gravy and waiting to test now.

Have not had a lot of time to care for him as I now have a diabetic CHILD and dealing with his diabetes is a lot.

Last month Peter was in VET emergency as he had ketones. I think we were struggling to give him his Lantus correctly, and he was hypoglycemic a lot so ketones built up. Peter stayed in an emergency vet for 1/2 day (and a fortune in $$$). He was supposed to be hospitalized for a couple of days, but the quote was staggering. Peter was therefore sent home to be home-hospitalized. The emergency vet sent subcutaneous hydration, potassium, etc, and Peter recovered. His regular vet cleared him during a visit on a weekday. Phew!

I am not having a great time with my regular vets who usually just ask to give him rx prescription food and miss my emails with curves...but I am going to try again. In the mean time, I am thinking of decreasing to 2.25 ut BID starting tonight and dosing carefully and watching for injection site as shooting scar tissue, seems to have impeded absorption last month.
 
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I can’t see Peter’s spreadsheet, I think you need to share it but I’m not sure what you need to do to make that happen. Can you edit your thread title to add a second question ‘how to share spreadsheet?’ please.
 
You’re going to want to add the second lot of ketones to your signature as that affects the advice we would give. You said last month but when exactly was that? Was it early in the month and hence the increase with no data to show it was needed? Was there anything else up with Peter at that time that you are aware of e.g. infection or inflammation and was he off his food? It’s also helpful if you note things like that in the comments section of his spreadsheet.

Your spreadsheet is pretty scary, you really need to test before you give each shot to make sure that it’s safe, and follow up more on those greens and blues especially, I’m sure you’re missing some low numbers. I’m sorry things are a bit tough right now but I’m sure you’d feel even worse if you accidentally killed Peter. Do you leave food out for him?

I am very glad you reduced tonight and hopefully you will get another test at some point this evening, after the run of green today he may bounce or he may get straight back to business. Please try to get more tests, every piece of data is helpful so as well as a weekly curve spot tests whenever you can will be very informative and unlike the vet we won’t ignore your data ;)

In case you’re not aware, you definitely should be moving the shot site around and you don’t need to inject in the scruff everytime you can also get a good skin tent on the sides. Scar tissue may affect absorption.
 
Hello, yes, I understand. I am adding ketones to my signature. Peter eats two times a day only. I think he was eating pine needles that he was finding on the doormat (crazy cat!). He was throwing them up before his emergency, so I think he might have gotten unbalanced like that.

I need a solution that is going to work for me and my family. Can someone help me understand about the testing. I do not understand what to do after testing. For instance, this AMPS I had a low reading. Is this going to mean that I reduce the dose? This was my problem with the method in the first place. Also, what about those periods of time when you cannot test. What happens then? Thank you!
 
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First of all, you don't need to limit his food to twice a day. It's actually better if you feed several small meals a day. Probably the same advice you'll hear about your diabetic child (sorry about that :(). Several small meals will also mean he's less likely to vomit. Getting a cat regulated is a balance of the right insulin dose, and food/feeding schedule.

We don't lower the dose based on AMPS or PMPS number, but rather based on how low the dose takes the cat. It's possible the low numbers occur at preshot, but more often towards the middle of the cycle, like you saw today. However, your signature says you are following SLGS, and with SLGS, you do not shoot if the preshot number is below 90. He actually earns a dose reduction whenever he goes below 90, so that AMPS earned him a reduction to 2.25 units.

Next time you see a number under 90 at preshot, you have a couple options. A skip is one option. A second option is to delay, without feeding for 20-30 minutes, and see if his number comes up over 90. If it doesn't come you skip or wait longer. If the number is lower than you have the data to shoot, you can either skip or reduce the dose for that one cycle. However, with recent ketones, skipping is not an idea solution. It is better to get some insulin in him.
 
Wendy&Neko said:
First of all, you don't need to limit his food to twice a day. It's actually better if you feed several small meals a day. Probably the same advice you'll hear about your diabetic child (sorry about that :(). Several small meals will also mean he's less likely to vomit. Getting a cat regulated is a balance of the right insulin dose, and food/feeding schedule.

We don't lower the dose based on AMPS or PMPS number, but rather based on how low the dose takes the cat. It's possible the low numbers occur at preshot, but more often towards the middle of the cycle, like you saw today. However, your signature says you are following SLGS, and with SLGS, you do not shoot if the preshot number is below 90. He actually earns a dose reduction whenever he goes below 90, so that AMPS earned him a reduction to 2.25 units.

Next time you see a number under 90 at preshot, you have a couple options. A skip is one option. A second option is to delay, without feeding for 20-30 minutes, and see if his number comes up over 90. If it doesn't come you skip or wait longer. If the number is lower than you have the data to shoot, you can either skip or reduce the dose for that one cycle. However, with recent ketones, skipping is not an idea solution. It is better to get some insulin in him.
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Your reply is super helpful. Thank you! I think I understand better now. Indeed I am not sure if I am comfortable skipping the dose considering his recent situation. He seems to be doing well but I know hypo is a serious worry. Let's see how he test. I have a spreadsheet from last year with much more data. I will try to attach it to the signature.
 
So, I’m thinking that preshot tests wouldn’t be a problem because that’s when you’re feeding and shooting anyway.

With food I’m guessing the vet may have told you to only feed twice a day. This is not the best way to go when using a gentle action depot insulin like lantus. Vet’s often don’t understand how it works and provide feeding advice as if lantus was a harsh in and out insulin. If the food is spread out over the first 1/3-1/2 of the cycle you will get flatter curves. Free feeding, with the exception of always picking up the food two hours before shot time so that you know the preshot test isn’t food influenced, is fine too.
I asked about leaving food out because usually when a cat’s BG gets too low they will get very hungry, eating raises the BG again and takes them to a safe place (I wonder if that was why he was trying to snack on pine needles?). If you are unable to test but have any concerns about numbers going too low you can leave food out to keep him safe. You may need to use a timed feeder if the food will just vanish as soon as you put it down. I see you have another kitty too so you may need one that only opens for Peter.

Have you read the sticky at the top of this forum about handling low numbers? That is a very good one to print out and stick on the fridge so it is always handy when you need it.

Also we are always here for you when you have questions. If you’re not sure about anything that’s going on post for advice like you have done today and keep asking questions if you haven’t got the answers that you need yet. It might be good to post at least once a week after his curve for a while so we can see how the dose is doing and teach you all the tricks along the way :cat:
 
1.Is it a big difference to feed him more often? I would consider adding a "lunch" feeding, but he tends to put on weight, and I am worried I will overfeed him. Maybe if he is begging in the kitchen, that could be my sign to give him something small, in case he is low?

2.He always had a thing for eating twigs, grass and stuff. Usually there are digestive consequences. ;-)

3When he had his DKA, I was worried that he had blood in his stool (dark stools and stinky), but the vet was not concerned. He is OK now, but does anyone think this could be something concerning?

4.I must have given him too much carbs when I saw the low this afternoon because he was 400 PMPS. I know I should have given just a spoon fool. Next time. When do I test? Tonight? AMPS? Always or only in a week after the dose change? I don't know what use it is to test him now since his numbers will likely be all over the place from the carbs and the dose decrease. I know him pretty well and I can tell how he is doing based on what he looks like. Now I know to pay attention more to him being sleepy and hungry, because it might be that he is getting close to the 50 when he is like that.

5. Last year he had a big low one time when, he was hallucinating etc. When I called the vet after treating that low with honey, all they did is tell me off that I changed the dose and did not notify them.

6. I think his levels will be all over now due to the carbs. When do I test for ketones? I have ketostix, but I also have blood strips for ketones (b/c of the diabetic person in my family who uses precision neo glucometer).

TIA
 
Welcome. I can see your spreadsheet now and it is scary. A +2 gives an indication if it could be an active cycle where more testing or leaving out higher car food might be needed. If the +2 is lower than the preshot it will likely be active.

You need to get an AMPS and PMPS every day. That’s because it lets you know if the BG is high enough to safely shoot. You already had a symptomatic hypo once. Those can be deadly or at least requiring an ER visit if you can’t get the bg up to a safe level. Feeding several smaller meals helps level out the bg. You would feed the same amount, just divide it into mini meals.

If he’s begging for food he could be low and I would test to see.
When a cat drops into lower bg than they are used to, their body protects itself by releasing more insulin and the bg rises high. We call that a bounce. It can take 4-6 cycles to clear. So that may very well be cause of the 400 and not the hc you fed him. We suggest a couple teaspoons though and a retest in 20 minutes.

When high like the 400 is a good time to test for ketones.
 
1. The short answer is yes
2. Silly Peter have you told him that he’s not designed to be vegetarian lol
3. If the poops are ok now I wouldn’t worry but various changes in poop can indicate problems. I wouldn’t be concerned if the odd one’s a bit different but if I saw blood that would concern me.
4. Elise has explained about bounces (except she meant to say the body releases sugar not insulin) and I agree that this is more likely to be a bounce than the food. However I also want to clarify that while bounces can last up to six cycles they can also pass as quickly as one cycle. Also, please don’t think you’re going to know he’s low just by looking at him, by the time you can tell from looking at him it might be because he’s having hypo symptoms. The only time I could tell that Vyktor was low from his behaviour (and we were very close it was just me and him and I didn’t have other things going on) was when he’d suddenly empty his food bowl, and he didn’t do that at 50. If he did that he’d be much lower.
5. Not very helpful advice from the vet but it’s clear he was getting too much insulin, it’s a good idea to post here and ask for advice before increasing.
6. A kitty sitting in high numbers is more prone to ketones so anytime he’s having a lot of high numbers you want to test for those nasty beasties.
 
Barbara and Peter said:
.I must have given him too much carbs when I saw the low this afternoon because he was 400 PMPS. I know I should have given just a spoon fool. Next time.
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Here's my "you're not the only one" story!

When China was first diagnosed, I'd learned that if she dropped below 50, I could give her some Karo, honey or syrup to bring her back up so the first time she did, I thought I was ready! I had a bottle in every room in the house, just in case!

So I dumped about a cup full into a bowl and gave it to her. She loved it!! (that was my first surprise!) Needless to say, her numbers went up...and up....and up....

Afterwards, I learned I was only supposed to give her a drop or two, not half the bottle!

We live and learn....LOL
 
tiffmaxee said:
Welcome. I can see your spreadsheet now and it is scary. A +2 gives an indication if it could be an active cycle where more testing or leaving out higher car food might be needed. If the +2 is lower than the preshot it will likely be active.

You need to get an AMPS and PMPS every day. That’s because it lets you know if the BG is high enough to safely shoot. You already had a symptomatic hypo once. Those can be deadly or at least requiring an ER visit if you can’t get the bg up to a safe level. Feeding several smaller meals helps level out the bg. You would feed the same amount, just divide it into mini meals.

If he’s begging for food he could be low and I would test to see.
When a cat drops into lower bg than they are used to, their body protects itself by releasing more insulin and the bg rises high. We call that a bounce. It can take 4-6 cycles to clear. So that may very well be cause of the 400 and not the hc you fed him. We suggest a couple teaspoons though and a retest in 20 minutes.

When high like the 400 is a good time to test for ketones.
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I have a dilemma tonight again. He was 300 in the AM and I tested his BLOOD for Ketones. The blood ketone reader said 0.3 mmol/L for ketones. (The other day the vet said that these blood ketone strips were not calibrated for cats so in reality a low number like that would be no ketones for a cat.) I got scared tho and shot him a slightly higher dose. Now all the way through the day he has been in the greens. I fed him and I am thinking of shooting a low dose; scared not to shoot anything. He is like a yoyo. I am so confused.
 
He has gone under 50 twice. You don’t dose based upon the preshot numbers. The low number caused the bounce to higher numbers. Your signature says SLGS. Ordinarily that would mean no shot but with ketones you need to shoot something. When did he last eat? How far off schedule can you be?
 
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Thank you for replying. I just fed him, but feeding him little carb food throughout the day (it did bump him up a little!) I don't understand what you mean when you ask about far off schedule?
 
One thing you could do is feed him which you did and then see how high he is in one or two hours which would mean shooting late. There just isn’t enough data to know how many times he has dropped and how low. If less than 30 minutes since you fed, get another test now.
 
Can you monitor closely if needed? Have plenty of test strips, hc food, and honey or syrup if needed. Was food picked up 2 hours before the PMPS time?
 
Could you help me with the time sequence?

+12 - 68 - fed how much and how many carbs?
+some time later (how much later after that +12) 104
 
Wendy&Neko said:
Could you help me with the time sequence?

+12 - 68 - fed how much and how many carbs?
+some time later (how much later after that +12) 104
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I am going to try to answer. I gave him approximately 20 g of "whiskas cuts in gravy ' separated into small teaspoon portions (so not a lot)
I don'understand your question but I think you are asking how much time between 68 and 104. It is 1 hour.
 
OK, so you saw the 68, gave him 20g of some whiskas (any idea on the carbs?), the 1 hour after the 68 he was at 104. I am trying to figure out if the 104 was because of a natural rise at the end of the cycle, or because you gave him some higher carb food. If the latter, and the carbs wear off, he could come down again and that 104 might drop below 90 and the "do not shoot" range.
 
Just wondering if she needs to wait longer before shooting, but yes, should shoot something tonight.
 
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