11/21 Emma AMPS 106; 68 @+5 with no insulin?

Manuel

Manuel

Member Since 2022
https://felinediabetes.com/FDMB/threads/11-19-emma-amps-157-94-3-pmps-73.270964/

Good morning! Emma is sitting at 106 at AMPS this morning. Last night was 121 PMPS, +2 115. Slow descent, or so I thought.

edit: I decided not to shoot since I couldn't monitor from +2 to +4.5.

Is it safe to shoot her? She's hungry so I gave her a little low carb wet food in the meantime. It won't make a substantial difference for her blood glucose. I could also give her HC dry kibbles up front instead of at +2 as I usually do.
 
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Another consideration: if I shoot her now, I can test at +1.5, but not again until +4.75. Maybe today's the day to feed her only wet food and no shot, and see how she does?
 
Hi Manuel - I am not qualified to give dosing advice, but this is from the SLGS sticky:

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.
 
Thank you, Virginie! I think since I'm not here to monitor from +2 to +4.5, I'd best not shoot. I'm on a modified SLGS I think because I'm giving only a drop; certainly Bhooma has encouraged me to shoot below 150 given the circumstances.
 
I guess we made the right call, because Emma is at 68 at +5 with no insulin given this morning! That means she came naturally from 106 to 68. The only change I made was no insulin and no dry kibble. Seems like good news. but then I'm not sure what to do tonight if she's back at around 106!
 
So she earned a reduction. With SLGS you don’t shoot under 90. There’s too much blue to call for a otj trial I think so I would try a food trial. Get an Ambg/ pmbg and another test in 3-4 hours to see if the bg comes down. Feed lc and let’s see what happens. Is it possible to not feed any dry food for now? That would tell us a lot.
 
Thanks, Virginie!

tiffmaxee said:
So she earned a reduction. With SLGS you don’t shoot under 90. There’s too much blue to call for a otj trial I think so I would try a food trial. Get an Ambg/ pmbg and another test in 3-4 hours to see if the bg comes down. Feed lc and let’s see what happens. Is it possible to not feed any dry food for now? That would tell us a lot.
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Thank you, Elise. I think AMBG and PMBG are the same thing as AMPS and PMPS, right? So you're saying I should keep giving the drop of insulin, but test pre-shot, as well as at +3 or +4.

I always test at shot time, and in the evenings I can consistently get +3 or +4. Yet if I were to keep giving a drop of insulin but also no dry food, I think she would dip into hypo. I've been very slowly reducing kibble and each time I do she dips. Right now she gets 3g of kibble per cycle so my plan was to slowly decrease this to 2g and then 1g. Would that be suitable? An alternative could be to not give any dry food but give some small honey with her LC wet snack.
 
Ambg and pmbg mean you are taking a reading but NOT giving insulin. Amos snd pmps are preshots and mean if high enough you give insulin
She earned a reduction from a drop so we need to see how she does without any.
 
Ah, that makes sense! Sorry - I looked for the glossary but didn't see those terms there.

In that case I'll test at the usual times, and if she's below 90, no shot, and if she's above 90, I'll give a drop. The only grey zone I guess would be days like today, where she was at 106 and reached good greens without a shot; I worry a bit about shooting low numbers like that with no dry food. But I guess I can intervene with kibble if I need to at +2.

Hold on. It's possible I'm just being too literalist about this, but if AMPS and PMPS means you shoot if high enough, and AMBG and PMBG are different, does that mean that even if Emma is >90 I still don't give a drop? How is that different from OTJ?

Sorry to waste your time like this. I must be missing a thread that details what to do from a drop onwards.
 
Do not shoot even a drop. She’s earned a reduction. A food trial means test at ambg and pmbg. If blue test again in 3-4 hours. A working pancreas will bring the BG down. If green either grab a test mid to late in the cycle or no test needed until pmbg. We are seeing how she does without any insulin. If she stays green it becomes an OTJ trial. IF BG goes up AFTER A FEW DAYS we would try a drop dose. again. DO NOT GIVE EVEN A DROP UNLESS ONE OF US TELLS YOU TO DO SO.
 
Today you saw action, possibly because of the depot as well. I wouldn't rush into an OTJ trial with the sort of numbers Emma is getting. Just six days ago you saw yellows. I don't think she's quite ready to go solo or without insulin. You might want to take a look at this post: Reminder: *earning* reductions and starting OTJ trials

One way to keep her on insulin a little bit longer is to raise the carb levels of the wet food you are giving, maybe just a few percent points if possible. But if you can, keep the dry food out of the picture.

AMBG - AM blood glucose, instead of pre shot. Meaning test is done but no insulin given.
 
Wendy&Neko said:
Today you saw action, possibly because of the depot as well. I wouldn't rush into an OTJ trial with the sort of numbers Emma is getting. Just six days ago you saw yellows. I don't think she's quite ready to go solo or without insulin. You might want to take a look at this post: Reminder: *earning* reductions and starting OTJ trials

One way to keep her on insulin a little bit longer is to raise the carb levels of the wet food you are giving, maybe just a few percent points if possible. But if you can, keep the dry food out of the picture.

AMBG - AM blood glucose, instead of pre shot. Meaning test is done but no insulin given.
Click to expand...
They have been feeding dry food so a reduction was earned. Should the reduction number be lowered?
 
tiffmaxee said:
Do not shoot even a drop. She’s earned a reduction. A food trial means test at ambg and pmbg. If blue test again in 3-4 hours. A working pancreas will bring the BG down. If green either grab a test mid to late in the cycle or no test needed until pmbg. We are seeing how she does without any insulin. If she stays green it becomes an OTJ trial. IF BG goes up AFTER A FEW DAYS we would try a drop dose. again. DO NOT GIVE EVEN A DROP UNLESS ONE OF US TELLS YOU TO DO SO.
Click to expand...
Thank you. I'll stop giving dry food and do PMBG this evening; if this test is blue, I'll test 3-4h later, but if it's green I'll try to test as late as possible in the cycle.

Wendy&Neko said:
Today you saw action, possibly because of the depot as well. I wouldn't rush into an OTJ trial with the sort of numbers Emma is getting. Just six days ago you saw yellows. I don't think she's quite ready to go solo or without insulin. You might want to take a look at this post: Reminder: *earning* reductions and starting OTJ trials

One way to keep her on insulin a little bit longer is to raise the carb levels of the wet food you are giving, maybe just a few percent points if possible. But if you can, keep the dry food out of the picture.

AMBG - AM blood glucose, instead of pre shot. Meaning test is done but no insulin given.
Click to expand...

Thank you. Is the suggestion here that maybe I shouldn't go on a food test yet, but rather keep a drop and perhaps add a bit of honey to the wet snacks? The yellow from a few days ago was from the prednisolone (always high 12 hr after I administer it) but with the advice of the vet I have stopped giving pred altogether. The last time she had a yellow that wasn't exactly 12 hours after a pred pill was 14 days ago.
 
From the note I linked:
Prior to starting an OTJ trial, one wants to see kitty mostly in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range.
Click to expand...
Even without pred in the pictures, you are still seeing numbers above 120, much less the majority of time under 100.

Why don't you try going without dry first, and see what happens with her numbers. If she stills gives you blues, then she needs insulin. The hydrolized food is very HC. I wouldn't add honey to the wet snacks. Is there any LC wet she can eat that is in the 8-9% carb range?

For what it's worth, I've seen a 1mg change in a pred dose make a difference in an IBD cat. It would be great if you could do without it.
 
Wendy&Neko said:
From the note I linked:
Even without pred in the pictures, you are still seeing numbers above 120, much less the majority of time under 100.

Why don't you try going without dry first, and see what happens with her numbers. If she stills gives you blues, then she needs insulin. The hydrolized food is very HC. I wouldn't add honey to the wet snacks. Is there any LC wet she can eat that is in the 8-9% carb range?

For what it's worth, I've seen a 1mg change in a pred dose make a difference in an IBD cat. It would be great if you could do without it.
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Yes - so far so good! 6 days since no-pred. She did vomit 2 days ago but it was a bit out of the blue (maybe food anxiety?). Hopefully won't happen again.

I think she is giving me blues pre-shot because she was still getting 11% of calories from the dry kibble (as you say, the HP food is very HC). I read in the thread you linked to that we want to see those healthy greens, and only occasional readings in 100-120 before going OTJ. But what's the difference between a food trial as Elise was suggesting and OTJ?

I think your recommendation is to keep giving her a drop of insulin and also stop feeding dry food, as soon as tonight. I don't have any wet food that's 8-9% carb range, since I have been very selective in the food I've given her. I know you are saying it'd be best not to give mix in any honey but I don't have a middle option right now, and I'm concerned that the drop might precipitate a fall below 60 (she reached 68 today without any shot).

Maybe a compromise might be to shoot a drop if she's over 120, and monitor at +2. If she's already dipped <100, perhaps I'll give her a reduced amount of kibble and mostly wet food? This is more or less what I was planning on doing anyway: slowly taper off the dry food (reduce to 2g per cycle, then 1g, then none).

She's at 92, fwiw, at +10.25.
 
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I decided to shoot a drop, with her PMPS of 130. I'll test at +2 and give just wet food if she's dropping slowly, or else a reduced amount of kibble if moderate drop or faster.
 
Manuel said:
But what's the difference between a food trial as Elise was suggesting and OTJ?
Click to expand...
Sometimes we'll suggest a food trial for a couple days before starting an OTJ, especially if there is a switch to lower carb food happening. Bottom line though, we want a strong remission, but done safely.
 
Thank you. I'll search to learn as much as I can about food trials and OTJ. Emma is at 86 at +2, a drop of 44. Will probably need to monitor more closely tonight.
 
I only suggested a food trial because she earned a reduction following SLGS and you said you were cutting out dry and lowering prednisolone. It’s only under special circumstances we try a food trial. If BG goes up you go hack to giving insulin. If it stays in normal numbers it becomes a food trial. Alternatively you can feed slightly higher carbs to prevent a drop too low. That’s what I think Wendy suggests. You won’t find this written anywhere.
 
Thanks very much, Elise. I’m very interested in the food trial because my suspicion all along has been that it’s the prednisolone and HC food that has made Emma diabetic. Every time I’ve reduced dry food she earns a reduction sooner or later. And I’m down to 10% of calories coming from dry food and that will decrease. And I’ve stopped giving pred altogether now that the vet got back to me and said the dosage I was giving her was so low as to not be doing anything for her medically.

I will keep reducing dry food from now on, down to 7% of calories now. I’ll let that stabilize and shoot only when >120. Soon enough it’ll be 0 dry food and maybe by then or before then it’ll be time for a food trial.

Once more, my deep gratitude to you all!
 
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