11/27 Mimi, PMPS 134 - How long to wait, re-test every 20 minutes, and shoot?

Lena1

Member Since 2022
Previous post for continuity: https://felinediabetes.com/FDMB/threads/11-26-mimi-pmps-167-2-86.271200/#post-3019722

Hello! I just tested Mimi pre-shot and her BG was 134. I'm going to re-test every 20 minutes and not feed to see if her BG is increasing. How long should I do this for before I decide if I should/shouldn't shoot? I read the guidelines that it's best not to shoot if BG is below either 150 or 200 (I am going with the 150). Mimi's dosage has been a little wonky since I've been trying to readjust since starting at home testing but I have decided to go with .5 units for now. Thank you!
 
You should know after the first 20 min test if bg is increasing or not. It looks like Mimi was a bit higher at +6 so she might still be headed down? It’s great that you are testing now! Good luck :bighug:
 
Thank you Kyle! 20 minutes later BG is 135. Does a +1 increase count as increasing?
It seems pretty flat? You could wait for one more test after 20 minutes and see, but I’m not sure I would say it is increasing at this point? If your threshold is 150 you might be safer skipping tonight?
 
You did shoot a 112 a few days ago so it might be safe to shoot lower than 150 if you can test after that shot? Hopefully someone more experienced can chime in?
 
You did shoot a 112 a few days ago so it might be safe to shoot lower than 150 if you can test after that shot?

Yes, this is what I was thinking! I can test after the shot..based on the other night it seems like 2 hours in, the insulin has kicked in so I could test at 2 hours, or even sooner. I'm going to test her again though in a few minutes as my second 20 minute mark. I will keep this thread updated. Thank you for your help!
 
BG is not increasing or decreasing and is pretty flat. Just tested at the second 20 minute mark and BG was 134.
 
I can't give Mimi her insulin too late because the morning shot would become an issue for me due to work. I am leaning towards giving her the .5 units since she was okay the other night with .5 and BG an hour before shot at 112.
 
I can't give Mimi her insulin too late because the morning shot would become an issue for me due to work. I am leaning towards giving her the .5 units since she was okay the other night with .5 and BG an hour before shot at 112.
If you can test at +2 and afterwards I think it should be okay. Are you ready with MC and HC just in case?
 
With SLGS you can shoot any number over 90 if you can monitor. Sometimes stalling without food can cause numbers to drop further making the shooting decision even more difficult.
She has been pretty flat all day if you consider meter variance. And 134 is not very different from 150 that you shot this morning :-)
 
With SLGS you can shoot any number over 90 if you can monitor. Sometimes stalling without food can cause numbers to drop further making the shooting decision even more difficult.
She has been pretty flat all day if you consider meter variance. And 134 is not very different from 150 that you shot this morning :)

Thank you! I didn't realize the 150/200 rule doesn't always apply with SLGS. Yes, that's true, 134 and 150 are not that far off from each other. +2.5 hours in BG was 100, so I think we might be okay for the night, but I will keep checking occasionally.
 
Thank you! I didn't realize the 150/200 rule doesn't always apply with SLGS.
When a cat is newly diagnosed and the caregiver does not have enough data on how a cat responds to insulin, we suggest skipping the shot or giving a token does below 150. Provided the cat doesn't have any ketones or history of ketones/DKA. With data and experience you can shoot any number over 90.

+2.5 hours in BG was 100, so I think we might be okay for the night, but I will keep checking occasionally.
It would be good to get one more test at +4 since she is much lower at +2.5 from PMPS.
 
It would be good to get one more test at +4 since she is much lower at +2.5 from PMPS.

Thank you Bhooma. I accidentally fell asleep so I missed +4, but I got +5.25 and it was 126. It's odd because her shot this morning was .75 units and it seems like her BG was pretty flat throughout the day but with a lower dose shot this evening at .5, it's fluctuating. Is this normal? The only change was I am using a new syringe with the .5 unit marker.
 
Thank you Bhooma. I accidentally fell asleep so I missed +4, but I got +5.25 and it was 126. It's odd because her shot this morning was .75 units and it seems like her BG was pretty flat throughout the day but with a lower dose shot this evening at .5, it's fluctuating. Is this normal? The only change was I am using a new syringe with the .5 unit marker.
It's possible that this morning she was clearing the bounce from last night's greens. Bounce clearing cycles can have late nadirs - even as late as the end of the cycle - which is what you saw today. Tonight she might be headed up after her nadir which is typically around +4 but can be sooner or later for some cats.

I would go back to 0.75U tomorrow morning since she hasn't earned a reduction by dropping below 90.
 
It's possible that this morning she was clearing the bounce from last night's greens. Bounce clearing cycles can have late nadirs - even as late as the end of the cycle - which is what you saw today. Tonight she might be headed up after her nadir which is typically around +4 but can be sooner or later for some cats.

I would go back to 0.75U tomorrow morning since she hasn't earned a reduction by dropping below 90.

Thank you Bhooma. I know Mimi technically didn't earn a reduction, but I was thinking it might be safer to go down to .5 since she hasn't been having pre-shot values above 150 that often and then increase as needed according to SLGS protocol. In my first new member post, Sienne, said this:

"The lower carb food can cause diabetic numbers to drop, especially if Mimi was getting a diet significantly higher in carbs. There's a degree in variability with respect to how cats respond to insulin. At least to me, Mimi's spreadsheet looks like there could have been some other factor influencing the higher numbers. That's more of a guess given that your vet did the lab work. What I would suggest is that you take a look at other members spreadsheets. It will give you a sense of what cats' numbers look like. You may want to venture over to the Lantus forum to look at spreadsheets since most members once they are comfortable with the basics of diabetes management will move over to the Lantus board.

If you read through either of the dosing protocols, you'll notice that doses are held a minimum of 3 days/6 cycles barring a drop in numbers that necessitates a dose reduction. The reason for a holding doses is that Lantus is a "depot" insulin. Every time you give a shot, Lantus forms microcrystals that are deposited in the fat tissue. Over the course of the cycle, most of the crystals dissolve. However, a small amount do not dissolve during each cycle which is what gives Lantus its long duration and gentle action. Every time you change the dose, it has an effect on the depot. In order for the depot to stabilize, you need to hold the dose. If you make repeated back-to-back changes in the dose, you can end up with wonky numbers and in addition, it's next to impossible to know which dose is causing the change in numbers. This is my long winded way of suggesting that you need to pick a dose and stick with it. When following SLGS, you want to hold the dose for a week. Whether you pick 0.5u or 0.75u is entirely up to you."

I had decided to stick with .5u but I could stick with .75u instead if you think that makes more sense?
 
I had decided to stick with .5u but I could stick with .75u instead if you think that makes more sense?
Sure. If there has been a diet change from high carb to low carb then it's possible that she is going to need much less insulin than she was on.
 
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