12/22/2020 Sugar AMPS: 322 +4 104 +6 75 PMPS 376

Claude

Claude

Member Since 2020
Hi,

My cat's BG has been low lately compared to his usual numbers.

AMPS 322
+2 244
+3 105
+4 104
+5 81
+5.5 75

That's his lower number yet. He had never been below 100.

He had not eaten much in the afternoon (didn't want to eat the food he left in the morning, so he didn't eat much until I opened a new can of Friskies). I tested him at +5 and he was 81, his lowest number yet. So I opened a new can of food and he ate. 10 minutes after he ate he was 75. I got scared that he was still dropping and fed a dry food snack. He's never been this low.

Should I be worried?

Is it time to lower the dose?

See his SS for full numbers today.

Thanks.
 
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Hi Claude, I'm new to the board so don't give dosing advice but if you're following TR, then this sticky explains that you decrease doses when Sugar tests below 50 (excerpt of the relevant paragraphs below re: reducing doses). You should also print out and stick on your refrigerator this sticky about low numbers so you can be prepared. I always have honey, low carb (<10%), medium carb (11-19%) and high carb (>20%) foods on hand to guide my Ruby in case she goes low. At 75, I would stick with either LC or MC foods, and reserve the high carb foods for when Sugar drops below 50. If she ever does do that, post the numbers in your thread title with a question mark prefix and something like "low number--HELP" and someone will guide you through the process of keeping your kitty safe!

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Basaglar, & Levemir ISG safe by taking reductions when appropriate.
  • If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit.
  • Alternatively, attempt a reduction when the cat regularly has its lowest BGs in the normal range of a non-diabetic healthy cat (50 - 80 mg/dL) while staying under 100 mg/dl overall for at least one week.
  • Please do not let yourself become complacent or blasé about drops into the 20s or 30s. Please ask for advice immediately.
  • If your cat drops into the 30s, a full reduction of 0.25u is recommended. There are few exceptions given to caregivers who have collected years of data and KNOW their cat's response to the combination of insulin and food backwards, forwards, and inside out.
  • Caregivers whose kitties have "High Dose" conditions may find the need to reduce in whole units or more.
  • If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.
  • We've found many kitties benefit from reducing the dose from 0.25u to 0.1u before stopping insulin completely. During a two week OTJ trial, you want to see mostly green numbers (under 100) with only a few random blue numbers between 100 - 120 to help ensure a strong remission. Most kitties will be in the range of a healthy cat (50 - 80 mg/dL) overall.
 
That’s a good sign that he hit a green nadir. You only reduce if under 50. Post the PMPS for dosing advice if he’s lower than you have seen at PMPS. At that point, stall, don’t feed and retest in 20 minutes. Post the next bg reading if you are worried.
 
Thank you @tiffmaxee and @PerfumedCatMom. I tested him again and he went up to 129. What worried me is that he could drop further below 50. I heard some cats had hypo symptoms in the 60's. He had never been below 100 til today.

Will update PMPS for advice on dosage.

Thanks again!
 
Max dropped into the 30’s and never had hypo symptoms. I can’t recall any cats here having symptoms in the 60’s on a human meter. Maybe a bad strip? Before I tested at home I went to my vet every couple days around nadir. He was at 60. My vet was not concerned and didn’t even think of reducing. I brought my meter with me the next day and tested with him. Cats that go OTJ here are almost all green and under 100. He won’t go under 50 for long as long as you keep testing. The take action number to feed hc is around 50. Then you check every 20 minutes. I suggest reading and printing how to handle low numbers. Pist when it happens. It will.
 
Hello,

PMPS is 376 which is a lot higher than yesterday. I think that means the regular dose will be fine despite the lower numbers today.
 
Yes. Keep in mind though that with TR one bases doses on the lowest numbers or nadirs in the middle of the cycle, not the preshot. If that 75 was a 45 instead, you would take a reduction regardless of how high her numbers were at AMPS or PMPS.
 
PerfumedCatMom said:
Yes. Keep in mind though that with TR one bases doses on the lowest numbers or nadirs in the middle of the cycle, not the preshot. If that 75 was a 45 instead, you would take a reduction regardless of how high her numbers were at AMPS or PMPS.
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Thanks.

Do you think I should test him every 2 hours tonight? Is it possible that he goes lower than 75 and into the 50's at nadir?
 
He’s bouncing from being in a lower BG than he’s used to. I doubt he will get close to 50 tonight. Bounces can take 4 or more cycles to clear or clear in a cycle of two. As Katherine said the +2 will be a clue to the rest of the cycle.
 
Thank you.

Just tested him at +1.25 and he's 352 (just a little lower than his 376 PMPS). He ate a little bit afterwards. Will test him again at +2.
 
Claude said:
Thank you.

Just tested him at +1.25 and he's 352 (just a little lower than his 376 PMPS). He ate a little bit afterwards. Will test him again at +2.
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The period of onset or the moment when Lantus starts to work is usually somewhere around +2 or 3, so you will start to see the effects of the PM shot then in the numbers. If Sugar is at the same or lower than PMPS at +2, I'd get a test at +4 if you can stay up to make sure he's not doing a rapid dive as he did this morning.

What is your feeding schedule for Sugar? With Ruby, I've broken her meals up to 6 portions, 3 in the morning and 3 in the evening: 1 at shot time and two more meals spaced out before her +6 nadir in the hopes of preventing steeply declining numbers. Sometimes it works, sometimes it doesn't as you would see if you looked at Ruby's spreadsheet. It just depends on how determined she is to earn a reduction. :) It also keeps her a little hungry in case I need to steer her numbers up from lows with high carb food.
 
PerfumedCatMom said:
The period of onset or the moment when Lantus starts to work is usually somewhere around +2 or 3, so you will start to see the effects of the PM shot then in the numbers. If Sugar is at the same or lower than PMPS at +2, I'd get a test at +4 if you can stay up to make sure he's not doing a rapid dive as he did this morning.

What is your feeding schedule for Sugar? With Ruby, I've broken her meals up to 6 portions, 3 in the morning and 3 in the evening: 1 at shot time and two more meals spaced out before her +6 nadir in the hopes of preventing steeply declining numbers. Sometimes it works, sometimes it doesn't as you would see if you looked at Ruby's spreadsheet. It just depends on how determined she is to earn a reduction. :) It also keeps her a little hungry in case I need to steer her numbers up from lows with high carb food.
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I just tested him at +3 and he's 352, same as 2 hours before. Apparently he won't be going very low this time, although I might test him at +5 or +6 just in case.

That's a good idea.

He has food avaible most of the time (Friskies Pate) except 2 hours before his shots. Only problem is he doesn't eat much when his food has been sitting out for a few hours (nor when it's refrigerated), so I have to open about 4 cans a day. I have another cat so they share the food.
 
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