12/31 Chronos PMPS 112, do I shoot?

I checked it 3 times, using two meters to be sure. We are feeding him now, but I guess depending on his PMPS what should we do?
 
Give him a couple tsps of his regular low carb food, and test again 30 minutes after that, to see if you've stopped the drop. He could just be nadiring late and breaking a bounce.

Has your vet given any guidance on lower preshots?

One option is to test at +11 or +11.5 and post for suggestions. That'll give you some time before PMPS and an idea where his numbers might be.
 
He gets one of his normal meals at this time which he is eating right now. I can check 30 minutes or an hour after that since its about 85 calories that he gets at each meal.


I don't recall if she mentioned what to do with lower preshot numbers or not.
 
OK, if you have no guidelines from the vet, you can follow what is written in the SLGS documentation. The lowest you've shot so far is 221, so you don't have some data on shooting that low. Let's see where he is closer to PMPS time.
 
Just checked, 20 minutes after he ate 1 tbsp of additional the Weruva and its 112.

Original plan was to do half and half to start. I explained it briefly it yesterdays post but basically it seems his kidneys might react to much protein even tho he is currently still at good CKD levels.
 
+11 is 109. We check his PMPS in 45 minutes(10:30pm) normally, feed a normal meal (around 85 calories some Weruva mainly Royal Canin D), then shoot at 10:45pm. Seems like he is staying at this level for whatever reason. Any advice, assuming the PMPS is also still at this or lower?

Editing, was +11 not +10
 
Last edited:
With SLGS you can shoot any number over 90, if you can monitor. Lantus is very good at giving flat cycles when shooting low and Chronos has been flat for the last 4 hours. I presume he will bounce at some point from this long stretch in lower numbers.

You want to feed a little less at PMPS. He has been snacking and might already be half full. You could break his dinner into 3 meals and feed a little at PM+1 and +2.
 
I guess my main concern is that its such a decrease in his numbers and we increased the dose last night.

I think he has only been flat for the past 3 hours +8 through +11 during which he had a full meal right after the +8 (mainly Royal Canin D and some Weruva) and then a little more Weruva an hour after.

I know he is used to the higher carb of Royal Canin D so not sure how much he really changes from it food wise, but this at least showed not a big change since he only went up to 125.

I normally go to sleep at his +4 PM and can test throughout that, and if I have to stay up I will, just worried he will drop more since this was such a large change from this AM?

I'll post again his PMPS which we do in 15 minutes.
 
Also remembering now that Wendy said depending on his PMPS we should follow whats written in the SLSG documentation which says:

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.

So if he is below 150 shouldn't we not shoot or is it 90 like you said?
 
I am asking if I should shoot, I can stay up to check till +4 or longer if I have to, but am worried he will drop further I guess?
 
Dan and Marc said:
I am asking if I should shoot, I can stay up to check till +4 or longer if I have to, but am worried he will drop further I guess?
Click to expand...
If you can monitor, you can shoot the full dose. Break up his dinner into multiple small meals between PMPS and +4. You don't want him to be too full to eat.
 
He already ate his meal. I can monitor the early time just worried about the rest of the times since he dropped low pretty late into the cycle?
 
Dan and Marc said:
I can monitor the early time just worried about the rest of the times since he dropped low pretty late into the cycle?
Click to expand...
He has later nadirs in bounce breaking cycles which is what you saw today. There is also more downward momentum in bounce breaking cycles. When you shoot lower numbers you get typical Lantus cycles which are nice and flat. It's possible you might have to set an alarm for later in the cycle tonight but it's also likely that he will bounce from the lower numbers of today.
 
I guess how much risk is there that he will go hypo if we shoot normally? Especially since its when we will be sleeping, unless we wake up each hour to check which we will do if we have to. Would doing a reduced dose be safer like 1 unit?
 
Dan and Marc said:
Also remembering now that Wendy said depending on his PMPS we should follow whats written in the SLSG documentation which says:

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.

So if he is below 150 shouldn't we not shoot or is it 90 like you said?
Click to expand...
Also, these guidelines are for CGs whose cats are new to insulin and they do not have enough data on how their cats respond to insulin. ("Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:")

The guidelines also say:
"Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. "

You are actually testing enough to follow TR. CGs who follow SLGS usually just about manage preshot tests and a weekly curve. Some get some spot checks.
 
Dan and Marc said:
Sorry we are just anxious seeing such a drop and not having data to back up shooting this low.
Click to expand...
No need to apologize. Shooting low is always scary. Even though, there are greater chances of numbers dropping harder with higher preshots and bounce breaking cycles like you saw today than when you shoot low. But that's something that takes a while to get used to! :-)

Dan and Marc said:
I guess how much risk is there that he will go hypo if we shoot normally? Especially since its when we will be sleeping, unless we wake up each hour to check which we will do if we have to. Would doing a reduced dose be safer like 1 unit?
Click to expand...
You can shoot a token dose of 1U but the higher depot will continue to affect the first part of the cycle.

Dan and Marc said:
Since the lowest we have ever shot is 221 and was 1 unit, you still think its safe to shoot 1.5 at this value?
Click to expand...
The size of the dose does not matter in a decision about whether to shoot or not if it is a good dose for a cat. A preshot is not always a good indicator of how the cycle will play out. Some cats nadir at the end of the cycle and those CGs get used to shooting low.
 
My husband called the ER hospital we go to for advice and we spoke to a tech who recommended not shooting and monitoring since he hasn't been on insulin that long and its quite a drop for 1 day.

I know we are checking a lot but still have very little data especially for low pre shot values. I think we would basically be up all night checking him non stop if we shot at this point.
 
Why not get another test and see where he is at after food? The number would be food-influenced, but you would also know whether he is zooming up in a bounce.
 
I am not an expert, but if you’re following SLGS the protocol would be to shoot, but given the large drop I can understand your concern 100%.

I would do what @Bandit's Mom advised. Give it a bit, retest, as I suspect the bounce will start soon. With Sam the bounces from prolonged lows that he isn’t used to (not one time drops that immediately cause a hard bounce) it takes typically a full cycle for the bounce to begin.

@Wendy&Neko any advice?
 
Last edited:
Just checked his +1, up to 160.

Also @chuckstables we have been checking his ketones regularly, we have the Nova Max Plus blood meter, he has never even had trace levels even at his highest points. He also still has yet to show actual symptoms of diabetes (drinking, peeing more and weight is good).

So 160 with food, should we shoot normal?
 
Dan and Marc said:
Just checked his +1, up to 160.

Also @chuckstables we have been checking his ketones regularly, we have the Nova Max Plus blood meter, he has never even had trace levels even at his highest points. He also still has yet to show actual symptoms of diabetes (drinking, peeing more and weight is good).

So 160 with food, should we shoot normal?
Click to expand...

Great! I’m glad that you’re keeping him safe by testing for ketones. Just wanted to make sure as I had a recent scare with Sam where he tested positive for ketones despite only being in the 200-300’s for a day!

I’d wait for @Bandit's Mom to reply. I’d say you’re safe to shoot, but I am not an expert like @Bandit's Mom is. If this was Sam i’d be comfortable shooting if he’s above 80.
 
Last edited:
Dan and Marc said:
So 160 with food, should we shoot normal?
Click to expand...
The 160 is food influenced. My sense is that he will slowly head up in a bounce. But you are an hour later than your usual shot time. Is that something you can adjust in future? The soonest you can shoot tomorrow morning would be 11.5 hours from the time you shoot tonight.

chuckstables said:
I’d wait for @Bandit's Mom to reply. I’d say you’re safe to shoot, but I am not an expert like @Bandit's Mom is.
Click to expand...
Thanks for the compliment @chuckstables, but we don't have experts here. :-) Just volunteers with various degrees of experience with FD who are paying it forward
 
Bandit's Mom said:
The 160 is food influenced. My sense is that he will slowly head up in a bounce. But you are an hour later than your usual shot time. Is that something you can adjust in future? The soonest you can shoot tomorrow morning would be 11.5 hours from the time you shoot tonight.


Thanks for the compliment @chuckstables, but we don't have experts here. :) Just volunteers with various degrees of experience with FD who are paying it forward
Click to expand...

Haha, totally fair. I just meant compared to me you’re an expert :). Thanks for paying it forward.

I’d also agree that the 160 is food influenced. I suspect the bounce is starting. I’d shoot the full dose, and just adjust the time back 15 mins for the next 4 cycles. If there are concerns of being hypo @Dan and Marc can always do a +2 test and give MC/HC wet if need be.
 
Yea we can adjust him if we shoot now. Do you think we should wait and check again at his regular +2 which is in 30ish minutes or just shoot now?
 
Dan and Marc said:
Yea we can adjust him if we shoot now. Do you think we should wait and check again at his regular +2 which is in 30ish minutes or just shoot now?
Click to expand...
At this point I think it’s safe to give the 1.5 and retest at +2. That’d be my advice. You can always leave out some LC wet on an icepack in case Chronos gets hungry. Keep in mind that 160 is actually on the upper end of the normal range for a non diabetic cat, we regularly shoot in the 70’s-80’s when on TR. Even on SLGS though 160 is perfectly fine to shoot at.

But based on his current readings going up i’d just shoot. That’s just my two cents.

If you still aren’t okay shooting or just won’t then please let us know
 
Last edited:
Dan and Marc said:
Yea we can adjust him if we shoot now. Do you think we should wait and check again at his regular +2 which is in 30ish minutes or just shoot now?
Click to expand...
The problem with delaying the shot is that you can monitor for less time before going to bed and it disrupts future shooting schedule. It's possible he might be higher at +2, giving you more comfort with shooting but he might also be flat.
 
You must log in or register to reply here.
Back
Top