2/11 Todd PMPS 62, +1 1/2 122 *Eyes Please!*

[ToddyTiger]

Hey all,

it's been a few weeks since I posted. We've been busy here with two family emergencies and some very bad personal family news. :/


However, Todd has been doing very well! he's gained 8 ounces in about a month, and hasn't needed his appetite stimulant in a month. he's eating and drinking on his own just fine. The vet says unless he starts acting REALLY odd, no need to bring him in for at least 2 months (for a kidney value recheck)

His BG has been doing well, however yesterday morning, this morning and tonight, his numbers have been oddly low. Especially tonight!! 62 is the lowest I've seen him at since last summer when he crashed at 40. He's acting totally fine though. Eating, purring, walking, he just cleaned his bum and his paws.. I didn't give his insulin yet, because he just ate and I wanted to give it about 10-15 minutes and recheck his BG. Make sure it's going up after eating. I don't want to be a worry wart like I was in Dec when he had a low number and I shoved Karo into his mouth when he didn't need it. heh

Question though... when (if at all) should I give him his 2.0 units? I certainly don't want to with him at 62. What number should he be at before I give it?

I would also assume, IF it does go lower when I recheck, that I should probably give him Karo and go to the ER vet?? Like I said, he's acting ok.

As you can see by looking at his SS, I haven't been able to do mid-day checks (not around), but I can tomorrow, to see what is up.

Anyway.. thanks! I'll repost with new numbers shortly.

*UPDATE* a little over 15 minutes he is up to 125 now.

*Update 2* 20 minutes after last update, we're at 134

*Update 3* He's up to 149, so I gave him his insulin. Late yes, but he got it.

*Update 4* 122 @ + 1 1/2

Hope it's safe to go to bed. :/ Kinda worried he's gonna crash while I'm sleeping. Though he is acting fine still

-Sarah

 

[Ronnie & Luna]

hi there

looks like you did alright...but I would recommend the link below:

Dealing With Low Preshots

As well as, have a look at the various starred stickies at the top of the forum.

...and to add, whenever you get up, to sneak in a spot check. Every little bit helps and counts!
I'm not sure what your schedule is like, but it is very hard to see what is happening with the current dose without any spotchecks.
Sounds like you may be planning a curve this weekend? That will help too.
Have a good weekend!

 

[Pat+Raja+Shadow (GA)]

Good job with the testing and updates!
I am sorry about all the issues you have been dealing with lately... :YMHUG:

If it is not possible to get checks in during the AM cycle, maybe you could get a few tests in at night. Some kitties do have their lowest numbers at night too...so at least a before bed time check would be helpful If you could alternate between a +2/+4 and a +3/+5 maybe it would help fill in the picture as to what is happening with Todd during the cycles.
The more data you have, the better.
I am wondering if you got any more spot checks in ....that was a nice green PMPS for Todd.

 

[Sienne and Gabby (GA)]

Sarah:

I'm guessing that Todd's numbers were lower earlier in the cycle. Spot checks are very important. There's no means of making suggestions regarding dose if you don't get spot checks. Todd may have earned a dose reduction/been under 50 and you have no way to know.

Please see this post on the topic.

 

[Ilkka and Tom]

Hey all,

His BG has been doing well, however yesterday morning, this morning and tonight, his numbers have been oddly low. Especially tonight!! 62 is the lowest I've seen him at since last summer when he crashed at 40. He's acting totally fine though. Eating, purring, walking, he just cleaned his bum and his paws.. I didn't give his insulin yet, because he just ate and I wanted to give it about 10-15 minutes and recheck his BG. Make sure it's going up after eating. I don't want to be a worry wart like I was in Dec when he had a low number and I shoved Karo into his mouth when he didn't need it. heh

Question though... when (if at all) should I give him his 2.0 units? I certainly don't want to with him at 62. What number should he be at before I give it?

I would also assume, IF it does go lower when I recheck, that I should probably give him Karo and go to the ER vet?? Like I said, he's acting ok.

-Sarah

Hi Sarah

Boy, that's quite an emotional roller coaster... Libby and Lucy's low preshots advisory is really good, but it also leaves a lot open in terms of decisions. I just looked at the chart and read your notes.

It's always hard to know what to say when a kitty has other complications in addition to high glucose -- but a couple of comments for you to think about. Everything always starts with "in the absence of other data" (IAOD)- so, IAOD, the unusual low numbers were a reflection / down bounce off the high numbers on 02/08 - 02/09 -- not just high, agitated. The dose has been constant for a while, so you know those numbers come from somewhere, and the warning sign of something to come was the 163/453 AMPS/PMPS, this past Tuesday, an over 2.5 ratio UP (2.78x), which is pretty dramatic and what I mean by "agitated." When that appears it can invert and then you get a similar ratio down, off some imaginary mid-level, which is just what happened, so you had 148 to 62 (2.38x).

Was /is there a way to avoid this? I sure don't know, but probably the dose should have been raised to 2.25 about the middle of January. The numbers back then were too high, way too high, and these current measures show there is drama behind Todd's fur curtain: that low bg is the visible sign of a system sputter, some reason that Todd suddenly provided more glucose, and a pancreas that is allowing 400s on 2 units, has to really be alarmed to do that. Or there was other unusual hormonal activity that caused a sub-70. These sputters may be in protest against too high a glucose level for too long. So I think a raise was indicated in mid Jan because even though it is hard to discern a tight pattern and data for mid cycle is missing, there is a) consistency, repeating patterns and ratios and b) part of that consistency is in a range that is too high much of the time. That's your signal. Steadiness of any kind is good, because it is less scary and more predictable -- you can adjust the dose to that.

Then the question of when to shoot when you get the low preshots, like just happened. I would probably done pretty much what you did, but reluctantly may have reduced the dose also, just for that one cycle. Again, that is a judgment call but reduction is a sort of insurance against the nasty bounce that will happen if you have to use karo, which, by the way, isn't needed until sub-40 looms. Nor would I take him to ER at 37, say, if a bit of karo is given and you can retest in 20 and 40 minutes. I know really low numbers are totally terrifying, and I can't ever express my state when Tom was throwing 30s in the meter, but you don't have anything to show that a high thirties can't be dealt with by you if you keep your head (which I demonstrated myself incapable of doing, pretty much). As long as your cat is acting all right, it is all right. My guy was in the high 20s a couple of times, acting okay -- I was the one who was not "acting okay" lol. (And yes, I gave karo and don't regret it one bit.)

Good luck... I'll be curious about Todd's next numbers and what you / others think about a raise if the bg settles in the same pattern.

Ilkka

 

[Sienne and Gabby (GA)]

Sarah:

Please remember that if you shot later than usual last night, then your AM shot is 12 hours after your previous shot. Your PMPS is really whatever the number was when you actually gave insulin.

Generally, you do not want to feed to raise the numbers. You are then shooting a food spike. As soon as the food wears off, numbers will drop. I am concerned that you have no posted tests after you shot. This post on handling low numbers is one you should print out along with the one on low pre-shots that Ronnie linked.

Whenever you shoot a lower than you have previously done, you need to get at minimum, a +1 and a +2. Going to sleep on a low number in the absence of any data is dangerous. You do not have spot checks that tell you about the pattern of Todd's cycles.

 

[ToddyTiger]

Sienne, I did update with a +2 after I shot last night. I got a 122 almost 2 hours after giving the insulin last night. I'm afraid that already being up for over 24 hours had made it impossible for me to even wake up with my alarm for a +4 or +5. I set three alarms for that.

Since I shot late last night, I am over an hour away from shot time now, normally I would be doing the AMPS right about now. However, I did just get a +10. He's at 310 right now.

Of course I will again check his BG right before shot time. He seems fine this morning. Chatty, following me around the house, purring, jumping up onto the couch (doesn't normally do that, but has been lately!).

I will get at least two spot checks in this afternoon to see what he is doing.

I understand most folks try to get as many spot checks in as possible during the day, and I was for a while able to do that during the day, but I haven't been home much during the day the last few weeks (death in the family, husband had surgery and I've had several Dr. appointments (trying to get preggers) Thats just been the last month. I certainly plan on getting back on that, so no need to worry.

Night time is harder for me, as I go to bed not long after doing Todd's evening BG check and shot. But if I do happen to be up late, I try to get a + check during the night. It doesn't happen much though. :/ I made sure to do it last night, even though I'm dead tired now. heh


Thanks for the help folks! I'm doing the best I can, and considering he seems to be gaining weight and doing better, I must be doing something right! I hope so, anyway.. heh

I hope you're all having a great weekend!

-Sarah

 

[Sienne and Gabby (GA)]

It sounds like you've had your hands full. I hope life is calming down for you.

Just a thought, and I have no idea if this will work for you. If you moved Todd's shot time earlier, you would have more opportunity to catch some of the PM spot checks. I realize that may not be feasible but I thought I would put it out there. I moved Gabby's times from 7:00 to 6:00 and it has helped me with getting in the AM checks before I leave for work and it means I'm not up to totally ridiculous hours if her numbers are running low in the PM.

We do try to encourage the PM checks. Many of the cats here have lower numbers at night. In addition, if you don't test at night, you miss half of the data and half of the opportunity to find out if Todd earns a dose reduction.

 

[ToddyTiger]

I do plan to make his shot time earlier. I just wasn't 100% sure how to go about it safely. I can't go too early, because a lot of evening activities are done between 4pm and 7pm. Right now (well, before last night) his shot time was 11am and 11pm. But I would like to do 9:30 or 10ish.