3/12 Dimi AMPS 153 (libre) +2.5 <40 +3 107 +4 54 +4.5 41

Bobbi Kraham

Bobbi Kraham

Member Since 2022
Feeling worried. Three days ago I removed kibble from Dimi's diet and his BG came down so far that I couldn't give him his PM shot (PMPS 56). He was receiving 3 units of Lantus at the time. Since then I've decreased his dose to 1.5 units, and without the kibble, his BG continues to improve. The huge rises and dips in BG seem to have gone away, but oddly, now his nadir is unpredictable. Previously, it was consistently at +6. Now it is closer to shot time, or a couple hours post shot. Today his AMPS was 153. He ate well so I gave him his shot. Now I'm worried that I shouldn't have. At +4.5 it is 41. Just got him to eat some. He's not showing obvious signs of hypo, just resting peacefully. I'm keeping a close eye and hoping it continues to rise. Is there anything else I should do right now? A few questions...1) In the future, should I hold off on giving a shot if his BG is within a normal range? Is there a number below which I should not give him his shot? 2) What's going on with his nadir? 3) Should I decrease his dose further? Thanks for your thoughts.

Previous post: https://www.felinediabetes.com/FDMB...e-2-hi-3-492-7-313-8-356.260484/#post-2923862
 
  • Bobbi Kraham said:
    Feeling worried. Three days ago I removed kibble from Dimi's diet and his BG came down so far that I couldn't give him his PM shot (PMPS 56). He was receiving 3 units of Lantus at the time. Since then I've decreased his dose to 1.5 units, and without the kibble, his BG continues to improve. The huge rises and dips in BG seem to have gone away, but oddly, now his nadir is unpredictable. Previously, it was consistently at +6. Now it is closer to shot time, or a couple hours post shot. Today his AMPS was 153. He ate well so I gave him his shot. Now I'm worried that I shouldn't have. At +4.5 it is 41. Just got him to eat some. He's not showing obvious signs of hypo, just resting peacefully. I'm keeping a close eye and hoping it continues to rise. Is there anything else I should do right now? A few questions...1) In the future, should I hold off on giving a shot if his BG is within a normal range? Is there a number below which I should not give him his shot? 2) What's going on with his nadir? 3) Should I decrease his dose further? Thanks for your thoughts.
    Click to expand...
Bobbi Kraham said:
Previous post: https://www.felinediabetes.com/FDMB...e-2-hi-3-492-7-313-8-356.260484/#post-2923862
Click to expand...

Hi Bobbi, I'm going to tag a few members for you
I would reduce his dose tonight and shoot 1.25 units,
but let's ask the experts
Are you still going out of town this Sun to Tues ?
I see you said on your previous post you husband and daughter will be taking over

@Chris & China (GA)
@Sienne and Gabby (GA)



@tiffmaxee

@Wendy&Neko

@tiffmaxee

Hi Ladies Bobbi came over from the FB group ,her intro post is attached above
Can you answer her 3 questions please
 
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Bobbi when you get a chance there are 2 dosing methods to follow when using lantus.
I'll give you the link, see if they make sense to you and pick one and add it to your signature and SS . Are you going to be feeding g anymore kibble at all , if not you can remove that from your signature about transitioning
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Here is a quick explanation
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 ( Newley Diagnosed). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

You could try TR if you are feeding LC wet (and no dry) and if you think that's more testing than you can manage, you can switch to SLGS.
 
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With even TR a reduction was earned by dropping under 50. New dose beginning tonight is 1.25. If too low at pmps stall, don’t feed, and retest in 20-30 minutes. Then post for dosing advice. Congrats on the reduction. The food change seems to be making a big difference. :D
 
Diane Tyler's Mom said:
Bobbi when you get a chance there are 2 dosing methods to follow when using lantus.
I'll give you the link, see if they make sense to you and pick one and add it to your signature and SS . Are you going to be feeding g anymore kibble at all , if not you can remove that from your signature about transitioning
https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Here is a quick explanation
SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50 ( Newley Diagnosed). The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.

You could try TR if you are feeding LC wet (and no dry) and if you think that's more testing than you can manage, you can switch to SLGS.
Click to expand...
Diane, First, thanks so much for always being here to help! I'm obsessive about testing (it's easy with the libre) so could probably do TR, but I'm heading out of town for 3 days starting tmrw. I can't count on my husband and daughter to monitor as closely while I'm away. I'll take a closer look when I'm back.
 
Bobbi Kraham said:
Diane, First, thanks so much for always being here to help! I'm obsessive about testing (it's easy with the libre) so could probably do TR, but I'm heading out of town for 3 days starting tmrw. I can't count on my husband and daughter to monitor as closely while I'm away. I'll take a closer look when I'm back.
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No problem ,yes I read you will be out of town until Mom , they will be keeping in touch with you though right, in case he earns another reduction.
I assume you have med and high carbs wet foods at home and some honey
So the kibble is gone completely now
Oops I see it is, thanks for removing it from your signature :cat:
 
Bobbi Kraham said:
Diane, First, thanks so much for always being here to help! I'm obsessive about testing (it's easy with the libre) so could probably do TR, but I'm heading out of town for 3 days starting tmrw. I can't count on my husband and daughter to monitor as closely while I'm away. I'll take a closer look when I'm back.
Click to expand...

You might want to give a vacation dose if you don’t think they will be checking often. You could try 1.0. What do you think?
 
tiffmaxee said:
With even TR a reduction was earned by dropping under 50. New dose beginning tonight is 1.25. If too low at pmps stall, don’t feed, and retest in 20-30 minutes. Then post for dosing advice. Congrats on the reduction. The food change seems to be making a big difference. :D
Click to expand...
Thanks so much for your reply. A few questions: 1) What number is considered too low at PMPS? 2) How do I find 1.25? I'm using syringes w/half unit markings and really struggle with the tiny lines. 3) I'm heading out of town for 3 days starting tmrw am. I don't think he'll eat as well without my urging, and I can't count on my husband and daughter to monitor him as diligently as I do. They won't even notice a potential hypo situation. Given that info., would it be safer to decrease his dose to 1 unit until I'm back? Thanks again!
 
You have enough data now to shoot 150+ if you can monitor actually. With SLGS you have options if under 150.

Stall and see if going up, shoot a token dose, or skip. I’d try and do one of the first two options.

You have to eyeball 1.25. I’d make a sample with colored water and a used syringe. I used digital calipers and ignored the markings. There’s info and a video at this link. I know you can’t use them now but the link is for later. He might very well become diet controlled and not needed. He’s made a big change recently.

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

I would decrease to 1.0 until you get home and have them give a token dose of .25 or skip if low while you are gone. Better a day or three too high than a hypo.
 
Bobbi Kraham said:
Thanks so much for your reply. A few questions: 1) What number is considered too low at PMPS? 2) How do I find 1.25? I'm using syringes w/half unit markings and really struggle with the tiny lines. 3) I'm heading out of town for 3 days starting tmrw am. I don't think he'll eat as well without my urging, and I can't count on my husband and daughter to monitor him as diligently as I do. They won't even notice a potential hypo situation. Given that info., would it be safer to decrease his dose to 1 unit until I'm back? Thanks again!
Click to expand...

Bobbi I doubt that your husband or daughter will stall and not feed and wait 20-30 minutes to test again if the pre shot is to low correct?
I'll tag @tiffmaxee again to see what she thinks would be a no shoot number for you would be

I see you already answered her questions :p
Thanks
 
tiffmaxee said:
You have enough data now to shoot 150+ if you can monitor actually. With SLGS you have options if under 150.

Stall and see if going up, shoot a token dose, or skip. I’d try and do one of the first two options.

You have to eyeball 1.25. I’d make a sample with colored water and a used syringe. I used digital calipers and ignored the markings. There’s info and a video at this link. I know you can’t use them now but the link is for later. He might very well become diet controlled and not needed. He’s made a big change recently.

https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835

I would decrease to 1.0 until you get home and have them give a token dose of .25 or skip if low while you are gone. Better a day or three too high than a hypo.
Click to expand...
Sounds great, thanks so much!
 
So you have this for the future if needed. Shooting 0.25 units
49822973683_0559ae843a_o.jpg




This would be 0.10 if needed in the future
49822973598_359300d752_o.jpg
 
I found it helpful when his nadir was +6. Now I have no idea when to tell my husband to watch closely while I'm away. Any thoughts on why his nadir became unpredictable with the removal of kibble and the reduced dose of lantus?
 
Just an FYI... The nadir isn't a fixed point. It can and does move around. It can be influenced by any number of factors. My kitty's nadir was generally early -- at around +3 or +4 except for those times when it wasn't. It does really make life a challenge when it comes to diabetes management. (Sorry -- that's probably not what you wanted to hear!!)

Part of what you were seeing this morning was that it looks like Dimi's numbers were dropping at shot time. She was at 291 at PM +3 and your AMPS was 153. Shooting a dropping number can be a bit of an adventure! The only thing I would have suggested you do differently was to have tested at +1 and if numbers were still dropping, you could have steered the numbers upward with a bit of higher carb food. Do not be surprised if Dimi's numbers bounce into a higher range by PMPS.

I agree with Elise. If you are not confident that your husband or daughter will be diligent about testing, for everyone's peace of mind, reduce the dose. I was Gabby's sole caretaker. I had a wonderful cat sitter but she was there only twice a day when I had to travel. I would reduce Gabby's dose.
 
Any chance your husband or daughter would be willing to post here (on your account) should they have questions while you are gone and they are unable to reach you? We've had people do that before.

Nadirs are highly variable in some cats. With Neko, her Lantus nadir was anywhere from +3.5 to +13, depending on many factors. Bounce breaking cycles, like you saw on 3/9 AM cycle and yesterday AM often mean later nadirs. If they are looking to earn a reduction, like today, that can move the nadir earlier.

Congrats on the switch away from dry food. We've seen some major changes in the amount of insulin needed when that happens, just as Dimi is showing.
 
Sienne and Gabby (GA) said:
Just an FYI... The nadir isn't a fixed point. It can and does move around. It can be influenced by any number of factors. My kitty's nadir was generally early -- at around +3 or +4 except for those times when it wasn't. It does really make life a challenge when it comes to diabetes management. (Sorry -- that's probably not what you wanted to hear!!)

Part of what you were seeing this morning was that it looks like Dimi's numbers were dropping at shot time. She was at 291 at PM +3 and your AMPS was 153. Shooting a dropping number can be a bit of an adventure! The only thing I would have suggested you do differently was to have tested at +1 and if numbers were still dropping, you could have steered the numbers upward with a bit of higher carb food. Do not be surprised if Dimi's numbers bounce into a higher range by PMPS.

I agree with Elise. If you are not confident that your husband or daughter will be diligent about testing, for everyone's peace of mind, reduce the dose. I was Gabby's sole caretaker. I had a wonderful cat sitter but she was there only twice a day when I had to travel. I would reduce Gabby's dose.
Click to expand...
Thanks so much for your feedback and info. on the nadir, Sienne and Gabby! Much appreciated!
 
Wendy&Neko said:
Any chance your husband or daughter would be willing to post here (on your account) should they have questions while you are gone and they are unable to reach you? We've had people do that before.

Nadirs are highly variable in some cats. With Neko, her Lantus nadir was anywhere from +3.5 to +13, depending on many factors. Bounce breaking cycles, like you saw on 3/9 AM cycle and yesterday AM often mean later nadirs. If they are looking to earn a reduction, like today, that can move the nadir earlier.

Congrats on the switch away from dry food. We've seen some major changes in the amount of insulin needed when that happens, just as Dimi is showing.
Click to expand...
Thanks for looking at his spreadsheet, Wendy, and providing feedback. I have so much to learn, and find it so helpful! I don't think I can get my husband or daughter to post, I'm not even sure they will recognize if/when they should be concerned. I'll provide them instructions tonight, and hope for the best. I'll definitely decrease his dose to 1 unit while away as tiffmaxee suggested. Though I'm hoping for remission, I hope it waits until I'm back!
 
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