4/13 Wrigley - AMPS=258 | +10.5=79 | +12=45 - Need help

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ewalker405

ewalker405

Member Since 2015
Wrigley is in good spirits again this morning. He was begging for food again. His appetite has come roaring back. His BG was 258 this morning.
 
Wife tested him when she got home from work and at +10.5 he was down to 79. That is a big drop isn't it? He is so hungry but we are holding off feeding him until we test again 12 hours from his morning shot. We are going to do another test in about 45 min to see if he is coming back up. These low numbers before a shot always scare me and I don't know what to do. He had ketones a week ago so I know doing the shots are important. Is there times when we should do .5 units vs 1 unit if he is low?

Thanks
 
no, that's not an especially big drop from amps 258 to +10.5/79. He had a lot of hours to go down, although it's always possible he dropped quickly in one hour and was flat for the rest of the time. No way to know. What may be happening is that his body is getting used to those green (normal) numbers and his bounces are getting shorter. That's likely why you're seeing more green numbers.

Typically we hold the dose unless a cat goes below 90 (for Start Low Go Slow) or 50 (for Tight Regulation). You haven't said which dosing method you want to use, have you? You're testing more than enough for TR, which is a faster path to regulation. But it's completely up to you.

If you want to follow SLGS, then you would reduce the dose by 0.25u to a new dose of 0.75u starting tonight. There's no easy way to measure that, you just have to do the best you can and be consistent.

If you're following TR, then you would hold the dose at 1.0u until he goes below 50.

He may zoom up by pmps. Some cats really rise at the end of the cycle.

Does he have food available while you and your wife are at work?
 
Thanks

I don't know which method I want to use. I think TR seems best but we will never be able to test him after AMPS during the week. Both of us work and are out of the house from 7:30 to 5:30 Monday - Friday. Neither of us are close enough to ever come back during lunch or anything cause we take public transportation to work. Do you think we could still get away with TR? We can test him multiple times at night if needed and also on the weekends.

My biggest fears are what if his numbers are low in the morning and we can't test him during the day. What do we do if he is under 100 in the morning and we have to leave for work?

This morning we fed him about 2/3 can of FF around 6:45 after testing him. Then I gave him the rest of the can before I left and he ate it right away. I was hoping he would eat it later. So he didn't have anything during the day. I was thinking of getting a timed feeder but don't know exactly how people use them (how much food, how long of a timer, etc). Also we have another cat that might be stealing Wrigley's food from the timed feeder. We wouldn't be able to tell which is eating it unless we got a dropcam or something.
 
Look here - down the the lower part of the first post for "Timed Feeders" for some chatter on them. I think they are worth their weight in gold for a diabetic cat. When I went back to work we had punkin always fed at +3 from the feeder, and if there was a lower preshot, then it fed him every 1/2 hr or so. You might consider getting 2 feeders and having them timed to open simulataneously. Put the same amount of food in both and unless Wrigley is really skittish he'd probably get to eat at least one of the feeders. It's pretty important for a diabetic cat to eat more than just once every 12 hrs. You don't want to overfeed them to the point they gain weight, but food is how you bring up low numbers, and if you're not there, the timed feeder substitutes for you in case he goes into low numbers.

If he is low in the morning at this stage, I'd probably just skip his shot. If you had data to show that he would just stay flat in greens, that would be different, but he hasn't been diabetic long enough for you to know that yet.

Also take a look at the top of the "stickies" - the posts that are fixed at the top of this page and the first one is on how to manage TR with a full-time job. It can be done - but honestly, i think skipping is part of the solution when your cat is newly diagnosed.

For the feeder - I'd take the amount you normally feed him in the morning and divide it into 3 portions or so. Feed him one portion with his shot. Set the timed feeder to go off at +2 and +4, and put the two remaining portions in those two slots. There's some tips about timed feeders in the post above that'll be helpful to you.

I did the same thing in the evening for punkin. He always got his +3 meals from the feeder.
 
Smaller meals spaced out over the day are generally recommended for diabetic cats. That's the reason for the automatic feeder. Do both of your cats eat at the same time? In that case, you might be able to get 2 feeders. I assume that you wouldn't want to isolate Wrigley for the whole day. Rusty likes the CatMate C-20 feeder. It has two compartments and each compartment has a timer. It comes with a freezer block that fits under the food trays and will keep the wet food cool for quite a long time (nice for the summer). If you got two--one for each cat-- they might not go after each other's food. We serve Rusty almost all his meals in his feeder. When we are home we don't set the timers, just put the bowl of food into one of the trays and he uses the feeder as a "table". So he knows where to look for his food. Both of your cats might adjust to this.
Here's a link. You can find the feeder on Amazon, too.
http://www.kvsupply.com/cat-mate-c20

Edited to say that Julie's post appeared as I was typing this. "great minds . . . " you know!!

I hope that Wrigley will have a good cycle this evening. He is looking good.

Ella & Rusty
 
Woah, just tested him again. It is +12 from his AMPS and he is down to 45... We haven't gave him a shot yet. How is he still going down? Also, he is so hungry and begging for food. Now what? I didn't expect to see him with a lower number on this test.
 
Time to break out the high carb food!! Any time they drop below 50, you need to get them back up.

If you have some "gravy lovers" type of food, pop the top, squeeze out the gravy into a bowl and give him a teaspoon or 2 of just the gravy. We don't want to fill him up, just bring his numbers up.

If you don't have any high carb food, a couple of drops of Karo/honey/syrup in a teaspoon of his food will work

Re-test in about 20-30 minutes

It also means he gets a dose reduction, but let's get his numbers up first
 
Ok, just gave him the gravy from a FF beef with gravy. He licked it up in about 10 seconds. Poor starving boy. I will test again in about 20 minutes and see. Another problem this may cause is that the latest we can shoot him in the morning is 7:30 CST (12 hours from right now). I am not sure how it works if we have to push this shot back tonight and give him his shot in the morning still before the 12 hour mark would be up.

Thanks. I will report back in 20 with his next test.
 
If you have to skip tonight, you skip and start over in the morning...it's more important that you keep him safe than it is to keep right on schedule

Let's see where he's at in a few minutes

And yeah....they really love that gravy!!!
 
The general rule of thumb is to "feed the 40s". I would be inclined to skip the shot this evening, give him his dinner, and give tomorrow morning's shot at your preferred time. Take the reduction tomorrow morning. Bear in mind that Wrigley's "shed" will still be influencing this evening's cycle, so do keep testing; but don't go overboard on high carb food or you will certainly see a big bounce. Feed him his normal foods and if you need to bring his blood glucose up, add a little Karo syrup to his low-carb foods.

Ella & Rusty
 
About the skipping... he did have ketones a week ago. He seems 1000% better energy/appetite/attitude since then though. I know ketones makes skipping a shot tougher.
 
I have ketone strips but haven't tested him yet. I think he is going to the vet for testing on everything on Wednesday and was going to ask them to test.

Any other opinions on skipping the shot vs giving him like .25?
 
No, I couldn't shoot in 12 hours. About +11.25 would be the latest. It is 8:11 CST here and the latest I can shoot tomorrow morning is 7:30 AM CST.
 
I don't have any experience with ketones other than knowing that it's even more important to keep insulin going, especially if ketones have been in the picture lately.

That being said, shooting early without being home to test really isn't safe either.

I'd be sure to start testing for ketones though....they're a lot easier to deal with if you catch them early...as well as being a lot cheaper. You can pick up some urine ketone test strips at any pharmacy

Here are some Urine Testing Tips too
 
I can be up for about another 4 hours. If we have to shoot him earlier than +12 tomorrow, it could be bad because we can't test him at all during the day tomorrow. Sounds like it might be best to skip tonight since we are about an hour over his shot time..?
 
Yeah....I think that's probably for the best but please try to start getting those ketone tests in

They're not something any of us want to fool with....they can go from a "trace" to "high" within the same cycle, so it's really important to catch them early. "Trace" can sometimes be handled at home....any more than that and they really need to be at the vets office and besides being expensive, it's not always successful

As you go forward, the longer he goes without any signs of ketones, the better ...and eventually you can relax a little
 
I've sent a message to some people with ketones experience to see if they are around. It's unfortunate that he's had some high carb food, because now we don't know if he had reached his nadir. That 58 could just be his food spike and when it wears off it would be unsafe to shoot. For the next time (and it better not Wrigley!), here is the procedure from the Sticky on Shooting and Handling Low Numbers.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.
  • When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
  • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
  • --- Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?

** Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.

Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.
 
I saw this condo on my phone and wanted to get home to respond because I wanted to post what Wendy did....thank you, Wendy!!! The rule of thumb for a 40 something number at PS is not "feed the 40s". It's retest in 15-20 minutes and then feed 1-2 tsp of low carb. As Wendy said, with the 58, we have no idea if that is a carb-induced number or whether it's a nadir. My bet is on the carb induced number. If Eric had been told to just feed a bit of LC, then we would have known where he was and it would have been safe to give him a full dose of insulin pretty much on time as long as the BG was above 50.

I see the SS already says "NS". I would have encouraged you to shoot and feed due to him having ketones in the not so distant past. It's not uncommon for cats who have had ketones (or DKA) to have them again. So it's important to get the insulin in them and feed HC if you have to to keep the numbers up.
 
Thanks Marje, Would you suggest shooting .25 just to get some in him? Or should I shoot something different? I will have to shoot him in the morning 10.75 hours from now. Hopefully that isn't messed up.

I was just thinking today that I have learned so much the last week and know what is going on. Now tonight, I am confused big time.

Thank you guys for all the help and advice. I am leaning toward giving him .25 soon. Sound good?
 
Thanks Wendy and Marje....that's why I tagged you guys!!

You both have more experience in these situations than I do

Sorry for leading you the wrong way Eric....just when I see those low numbers in a cat that's so new to this, it worries me

Wendy is right though....for "next" time

Hopefully one of them will comment soon on the idea of shooting tonight when you can't be home to test tomorrow and would have to shoot early
 
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I'm really scared about the time issue now. Should I give .25 units right now and then see what he is at in the morning when I can shoot him at +10.5? It's either that or skip tonight.
 
Sorry, Eric. It was Gracies shot time right after my last post.

If we knew that he would be high tomorrow morning, then shooting at your normal time would not be an issue. You could shoot a small amount right now just because he is likely to be high with such a low number and a drained depot so shooting the new dose on time(which would be early) would normally be an option. My biggest concern would be shooting early and being gone all day.

I think the best option at this point is to skip, stay on top of ketone testing, reduce the dose at his normal shot time tomorrow.

What do you think?
 
Yes, I think you guys are right. It is too late to do any shooting because of the timing tomorrow and us being gone. I have learned what to do for next time though. I will follow the directions above about low numbers and stalling with no food or lc food.

Should his new default dose be .75 units or is that only for tomorrow?

Also about testing for ketones. I have seen people say put crumpled up plastic wrap in the litter box to get some urine. How does that work? Just put balls of plastic wrap all around on top of the litter and hope he pees on one of them? Or cover the whole top of the litter with plastic wrap?

Thanks
 
His new dose should be 0.75u beginning with his next shot.

I haven't done that, but i think what people do is put a little plastic wrap across the litter to catch some urine so they can test it. I suspect balls of plastic wrap would end up being thoroughly scratched into a mess and no urine left to test. I used an alternate box - i think i described it. A box lid inside of a garbage bag, then something non-absorbent in the tray you've created. I used dry lentils, but anything clean like aquarium gravel would work fine. Our local grocery store sells disposable trays which might be an option. Then you just tip the box and can test the urine.
 
Normally, it would be 0.75u but we want to lay some things out for you and let you decide. Once of us will post soon. I see Julie posted but I want to chitchat with her because she had some valid concerns about shooting 0.75u. Hold tight.

I am unsure about the crumpled up plastic wrap. I just made tiny fold trays and as Gracie squats, I stick one under her bottom. Some people just get a large plastic spoon and stick that under the kitty's bottom as he/she squats.
 
I just tested and he is 139. If I had given him the shot, it would be +2 right now. Do I still enter this as +2 on the PM side of the SS?

Thanks for the urine testing tips. I will figure out something that works for us.
 
to follow up about the dose & Marje's comments . . .

the "normal" process of going down the dosing scale is to reduce by 0.25u increments. That would mean that Wrigley's next dose would be 0.75u.

Here's the concern. He's got a lot of green on his spreadsheet - and green is the range (50-120ish) where the pancreas has the opportunity to heal. Some newly diagnosed cats only need a switch to low carb canned food and a short time of insulin support, and their pancreas will sputter back to life. Those kitties can go pretty fast down the dosing scale, and sometimes they need larger dose reductions.

With Wrigley being alone during the days, it might be that the safer course would be to reduce to 0.5u. If that's not enough, you could increase the dose back up to 0.75u.

There are pros and cons to a lot of FD - so we weigh out the risks and benefits of whatever we do. This is one of those situations where you and your wife may want to talk about it and decide what you want to do in the morning. He may bounce and be high, especially after skipping the shot tonight. There's no way to know how long a bounce will last - his last one went from Sunday pmps to sometime mid-day today, so roughly 24 hrs or less.

Think about what you might want to do and ask questions. I think Marje will be on the board in a while and maybe she can explain further about this.
 
In general, how is Wrigley's appetite? Has he been eating the usual amount without any problems?
Has he been active/acting normal or would you say lethargic or sickly?

When is the last time his urine was tested for ketones? Does his breath smell unusual... similar to nail polish remover?

The reason I'm asking these questions is because I'm trying to figure out if it sounds like there's a possibility Wrigley is actively throwing ketones without having been tested for ketones recently. If he's actively throwing ketones dosing suggestions would generally be more aggressive than usual.

The answers to these questions may help Marje and Julie with suggesting a dose.

Also, depending on what happens in the next few hours...
Another option "if" Wrigley's number zoom up: shoot what we call an an 18/18 (shoot 18 hours from this morning's shot and then shoot at the normal time tomorrow evening).
 
His +4 (after no shot) and it's 202. Hope he isn't too high by the morning and hope I didn't mess up too bad by not shooting at least a small dose.

His appetite has been awesome. He eats whatever we give him. His appetite last week was nothing. The last few days have been great. He has acted like the normal cat from months ago.

His ketones were tested by the vet a week ago and I haven't been able to test him at home yet. I got the strips but need to get urine. I have the urine catching tips. His breath doesn't smell like nail polish.
 
I like the idea of shooting an 18/18 schedule if you'll be up. That will keep him from getting too high. As an example, let's say you shot at 6 this morning. You could shoot at midnight, do not shoot in the morning, and then shoot at 6 pm tomorrow night. Or, you can just wait and shoot at your regular time in the morning.

As Julie said, normally the next step down would be 0.75u. I'm not sure when he's done with the antibiotic but it's always possible for ketones to come back and DKA to occur if the infection wasn't addressed. Balance that with us not knowing if he's coming down the scale fast because the infection is resolving or if brcsuse he was on way too much insulin. So we don't know if 0.75u will still be too much for you to feel you can safely leave him.

I think it has to be your and your wife's decision. If he were my cat, I'd probably try the 0.75u in order to hopefully help keep ketones at bay. At the first indication that it might not be a safe dose to leave him for so long during the day, I'd reduce...unless he has ketones.
 
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