5/21 Heidi AMPS 152, +7=49, dose??

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heidismom

Member Since 2012
Heidi's bg has been pretty good. The general trend is that it is lower in the morning (152 today) and then around 200 in the evening.

Her vet wants me to give her either 1 unit per day, or .5 units twice a day, and nothing if her bg drops below 150.

Bear in mind, she is tapering off prednisone, at this time getting only 2.5 mg twice weekly. She was on 2.5 mg pred every other day for years, and of course, now it has caused the diabetes.

Thanks.
Corinne
 
Re: Heidi --dose??

Hi Corinne:

Could you please change your subject line to read:
5/21 Heidi AMPS 152 dose??

Have you been able to get any other tests today? It would help us to know what she is doing midcycle so it lets us know how low she is getting. Since we have time until you give her insulin tonight, if you could grab a test for us, that would help since she should be about mid cycle now (I believe she is coming up on +6?). Once you get that test number, if you can add it into your subject line so it would be : 5/21 Heidi AMPS 152 +6 xxx dose ??

You gave her insulin last night.....1u if my memory serves me correctly?

Thank you!!!
 
Re: 5/21 Heidi AMPS 152, +7= 49, dose??

Hi Marje,
I haven't been able to get any other tests today. She hid most of the day; now, every time she sees me, she prepares to flee so I am giving her a rest so she can be relaxed and confident again. I picked up some 28 gauge lancets and hopefully that will make a difference. Poor little thing.

I did give her 1 unit last night. That's right, she is almost mid-cycle. I'll see if she feels a little better now, and maybe I can get a sample.

Thanks!
Corinne
 
Re: 5/21 Heidi AMPS 152 dose??

Corinne:

Can you please edit your subject line the way Marje suggested? For those of us that try to keep an eye on things, it's very helpful to be able to scan the subject lines to see if anyone needs help. By updating your subject lines, we can see that.

To edit, go to your first post and click on the "edit" button and make the changes. Then click on "submit." Changes are only visible on the Board if you change the subject line in the first post.
 
Re: 5/21 Heidi AMPS 152 dose??

Sienne and Gabby said:
Corinne:

Can you please edit your subject line the way Marje suggested? For those of us that try to keep an eye on things, it's very helpful to be able to scan the subject lines to see if anyone needs help. By updating your subject lines, we can see that.

To edit, go to your first post and click on the "edit" button and make the changes. Then click on "submit." Changes are only visible on the Board if you change the subject line in the first post.
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Done.
 
Corinne

We need you to get her up a little. Can you please feed her two good tsps of her favorite low carb food and retest in 30 mins?

We'll discuss dose in a minute but let's get her up first ok?
 
I'll try but she just ate after I tested her at 5 p.m--not sure she will go for any more food at this time.
 
She's past mid cycle so I hope she's coming up. Did you feed her after you got the 49 or before? If you fed her after, then try and get a test now before you feed her.

How long has it been since you got the 49?
 
Okay, well I was wrong, the turkey baby food was too much to resist. She didn't eat a full 2 tsp, but almost.

Why are we doing this? (getting her back up)

So test her in 1/2 hour from now?

Thanks,
Corinne
 
Marjorie and Gracie said:
She's past mid cycle so I hope she's coming up. Did you feed her after you got the 49 or before? If you fed her after, then try and get a test now before you feed her.

How long has it been since you got the 49?
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Too late. I got the 49 at about 5 p.m. and she ate some food afterward. It's now 6:18 p.m. so it's 1 hour 18 minutes after the test. I just gave her some turkey baby food and she ate not quite 2 tsp full. So I guess it's too late to test?
 
You don't think she is going hypo, do you? I only gave her .5 units this morning, so she shouldn't be going hypo....

If her reading is this low pre-shot tonight (which will be app 10 p.m.), then I shouldn't give her any insulin, should I?

Should I call the vet or start giving her honey/syrup?

Thanks,
Corinne
 
Corinne

Not to scare you but a cat can hypo on .1u. For most cats, 49 is not a hypo number but every cat is different. If she is not exhibiting any symptoms, then she is probably just fine but because you have no data on her at these numbers, we want her to get up into the 50s/60s.

Don't worry right now about whether you will shoot tonight or what you will shoot. There's a lot of time and she could bounce up into the 200s. I'd just like a test showing she is coming up.
 
For a newly diagnosed cat, numbers below 50 indicate a dose reduction is needed. The way you are testing and shooting is potentially endangering Heidi. Marje is being polite. I'm blunt. Marje was politely telling you that you need to move Heidi into a BG range where she won't potentially drop further. Frankly, given that your only spot check gave you a 49, you haven't a clue if Heidi was a 30 at +4. Until you have a clearer idea of when Lantus onset and nadir are for your cat, you need to be getting spot checks. And even then, no matter how well you know Heidi, she can and will surprise you.

You do not yet have sufficient data from which to draw any meaningful conclusions. You are shooting inconsistent amounts at AM and PM. I would encourage you to shoot 0.5u twice a day. If you want to lower the dose to 0.25u BID because that makes you more comfortable, that's fine. Just shoot the same amount twice a day. Regardless of the dose, you MUST test. We've seen cats hit numbers in the 30s at 0.1u. Do not become complacent or overly confident. We have seen overly confident caregivers not test and leave the house and come home to a cat in seizures. Not testing can have terrible consequences. Not testing also severely limits the amount of help we can offer without the fear of endangering Heidi and I, for one, will not risk endangering your cat.

We generally suggest that if you are new to FDMB that you post if you get a pre-shot test that is 150 or lower. We will help you. Skipping shots makes for big swings in numbers.
 
Sorry that took so long. I had trouble getting blood with the lancet, then had to get her treats, then computer didn't respond. She's up to 75. yay.

I had to use the 22 gauge needle again.
 
Sienne and Gabby said:
For a newly diagnosed cat, numbers below 50 indicate a dose reduction is needed. The way you are testing and shooting is potentially endangering Heidi. Marje is being polite. I'm blunt. Marje was politely telling you that you need to move Heidi into a BG range where she won't potentially drop further. Frankly, given that your only spot check gave you a 49, you haven't a clue if Heidi was a 30 at +4. Until you have a clearer idea of when Lantus onset and nadir are for your cat, you need to be getting spot checks. And even then, no matter how well you know Heidi, she can and will surprise you.

You do not yet have sufficient data from which to draw any meaningful conclusions. You are shooting inconsistent amounts at AM and PM. I would encourage you to shoot 0.5u twice a day. If you want to lower the dose to 0.25u BID because that makes you more comfortable, that's fine. Just shoot the same amount twice a day. Regardless of the dose, you MUST test. We've seen cats hit numbers in the 30s at 0.1u. Do not become complacent or overly confident. We have seen overly confident caregivers not test and leave the house and come home to a cat in seizures. Not testing can have terrible consequences. Not testing also severely limits the amount of help we can offer without the fear of endangering Heidi and I, for one, will not risk endangering your cat.

We generally suggest that if you are new to FDMB that you post if you get a pre-shot test that is 150 or lower. We will help you. Skipping shots makes for big swings in numbers.
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Thanks, Sienne. I am confused.
Are you saying I must give her insulin in some amount, no matter how low her bg is? My vet says that under 150 , do not give insulin. So you are saying that doing that (skipping the insulin) is going to result in big swings in numbers?

Are you saying, give insulin even if her bg is 49 for example, then keep testing afterward ?

Also, what if I have to leave the house? For example, tomorrow morning I have to inject Heidi at 9:40 a.m. and I have a class at 10 a.m. which means I have to leave right after dosing her provided she isn't too low to dose.

I appreciate your help.

Corinne
 
Corinne:

You are using an Alpha Trak so that 49 could have been close to a 49 on a human meter or it could have even been close to 20 on a human meter....which is a number where we absolutely worry about hypos. I, unfortunately, forgot for a few minutes that you were using an AT or I would have had you give her karo to get her up. Because we do not know how close a 49 on your AT is to a human glucometer, we'd rather err on the side of caution.

She needs to be up more. I'd like to see her above 80. So please feed her just a bit more baby food and then retest her 30 mins after feeding.

No....most very experienced caregivers do not shoot below 50 with lantus insulin. That would be 80 on an AT. What Sienne is saying is that we can help you learn to shoot the numbers you have been skipping. I believe I've said (Health condo?) that if she was below 200, don't feed, post, and let us help you.

Yes....skipping insulin and changing doses can cause huge swings in numbers that can also be hard to get under control. Lantus likes consistency and we like to have a dose that is safe to shoot every 12 hours. Because you've been skipping shots and changing doses, we aren't exactly sure what that is.

When you shoot a number lower than you have shot before (like this morning) even if you reduced the dose, you MUST test. When you shoot a number that is dropping (probably like this morning) you MUST get a +1 and +2; when you get a +2 that is similar to the PS, you MUST test and expect she will come down during the cycle; when you get a +2 that is much lower than the PS, then you MUST test and be ready for a possibly very active cycle with early drops.
 
I would never tell you to shoot numbers under 50. (There are some cats where this is possible but in general, even those of us who have been around for a while and shoot low would not shoot numbers in the 40s.)

I am, however, disagreeing with your vet. Most vets set "no shoot" numbers much higher than we do here. They do this for several reasons. Most of their clients do not home test. As a result, they can't manage the curve. Also, telling someone to shoot low is a liability for the vet. They are not around 24/7 and some vets are not even accessible any time after hours. We try to school you to shoot low numbers safely. If you look at the subject lines on the Board, you'll see that people are routinely shooting numbers that are lower than 150. For example, Tess' bean, Ann, shot a 68 at AMPS. Marje and I will shoot pretty much any number above 49.

I am indeed saying that skipping shots can result in swings in numbers. The duration for Lantus is typically around 12 hrs. (give or take). As the remnants of the cycle wear off, BG numbers will rise. Sometimes, they will even spike into high ranges. And then you shoot and numbers drop again. So you skip and numbers rise. If you look at Ella's SS around 4/24, she was skipping shots. It illustrates my point.

You have to take each day and each shot as it comes. On a day like tomorrow when you must leave, get a +11 and post if you are concerned about Ella's numbers.

Also, what is your shot time? It looks like you stalled your AM shot until 10:30 yesterday. You can adjust shot time by 15 min. at each shot or by 30 min. once a day. An early shot acts like a dose increase and a late shot acts like a dose reduction.
 
Marjorie and Gracie said:
Corinne:

You are using an Alpha Trak so that 49 could have been close to a 49 on a human meter or it could have even been close to 20 on a human meter....which is a number where we absolutely worry about hypos. I, unfortunately, forgot for a few minutes that you were using an AT or I would have had you give her karo to get her up. Because we do not know how close a 49 on your AT is to a human glucometer, we'd rather err on the side of caution.

She needs to be up more. I'd like to see her above 80. So please feed her just a bit more baby food and then retest her 30 mins after feeding.

No....most very experienced caregivers do not shoot below 50 with lantus insulin. That would be 80 on an AT. What Sienne is saying is that we can help you learn to shoot the numbers you have been skipping. I believe I've said (Health condo?) that if she was below 200, don't feed, post, and let us help you.

Yes....skipping insulin and changing doses can cause huge swings in numbers that can also be hard to get under control. Lantus likes consistency and we like to have a dose that is safe to shoot every 12 hours. Because you've been skipping shots and changing doses, we aren't exactly sure what that is.

When you shoot a number lower than you have shot before (like this morning) even if you reduced the dose, you MUST test. When you shoot a number that is dropping (probably like this morning) you MUST get a +1 and +2; when you get a +2 that is similar to the PS, you MUST test and expect she will come down during the cycle; when you get a +2 that is much lower than the PS, then you MUST test and be ready for a possibly very active cycle with early drops.
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So about shooting low numbers, for example I skipped on 156 on Sat morning, but you would teach me how to shoot on that number (which I can see now, is not that low, but anyway).

And when you say "you MUST test" if I shoot a number lower than I shot before, why do I have to get a +1 and +2? When you say I "must be ready for a very active cycle with early drops" if the +2 is similar to PS--does this mean she probably is going to go hypo?

I just gave her some more baby food, but she is not happy about all this testing. It's making her resent me.
 
Sienne and Gabby said:
I would never tell you to shoot numbers under 50. (There are some cats where this is possible but in general, even those of us who have been around for a while and shoot low would not shoot numbers in the 40s.)

I am, however, disagreeing with your vet. Most vets set "no shoot" numbers much higher than we do here. They do this for several reasons. Most of their clients do not home test. As a result, they can't manage the curve. Also, telling someone to shoot low is a liability for the vet. They are not around 24/7 and some vets are not even accessible any time after hours. We try to school you to shoot low numbers safely. If you look at the subject lines on the Board, you'll see that people are routinely shooting numbers that are lower than 150. For example, Tess' bean, Ann, shot a 68 at AMPS. Marje and I will shoot pretty much any number above 49.

I am indeed saying that skipping shots can result in swings in numbers. The duration for Lantus is typically around 12 hrs. (give or take). As the remnants of the cycle wear off, BG numbers will rise. Sometimes, they will even spike into high ranges. And then you shoot and numbers drop again. So you skip and numbers rise. If you look at Ella's SS around 4/24, she was skipping shots. It illustrates my point.

You have to take each day and each shot as it comes. On a day like tomorrow when you must leave, get a +11 and post if you are concerned about Ella's numbers.

Also, what is your shot time? It looks like you stalled your AM shot until 10:30 yesterday. You can adjust shot time by 15 min. at each shot or by 30 min. once a day. An early shot acts like a dose increase and a late shot acts like a dose reduction.
Click to expand...

So if she's lower than 50 I shouldn't shoot....but you said not to skip shots because it results in swings in numbers.
 
heidismom said:
So about shooting low numbers, for example I skipped on 156 on Sat morning, but you would teach me how to shoot on that number (which I can see now, is not that low, but anyway).

And when you say "you MUST test" if I shoot a number lower than I shot before, why do I have to get a +1 and +2? When you say I "must be ready for a very active cycle with early drops" if the +2 is similar to PS--does this mean she probably is going to go hypo?

I just gave her some more baby food, but she is not happy about all this testing. It's making her resent me.
Click to expand...

Yes....if you post, we can help you gradually learn to shoot lower (I also put this in your Health condo the other day).

If you look back again at the Health condo (and I know you can't remember all of what I told you or pasted in there but if you refer back to it, it has a lot of info) a +1 test tells you if you are getting a food spike....you should. A +2 test tells you if kitty is headed up into a bounce (it will be much higher than the PS test), if you can expect a normal lantus cycle (+2 will be similar to PS) which onsets at about +2 and then comes down towards mid-cycle, or if you need to really be on your toes (+2 is much lower than PS) and expect an early drop.

Personally, unless Gracie was in the 300 s and not budging, I look at every cycle with the eye on when to test to be sure she doesn't hypo. But as Sienne said, no matter how much data you have or think you know your cat, she will surprise you.

Example...on Thansgiving last year, Gracie was in the mid 200s and had not moved in BG for most of the day. I went to a friends house for dinner...I got an out the door test (mid 200s) and was gone a couple hours and got an in the door test of 192 at shot time. She was sitting with me in the two hours since shot time and was playing, purring, etc. I checked her at +2 and she was at 20. That is definitely a hypo number but thankfully she did not show a hypo. But I have no idea if there were any changes to her brain waves, temp, heart rate, etc.

I know you are worried about testing a lot. But if you can always get a +2, then that will help you know if you need to get other tests or just a mid cycle test. When she lets you test more, then an occasional spot check at +1 and at either +10 or +11 is helpful. And I would suggest this no matter which protocol you use.
 
Her reading just now was 78. I think that is her +11. It's all kind of approximate since shoot times got all discombobulated.

That is really something about Gracie. What a dramatic drop, to say the least. So you saw the low number but since she didn't have any outward symptoms, didn't need to give syrup?

I haven't looked at the Health condo for awhile, so I will check that out.

Thanks, Marje.

Corinne
 
Gracie got about 1 ml of karo! I don't want her below 40 for any time...that would be 70 on an AT.

Here are options for you tonight:

First, she needs to be higher to shoot. She is still below 80 and I would really like to see her come up

Option One: shoot .5u on time (12 hours from this morning); you must be prepared to monitor her at +1 and +2 and then as needs after that until you have two rising numbers. That means if she comes back down, you may have to test her every 30 mins and feed her to get her up.

Option Two: do not feed, stall, test every 20 mins, and wait for her to rise more. You shoot when she starts to come up. This, of course, puts you further behind. You will still be testing as in option one.

Option Three: shoot a reduced dose on time.....something like .25u. But you will still have to test her because the cycle can be the same as shooting the full dose on time.

Option Four: skip. This allows you to shoot the .5u dose tomorrow morning at whatever time you wish and you can get back on schedule. Her BG may shoot up and you may have to deal with wonky numbers for a cycle or two.

Normally dose reductions are done in increments of .25u for newly diagnosed cats but since her dose was actually 1u and you've shot temporary reduced doses, her new dose should be .5u bid for safety and so we can see where she is when she gets a consistent dose.
 
Marje, thanks for listing those options. I'll test her one more time before her nightly injection time, and if she is still around 80, I am not going to give her insulin. I can't stay up all night testing her and I also have to take into account,she is not happy getting her ear poked all the time. Also, skipping the dose will allow me to get back on track with the schedule. Not that I would do anything to hurt Heidi just to get back on track but right now it seems like it might be best if her numbers are the same at 10 p.m.

If I do skip the dose and her numbers get all wonky, would .5 unit twice daily still be the appropriate dose ? okay, editing because I just re-read your post and see that it would be her best dose

I have it in the back of my head that maybe reducing her prednisone has something to do with her numbers getting lower and possibly it's allowing her pancreas to recover. I know, two weeks of a reduction in pred doesn't seem like enough time for a recovery but who knows.

Take care, and thanks again,
Corinne
 
I think she is doing great and it could figure in.

I'm waiting up for your number and also to help another member so could you please post it in your subject line when you get it in case she has shot up?

Thank you!
 
Hi Marje,
She's up to 112 PMPS. You know, I think I am going to skip the shot. I'm glad her numbers have gone up a bit, but it seems most prudent to skip it, all things considered. ?
 
Sorry...I was testing.feeding Gracie.

It's your decision. It would definitely require you to stay on top of her tests tonight. If you choose not to shoot, you should shoot .5u in the morning.

Night!
 
No problem! You have to take care of your baby.

So whether or not I give her the shot, you think I would need to keep testing her all night?
 
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