6/11 Martin PMPS 67, + .5 90, +1 105, +2 136

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jakes

jakes

Member Since 2012
Hey everyone,

This is our first time dealing with a low pre-shot properly - previously we were just skipping his shot when he was low pre-shot (which I now understand was a bad idea). Martin's BG was at 59 at his normal pre-shot time, then 15 minutes later it was 55, then 15 minutes after that (right now) it's at 56. We're planning to just keep testing every 15 minutes until we see it going back up, then feed him and shoot, and then make sure to get a +1 and +2. Does that sound like a reasonable plan? How high should his BG get before feeding and shooting?

Thanks!
 
Re: 6/11 Martin PMPS 59

If you've not see Libby's post on dealing with low pre-shot numbers, it's a good read. You do have the basic idea down.

If you are considering shooting low, there are a couple of considerations:
  • Can you stay up to monitor?
  • You will need to get a +1 and a +2 (or maybe even earlier and more frequent tests) and then decide how frequently to test.
  • Do you have strips and high carb food on hand.
  • If you are stalling, can you afford to be off schedule? Your AM shot will be 12 hours from when you shoot tonight.

If the answer to any of the above is "no," then you need to reconsider your strategy.
 
Re: 6/11 Martin PMPS 59

Yes, we can stay up to monitor for the most part. We probably can't get a test every hour but we can get them pretty frequently.

We have lots of strips and high-carb food on hand in case he goes hypo.

We can afford to be off-schedule for a day as my wife will be home all day tomorrow. By Wednesday though we'll need to be mostly back to our normal routine due to work schedules. Speaking of, how should we move the timing of his shots back? Is it okay to do them a half hour early each time to get them back to his normal schedule?

He's not going up yet - I just tested again and he's at 46. I wonder how long it's going to take before he starts going up again.
 
Re: 6/11 Martin PMPS 59

If Martin dropped into the 40s, please give him a teaspoon or two of LC food.

You can move shots by 15 min. at each shot or by 30 min. once a day with minimal effect on the numbers. If Martin bounces, you could move the shot time by more. When you shoot early, it acts like a dose increase.
 
Re: 6/11 Martin PMPS 59

Alright, we just gave him 2 tsp. of his normal canned food and we'll continue checking his BG frequently. Thanks for the quick advice! I'll keep posting updates :smile:
 
Re: 6/11 Martin PMPS 59

Just a note to keep things less confused. Until you shoot, you don't have a PMPS. The 59 is your +12. You keep marking the time based on how long it's been from your AMPS until you shoot and whatever that last number is, it's your PMPS.

So, you have a 59 @ +12, a 55 @ +12.25, 56 @ +12.5 and I'm not sure what time the number in the 40s was.
 
Re: 6/11 Martin PMPS 59

Sienne and I are doing a little tag team tonight to keep you covered since I'm on the west coast and she has to work tomorrow.

Can you please let me know the next number? We need to be careful of you shooting a food spike so depending on what the number is and How long you can continue to stall. Please just post the number in your subject line as Sienne illustrated. Thanks!
 
Re: 6/11 Martin PMPS 59

Thanks - here's where we're at now:

+12 - 59
+12.25 - 55
+12.5ish - 56
+13ish - 46, fed 2 tsp. of his normal canned food
+13.25 - 49
+13.5 - 55
 
Re: 6/11 Martin PMPS 59

So you are now 1.5 hours late. How much longer can you stall? If at all possible, I'd like to see him just a bit higher but that would put you stalling for another 30 minutes. You won't be back on time by Wednesday unless he bounces ....if he bounces, you can shoot an hour early.
 
Re: 6/11 Martin PMPS 59

We can stall another 30 minutes at the most and we'll still be able to make things work on Wednesday.

This does bring up a question though - what do we do if something like this happens when we don't have time to stall? I guess our options are either shoot and hope he's okay without being able to monitor him, skip the shot, or shoot a reduced dose. None of those seem like very good options.
 
Re: 6/11 Martin PMPS 59

They are not as good an option as shooting but sometimes, life interferes with your good intentions. (Then again, I've had a "migraine" and gone in late to work.)
 
Re: 6/11 Martin PMPS 59

I would never suggest that you shoot a low number without monitoring. Likewise, shooting a reduced dose without monitoring is also not safe.

Lantus, unlike PZI, has an insulin depot. Each shot builds upon the previous one and you get a cumulative effect. So when you shoot a reduced dose or you stall, you still have to monitor because the cycle will likely play out the same way no matter what you did. You would see an effect in a later cycle.

If he is low and you cannot monitor, you would need to skip. You'd still need to test to make sure he was coming up before you left but he can't hypo with no insulin on board.

Please let me know if you have other questions. I'll be waitigng for your next test. You will need to get a +1 and +2 to start with....depending on his number, I may also ask you to get a +.5.

And he's not had any other food since +13 right?
 
Re: 6/11 Martin PMPS 59

Thanks for the guidance :smile:

Correct - the only food was at +13. I just tested again (I guess this would be about +13.75) and he's at 67, so slightly on his way back up. Should we feed him and shoot now that he seems to be going back up?
 
Re: 6/11 Martin PMPS 59

Yes....shoooooooooottttt! Give him his .5u and feed.

Let's get a +.5 to start just to make sure he's continuing up. Nsee you in 30.
 
Re: 6/11 Martin PMPS 59

Alright, just fed him and shot, I'll post a +.5 in a half hour. Thanks!
 
Re: 6/11 Martin PMPS 59

You're welcome. Could you update your subject line to PMPS 67 please?

I'm also curious about his dosing. For newly diagnosed cats, we would do increases and decreases by .25u (unless kitty has nadirs over 300...then we increase by .5u). Dosing is not done on the PS like PZI.

Also, Martin earned a reduction by dropping under 50. If he bounces, you can shoot through the bounce once with the .5u but then you would need to reduce his dose the next cycle.
 
Re: 6/11 Martin PMPS 59

Marjorie and Gracie said:
Also, Martin earned a reduction by dropping under 50. If he bounces, you can shoot through the bounce once with the .5u but then you would need to reduce his dose the next cycle.
Click to expand...
Do you mean we should reduce his dose to 0.25u? That just seems like a really significant reduction - it's 50% less insulin than he's getting now.
 
Re: 6/11 Martin PMPS 67

He earned a reduction, yes, but I think you should shave his dose.

My reference before was because you reduced him to .4u when he hadn't gone low enough to earn a reduction and then raised by .1.

Let me study his SS and see if we want to try .1 or a bit more. He was pretty low tonight. You have to be sure to reduce enough to keep the depot from getting overly full or you could be stuck with battling low numbers over an extended time.

Brb.
 
Re: 6/11 Martin PMPS 67

Alright, his +.5 BG is 90, so he is on his way back up. I'll get a +1 and +2 as well.
 
Re: 6/11 Martin PMPS 67

Thank you. I'll be here for the +1. I think he' ll likely bounce. I'm still looking at his SS and it's a busy night tonight :-D
 
Re: 6/11 Martin PMPS 67

Yes it is :smile: His +1 was 105 - I'll post again in an hour with the +2.
 
Re: 6/11 Martin PMPS 67

I've been looking at his SS. His is a little unusual.....he's bouncing way up from high numbers but he's also going fairly low.

If we just shave .1 off and his depot is full, you could be faced with another reduction too soon. If we take him to a dose In between .25 and .5, he might have to go back up at some point.

In order to be safe and considering your schedules, I'd suggest shooting w dose that is halfway between .25 and .5. You can call it a sk.5u or f.25u but you should be consistent on the dosing. You can draw up some colored water or milk in a sample syringe to refer back to.

How does that sound?
 
Re: 6/11 Martin PMPS 67

Yeah, he's a very unusual cat - we've had a difficult time trying to get him regulated. I'll talk to my wife about adjusting his dose a little bit. Do you have any tips on how to draw up that smaller dose? Halfway in between is 0.375u, but it seems like it's going to be nearly impossible to distinguish that from 0.4u or even 0.3u.
 
Re: 6/11 Martin PMPS 67

It's tough.....I started using digital calipers to get the most accurate dose on small doses like that. Syringes are notoriously inaccurate. Are you using syringes with half unit markings?
 
Re: 6/11 Martin PMPS 67

Could you please update your subject line with the subsequent numbers? PMPS 67 + .5 90 +1 105

If you scroll down on the link, you'll see some syringes and info on micro dosing that might help: microdosing

When was the last time you fed and was it low carb?
 
Well his +2 was 136 so he's still going up - that seems to be a good sign.

Yes, we're using syringes with half-unit markings. I looked at the microdosing pictures and those are helpful, but it's still going to be really difficult to get a consistent 0.375u. I'll look into the digital calipers too.

The last time we fed was right before his shot tonight. We only feed twice a day, always right before we shoot. We feed him the same food every time - it's Friskies Liver and Chicken Dinner Classic Pate, and we feed a 1/2 can in the morning and a 1/2 can at night.
 
Ok. I think it would be a good idea if you set an alarm and got up for one more test in two hours to be sure he's still headed up.

Tomorrow morning, if he's high (above 300) at +11, you can shoot an hour early. But since he's pretty new on lantus, I would not also shoot through the bounce. After I looked at his SS, there just isnt enough data yet to do that. You could choose to shoot through the bounce with .5u if you don't want to shoot early. But I think shooting early will help you more.

If you need help in the morning, Dyana should be on early.

I'm going to head to bed since he's probably going to keep going up. Any questions before I do?
 
Not sure if I lost you to sleep but I'll assume everything is ok.if you get up and need help, just post it in the subject line. There is usually someone on most of the time. Dyana is usually on by 4 or 5 EDT.

Good job tonight. Hope you get some rest.
 
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