8/5 Emma AMPS 124, +1 115 (bit confused?)

Manuel

Manuel

Member Since 2022
https://felinediabetes.com/FDMB/threads/8-1-emma-amps-299-failed-reduction.266556/

Hi! Emma came in at 124 this morning, though I wonder whether that could be an error on my part. I got her either on the vein or so-called sweet spot and a lot more blood came out than usual (!), so I got the sample from my nail/hand. Does that affect the reading?

In any case, I'm a bit confused, because last night PMPS was 248 and +5 was 270. Numbers have been in the 200 range generally for the last week, but 4 days ago I started introducing some wet food accounting for about 35% of her daily calories. She seems to be tolerating it well (no vomit), which I take to be a very good thing.

What might explain the lower starting number this time? She was starving, so I gave her about half her meal and will give the rest in a bit. With stalling, do I wait 30 minute, test and shoot? I recall reading different things, though I know ideally I wouldn't have fed her. Thanks for any thoughts or advice.

I tested at +1 and I see she's still falling somewhat, even though I didn't give her any insulin. I guess it could be within margin of error. I will skip the morning shot today and give the remainder of the food at +2.
 
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Manuel said:
https://felinediabetes.com/FDMB/threads/8-1-emma-amps-299-failed-reduction.266556/

Hi! Emma came in at 124 this morning, though I wonder whether that could be an error on my part. I got her either on the vein or so-called sweet spot and a lot more blood came out than usual (!), so I got the sample from my nail/hand. Does that affect the reading?

In any case, I'm a bit confused, because last night PMPS was 248 and +5 was 270. Numbers have been in the 200 range generally for the last week, but 4 days ago I started introducing some wet food accounting for about 35% of her daily calories. She seems to be tolerating it well (no vomit), which I take to be a very good thing.

What might explain the lower starting number this time? She was starving, so I gave her about half her meal and will give the rest in a bit. With stalling, do I wait 30 minute, test and shoot? I recall reading different things, though I know ideally I wouldn't have fed her. Thanks for any thoughts or advice.

I tested at +1 and I see she's still falling somewhat, even though I didn't give her any insulin. I guess it could be within margin of error. I will skip the morning shot today and give the remainder of the food at +2.
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Good job at getting those night time tests in keep it up
Sorry no one saw this, but I'm glad you skipped.
About stalling , if Emma's BG is too low to shoot , don't feed as you know , then test in 30 minutes to see if it went up
I'm going to tag more experienced members than me to give you a no shoot number for now
@tiffmaxee

@Wendy&Neko

@Suzanne & Darcy
 
Good job getting that extra night test. It’s showing just what I thought. Your nadir was in the range you want. So you will stick with the current dose. Drawing up the insulin from your finger is just fine unless you get an error message on your machine. I did that more than once so as not to have to poke a second time.

When you stall sometimes the bg continues to come down. Next time stall without feeding, test again in 20-30 and post saying safe to shoot, AMBG ### or PMBG### in the subject box. I was in bed so just seeing now. I’m on the west coast. Skipping was smart.

You have choices as to what to do depending on if the bg stays the same, goes up, or goes down. It’s all in the SLGS sticky. It depends on whether you can monitor. Right now if under 150 skip which you did. You will gradually be able to lower that no shot number as you have data until you shoot 90+.

If 150-200 give nothing, give a token dose of 10-25% of the usual dose or feed and wait 2 hours to decide if you want to shoot them. Waiting two hours makes it hard to get back to your shot time though.

Personal experience will be your guide. Looking at your ss I would suggest stalling for 20-30 if the bg is 160 to see if it goes up or doesn’t come down. Unless it drops I would shoot a full dose with that bg. Over 160 don’t stall and shoot a full dose. Under 160 but rising depending on whether you can monitor a token dose or skip.

Hopefully I haven’t confused you. Always post for advice while you stall until you know how she responds.
 
Thank you, Diane and Elise. My takeaways:
1. if relatively low number, don't feed, then test 20-30 min after. Post thread titled "SAFE TO SHOOT, AMBG ___".
2. the no-shot number can decrease over time, based on data. Wendy helpfully previously recommended a no-shoot from 170 onwards, but that was before I started giving some wet food. For now I'll shoot >160, and stall at 160 to see if it climbs or dips, as per your suggestion.

I still don't understand why the morning pre-shot is lower, when at +5 after PMPS it was decently high. Emma is typically quite predictable, but I guess maybe the introduction of some wet food is playing with things a bit. Anyway, I'm just glad to see blues again. :)
 
tiffmaxee said:
You have it right. Cats often have lower bg at night. The +5 was not her nadir. She could have hit that at +6-9 or kept heading down all night. When is her last snack?
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Thank you. I haven't done night-time curves, but typically her day-time nadirs are early rather than later. Most of what I've noticed is that Emma tends to start in mid-200s pre-shot, dip down fairly fast to a nadir at +2 to +4, then rise steadily but slowly up. The same was true of the curves the vet did. Now that I am giving insulin earlier at night I can test here and there later on, too, to see if maybe the nadir is later at night.

I have been giving a snack at +2, because of that earlier nadir. I think it works fine for now. I tried splitting it up into two main meals a day with two snacks each, but I found her food-anxious (which really isn't great given her past history of food anxiety and vomiting). So I do about 80% at shot time, and 20% at a snack +2. Maybe for the night cycle I could give her the snack later?
 
If possible I would feed another snack around +4-5. The general rule of thumb is if the +2 is lower than the amps/pmps it might be an active cycle. If that earlier than your bedtime when that happens grab a before bed test if it’s +4 that’s great. Cats often are lower at night.
 
tiffmaxee said:
If possible I would feed another snack around +4-5. The general rule of thumb is if the +2 is lower than the amps/pmps it might be an active cycle. If that earlier than your bedtime when that happens grab a before bed test if it’s +4 that’s great. Cats often are lower at night.
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Only twice has Emma ever been higher at +2 than at PS, and even then that was on the same day, and by a very small margin.

I'll test at +4 for a few nights before adding a second snack. She really does hate not feeling full after a meal... maybe the solution is to have a snack at +2 in the morning cycle and at +4 in the evening cycle. But first, some data. :)
 
Nadir usually moves around in unregulated cats so its too early to tell that she is always nadiring early in the cycle. When you do your weekly curve and you suspect an early nadir, maybe it is worth testing +1 as well, she had a huuuge drop from AM preshot to +2 on the 28th of July.

most of us here feed more smaller snacks thru the day, most make the preshot meals bigger than the rest. The reason for feeding more smaller meals is because it is easier on the pancreas but as well because it helps feeding the curve, i will give you some reading on the topic here. We found keeping an identical feeding schedule in the AM cycle and PM cycle (when possible) helpful, because it removes at least one unknown from the equation when we analyze his values.

Introducing wet food can definitely help with lowering BG, sometimes it makes such a huge difference that it is recommended to switch gradually from dry to wet, which you are doing already.

The PM cycle on 4th of August could have been a bounce which cleared by the end of the cycle and gave you that lower AM preshot on the 5th but it is hard to tell for sure, a +2 would have helped to understand.

you are doing great work in managing Emma’s FD :bighug:
 
Marina & Chico said:
Nadir usually moves around in unregulated cats so its too early to tell that she is always nadiring early in the cycle. When you do your weekly curve and you suspect an early nadir, maybe it is worth testing +1 as well, she had a huuuge drop from AM preshot to +2 on the 28th of July.

most of us here feed more smaller snacks thru the day, most make the preshot meals bigger than the rest. The reason for feeding more smaller meals is because it is easier on the pancreas but as well because it helps feeding the curve, i will give you some reading on the topic here. We found keeping an identical feeding schedule in the AM cycle and PM cycle (when possible) helpful, because it removes at least one unknown from the equation when we analyze his values.

Introducing wet food can definitely help with lowering BG, sometimes it makes such a huge difference that it is recommended to switch gradually from dry to wet, which you are doing already.

The PM cycle on 4th of August could have been a bounce which cleared by the end of the cycle and gave you that lower AM preshot on the 5th but it is hard to tell for sure, a +2 would have helped to understand.

you are doing great work in managing Emma’s FD :bighug:
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Thank you - lots of great insights here. I had read the post you linked to but of course it reads differently having changed up her food a little bit. Towards the end of the post they quote someone who does keep AM and PM snacks slightly different; at the same time, I can understand why consistency is important... a lot to think about! Mostly I think I'll try to learn more about PM curves and run a proper curve in the coming days when I think the introduction of wet food has stabilized a bit. I'm just relieved she's keeping the food down since I think wet food will go a long way towards helping her get regulated. Thanks again.
 
Manuel said:
I had read the post you linked to but of course it reads differently having changed up her food a little bit. Towards the end of the post they quote someone who does keep AM and PM snacks slightly different; at the same time
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There are cycles when you need to stir and cycles when you don’t. When it is needed to stir we move some grams of food to different hours or add honey to the planned meals (we feed raw and honey is our HC). When no stirring is required the normal feeding schedule is kept.
Now to keep the identical planned feeding schedule in the AM and PM cycles was our decision (im sure it was inspired by someone on the forum, i just can’t recall who exactly) and as i mentioned, the reason is to have one less variable when analyzing the data. I am sure there is nothing wrong in feeding differently if that would be your preference but you will have to consider it when comparing 2 cycles plus to be honest i think it would drive us crazy to have to be constantly aware about another thing when syringe preparing, testing, feeding routine:rolleyes:
 
Thank you all!

I'm still figuring out how to do feeding + snacks in a way that will be healthy for Emma and sustainable for us in the longterm. We have an automatic feeder, which means it's not hard to give small bits of hydrolyzed protein dry food during the day. In the end we might do wet food for the majority of calories with the HP dry food as snacks during day when we're gone. But it's all going to take a bit of experimentation, and I appreciate all your advice and experience.
 
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