9/16 Jack PMPS 147 check-in

[Nicole and Jack]

Hello all,

This is Jack’s previous thread, including a link to his first thread on his BG levels: https://felinediabetes.com/FDMB/threads/9-4-jack-amps-523-6-489.267984/#post-2996582

Jack’s BG is coming down to reasonable levels finally. This creates new questions as to how low is too low and how to maintain his lower levels. The instructions from his vet stated that if his pre-shot BG is below 150 to give him a half dose, but that seems to conflict with the SLGS guidance. I’d love some guidance on where to go from here.

His current spreadsheet is here and below:

https://docs.google.com/spreadsheets/d/1v_aftjqVYSgM-Qn0nfFRshmKkSC-KGJBV_JsfgvKKWo/edit?usp=sharing

 

[Diane Tyler's Mom GA]

Hello all,

This is Jack’s previous thread, including a link to his first thread on his BG levels: https://felinediabetes.com/FDMB/threads/9-4-jack-amps-523-6-489.267984/#post-2996582

Jack’s BG is coming down to reasonable levels finally. This creates new questions as to how low is too low and how to maintain his lower levels. The instructions from his vet stated that if his pre-shot BG is below 150 to give him a half dose, but that seems to conflict with the SLGS guidance. I’d love some guidance on where to go from here.

His current spreadsheet is here and below:

https://docs.google.com/spreadsheets/d/1v_aftjqVYSgM-Qn0nfFRshmKkSC-KGJBV_JsfgvKKWo/edit?usp=sharing

@Bandit's Mom

@Bron and Sheba (GA)
Can you take a look at her SS please when it comes to the doses she has been shooting
Thanks ladies

 

[Bron and Sheba (GA)]

You are chopping and changing the dose a bit which is not a good idea as it messes with the depot.
To follow SLGS (which is a good idea and much better than the suggestion of the vet to give a half dose if under 150 in my opinion), you need to stay with the same dose for 7 days, unless Jack drops under 90, in which case you reduce the dose by 0.25 units.
If you get a preshot lower than normal, stall, don't feed and test again in 20 minutes to see if the BG is rising. and post and ask for help.
From the sticky SLGS on what to do if you get a lower than normal preshot:

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

I'm not sure why you gave 1.25 units this evening with a preshot of 147 when you gave 2.5 units with a preshot of 151 two days before. You have got some data now showing how he responds to the doses so you can start lowering the preshot BG gradually from 150.
Your new dose should be 2.5 units after Jack dropped to 87 yesterday. I know you only gave a smaller dose that cycle but that was influenced by the previous doses of 2.75 units.
Does that make sense?

 

[Nicole and Jack]

Thank you! Your post was very helpful. I think I was confusing myself with the instructions from the vet and advice from the board. And this clarifies things for me. I will keep on with 2.5U.

You are chopping and changing the dose a bit which is not a good idea as it messes with the depot.
To follow SLGS (which is a good idea and much better than the suggestion of the vet to give a half dose if under 150 in my opinion), you need to stay with the same dose for 7 days, unless Jack drops under 90, in which case you reduce the dose by 0.25 units.
If you get a preshot lower than normal, stall, don't feed and test again in 20 minutes to see if the BG is rising. and post and ask for help.
From the sticky SLGS on what to do if you get a lower than normal preshot:

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.
• Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
  • a.) give nothing
  • b.) give a token dose (10-25% of the usual dose)
  • c.) feed as usual, test in a couple of hours, and make a decision based on that value
• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

I'm not sure why you gave 1.25 units this evening with a preshot of 147 when you gave 2.5 units with a preshot of 151 two days before. You have got some data now showing how he responds to the doses so you can start lowering the preshot BG gradually from 150.
Your new dose should be 2.5 units after Jack dropped to 87 yesterday. I know you only gave a smaller dose that cycle but that was influenced by the previous doses of 2.75 units.
Does that make sense?