? 9/7 Smudge PMPS 139 Need Guidance

allicatmeow

allicatmeow

Member Since 2023
455 @ AMPS.
Another high morning.

Yesterday: https://www.felinediabetes.com/FDMB...-386-3-279-6-492-9-386-pmps-453-2-377.281258/

JL and Chip said:
Yes. Sometimes we want results right now and it’s hard to be patient. High numbers stress us out, we want to do something immediately to “fix” it, but it’s important to remind ourselves that being steady and methodical is best. Even after being around all these years, I still had to remind myself of that at times.

You’re doing great. You’re catching on fast, not being impulsive, and seem to have a realistic grasp on what you can handle. As for how overwhelming this all seems at first … yes, it’s a lot. But it gets easier. Wendy’s suggestion to look at other newbie spreadsheets and questions really does help establish expectations about what is “normal” in the trajectory of treatment.

I often liken learning the ropes of FD to a Polaroid photo (if you’re old enough to know what they are, lol) — everything is unfamiliar and gray at first with no clarity or perspective, then slowly rough outlines begin to appear, and finally the image becomes clear and suddenly makes sense. Someday you’ll look back at these early days and think “wow, that was a heckuva ride” but you will understand exactly how far you’ve both come and, hopefully, smile at it. :)
Click to expand...

Thank you for this encouragement, @JL and Chip. I am a "fixer" by nature and not being able to fix those high numbers really does eat at me. I question my moves, like the 2U, now that his numbers are high again. I worry myself sick sometimes, but trying to stay calm and methodical as best I can. I worry the vet will see high numbers tomorrow and want him bumped way back up.

And yes, I'm old enough to know Polaroids! They're a staple of my 80s childhood. I really am still waiting for those rough outlines, aren't I?
 
You’re doing great with Smudge, Alli. He’s adorable and is so lucky to have found you! Sending big hugs and hope have a great day. :bighug::bighug::bighug:
 
allicatmeow said:
Thank you Stacy! I see in your signature you use(d) the Freestyle Libre, how did you like it?
Click to expand...
I still use the Libre 3 and like it very much.
What I like is that I can see 24/7 on my phone app what’s happening. If Ivy is going low, then I know I have to test her with an ear prick.
Ivy is very combative so I have to limit the air pricks and this is a tool for me to use to know when I must.
While the Libre reads lower than the handheld meters. It gives me a guide as to what’s happening and then I can take action.

I’ve learned to attach the sensor myself (pretty easy with practice) so no need to go to the vet (plus she’s awful at the vet and I have to sedate her, etc).
 
Staci & Ivy said:
I still use the Libre 3 and like it very much.
What I like is that I can see 24/7 on my phone app what’s happening. If Ivy is going low, then I know I have to test her with an ear prick.
Ivy is very combative so I have to limit the air pricks and this is a tool for me to use to know when I must.
While the Libre reads lower than the handheld meters. It gives me a guide as to what’s happening and then I can take action.

I’ve learned to attach the sensor myself (pretty easy with practice) so no need to go to the vet (plus she’s awful at the vet and I have to sedate her, etc).
Click to expand...
Thank you! I am considering it during Smudge's regulation, so I have a constant view like you said, and also so I don't have to prick him so much. The downside that I see is the cost, the sensors are so expensive. Two of my very close friends are vet techs and one of them applies them regularly at her clinic, so she said she would be able to apply it for me with no issue anytime I wanted. Do you find that the sensors are lasting the full 14 days?
 
allicatmeow said:
Thank you! I am considering it during Smudge's regulation, so I have a constant view like you said, and also so I don't have to prick him so much. The downside that I see is the cost, the sensors are so expensive. Two of my very close friends are vet techs and one of them applies them regularly at her clinic, so she said she would be able to apply it for me with no issue anytime I wanted. Do you find that the sensors are lasting the full 14 days?
Click to expand...
I am paying only $62.47 for 2 (so $31.25 each).
You need a prescription from your vet. I get it at a local pharmacy inside my grocery store, Wegman’s, I’m in Pennsylvania). I don’t think that’s expensive at all. They use the best discount they find and keep on file for my refills)
They are expensive if the vet office sells to you and installs it. So if you have a friend who can do it for you, that would be perfect and even better if you can learn to do it yourself.
There’s a Facebook group (Freestyle Libre for Dogs and Cats) with tons of tutorial information that you should take a look at.
I found it very helpful, and I studied videos etc.
I’m happy to answer any and all questions if I can be of any help to you.
I never thought I would be able to install it on Ivy because she’s so feisty, but she’s actually really well behaved because I only do it approximately every two weeks.

Yes, I do find they generally last 14 days but be sure to follow all instructions from the tutorials. And I have a tank top on Ivy. She pulled 1 right off when I tried to Allie her no top. Learned my lesson!
Sometimes they don’t and that’s why I always make sure I have extras on hand and I have had to install them in the middle of the night when one failed.
(Never fun but it happens), so be prepared.

The manufacture will also send you a replacement for free if you submit a claim online or you can just call them.
***You just never tell them it’s for a pet you tell them it’s for you. Usually they want the one that failed to be mailed back and they sent you a box with prepaid shipping to do that.

Hope this helps. Ask any questions!
 
both paws crossed that you see some downward movement in his numbers soon.

One thing about TR is you increase more aggressively. I personally believe Smudge needs this approach, but that's just my layperson's opinion and since TR did wonders for Hendrick I have bias.

Just have to point out that technically, you are doing enough testing for TR. TR requires a minimum of 4 tests a day: AMPS, PMPS, and at least one other test during each cycle.

Sure, you're not staying up all hours and testing late at night much but that is not technically required. Also, I am fairly certain that you could switch to TR, aggressively increase for a little while and then back off and go back to SLGS if you so choose.
 
Last edited:
I personally do not like the Libre. It gives false lows and the data is not at the moment actuality but instead 40 minutes after. If testing enough and able to an eat prick is far more accurate. In fact when a low BG shows up on a Libre we suggest an ear prick for verification. I posted a recent stacks on the Libre on the main/health forum.

https://felinediabetes.com/FDMB/threads/continuous-glucose-monitoring-article.281245/
 
Staci & Ivy said:
I am paying only $62.47 for 2 (so $31.25 each).
You need a prescription from your vet. I get it at a local pharmacy inside my grocery store, Wegman’s, I’m in Pennsylvania). I don’t think that’s expensive at all. They use the best discount they find and keep on file for my refills)
They are expensive if the vet office sells to you and installs it. So if you have a friend who can do it for you, that would be perfect and even better if you can learn to do it yourself.
There’s a Facebook group (Freestyle Libre for Dogs and Cats) with tons of tutorial information that you should take a look at.
I found it very helpful, and I studied videos etc.
I’m happy to answer any and all questions if I can be of any help to you.
I never thought I would be able to install it on Ivy because she’s so feisty, but she’s actually really well behaved because I only do it approximately every two weeks.

Yes, I do find they generally last 14 days but be sure to follow all instructions from the tutorials. And I have a tank top on Ivy. She pulled 1 right off when I tried to Allie her no top. Learned my lesson!
Sometimes they don’t and that’s why I always make sure I have extras on hand and I have had to install them in the middle of the night when one failed.
(Never fun but it happens), so be prepared.

The manufacture will also send you a replacement for free if you submit a claim online or you can just call them.
***You just never tell them it’s for a pet you tell them it’s for you. Usually they want the one that failed to be mailed back and they sent you a box with prepaid shipping to do that.

Hope this helps. Ask any questions!
Click to expand...
This is a great help from personal experience, thank you!!

tiffmaxee said:
I personally do not like the Libre. It gives false lows and the data is not at the moment actuality but instead 40 minutes after. If testing enough and able to an eat prick is far more accurate. In fact when a low BG shows up on a Libre we suggest an ear prick for verification. I posted a recent stacks on the Libre on the main/health forum.

https://felinediabetes.com/FDMB/threads/continuous-glucose-monitoring-article.281245/
Click to expand...
Thank you Tiff, I am going to read through this today.

Hendrick Cuddleclaw said:
both paws crossed that you see some downward movement in his numbers soon.

One thing about TR is you increase more aggressively. I personally believe Smudge needs this approach, but that's just my layperson's opinion and since TR did wonders for Hendrick I have bias.

Just have to point out that technically, you are doing enough testing for TR. TR requires a minimum of 4 tests a day: AMPS, PMPS, and at least one other test during each cycle.

Sure, you're not staying up all hours and testing late at night much but that is not technically required. Also, I am fairly certain that you could switch to TR, aggressively increase for a little while and then back off and go back to SLGS if you so choose.
Click to expand...
We have downward movement!!! 170 @ +4! I wasn't going to test til +6, because as you said, 4 a day is sufficient for TR (I just assumed more was needed with the way people's spreadsheets look, despite what I've read), but I am glad I did! I will test again at +6 for nadir, because that is quite a drop.

Smudge is trying out his new auto feeder in his room today (easy to move to my office if need be). It has ice packs and rotates 6 meals, to better portion him throughout the day. Full meals at AMPS/PMPS, then small portions 4 other times throughout the day and night. He took to it right away this morning and I'm about to go see him witness the first beep and spin of the feeder.
 
yay some blues for Smudge!

Now, don't get me wrong, 4 tests a day is the absolute bare bottom-of-the-barrel minimum for TR and more is absolutely 100% better. The more tests you can get at different times of the day the more data you have and the more clear the picture becomes!

I just wanted you to understand that your usual lack of late-night testing does not technically eliminate TR as an option. Also, regarding the nadir -- it can move around. And I don't feel as if we really know where Smudge's nadir typically falls just yet. It might be at +4.
 
Glad you got the +4. All data is valuable, but especially in the early days when you’re still learning how insulin works in your cat (because the ECID, “every cat is different,” mantra is so true). Nadir isn’t always at +6 — so I always tested more as well. Soon you’ll likely start seeing patterns. I did sometimes get surprises.
 
Hendrick Cuddleclaw said:
yay some blues for Smudge!

Now, don't get me wrong, 4 tests a day is the absolute bare bottom-of-the-barrel minimum for TR and more is absolutely 100% better. The more tests you can get at different times of the day the more data you have and the more clear the picture becomes!

I just wanted you to understand that your usual lack of late-night testing does not technically eliminate TR as an option. Also, regarding the nadir -- it can move around. And I don't feel as if we really know where Smudge's nadir typically falls just yet. It might be at +4.
Click to expand...
I understand. I assumed because I couldn't test more frequently at night that it may not qualify him for TR. I will always do my best to get a "before bed" reading after his PMPS, whether that's +2, +3, +4, etc.

Yay blue!! Go Smudge go!
 
allicatmeow said:
I understand. I assumed because I couldn't test more frequently at night that it may not qualify him for TR. I will always do my best to get a "before bed" reading after his PMPS, whether that's +2, +3, +4, etc.
Click to expand...
Just do what you’re comfortable with for now and don’t feel pressured. Some cats settle into a dose slower than others, some cats bounce a lot, some cats go lower at night. It’s all about gathering data. You’re doing great. :)
 
124 @ +6

JL and Chip said:
Just do what you’re comfortable with for now and don’t feel pressured. Some cats settle into a dose slower than others, some cats bounce a lot, some cats go lower at night. It’s all about gathering data. You’re doing great. :)
Click to expand...
Thank you. I am going to try to stick to 4-a-days, for my sanity and his ears. Unless I see something wonky or high/low of course.
 
allicatmeow said:
I am going to try to stick to 4-a-days, for my sanity and his ears.
Click to expand...
The trick is to find the lowest number of the cycle. Until you start seeing patterns, I’d do as much testing as possible. I was probably a testaholic at first but dosing is based on the lows so it became a bit of a “game” to find them.
 
That 124 is nice. :)
Still using an AT, correct?
I hate to suggest it when you want to test less, but it might be useful to know if he’s going to go lower and where he “turns the corner” and heads back up again this cycle. With going from 400s to 100s, you might very likely see a bounce in the ensuing cycle(a) so now might be a good opportunity for data gathering…
 
JL and Chip said:
That 124 is nice. :)
Still using an AT, correct?
I hate to suggest it when you want to test less, but it might be useful to know if he’s going to go lower and where he “turns the corner” and heads back up again this cycle. With going from 400s to 100s, you might very likely see a bounce in the ensuing cycle(a) so now might be a good opportunity for data gathering…
Click to expand...
Yes, still using the AT3. He goes to the vet at his +7 tomorrow, where I plan to inform them I'm switching to the ReliOn.

I can do tests every couple hours today if need be, so at +8, +10, PMPS, +2. He's been quite tolerant today because I've given him more exploration time than usual between tests.

This frequency in testing is another reason for the ReliOn switch, $1/strip hurts. My vet understood when we discussed it previously, so shouldn't get pushback.
 
I'm recalling maybe Wendy mentioning that bounce-breaking cycles can have extra downward momentum. Perhaps that is what we're seeing. This can, iirc, also create a later nadir.
 
Hendrick Cuddleclaw said:
I'm recalling maybe Wendy mentioning that bounce-breaking cycles can have extra downward momentum. Perhaps that is what we're seeing. This can, iirc, also create a later nadir.
Click to expand...
I would definitely consider yesterday a bounce with those high numbers. I don't think he ever even saw 492 while in hospital (still waiting for that transcription).
 
That 91 is brushing the reduction point (90) for an AT, whether you’re SLGS or TR.

This is a great example of why testing is so important. You now know Smudge is capable of significant BG swings. You also know you don’t want to rush into an increase too quickly. And you see how bounces occur and break, and that you need to draw a “box” around several days’ worth of data and interpret it as whole rather than just looking at one single cycle.

I’m really glad Smudge decided to show some movement BEFORE you talk to the vet tomorrow! :)

If you do consider shooting a lowish PM number at some point, you might need to be prepared to stay up that night to monitor. There’s a Sticky at the top of this board that discusses being data ready to shoot low. You might want to peruse it at some point.

Hooray for good numbers today. And for what it’s worth, 91 on an AT is firmly in “normal range” (I actually think green should go up to 120 for AT spreadsheets, but that’s a minor detail). So definitely not looking at an increase, but brace yourself for some possible higher numbers if today triggers a bounce (bounces aren’t just from going low, but also from large shifts in BG as well as lower numbers than their body is used to).
 
JL and Chip said:
That 91 is brushing the reduction point (90) for an AT, whether you’re SLGS or TR.

This is a great example of why testing is so important. You now know Smudge is capable of significant BG swings. You also know you don’t want to rush into an increase too quickly. And you see how bounces occur and break, and that you need to draw a “box” around several days’ worth of data and interpret it as whole rather than just looking at one single cycle.

I’m really glad Smudge decided to show some movement BEFORE you talk to the vet tomorrow! :)

If you do consider shooting a lowish PM number at some point, you might need to be prepared to stay up that night to monitor. There’s a Sticky at the top of this board that discusses being data ready to shoot low. You might want to peruse it at some point.

Hooray for good numbers today. And for what it’s worth, 91 on an AT is firmly in “normal range” (I actually think green should go up to 120 for AT spreadsheets, but that’s a minor detail). So definitely not looking at an increase, but brace yourself for some possible higher numbers if today triggers a bounce (bounces aren’t just from going low, but also from large shifts in BG as well as lower numbers than their body is used to).
Click to expand...
I've honestly read that sticky 10 times now and I'm more confused than ever. When you say, "If you do consider shooting a lowish PM number", does this mean I will get some guidance/opinions here on shooting less units because of a low PMPS? Instead of his 2.25? It's very confusing to me how to determine this, when a vet tells you to stay the course unless numbers are in the lime.
 
Yep, just post for guidance.
We all learn to “shoot low to stay low” but the first few times it can be nerve wracking and important to monitor and track what happens.

Edited to add: sorry, that didn’t totally answer your question. Usually stall without feeding and then retest to see if number is rising. Sometimes you end up shooting a full dose and monitoring, other times shoot reduced dose, other times skip. Depends on situation. (I’m walking out door so sorry for rushed response)
 
To elaborate on the "stall without feeding" because people said this a lot when I was new but I did not know what it meant.

It means, if you take a PS reading, whether AMPS or PMPS, and it is a lot lower than you have seen before AND you don't yet have much data yet to go by, it is recommended that you stall. To stall is to not shoot, also don't feed, even if it is your regular shot time.

So instead of your regular routine of shooting and feeding, you wait 20 minutes or so and test again to see if the number is rising.

Again this is usually for people who don't have a ton of data on the SS yet because your cat is recently diagnosed. Once people have more data and have an idea of how the insulin is working, most people feel a lot more confident shooting a full dose even if the AMPS or PMPS is a lot lower than they usually see.


For example, I once shot a full 2.5U into Hendrick when his PMPS was a green 74 on a human meter. Honestly I was terrified but he stayed flat and had a great cycle, stayed in the greens the ENTIRE CYCLE.
 
Hendrick Cuddleclaw said:
To elaborate on the "stall without feeding" because people said this a lot when I was new but I did not know what it meant.

It means, if you take a PS reading, whether AMPS or PMPS, and it is a lot lower than you have seen before AND you don't yet have much data yet to go by, it is recommended that you stall. To stall is to not shoot, also don't feed, even if it is your regular shot time.

So instead of your regular routine of shooting and feeding, you wait 20 minutes or so and test again to see if the number is rising.

Again this is usually for people who don't have a ton of data on the SS yet because your cat is recently diagnosed. Once people have more data and have an idea of how the insulin is working, most people feel a lot more confident shooting a full dose even if the AMPS or PMPS is a lot lower than they usually see.


For example, I once shot a full 2.5U into Hendrick when his PMPS was a green 74 on a human meter. Honestly I was terrified but he stayed flat and had a great cycle, stayed in the greens the ENTIRE CYCLE.
Click to expand...
The stall feeding/stall shooting makes sense now. But... Agh. This makes me so nervous that it's a night cycle that I may have to make this decision for. Staying up all night just isn't an option for me (my job is mentally demanding, albeit at home). I will need that taken into account with the guidance.
 
allicatmeow said:
Staying up all night just isn't an option for me (my job is mentally demanding, albeit at home). I will need that taken into account with the guidance.
Click to expand...
And it will be. Just state that clearly as being a non-negotiable when asking for help. Usually advice is caveated with “if you can stay up and monitor” so the answer is simply “nope” to that.

(I’m really going out of pocket now, lol. Am in a car — not:driving! —with a low battery. Thanks @Hendrick Cuddleclaw for explaining the:stall.)
 
PMPS @ 139

Need guidance.
Cannot stay up all night monitoring.
Please note his spreadsheet. He rises with food 50% of the time.
 
Last edited:
allicatmeow said:
I will retest shortly in the meantime. If no one can help, my vet is open til the top of the hour so I can call.
Click to expand...

99% sure your vet would just say skip.

here is what SLGS says (these are human meter numbers)

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
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.


So per SLGS you can skip if you're not confident. 139 on an AT is definitely lower than 150 on a human meter. Skipping is a concern with ketones and DKA history though.
 
Hendrick Cuddleclaw said:
99% sure your vet would just say skip.

here is what SLGS says (these are human meter numbers)

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
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.


So per SLGS you can skip if you're not confident. 139 on an AT is definitely lower than 150 on a human meter. Skipping is a concern with ketones and DKA history though.
Click to expand...
I think I am going to test in a few mins here and do letter b or c of this one if he is still rising a bit:

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
 
the thing about C is, if you end up shooting insulin a couple hours later than usual, your schedule is now off.

And then, to get back on schedule you move back to your regular shot time by adjusting shot time by 15 minutes a cycle, iirc

but my point is you can't just shoot late 2 hours then shoot normal time tomorrow as you would risk an overlap and hypo.
 
Hendrick Cuddleclaw said:
the thing about C is, if you end up shooting insulin a couple hours later than usual, your schedule is now off.

And then, to get back on schedule you move back to your regular shot time by adjusting shot time by 15 minutes a cycle, iirc

but my point is you can't just shoot late 2 hours then shoot normal time tomorrow as you would risk an overlap and hypo.
Click to expand...
I am okay with that, especially going into the weekend. He has a vet visit tomorrow too, so I can fill them in on this. He is hungry and I just don't feel good withholding with his history right before his checkup.
 
Hendrick Cuddleclaw said:
99% sure your vet would just say skip.
Click to expand...
You nailed it! Haha. He did say to test him after eating and make a decision, delaying is more than okay to make this choice. Also okayed a lower dose tonight if he rises, my choice, 1-1.5U was his suggestion. He said if he is still low-ish tomorrow morning, NOT to skip again, but if he is hovering around 200ish, to shoot a lower 1.5U.

Fortunate to have an appt lined up tomorrow I guess!
 
139 @ 1.25
Will retest at +2. Looking like a dose skip tonight per vet guidance.

Finished his meal just before, just about 1 full can of FF classic pate.
 
So the 165 is +14, correct? (We count hours since the last shot)

And that’s 45 minutes after eating?

So I believe this summarizes today:
AMPS 455 - 2.25u Lantus
+4 170
+6 124
+8 91
+10 122
+12 139 (stall)
+12.5 131
+13.25 139 (fed)
+14 165 (45 minutes after food)

I ask because I’m hesitant to completely skip given the recent history of DKA. And, the steep drop/lower numbers today might precipitate a bounce. I don’t typically give dosing advice, but if I were holding the needle, I would probably test again at approx two hours after he finished eating and, if BG still rising, give at least a token dose of 0.5u to 1u and then leave food down overnight. This is acknowledging that you won’t be able to get another test in tonight. I would, however, check on him and test first thing in the morning just to see where things stand. And of course, you’d be on a new shot time schedule (which you’ve already addressed as being ok). Just my two cents and not trying to muddy the.waters. :bighug:
 
Last edited:
You must log in or register to reply here.
Back
Top