AMPS 153 - HELP - do I shoot?

Sarah and Muffin

Sarah and Muffin

Member Since 2021
Hi there

Muffin and I are very much newbees. Diagnosed last week. Vet started her on 1Unit lantus last Monday, I borrowed the vet's AlphaTrak to do a curve at home on Friday, and discovered that Muffin had probably been going low and bouncing all week.

Reduced her dose to 0.5units immediately and took readings over the weekend as best I could. Started using a human meter yesterday, and got a pretty good curve with a low point of 272. Tried to get a PM cycle reading, but couldn't get her ear to bleed :-(. This morning's AMPS is 153. Given that the PMPS was 326 this doesn't feel like much of a curve overnight, and after last week, and the difficulties I've been having doing the BG readings on my own (when hubbie's not here to help) I'm a bit scared of shooting this morning and her going low again during the day.

Her AMPS seems pretty borderline based on the SLGS guidelines. What should I do?
 
Hi Sarah! Just writing so you know you're not alone, one of the experts will be along with advice.

In the meantime, guidelines are to stall (withhold food) and re-test. I know that's hard at the beginning getting the blood (have you tried holding a jar/pill bottle full of warm water against her ear?). I am checking to find how long you're supposed to stall. Be right back.
 
Hi Sarah,
per SLGS you have the following 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
  • I think "give nothing should always be the last option....can you stall for 30 minutes and see if muffin is coming up? you would have to delay her next shot also....
 
Thank you so much. Glad you advised to stall. That was my gut feeling too, but because the reading was slightly above the stall boundary, and me being such a newbee and all, it was good to hear it from someone else. I will try and get another reading in 30 minutes; she's hiding under the bed at the moment (which is where she goes after every reading and injection. She's pretty stubborn, and now goes under the bed every time she hears me pick up the bag of treats). I've been warming her ear with the sock/rice/microwave. Sometimes her ear bleeds like crazy (must have hit the vein) othertimes I'll prick 3 or 4 times and get nothing at all.
 
Hercule's mum said:
Hi Sarah,
per SLGS you have the following 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
  • I think "give nothing should always be the last option....can you stall for 30 minutes and see if muffin is coming up? you would have to delay her next shot also....
Click to expand...
Thanks for filling in the huge gap in my knowledge there.

Sarah - since you're so new...a bit of explanation when you have time to breathe. When you get a low pre-shot reading, the idea is to "stall" - not give food (which would make the BG go up) and wait, re-test to see if the BG goes up on its own. Since Muffin is at the end of the cycle and the insulin wearing off, you would expect BG to be on its way back up. Ha, I started writing more but don't want to give advice. I am certain it is in a sticky somewhere :) If you do stall (say 30min) before shooting, that means you have to delay the next shot by 30min. You can get back on track tomorrow by bringing shot time forward either 15min in the AM and 15min in the PM, or 30min at one or the other.

@Hercule's mum will correct/clarify ... and possibly find the right sticky much faster than me!!

ETA - Or maybe you already know this, reading your last post!
 
Thanks @Liz & Minnie
Muffin tends to graze on her food all night, and I know she ate something at around 7.30 (an hour before the AMPS reading). She pretty much eats on and off all day and all night, so not sure what this means and how this effects the SLGS stalling guidelines.
 
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Hi! If you haven't fed (per advice above), can you retest if it's been 15 minutes? The stall is to see if the number is rising or falling however, this is just giving you information for the cycle; remember, the new dose of lantus won't onset for 2-3 hours; so if you do shoot, you would want to monitor - a +2 would be a good idea. Do you have the ability to monitor/test strips/Medium Carb/High Carb/syrup?
 
Found it! https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

I am not smart enough to know how it effects stalling guidelines either so going to keep quiet...but at least our posting is keeping this near the top of the list :)

Have you been able to get syringes with 0.5u markings? The Walmart syringes have 0.5u markings but for me, the needle was too short so I had to go on line. These are the ones I like with 1/2 inch needles Monoject Ultra Comfort 29G Syringes | ADW Diabetes
 
@Liz & Minnie Unfortunately, you can't get syringes with 0.5unit markings here in New Zealand. I've looked everywhere, and Bron and Sheba said the same about Australia. However, the photographs on the Fine Dosing thread were really helpful, and I've been applying the same principles to the 1Unit syringes and have been practising measuring 0.5units, 0.25units and 0.75units.

@JaxBenji Yes, I have all the kit (metre, strips, hypo kit). My biggest issue is pinning down the cat, who just hides under the bed as soon as she hears me coming (and yes, I've been treating every time. She turns her nose up at the treats at the time, but I then feed them to her from under the bed after she's run there) She's 16yo and very stubborn).
 
Liz & Minnie said:
If you do stall (say 30min) before shooting, that means you have to delay the next shot by 30min
Click to expand...
She doesn't have to delay by 30 minutes tonight - the guidance is to not move shot time by more than 30 minutes in a 24-hour period as shooting earlier than that can act like an increase and shooting later than that acts like a decrease. So if a caregiver delays the AM shot by 30 minutes, they can shoot the PM shot at regular time (i.e. +11.5 from AMPS). Lots of info here on moving shot times - link.
 
JaxBenji said:
She doesn't have to delay by 30 minutes tonight - the guidance is to not move shot time by more than 30 minutes in a 24-hour period as shooting earlier than that can act like an increase and shooting later than that acts like a decrease. So if a caregiver delays the AM shot by 30 minutes, they can shoot the PM shot at regular time (i.e. +11.5 from AMPS). Lots of info here on moving shot times - link.
Click to expand...
Thank you!!
 
Hi Sarah,

You can give small doses, even without marking if you use calipers. I know you are new and this all sounds too much. But when you are ready, check this out: https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

I can get syringes with 0.5 units, but they vary a lot on their markings so I use calipers to insure I am more consistent with my doses. I have some tips if you decide to go down this road, just PM me.
 
Sarah and Muffin said:
Did it. Reading was 11.1 (200mg/dl). I went ahead and gave her her full 0.5unit shot. Will check BG again in 2 hours. This was a 1 hour stall. So I will give the PM shot at least 30 minutes later than usual.

Thanks again everybody.
Click to expand...
You're doing great, Sarah :bighug: And yes you can shoot tonight 30 minute later than your "usual" (i.e. today's AMPS +11.5). Shoot tomorrow's AMPS 12 hours from your PMPS and then tomorrow's PMPS back to your regular shot time.
 
Hi Sarah. Just coming online and seeing your thread. Well done stalling then shooting.
I see you are using a human meter now. That’s good. t
I would get a +4 to see how Muffin is going. She could bounce from the lower Preshot so don’t be surprised but time will tell.
 
Bron and Sheba (GA) said:
Hi Sarah. Just coming online and seeing your thread. Well done stalling then shooting.
I see you are using a human meter now. That’s good. t
I would get a +4 to see how Muffin is going. She could bounce from the lower Preshot so don’t be surprised but time will tell.
Click to expand...

@Bron and Sheba (GA) Just got a reading now of 20 (360). Does that mean she bounced? Why does she bounce with a BG of 8.5? I thought it was our goal for the nadir to be around this figure?
 
Sarah and Muffin said:
@Bron and Sheba (GA) Just got a reading now of 20 (360). Does that mean she bounced? Why does she bounce with a BG of 8.5? I thought it was our goal for the nadir to be around this figure?
Click to expand...
Yes it looks like she is going to bounce.
It is very common for newly diagnosed diabetic cats to bounce. Bounces can happen when the BG drops too fast, too low or lower than the cat has been used to for a while.
When any of these things happen the cats body thinks it has to save itself and dumps counter regulatory hormones and stored glucose into its system and this causes the BG to skyrocket. Bounces can last for 1 to 6 cycles and there is nothing you can do about it but wait it out.
Yes we do want the BG to be in the 50-120 range but she has to get used to the normal numbers again. At the moment she thinks the higher numbers are normal. The more often you can have her in normal numbers, the sooner she will get used to them. .
 
Bron and Sheba (GA) said:
Yes it looks like she is going to bounce.
It is very common for newly diagnosed diabetic cats to bounce. Bounces can happen when the BG drops too fast, too low or lower than the cat has been used to for a while.
When any of these things happen the cats body thinks it has to save itself and dumps counter regulatory hormones and stored glucose into its system and this causes the BG to skyrocket. Bounces can last for 1 to 6 cycles and there is nothing you can do about it but wait it out.
Yes we do want the BG to be in the 50-120 range but she has to get used to the normal numbers again. At the moment she thinks the higher numbers are normal. The more often you can have her in normal numbers, the sooner she will get used to them. .
Click to expand...

Thanks Bron. So I take it I just stick with the dose I am giving her, treat hypos if they occur (which hopefully they won't), and stall if the preshot is too low. And then just wait it out, and hopefully eventually her system will get used to the new numbers :-)
 
Sarah and Muffin said:
Thanks Bron. So I take it I just stick with the dose I am giving her, treat hypos if they occur (which hopefully they won't), and stall if the preshot is too low. And then just wait it out, and hopefully eventually her system will get used to the new numbers :)
Click to expand...
Basically yes. You also reduce the dose if she drops under 90 (5) and I would make sure to get at least one test in during the PM cycle as cats often drop lower at night. And the pm cycle is telling half the story.
 
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