AMPS 174, shoot or not?

[MemberLeftDueToAbusiveMod]

Needing guidance on new sugar kitty Artemis.

8:00 am MT AMPS 174

Fed 6% FF right after testing (didn't know we were supposed to hold food. He gets nauseated if we don't feed in am.

10:16 am MT tested 380. Inject or not?

 

[Ale & Bobo & Minnie (GA)]

At this point, I would just skip the shot.

it’s okay. It’s a lot of info we’ve been giving you. Here you go again:

when you get a lower than 200 bg value, you want to stall 20 minutes without feeding, then retest to see if the bg is going up on its own and it’s safe to shoot his regular dose. The reason being is you want to see if the bg is going up on its own without food

 

[Ale & Bobo & Minnie (GA)]

I would look into a way to leave an overnight snack for him. I have a feeling with that low amps that he’s going lower overnight. Did you see my comments on the other thread about trying to take his +2 evening test? It will help you see where he’s headed for the night.

 

[Ale & Bobo & Minnie (GA)]

I see that you gave the full dose. Since you gave the full dose, at least that’s what I see on the spreadsheet, please test him again at +2. You’ll also need to adjust the evening shooting time so that it is 12 hours from when you gave insulin this morning.

 

[MemberLeftDueToAbusiveMod]

I see that you gave the full dose. Since you gave the full dose, at least that’s what I see on the spreadsheet, please test him again at +2. You’ll also need to adjust the evening shooting time so that it is 12 hours from when you gave insulin this morning.

Yes. This is getting very confusing. If I don't get a response I don't know what to do. And sometimes I don't understand the material. I'm going to step back here until my son can just take over. I explained that I have some limitations with cognition here and the way the information is given makes it even more confusing. It's too much. My son's name is Josh and he will be posting in my place.

 

[Ale & Bobo & Minnie (GA)]

I’m sorry you find this confusing. You didn’t do anything terribly wrong. It’s only been a few days and you’re learning. He may go under 90 again today and he’ll earn another reduction which I think is what he needs given the lower preshot test value you got today.

Here’s what you need to do next time you get a lower than 200 preshot test. You or Josh may want to print this so you have it handy and it’s easier to follow than looking through a thread:

It’s time for my cat’s shot, but the BG is a little too low. What now?

• If your cat’s BG is a bit below 200 mg/dL [11 mmol/L] on a human meter, consider ‘stalling’.
  • Stalling is waiting - without feeding your cat - for 20+ minutes, then retesting to see if the BG has risen to a suitable level.
  • You are looking for a number that is rising, not falling, and is high enough to give insulin.
  • If you have time, you can repeat the stalling process to see if the cat’s BG reaches a number you can shoot.
• If you cannot stall do to time constraints, if numbers are continuing to drop or if you do not have a supply of strips and high carb food on hand, it will be safer if you skip the shot.
• Note: As you gain experience with home testing and have gathered data to show how your cat responds to insulin, you will become more confident and better able to shoot progressively lower numbers.
• Ask for help on the forum before giving insulin if you are unsure, as you can never ‘un-shoot’ insulin (best to start a new thread to get more eyes on it).

you can also print out the information from the Vetsulin forum and highlight the important sections so it’s easy to find when you need it. I recommend you guys print it out and put it on your fridge so it’s easy to see: https://www.felinediabetes.com/FDMB/threads/beginners-guide-to-caninsulin-vetsulin.231587/

 

[Sienne and Gabby (GA)]

There's a lot to learn in the beginning of this process. With Vetsulin, you need to test, feed your cat, wait 20 - 30 min, and then give the insulin dose. There's never any guarantee that someone will be available to respond to a post immediately. While this is a busy forum, there's no way to say for sure that someone will be around. You would either need to wait or make a decision.

If you are uncertain whether you did the right thing, my best advice is to get a few tests. If you've given a shot at a lower number, the best way to ensure. your cat is safe is to get additional tests. You would be tracking your cat's progress at that dose. I would get a test at +1 or +2.

I would also encourage you to get at least one test every night during the PM cycle. Without PM tests, you're missing half of your data.

 

[MemberLeftDueToAbusiveMod]

I see that you gave the full dose. Since you gave the full dose, at least that’s what I see on the spreadsheet, please test him again at +2. You’ll also need to adjust the evening shooting time so that it is 12 hours from when you gave insulin this morning.

The vetsulin seems to wear off at +8 or +10. Why not adjust to +10 for the PM dose (if PMPS is 200+) and then +12 for the AM dose?

 

[MemberLeftDueToAbusiveMod]

If your cat’s BG is a bit below 200 mg/dL [11 mmol/L] on a human meter, consider ‘stalling’.

• Stalling is waiting - without feeding your cat - for 20+ minutes, then retesting to see if the BG has risen to a suitable level.

He's hungry in the AM and has issues if he doesn't eat.
Question on 2 scenarios:

1. What happens if he's really hungry and needs food but his AMPS is lower than 200 and we feel like we can't wait to feed due to his distress level?

2. What do we do if the AMPS is lower than 200 but he needs to eat because we have to leave and can't wait around to retest at 20+ minute intervals until he starts rising again?

 

[MemberLeftDueToAbusiveMod]

I would also encourage you to get at least one test every night during the PM cycle. Without PM tests, you're missing half of your data.

I'm a data guy and I really hate to miss out on data... but at this point the process is so distressing that we need to decrease testing to only the minimum required to be safe and make progress toward lowering dose. Anything more than that is superfluous and adds stress which will make testing more difficult in the long run for him. Is it absolutely necessary to get the evening data after collecting a "GO" PMPS? If so, what interval would you test at +1? +2?

 

[Ale & Bobo & Minnie (GA)]

He's hungry in the AM and has issues if he doesn't eat.
Question on 2 scenarios:

1. What happens if he's really hungry and needs food but his AMPS is lower than 200 and we feel like we can't wait to feed due to his distress level?

2. What do we do if the AMPS is lower than 200 but he needs to eat because we have to leave and can't wait around to retest at 20+ minute intervals until he starts rising again?

In both scenarios, if you got a 176 like you did today, I’d recommend skipping the dose. As you get more used to his numbers and how he’s reacting to the insulin, you could revisit. If the number you get is close to 200, like 191 or 196, I’d give the regular dose. Again, I think he’ll earn a reduction today and I believe the 4.5 is till too high for him. When we find his ideal dose, you’ll probably see preshots at around 200 again.

 

[Ale & Bobo & Minnie (GA)]

I'm a data guy and I really hate to miss out on data... but at this point the process is so distressing that we need to decrease testing to only the minimum required to be safe and make progress toward lowering dose. Anything more than that is superfluous and adds stress which will make testing more difficult in the long run for him. Is it absolutely necessary to get the evening data after collecting a "GO" PMPS? If so, what interval would you test at +1? +2?

I’ll let Bron answer this one. In the meantime, if you want to take a look at Bobo’s spreadsheet linked in my signature, you’ll see how many times that +2 evening test was needed to keep him safe and how huge drops he was having from the pmps to the +2
@Bron and Sheba (GA)

 

[Ale & Bobo & Minnie (GA)]

One note on the nausea issue. Both Minnie and Bobo had/have IBD and if they went over 7 hours without food, they’d be nauseated and sometimes even vomit. Getting an auto feeder set up to go off at around 1-2am has helped deal with that. You don’t want a diabetic cat going all night without food. Just like they get meals throughout the day, they should also get a snack or 2 overnight.

 

[Sienne and Gabby (GA)]

I was very data driven when managing Gabby's diabetes. I understand where you're coming from! (Look at her spreadsheet and you'll see what I mean!!)

There are a couple of points for discussion. If you are routinely seeing numbers that you're uncomfortable shooting, one thought is to lower the overall dose. At least based on when you started putting numbers on Artemis' spreadsheet, 5.0u is a big dose. We encourage members to start at a more conservative dose unless the dose has been systematically raised and providing there aren't other considerations such as a history of diabetic ketoacidosis (DKA).

Generally, if you get a lower number than expected, don't feed your cat. You would want to stall and re-test in 15 - 20 min to see if numbers are rising. If stalling is problematic, give some thought to altering your shot time if that's at all possible. I ended up shooting at 5:00. Gabby was notorious for early, fast drops in her numbers. Shooting early meant I could get tests in before I left for work and could manage her numbers with high carb food if necessary. (I was also using Lantus which in some ways is more forgiving than Vetsulin.)

When you stall, you have to balance how long to hold off on shooting vs being off schedule. I would not have been able to manage being even an hour off schedule. If stalling isn't an option, reducing the dose for that cycle may be an alternative. Again, it's a balancing act. When Gabby was diving, I may have stalled 15 min but with Lantus, the "no shot" number is much lower and I had a good deal of flexibility (e.g., I could run home at lunch to check on her). I also knew she was food motivated and I had a timed feeder and if I was nervous about her numbers, would leave higher carb food in the feeder.

Basically, with low pre-shot numbers, you have 3 options:

• Don't feed and stall in 15 - 20 min increments, re-test, and when numbers are on the way up, shoot.
• Reduce the dose/give a token dose
• Skip the shot

All of this plays havoc with your nervous system until you have a better sense of how Artemis is responding to insulin. It will never be fully predictable but you will have a better idea of what your cat does. There is a common saying here, "every cat is different" (ECID). How Artemis reacts to insulin may be very different than another cat that's prescribed Vetsulin.

 

[MemberLeftDueToAbusiveMod]

If you are routinely seeing numbers that you're uncomfortable shooting, one thought is to lower the overall dose. At least based on when you started putting numbers on Artemis' spreadsheet, 5.0u is a big dose.

Again, I think he’ll earn a reduction today and I believe the 4.5 is till too high for him.

Artemis' +5 reading today (with a different meter as we ran out of test strips for the Contour Next EZ and had to switch to the newly purchased ReliOn Premier) was 291... He had just under 2.5 3 oz cans of 5% carb fancy feast today between waking and +5.

 

[Ale & Bobo & Minnie (GA)]

Can you enter the 176 you got this am in the spreadsheet? Members will need to see that to get the full picture. We’re also very data driven here too because we want to make sure we’re giving you correct advice when it comes to your cat. I think you’re seeing a bounce from maybe going low overnight and I think Sienne has a point about reducing the dose. It’s up to you though and what you’re comfortable with.

 

[Ale & Bobo & Minnie (GA)]

I was very data driven when managing Gabby's diabetes. I understand where you're coming from! (Look at her spreadsheet and you'll see what I mean!!)

There are a couple of points for discussion. If you are routinely seeing numbers that you're uncomfortable shooting, one thought is to lower the overall dose. At least based on when you started putting numbers on Artemis' spreadsheet, 5.0u is a big dose. We encourage members to start at a more conservative dose unless the dose has been systematically raised and providing there aren't other considerations such as a history of diabetic ketoacidosis (DKA).

Generally, if you get a lower number than expected, don't feed your cat. You would want to stall and re-test in 15 - 20 min to see if numbers are rising. If stalling is problematic, give some thought to altering your shot time if that's at all possible. I ended up shooting at 5:00. Gabby was notorious for early, fast drops in her numbers. Shooting early meant I could get tests in before I left for work and could manage her numbers with high carb food if necessary. (I was also using Lantus which in some ways is more forgiving than Vetsulin.)

When you stall, you have to balance how long to hold off on shooting vs being off schedule. I would not have been able to manage being even an hour off schedule. If stalling isn't an option, reducing the dose for that cycle may be an alternative. Again, it's a balancing act. When Gabby was diving, I may have stalled 15 min but with Lantus, the "no shot" number is much lower and I had a good deal of flexibility (e.g., I could run home at lunch to check on her). I also knew she was food motivated and I had a timed feeder and if I was nervous about her numbers, would leave higher carb food in the feeder.

Basically, with low pre-shot numbers, you have 3 options:

• Don't feed and stall in 15 - 20 min increments, re-test, and when numbers are on the way up, shoot.
• Reduce the dose/give a token dose
• Skip the shot

All of this plays havoc with your nervous system until you have a better sense of how Artemis is responding to insulin. It will never be fully predictable but you will have a better idea of what your cat does. There is a common saying here, "every cat is different" (ECID). How Artemis reacts to insulin may be very different than another cat that's prescribed Vetsulin.

Previous threads here. His vet upped the dose from 2 to 6 and he’s now down to 4.5: https://www.felinediabetes.com/FDMB/threads/bg-99-at-12pm-mt.279797/#post-3090202

 

[Bron and Sheba (GA)]

I'm a data guy and I really hate to miss out on data... but at this point the process is so distressing that we need to decrease testing to only the minimum required to be safe and make progress toward lowering dose. Anything more than that is superfluous and adds stress which will make testing more difficult in the long run for him. Is it absolutely necessary to get the evening data after collecting a "GO" PMPS? If so, what interval would you test at +1? +2?

I’m sorry you are finding it all overwhelming at the moment. It’s very common for new caregivers to feel like this in the beginning. Hopefully things will get better for you.
I think it is important to get a test in during the pm cycles if at all possible. The reasons are…cats often drop lower at night and the pm cycle is half of the data we need to be able to see.
So what I would do if you can, is get a test in around +4 at night. Is that doable for you? That should be around the time the BG is at its lowest with Vetsulin. If the BG at +4 is in the greens or low blues, I would get another test in an hour later to check it hasn’t dropped too low.

 

[MemberLeftDueToAbusiveMod]

Can you enter the 176 you got this am in the spreadsheet? Members will need to see that to get the full picture. We’re also very data driven here too because we want to make sure we’re giving you correct advice when it comes to your cat. I think you’re seeing a bounce from maybe going low overnight and I think Sienne has a point about reducing the dose. It’s up to you though and what you’re comfortable with.

Is the AMPS always the very 1st BG reading even if it goes below 200 for AMPS and therefore we need retest? If so what do we do with the subsequent readings?

I figure we would put in the final test result that is 200 or above? I put the number I got just before I gave the insulin.

 

[Sienne and Gabby (GA)]

If you get a number at pre-shot time that you are uncomfortable with, the pre-shot is the equivalent of a +12. If you stall for a half hour, you can enter the number as your +12 and then the next test would ostensibly be your pre-shot. If you look at Gabby's spreadsheet on 6/27/2015 for the PMPS, you'll see what I mean.