AMPS much lower than usual...uncertain

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D Marchus

D Marchus

Member Since 2017
Good morning! Neo, who usually rides higher in the morning had a BG of 155 (ALPHATRAK 2) this morning and, because of conflict between a previous recommendation on how to handle the lower than usual number and what the SLGS says I should do, I'm uncertain about giving him any insulin. According to the SLGS (which uses human meter references), it looks like I really shouldn't:

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.
Thoughts? I also worry about not giving any due to previous experience on how that seems to really throw things off. Grrrr, really trying to get this right for my baby.

Thanks!
Daniela
 
P.S. Sorry, not sure if I used the 911 tag correctly. Selected it and pressed send before really thinking about it.
 
While we wait for the pros, how much can you monitor today?

If you haven't already fed, please don't feed yet-- step 1 is usually to stall a little while and test again to see if the number is rising, so it's better to judge that without any food influence.
 
As already said the first thing you need to do is stall (NO SHOT NO FOOD) and retest in 20 minutes.

Are you going to be around all day to test?
 
Thanks so much for the speedy replies! Yes, I love seeing the lower number. I'm just uncertain what to do because it's way lower than his usual. As for feeding, he's free fed Young Again Mature Zero (won't eat wet no matter what I try). I'll put it away for now, if that's still the recommendation. By the way, I did a second test to be certain it wasn't a fluke and that one was 158. I can monitor all day.
 
How long has he been eating the YA? Is this a change from his previous food?

Let's see if he is coming up on the next test-- with his high numbers and relatively high dose, you would hate to skip entirely, but let's see what he's got in mind first.
 
Had you given any food before you did the second test of 158 and was it done at the same time as the first test?

The question now is to determine whether Neo's glucose levels were rising or whether they were still dropping. With unexpected low preshot numbers you should NOT FEED ANYTHING and retest in 20 minutes to see which way the numbers are going.

Has Neo eaten since the first test?
 
The two tests were back-to-back & he'd already gotten to his food after those tests and before the recommendation to take it away. Ugh, also just realized I'm down to my last 4 Alphatrak strips. More arrive today, hopefully in time to do this properly. However, I do have a Relion meter and strips as a fallback.
 
D Marchus said:
The two tests were back-to-back & he'd already gotten to his food after those tests and before the recommendation to take it away. Ugh, also just realized I'm down to my last 4 Alphatrak strips. More arrive today, hopefully in time to do this properly. However, I do have a Relion meter and strips as a fallback.
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With a lack of test strips then my suggestion would be to skip the shot. It may have been possible to shoot a reduced dose with this lower number, but with only a few strips it is not a good decision. If Neo were to drop low you could easily go through 6-10 strips during this cycle. Since you don't have data with the Relion it would be difficult to know what numbers Neo would normally get with a Relion meter.

Try to get as many mid cycle tests every day as possible. As well if you could get a test before bedtime it would give a clearer picture of what is happening during the cycle
 
Tuxedo Mom said:
With a lack of test strips then my suggestion would be to skip the shot. It may have been possible to shoot a reduced dose with this lower number, but with only a few strips it is not a good decision. If Neo were to drop low you could easily go through 6-10 strips during this cycle. Since you don't have data with the Relion it would be difficult to know what numbers Neo would normally get with a Relion meter.

Try to get as many mid cycle tests every day as possible. As well if you could get a test before bedtime it would give a clearer picture of what is happening during the cycle
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The Relion meter is fine so I would shoot as long as you can monitor closely and have plenty of strips fornit.
 
Nan & Amber said:
How long has he been eating the YA? Is this a change from his previous food?

Let's see if he is coming up on the next test-- with his high numbers and relatively high dose, you would hate to skip entirely, but let's see what he's got in mind first.
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He's been on the YA for about a month now.
 
tiffmaxee said:
The Relion meter is fine so I would shoot as long as you can monitor closely and have plenty of strips fornit.
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I am hesitant about this if she has not done readings with the Relion to know what "usual" readings are with the Relion.

If she shoots what would you suggest as a dose? Since Neo was fed it is unclear whether the number was still dropping or on the rise.
 
tiffmaxee said:
The Relion meter is fine so I would shoot as long as you can monitor closely and have plenty of strips fornit.
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Just tested again and he's at 181, about an hour after the others. You suggest shooting but I'm unsure if your recommendation is for full 3.0 dose?
 
D Marchus said:
Just tested again and he's at 181, about an hour after the others. You suggest shooting but I'm unsure if your recommendation is for full 3.0 dose?
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That number would be food influenced since you fed already. How much can you afford to be off schedule? I would suggest waiting one more hour so that the food influence has worn off and retesting and making a decision then. However this would put your normal schedule off by 2 hours so I don't know if that would work for you. If you choose to do this it would take a few days before you could get the hours back to what they were before.

Is this possible?
 
Yes, I can handle the schedule adjustment. Which brings to mind another question. If you do get off schedule, by what time increments is it recommended you adjust daily to get to where you want it to be? As for getting the Relion reading, I can do that as well when I test again in an hour.

Really appreciate everyone's help! Although Neo and I have gotten fairly comfortable with the testing and shot routine, I still have a long way to go figuring out the numbers game.
 
Tuxedo Mom said:
With a lack of test strips then my suggestion would be to skip the shot. It may have been possible to shoot a reduced dose with this lower number, but with only a few strips it is not a good decision. If Neo were to drop low you could easily go through 6-10 strips during this cycle. Since you don't have data with the Relion it would be difficult to know what numbers Neo would normally get with a Relion meter.

Try to get as many mid cycle tests every day as possible. As well if you could get a test before bedtime it would give a clearer picture of what is happening during the cycle
Click to expand...

Yes, I definitely plan to do more testing in the days ahead. Was planning to do a full curve tomorrow before this came up but expect today may throw things off. Do I need to wait another week for things to settle for a full curve or will a couple days do?
 
To change back it is suggested to do changes of 15 minutes each cycle or 30 minutes once per day so it would take a few days to get back to your current shedule.

If this is doable then retesting at 2 hours after the first test, with NO MORE FOOD will give a better idea of where the numbers are. If you could take a test now with the Relion and then again in one hour you will have a working set of numbers for the Relion meter.
 
D Marchus said:
Do I need to wait another week for things to settle for a full curve or will a couple days do?
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If Neo ends up bouncing into higher numbers a curve may not be useful until the bounce has cleared. Right now it is unsure what is going to happen so you should see how this cycle and the next go before deciding on a full curve. However getting more tests in between shots would be very useful data to see what sort of ups/down happen during the cycle.

So as far as the curve let's see how today goes before deciding if tomorrow would be a good day, but extra tests can and should be done each cycle.
 
Also could you remove the "911" from your title since there is no immediate emergency. If you need quick help later you can add it back in.

Thanks :)
 
Tuxedo Mom said:
If you could take a test now with the Relion and then again in one hour you will have a working set of numbers for the Relion meter.
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It's already been 30 minutes since the last test so I think I'll wait. Will do the planned follow up with the Alphatrack in another 30 to make a shoot/no shoot determination and get a Relion reading at the same time. Will use up my last two Alphatrak strips the following two hours and get more Relion readings at the same time so I can at least get us through today with decent info for the alternate meter if I need to do more tests later. Sound reasonable? My new Alphatrak strips may also arrive earlier than expected today too! :)
 
Sounds like a plan. As long as you have Relion readings as well it will make it easier to see how the cycle goes if/when the decision to shoot is made.
 
Ok, took another reading. Here are the #'s so far:

8am 155
9am 181
10am 207 (Relion backup 151)

Hmmm, shoot (full/partial) or not? Again, this is the first time I've had an AMPS this low. Usually it's High 300s & 400s.
 
Neo is only rising slightly from the earlier numbers.

I tend to be very conservative and with not a lot of mid cycle data, my suggestion would be to shoot a one time reduction of 1.5 units for this cycle and get a number of tests in.

Just to be sure...you have lots of the Relion strips, you have medium carb and high carb food and you have some sort of syrup on hand?

If you are comfortable with the 1.5 units that would be my suggestion since you are able to monitor through the cycle. Some may suggest a full dose or a higher reduced dose, but without more data between shots I personally would feel more comfortable with 1.5 units.
 
To make it easier to follow, could you "stack" your readings in the AMPS box so that the actual number you shot at is showing there. You would have to manually colour the box fill using the paint can icon at the top of the spreadsheet. Since you didn't shoot at the normal AMPS time you can make a notation in the comments that you are shooting 2 hours later, but the actual number you shoot should be in the AMPS box. As well if you could maybe do a separate line for the Relion readings it would be less confusing, especially if you need help later and someone different comes to help so that they don't have to read the thread to see what has happened.
 
I think conservative this time is the way to go. 1.5 sounds right to me and yes, I do have the syrups and food handy. By "a number of tests" do you mean hourly through the day or more?
 
I would test at +1 since this is lower than usual preshot for you, then +2 . This might be a good day to do a mini curve to see how Neo reacts to lower preshots with a lower dose. Normally you would test every 2 hours for the cycle unless the numbers start to drop more than expected
 
If you could put the new AMPS reading with the Relion meter on a separate line it will make it easier to follow since the rest of the test will be done with the Relion. Please post your +1 reading when you get it.

Thanks
 
Tuxedo Mom said:
To make it easier to follow, could you "stack" your readings in the AMPS box so that the actual number you shot at is showing there.
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Not quite sure what you meant by stacking readings but made some changes that I hope make sense to the viewer.
 
The AT numbers are fine since you notated that you are using the Relion for this cycle. Put the 151 Relion preshot in the AMPS box, then put the readings you do afterwards in the box that would correspond to the time since the shot. So when you do a test at 1 hour after the shot it becomes a +1 reading and the test at 2 hours after the shot would be a +2..etc.Hope that makes sense?
 
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Looks like Neo is on the rise now. The only thing I will add is how important it will be to get more test in during the PM cycles. Most cats go lower at night so even if you start off with a higher preshot number , Neo could drop and that info is important to know how low the insulin is taking him. If you are unable to get a PM mid cycle test, get one before you go to bed. A +2 will tell you how active the cycle is if the number is the same or lower than the pre shot number. Then you'd know you'd need to test further.

Since you all ready have a Relion meter, you can save lots by using in rather than the AT2.
 
D Marchus said:
AMPS at delayed shot time was 151 Relion (207 AT)
+1 was 171 on Relion (229 on AT)
+2 was 206 on Relion, (last AT strip had error)
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This looks about right, There is usually a bit of a food spike the first 2 hours. I would suggest to test again at +4 since the Lantus should be in effect by then.

ETA It might have been possible to shoot a higher dose BUT without much data in between shots and with a lower than expected preshot this was still the best way to go.
 
Will do. Because of my inexperience and the fact that we're only starting to test more, the dose made sense to me. Tuxedo Mom, you've been great, thanks. I'll post once more this eve with the follow-up tests and his PMPS just to complete the day's picture.
 
Do get a +4 and then a +6 shot as long as the numbers are not dropping too much. The more tests you can get the easier it will be to understand Neo's responses to the insulin. It would be good if you could determine when the nadir (lowest number) is. With a smaller dose the data will not be totally accurate for when you use the regular dose but all information is helpful.
 
Well, I think it's safe to assume that Neo's PMPS in two hours will be super high and that his 3.0 dose is a non-issue. Sadly, his numbers were up, up, and away this afternoon. :( Not sure if that is an indicator that I could have done his normal dose this morning or not. Also, thinking it might be a good idea to catch some readings on the odd hours tomorrow to further flesh things out. If anyone has thoughts or suggestions, they're welcome.

Anyway, Neo's spreadsheet tells today's tale in full. Kept up the Relion testing along with the AT tests once my new strips arrived. Probably won't be doing a later test after his PMPS since his shot time got shifted two hours later today. Will look at doing more of those once we get back on schedule.

Hoping for less of a roller coaster ride tomorrow!
 
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