AMPS & PMPS always lower

Bella & Puddin

Bella & Puddin

Active Member
Hi, everyone!

My cat's BG always seemed to spike soon after receiving his insulin shot. We were all the way up to 9.5u and then our vet suggested monitoring him and slowly decreasing units...we are at 2u and I find the spikes to have lessened in intensity and I also find him more calm with a decrease in thirst and urine production (albeit still not normal).

What's to be thought of this? I'm still not really seeing a curve in his data...he starts lower, get shot, spikes up then slowly goes down. Whereas I've understood from shot to shot he should be starting high, reach a low, then increase again. Is this correct?

Thank you.

https://felinediabetes.com/FDMB/threads/insight-on-bg-readings.286934/#post-3155924
 
Hi there. I’m really happy that you have reduced Puddin’s dose. None of us here were happy with the starting dose of 4 units and the way the vet increased the doses so rapidly and in such large increments. I am glad Puddin seems to be feeling better also!

I do see cats here who have a +2 that is higher than their preshot value, it’s not uncommon. Usually it’s just that the previous insulin shot has worn off and the current insulin shot hasn’t kicked in yet (onset). With ProZinc, the onset time is usually around +2, but it can vary from cat to cat with some cats taking a little longer to start going down. Notice how sometimes you start seeing the lower BG when you get a +3 test. Also, higher numbers at the end of the cycle can mean that the insulin just isn’t lasting as long as we would like it to (loss of duration.) Feeding after nadir can contribute to loss of duration, but other factors can be at play.

Will you be available soon (this weekend perhaps?) to do a curve on Puddin? You would test at least every two hours for one cycle. What we don’t have on this 2 unit dose is a lot of data about what is going on during the +4 to +8 timeframe. This would be really helpful information.
 
We were very happy to decrease his units, as well! Something just wasn't making sense and I still can't believe it isn't encouraged for owners to test their cats at home...I recall asking the first time I brought Puddin in for a curve and the response was "it's too hard for you to do it". In my ignorance, I believed them!

If I'm unable this weekend to check every 2 hours in a cycle, I will make sure to do it the first days of the week.

Puddin only eats twice a day (0530 and 1730); is there any benefit to providing more, smaller, meals? What I know of human diabetes is that there is a benefit to less meals (longer fasting); is this true for cats?

Thank you and we will chat again soon!
 
Well, it really looks like Puddin is going to need an increase in insulin. So if you can get a curve done -- or at least test at say +3, +5, +6 or 7 ish, that would be valuable information and we can probably go ahead with an increase. I would recommend that we not hold the doses too long while Puddin is in these higher numbers so much of the time. He's already too comfortable in these higher numbers and that makes it more difficult to make progress and get him into better numbers.

And yes, diabetic cats do much better on multiple small meals given at specific times in the cycle. People who are not at home a lot usually buy automatic feeders to dispense food at specified times in the cycle. What is a good idea is to figure out exactly how much food you want them to eat in a day and then split this amount up into several smaller meals. To begin with, since Puddin isn't a "diver" (cat who drops dramatically early in the cycle) I would recommend at least feeding small snacks (can be one or two teaspoons of low carb wet food) given at +2, +4 and +6 but nothing after +6. Feeding too late in the cycle can contribute to the insulin not lasting as long (loss of duration.)
 
So I guess what I'm saying is, don't stress out about whether you can run an official "curve" and get a test every two hours. See if you can at least fill in some of the blanks for us in the hours where we don't usually get tests (the hours I talked about before). I'd like to be able to see that and go ahead and recommend an increase for Puddin.
 
Suzanne & Darcy said:
So I guess what I'm saying is, don't stress out about whether you can run an official "curve" and get a test every two hours. See if you can at least fill in some of the blanks for us in the hours where we don't usually get tests (the hours I talked about before). I'd like to be able to see that and go ahead and recommend an increase for Puddin.
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OK, thank you. I will make sure to gather those numbers tomorrow then.

I can do the smaller meals if that's what's going to help him and even get an automatic feeder. Would these be given during the evening cycle, as well?

I'll be back tomorrow with the missing BG numbers!
 
Did you get any tests today?

Anyway, based on that curve, Puddin definitely needs an increase. What is your schedule like tomorrow? Will you be able to test Puddin?

and definitely start feeding him the smaller more frequent snack meals.
 
Suzanne & Darcy said:
Did you get any tests today?

Anyway, based on that curve, Puddin definitely needs an increase. What is your schedule like tomorrow? Will you be able to test Puddin?

and definitely start feeding him the smaller more frequent snack meals.
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I have not tested him at all today (03/17).

OK, is this a .5u increase?

I can possibly do another every 2 hrs testing tomorrow during the day cycle.

I can even try giving him smaller meals during the day cycle tomorrow and will order an automatic feeder.

Should I try 2.5u tomorrow?

Thank you.
 
It’s never a good idea to not test for a whole day. At the very least you should test before every single shot. I know it seems like, right now, there’s no way he would ever have a low number, but I have seen some very surprising things. Also, it’s important to maintain the routine of testing, giving a treat, and feeding at shot time.
 
And yes, in this case since Puddin’s nadirs are quite high and because you have held the previous dose for almost 14 cycles— and because you are going to be testing him during the cycle — (and because you don’t feed dry food) then this time I think you can do a .5 unit increase (where normally it would be a .25 unit increase.).
 
Suzanne & Darcy said:
It’s never a good idea to not test for a whole day. At the very least you should test before every single shot. I know it seems like, right now, there’s no way he would ever have a low number, but I have seen some very surprising things. Also, it’s important to maintain the routine of testing, giving a treat, and feeding at shot time.
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Yes, I understand. We had a full day with sensitive children so I thought it would be ok to take a break; even maybe for Puddin's sake - even though he is such a good boy with all of this!

I will continue to check him as I have been on our usual schedule and do a full cycle check tomorrow with the addition of snacks (at least in the daytime cycle) until I get the automatic feeder.

Thank you for helping us and gently guiding us in this. I will update you tomorrow!
 
Suzanne & Darcy said:
:) It sounds like you certainly have your hands full!
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I have some questions...

What would give clues that the insulin type needs to be changed (as vet would want to do as a next step)?

And why is he getting mostly similar readings at 9.5u and now down to 2.5u? Was his dose just increased too rapidly?

Does it seem I should follow the MPM or SLGS?

Thank you.
 
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Since Puddin dose not eat dry food, then you could follow MPM because you test a lot. I really think that your vet needs to do the testing for Insulin Autoantibodies and for Acromegaly (IGF-1 test.). You need to find out of there are any conditions that are making Puddin insulin resistant. Tooth problems are a more common cause of insulin resistance though.

As for changing insulin, if the vet wants to switch Puddin to Lantus (glargine) insulin then that might be helpful, but I would not switch until I found out if he is insulin resistant for some other reason (teeth, infection, IAA or Acromegaly).
 
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