Blue PMPS 197

https://www.felinediabetes.com/FDMB/threads/blue-amps-151.234026/

I know the last thread was way too long. Sorry! Blue is at 197 and has been good all day. He is so much better and it shows. I will get a +2 tonight.

 

Perfect. You might have to set an alarm for later. Let’s see the +2.

 

Oh, I think we'll let you off this time, Patty.


Mogs
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Oh, you think I might need another after the +2?

 

The +2 can be an indicator of an active cycle. The emphasis is on "can be."

This is what an active cycle might look like.
From The Basics: New to the Group? Start here!

Learn how YOUR kitty is responding to insulin:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose
• How to do a Curve - a simple explanation

Example of an ACTIVE, but NOT necessarily typical Lantus/Basaglar cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus/Basaglar cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Basaglar/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

 

We reduced and he’s not bounced for long and part of that was the hc. Max would indicate if a cycle would be active at +3. Blue won’t eat on his own so you can’t just leave food out. FD can be exhausting especially at first. That’s why I keep saying you need an earlier shot time.

 

I used to leave dry food out and he grazed on it. The problem is the others want to graze on it too. Maybe I'll look for another low carb dry that everycat can eat.

 

It would be easier to find a food they all can eat. It’s hard to find with different medical issues though. What can the others eat?

 

I think they might be ok with a low carb but the brand I bought caused diarrhea. I wasn't able to mix but maybe I can now that I'm separating them. Eventually, I could leave food out and Blue could graze again. Yakkkk it's crazy around here. They are all seniors with issues but not like Blue. Diabetes is serious.

 

You have to switch foods slowly or they get diarrhea. It might be that they will be able to eat what you bought.

 

242 +2

Yes, I was so focused on Blue I forgot I always mix the food. I can start tomorrow and see what happens.

 

Good. He’s up. I think you can go to sleep. If you wake up at all get a test at +8-9 ow whenever you wake up. I think I would get a +11 or 11.5 for sure.

 

Sounds good. That's around 5-6:00 so maybe my bathroom trip for the night.

Thank you. Get some sleep.

 

Good night. Remember, it will get easier.

 

434 at +8

 

Bouncing again. Just get a amps. No need for a +11

 

433 AMPS eating and gave shot at 9:30

 

You don’t need another test until +3.

 

Greetings, ladies! I hope you're both well, and I hope you got some decent rest, Patty.


Mogs
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Good morning. Coffee on board now. I didn’t sleep well last night so it was needed. Just a heads that I will be away starting at +3.5 for possibly 3 hours. I’ll check in when I’m able but just won’t be able to hang out.

 

Hi Elise,

Sorry you didn't sleep so well.

How long till +3.5, Elise? (Brain can't handle the time zone thang. It's 17:00 BST here as I post this.) Let me know and I'll keep an eye on Patty and Blue.


Mogs
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About 45 minutes.

 

Cushty. On it.

.

 

Bounce cleared already. I’d get a +5. Feed a little lc now.

 

Hi guys,
Sorry about bad sleep. It definitely can impact the day. Thanks for the backup.

Blue just tested 181 and I updated the SS. I have PT at 2:00 today and it's 12:30 here now. I'm so happy Blue is feeling so good. I noticed a few things. When his numbers start to rise he seems to just lay down and not move. His pupils are very dilated. I'm not sure if this is normal or not. He has been out and about more and is tipping things over more and more when numbers are low.
Should I test again this afternoon?

 

I will be gone but can test as soon as I get home. Maybe +6

 

That will be fine.

 

I'll be here, Patty. Tag me when you're back.


Mogs
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How do I tag you on here?

 

Higher numbers can make a cat quite lethargic and not feel very well.

Hypos can also sometimes make a cat lethargic.

Caninsulin made Saoirse very lethargic for hours at a time. For the early part of her treatment I got outright hostility towards my desire to home test from the vets at the practice we were registered with at the time. There was no way for me to distinguish whether or not she was in low numbers and whether she might need honey to raise her numbers. I was sick with fear.

When I started home testing, my fear of hurting Saoirse's little ears was utterly eclipsed by my dread of giving her an insulin dose that might harm her. (((Saoirse))) The relief of knowing that I could test her BG levels any time I had even the slightest concern about her was overwhelming.


Mogs
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Just stick @Critter Mom in a post.

NB: Tags have been hit 'n' miss on occasion lately so I'll be monitoring your thread for updates as well, but the tag might get to me faster if I'm looking at another thread when you first get back.

I'm going to tag you in this post - @Patty and Blue - and you should get a notification in your 'Alerts'.

Hope the PT goes well. Keep safe.


Mogs
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I am late but just tested and it's 138. I'm getting ready to feed. I'll be back in a few minutes.

@Critter Mom

 

Hiya, Patty. Thanks for the tag. I've been popping in throughout the afternoon to check for updates. Glad you're home safe.

That 138 is nice.

Feeding low carb?

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I’m back too. That’s a good number. I’d get a test around 11.5 to make sure he’s on tge way up at PMPS and allow time so you won’t have to stall.

 

Hi Elise. Glad you're back safe too.

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@Critter Mom You do just fine without me.

 

Thanks guys. Yes, all low carb. He’s getting feisty and I love it. I will post an update later.

Do cats “bounce” every day? Just trying to understand if this happens daily?

 

Depends on the cycle, e.g. in a 'quiet' cycle where the cat has a fairly flat series of readings in a range the cat is used to there's nothing to trigger a bounce, or the cat may dip into less familiar numbers in a more active cycle and then their numbers head north for a while in response to the body's self-protection mechanisms kicking in.

It also depends on the cat: some are fonder of their trampolines than others. Blue seems to clear his bounces quite quickly thus far (anti-jinx!). Some cats head up to the gods and stay there for the best part of 3 days!!!

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Some do. Some don’t. Some never stop. How’s that for an answer. Tge quick clearing is a really good sign as Mogs said.

 

So will this always happen for the rest of his life? I’m thinking you can probably see the signs eventually but do you still have to test a lot? What’s the ideal or level where they should be?
So full of questions.....

 

Another thing I was wondering, why would Blue’s number go up at night when he’s not eating? Does he need to have food at night?

 

Cats and FD just don’t make sense. With humans and dogs too I believe, feed them the same and they stabilize. Cats aren’t like that. Carbs work to bring them up but you can feed exactly the same day and night and the cycles won’t necessarily be the same. The good thing about cats is they can go into remission.

Once you have eniugh data you can kind of predict what will happen from the +2-3 test. Blue has actually gone down at night giving you low amps numbers. He hasn’t been on a constant dose for enough days. That’s because he earned reductions. When that happens the count starts over. The fact that he earned reductions so soon is a very good sign. He also was dosed too high and at different levels. Lantus likes consistency.

It’s best to try and feed most of the food in a cycle during the first half. That might help the PMPS numbers to go down.

 

That makes a lot of sense. He was definitely prescribed to much insulin and I feel more comfortable at this level. We see vet again week after next.
Oh, and Blue wants my people food suddenly. He’s like a dog trying to climb into my plate to eat. Very strange because he has never done this.

 

When bg is either hi or low they often get very hungry.

We want to see him staying between 50-120 eventually. Those are normal bg readings. The great news is you are not seeing hi or black much since lowering his dose. Remind me how long ago was the steroid shot and what was it.

 

I had to pull the paperwork but it just says Steroid injection. Date was June 5.

 

Can I use this number for PMPS or should I test again? It’s 7:00 here and I’m giving his shot at 9:30.

 

It’s up to 350 now

 

You are doing so well! Of course I cant give dosing advice but that spreadsheet is impressive. well done!

 

No. Sorry. I know I keep saying it but shooting so late the feeding schedule is so off. If he eats dinner 2 1/2 hours before PMPS it’s messing with the cycles. It makes him high at night. It’s best for most of his food to be eaten during the first half of the cycle. That’s one reason why his preshots are high. I shot at 6:00. I think most give it at 6 or 7.

 

Thanks to Elise it is....and Critter Mom but I don’t know her real name. They know their stuff. I was in total freak out mode! I think you hooked me up didn’t you?

 

I thought he was supposed to eat right before his shot? I normally feed in the Morning and afternoon but now also feed before shot at night. Is that right? I was on a different injection schedule but have got later and later. I’m trying to get back to maybe 8:30...or 8:00 but will take a few days to get there.”

 

I may have been one of the first to greet you.

 

I’m pretty sure you were and said you’re get me help I think. Blue has come a long way. My vet would have killed him with 2 units twice a day. Wow
Thank you for being here for us.

 

I’m pretty sure you were and said you’re get me help I think. Blue has come a long way. My vet would have killed him with 2 units twice a day. Wow
Thank you for being here for us.

 

You are MOST welcome. It is my complete pleasure.This is a magical place one I have a hard time leaving every day. I havent had a diabetic cat in many years yet here I am and if I can help a stranger feel comfortable enough to stay? I have done my job!

 

The drill for each Lantus cycle, AM and PM, is as follows:

* Withhold all food for 2 hours before each preshot BG check is due (so PS test won't be food-influenced.

When the dose is due:

* Do preshot BG check.
* If BG is too low for comfort, stall, don't feed and test again in 20 minutes to see if the BG is rising. If it's high enough proceed, else shout out for help.
* Assuming BG high enough to give insulin, feed the kitty.
* Provided that the cat has eaten enough food and you are confident the cat will continue eating enough during the cycle, then administer the insulin dose.

The shorthand, nuance- and complication-free version is: 'Test, Feed, Shoot.' With a bit of practice, provided BG is high enough on the first PS test and appetite is good then the routine can be done within 15 minutes at the beginning of each cycle.

BTW, I'm known as Mogs, or Moglet.


Mogs
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I used to frequent a hostelry with similar properties when I was busy misspending my youth. It was fondly referred to by its patrons as the Gluepot.


Mogs
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I wasn't sure if that was your name or not....Mogs.
Ok, since I feed in the afternoon, does that mess up the cycle. I think I'm getting confused by what my vet has told me and what I have learned here. I just want to get this right so Blue can be as healthy as possible. Did you feed only every 12 hours or throughout the day and took up food two hours before PMPS?
My vet even mentioned giving him insulin in afternoon if he ate....does this sound right?

 

But you will always have an extra-sweet heart, Jeanne.


Mogs
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You are the welcome committee and I appreciate it. I wasn't sure if anyone would notice me with so many Diabetic kitties in need.
Do you still have a cat or cats?

 

You only need to withhold food for the two hour period before each preshot test. At all other times you can make food available and Blue can fill his boots.

Not in addition to the two scheduled 12/12 doses. Noooooooooo!! (This is a new one on me! )

Technically [*cough*] you could schedule one of the two daily doses in the afternoon, but the other dose - 12 hours later - would have to be given at stupid o'clock every day.


Mogs
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No you can feed several small meals and pick up food until you have enough data two hours before shots. It’s best to feed the majority of the food in the first half of the cycle though as the insulin starts to wear off later. At first Blue was dropping late so I wasn’t thinking about when you fed. I fed Max before insulin and then at +2, +3 or 4 and +6-7. It’s fine to free feed too. I don’t want to confuse you. If you start to see the PMPS high it’s worth trying to not feed late in the cycle. By shooting at 9:30 I was wondering if he ate a lot earlier in the evening. Does this make sense?

 

He ate at 4 with the others. I have one baby that cries for wet food everyday at the same time. OMG it will drive you crazy, but that's what started the afternoon feeding. When I worked we didn't have a problem because I wasn't here to hear Bella.

Blue doesn't normally eat at night but recently he has been hungry. I just fed and shot at 9:15 so I'm easing back to earlier. I feed in the morning of course so that works fine to test, feed and shoot. It's the night I have more problems with. I'll get it.

What's the plan for tonight?

 

I don't really understand why Blue gets high BG in the middle of the night and early a.m. He doesn't eat.

 

That’s perfect then! My girls get fed 3 times a day. They start screaming at me 1/2 hour before.

 

Right now he’s all over the place because he’s had so many different doses. Give it a week ay .75 unless he drops under 90 and see what happens. With all your testing I don’t know why you need to go back to the vet so soon.

 

Glad you restated this, Elise. I should have included that in my response above. (Too used to the need to feed small meals every 3 hours. )


Mogs
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She wanted a follow up to see how he was doing and also his sister Layla, who was constipated. I agree, I might cancel. Maybe I'll just send her the SS to show her what I'm doing.

 

The problem with me feeding so many small meals is he just doesn't eat very much. He ate about a quarter of a can of wet and I gave him some freeze dried chicken treats because he wasn't eating much. I hope that's enough for the shot?

 

Test tonight like last night? +2-3 and +6-7?

 

You have bossy, hungry cats too! Okay, I feel better about the feeding schedule now.

 

Even if a cat doesn't eat for many hours the liver still keeps releasing sugars from its stores throughout that time. (If it didn't do that we'd all completely shut down between meals!)

For general information, in addition to food rises and bounces, two other things of note may markedly elevate BG levels: dawn phenomenon (affects morning blood glucose levels), and impaired fasting glucose (BG goes higher at the end of a longer period without eating anything). Often the AMPS is the last number to come into range when a cat is heading for remission.


Mogs
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I'm knackered. I'm gone.

Till the morrow...




Mogs
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Nite and thank you.

 

Nite Mogs.

 

Mogs made some good points. That’s why when you were seeing the numbers going down at the end I suggested a +11. If it were lower than you have shot but the +12 was going up it would be okay to shoot provided you were able to stay up and monitor possibly for several hours. Stalling too long sometimes the bg goes down and you can’t shoot. Tiger times the insulin is wearing off and the bg rises. Often shooting low gives a nice flat cycle.

 

I think I understand what you're saying. So test tonight same as last night okay?

 

You might not need to set the alarm. Get a +2 for sure. If it’s higher or about like last night just get some sleep and test when you wake up. How does that sound?

 

That sou

That sounds really good! Will be testing soon.

 

How did it go up so much? 542...food?

 

That’s more than a food bump. What did he eat? I dint think he onsets yet. Probably a +3 tomorrow night instead of +2. Ma. Onset between 2-3 .

 

FF classic pate and some freeze dried chicken treats

 

Get some rest.

 

So lc. And the previous Meal?

 

Same FF classic pate and Am Journey morsels (her and "Brat" trade foods) I'm not feeding anyone anything but lc canned.

 

M not familiar with those. Seems he’s just being a cat. Max had a nickname around here, Mr,Unpredictable. Let’s see where he is in the morning.