Dude, newly diagnosed blood glucose PMPS @ 143, 4th test

[jmichaelp]

Another first time success! Blood glucose at 373. This is the same as the "no shot" value, so it looks like he needed 1 unit for the PM dose. I'm going to give him 1 unit, the same as yesterday's 373 & see if it moves blood glucose down as much as yesterday.

 

[jmichaelp]

I'm gonna be brutally honest with you, he probably did, we just don't know about it due to the lack of data/tests. But he's clearly been riding them out like a wee champion he is! Their bodies know something is wrong, and when they drop to dangerously low levels they either
a) intuitively seek food to bring their BG up [is there a possibility he'd eat on his own without your knowledge e.g. when you're asleep?]
b) their liver "panic" and secrete extra glucose.
The suggestion to lower his humongously high dose drastically was based on him giving very inconsistent BG values - to me it looked like he was "bouncing" - dropping low, then bouncing sky high as a result of his panicky liver.


I'm incredibly happy for you have being able to get a test for first try! It'll become easier, once his blood is less concentrated/clogged with sugar, allowing for easier blood flow.
Plus clearly your patience and persistence is paying off, too!

You were meant to decrease by 0.25 IU, so his dose should've been 0.75 IU. Let's see what he gives you for AMPS. Hopefully it's another blue, then you'll know your judgement of injecting 0.5 IU was correct.
However, looking at his sheet where you shot a blue with 0.5 IU, the following PRE was yellow, which makes me think he'll give you a yellow AMPS again.
With that said though, Lantus likes consistency, so perhaps it would be best practice to keep with the 0.5 IU for the next at least 5 cycles.
In these upcoming 2 days, could you perhaps buy a digital caliper, which would allow you to measure out 0.25 units?

Well done Mike and little Dude, you've got this!

This 373 reading is almost 2 hours since being fed while yesterday's was fasting.

Whether he will live is still undecided. I discontinued the Zeniquin for his UTI, that seemed to bother him, when I stopped it before I wasn't sure now I am. He was more active this morning, even tried to jump up onto the bed with me.

I see where it states reducing by 0.25 units but then references the FAQ & states:
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)

 

[Don Degludec]

This 373 reading is almost 2 hours since being fed while yesterday's was fasting.

We don't feed 2 hours prior shooting, for the pre-shot number is being influenced by the food and it reads higher. We test, feed and shoot [usually while their heads are in the bowl]. His "actual" pre-shot value likely have been much lower than 373, probably in the yellows [or maybe even in the blues].

I'd encourage you to stick to a consistent dose, or you'll end up in the exact same predicament where you were at the beginning.

Lantus. Likes. Consistency.

Dude needs 0.75 IU twice a day in my opinion. If you can't measure that, stick to 0.5 IU for the following 3 days. You can't keep dose-hopping, you're endangering him.

 

[jmichaelp]

We don't feed 2 hours prior shooting, for the pre-shot number is being influenced by the food and it reads higher. We test, feed and shoot [usually while their heads are in the bowl]. His "actual" pre-shot value likely have been much lower than 373, probably in the yellows [or maybe even in the blues].

I'd encourage you to stick to a consistent dose, or you'll end up in the exact same predicament where you were at the beginning.

Lantus. Likes. Consistency.

Dude needs 0.75 IU twice a day in my opinion. If you can't measure that, stick to 0.5 IU for the following 3 days. You can't keep dose-hopping, you're endangering him.

I have to feed him when he seems hungry. Sometimes he doesn't want the syringe. The spreadsheet doesn't show food consumption, which is a reason it didn't make sense to me. So I assumed that food must not matter as much as I thought.

As I'm interpreting the guidelines, they indicate that I should alter the dose according to his blood glucose level. I'm confused.

With two straight 1st attempt successes, I'm going to try to get more readings during the day today. However since I'm syringe-feeding him throughout the day there's always going to be a food effect.

 

[Don Degludec]

I see where it states reducing by 0.25 units but then references the FAQ & states:
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)

I stand corrected, apologies. It's been a while since I've followed SLGS.

so it looks like he needed 1 unit for the PM dose

I don't understand your thought process, Mike. First you state you wanted to give 0.25 IU, then you state he likely have needed 1 IU. Although the latter may be the case, due to the lack of monitoring and data, we cannot be sure. It takes time to see a pattern in a spreadsheet, and some experience and knowledge to understand how depot insulins work.

E.g. you shot 1 IU on a pink yesterday AM. Nadir [the lowest point in cycle] can occur anywhere between +4 and +8 [as a rule of thumb we say usually at +6]. His PMPS likely reflects his BG curving back up already. Had you shot that number with 1 IU, in the PM cycle he could have dropped dangerously low while you're asleep. There is also an overlap between doses...

That's why it's so important to get at least one more test mid-cycle. Also, please remember, we adjust the dose based on the nadir. If you're able to get in more tests mid-cycle, you have to adhere to those rules, for the safety of your cat.

 

[Don Degludec]

Sorry, we were posting at the same time.

So I assumed that food must not matter as much as I thought.

Food does matter, quite a lot. It is encouraged to feed the cat all day, or "feed the cycle" per se, so his BG stays stable or he's giving us a "flat" cycle - meaning he is in the same colour bracket throughout the entire cycle.
The original [German] guidelines state to feed the cat at AM PRE +3 +6 +9 / PM PRE +3 +6 +9. I believe here is encouraged to feed the cat every 2 hours. Sounds like it's working out perfectly in your case, but I would definitely hold food off for 2-3 hours prior to PRE checks.

As I'm interpreting the guidelines, they indicate that I should alter the dose according to his blood glucose level. I'm confused.

We alter the dose based on the lowest point in cycle which is why it's important to spot-check the cat throughout the day. We only alter the dose based on pre-shots if it's too low for comfort. It is to ensure the cat doesn't go hypo mid-cycle - see my previous comment re: why it was wise to give him a reduced dose seeing that blue at PMPS yesterday.

I'm going to try to get more readings during the day today.

If you can, today try and check Dude at +6. Tomorrow at +4. The day after +7...etc. This way the "gaps" will be filled on the sheet, thus more accurate dosing advice can be given.

 

[Don Degludec]

The spreadsheet doesn't show food consumption, which is a reason it didn't make sense to me.

You can add food consumption in the "Remarks" block at the far right column of the sheet. Or can even type the food amount and type etc under the hour [e.g. +3, +6 etc] when you feed him.

 

[jmichaelp]

I was able to get blood to test after only 2 tries! Blood glucose level at 225. I was antsy & took it early (2hr 45min), wanted to make sure if was before the next time I feed him.

 

[jmichaelp]

I stand corrected, apologies. It's been a while since I've followed SLGS.



I don't understand your thought process, Mike. First you state you wanted to give 0.25 IU, then you state he likely have needed 1 IU. Although the latter may be the case, due to the lack of monitoring and data, we cannot be sure. It takes time to see a pattern in a spreadsheet, and some experience and knowledge to understand how depot insulins work.

E.g. you shot 1 IU on a pink yesterday AM. Nadir [the lowest point in cycle] can occur anywhere between +4 and +8 [as a rule of thumb we say usually at +6]. His PMPS likely reflects his BG curving back up already. Had you shot that number with 1 IU, in the PM cycle he could have dropped dangerously low while you're asleep. There is also an overlap between doses...

That's why it's so important to get at least one more test mid-cycle. Also, please remember, we adjust the dose based on the nadir. If you're able to get in more tests mid-cycle, you have to adhere to those rules, for the safety of your cat.

From what I read "give a token dose (10-25% of the usual dose)". "The usual dose" is that which I was adjusting down to, 1 unit, from the earlier very high dose. So 0.25 units for the PM dose, but 0.5 units was the only value I thought I could reliably dose so that's what I gave. I also didn't want to give him much (i.e. 1 unit) and have him go hypoglycemic when I was asleep so I was unsure about how much to give.

I went with 1 unit for the AM dose to give a consistent dose & because that's what I gave the previous day when he was at 373. I was going off the feline diabetes spreadsheet & forgot to look at my spreadsheet that has feeding time/amount on it.

Due to my lack of knowledge, I'm asking before each dose & putting a "?" in the title. If I don't receive a response then I have to make a decision give him the insulin.

 

[Don Degludec]

You're doing great Mike, and learning fast! You'll have this down to a T in no time

If you need dosing advice, start a new thread under Lantus/Levemir/Biosimilars, starting with the current day's date, whether you need help with AMPS or PMPS and the value. Can pop a question mark at the front as well, so it pops out to the mods/well-known members. You'll see there how the members write their titles.

E.g.:
[?] 11/05 Dude PMPS 190 - Do I shoot?

Or 05/11, even. My mind is set to EU date format

 

[jmichaelp]

You're doing great Mike, and learning fast! You'll have this down to a T in no time

If you need dosing advice, start a new thread under Lantus/Levemir/Biosimilars, starting with the current day's date, whether you need help with AMPS or PMPS and the value. Can pop a question mark at the front as well, so it pops out to the mods/well-known members. You'll see there how the members write their titles.

E.g.:
[?] 11/05 Dude PMPS 190 - Do I shoot?

Or 05/11, even. My mind is set to EU date format

Thank you so much for your help & patience!

Really happy to report that Dude is doing so much better post-Zeniquin. He actually went exploring all over the house & all of the way out to the screened porch to look over his territory. He was able to interact with my other cat Lilli, which was good for both of them (she knows something is going on in my office & doesn't even come in anymore, never asked to her to refrain from doing so).

 

[Don Degludec]

I'm glad I could help

That's wonderful news!!! I'm extremely proud of you, and over the moon that you didn't give up on your little dude, regardless of all the struggles you both are experiencing.
Remember: ask for advice, but if something doesn't sit well, go with your gut - like I know you would, e.g. signing up to this forum and asking for dosing advice here and discontinuing Zeniquin. I am 100% sure your vet has Dude's best interest, but sometimes vets get overwhelmed too [they're only human after all] so they may overlook or misjudge things.

Now if I can be cheeky enough to ask you to try and get in an additional test at the +6 or +7 mark please...
Provided that, once PMPS hits and Dude's BG is under 200 again, if you post in the Lantus forum, the experienced members will be able to help you hopefully, if they see how low 1 IU brought Dude down from the pinks/have a rough idea how the cycle progressed.

Edit: If/when you're starting a new thread under Lantus, you may want to copy-paste this thread's link on the top [not the title, but on top of the conversation/post box] so others can have easy access to this sequence of conversation, to prevent questions repeated etc etc. Would eliminate probable confusion and speed up things both for you and the members who'll try to help you.

 

[jmichaelp]

Blood glucose nadir test 173. 2.5 hours after feeding 57 calories. Do I need one more test before his PMPS?

 

[Don Degludec]

Excuse me, where is the "I can't test my cat" Michael, and what did you do to him?

I was just going to ask whether you think you could get in another test before PMPS, but I didn't want to push my luck

Will you be able to monitor the PM cycle at all? If so, give your boy a break for now [and lots of pets for being amazing with the ear pricks] and perhaps test him during the PM cycle. If you won't be able to monitor that, then a +9 before a little feed would be great. And try to not feed him after that [so after +9.5/+10 - depending how long it takes for him to eat].

I'm wondering whether your little champion will be giving us a blue as a PMPS again...
Since you've shot last night's blue with 0.5 IU and the cycle wasn't monitored/tested, we can't be sure whether he gave us a pink AMPS today because
a) the 0.5 IU wasn't enough, or
b) the 0.5 IU was too much for a blue and he dropped low and bounced back up by the morning... or
c) simply because you fed him before the AMPS test

But I'm thinking way ahead already.

Edit to add: if his PMPS is blue again, definitely post and ask for advice under Lantus, mainly because 1) more experienced members, but also 2) I probably won't be awake to see if you post under this thread.

Edit #2: if his PMPS is yellow, I think you can safely give him the 1 IU. But if you're not sure, it's always better to ask.

 

[jmichaelp]

Excuse me, where is the "I can't test my cat" Michael, and what did you do to him?

I was just going to ask whether you think you could get in another test before PMPS, but I didn't want to push my luck

Will you be able to monitor the PM cycle at all? If so, give your boy a break for now [and lots of pets for being amazing with the ear pricks] and perhaps test him during the PM cycle. If you won't be able to monitor that, then a +9 before a little feed would be great. And try to not feed him after that [so after +9.5/+10 - depending how long it takes for him to eat].

I'm wondering whether your little champion will be giving us a blue as a PMPS again...
Since you've shot last night's blue with 0.5 IU and the cycle wasn't monitored/tested, we can't be sure whether he gave us a pink AMPS today because
a) the 0.5 IU wasn't enough, or
b) the 0.5 IU was too much for a blue and he dropped low and bounced back up by the morning... or
c) simply because you fed him before the AMPS test

But I'm thinking way ahead already.

Edit to add: if his PMPS is blue again, definitely post and ask for advice under Lantus, mainly because 1) more experienced members, but also 2) I probably won't be awake to see if you post under this thread.

Edit #2: if his PMPS is yellow, I think you can safely give him the 1 IU. But if you're not sure, it's always better to ask.

Luck be a lady tonight - was headed to Vegas after my recent success!

I was slated to feed him @7:30 pm & then @11:30 pm. With that schedule, I could give a +10.5 but then I'd have to give another right after for PMPS.

 

[Don Degludec]

Oh no, men of Vegas better be locking away their girlfriends tonight!!!

Mike, I have absolutely no idea what time zone you at, I'm in GMT, so on my end it's 00:15 at the moment.

We normally feed the cats with a main meal/bulk of their calories after testing their pre-shots/giving them the insulin. I inject mine when his head is in the bowl and he doesn't notice it, because I'm not willing to put up with his dramatic attitude. Then we feed them little amounts of food throughout the cycle, don't feed at least 2 hours prior to the pre-shot checks, and rinse and repeat.

 

[jmichaelp]

So the PMPS was at 143. This is a continual decline from the AMPS of 373. Last night the PMPS was 189 & jumped to that 373 with 0.50 unit of Lantus. So it seems as if I should give more tonight since last nights jump. I didn't hear from anyone so I went with 0.50 since I'll be feeding him less than last night.

 

[Don Degludec]

So it seems as if I should give more tonight

Ummm... no?
From what we know his nadir was at PMPS. You're injecting a still decreasing number...

b) the 0.5 IU was too much for a blue and he dropped low and bounced back up by the morning...

If you don't feed him during the night, this might be the case.

 

[Sienne and Gabby (GA)]

I'd like to kindly ask that you start a new thread. If you look at the top of the board, there are a couple of posts that ask that threads be capped at 50 posts. There's a lot to read! You can link this thread to your new one.

 

[Don Degludec]

He did here, under Lantus.

Sorry, it was my fault too - the # of each post doesn't show on my phone for some reason.