Emergency advice please!!!!! AMPS 63

tabbylvr

tabbylvr

Member Since 2019
Hi,

I don't know what to do! I'm curving my boy today and his AMPS was 63. I double checked and the next result was 65. He's acting completely normal.

What do I do now????

I've been struggling to get him regulated because he also has IBD. He was diagnosed in January and his numbers have been consistently in the 500s and upper 400s until about 3 weeks ago. His numbers finally started to come down on 4 units.

Do I give him insulin this morning? Do I take his bg again after he eats? Do I give a half dose?

It's worth mentioning that his numbers were high on w/d. I switched to DM and his numbers improved along with the increase to 4 units. But he had horrible smelling diarrhea. I switched to Friskies all canned (not the best choice but they like it) about 2 weeks ago. They get 5 feedings a day.

Again, he's acting completely normal this morning. I hadn't checked bg for a little while :( so I'm not sure if this is normal for him.

Please help,

Nadine
 
It is worth mentioning that my glucometer reads lower than the one we have at work (we did a side by side comparison for the last glucose curve). On average it read between 30 to 60 units lower. That was very confusing. But maybe the 63 is closer to 93 or above - still low but it would explain why he is acting normal.
 
First BREATHE. First 63 is a normal glucose reading. A bit on the low side but normal.

Have you taken another test, if not do so now and post back here.
 
It appears you are using a pet meter and 63 on a pet meter is a bit low assuming the normal range for that meter is the same as it is for the AT2 meter (68 to 150). Not sure why your meter would be reading that much lower than your vet's but it could have been a bad strip or perhaps not a big enough blood sample. Have you rechecked Jeckle's BG again yet?
 
I checked again 20 minutes after eating and it still read as 63. I used the control fluid and that checked out in normal range before taking Jeckle's blood. He's currently running around with a toy in his mouth! I'm not really concerned about him getting hypoglycemic. I just didn't know what to do with the insulin this morning. Giving 4 units with such a low AMPS seemed dangerous to me. I have not given insulin. I will run the curve without am insulin to see what his values are. Is it possible he put himself into remission????
 
You mentioned having just changed Jeckle over to a diet of Friskies so yes it is possible that he has reverted from the diet change. Please recheck his BG again as cats do not always show signs of hypoglycemia until things gets serious. Lantus is a depot insulin so there is still insulin in his system that will be affecting his BG today even though he didn't get a shot this morning. And with a 4u dose, his depot will be playing out for a few cycles.
 
Thank you so much for helping. My own vet isn't helping much lol. Should I not give insulin tonight if his numbers remain low or in range? It's so confusing! I have to work tomorrow but my husband will be home to observe Jeckle. The "good" news is that without getiing insulin his numbers would get higher should he still need it which is less dangerous short term. I can take AMPS and PMPS on Friday and do a midday value as well on Saturday and will be home with him on Sunday. Is there a recommendation when you should not give insulin?
 
I think you are going to have to take this day by day. It would be easier to give you advice if you would plug in some readings between the 6th and 16th of April on the spreadsheet for us to review. I definitely think a dose decrease is needed but by how much is impossible to know without some more current data. We need to see what his pre-shots have been and what his mid cycle readings have been but that low reading today definitely suggests the 4u is too high.

Has Jeckle ever has ketones or DKA? That info has to be taken into consideration before I can suggest any dose change. What dose did your vet start him on? How quickly was the dose increased? It appears to have been 1 unit at a time and you've indicated you're using the Solostar pen which doesn't allow any smaller dose changes.

I'd strongly advise you to get some syringes with half unit markings so you can make smaller incremental dose changes of 0.25u. Our kitties are tiny creatures and dose increase of 1u at a time often lead to missing the ideal dose. You need 3/10ml gauge 31/33 8mm syringes.

For now, I'd suggest no insulin unless BG is at least 225 until we can see more recent data.
 
MrWorfMen's Mom said:
It would be easier to give you advice if you would plug in some readings between the 6th and 16th of April on the spreadsheet for us to review.
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I don't have data for those days. I became complacent and didn't take his bg because he was doing great.

MrWorfMen's Mom said:
Has Jeckle ever has ketones or DKA?
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Yes, he did. When I first took him in he had DKA. He's better now, no more ketones in his recent labs and he has gained weight.
MrWorfMen's Mom said:
What dose did your vet start him on?
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We started at 1 unit bid, then went up to 1.5 then 2, 3 and 4. I use the pen with regular .3cc syringes
 
Are you testing for ketones at home? It would be wise to do so regularly as ketones can start and overwhelm the system quickly and you definitely don't want to go there again! You can get ketostix at the pharmacy and test Jeckle at home. SOme folks can hold a ladle under kitty's butt as they pee while others use plastic wrap crumpled up in the litter box to grab a small sample. That can be problematic is there are other kitties in the house but otherwise often works well.
As far as dose is concerned, given those low readings of late and the history of DKA, I'd suggest dropping the dose to 3.75u for now but make sure you are monitoring Jeckle if you give insulin. Does your husband test Jeckle or just visually observe? It's imperative that you get some mid cycle tests so you can intervene to ensure that Jeckle doesn't drop too low.
 
MrWorfMen's Mom said:
Does your husband test Jeckle or just visually observe?
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Unfortunately, he's pretty much useless. So no on taking a bg :(

I will be checking throughout the day. His bg at 9:45am was 76. Let's see how it goes for the rest of the day. If I end up giving insulin tomorrow, my husband will have to observe for any signs of hypoglycemia. Although he shouldn't get too low if I don't give insulin. Or I could take him to work with me tomorrow if I end up giving insulin. He doesn't like it, lol, but he'll be close to me (did I mention he's my favorite and the best cat ever!!!!).

I will grab some ketostix from work. Luckily for me, he's a very regular peer (always right after eating) and trusts me completely so I'll be able to get that done without problems.

I have to admit that with work I'm not always able to stay on an exact 12/12 schedule. I have been really close though for quite some time with an occasional deviation of 45 min. I'm hoping that the diet change and clearing up of diarrhea has influenced his numbers positively. Keep all fingers and paws crossed.

My glucometer marks 70 and below as low and 180 and above as high. If I get a reading of 200 or higher tomorrow (am not expecting it today), then I'll give 3.75 units and take him to work.
 
Just make sure you have lots of supplies (strips, honey/karo syrup, high carb wet food) so you are equipped to deal with any potential low event if you take him to work with you. I love your dedication. There are a lot of folks who would envy you having a job you can take your cat to. Just keep in mind that you do not want Jeckle going below 70 (68 is the number we use here which is basically the same).
Given the DKA history, you might want to give a bit of insulin if BG is between 150 and 200 at preshot but I'd keep it at 1 to 1.5u at most until you can grab some more data and watch how low Jeckle's BG is going. Don't want to chance ketones showing up again or a hypo episode. Jeckle may be higher tonight at pre-shot tonight from bouncing due to those low readings today but don't think that means he needs more insulin. He still earned the reduction regardless.
 
tabbylvr said:
It is worth mentioning that my glucometer reads lower than the one we have at work (we did a side by side comparison for the last glucose curve). On average it read between 30 to 60 units lower.
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Did you do those tests in high numbers or low? Meters can be up to 20% out, so if you are testing in the 300's, those 30-60 points out are perfectly valid. BG readings are much closer between different meters when you get to the low numbers where you really need them to be accurate.
tabbylvr said:
Is it possible he put himself into remission????
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More likely he need a dose reduction. First aim for regulation, it's a prerequisite for remission. It's like with the low AMPS and skipping he will be quite a bit higher tonight. No more than 3.75 units tonight. I wouldn't suggest a lot lower due to the history of DKA. We have seen ketones go from trace to high in less than 24 hours.
tabbylvr said:
I don't have data for those days. I became complacent and didn't take his bg because he was doing great.
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Aren't you glad you decided to test today. What if you hadn't? This is why we stress testing before each and every shot. Your spidey senses must have been tingling this morning.
tabbylvr said:
I have to admit that with work I'm not always able to stay on an exact 12/12 schedule. I have been really close though for quite some time with an occasional deviation of 45 min.
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1/2 hour out per day is fine. The 45 minutes may be OK when he's running in higher numbers.
 
Can you confirm if you are using a pet meter ( alphatrak 2) or a human meter please and put it in your signature. Thanks. It makes a difference in suggestions.
 
His numbers have remained low throughout the day. I will take another bg at 7pm and then decide if he needs insulin. It doesn't seem to come up very fast.

My vet finally responded. She said no insulin if number is below 200, 2 units if above 200, 3 units if above 300 and 4 units if above 400.

Jeckle has a healthy appetite (not ravenous), is not drinking a lot of water (hardly any since eating all canned), is active and content, and has gained weight steadily.

I really am wondering if the 4 units bid aren't the reason his numbers have stabilized. But I'm right in not wanting to give 4 units when bg is 63 right???? All I want to do is right by him! It's so stressful. I wish I had checked more often the last couple of weeks. Maybe this is normal for him?
 
tabbylvr said:
His numbers have remained low throughout the day. I will take another bg at 7pm and then decide if he needs insulin. It doesn't seem to come up very fast.

My vet finally responded. She said no insulin if number is below 200, 2 units if above 200, 3 units if above 300 and 4 units if above 400.

Jeckle has a healthy appetite (not ravenous), is not drinking a lot of water (hardly any since eating all canned), is active and content, and has gained weight steadily.

I really am wondering if the 4 units bid aren't the reason his numbers have stabilized. But I'm right in not wanting to give 4 units when bg is 63 right???? All I want to do is right by him! It's so stressful. I wish I had checked more often the last couple of weeks. Maybe this is normal for him?
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Lantus insulin does not get dosed on a sliding scale. Lantus like consistent dosing.. unless kitty drops low in which case you reduce the dose.

It does not sound as if your vet has a lot of experience with FD.
I would not give your kitty 4 units. Looking at your SS it looks like Jeckle is maintaining normal numbers with no insulin at the moment. I would continue to test frequently ( noting when you give food in the remarks column so we can see) and if the Preshot is over 200 post and ask for help. Don’t give any insulin under 200 without posting and asking advise.
It is possible Jeckle has gone into remission but only time and testing will tell
 
tabbylvr said:
Does that help?
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That does sound as if it falls into the same group as the other pet meter, the alphatrak meter. So the numbers you are getting at the moment are in the normal range for a cat so keep testing and recording for a few days and if he stays in these numbers we can start an off the juice trial which lasts for 14 days. We want him to have a strong remission if that is the way he is heading. Keep feeding the low carb food only. If he is not getting any insulin he will not drop too low.
 
Bron and Sheba said:
I have not heard of the iPetPro meter. I am going to tag @Jill & Alex (GA) to see if she knows anything about it. Here is a link Jill
http://www.ulticare.com/pet-blood-glucose-monitoring/
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Yes, this is one of several meters calibrated for pets. Expect to see numbers similar to what you'd see with an AT.

Although, found this interesting:
http://www.ulticare.com/pet-blood-glucose-monitoring/

The iPet PRO™ is the first pet blood glucose monitoring system to consistently achieve ±15 mg/dL accuracy against a laboratory standard 98% of the time, exceeding the minimum acceptable accuracy criteria specified in ISO 15197:2013.
  • New advanced technology detects and corrects sources of error
  • Accurate data from home measurement helps assess an ongoing treatment plan
  • Analyzes both venous and capillary blood samples

FWIW, In the absence of a current ketone test I'm less worried about a ONE time skip or shooting a reduced dose once under these circumstances if kitty is eating well, is not showing any signs of illness, and is acting normally (not sick or lethargic).

I'm sorry. I'm in the middle of a family emergency involving my granddaughter. I'll try to check back later.
 
Bron and Sheba said:
It does not sound as if your vet has a lot of experience with FD.
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Sigh, it's so difficult because I work there...but she has called the specialist a few times already for advice.
Bron and Sheba said:
Don’t give any insulin under 200 without posting and asking advise.
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That you agree on with my vet!
The problem is, I might be needing to leave for work and won't be able to wait for an answer (if that occurs Sat)...some people here mentioned to reduce the dose to 3.75 once the numbers go over 200. I will continue to test and obviously post when I get to that point but I may have to make a decision. But, I suppose, I can always take him with me.
 
Jill & Alex (GA) said:
FWIW, In the absence of a current ketone test I'm less worried about a ONE time skip or shooting a reduced dose once under these circumstances if kitty is eating well, is not showing any signs of illness, and is acting normally (not sick or lethargic).
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Definitely not acting sick. Zooming around, playing, etc. Now snoozing. I will check for ketones tomorrow.
 
Can you put that he has a history of DKA in the signature please. I had checked the signature and thought no DKA in picture then read back through and saw he had after I read Jill’s post.
Definitely get a ketone test ASAP as stopping insulin with recent DKA needs constant testing for ketones.
It’s really important he is eating well and any sign of being unwell or lethargic is acted upon. .
Obviously you can’t give any insulin with the numbers the way they are at the moment but if They go up to 200 again it is important that the insulin is given.
 
Ok, PMPS was 82. Definitely no insulin tonight.

I'll have to run a quick errand but I have 2 questions:

1. Ketones - he did have ketones when he was first diagnosed. I assumed that ketones were a by-product of the disease. In other words, because I didn't recognize the symptoms soon enough, his body started metabolizing itself so to speak. Now that he is better and hasn't had ketones in his recent labs (4/3), why are you guys so concerned about ketones? If anything, wouldn't those occur with abnormally high numbers?

2. Any suggestions on how NOT to bruise the ears during bg testing? That's the main reason I stopped for a couple of weeks. Maybe I'm too heavy handed? I use the rice sock which has helped tremendously and 30g lancets. Truth be told, his ears don't look better when our RVT does it lol. Is that just the way it is?
 
Did he have just ketones or DKA?
DKA is a much more serious illness which results from ketones and he would have been hospitalised.
We worry about ketones because ketones develop in the urine and blood if there is not enough insulin given or not enough food eaten and an infection or inflammation present. If not addresses it can snowball into DKA. Some cats are more prone to getting ketones than others. Once they have had them it is really important to monitor them to see they don’t Reoccur. Stopping insulin suddenly or reducing insulin with recent DKA is not without its risks.
 
Bron and Sheba said:
Did he have just ketones or DKA?
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I believe DKA. He had elevated liver enzymes, high cholesterol, low phosphorus etc.
He was hospitalized on IV fluids for a few days but I always felt that was done more for me - to make me more comfortable with the situation and less panicked. He probably could have gone home sooner according to my vet.

But now I'm even more confused. His bg only reached 95 at 4:05pm. All other values were lower. PMPS was 82. So still in range. I thought that was a good thing. But I guess I have to see what happens once he uses up his depot? Let's see what his value is in the morning. If I don't take him to work then I'll bring ketostix home with me.
Bron and Sheba said:
Stopping insulin suddenly or reducing insulin with recent DKA is not without its risks.
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What if his values stay low??? Why can't it be easy??? I don't want to stop suddenly but if his numbers don't come up and I don't give insulin, he can get sick again???
 
tabbylvr said:
I believe DKA. He had elevated liver enzymes, high cholesterol, low phosphorus etc.
He was hospitalized on IV fluids for a few days but I always felt that was done more for me - to make me more comfortable with the situation and less panicked. He probably could have gone home sooner according to my vet.

But now I'm even more confused. His bg only reached 95 at 4:05pm. All other values were lower. PMPS was 82. So still in range. I thought that was a good thing. But I guess I have to see what happens once he uses up his depot? Let's see what his value is in the morning. If I don't take him to work then I'll bring ketostix home with me.

What if his values stay low??? Why can't it be easy??? I don't want to stop suddenly but if his numbers don't come up and I don't give insulin, he can get sick again???
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Ok so best put DKA in the signature so we are alerted to that.
It is good that his numbers are in the normal range. If they are in normal range you can’t give insulin, but I’d still monitor for ketones until we see what he is going to do. It could still be the depot talking. Do exactly what you are doing now except add in the ketone tests at least daily.
If his numbers stay low then you start an OTJ ( off the juice trial)
I’m going to tag @Kris & Teasel to see if she has any other suggestions. Jill said she would pop back in later when she had dealt with her emergency.
ETA it is my understanding that once the cat is no longer dependent on insulin to maintain normal BSLs ie are in remission, they won’t get ketones. If I am incorrect I’m sure someone will correct me on that.
 
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tabbylvr said:
What if his values stay low??? Why can't it be easy??? I don't want to stop suddenly but if his numbers don't come up and I don't give insulin, he can get sick again???
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All you can do is take this one day at a time.

You have a blood glucose meter and you know how to use it. Let your meter be your guide. Start testing for ketones as Bron mentioned. Don't worry. Between testing his BG levels and for ketones... you've got this! Post your results and we can help you through this. Jeckyle may or may not require more insulin. Time will tell.

Hope to see you posting often!
 
His bg this morning on my glucometer was 126, the one at work (which usually clocks him higher) showed a surprising 107. Both were done side by side. I'm also sending out a glucose test to our lab. I should have the results late this afternoon but I'm expecting them to be similar. We checked for ketones - negative.
No insulin given this morning either. That's 3 doses missed now. It seems like his numbers are creeping up though. Keep all fingers and paws crossed please that they stay in range!!!!!
The good news is he has gained more weight and is back to his old fighting weight of 11#. He's a very lean, lanky, long cat.
 
Thrilled to hear ketones are negative! Since you checked Jeckles BG at work today and he doesn't like it there, those readings could be a bit stress elevated. Both are still within normal range so I think you'd be better off right now deciding on whether he needs insulin or not based on home readings where he is not stressed given how low he went yesterday. Your vet gave you some suggestions about dosing and if and when you get a pre-shot above 200, if you want our opinion, I'd suggest you post then as clinical signs at the time will also need to be taken into consideration. Keep checking for ketones.

If you could enter the data you got today on the spreadsheet and keep the spreadsheet up to date, it will make it easier for folks here to help you make dosing decisions.
 
Day 3 without insulin!!!! Numbers have crept up to the 100s though...131 this morning being the highest so far.
MrWorfMen's Mom said:
If you could enter the data you got today on the spreadsheet and keep the spreadsheet up to date, it will make it easier for folks here to help you make dosing decisions.
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It's updated! I'm getting am and pm bg's now. I got some 28g lancets and life is much easier all of a sudden!
 
To prevent ear bruising on M'row, I put one finger on each side of the ear at the puncture site and maintain pressure for 15-30 seconds; hope this helps!
 
Bron and Sheba said:
Try testing the BSL 2 to 3 hours after feeding (and testing.) If the BSL goes down that means the pancreas is working .... how much is yet to be seen.
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I ran low on glucose strips...how does that happen...one minute the container is full, the next you have 5 left :oops:! I've only taken AMPS which have all been in range. I've received more glucose strips today and will continue to test. I may only do AMPS because his values have been perfect (in the 80s). I will check 2-3 hours after breakfast and BG as soon as possible though!
I really believe that this may have been steroid induced. He must be very, very sensitive to them. He started to look/act different once put on Budesonide. I know it's a locally acting steroid and that only a tiny amount gets absorbed by the body but that tiny amount is 15x stronger than Prednisone...Jeckle may have a slight predisposition towards diabetes and that combined with steroids and a high carb diet may have just put him over the edge. At least that's my hope! For now I keep on testing (ketones too!) and hope for the best. Maybe I got lucky!!!! I marked his chart 'No Steroids' to prevent any further flare-ups
 
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