? Help! 10.2 PMPS Test

Hi

Douglas' BG pre shot result just now was 10.2.

Shall I not feed him and test again in 20 mins?

 

Yes, do not feed and test again.

I'll see if I can find a caninsulin user for you.

 

@Panic

 

Please post the test in 20 min, should be a few minutes from now.

 

New test just done, 11.6

Not sure where to add on the spreadsheet, sorry

 

Also, a very moany cat asking where his food is!

 

Okay he's high enough for full dose. Will you be able to monitor a bit though since this is the lowest he's been at pre-shot for dosing?

Here's what you put on the SS to make it make sense: 10.2, 11.6 (+12.20)

You'll have to color the cell manually, I would color it blue since that was the lowest number.

 

Yup, I can monitor for a bit see how he gets on. He'll be glad to be getting some food!

Will update the spreadsheet

Thank you @Panic

 

They always get so offended when we stall! Great job though!

 

So, just to know for future. If the number is below the no-shoot threshold (11.1), would you always stall 20/30 mins, retest, and if the numbers are going up (above this threshold) then go ahead and continue with feeding and then shooting?

 

Ha, so offended! I was trying to distract him but he was not having any of it!

 

Typically yes, because if the numbers are going up on their own they're going to keep climbing if you were to skip. Here's a refresher from the Caninsulin guide:

Q: Is my cat’s BG high enough for insulin?
For those NEW to treating feline diabetes, and/or those who don’t have much data about how their cat responds to insulin, we generally recommend that you post to either this forum or the Health board and ask for help if the pre-shot BG is below 200 mg/dL [11 mmol/L] on a human meter. Experienced members can walk you through the options of what to do if you have a lower than expected pre-shot number.

Q: It’s time for my cat’s shot, but the BG is a little too low. What now?

• If your cat’s BG is a bit below 200 mg/dL [11 mmol/L] on a human meter, consider ‘stalling’.
  • Stalling is waiting - without feeding your cat - for 20+ minutes, then retesting to see if the BG has risen to a suitable level.
  • You are looking for a number that is rising, not falling, and is high enough to give insulin.
  • If you have time, you can repeat the stalling process to see if the cat’s BG reaches a number you can shoot.
• If you cannot stall do to time constraints, if numbers are continuing to drop or if you do not have a supply of strips and high carb food on hand, it will be safer if you skip the shot.
• Note: As you gain experience with home testing and have gathered data to show how your cat responds to insulin, you will become more confident and better able to shoot progressively lower numbers.
• Ask for help on the forum before giving insulin if you are unsure, as you can never ‘un-shoot’ insulin.
• If your cat has history of ketones or DKA, or other health issues, or you are concerned, DO post on the Main Health forum for further advice

These kitties are not to be messed with when food is involved! I used to have to hide in closets and spare bedrooms when opening any sort of can - even if it was just something for me!

 

Thats great, thank you

And as I am adminsitering his insulin a little later than usual. Should tomorrow mornings shot still be at the usual time or 12 hours from his shot this evening?

 

Caninsulin has a lot of wiggle room honestly since the duration is so short. If you're less than an hour off I would just go back to your regular time in the morning.

 

It does start to get a bit nightmarish when you start shooting lower than usual numbers. Your 10.2 and 11.6 aren’t really much different and although the key is to shoot “on the rise”, ie when numbers are going up, at that kind of number I would exercise caution. He may start going up again quite quickly in which case shooting now should help to stop too steep a climb, or he may have been surfing in the blues in which case a full dose might drop him a bit too fast. It’s one of those situations where you just have to stay alert and get a few more tests in early in the cycle to monitor what’s happening. Good luck!

 

Agreed, especially on Caninsulin. Early testing is often needed on fast-acting insulin such as this.

 

Look for any hint of a 'hunger uptick' from +1 onwards as that can signal dose onset time (varies, but usually between +1 and +1.5).

Test at +2 to potentially get advance warning of a big drop. Test at +3 minimum to see how low the dose is going (most of the drop usually occurs by then, but nadirs can be later).


Mogs
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Sorry, but whats a hunger uptick?

 

See if Douglas starts behaving as though he's looking for food (e.g. going to his bowl). Sorry I didn't explain properly first time, Anna.


Mogs
.

 

In my defence, I did put the term in quotes!


Mogs
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'Stalling' is a very useful option if the preshot is 'close' to a shootable number, but is just a bit too low.
With Caninsulin you do certainly want to see that the number is 'shootable' and is rising.

If the preshot is technically shootable but is lower than usual then you have several options. You could skip the shot. You could give a reduced dose, maybe a half dose, maybe a small token dose. Or you could give the full dose. But ideally in that last situation you DO need to be prepared to monitor blood glucose and to keep the blood glucose at a safe level if it looks like it might drop too low.
Do take the course of action that you feel most comfortable with. And you always have the option of giving a lower dose, which can be especially helpful if it is the evening shot and you know you really need to get some sleep....

Douglas seems to get the lowest number of the cycle later than is typical with Caninsuln, and anywhere between +5 - +7 (maybe even later on occasion...).
It may be an 'uneventful' cycle this evening. But if you are at all concerned, Anna, then DO post here for advice. And the lovely folks here will guide you through any situation that may arise.

BTW, that was a lovely PM cycle yesterday....

Eliz

 

@Douglas_my ginger cat

Anna, Eliz has said it all nice and clearly. Do please keep posting this evening if you are at all worried... there will always be someone around. I see Douglas has risen slightly from his PS number but you just never know where he might be going next.
Paws crossed for a nice cycle

 

Down to 8.5 at +2... keep a close eye!

 

To be honest, Douglas has been looking for his bowl for the last few days. I mean he's definitely been a bit more 'active' and vocal including letting me know he's leaving or coming into my bed at all hours of night! Which in some way is nice as its a little like his old self, prior to diagnosis.

If he does look for food, should I give him some?

Its lovely to see his numbers so low but does put me slightly on edge as I dont want them to go too low.. Its almost like a double edged sword for me

@Diana&Tom paws crossed!

 

This may be a silly question but what number is 'too low'. Just in case no hypo symptoms show

 

2.8 is the "take action" number, however with Caninsulin you really don't want him dropping below 5. If he does you want to start feeding small meals and testing every 15-20 min until he goes over 5 again and can stay there.

 

Yes, unaccustomed numbers can be scary that’s for sure. It is a fine balancing act as you’re now starting to see.
If he wants food, I would give it to him, yes, just small amounts though, and keep testing, especially if he starts acting strangely. If he keeps dropping from the 8.5 in the next hour, say below 5 or 6, you may want to get out some higher carb food as a kind of first defence against a further big drop. 5 or 6 are lovely normal numbers but you don’t want to be seeing them too early in a Caninsulin cycle when there may be further drops to come. Let’s not expect hypo numbers but you’d know what to do if that did happen, would you?

 

Can I feed him his normal low carb food or should I feed him the high carb food?

 

Just read up about it again so ready to go. Going to test again in about half hour. Although I am literally staring at the clock and waiting to test again!

 

Tense times I know. I think you’ve got this under control but again, if you do need help, post an urgent message and someone or several people will respond. It’s getting late for most of us in the UK but Mogs may be up as will people elsewhere.

 

Hmm. That's a good question. With the longer-acting insulin you wouldn't break out the HC unless they dip below 2.8. Caninsulin doesn't have that luxury really. Perhaps medium-carb food would be warranted if they dip under 5, then if still dropping, bring out the HC.

You can test in half hour increments if you're nervous too! Caninsulin works quickly so it wouldn't hurt.

 

FDMB uses 3.8mmol/L // 68mg/dL as the hypo threshold.

The FDMB Caninsulin Beginner's Guide has this to say about nadir BG:

FDMB has various studies that provide evidence for the human meter thresholds that are used in the dosing protocols. This isn't the case for pet meters (where only the hypo threshold and the top end of the normal reference range is mentioned in FDMB guides.

When Saoirse was on Caninsulin I was really uncomfortable when her BG went below 6.0mmol/L (Alphatrak). When she started ducking below that level I switched insulins.


Mogs
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PS: I wanted to switch to Lantus anyway.


Mogs
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Well I'm thinking that I will request a swap to Prozinc now that numbers are dropping.

I dont think I'd be comfortable increasing the Caninsulin dosage with such steep drops/elevations

 

Yes, that’s the typical observation at this point.

 

Quite.

Even when you get a much higher preshot BG reading, the same dose can tank numbers straight back down again.

When I hit the Caninsulin 'dosing wall' my heart was in my mouth on every single cycle. I had to stop. My vet held off a little while before issuing the Lantus Rx to see whether Saoirse was in remission. I didn't think so. I was right. Her numbers started trending upwards shortly after suspension of Caninsulin. I had to wait for her numbers to rise a good deal before I was prepared to give her Caninsulin again (and I switched to U100 syringes to try to measure smaller doses properly).


Mogs
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First green reading!

 

I'll be signing off shortly. Hope all goes well with Douglas, Anna.

If you do need help, shout out. If you're badly stuck and Feline Health is quiet, try posting on the Lantus board for help (usually more traffic there), and include a link back to this thread for members to follow you back here. Put a question mark flag against the title of the Lantus board post to attract more attention to your thread. If Douglas were to go down into the low 80s or 70s and you can't get numbers back up again, set the thread title flags to 911 on Feline Health and also on the Lantus board if you don't get a prompt answer on FH first.


Mogs
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Don't want him any lower than that! Give him a LC snack and maybe test in 20 to check.

 

Thanks Mogs, may test again in 30 mins

 

Woot!

I suggest giving Douglas some low carb to eat: it's still early in the cycle.

I'm sorry I can't stay with you tonight, Anna. (Not very well and wouldn't be able to stay the course.)


Mogs
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Please don't apologise, thank you for your help and support. I hope you feel better soon

He's quite happily hoovering up some LC food, will test again in a bit. Thank you

 

Wow. Stay vigilant, Anna.

I agree, give Douglas some food now (this is why you don’t want to over feed him too early; you don’t want to fill him up so he’s not interested in food if you need to get high-carb stuff into him).

I’m afraid I’m not going to be able to stay awake much longer either but Mogs has pointed you in the direction of help if you need it.

 

Don't let him eat too much in one go, Anna. You may need him to eat again later in the cycle so you don't want to fill him up.

Nite, nite!


Mogs
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@Diana&Tom - Snap!


Mogs
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Sleep well guys! Thanks again for all your help

 

Oop! 4.7. Might be wise to bring out the HC. He's earned a reduction.

 

Yup, cracked open the Gourmet Gold Gravy. Douglas must think its his birthday, all these snacks he's getting!

Will test again in 30 mins

 

What an honor he must be thinking!

I'm going to pop off real quick and get a shower but you know what to do! Will come back in a few and check.

 

Thanks for all your help @Panic

 

Nice to see him up a little!

 

Me too! Given him a little more HC food and will test again in an hour.

 

Just popped in for a look-see before I switch off the lights and pull the duvet over my head.

I suggest you test sooner than the hour, Anna, to be on the safe side. His numbers barely budged after the last high carb food and if you look at his data for AM cycle on 6 September he has shown he can continue to drop until quite late in the cycle.


Mogs
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He's on the rise!

 

Still on the rise! Thankfully!

I am gonna try to get a couple of winks before work.

 

G'night.

 

Good morning. We made it through the night! Douglas thought he had won the jackpot with all the food, I was definitely feeling the opposite with worry. Although this morning when I woke up, Douglas had snuggled very close to me so I woke up to a little meow and some deep purring which was lovely.

His numbers are back up, if not a little higher than yesterday AMPS. Which I suppose is due to the HC food he had. My next step, as mentioned a yesterday, I am going to share the data with my vet and ask him to change us to Prozinc (along with letting him know that I have changed meters and moved him off Purina DM *gulp*)

How long until the effects of the HC food is out of Douglas' system?

 

Gosh, Anna that was quite a night for you... Well done for dealing with that. And well done to your helpers and cheerleaders, too.

...I had a feeling that 2.5 might be too much since it's already dropped him 11 - 12 mmol over the preceding couple of days. ...He is responding better to the insulin now... That happened pretty quickly!

One of the good things about Caninsulin is that you do have the freedom to change the dose if you feel the need to. A Caninsulin dose only usually affects 'that' insulin cycle. It's not like a depot insulin (lantus for example) which works best with consistent dosage.

I'm not surprised if the number is higher this morning. High carb food can take more than 24 hours to clear the system. But I suspect that you may also be getting a 'bounce' from Douglas dropping too low or too fast.
Quick explanation of bouncing: When the blood glucose drops too low or too fast (or both) the body can respond to that by releasing stored glycogen to raise the blood glucose level. It can also release counter-regulatory hormones that cause temporary insulin resistance. It's a protection mechanism. And a bounce can last anything up to a few days. There is nothing that can be done about a bounce. You just have to ride it out. And it will pass...

I actually think Douglas is doing pretty well on the Caninsulin at the moment. That's not to say 'don't' change to Prozinc if you feel you need to, but from what I'm seeing I don't think there's any great rush to do that. Douglas dropped low because the dose was too high last night. It was the dose, not the Caninsulin per se...
As said above, one of the advantages of Caninsulin is that it is flexible with regard to dose changes. Some cats even do well with 'sliding scale' dosage on Caninsulin (varying dose according to preshot + anticipated nadir).
Disadvantages of Caninsulin include that it tends to have a short duration (although Douglas is getting better duration than is typical - and you got a lovely AM cycle the day before yesterday); and also that it can tend to drop the blood glucose too fast.
Advantages of Prozinc are that it tends to be more gentle in its action, and typically has a longer duration. However, Prozinc also 'usually' works best with fixed dosage. It isn't quite so flexible with regard to dose changes.

Usually I'm trying to persuade people to change from Caninsulin to Prozinc or one of the human insulins, haha! But he seems to me to be doing pretty well on it at the moment. Although the dose is clearly too high now and needs to be reduced.

How is the food change going? Is Douglas only eating the Wild Freedom at the moment?

And did you get much sleep...? How are you feeling today...?

 

Very well handled, Anna, you did a great job staying calm in a tricky situation. Your reward was getting those snuggles when you woke up - Douglas knew you were looking after him

In future, if you get a PS number that is borderline shootable, take a moment to look at the data for that cycle and weigh up your options. You didn’t know what Douglas’s bg had been all day while you were at work, so he may have been going up or down and as you know, you always shoot on the rise. He may well have been rising, of course, and fast, and the full dose might have been warranted - but guessing is risky so best to err on the side of caution. Remember how Caninsulin acts with its typically fast onset and steep drop. 2.5u doesn’t sound a lot to us but actually it’s a lot of insulin for a little kitty’s system. And you know now also that you always have the option of a reduced or token dose, which is often a good option. In fact, with all the extra food he had, he had quite a nice cycle!

Yes, no surprise to see a slightly higher number this morning, high carb food and a bit of trampolining. You may still see the effects of the high carb food for the rest of the day.

I can imagine your apprehension at discussing all this with the vet but if they see what we see - a sensible, intelligent, caring owner who is doing her very best for her cat - they will respect how you’ve been looking after Douglas so far and will be open to discussing the next steps.

Well done again - I take my hat off to you!

 

Food change is fine and he is now fully on Wild Freedom. I have been quite lucky with Douglas, he would pretty much eat anything (not fussy) although I think the Purina was the only food he was fussy about but even then he ate it when he realised nothing else was coming.

I got about 4 hours sleep, so today will be interesting. Struggled with his AM shot, I think the tiredness made me reluctant to fight and Douglas was not having any of it.

Its interesting what you say about the Caninsulin. He does have a better duration on it so perhaps I will keep to it for now and monitor this.

I think I am starting to understand how to react to such numbers and realise the importance of having as much data as possible. Its a slow but very educational process.

Cannot thank my helpers and cheerleaders enough! This forum really is invaluable

 

Your wallet, your cat.

Glad all went well overnight, Anna.


Mogs
.

 

[elvis]

Thangyouveraymuch!

[/elvis]




Mogs
.

 

An additional note to be aware of: If a cat goes through a very steep, very fast drop from a PS on the high side, it is possible for the cat to have a symptomatic hypo while still in the low end of the normal reference range (i.e. ABOVE 2.8mmol/L on a human meter).

(I speak from very scary first-hand experience.)


Mogs
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I think this is what I am afraid of. I don't think I will cope very well is Douglas starting showing signs of hypo. Not very good in highly stressful situations, sadly I am more of a flight than fight individual

 

For the above reasons I do not advocate using a sliding-scale dosing technique with Caninsulin.


Mogs
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I'm more of a 'freeze' girl meself.

I think when one finds oneself in such a situation one goes into fix-it-now overdrive and it's only when the danger is averted and one starts to breathe again that the shock hits.

It can help to follow threads where members here are helping others to steer their kitty through a low run. It's a way of mentally rehearsing what you yourself would need to do in a similar situation. Granted you don't have the abject terror of the real thing thrown in, but should you find yourself needing to manage your way through a low, already having seen worked examples of the drill may help you stay calmer because the method will be familiar even if the situation is new.


Mogs
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Same here, Anna.
I know you’re mulling over the pros and cons of Caninsulin and Prozinc, and as Elizabeth said earlier, Douglas seems to be doing ok on Caninsulin at the moment. BUT if his bg is starting to go lower (whether because of the change in diet, or a bit of pancreas spluttering) you do need to bear in mind Caninsulin’s relatively harsh action. You need to be on the ball with this insulin - be prepared to tweak doses, test a lot in circs like last night, etc. That’s not to say that Prozinc is perfect but that gentler action does have a bit more going for it, IMHO. I do think care-givers have to factor in their own response to things when they’re in a situation like this. You can’t afford to start getting burnt-out, Douglas is relying on you.

Just my two cents from a slightly different perspective.

 

^ This. ^


Mogs
.

 

I hear your concerns, Mogs. But one of the advantages is the greater freedom to reduce the dose. This can make using Caninsulin safer... 'Sliding scale', is more about reducing for lower numbers, rather than increasing for higher numbers. And insulin dose should always be based on the nadir, whether using fixed dosage or sliding scale. The difference with sliding scale is that there is (or should be) an observable and reliably repeatable correlation between preshot, dose, and nadir.

BTW, I'm not advocating that Anna uses sliding scale for Douglas (it's always important to establish a baseline response before doing that anyway, and Douglas appears to be in a changing situation so that's not possible). But I do advocate the freedom to reduce the dose on a lower than usual preshot. Sometimes we think we 'have' to give the same dose all the time (especially if we're more used to depot insulins) And we don't 'have' to give the same dose, especially with Caninsulin.

 

This is a brilliant idea! Mentally rehearsing and hopefully build a little bit of a library in my subconscious that I can refer too.

And I keep changing my mind on what to do! Instead of telling my vet (kindly, of course) for a move to Prozinc, I will ask him what he thinks would be best.

I suppose my biggest shock is that Douglas is reaching these low numbers already, was not expecting this to happen so quickly.

 

Maybe talk to the vet about setting a time limit on making up your mind, eg end of September, that would give you a decent length of time to see what can be achieved on Caninsulin plus you’re learning all the time how it works for Douglas and when you need to be cautious about dosing so you’re not risking hypo. If after that time you’re not happy with the results you’re getting, including duration, and dosing decisions are tricky, then think seriously about switching insulins.
Douglas is doing well in quite a short time and that does bode well (anti jinx) for his future. I think most people would say Prozinc is better, but if Caninsulin is gradually getting you where you want to be, give it a bit longer.

 

It is amazing what a change of food can often do...
And some cats heal quite quickly once they are on insulin, and then their bodies can start to use insulin better.

BTW, if it helps you, it is possible to give the PM shot a bit earlier today (because of this morning's missed shot), maybe an hour earlier, something like that. It would mean he has insulin in his system a tad sooner. But, it would also mean that the PM cycle will be an hour longer if you give tomorrow's AM shot at the usual time (not necessarily an issue).

Will be interesting to see what Douglas's blood glucose is later on...

I wonder what he'll think about the diet change, and whether he'll agree that it's made a difference to Douglas's blood glucose levels....?

 

In fairness, there's nothing to prevent a caregiver reducing the dose for safety when a cat starts getting into a lower range when using any insulin, Eliz, even the depot insulins.

With your 'sliding scale' approach, upon what criteria do you base the decision to increase a dose? If the scale slides there need to be guidelines for increases as well as decreases.


Mogs
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It all depends on the individual cat, Mogs, and how they respond to insulin. But you'd 'usually' start out with seeing how a cat responds on a fixed dose, and then try tiny adjustments from there.
Not all cats are suitable for sliding scale dosage. Many aren't. But both of mine have been. And I've used it with three different insulins over the years, short-acting and long-acting. To me it actually made much more sense than sticking with a fixed dose...
It doesn't work with 'bouncy' cats, because there are too many unpredictable variables involved. There needs to be a reasonably predictable and reliable 'drop' rate from the insulin.

 

So the adjustments are tailored to the individual cat? Presumably then it would would take a fair amount of time and testing in order to develop a bespoke dosing method.


Mogs
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Yes, possibly; but really not so different to other dosing methods with regard to finding out 'what doses work best'... There is no 'one size fits all' with any of this stuff. Every Cat Is Different whatever the insulin type or the dosing method...