? Help! 10.2 PMPS Test

[Panic]

Nice to see him up a little!

 

[Douglas_my ginger cat]

Nice to see him up a little!

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

 

[Critter Mom]

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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[Douglas_my ginger cat]

He's on the rise!

 

[Douglas_my ginger cat]

Still on the rise! Thankfully!

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

 

[Red & Rover (GA)]

G'night.

 

[Douglas_my ginger cat]

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?

 

[Elizabeth and Bertie]

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...?

 

[Diana&Tom]

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!

 

[Douglas_my ginger cat]

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...?

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.

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!

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.

And well done to your helpers and cheerleaders, too.

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

 

[Critter Mom]

(along with letting him know that I have changed meters and moved him off Purina DM *gulp*)

Your wallet, your cat.

Glad all went well overnight, Anna.


Mogs
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[Critter Mom]

And well done to your helpers and cheerleaders, too

[elvis]

Thangyouveraymuch!

[/elvis]




Mogs
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[Critter Mom]

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

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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[Douglas_my ginger cat]

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

 

[Critter Mom]

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

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

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


Mogs
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[Critter Mom]

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

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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[Diana&Tom]

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

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.

 

[Critter Mom]

I do think care-givers have to factor in their own response to things when they’re in a situation like this.

^ This. ^


Mogs
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[Elizabeth and Bertie]

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

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.

 

[Douglas_my ginger cat]

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.

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

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.

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.

 

[Diana&Tom]

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.

 

[Elizabeth and Bertie]

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

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...

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 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....?

 

[Critter Mom]

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

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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[Elizabeth and Bertie]

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.

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.

 

[Critter Mom]

But you'd 'usually' start out with seeing how a cat responds on a fixed dose, and then try tiny adjustments from there.

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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[Elizabeth and Bertie]

Presumably then it would would take a fair amount of time and testing in order to develop a bespoke dosing method.

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...