Help! Lowest PMPS

Howiesmom

Howiesmom

Member Since 2020
@Deb & Wink @Panic
Howie just shot a PMPS of 134. The lowest he’s ever been in the 3 months of diagnosis. I’m stalling for 20 min right? He’s not ever broken 200 before so have no idea! He’s on 4units right now. What do I do? I know it’s not a crazy low # but it is for Howie!
 
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You can wait another 20 to see if he goes higher, he's not really moving any though so skipping might be a good idea tonight.
 
I think I will skip. He was at the vet today and I wonder what they did as he came home and had a +6.5 of 184. He’s, again, never been below 200! I wonder if the switch to 4units is taking effect or if this is a bounce?!
 
Since you already fed, the BG numbers will be food influenced.
So SKIP @Howiesmom and keep Howie safe.
Expect a bounce in the AM with the skipped shot.

For future reference, that 184 BG at +6.5 isn't terribly low. Only lower than you have ever seen before.
Just wait until you see GREENS!!!!

Because Howie was at the vet, he probably didn't eat at his usual times and/or his usual amounts.
 
Another question...he had to fast for a test this AM and so didn’t get breakfast or insulin for 1hr 15min after his normal time. I think that is ok on Prozinc, right? I thought I read somewhere you could go an hour either way if you have to (not on a regular basis). I want to get him back on his regular schedule tomorrow.
 
Yes, Prozinc has about an hour's wiggle room IF needed. Since you're skipping tonight you can just go back to regular schedule tomorrow morning.
 
Last question of the night. I’ve been treating him with fluids for small amount of ketones (sorry...I forgot to include that info in the first place). I’m still ok to skip? He’s acting fine and eating normal. Thanks so much!
 
With a small amount of ketones, no I would not skip the insulin shot entirely for any cycle.

At least some insulin is needed, to keep his body from producing even more ketones. When was the last ketone test? Fluids done last when?

How about testing again in 20 minutes, food influence or not and then maybe 1/2 the normal dose.
Depends on how high the BG test is.

If the BG is high enough, you might consider giving the full insulin dose.
 
Ok. Will do that. Can I let you know the # and then you can make a recommendation? New territory for me!
 
Ok, looked at some of the SS history and the trend in the BG levels.
I don't think you want to give him the full 4U dose, not with that 175 BG level.
That 184 and the 175 are basically the same number, within meter variance (15-20%).

He needs some insulin, to help him process the food and keep the ketones away.

I think that 3U might be ok for Howie. The lower dose will likely lead to a bounce in the AM.
But you hold the syringe and will have to make the final decision.
He's never really dropped down into the green BG levels, under 100 mg/dL. Unlikely that he will, but it's always a possibility. Our crystal balls don't always predict the future well. He's never dropped down into the low blue number BG ranges either. But again, cats are cats and do surprise us.

I'd suggest that you get at least a +2 after the shot, to see where his BG levels are headed.
Plus, you might want to set an alarm, and get 1 more test later in the cycle.

Plenty of test strips, a hypo toolkit well stocked with MC and HC food and some sort of simple sugar like karo syrup or honey just in case.

It wasn't that long ago that Howie was getting 6U of insulin in the AM and 3U in the PM. So I took that into consideration also.
 
@Deb & Wink @Panic
Does Howie’s numbers for this AM look like what I should have expected after last night? A 200 point leap for a bounce? Good news though...ketones tested negative this AM!
 
Part of that increase might just be from the reduced dose. HOORAY on the negative ketones!!
 
Howie sings the blues! The next "Billy Holiday" perhaps?

So he got a good bounce from those blues at PM pre-shot until the +2 reading.
Even the 3U 1 time dose reduction did not make much of an impact on his BG levels this morning.
I think most of what you are seeing for the AM pre-shot number on 9/18/20 is the bounce from those blues yesterday, 9/17/20.

Good to get his dose back up to the 4U dose this AM, like you did. He needed the larger dose of insulin.
 
I feel kind of dumb asking, but I will anyway. I give Howie’s insulin toward the end of his meals so he is distracted. Do I need to alter that practice for perhaps better results? I just can’t figure out how he got in the blues yesterday (vet tech fed and gave him insulin when he was there for tests.) I also am questioning if I am administering insulin wrong even though the vet says I’m doing it fine. I move around his lower neck/scruff area towards his shoulders, syringe at 45 degree angle, beveled edge up. I know the higher up in the scruff towards his head, the less consistency in absorption due to blood flow. Is there a better/preferred spot? These seem like very elementary questions at almost 3 months in, but I’m just trying to rule out anything I could be doing wrong which is keeping him in the yellows and pinks constantly. He just got tested for IAA and acromegaly yesterday. Luckily his Cushings test came back negative. Depending on those results, the next thought is to switch his insulin which makes me nervous to think about.
The next puzzling thing is that he’s had small amounts of ketones through yesterday and I have been giving him fluids at home per the vet. This AM I was excited as he tested negative for ketones. But when I tested him tonight, he has a trace amount now. This can’t possibly be normal, right? I’ve been giving him 50 mL fluids twice/day since Wednesday (increased from 30 mL twice/day before that.)
Thanks!
 
I think I'd be surprised if he had IAA or acro, we usually only recommend testing for those at 6 units and he is hitting blues at 4. But cats surprise you I guess.

I doubt you're injecting wrong. Do you "feel" the needle go in? I don't know how to explain it but you can usually tell. Are you using U-40 needles? Do you gently touch (don't pat) the fur after injection to check for wetness? Maybe you would do better with U-100 needles, they have shorter length options.

Those blues are likely just an overdue welcome, not anything you're doing wrong. Switching insulin isn't scary, especially since you'd be moving to a depot shot. Since you're already checking for high-dose conditions you might as well wait and confirm them as negative, otherwise Levemir would be your next step.

The ketones I can't tell you, maybe it was from the reduced shot yesterday. I'd ask on the Main Health forum about it to be sure.
 
Panic said:
I think I'd be surprised if he had IAA or acro, we usually only recommend testing for those at 6 units and he is hitting blues at 4. But cats surprise you I guess.

I doubt you're injecting wrong. Do you "feel" the needle go in? I don't know how to explain it but you can usually tell. Are you using U-40 needles? Do you gently touch (don't pat) the fur after injection to check for wetness? Maybe you would do better with U-100 needles, they have shorter length options.

Those blues are likely just an overdue welcome, not anything you're doing wrong. Switching insulin isn't scary, especially since you'd be moving to a depot shot. Since you're already checking for high-dose conditions you might as well wait and confirm them as negative, otherwise Levemir would be your next step.

The ketones I can't tell you, maybe it was from the reduced shot yesterday. I'd ask on the Main Health forum about it to be sure.
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He had been in 6units earlier this summer and we backed him off as we thought he was getting too much. But at 4 units he’s not even getting near any good #s except for Thursday’s blues. I think I feel the needle going in using U40s. Is there a difference of the needle going in vs being too surface in his skin? The massive needles I use for giving his fluids definitely has some resistance so I know it’s gone in. Obviously a thinner needle doesn’t feel like that. Knock on wood, I haven’t given a fur shot in a month. Thanks for the help and reassurance!
 
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Howiesmom said:
I give Howie’s insulin toward the end of his meals so he is distracted. Do I need to alter that practice for perhaps better results?
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No, that should not make a difference. Plenty of people give their cat insulin while the cat has their head in the food bowl.

Howiesmom said:
I also am questioning if I am administering insulin wrong even though the vet says I’m doing it fine. I move around his lower neck/scruff area towards his shoulders, syringe at 45 degree angle, beveled edge up. I know the higher up in the scruff towards his head, the less consistency in absorption due to blood flow. Is there a better/preferred spot? These seem like very elementary questions at almost 3 months in, but I’m just trying to rule out anything I could be doing wrong which is keeping him in the yellows and pinks constantly.
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I was wondering much along the same lines, last night trying to fall asleep.
Are you shooting the insulin into a "tent" of skin that you pull up, and not pushing the needle all the way through to the other side?
Shooting into the fat layer under the skin, not into the muscle?

Not rubbing the injection spot afterward, as you may be pushing the insulin back out when you do that?
You might think about shaving a small patch of fur, so you can check better.

Fur grows back pretty quickly. Just think "home barber shop is open" and waiting for Howie to step right in. You can use scissors to clip the fur close, and then a safety razor to get the last bit of fur off.

Are you sure your insulin vial/pen still has insulin left in it? Might seem like a silly question, but we had someone in the lantus forum that was shooting using an empty insulin pen for about a week. The vial is more obvious that it has insulin left. The pen, not so much.

Mixing the insulin up every time? Gently rolling the vial to get the particles re-suspended in the solution?
No floaties, still that nice milky color, vial not too old, good storage conditions, not ever frozen getting pushed to the back of the fridge or a cold spot in the fridge?

Just checking some of the basics. Like I did yesterday, with the "contraband" food questions.
 
Deb & Wink said:
No, that should not make a difference. Plenty of people give their cat insulin while the cat has their head in the food bowl.


I was wondering much along the same lines, last night trying to fall asleep.
Are you shooting the insulin into a "tent" of skin that you pull up, and not pushing the needle all the way through to the other side?
Shooting into the fat layer under the skin, not into the muscle?

Not rubbing the injection spot afterward, as you may be pushing the insulin back out when you do that?
You might think about shaving a small patch of fur, so you can check better.

Fur grows back pretty quickly. Just think "home barber shop is open" and waiting for Howie to step right in. You can use scissors to clip the fur close, and then a safety razor to get the last bit of fur off.

Are you sure your insulin vial/pen still has insulin left in it? Might seem like a silly question, but we had someone in the lantus forum that was shooting using an empty insulin pen for about a week. The vial is more obvious that it has insulin left. The pen, not so much.

Mixing the insulin up every time? Gently rolling the vial to get the particles re-suspended in the solution?
No floaties, still that nice milky color, vial not too old, good storage conditions, not ever frozen getting pushed to the back of the fridge or a cold spot in the fridge?

Just checking some of the basics. Like I did yesterday, with the "contraband" food questions.
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I appreciate all those questions! I don’t think I’m hitting muscle as he never squirms or yelps which is what I would assume he would do if I hit muscle. I also pull up his skin and haven’t felt wetness (as if I poked through the skin) and give him a little rub after his shot. I draw his insulin from a vial. I am at the tail end of it, but I know there is some left in there. And I do roll it in the counter before drawing it into the syringe each time. The vial is his original one from 6/23 (Ive read that’s still ok) and is always stored in the front part of my fridge (but not the door). I still don’t know why he got into the blues Thurs based on all this unless the vet techs administered his insulin somehow out of the ordinary?? Thanks!

sad day...his ketones are “ back.” I’m guessing I got a bad test strip yesterday that showed a negative result. He is definitely still in the small amount category that he’s been in for a week. So more sub q fluids to flush those out.
 
No more ketones Howie! You hear me? Eat your food and get enough insulin into you and those should go away.

So maybe have the vet tech show you how she gave the insulin? Using an empty syringe would be fine.
Ask where on his body she gave the insulin shot also. That could make a difference.

I do think Howie will need more insulin soon. I think you need to increase the dose to 4.5U, next cycle.
That is because his BG numbers are still high and combined with the ketone levels, those highs are worrisome.

If there is still insulin in the vial, you should be able to see it, as it is cloudy. Do you see the cloudy color of the insulin in your syringe, once you withdraw the syringe from the vial?
 
Deb & Wink said:
No more ketones Howie! You hear me? Eat your food and get enough insulin into you and those should go away.

So maybe have the vet tech show you how she gave the insulin? Using an empty syringe would be fine.
Ask where on his body she gave the insulin shot also. That could make a difference.

I do think Howie will need more insulin soon. I think you need to increase the dose to 4.5U, next cycle.
That is because his BG numbers are still high and combined with the ketone levels, those highs are worrisome.

If there is still insulin in the vial, you should be able to see it, as it is cloudy. Do you see the cloudy color of the insulin in your syringe, once you withdraw the syringe from the vial?
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Yes, the insulin still looks cloudy in the vial and in the syringe. I’ll have to see what vet tech fed him and gave him insulin on Thurs to see if they can recall what they did. That is the last thing we can come up with as the variable. I do wish these ketones would go away. The good news from his local blood tests on Thursday is that his kidneys and thyroid are fine. His RBCs are low though.

I just wish he would be calm. All he does these days is pace in my kitchen Jones-ing for food and whining even though he gets 2cans (400 cal) every 24 hrs plus treats with each test. He’s 8.8 lbs. No sitting in my lap, no sleeping with me, etc. He did play a little on Fri which was a miracle. The only time he leaves the kitchen is for the litter box or if he sees me eating and then he comes begging.
 
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Does he need to gain weight?

If so, please feed him more.
My cat Wink was eating 11 ounces of food, when he was still unregulated. No idea what the calorie count was.
 
Deb & Wink said:
Does he need to gain weight?

If so, please feed him more.
My cat Wink was eating 11 ounces of food, when he was still unregulated. No idea what the calorie count was.
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He was 10.2 lbs in July. He was 8.5 lbs not long ago but has gained a little once I got his diarrhea under control.
 
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