Help! PMPS 5.2?!

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Hercule's mum

Hercule's mum

Member Since 2020
Hercs seem to be having high numbers today so I relaxed, and didn't measure after +4. Just checked his PMPS and is 5.2. Double checked with a second meter and it is green.

I know I am supposed to stall and test again, but he is very hungry.... and I don't want o have him go any lower...

What should I do?

I am so confused, @jt and trouble (GA), you promissed chocolate helped!
 
Whenever you get what seems to be an "off" number you should always retest to make SURE before you change anything.
IF you've already done that then I would tag a dosing helper. I cannot give dosing advice. Now the chocolate is another thing. One item in your hypo kit should contain chocolate. You have my permission to raid it. :p I would send you some but for two things England has superior chocolate and mine wouldnt make it through customs :eek:
;)
I hope this helps. :smuggrin:
 
You can skip or given a token dose (10-25% of dose now, which is 0.10 - 0.15 u). Next time try to make Herc wait it out, 20 minutes won't hurt him. ;)

A retest now is just going to show an elevated number from the food - not really helpful at this point.

On the 2nd and 4th he got green pre-shots too - did you stall and retest? It's very beneficial to record what you did in the remarks, so that way when you're faced with something like today you can look back and say "okay well, on this date he also had a green pre-shot, and this is what happened" so you can make educated judgments :)
 
Hercule's mum said:
Yes. when he got green at AmPS before I did stall and retest. But I haven't seen at PM and just din't make any sense given the early numbers... so I panicked.
Ok, I'll try and see if I can just get 0.1U measured in my U40 syringes.... I can't wait for my U100 order to arrive!
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Weird stuff happens sometimes! I once got a 42 (2.3) at AMPS which really threw me for a loop. :p

Like Jeanne said, you haven't done anything we have't done ourselves! Better safe than sorry!
Just make sure you keep everything in your remarks so you can go back and reference it for later use.

Make sure you check him tonight at +2. I wouldn't be surprised if he heads up though.
 
Thank you @Panic ! So, that I understand a bit better.... I know that I should shoot below 11 (and Hercs is still to unpredictable to be adventurous at lower numbers..). So in an evening like today, is I had done the right thing and stalled without feeding him. Let's say I do see BG is increasing 20 minutes later, does still have to touch 11 for me to shoot? or is the pure evidence of increasing enough?

Also, could I get your opinion on feeding schedule? I wonder if the lack of pattern is because I keep changing his feeding around... He is always hungry and beggimg for food, so when we started doing lots of testing he was getting some food after every test (so about every 2 hours). to compensate for the constant feeding I was giiving him about a tablespoon or 2 each time. We had a few crashes, and I read soemwhere about feeding more in the start of the cycle to reduce the crashing after the shot. So I started giving him a quite large portion before shooting (~80 grams), then another 50g at +2, 30g +4 and just tiny bits after tests. I'm wondering if all the food is what is masking the usual descent and whether I need to watch for a later nadir, or go back to a more equal division of food?

Thanks for the help!
 
Hercule's mum said:
Let's say I do see BG is increasing 20 minutes later, does still have to touch 11 for me to shoot?
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Hi, to be clear... Do you mean an increase after feeding or an increase without feeding...?
When 'stalling' we're not feeding but waiting to see if the blood glucose rises on its own to a shootable level.
If we've already fed then any number we get is probably going to be food-influenced and so may not be reliable...
 
Elizabeth and Bertie said:
Hi, to be clear... Do you mean an increase after feeding or an increase without feeding...?
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I meant, if it does increase without feeding. I understand that means the insulin if wearing out if BG increases without insulin, but it would be unusual to jump from 5.3 to 11 in 20 minutes without food, no? So, my question is, does an increase without feeding is enough to go ahead and shoot, or do i need to see getting higher than 11 before shooting? I hope I am making sense....:oops:
 
Hercule's mum said:
....do i need to see getting higher than 11 before shooting?
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The advice to 'not give insulin below 11' is a general guideline for those new to feline diabetes, and for those who don't have much blood test data. Once people are used to testing and have a fair amount of data under their belt then they may well start to give shots below 11, and most will actually do just that. It all depends on the individual cat, their response to insulin, and on the caregiver's ability to deal with any low number situations that arise from shooting at lower numbers.
 
Just had a mini heart-attack - can you do me a huge favor and edit your spreadsheet at the top so it says Gluco Navii meter instead of Alphatrak? That's a big difference in advice when Alphatrak numbers are involved.

With time, data, and experience you can start lowering that 11 no-shoot number. Part of that is asking yourself: can I stall? Am I going to be home to monitor? Do I have experience shooting a lower number? You wouldn't want to shoot a say, 7, without first having experience shooting anything below 11. You'd want experience shooting say 9-10 first. Heading out the door/going to sleep isn't the time to shoot a lower-than-average number.

Are you using SLGS or MPM dosing protocol? SLGS has reductions being earned below 90 (5 mmol/L) and MPM has reductions below 50 (2.8 mmol/L). Either way, you have a bit of experience already shooting numbers lower than 11. I'd say you're beyond using 11 as your no-shoot number. See below where it talks about 8.3 being the no-shoot number.

How to handle a lower than normal preshot number when following SLGS:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • 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)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Prozinc users following the Start Low Go Slow approach:

If the preshot number is far below usual preshot numbers:
  • Do you need to stay on schedule? Then skip the shot.
  • Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
  • Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
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How to handle a low pre-shot number with MPM:
  • Sometimes your kitty will surprise you with a lower than normal PS number (but above 50). When that happens you have four choices:
    • Skip the dose: If the number is below 200, and your kitty is newly diagnosed (less than three months), your best option is to skip unless your kitty has ketones or is post-DKA (see below) and you should post here or in the Health Forum for help.
    • As you gain more experience and data, your goal is to gradually learn to shoot lower and lower numbers (never below 50). You can use other options below as you are learning to shoot below 200. Ultimately, with data, experience, and knowing your cat, you should be able to shoot PSs above 50 provided you are available and able to monitor.
      • If your cat has been diabetic for awhile and the PS is much lower than normal, you may still need to skip if you have to leave the house for many hours and can’t monitor, but in general we don’t recommend skipping if your cat has a good body of data, so see the other options.
    • Stall: Do not feed your kitty but wait 30 minutes and test again. (Note: we generally stall without feeding because food will falsely cause the BG to rise. It’s important to not shoot a food spike
    • If after stalling the number is rising into safer ranges, you can then give the full-dose shot. You can stall as long as you need to (in 30 minute increments), but keep in mind that the next shot needs to be 12 hours later, so be mindful of your new shot time. If it’s getting too late, try the next option.
    • Reduce the dose: How much to reduce can be a tough decision. Some of it will depend on how well you know your cat, how confident you are in testing, if you’ll be around to monitor, etc. This is a good time to ask for advice. If no one is around and it’s your first time, reduce the dose by 50%. If you have been at this awhile and know your cat’s reactions well, you can do a smaller reduction. If your cat is below 150, do not give a dose at all unless you can get regular BG tests throughout the cycle.
    • Give the regular dose: this is recommended if you are able to monitor closely and/or if your cat is a long-term diabetic (more than a year) and you have a lot of data to know it’s safe. Long-term diabetics with solid data can often safely shoot below 150 (and should if possible to do so safely).
If the BG is in the 40s at PS:
  • Stall without feeding for 20 minutes and recheck the BG.
  • If they are hanging in the 40s for a while, or if they are still dropping, it is ok to feed a tsp or two of LC and retest. This is very tricky. You want to avoid feeding too much while you’re waiting for them to go over 50, because you don’t want to artificially inflate the number with food.
    • Example: if kitty is 43 and you feed a whole meal, or feed some HC, and the number bumps up to 52, is that the cat’s natural end-of-cycle rise, or is it food spike? What if it is food spike? Then if you shoot the 52, when the food wears off he might drop back to the 40’s (and when insulin kicks in a couple of hours later, you might have a problem). If the 52 is the cat’s natural rise, then he will probably keep rising for the next few hours until insulin kicks in. If you can’t tell whether the number is food spike or natural rise, it’s safest to wait. Your data will help you here. Study the spreadsheet. How much food spike does the cat usually get? How many hours after the shot does the insulin’s onset usually occur in this cat? At what number is the cat likely to be when onset occurs? If the cat does drop, how easy/hard is it to regain control of the numbers? How carb sensitive is he?
  • Test often (every 15-20 minutes, or at most every 30 minutes). You want to catch the rise the minute it starts. With most of our cats, once they start to rise they will really zoom. You want to get the insulin in as soon as possible, because it will be another 2-3 hours before the insulin kicks in and you don’t want to let the cycle get too far ahead of you.
If the BG is in the 30s at PS:
  • Feed a small amount of HC food/syrup and a drop of syrup/honey and skip the shot, testing 20 mins after the meal to ensure the BG is coming up.
  • Be sure, even when you skip, to continue testing regularly until the BG is at a safe number and remains there more than two hours after eating.
Perhaps the most important guideline in shooting low is that any time you shoot your lowest ever number, you should get a +1 and +2 to give you an idea of how the cycle will go. If the +1 is not higher than PS, or if +2 is much lower than PS, that means “pay attention” over the next few hours. Those tests will also help you become even more data ready for the next time you are presented with a low preshot reading.
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As for your question on feeding - if treats after testing makes Herc happy, keep it up! My girl was very indifferent to testing so I never felt like I needed to "reward" her every time, but many cats expect it. One thing you can do instead of giving FOOD food at treat time is to give little treats - freeze-dried chicken treats or my personal favorite, treat-sized pieces of baked chicken. I kept a small tupperware cup with her treats in them, and we would go to the fridge and I would hold the container out and let her "pick out" a piece after a test. Just a little treat, not a mini-meal.

A mini-meal at +2 is a good idea for most cats on Prozinc, and then a couple more before nadir. I'm not GREAT at reading spreadsheets, it kind of looks like Herc nadirs somewhere between +5 and +7, so you might consider another snack at +4 and +6, unless someone has a better recommendation (perhaps +5 instead of +6). Maybe @Elizabeth and Bertie , @Critter Mom or @Deb & Wink can offer more precise advise on the feeding schedule?

And then after nadir, just stick with the chicken treats (or whatever).
 
Sorry, Elizabeth! I wasn't sure how to deal with the fact that old numbers were in the alphat trak.... I changed, and made a note on top that those number were alphatrak 2. Hope that clarifies.

Panic said:
t kind of looks like Herc nadirs somewhere between +5 and +7,
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That is alo my reading, which is why I was dumbfounded with his PMPS being so low...

So, I do give him freeze dried treats after testing....:oops: and then he runs straight to his plate..... Have I mentioned he is a really big eater :rolleyes: ?? Usually I am not home, so I managed to feed him 2 or 3 times, But currently working from home (which is a blessing, with his dx), but I am weak... and he asks for food all the time!

Err... when I am stalling, should I also withdraw the freeze dried treats?
 
Critter Mom said:
Welled up reading this. Beautiful...
.
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She was an absolute delight to have and care for...sniff.

Hercule's mum said:
Sorry, Elizabeth! I wasn't sure how to deal with the fact that old numbers were in the alphat trak.... I changed, and made a note on top that those number were alphatrak 2. Hope that clarifies.



That is alo my reading, which is why I was dumbfounded with his PMPS being so low...

So, I do give him freeze dried treats after testing....:oops: and then he runs straight to his plate..... Have I mentioned he is a really big eater :rolleyes: ?? Usually I am not home, so I managed to feed him 2 or 3 times, But currently working from home (which is a blessing, with his dx), but I am weak... and he asks for food all the time!

Err... when I am stalling, should I also withdraw the freeze dried treats?
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The edit is perfect, thank you! :)

Sounds like he's trained you! :woot:
My girl was like that too at first - that's why I kept giving her chicken treats instead to hold her over! Sometimes I would give in though and give her just a little. :oops:

Yes, no food at all when stalling. Poor Herc!
 
Hercule's mum said:
Sorry, Elizabeth! I wasn't sure how to deal with the fact that old numbers were in the alphat trak.... I changed, and made a note on top that those number were alphatrak 2. Hope that clarifies.



That is alo my reading, which is why I was dumbfounded with his PMPS being so low...

So, I do give him freeze dried treats after testing....:oops: and then he runs straight to his plate..... Have I mentioned he is a really big eater :rolleyes: ?? Usually I am not home, so I managed to feed him 2 or 3 times, But currently working from home (which is a blessing, with his dx), but I am weak... and he asks for food all the time!

Err... when I am stalling, should I also withdraw the freeze dried treats?
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Yes, stalling means not food and that includes treats :p
 
@Panic - I am so sorry you have lost your companion.:bighug: It is always horrible, but sometimes more so. I have had a few beloved cats, but since I adopted Hercs, I cannot imagine not having him.... Hence, my constant panic on how to best treat him.... I would say he is like one of my children, but since mine own are teenagers at the moment, he is actually better than them. o_O
 
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5.2 mmol/L times 18 = 93.6 mg/dL

Not quite low enough to lower the dose, per the SLGS protocol.
But you could chalk up the 3.6 mg/dL difference to meter variance, and go ahead and reduce the dose.
I'm not quite the "stickler" for following the Prozinc dosing protocol to the letter.
That is because, ECID. Every Cat is Different.

Hercules actually earned a dose reduction back on 8/17/20 (17/8/20 in your date format). And you did not take it.

So I do think you should do a dose reduction. Down by 0.25U please would be my recommendation.
 
Hercule's mum said:
@Panic - I am so sorry you have lost your companion.:bighug:
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Thank you. :bighug: Have yet to go a day without tearing up but I truly believe everyone here cared for and miss her too. We all get attached to the sugar cats here, just like Herc! :) Love is ...

Hercule's mum said:
I am trying to follow SLGS until I feel more confident. I increase a tad bit his dose recently (to 0.6U since 17/08) and he had a couple of green points, but I tought only bellow 2.8 was the trigger with a human meter
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Okay, so just remember then - hold the dose 7 days unless he earns a reduction by dropping under 90 (5 mmol/L). That's at any time in the cycle.
Congrats on the Deb-approved dose reduction! (and thanks Deb!)
 
Thanks @Deb & Wink ! I will reduce his dose. I thought I should have reduced, and I wrote a message on the prozinc board that day, but I guess everyone was busy.

The reason I was unsure is that overall his numbers has been mostly on the high side, and that day I double checked the 3.5 with a second meter, which gave 5.2. So, I worry I am overeacting to perfectly fine numbers and hence making him run high most of the time? I had just increased to 0.6 after spending 7 days @ 0.5U with values mostly above 14.
 
Doses can change pretty frequently, especially in the first few months.
It's tough to roll with those dose changes, but you need to do them.

I'm rarely on until after 8 pm east coast time, and only have about 1 hour on the message board before I need to do other things.
 
OK, Hercules is likely to stay high for several cycles. Let's wait and see how long it takes him to clear this bounce and give you better BG numbers. His body is not used to those blue BG ranges, so it overreacts and causes him to go much higher. At least he isn't wearing black today!

Remember that dose changes can be needed fairly frequently. You test plenty in the AM cycle to catch any low numbers. Doing ok in the PM cycle too. Just remember to get that "before bed test" in every PM cycle and you should be good.
 
The BG level does not HAVE to go really low, for a cat's body to overreact and think it needs to bring that BG number back up to what it's used to.
So for some cats, even numbers down in the yellow colored ranges on the SS can be lower than the cat has been getting for some time, and cause a bounce.

Black color coded numbers on the SS almost always means bouncing.
Red color coded numbers on the SS usually means bouncing too.

It's the relationship between the pre-shot and the lows (aka nadirs) during the cycle that lead to the bounce.
If there is only a 10-20% drop, there may not be a bounce.
If there is a 20% drop in the first hour or 2 of the cycle, that may lead to lows in the middle of the cycle and then the subsequent bounce.
How hard and fast the drop happens determines how low a cat's BG levels will go and then rise up at the end of the cycle.

Your cat drops from those pink colored coded ranges on the SS, down to the blues? Expect a bounce.
Your cat drops from those yellow color coded ranges (or the pinks or reds) on the SS, down to the greens? Expect a bounce.

Duration of the insulin also comes into play.
Not all cats get the same duration from the different insulins.
Duration can vary a bit from cycle to cycle also, as a cat eats or sleeps or plays more.
 
Deb & Wink said:
The BG level does not HAVE to go really low, for a cat's body to overreact and think it needs to bring that BG number back up to what it's used to.
So for some cats, even numbers down in the yellow colored ranges on the SS can be lower than the cat has been getting for some time, and cause a bounce.

Black color coded numbers on the SS almost always means bouncing.
Red color coded numbers on the SS usually means bouncing too.

It's the relationship between the pre-shot and the lows (aka nadirs) during the cycle that lead to the bounce.
If there is only a 10-20% drop, there may not be a bounce.
If there is a 20% drop in the first hour or 2 of the cycle, that may lead to lows in the middle of the cycle and then the subsequent bounce.
How hard and fast the drop happens determines how low a cat's BG levels will go and then rise up at the end of the cycle.

Your cat drops from those pink colored coded ranges on the SS, down to the blues? Expect a bounce.
Your cat drops from those yellow color coded ranges (or the pinks or reds) on the SS, down to the greens? Expect a bounce.

Duration of the insulin also comes into play.
Not all cats get the same duration from the different insulins.
Duration can vary a bit from cycle to cycle also, as a cat eats or sleeps or plays more.
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Wow Deb this should be a sticky somewhere . Too much for me to memorize. :bookworm:
Actually more than 2 sentences are too much for my brain :rolleyes::p
 
jt and trouble (GA) said:
Wow Deb this should be a sticky somewhere . Too much for me to memorize. :bookworm:
Actually more than 2 sentences are too much for my brain :rolleyes::p
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Cut and paste it to a word document or something. I'll never be able to recreate what I said. :eek:

Critter Mom said:
@Deb & Wink -

First-class tutorial, Deb. Extremely helpful. Mogs.
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I may not have everything right, but at least it's a start to help someone identify bounces.
 
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