Lily AMPS 225 0ct 20

Good morning Mogs, Lily is reading 225 this morning.

 

lovely #

 

Morning, Sally.

Just seen this (was sorting the furchild).

Are you around to monitor throughout this cycle, and how is Lily's appetite? She's in the same PS ballpark as yesterday.


Mogs
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QUOTE="Critter Mom, post: 2662165, member: 10789"]Morning, Sally.

Just seen this (was sorting the furchild).

Are you around to monitor throughout this cycle, and how is Lily's appetite? She's in the same PS ballpark as yesterday.


Mogs
.[/QUOTE]
Yes I will be available all day to monitor. Lily has a wonderful appetite, all are patiently waiting to eat staring at me right now!

 

Okey dokey. Time to feed the troops.

Lily needs to be able to eat more during this cycle, initially small snacks at +1, +2 and +3. She needs a substantial feed now but not enough to fill her up where she won't eat again for you as needed during the cycle. Are you confident that this is manageable?


Mogs
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Yes, we can do that.

 

Should I give her her regular insulin dosage after eating then?

 

Yep.

Please can you then test at +1 and post the result. I'll be monitoring your thread.


Mogs
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Yes will do.

 

@Critter Mom , dumb question but should I feed and then check ?

 

Check and then post the reading please, Sally. Don't feed till I answer. I need to see the result first so I can recommend the best food option.


Mogs
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Sounds good, and I would have done the opposite

 

The idea is to get the test to see where numbers are and then feed accordingly.

If the BG is around the same or slightly higher than the PS test that would show dose onset has not yet occurred. If numbers have dropped in any significant way at +1 that's an indication of early onset of the dose. (Vetsulin typically gets going around the +1 to +1.25 mark but some cats metabolise insulin faster and have an earlier onset.) If early onset, then you feed a little (LC or MC depending on the drop) to hopefully slow the fall. Then you repeat this process at suitable intervals to ease the kitty down to nadir. If numbers start to run in a lower range, you can then feed small amounts of food with the required carb level to 'steer the curve' to keep BG levels in the safe range until the dose starts to wear off.


Mogs
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Is everything OK? Worried you haven't posted yet.


Mogs
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Ok, that makes sense. She is 269 @ +1

 

Sorry she was hiding, LOL

 

Lily!!!!



Was that 269 bang on +1 or later, Sally? Because Vetsulin hits so early in the cycle I need to ask you to be precise to the timings you post along with the test results because that is key to the feeding decisions today.

Don't give any food yet. Please test 30 minutes from the time of the most recent test and post the result please (assuming Her Maj will let you! ).


Mogs
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Yes, I try to get it on the hour. Will test at +1.5 or 9:30 here.

 

Ace! Will keep an eye out for the next result.

BTW is there any point in the cycle where you need to pop over to your FIL today? If yes, can you let me know the time period please relative to dose time (e.g. I'll be away from +4 to +5.5) so I can take that into account when thinking of what to feed next.


Mogs
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Yes, I need to go over there at noon which is +4. But should only be there a half hour.

 

Thanks for the info.


Mogs
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Hey Mogs, she is 286 @+1.5

 

Still no budge from her! Cats.

No food yet, Sally. Please can you get the next test at +2. I hope that there will be some shift by then. I'm actually wondering whether this morning's numbers might have a little bit of a bounce in them from the 87 yesterday. Looking at Lily's patterns in the spreadsheet she has an overall tendency toward early onset. Of course, the day we need to look closer, she decides to do something else completely.

Wish there was a way to know what to do that didn't require so much trial and error.


Mogs
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Hey Mogs, Lily is 253 at +2.

 

At last some bit of movement!

No food yet and, much as it grieves me to ask, please can you test Lily at +2.5 (and give her some fusses from me). Fingers and paws crossed we've now caught the start of today's drop.


Mogs
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Will Do!

 

Lily at 257 2.5

 

Is she hungry?

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Not really, sleeping right now.

 

I think you could leave her be till +3.5, test and provided she's in safe numbers at that point give her some of her regular food to tide her over while you go to your FIL. I'll check in at the 3.5 to see if you need more specific suggestions on what food to give.

Cats.




Mogs
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gotta luv'em cant kill'em

 

She is 253 a +3.5

 

Like I said cant Kill'em

 

She is back asleep so I don’t think she needs to eat unless you say she should.

 

As long as she's not hungry, she should be fine. One thing's for sure is that she's w-a-y away from greens at the moment. I'd suggest grabbing a test when you get back, Sally, just to make sure she doesn't throw any wobblers and, provided there's nothing unusual or worrying, feed her as you see fit up to the usual +10 cut-off.

Be sure to post if you need help. Keep safe while you're out and about.


Mogs
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Thanks Mogs, you too.

 

Just been looking at the spreadsheet. Same story as the night when you ran the curve. I reckon Lily must see us coming.

Sally, I'd be very wary of giving Lily any Vetsulin at night. I think it's too risky. Per the FDMB protocol, she earned a dose reduction of 0.25IU yesterday. While there may have been a dose measurement hiccup there's no guarantee that that was what dropped her below 90 yesterday. One has to work with the data.

I had hoped that today we'd be able to check Lily's response to a different feeding plan but that was not to be. In the absence of evidence that you can keep Lily safe on the 0.25IU in a more 'normal' cycle, I think it's safer to skip tonight. Even if she has a high PMPS tonight it's not possible with this insulin to say that the nadir would also be in a correspondingly higher range. Vetsulin is capable of dragging BG right back down from higher preshot levels into much lower numbers. If it was my cat, I wouldn't give it.

Wishing you both a safe and peaceful night.




Mogs
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I agree with you Mogs. I will hold on insulin tonight. Thanks very much hope you have a good night!

 

You too, Sally.

Nite nite!




MOgs
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Hi Sally,

I was just checking in on Lily's spreadsheet and I see you've got your AMPS test done. I'm wondering how you want to approach things today.


Mogs
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What do you suggest Mogs. I am available all day.

 

I have not given Lily her Vetsulin yet.

 

Hi Sally "REPLY" to Mogs' thread and she will get the alert. You've replied to your own post

 

Thanks Jeanne!

 

I haven’t given Lily her insulin today.

 

Hey, sorry I have to leave to take care of FIL I will be back in about an hour. I just gave Lily her Vetsulin. If you want to try again I am game. Thx, Sally

 

Sorry for not getting to you sooner, Sally (stuff going on here). Give a shout when you get back.


Mogs
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Hi Mogs, I am back!

 

Hi Sally.

How far along in the cycle is Lily now?


Mogs
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I just tested for her +1 and it is 260.

 

Pretty much the same as yesterday.

When Saoirse was on Vetsulin, she'd get very sleepy after the dose was given but somewhere after +1 she'd usually perk up a bit and go to her food bowl looking for something to eat. Have you observed any similar behaviour in Lily? If yes, typically how long after the insulin dose would she typically look for more food? (Trying to see if Lily gives you some sort of visible signal that the dose is starting to kick in.)


Mogs
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No, I haven’t noticed her being hungry at all. I think all the cats have gotten used to eating at 12 hours intervals. She did sleep a lot yesterday and she is just laying around now. But they all are, I have some lazy cats! LOL

 

They were put on the planet to supervise humans. It doesn't require much movement on their part.

I'd suggest next test at +2.5, Sally. Does that fit in with your schedule OK?


Mogs
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How are you doing for supplies of test strips, BTW?


Mogs
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Yes, 2.5 is good with me! I have an abundance of test strips, I have learned my lesson the hard way, as usual.

 

Pair of us in that!

How long in hours and mins till +2.5, Sally? I want to set an alarm to check in with you.


Mogs
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Thirty min.

 

Mogs she is at 231 at +2.5.

 

Especially during a pandemic.

 

wakie wakie Mogs

 

I'm allowed bathroom breaks!

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Ahhh I'm just funni'n with ya

 

Looks like a mirror of yesterday, Sally. I'd suggest checking her before you go to FIL and again when you get back. If in the unlikely event that she has dropped a lot before you leave you could give her a small feed to tide her over till you get back.

I'm also wondering whether Lily might normally be getting a small bit of carryover between doses (not common with Vetsulin and not usually discernible unless insulin doses are skipped for some reason. We shall have to see...


Mogs
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I know this!


Mogs
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Hi Sally,

Been following along on Lily's spreadsheet and I see that she's basically flat again today and I am wondering whether this might be an influence of the skipped PM doses. My best suggestion to you is to put a call in to your vet to discuss the low reading that you got for Lily the day before yesterday, that you're now wary of the dose taking her too low but that her BG levels have been running higher during the day when you've needed to skip evening doses for safety. Your vet should be able to advise you how best to proceed.

From my perspective, I don't think there's much more I can do to help you on the Vetsulin side of things for Lily because there's no way I'd suggest you give insulin if I didn't think you'd be able to keep Lily safe and, both according to FDMB dosing guidelines plus my own experience of using this insulin, going below 90 on this insulin isn't wise. The indicated dose reduction is merited but Lily's dose is so small there's nowhere to go.

My best suggestion to you is to maybe consider having a discussion with your vet about switching Lily to Lantus insulin. It has a much gentler mode of action which makes it better at providing safe, continued insulin support for cats who still need insulin but who are in an overall range too low to permit continued safe administration of the in-out insulin they are currently being treated with. With Lantus it's also possible to give insulin safely at lower preshot levels and thus keep a kitty in healthier numbers for longer (can take a little while to get the kitty to this stage, of course!).

Thoughts?


Mogs
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I agree with you Mogs. I just hope the vet will too. If we switch over to Lantus would we start at the same dosage?

 

I left a message for the veterinarian to call me when she comes in tomorrow and I emailed Lily’s spreadsheet. Hopefully she will be receptive. In the meantime, should I skip the evening dose?

 

For a newly diagnosed cat, the starting dose is based on ideal weight (for cats at ideal weight or overweight) or current weight if they are under their ideal weight. However, for cats who've already been treated with another insulin the previous insulin dose is considered.

I'm going to ask Elise (@tiffmaxee) if she can pop onto this thread next time she's online and ask her whether she can give you a little more information on determining starting dose for a kitty making the switch to Lantus. (It's an area that always gives me the wibbles! ). One thing I can say with confidence is that I think Lily would only need a very small dose of Lantus to start with. It can always be adjusted in small increments thereafter if required.


Mogs
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As per last night, because of that drop below 90 on this dose I think it's too risky. It's one thing to give a dose that's taking BG numbers right to the limit of what's considered a safe nadir for a given insulin when one is awake and able to test and intervene with food at any point if numbers drop a bit low, but it's a very different scenario to give that same dose when monitoring/intervening isn't possible. As I said to you last night, if it was my cat in this situation I wouldn't give insulin tonight.

While things are in flux - and purely as a general safety precaution - I'd suggest doing a daily check for ketones until you can return to regular administration of insulin again.

I hope things go well with your vet. Be sure to give a shout for any help you need.


Mogs
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Thanks so much Mogs, I will let you know the outcome. This is the same vet that told me to give her 2 units and didn’t mention testing and going back in a month for a curve.

 

Oh dear...

We'll still be here to help with any questions you have, Sally, and we'll do all we can to support yourself and Lily going forward.


Mogs
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PS: You certainly wouldn't look to start Lily on 2IU Lantus every 12 hours! IIRC last time you reviewed Lily's progress with the vet they were pleased with how she's been doing on the small dose of Vetsulin so hopefully any dosing suggestions they might make for Lantus would be a tad more conservative now there's a record of how Lily responds to her insulin treatment.


Mogs
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Just seen Lily's +7! That was a good catch from you, Sally. Wonder where she'll be at PMPS tonight? (NB: Just wondering whether she might still be under 200 because that could potentially give a clue to why her AM numbers have been flatter yesterday and today. For clarity, I still think it's not safe to give her insulin tonight.)


Mogs
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Yes I was glad to see it going down too. I won’t give her insulin tonight. Thanks for checking on us!!!

 

I like following along! (((Lily)))


Mogs
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And it sure makes me feel better to know that! I feel not so alone!

 

I know exactly what you mean about the alone feeling, Sally. I can't tell you how grateful I was to find FDMB and for all the help I have received here. We all need a lot of 'technical support' with the nuts and bolts of managing feline diabetes ('cause it's overwhelming!) but the bit of moral and emotional support is very much needed too ('cause sometimes it can be very scary and exhausting).


Mogs
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Lily is 149 at +9. Is this good or bad?

 

Another good catch, Sally.

First things first: that's a perfectly safe number. Will post again in a few minutes. (Just caught me on my way to a comfort break. )

BRB...

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Take your time Mogs, nothing urgent at all.

 

Back to you.

You've probably been reading about bouncing here and there on the board. It's where the body reacts to a number it perceives to be too low and dumps extra glucose into the bloodstream to compensate. In some cases the BG may indeed be too low (below 50 on a human meter) but with a diabetic the body will have become accustomed to running in too-high BG numbers and if BG falls to a lower, perfectly safe but unfamiliar level the defence mechanism gets triggered as well. It can take up to 3 days for the effect of a bounce to clear.

In addition to the potential carryover from a previous dose that I've discussed before, I have been wondering whether Lily's flat cycle yesterday might have been influenced by a bounce triggered by her drop to 87 on yesterday's AM cycle. It can be trickier to spot bounces with Vetsulin because of its ability to yank high numbers down. (Lantus is better at keeping already low numbers down.)

When a bounce starts clearing you usually see numbers coming down into a better range, often at an unexpected time in the cycle. When Lily's BG finally started heading into blues at +7 today it made me wonder more whether her earlier numbers were a bit 'bouncy'. That her BG levels have dropped a little lower again at +9 - very late to see a fall in a Vetsulin cycle - makes today's cycle look a little more like a bounce that's clearing, rather than an issue with lack of dose carryover from the skipped dose. This is a practical demonstration of why I said that it was too risky to keep giving the current dose when Lily's not being closely monitored. If yesterday's numbers were indeed bounce-influenced, insulin had been given last night based on her numbers not having budged much during the day but then a bounce cleared during the night, what looked like a safe dose in the morning cycle could potentially have dropped Lily's numbers too low during the PM cycle (and a lot of cats naturally run lower at night).

I hope I've explained the above OK. Tonight, I'd strongly recommend that you get the PMPS test to be sure nothing weird is going on. By then this morning's dose should be spent, but as well to double-check.

Overall, Lily's doing really well - and you're doing a great job with her.


Mogs
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Thanks for all the explanations Mogs, you are awesome!!!

 

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Just seen the PMPS. For peace of mind, I'm glad Lily's a bit higher than +9. Three blue PMPS results in 5 days. Definite downward trend. C'mon, Lily!

Wishing you both a grand evening.

(((Sally and Lily)))




Mogs
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Hi Sally,

I see from the spreadsheet you've already given Lily insulin this morning. I'd recommend you start closely monitoring Lily's BG from +1.5 - certainly no later than +2. If she's going to drop then for safety it's better to catch it early.


Mogs
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Will do, thanks Mogs!

 

Great, Sally.

When you're posting the result is there any chance you could start a new thread, please? This one's got a bit long (and apparently it's better for the server if threads stay under 50 posts). Will look out for it.

Lily is doing so well (anti-jinx!). I hope the vet gives the OK for Lantus later. My hope is that it would help you get her into lower numbers safely, and that would increase chances of achieving remission. Was Lily on steroids at all before she was diagnosed as a diabetic? (Sorry if you've posted this info before. PTSD affects my memory. )


Mogs
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No, she has never been on steroids to my knowledge. I got her when she was 3 and she is 5 now. Was in excellent health until this.