Lolly pmps 158AT, BCS shot+1/128 +2/139

Status
Not open for further replies.
Martha and Lolly (GA)

Martha and Lolly (GA)

Member Since 2015
My vet told me not to shoot if the bg was under 100. Lolly just seems to be going down, down,. But if I give no shot, won't her bg just shoot up? Should I give 0, or .5 insulin rather than her presecribed 1?
 
Is AT still correct for your meter? so that 108 is AT?

I don't really think you have enough data to be able to shoot the full dose into her.

Let me grab some info on your choices for you and i'll be right back.
 
Basically your options are to

- shoot the full dose
- shoot a reduced dose
- skip the shot
- stall (wait) without feeding and as soon as her BGs begin to rise, shoot then.

With a kitty as newly diagnosed as Lolly, who is moving as quickly down the dosing scale as Lolly is doing, I would err on the side of caution and either only give a tiny amount or i'd skip it. I can't promise to stay with you tonight to handle low numbers, so I'm not going to encourage you to shoot. it's definitely up to you, but here is some info for you to consider.

from the "Shooting and Handling low numbers" sticky:

HOW TO DEAL WITH LOW PRESHOT NUMBERS
**** The following guidelines apply to the Tight Regulation Protocol for Lantus or Levemir ****

You just tested your cat’s preshot number, and there is a much lower than usual number staring back at you. What do you do?

There is no one-size-fits all answer, but there are some general guidelines. As with everything else, each cat is different (ECID) and each caregiver is different too.

The short answer is that most kitties can be shot at +12, almost regardless of the number, once you are data ready to do so. The exception is that shooting 30s or 40s is not recommended for most cats, so if the cat is less than 50 then usually the best option is to wait until they are above 50 to shoot. While you’re waiting, the shed is draining, so you want to get the insulin in as soon as it makes sense to shoot.

If it is your first time shooting green, then we will likely suggest that you stall the first time, even if the number is 80-100. That will let you collect data on what your cat will do when you stall. One thing you can do if you are having a low cycle is to get a +10 and +11. Those will give you a good idea of how quickly the cat’s numbers are rising (or not) when preshot time arrives.

Beyond the general guidelines, there are other factors we consider when we are helping someone with a low preshot.
  • If the low preshot is not part of that cat’s normal pattern or there is reason to think something might be wrong, we will be more conservative.
  • If the cat is not a food spiker or tends to have an early onset/early nadir then they may not want to shoot as low. If the cat has a late nadir, then they will HAVE to learn to shoot low.
  • We will also be more conservative in some cases because of the person – if you are not able to monitor then you want to be more careful, or if you are not sure that you can get back to the board to keep us updated throughout the cycle. Trust me, if you shoot low, we will be watching for your updates and we will worry if we don’t see them.
  • We have to be a lot more careful with the cats who eat only dry food, because they don’t have access to the tools the rest of us use to keep our cats safe.
  • Also, when it comes to very low preshots, there is an unwritten rule that whoever helps that person shoot low should expect to sit with them through any low parts of the cycle. There have been times when I knew a cat’s number was likely shootable, but I also knew that I could not be around to help if the shot resulted in low numbers later in the cycle. For safety’s sake, if I could not find someone else who would be available to support for the next several hours, I would most likely suggest that the shot be reduced or skipped. I will not encourage someone to shoot low and then abandon them.
  • There are a lot of other scenarios, and you always want to keep your cat in mind.

Some general rules when stalling (ECID):

** 50s or higher – don’t feed. The number will bump up on its own soon due to the insulin wearing off.
** 40s or lower – you have a couple of choices.

  • When 40’s occur at the end of the cycle, it can be beneficial to withhold food and test in 15-20 minutes to determine if kitty is on the rise or hasn’t reached nadir yet.
  • 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.

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.

Using the overlap by shooting low is a great way to take advantage of Lantus/Levemir’s long, flat cycles, once you have learned to do so safely.

~ written by Libby and Lucy​
 
That is on the AlphaTrak? And without food? Are you home tonight, able to monitor, and have plenty of strips and high carb food?
 
Maybe a lower dose like .75 or .5U since you have the flu. I'd get a +1 and a +2 test after you shoot.
 
I could only do .5 I have to get syringes with .5 markings. I'll take a reading at +1 and +2. I read the excerpt above re shooting with low numbers; the article talks about 40s and 50s. Even on an alpha trak, which is what I have, 108 is nowhere near that.

I'll be home next three days, so I should be able to get some good numbers, I'll do a curve on Sat

Thanks
 
Syringes with .5U markings are really key for getting those .25U changes. Even though 108 AT is still a ways from the 40's and 50's, the low numbers are low to you, so the techniques still apply. Over time as you gather data on Lolly, you'll gain more confidence on shooting low. I'll keep an eye out for your next couple of tests.
 
Just to be clear, Martha, for Alpha Trak users, your low numbers begin at 68. 50 is the line for human glucometers.

When/if Lolly goes below 68, that's when you pop open a can of gravy cat food, put the lid back on and squeeze like mad to get the gravy out. Give her about a teaspoon of gravy (most of the carbs are in the gravy) and then post here for help.

Our documents are written in US numbers and based upon human glucometers. When you read 50 - that's human glucometer, so make a mental switch and think 68 for your AT. Below that is "low" numbers.

Here is the "official" guidelines for dealing with low numbers:

DON'T PANIC! or HOW TO HANDLE LOW NUMBERS
First, try to not panic.Post to the Lantus Insulin Support Group or on the Health Board. Make sure your subject line indicates you are concerned about a possible hypo and/or add the 911 icon to the first post in your condo. People who are experienced in dealing with low numbers will be there to help. After posting, remember to refresh your browser periodically to see if people have replied.

It’s important to recognize that just because your cat may be experiencing low BG numbers doesn’t mean that your kitty is critically hypoglycemic. Many cats will have low numbers and never have symptoms. It’s important, though, to bring those numbers up into a safe range. ALWAYS make sure you have a stock of test strips, high carb (HC) canned food that contains gravy and is over 15% carb such as Fancy Feast grilled, marinated, or Gravy Lovers varieties (see Dr. Lisa's Cat Food Nutritional Composition List for a full list of options), and/or a simple sugar solution such as Karo/corn syrup, honey, maple syrup, etc.
If your cat is experiencing symptoms, especially if those symptoms are severe, you need to rub Karo syrup, honey, or maple syrup on the gums or, if symptoms are very severe, administer rectally and get your cat to the nearest 24-hour emergency facility. Take the bottle of syrup with you to administer on the way if necessary. (Note that it is rare that we see episodes of symptomatic hypoglycemia with Lantus and even rarer to see severe symptoms. But, you need to know what to do should they occur.)

The symptoms to be concerned about include but are not limited to:
  • staggering, uncoordinated movements, 'drunken' walk, wobbling, balance problems
  • ataxia - usually lack of muscular coordination, but maybe changes in head and neck movements
  • disorientation (yowling, walking in circles, etc.)
  • twitching
  • stupor
  • convulsions or seizures
  • coma
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only.
    (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If number have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.

In the case of an accidental overdose or should there be symptoms of hypoglycemia, even if you have caught this in the early stages, you may need to monitor for literally 16 or more hours. Lantus and Levemir are long acting types of insulin. This means if your cat is over dose, you will need to stay alert for hours in order to closely monitor and to keep your cat safe.

Please post your numbers. Those people who are helping you will not abandon you. In fact, they are staying up with you. The experienced people will even work in shifts to make sure your cat is safe and you have the support you need. Remember to refresh your browser to see new posts and keep posting so we know all is well.

~ written by Sienne and Gabby

​
 
you may want to dole out a couple of teaspoons of low carb regular canned food every hour or so for a while to help her surf.

and by the way, sometimes posts will come fast and furious if you have anything going on. You may need to refresh your browser and scan back up to make sure you don't miss anything.

Looking good - 128 is a perfect number!
 
Thanks BJ. Let's really hope that nothing happens. I on't think I can handle another night like the last. I'm trying follow instructions of my vet, advice here. Two weeks ago she was measuring in the 400s (at vets office) now what's going on?
 
newly diagnosed cats have the ability for their pancreas to heal. when the cat's blood sugar gets held in normal numbers we see this sometimes. Her pancreas is likely sputtering back to life and adding some of its own insulin to the mix. So you are having to decrease what you inject to keep the balance.

Did you also make a change in food from dry to low carb canned? that can make a huge difference, too.
 
The food changed and you've allowed the pancreas to rest by giving insulin. The pancreas may be starting to recover.
 
by the way, if you would edit and update the subject line of this post as you get more tests in tonight, it will help people monitor you and jump in if you need help. I'd suggest adding "AT" to the subject line so folks know the right scale to be thinking of, not human glucometer #s.
 
I meant doing +2 Her +2 is 139. That would be FANTASTIC if her pancreas were kicking back in. I really thought it might be too late, as I think she may have beeb diabetic 4-6 most before dx.

Do these two readings look strong enough for me to wait until morning AMPS?
 
That's still a pretty good drop for so early in the cycle

I'd plan on getting at least a +4 in tonight .....if you're tired and think you can sleep, why not set an alarm for a couple of hours from now and get a nap in?
 
Honestly, probably not. But more than eyeballing, the problem is getting the plunger to stay where I want it. It's "jerky jerky", always stops and starts and goes past the line I want. I wish there were a solution of Lantus made with more volume.
 
So was the BG you shot 158AT?

I'm just trying to make sure i have the story right. If so, that would be

pmps 158AT, BCS shot+1/128 +2/139

So she's flat right now. That's super. Would you please edit the subject line and copy what i've got above and put it in? the BCS means you gave a "Big Chicken Shot", ie, reduced the dose for just this one shot. I just want to make sure people can see if you need help. Then keep updating tonight with any more tests. I think a +4 is a good idea too.
 
thanks for the subject line - it really helps - sometimes when folks are new they don't know when they need help, but an experienced person can spot things by the subject line numbers!

See you in a couple of hours.
 
Martha said:
Honestly, probably not. But more than eyeballing, the problem is getting the plunger to stay where I want it. It's "jerky jerky", always stops and starts
Click to expand...

Have you tried pulling the plunger in and out several times before you put it into the insulin?

There's a lubricant inside the barrel and it can help to "spread it around" a little first
 
Do you think she's ok then until her AMPS 5hours from now? It's hard to say because I don't have enough data yet, but her nadir seems to fall +5-+7. Also, if she's well above 100 at her AMP do I back to the 1 unit? This is driving me nuts, not knowing what to do.
 
You are probably good for the night. If you are worried you can always leave a little low carb food out for her to eat.
 
looking great! Yes, I think you're ok for tonight - flat is good. She'd have to drop to 68 for you to intervene. You can always leave out some regular food for her if you are concerned at all.

I'd post in the morning if you aren't sure.
 
Martha:bighug:

Been thinking about you this week. I haven't had much time to pop on so have not read back all your threads and only glanced through this one without reading everything. So please forgive me if any of this is repetitive.
So many things were mentioned the other night that may have gotten lost in shuffle with all that was going on with Lolly's low numbers. She was low, but not hypo. The bad thing was she wouldn't eat.
I know i mentioned this but think it's key that you try out a bunch of varieties & flavors of LC to find some she loves & cannot refuse that you can count on her to eat. AND also pick up some cans of MC (11-14% or so) and HC (15-24%+) any of the ones of Dr. Lisa's list. I linked you this already and am sure others have as well, but did you get a chance to look over catinfo.org? it is the bible for the nutrition part of this. Check out diabetes page, the food charts...select anything under 10% for LC, some FF grilled or gravy lovers for HC, and whatever else looks appealing from the list to try out. Mark the MC/ & HC with a marker and keep them separate so you know.
I have worried she is not eating often enough. I am not sure what total amounts she is getting, but they really should be spread out over the day, and she needs to be fed near or soon after shot time. I think you are still feeding at +9 but not after? It may help to add the feeding times and amounts to your SS, many do this. You can add to the column squares, or over in comments on the right. It's part of the puzzle and will help those guiding you to be able to see the food and amounts in relation to numbers. She dropped like a rock the other nite because she just had no food on board. And hopefully she will eat the HC gravy...most go gaga over it. you could try out a teensie bit to see.

I see you added AlphaTrak to your signature, GREAT..can you also add it to your SPREADSHEET? You probably notice most here use human meters, so the ranges are different and the numbers mean different things, with accordingly different actions or suggestions to be made. So that distinction is VERY important. You asked about saving money, I think this is a BIG way for you to save. Biggest expense for FD is really in the strips. I am sure several human meters were recommended, (lots of folks use the Relion Micro or Confirm- NO PRIME!- cheap strips and easy to access) If you do swtich we will want to make that clear also, so the advice is geared accordingly.
Also I am sure you hear buying the pens ends up more cost effective than vials. But those are your only real expenses.

Basically the issue the other night was you had no IDEA that you were shooting such a low number. You shot 1.5U into what in human meters is a 40! Most of even the most seasoned would not shoot that low. But in the end she mostly surfed all night.
Your vet telling you to shoot 100 is like us shooting a 65 in human meter. Many here would shoot a 65, but that would be after having lots of experience and data to know how your kitty responds. Once you work your way down in dose, it is not as scary shooting 1/4U into a 65. But is fairly daring to have a vet advise a newbie to do that. If it were a human meter 100, even that is considered a bit low to shoot as a newbie around here. We start at 'ask for help if below 150' around here. Then gradually work your no shoot number down. Eventually it is true you want to shoot low to stay low, you just don't start there. I would just keep posting your number here a little before shot time, and get feedback for now, then as you ease into it a bit you will more easily be able to have a sense of what to do.

I definately think she is responding well to the insulin, and you are right to want to keep her consistent and not skip shots. The key is finding the right dose that you can shoot twice per day, one that does not take her too low. That is where the nadir test come in and why they are so important.
Your vet on the one had is somewhat progressive in her attempts at TR, but pieces really seem to still be off. Lollys dose was raised too high. And forgive if this has already been mentioned, but cats who get in-office glucose curves are typically stressed and their numbers reflect that. They can spike sometimes 100-150 pts or more, so inherently the curves done there are not providing accurate reliable numbers. Kitty tests 400 at a moment in time at the vet, but might test 150 at your house. Dose adjustments get made on these artificially inflated numbers, on top of which vets tend to raise in whole U vs. smaller increments like we do here. So THAT is why we see so many kitties over dose, some way over, many bouncing, etc. Yes Lolly is responding well to insulin, but she was on way too high a dose by the time we found you. Had she started at 1U as many kitties here do, then you would have methodically worked her either up 1/4U at a time, or down, depending on what numbers she threw you as per the protocol. SO she is coming down the ladder quickly, but because she was already doubled in dose before we found you, it was more like a re-set that needed to happen. Hank was on 1U to start and after a couple of low numbers and BCS doses, that lower amount became our new dose and next thing you know it stuck and he was working his way down the ladder until he was weening off then OTJ. That is how it happens. It can be a lot to stay on top of when they are flying down the ladder like that, but the payoff is great. Not every night is like the one we had with you, but there can be some as they begin to make progress.

If you can make the food connection part, and we get Lolly on her correct dose, it may be you are not doing this for long. I know it feels crazy with your schedule which is a challenge and we need to help you figure out how to work it, but I have a feeling Lolly is going to do really well.
FYI you would need to test whether TR or not to keep her safe and know how a given dose of insulin is responding, the only thing that changes is the levels at which you increase/reduce doses on other protocol.
You pretty much got trial by fire learning to test, so I imagine it is getting much easier and by now her ears have learned to bleed. Hopefully with that confidence your husband will see it is not that big a deal and be willing to at least learn and help pinch hit here and there. It actually could be the perfect solution to your odd schedule, as it seems he can be there on those times your are not.

Sorry for the long post...I need to find your threads from before and get caught up on what I may have missed. I just saw you here and had been thinking about you and wanted to check in. You practically became a pro overnight. Ya'll are doing just great! Hope her baby ears are all better, and so sorry about the flu- hope you feel better too!
 
Last edited:
A lot with feline diabetes is decided one cycle at a time. Typically, a person would go back to her "regular" 1.0u dose in the morning and keep giving that dose unless she goes below 68.

One good little tip to know about lantus - if you can get a +2 and compare it to the preshot number, that is often a good indicator of what you might be able to expect in the rest of that cycle.

If the +2 is higher than the preshot, often that signals a cat is starting a bounce.
If the +2 is much lower than the preshot, that can be a giant red flag that the cat is going to have a very active cycle and you have to pay extra attention.
If the +2 is about the same as the preshot, that signifies the cat is likely to have a "normal active" lantus cycle, where the blood sugar will continue to drop til around mid-cycle and then rise to the next preshot time.

You're doing great! way to be cool tonight! I hope you feel better - the flu is no fun.
 
Thanks everyone- One side effect of the flu, is that I'll be home tomorrow, so I'll see what her AMPS is and hopefully can shoot 1u, and monitor. Thanks for all your thoughts Betty -- they are on target, and if you see my other threads (to sick to find it now) I'm having concerns about my vet. Talk to everyone later, thanks again.
 
Its not YOUR vet per se'.... Just mosts vets in general don't have much FD knowledge or training, and many are out of date. All they see is a snapshot of your kitty at a moment in time... And probably treat very few diabetics. The real experience and understanding the nuance comes from dealing with it day in and out. People here are doing diabetes 24/7...you will learn as much reading other peoples condos as from advice you get in yours. If you like your vet in other ways, keep her. You will be able to manage the diabetes on your own with help of these great folks who have been there already....they are the gurus.

So sorry you are feeling bad...flu sucks. Chicken soup & hugs from me to you. And scritches to Lolly!

B2HbonZIEAARWmn.jpg
 
Last edited:
bettyandhank said:
you will learn as much reading other peoples condos as from advice you get in yours. If you like your vet in other ways, keep her.
Click to expand...

so true! I switched to a vet with 2 diabetic cats of her own thinking she'd get it - but she never hometested, just treated them when they had hypos. :banghead: that was ok, though - she let me do what i wanted (which was learn from folks here) and she was great in everything else. If your vet is good otherwise, i'd keep her too. Vets have to know a ton of info on many animals and many topics - most don't have intensive education or experience with feline diabetes.
 
Thank you for the cat superpower feel good rays! AMPS = 165, just did +5.5 of 100. Think that's her nadir, can't do a full curve, just too sick, hopefully tomorrow. Hopefully she'll be up by the PMPS.

That's just plain weird about the vet only treating hypos. Even before I found this board, I figured I'd have to test. (maybe just not so much ;-) My ex-husband was type 1, I can't imagine him just blithely sticking himself am and pm without a test.
 
Similar story to Julie... when Hank was DX w/ diabetes we did not have a deep relationship with any vet...will skip some of the rest of story but after vet#1 and #2 did not work out after which by then we had found this board with Hank well on his way, we decided we needed to try to at least establish relationship with some vet should we need something else, an insulin script, etc..
I knew more by then, what questions to ask, made sure on board with home testing, etc.. and found a female vet who herself had a diabetic cat, and they promoted LC canned diets, etc.. so decided might be a good fit. We didn't really need anything , we had insulin and he was doing great, so the appt was just a meet and greet sort of thing to learn more about them. I showed up with my BG charts, and she says... well I only test my cat 'when he looks funny'.. and NEVER is he below 200. I thought, well how do you know he wasn't this morning? So basically same story as Julie. This vet seemed sort of up to date in ways but never tests her own cat (diabetic forever) No wonder they don't have same remission rates. She looked at our numbers wondering why I was still giving insulin at .25 and how is that even possible- to her that was a placebo dose. She assumed my cat was a transient diabetic.
But we had worked our way down to that dose logically. I thought she was very nice but did not see her again. Other than diabetes he really was healthy and we had the diabetes under control. It was a very long time before we even needed to see a vet again. We ended up trying someone new, by then Hank was long OTJ.
Anyway..hope you are feeling better and better. Miss Lolly needs to cooperate while her bean is recuperating
 
Last edited:
Status
Not open for further replies.
Back
Top