Low AMPS, but skyhigh PMPS - What dose?

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Hercule's mum

Hercule's mum

Member Since 2020
Hercules is giving me quite low AMPS, below the cut off for giving him a shot. I tried to stall his food, but he is ready to pin me dow and chew my ears....:D Also, my thinking is that with hif BG at 76 I ought to be giving him food?

The problem is that if I skip the dose, or reduce it, he goes into really high numbers by his PMPS.... Any suggestions of what to do?:arghh:
 
Have you thought of an auto feeder during the night? It is important to try and feed the same amount of food during all the cycles....not all during the day and none at night.
I see you have given 1 unit at +2. That will mean you will need to give the next dose 1 3/4 hours later.
I would also try and get at least one test in during the pm cycles. They are just as important as the am cycles.
 
Hi Bron,

Thanks for your message.

Yes I have been thinking about an autofeeder. But I also don't know how much food he can actually have. He has lost weight before his diagnosis but I think he is recovering well. He always acts like he is starviiiiing... How do I come up with an ideal weight and amount of food?

So do you think the food distribution is the issue here?

Would it be wrong to give a lower dose at night? Prozinc user.
 
Hercule's mum said:
Hi Bron,

Thanks for your message.

Yes I have been thinking about an autofeeder. But I also don't know how much food he can actually have. He has lost weight before his diagnosis but I think he is recovering well. He always acts like he is starviiiiing... How do I come up with an ideal weight and amount of food?

So do you think the food distribution is the issue here?

Would it be wrong to give a lower dose at night? Prozinc user.
Click to expand...
I am not a Prozinc user so you would need to ask @Deb & Wink that question.

If you feed about the same amount of food each cycle you are giving your kitty the same amount of food to work with the insulin each time. If you give most of the food during the day and not much at night you will get a big variation in the BGs.

A lot of cats lose weight when they are first diagnosed. That is because they can’t utilise the nutrients in the food. Once they are getting insulin and the BGs come down they will start to put in weight.
To work out how much food he needs you can use:
20 calories /lb healthy body weight/day OR
Calories per day = 13.6 x optimal lean body weight In lbs +70.
 
I think it would be quite hard to spread food equally throughout the day. I have been lucky that the diagnosis happened while I was working from home, but it (hopefully) won't stay like this forever....

If I could schedule 4 equivalent feeds a day (adding one at night by an autofeeder) would that work?

Also, since there is another cat in the house, how to make sure the right cat cats the evening feed? Anyone with multiple cat household could advise?
 
You don’t have to spread the food over the whole day. It is usually better to feed most of the food in the first half of the cycles when the insulin is working the most.
I understand how hard it is in a multi cat household. Are you awake for the first 5 or 6 hours of both cycles?
 
I'm afraid not :oops:... I am a 9 hours sleep girl..... I have been planning a PJ party, but I keep getting worried I'll make a horrible mistake because I am not thinking clearly....I could possibly do 4 hour after PM shot evry now and then :oops: Am I a bad mother?
 
Hercules is not regulated yet. Once he is his appetite should diminish. I would feed him more snacks. There should be more solutions so hang on for more replies.
A timed feeder may be in your future. No doubt Herc. loves his foods. There is a balance and a tricky one at that.
 
Help, someone!

I just for a walk for a couple of hours and came back to a meassurement of 3.2 :woot:
Gave him food and meassured again (5 minutes later, just to confirm the reading) and it gave me 3.5
Is this a hypo, do I go ahead and give him sugar. He seems ok, behaviour wise and ate all his food and is happy to eat more...
 
Hercule's mum said:
Help, someone!

I just for a walk for a couple of hours and came back to a meassurement of 3.2 :woot:
Gave him food and meassured again (5 minutes later, just to confirm the reading) and it gave me 3.5
Is this a hypo, do I go ahead and give him sugar. He seems ok, behaviour wise and ate all his food and is happy to eat more...
Click to expand...
Give some high carb food and retest in 30 mins. As long as he isnt showing symptoms. If he gets lethargic then give honey or Karo tagging some folks to be sure.
@JanetNJ
@Nan & Amber (GA)
 
Thanks for answering me, JT. :bighug:

Just retested him and was 5.2. I did panick and gave him a lick of honey....
I am just getting really confused about what to do going forward....
 
Also, even without a Prozinc user here, pretty sure Herc has answered the dose question-- he wants less insulin :D.

It looks like you shot 2hrs late this morning? I think you have an hour or so of wiggle room with Prozinc, but even so you will be shooting an hour later than your usual time tonight (that's assuming he comes up enough, that is).
 
Hi Nan, It looks he will come up enough for his Pm shot, but how much to give him? If he has 4.2 12 hours after his night shot (as he did this morning), how low is he going in the middle of the night? Yet he still rebounds quite high at the end of the day.... I'm tempted to give him only 1U this evening, what do you think?
 
He has at least earned the 0.25U down to 1.0U. That's probably his new dose going forward, unless a Prozinc person comes on to suggest something different (he went this low on the reduced dose of 1.0U this morning, not sure if that makes a difference for this insulin-- I'm a lantus/levemir user).

The rebounds you are seeing are perfectly normal-- he's just not used to these low numbers yet. His bounces are relatively short, at least!

Yes, he may be going lower at night. If you can possibly get some nighttime tests in, that would be the best, but if not that's another reason to reduce for a while. Better to run a bit high than go too low when you can't monitor! Although again, I suspect the "highs" in Hercules' case are reactions to low numbers.
 
iu


;)

.
 
BG-wise, there's only one thing worse than the way your heart sinks at seeing a really high reading, and that's the way it jumps up into your throat at the sight of a really low one. :nailbiting:

Bouncing's not uncommon. Some cats don't bounce much at all, some bounce a bit, and then there are those who could win successive Olympic golds in trampolining. :rolleyes:


Mogs
.
 
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Any time your newly diagnosed cat drops into those neon green colors on the SS, it's time for a dose reduction of 0.25U. Doesn't matter which insulin you are using. This rule holds true for all the insulins.

The only exceptions are cats that have been diabetic more than 1 year. Or cats that have higher ketones present.

Some cats don't hold on to the good BG numbers with a dose reduction. But FIRST, you have to let the bounce clear. That can take 3 to 6 cycles (12 hours in each cycle). So be patient before deciding to increase the dose.

Prozinc likes some consistency in the dose also, so no to the question about giving a different amount of insulin at night. You want to find a dose you can give every 12 hours.

Don't concentrate too much, or worry too much over the high BG pre-shots. They should come down. We look at the mid-cycle nadirs to tell us if a dose adjustment is needed.

You just did a food change too, to lower carb food. So you are likely to see some more low numbers, once the bouncing clears. Lower carb food can make a BIG difference in how well a feline diabetic does.

Oyumpics contender in the high jump! Hercules!!!!! Go give yourselves gold medals, for doing such a good job managing this stressful situation.
 
Nan & Amber (GA) said:
@Deb & Wink , is the reduced dose going forward 1.0U or (because only 1.0U was shot this morning) 0.75U? On Lantus, it'd be 1.0U (on the assumption that most of the action today was due to the 1.25U depot from previous shots), but I was wondering if the logic would be different with the in-and-out insulins like ProZinc?
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Good question Nan.

The reduced dose going forward should be 0.75U. No depot with the in-and-out insulins like Prozinc.

The reduction is taken because of the 3.2 mmol/L (58 mg/dL) at +8 from today's AM cycle 8/4/20. (or 4/8/20 in European format).
Dose reduction is done with Prozinc, based on the most recent dose, which was the 1U. So 1U - the automatic 0.25U dose reduction would bring the dose down to 0.75U.

p.s. I would not stall for more than 1 hour with Prozinc. If the BG level is not high enough after your 1 hour stall, than I would recommend either skipping the shot or doing a token dose. Token dose with Prozinc is usually somewhere in the 10% to 25% range of the regular dose.
 
Thanks Deb and Nan. I woke up early today to do an "evening read", and went back to sleep, so only saw this now.... so I did gave him 1U this morning. His BG was much higher in the AMPS so hopefully will be OK. I'll stay home the whole day and stick with it if no bright greens to give his body a chance to regulate. I do understand what you say though, that it should be 0.75 and if I see a bright green I'll go down. I'll also try to get more readings this evening.

Thank you so much for this discussion, super helpful! I learned a lot!
 
Deb & Wink said:
Any time your newly diagnosed cat drops into those neon green colors on the SS, it's time for a dose reduction of 0.25U. Doesn't matter which insulin you are using. This rule holds true for all the insulins.

The only exceptions are cats that have been diabetic more than 1 year.
Click to expand...

I've not come across this distinction before, Deb (I'm always learning from you! :) ). Could you explain why this particular exception, please?


Mogs
.
 
Hercule's mum said:
so only saw this now.... so I did gave him 1U this morning. His BG was much higher in the AMPS so hopefully will be OK.
Click to expand...

Yes, I think he'll be fine, but glad you'll be home to monitor anyway. I'm not worried in this case, but next time I will wait for a prozinc person if I'm at all unsure about which dose :confused: :confused: :confused:!

Mogs, I think what Deb is referring to is the "three drops" standard for reductions for long-term diabetics. The rationale: some long-term diabetics don't seem to hold reductions well if you reduce every time they dip into the 40's. So, to keep from constantly yoyo-ing up and down, there's an alternate standard for reductions that caregivers with cats like this can use: take the 0.25U reduction only after you see three drops into the 40's on separate cycles, or a single drop below 40. I was just looking through the stickies on that board and I can't seem to locate a reference (other than the rule that any drop below 40 demands a reduction, no exceptions), but it's definitely in wide use over there. Not universally-- ECID and some long term diabetics hold reductions just fine-- but as a commonly-used option.
 
No problem Mogs, anytime!

That said, that explanation was for common practice on the Lantus board. I just checked the Prozinc stickies, and they have a more detailed and nuanced procedure [Edit: this is for the "Modified Prozinc Method"; the SLGS reduction point is unchanged at 90 as far as I can tell]:

  • If your cat is between six months to a year of diagnosis, look at the overall picture of your data to determine if a 0.25u reduction is warranted on a single number below 50.
    • Prozinc can be a little volatile at times, and there will be the occasional random drop. If you have a consistent body of mid-cycle tests that indicate the low number is unusual, you may consider holding the dose and continuing to monitor or you may choose to just shave a little off the dose.
    • If the low number appears to indicate a general downward trend of numbers, then it may indicate that you should indeed lower the dose.
    • If your cat is more than a year since diagnosis, a single number between 40-50 should not mean a full 0.25u reduction. You may shave a little off the next dose, or just hold the dose and continue to monitor.
    • Additional numbers between 40-50 in the days following would indicate the dose should be reduced.
    • Any cat, regardless of time since diagnosis should receive a reduction if there is a number below 40.

Have to say, reading this, I kind of like this approach better. It doesn't have the simplicity, but it's a lot more geared to the individual cat.
 
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