low AMPS, resolved - still want advice on dosing going forward

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CandyH & Catcat

CandyH & Catcat

Member Since 2019
all of a sudden I have a no-shoot number (168) on AMPS

this, after Catcat has been languishing in the yellows for several days, and I was wondering if he was getting too LITTLE insulin, or too MUCH

as is usual, this morning I fed him a couple of tablespoons of pate, mixed with water, so he'd hold still for the poke

so -- hurry up and wait? test in 20 minutes and decide then?

experienced CGs, please chime in, look at his spreadsheet, look at my previous postings on Caninsulin forum, I have been looking for advice there too
 
I have no personal experience with Vetsulin, but from what I have seen here, it can have a quicker onset and harsher drop than the other insulins. So, I think you need to be cautious. I know with ProZinc you have about an hour of 'play' time in giving the shot, and I would assume this is the same. So could you delay him a little while longer and test once more before deciding what to do? Based on the times you posted, I think you have another 15-ish before it will have been an hour.
 
If you have not already done so, post also in the Vetsulin forum. My recommendation is to skip the shot. However I have never used Vetsulin. It is better to skip a shot than give it and glucose levels drop too low.
 
been an hour-fifteen since the first PS -- 25 minutes since second test -- he has been dropping ~100 points usually, from morning 1u injection
but has dropped 150 points a couple of times, with high PS numbers
he's so hungry right now he's trying to eat the dog's kibble (it's grain free, BUT... )
I've fed him bonito flakes after each of the tests
I have leftover Temptations treats (high carb) to keep him from awful crash -- also Karo, honey, TwinPet (mfg Simmons) canned food

tempted to give "scant" 1u dose (what I've been calling .9) plus food now, with dried sardines and bonito flakes after subsequent tests
 
Lisa and Witn (GA) said:
If you have not already done so, post also in the Vetsulin forum. My recommendation is to skip the shot. However I have never used Vetsulin. It is better to skip a shot than give it and glucose levels drop too low.
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have been posting in the Vetsulin forum for several days, only one answer so far, from another newbie, would like more confirmation if poss -- am seeing several possibilities for analyzing his spreadsheet -- forgive me, I'm only a month into this and worried
 
If you 1) are going to be home to monitor and 2) have the things you would need to steer should he start going too low and 3) are wanting to test out how he does with getting insulin on a lower pre-shot number, I would say give a very reduced dose, maybe 1/2 unit. If any of the 3 things are NOT true, just skip. It is better to be safe than sorry.

I would test once more before making the call. You said it has been 25 mins since you tested.
 
CandyH and Catcat said:
tempted to give "scant" 1u dose (what I've been calling .9)
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If your pre-shot test was below your no-shoot number, I think you need to reduce more than that. The fact that there was too low of a pre-shot in the first place may indicate the 1u is a bit too much for him. I would not give more than .75 at the very most and would probably go safer and do 1/2. There is just no reason to risk making him go too low. Better safe than sorry!
 
1) will be home to monitor -- 2) see previous posting, got them -- 3) he has been down to the 50s with no food at all (at the vet) into the 70s (here) with no perceived symptoms

has now been 45 minutes since last test, hair over an hour and a half since initial test; I kept him away from dog's food (usually he can't eat that, kibble too large, dog is husky/lab)

okay, he's at 212 now
 
maybe this will answer the questions I had, about whether the yellows were a bounce and it was time to reduce dose (or whether it was time to increase dose to knock down the PS numbers)
 
CandyH and Catcat said:
3) he has been down to the 50s with no food at all (at the vet) into the 70s (here) with no perceived symptoms
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I was saying if you want to test how he does getting insulin at a lower number. There is no data on your spreadsheet for a dose given on a pre-shot this low. I was not referring to how low he had ever gone. (70s on a human meter is great. If he was 50 on a pet meter/vet test that is too low - symptoms or not, that is not something you want to intentionally repeat.)

CandyH and Catcat said:
okay, he's at 212 now
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So, what did you give?
 
have not given anything yet -- syringe is loaded with something like .8-.9, can always reduce that; vet never gave me preshot no-go number, I'm working with message board's advice not to shoot under 200 -- the 50 was on a post diagnostic curve at vet when he was at 2u dose (see the "vetcurve ss") -- I feed him mini meals every hour or so, so he would never be going that low again
 
CandyH and Catcat said:
have not given anything yet -- syringe is loaded with something like .8-.9, can always reduce that; vet never gave me preshot no-go number, I'm working with message board's advice not to shoot under 200 -- the 50 was on a post diagnostic curve at vet when he was at 2u dose -- I feed him mini meals every hour or so, so he would never be going that low again
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If you are going to give a dose, you probably need to hurry up. You are already pushing it on the time. Hopefully, you will be okay to give the PM shot at the normal time since it looks like he usually gets back up pretty high by then.

I still would not give more than .75 at most.
 
CandyH and Catcat said:
maybe this will answer the questions I had, about whether the yellows were a bounce and it was time to reduce dose (or whether it was time to increase dose to knock down the PS numbers)
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Keep in mind that there is a good chance he went lower during the night since there are not tests during the time he would have hit nadir (understandably, you had to sleep :)). So, you could see a bounce from this that could take several cycles to clear. Mia used to be a very bouncy girl, and I found that consistency was very important in calming that down. So, I recommend that you hold the reduced dose for several cycles, at least a couple of days, before making any dosing changes (unless, of course there is a crazy low number to address).

The pre-shot numbers will be the last to come down. Right now, if you can achieve consistently shootable pre-shot numbers and mid-cycle drops that are 50% or so, as opposed to extreme drops, you will be doing good. Then, you can gradually push things down. It's a bit harder with Vetsulin since it is not quite as long lasting as ProZinc, Lantus or Levemir, but it is possible. I know that @JanetNJ has past experience with Vetsulin, so maybe she can pop in and advise you at some point.
 
bit the bullet, reduced the dose to .75 or thereabouts (syringes don't have half unit markings) -- difference between what I initially loaded, and what I eyeball as .75, was 1 drop; if I shoot at normal time tonight it would be an 11 hour difference, and considering that vetsulin for Catcat normally lasts only about 10 hours, possibly no problem -- had done the AMPS half an hour early because he was agitating even more than usual, for food (and at 168 I can understand that! since he's usually in the 300s)
 
Ooh, you need some syringes with 1/2 unit markings. They make things so much easier!

I'm glad you reduced the dose. I hope it turns out to be a good cycle.
 
we're pretty much on a 7am-7pm schedule for the injection, test at 6:30-6:30 with a mini meal -- Catcat wakes us up at 5 AM wanting food then, which is why we pretty much have to sack out at 10 pm (+3 from evening shot)

I like your advice to stick at .75 for a few cycles -- maybe that's what all the yellows were about
 
with luck I'm getting some half unit marked syringes from someone here on Supply Closet, they haven't shown up yet; I'm going by the "plunger is .25u" approximation; DH bought me a digital caliper from Harbor Freight yesterday, I need to learn how to use it; I have the possibility of another board member bringing me some Lantus, which would be a HUGE relief since it may do away with some of these BG swings,
 
Catcat is happily washing and grooming, had his usual amount of pate, laced with turmeric and olive oil (to help with the healing of the abscess under his chin), also those might help teeth, will be having vet clean them in a month or so, once diabetes is semi-controlled (and when we have enough funds in the budget to afford)
 
+3 = 241 -- odd to have the same reading a hour apart -- now beginning to believe that the 168 earlier this morning, was the fabled "double bounce" from last evening's shot -- either he's hit nadir (probably not) or it has yet to occur -- his ears are getting raggedy so I may not retest until +5 -- I tried the newer thinner lancets, really hard to get a testable drop even with warmed rice sock applied, he isn't happy but at least this time I have no claw nor teeth punctures, my earlier ones are healing up well
 
+5 = 204 I doubt that he's going lower -- usually he's on the upswing by +6

really don't want to waste any more strips this part of cycle, have already had to dump three for "not enough blood" --

though this 204 is slightly encouraging -- it's within a loud shout of blue even if not that close to normal

we'll stick at .75 for the next few days, see how it goes
 
Don't forget that you may see him stay rather 'flat' for a couple/few cycles after going lower than usual last night. So, don't get too disappointed over more yellow. Try to keep with the .75 until it clears, and you can see the true impact of that dose.
 
I've been mixing the insulin before injecting, as it says on the package, as my vet demonstrated, though I'm not shaking it to beat the band as she did (that causes a lot of foam in the vial, which package says is not recommended) but am agitating it like passengers on a carnival ride (whee! :woot:) -- nevertheless, some of the long-term-acting portion may have triggered a late trough (no, not nadir, no no) in the 11th hour, since I did test earlier than usual, though only by 20 or 30 minutes from usual

so -- flat is good, less insulin I HOPE is good, Catcat says it's the pits to have to wait 6 hours for more food -- a little less than 2 more to go from now -- because it's been a rough day for ME, I gave HIM some catnip .. he's snoozing with a big smile on his face .. maybe some of all that yellow beforehand was actually a bounce and it was just taking longer than my patience allowed, to clear

the food bank today offered croissants and maple/pecan strudels (for me) and Newman's Own organic chicken/liver can (for him) -- it has alfalfa in it! I also stopped by Tractor Supply (a half mile or so from the food bank) to get some more of their Blue Buffalo Wilderness grain free canned food (has been on sale 33% off if you buy 10); they'd pulled the tag off the shelf, clerk said the promotion had run out, but IT'S STILL AVAILABLE ONLINE if the cans are still in stock at the store, so I dashed home and ordered the two varieties (salmon and chicken) in stock at the store here; if I want the turkey, DH can pick it up in Olympia (which still has some) since he goes that way every day

sigh -- you have no idea how much you helped today, I was frazzled and frantic -- luckily Catcat just played and purred as usual except when I approached his ear with that lancet ...
 
you called it correctly -- can't really tell if the curve is flat, but the tests I've done have been consistently in the yellow

oh for Memorial Day, I'm wishing for some BLUE (no red, no white, no, please!)

hate to keep my kitty out of normal range, but it could be he's riding out a bounce

I'd like to be able to test earlier and oftener, but his poor ears are developing a fringe .. and he fights me ..
I've got the red (bloody scratches and bites) and the white (antibiotic lotion on them)

oh well, I'm feeding him BLUE Wilderness food today salmon cuz it's a holiday weekend
 
may be coming out of the bounce, just got my first blue though just barely -- +3 = 199

he shouldn't get hungry tonight, with his main meal just short of 7, he got about 5 tablespoons of the plain grilled chicken (from the inside, not the crust) that we were having for dinner, as well as half a can of BW salmon and a quarter of 4Health chicken/whitefish, then for his post-test treat at 9:30, the rest of the salmon and the rest of the chicken/whitefish plus a dry sardine and the bonito flakes he loves

he's still searching for any leftover scraps, licking bowls and spoon shiny clean
 
nice blue numbers at +4 for Memorial Day = 116 :joyful:

now he's bouncing, I suspect at +5 = 194

he's eating Friskies mixed grill pate today, not absolutely sure, but I'm seeing higher numbers from Friskies than from Blue Wilderness, 4Health, and FancyFeast

he may be more carb sensitive to the rice in Friskies than to the potato in BW or the dried egg in 4H
 
FurBabiesMama said:
Don't forget that you may see him stay rather 'flat' for a couple/few cycles after going lower than usual last night. So, don't get too disappointed over more yellow. Try to keep with the .75 until it clears, and you can see the true impact of that dose.
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looks like a pretty much flat curve, as you predicted, would be nicer if all those numbers were about 50 lower -- pretty clear the vetsulin loses effectiveness before the 12 hours (this is news ??? ) -- not too much different from my previous attempt to reduce to .75

would be nice to get those AMPS numbers down but the only way I can think to do that is to test him earlier, and I'm already doing so between 6 and 6:30 am -- cat wakes us up around 5 wanting food, but I am not sufficiently awake then to test coherently -- I need run to bathroom plus morning coffee flavored milk -- MY glucose is bottomed out in early morning, I'm shaky til I get some fat and protein in

good possibility I might switch to Lantus, which could even things out even more -- have located a supply

guess I ought to tag you since not sure you are following this any more == you might see it in your morning @FurBabiesMama
 
Switching to Lantus would probably be a good idea. While Vetsulin can work, it is not an ideal choice for cats. It just does not last long enough and can have some harsh drops. If you go over to the Lantus forum, there are a couple of posts at the top that you will want to read. There are two methods of dosing, and you will want to decide what works for you. That will give you guidelines to follow with your dosing. That forum is also VERY active, so you will be able to post for help with dosing and probably get a lot of input.

If you are not switching soon, it looks like you may need to increase the current dose a tiny bit. Can you hit something between .75 and 1? I see some .9s on there in the past. Maybe with a tiny increase that is held for awhile, he will stay leveled out and not nose dive. Only one way to find out. :)

Are you currently keeping his eating pretty consistent? What I mean by that is are you consistently giving him the same food or foods with the same level of carbs? Also, does he have set feeding times during the day? I bring this up because having consistency with the food can also help keeps things more level/stable and less volatile.
 
food: I'm rotating amongst Fancy Feast, 4Health, Blue Wilderness, and Friskies -- all "grain free" pates, all in the 3-4 carb % range according to Dr Lisa's chart, with Meow Mix Tender Favorites (2 varieties) for treats that fit the profile too -- he gets the equivalent of 2 - 5.5 oz cans and 1 - 3 oz can a day, split up this way:

2 Tablespoons for morning test plus 2 Tablespoons of "treat" immediately post test plus a large pinch of bonito flakes, half an hour later he gets 2/3-3/4 of the 5.5 can I opened for test, this is when I shoot;
at +1 he gets a heaping Tablespoon of food, at +2 another one,
at +3 when I often test, one more T of food pretest, plus 2 T of treat food (about 1/3 of the can) plus a dry sardine and another big pinch of bonito flakes

if I choose instead to test at +4 (close to nadir time) instead, I'll give him what I would have given otherwise at +3, which means giving him 2 T at +3
if I tested at +3, he gets the heaping T at +4

(in other words, +3 and +4 swap back and forth, depending on which time I test -- I'm trying to anticipate where he'll drop to at nadir, and "cushion" it slightly)

+5 and +6 -- a heaping T each time, then no more food until PMPS

nights -- test at 6:30 (or whatever is 12 hours from AMPS) with minimeal and treat
shoot half an hour later with 2/3 of a 5.5 oz can
+1 and +2 a heaping T apiece
+3 1 T pretest, treat following, then the rest of the can of food to carry him through the night

main meals at AM and PM I add turmeric and roughly half a teaspoon of extra virgin olive oil (for skin condition, digestion, and his case of cat acne)
+3 treats usually include one dry sardine broken up along with the treat food and bonito flakes

yes, I know it appears complicated -- I don't dare free-feed him because he would eat it all in big gulps and still ask for more, this way he gets something to eat every hour to hour and a half, while the vetsulin is effective, just hope that this will let his pancreas start working properly again
 
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no half unit marks on the U-40 syringes the vet supplied -- I'm eyeballing the .75 by using the estimation that the plunger itself is .25u or thereabouts
so a .75 is with the bottom of the plunger at the 1u mark

that .9 (gross estimate) was with the top of the plunger just barely short of the 1u mark -- a "skinny 1 u" more or less
as I mentioned earlier, when I reduced from that point to .75 u -- one drop came out of syringe -- I free-shot it out after removing syringe from vial

clear as mud?
 
okay, 216 at +3 today, may drop at bit at +4 or +4.5 but not as much as I hope -- will hold the .75 for tonight so he doesn't get too low at night, will try bumping up dose tomorrow morning, just a squeesh -- sort of a real-skinny 1u -- supposed to go to a homeowners' annual meeting for lunch tomorrow but think I will skip it unless it's clear I don't have to monitor Catcat closely then
 
and again, you were right -- 383 at AMPS -- going to try the "skinny 1u" aka .9 today since I can monitor him -- looks like he might be losing weight again so will also increase the food I offer (which he nearly inhales) -- I wonder if we're dealing with insulin intolerance issues -- he's active WHEN he's active, grooming quite a bit (another hair "worm" this morning), playing with fish-on-a-line, bounding up and down the stairs, out to visit the barn cats, but he may be sleeping a bit more than usual too
 
+2 = 250 -- with that slight dose increase, yes, he's going to bounce ... :banghead: :p

+4 = 247 -- yes, Houston, we have a bounce

+6 = 273

PMPS = 279
 
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