Low PMPS again, stalling, new post at end of thread

Megan and Bernie

Megan and Bernie

Active Member
Hi, all!

Bernie gave me a surprise with a beautiful PMPS today, but I'm not sure where to go with dosing. She was 119 mg/dL on the ReliOn and 155 mg/dL on the AlphaTrak 2 (yes, I'm a nerd and have two meters LOL).

I recently switched her from free-feeding and SLGS to structured feedings (2oz with insulin, 1oz at +3/4 and 1oz at +6) and Modified ProZinc Dosing. She is prone to bouncing, so I've been increasing her every 6-8 cycles (I've been working on decreasing the amount of cycles between increases), and I've been increasing her by fat units (so we went from 2.75 to 2.75f to 3), and it's been working really well, with WAY more yellow PS numbers, only one of two bounces (knock on wood), blue nadirs, and even a few green nadirs finally!! And nowwww she gives me this beautiful PMPS, but the last time I shot her in the blue, she dropped down to 68 mg/dL on her AlphaTrak2 (I didn't get a reading on the ReliOn because I was too busy panicking and looking for the Karo).

Currently I'm stalling, her first +30min is due about now, but I don't want to get her too off schedule because she's been making such good progress with the more aggressive dosing. I'm leaning towards a one-time reduction, but not sure how much to give.

She's currently at 3u (and was due to be increased to 3f tonight). Should I reduce her to 2u? 1u? I'm so happy she's at 119 mg/dL, but I'm super nervous to shoot her. Any help would be greatly appreciated!

Love,
Megan and Bernie
 
NoahFL said:
@JanetNJ or @Panic may be able to help.
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I’m by no means an expert, but are you able to stall another 30? From what I understand you can stall up to an hour and still be ok. This is from the dosing sticky:

“
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.”
 
NoahFL said:
@JanetNJ or @Panic may be able to help.
Click to expand...
How funny, I was JUST reading your post from yesterday when Noah gave you a 190! Must be a sign! I saw someone suggested a token dose of 10-25% (I think Deb?) I think I might do that if she’s gone back up a little? Ugh this is so confusing! I literally laughed out loud when you said you think you know what’s going on and then they give you a curve ball or 4 chain saws hah!! So true! Thanks for the reply!
 
@NoahFL @JanetNJ Thank you both so much for your help! I just did her +1hour stall and she was still dropping. She was 88 mg/dL on the ReliOn and 97 mg/dL on the AT2. I’m gonna skip tonight entirely. Thank you again for the help. Bernie is very happy to be getting her dinner now :) :)
 
Megan and Bernie said:
@NoahFL @JanetNJ Thank you both so much for your help! I just did her +1hour stall and she was still dropping. She was 88 mg/dL on the ReliOn and 97 mg/dL on the AT2. I’m gonna skip tonight entirely. Thank you again for the help. Bernie is very happy to be getting her dinner now :) :)
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Not a problem. That’s a great number! Good luck tomorrow! Hoping for no crazy bounces. That seems to be the norm for Max lately!
 
Replied in your other thread first, saying I wouldn't shoot the full 3U dose on that low BG number.

A skip is fine.

Even with the MPM dosing protocol, your cat won't always be high enough to give the full dose. so knowing how your cat reacts to the various carb percentages of food (LC, Mc\C, HC) becomes important. So you know what foods to feed to bring the BG levels back up from low numbers.

Juggling chain saws is a real thing.

The ones juggling on a 6 foot unicycle are even crazier. Knew someone like this.
589b6862448b4.preview.jpg
 
Deb & Wink said:
Replied in your other thread first, saying I wouldn't shoot the full 3U dose on that low BG number.

A skip is fine.

Even with the MPM dosing protocol, your cat won't always be high enough to give the full dose. so knowing how your cat reacts to the various carb percentages of food (LC, Mc\C, HC) becomes important. So you know what foods to feed to bring the BG levels back up from low numbers.

Juggling chain saws is a real thing.

The ones juggling on a 6 foot unicycle are even crazier. Knew someone like this.
589b6862448b4.preview.jpg
Click to expand...

Oh my gosh, that’s wild haha!!! Thank you! I highlighted the MPM all over and kept rereading the line tonight where the goal is to eventually shoot as long as they’re over 50, I can’t even imagine! The last couple times she’s gone into the green it’s been because she was finicky with eating, but she ate all her breakfast and snacks today, so I’m totally baffled at those numbers! And she wolfed down here dinner and usually she kind of grazes on it over the course of an hour or so. Fingers crossed it’s a good sign! She’s been SUPER playful lately too, more playful than I’ve seen her in legitimately like 4 years. She even brings me toys and pounces on me to wake me up and play in the middle of the night hah!
 
Megan and Bernie said:
I highlighted the MPM all over and kept rereading the line tonight where the goal is to eventually shoot as long as they’re over 50, I can’t even imagine! The last couple times she’s gone into the green it’s been because she was finicky with eating, but she ate all her breakfast and snacks today, so I’m totally baffled at those numbers! And she wolfed down here dinner and usually she kind of grazes on it over the course of an hour or so. Fingers crossed it’s a good sign!
Click to expand...
Yes, eventually when you know more about how Bernie reacts to the different carb food options, you can shoot any BG pre-shot that is >50 mg/dL.
You've only been on MPM for about 2 weeks. Don't think you are quite ready to shoot that low yet.

Wolfed down her dinner you say? Many cats naturally seek out food when they feel their BG levels going low. So Bernie was "talking" to you, to let you know her sugar was low and she needed food NOW!!!!

Megan and Bernie said:
She’s been SUPER playful lately too, more playful than I’ve seen her in legitimately like 4 years. She even brings me toys and pounces on me to wake me up and play in the middle of the night hah!
Click to expand...
So all that you are doing for her is worth it!:)

The 5 P's (playing, preening, purring, peeing, pooping) returning to normal along with the appetite give you a good visual assessment of how Bernie is doing.
 
Deb & Wink said:
Yes, eventually when you know more about how Bernie reacts to the different carb food options, you can shoot any BG pre-shot that is >50 mg/dL.
You've only been on MPM for about 2 weeks. Don't think you are quite ready to shoot that low yet.

Wolfed down her dinner you say? Many cats naturally seek out food when they feel their BG levels going low. So Bernie was "talking" to you, to let you know her sugar was low and she needed food NOW!!!!


So all that you are doing for her is worth it!:)

The 5 P's (playing, preening, purring, peeing, pooping) returning to normal along with the appetite give you a good visual assessment of how Bernie is doing.
Click to expand...

Oh yay, that makes me so happy! She inhaled both of her snacks and her breakfast this morning.
Her AMPS was way better than I expected, too! She was at 282 mg/dL on the ReliOn. Her mid-cycle last night was 399 mg/dL, so I was sweatin’ for sure about this morning haha!

I gave her the full 3u this morning, but her increase schedule resets now, right? I hold the 3u for a new 3-6 cycles before increasing?
 
Bernie is high this morning, 6/30/20, because of that skipped shot last night.
Megan and Bernie said:
I gave her the full 3u this morning, but her increase schedule resets now, right? I hold the 3u for a new 3-6 cycles before increasing?
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Kind of.

She is bouncing from those highs last night and the skipped shot. A combination of both of those situations. Let's see if she settles down in 3 cycles. I'd like to see what she does in 3 cycles, instead of waiting for 6 cycles.

Would you please test for ketones? Ketones can form very quickly when a cat isn't getting enough insulin, not eating enough, and might have an infection/inflammation going on. (think bad teeth and gums or a UTI). Better to be safe than sorry.
 
Okay, that sounds good! I have the keto urine strips but have yet to be able to catch her peeing, but will try to keep an eye on her and get some! I ordered a blood ketone monitor that is supposed to arrive in 2 days. If I can’t catch her pee, should I try and find one at Walmart or CVS before the other one arrives?

Her PMPS today was 233 mg/dL and her +4 was 181 mg/dL, I’ll get another before bed around +6/7 and update about trying to catch her pee (fingers crossed!).
 
2 days for the blood ketone meter to arrive should be ok. Fingers crossed, as the unexpected can always happen. Not sure if Walmart or CVS would have one in stock.

Did we share the Urine Catching Tips with you?

MPM doesn't do a dose reduction, until the BG level drops to 50 or below.
 
Still haven’t been able to catch her peeing yet. She’s like a bathroom ninja! Thank you for the tips! I have it all set up next to the box with a ladle and the strips, I just have to catch her entering the box. I have three cats, so the plastic cover won’t work (I swear, my boy civvie spontaneously produces urine at the sight of changed litter haha!) but I think the ladle will do the trick!

Her PMPS was a little higher than normal, but it was an hour late (so +13). I have a wedding tomorrow night and won’t be home until 9P (her normal time is 6A/P). I completely fudged up, I wish it had occurred to me earlier to start pushing her back 15 min a cycle, but realized this morning that she’s either going to miss a shot or be 3 hours late, so I thought maybe doing 3 one-hour-late cycles would be less harsh? Would it be better to do tomorrow morning at +12 and then tomorrow night at +14, or do both of them at +13?

I’ll taper her back by 15 min increments starting Friday morning until she’s back to her normal schedule, and I plan to increase her tomorrow night or Friday morning as long as her nadir tonight and early morning numbers tomorrow are good.
 
There's a bit more leeway when dosing Prozinc, than shifting the cycle 15 minutes a cycle. 30 or 60 minute shifts can be ok.
Up to an hour difference in the shot time, as long as it's not a regular occurrence, usually works ok.
So shift 1 hour per cycle if you get the chance.
If not, you could consider this event a "fur shot" and know that she'll be higher.

Life happens, and you have to work things around that.
If Bernie had ketones, it would be a different situation, and you would not want to "skip" the shot.

p.s. The ladle trick works for lots of people. If that doesn't help, you could get a blood ketone test meter, and check the ketones directly in the blood, instead of waiting until they show up in the urine.
 
@Deb & Wink
Thank you! I didn’t realize you could move it up faster, that’s good news! I loved her up an hour this morning and was going to move her up an hour at dinner, but she’s way lower than normal again. She started looking for food a few hours before shot time (around her normal 6PM feed time), and started trying to eat crumbs my kids left on the floor. She ended up throwing up bile at +11, so I checked her BGL and it was 133 mg/dL on ReliOn. I fed her and planned to shoot her at +12 keeping in mind I’d be shooting a food bump, but her +12 (1 hour after eating 1oz) was only 139 mg/dL. She nibbled a little more just now but doesn’t seem very hungry. I also just checked her ketone meter for the first time and it read 0.2mmol/L, but I have no clue what the reference range is normal for ketones (or should it be 0??).

Where do I go from here? Do I shoot the full 3? Skip? Give her a token dose?
 
@Deb & Wink I forgot to add that yesterday morning (before I left for the wedding), she was in the low 100s at +13 again, and I wasn’t going to be home to monitor her all day, so I skipped her AM shot. She got her full 3u last night and this morning.
 
Or should I skip her tonight entirely and reset her back to her normal 6A/P times in the morning? The only thing I’m worried about is the ketones, but I don’t know what the “within normal limits” range is. The meter reads 0.1mmol/L as a minimum, so is 0.2mmol/L considered positive?
 
Then skip the shot and reset to your normal shot times in the AM.
Deb & Wink said:
So shift 1 hour per cycle if you get the chance.
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I forgot to say back in this post, that shooting 1 hour early can sometimes act like a dose increase.
Conversely, shooting 1 hour late can sometimes act like a dose decrease.

ECID - Every Cat is Different and Bernie may not react at all to the 1 hour time difference.
 
Deb & Wink said:
Then skip the shot and reset to your normal shot times in the AM.

I forgot to say back in this post, that shooting 1 hour early can sometimes act like a dose increase.
Conversely, shooting 1 hour late can sometimes act like a dose decrease.

ECID - Every Cat is Different and Bernie may not react at all to the 1 hour time difference.
Click to expand...

Okie dokey, thank you for your help, as always! :)
 
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