Low PMPS

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misskitty007

misskitty007

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So at PMPS Fredo was 93, clearly too low to shoot. Waited about 10 minutes and got 113, still too low. I needed to give him some chicken with his test, so now technically he has eaten, meaning his BG will rise. He is due for .5 in the next hour, what to do? He gets small dose, but vet says 125 should be no-shoot cut off.
(AlphaTrak2) I literally don't know whether to be standing by with honey or an injection. Help..
 
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Plain chicken shouldn't raise the numbers much.
If you're using an AT meter, I'd skip in your shoes.
 
ugh, up to 141 an hour later. no idea what do. how long can i slide injection? we are only a half hour past 12 hr window. i'm inclined to skip, but hate to send him skyrocketing, we've been doing so well.
 
You can wait as long as you want. If you do give a shot, that becomes your "new" normal shot time, at least for now.
With Prozinc, the "12 hours between shots" isn't a hard rule. You need to think hard about less than 12 hours. More than 12 isn't a big deal.
You can let the numbers you see help you decide when (or how much) to shoot.

You could test in an hour. If higher, maybe .5u, or if you can see well enough, a smidge less?
Then in the morning, check at your regular shot time. If it is high enough, you might consider a shot. If not, test a little while later.

Make sense?
 
Can you eyeball 0.25 units? Or even just less than 0.5 units?
You can use a stiff ruler to line it up with the U-40 syringe to help you be consistent.
 
it does. thanks. i will try to take one more test at 11 and see where we are. not a problem to adjust shoot time for me . but he did just have some diarrhea so i want to give him some time.
 
If he has diarrhea, be prepared. That can be a warning sign of a number of issues, including a bad batch of food, pancreatitis, inflammatory bowel disease, and more. Those issues may decrease glucose levels, so make sure you have your hypo kit, with Karo syrup, high carb gravied foods, an oral syringe, and the locations and hours of nearby veterinary emergency clinics.
 
the diarrhea has been ongoing, tonight's was at least a little more formed. vet is aware. and he has been tested. negative for pancreatitis and various other things. i am really not willing to risk a hypo so maybe i will skip dose. i'm frustrated as we were on a good run.
 
A pinch of psyllium at each meal may help give it some form.
Just a note - the fPLI is not a perfect test and can miss some cases of pancreatitis.
Was there a test for exocrine pancreatic insufficiency to see if the digestive enzymes are being produced properly?
 
i went ahead and shot the eyeballed 0.25. of course now i'm nervous, but i'm sure it's fine. he was up to 171. this is all so scary. and constant.
 
sorry to ask this as well, and maybe I shouldn't be asking you this, but I just realized my regular vet is out tomorrow. If his numbers allow a morning dose, would I keep it at 0.25 or go back to his regular 0.5?
 
In my opinion, it depends on the number you see in the morning.
What time was it that you gave the shot tonight? (I don't know what time zone you are in).

I personally wouldn't suggest shooting if his number is below 150, which would be the upper end of "normal" on an AT meter. I myself might do it, but I'm not going to advise you to.
 
East Coast. gave shot at 11:40pm tonight. and i agree, i would definitely not shoot below 150 at this point. generally his AMPS #'s have been around 200 or yesterday a bit above that.
 
OK, here's the deal. :)
I think you said your vet said that 125 is the line in the sand for shooting or not? That is fairly aggressive advice that I don't disagree with because I was aggressive with Bob. But Bob was my cat so it was my call. And I also knew what I was able to do later in the cycle as far as testing goes. It's a different story when I'm dealing with a stranger and it's not my cat.

I might draw a line at 200 in your case, depending on when/if you can test tomorrow.
If between 150-200, maybe .25u. If above 200, maybe .5u. And I'd test 3-4 hours after the shot.

How is his appetite? As long as he is eating OK, I don't think that is a problem.

So far, on your spreadsheet, I don't see a number that is scary at all. Actually, I see some really nice numbers. Bob didn't have blue preshots until he'd been getting insulin for a few weeks, lol. And his doses weren't less than one unit until a week or two before he went into remission. In other words, both you and your kitty are doing really well at this point.

And yes, all of this does get much easier! The longer you do this, the more you will "learn your cat", and the more confidence that will give you.
 
Hey Carl.
My vet actually originally had us at a don't shoot below 200 when Fredo was on 1.0 unit. He changed it when we switched him to 0.5, but now I am questioning whether he said 150 or 125. Regardless, I am not shooting below 150, and only if it's rising. I'm not a gambler. (Thus I checked on him three times last night even at that super low dose.)

His appetite was great this morning (unusual) as he ate almost an entire can of FF Chunky. He was perky and happy. Waiting now to test at 11:30am because he didn't finish eating until 10am. I will have to make the shoot or skip call on the spot, as I can't push it time-wise past 11:30am/pm with my life.

And to be fair and clear Fredo did start insulin on January 17th, I just didn't start the spreadsheet until this past week. Ha. It was/is all too overwhelming to get on top of everything. But we did quickly change to a lower dosage so fingers and paws crossed! And the last few days, other than the neuropathy, Fredo has seemed more like himself again. Thanks for the support and encouragement.
I just had my birthday, and to be honest, when I blew out my candle I only had one wish.
 
168 at 11:10am. I will try to check one more time in about 15 but then have to go. Oh my guy keeps me on my toes. What to do what to do? I will be able to be home about 3 hours after shot, but then have to go out again this evening. sigh.
 
If he ate at 10 and his BG was holding steady or slightly dropping an hour and a half later, that's encouraging.
Happy belated birthday, and may your one wish come true!
 
2:10 pm (2 1/2 hours since last test) and we are down to BG125, with no AM shot. i don't want to get ahead of myself, but could this be...
 
Hi misskitty007,

I found your thread- I was thinking about you and Fredo. Although he's keeping you on your toes, it does sound like he's doing better.:) Who knows-- maybe the ladder... Lollie was dx'd Jan 2, and we're on our OTJ test now. She went really fast, and I had to constantly watch for low numbers. More experienced people will look at Fredo's numbers and advise you. Don't feel bad about asking for advice on every shot-- I think I asked on every shot for two weeks straight-- and everyone still talks to me:)!

I'm so glad Fredo's doing better! Hugs for both of you :bighug::bighug::bighug::bighug::bighug::bighug:
 
Awesome! It looks like his pancreas is doing its best to keep up.
Would his routine feeding schedule be to eat between now and PMPS? Or are you feeding just twice per day?
 
Just wanted to say that Fredo is an AWESOME name. If he were mine, I would continue with tiny doses (0.25) until you're getting all blues and greens for a few days, then try OTJ trial. Don't sweat small ups and downs. The meters have a huge margin of error.

Good luck Fredo and Bean!

Lori
 
He is more of a grazer and because his appetite has been so on and off with all of this i want to encourage his eating when he feels like it. that said, he loves his chicken breast when he gets tested! I will continue to monitor and i'm sure he will eat at least once before tonight's possible dose (which I would probably schedule around 10pm). My vet just suggested that if he goes above 180 i can go back to 0.5 tonight, but i might be more inclined to stick with the 0.25. I will have to see how his numbers progress throughout the "undosed' day. I guess I want him in the greens, but I am so scared!
 
My apologies, I'm at work right now. He is looking pretty good. As Carl noted, when you can be home to monitor and intervene (ie awake!), you can be more aggressive. If you're not able to monitor, being cautious is fine.
You may be able to develop a sliding scale where lower glucose levels at pre-shot get lower insulin doses. Keep in mind that the amount of drop at a given pre-shot with a given dose varies, so be flexible based on what you see in your cat.
 
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Looks like Fredo's pancreas is pulsing insulin in response to inbound food carbs. Yay! :) I suggest making a note of the food and the carb percentage that produced such good results in your spreadsheet. That may be a goldilocks level of carbs for Fredo, so it's very useful to have a record of it.

I'd suggest monitoring BG quite closely now. Saoirse's pancreas started responding to food like that just before she became diet-controlled, and even though she was only on tiny doses of Lantus once a day at that stage, she went surprisingly low on me a couple of times before her OTJ trial. (Caught them because I was doing the helicopter parent thang.)

Go Fredo! :D
 
I am definitely able to be home to monitor a lot. I'm just terrified. But I guess pushing the envelope is the only way we eventually get into the greens and the possibility of remission?
 
Don't be terrified. I know, easier said than done. Grazing is actually not a bad thing. It helps spread the carbs from eating more evenly over the course of a easy or night.

The reason I asked - it would be normal to see the BG go up some an hour after eating. But when you don't give insulin, what you wouldn't expect (in a non regulated diabetic) is for the number to go back down a couple/few hours later. His last dose would have worn off by that time. So it indicates that his pancreas is producing at least some insulin and helping to regulate his numbers. That's a good thing!
 
I know that terrified feeling oh-so-well. :bighug:

As you accumulate more data in your spreadsheet, that helps calm the nerves. A lot. :)
 
Hey All,
Thanks again for all your support. He was up to 189 when I got home tonight at 8:30pm, which still ain't bad for almost 24 hours without a dose. so I am just waiting until 10pm and will go back to 0.5. on vet's recommendation. I am hopeful that we are moving in the right direction. As I said if being aggressive can get us to remission, I want to try, but it really is such a scary thought to be playing so close to the edge, definitely not my nature. That said, I would love to have our lives back (Fredo's and mine!).
 
At 158 this morning AMPS, I gave him a little less than 0.5. Definitely a little nervous. His nadir does not seem to come until much later than the average on ProZinc, but will have to be mindful. I feel like if I want to get him closer to normal I still have to dose at 158. Ugh.
I really don't understand that this can ever not be 24/7. O that you can ever go away (something I need to do for work). I mean you can find someone to inject, but not test, and testing seems so crucial, if not totally reliable.
 
Hard to tell when nadir might be happening. If possible, you can try getting a +3 and a +6 reading. +3 is when onset should be happening, and +6 should be nadir time. Emphasis on "should be".
 
he is sooo over getting tested right now, i feel like i need to save my tests for preshoots and making sure he's rising when necessary. his nadir seems to be much later than +6.
trying to trust my decision to shoot this morning, and of course today he's eating less. just fed him some egg.
 
What leads you to think his nadir is much later?

The only cycle I see that looks "odd" is the one where you saw the 98 at PMPS.

What I don't see, and it is encouraging, is a preshot test that would indicate a "bounce" from a low number during the middle of a cycle. He doesn't seem to be going "scary low" between shots.

One thing in your favor is the size of his doses. Half a unit is tiny, much less than many/most cats need. Easy for me to say because Bob got as much as 4u on occasion.
 
I've seen it, tho maybe not documented, that a few times his low seems to be only 3 or 4 hours before his next dose. On 2/11 when I did not shoot at all his numbers just kept dropping as well. I still don't completely understand what a "bounce" is. And yes, my vet feels like his dose is so low, that hopefully he should be safe. And he's a big boy, around 15 lbs, though more big then fat.
 
A bounce - when levels of blood glucose drop either too fast or too low, a series of automatic responses takes place involving the pancreas and liver. They release hormones that result in the liver dumping "sugar" into the bloodstream, which raises the BG to safer levels. The problem is that it usually exceeds "safe and normal" range, and you end up seeing a BG of 300 and higher a few hours later.
This is where the mid cycle tests come in handy. Sometimes the high BG is due to an unseen low number between shots. A true "bounce". But sometimes, there is no low number in the middle, and the high numbers are just due to " not enough insulin". Knowing the cause is important so that you know what to do dose-wise going forward.

On your spreadsheet, there are no high numbers recorded. So it would seem that he isn't bouncing due to low numbers mid-cycle. Likewise, it doesn't seem like the dose is too low, because you aren't seeing a trend of higher preshots that you might see with a cat who is significantly under dosed.

With Prozinc, the value in knowing the nadir is that it can tell you how effective a given dose might be. The difference between preshots and nadir let's you see the effect of the dose. It isn't foolproof by any means. A .5u dose might cause a 50 point drop one day, and a 100 point drop the next day. Or no drop at all. Insulin is a hormone, not a drug, and the results are not linear or exactly proportional. All testing does is reveal patterns that give you a better idea of what is going on and some ability to predict what can happen over the course of a 12 hour cycle. Testing allows you to gain confidence as far as how your cat will react, because they all react differently. A .5u dose would have had no to little effect on Bob. Just like a 4u dose would NOT be appropriate for Fredo.
 
Vet (who i may have mentioned, is a specialist) is really a bit flummoxed by Fredo's #'s and curve. he has suggested a 0.5 once a day, as Fredo's insulin seems to be lasting much longer in his system that per usual with ProZinc. And after blood tests, urinalysis, negative pancreatitis and negative parasite tests, has no idea what to do about the diarrhea other than adding some fiber to his wet food (which he is hit or miss with depending on the day, yesterday 2 1/2 cans of FF, today nothing but chicken breast). Even my vet says Fredo is a completely unique case (and he is published regularly in Cat Fancy) and if we can't get this figured out, he will send us to endocrinologist.
 
at this point Fredo's diabetes doesn't even seem to be the issue. i'm afraid we are missing something. and it's all just so confusing. it literally is every other day that he is good, then not. and we have run a million tests. maybe an ultrasound at this point could show us if anything else is wrong. just don't know anymore.
 
My vet instructs me to give the insulin despite a low reading. If I feed and then inject the insulin....the blood sugar is rising as the insulin is being used. When I was holding the insulin due to the low sugar she would rebound with some really high numbers and then it would take days to get everything back on line. Since I am no longer holding the insulin ahe has doen really well. I only do a blood sugar curve monthly now. Good luck from jane and stewey
 
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