Meadow AMPS 64! Questions!

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Meadow

Meadow

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Hi all,

Meadow's AMPS at 9am was 62! Needless to say, I did not give her any insulin.

She did not eat as well as usual last night....her asthma was giving her a bit of trouble last night and this morning she seemed to have a bit of an upset tummy because she vomited up a tiny amount of clear liquid. But then she ate a FF Appetizer at 6am after turning her nose at several other flavors of FF and ProPlan. And at 9am she ate 1/2 can of FF beef flavor.

I have some questions..one I asked yesterday but it must have been missed in the midst of all the other replies. Can she have her breakfast at the normal 6am time that she is used to and not get her insulin until 9am along with a little more food? No way I can make her and all the other cats wait until 9am to eat because they have been eating at 6am forever and scream incessantly if they don't get fed at that time. If that's not conducive to good control, I'll have to ease her back into the 6am/6pm cycle we started at. And since she did not get any insulin this morning so far, I assume I could start that 6/6 split at 6pm tonight?

Also, I read somewhere (either here or on the yahoo boards) that fish should only be given once or twice a week. Can anyone tell me the reason for this? Meadow loves the fish flavors of FF and eats them the best.

TGIF everyone! :smile:
 
Good morning Dottie ~O)

To answer your question about breakfast----yes you can feed at 6am if you give her insulin at 9am. We discourage feeding within 2 hours prior to testing so as to not get a possible food spike reading at the pre-shot times. But feeding within 3 hours of her shot is ok :thumbup

Since she missed her shot this morning with the 64 :shock: you can start over your cycles at 6pm/6am if you like. You did good in not shooting. We don't have enough data with Meadow to shoot low numbers yet. :?

I am not familiar with dosing on a kitty with pred on board but it looks like Meadow could benefit from a decrease in her dose. BUT don't do anything until you hear from the others. From the looks of her SS she appears to go low and then bouce....go low and then bounce.

As for the fish food....I am not sure about that. I bet some others will come along. You can also post this question in "Health" as I am sure others have asked the same. :mrgreen:

BTW - not to sound like the SS police but can you update the ss today with her AMPS reading and indicate that you gave no insulin? Thanks :YMHUG:
 
Hi Dottie,

I think (and others may correct me if I'm wrong) that the reasons for limiting fish and seafood have to do with two separate issues:

1) Some people feed human canned tuna and that is NOT a complete food with all the nutrients a kitty needs. There are also some cat foods for which this is true. But the vast majority, seafood or not, say they meet these standards.

2) Seafood can be contaminated with nasty stuff. A lifetime of eating contaminated food could be a serious problem. I don't worry about it so much with mine now since they are nearly 14.

Some folks avoid seafood flavors altogether because they do not want to feed those flavors too much and their cats will turn down non-seafood flavors if they think seafood is a possibility. Again, not a problem here, but a real issue for some.
 
paige said:
I am not familiar with dosing on a kitty with pred on board but it looks like Meadow could benefit from a decrease in her dose. BUT don't do anything until you hear from the others. From the looks of her SS she appears to go low and then bouce....go low and then bounce.
Click to expand...

I was wondering about that too, Paige. I hate the bouncing. The only thing that worries me is that her basic levels seem to hover in the 300 range and on 2u they seem to stay pretty much in the 200's.
It's good to know I can feed her and wait to give the insulin because that does make my life a bit easier...not that anything is easy with this diabetes stuff. @-)
 
Thanks for your explanations on the seafood issue, Lydia. It was actually on Dr. Pierson's site that I read about it a while ago when researching food, just couldn't remember until you mentioned it. Meadow does eat some fish, but I do limit her intake of it to a couple times a week and it is always regular cat food and not human tuna.
 
Meadow said:
paige said:
I am not familiar with dosing on a kitty with pred on board but it looks like Meadow could benefit from a decrease in her dose. BUT don't do anything until you hear from the others. From the looks of her SS she appears to go low and then bouce....go low and then bounce.
Click to expand...

I was wondering about that too, Paige. I hate the bouncing. The only thing that worries me is that her basic levels seem to hover in the 300 range and on 2u they seem to stay pretty much in the 200's.
It's good to know I can feed her and wait to give the insulin because that does make my life a bit easier...not that anything is easy with this diabetes stuff. @-)
Click to expand...

Now that you are here in the wonderful Lantus Land you can start to be more consistant testing and shooting. With her 2U she seems to drop to low for my comfort too fast and remaining consistant with shooting would be difficult. The most important thing with Lantus is to retain consistantancy with shooting schedule, dose and trying not to skip shots. One dose takes time to build up the shed and time to see how their body will react the each new dose.

My gut is telling me that 2U is a little too much. I know that you started on a lower dose back when she was diagnosed, but if my memory serves me correct you and the vet went up 0.5u at a time rather than 0.25u with increases? Here we recommend 0.25 increments (under most circumstances-unless the nadirs remain above a certain level)

Here is some good info from the sticky at the top of this board called: STICKY: LANTUS & LEVEMIR - TIGHT REGULATION PROTOCOLS

General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Whew-----sorry this is sooo long. There is just so much info to tell. I love helping newbies :mrgreen: :mrgreen:
 
My gut is telling me that 2U is a little too much. I know that you started on a lower dose back when she was diagnosed, but if my memory serves me correct you and the vet went up 0.5u at a time rather than 0.25u with increases?
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Yes, Paige, that is correct. So maybe tonight I should give her 1.75 instead of the full 2u? And then try that dose for several days and see what happens. I printed out the articles from the sticky link to give to my vet. He wasn't surprised when I said I wanted to home test even though the normal protocol at that clinic is to do the curves at the clinic. He's good that way and is always open to learning a better way to do things. I am also going to order some of the syringes from Hocks because it is extremely difficult to judge such minute quantities of insulin on the syringes I have. Once I am done with school for summer, I can do much better curves because I can make sure I will be home for the entire 12 hour duration. Until the 25th of the month, I am in and out all day and sometimes for more than 3-4 hours at a time. I also want to give her ears a bit of a rest because they look sore to me, although she gives no indication they are. At times, they don't seem to want to give much blood and sometimes none at all. I tried the paw once and she went ballistic and drove herself into an asthma attack. She has some type of birth defect which might involve nerves in one of her legs and some odd shaped toes on the others, so she is super sensitive about her paws.
 
Hi Dottie,
Here's the thing about the foods and the timing.
When you test Meadow, you want to get a pure number that is not affected by external things ... like foods. If Meadow goes too low, what do you do? You feed her and what does that do? It brings up her BG, so when you test after she eats, you will likely get a higher number, depending on what she ate, and it's not a pure BG number.

I went for some fasting blood work today. Looking at all the stuff my dr checked on the lab sheet, he had included glucose and a whole whack of other things that would be less representative if I had eaten.

Some cats are very sensitive to their foods and it's noticeable in their BG numbers. I take up all foods for the 2 hrs prior to testing Shadoe and Oliver. For Shadoe, her nadir is more typical around mid cycle, but Oliver is late and I need to know if he is still dropping or if he is rising by ps time. If I let him eat, his numbers may falsely tell me he is already rising.

Whenever your shot time is, pick up the foods 2 hrs sooner. It's not vital, critical and cause problems if Meadow sneaks in some nibbles in the period, but you just need to know that it may be reflecting in Meadow's BG test result.

Oliver is starving in the mornings, so I give him a couple bits of raw chicken chunks, just to tide him over till his amps. For Shadoe, I steam some of the chicken and give her a couple little pieces if she is hungry, but the bits are never anything that would throw their numbers and they are just enough to quiet them down.
 
Okay, so now I am really confused!


Okay Gayle, what you say here makes absolute sense. However, now I am confused since the 64 Meadow got at AMPS this morning was taken 3 hours AFTER she ate breakfast. So what the heck was her number at breakfast time then after not having eaten since 11pm last night? I think I will definitely go back to the 6am/6pm split tonight because then I can get her AMPS before breakfast and before she eats dinner since they don't get any food for several hours before 6pm dinnertime.

Good heavens...I feel like I won't ever get any of this straight! But thanks so much for your explanation. It definitely makes sense.

Gayle and Shadoe said:
Hi Dottie,
Here's the thing about the foods and the timing.
When you test Meadow, you want to get a pure number that is not affected by external things ... like foods. If Meadow goes too low, what do you do? You feed her and what does that do? It brings up her BG, so when you test after she eats, you will likely get a higher number, depending on what she ate, and it's not a pure BG number.

I went for some fasting blood work today. Looking at all the stuff my dr checked on the lab sheet, he had included glucose and a whole whack of other things that would be less representative if I had eaten.

Some cats are very sensitive to their foods and it's noticeable in their BG numbers. I take up all foods for the 2 hrs prior to testing Shadoe and Oliver. For Shadoe, her nadir is more typical around mid cycle, but Oliver is late and I need to know if he is still dropping or if he is rising by ps time. If I let him eat, his numbers may falsely tell me he is already rising.

Whenever your shot time is, pick up the foods 2 hrs sooner. It's not vital, critical and cause problems if Meadow sneaks in some nibbles in the period, but you just need to know that it may be reflecting in Meadow's BG test result.

Oliver is starving in the mornings, so I give him a couple bits of raw chicken chunks, just to tide him over till his amps. For Shadoe, I steam some of the chicken and give her a couple little pieces if she is hungry, but the bits are never anything that would throw their numbers and they are just enough to quiet them down.
Click to expand...
 
Naw, don't worry about it Dottie, you'll get the hang of it all soon enough.
If Meadow had not eaten for 3 hrs, chances are that the number you got at 9am, her amps, was not affected by foods.

Ya know, you can test any time you like, and you can test every hour if you like but that would get a bit expensive on the strips and Meadow's ears would likely get tired of being poked, but there can be an advantage to knowing how Meadow's numbers are changing.

if you ever wonder what her number is, nothing is stopping you from testing. Also, it's a good idea if you think she is acting out of her normal ways to test her. You could well see her acting different, then test, and find that her number is low.

When Shadoe first was dx, she seemed OK, but her numbers were all high. She felt OK because they were normal to her. When her numbers started to come down or when she went low, she acted differently, like more quiet and looking uncomfortable. Over time, I have seen those looks switch places. Now, if she goes high, she gets that quiet, uncomfortable look about her.

In time, you will be able to see the good changes in Meadow.
Test whenever you like in addition to your 2 ps times, there is no such thing as too much data!
 
There can be several issues that may need to get teased apart.

If Meadow is a steroid induced diabetic, her pancrease may be putting out insulin on it's own. You probably haven't been here long enough to notice that for kitties who are on an OTJ (off the juice) trial, if they should have a non-normal BG number, we instruct the bean to feet and test approx. 3 hours later to see if the pancreas is putting out endogenous insulin and spontaneously lowering BG values. So, it may have been the 64 actually represents a number was lowered by your having fed several hours earlier. That said, as others have noted, you want to do what you can to not feed withing a 2-hour window of your shot time. What is also important to consider is that you want food to be on board at least some time prior to Lantus onset. You will need to do a curve in order to know when the Lantus dose begins to kick in.

I'm a little concerned about the vomiting given Meadow having a history of pancreatitis. Is she typically a picky eater or was her refusing food this morning atypical? Many cats here have problems with chronic pancreatitis -- they have flares where poor appetite, vomiting and other symptoms are present. Given how painful this condition can be, it needs to be treated if this is a problem that Meadow is dealing with.

I would want to have several of the more experienced members here take a look at Meadow's SS and spend some time analyzing the data. It would help if you could note on the SS when you are giving steroids and especially if you are having to raise the steroid dose if Meadow is having an acute asthma attack. There is a distinct possibility that Meadow ends up needing more insulin as a result of an increase in the steroid dose and as you taper it back, her insulin dose needs to be adjusted as well.

I'm not sure what your schedule is. However, it's important to get at least one spot check, in addition to your pre-shot test, every cycle. Obviously, more is better. During the PM cycle, at the minimum, please try to get a before bed test every night. It would have been helpful to see if it was the pred that had spiked Meadow's BG level as a result of the 2 asthma attacks where you administered both pred and theophylline.
 
Hey Dottie! If you ever need some dosing advice prior to your shooting time you can change the header of your first post to read something like "dosing help", ADVICE please or whatever suits you. I was hoping that someone would come along and advise tonights dose. I am anxious to see what her BG is tonight.
 
Hi Dottie, I'm glad you're back on schedule and I'm glad you reduced the dose. She might need to go back up to that dose, we'll have to see, but for now a slightly lower dose should help get Meadow to numbers that you're comfortable shooting at +12. I don't blame you for not wanting to shoot 60's, you don't have the data to do that yet. By reducing the dose a little, maybe those numbers will shift upward enough to leave her shootable at +12.

Now that you're back at 6:00, you'll be feeding and shooting at approximately the same time, correct? You do need to make sure there is food on board when the insulin onset happens, so usually feeding a meal at PS is the best way to accomplish that.

Next time you get a number you're not sure about shooting, you can post here for advice. Depending on your availability to monitor, the options are to shoot the full dose and monitor, stall for 15-30 and retest to see if she is rising (and repeat until you get a number you're comfortable shooting), or shooting a reduced dose on time. Skipping the shot altogether usually isn't necessary, although there are times when people will choose to do that. We can help you figure it all out as you go along.
 
Sienne and Gabby said:
I'm a little concerned about the vomiting given Meadow having a history of pancreatitis. Is she typically a picky eater or was her refusing food this morning atypical? Many cats here have problems with chronic pancreatitis -- they have flares where poor appetite, vomiting and other symptoms are present. Given how painful this condition can be, it needs to be treated if this is a problem that Meadow is dealing with.

HI Sienne,
The vet and I do believe that Meadow is a steroid induced diabetic. The thought of pancreatitis crosses my mind every time she doesn't act normal or seems to have less of an appetite. She is normally not a picky eater at all and gobbles down just about anything. I am thinking that this mornings low BG might have precipitated her not feeling well. When I say vomit, it wasn't even that bad. It could have been a little hairball irritating her tummy too. The amount she brought up was only maybe a quarter size puddle of clear liquid. But I did notice that as her numbers must have been rising to the 412 she had at PMPS, she was acting playful and more alert and she ate dinner with gusto at that time.

Sienne and Gabby said:
I'm not sure what your schedule is. However, it's important to get at least one spot check, in addition to your pre-shot test, every cycle. Obviously, more is better. During the PM cycle, at the minimum, please try to get a before bed test every night. It would have been helpful to see if it was the pred that had spiked Meadow's BG level as a result of the 2 asthma attacks where you administered both pred and theophylline.
Click to expand...
Click to expand...

She gets the theophylline every night with dinner regardless if she is gets the pred or not. I made the notations on the SS as best I could as to when she got the pred. Since she got no pred tonight and her PMPS was 412, I am leaning towards it being the Somogyi I have read about. I'll see how she is on the 1.75u for a few days as suggested and go from there. Sound ok?
 
Re: Meadow AMPS 64! PMPS 412 :(

paige said:
Hey Dottie! If you ever need some dosing advice prior to your shooting time you can change the header of your first post to read something like "dosing help", ADVICE please or whatever suits you. I was hoping that someone would come along and advise tonights dose. I am anxious to see what her BG is tonight.
Click to expand...

Thanks for that hint, Paige. I went with a .25 lower dose based on the reading I have been doing. We'll see how that goes for a few days. Her PMPS was 412, but 5 hours later it is 150 tonight.
 
Libby and Lucy said:
Now that you're back at 6:00, you'll be feeding and shooting at approximately the same time, correct? You do need to make sure there is food on board when the insulin onset happens, so usually feeding a meal at PS is the best way to accomplish that.
Click to expand...
Libby, my normal schedule is to test her at 6am, feed her breakfast (she usually eats almost an entire can of Fancy Feast or the same amount of Evo or Wellness canned and then she gets her insulin.

Libby and Lucy said:
Next time you get a number you're not sure about shooting, you can post here for advice. Depending on your availability to monitor, the options are to shoot the full dose and monitor, stall for 15-30 and retest to see if she is rising (and repeat until you get a number you're comfortable shooting), or shooting a reduced dose on time. Skipping the shot altogether usually isn't necessary, although there are times when people will choose to do that. We can help you figure it all out as you go along.
Click to expand...
Thank you Libby. I appreciate your input and advice. I am still very nervous about shooting her at anything less than 200, mostly because her levels are all over the chart still. But let's say I did get a PS of 175, would it be okay to just give her 1/2 the dose of insulin at the normal time?
 
Hi Dottie,
If you dare to look at Latte's ss, you *may* see some of the patterns with her pred dosing.
I think most of us who have their cats on pred AND see it make a difference in BG's, see it affecting within the cycle they are given the pred, and sometimes the ps # of the next cycle. Giving it once /day or eod can lead to imbalanced cycles, making dosing challenging if the pred is causing an obvious rise. But, you know as well as I that sometimes it has to be given when it needs to be given.

If you want to add another line underneath each day on your ss, as we do, then note pred, meal times, etc...could help you see patterns easier.

That drop was pretty huge tonight. You might expect to see another high ps...bouncing...in the a.m.
 
carolynandlatte said:
That drop was pretty huge tonight. You might expect to see another high ps...bouncing...in the a.m.
Click to expand...

Thanks for replying, Carolyn. I have to study these SS more because I have a difficult time following them. I do much better with graph type charts. I hope this bouncing will stop sooner or later....preferrably sooner! But, as you say, the pred will have an impact on her levels. I'd be happy if I saw her BG's remaining consistently in the 200's.
 
Good morning. Not sure if you are going to have a condo today but I was checking out your ss this AM. This mornings AMPS is a bouce from last nights lows. She is doing good!!
 
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