? Perry 6/7 AMPS 136; delayed shooting, but now what?

Perry & Jenn

Perry & Jenn

Member Since 2019
Perry's AMPS is only 136, and I got scared to shoot, because yesterday, his AMPS was 218, and he dropped to 107 at +4. It's all a huge swing since his miserable adventures with constipation and an enema (which I posted about yesterday) -- his AMPS on 6/5 was 396!

Unfortunately, I don't have a lot of data points to go by at this point, as you can see from his spreadsheet in my signature. Quick backstory: Perry started the Lantus pen two weeks ago today (5/24) at 1u in the morning only; he went to 1u twice a day at his four-day check with the vet (for that check, he was at 283 at +4, but that's from the vet's office, where he was presumably more stressed out), so he's been at 1u twice a day for about nine days.

Amanda pointed out yesterday that he probably has his little insulin depot going now, which is good! Perhaps that's why he's so low this morning--and the stress of the enema is over. It's been an hour since I took that AMPS, and I fed him, so I could check again to see where he is ... I haven't done the delay method yet, so I'm not really sure how to proceed, nor do I know how to interpret a reading right after he eats since in my limited experienced I have done test, eat, shoot. Thoughts?
 
Perry & Jenn said:
Perry's AMPS is only 136, and I got scared to shoot, because yesterday, his AMPS was 218, and he dropped to 107 at +4. It's all a huge swing since his miserable adventures with constipation and an enema (which I posted about yesterday) -- his AMPS on 6/5 was 396!

Unfortunately, I don't have a lot of data points to go by at this point, as you can see from his spreadsheet in my signature. Quick backstory: Perry started the Lantus pen two weeks ago today (5/24) at 1u in the morning only; he went to 1u twice a day at his four-day check with the vet (for that check, he was at 283 at +4, but that's from the vet's office, where he was presumably more stressed out), so he's been at 1u twice a day for about nine days.

Amanda pointed out yesterday that he probably has his little insulin depot going now, which is good! Perhaps that's why he's so low this morning--and the stress of the enema is over. It's been an hour since I took that AMPS, and I fed him, so I could check again to see where he is ... I haven't done the delay method yet, so I'm not really sure how to proceed, nor do I know how to interpret a reading right after he eats since in my limited experienced I have done test, eat, shoot. Thoughts?
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Normally you would not feed and recheck blood about 20- 30 minutes later. If number is increasing at recheck, and is a safe number to shoot, then you would shoot and feed. Since you already fed, any subsequent recheck, now the number would be higher due to food. At this point since you are more than an hour off schedule and he ate, may want to skip morning dose. This will reduce depot some, but we have all skipped or given a fur shot occasionally, which is the equivalent of skipping, so it is not the end of the world. Better than messing up shot schedule by several hours, because remember, pm shot would have to be 12 hours later.

I think I responded to your intro post yesterday and you were talking about 1 unit vs 2 units? Just to clarify on that, when we say 1 unit, we mean 1 unit twice a day. When we say 2 units, we mean 2 units twice a day. It seems you are referring to 1unit every 12 hours as 2 units, (it is 2 for the entire day, but we refer to dose as the amount being shot). So if kitty is getting 1 unit in am and 1 unit in pm, as indicated by spreadsheet, his dose is 1unit. Does that make sense? When you said increasing to 2 units in your intro post, I think you meant total for day and anyone reading 2 units (including me) would have thought vet suggested 2 units twice a day, which is why I mentioned in other post that would be a big increase. Now that I see it is 1 unit twice a day, that is more reasonable. Copying Amanda as she had input previously.

@Amanda and a Loudogg
 
Looks to me like Perry may have dropped lower last night given that low pre-shot this AM. Given that and since you are using the AT2 meter and have never shot a pre-shot that low, I'd be inclined to skip the shot this morning as long as Perry has no history of ketones or DKA because any reading you get now will be food influenced and you won't know how much of any rise is food influenced vs normal rise in BG. If there is a history of ketones or DKA, let us know as skipping might not be the best option.

Next time you get a low pre-shot like this, use the stall tactic without feeding and retest 20 to 30 minutes later to see if BG is rising on it's own.
 
Okay so the stall tactic involves NOT feeding, which is not what I did ... sigh. I feel like I'm really blowing it here.

I fed right after that AMPS, which was almost two hours ago now, and just tested again and he was at 273 -- clearly food elevated. I guess that does answer something I've been wondering, tho, which is just how much food makes his BG go up.

Sorry I didn't clarify the units there! He is currently on 1u twice a day. Vet had talked about taking him to 2u in the morning, 1u in the evening, but after his BG came down so much after the enema, I kept him at 1u twice a day.

When we went to the vet Wednesday morning, I was worried about DKA because he was lethargic, grumpy and didn't want to eat. The vet tested and found a trace of ketones but also said he thought the constipation was the real problem. So no DKA history, but he did have a trace of ketones in his urine Wednesday morning, and he hadn't in previous tests.

Thanks again, everyone!
 
Jenn, we've all gone ahead and fed and then had the lightbulb go on too late. Not to worry and don't beat yourself up. Just pretend today was a fur shot and carry on. :D

That rise in BG is likely the last dose of insulin wearing off along with the food "bump" but how much can be attributed to food vs physiological change is anybody's guess.

Since Perry had a trace of ketones, even if it was likely from the constipation, it would be a good idea to test him at home. Ketostix are readily available at the pharmacy. Some kitties let their peeps grab a sample on a ladle held under them while piddling. In other cases, you can put some bunched up plastic wrap in the litter box where kitty normally like to pee and hope to catch a sample that way. It doesn't take but a small sample to test. Of course if there are other felines in the house, it gets a bit more complicated to ensure one is testing the right sample.
 
Also now we are clear on what was meant on dosing...It is not recommended to have one dose in am and a different dose in pm as your vet is suggesting. That would throw off the depot and be hard for you to see what the insulin is really doing. One unit twice a day is the highest I think anyone here would recommend until you have more test data for that dose. Then, if an increase is needed after that, it would be in small increments and the same amount am and pm. It is even possible the dose may need to be less, wont know for sure until you have current dose data.

Lantus works differently than other insulins vets may be used to using and there is no question (and data to back it up) that it should be the same amount every 12 hours for best results.:cat:

You absolutely did the right thing not increasing to vets recommendation.
 
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