pmps 147...should I have shot?

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imogen

imogen

Member Since 2010
HI,
Imogen's numbers last night at PMPS were 117 and then +1 was 147. According to my vets scale I should not have given any insulin. (anything under 199 after +1 should hold off on insulin dose) at the AMPS she was back up to 357 and I feel I should have shot. Any advice would be great. My vet is awesome and is on the forefront of Feline Diabetes and I don't want to go against her recommendation. I am so torn as to what to do. I gave Imogen 3u's this morning. Her normal dose is 2.5 but if she goes over 350 I am to up it .5. Help!! I am also finding I am an emotional roller coaster that goes along with her numbers. The lower the numbers the less stressed I am only to be totally devastated when her number goes back up. She usually reads between mid 200's to mid 300's. on her am and pmps's
 
I would really need to see a spreadsheet to offer any input. I would suggest looking at our dosing protocols or the Data Ready sticky. The Queensland protocol would offer some different options than what we typically suggest. Further we do not increase Lantus because you get a high pre-shot number. That logic is not applicable to a long-acting insulin. That way of thinking is more in line with how shorter acting insulin is dosed.
 
Hi and welcome! :mrgreen:
I am so happy that you posted here! We have many kitties on this forum and many experienced people who will be happy to give you suggestions. We post a condo (thread) each day...one condor per kitty per day. We link our previous day's post to the first post of the day...and we update the BG numbers throughout the day....
I am happy to see that you are testing! We have a SS (spreadsheet) that we keep for all our kitties and the BG numbers. here is a link to a post in the Tech Support forum that will help you set up your SS and link it to your signature. viewtopic.php?f=6&t=18207
Please work on that. Without a SS we are not really able to help you too much. It is important for us to see the numbers....

It doesn't sound as if your vet is familiar with the dosing Protocols. You will find more about them in the starred stickies at the top of the page. New to the Group: viewtopic.php?f=9&t=18139

When was Imogen diagnosed? What foods are you feeding? Low Carb canned foods are best. Here is link to the Binky's food chart. maybe you will select a LC (<10%) to feed if you are not already doing so.... http://www.felinediabetes.com/diabetic-cat-diets.htm


After reading the stickies, you are welcome to post any questions you may have right here in this condo. I do hope you will set up your SS quickly and post each day! :mrgreen:
 
OK just to verify ... you are using Lantus, yes? If you are, then dosing is not done based on one number, like a preshot number.
So I went to look at your spreadsheet to see what kind of numbers you normally have, but you don't have a spreadsheet.

As has already been said, it's hard to say what should have been done without a history of past numbers. You can see the info I record in my spreadsheets that show you what our numbers have been and what dosing we have done.


Anyways, for Lantus, there are guidelines that are usually followed by many on this board. You can take a look and print them off to show to your vet. I am sure she will appreciate to see them.
"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.


Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.

--- Try to go from 0.25u to 0.1u before stopping insulin completely.


Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.


And here are the links to the sticky posts in the Lantus board:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers


If you are giving some other insulin, my apologies. Other insulins use scales for dosing, as they do not involve a shed, but I have not used any of them.
 
I'm working on the spread sheet now. Imogen was diagnosed on 9/3/10 and started on Purina D/M immediately. I didn't like my current vet and found a vet that has done many articles on Feline Diebetes so I felt she was great. I consult with her on line as she in Chicago and I am in NY. She had me give 1u's for a few days and then had me go to a vet to get a fructosamine test done along with a host of other tests to rule other illnesses out. When she got all the reports, based on Imogen's weight. (15.3 pounds and considered obese) she said we should to 2u's 2x's a day. I then did a curve on day 14 and she said based on the curve we should go up to 2.5u's 2x's a day. She was on 2u's for 7 days before going up to 2.5. My vet said if she goes over 350 to add .5 to her dose only for that shot and she has only been over 350 4x's. So mostly it has been 2.5 u's except when she is under 250 and then it is 2u's. I'll have her sheet up shortly.
 
We usually go up in .25u increments (except in certain circumstances0 but increasing by smaller amounts, it allow for finding the bet dose instead of upping by .50u and perhaps overshooting the ideal.
If you are using Lantus, consistent dosing works best. We shoot the same dose AM/PM. each day.

The prescription foods are really not necessary. We use canned foods that are listed on the Binky's chart with lower carbs. Food can make a big difference in the BGs alone. All dry foods are a No-No. Many people use the Fancy Feast varieties and I use the Wellness chicken. There are many to choose from....I encourage you to try some low carb canned foods from the list.

Some vets have a different way of dealing with the FD. We have the Protocol that we follow here and there are many experienced people here who have seen hundreds of cases of kitties with FD. I hope you will look over the stickies at the top of the page. The frustosamine test is an average of the BGs over a period o time. If you are home testing, the numbers you are recording give a much clearer picture than that test will give.
 
Who's your vet in Chicago? I'm there and didn't know of anyone who specialized or did research in feline diabetes since the vet school is downstate.
 
Articles! I would love to read them! What's your new vet's name? Maybe some others on this site who are in her city will know her already.

Seems like an odd instruction to give an increase based on a preshot number, and just for that one shot because that one change will make a difference in the Lantus shed; maybe you can ask her if she could explain how it works.

The protocol I mentioned is based on the nadir of a cycle, not the preshot, so I imagine what you are following does not go along the same guidelines.
 
Just posted my spread sheet. I am new at testing and unfortunately Imogen HATES it so am only doing AMPS and PMPS currently with a few thrown in in the middle. I found Dr Donna Spector through links on this site and she has been AMAZING!! She suggested lantus to me after my vet said Humilin was the only one that would kill my cat. She does phone and e-mail consults and has been awesome!! She said to do only wet food which I have been doing. Imogen likes the D/M wet so I figured why ruin a good thing. I throw in a little FF or Wellness every now and again. I am using the Contour but don't know if that's the best. No Walmart in NYC so can't go with the Reli On which sounds like what most people use. I am doing shots every 12hrs. 7am/7pm and only once had to give an hour early. Any advice would be welcomed. I feel like I don't know which way to turn in giving Imogen the best care!!
 
I used to use the Contour myself until I switched to the Reli-on. Others might have some suggestions for you.

If you are giving Hills M/D it is shown on the Binky's chart as having 14% carbs. There are lower carb foods available that have been ingredients too I believe. I do not know D/M though....is that not on the chart?
Your SS is attached perfectly! :thumbup Now it is easier for people to study Imogen's numbers.

Is she on any other meds? Any other medical conditions?

And shall we call you Imogen's Mama or would you share your name?

ETA: If you are home during the weekdays, you can get checks during the daytime. If not, then perhaps weekends are the bet time for you to do a curve. We ask that everyone get at least a before bedtime BG check each night. We are looking to study how Imogen responds to her insulin and getting the data is the only way to now what is going on We also will see when the nadir or lowest BGs are. Information about curves are in tht sticky that I linked to you earlier...
Nice job on the SS! Welcome! :mrgreen:
 
You are a fast learner and it sounds like you are doing a good job.

I have a pretty FD savvy Vet too and have complete confidence in him. I'm also aware that the Vet's approach was very conservative especially at the beginning...until I became more comfortable....However, when I would email the Vet what I was doing later on...he was very, very supportive and encouraged my continuing to shoot the lower numbers. I also suspect that because of liability issues...they may not be enthusiastic with telling their clients about it being OK to shoot lower numbers......I had to go slow at the beginning....Its OK to do that...

However, if you listen to the folks here....get your SS up and running....you will have a better idea what your kitty is doing daily, weekly and monthly....The trends are very important...and you need lots of numbers to get a trend. Also, the group here can give you good advice specific to your cat when they can look at how your cat has been responding to the insulin.....but they will need to review your spreadsheet before giving any advice....cuz every cat is so different.

I feel like I'm fairly new to this whole process too.....Curry was only dx 2 months ago.......I'm just now feeling more comfortable....I can totally related to feeling UP when your cat's numbers are lower and DOWN when your cat's numbers are up. It just drives me crazy. Its a darn roller coaster ride. And my stomach gets tied in knots when I see a "new" low number to shoot. But I throw it out to this group for feedback and advice...but they can look at my spread sheet before giving a recommendation.
 
imogen said:
Just posted my spread sheet. I am new at testing and unfortunately Imogen HATES it so am only doing AMPS and PMPS currently with a few thrown in in the middle. !!
Click to expand...


My kitty HATES it too. I've watched the videos of folks testing their cats.....Curry is not a passive, sweet kitty....She's quite the opposite....Kinda a pissy, whiny kitty..... She growls the entire time I try to test her....but she dearly loves the treats afterwards. Sometimes I still have to pick her up and bring her to the testing ottoman (growling all the way) and sometimes I can entice her w/the food.

I do know that the more numbers I get...the better I can understand how she is responding to the insulin.....I think the testing is the hardest part.....Wish someone would invent a glucose meter that didn't require getting blood.....Yeah....I'm just wishing......

Hey...Welcome aboard....And ask lots of questions.....And vent when ya need to....You've got a great support group here.
 
Oh how I can relate to that pit in the stomach feeling!! I am confident my vet will tell me to continue shooting. I will be speaking with her tomorrow am. She has matched pretty much everything else that has been said on here.
To answer the food question, she is on Purina D/M wet food. Not the hills and NO dry food whatsoever. Luckily she made the change pretty quickly.
I am going to start testing more during the day. I think I haven't more so for myself than her! I still start shaking before I have to do it.
having this site has been a god send!! so much information that is soooo helpful. Even if it is reading someone's post that connects to exactly how I am feeling makes me feel a little better! Her number now at +6 is 258 so thats good (I think). Hoping for more blue days ahead!
Does anyone feel her dose is too high?
She has no other medications, for sometime we thought she had slight asthma but her latest 2 xrays show she is good. She has a weird hacking cough that comes occasionally but may be allergies. She is overweight and has a little bit of fat around her heart but they say that will subside as she loses weight. She is an academy award winning actress when it comes to trying to get food. It kills us!! She has always had negative ketones and her urine strips are between 1/2 and 1/%. We still have to do the burrito wrap for the testing. a little fuss meow when the needle hits but then she's okay. She is definitely learning that food comes after. (bolting to the kitchen a second after I get blood
Thank you all sosooo much!
Cynthia
 
imogen said:
I am going to start testing more during the day. I think I haven't more so for myself than her! I still start shaking before I have to do it.
Cynthia
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Wow....I would shake too....I would see my hand shaking as I was poking her and thinking this is not cool......and after....I'd be sweating profusely ok, more like a pig)....geez....it was so nerve racking at the beginning.....

Cynthia...you are doing great!!!!

I don't have any advice on the dosing though....I'll leave that to the experts here.......

Let us know how you and Imogen is doing, k?
 
Ok...that is 7% carbs...
If you put the negative ketones in the note section on your SS that will help you keep track. Also, we do put the date of new insulin in the notes section too.

We usually suggest that people start low and go slow with the dosing. As I said we do go up slowly too with only .25u increases at a time. The only way we can really say anything about the dose is to see more numbers on your SS. The more data you can collect, the clearer the picture.
 
Thanks for the info on your consulting vet. She doesn't have a practice, from what I can tell, here in Chicago.

I'm surprised that your kitty likes D/M. If you read the contents, it's pretty much animal by-products. Fancy Feast is actually a better quality food!! Gabby started refusing D/M and loved pretty much loved anything else.

I'd like to encourage you to start getting some tests in at night. Many cats have lower numbers at night. In addition, without PM testing, you're missing half of your data.
 
She was in Manhattan and is technically still licensed here. She does strictly consulting work at the moment. She was the Vet that worked on Halo food products. If you google Donna Spector DVM you will find her. I can't tell you how great and helpful she has been.
She had me do the D/M for the time being for calorie control as well, but we are going to introduce other things in down the road. I have snuck in a fancy feast here and there...I'll start adding some wellness in as well as I do think Imogen is tiring of it...It's so hard to feel like you are doing the right thing!! I am so torn about food, dosage, etc that my head spins.
 
images


Cynthia...is your brain feeling full just about now? @-)

Keep in mind you are way ahead of the game. You caught the diabetes, you are changing the food, you are testing (most awesome) and you've got your speadsheet going. Give yourself a huge pat on the back for all the changes you've made so far. That a heck of alot of transitions and change. And your sweet kitty is already reaping the benefits.

Breathe.....Wait until your head stops that spinning.....Breathe again....Take step back and acknowledge all the changes...Yup, Breathe again...Lots of breathing as a matter of fact.....Then look at one suggestion or one recommendation at a time....You've got the basics down.....Now you will begin the process of tweaking of what you are doing.....And remember to breathe.

And no more head spinning....k ?
 
(ahhhhh.....) nice big breath. Thank you. I LOVED the cartoon!! totally relatable! Sent the Lantus protocal to my vet and she said we could easily work it in with nadir checks.She is fully aware of it, but also can work with people only on amps and pmps as she says most people can't stay home during the day to nadir check.
Imogen is back in the blue this morning so I am feeling much better. Vet says that seeing how she did with the no shot and staying in her "typical" range was a good sign. I gave 2u's this morning although feel torn about it. (what else is new?!). Imogen slept like log last night which is unusual, but the weather has turned to fall over night here so that could be it. I'm home today so can do spot checking. (I can feel Imogen groan at the thought of this!)
 
Hi Cynthia....can you open a new condo for Imogen this morning?
Please put in your header: Date, Kitty's Name, AMPS____________
And then link this ntire thread to the firs tpost of the day.

That is the lowest AMPS she has gotten thus far. We recommend testing at the +1 hour to see where the food takes her. It would normally be a higher number but we want to make sure of that. I am glad you will be home to test today. Multiple BG tests are recommended when starting out at a lower AMPS, okay?

do you have cans of HC gravy food on hand....and plenty of strips?
I have the Friskies chicken and tuna in gravy... 19% on hand here and find that it works well to bring up the numbers if they should start to go lower. I do hope you have that on had as per the HYPO Kit in the sticky I linked to you earlier...karo syrup and HC cans of food....
 
Is that good? I have no clue. I thought the numbers were supposed to go down! I was thinking I should have shot her normal 2.5. this is so confusing!
 
imogen said:
Is that good? I have no clue. I thought the numbers were supposed to go down! I was thinking I should have shot her normal 2.5. this is so confusing!
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Hmmmm.......I'm not seeing any night-time test numbers. I'm wondering if that blue ps number was coming up from an even lower number she may have hit during the night. If that is the case, Imogen could be starting to bounce.
 
Pat+Raja+Shadow said:
....
ETA: If you are home during the weekdays, you can get checks during the daytime. If not, then perhaps weekends are the bet time for you to do a curve. We ask that everyone get at least a before bedtime BG check each night. We are looking to study how Imogen responds to her insulin and getting the data is the only way to now what is going on We also will see when the nadir or lowest BGs are. Information about curves are in tht sticky that I linked to you earlier...
Nice job on the SS! Welcome! :mrgreen:
Click to expand...

Fleapunk has an excellent point about testing last night... we ask for at least a before bed time check so we can see where they are going with their numbers. many kitties have their lowest numbers during the PM cycle....
 
Bounce?!! what is a bounce? (omg, one more thing to worry about! :shock: ) how will I know and what do I need to do?
 
How about posting a new condo for today as I said earlier...okay? we will talk about bounces there...
You can write date, Cats' name, AMPS+___, +4=_____ and any other tests you have done today in the header...
 
looking for new condo, sorry

Don't panic over a bounce! :smile: Punk's been on the juice for 2 years and still gets bouncey after a low number. A bounce is just the body's built-in response to low blood sugar. Since the liver is now comfy with the higher BG levels, when it starts to experience the lower, more normal range, it panics and sends out a ton of sugars to counter-act the low BGs....it's a safety mechanism and means the liver is doing its job. Once the liver re-learns to like the normal BG range, the "bounces" won't be so severe. Some kitties bounce higher than others and more quickly, sometimes a bounce can last up to 72 hours, so don't panic if you don't see a quick response to the insulin. It takes a little time to see how each cat responds.

But if you can, try to get some pm spot checks.
 
Most of us here have normal 9-5 jobs so we can't do spot checks as frequently during the week. I try to combat that by getting a spot check when I get home which gives me a late cycle number, and then after her PM shot I try to at least get a +2 or +3 before bed to get an early cycle number. Weekends and days off I try to get those mid cycle numbers, and occasionally get a full curve to see everything play out completely. The more data you have the more comfortable you'll be, and it will let you shoot that 147 without worrying! :smile:
 
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