Pmps 4.6(83), then 3.5(63) don't know what to do?

K8&Luna

K8&Luna

Member Since 2019
Hi,

My kitty was recently diagnosed and had her first curve today, which the vet said was abnormal.

9am amps 4.8 mmol (86) human meter
Fed at 9am
1015 amps 6.6 mmol (119)
Insulin at 1045 3 units lantus
+2 =9.2 (166)
+4= 9.8 (176)
+6= 10 (180)
+10= 4.6 (83) Fed, no shot, ate 1/2 portion
+11.5=3.5 (63)
Do i give her insulin now?

11yo, wt is 8.8kg
Started lantus 14 days ago, 3 units bid for 7 days then 4 units bid for 7 days then curve today.
 
Last edited:
Looking at the curve done at the vet today, the insulin dose is far too high for your cat. For safety reasons, it is recommended that in the beginning, no insulin should be given for numbers under 150.

The curve done at the vet was abnormal because most likely the dose is way too high. The starting dose for Lantus is 1 unit twice daily, not 3. In all honesty, your vet is out to lunch.
 
Also, this is with my human meter. The vet used their alphatrak 2 and mine too, and mine was always lower. But i read that you usually deal with human meter values here right? Is there a consistent difference between human and pet meter?
 
Luna's curve is inverted and if she was started on a dose of 3u BID, and then raised to 4u the dose is too high. Normal starting dose would be 1u max. unless she is a very large cat. I agree with Red & Rover, your vet apparently isn't up to date on feline diabetes.

Did you give her some MC carb food? If so then test again 20 to 30 minutes after the food. You need to be sure her BG is not still dropping and that she can keep a safe BG without needing more food to prop up her BG.
 
Red & Rover (GA) said:
Looking at the curve done at the vet today, the insulin dose is far too high for your cat. For safety reasons, it is recommended that in the beginning, no insulin should be given for numbers under 150.

The curve done at the vet was abnormal because most likely the dose is way too high. The starting dose for Lantus is 1 unit twice daily, not 3. In all honesty, your vet is out to lunch.
Click to expand...
Ok, so vet is calling me tomorrow.... not sure how to handle this? I expressed concern earlier at the high dose, but she said that that was her calculated dose based on weight and initial bg of 22 mmol, so she said to go ahead. But this was our first day of bg testing.
 
MrWorfMen's Mom said:
Luna's curve is inverted and if she was started on a dose of 3u BID, and then raised to 4u the dose is too high. Normal starting dose would be 1u max. unless she is a very large cat. I agree with Red & Rover, your vet apparently isn't up to date on feline diabetes.

Did you give her some MC carb food? If so then test again 20 to 30 minutes after the food. You need to be sure her BG is not still dropping and that she can keep a safe BG without needing more food to prop up her BG.
Click to expand...
She is 8.8kg (19.4lbs) so quite large. She ate some dry purina dm (1/4 cup) which i think was 18% carbs. I'll test again now.
 
First thing is to test, then feed, then test again in 15 minutes, etc, until you can see her BG is rising, but @Red & Rover (GA) is right, it can last for a long time, even 18 hours. If she is in overdose, she is not safe. Please read this: http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

(From the sticky) "If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out."
 
Penelope and Mačka said:
First thing is to test, then feed, then test again in 15 minutes, etc, until you can see her BG is rising, but @Red & Rover (GA) is right, it can last for a long time, even 18 hours. If she is in overdose, she is not safe. Please read this: http://www.felinediabetes.com/FDMB/threads/dont-panic-or-how-to-handle-low-numbers.210109/

(From the sticky) "If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out."
Click to expand...
She's not low according to this though, not under 50?
 
Human meters generally read lower than pet meters with the difference in readings being greater the higher the BG. There is no way to convert human to pet meter readings or vice versa. If you were to graph the readings of comparison tests however the graphs would look very similar.

While Luna is a big girl, a starting dose of 3u is still too high. Not sure where your vet got her calculations from but the AAHA guidelines state the starting dose should not exceed 2u BID even for a very large cat.

If Luna just finished eating dry food, the food is propping up her BG right now. Retest in 30 minutes and repost. Do not feed her anything else for now.
 
Well, 63 is still very low, and she is/was obviously dropping. You had the right reflex of asking here, because yes, you don't shoot with such a number; But also, her dose looks very high for a start.
You need to monitor her tonight and make sure she's safe. Lantus is a long effect insulin.
 
MrWorfMen's Mom said:
Human meters generally read lower than pet meters with the difference in readings being greater the higher the BG. There is no way to convert human to pet meter readings or vice versa. If you were to graph the readings of comparison tests however the graphs would look very similar.

While Luna is a big girl, a starting dose of 3u is still too high. Not sure where your vet got her calculations from but the AAHA guidelines state the starting dose should not exceed 2u BID even for a very large cat.

If Luna just finished eating dry food, the food is propping up her BG right now. Retest in 30 minutes and repost. Do not feed her anything else for now.
Click to expand...
She ate at 9pm, 2 hrs ago.
9pm bg was 83, and she ate then.
10pm bg was 63
11pm bg (just now) was 77
 
K8&Luna said:
Ok, so vet is calling me tomorrow.... not sure how to handle this? I expressed concern earlier at the high dose, but she said that that was her calculated dose based on weight and initial bg of 22 mmol, so she said to go ahead. But this was our first day of bg testing.
Click to expand...
Please listen to the people on this forum, your vet does not look like she's very used to diabetes, which is fairly common apparently.
 
Ok if she last ate at 9pm, since it was dry food, you may just now be seeing the effect of the 9pm meal or she may be starting to bounce from the low BG. In any event, you need to be sure Luna is holding a reasonable BG before letting down your guard. Check her again in 30 minutes to see if she is holding or still rising.

As for handling this with your vet, I'd just tell her that Luna's BG dropped down low tonight and you could not give her insulin. Tell her on your meter 50 is the warning point where you need to intervene to prevent hypoglycemia and Luna wasn't far above that limit.
 
Thanks for the summary. It helps a lot. Saves having to scroll up all the times.

K8&Luna said:
Ok, so vet is calling me tomorrow.... not sure how to handle this? I expressed concern earlier at the high dose, but she said that that was her calculated dose based on weight and initial bg of 22 mmol, so she said to go ahead. But this was our first day of bg testing.
Click to expand...
Thank goodness you started testing. Most likely, you just saved your cat's life.
Lantus dosing cannot be based on one number. Lantus dosing is also not based on a preshot number. Lantus is based on how low the cat does during a cycle (the nadir).
It is safer to start low and go up in micro-increments of 0.25 until the correct dose is found. Increasing in larger increments means that you might skip right past the correct dose. In starting with a dose that is too high, you end up in a crisis situation that could end badly.
To add to what @MrWorfMen's Mom has said, tell your vet that after tonight's scare you want to be cautious and want to immediately drop down to a lower dose and work up slowly if needed.

Do bear in mind that tomorrow's preshot reading might be very high. This does not mean that Luna still needs a lot of insulin. It means that Luna is having a bounce from the low numbers she has experienced tonight. Below is the definition of a bounce:

  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Last insulin 3 units 1045am
She ate at 9pm, 2 hrs ago.
9pm bg was 83, and she ate then.
10pm bg was 63
11pm bg was 77

1140 pm now 4.9 (88).

At what bg reading in the am do i give insulin and how much?
 
Not only did your home testing save Luna, but I'm sure the DM dry food at 18% carbs helped keep Luna from crashing up till now. That dry food is not appropriate for a diabetic even though the vet prescribed it. Luna should be on a wet diet of food that is 10% carbs or less. Many folks feed Fancy Feast Pates (Classics) or Friskies pates. The food lists we use for reference are HERE.

Since you don't have much data yet and Luna has obviously been getting too high a dose of insulin, I would suggest no insulin unless her BG is over 200 in the AM and I would reduce the dose to 1u. Are you home during the day to monitor Luna?
 
Krystina & Nelli said:
You are doing a good (great job!)... hang in there, everything is going to be ok :bighug:
You have two seasoned veterans here tonight with you, @MrWorfMen's Mom and @Red & Rover (GA) :).
Happy to see you got a SS up ;). This, data becomes very valuable not only for you but for others when you need help, advice, etc.
What country are you in... if North America, which time zone?
Hang in there and... breathe :)
Click to expand...
Thanks! It's a lot to learn quickly!
I'm in Canada, eastern time zone. It's midnight now. I'm hoping with 2 increasing readings and skipping insulin it's ok to go to bed. I have a 2 year old that will be up at 6!
 
K8&Luna said:
Thanks! It's a lot to learn quickly!
I'm in Canada, eastern time zone. It's midnight now. I'm hoping with 2 increasing readings and skipping insulin it's ok to go to bed. I have a 2 year old that will be up at 6!
Click to expand...
Yes, go get some sleep ;).
I agree with @MrWorfMen's Mom ... unless her BG at AMPS is over 200- don’t give any insulin.
I too am in ETZ and am exhausted... hitting the rack now.
I will check in with you tomorrow
 
MrWorfMen's Mom said:
Not only did your home testing save Luna, but I'm sure the DM dry food at 18% carbs helped keep Luna from crashing up till now. That dry food is not appropriate for a diabetic even though the vet prescribed it. Luna should be on a wet diet of food that is 10% carbs or less. Many folks feed Fancy Feast Pates (Classics) or Friskies pates. The food lists we use for reference are HERE.

Since you don't have much data yet and Luna has obviously been getting too high a dose of insulin, I would suggest no insulin unless her BG is over 200 in the AM and I would reduce the dose to 1u. Are you home during the day to monitor Luna?
Click to expand...
Yes, I'm home tomorrow because it's the weekend. I'm usually gone for 9 hrs a day though. Thanks for the advice. I asked my vet about the food twice.
She said that other wet food isn't as good as the purina dm wet food, and not to use it - specially formulated or something. I Allen just today again about switching to wet only instead of combo feeding, and she said wet is best, but the purina dm dry is also ok, because of the type of fibre in it. Luna hasn't been eating all of her food either, I've been mixing the wet and dry and there's often some left, when I'm ready to feed again (before switching to dm she would finish all her dry food). I just separated then tonight, and she ate more dry than wet, but still didn't finish. Any advice on what to do with food?
 
Howdy neighbour. I'm in Toronto. Red is a northeast of me. It's Canuck night! :D

Test Luna again now and if she is up even higher you can call it a night. Assuming the DM wet food is the pate and not the savoury select, you could leave a bit out for her to munch on should she feel the need. The DM is NOT diabetic food....it is dietetic and there is absolutely nothing special about it except that they call it prescription. There is nothing medicinal about it and the ingredients are not as good as Fancy Feast pates! Vets get their nutritional info from the pet food companies who brain wash them into selling their products.

Please let me know what the BG reading is.
 
MrWorfMen's Mom said:
Howdy neighbour. I'm in Toronto. Red is a northeast of me. It's Canuck night! :D

Test Luna again now and if she is up even higher you can call it a night. Assuming the DM wet food is the pate and not the savoury select, you could leave a bit out for her to munch on should she feel the need. The DM is NOT diabetic food....it is dietetic and there is absolutely nothing special about it except that they call it prescription. There is nothing medicinal about it and the ingredients are not as good as Fancy Feast pates! Vets get their nutritional info from the pet food companies who brain wash them into selling their products.

Please let me know what the BG reading is.
Click to expand...
Last reading right now is 99
 
Waving from the Kawarthas.

Unfortunately, there is no dry food in Canada that is low enough in carbs (under 10%) for a diabetic cat.

That 99 looks good to me.

Do post in the morning and keep the spreadsheet up. It is a good tool to have. And please let us know what your vet has to say.

I hope your little one lets you sleep in a bit.
 
Food wise, the DM pates are Ok carb wise but many cats get sick of it and it's horribly expensive. If I were you, I'd switch to Fancy Feast pates and that would give you some variety of food to offer Luna. Fancy Feast also has chunks, grilled and gravy lover which are higher in carbs but good to keep in the pantry for times like tonight when BG has dropped down and needs propping up. There are lots of options for low carb wet food but FF and Friskies tend to be the cheapest and seem to be liked by most cats.
 
You had a rough start there - and you know it's your vet's fault - just about every hypo situation I see is due to advice from someone's vet.

As you have probably concluded by now most vets don't know the first thing about feline diabetes! Please, please listen to the people in this group. Their collective information has save the lives of many cats! Read the stickies and yes, it's a ton of information.

Toss the dry food, return the DM (if you bought it) and find the list of supplies to test yourself at home. Determine the first dose based on recommendations you get here - better to allow your cat to be a bit high in the numbers than to go too low! She won't die from a day or two of higher numbers - while you re-group. When your vet calls, tell her she's fired (if you're bold enough)...if not, just listen and say thanks and hang up - disregard everything she says!!! Seriously! Move on and spend your time reading the stickies, asking questions and reviewing other people's condos and spreadsheets - you'll get the idea soon. I haven't seen a vet for diabetes in over a year - nor do I intend to do so. I take Luci for other things - tell them she's a diabetic - show them her SS - and then tune out their advice by saying, uh huh...thank you...I'll keep you posted - they never hear back from me again about that!

Best of luck to you - regroup today and restart. We'll look for a new post from you tomorrow.. :)
 
I can see you gave a 2 unit shot. Please monitor her closely today and tonight, because it is more than likely too strong still. You need to start with a low dose such as 1 unit, and then increase by 0.25 increments after at least 6-9 cycles.
 
Seconding Penelope here... test often and keep a close eye on kitty. Make sure you read the hypo sticky as soon as you can, and print it out so that you have it if the board goes down again!!
 
Hi, yes I'm doing a full curve today and testing every 2 hrs. So far Spreadsheet looks good at +4 = 194. Keeping a close eye though and have higher carb food and honey
Available. Thank you so much everyone for your help, I'd be so lost without you!!
 
Red & Rover (GA) said:
Waving from the Kawarthas.

Unfortunately, there is no dry food in Canada that is low enough in carbs (under 10%) for a diabetic cat.

That 99 looks good to me.

Do post in the morning and keep the spreadsheet up. It is a good tool to have. And please let us know what your vet has to say.

I hope your little one lets you sleep in a bit
Click to expand...

hello! Thanks for your help, nice to see someone close. What food do you feed? Is friskies pate ok? What if Luna doesn't like it? My vet agreed with my decision to hold the dose. She said to test q2h today and pmps, And give 2units if over 8mmol(144). If under that skip dose. She said that the dry purina dm was ok for now, as she's not eating much wet (although wet is better). She wants to make sure she's eating, and get a dose stabilized before changing food again. Doesn't want to take chance of only offering wet and Luna not eating it.
 
You must log in or register to reply here.
Back
Top