? PMPS 99!! How long to wait?

Madm4444

Member
@Suzanne & Darcy

He's at 99 now. I know that's a great number but I've never had one so low at shot time. How long do I wait? Until it is on the upswing on the Libre or a specific number? :nailbiting:

Also, he's screaming for dinner...
 
I see the 99 and then a 125. And you shot 14. It will be okay as long as you can monitor the cycle. Was the 125 before food?
 
I see the 99 and then a 125. And you shot 14. It will be okay as long as you can monitor the cycle. Was the 125 before food?

Yes before food. I waited about 30 minutes. Needless to say, getting him to eat was not a problem! :cat:

The reader will be next to me all night. Alarm is set for 70 (which isn't really 70 on Libre).

Any words of wisdom for tomorrow morning? Stay at 14 unless drop below 200?
 
Well, you just shot a 125 with 14 units. So it depends on how tonight’s numbers go. If he does okay tonight then it will tell you that it’s okay to shoot the full dose tomorrow with a similar or higher number. If he earns a reduction tonight then you will shoot 13 in the morning.
 
Well, you just shot a 125 with 14 units. So it depends on how tonight’s numbers go. If he does okay tonight then it will tell you that it’s okay to shoot the full dose tomorrow with a similar or higher number. If he earns a reduction tonight then you will shoot 13 in the morning.

Sounds good.
Although these numbers are a good thing, I'm just really out of my comfort zone here.
Thank you for the support. :bighug:
 
Oh I know! They are good numbers, but at first they are scary. Later on, most of us are addicted to green.

Getting freaked out again. Numbers still going down as I write this...

Are these sudden drops good or bad?

If he goes into green, does that warrant a reduction? 13.5 put him in the pink before, should I try it again?
 
I’m seeing this now. What happened?

Similar to last night. I shot 14S at 118. Is it weird that I feel like that's his sweet spot?He's currently 181 on the Libre.
I'll be ready again tonight should anything happen.

It has been wild for me to see colors other than black & pink. Honestly, I never thought I would. Thank you again for being here for us. :bighug:

My plan is to stay with 14 if he is 150 or above in the morning. Does that seem reasonable?
 
Similar to last night. I shot 14S at 118. Is it weird that I feel like that's his sweet spot?He's currently 181 on the Libre.
I'll be ready again tonight should anything happen.

It has been wild for me to see colors other than black & pink. Honestly, I never thought I would. Thank you again for being here for us. :bighug:

My plan is to stay with 14 if he is 150 or above in the morning. Does that seem reasonable?
Well, may I see the Libre numbers from last night before I answer that? :)
 
When we are talking about 14 units, skinnying the dose really isn’t going to affect the numbers (unless perhaps you are really shooting more like 13.5.)
 
So yesterday he had an AMPS of 240 and you shot 14 so today he had a higher AMPS and you shot 14S. That’s not making sense to me. His numbers have been pretty good.
 
So yesterday he had an AMPS of 240 and you shot 14 so today he had a higher AMPS and you shot 14S. That’s not making sense to me. His numbers have been pretty good.

I think I was just trying to stay consistent with last night's shot. No, it wasn't 13.5. More like 13.95. :rolleyes: So, basically, to your point, 14, at these high numbers.

We have been trying to get back to 6a/6p but his nadirs are saying no to us. These low numbers are so new to us. Since we don't have a lot of data in the lows, we should wait to shoot until his low is done, correct? When it's back on the upswing? I'm a bit confused.o_O
 
Since we don't have a lot of data in the lows, we should wait to shoot until his low is done, correct? When it's back on the upswing?
Do you mean if you have a lower AMPS or PMPS that you should stall? And wait until his numbers come up? I am not sure if that is what you mean, but I would not stall for long (maybe 30 minutes) because it will mess up the shot time and possibly mess up his opportunity to get some lower numbers. The last few nights (before tonight’s pink PMPS) you shot some of his lowest numbers yet with 14 units. He did well. Having that Libre to alert you to low numbers is a comfort. Are you able to place them yourself now?

Today’s all pink cycle looks like a bounce for sure. He will come back down.
 
Do you mean if you have a lower AMPS or PMPS that you should stall? And wait until his numbers come up? I am not sure if that is what you mean, but I would not stall for long (maybe 30 minutes) because it will mess up the shot time and possibly mess up his opportunity to get some lower numbers. The last few nights (before tonight’s pink PMPS) you shot some of his lowest numbers yet with 14 units. He did well. Having that Libre to alert you to low numbers is a comfort. Are you able to place them yourself now?

Today’s all pink cycle looks like a bounce for sure. He will come back down.

Yes, that is what I was wondering about the stalling. Sometimes we wait longer & it takes several days to adjust. It messes up our schedule & his - and we all know how much cats like their schedules... ;)

We don't apply the Libres. There are a couple of really good vet techs in the IM dept that do it. Aside from being concerned that we'll mess it up, I just don't want to be the one that does yet another thing to him.

I'm bummed that he's in these higher numbers. :( I pray it's just a bounce.
 
It is discouraging when you have higher numbers after the better ones. And so frustrating that you just have to wait it out! He is going to come down though! :bighug:
 
It is discouraging when you have higher numbers after the better ones. And so frustrating that you just have to wait it out! He is going to come down though! :bighug:

Sooo... we are having an adventure with Libre & we're not entirely sure when it started. But this morning the Libre said 117. It didn't seem right to me so we checked with AlphaTrak3. First, AT3 183. What?! Then another check on other ear. AT3 189. Something is awry. We then did a check at AMPS +6. Libre at 109. AT3 was 186. The latest check was PMPS. Libre at 111. AT3 at 187. I got concerned that the AT3 wasn't correct so checked it with the control solution. Right within the requisite range.

Not sure if it's linear but the Libre seems 70-80 points lower than the AT3 right now. If that's the case, he's had a heck of a good day. Regardless, he's had 3 AT3 checks today, all showing less than 200.

I stayed consistent with 14u given all the other uncertainty. Hope it was the right decision...
 
@Suzanne & Darcy

It's been a hectic few days here. Finally got the Libre. Movement yesterday but stayed HI all night. I'm uploading now. Could you please take a look at Buster's data for dosing recommendation this morning? Thank you.
 
Watch him closely. I don’t know that I would have increased to 15 with those greens yesterday. He appears to be bouncing now.
 
And I am sorry I haven’t been around much for a few days. I am trying to catch up. I’ve been trapping and fixing feral cats and had a cat who needed unexpected surgery. I took him to the vet Monday and he needed surgery Tuesday. Wednesday I took five feral cats for fixing. They’re in my garage recuperating now.
 
And I am sorry I haven’t been around much for a few days. I am trying to catch up. I’ve been trapping and fixing feral cats and had a cat who needed unexpected surgery. I took him to the vet Monday and he needed surgery Tuesday. Wednesday I took five feral cats for fixing. They’re in my garage recuperating now.

Omigosh! That's a lot. I hope your kitty's surgery went well & he's recovering.
Thank you for all your doing with the ferals. I hope they all recover nicely, too.

I know I have to learn to make these decisions. I just wish I could make the right ones for him. So now I've screwed up another potentially ideal dose...
 
Hi there - I'm posting a reply to a question you asked me via PM, cause I want it to be "on record".
I feel like we are finally getting some good responses with ProZinc but he seems to shoot back to the high 300s quickly. It is my understanding that Lantus provides a more even 'curve.'
Is that correct?
How long would it take an acro cat like Buster to adjust to a switch from ProZinc to Lantus?
Kitties will still bounce on Lantus, but the depot can help even things out a bit more. However, you still need to get to a good fitting dose to even things out optimally.

I've seen all sorts of reaction in acro/IAA combo to a Prozinc to a Levemir switch, which was a more common switch. But switch to Lantus could be similar. The IAA combo can make it even more tricky as the antibodies can be fooled at first into not recognizing the Lantus. I remember one kitty who'd see at best high yellows but mostly pinks and above seen greens on his first cycle of Lev. Here is the link to Jack's SS. And a similar but not quite as dramatic change for Beenie and her SS. Kitties without IAA often are less "dramatic" for the switch. I presume you've looked at Suzanne's Darcy's SS.

Regarding what to do with dosing, there is more experience with higher dose cats on the Lantus forum, so more examples to look at plus more people to help out. You WILL get there. :bighug:. I spent forever with "dosing help?" on my subject line.
 
Another wrong decision on my part... I don't feel like I'm helping him very much.
You are helping him a lot! More than you know. He may end up needing the increase and time will tell, of course. He’s not going to be in danger with your vigilance

Are you placing the Libre sensors yourself? If so, I have a new ProZinc member that you may be able to help.
 
What is the schedule for Buster SRT? March? I was just thinking about the talk of switching to Lantus and wondering if it is a possibility or if you don’t want to change too many things at one time. On the other hand, if you are considering a switch and have some weeks to do it, you may want to consider doing it first.
 
You are helping him a lot! More than you know. He may end up needing the increase and time will tell, of course. He’s not going to be in danger with your vigilance

Are you placing the Libre sensors yourself? If so, I have a new ProZinc member that you may be able to help.

Thank you for the kind words. It's been a tough week over here.

Unfortunately, we don't place the Libre ourselves so I won't be much help with that. We take him to the IM vet tech for replacements. However, I am getting pretty familiar with the idiosyncrasies of the Libre (using a reader) if anyone wants to reach out.
 
What is the schedule for Buster SRT? March? I was just thinking about the talk of switching to Lantus and wondering if it is a possibility or if you don’t want to change too many things at one time. On the other hand, if you are considering a switch and have some weeks to do it, you may want to consider doing it first.

He is scheduled for March 17th so we would have less than 2 weeks. I'm not sure if that's enough time. But, if we don't switch now, I'm not sure if I would be comfortable changing after the procedure since we don't know how he will react.
 
If you are around to monitor closely for a couple days, I would switch sooner than later.

I think so too because you should know within a few days if he’s going to have a dramatic reaction to the Lantus.

I am expecting a call from IM doc today or tomorrow to discuss the switch. If we can get it moving, we would start Mar 4 or 5. That would give 10+ days before SRT.

In reading the posts, most people seem to use the pen. I am more comfortable with a vial than a pen. Plus I'm using a lot more than most folks.

I will need some help to determine his initial dose. He is about 5.7 kg right now. Also, since his dose will be higher than most, which is the best U-100 syringe to use?

Just trying to get all my supplies ordered...
 
Watch him closely. I don’t know that I would have increased to 15 with those greens yesterday. He appears to be bouncing now.

Please see spreadsheet. 15 really dropped him. First Libre low glucose alarm at 62. AlphaTrak was 115. Second alarm at 56/57. I gave him a tsp of lc FF. It hasn't moved much. Only up to 76 at 530p. Guess he'll be eating (& I'll be shooting) much later tonight.

What is your recommendation for his dose tonight?
 
On top of the Lantus forum are a lot of Sticky Notes, including one about syringes. It has a list of suggested U-100 syringes with half unit markings, pick one of them.

Typically when someone switches from another insulin to Lantus, they use the same size of dose. But since it's a U-100 insulin, it's actually a lot less volume. If you want, you can dial it back a bit cause he is getting lower greens on 15 units. I'd also take into consideration the possible antibody action as a reason to lower the dose a little bit. We can always fast track you back up if he stays above 300's. Normally the initial dose is held 5-7 days.
 
In reading the posts, most people seem to use the pen. I am more comfortable with a vial than a pen. Plus I'm using a lot more than most folks.
A pen is very easy to use. You just insert the syringe needle into the pen and draw back the insulin. You don’t insert any air into the pen. Now, having said that, I also used a vial of Lantus because it’s what my local pharmacy had available. It was only after I finally switched to Levemir that I got pens. We were on a huge dose of over 40 units when we switched.
 
really dropped him. First Libre low glucose alarm at 62. AlphaTrak was 115. Second alarm at 56/57. I g
This is what I was talking about— that I would not have increased to 15 units because you were already seeing green on 14 units… then he bounced… and I was anticipating the drop into lower greens (but I am happy it wasn’t lime green!)
 
Please see spreadsheet. 15 really dropped him. First Libre low glucose alarm at 62. AlphaTrak was 115. Second alarm at 56/57. I gave him a tsp of lc FF. It hasn't moved much. Only up to 76 at 530p. Guess he'll be eating (& I'll be shooting) much later tonight.

What is your recommendation for his dose tonight?
So as far as his dose goes. What is his PMPS?
 
I panicked again. I know his ketones have been okay (for him) but I get so nervous that they will shoot up when he's in the high numbers.

I presume he will stay high all night after the low numbers. If that is the case & he's high 300s in the morning, do I still shoot 14u?

Thank you for your time. I know you have a lot going on.
 
@Suzanne & Darcy

Buster stayed HI all night on the Libre. AMPS 392 (AlphaTrak3); Ketones 0.4.

I know I missed the reduction opportunity yesterday. But I wasn't sure what to do this morning since he's so high (bouncing?).

I looked through old posts and found this from @Sienne and Gabby (GA)
"you can hold the current dose for a cycle and then shoot the reduced dose the following cycle. We refer to this as "shooting though the bounce." The idea is that holding the current dose for the additional cycle may help the bounce to clear a bit more quickly"

So I held the dose from last night. Was this correct?
 
At the dose of 14 units, I don’t think it’s that big of a deal that you shot the extra half a unit. In my mind, the issue is that you are not taking reductions when they are earned so I am not sure what dosing method you are using. His ketones have been running around .4 or .6 and are not at a concerning level at this point, although they should be checked regularly as you already do. In Buster’s case, I know you watch him like a hawk and he will be safe from hypo with your constant vigilance. I know how much you love that boy! ❤️
 
At the dose of 14 units, I don’t think it’s that big of a deal that you shot the extra half a unit. In my mind, the issue is that you are not taking reductions when they are earned so I am not sure what dosing method you are using. His ketones have been running around .4 or .6 and are not at a concerning level at this point, although they should be checked regularly as you already do. In Buster’s case, I know you watch him like a hawk and he will be safe from hypo with your constant vigilance. I know how much you love that boy! ❤️

Thank you. I do love him like crazy & try to do right by him.

I think there's a couple things going on:
1 - I'm not used to reducing a dose & it scares me (acro + post-DKA)
2 - I'm getting confused by the Libre vs AlphaTrak3. When he was in the 60s yesterday, the AT3 read 115. It was a comfort to know that he wasn't going hypo but it messes with my head for reductions. Should I be using the Libre data (human) with the human spreadsheet for dosing decisions and only use AT3 for safety checks (when Libre shows very high/low)?

Regarding the method, I'm using the Modified ProZinc as a guide but with the acro/IAA & post-DKA present, I feel like there are caveats which is why I'm always asking for some help.

I would expect he will stay high today. Do I hold the dose until another drop?

Also, how are all your kitties doing?
 
Did you find that post on the ProZinc forum or was it in reference to a Lantus user or a ProZinc user?

Oh, and I do think it’s okay that you went ahead and shot through the bounce in this case. It’s a strategy that can be used sometimes depending upon how well you understand your cat’s patterns (if there is a clear pattern) and how long your cat’s bounces typically last. Also, it’s important that you will be able to monitor in case something unexpected happens. I say this more for those people who read threads yet never post for themselves to ask for help.
 
2 - I'm getting confused by the Libre vs AlphaTrak3. When he was in the 60s yesterday, the AT3 read 115. It was a comfort to know that he wasn't going hypo but it messes with my head for reductions. Should I be using the Libre data (human) wi
This was really bothering me too — this morning as I pondered his spreadsheet. I think it really should be the Alpha Trak that is used for reductions because of the Libre’s tendency to read lower in the lower numbers. It’s extremely confusing. I got frustrated thinking … well if we are basing the need to reduce solely on the Libre then … does he really need the reduction at all? It needs to be made somehow very clear in the spreadsheet and in the remarks which are Libre readings and which are AT — and that it’s the AT numbers used for reductions. Even so, hopefully it will be clear enough to someone reading the SS and making recommendations that reductions will be made based on AT readings. I know your AT readings are in bold, but I couldn’t find a bold number in any of the cells where he’s been in the lower green numbers. So I was left wondering if we were even making the right decision based upon the most important data.
 
You should put something in your signature about Custom dosing for Acromegaly/Do not copy dosing. Reductions at 68 pet meter. We usually request that members do this— again for those who read theeads and don’t make their own psots asking for assistance.
 
Thanks for asking about my kitties. The five ferals in the garage all are recovering well, and I should be able to release them tomorrow morning very early before the sun is up. Many of our personal cats have been sick this week. They’ve had some sort of bug going through the house. I am just trying to keep my most fragile FIV+, IBD boy away from them and well. I am worried about him and I am taking him for an ultrasound on Monday. He had one at diagnosis and before his biopsy, but he’s just not doing as well as I feel like he should be so I want my vet to look around and see what’s happening inside.
 
Back
Top