PMPS and dosing help please!

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David - coco

Member Since 2022
So I tested ps at 11.5 as I was trying to reduce the time of her shot by 15 minutes (yesterday was 8:30) but it was 169 so I stalled for 25 minutes and now it’s 159? Not sure why it’s going down??
Now I guess I’ll stall again for 20 minutes and test again? If it continues to go down or doesn’t rise up to 200, should I skip this dose? The vet told me not to dose at <150 and obviously it’s recommended on here <200. The other night I gave her full dose at 171 and seemed to do ok?
she did go to the vet this morning and I tested her at +6 and seemed high but maybe stress?
See my spreadsheet
Recommendations? I’m sort of leaning of skipping tonight but not sure how this affects anything for tomorrow and beyond? Not sure sure I’m comfortable reducing the dose with talking without my vets approval . Plus I don’t have 1/4 unit increments on my syringes, only half.@FrostD @Bron and Sheba (GA) ? Thanks

UPDATE: at +12.5 now we’ve dropped to 130. Is it normal for it to be dropping this late in the cycle? I’m thinking best to skip tonight…
she’s had diarrhea and throwing up the last 24 hours so maybe that and the vet visit this morning is causing some goofy things with her numbers?

UPDATE
Since I didn’t get any feedback I decided it was best to skip tonight and fed her. Still curious your thoughts on it dropping so late in the cycle? I started her on metronidazole this morning, could this have caused any issues with BG? Any recommendations for tonight? I assume with no shot and a high carb food (KD wet) we should be safe.

with that, what kind of ramifications are likely to happen from skipping a dose? I assume I should just go back to normal dosing tomorrow…can I give the dose earlier tomorrow now? Like instead of 8:30, can I do 7 or 7:30?
 
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Sometimes cats will continue dropping late in the cycle, especially if you are stalling without giving food. I think you are right that her mid cycle number could have been higher due to the vet visit. The other reason her numbers were probably coming down end of cycle is that she's breaking a bounce. Bounces can take six cycles to resolve, today was the sixth cycle after her last blues.

Since you skipped tonight, you can choose the next shot time to be what you want, as it'll be 12+ hours from the last shot time. You can stick with the same size dose in the AM. If you do find yourself skipping quite a bit on a dose, it can be easier to reduce the dose a bit, maybe down to 1.75 units, to avoid skipping. When you are new, it's always easier to start on a lower dose and work your way up, than having to worry about low numbers. Her numbers weren't that low, just worrying showing up at preshot time.

As for ramifications, it should be OK, unless your kitty has history of ketones or DKA. It might be a good idea to test her for ketones tonight if you get the chance. You might want to test an hour after the food, to make sure she's either flat or on her way up now.

As far as metronidazole goes, it shouldn't impact BG by itself, unless it's compounded in a solution that has sugar in it.
 
Wendy&Neko said:
Sometimes cats will continue dropping late in the cycle, especially if you are stalling without giving food. I think you are right that her mid cycle number could have been higher due to the vet visit. The other reason her numbers were probably coming down end of cycle is that she's breaking a bounce. Bounces can take six cycles to resolve, today was the sixth cycle after her last blues.

Since you skipped tonight, you can choose the next shot time to be what you want, as it'll be 12+ hours from the last shot time. You can stick with the same size dose in the AM. If you do find yourself skipping quite a bit on a dose, it can be easier to reduce the dose a bit, maybe down to 1.75 units, to avoid skipping. When you are new, it's always easier to start on a lower dose and work your way up, than having to worry about low numbers. Her numbers weren't that low, just worrying showing up at preshot time.

As for ramifications, it should be OK, unless your kitty has history of ketones or DKA. It might be a good idea to test her for ketones tonight if you get the chance. You might want to test an hour after the food, to make sure she's either flat or on her way up now.

As far as metronidazole goes, it shouldn't impact BG by itself, unless it's compounded in a solution that has sugar in it.
Click to expand...
Thank you for responding, I was getting worried there was an issue with my post.
I was going to test at +2 since feeding her which I’m about 10 minutes, so I’ll update.
The last blood test 3 weeks ago said “ketones - 0” so I’m assuming no on the ketones and the vet didn’t talk to me about it.
I wasn’t advised to reduce dose by the vet, just skip. How would i reduce it by 1/4 when my syringes don’t do 1/4 increments?
The metronidazole is compounded but not sure if it has sugar in it? But she needs to be on it to get her gut back to normal. They also put her on a probiotic.

As an update - @+2 post feeding she’s at 286
 
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Looks like you are good for sleep tonight.

Ketones can go to dangerous levels in less than a day. If the right things are in play. This post has more details:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Do you have syringes with half unit markings? You can eyeball the 0.25 units from there. You don't have to reduce the dose, just be aware that if this dose can take her to low blues at preshot time, you may see this scenario again. If you do, then at that time reducing the dose may be a consideration. It's better to be able to find a dose that you can shoot twice a day than to skip.

If you know where the metronidazole was compounded, maybe the pharmacist, or the vet, can tell you what's in it. Since she got down to low 100's today, I doubt there was sugar in it. If nothing else, put a note in the Remarks column of the spreadsheet when you start a new med, and you might be able to figure out if it's impacting her blood sugar.
 
Wendy&Neko said:
Looks like you are good for sleep tonight.

Ketones can go to dangerous levels in less than a day. If the right things are in play. This post has more details:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Do you have syringes with half unit markings? You can eyeball the 0.25 units from there. You don't have to reduce the dose, just be aware that if this dose can take her to low blues at preshot time, you may see this scenario again. If you do, then at that time reducing the dose may be a consideration. It's better to be able to find a dose that you can shoot twice a day than to skip.

If you know where the metronidazole was compounded, maybe the pharmacist, or the vet, can tell you what's in it. Since she got down to low 100's today, I doubt there was sugar in it. If nothing else, put a note in the Remarks column of the spreadsheet when you start a new med, and you might be able to figure out if it's impacting her blood sugar.
Click to expand...
So in general if she constantly drops low at preshot time then it likely to high of a dose and should be adjusted?

Question that maybe you can help with. One thing I’ve noticed is at times she will twitch when she is trying to rest. Sometimes it’s an actual twitch of like her paw, ears or head but sometimes it’s a little more subtle like a muscle spasm. It makes her a little restless. I thought maybe it was low blood sugar but she’s doing it now and I had just tested her and she’s not low. Is it possible this is a sort of diabetic neuropathy? She does twitch when she’s in a deeper sleep like she’s dreaming. But this different. Seems to happen more times than not in the evening but usually goes away and good and shot. It’s just weird.
 
Wendy&Neko said:
Looks like you are good for sleep tonight.

Ketones can go to dangerous levels in less than a day. If the right things are in play. This post has more details:
Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones

Do you have syringes with half unit markings? You can eyeball the 0.25 units from there. You don't have to reduce the dose, just be aware that if this dose can take her to low blues at preshot time, you may see this scenario again. If you do, then at that time reducing the dose may be a consideration. It's better to be able to find a dose that you can shoot twice a day than to skip.

If you know where the metronidazole was compounded, maybe the pharmacist, or the vet, can tell you what's in it. Since she got down to low 100's today, I doubt there was sugar in it. If nothing else, put a note in the Remarks column of the spreadsheet when you start a new med, and you might be able to figure out if it's impacting her blood sugar.
Click to expand...
As an update. Her amps was 500 this morning. Was this sort of expected with no shot last night and a higher carb diet?
 
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Higher numbers expected due to missed shot, and probably bouncing from the blues she's not used to yet.

David - coco said:
So in general if she constantly drops low at preshot time then it likely to high of a dose and should be adjusted?
Click to expand...
Not a general statement, no. Some cats just nadir later than others. But for new people it's easier to start with a lower dose, get used to testing and their kitty's patterns on insulin, then increase. Rather than worrying and skipping shots. As you get more comfortable with routine, and get more BG data, it'll be easier to shoot lower numbers too.
 
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