? Pookie 5/15 AMPS+11=97, PMPS=108 - shoot or stall?

wh1rlwind

wh1rlwind

Member Since 2020
Hi,
Pookie doesn't seem to have much appetite tonight, and his numbers are low blues/greens...should I still give his usual dose of 2.75IU or reduce? Or keep stalling and testing for how long? His PM dose is due now
Apologies I don't have much data on the spreadsheet as have only managed to test him in the evenings, working full time so not able to test during the days :(
Any advice much appreciated...thank you!!
 
Hello! I don’t feel comfortable giving advice re: shooting, but I do know one thing the people who can will ask is if you’re going to able to monitor throughout the cycle to keep him safe. That will be an important factor in their advice.

Even with working FT during the day, are you able to schedule his shot times so you can get an AMPS? That’s critical in knowing if it is safe to shoot in the mornings, too.
 
Thanks for the reply Patricia!
I should be able to monitor him for the next couple of hours, but not after midnight in Australia (so can test for the next 4 hours or so?)
Will try my best to start getting AMPS but its been hard as it's a mad rush in the mornings for my partner and I to get to work with a screaming toddler too..I'm thinking maybe I should reduce his dose to 2IU or even 1.5IU tonight and test tomorrow morning?
 
Hi again! Sorry, I couldn't access the board for a bit there. I still don't feel confident/comfortable giving a recommendation, but with Pookie's history of DKA I would venture to guess we should err on the side of giving insulin. It would be best if you could monitor a little longer if needed - maybe an alarm to check around +6 and go back to bed? - but a reduced dose could be a good way to get him some insulin and keep him safe. You could also give him some higher carb food to support him through the cycle.

I totally understand the mad rush in the morning! It's definitely a hard routine to get into at first. Is there a time where it's a little quieter (toddler eating while partner keeps an eye?) where you could do his test and shoot? It's really important to get that preshot test so that you know it's safe to give insulin, especially on newly diagnosed kitties where we don't have a ton of data. It works for me to do my cat's test + shot just before I grab my coffee in the AM so I have it taken care of before the rush really ramps up. Maybe that could work for you?
 
Hi Pookies mum,
I feel sure I have met you before but I can't find a previous post of yours.
I live in Australia as well
I know it can be a mad rush in the morning but I would strongly recommend you find time to test because if you give the insulin when the BG is too low you won't have any idea and the result could be a cat who has a hypo and you are not there.

Do you leave food out for Pookie for during the day?
I'm sorry no one was able to help you tonight. What did you decide to do with the dose?
 
Another thing (sorry to pepper you with questions!) - based on your last condo (here) it looks like you want to do SLGS. It would be worth revisiting the sticky on that method to guide you when more experienced members aren't able to give advice. Pookie did get close to earning a reduction today with that 97, but as @Bron and Sheba (GA) said above, it's important to get those preshot tests and a weekly curve to be sure. Based on the SLGS sticky, you could have skipped today since he was under 150, but again, the recent DKA does complicate that. I hope others are able to give more clear guidance than I am. :bighug:
 
Hi Patricia and Bron,
Thank you so much for your replies!! I am sorry I will do my best to try get AMPS readings in the future, I am still new to the ear testing so I need my partner's help...and our toddler in his terrible twos doesn't leave both of us free at the same time in the morning very often :(
I'll re-read the sticky again, thanks for the advice! Once again I really appreciate your assistance
I ended up giving him a reduced dose of 2IU but I was too scared to do so until 3 hours after his usual PM dose..I stalled until I was sure his BSL was on the way up (8.5 mmol / 153 mg, from 5.5 mmol at PMPS) and he started perking up a lot and demanding food
I hope I did the right thing! I'll have to test him again in the morning and hope it didn't stuff him around too much..I don't know if I should still give him his morning shot at the usual time now or wait until a bit later coz I stalled so long tonight :(
 
@wh1rlwind You're definitely going to need to adjust his AM shot time, Lantus can only be given at 12 hour intervals so his AM shot can't be given sooner than 3 hours later than his typical time. That may cause problems for your schedule next week, though. Others may be able to offer more clear advice on how to get back on schedule, sometimes people will recommend skipping a shot or giving his next shot at +18 then getting back to your normal time the following AM (so he isn't spending a full 24 hours without insulin).
For example, if your usual shot time is 9am and you stall for 3 hrs:
3 hours late - 12pm
Next shot, +18 - 6am
Back on schedule, +15 - 9pm
I'd want some additional input on that strategy, though, given his recent history with DKA.

Adjusting to this new lifestyle is hard and scary, too. :bighug: You did the best with the information you had this morning, we've all been there. Trust me, my cat's BG was a terrifying roller coaster when she was first DX'ed. It helped me to just test and test so we both got more comfortable. I could never test her ears, but she was used to me clipping her nails, so I test her back paws using the strategy I used to clip her nails. Most people here use the ears, but the feet really work well for us and allow me to do it without help.

It took a LOT of bribery - maybe I'm the one who was trained here... - but she quickly learned and started to sit in my lap without being wrapped in a towel for her tests and treats. Is there anything that Pookie loves that you could only give when he's getting tests to start that process? Tuna, freeze dried chicken treats, plain boiled chicken, etc? That might help you get to a place where you don't need your partners help!

Be easy on yourself while you're learning. For me, it was when I really got comfortable testing that I felt comfortable with her diabetes, the knowledge gives you a lot of power in treatment and makes you feel much better.
 
Hi Patricia!
Thank you so much for all the details you put in your response! It is really wonderful getting so much support from you and others here :)
So just confirming...since I gave last nights shot 3 hours late at 10pm, I should delay his 7am shot until 4pm today (+18 hours)? And then I can get back to his usual shot time of 7am the following day?
Also unsure now if I should stick with a reduced dose of 2 IU or go back to his usual of 2.75IU... I’m assuming his BSL levels will be high if I don’t shoot until 4pm today so may not be an accurate gauge
 
Let's see if some of the more experienced members have advice, I'll tag a few people here to see if they have thoughts: @Bron and Sheba (GA), @Wendy&Neko, @Marje and Gracie

I've been out of the loop for a while, so I don't want to present myself as an expert here even though you can see that I've had a diabetic cat for quite a while. I can say that the 18hr cycle is what I would do without advice from a more experienced caregiver, but I want to give others the opportunity to weigh in. Do you have any tests to update his SS with for now?
 
If you do the 18 hour cycle, you should your normal dose, which is 2.75 units. The alternative, to get back on schedule, is to move shot time up by 1/2 hour a day, or 15 minutes a cycle. This post on Getting Back on Schedule explains and has some examples. If you do decide to reduce the dose, I wouldn't go any lower than 2.5 units. Especially with recent history of DKA. Are you testing for ketones regularly.

SLGS calls for curves at least every week, as well as spot checks. It's important to see how low this dose is taking Pookie.

A favour to ask on your spreadsheet so we can easily see what happened. In the PMPS cell, write 108@+12, 117@+14, 153@+15 - that tells us you stalled 3 hours before shooting and what the in between tests were. Then go ahead and put 2 in the units column for tonight.
 
Patricia & Noodle said:
Let's see if some of the more experienced members have advice, I'll tag a few people here to see if they have thoughts: @Bron and Sheba (GA), @Wendy&Neko, @Marje and Gracie

I've been out of the loop for a while, so I don't want to present myself as an expert here even though you can see that I've had a diabetic cat for quite a while. I can say that the 18hr cycle is what I would do without advice from a more experienced caregiver, but I want to give others the opportunity to weigh in. Do you have any tests to update his SS with for now?
Click to expand...
Thanks, Patricia, for the tag.

wh1rlwind said:
Hi Patricia!
Thank you so much for all the details you put in your response! It is really wonderful getting so much support from you and others here :)
So just confirming...since I gave last nights shot 3 hours late at 10pm, I should delay his 7am shot until 4pm today (+18 hours)? And then I can get back to his usual shot time of 7am the following day?
Also unsure now if I should stick with a reduced dose of 2 IU or go back to his usual of 2.75IU... I’m assuming his BSL levels will be high if I don’t shoot until 4pm today so may not be an accurate gauge
Click to expand...
Do we know your name? I really prefer to address members by their names :)

At any rate, here is a post on how to get back on schedule when you shoot late. Typically, we do not shoot more than two hours late because it makes it hard to get back on schedule as you can see by that post. We also usually shoot the full dose when we stall because stalling and reducing are like a double whammy.

I would not shoot an 18 hour schedule in this scenario. You have some other options but without knowing where his BG is, I’ll have to just toss them out there for you because, like as not, I will not be up when you shoot next.

It’s best to shoot as close to 12 hours apart as you can. If you shot at 10 pm last night, the easiest thing to do is shoot 30 minutes early once a day until you get back to your normal 7/7 shot time. You can see that will take some time. If he bounces into the 300s at shot time, you can shoot one hour early but that would be just once a day and if he’s in the 300s.

I also have to say this and I know you said you’d try to start getting AMPS but there should never be a reason why you don’t test every time before you shoot insulin. It’s just dangerous. And more so if you have to leave immediately. I’ve been up all night with members who didn’t get a preshot test and found their cat was acting odd at +1, tested, and the cat was in the 20s. They didn’t get that way without the member shooting too low. I don’t want to seem like I’m admonishing you but I can’t underscore how vitally important it is to get that test.

If you are doing SLGS, you would reduce the dose when he drops below 90 which he didn’t do, so I’d suggest sticking with 2.75u.
 
Hi Patricia, Wendy and Marje!
Thank you all so much for your advice :)
Pookie's AMPS was 259 which is pretty good considering I reduced the dose by so much last night! So I shot 2.5 IU this morning and I will take your suggestions and slowly shoot 30 mins early once a day until he's back to his normal time.
Yes, I have the keto urine sticks to test for ketones and he's been great lately...when he went into DKA last time it was due to a misdiagnosis by the vet (he didn't have noticeable PU/PD, they said his weight loss was due to dental problems and his hyperglycaemia was due to stress at the consult) - I watch his behaviour much more closely now!
Hope you all have a lovely day and once again, am very grateful for everything.
PS. My name is Adele :)
 
wh1rlwind said:
Hi Patricia, Wendy and Marje!
Thank you all so much for your advice :)
Pookie's AMPS was 259 which is pretty good considering I reduced the dose by so much last night! So I shot 2.5 IU this morning and I will take your suggestions and slowly shoot 30 mins early once a day until he's back to his normal time.
Yes, I have the keto urine sticks to test for ketones and he's been great lately...when he went into DKA last time it was due to a misdiagnosis by the vet (he didn't have noticeable PU/PD, they said his weight loss was due to dental problems and his hyperglycaemia was due to stress at the consult) - I watch his behaviour much more closely now!
Hope you all have a lovely day and once again, am very grateful for everything.
PS. My name is Adele :)
Click to expand...
Great! Thank you and welcome, Adele!
 
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