Scratchie AMPS BG193 - Need Advice Please

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Scratchie'smom

Everyone, I hope I made the right decision this morning. Listed is Scratchie's number as of 5:00 AM. 24 hours after his last shot, 1/2 hour after his 'breakfast'.

Our normal routine is up at 4:15, feed Scratch by 4:30 then his insulin at 5:00AM as I have to be out the door for work by 5:30. Since he was below 200, and it was only 30 minutes after eating, I did not give him any insulin, yet again. Did I make the right decision?? I read that his food will make the BG go up so I am assuming that was why it's was so much higher this morning. I think I see the writing on the wall and I'm going to need to do a 'mini curve' possibly?

The vet wants me to call him after each BG so he knows what's going on. I'll do that as soon as they open, but would appreciate advise from you guys! Thanks!
 
I am hoping the experts will chime in here soon. As background (from your last post), Scratchie's BG last night (pre-shot) was 63 -- 12 hours after you gave him 3 units of Lantus. This might indicate that he was (or was near) hypo at some point in your cycle yesterday. Therefore, last night, you gave him no additional Lantus. This morning his BG is now at 193 (again, without insulin last night). His typical dose is 3 units, but you are wondering now if that is too much (my guess is YES), so you did not shoot him again this morning with the 3 units before leaving for work (a very good decision).

So are looking for expert advice on what to shoot now. Is that correct? My guess (and this is only a guess) is that the experts will tell you to go down from 3 units to .5 or maybe 1 unit and build up from there if needed. They may even tell you to give nothing for a day or two to see how Scratchie's numbers even out (as he may have been going hypo for a few days now on that 3 unit dose).

You might want to attach a star icon to this note to get more attention. But until you hear from the experts, I would hold off shooting anything. PS: Congrats on getting your second BG reading!! I know how tough this has been for you! Also, if you need help setting up a spreadsheet just let me know and I can help you get one together (send me a private message -- PM button to the right).

EXPERTS???
 
Hi, Jo. Melanie asked me to stop by. I'm usually over on the Lantus TR board. If you've not already done so, you may want to take a look at the starred, sticky notes at the top of the Board.

Now that you're able to get tests, it's going to be very helpful if you can start a spreadsheet. This will allow you to keep all of your test data in one place. When you link it to your signature and set the access so anyone with the link can view the spreadsheet, it will let us give you more accurate assistance with any questions you have.

From my briefly scanning your old posts, it sounds like you're transitioning Scratch to canned food. I'm hoping you're not just feeding Hill's M/D. It's 14% carb which is higher than what we consider low carb. However, when you transition a cat to lower carb food, insulin needs can change dramatically so it's a very good thing that you're testing! On the Lantus board, we suggest using a pre-shot test value below 150 as a "no shot" number. Here on Health, often people will use 200 as their "no shot" number. If you're not going to be home today, not shooting was the safest choice.

I feel like I'm a bit disabled by not having numbers to look at. I do think that if you've been changing your cat's diet, insulin needs are going to decrease. Likewise, whenever we see that people are encountering a pre-shot number that they can't shoot, it suggests that reducing the dose so you can shoot twice a day makes good sense. If you're currently shooting 3.0u, I'd really consider dropping the dose to 2.0u. For most of us, it's easier on the nerves to have to deal with higher BG numbers and increase the dose than to give a larger dose and scramble to deal with low numbers.

Does Scratch have any history of ketones or diabetic ketoacidosis (DKA)? If so, you should be testing for ketones, especially if you're going to drop the dose. You can get Ketostix at most pharmacies. These are strips that you dip into your cat's urine stream and the end of the strip turns color to indicate whether ketones are present.
 
Sienne,

Thank you for the info! I will start the spreadsheet as I did download, just haven't had a chance to do it yet. Scratch is totally on 'wet' food now and I made the transition July 9th. I had wanted to get him into the vet last week to have a fructose level, but he didn't want to see Scratchie until the diet had been changed for 4 weeks. He also wanted me to keep him on 4.0u 2xday. I felt that was too much so I have been slowly backing it off. Lowered to 3.5u waited two days, then lowered to 3.0u - then finally got the BG. I am feeding him Authority canned food - beef as that is all I could get him to eat. Saw this listed on Binky's list as ok food. Nothing else seemed to please his palate. I have been testing his Ketone level and he has been showing a fabulous negative!

I have been reading the Lantus board and must have missed that on the 150 level. With him eating within 1/2 hour of the BG I was thinking that was why the number was higher this morning. He hasn't had any insulin since 5AM yesterday and that was the 3.0u. Glad you think I made the right decision this morning. I'll test him again when I get off work and see where he is at prior to eating....

Could his food have made the change??

Thanks! Jo
 
Jo: Is it possible to get a mid cycle reading (either today or tonight) around +5 or +6. In my understanding, all dosing decisions are to be based on the nadir (or the low point, which usually happens about 6 hours after the shot). I am really concerned about the 63 BG reading you got at as a pre-shot last night - and what it might have indicated about Scratchie's nadir levels earlier in the day yesterday. If his BG was 63 at preshot, could it have been 20 at +6 (the nadir)? We just don't know. Question for the experts: couldn't even 2 units be too much for Scratchie at this point -- and shouldn't Jo try to get some nadir readings before deciding on next dose (or alternately, go really low on the dose until she has more data)?

On the food question, some cats can go into remission (no longer needing insulin) with just a diet change alone; but for those who still need insulin after the switch, less insulin is typically needed.
 
Melanie,

I will definitely try to get that done tonight. Have to admit that I haven't investigated the spreadsheet since I wasn't getting any BG levels, so might take me a bit to figure out what you are talking about! :smile:

I know where the section is describing what to record and how, just need to do the research. I don't have his old numbers from when this started in February, but I have the numbers from the end of June and the first part of July when the vet ran the last curve on him. Should I add those to the spreadsheet as well?

I'll get levels tonight and study up on the spreadsheet. Might have more questions then. :oops:
 
The vet curves will probably not have relevance, and they weren't recent anyway - so I would probably leave them off. Cats are typically so stressed at the vet that it raises their BG considerably and any readings you get are unreliable. I'll be glad to help you set up the spreadsheet if you need help. It is pretty simple and goes on the premise that Lantus lasts about 12 hours -- so there are two cycles in every day. At the beginning of every day you get a pre-shot blood glucose reading (called AMPS -- which stands for the preshot you took in the AM), then you'll see numbers like +1, +2, +3 and so on. That simply refers to how many hours after you gave the shot. So if you check Scratchie's BG 4 hours after you give his shot, then you record that number under the +4 box. It's pretty easy once you get the hang of it.

The reason it is so important to get the +6 readings (approximately 6 hours after you give Scratchie his shot), is because that is typically the LOW point, the lowest the BG will go based on the insulin dose you gave six hours earlier. So, for example, if you gave Scratchie 1 unit of Lantus at 7am (no matter what his preshot number was) and by 1pm, his BG was 30 (which is an emergency) then that would indicate to you that 1 unit is too much for Scratchie. But you can't guess at this by looking at a preshot number and saying...his preshot is 350 so he probably needs 2 units. You see what I mean? Experts, did I explain this correctly?
 
Jo: What is the plan for this evening? Are you planning to do a preshot BG and then ask for advice from the experts here on what might be a safe dosage or do you feel you got enough guidance to decide that on your own? If there are other experts out there, please look over this string and weigh in. Just don't want to leave Jo hanging (uncertain what to do tonight).

To recap, Scratchie's BG last night (pre-shot) was 63 -- 12 hours after Jo gave him 3 units of Lantus. This was the first BG Jo has been able to get from Scratchie (it has been a difficult road for them both). This 63 pre-shot reading might indicate that Scratchie was (or could have been near) hypo at some point his cycle yesterday; though we don't know for sure; and we don't know what the 3 units was doing to Scratchie's BG levels prior to yesterday. Last night, after getting the 63 BG Jo gave Scratchie no additional Lantus. This morning his BG was at 193 (without having received insulin for 24 hours now) and Jo gave him nothing again (she had to work today so could not watch him).

The dose Jo has been giving Scratchie till now has been 3 units, twice a day, though we don't have readings on Scratchie prior to yesterday to know if this is even appropriate (Jo's vet recommended 4 units, Jo reduced it to 3). Do the experts think 3 units is too much at this point? What should Jo give Schatchie tonight? Any recommendations?

Melanie
 
Melanie. Not sure what to do yet tonight. Tried
to get another reading and he wouldn't handle it tonight!

Thought I would try again here shortly (it's almost been an
hour) and see what happens. Internet down and doing this from my
phone so I apologize if looking funny.

I'll post later as I am concerned on what to do tonight especially
without a level.
 
When in doubt it is probably best to do nothing (don't shoot). That is my non-expert opinion. Scratchie's number this morning was under 200, and the experts advise not to shoot under 200. If you are not sure what the BG is now, then probably better to be safe and do nothing. Scratchie's numbers yesterday and today (so far) have been low (including a 63 pre-shot last night and an unknown nadir) so it doesn't look like he will be harmed by waiting until you can get more numbers in the coming days.

If it were my cat (and this is only my non-expert opinion), I would probably give no insulin for a couple of days, practice my BG testing skills in the meantime, and try to get some BG readings at different times of day. Armed with a few days of readings, the experts might be better able to advise you on a safe dose for Scratchie. Typically they recommend starting at .5 or 1 unit twice a day -- but again a lot will be dictated by the numbers you get from Scratchie over the next couple of days.

Hopefully the experts will post here -- whether they believe this is a good plan, or perhaps suggest a different direction.
 
Thank you again Melanie I'll keep trying through the night. He is acting
just fine but watching him closely. Thanks again for your
time and encouragement!
 
If you try to get a few readings over the weekend (without giving insulin), I will help you put together the spreadsheet (if you need help with it), and with that info, the experts should be able to recommend a good starting (or restarting) dose for Scratchie.

Hopefully others will comment on this strategy too (those with more experience than I have).

Feel free to PM me if you need anything (I can certainly provide emotional support if nothing else...LOL! Try to relax. All will be well!!

PS: You don't have to watch Scratchie too closely tonight. It is impossible for him to have a hypo if you are not giving him insulin.

:)
 
There are no experts here, only those with more experience than others.

Based on the limited information, Scratchie is doing pretty well. After 24 hours since his last shot, he was only 193.

Lantus works by building up, some members here call this a "shed" or depot of insulin. 3U doses would fill that depot fairly quickly and at some point, there's overflow because more than likely that dose is much too high. That is why he had a 63 at 12 hours and probably why his BG is still decent after 24 hours.

Even without more BG numbers, it would be safest to give only 1U twice a day and home test, especially if the vet had you start out at 3U twice a day. We see 3U as a starting dose frequently from new members and I have yet to understand where vets are getting that dose from. Insulin should not be dosed by weight and if it is, only by "ideal weight" which is somewhat subjective.

Even the AAHA now advises starting at only 1U BID (twice daily.) http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
 
Re: Scratchie Clarification

Vicky. Thanks. Small clarification. He was diagnosed in February and started on lantus at 1.0u. Gradually increased as couldn't regulate. In June his numbers were 365 with a high of 401. That's when we upped to 4.0u.

He was still on dry food at that point. The first part of July (7/5) he had a curve and averaged 358. That's when I decided no
more messing around with the M/D food and switched to wet. I finally found something he liked and would eat. In the last week I dropped his dose as I felt it was too much - have no idea why. Amazing what the food change does. So glad I finally found something he would eat that was as frustrating as anything. I tried so many varieties.

Now no insulin since morning of 7/26 and he is acting great!

I'll keep posting as I have stuff to report. Jo
 
Vicky & Gandalf (GA) & Murrlin said:
There are no experts here, only those with more experience than others.
Click to expand...

Vicky: I consider you experts as you seem to know a lot more than even my vet (no kidding! LOL!) but if you prefer, I will use the term "more experienced users." :) Thanks for your insight with this and for all your help.
 
That's awesome that he hasn't had insulin in 2 days. What is his BG now? And yes, the food change can make a dramatic improvement. Good for you for going with your instincts. :-D

Thanks for clarifying the background on Scratchie. Melanie asked me to check in yesterday but I didn't see her request in time to reply yesterday.
 
Hi,
I'm glad you haven't been giving a dose.
You are kinda driving with a bag on your head, higher doses scare me.
I want to encourage you to get that spreadsheet up before you continue with a high dose. It sounds like the food change
helped a lot and is giving you better numbers.

If it's lack of time, there are those who will set up the sheet for you.
I had to get help with some aspect of it so I changed my google password temporarily and private messaged (pm) my temporary password and id to someone who went and did it all lickity split.
And then I changed my password back.

Having your bg readings really helps us out here guide you better and you need to be able to see your own numbers
to learn Scratchies patterns.
 
MelanieP and Ninja said:
Vicky & Gandalf (GA) & Murrlin said:
There are no experts here, only those with more experience than others.
Click to expand...

Vicky: I consider you experts as you seem to know a lot more than even my vet (no kidding! LOL!) but if you prefer, I will use the term "more experienced users." :) Thanks for your insight with this and for all your help.
Click to expand...

:-D Everyone should feel valuable, because it's their experiences which have taught them. Even those who've only been at this FD business a week or 2 have learned some important facts, like about foods and home-testing. Dosing recommendations, however, are a more delicate area and some of us have the experience and knowledge to explain what dose is best or safest based on BG values. Having that experience doesn't make us experts by any means but in cases like this it is best to call on those members, so thank you for doing so.
 
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