Solomon AMPS 4.9/88.. Advice needed please!

[Emma and Solomon]

Solomon randomly hit me with an AMPS of 4.9mmol today so I obviously didn't give him any insulin and he has remained around that at +2 & +4. I don't really know what's going on as last nights pre shot was 16.4 and +7 was 13.6 so I was actually expecting him to be pretty high this morning.

No changes recently, he is still eating a mix of around 7% & 2% wet food and 9.5% dry food and he is acting completely fine and no change in appetite. Same Prozinc vial for over a month too. The only thing that comes to mind about last night is he hadn't had b12 methylcobalamin for a few days and I gave him one mixed in a 3.9% carb yogurt treat while I was giving him his injection but I don't see how that would make a difference and I injected above his rear leg which ive done many times so not that either.

It has been very hot here for the past few days but he usually runs higher than normal in the heat.

Hoping someone will be able to give me an idea of what on earth is going on with this boys numbers today?!

 

[Diane Tyler's Mom GA]

Solomon randomly hit me with an AMPS of 4.9mmol today so I obviously didn't give him any insulin and he has remained around that at +2 & +4. I don't really know what's going on as last nights pre shot was 16.4 and +7 was 13.6 so I was actually expecting him to be pretty high this morning.

No changes recently, he is still eating a mix of around 7% & 2% wet food and 9.5% dry food and he is acting completely fine and no change in appetite. Same Prozinc vial for over a month too. The only thing that comes to mind about last night is he hadn't had b12 methylcobalamin for a few days and I gave him one mixed in a 3.9% carb yogurt treat while I was giving him his injection but I don't see how that would make a difference and I injected above his rear leg which ive done many times so not that either.

It has been very hot here for the past few days but he usually runs higher than normal in the heat.

Hoping someone will be able to give me an idea of what on earth is going on with this boys numbers today?!

@FrostD

 

[FrostD]

Ah this is interesting.

1. He just doesn't like 4.75U

2. Its possible he "stacks cycles", I've only seen it in two other cats here. Most cats when you give a shot, nadir is fairly predictably 4-8 hours later. But very infrequently, the relationship is between nadirs and not shot time. So for normal cats - if they nadir at +10 on a bounce break, shot given at +12, nadir will still be around +4 to +8 the next cycle. In cats that "stack": a nadir at +10 on a bounce break, shot given +12, nadir is pushed out sometimes to +16 in relation to that shot.

I need to study his SS a little more though when I have more time.

BUT a few more likely things to rule out first:
1. Was he ever tested for IAA or acromegaly? His spreadsheet reads a bit like a cat with one or both of those conditions. We typically don't recommend testing until you hit 6U, so I wouldn't bother just yet, especially since he also gets dry food. Just curious (also can't test for IAA unless.you send it to the US anyway).

2. Are you shooting 12 hrs apart, with only maybe 30 mins of leeway?

3. Is he consistently eating that dry food? Because theoretically, if he didn't touch it one time or ate less sometime.in the past week or two, these random spurts of green could be due to that. The effects of dry hang around quite awhile.

4. Thyroid checked recently? That can have unusual effects on duration and numbers.

 

[Emma and Solomon]

Ah this is interesting.

1. He just doesn't like 4.75U

2. Its possible he "stacks cycles", I've only seen it in two other cats here. Most cats when you give a shot, nadir is fairly predictably 4-8 hours later. But very infrequently, the relationship is between nadirs and not shot time. So for normal cats - if they nadir at +10 on a bounce break, shot given at +12, nadir will still be around +4 to +8 the next cycle. In cats that "stack": a nadir at +10 on a bounce break, shot given +12, nadir is pushed out sometimes to +16 in relation to that shot.

I need to study his SS a little more though when I have more time.

BUT a few more likely things to rule out first:
1. Was he ever tested for IAA or acromegaly? His spreadsheet reads a bit like a cat with one or both of those conditions. We typically don't recommend testing until you hit 6U, so I wouldn't bother just yet, especially since he also gets dry food. Just curious (also can't test for IAA unless.you send it to the US anyway).

2. Are you shooting 12 hrs apart, with only maybe 30 mins of leeway?

3. Is he consistently eating that dry food? Because theoretically, if he didn't touch it one time or ate less sometime.in the past week or two, these random spurts of green could be due to that. The effects of dry hang around quite awhile.

4. Thyroid checked recently? That can have unusual effects on duration and numbers.

Oh I hope he isn't stacking cycles, I feel like I can never predict his nadir as it is!

He hasn't been tested for IAA or acromegaly. He got a full blood panel done at the end of March that led to his diabetes diagnosis and his thyroid was all good but I am planning to take him in a couple of weeks to get bloods checked as it will have been 6 months since last check, I am happy to as the vet to test for IAA and Acro while we are there.

Yeah shooting 12hrs apart give or take 15 mins either way (just had to work back from 12 to 10 but done it in 15 minute increments)

Unfortunately the dry food is the only thing he does eat consistently . We restarted his weight loss journey about 3 weeks ago lol so I reduced it then but now gets weighed/portioned so I can calculate his daily calories. He doesn't eat at consistent times though which I assumed is why his nadir jumps around so much.

I convinced myself he had a UTI and thats why his numbers have been a bit all over the place so took a sample in for a urinalysis and culture last week but all values were normal and no bacteria.

I have been racking my brain all day trying to think of anything out of ordinary last night and remembered that I gave him 5mg of Loratadine antihistamine last night and night before as he had a little sore above his mouth and watery eyes after a day of lounging in the grass in the garden. No idea if that could have made any difference?

He was 18.4 at +11 and due his shot in about 40 mins but I have no idea what dose I should give him?

Thank you again for all your help and wisdom!

 

[FrostD]

I will study SS more tonight. It doesn't read like a cat with an infection either, numbers are usually much higher. But something like allergies might be just bothersome enough to keep him elevated but not too badly.

If anything the eating would be flattening him out and could give the illusion of a moving nadir, but he's usually pretty flat. That usually means dose isn't high enough yet BUT with these random greens he's not giving you much of an option.

You can always do the IAA and acro tests if you want, but they're fairly expensive (which is why we use 6U as the cutoff, sometimes you hit a breakthrough around 4-5.5U and they come down in dose)

I'm late, but stick with 4.5U. If your gut is telling you something is happening, just be vigilant.

 

[Emma and Solomon]

He does get watery eyes sometimes and every so often a sore around his mouth that I thought was feline acne but I thought the recent one was a bug bite as its above his mouth so had a virtual vet appointment and they thought it sounded like allergies and told me what antihistamines to get so that's the first time he has had them. I could always try giving them again and seeing if it affects his numbers?

Luckily I actually got Solomon insured 2 months before he was diagnosed so I will probably get the tests done soon anyway- certainly before I get the renewal quote lol

I ended up doing 4.5U anyway and had a drama free night and preshot this morning