Stalling for the first time, Need advice, PMPS 150

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putus_human

putus_human

Member Since 2020
So Putu increased her dose this morning from 1 to 1.75 units of Vetsulin. Her BG is at 146 on the AlphaTrak 2. Per the beginner's guidelines, we are stalling and testing again in 20 minutes.

It's my understanding that any BG below 225, I skip the shot.
I've also read elsewhere that if she's between 150 and 225 but her BG is rising I can give it to her.
And of course, I've read also that I can give a token dose, like half a dose.

Any advice on what's best?

And no matter what I should feed her after the second retest?
 
Yup, retested 20 mins later and she's at 126. Feeding her regular meal now. It's 13% carbs. Should I switch to higher carb food (I have 25%)?

The beginner guide says retest in an hour. Should I wait that long or test again in another 20 mins.
 
putus_human said:
Yup, retested 20 mins later and she's at 126. Feeding her regular meal now. It's 13% carbs. Should I switch to higher carb food (I have 25%)?

The beginner guide says retest in an hour. Should I wait that long or test again in another 20 mins.
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If you feed you will not get a true reading of the BG, it will be food influenced.

I think the 1.75 units is too much to give at this point as you need a dose that will let you safely give the insulin twice a day.
If you haven’t fed yet wait 20 minutes. If you have fed let me know please
 
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Yes, I think the jump was too much.

I just fed her the usual food (13% carbs). She vomited. I think it may have been from eating too much too fast. She tested negative for urine ketones a minute ago. She just ate a tablespoon of high-carb wet food (25%).

When should I retest.
 
putus_human said:
Yes, I think the jump was too much.

I just fed her the usual food (13% carbs). She vomited. I think it may have been from eating too much too fast. She tested negative for urine ketones a minute ago. She just ate a tablespoon of high-carb wet food (25%).

When should I retest.
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The 126 (Alphatrak) is too low to give a dose to but we don’t really won’t to skip a dose because of the history of DKA.that is good the ketones were negative in the urine just now.
Retest when she next pees if you can please.
Now that you have fed her you will need to wait 2 hours before you can test her to see if she is high enough to give the insulin to. Don’t feed during the 2 hour wait please.
Will that throw your schedule out too much..?
I would feed her a good meal now of the higher carb food then wait the 2 hours and retest. Hopefully the BG will be high enough to give the dose to. You may need to continue to feed higher carb food through out this cycle to keep her up enough to give a dose.
You can test again whenever you like but we need to wait for the 2 hours to get another preshot BG.
 
Thanks for all your help! Her BG is going back up (at 150 again) and she got a nice meal of 25% carb food. I'll check ketones if she pees too.

I can check her again for a pre-shot in 2 hours. Is there any particular threshold for a shoot/no-shoot or just the usual ("New Here" Guide says 200 but because I'm on AlphaTrak it should be higher, maybe 250)? Or should I be looking for numbers similar to her usual pre-shots (she's been in the 500's)?

And what dose should I aim for? Obviously, 1.75 was too high (I can't believe both my vet and the AAHA were sooo wrong.) Maybe 1.25? Or does it depend on her pre-shot number?

Thanks again!
 
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putus_human said:
Thanks for all your help! Her BG is going back up (at 150 again) and she got a nice meal of 25% carb food. I'll check ketones if she pees too.

I can check her again for a pre-shot in 2 hours. Is there any particular threshold for a shoot/no-shoot or just the usual ("New Here" Guide says 200 but because I'm on AlphaTrak it should be higher, maybe 250)? Or should I be looking for numbers similar to her usual pre-shots (she's been in the 500's)?

And what dose should I aim for? Obviously, 1.75 was too high (I can't believe both my vet and the were AAHA sooo wrong.) Maybe 1.25? Or does it depend on her pre-shot number?

Thanks again!
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Just want to say that I am not a vetsulin user, but I doubt there are any online at the moment. I would not want to shoot anything under 225 /250 on the alphatrak with so little data using vetsulin. But as there is a recent history of DKA in the picture, we have to keep that in mind. Feeding some higher carb food can allow you to shoot lower numbers. (This is only used for DKA kitties when it is so important that they get the insulin)

I would go back to 1.25 units (if the preshot is high enough) and that will hopefully allow you to shoot both the am and the pm doses.
Try and get some tests in during the pm cycles if you can. At least one around +3 or +4.

Post when you get the preshot and I will keep an eye out for you. That will be in about 11/2 hours time? Then we can decide what dose.
 
Yeah, that will be in about 1 hr and 15 mins (around 10:15 PM Pacific Time). Should I be concerned about a bounce given how much she dropped?

I'm also just confused because I tested her around her usual nadir (+4) today and it was higher than usual so I thought the dose didn't have an effect.
 
putus_human said:
Yeah, that will be in about 1 hr and 15 mins (around 10:15 PM Pacific Time). Should I be concerned about a bounce given how much she dropped?

I'm also just confused because I tested her around her usual nadir (+4) today and it was higher than usual so I thought the dose didn't have an effect.
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I am in Australia so best to give + number of hours as Pacific time means nothing to me.
She might bounce from the lower numbers or the fast drop this morning but I wouldn’t worry about that.
She started out in the black and dropped to a pink number at +4 so that is quite a drop
 
Hey there! Putu is now at 383 2 hours after eating ~1/4 can of high carb food. Any advice on dosing a shot? It's lower than she's been at night (usual around 500) but similar to what she's got in the morning a few days ago.
 
putus_human said:
Hey there! Putu is now at 383 2 hours after eating ~1/4 can of high carb food. Any advice on dosing a shot? It's lower than she's been at night (usual around 500) but similar to what she's got in the morning a few days ago.
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I think you could give the 1.25 units and just keep testing and giving higher carb food if needed to keep the BG up into safe numbers.
 
Sorry I changed my answer when I realised you had said 2 hours after food!
I would get a +1 and a +2 to start with to see how she’s going
 
Bron and Sheba (GA) said:
I think you could give the 1.25 units and just keep testing and giving higher carb food if needed to keep the BG up into safe numbers.
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Okay, thank you! Just curious, does this mean her cycle is pushed back a couple of hours? Or should I test in the morning around her usual time and see if the Vetsulin is out of her system? I'll call the vet in the morning too... but I like to get some opinions here as well since the vet has not been spot-on so far and is sometimes not available to talk.

I'll test a couple of times tonight too, thank you.
 
Yes that means that the cycle is pushed back 2 hours. But you can decrease that 15 minutes a cycle or 1/2 hour once a day to get back on track.

So in the SS You will put +12 146; +12.5 126 fed. +14 382(PMPS). So the 382 is your PMPS. Stack all those numbers on top of one another in the PMPS square. Does that make sense?

We have found many times that vets often don’t know a lot about feline diabetes. They know more about dog diabetes which is quite different to feline diabetes.

please ask lots of questions here as we are very happy to help.
The most important things post DKA for you is to make sure
  • You feed as much as possible as food asks like a medicine with DKA. Up to 1 and 1/2 as many calories as normal a day.
  • Don’t skip the insulin as insulin is also very important in stopping the ketones reforming. If you are unsure, post and ask for help and we will try and find a solution.
  • Test every day for ketones. This is the way to tell if you have the food and insulin in the right proportions.
  • Test the BG Preshot and during the cycles to see the dose is correct.
  • Give plenty of fluids
  • If you are unsure of anything post and ask for advice.
I would definitely get several tests in during this cycle as we need to see how she is going on this dose.
Well done!
 
THANK YOU THANK YOU THANK YOU

Thank you especially for the DKA advice. I didn't know there was a recovery period for it -- any idea how long until it would be safe to skip doses? I also didn't even know she had DKA (vet just said she had diabetes), so I figured it out from this forum because the symptoms were unmistakable.

Bron and Sheba (GA) said:
So in the SS You will put +12 146; +12.5 126 fed. +14 382(PMPS). So the 382 is your PMPS. Stack all those numbers on top of one another in the PMPS square. Does that make sense?
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I tried to update the ss as described, may need to stalk someone else's to fully get the format.

I'll do tests overnight and post updates. She ate about another 1/4 can of high carb food with this shot.
 
UPDATE: She's at 553 1 hour and 20 minutes after her shot. Should I take any action other than checking again in an hour?
 
UPDATE 2: She's at 483 2 hours and 20 minutes after her shot. Maybe she's not bouncing? I did switch her back to her regular food but she only ate a couple of bites bc she doesn't like it.

Maybe I can give the testing a little break now? I want to test again for the nadir which is usually +4 or 5 but I have no idea where to look for it now because she somehow blew right past it in this AM cycle. She was 349 at +4 and 146 at +11.5 -- how do I even interpret that?? :confused:
 
putus_human said:
UPDATE 2: She's at 483 2 hours and 20 minutes after her shot. Maybe she's not bouncing? I did switch her back to her regular food but she only ate a couple of bites bc she doesn't like it.

Maybe I can give the testing a little break now? I want to test again for the nadir which is usually +4 or 5 but I have no idea where to look for it now because she somehow blew right past it in this AM cycle. She was 349 at +4 and 146 at +11.5 -- how do I even interpret that?? :confused:
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Yes give it a break until closer to nadir.
It was possibly because the dose was too much that she didn’t drop lower until later in the cycle.
 
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