Sudden BG Drop PMPS 219; 84 +1.75; 117 +2

Missy is on day 7 of insulin. I need to put today’s data in spreadsheet. I will do that as soon as I can.

PMPS BG 212
+ 1.75 BG 84

that’s a bit drop fast. She’s never been this low. I gave her one can of Fancy Feast Gravy Lovers. She licked gravy didn’t eat much meat.
Going to retest.

Any help please. First time for time. I’m kinda worried. Thank you

 

That’s a lot of gravy. A teaspoon or two would have been enough. It’s a natural reaction to give a lot. That is a big drop. Test again in 30 minutes.

 

I have now updated her spreadsheet for you to look at.
I wasn't sure how much food to offer so I just gave her all the gravy...

10min after food BG went from 84 to 117. Tested again 10 min later and it was 131.

Now what do I do? How often do I test throughout the night? Now that her BG is raising will it drop again? This came on very suddenly and scared me.
Thank you for your help. Trying to be calm. I am prepared. I have honey, food, lots of test strips. I will stay up all night if I have to. Thank you for help me!

 

First breathe. She will be fine. Test again in 30 minutes . I can’t tell you how long you will need to test yet. I’ll check on you then.

 

I just tested again 30 minutes after last test and her BG is now 138.
Spreadsheet is updated.

Thank you!

 

Give a teaspoon of lc and check in an hour.

 

what is lc?

 

low carb. anything less than 10% carbs

 

what am I trying to do here raise her

I think liquid glucose? I’ve never done this before. Can you tell me the best way to do this? What is best accepted by most cats. I have honey or maple syrup? Rub on gums or dilute and use syringe dropper
Sorry for all the questions. Thanks for your help.

 

Low carb... got it. Fancy Feast Pate??? Would that work?

 

So next time this happens give just a couple teaspoons of m 15%/carb and test in 30 minutes. Reserve hc if she’s close to 50. Have you decided which method you will follow? If SLGS she has earned a reduction and her new dose is .75. If TR she has not earned a reduction.

 

Yes, Her normal food.

 

Just to add to what Else said, seeing greens for the first time is absolutely terrifying! And we have all been there. But 84 is a normal number for a cat. We are aiming for BGs to be in the range of 50-100 on a human meter.

 

Keep asking questions you want to keep her between over 50. If she stays where she is that’s great. The food might wear off in a couple hours or she might continue to go up from the high carb food. If she’s not continuing to drop just feed small amounts of food. Reserve the honey for a drop under 50. Honey works quickly but leaves quickly. Food will keep her surfing in safe numbers.

 

ok I just tested again... so about 20 min from her last test. This time down again to 117. It was 131 only 20 min ago. Do I still just give her regular food or more of the high carb?

Will it stabilize ? I hope this doesn’t go on all night.

 

If she drops below 50, you need to give a little HC food - maybe a spoon or two of gravy. If you find that you don't have HC or MC food, you can add a little honey or karo or maple syrup to her LC food to raise the carb level of the food. You could also apply a little honey/karo/maple syrup to her gums with your finger.

HC is high carb - carb% > 15
MC is medium carb - carb% between 10 and 15
LC is low carb < 10% carbs.

 

food takes 20-30 mins to affect the BG numbers, so you test 20-30 mins after giving food to see how much it has raised numbers.

the other thing you need to keep in mind is that there is a meter variance of around 20% so 117 and 131 is essentially flat.

HC only below 50. so only LC now - FF is fine.

 

Ok thank you. I will give her some of her own food then. I have a hard time determining carbs in food. I have Fancy Feast Pate and Fancy Feast Gravy Lovers. Will that work for high and low carb food choices?

 

Yes. The pate is low carb and gravy is high carb. You need to stock up on some MC. For times when she needs slightly higher carbs than LC but not as much as HC.

This cat food database can help you identify the carb% of various foods:
https://catinfo.org/chart/index.php

 

I will look at the list of foods. I really appreciate you being here to help me. You have helped me before and I am very grateful for you. She is eating now. I will test her again in 30 min. Will you be online anymore tonight? I live in BC, Canada so its 10:15pm PST.

 

Elise is on the West Coast. I am in India and it's noon here, so I will be around for quite a while.

Could you do me a favour and just list out all the tests done in the PM cycle so far? Also edit the thread title to list them. Easier to keep track that way.
Thanks!

 

No problem. I can edit the thread shortly. I just fed Missy and retested her 30 min later. Her BG was 140. So that’s good. It’s coming up. I still have to decide what protocol to use. I think I’m too nervous to do TR. Are you able to explain how I deal with her if I follow SLGS? I think you mentioned if I chose this protocol I should lower her next dose.

 

With SLGS you hold doses for 7 days. The reduction point is 90. SLGS is a less aggressive protocol in terms of regulation. You are aiming to keep the cat in the 90-150 range.
TR is a more aggressive protocol. Aims for tight regulation to begin with and eventual remission. You hold doses for 3 days and the reduction point is 50.

However, I should clarify that TR does not guarantee remission. And cats can and have gone into remission following SLGS.

You could always continue with SLGS for now and once you are comfortable with testing and seeing lower numbers you could switch to TR. There is no rush and the choice is not etched in stone.

With SLGS, Missy has earned a reduction to 0.75U from tomorrow. You hold the dose for 7 days - unless she falls below 90 again, in which case you reduce to 0.50 units

The 140 you got is how many hours after the shot?

 

Hi Bandits Mom

The 140 BG I got was +3.75
Her NADIR isn't usually until +6, however today it was at +7. So I did see some changes in her data today after her AMPS.

These were her numbers after PMPS
PMPS 219; +1.75 BG 84, then I started testing every 10 minutes after feeding Fancy Feast Gravy.
- 10 min BG 117
- 10 min BG 113
- 20 min BG 138
- 20 min BG 117 - gave Fancy Feast Pate
- 30 min BG 140
- 30 min BG 149
- 30 min BG 140
- 45 min BG 151

I am going to edit my thread. I have also decided I am going to go with SLGS because I cannot handle the stress of TR. It's too risky for me and I don't like these potential hypo situations. I will likely get very little sleep tonight. I will plan to decrease her dose .25units so I will only give her .75units when she is do. I will of course test first.
Now I just need to figure out how to reduce dose by such a small amount. The syringe I have does have 1/2 unit markings so that will make it easier.

 

Hi Tammy, nadirs can and do move around. They are usually later in bounce breaking cycles like today.

You also need to keep in mind that there is a meter variance of up to 20% so 201 and 220 are more or less the same. She was pretty much flat today for the second half of the AM cycle

I know lower numbers are scary, but you don't need to test every 10 mins. We usually ask to test every 20 mins when numbers go below 50. Like I said before, food takes 20-30 mins to influence the BG, so testing before then will not give you an idea of how much the food has brought her up. Honey is a little faster at 20 mins - but again, to be used only below 50.

Let us stick to SLGS till you get comfortable. There is no pressure to switch to TR. Once you get used to seeing normal numbers, they become addictive and you will want to be more aggressive with dosing and taking reductions. That takes time and experience. No rush!

Looks like Missy is flat and you can call it a night.

 

When you get more than 1 test in an hour, you stack up the values within the same cell in the SS. I have done it for you today. Take a look and you will get an idea of what I mean.

 

Wow thats great thank you for changing her spreadsheet.

I have a couple of questions:

1. At what BG numbers would I give medium carb food? That food chart you sent me was very helpful.

2. Is there any links you can send me regarding how to fine dose? Seeing I now need to reduce her dose to .75units I need to ensure I am decreasing .25units. It's such a small amount and would be difficult to be super accurate with syringe. I already use a magnifying glass but do you have any other tips? I have read and watched the video in the sticky under this topic already.

Thank you!

 

We use foods with different levels of carbs to "manipulate the curve". Sometimes you use MC when you see steep drop early on in the cycle and you want to feed some extra carbs to prevent a drop below 50 later in the cyle. That is just one example. Some cats are very carb sensitive and may need only MC when they are below 50 to get them up. It depends from cat to cat and where you are in the cycle - early in the cycle when the insulin action is strongest is when you want to use higher carbs. As you approach the nadir and later, you want to use lower carbs to keep the BG surfing in greens.

This is also something that you will figure out as you get more data on how Missy behaves and how carb sensitive she is.
https://www.felinediabetes.com/FDMB/threads/8-10-tashie-pmps-high-questions.101989/#post-1087990


A lot of folks here use calipers for accurate dosing. I just eyeball the 0.25. I use a magnifier. As long as you are consistent, it should be okay.
https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/

 

So much great info you’re giving me. I will check these links out in detail.

so I just tested Missy again. It’s been 1 hour since her last test. She was at +5 BG 151. One hour later +6 BG 218.

Is this normal? Seems like drastic bouncing? If she’s really high by AMPS do I still go ahead with the reduced dose and give her .75units instead of 1 unit?

 

Tammy! Why are you still up? You could have stopped testing and gone to bed when she crossed 130-140 a couple of hours back!

Yes, bouncing is very normal and in the initial days, they bounce to the moon. Bandit would bounce 100 points in an hour. As they get used to lower numbers, bounces are slower and clear faster. Like you, Missy's liver is panicking at the green!

Dosing is based on nadirs. Not based on pre-shots or how high they bounce. Ignore those numbers.
With SLGS, you reduce to 0.75U. Bounces can take up to 6 cycles to clear and she will run higher till then. Just stay the course and wait patiently for the bounce to clear.

NOW GO TO BED!!!!

 

Lol ok I will go to bed now. However I am setting my alarm to get up in a few hours to check on her. That’s if I can sleep.

Having a cat with diabetes is not for the faint of heart. It’s been quite the experience so far. I cannot believe how much I’ve learned in just one week.
I already am starting to feel myself calm down. I knew I would likely experience a situation like this sooner or later. Now I have the experience and I cannot thank you enough for being there and coaching me through it all.

Have a wonderful day!

 

You can test at AMPS. No need to test before that.

You are doing great! Missy is lucky to have you!