Twix_Low AMPS Reading

Samantha Styles

Samantha Styles

Member Since 2024
Hi All!

Twix and I are new to this journey and are only just starting to get the hang of things. I did grab a reading from him this morning before his shot; however, it's the lowest reading I've had for a pre-shot. (The last time this happened, I had his "lowest reading" at 235, and he dropped to 66), so I have some hesitancy and want to check in regarding his morning insulin shot with his AMPS being at 188. I did feed him breakfast and I could test again in a few hours. But my normal day-to-day schedule wouldn't allow for a huge change to insulin dosing times.

Would a token dose make the most sense here?

Twix’s Background:
  • Age: 15 years old
  • Medical History:
    • Diagnosed with hyperthyroidism two years ago; was on oral meds for one year, then received I-131 treatment about a year ago.
    • Post-I-131 radiation treatment:
      • Approx. 6 months post-treatment, we started giving him hypothyroid meds 3 times a week, but this resulted in a very greasy and matted coat (we had to shave his coat). We decided to discontinue use. Clinically, he seemed better off the meds. However, in hindsight, we realize this probably wasn’t the best option.
      • After some time, he started to look sick again and further testing and noticed high blood sugar levels, his radiation doctor had us resume his hypothyroid meds for about 1 month prior to starting insulin (started July 19).
      • He is now on daily hypothyroid meds (Levothyroxine) and started ProZinc insulin injections (twice daily) on August 21.
    • Insulin Progression:
      • He was non-responsive to insulin for the first month and by August 30, was up to 3 units with no response on charge (always 350+). He had many signs of hyperglycemia (neuropathy started, he was drinking very large quantities, peeing every 1-3 hours, unable to hold urine, peeing outside of litter box and litter box room, etc.)
      • Around this time, I began focusing more on changing his diet rather than upping his insulin again as suggested. I started by switching his soft food to Fancy Feast Naturals Pate 2x per day, while still free-feeding kibble. We noticed a response in his chart for about 4 days, then he went back to continuously high levels.
      • I then removed ALL dry kibble and increased his soft food to 3x per day. Within 1.5 days of the diet change, we had to skip an insulin injection and reduced him to 2 units.
      • He was on 2 units for about 2 weeks, then had a dip below 90 this week, and we reduced him to 1.75 units per the help of people on this board and via the SLGS method.
  • Current Condition:
    • He is currently experiencing diabetic neuropathy. I just ordered Zorbalin today (10/15), and it should arrive later this week.
    • Clinically he seems to have improved, minus his neuropathy
  • Monitoring:
    • Twix wears a Libre3 sensor for 24/7 glucose monitoring. I also use the ReliOn sensor between Libre sensors and alongside it.
  • Diet:
    • He is now on Fancy Feast Naturals Pate, 3x per day.
 
Hi Sam! Sorry that you and Twix are going through this…

You’re in good hands here and pretty soon, some experienced people will take over.

I just want to chime in regarding the hypothyroidism post the radioiodine treatment: the vet had him on levothyroxine 3 times a week?
That is absolutely not the treatment that is indicated in this case! I certainly do hope that the dose you’re giving him now is divided in two, half mornings and half evenings.

Cats metabolise this hormone much faster than humans and dogs, and it has to be given every 12hours.

How is his hypothyroidism monitored, any additional tests besides the tT4?

Hypothyroidism is a serious condition and it can be easily corrected, but the vets aren’t always up to date with the current recommendation.

If it isn’t well treated, it heavily impacts the kidneys and causes chronic kidney disease.

In case you’re not already a member of it, there’s an amazing forum similar to this one specifically dedicated to feline hyper- and hypothyroidism: https://groups.io/g/FelineThyroidManagement

Don’t mean to sound alarmist but having a cat in the same condition I was super surprised with this 3 times a week!
 
Hi Daphne –

Twix was slightly hypo post-radiation treatment, so they started him on meds as a small assistance, as they were still anticipating this to equalize out on its own. However, when we started the meds his coat and everything started to get really bad, and I stopped giving him the meds. Which likely didn't help the scenario (the specialist mentioned these were likely still signs of his hypo and he probably needed to up his dose and not have me discontinue it. Although his coat did improve once I stopped, so it made us think I made the right decision). I can’t recall the timeline anymore, but I believe it was a few months after that, I started to notice he was sick and not in the best shape. I brought him back in and urinalysis showed sugar in his urine, that he had E. coli, and he was still hypo. At this time his specialist told me to get him back on the hypo meds and to give him a dose daily. He was on antibiotics for E coli, and she wanted to address his hypo before diabetes in the event fixing his thyroid helped everything else (as she has seen this in previous cases). In addition, she knew not having his thyroid under control would influence his insulin response. We then retested for diabetes shortly after restarting his hypo meds and once we confirmed it was diabetes and not a stress event, we got him started on insulin right away. His most recent tests showed his thyroid in good levels with daily meds. My vet confers with our radiation specialist for all treatment plans with Twix and they have both been assisting with his progress. I am pretty sure we did the T4 most recently, however, we did have kidney values that were assessed as well. So, I will have to double check that.

He is getting 0.25 ML per day. I will confer with the vet and ask him to check in with the specialist to see if they recommend splitting the dose to 2x per day.

I am still crossing my fingers that once we get everything fixed for him and his body has time to heal his diabetes will go into remission and his thyroid will even out. I may be overly optimistic, but my ultimate goal is to get him back healthy and off of all medications. Which was the whole point of doing the I-131 treatment, but instead we’ve just been having issues following it.

I am not familiar with the thyroid forum. I am for sure going to check it out. Thank you for sharing.
 
Last edited:
Hi there. I am trying to study the spreadsheet. If Twix is wearing a Libre sensor, don’t you get a reading every hour that could be added to the spreadsheet’s? I am used to seeing that with cats wearing a Libre. I’m really happy that you know how to test and are using the ReliOn as a backup since the Libre sensors are known for giving artificially low readings in the lower range (under 100). I would carefully monitor Twix even on this new 1.75 unit dose. I would really like to see the Libre readings from last night and what led up to this morning’s lower preshot value.
 
Suzanne & Darcy said:
Hi there. I am trying to study the spreadsheet. If Twix is wearing a Libre sensor, don’t you get a reading every hour that could be added to the spreadsheet’s? I am used to seeing that with cats wearing a Libre. I’m really happy that you know how to test and are using the ReliOn as a backup since the Libre sensors are known for giving artificially low readings in the lower range (under 100). I would carefully monitor Twix even on this new 1.75 unit dose. I would really like to see the Libre readings from last night and what led up to this morning’s lower preshot value.
Click to expand...

Yes, I can! And I can work on getting each hour added into the days I have charts from the Libre. The only downside is I won't be able to for last night or today. I don't currently have a Libre on him, as the one I had on him ended. So 10/15 AMPS was my last Libre reading, the rest have been from ReliOn. I did just return home to get his PMPS reading and to administer his PM dose, and I have a new Libre which I will be able to place on him shortly. Of course this would happen the one time I don't have a Libre on him and the curve would be extra handy ;-) (sigh....)

When I take a direct reading from the Libre, I label it as a hard number. When I pull it from the graph, I indicate it as an -ish, as it's not a direct Libre reading and my interpretation could be off slightly.

I have not administered his PM shot yet, as his 185 is lower than anything I've shot him with previously (same trend as I experienced this morning). But I did just feed him dinner, and I will take his levels again at 7pm and see if they are high enough to adminster a dose. As I did this morning.
 
295 @ 1950, administered dose.

Tomorrow I will not have the flexibility to delay the dose, so I would be curious thoughts on best course of action if in 180s again for AMPS. Maybe this number isn’t a concern and I should shoot as normal, it just feels low to me because it’s not a number I’m used to seeing.
 
Samantha Styles said:
Hi Daphne –

Twix was slightly hypo post-radiation treatment, so they started him on meds as a small assistance, as they were still anticipating this to equalize out on its own. However, when we started the meds his coat and everything started to get really bad, and I stopped giving him the meds. Which likely didn't help the scenario (the specialist mentioned these were likely still signs of his hypo and he probably needed to up his dose and not have me discontinue it. Although his coat did improve once I stopped, so it made us think I made the right decision). I can’t recall the timeline anymore, but I believe it was a few months after that, I started to notice he was sick and not in the best shape. I brought him back in and urinalysis showed sugar in his urine, that he had E. coli, and he was still hypo. At this time his specialist told me to get him back on the hypo meds and to give him a dose daily. He was on antibiotics for E coli, and she wanted to address his hypo before diabetes in the event fixing his thyroid helped everything else (as she has seen this in previous cases). In addition, she knew not having his thyroid under control would influence his insulin response. We then retested for diabetes shortly after restarting his hypo meds and once we confirmed it was diabetes and not a stress event, we got him started on insulin right away. His most recent tests showed his thyroid in good levels with daily meds. My vet confers with our radiation specialist for all treatment plans with Twix and they have both been assisting with his progress. I am pretty sure we did the T4 most recently, however, we did have kidney values that were assessed as well. So, I will have to double check that.

He is getting 0.25 ML per day. I will confer with the vet and ask him to check in with the specialist to see if they recommend splitting the dose to 2x per day.

I am still crossing my fingers that once we get everything fixed for him and his body has time to heal his diabetes will go into remission and his thyroid will even out. I may be overly optimistic, but my ultimate goal is to get him back healthy and off of all medications. Which was the whole point of doing the I-131 treatment, but instead we’ve just been having issues following it.

I am not familiar with the thyroid forum. I am for sure going to check it out. Thank you for sharing.
Click to expand...
Sorry for insisting, but…

The golden standard tests to monitor thyroid function after the treatment is tT4, TSH, and creatinine. The TSH test isn't well known at all, although a scurry of studies state that it has to be included. For many years there was no feline TSH - in fact, in Europe it still isn't available as far as I know. It's been now a couple of years that a feline TSH has been developed.
These three together show if the thyroid gland is functioning, but can't transform the T4 into T3, and the pituitary gland sees no circulating T3 and speeds up the production of TSH - Thyroid Stimulating Hormone - to tell the thyroid to keep producing it. This is subclinical hypothyroidism, and it shows with T4 within range and high TSH. If T4 is lower than the normal range and TSH is high then it's overt hypothyroidism. And the crea test shows the impact of it all on the renal function. In cats with compromised thyroid function (be it hypo or hyper), the SDMA test isn't specific at all and can't be used to monitor renal function.

Your vet is totally right, T4 is indeed reduced when other illnesses are present. Your endocrinologist might however not be quite up to date with the current research regarding hyperT and the subsequent hyPOT in cats. There are a lot of endocrinologists working to figure out which cat can be predicted to become hypoT after the treatment, and some research suggests that as much as 50% of all treated cats become hypoT.

This doesn't mean that it's a loss - you paid for a treatment that led to a new problem.
It is well known that long-term methimazole treatment - or, if you prefer, the medical control or hyperthyroidism - does not prevent the thyroid tumor from growing. In fact, a long-term study that followed close to 1000 cats showed that after 4 to 5 years, with the dose of methimazole having to be constantly upped and adjusted to the tumor growth, the % of this tumor becoming carcinogenic increases from 0.4 to 20%.
Secondly, methimazole is very toxic to the liver. Some cats can't have it at all. The T4 replacement therapy post radioiodine treatment is not toxic, it is a synthesized hormone that has absolutely no side effects, and there is no danger of your cat developing cancer any longer.

I'm attaching some links for the importance of assessing hypothyroidism and the use of TSH :
the 2023 AAHA guidelines on endocrinopathies - check from page 13 to page 15 and from 17 to 19: https://www.aaha.org/wp-content/upl...ocrinopathies-of-dogs-and-cats-guidelines.pdf
The 2016 AAFP Guidelines for the management of Feline Hyperthyroidism - from page 405 and the "myths" page 411: https://journals.sagepub.com/doi/epub/10.1177/1098612X16643252
Broome's paper on avoiding further renal injury: https://web.archive.org/web/2017031...ngFurtherRenalInjuryMichaelBroomeDVMDABVP.pdf
Two papers by Marc Peterson, the worldwide feline endocrinologist: https://www.researchgate.net/public...ng_for_feline_thyroid_disease_hyperthyroidism, https://www.researchgate.net/public...oidism_after_successful_radioiodine_treatment
A study from 2019 about the prevalence of hypoT after treatment: https://journals.sagepub.com/doi/10.1177/1098612X18822396
And a 2022 study reviewing all research done so far on the topic of Feline Hyperthyroidism, check from page 421 to 423: https://onlinelibrary.wiley.com/doi/10.1111/avj.13179

I'm searching for the paper talking about the dose protocol of levothyroxine, can't find it currently, made a request, however here you can read that "For cats that require thyroid hormone supplementation, Peterson recommends a starting dose of levothyroxine 0.075 mg orally twice a day. This is higher than what is commonly used in dogs because cats metabolize the hormone much more quickly and don't absorb it as well as dogs. Administration on an empty stomach is recommended." (https://www.dvm360.com/view/hypothyroidism-cats-how-it-diagnosed-and-treated)

With all that, I mean that Twix's thyroid function can be managed, but it's highly recommended to check TSH along with tT4 and crea. And the levothyroxine has to be given twice daily. Once the dose has been determined, you have to stick to it for 3 to 4 weeks before reassessing - checking with tT4, TSH and crea again.

Sorry for the super long post! I know it's a diabetes forum, but I'd hate to see Twix develop renal failure due to a thyroid mismanagement!
 
Daphne and Aida said:
Sorry for insisting, but…

The golden standard tests to monitor thyroid function after the treatment is tT4, TSH, and creatinine. The TSH test isn't well known at all, although a scurry of studies state that it has to be included. For many years there was no feline TSH - in fact, in Europe it still isn't available as far as I know. It's been now a couple of years that a feline TSH has been developed.
These three together show if the thyroid gland is functioning, but can't transform the T4 into T3, and the pituitary gland sees no circulating T3 and speeds up the production of TSH - Thyroid Stimulating Hormone - to tell the thyroid to keep producing it. This is subclinical hypothyroidism, and it shows with T4 within range and high TSH. If T4 is lower than the normal range and TSH is high then it's overt hypothyroidism. And the crea test shows the impact of it all on the renal function. In cats with compromised thyroid function (be it hypo or hyper), the SDMA test isn't specific at all and can't be used to monitor renal function.

Your vet is totally right, T4 is indeed reduced when other illnesses are present. Your endocrinologist might however not be quite up to date with the current research regarding hyperT and the subsequent hyPOT in cats. There are a lot of endocrinologists working to figure out which cat can be predicted to become hypoT after the treatment, and some research suggests that as much as 50% of all treated cats become hypoT.

This doesn't mean that it's a loss - you paid for a treatment that led to a new problem.
It is well known that long-term methimazole treatment - or, if you prefer, the medical control or hyperthyroidism - does not prevent the thyroid tumor from growing. In fact, a long-term study that followed close to 1000 cats showed that after 4 to 5 years, with the dose of methimazole having to be constantly upped and adjusted to the tumor growth, the % of this tumor becoming carcinogenic increases from 0.4 to 20%.
Secondly, methimazole is very toxic to the liver. Some cats can't have it at all. The T4 replacement therapy post radioiodine treatment is not toxic, it is a synthesized hormone that has absolutely no side effects, and there is no danger of your cat developing cancer any longer.

I'm attaching some links for the importance of assessing hypothyroidism and the use of TSH :
the 2023 AAHA guidelines on endocrinopathies - check from page 13 to page 15 and from 17 to 19: https://www.aaha.org/wp-content/upl...ocrinopathies-of-dogs-and-cats-guidelines.pdf
The 2016 AAFP Guidelines for the management of Feline Hyperthyroidism - from page 405 and the "myths" page 411: https://journals.sagepub.com/doi/epub/10.1177/1098612X16643252
Broome's paper on avoiding further renal injury: https://web.archive.org/web/2017031...ngFurtherRenalInjuryMichaelBroomeDVMDABVP.pdf
Two papers by Marc Peterson, the worldwide feline endocrinologist: https://www.researchgate.net/public...ng_for_feline_thyroid_disease_hyperthyroidism, https://www.researchgate.net/public...oidism_after_successful_radioiodine_treatment
A study from 2019 about the prevalence of hypoT after treatment: https://journals.sagepub.com/doi/10.1177/1098612X18822396
And a 2022 study reviewing all research done so far on the topic of Feline Hyperthyroidism, check from page 421 to 423: https://onlinelibrary.wiley.com/doi/10.1111/avj.13179

I'm searching for the paper talking about the dose protocol of levothyroxine, can't find it currently, made a request, however here you can read that "For cats that require thyroid hormone supplementation, Peterson recommends a starting dose of levothyroxine 0.075 mg orally twice a day. This is higher than what is commonly used in dogs because cats metabolize the hormone much more quickly and don't absorb it as well as dogs. Administration on an empty stomach is recommended." (https://www.dvm360.com/view/hypothyroidism-cats-how-it-diagnosed-and-treated)

With all that, I mean that Twix's thyroid function can be managed, but it's highly recommended to check TSH along with tT4 and crea. And the levothyroxine has to be given twice daily. Once the dose has been determined, you have to stick to it for 3 to 4 weeks before reassessing - checking with tT4, TSH and crea again.

Sorry for the super long post! I know it's a diabetes forum, but I'd hate to see Twix develop renal failure due to a thyroid mismanagement!
Click to expand...

I did start looking into his paperwork and my test results for him have his creatinine levels - they did a hyperthyroid panel w/GGT SA805X (whatever that means). He had his latest one on July 11, and has had a T4 test since then on 09/04. I maybe opted out of the full panel due to monetary reasons? But I cannot recall now why we did this and not full panel in September. There was a lot going on at that time.

I don’t see TSH levels listed however, would they be listed as TSH or something else? Either way I’ll poke my head into the other discussion forum at some point today. Thanks.
 
Oh yes do join the other forum for this!
TSH is either listed as cTSH (c for canine) or fTSH.
No idea what these w/GGT SA805X mean, which lab were the tests done? (IDEXX or another one?)

sorry edit to add:
a full thyroid pannel is actually only done by Hemopet and Antech, and they include fT4, tT4, fT3, tT3 and TSH. The other forum recommends doing it when the T4 and TSH don't seem to be regulated with levothyroxine supplementation, and a problem with the T3 is suspected. Few cats do need to be supplemented in both T4 and T3.
 
I look forward to seeing how today’s cycle went when you get a chance to input Libre readings (even if they are the ish ones :)

When you encounter a lower than previously recorded preshot number, you can, if you have the time, stall in 30 minute increments but DO NOT FEED because if you do, we can’t rely on the subsequent tests because they could be food influenced (elevated) and we can’t know what the BG would have been without food, so it doesn’t provide us with useful information about whether it’s safe to give the full dose or a reduced dose or skip.
 
Continued from previous post….

Right now, we don’t have data to know whether shooting 1.75 units with a blue preshot is safe. We need to work our way down to that. A lot depends on whether you will be around to monitor the cycle and intervene with carbs if necessary. If not, for now I would recommend shooting a reduced dose of perhaps half-ish (so maybe 1 unit or even .75 units depending upon how low of a blue the number is.) Then hopefully you are either home to test or can gather Libre data later. What is his feeding schedule? When are snacks dispensed? Do you have an automatic feeder to give low carb wet food small snacks when you’re not at home? I recommend giving snacks at +2 and +4 as a starting point, to help smooth the cycle and prevent steep drops. For many cats, ProZinc onsets (starts to lower BG) at about +2, so that’s a great time for a low carb wet snack of a couple teaspoons.

What is your work schedule like?
 
Oh shoot, I was feeding him and then giving him a dose. Man, even when I read up on stuff, I still miss important things. I am at least feeling a little less overwhelmed the more I continue to learn. I'll be an expert by the time he goes into remission ;-) (fingers crossed).

I didn't do anything special this morning and he was in yellow when I gave him his shot. I did delay the shot to 0700 only because the evening before he received his shot at 2000, and I am trying to get us back slowly to our 0600 & 1800 time slots. He did get below 100 again today when shooting him in the yellow. I updated his spreadsheet accordingly.

I sent the charts to my vet, and he was not worried about his small dips below 100 if clinically he is doing well. He did say he does not want him below 100 for an extended time and wants me to focus more big picture than on trying to micromanage every number. He wants me to keep on this dose and monitor it over the weekend. He would like me to think about keeping AM and PM food the same (I currently feed him lunch but nothing in PM) so he does want me to add meals. As many small meals as I can while ensuring I create a schedule I can maintain. He's happy with the progress. (THANK YOU EVERYONE FOR YOUR HELP!)

My work schedule varies day-to-day and is weather-based. But I work 4-6 days a week, always weekends, and 6-10 hours each day, depending on operations. In the summer an insulin schedule will be hard for us to maintain because we usually work 12+ hour days. I am hopeful we can get him into remission before this becomes a factor.

I feel comfortable giving him the current dose when he's in the yellow. I have a lot of hesitancy when he's in the blue. I think I would feel comfortable giving him 1 unit as you suggested when he's in the blue. I would rather his levels be slightly elevated while I am at work, versus him dropping too low and not being here to help. If I run into this predicament in the upcoming days I will do this.

I am planning to add PM snacks and an additional AM snack as you suggested.
 
Last edited:
When your shot is delayed, you should adjust back to your original shot time by 30 minutes per day so that the shots are no closer together than 11.5 hours. If the numbers are very high consistently, you can perhaps move it up a bit more quickly, but if not, it’s best to move the shot time no more than 30 minutes per day.
 
Suzanne & Darcy said:
When your shot is delayed, you should adjust back to your original shot time by 30 minutes per day so that the shots are no closer together than 11.5 hours. If the numbers are very high consistently, you can perhaps move it up a bit more quickly, but if not, it’s best to move the shot time no more than 30 minutes per day.
Click to expand...

His AMPS level is 151. I am skipping his morning dose as I don’t have the flexibility to adjust the shot times these next few days. I feel like I need to probably get comfortable with giving him a token dose, but I’m not certain I’m comfortable determining that value.

Last time I had to skip a shot I reduced his dose in half. But I’m not sure if that big of a decrease is warranted here.
 
Vet agreed with skipping morning shot, and suggested reducing to 1 unit moving forward. He thinks he may be going into remission, but noted levels can fluctuate a lot during this time and to keep monitoring. He did mention this could be difficult with his thyroid issues, there is a thyroid discussion group I can join and I did ask my vet if there are other ways I can support his thyroid to hopefully get him off those meds as well.
 
Samantha Styles said:
His AMPS level is 151. I am skipping his morning dose as I don’t have the flexibility to adjust the shot times these next few days. I feel like I need to probably get comfortable with giving him a token dose, but I’m not certain I’m comfortable determining that value.

Last time I had to skip a shot I reduced his dose in half. But I’m not sure if that big of a decrease is warranted here.
Click to expand...
Usually it’s better to shoot some insulin rather than none. But let’s see how it goes.
 
He was supposed to get a reduction (new dose going forward) to 1.5 units. I think my messages from last night never went through because the Board crashed. Let’s see what happens today with the skipped dose.
 
Suzanne & Darcy said:
Usually it’s better to shoot some insulin rather than none. But let’s see how it goes.
Click to expand...

Ok, good to know. I would have preferred to give him something, but I was not very confident with how to decide that dose. I

I did end up home today so I can monitor him, but now we’re 2 1/2 hours past his normal time which wouldn’t be sustainable for me to maintain this new time frame over the weekend.

He’s at 171 for his most current reading.
 
Okay so one thing I was going to mention last night (prompted by your vet’s comments) is that normal BG for a cat is between 50 and 120 (human meter). In order for a cat to be in remission, the BG needs to stay between those numbers with zero insulin being given. If the numbers are higher than that, the cat is not in remission. So hopefully we can get your sweet baby spending more time in those “healing greens” that allow the pancreatic beta cells to recover and we can get him into remission. We can certainly try and certainly hope.
 
Last edited:
Samantha Styles said:
Ok, good to know. I would have preferred to give him something, but I was not very confident with how to decide that dose. I

I did end up home today so I can monitor him, but now we’re 2 1/2 hours past his normal time which wouldn’t be sustainable for me to maintain this new time frame over the weekend.

He’s at 171 for his most current reading.
Click to expand...
A strategy for when they are lower than expected at preshot time is to wait for 30 minutes and do not feed the cat. Retest in 30 to see if the numbers are stable or rising. Often they are rising as the previous shot is wearing off. Also, remember that it will be another two hours before the new insulin shot starts to lower BG (onset) so the BG will generally rise during that time also and also food may help to raise the BG (or at least keep it from dropping and will stabilize things.)
 
So this morning, I probably would have recommended shooting .75 units which would be half of his new dose. This is because we have never had a blue preshot before and we would need to gather data to see if that was too little or too much insulin for an AMPS of 151. The decision would also be made based on whether you were around to monitor and, if you stalled and his BG was going up without food then I probably would have recommended a higher dose or the full 1.5 units.
 
Suzanne & Darcy said:
So this morning, I probably would have recommended shooting .75 units which would be half of his new dose. This is because we have never had a blue preshot before and we would need to gather data to see if that was too little or too much insulin for an AMPS of 151. The decision would also be made based on whether you were around to monitor and, if you stalled and his BG was going up without food then I probably would have recommended a higher dose or the full 1.5 units.
Click to expand...

Okay, I certainly would have preferred to give him dose. I just wasn’t confident with how to determine that. This morning when I made the decision I did not know I’d be home today to monitor, which was another concern of mine (called off unexpectedly because of weather).

He’s about 3 hours post original shot time now and in the 190’s so his levels today will probably get higher than I would have liked. If I dose him now I will not be able to maintain the new time frame over the weekend mornings with my work schedule.

Sounds like you suggest going to 1.5 instead of 1 for his future doses keeping in line with the SLGS method.
 
Suzanne & Darcy said:
So this morning, I probably would have recommended shooting .75 units which would be half of his new dose. This is because we have never had a blue preshot before and we would need to gather data to see if that was too little or too much insulin for an AMPS of 151. The decision would also be made based on whether you were around to monitor and, if you stalled and his BG was going up without food then I probably would have recommended a higher dose or the full 1.5 units.
Click to expand...

I’m assuming since we’re now 3 hrs post shot time and with me not having the ability to fluctuate his timing in the next few days I need to continue with the NS? Or would you suggest I still give him something this morning?
 
I was just trying to explain what you might do on another day when you have a similar situation. I didn’t mean to be confusing and make you think that I thought you should shoot now. :)
 
Suzanne & Darcy said:
I was just trying to explain what you might do on another day when you have a similar situation. I didn’t mean to be confusing and make you think that I thought you should shoot now. :)
Click to expand...

Yes, makes sense! I just feel bad now that I didn’t shoot him this morning so wanted to confirm. But I’m happy I feel more confident with how proceed if I run into this again in future. Thank you.
 
Samantha Styles said:
Sounds like you suggest going to 1.5 instead of 1 for his future doses keeping in line with the SLGS method.
Click to expand...
I would follow the SLGS method (for now) with my own cat. His greens of yesterday were not dangerous numbers at all, and the Libre sensors are notorious for reading excessively low in the low end of the BG range. When you get a mid to lower green, it’s always a good idea to check it with your handheld glucometer to see. So I am wondering what number those greens would have been on a regular meter. Nevertheless, a .25 reduction was earned according to SLGS. If you feel compelled to reduce to 1 unit, I would be okay with that too— because we can always go back up again in dose. I feel like it would be better to let the reductions be earned rather than reducing by too much (potentially) and then needing to hold the dose for a week before increasing. It would be a slower process, but it’s okay. I would not have started out with such a high dose in the first place with a newly diagnosed diabetic cat. Didn’t you start at 4? Then 2?
 
Samantha Styles said:
Yes, makes sense! I just feel bad now that I didn’t shoot him this morning so wanted to confirm. But I’m happy I feel more confident with how proceed if I run into this again in future. Thank you.
Click to expand...
Don’t feel badly. It’s all new and the single most important thing is that we keep Twix safe. That’s what you wanted to do — and you weren’t even supposed to be home (which makes a difference.) :bighug:
 
Okay. I don’t want to lose progress I am going to plan for 1.5 moving forward and go from there and stay on the SLGS method.

I wasn’t home yesterday when he hit his lows to test with handheld. But will definitely do this when I am here. Last time Libre showed lowed 70s and the handheld actually showed lower at 66!

The vet actually had him starting at 1, then he got up to 4 pretty quickly (probably quicker than we needed to) but he was having some bad signs and non responsive. He really wasn’t responsive until I corrected his diet. I think had I fixed that sooner he would have remained on a lower more manageable dose and never gotten that high. I know better now..

I have great access to my vet and he’s a great asset, I do think it helps to have these other resources/advice so that I can make the best decision based on all the advice given. I don’t think the vets study our charts quite like we do or have the time to be as heavily invested. Which of course makes sense, as this has pretty much taken up a lot of my life recently and it’s only 1 animal I’m caring for haha.
 
Samantha Styles said:
Okay. I don’t want to lose progress I am going to plan for 1.5 moving forward and go from there and stay on the SLGS method.

I wasn’t home yesterday when he hit his lows to test with handheld. But will definitely do this when I am here. Last time Libre showed lowed 70s and the handheld actually showed lower at 66!

The vet actually had him starting at 1, then he got up to 4 pretty quickly (probably quicker than we needed to) but he was having some bad signs and non responsive. He really wasn’t responsive until I corrected his diet. I think had I fixed that sooner he would have remained on a lower more manageable dose and never gotten that high. I know better now..

I have great access to my vet and he’s a great asset, I do think it helps to have these other resources/advice so that I can make the best decision based on all the advice given. I don’t think the vets study our charts quite like we do or have the time to be as heavily invested. Which of course makes sense, as this has pretty much taken up a lot of my life recently and it’s only 1 animal I’m caring for haha.
Click to expand...
That’s true. It’s good to have a positive relationship with your vet, but most of them have never done the day to day micromanagement of a diabetic cat. And all we do here day after day is help people with their diabetic cats. :cat: Have a great afternoon and I will peek at Twix’s spreadsheet again later on. What time zone are you in and what is your shot time? I’m on Eastern time. I have a cat to take to the vet this afternoon, but I will be around after that.
 
Suzanne & Darcy said:
That’s true. It’s good to have a positive relationship with your vet, but most of them have never done the day to day micromanagement of a diabetic cat. And all we do here day after day is help people with their diabetic cats. :cat: Have a great afternoon and I will peek at Twix’s spreadsheet again later on. What time zone are you in and what is your shot time? I’m on Eastern time. I have a cat to take to the vet this afternoon, but I will be around after that.
Click to expand...

Thank you! I appreciate that. I am Pacific time, so I believe 3 hrs behind you. Our dosing times are @ 0600 & 1800 PST.
 
Me too! However, there was a time I never thought I’d see him under 350, even with insulin. So I guess I’ll take my small wins.

Knowing we can play it safe with a half dose if he’s lower tomorrow morning helps me feel better prepared for handling this future occurrence.
 
Ok, his first blue pre shot happened tonight! I did give him a token dose, as I am way too worried to give him an full dose without seeing how he’ll react.

And he hit below 90 again today, so I’m also reducing his dose to 1.25 for tomorrow.

I gave him him 0.75 for his token dose because it’s very hard to half his current dose, and based on his current trends this feels like a safe & conservative reduction. I hope I am correct with that. I have to go to dinner event for a couple hours but will be home to monitor him for the majority of the evening.

Here’s to hoping we can keep little man out of the yellow & in blue/green only!
 
Last edited:
You shot a 226 PMPS with 1.75 units and a 221 on 10/17 AMPS, it’s not that much higher than tonight so I may have tried a bit higher dose, but I totally understand your anxiety. You are doing very well!
 
As I think you saw coming, his token dose was not quite enough. Looking at his data now I’m thinking he probably would have been okay with his full dose (or newly adjusted dose of 1.25).

However, one plus is his graph was the most even I’ve ever seen it! Not much of a curve just very consistent levels all night, pretty much all between 200-250. Which feels like a small win. Now I just need to get those same results but at lower levels!

I will be interested to see how he does today with his adjusted dose.
 
A little discouraging (I’ll get his spread updated shortly) but his levels when I got home from work today were in the 380/390s. It’s been a minute since he’s has this high of levels.
 
Do you have any idea what could have caused the spike between +9 and +10? Did he eat? Don’t worry too much. The cycle was really good for a large portion of the day. And one cycle can influence the next to a certain extent, so it’s possible that not getting enough last night caused today’s cycle to be a little wonky. The insulin does seem to take a longer than average to onset with him. I am not sure why, but he is still new to insulin so things can change. How much is he eating in the morning and when does he usually eat?
 
I’m not sure what would have prompted this big jump. I found it strange. I lock away the other cats
food, I don’t know if he found a crumb or something? But I’m usually pretty good about ensuring no crumbs are out when I put away their food. As far as I know he didn’t get into anything.

I just added am & pm snacks per your suggestion a few days ago. So he eats breakfast at 6:00am & 6:00pm (also received his shot at this time), then I feed him snacks at +2 & +4. These are fed to him via his automated feeder so it’s his option to eat it. If I’m home I ensure he eats, but for example, he didn’t eat his +4 snack last night.

Food schedule:
6:00am - one 3 oz can
8:00am - 1/4 can
10:00am - 1/4 can
06:00pm - one 3 oz can
08:00pm - 1/4 can
10:00 pm - 1/4 can
 
This boy is keeping me on my toes. Haha. His AMPS level today is 144. Now when he was at 192 the other day and I gave him 0.75 his levels were in yellow all day & he probably would have been good with full dose. However, 50 points seems like a big difference, but maybe it’s not and I should treat these numbers similarly?

I’m going to delay food & shot 30 minutes for now and see. This likes to happen on the days I won’t be home to monitor him it seems.
 
He was still at 150 30 minutes later. I don’t have ability to delay again. Last time he was at this level I skipped a shot, and you recommended a token dose of 0.75. I don’t want to skip his shot and based on his charts and last reaction to this token dose amount I think this is safe and conservative. I certainly don't feel confident going higher without input.
 
You must log in or register to reply here.
Back
Top