? Urgent AMPS 176, retested 191.

I don’t feel comfortable shooting the full dose with those numbers, as I will be gone in 2 hours for the rest of the day. But I’m also worried about skipping those dose entirely. What would you, wonderful and experienced people, recommend?

 

Morning Viktoria! So exciting about Ninja's AMPS! The general rule of thumb when new is to not dose when under 200, but I see your worry considering this is his first foray into blues during preshot time. When you retested, was it right after or did you stall without food? Do you have any medium or high carb food?

 

Good morning! I retested right as he started to eat (my brain didn’t think fast enough to retest before I set the food down). For high carb food I have Fancy Feast chunks in gravy (Pure I think is what it’s called) and I have limited ingredient Natural Balance dry food.
I’m also scared to skip insulin entirely, since we have been able to get him a bit lower.

 

Some basic information from the SLGS sticky:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.

• Below 150 mg/dl (8.3 mmol/L), don't give insulin.

• Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.

If the preshot number is far below usual preshot numbers:

• Do you need to stay on schedule? Then skip the shot.

• Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.

• Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.

My fear with skipping, as I'm sure yours is as well, is that skipping will likely push back the progress you've made. Not forever, but for a few days at least. So you could either dose him as usual and grab a BG before you leave to see how active the cycle will be, or give him a reduced dose of 1u or perhaps 0.75u to ensure he should stay safe. That way you won't completely disrupt the depot as you would with a skipped shot. It does seem that Ninja is not at all used to these blue numbers and he bounces pretty quickly. Obviously you can't say for sure he'll bounce but there's a chance based on his numbers. How far past shot time are you now?

 

Thank you so much for your help! ❤️

I’m 45 mins past now. And yes, I’m very concerned about the progress, but also really scared to shoot and leave him. If this was in the evening, I’d be far less worried - who needs sleep anyway?

 

Haha, I hear that. Sleep? What is this sleep you speak of?! Have you decided to skip or are you going to give a reduced dose today?

 

I’m going to test him in about 5 mins here and then give .5 insulin. That should be safe, right? Do I give him high carb food or leave him with the usual?

 

Agree on giving some insulin as opposed to nothing. Test, shoot the dose according to his test number and if it's "safe" for your comfort then give normal food, if not, give some HC food about 1tsp and can always leave some other food out for grazing

 

I think the 0.5 should be safe based on his numbers.

 

He tested 222, so I gave .75 of insulin and left his usual food out for grazing. I feel like he should be ok without HC food, and I’d rather not give it if I don’t have to.

 

Sounds like a good plan!

 

Yup, good call on the higher dose and no HC........

 

Phew, thank you both!! I stayed home a little late to get a +1 and he was at 274, so I’m really glad I still shot, even if a smaller dose and later.
If his numbers are in his normal 200s-300s range I can go back to the 1.25 at our normal time, right?

 

Absolutely! I definitely would!

 

Now, since it’s time to increase in theory, should I keep holding 1.25 or increase to 1.50 tonight or tomorrow?