Pmps 75!!! Advice please

Greetings. I've posted before but I don't post much. I would much appreciate it if someone could look at Dusty's spreadsheet and let me know what you think.

He just tested at 75 for Pmps (repeat at 80, 127 on alpha trak . Typically he's on in the 200s. Because of testing I performed over the holiday I backed him down to a skinny 4 unit shot (closer to 4 than 3.5) versus the usual 4 units he was receiving. Also to note - I switched to the relion micro from alpha trak meter on the first of the year. I'm shocked he is still so low this evening. What should I do in the morning?

Thank you in advance!!!

Here is his spreadsheet: https://docs.google.com/spreadsheet...dEqg5tYsP-UbMAdXUCZDmvg/edit?usp=docslist_api

 

The question is, how low is this dose taking him? For now, all we know is that it's at least 75, since we can see that tonight.

I'd encourage you to either use the Start Low Go Slow dosing method, or get a midcycle test at least once a day.

Following SLGS means that you reduce by 0.25u when you get a test under 90 on your Relion, and that you do a curve (every 2 hours for 12 hours or every 3 hours for 18 hours) once a week.

Following Tight Reg means getting a minimum of 3-5 tests per day, including both preshots and at least one mid-cycle. With it, you reduce the dose at 50.
On 1/3, I'm looking at the 51 and the 62 followed by a skinnying of the dose. At this point it's not safe to try to run Dusty in that low of a range unless you're going to get more testing in.

I'm not criticizing, just giving you some ideas for how to treat him a little more safely.

For morning he will no doubt be high from the skipped shot tonight. I can't really suggest anything on the dose until I saw some tests inbetween the shots. If you can get a few days of that it would be super helpful! The one thing I could suggest is to decrease the dose by 0.25u in the morning since he dropped below 90 (per the SLGS guidelines).

 

I have to agree with Julie. It's very hard to interpret Dusty's numbers without the benefit of more spot checks. Tonight's PMPS is a case in point -- you can't tell if your pre-shot test was Dusty's low point for the day or if he went even lower during the AM cycle. Is there any way that you can start to get some additional tests at points during both the AM and PM cycles. A "before bed" test every night is a great place to start.

 

Thank you. I will reduce to 3.75 and work for home tomorrow to get a cycle again. I will also start getting a pre bedtime test. Thank you again!

 

You're welcome! Just ask anytime you have questions - lots of experienced people here that can help you. There are no dumb questions!

 

Just an update, for those who may be interested. He tested at 277 for AMPS (not surprising... actually still quite low, considering the missed shot). I administered 3.75 units of Lantus and tested again at +5.5 (I missed my earlier time points I had hoped for). He was at 44. He had been behaving just fine all morning - no signs of hypo. I will retest at +6 to see if this is his nadir or if he's actually rising. Either way, it seems that he would qualify for another reduction, to 3.5 units - based on the 44?



Thank you again for all your sage advice.

 

Have you fed him some high carb to bring him up 44 is very low, I would encourage you to feed and test every 20min till he comes up these are the guidelines for dealing with low numbers,
taken from the sticky Shooting and Handling low numbers,
If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)

• Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
• Test again in 15 – 20 min. Depending on the numbers, give more HC food.
• Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
• Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
• Test in an hour and follow the same steps.

If he drops below 40 I would put the 911 prefix on your title, to get some eyes on you asap, you can select it by going to edit thread on the right of the screen. I'm on my way out so won't be around, 44 is very low.

 

I'm just seconding the call for more testing.

I think he probably wants a decrease and is likely rebounding after low numbers but there is no way to know without more frequent testing. Everyday you should aim to get +3/+4 and +7/+8 or around there atleast. This will show how fast he drops and what his lowest points are. If work/sleep interfers then you may need to adjust the time you give him his insulin to try to be around for the important times.

 

Hey Luke I just checked SS seems he is up at 60 @ +6

 

Thank you all. I was about to update +6 at 60, +7.5 at 64. I will reduce his next dose to 3.5, test more and continue to monitor.

 

He did eat between the 44 result at +5.5 and the 60 result at +6, so I'm sure that helped to raise his BG. I was nervous as well at the 44, and thankful that I am working from home today to monitor him. He seems to be reacting to the Lantus with very low BGs all of a sudden - and hasn't been eating quite as much (but still plenty for his size 2-3 cans of fancy feast versus 4+ a day).

 

Congrats of the reducie!

 

It's very hard to say what has been happening with his BG due to the lack of midcycle testing. He may well have been having low numbers for over a week, it's just that we don't know.

Well done, getting those midcycle tests today, he has earned a reduction, we usually take reductions in full 0.25, I see you shot 3.75 this morning so that would take him down to 3.50. Is that right @julie & punkin (ga) @Sienne and Gabby (GA) ?

I would encourage re read Julie's and Sienne's posts above and follow the links and advice they have given you, they know their stuff, I honestly think it will be the best way to keep Dusty safe and get him better regulated.

Good job on catching that drop.

 

Dusty's BG is 148 at Pmps. What should I do? I'm not comfortable shooting anything more than 1/2 a dose (1.5 -2 units). I could also skip, but we skipped the evening shot the past 2 nights (once was a definite fur shot, yesterday was due to a 77 at Pmps). I'm holding off for now.

Thanks in advance.

 

normally people would suggest you wait 30 mins and retest but are you looking to take the night off after todays stress?

 

Shannon, if you can hold off feeding and retest in 20-30 minutes from the last test and IF Dusty's number is 200 or over, go ahead and feed and shoot. If not skip as a new diabetic you don't want to shoot 200 or below.

 

The most important question is whether or not you can monitor him tonight? Do you have plenty of strips and high carb food?

I like the idea of holding off on feeding (if you haven't already fed) and retesting in 20-30 minutes and seeing if he's high enough to shoot.

As far as the dose goes, we don't really know what a good dose is, but we know he needs less than he's been getting. So let's see where he is in a bit and go from there.

GREAT job getting the tests today! You can now see why they are so important!

 

Pmps +1 with no insulin and he's at 158. I'm happy... Just confused!

 

Shannon, was that with or without food?

 

That's not entirely accurate. If you are following Tight Regulation, for those who are new to managing their cat's diabetes, with Lantus or Lev, your "no shoot" number is 150. If you're following SLGS, then 200 is the no shoot number.

Ideally, regardless of which approach is being used to guide dosing decisions, you want to be able to shoot progressively lower numbers. It can take a little while to get comfortable with shooting low.

 

There was wet food out, so it's possible he ate. I don't think he went downstairs, but I took a shower so I can't be sure. I have an automatic wet food feeder (3-4 cans of FF over 5 feedings a day).

Now that it is 9 pm (close to +2) I'm leaning towards giving him until the morning. I need to get some sleep and unfortunately I have to go to work tomorrow - there are lay offs happening in my group tomorrow at DuPont :-(. I guess the bright side of possibly getting a pink slip is that I would be home more to monitor my sugar kitty and possibly get him into remission.

I would like to tightly regulate but my work schedule makes it hard to get enough readings. A pre bedtime reading is feasible, but if he's going to play games like this I won't know what to do!!

 

Wishing you good luck tomorrow - I hope you're not on the Pink Slip List!

Don't rule out following Tight Reg just because you're working. Many people do it - there are lots of tips on how folks make it happen. One very nice feature about Lantus is that when you shoot a lower number, like that 158 tonight, the cat usually won't drop as dramatically as it does when you shoot a 500 and the cat drops 400 points. It's just an entirely different game. Cats that are tightly regulated might stay at 60 -70 for the entire day. When you're at the point where you're interested in seeing examples of how that works, I'll be happy to give you an explanation and spreadsheets so you can see it in action.

 

Thanks!!! I would click "love" on this post if there was an option. You've given me hope. I am very interested - I want what's best for him and would love to see him go into remission. This odd behavior he's exhibiting is also giving me hope that he could get there!

I read the sticky but haven't seen any of the spreadsheets. Anything to share this evening in the event I have a sleepless night?

 

hehe a little light reading - sure! Take a peek at this post, and make sure and look at the spreadsheets. Then ask if you've got questions.

 

Ok - I just checked him, and he's -at 216. Knowing that should be going to bed soon, and if he has a amps it will be at 7AM (it's 10PM here), what do you recommend?

 

It's really hard to say. the 4u is too much. Even with a skipped shot last night, the 3.75u got him under 50 - but remember with this also that the depot from the 4u would've still been influencing his BGs today. A depot from a larger dose can last up to 6 cycles after you've reduced the dose.

Since you skipped tonight's shot he's likely to be high in the morning. You could try 3.5u and see how he does. You'll definitely want to get a test when you walk in the door from work tomorrow, and a test before you go to bed tomorrow night.

I can't recommend a dose with any confidence at this point. But I would definitely give less than 4u.

 

Ok, thank you.

 

Julie's post contains lots of great information as well as links to spreadsheets for several of the kitties who've gone into remission ...YEAH!! for them!!

China's spreadsheet is a pretty good example of a "tightly regulated" cat who's still on insulin...You'll see I've shot lots of low numbers, but I've also got data on China for almost 3 years and know her very well

Since it's already +3 for you, since you haven't shot tonight, it's probably best to just skip it. If you shot tonight, you'd be off by 3 hours in the morning and couldn't shoot until almost 10am. If you get off schedule, you have to work your way back to your chosen schedule 15 minutes per cycle

I agree with Julie on the dose question too... I think I'd go with 3.5U tomorrow....you can always go up if you have to!!

Better too high for a day than too low for a moment!!