? 1/20 Stella AMPS: 291, PMPS: 89, still give regular insulin dose?

So Stella has been fairly regular this past week, has been eating well and acting pretty normal. My question is this: her morning BG (AMPS) was 291, which has been fairly consistent with other readings this week. So I went to work and haven't been able to test her in-between. However, when I just took her evening BG (PMPS) it was 89. Now, that is low for where she's been lately and I still plan to give her insulin but I don't know if I should give her the full dose or not. She's been getting 2 units of Lantus twice a day for the past week. Should I still give her the 2 units of Lantus tonight although her BG has dropped so much from her reading this morning? She's acting normal, she's eating right now in fact. Any advice you can provide would be greatly appreciated.

 

Next time you get a PS that you're unsure about shooting you should stall, don't feed and test again in about 20 minutes...if the number rises without food, then it's usually fine to shoot the scheduled dose since that means the insulin is starting to wear off

Since you've fed already, that clouds the picture since there's no way to know if the next test is a "food spike" or she's actually heading up

Can you switch your shooting schedule by 2 hours in the morning? If you can, I'd wait 2 hours and test again ....you can work your way back to your "chosen" shot schedule 15 minutes per cycle or 30 minutes per day until you're back where you want to be

If you can't adjust the schedule, you could go ahead and give a "token" dose (just to give her a little insulin to help support her over this next cycle) like .5u but if you give any amount of insulin tonight, you'll want to get a +1 and +2 (to start with) just to make sure she stays safe

 

It will really help if you could get some mid-cycle tests on the AM cycle and at least a "before bed" test at night too...Most cats go lower at night, so grabbing that "before bed" test will help keep her safe as well as possibly telling us a lot more about what's going on with her

When you only get PS tests, you don't know how low that dose is taking them, and that's how Lantus dosing is based....on how low it takes them. We've seen cats go from 400's to 40 and back to 400's in one 12 hour cycle....without that mid-cycle test, we might think they needed more insulin, when in fact they need less!!

If there's NO way to get mid-cycle's on the AM cycle due to work, it's even more important to get some tests on the PM cycle....it's the only way to know how she's really doing

 

So...I ended up giving her insulin before I read your first post because I can't deviate my schedule at all. I gave her regular dose of 2 units...sigh. I have to give her insulin at the same time because it's literally the only time that fits in my schedule. I wake up, get ready, take AMPS, give insulin, go to work, come home 10+ hours later, take PMPS, and give insulin. I can't delay at all. But anyway, I just took her +1 and it's 169. I'll try to keep taking it every hour until +6

 

You may not need to test every hour until then....she may "bounce" from that 89 tonight but since we don't have a lot of data on her yet, it would have been safer to stall without feeding her and retesting in about 20 minutes

They "bounce" for several reasons....going too low, dropping too fast too quickly and just from dropping into a number their body isn't used to being at anymore. (or any combination of all 3)

I suspect with Stella, it's the latter...that it's probably been awhile since she's been in normal numbers so her liver panicked and released stored sugars and hormones to bring her back up to where it's been "used to" living

It's possible that +1 is just a food spike, but if she's even higher at +2, that's a pretty good indication she's started a bounce and you can probably plan on getting some sleep tonight

 

You can probably test in a couple of hours. If she's still the same or higher, you can probably call it a night. If your schedule doesn't allow any spot checks during the day, I'd definitely aim for a before bed test each night to help us figure out how this dose is doing for Stella. Any days you have off, getting a mid cycle test, somewhere from +4 to +7 will also help.

I'm not sure what method you are using for dose changes, but here we change by .25U amounts at a time. Cats are quite sensitive to small changes. You need syringes with .5u markings and eyeball the difference. Changing by whole units at once means you can miss the ideal dose.

 

Thanks for all of the advice Chris & China and Wendy & Neko. I'm going to definitely take her BG at +2 (or maybe +3) to see how she's doing. And going forward, I'll definitely start taking a before bed test each night. I was hesitant to do this because at my last visit, I showed the vet Stella's spreadsheet. The vet liked it but she told me that I should only be taking her BG twice a day and not to test any more than that. I never know what to listen to when the vet tells me something anymore. Stella has a check-up with the vet again on Friday too.

Question: say Stella has a normal night. What would you do if her AMPS is around 89 again? Would you not give her any insulin at all? Or maybe just the .5 unit dose like Chris & China first suggested?

 

A lot of vets don't support home testing, but if you had a child, you'd test throughout the day and night, and it's the same with our sugarcats! With other older types of insulin that were dosed based on the Pre-shot number, it was one thing, but with Lantus, it's important to know how low it's taking them

It's always better to err on the side of caution if you absolutely can't stall to make sure they're coming up before feeding/shooting

One of our sayings around here is "better too high for a day than too low for a moment"

 

Shooting low (shooting the full dose into normal numbers) is great for gaining control of blood sugar and flattening things out, but you don't want to start out doing it when you can't be home to monitor. In your case, until you've got a little more data telling you what she's doing with this dose, I'd make a conservative choice in the mornings if the preshot is lower than normal. Chris' suggestion of 0.5u as a token dose is a possibility.

How do you feed her during the day? For those who work during the day, having a way to dispense food to a diabetic cat can be a lifesaver, literally. Many people get autofeeders - I had a PetSafe 5 compartment feeder for punkin. It has 4 covered compartments which means you can set the feeder to feed the cat 4 different times. Here is a good thread (sticky) on managing a diabetic cat when you work full time. One of the best suggestions I've seen is to get 2 of those feeders, so that if you need to, your feeder could actually open 8 times during the day. Take a look at that link above and see if there are some ideas that would work for you. It's pretty important to have food during the cycle for a cat. If their blood sugar goes low, they really need access to food. Many cats will seek out food, although not all do.

As far as your vet, testing and the spreadsheet goes . . . I'd stop showing it to the vet. Nobody else uses the ss except those of us on FDMB, so the vet's not going to expect it. Is your vet helping you with the dosing adjustments? Wendy's point is really good - you'll find that even something as small as a quarter of a unit adjustment (0.25u) will make a significant difference in your cat's blood sugar.

I think in your case, I'd go ahead and decrease your dose by 0.25u as though you were following the Start Low Go Slow dosing method. That's what we suggest for people who either are feeding dry food, or who aren't able to test much. If you can always get a test before you go to bed then you could use the Tight Regulation dosing protocol, but if you can only get preshots, for safety, I'd suggest the SLGS method. With it, when the blood sugar drops below 90 you decrease the dose immediately by 0.25u. Dosing decisions are made by how low the dose causes the cat's blood sugar to go - which is why I'm focused on the 89 that you got this evening - so knowing how low a dose can make a cat drop is really important.

For figuring out those lows, you can get spot checks in, like grabbing a test before you go to bed, or you can do a curve once a week. That's described on the SLGS link above. Somehow you want to know how low she's going so you can keep her safe.

Are you familiar with bouncing? There's a description of it in the second post in this thread. I mention it because it wouldn't be surprising - in fact it is likely - that Stella may bounce from hitting green numbers today. If she does, she may be high for as long as 3 days - til Saturday night - and during that time if she IS high, it doesn't mean that she needs more insulin. The bounce will pass and when she comes down, then you'll be able to see what the 1.75u dose is doing for her.

And I just wanted to add a word of welcome - glad to have you here. It's a nice place to be. Ask as many questions as you have and we'll try to help you figure out how to help care for Stella!

 

You guys were exactly right. I took a +4 last night and Stella's BG was 291. And then I took her AMPS this morning and it was 329. I just gave her the regular dose of 2 units of Lantus this morning. I can't really adjust the doseage as precisely as suggested because the syringes I have don't have those measurements. I just got the same type of syringes that the vet had and they go only by unit measurements, not .5 or .25 increments. I'll have to get some better syringes clearly. Are there brands/specific types that are recommended? I need to have the U-100 syringes.

 

All these have half unit markings and are the correct syringes for U100 insulin and are available from ADW online:
UtiCare
Monoject
Carepoint
Sure Comfort
BD Ultra-Fine

They're also available at WalMart if you have one near you..Their Relion Brand 3/10ml, 3o or 31 gauge, 8mm insulin syringes all come with half unit markings and are only $12.58 for a box of 100

 

Hey - so I just took Stella's AMPS and it was 88. I didn't feed her, waited 20 minutes, and tested again. It was 87. So I eyeballed my syringe and tried to give her 0.5 units. I'm going to be home today since my vet cancelled the appointment so I can watch how she's doing. Do you think I should be testing her every 2 hours or so?

 

I would have suggested you get a +1 and +2 to start with...anytime you shoot a lower PS than you're used to, it's good to get those early tests to make sure you don't need to intervene sooner to keep her safe

It looks like she's doing OK so far though with that 97 at +3.....I'd try to get several more tests in during this cycle if you can...it's great data to have!

In the future, it's best to start a new thread every day here with the current date, cats name and AMPS number....kitties can get "lost" if you just keep using the same thread and the people here that scan the forum for problems and questions look at that subject line

 

fabulous to see some green for miss Stella!!! What a good day for her!

Now that you're at 1.75u stick with that unless she goes below 90. That's per the guidelines from the Start Low Go Slow dosing guidelines.

We've seen one or two diabetic cats here. None of us are vets, but we learned from others and then stick around to teach new people. You learn a ton taking care of a diabetic cat 24/7 for years.

Cats do have patterns to their blood sugar and the patterns emerge if we can see enough test data. I like to think of the spreadsheet like a jigsaw puzzle. If you have a sprinkling of pieces all over the puzzle, you can get a pretty good idea of the image. Now that you're getting the hang of things, a mid-cycle test in each cycle (when you can get it), will really help you see what's going on with your sweet girl.