1/24 Simon AMPS 79 drastic drop - what to shoot this am?

It appears the increase to 3 units created a huge drop! Last night +3 he was 239 and now this morning he was lower than ever. Ugh. I had to give him his heart meds (which he only takes if I hide in food) so he's had a Tbl of Hills a/d. So, should I give him a dose this morning? I have to leave for work at 9AM.

This has happened before but not such a drastic drop. I held off the morning dose but then he spiked way up later in the day - into the 700 range. I feel like a confused idiot at this moment.

 

I can't stay with you this morning - but you know you're supposed to hold the food at this point and then test again in 20 minutes to find out which way he's going before you shooot.

Let's see what he's doing with NO food in 20 minutes.

 

Thank you, I know about the food thing but that's the only way he'll take his heart meds (which need to be given every 12 hours also). That was about 30 minutes ago. I just checked him again and he was 78. Based on what I was advised last time this happened I think I need to hold off on the morning shot? Also - should I give him a teeny amount of carb?

 

If you're skipping the shot, you don't need to worry about giving any carbs. You'll be feeding Simon his breakfast so he'll be getting food.

 

Katie, what dosing method are you following? With that 79 this morning, if you are doing SLGS Simon has earned a reduction in dose back to 2.75 units. I see you are going up in 1/2 unit doses. We recommend you go up and down in 1/4 unit increments.
I notice you are not always testing the preshot. Always test before every preshot to see it is safe to give the insulin, otherwise you run the very real risk of giving the insulin when it is not safe to do so.

Would you mind putting in your signature please that you are using an Alphatrak meter and if you have decided what dosing method, that too. And as the dose of Lantus changes, all you need to put in the signature is that the insulin is Lantus....not the dose. We look at the SS for that. Thanks!!

 

Thank you Bron, I haven't really decided on a dosing method as (after reading a couple times) about each of them, I will admit I am confused. It's too late for us to "start low" so I don't know if that one would be appropriate. With my work schedule (as well as some other demanding things going on in my life) it's hard for me to test more often than I do. I know the danger of shooting without a test prior, but since Simon has run consistently high in the later part of the day I didn't think there was any danger of him being too low to shoot - I always test him when I get home from work (between 5 & 6) so I thought that would be safe if he gets his insulin at 7. In the morning he always gets tested preshot. When I am home during the day I try to do a mid-cycle as I know that is an important one.

Someone did advise me to only increase by .25, but I am having trouble with the syringes I am using (need different ones) so I tried to get it close, but it has ended up being closer to 3 units. I realize that with cats each .25 can make a difference, and I am doing my best. Needless to say I have wasted a lot of insulin shooting it out in the sink and starting over. Ugh!

Also, I am planning on changing over to a Relion meter due to the cost of the Alphatrac strips. I will add it to the signature as well, thank you for that suggestion.

Tonight I feel stressed and that I haven't been able to stay on top of this! I appreciate you taking the time to reply to me, and I hope to be able to test him more often over the weekend.

 

I don't want to pile on and Bron has given you such excellent advice - I do however want to say - that the one time - just that one time - that you don't test in the evening - Simon could throw a number like he did this morning - it's one of the issues with us giving our kitties insulin - it could prove to be your un-doing if you shoot as you usually shoot - the one time when he's low and you didn't know what his number was - that he'll go into a hypo situation. None of us want to see that - especially you. It could end disastrously - the least of which could mean a late evening trip to the ER. I don't want to frighten you but we've seen it and we just want to make sure that you and Simon are safe. No one knows when his pancreas could kick in one afternoon and be going full blast when you are ready to shoot - surprise! A lower number than you've seen and then what to do? Like you did this morning - ask for help.

So for now, please get that test in before shooting any insulin - ever. I've recommended that if caregivers are unable to test, then perhaps it would be better not to give any insulin at all (typically for newbies who either aren't informed about home testing, or are unprepared to home test)...it's the difference that will pay off!

Try not to feel stressed...we've all been there...I was so stressed starting this process I was sure I was never going to be able to figure any of it out...but with time and patience and the help of many kind people here...well...you too will get there!

Take care Karrie and have a good evening.

 

Hi Kerrie,
You are actually doing a really good job looking after Simon. There are just a few little things that you can do to make it even better. It is a big learning curve in the beginning so please don't stress about it. You and Simon are still very early in the FD journey.
We tend to freak out here when preshot tests are not done, as we have seen what can happen when insulin is given when the preshot was actually really low and the caregiver didn't test/know.

One thing I would do is always get a before bed test done. That can tell you if Simon might drop lower at night which a lot of cats do like to do. So before you go to bed, get a test done.....if it is the same or lower than the preshot, then it could be going to be an active cycle and it would be a good idea to set the alarm and get up and test again later to see that it hasn't dropped too low. That way you will keep Simon safe.

You can still do the SLGS method if that suits you better. The main difference between SLGS and TR is that you can increase the dose every 3 days if needed with TR and with SLGS it is every 7 days after a curve. Your choice. You are testing enough to do TR if you get some tests in during the PM cycle such as a before bed test.

Simon is going to be in high numbers for the PMPS test because he is bouncing from that 79 this morning and he didn't get insulin this morning. But still give the reduced dose of insulin that he has earned. The bounce can last from 1 to 6 cycles and there is nothing you can do about it. It is a normal reaction by Simon to the low preshot that he is not used to.

Keep asking questions. Simon is a lucky boy to have you.

 

Thank you again for taking the time to help me here. I am home today so checking him at 3 hour intervals. As far as the dose, on the spreadsheet I have indicated 3 units as I am really having a hard time getting a .25 on these blasted syringes (I have been doing some reading to get recommendations for more user-friendly ones) so I believe he is getting somewhere between 2.75 and 3. I know every .25 makes a difference but I am really trying to get it as close as possible.

As far as the before bed test, that makes sense and is do-able but I am a little confused; I usually go to bed around 10PM which would be at his +3. If he is the same or lower than the preshot (which would have been at 7PM) isn't that is what should happen? Or does it depend on how much it has dropped since his preshot?

 

Generally, Lantus onset begins at around +2. (Just remember every cat is different!) So, if you are seeing a marked difference by +3, I'd encourage you to get another test. It could signal that numbers are dropping.

Have you considered using digital calipers to help you with dosing? Syringes can be challenging. Calipers can help. This is a post on dosing with calipers so you have more information.

 

His +9 was 118, so he's been dropping all day. What could be causing that? He is due for his next shot at 7PM (Central time) but I definitely won't shoot if he has dropped even more. I am going to check him again in about 15 minutes.

Definitely will consider calipers. Thank you. The uncertainty of the measurements in the syringes is troubling.

 

He looks like he may be coming off the bounce. That will cause the numbers to drop like that are this cycle. I would get a +11.

 

Definitely. Thank you.