? AMPS 58

23/4/2018
This is a first. So I don't know wether to give him the insulin or wait for an hour or something.

Update:7/5/2018
I skipped the dose three successive days in the morning but he keeps getting low numbers.

 

I retested after 45 minutes and now he's 130. So I'm giving the shot

 

Did he come up to 130 after you fed him? Or did you stall without feed for 45min?

Remember your shot tonight will be 45 min later.

 

Have you decided which of the dosing methods you are following?

On SLGS that 58 would have earned him a reduction to 4u.

On TR you would hold the dose. However, if you intend to follow TR, you need to get more tests on each and every cycle. You don't have to test every single hour but a couple of tests both in the am and pm cycle are necessary so you can dose confidently and keep kitty safe.

Do you think you could run a curve some time soon??
That's when you test every 2 hours for a 12 hour period.
or every 3 hours over an 18 hour period.
I'm concerned that you may have missed some significantly low numbers, with the limited testing you have been able to do recently.

ETA
Try and at least get a couple of tests done this morning, he might bounce, and so you will find his numbers rise, he maye even go to red, given that 58 this morning it wouldn't surprise me if that is what happens.
However, it is also possible that this is a good dose for him and you could see his numbers come back down.

Thanks

 

Thank you.
I didn't know that I shouldn't give him food and see what happens. So I gave him a little something to eat after that 58.

I did reduce to 4 u and I'll get a couple of more readings during the cycle.

What I don't understand is why he sometimes still gets to red in his AMPS the last few days. Maybe that's bouncing, right? So if it keeps happening every 3 cycles or something does it mean I should reduce further?

 

• Correct, a bounce can be triggered, by a number of things, a fast drop, not necessarily all the way to green, a drop from black to yellow in a few hours, could be enough to trigger a bounce in some kitties.
• Some kitties will bounce when they get into a range that is lower than they have become used to. Again this doesn't have to be green, it could be blue or yellow for some cats, just lower than they are used to.
• When they do get to a lower range and spend quite a bit of time there, the first few times they may bounce of that as well

Bouncing is basically a physiological response, when any of the above (or combination) happens, the liver 'panics' thinks kitty is in danger and a response is triggered which results in glucose being dumped into the blood stream and the BG as a result spiking. Bounces can take up to 6 cycles to clear, but it is not unusual for them to clear sooner.

If you are doing SLGS hold this reduction tonight.
Nice blue number midcycle today, let's hope he stays flat and blue today.

We don't adjust the dose because of the bounces, we largely ignore those numbers, the dosing methods we use are based on how low a dose takes our kitty, that is, how low kitty is going when he is not bouncing up into those reds/blacks

• On TR We take reductions if kitty drops below 50 on a human meter
• On SLGS we take reductions if kitty drops below 90
• If kitty does not earn a reduction, dose is reassessed every 4-6cycles on TR
• If kitty does not earn a reduction, dose is reassessed every 7 days (14cycles)
• If dose is not getting kitty into a good BG it is important not to hold on to a dose for too long.

 

Thank you for taking the time to reply!
I'm going to follow the SLGS method and see what happens. So basically if he gets below 90 in a cycle I reduce by .25 even if I'd just started the dose, right?

 

Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit

• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose

• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases.

If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.


Lather, Rinse, and Repeat!


How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
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.

• In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.

• Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

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.

If the preshot number is near usual preshot numbers:

• Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.

We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.

 

Not quite as straight foward as that.
We usually avoid taking back to back reductions, this is because of the depot. The depot of the larger dose can still influence the numbers in the following cyclces, it's preferable to allow the dose to settle.
So, for example, if Farafero, were to drop to lets say 87 in this cycle or tonight, you might consider holding on to the 4u, because it is quite likely that the depot is responsible for the lower numbers.
If in doubt just post up and ask the question on the condo.

 

Can someone tell me what to do? I misses his morning dose three successive times. That never happened before. But he keeps getting the hypo numbers in his morning AMPS. It happened before and I usually wait for an hour max but it was never this frequent.

 

How long ago did u test him, has he eaten

 

It was 6 hours ago and I'd just woken up, so he would have eaten 5_6 houra prior to that.

 

What I would do if he hasn’t eaten, is wait 15min retest and then come back on here with results, are you gonna be home to monitor him if you shoot?

 

Test now and see what it is

 

His amps 6 hrs ago was 58? I’m confused I guess

 

@Kris & Teasel , input please
@Bobbie And Bubba

 

I skipped the dose and didn't have time to post, so I'm doing it now. That was an old post by the way and I wrote a reply in it.. I'm sticking to his night dose but I don't know how much I should give..

 

Three AMs with no dose resulted in high PMPS so insulin is obviously needed. Are you at home to test today? If so, try 3 u and test at +1 and +2 to see where he's headed. Post here for advice. If you can't be at home at all, give a reduced dose, say 1.5 - 2 u, to get some insulin into him.

You need a lot more data between doses to know what his responses are and to be able to assess a dose properly.

 

HI Nada, without testing through the night it is really difficult to see what is happening. Ideally, you want to have a dose that you can shoot safely every 12 hours . Last night he zoomed up at the PMPS because of 1. a skipped shot from the AM and 2. From bouncing. The more test you can get will be helpful to know how low the dose is taking him in the PM cycle.

Is your schedule flexible where you can let him come up some this AM then shot? With him being DKA, getting some insulin into him is important.

Also, could you start a new thread each day to avoid confusion.

 

Yes I can be flexible with his schedule but I thought I'd follow the protocol and skip.
But I won't be able to shoot him now after 6 hours so I'll wait for his PM shot and start testing.. I'll do a curve also in the morning

 

Hi Nada,

Are you able to get tests other than amps and pmps?

With DKA in the picture it is important that he get some insulin, lack of insulin can trigger DKA, especially if there are other things in the picture, like

• not eating
• infection
• stress

As @Bobbie And Bubba has already said it is very hard to know what to do about the dose without a bit more data, the dose is based on how low the insulin is getting kitty, we are seeing low numbers at preshot in the morning, but he may be going even lower than that in the night.

Could you explain how you normally feed and what you are now feeding him? at what time in the cycle? (perhaps you could note feeding times in the spreadsheet I found that helpful to help me keep track, and others found it helpful when they were trying to help me when I was starting out)
Have you changed his food recently from dry to a wet low carb?? If you have changed food, when did you do that?

How is he feeling? Is he eating well?Is he behaving normally?

 

He's doing great actually. He had a recent UTI but now it's gone. I don't have a schedule for his feeding but I usually give him small meals every 4 hours. And always a meal with his shot.
I'm feeding cooked chicken, liver, fish and friskies pate although the later isn't so frequent because of the cost here.

Thank you and I'll get more data

 

Feeding a homemade diet can be great, but I don't know if you are aware, you need to supplement it with certain vitamins/minerals otherwise it can lead to health issues. Cooked chicken wouldn't have the right balance to keep him healthy.

I'm glad he's doing well.

Getting a little more data will be really helpful, thanks, I look forward to seeing it.