11/02 Cole - PMPS 241 / +1 281 / +2 248

https://felinediabetes.com/FDMB/thr...151-6-160-9-225-pmps-241.237924/#post-2671685

Good morning - lowest AMPS for Cole to date. He was very perky this morning, up on the counter and behaving more like his old self. Hoping we have a good day today!

Going to be a bit of a challenge with work - WFH but on video calls

 

With your first low PMPS (and not a fur shot) I'd get a +1 and a +2 so you can get a good picture of where he is headed. Do you have MC and HC foods now? And lots of test strips? And honey/karo? I'm not trying to scare you or anything. I just want to make sure you are prepared as it seems like you are getting closer to a dose where he may show you lower numbers...like the healing greens.

Also, consider collecting some overnight tests. It's hard to know what Cole is doing on the PM cycles without them. He was likely sliding down overnight.

 

I should have done +1, but wow - the +2 has just scared the daylights out of me. Gave him MC food with honey, and gravy...

Should i test every 30 minutes?

 

Yes - test in 30 from that 49. You're on Alphatrak right? that's low so we will want to keep checking to get him >68

 

@Butters & Lyla I'll be around for about an hour to help - are you able to check-in later? If not, I'll look for others

 

Yes on the Alpha Trak - will test again at the 30 min mark

thx

 

@Colio is Cole acting okay? Showing any physical symptoms? Jax never has but wanted to check.

 

No symptoms - he's acting just fine. Wants more food so there's some of the usual meowing going on but nothing unusual.

 

That's good they know they need food when they are low. You're doing great

 

If you aren't already, try to write down what you are feeding. So for that 49 - did you feed 1t MC, 1t honey? Or something like that (my measurements are just an example )? It will help us see how he's reacting to carbs and will help you next time he dips low.

 

I might have given him too much food - probably 2 tbs of MC and 1 tsp honey, and then another 1 tbs of MC

Will start to keep track..

Time for a test

 

Good catch. Last night you got two lower than usual tests so another at +4 was needed. He likely continued to drop. When the +2 is the same another test in an hour or two is suggested. If lower than the amps it’s definitely likely to be an active cycle and needs to be monitored. Many cats go lower at night so once in a while it’s a good idea to set an alarm and test between +5-7. The high preshots you have been experiencing are likely bounces from dropping lower than he’s used to.

A reduction has been earned starting tonight. The dose will be 2.75. Congrats!

 

Up to 77 - more food?

 

@tiffmaxee we'll see what the next test is but are you around to check-in? I need to run out in about 30 min for a bit.

 

I would hold food and test in another 30. Way to get him up to safety

 

I will check in. Yes. just reading through.

 

Thank you all - testing again in 30...

 

I'll be here for next test then won't be around for a bit.

 

No problem. I'll keep my eyes on. Light work day for me now until late this afternoon.

 

I can check back. Time to remove the 911. Put it back if he drops again. Thanks.

 

@Colio you could probably remove the 911 now if you're comfortable with that? I see you have three of us with eyes on you now.

 

Time for the next test and when you get it please add the results to your title so we know all is good. Thanks.

 

Thanks @tiffmaxee and @Butters & Lyla - I’ll check back this afternoon

 

Dropped again - more MC and honey ...

Should I drop the 911?

 

Did you already give him more MC and honey? How much?
Can you check again in 30?

 

1 tbs food and 1 tsp honey - and yes I can check again in 30 minutes

 

We are watching so you can remove the 911.

 

Okay perfect. You're doing good. 52 is still too low on the AlphaTrak. See you in 30 for next test.

 

You need to get over 68 and continue feeding until into the 80’s and then maintaining without food.

 

Thanks - trying to be calm but this is stressful
Glad I have all the support.

 

You are doing fine. The honey wears off quickly. It’s important until at least in high 70’s to test every 30 minutes. The food lasts about that long. Tough when working I know.

 

I know. You're doing good though. We know the food is bringing him up. But we don't want to go longer than 30 minutes without testing Cole right now if you can help it.

 

Finished the part of the meeting where I had to present so I can focus on testing now

 

If you need to wait 60 like what just happened just put food in a dish for the second 30. They pick the worst times to throw us a curveball.

 

OK - got the next test done and he came up to 59

Fed another tbs of MC food - but no honey

Should I give more honey?

 

He's not really coming up that quick from the MC and honey. I'd give him more honey.
Still well below the 68. @tiffmaxee what do you think?

 

In my opinion, you prob should have been feeding some HC, so the honey and some MC is a good substitute. Yes I'd give him a bit more honey too and test again in 30.

 

Gave him another tbs and 1 tsp honey

 

Good. See you in 30 for next test.

 

I won't interfere with the great folks helping you, but just wanted to note you probably want to get some HC in the house next time you are out shopping. When they drop early in the cycle, the insulin is at it's strongest and you still have a ways to go until nadir. So HC for low numbers in the first part of the cycle. MC + honey works, HC + honey even better. Do keep good notes on how much and what you fed. That will help you next time you see low numbers and help you figure out how carbs sensitive Cole is. ECID.

Aren't you glad you didn't increase. Congrats on the reduction. Many a cat reacts to the threat of an increase by going low.

 

At +4.5 up just a little to 65.

1 tbs MC and 1 tsp honey


What do you suggest for best HC food? i bought Iams Perfect Portions Tuna and Chicken because I thought it had gravy but realize I can't read the %

Test again in 30 min

 

I am so glad I didn't reduce - this has been a roller coaster!

 

Okay good so you gave him another 1 tbsp MC and 1 tsp honey. And other test in 30. Great will see you for another test in 30 minutes.

 

As for HC food, I use Weruva Grandma's Chicken Soup, which is 21%. And some of the Weruva and BFF pouches on Dr. Pierson's food list. I also have some first mate.
The Grandma's chicken soup @ 21% is the highest % HC food I have used with Butters.

I'm curious, what are you using for MC food? And what % carbs is it?

Also, remember the carbs are in the gravy.

 

@Butters & Lyla - i'm back if you need to take a break

BTW, when Cole when from 49 to 77, she gave him "2 tbs of MC and 1 tsp honey, and then another 1 tbs of MC" - if he's still not coming up, maybe we need to up the honey to food ratio - so like 2 teaspoons honey, 2 teaspoons food? Just a thought running in my head that I felt the need to type out

Another HC option is Fancy Feast Gravy Lovers Beef - it's 20%.

 

That is good info, thanks. I'm glad Cole is still eating! He has had a lot of food.
Agree that more honey may be needed. I'm worried his appetite may wane.

I'm okay, Susanne. I can still hang around, too. I'm popping on and off.

 

Okay - shoot me a DM if you me to come back I'll try to keep watching too

 

Down again to 59 - another tbs of MC and tsp honey

 

Give him 2 tsp honey with the MC.
ANd you're giving him the gravy, right?

 

he has eaten a ton - I can switch to higher ratio of honey - and do 50/50 with smaller amount of food

 

I would do that. Yes, as Susanne suggested. 2 tsp honey and 2 tsp MC.

 

When you have a moment, please let me know the name of the MC you're feeding.

 

done - he gobbled that up

 

Think you can get a test in 15 minutes? I don't like that he dropped lower 30 minutes after eating MC and honey.

 

it was Beyond the Grain Chicken and Sweet Potato - but looking at it, I'm not sure if it qualifies as MC.
Then I tried the IAMS Iams Perfect Portions Chicken as it has gravy - but I can't read the %
Now this last time I'm trying some prescription food Royal Canin Fiber which is 6% protein, 2% fat - so I think this is better? HC?

 

BEYOND - PATE Grain Free Chicken & Sweet Potato is only 3% carbs per pierson

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

 

Is the royal canin wet or dry? What's the exact name? I'll try to find the carb %

 

went to 70 at +5.25

 

Royal Canin Fiber canned looks like it might be a better bet.

 

Okay good. Hopefully he is still going to go up. The honey isn't going to hold him but maybe the other food or a bounce will kick in. Hold off feeding and test again in another 15 minutes. He has a tiny bit of buffer. I'm glad you got the test after 15 minutes.

 

it's wet

Royal Canin Fiber - Veterinary Diet

 

will do - thanks

 

I can't find carb content for it but it's not ver high carb if we use the rough anaylis from Pierson - it's at most 7%.

The rough analysis is you take 100% and subtract out moisture, protein, fat, fiber, and ash. Here's the Commercial Cat Food page from Pierson - https://catinfo.org/commercial-cat-foods/#Calculating__Percentage_of_Carbohydrates:

Royal Canin doesn't have ash listed so I subtracted the rest and got 7%...and then maybe minus about 1-2% for ash. Here's the RC info - https://www.royalcanin.com/ca/en_ca/cats/products/vet-products/feline-fiber-canned-cat-food

 

I did a poor job of shopping for what I thought was MC and HC food ...

 

Honey and LC works too - in fact it's listed on the low number sticky - we should have asked what exactly you had from the start. And now you have a shopping list So from here on out, use your prescription food + honey. Small bites. Like tsp food with tsp honey. We want him to keep eating if needed.

 

Just tested again - at 95 at +5.5

food and honey?

 

Actually let's just do a tsp of the fiber food. no honey. and test in 20. That honey brought him up but will wear off.

 

If he's up again at the next test...which I'm hoping he will be, we can probably give an hour pokie break (and you can take breath again too )

 

done - will test in 20

 

I think this is a summary of food and numbers. Did you get a +3? It doesn't look like it but not sure if I missed it because that was right when I ran out earlier today. I like looking back at #s and food after the fact to see how my cat reacted to the food. It's all a learning experience

+2 49 *3 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+2.5 77 *no food
+3 ??
+3.5 52 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4 59 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4.5 65 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+5 59 *2 tsp ~7%, 2 tsp honey (RC Fiber Vet Diet Wet)
+5.25 70 *no food
+5.5 95 *1 tsp Fiber Rx ~7% (RC Fiber Vet Diet Wet)

 

up to 99

What next - food?

 

He's flat from 20 minutes ago (95 and 99 are essentially the same). We can wait 30 and see what he does with no food. We are coming up on the second half the cycle so the insulin impact should be coming down. What do you think?

 

BTW, he's in a safe # right now.

 

I'll wait and Lyla is bringing me some HC so should have better options in 30 minutes... I hope this stays flat

 

Sounds good - so next test around +6.25.

+2 49 *3 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+2.5 77 *no food
+3 ??
+3.5 52 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4 59 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4.5 65 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+5 59 *2 tsp ~7%, 2 tsp honey (RC Fiber Vet Diet Wet)
+5.25 70 *no food
+5.5 95 *1 tsp Fiber Rx ~7% (RC Fiber Vet Diet Wet)
+5.75 99 *no food

 

And I'm hoping you won't need the HC today but glad you'll have it on hand

 

No plus 3 today - on a call.

You captured it all really well - thank you!

 

Up again with no food - at 122.

Should I wait on more food?

 

Yay. Yes wait an hour!

 

Let's see if I can be more clear - I was just excited lol.

No food and test again in one hour

 

If I test in a hour and he is up, I assume wait / if he is down again?

 

Are we at +6.25 right now?

 

He *should* continue to rise till PMPS but he's cat and honey does wear off. So the extra test is just insurance.

If he's lower, we'll see the number and see if we want to feed. We can give small snacks up to +10 to make sure the PMPS isn't food influenced (if he's in low #s at +10, we would of course feed and discuss the PM shot)

 

Actually at +6.5

 

Awesome - corrected the timeline below. Also added the AMPS...I keep track of breakfast and dinners too so may be worth noting.

See you at +7.5.

AMPS 137 *breakfast
+2 49 *3 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+2.5 77 *no food
+3 ??
+3.5 52 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4 59 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4.5 65 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+5 59 *2 tsp ~7%, 2 tsp honey (RC Fiber Vet Diet Wet)
+5.25 70 *no food
+5.75 95 *1 tsp Fiber Rx ~7% (RC Fiber Vet Diet Wet)
+6 99 *no food
+6.5 122 *no food, test in 1 hour

 

Hi, I'm back. Good to see Cole is still rising. You want him to stay up for two full hours without any food or honey, not sure if Susanne mentioned. I'll pop on and off I just have to feed Butters.

So I gave you 3 pouches: those are all MC foods.
And three cans: those are HC foods.

 

I will also be hanging around to see the +7.5 test.

 

Thank you so much Lyla for your kindness and help today. It helped with my stress over not having the right food - and I am so appreciative.

 

He's up again to 135 at the +7.5.

 

Team effort. Also, others have helped me as much and more. I'm just paying forward the kindnesses other people on the board have shown me.
So when you need one, double check what % to use if someone is helping you. HC should definitely have been used today. I'm not great with AT numbers but I'd say roughly between 58-67, an MC would be a good place to start. You'll need to play around at first while you figure out how responsive Cole is to the carbs. That's why it is so important to note what % carb food you feed him and what impact it had on his BG, so you know for next time.

The summary that Susanne did for you, I recommend you copy that right into the remarks in your spreadsheet.

 

He is up a bit more, that's good. We are almost at the 2 hour mark without food. How do you feel about withholding food for another hour and testing again?

That will bring us to 8.5, then we can see where he is at and discuss when next to feed (no food 2 hours prior to giving insulin), and hopefully start getting a slightly better idea of where he might be headed for PMPS.

 

Definitely ok with that. Stayed tuned for +8.5

 

You're doing wonderful! I think Cole is in a safe spot. He should continue to rise to PMPS.

FWIW, I would use HC any time you are under the "take action number" which is 68 on AT2. If Cole is near 68 but above it, I would use MC to help keep him surfing. If Cole is under 68 but super close to it 68 (say 65-67), you could try the MC to see if that raises him (assuming you can test in 30 minutes from feeding). You will adjust all this feeding strategy as you get more familiar with how Cole reacts to food. I can bring Jax up from the 50s (on human meter) with MC but when he dips into the 40s (on human meter), I usually need to give him a bit of the HC. It's an ECID thing.

And do a tsp at a time of the gravy whether its MC or HC. The idea is to get the kitty to safe numbers and then have them stay there as long as we can and if our schedules allow If our schedules don't allow, we would be more heavy handed with the food.

Hope that helps. Excellent work today

 

And updated timeline

AMPS 137 *breakfast
+2 49 *3 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+2.5 77 *no food
+3 *missed due to work conflict
+3.5 52 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4 59 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+4.5 65 *1 tbs 3%, 1 tsp honey (Beyond the Grain Chicken and Sweet Potato)
+5 59 *2 tsp ~7%, 2 tsp honey (RC Fiber Vet Diet Wet)
+5.25 70 *no food
+5.75 95 *1 tsp Fiber Rx ~7% (RC Fiber Vet Diet Wet)
+6 99 *no food
+6.5 122 *no food, test in 1 hour
+7.5 135 *no food, test in 1 hour

 

I am printing this out so I have it to refer to - I learned alot today - wish it hadn't been so dramatic, but you and Lyla have been wonderful. Thank you for the support

 

I use a human meter, like Susanne. All things being equal, I would use LC to bring Butters up from the 50s, MC to bring her out of the 40s, and HC lower than that. This is what I was taught. And it assumes she hasn't had a big dramatic drop. If she has, then I'll be more aggressive and break out MC food earlier. I'd also use MC sooner if she was sliding lower earlier in the cycle. Totally clear, right? We err on the side of caution when you're new. It is somewhat an ECID thing and somewhat what you're taught. You'll find what works well for Cole. That's why you wanna keep a variety of foods on hand and track what you use.

 

Up to 193 @ +8.5

Usually I feed dinner in an hour - so +9.5. Thoughts?

 

You are free to do as you please Withhold food 2 hours before shot time.

BTW, do you usually feed two meals or several small ones? I used to feed Jax two meals but then switched to several small ones (with a little larger breakfast and dinner which I serve at shot time). I serve a small snack at +9.5 or +10 (1-2 tsp) and then dinner at shot time.

 

I'd say we're good. Nice job. Carry on as normal with dinner. You can give him a poke break to PMPS. But do post at PMPS time with the number.
Remember Cole earned a reduction to 2.75u.

 

It used to be 2 meals, with dry down all the time. Now that we are only having wet food, it's several small meals, and two larger ones for breakfast and dinner. Evening shot is about 2.5 hours after dinner.