? 4/16 Benny AMPS 400 +6.5 64 +7 142 dose question

Benny's AMPS was 400 on the human meter, then at 6.5 it was 64. Is this a fast drop?

I am working with my vet on TR vs. SLGS but have not established which I will use. In the meantime, the vet has instructed that Benny's dose should be 2 units. I understand that this is not within the TR or SLGS protocol, but I have a question.

I've been told that Benny's PMPS should not drive a dose reduction, but his nadir. Am I misunderstanding that? His last number is low; I will take another BG to assess whether this is actually his nadir.

His BG values are all over the place and I feel like I am failing but I am trying to learn. At the same time, I am not in a position to tell his new vet that I won't listen to her, or find another vet right now. We will get to TR or SLGS in a little more time. In the meantime, I am trying to learn because I feel lost.

EDITED to add: +7 was 142. Is it possible to go from 64 to 142 in a half hour? I just gave him his low carb food, although he ate it up. Did I mess up the tests?

 

Previous post
https://www.felinediabetes.com/FDMB...45-did-he-hypo-overnight.261998/#post-2937741

Looking at your SS it looks like you are deciding on how many units to give by the pre shots
Shooting the same units for both cycles is what is advised
Dosing is based on how low your kitty drops
Have you decided on a dosing method yet. TR or SLGS
On your SS up top where you have Alpha Trak can you please put using Contour Next
@tiffmaxee

@Wendy&Neko

@Sienne and Gabby (GA)

@Suzanne & MeNow

 

This is what I'm asking about. Would a nadir this low require a reduction in insulin dose regardless of his recovery from it?

I'm wondering whether I have just messed up his BG test results somehow. Is it normal for the values to change this much in such a short time? I have not given him any HC food, just his usual LC.

 

Reducing the dose:

The TR Protocol is an aggressive method in itself. The modified version of the protocol is slightly more aggressive. Let's keep all our kitties in the Lantus, Levemir, & Biosimilars ISG safe by taking reductions when appropriate.

• If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit

SLGS
Starting Dose:

• 1u BID if kitty is not on a wet/canned low carb diet
• 0.5u BID if kitty has been switched to a wet/canned low carb diet
• If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
• Generally, shots are to be given 12 hours apart.

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

 

It’s very possible for the bg to rise like it has. It’s because he’s bouncing from the low for him bg. It’s actually within normal range with a human meter.

Lantus likes consistency. Your dosing is all over the place and it’s causing his bg to be all over as well. It’s a depot insulin that builds in the body over time. Since you have not decided upon a dosing method my suggestion would be to stick with 2.0 for 3-5 days. I can’t tell you when to reduce from there because with SLGS it’s under 90 and with TR it’s under 50.

 

And no matter what his PMPS number is, this reduction should take place due to his low number today?

 

That makes sense.

TBH, I'm afraid of his BG going really low overnight, since his values are so unpredictable. I'm afraid I'll sleep through it.

 

It is scary at first I know. How soon after his pmps do you usually go to bed?

 

The color coding needs to be changed since you are using a human meter. @Bandit's Mom can do that for you.

 

You don't have to ask your vet what dosing method to use
Do you know which one you want to follow yet
If you are going to follow SLGS you would reduce tonight and give 1.5 units
Get a test at +11 today to see what it is and post it above, when you do his PMPS if it's too low post and ask for help , After PMPS get a test @+2 if it's lower than the PMPS you will need to continue testing because he may drop lower, most if us will set an alarm if needed.

On your spreads you have the 64 in the +5 column and in your title you have it at +6.5
Which is it
You have 147 on your SS @+6 and 147 @+7 in your title?
You need to add the 210 also in your title

 

@tiffmaxee I go to bed about 2-3 hours after his PMPS and insulin administration. I'm not sure if I am taking the "insulin at the same time every day" too literally; if I could give him the insulin a little earlier I could go to bed after more time.

 

No, I am not sure yet.

 

It’s okay to shoot 15 minutes earlier or later without effecting the bg. If he’s high 30 minutes early every 24 hours is okay. If you shoot any earlier than that it can act like a small increase. Cats usually onset at +2-3. If that test is the same or lower than the pretest he might drop a lot. That is when you might want to set an alarm for later. It will become more clear when he is at the same dose for 3-5 days.

 

Meaning if his PS is high, 30 minutes early once a day is okay?

 

What are your shooting times now
Do you want to change them altogether for good

 

It would be best to change your shot time to one that works best for you and if needed occasionally shoot a little early or late if needed.

 

Okay, I understand. These are the hours that will not need any or much adjustment.

Should I set an alarm for the time that was Benny's nadir today and test him at that point again in the morning, since I'm going to give the same dose?

 

Nadirs can change , If it were me I would test @+2 or 3 and then @+6 for both cycles unless he drops really low then you will need to be testing more often

 

Okay, thank you!

 

This is done.

 

Thank you Bhooma! I could not have done that.

 

Most welcome

 

So here's what I would advise to avoid the million questions each time lol

Add "dosing per vet" to your signature and the dosing method cell at the top of the spreadsheet. Think about what number you want to take a reduction at, and add that as well (so "dosing per vet, reductions at 90" as example)

Has the vet seen your spreadsheet? If she saw those greens during the 3U/1.5U shuffle and still wants 2U, I'd say that means she's ok with numbers that low at least before reducing. At the very least I'd call on Monday and say hey I'm getting these low numbers, what is your guidance for reductions? How much do you want me to reduce and at what number?