4.18 Ruarach AMPS 487; +1 446; +3 267; +4 242; +5 208; +6 181; +7 169

L

LauraZZ

Member Since 2023
Not sure why AMPS so high. Possible fur shot in PM on 4.17 - I'm pretty careful to make sure needle is in but I felt a tiny bit of moisture after removing it, so possibly only a partial dose went in. The 5/16 inch half unit needles are more difficult than the 1/2 inch needles, as far as making sure the needle is in. Glad to see BG drop to 267 by +3.

I also gave lactulose around 330 am - I had omitted that during the 4/16 intensive glucose curve I did. I've decided to omit the lactulose today, 4.18, while I do the glucose curve. Will have to figure out over the next few days whether lactulose spikes his blood sugar. Some artificial sweeteners do increase blood sugar although not as much as 'sugar' itself; and many compounded medications include artificial sweeteners like saccharine, to mask the (awful, sometimes bitter) flavor of medications. I know the cisapride I got does, because I called and talked to a pharmacists at the pharmacy I bought it from. I had given cisapride (0.25 ml) on 4.16, and it didn't seem to have any effect. The lactulose dose is higher, although I only gave about 0.5 ml at 3:30 am today.

Gave SubQ fluids around 530 am on 4.18; I give these over the right or left shoulder, whereas I give the insulin shot in the right or left (rear) flank.

No food between 530 AM and AMPS blood glucose reading.
 
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@LauraZZ
Hi laura , I confused about the doses you are giving, you are chopping up the doses
I see Bron suggested in one of your posts to reduce to 2 units
With following SLGS here is what it says
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 (unitmol/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
You need to stay with the same dose for 7 days and then do a curve Unless he drops under 90 at any time you would reduce by 0.25 units , hold that for 7 days , then another curve.
We do not adjust the dose going by the preshot numbers.
New members are told if the preshots are under 200 you would stall not feed wait 20 minutes and see if it comes up on it's own
You would put in your Title The Date Ruarach Stalling NEED Help AMPS #
We adjust the dose on how low the BG is dropping ,you want to see when he nadirs , the lowest point in the cycle

You are changing the doses too often , disrupting how the lantus works
I have never heard of giving a scant 2 or a 1.3 units when giving lantus
You definitely need to get more tests in during both cycles ,Especially during the night time cycle , cat often drop lower at night, so we are only seeing half the picture

When doing a curve you only have to test every 2 hours until you reach his PMPS BG

You only have to withhold feeding 2 hours before you test his AMPS and PMPS tests so it's not influenced by food, after that you can feed about 2 teaspoons as a snack low carb wet food , maybe around @+2, or +3 and +5 , sane with the night cycle
You can always post for help if you are not about something, start the post off with a ? Need Help
 
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Hi Diane,
Thanks for your reply and concern, and advice about posting for help.

Ruarach eats throughout the day, and (as of 4.16.2023), I do withhold food for 2 hours before each AMPS and PMPS BG reading. He doesn't eat a lot at once, this is something you see with some kidney cats. So I offer him food throughout the day (and night) to be sure he maintains his weight.

I know that right now, I'm testing more frequently than is typical, but I want to have detailed data that tells me how his body typically responds to insulin over time. I know have a pretty good idea of when he hits the nadir. I would have tested every other hours today, but the 447 in the morning concerned me, and I wanted to see his response to the insulin. (I was surprised that he dropped so quickly into the 200s - seeing that is really valuable going forward).

As I said in my post on 4.16 in the evening, before giving PM insulin, I was really concerned about the large drop from AMPS (336) and the PMPS of 229. I was afraid 2 U (or even a scant 2 U) was too much.
I decided to drop down to 1.25 U to err on the side of safety. The 4/17 and 4/18 glucose curve readings, in my opinion, underline that my concern was valid about 2U being too high. Maybe I'm wrong, but forgive me - I don't want to send him into hypoglycemia, and these low numbers, which I hadn't seen before, make me very cautious.

As I mentioned to Bron on 4.15, I have shifted his diet towards less carbs, and on 4.15, his PMPS BG rdg plummeted - far more, and far more quickly, than I expected.

So yes, from 4.15 to 4.16, I've reduced his insulin. But I think the caution was merited.

As for the 1.25 vs. 1.3: They're essentially the same. But the Relion half-unit syringes are difficult to get precisely where you'd like them to be, and if I get it to what seems about 1.3, I've decided to stop fiddling with the dose - because every time I've tried to move it to 1.25, I overshoot, and have to draw up more insulin. I could simply record as 1.25, (not 1.3) but I like to be precise.

Unfortunately, my vet's instructions have been very different from what are given here (she increased his dose in full units; he was diagnosed with diabetes in mid-March), and I only discovered this site about 2 weeks ago - and it has taken me some time to process all the information. (Ruarach's profile, link in my signature, has some detail on this, as have his threads from the 4.16 and 4.17.)

Thanks for being concerned about Ruarach's well-being (I really do appreciate it). I'm aware of the guidelines, and plan to follow them - I've held steady at 1.25 since 4.16 evening insulin.

=====

On 4.16, in the evening, I had posted for help, but no one replied (I've since modified the thread title (per instructions), but I did indicate in the title I needed help). https://www.felinediabetes.com/FDMB...9-unsure-re-insulin-in-pm-gave-1-25-u.276517/

This is what I posted on 4.16:

Big question for PM: How much insulin should I give?​

Time is 8:24 pm. I gave him 1.25U insulin, just to be safe. Nervous about the big drop from AMPS (336 - in part likely due to skipping insulin last night) and PMPS of 229. These are numbers I haven't seen in him since starting insulin a month ago. Will continue to monitor closely for at least next few hours. Probably try to get a reading in middle of night as wel.​

posted 45 min ago:
AMPS: blood glucose 336; gave scant 2 U (about 1.8-1.9) in AM. Nadir was 218 at +6.75, then BG increased a bit, then was 221 at +8.5.
PMPS is 229, much lower than in AM. Should I give the scant 2 U again?
I've dropped more than 100 points for BG since AMPS.
I did a BG reading at 2021, just a few minutes before he's due for insulin; BG = 267. (He ate between 1927 PMPS and this reading.
I'm a little nervous that even a scant 2U might be too much.
Would appreciate advice. I'm thinking I should drop back to 1.5 U, and maybe go back to 1.25 U.​
 
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LauraZZ said:
. Nervous about the big drop from AMPS (336 - in part likely due to skipping insulin last night) and PMPS of 229.
Click to expand...
On 4-15 when you skipped the PM dose of 113 you need to put skip under 133 in the same cell or the square and color iI in manually blue , I don't think members will see that you skipped and wrote it in the remarks sometimes they don't always read what's in the remarks section
Also I see on your SS for 4-17 PM in the remarks cell you have possible fur shot, you need to put FS? in the PMPS cell under the BG Number you got
@LauraZZ
 
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If I were you I would go to your Title above and in front of the date put a ? then NEED ADVICE for tonights dose
Look to the right , tap on Thread Tools then tap in Edit Title add what I said then tap save
What time is he due for his PMPS shot?
@LauraZZ
 
@Diane Tyler's Mom
I made the changes to the SS you suggested; thank you for that.
Sorry, didn't see your message until after PM insulin - things got crazy here this evening.
When I dropped to 1.25 U, I was expecting to stay at that dose for 7 days - are you suggesting I should ask about increasing earlier than 7 days?

I'm pretty pleased with how today's BG readings turned out, other than the 2 400s at AMPS & 1st BG after that at +1. After seeing the 487, I did not expect the BG to drop that much.

I'll try to get some overnight readings. Ruarach usually wakes me up wanting to eat. I have 2 cats, so I can't just set food out for Ruarach.
 
So you shot 1.25 units tonight? I don’t see that on the spreadsheet. But if so then good. Hold the 1.25 dose for a total of 7 days unless he drops below 90. If he does drop below 90 then give him a reduction of .25 units (so new dose would be a straight 1 unit going forward.)
 
Are you not testing at night? Many cats do drop into lower BG at night so it’s important to get a “before bed test” at least — to check and see if his BG is substantially lower than the PMPS number. If it is, you may need to give higher carb food or set an alarm to wake up and get a glucose reading a little later in the cycle to see if he’s still in safe numbers.
 
Suzanne is correct. Getting a minimum of one test during the PM cycle is very important both in terms of safety as well as to make sure you're not missing a dose reduction.

I would hold this dose. If you are following SLGS, you hold the dose for a week (unless a dose reduction -- numbers dropping below 90 on a human meter -- is needed) and then do a curve to evaluate the effectiveness of the dose. I suspect the high numbers you're seeing are the result of a bounce. When a cat isn't used to lower numbers, when the numbers drop into a lower range, the liver and pancreas release counterregulatory hormones along with a stored form of glucose. This causes numbers to "bounce" back into a higher range. It can take up to 3 days for the bounce to clear.
 
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