? 9/18 Mable AMPS 62 gave half dose

Hello I need some help.
Can someone please review our chart and advise?

9/18 Mable's AMPS was 62. I gave .5u (half normal dose) and 1/2 and 1/2 mix of regular food FF Pate and FF chicken florentine medium carb food.

Our vet has said 65 from the other day was not concerning and a full 1u dose is appropriate. If we are nervous we can do .5U but not to dose one day, and not the next day. I understand below 90 she should probably have a dose decrease and I also asked about small token doses ie .1 or .2 and she said it was impossible and only guess work.

I guess I need confirmation that Mable will be ok to give 1u at low numbers? She explained lantus
And that most cats come in once a week for a spot glucose check and they do not do curves. She is very pleased with our chart and taking control of this at home.

spread sheet
https://docs.google.com/spreadsheet...PwJ8HdYC3at0le8fRu7F5y-e29IULOPHL7p-d/pubhtml

 

I also just gave her another 1T of LC pate.

 

Hi Courtney, it's possible that Mabel is getting too much insulin - if she has dipped to 62 at AMPS after a skipped shot yesterday morning and another in the PM on 9/15 (as well as on 9/13) .

Lantus works best when doses consistently - that is the same dose AM and PM. It is a depot insulin and not dosed based on preshots.

I would suggest reducing her dose to 0.5U from today and see how she does. How are you placed with regard to tests? Can you get more than preshot tests or is no one at home to do so?
Was there any food change recently? She has been on Purina DM canned, right?

For this morning, please get another test an hour after the shot?

Link to your previous post:
https://www.felinediabetes.com/FDMB...spreadsheet-dose-increase-and-numbers.252508/

 

Thank you for the help. +1 is in 10 minutes. I will post again.

Yes that's what I thought, The vet said to keep her at 1u but i can't keep skipping a dose every day or she's going to bounce. I don't want them to get upset that we're modifying treatment but I also cant stay up every night because I'm worried about low numbers, and I don't want to mess up multiple cycles because of skipping.

We switched from DM to LC ff a week ago but the carb numbers should be about the same as confirmed by another member here to me last week.

I can only get a pre shot in the morning around 7am and tests again at +9 (4pm) through PMPS and a few hours after PMPS.

 

+1 109 and 110- had a larger sample

 

Can you get another test at +2? This could be just a food bump or the carbs from the MC.

Yes. DM canned is around 6% and FF Pates are around 1-3%. Unless Mable is super-carb sensitive, it should not make a huge difference.

Just a suggestion - any chance you can move your shot time earlier so you can get a +1 or +2 before you leave?

 

Yes I will test again in a half hour for +2. I think the increase might be from the MC food. I am home for the most part today. I would like to do some errands but nothing is critical that can't wait if i have to monitor all day.

We were doing her shot a half hour earlier at 6:30am but I changed it to 7am after a skipped dose the other day. I have to leave the house at 7:30. I can try for a 5:30 shot time but it would definitely be an adjustment. So our test and AM prep and test procedure would start around 5am.

 

+2 143

 

Safe to stop testing till PMPS. Stick with the 0.5U dose for now and see how she does on it.

 

Thanks so much for the help. I can relax now.

 

Agree. Regardless of any fluctuations (unless she hypos obviously) stick to the .5 like Bhooma said. Don't worry about going against the vets advice and "making them upset." We all do it lol and it's YOUR cat.

 

Yes my bf and I just had this conversation, we employ them. Ultimately I have to do what's best for Mable and for our situation. Thank you both.

 

I wanted some thoughts on a convo i just had with our vet. Apparently the dr yesterday that told me her range is 72-175 in the lab and to give a half dose with a low number might have been confusing. They clarified by saying, if her blood sugar is around 65 do not give a shot, then give a half shot for the next dose. And then go back to the regular shot amount the next cycle. So in this instance it would be no shot at 65 AMPS, half shot at night and then 1u the next morning. That doesn't make sense to keep continuing that cycle. So i asked if she could call me back and she recommends a fructosamine so we can see average values of the past two weeks to see if mable actually needs a decrease.

I told them for the next several days we're sticking with .5 and can review at our appointment on Thursday for a"cyst" ultrasound. They don't usually recommend .5 because it can be hard to see where that is on a needle. But I have U100 syringes with .5 markings.

They're also considering smoigy effect and that Mable's higher numbers can be from her suspected pancreatic cyst.

And also that I have to resist the urge to change the dose, unless it needs to be decreased. Which i agree with.

I maybe made the mistake of mentioning the forum but one of the drs there referred me to dr lisa's food chart several weeks ago.

Does anyone have any info? I'm very confused.

 

You are right. It makes no sense at all! Lantus is a depot insulin and not an in-and-out insulin that can be dosed differently each cycle. Lantus dosing is based on nadirs - how low a dose takes the cat and requires consistent dosing (in terms of dose size and times) to work properly.

I would save my $$$ and use my meter to give me an idea of how my cat is doing numbers-wise, rather than a fructosamine test.

Lastly, a cat's insulin needs can and do change, and sometimes very quickly. A dose that was right 2 weeks back could be too much or too little now.

Exactly. With syringes and callipers, you can change doses by as little as 0.125U.

I will not be able to able to comment on the pancreatic cyst aspect but yes, without enough tests much insulin can look like too little insulin. I don't know if your vet is referring to what we call bouncing. And like we discussed earlier, considering Mabel is dropping to the 60s after skipped shots, it does indeed look like she needs a decrease.

And I am confused - aren't they asking you to change the dose depending on the preshots? So how does that tie in with their advice to resist the urge to change the dose?

 

Based on a previous convo a few weeks ago I think they mean don't change the dose to be higher if her numbers are higher. But yes they are telling me to skip and change lower after AM tests. The reasoning for the fructosamine is it will give a truer value of within normal range or higher and that's what they base the dosing req. off of and NOT spot testing??

But last week they told me she needs a spot check once a week in office to make sure her dose is right I declined because of at home testing + they can see my chart.

 

Hi Courtney, and welcome! Mable is a very lovely girl . I'd like to offer a few suggestions, since I noted that you are currently following SLGS. I don't know if you have had a chance to read the dosing method stickies yet? Dosing Methods

Particularly when you are new, still getting a sense of how insulin and carbs affect your cat, and getting lower preshots than you are used to, we recommend here on the sub-forum that if you get a preshot test under 150, to stall, not feed, and retest again in 20 minutes to see if the number is heading back up (without the influence of food), and post for help. Of particular note, with SLGS, we don't recommend shooting under 90, so my suggestion for next time you get a number under 150 is to stall (not feed) and retest.

Also, with SLGS, kitties who get a BG under 90 get an immediate reduction of 0.25u. If you get another preshot under 90 again, you need to make sure that Mable is coming up on her own, and it may require you to continue to stall until you are sure the number is rising. This also depends on your ability to continue to monitor the upcoming cycle if you do decide to shoot.

Here are some general guidelines from the sticky. 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.

That said, you have noted that Mable had been previously diagnosed with DKA, and more recently appears to have had issues with UTIs, so skipping is not going to be ideal. Again, it is best if you aren't sure to post your current BG test, that you are stalling, and ask for help. Given that Mable has had previous DKA, you may need to give some insulin. With a kitty who has previously had DKA, I would also strongly suggest you pick up some Ketostix at the pharmacy and monitor for ketones in her urine on a regular basis.

I'd also recommend getting a before bed test regularly regardless of what the previous preshot number was. We've often found here that kitties like to go lower at night. You've had a few cycles now after skipping, where you were in a situation with low preshots, and no mid-cycle tests, which makes me wonder what she was doing in earlier that previous cycle. With SLGS random spot checks during each cycle help to fill in the missing pieces, and get a better picture of how the insulin is working, and how low the dose is taking the kitty.

Give the 0.5u a try, and see if you can continue to dose both am and pm at the same dose, and see how the cycles go. If you get a BG test under 90, reduce again immediately to 0.25u. If Mable continues to stay above 90, then hold the dose for a week, and run a curve, and assess whether any dose adjustments are required.

Here is a pic from one of the stickies on smaller dosing of what 0.25u looks like, halfway between 0.5u and the zero line:



Questions? I know I've thrown a lot at you in one post

 

I agree with everything Bhooma says. Also, I would not pay for a fructosamine test in this case. Doesn’t your meter have the feature that gives you an average of BG readings for the last 7 days and the last 14 days. Fructosamine tests just tell you what the average BG has been for the past 14 days.

 

Oh by the way, your kitty is gorgeous!