? 10/31 PMPS 146—how much insulin do I give?

Starting the morning unusually low—waiting 20 minutes and will test him again.
Previous thread:
https://www.felinediabetes.com/FDMB/threads/pmps-224-10-18.237002/#post-2663528

 

83 at 20 minutes

 

I guess we are skipping this morning? Please let me know if I’m doing something incorrectly.
I fed him breakfast. He ate normally.

 

LOL I dont think you have a choice

 

@Panic @JanetNJ does this warrant a .25 decrease beginning this evening?

 

Don’t think so either! Haha. Could this be indicative of his pancreas starting to “wake up,” or just a fluke?

 

Either or...He is after all a...cat

 

Indeed!

 

Yes. . Good luck

 

Perfect! I will do 3.25 tonight. Thank you so much!

 

299 PMPS—not too bad considering he didn’t have his AM dose.

 

Absolutely!

Good call on the skipped dose this morning, even if that did cause Little Bit to trend higher and get that PMPS of 299.

 

Thank you! Glad he earned a decrease.

 

Little Bit is at 168 this morning—do I give a token dose? @JanetNJ @Panic @Deb & Wink

 

He’s at 162 now

 

I gave him .5F

 

Overslept this morning, sorry! Did you give .5 or .75? It says the latter on your spreadsheet

 

I was going to do .75 at first, but changed my mind to err on the side of caution. Will fix it now! Hope you’re doing well!

 

Next time you get a low preshot, try stalling up to an hour without feeding and see if it's going up.

 

Glad you got some replies. I was off running errands today. Not enough time in the mornings to be on the message board for at least another month to 6 weeks.

 

Yes ma’am, thank you!

 

Thank you! Hope all is well.

 

Little Bit is at 149 PMPS—waiting 20 minutes to test again.

 

Nice pre-shot!

 

Go LB! If it doesn’t budge much in 20 minutes, should I give .5?

 

You know, I am thinking LB is seeing a lot of low yellow pre-shots with a few blues mixed in. You may want to consider lowering your full-dose number and/or giving smaller reductions when he's so close to 150. I think 0.5u is a little low for him being a 3.25u kitty. Maybe we need to consider that new reduced dose being higher, perhaps 1-2u? @Deb & Wink would I be on the right track with LB?

 

150 now

 

You know best! I will give him the dose you feel works for him. So maybe 1.5 units tonight? And reduce his normal dose?

 

I think 1.5u might be good! Keep an eye on him of course. And not sureee about the reduction, he hasn't "officially" earned it but it is sometimes better to have higher pre-shots you can shoot regularly so maybe.

 

I gave him 1.5 tonight. What should I start giving him regularly in the morning? 3.0?

 

I would try for 3u UNLESS Janet or Deb have a different suggestion.

 

Thank you so much! I’ll tag them @JanetNJ @Deb & Wink

 

149 and 150 are basically the same number.

The decision point threshold, sometimes called the shoot/no-shoot number, is 150 for Prozinc.
With the MPM protocol you are following, the dose reduction BG is 50. So no, Little Bit has not earned a dose reduction.

So some questions to ask yourself when you get a pre-shot that is lower than normal, include:
Do you have plenty of test strips, is your hypo toolkit well stocked, can you stay up and test if needed and support Little Bit's BG levels with food?

It's ok that you only gave 1.5U for tonight, but the MPM protocol is more aggressive on when you should give the full dose, instead of a token dose.
I'd expect Little Bit to bounce high in the AM tomorrow, into the pink or red or even the black BG ranges after that token dose you gave tonight on 10/27/20.

Little Bit is more than 1 year since diagnosis so he's considered a long term diabetic, you are using a human meter, and the nadirs are over 200. So I'd hold that dose steady for now, and think about increasing the dose in the next cycle or 2 if you don't see nadirs <100 real soon.

A BG of 150 is perfectly shootable for the full dose, as long as you are able to monitor frequently and can provide food access with the testing, such as with a timed feeder or small snacks while you are monitoring.

 

Thank you. I will plan to increase his dose to 3.5 soon if nadirs don’t drop. I don’t expect they will since they have not yet.
What number range do you suggest for a token dose and how many units would be the token dose? What would the “no shoot” number be? I want to make sure I’m clear so I can do my very best for him.
I am beyond appreciative for you, @Panic & @JanetNJ.

 

+2 is 179

 

I think I'd stay with 3.25 for now.

 

AMPS 315

 

Thank you, Janet. We will stay with that dose.

 

Hugs to you, Jeanne!

 

PMPS 146 @Panic @JanetNJ — should I give the full dose?

 

He did eat

 

I think based off Deb's comments about the aggressiveness of MPM you would want to give full dose as long as you can monitor since it's basically 150, though it would have been nice if you were able to stall to confirm he's heading up on his own.

LB doesn't give you many options to shoot in between though to taper down the dose, he seems to either do well above 200 or below 150, no in-betweens.

Above Deb does say a BG of 150 is perfectly shootable as full dose, provided you of course have hypo supplies on-hand and can monitor.

 

I did see that Deb recommended the full dose. I was just a bit scared and hesitant. Sorry I didn’t stall! We were having trick or treaters and I wasn’t thinking while feeding on time.
I will give him the full dose since you and Deb deem it to be safe. I have a new vial of test strips and new box of lancets. I have about five cans of gravy FF and some karo syrup.
I was actually considering increasing to 3.5 before today—and now he throws me for a loop!

 

Oh, and I have temptations! Haha

 

Get that +2 BG test. That can often give you a good idea of where the BG levels are headed.

 

Yes ma’am I will! I will stay up a bit later to monitor him tonight.

 

Al right then! Sorry for the "drill sargent" thing, about getting that +2. But it is a good indicator of where the BG levels are headed.

Hope the trick or treaters have been fun. Even if they did "sidetrack" you from stalling without feeding.

Posting the +2 info for you again. To help guide you.

That +2, With Prozinc by Deb & Wink

More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

The steeper the drop, the higher the bounce.

It's a balancing act.

The +2 is like an "early warning" for most cats!
If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again. (About the same means taking meter variance, that 15% variance that hand held glucometers are allowed to have into account)
If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

It also kind of depends on what BG pre-shot your cat started out the cycle with. Lower than normal, keep a closer eye on the cycle. Lower than you are used to shooting, a number you may not have given insulin before, keep a closer eye on the cycle. Stalled and number rose some, but you did a reduced shot, maybe another test or 2 to see how much the number is rising.

It makes a big difference if your cat starts the cycle in the pink 300-399 mg/dL range (16.6 - 22.16 mmol/L) then if they are in the blue 150 mg/dL range ( 8.3 mmol/L).

p.s. Food notes in the Remarks column can be very useful. Helps to interpret what is happening in the cycle. Notes are done on AM and PM cycle basis and notations need to be with the + time format.

 

I would have said stall 30-60 min without feeding and recheck

 

I’m sorry. I should have known to do that by now. :/ I was discombobulated.

 

No worries at all! I truly appreciate all advice y’all are so kind to give me. I will start doing a +2 for each cycle. AM might be a little late because I teach live until his two hour mark. I have not read the information you attached about the +2, so I am grateful.

 

In order to taper down his dose, he would have to go below 100 for each .25 decrease?

 

318 now for +2! What in the world?

 

313 +4

 

Looks like LB might possibly be bouncing.


Mogs
.

 

Below 90

 

Thank you. Maybe we will get there soon!

 

He must be; he’s at 354 this morning. Mind boggling after a low-ish PMPS and full dose.

 

+2 is 269

 

He may have gone lower at nadir in the hours preceding that lowish PMPS and the bounce may have already been building when you got that preshot reading.


Mogs
.

 

Good point! That is definitely possible.

 

We all get "discombobulated" at times. No worries.

Yes, you want him to drop <90 mg/dL on a human meter (like the Relion you are now using), to earn a dose reduction. Per our dosing protocols fro Prozinc.

It's hard to juggle everything, when you teach from home and have a diabetic cat that is going a bit low.
If it's easier to get a +2.5, that's fine. Simply note that time in the +2 column on the SS, and manually color code the cell.

Do the best you can. That's all that anyone can be expected to do.

 

PMPS is 151. I have stalled for now. Test again in 30 minutes, correct?

 

No trick or treaters to bother me tonight! Haha

 

Thank you

 

They never come around here TG Hoping you have an uneventful evening. I'm off for now.

 

Thank you! Have a relaxing evening

 

LB is still enjoying Halloween. He is under our spider from the candy chute my husband constructed.

 

New thread: https://felinediabetes.com/FDMB/threads/pmps-151-11-1.237954/