? UPDATE: AMPS 136, need advice. Got a PMPS 88; but then retested, got 107

Update 06/10/2020 morning:
06/09/2020 evening shot skipped
fed at ususal evening shot time
pm+4 test: 118
fed after +4 test
pm+5 test: 154

06/10/2020
AMPS 136, immediate retest 137

I have already fed Nathan, because I don't think his BG will raise even if I stall for 1 hour by looking his numbers from yesterday evening.

So what to do now? Do I skip morning shot again (I am supposed to give him 0.25u if his BG were >200)? Or give him a token dose like 0.1u?

Please give me some advice. I will really appreciate. @Deb & Wink

Thanks a lot.

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Hello everyone,

Today we got Nathan a PMPS test reading as 88. We then retested immediately, and got a reading as 107.

Do I need to reduce another 0.25u dose from tomorrow morning, since I got a 88?

Or should I keep the 0.5u dose, since retest number was 107?

Thanks a lot.

 

I’d think yes but tagging someone who knows more than me @Deb & Wink

 

Yes, please do a reduction in the dose at the next cycle. Yes, the next retest was a bit higher, but Nathan is sending you a message that he needs less insulin.

If the reduction does not hold, then you can increase the dose again. But for now, let's keep Nathan safe and reduce the dose to 0.25U for at least 3-6 cycles, UNLESS Nathan gives you another BG number that is < 90 mg/dL. Then you post for help and need to learn to draw up the tiny doses, 0.1U and "some insulin". You might want to practice drawing up those tiny doses, with some colored water.

Expect a bounce into the higher numbers at pre-shot AMPS on 6/10/20, since you skipped the shot tonight.

If you can, please get at least one more test in this PM cycle for 6/9/20, to see how the skipped shot affected Nathan's BG levels. Would you be able to do that?

Nathan's SS looks very good! I think he may be trying to go OTJ.

 

Thank you very much for your reply.

Yes I will test tonight +4 or +5.

 

Just tested at +4 hour, got 118.

 

Update 06/10/2020 morning:

06/09/2020 evening shot skipped
fed at ususal evening shot time
pm+4 test: 118
fed after +4 test
pm+5 test: 154

06/10/2020
AMPS 136, immediate retest 137

I have already fed Nathan, because I don't think his BG will raise even I stall for 1 hour by looking his numbers from yesterday evening.

So what to do now? Do I skip morning shot again (I am supposed to give him 0.25u if his BG were >200)? Or give him a token dose like 0.1u?

Please give me some advice. I will really appreciate. @Deb & Wink

Thanks a lot.

 

Skipped the morning dose and fed Nathan 3oz canned food.

Tested +1, got 196.

 

Test at +3, got 171
Test at +5, got 128

 

Maybe have Nathan just SNIFF the bottle
Keep up the good work!

 

Next time, if you are around to monitor Nathan and check his BG levels, then try the token dose of 0.1U. These pictures show that tiny 0.1U dose in a U100 syringe, but the concept of where to place the end of the plunger is the same.



Skipping this morning was fine.

Getting Nathan off the dry food has made a big difference in his BG levels. Good job!
Let's hope that he stays down in those blues (100-199 mg/dL) and green (<99) BG levels. Those low blues and greens give his pancreas a rest, and helps him to heal and hopefully start making more insulin for him.

 

Thank you very much.

His PMPS was 147, so I gave him 0.15u.

Should I do the following based on Nathan's recent data? @Deb & Wink
Pre-shot numbers >=200, then shoot him 0.25u.
Pre-shot numbers around 175, then shoot him 0.2u.
Pre-shot numbers around 150, then shoot him 0.15u.
Pre-shot numbers between 100-150, then shoot him 0.1u.
Pre-shot numbers <100, then skip.

 

Sliding scales such you have proposed above often don't work. But sometimes they do.
So go ahead and try your sliding scale. A sliding scale is where you vary the insulin dose from cycle to cycle, based on the pre-shot BG level.

Let's hope that Nathan does ok on that and doesn't bounce.

 

Thank you very much.

I can also do the following if you think it is more appropriate: @Deb & Wink

Pre-shot numbers >=200, then shoot him 0.25u.
Pre-shot numbers between 100-200, then shoot him 0.1u.
Pre-shot numbers <100, then skip.

Please do let me know how you think. I will follow whichever you think is better.

I really don't have much experience dealing with low pre-shot BG numbers.

Thanks a lot.

 

This way sounds preferable to me. Mainly because there are fewer dose changes happening, and less of a chance you will mix up the doses. KISS Keep it short and simple. Keep it simple and straightforward.

It's almost impossible to tell 0.15 from 0.1 in a U40 insulin syringe. A little bit easier if you use calipers or if you use U100 syringes with calipers.

How is Nathan's weight? Is he at his ideal weight, heavier than he should be, lighter than he should be?

 

Thanks a lot. Then I will follow this.

He is 17.5-18 lbs now. His ideal weight would be 13-14 lbs.

I had always planned to get him lose some weight.

But now since he is diabetic, I just let him eat as much as he wants (now he eats 8 oz canned food daily), to avoid ketones.

 

At some point, you have to cut back on the food. Gradually. Maybe 1 teaspoon less per day for a week. Then try 1 teaspoon less in each cycle. See what that does.
Weight loss should be slow and gradual anyway. 2 teaspoons less a day will help with that.
Just like with humans, being overweight can make the body use insulin less efficiently.

You might want to read this thread,
Feed Kitty As Much As They Want?

Are you testing for Ketones? Either with urine ketone test strips or with a meter designed to test for ketones in the blood?
Has Nathan had ketones in the past?

 

Thank you so much.

I read somewhere that a cat needs 20 kcals per pound of body weight or at least 15 kcals per pound of body weight.

His daily calorie intake has been 230-250 kcals for a few months, but he didn't lose weight so far.

His bloodwork on 05/15/2020 showed negative for ketones, and he didn't have a history of ketones before.

I have purchased the ketone blood meter, but haven't started testing for ketone yet.

Should I test for ketone routinely?

Or is there a sign (such as fruity breath or not eating) to tell me it is time to test for ketone?

Thank you again for your kind and useful advices. I really appreciate them.

 

By the time your cat's breath smells fruity, the ketone levels will be pretty high. So you don't want to wait for that to happen, before you test for ketones.
Some people test for ketones daily, some only every few days. It's up to you how often to test. If your cat has ever had ketones, or their appetite is not normal or a cat is not eating as much or not eating at all, then a ketone test is an excellent idea.

Any time there may be an infection or inflammation, would also be a good time to check for ketones. That is because not enough food, not enough insulin and/or an infection/inflammation (think UTI or bad teeth as 2 examples) is the classic setup for ketone formation. Better to catch it early.

The blood ketone test strips can be expensive, so use your best judgement on when Nathan needs a test.

To maintain their weight, that is probably a good general rule for a cat to keep their current weight. But you said that Nathan was several pounds overweight. It's a balancing act, to get an overweight diabetic cat to lose weight and still not lose too fast or not eat enough so their body is burning off too much fat and muscle which leads to ketones being produced as a waste product.

 

Thanks a lot. I really appreciate your advice.