02/19 Salem - Numbers confusing...

[Rin & Salem]

02/16 POST HERE

Last night was day 4 since the bounce numbers mentioned. His AMPS was still around 300 and unfortunately I was unable to test him mid day as usual. His PMPS last night was 171 and I decided to wait on shooting because I feel like his regular dose would still be too much to shoot.

After a few hours he dropped to 166, so I made the decision to do 25% again... and then he was 153 a few hours later. (By this point it was 4:30AM and I hadn't slept..) And now as of this morning about 1.5 hours before shot time, he's back up to 338..

I know people can't really give dosing advice here but I'm wondering if I should be reducing his dose again since once these bounces clear he's starting to see under 200 pre-shot numbers? The token doses are clearly not the right choice but even with a hypo kit I'm really scared of something happening overnight.

(He has not had his morning shot yet since I had to push off his PM shot last night)

 

[Rin & Salem]

Ended up just giving his normal dose this morning... 336.. will do more testing today..

I've given him a regular dose at 188 before, so I don't know why 171 scared me so much. I guess just because it was during the night? I don't know.

 

[Jessica & Indy]

I feel you. Whenever it is slightly different at night, I want my sleep and I'm afraid to give a full dose.

 

[Rin & Salem]

I feel you. Whenever it is slightly different at night, I want my sleep and I'm afraid to give a full dose.

Honestly, considering I stayed up til 4:30 anyway, I could have probably just shot his normal dose and stayed up testing since my roommate wakes up at 5AM to work. They work from home so they could likely just keep an eye on him while I slept.

 

[Mary & Jude]

Hi Rin! People can and do give dosing guidance here! It's just that not everyone on the board feels comfortable giving it (and, personally, I appreciate those self-restraints).

Because Lantus is a depot drug, with each change in the dosing (e.g., shorting the dose), you run the risk of getting wonky numbers. When you start with Lantus, it takes 5 - 7 days for the depot to form and stabilize. With any change in dose, you have to factor in how the depot works. It can take up to 3 days/6 cycles for the depot to "catch up" with the dose change.

Following SLGS, here are the guidelines for increasing:

"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

As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change)."

Let's see if we can get someone with dosing experience to weigh in and offer some guidance: @Bandit's Mom @tiffmaxee @Christie & Maverick

 

[Bandit's Mom]

To add to what @Mary & Jude said above, it can be scary to shoot lower numbers at first, but with time you will find that his cycles become more flatter and predicable as you shoot lower and lower preshots. The preshot does not necessarily determine how a cycle will play out. You can have a pink preshot and drop to lime and have a wonderfully flat cycle when you shoot green and blue!

BTW, could you please add SLGS to your Signature as well? I see it in the SS.

Would he be OK without the kibble? We've found that even low carb kibble can affect the numbers of some kitties. One (not so) recent example I can think of is Pookey who went into remission after @Tim & Pookey stopped the kibble.
Pookey's Spreadsheet

 

[Rin & Salem]

To add to what @Mary & Jude said above, it can be scary to shoot lower numbers at first, but with time you will find that his cycles become more flatter and predicable as you shoot lower and lower preshots. The preshot does not necessarily determine how a cycle will play out. You can have a pink preshot and drop to lime and have a wonderfully flat cycle when you shoot green and blue!

BTW, could you please add SLGS to your Signature as well? I see it in the SS.

Would he be OK without the kibble? We've found that even low carb kibble can affect the numbers of some kitties. One (not so) recent example I can think of is Pookey who went into remission after @Tim & Pookey stopped the kibble.
Pookey's Spreadsheet

Hi, thank you both for the info.

I'm not sure - we did try him without kibble before, and I don't think I saw any drastic difference. I wouldn't be opposed to trying wet only, I just know it'll get more expensive.

I'm trying my best to not get so nervous about the lower shot numbers. It just always seems to be at night that his numbers like to play games with me, but I know I've shot around that range before but I think my anxiety made me forget to check previous numbers.