skipping a shot?

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Kristin & Scout

Kristin & Scout

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Hi, I was wondering how low Scout's BG levels would need to be to consider skipping a shot? he is currently getting 3.5 units of ProZinc 2x/day. we just increased from 3 units a few days ago. this is the first time his numbers have been in a normal range throughout an entire day (which I am super excited about!)

Here were his readings throughout today (done on an alphatrak 2 meter):

8:30AM - 157 (before food/insulin)
11:30AM - 93
3:00PM - 82
4:00PM - 75 (freaked out, ran to the store to buy some carb food, gave him half a can)
6:00PM - 115

any advice would be appreciated, thank you!
 
Actually, with ProZinc, you can develop a sliding scale where higher doses are given for higher pre-shot glucose levels and lower doses are given for lower pre-shot glucose levels.

So rather than skipping, you might consider using a lower dose.

As long as he remains above 50 mg/dL on a human glucometer at his lowest, he is safe.
If he is too low to shoot at pre-shot, stall without feeding for 30 minutes and re-test.
 
We generally suggest new diabetics not get a shot under 200. Instead stall. Wait 20 minutes without feeding (which raises bg levels) and retest. You want to be sure the number is rising, not falling and over 200.

After you have enough data to know what he might do, you can shoot at lower levels.

I'm with BJ. If you get an unshootable pre shot, it's time to reduce the dose. The goal is to get 2 shootable pre shots daily.

The protocol we put together for ProZinc is in my signature in blue.
 
oh wow. I'm so glad i have this information now, thank you! I still have a lot to learn.

Scout was diagnosed in the beginning of may (right after his 3rd birthday) and his numbers were always between 300-500. this is the first time I'm seeing anything in the normal range. with getting 2 shootable pre-shots daily, how would i know if he was heading into remission or not? my biggest fear is giving him a shot when i have to leave for part of the day and not being able to test him throughout.

as for tonight, I should test him to make sure his numbers are rising and give maybe a half dose? or would I be better off with less?
 
I think half if you are worried or if you'd can't get some tests in tonight. It's harder to monitor overnight. It may not be enough, but it's always better to be safe. You can always go up in dose tomorrow.

Did you recently changed to wet low carb? That can really reduce the insulin amounts. Or it may be that his body is just learning to adjust to the insulin.

With AlphaTrak, be sure always to mention that when asking for dose advice. It tends to read lower than human meters and we need to take that into consideration. (So our 200 might be more like 230)
 
yes, I switched him over to a low carb wet food diet almost immediately after being diagnosed. he was already eating FF classics 1x/day so all I had to do was eliminate the dry kibble, which wasn't hard for him to give up. is it better to do small meals throughout the day? I've been trying to figure out how much to give him- right now we're at three 3 oz cans of FF and/or Nutro, plus some freezedried treats and I think it's working out, but i'm not sure if I should be spreading the mid-day meal out.

and yes! I made sure to mention the alphatrak in my original post. the strips are expensive though so I might considering switching soon.
 
Lots of people do mini meals, thinking it helps support the pancreas and evens out the cycle. Just take the amount you are feeding and divide into the number of meals you want to feed.

Most people here use the ReliOn meter from Walmart. The meter and strips are the least expensive.
 
Hi, Kristen - Didn't see your post until today - looks like your Scout is doing well!

I use an Alpha Trak 2 meter, too - will you be plugging Scout's BG numbers into a spreadsheet soon? (Really helpful in seeing your kitty's unique BG patterns.) My Bat-cat gets her daily ration split into 4 smaller meals/ daily to help keep her even - but may not be convenient to you if you're not home most all of the time (as I am).

Sue is right-on about using a sliding scale on dosing; although if your kitty's pm meal is at 6 pm (I note that 115 BG @ that time), I would wait to see if Scout's BG rises before the meal - even if you're planning on shooting a reduced dose - as 115 on an Alpha Trak is an awfully low pre-shot #. While I have dosed Bat at a BG as low at the 130's, she is on a VERY tiny dose now (0.15U). Is always better to err on the side of caution where dosing is concerned.

It may be best to to avoid dosing Scout below 150 for now, especially until Scout's BG is regulated at a lower dosage level overall.

Again, would be really helpful if you could plug Scout's #s into a spreadsheet - just be sure you have the Alpha Trak BG range headers at top for your current #s, and then you can switch over to the other (human glucometer BG range headers) if you go with the Relion meter.

What did you end up doing on Sunday night, by the way? Reduced dose ... or what? And can you tell me how much Scout weighs and how much food he gets per day? (Bat eats mostly FF Classic turkey mixed with some Purina DM canned - but we're transitioning out of the DM, as it's sooo expensive & she seems to do just fine with the FF turkey & giblets.)

I think you're doing great, Kristen - keep up the good work! Cheers - Robin
 
Hi Robin! thanks for replying.

I think my meter has a spot to plug something in, but it didn't come with a cord to connect to my computer (unless I lost it), so if I do make a spreadsheet it would take me a while to input by hand.

I usually feed Scout between 7 & 8 and give him his nightly shot of insulin at 8:30. The other day when Scout had his first low numbers, I gave him 1.5 units- i called the vet on monday and she said that was good and told me i can scale it from now on. on Monday morning his BG # was through the roof though (from not getting enough insulin, I assume?).

Scout weighs in at about 12.8 lbs right now (was 20 lb last november 2014, diagnosed in may 2015 at 11ish lbs). the amount of food he gets varies- but usually 3-4 3oz cans of FF/nutro wet food per day. He is very vocal and tries to convince me he is very hungry every second of the day, but when i'm home i try to spread his meals out throughout the day. on a typical day he'll get a 3 oz can between 7-8 am, shot at 8:30, 3 oz can around 2 for lunch, and a 3 oz can for dinner between 7-8 pm, shot at 8:30. i'll give him some freeze dried chicken/beef as a treat/snack and sometimes if i'm up late at night i'll give him half a 3 oz can before I go to bed. he acts like he is always hungry though so sometimes i'm afraid i'm not feeding him enough, although most of what i've read seems like i'm feeding him enough for the time being (he's gonna rob me dry with all this food!). he is moderately active (sleeps less and plays more than any other cat i've ever had). before he was diagnosed he would scream for more food at night and was eating up to 4 cans of food for dinner! which looking back i realize how insanely crazy i must have been for not realizing something was seriously wrong sooner haha

someone told me that i should avoid dry food even when he's getting low numbers- something about it takes too long to get in and out of the system? any advice on that topic?

today i went out for lunch and when i came home and tested him i had a scare- the meter read at 41. i know that is dangerously low and i feel really bad. i gave him a can of carb FF (with gravy). he wasn't acting weird though, seemed normal. and the other day when his numbers were getting low he didn't seem off either. the vet said he could be in the beginning stages of becoming transient. fingers crossed.

thank you for taking the time to reply and taking the time to read my long response. i hope it all makes sense
 
Setting up a spreadsheet would be really helpful for you and for all of us. It will give you a great picture on how Scout is doing and it will help you find any patterns. You may have already stated it, but are you using a human meter? If you are, it would be helpful for you to put that information in your signature.

I also noticed that you mentioned that you give food 1 to 1 1/2 hours prior to your insulin shot. It is good to not give food two hours prior to your insulin shot so Scout's BG number isn't being influenced by food. Food increases the BG number.
 
Kristin & Scout said:
Hi Robin! thanks for replying.

I usually feed Scout between 7 & 8 and give him his nightly shot of insulin at 8:30. The other day when Scout had his first low numbers, I gave him 1.5 units- i called the vet on monday and she said that was good and told me i can scale it from now on.

Scout weighs in at about 12.8 lbs right now (was 20 lb last november 2014, diagnosed in may 2015 at 11ish lbs). the amount of food he gets varies- but usually 3-4 3oz cans of FF/nutro wet food per day.

someone told me that i should avoid dry food even when he's getting low numbers- something about it takes too long to get in and out of the system? any advice on that topic?
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Cindi is absolutely right: Please don't wait 30 min to 1.5 hrs. after the meal to give Scout the insulin. Ck. BG, feed, then immediately shoot (provided your pre-shot # is in safe zone, of course). I get the dose loaded into the syringe when Bat is about halfway through her meal, so that I can administer it right when she's finished up. I'd be hesitant to do much scaling of the dose right now, at least not until you have some sort of a good baseline with Scout - only because sometimes it takes a few cycles before a kitty "settles into" an insulin dose, so too many dose adjustments can cause bouncing, adding to the confusion with his BG #s.

Where food is concerned, don't feed him dry kibble, period: Too many carbs! I'm convinced that's how Bat-Bat became overweight (she used to be close to 20 lbs., too. Only Maine Coons should weigh that much!) Bat gets only about 2-1/4 cans of FF Classic turkey/giblets daily, and her weight is holding steady at a healthy 11 to 11.5 lbs. Would she like to eat more? Sure! But overfeeding her would not help me control her diabetes. I simply learned to turn a deaf ear to her "oh, but I'm starving..." routine, because she's actually not being starved at all. (Took her a while to stop pestering me all the time, though!)

What is your schedule like, btw? Are you gone most of the day for work, or do you work from home?
 
right now I'm usually home during the day (for the most part), but I recently graduated from college so I'm currently looking for a career.

Scout is a siamese mix, so theres really no shutting him up when he wants what he wants haha most of the time I think he talks just to hear himself talk.

what do I do if his # is in a safe zone before food? give the normal units of insulin? or only if his #s are high pre-shot?
 
Kristin & Scout said:
what do I do if his # is in a safe zone before food? give the normal units of insulin? or only if his #s are high pre-shot?
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Yes, if he's in the safe-to-shoot zone, feed him & shoot his usual dose of insulin. It's great to know you're mostly at home (until you start your new career), as you can test him to see where he's hitting his nadir. If he drops too low at nadir, then you can steer with a little food. (Bat-Bat actually hit the hypo zone twice this month (6th & 15th) - crazy! But I gave her some FF right away, & her BG was right back up into the green zone within 15 minutes.

I'm really looking forward to the Alpha Trak spreadsheet that Sue has offered to set up for you. (Sue's a jewel!) That will make it so much easier for you (and the rest of us) to see at a glance what Scout's numbers are doing.

We had Siamese cats at home when I was a kid; my mom was a breeder for a while. Ha, they are VERY vocal all the time. I always got a kick out of that!

Congratulations on your graduation, Kristin!!!
 
Yep, the spreadsheet is super helpful! We're all used to looking at it and it helps us help you. The colors on it really help us to see what's going on, as sometimes we can just zoom out and focus on the different colors, which help us to see patterns. Sue's excellent and does a great job helping set up the spreadsheets!

And yes! Congrats on graduating!!
 
Understanding the spreadsheet/grid:

The colored headings at the top are the ranges of glucose values. They are color-coded to clue you in as to meaning.

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
 
With ProZinc, stall 30 minutes without feeding and re-test. Then, if rising and/or over 180 mg/dL on the AlphaTrak, you might shoot a reduced dose.
See if you can open the following link and make a copy which will be in your Google account.
AlphaTrak spreadsheet
 
No, you need to File, Make a Copy, not edit it.
Once you have a copy in your own Google Account, you can double click on the label in the upper left corner to change the name and double-click on the bottom tab if you want to rename that, too.
 
So, are you at +12? You could stall - wait 20 minutes without feeding and retest. If you get 200+, you could shoot but maybe a little less than the last shot.
 
The most recent couple of weeks is most important as they reflect what is happening currently. Add the rest as time permits.
 
Just want to summarize and combine Robin's and my thoughts regarding testing, feeding and shooting.

Two hours prior to your "pre-shot", you do not want to feed your kitty. That way, your BG number is not based on food as food typically increases the blood glucose. So no food two hours prior to your AMPS and PMPS. Then you test, feed and shoot all in about 10 minutes. So you test, (confirm you have a shootable number), feed (because you want a little something in their stomach), then shoot either while they are eating or just as they are done.

Hopefully, that makes sense.
 
It doesn't look like it is going to come up soon enough. I think you will have to skip.

So tomorrow the amps will probably be high. But I would still reduce your last dose. I think it was 1.5, is that right? If so, .75 would be a conservative dose. One unit might be okay but could give you some lower numbers. It depends on what makes you most comfortable.

This probably seems a little scary. It is hard to decide how much to reduce. But this is really good news! The diet and the insulin are starting to work together and he is needing less insulin.
 
okay. i think i'll skip for tonight just to be safe. better to be high than low, right?

so i should check tomorrow morning and even though his numbers will probably be high i should still shoot with a low dose? i'll be sure to post here to get input before
 
Good morning! Yep, this morning, go ahead and check his BG. If it's above 200, I'd shoot the reduced dose like Sue suggested. More than likely his number will be high since he didn't get a shot last night. That's okay. Even though it doesn't seem right, the higher number will still warrant the lower dose. Since his PMPS was so low, you want to lower the dose to avoid getting such a lower number at preshot again. The goal is to have 2 shootable preshots so that insulin can be given consistently.
 
Hi Kristin.
What an adorable photo of Scout! I love how he is posed. Glad to hear you are getting a spreadsheet up and running, it will help so much.
I am quite new here myself, and just recently switched to ProZinc, so I am reading through all your posts and replies to reinforce my own knowledge! Maybe I won't have to ask so many questions *someday* :)
I do use the Walmart ReliOn Prime glucometer, works great now that I'm accustomed, and believe me, you will appreciate the cheaper strips!
Sounds like you're doing all the right things and have come to the right place.
All the best!
 
Sounds good, Kristin.

Let us know if you need help with the spreadsheet. Getting it in your signature is the next step so we know what is going on at a glance.
 
Sue and Oliver (GA) said:
Sounds good, Kristin.

Let us know if you need help with the spreadsheet. Getting it in your signature is the next step so we know what is going on at a glance.
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Sue & BJ - Are you setting Kristin up with 2 pages - 1 each for Alpha Trak 2 & Relion meters? (As sounds like she may be switching over to the Relion human glucometer in the near future. )
 
We can do that. Right now she has the AlphaTrak but we'll just do another one for ReliOn and she can have both in her signature when she switches over. Thanks, Robin.
 
Kristin & Scout said:
okay. i think i'll skip for tonight just to be safe. better to be high than low, right?
i'll be sure to post here to get input before
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Wow, Kristen - Sure looks like Scout's responding & needs a dose reduction; definitely was too low to shoot last night. (You handled it just right)

Sue's recommendation sounds good to me! Don't worry, it just takes a little time in the beginning to find that "sweet spot" where the dosing is concerned. You'll get there. Hang in! Looking forward to your next update.
 
good morning! still working on scouts spreadsheet, but it's coming along.

without his shot last night, he tested at 403 this morning. I did half a dose (2 units) and will monitor him throughout the day!
 
Tucker&Me said:
Hi Kristin.
What an adorable photo of Scout! I love how he is posed.
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thank you!! I take a lot of pride in his modeling pictures :cat: he is very cooperative and tolerating of me. here is one more I think you guys might enjoy! Halloween 2014
 

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Kristin & Scout said:
good morning! still working on scouts spreadsheet, but it's coming along.
without his shot last night, he tested at 403 this morning. I did half a dose (2 units) and will monitor him throughout the day!
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Adorable photo, Kristin! Will be good to see all Scout's #s plugged into the SS. I'm a little confused re: dosages - Scout had been on 3.5U; you reduced to 2U this morning in view of the skipped shot last night ... am I understanding that correctly?
 
Not necessarily, but would need to see his numbers from yesterday. I'm assuming you're monitoring today, too?
 
The spreadsheet works! Looks like the pmps might be low again. Darn! You might try giving him a snack around +7/8 to bring him up when he drops
 
+7/8 is right around now! i just gave him half a can of FF. he did eat a full 3 oz can for lunch right before 2 (+5ish) and his pre-lunch shot was 203
 
So great to have a SS for Scout! Maybe that snack you just have him will help pull his # up by PMPS time. So far, so good! I know it can be frustrating when he drops too-low-to-shoot, but hang in - Scout's responding pretty darned well, all in all.
 
Oops, didn't proof my last post: That was supposed to be "snack you just gave him." My bad. (My bad typing!)
 
Kristin & Scout said:
+7/8 is right around now! i just gave him half a can of FF. he did eat a full 3 oz can for lunch right before 2 (+5ish) and his pre-lunch shot was 203
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Hey, Kristen - Check your Inbox at top right, near where you log in. Sent you a quick note this a.m. - just wanted to make sure you saw. - Robin
 
So, 2 units on the 400 caused more than a 50% drop todayAnd 303 to 41 yesterday. I think it's too much. What would you think about a restart to one unit? You can raise it based on your testing rather than trying to guess how much to reduce. What do you think?

Even with the reduction, I'd get a +2 to see how he's headed.

If your gut says one unit sounds like too much, you could even do a restart of .5. It may not be enough but you can always slowly raise it.
 
I agree with Sue's recommendation of 1.0 unit tonight, with a +2 check (maybe even a +3, as well?) after, since 1 unit is only half as much of the dose that dropped him more than 50%.
 
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