Do I Shoot This AM?

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Sandi & Chase in AZ

Sandi & Chase in AZ

Member Since 2017
Good Morning,

Chase has a BG of 206 this morning. I thought someone linked his spreadsheet here but I don't see it. Does anyone else see it? I'm still new here and learning the ropes.
 
I don't see it... but if you go to File > Share on the spreadsheet, you can copy the link, then hover over your username at the top right of the page and go into Signature. There, you can type a name for the spreadsheet, highlight it, click the link icon, and paste the URL.
 
Also, are you following TR or SLGS? 206 is a shootable number with either protocol. If you get 150 or below for the first time, it's advised to stall and test again in 30 minutes to see if it's rising or still dropping.
 
Can you see it? I'm not following either, yet. I just got the spreadsheet yesterday and will be starting SLGS this weekend. I had been following the advice of a vet, but won't be doing that anymore as it was very conflicting with advice here. He's had insulin on and off, but only 1 unit. I guess I'll just give him the 1 unit since I don't know what else to do. I have to get ready for work so I don't have much time to stall. He just finished eating.
 
Hey Sandi. I can see your SS. It is a shootable number and I would shot if you can monitor today and have plenty of test strips and MC and HC food on hand if you should need it. Did you shoot last night, I don't see any number in the unit box. But that said, you don't have a lot of data as of yet.

ETA: I just saw that you are leaving for work and can't monitor so if you did shoot, I would leave some MC food for him for his next snack. Is it possible for you to come home to check on him?
 
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I did not shoot last night. As I said, I had been following the advice of a vet who told me to shoot only if he was above 250. I work all day and can't monitor him. His lowest BG ever, since our journey began, was 113. He's not yet had any kind of hypo event. So I guess I just don't know if I should shoot regular, shoot low, or don't shoot at all. The only time I've ever monitored him is when I increased his Lantus or when I did his first curve, and then last Saturday when his BG was at it's lowest with the 113. He has been responding extremely well, so far, as he has only been on insulin for just under a month.

I don't know what MC means. I guess HC means high carb. I'm still very new, here.
 
Thank you. I am comfortable with not shooting. I will see what his number is this evening and go from there. If I ever seem to drop out of sight it's because my computer constantly crashes. :(
 
Sandi & Chase in AZ said:
Thank you. I am comfortable with not shooting. I will see what his number is this evening and go from there. If I ever seem to drop out of sight it's because my computer constantly crashes. :(
Click to expand...
I think I like that idea of no shot since he didn't get one last night and he is in a low yellow number and you can't monitor.
 
I'm sorry....the SS not being linked was my fault and I'm glad you got it up, Sandi.

Just as an opinion, there is no reason you couldn't have shot a 206 and left plenty of food out for him...medium carb (11-15/16%) would have been fine. We need to work towards getting Chase regular shots about every 12 hours even if that means dropping the dose back a bit.

There is also no requirement for you to decide right away which method you follow; however, from what you told me about your work schedule in a PM while we were working on getting your SS going, I think your decision to start SLGS this weekend is a good one at least until you get your feet on the ground with managing FD and work.

With SLGS, you don't shoot below 90 which is also your reduction point.
 
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Sandi

I meant to get back to you earlier but I knew you were working. Before I did any dose adjustments, I think I’d run a curve on Saturday during the day and then also do some random spot tests Saturday night and Sunday, to see what he might be doing. That might give you a better idea of what to drop his dose to so you can shoot twice a day. He’s responding to the insulin and so I’d hate to see you drop him too low without knowing what that needs to be and then have him stall out in yellow.

It would be good if you could get a preshot test before you shoot every single time. For daytime cycles when you have to go to work, I’d get an “out the door” test so if you shoot at 6:15 and have to leave at 7:15, i’d test before you leave. If you get home by +10 or +11, I’d get a test and then another at PMPS. It would also be great to always get a +2 and a before bed test every single night. This way, you start to build some data so we can see where he’s going and what his insulin needs really are.

At night, if you get a +2 test and it is similar to or lower than the preshot, that’s a sign that he might have an active cycle where he drops down to nadir and then heads back up.

There is a lot of info to read and I’d suggest starting with the stickies at the top of this insulin support group. And let us know where you have questions.....we love questions!

BTW, we have a manner in which we post our subject line which helps all of us helping because we can scan the list, look at the numbers, and see how everyone is doing. You will find a lot of great info in this post on How to Make the Most of your Lantus/Levemir ISG Experience.

We ask that all members post their subject line in the following format:
Date Kitty’s Name AMPS/AMBG xxx +2 xxx +5 xxx PMPS/PMBG xxx +2 xxx

where xxx is the BG. AMPS is A.M. preshot or the BG you get before you shoot and AMBG is used if you do not shoot (A.M. Blood glucose). PMPS is P.M. preshot and PMBG is P.M. blood glucose if you don’t shoot.

The + numbers are hours since the shot and so those will vary depending on which tests you do that day. I put those up as an example but, as I said, they vary. As you get a test number, you add it to the subject line.

If you have any questions you need answered, you can select the “?” from the dropdown box next to the subject line. We just ask that you take it down once your question is answered. If you need to catch our attention, as in today, you could do something like:

2/16 +12 Chase 206 Need help shooting

Once you had decided to not shoot, you would change it to:
2/16 Chase AMBG 206
 
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Seems like I'm hurting Chase more than helping him.

He tested at 304 this morning so I shot 1/2 unit. I'm feeling like I'm messing up BIG time.

My home computer is so slow that I just can't seem to get any input in the mornings. I'm feeling so discouraged right now and I was feeling so inspired.

The spreadsheet and the way I should do my subject lines... it takes me a while. I'm so sorry.
 
Now I can't even update the spreadsheet and I'm sure the only 2 times I tried to log his numbers on my own... were wrong. I don't know why I can't edit the spreadsheet, now. :(
 
Oops! I sent you here from your other post and you've already posted. I recall referring you here yesterday ...

Even if you're having SS issues, you can still post data here for advice. Here are some questions to get started:
  1. Have you read and understood the comments made by others here on this thread?
  2. Did you understand how you're supposed to set up your thread title? It's done this way so readers can skim down the list of posts to look at numbers and decide who needs help. Put a question mark icon at the front of the title if you want faster attention.
  3. Have you read the info stickies on the two dosing protocols, TR and SLGS ? Which one works best for you?
  4. Do you have half unit marks on your syringes? If not, buy some syringes that do because the protocols recommend 0.25 u dose changes. These can be eyeballed if you have half unit marks but it's much harder with only full unit marks. With doses as small as you're giving, a tiny difference can have a huge effect.
  5. Read and reread the info sticky on how a depot insulin like Lantus works. That will help you understand why twice a day, consistent dosing is important. The stability of the insulin depot is key in getting Lantus working as well as it has the potential to do.
I certainly appreciate how scary and confusing all this is and the learning curve is steep. The folks here can guide you through the maze better than most vets can but you have to be willing to do some homework and follow advice as you learn the ropes. Eventually your training wheels will come off and your confidence will be much higher.

I'm sorry if l sound bossy. I'm trying to give you concrete things to do right now to get you and your kitty on the right track. Don't give up - you can do this! :)
 
Try not to be discouraged. Everything will fall into place. There is a lot to learn and it is overwhelming at first.
I have computer issues too and that really adds to the stress and frustration.
I hope you will be able to run a curve this weekend, and also get as many spot checks as you can.
 
Kris & Teasel said:
Oops! I sent you here from your other post and you've already posted. I recall referring you here yesterday ...

Even if you're having SS issues, you can still post data here for advice. Here are some questions to get started:
  1. Have you read and understood the comments made by others here on this thread?
  2. Did you understand how you're supposed to set up your thread title? It's done this way so readers can skim down the list of posts to look at numbers and decide who needs help. Put a question mark icon at the front of the title if you want faster attention.
  3. Have you read the info stickies on the two dosing protocols, TR and SLGS ? Which one works best for you?
  4. Do you have half unit marks on your syringes? If not, buy some syringes that do because the protocols recommend 0.25 u dose changes. These can be eyeballed if you have half unit marks but it's much harder with only full unit marks. With doses as small as you're giving, a tiny difference can have a huge effect.
  5. Read and reread the info sticky on how a depot insulin like Lantus works. That will help you understand why twice a day, consistent dosing is important. The stability of the insulin depot is key in getting Lantus working as well as it has the potential to do.
I certainly appreciate how scary and confusing all this is and the learning curve is steep. The folks here can guide you through the maze better than most vets can but you have to be willing to do some homework and follow advice as you learn the ropes. Eventually your training wheels will come off and your confidence will be much higher.

I'm sorry if l sound bossy. I'm trying to give you concrete things to do right now to get you and your kitty on the right track. Don't give up - you can do this! :)
Click to expand...

I have done a lot of homework. I have other things going on, as well. I am doing the absolute best that I can. I'm burnt out, and emotional. Sorry I was complaining. I am grateful to have Chase and he is my life. I would do anything for him. It's just that my job has been insane, and I have an adult child that has needed my help every other weekend, which has taken me out of town. I am following advice here, but it's not always the same coming from different people. :( And I'm sorry... I don't remember seeing this post yesterday.

What is SS? Is there somewhere that shows what all of these terms mean?
 
Julie and Eleanor said:
Try not to be discouraged. Everything will fall into place. There is a lot to learn and it is overwhelming at first.
I have computer issues too and that really adds to the stress and frustration.
I hope you will be able to run a curve this weekend, and also get as many spot checks as you can.
Click to expand...

Thank you, Julie. I'm a bit of an emotional mess today. :(
 
Kris & Teasel said:
Oops! I sent you here from your other post and you've already posted. I recall referring you here yesterday ...

Even if you're having SS issues, you can still post data here for advice. Here are some questions to get started:
  1. Have you read and understood the comments made by others here on this thread?
  2. Did you understand how you're supposed to set up your thread title? It's done this way so readers can skim down the list of posts to look at numbers and decide who needs help. Put a question mark icon at the front of the title if you want faster attention.
  3. Have you read the info stickies on the two dosing protocols, TR and SLGS ? Which one works best for you?
  4. Do you have half unit marks on your syringes? If not, buy some syringes that do because the protocols recommend 0.25 u dose changes. These can be eyeballed if you have half unit marks but it's much harder with only full unit marks. With doses as small as you're giving, a tiny difference can have a huge effect.
  5. Read and reread the info sticky on how a depot insulin like Lantus works. That will help you understand why twice a day, consistent dosing is important. The stability of the insulin depot is key in getting Lantus working as well as it has the potential to do.
I certainly appreciate how scary and confusing all this is and the learning curve is steep. The folks here can guide you through the maze better than most vets can but you have to be willing to do some homework and follow advice as you learn the ropes. Eventually your training wheels will come off and your confidence will be much higher.

I'm sorry if l sound bossy. I'm trying to give you concrete things to do right now to get you and your kitty on the right track. Don't give up - you can do this! :)
Click to expand...

Thank you for your suggestions, Kris. I will print this all out and take it home to read this weekend. :)
 
Sandi & Chase in AZ said:
I have done a lot of homework. I have other things going on, as well. I am doing the absolute best that I can. I'm burnt out, and emotional. Sorry I was complaining. I am grateful to have Chase and he is my life. I would do anything for him. It's just that my job has been insane, and I have an adult child that has needed my help every other weekend, which has taken me out of town. I am following advice here, but it's not always the same coming from different people. :( And I'm sorry... I don't remember seeing this post yesterday.

What is SS? Is there somewhere that shows what all of these terms mean?
Click to expand...
I apologize if you felt I was pressuring you, Sandi. I only posted this today. SS means "spreadsheet". If you ask for advice from the experienced Lantus folks you should be getting fairly similar advice. Having said that, this is a peer-reviewed forum so people will jump in to disagree or suggest a modification to a piece of advice. That's how the whole thing works. None of us is a vet so we rely on many pairs of eyes on the posts here to keep the information useful and safe. Ultimately, you make the final decision for Chase.

I saw this post in the list of L&L forum posts. It should help:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-land-slang-dictionary.1903/#post-1891178
 
Kris & Teasel said:
I apologize if you felt I was pressuring you, Sandi. I only posted this today. SS means "spreadsheet". If you ask for advice from the experienced Lantus folks you should be getting fairly similar advice. Having said that, this is a peer-reviewed forum so people will jump in to disagree or suggest a modification to a piece of advice. That's how the whole thing works. None of us is a vet so we rely on many pairs of eyes on the posts here to keep the inforamtion useful and safe. Ultimately, you make the final decision for Chase.

I saw this post in the list of L&L forum posts. It should help:
http://www.felinediabetes.com/FDMB/threads/lantus-levemir-land-slang-dictionary.1903/#post-1891178
Click to expand...
Oops! I see that Julie gave you this link too.
 
Sandi & Chase in AZ said:
I'm going to do another curve this weekend. :)
Click to expand...
You're doing great Sandi. From one newbie to another, just breathe. Our furbabies are our lives, our hearts. Have confidence in your abilities. And when you don't the members here are wonderful at reminding you. I need it often. It will start making more sense everyday. Good luck to you and your furbaby. :bighug::bighug::bighug::bighug:
 
Sandi, on your thread in the Health Forum, you mentioned that you had decided on SLGS. Below is a copy from the sticky on giving insulin when you get lower than normal preshot test. I thought this might help you a little bit, especially since you are concerned about when to shoot, etc. You are doing just fine!!!! I highlighted one title in red for you.


How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

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.
If the preshot number is near usual preshot numbers:
  • Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.
 
Shoeskitty said:
Sandi, on your thread in the Health Forum, you mentioned that you had decided on SLGS. Below is a copy from the sticky on giving insulin when you get lower than normal preshot test. I thought this might help you a little bit, especially since you are concerned about when to shoot, etc. You are doing just fine!!!! I highlighted one title in red for you.


How to handle a lower than normal preshot number:

In the beginning we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.

With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus and Levemir users following the Start Low Go Slow approach:

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.
If the preshot number is near usual preshot numbers:
  • Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, your goal is to achieve flat numbers that are greater than 90, so there is no need to push a cat into numbers lower than that.
Click to expand...

Ohhhh... thank you, so much. I think I printed this out to read at home this weekend. But just in case, I'm going to print it right now. It's great info.
 
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