How to treat Low number

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Janel and Alabaster

Janel and Alabaster

Member Since 2017
Hello,
This morning my kitties BG preshot was 51. We did not give him his Lantus. I was concerned with such a low number so I gave him his Fancy Feast Friskies Gravy to raise him up. Was this the best action to take? I had to leave for work so I hoping this will raise him up. Thank you
 
You were right not to shoot. If possible the best approach to not feed and check again in 20 minutes. You still would not shoot since you won't be able to monitor but would know if he was starting to come up on his own. Leave food out when you leave when this happens again. Cats often drop during the night. Max did that to me often but it always was a surprise. Looking at your ss it looks like in this case a bounce was cleared quickly. Even though he didn't drop under 50 I would think about a dose reduction so that you can shoot twice a day. He's getting a really good response to lantus. :D
 
Okay, thank you. I hope by giving him the gravy I'm not going to raise him up to high. :( I just hate that I have to go to work when I'm nervous about his numbers. We are dosing him twice a day at 630am and 630pm. Do you think we should be lowering his Lantus? Thank you for saying he's responding well.. I feel like I'm failing with this. But, we're trying! Oh, and I'm sorry, could you clarify what a "bounce" is? Does that have to do with his depot?
 
Janel and Alabaster said:
Okay, thank you. I hope by giving him the gravy I'm not going to raise him up to high. :( I just hate that I have to go to work when I'm nervous about his numbers. We are dosing him twice a day at 630am and 630pm. Do you think we should be lowering his Lantus? Thank you for saying he's responding well.. I feel like I'm failing with this. But, we're trying! Oh, and I'm sorry, could you clarify what a "bounce" is? Does that have to do with his depot?
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You did the right thing this AM. Have you considered trying the same dose AM and PM? It might give you more PS consistency.
 
Okay, thank you. We want to do the same dose but he's actually been getting lower than his high 300's at times so I'm afraid to give him too much. But then he'll jump up to the high 200's. We're trying to titrate by .25 or .50 as best we can. Thank you all so much.
 
You did absolutely the right thing by not shooting. If you were going to skip the shot, you didn't need to worry about feeding high carb food.

If I may make a suggestion, please take a look at the sticky notes about the two dosing methods we use -- Start Low Go Slow (SLGS) and the Tight Regulation Protocol. Lantus is different than most other types of insulin in that dosing isn't based on the pre-shot number. Dosing is based on the lowest number in the cycle. As a result, you need to hold doses for at least 6 cycles/3 days in order for the insulin depot to stabilize. It's hard to what's going on with Alabaster's numbers given the frequency with which you're changing the dose. Because Lantus is a long-acting, depot-type of insulin, if you change the dose too often, numbers get wonky. Please let us know if we can help with getting you and your kitty acclimated to using Lantus.

 
Oh wow. Okay. I read the SLGS but I found it a little confusing and I thought I understood it, but I guess I did not. I guess my fear is giving him lets say 1.5U in the morning and then at the next PS he's much lower. I'm afraid to give him the same amount if his PS is lets say 155. It's been a hard process too living with a diabetic (my husband), cause we can't wrap our heads around the PS number and not adjusting Alabaster's dose to that. It's also been scary when Ally's PS numbers have been in the high 300's and only giving him 1.5 units.
Thank you so much for all the advice and any future advice is needed and welcomed!
 
So is it suggested that for three days we keep him at lets say 1.5U no matter what, unless he's lower than a certain number like 150?
 
Janel and Alabaster said:
So is it suggested that for three days we keep him at lets say 1.5U no matter what, unless he's lower than a certain number like 150?
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The SLGS protocol spells it all out for you. In a nut shell (but please do read the actual protocol): hold a dose for a week, do a full curve after a week, look at nadir value on the curve to to assess dose effectiveness, keep/raise/lower dose based on that value.
 
One additional point on SLGS, if your cat BG is 90 or below at any point during the cycle, he earns a dose reduction right away. Meaning his next shot is reduced by .25u. That is the exception to holding for a week. If you are not comfortable with his preshot number, like the example you gave I used to post here and ask. If I didn't get a response I would either not shot or give a reduced shot, depending on the number and my comfort level. I have to admit there were probably a few occasion I could have shot, but like you not being around to monitor I decided not too, to make sure he is safe.

SLGS for me was the easiest one to follow, Kris summed it up well. You really don't want to adjust the dose too often, as you want the depo to stabilise, once it does that when you will truly see how your fur baby is doing on the dose. Please don't hesitate to ask questions, we were all at the same place and overwhelmed with all the information. I sometime asked the same question a few times, when I noticed I didn't get it .....

Gorgeous Alabaster - love the name and what a beautiful cat.......
 
Thank you so much! This has really been emotional. I feel like I'm doing a terrible job. I'm trying not to change his dose too much by only doing .25 or .5 and trying to keep it around 1.5 if we can. It's like he'll be in good numbers but then goes right back up to the 400's. I'm going to print this page and the SLGS out and keep it in sight during dosing times and really read it through. Again, thank you so incredibly much.
 
Marvin's Mom - Nat said:
One additional point on SLGS, if your cat BG is 90 or below at any point during the cycle, he earns a dose reduction right away. Meaning his next shot is reduced by .25u. That is the exception to holding for a week. If you are not comfortable with his preshot number, like the example you gave I used to post here and ask. If I didn't get a response I would either not shot or give a reduced shot, depending on the number and my comfort level. I have to admit there were probably a few occasion I could have shot, but like you not being around to monitor I decided not too, to make sure he is safe.

SLGS for me was the easiest one to follow, Kris summed it up well. You really don't want to adjust the dose too often, as you want the depo to stabilise, once it does that when you will truly see how your fur baby is doing on the dose. Please don't hesitate to ask questions, we were all at the same place and overwhelmed with all the information. I sometime asked the same question a few times, when I noticed I didn't get it .....

Gorgeous Alabaster - love the name and what a beautiful cat.......
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And just to clarify.. is the nadir the lowest number of the whole day based on the curve?
 
Janel and Alabaster said:
And just to clarify.. is the nadir the lowest number of the whole day based on the curve?
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Sort of yes, the nadir is the lowest point of the cycle. Typically mid day.

I just looked at your SS, it looks like you are trying to dose based on in/out insulin which is immediate acting, Lantus is a depo insulin so you should not be adjusting the dose all the time. Lantus is a long acting depo insulin so dosage is based on the nadir. If that was the instruction from the vet, I am thinking the vet confused the type of insulin he prescribed with other type of insulin...

Every time there is a change to the dose it take up to 6 cycles (3days) for the depo to build, and for the dose to stabilize. Right now because you are constantly changing the dose it's hard to tell what is the correct dose for her, and is also probably why her numbers are all over.

If it were me, I would hold her dose of 1.5u for 7 days, unless she earns a reduction. She earns a reduction of .25 if her BG is 90 or lower. Reductions are done at the next dose. If after 7 days she did not earn a reduction then you normally increase by .25. I was always scared I missed something so I would post daily to see if more experienced folks had suggestions, especially when it was time for an increase (I was too emotional to see the good or bad patterns).

When are you able to monitor, take some extra BG tests? I got a lot of help from here, figuring out how to handle giving Marvin his shot when I was working and unable to monitor. I needed to learn how Marvin reacted to lantus, so I felt comfortable giving his dose while I was at work and keep him safe.

The best suggestion is ask question, take advantage of the spread sheet and try to fill in the blanks (times you don't normally take BG test) by taking extra BG once and a while. There is so much to learn, so sometime all you can do is focus on one thing, one change at a time. Sorry for the long response just want to help and encourage you, as I know there is a lot to take into consideration.
 
Janel and Alabaster said:
And just to clarify.. is the nadir the lowest number of the whole day based on the curve?
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Yes and no. The nadir is the lowest point of the cycle. The nadir can change from day to day and from cycle to cycle. There are a lot of other factors that can change what the numbers look like in a given cycle. When you are evaluating the dose, you want to answer the question "how low does this dose take my kitty". So if you did a cycle in a few days and it was a day your kitty was bouncing, the data wouldn't tell you how low the dose could potentially take him. You would take into consideration your preshots and any other spot tests you had gotten. This morning's 51 would be included in the evaluation.

In the mean time, don't go changing the dose based on the preshot number. Shoot the same dose both AM and PM. If you find yourself having to lower the dose too often because that dose is giving you too low a preshot value, then lower the dose to 1.25 units and try shooting that both AM and PM.
 
Thank you All so much! We wanted to keep him at 1.5 this whole week, but then when he was dropping down to 136, I was worried that was going to make him Hypo. But all this info is incredibly helpful! I really appreciate all of your kindness and understanding.
 
Hi, if you were around to monitor when he got the 136, and since you are not used to these lower numbers people here can guide you through what to do or watch for. The key is if you are able to monitor, and have extra test strips, and MC/HC food :) . If you are not around to monitor, you can also post and see what the consensus is to skip dose or give a reduced dose. Will also be easier with a bit more data, in SS at times you don't have at the moment (those extra or bonus BG once in a while help fill in the blanks). In the case of the 136 amps, i would probably done the same and gave a reduced dose until I had more data, unless I was there to monitor.

Don't worry we were all there, in my case I needed a lot of hand holding, don't by shy....
 
Lots of great advice:) remember data is your best friend, once you get enough you will see the pattern your Alabaster will follow which helps in dosing and confidence.;)
your doing a great job!!!!!:bighug:
 
DebG said:
Lots of great advice:) remember data is your best friend, once you get enough you will see the pattern your Alabaster will follow which helps in dosing and confidence.;)
your doing a great job!!!!!:bighug:
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Thank you so much! We would both be lost if not for you all :bighug: . And just to be clear... I only want to adjust the dose if he's under 90? We would still shoot 1.5 if he's lets say 120? Sorry to ask again, I'm just a bit overwhelmed. :(
 
Marvin's Mom - Nat said:
Hi, if you were around to monitor when he got the 136, and since you are not used to these lower numbers people here can guide you through what to do or watch for. The key is if you are able to monitor, and have extra test strips, and MC/HC food :) . If you are not around to monitor, you can also post and see what the consensus is to skip dose or give a reduced dose. Will also be easier with a bit more data, in SS at times you don't have at the moment (those extra or bonus BG once in a while help fill in the blanks). In the case of the 136 amps, i would probably done the same and gave a reduced dose until I had more data, unless I was there to monitor.

Don't worry we were all there, in my case I needed a lot of hand holding, don't by shy....
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Thank you. On the weekends when I'm home I try to get some in between readings, or during the week I will get a before bed reading. I have the ones I have done in on SS, but yes I would like to get more info. I'm not sure if seeing those numbers help at all. But the plan moving forward will be 1.5 no matter what, unless under 90, then 1.25, and no shot if under 70 maybe?
 
Hi again, just wanted to add that when testing Ally we are using a human glucose meter (Relion). I was looking at some of your spreadsheets that have great numbers and you are using a feline calibrated meter. Just wondering if this would make a difference with our numbers? Thank you
 
Janel and Alabaster said:
Hi again, just wanted to add that when testing Ally we are using a human glucose meter (Relion). I was looking at some of your spreadsheets that have great numbers and you are using a feline calibrated meter. Just wondering if this would make a difference with our numbers? Thank you
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Most people are actually using human meters, and the guidelines are based on the human meter results. So I would stick with the human meter, plus strips are a lot cheaper.

Janel and Alabaster said:
But the plan moving forward will be 1.5 no matter what, unless under 90, then 1.25, and no shot if under 70 maybe?
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Just to clarify, yes you want to try and shot 1.5 at every shot, BUT you want kitty to stay safe. I think right now 70 for no shot is probably too low. Reason is that it will depend if you are available to monitor and test when you get low numbers at shot time. Until you get used to it, you may want to post when pre-shot number is 150 or lower, and get some guidance here. What is will be recommended will be based on the data in the spread sheet, and if you are going to be there to monitor or not. What is recommended will be different based on that. Most important thing is to keep Alabaster safe. :)

Decreasing Dose, yes on SLGS if you see a 90 or lower BG the next time you shoot you would decrease the dose by .25 (example based on your current dose, you would go to 1.25 if this happens)

Increases: If after 7 days at the same dose you didn't get a 90 or below, you would increase by .25. (example based on your current dose, you would increase to 1.75)

When not sure post and ask for advice (which is what I did) :)
 
Marvin's Mom - Nat said:
Most people are actually using human meters, and the guidelines are based on the human meter results. So I would stick with the human meter, plus strips are a lot cheaper.



Just to clarify, yes you want to try and shot 1.5 at every shot, BUT you want kitty to stay safe. I think right now 70 for no shot is probably too low. Reason is that it will depend if you are available to monitor and test when you get low numbers at shot time. Until you get used to it, you may want to post when pre-shot number is 150 or lower, and get some guidance here. What is will be recommended will be based on the data in the spread sheet, and if you are going to be there to monitor or not. What is recommended will be different based on that. Most important thing is to keep Alabaster safe. :)

Decreasing Dose, yes on SLGS if you see a 90 or lower BG the next time you shoot you would decrease the dose by .25 (example based on your current dose, you would go to 1.25 if this happens)

Increases: If after 7 days at the same dose you didn't get a 90 or below, you would increase by .25. (example based on your current dose, you would increase to 1.75)

When not sure post and ask for advice (which is what I did) :)
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Good Morning, and thank you for making me feel welcome to ask away.. yesterday morning and evening we did 1.5 units and when we checked him this morning he was down to 53. We did not give him any insulin and gave him two crunchy treats. I hope this was the right thing to do as we had to go to work for the day.
 
I would also leave out se mc or hc food for him as the depo is still active. If you are able to check is bg one more time b4 you go that would be good. Good job catching the low
 
Oh no! :( We already had to leave for work. I know he still had some Friskies in his bowl and was eating when I left for work. Do you recommend I try and go home and check him on my lunch break if possible? And for his PM shot should we give him now 1.25? Again, thanks for your advice.
 
If he had food left it's good. If it is possible to check on him at lunch I would. Up to you. That is a low amps. Yes he did earn a reduction for pmps
 
I was able to check him at 1:00pm and he was at 186. Should we still stick with 1.5, or 1.25? Sorry to be a pain, but you all have really been wonderful as Guides.
 
I think I would go with 1.25, it's a bit hard as there was a lot changes to dose, but the last little while was 1.5 or less. Hopefully at 1.25 you will be able to dose the same amount morning and night :) Mind you if Alabaster wants to keep us guessing, you never know :)
 
I forgot to thank you earlier. Thanks for helping! We've been really trying to stick to 1.25 but I think I made a mistake last night for his evening shot. :( Needless to say it was a sleepless night. Can you look at my spreadsheet and let me know if I treated his low number correctly. I was so scared! I didn't give him any insulin today. Just didn't feel safe as I couldn't be home.
 
Janel and Alabaster said:
I forgot to thank you earlier. Thanks for helping! We've been really trying to stick to 1.25 but I think I made a mistake last night for his evening shot. :( Needless to say it was a sleepless night. Can you look at my spreadsheet and let me know if I treated his low number correctly. I was so scared! I didn't give him any insulin today. Just didn't feel safe as I couldn't be home.
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Those lime greens last night tell you that 1.25 u is too high a dose right now. You still have frequent dose changes happening and that can lead to havoc in the BG numbers. You really should try a single dose and hold it both AM and PM for several days in a row. Why not try 1 unit twice a day for the next week. Don't change the dose in response to a pre shot number unless it's too low. If in doubt post here for advice.

This is taken from the SLGS guide:
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.
  • 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
 
Starting on 08/22 we tried doing 1 unit and did for 5 days. We thought we should bump it up by .25 when he reached up to 432 on the 27th. Starting from there we wanted to consistantly give him 1.25 for a week which was our plan (except for his low numbers where we didn't feel safe giving that). Last night was his fourth dose of 1.25. We're trying to keep it the same and not react to the pre-shot numbers, by keeping it the same, but those high numbers scare us. Again though, thanks all for trying to help.
 
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Hi Janel! I just looked at your SS for the past week. On 8/24, when you had a 58 for AMPS, you should have started giving 0.75u that night. I think the reason you are seeing high numbers is he is going too low that you are not seeing and bouncing up by PS times.

If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit as per the protocol Kris gave you.

Immediately go back to 1u, and if you see a number under 90, drop again to 0.75u.
 
Thank you for your advice. Just some questions, and I'm sorry if I'm being redundant or asking confusing questions. But when we kept him at 1u he was consistantly in the 300's, so that's when we increased by .25u. If we go back to 1u, then we're changing his dose again, which is not good, and then he might stay high again. Again, sorry, just needing some strength with all this. If you think it's best we will definitely go back to 1u. It's just so scary to want to give him anything when he's under 90. I guess it's something we just have to get comfortable with.
 
Janel and Alabaster said:
Thank you for your advice. Just some questions, and I'm sorry if I'm being redundant or asking confusing questions. But when we kept him at 1u he was consistantly in the 300's, so that's when we increased by .25u. If we go back to 1u, then we're changing his dose again, which is not good, and then he might stay high again. Again, sorry, just needing some strength with all this. If you think it's best we will definitely go back to 1u. It's just so scary to want to give him anything when he's under 90. I guess it's something we just have to get comfortable with.
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The 300's are probably his bouncing numbers. Has anyone explained to you what a bounce signifies? His body thinks he is going too low so glucose is being dumped by the pancreas to get him back higher. We look at the low numbers, not the high numbers, to see how much insulin the cat may need. I know it's hard, but "ignore" the high numbers.

Do not shoot if he is under 90. Skip that dose anytime you see a number under 90.

ETA: I misspoke so I want to fix it by noting: glycogen is being dumped by the liver.
 
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Oh my gosh thank you. Thank you for explaining the bounce thing! I am making copies of all of this to take home. That does help clarify some things. So go back to 1u, if preshot numbers are below 90 don't shoot, but if he is higher and then the next preshot he is a low number again.. drop down to .75. Is that correct? Again, I can't thank you all enough!!!
 
Janel and Alabaster said:
Oh my gosh thank you. Thank you for explaining the bounce thing! I am making copies of all of this to take home. That does help clarify some things. So go back to 1u, if preshot numbers are below 90 don't shoot, but if he is higher and then the next preshot he is a low number again.. drop down to .75. Is that correct? Again, I can't thank you all enough!!!
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Yes, keep the 1 u dose regardless of the AM/PMPS unless it's below 90. In that case, don't give any insulin and drop the dose to 0.75 u at the next dose. Hold that dose regardless of AM/PMPS unless it's below 90. If so, no shot and drop dose by 0.25 u and so on.

If any BG test gives you a number below 90 that means an automatic 0.25 u dose reduction at next dose if the PS is high enough to give insulin. Post here any time you're unsure. :)
 
Also, you're following SLGS guidelines and it would be helpful if you could add that bit of info to the light grey signature text under your posts. We always check that to get the basics when people post for help.
 
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