To shoot or not to shoot

[vstarjewel]

I know this has been posted on threads already, but I need to get ready for work and I couldn't find it through a search. Max had his first dosage yesterday night of Lantus, 2 units. Prior to the shoot he was at 233, 3 hours later before I went to bed he was at 155. This morning when I pre tested him he was at 60. I let him eat and did not give him a shot. I waited about 20 minutes and tested him again, 51. I don't know if I should give him a shot or not. And to complicate matters I have to be to work today... I do normally come home about six hours after his first shot just to monitor him and do his BG. Not sure if I should give him a shot or hold off. Suggestions?

Side notes.... I did switch his syringe tp U 100. He switched from prozinc. I haven't updated his chart while I was waiting for the Lantus, just gave him his prozinc as usual.

 

[FurBabiesMama]

I'm sorry no one responded sooner. 51 is too low to give a shot.

 

[vstarjewel]

Please don't apologize! I'm grateful for any help I can get here. I am coming back home in about 4 hours, if I test him and he's high should I shoot him? And if I do give him a shot in a day, I'm assuming I should wait until the following morning for his next one? Because they have to be 12 hours apart?

 

[Nan & Amber (GA)]

No, call this morning a skip-- you don't want to get that far off schedule.

So glad you were testing!

 

[Karen&Rocket]

I’m not an expert here so hoping someone else will chime in- if you’re just starting with a dose of two units, and you went down to 51 - sounds like you were started on too high a dose. Anyone have recommendations? Drop to one unit? Half?

Edit: sorry, thought you were completely new to insulin, not just Lantus. Still wondering about the dosage though.

 

[CandyH & Catcat]

keep testing but sounds to me like he's due for a reduction -- check the yellow sticky notes on the Lantus forum for reduced dose criteria

 

[vstarjewel]

Came home for lunch, BG 55. I'm going to see how it goes today and tomorrow with 2 units. If he's low tonight at dinner I will skip that shot, and test him before bedtime. If he is still low tomorrow morning, I might consider dropping the dose. I just want to give the Lantus ample time for the depot to level out. Will post again in 6 hours

 

[Idjit's mom]

@Marje and Gracie
@MrWorfMen's Mom
@Nan & Amber
@Chris & China (GA)

 

[Marje and Gracie]

Unfortunately, his SS is not up-to-date. There are three days in mid-August with “0” on them and many other dates before that which are similar which I have no idea what that means.

No testing at night means you are missing half your data. We have no idea how low the dose is taking him.

There’s the potential you are seeing all these black numbers because Max is going too low, which is exactly what I suspect.

Came home for lunch, BG 55. I'm going to see how it goes today and tomorrow with 2 units. If he's low tonight at dinner I will skip that shot, and test him before bedtime. If he is still low tomorrow morning, I might consider dropping the dose. I just want to give the Lantus ample time for the depot to level out. Will post again in 6 hours

Based on the comments above, I don’t think you understand how Lantus and the depot work. Plus, if you are doing curves once a week, I’m assuming you are following SLGS. If that’s the case, you absolutely need to reduce the dose and I would not wait.

Other than that, I’m not comfortable giving you dosing advice and neither should anyone else be. It would help us help you and Max if you could keep his SS current and also get some tests at night. We generally recommend a +2 and before bed as a minimum.

If you are getting “0” on your SS due to some error with it, please PM me and I’ll fix it for you.

 

[vstarjewel]

Unfortunately, his SS is not up-to-date. There are three days in mid-August with “0” on them and many other dates before that which are similar which I have no idea what that means.

No testing at night means you are missing half your data. We have no idea how low the dose is taking him.

There’s the potential you are seeing all these black numbers because Max is going too low, which is exactly what I suspect.


Based on the comments above, I don’t think you understand how Lantus and the depot work. Plus, if you are doing curves once a week, I’m assuming you are following SLGS. If that’s the case, you absolutely need to reduce the dose and I would not wait.

Other than that, I’m not comfortable giving you dosing advice and neither should anyone else be. It would help us help you and Max if you could keep his SS current and also get some tests at night. We generally recommend a +2 and before bed as a minimum.

If you are getting “0” on your SS due to some error with it, please PM me and I’ll fix it for you.

As my original post mentioned, there is no curve because he started the Lantus last night ( and, as my original post also mentioned, I tested him before he ate and 3 hours later before I went to bed). I do understand how the depot works, I've read all of the threads. I also understand it's going to take several days for it to adjust itself more or less. I was not doing the testing for the last week because he was taking the pro zinc and I didn't think it necessary to keep testing him , using his supplies and putting him through that. And I can fix the spreadsheet, thank you for offering to help, I have to find time to do so.

 

[Marje and Gracie]

As my original post mentioned, there is no curve because he started the Lantus last night ( and, as my original post also mentioned, I tested him before he ate and 3 hours later before I went to bed). I do understand how the depot works, I've read all of the threads. I also understand it's going to take several days for it to adjust itself more or less. I was not doing the testing for the last week because he was taking the pro zinc and I didn't think it necessary to keep testing him , using his supplies and putting him through that. And I can fix the spreadsheet, thank you for offering to help, I have to find time to do so.

I’m referring to your notes on 8/27 that you did a “curve day” which implies SLGS. SLGS can be done with any insulin.

The importance of testing even when he’s on PZ and switching to Lantus is so we are sure you start him at the correct dose. A lot can change in a day, not to mention a week, so we don’t know that you even started the Lantus at the right dose.

I’m not trying at all to be snarky here but I want to help you understand that just reading about the depot doesn’t mean one understands it. It takes using the insulin, gathering data, seeing patterns, etc. before one can really grasp how the depot works in your cat. This takes time. There are members in the Lantus group who have been doing this a while and are committed to data gathering and will openly tell you they still don’t quite understand the depot.

 

[Nan & Amber (GA)]

I agree with Marje, it's a little hard to interpret your spreadsheet data, but there are some definite signs that he's been getting too much insulin, dropping low, and then bouncing back up. For example, on 8/28, he had a nice green number in the middle of the cycle, then went "HI" for at least a day, maybe more. Kind of unfortunate, in retrospect, that that first day was your curve day-- it's just luck of the draw with a bouncy cat, but hitting a bounce on a curve day can give you an inaccurate picture of an insulin dose's effect.

Getting some more tests at night, and filling in the spreadsheet with all your old ProZinc data, is a good idea-- we need to get a better handle on what he's doing before giving any dose advice, right now we're mostly working from impressions. If you do end up shooting tonight, can you get at least one test before bed? One thing I noticed from the spreadsheet is that most of your "mid-cycle" tests (other than the curves) are done at exactly mid-cycle, at +6. I don't know if that's done because of work/life constraints during the day, but one of the nice things about grabbing nighttime tests is that (for most people) it's easier to get times like +2, +3, +4 etc, filling in an important part of the spreadsheet.

If he's low tonight at dinner I will skip that shot, and test him before bedtime. If he is still low tomorrow morning, I might consider dropping the dose. I just want to give the Lantus ample time for the depot to level out.

Here's the thing about the Lantus depot: it's definitely true in general that you want to give the depot a chance to settle before evaluating a dose, but that's more relevant when looking at a potential dose increase than a dose decrease, for safety reasons. Once the depot has been filled, it has a bit of momentum behind it, and you could find yourself fighting some seriously low numbers even after decreasing, so you want to respond quickly when you are getting signals that a dose is too high. That 51 this morning was very close to our usual cutoff for dose decreases (50), and it came at +12. I'm a little worried about Max's safety continuing on this dose, based on the information we have.