That's a good question. There are a few factors involved. The most important is ketones-- if at all possible, a cat who has recently had an episode of ketones should get
some insulin, every shot time. Other than that, I think there are some different approaches. Any change to the shot amount, whether reduced or skipped, will disrupt the depot, and I think there is some thought that a reduction should be less disruptive than a skip. In most situations where this question arises, in newly-diagnosed cats that probably aren't well-regulated yet, I tend to feel that that concern is swamped out by others if the only worry is having some difficulty interpreting spreadsheet patterns for a couple days. However, in cats on higher doses, it may be more of a concern because they really need that big depot at their back at all times. Another situation in which the token dose might be used is in a cat who tends to have huge, extended bounces, in hopes that that first zoom up might be tempered a little bit. In Disco's case, he zoomed up so high
mostly because he was bouncing, not the skipped shot, but having a little insulin on board at +2 or +3 might have helped slow him down some. I didn't recommend this route for the same reasons I didn't recommend shooting the full dose-- we didn't have enough information about the direction he was headed, and there would be no one around to help Teri in the opposite situation from what actually happened, if he were moving down and the insulin added to his momentum
.
So, it depends! As a personal inclination, I usually lean towards the "call it a fur shot" approach and skipping altogether, but that's really more of a personal quirk.
It is always important, though, whether reducing or skipping, to do as Teri did last night and keep testing for a while. With a depot insulin, you cannot assume that skip=safe in low numbers. That depot always gets a say!
There are also a couple of things you can do to try to keep yourself out of the most difficult form of this problem, where we just have no idea which direction the cat is headed. One is the "stall don't feed" after getting a low pre-shot: just like it sounds, you stall and hold off on shooting for a half hour, you
don't feed to keep the number free of food influence, and then see if the next test is moving up or down. The other thing you can do is on the other end of the pre-shot, trying to get late-cycle (+10 or +11) tests so that when you do the pre-shot, you know where the cat is coming from.
No matter what, though, these cats are always going to make us do some guessing games!
