You might want to re-read the
dosing methods sticky on TR and SLGS. With both methods, dosing is based on how low they are....the nadir's. (Even as long as I've been here, I still learn something or remember something I'd forgotten when I read that sticky).
Even on TR, until we have enough data and understand how our cat responds to food and insulin, we suggest stalling if you get a PS under 150. As you gain more data, the PS number you're willing to shoot starts to come down. Eventually, I got to where I'd shoot the scheduled dose for China if she was above 50 but that was only after a LONG time of learning, gathering data and learning about my girl. (as well as listening to the advice of the experienced folks that had been here before me)
Since you weren't testing when you were giving 3U, we really have no idea what was going on with Sam so we can't really say "because of this, that".
Luckily, the liver in our cats is sometimes our saving grace. If the BG drops too low or too fast, the liver releases stored sugars and hormones to bring the BG back up....that's what bouncing is. He could have been bouncing high, dropping low, bouncing high, dropping low that whole time. We'll never know but thankfully whatever happened during that time, Sam's still here!
From the SLGS dosing method:
How to handle a lower than normal preshot number:
Until you collect enough data to know how your cat will react, 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, Levemir, and Biosimilars 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 kitty's 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, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
If kitty is dropping faster or lower than you'd like, please see "
Don't Panic! or How to Handle Low Numbers" and post for help or suggestions.
. I’ve gone back through some history and I’m not sure if this will help you, but a general common theme in much of what was suggested by some very experienced people, revolved around data and how important it is. Setting aside for now the difference between TR and SLGS - if I asked you when Sam onsets, nadirs and what his typical duration is, what would you say? I often bring this up because I feel like it is truly key for each caregiver to learn the basics. Knowing how your cat responds to insulin and carbs has been ingrained in my journey and to me it really does matter! What my cat does with the same insulin and how sensitive he is or isn’t to carbs will not be the same as how Sam responds. Part of this whole process is learning: