Spreadsheet question

[Catrina]

Hello all,

can you take a look at Molsons spreadsheet? his numbers go decently low and then super high again, is this normal!?!?!? i know it hasn't been too long since he's been on insulin but i find myself desperately trying to find a pattern or see improvement but i don't seem to see anything. and i don't know if it is a coincidence but i find if i give him food that is 2% carbs or higher his numbers shoot up. but if hes on 0% or 1% he is better.. and again that could be a coincidence...

he sometimes pukes in the middle of the night as well. no fome just liquid and it looks like his wet food that i feed him. he is acting normal and still playful and cuddly.

 

[Melinda and Kitkat]

Hi Catrina. And welcome to the forum, you will get alot of help here. I'm not an expert but I can tell you that it is a 'normal thing' to see decent drops in mid cycle and higher numbers at the start of each cycle. Lantus will typically show this type of "glucose curve" over a 12 hr cycle. Here is an example, just to help explain. Please keep in mind every cat is different and the blood glucose numbers on the graph are just for explanation purposes.

Once kitty has been on insulin for awhile you may see a trend to a ' flatter curve' where dips and rises slowly level out. As well, you may also notice that your very high numbers slowly begin to drop down to lower numbers. Looking at your spreadsheet it does appear that there is some progress,,,, you are starting to see a few blues pop up.... this is progress!

i find myself desperately trying to find a pattern or see improvement but i don't seem to see anything

As you collect data, all of this info will give you information as to how the insulin and the dosage is working for Molson. The 'blue' values you are getting is progress.
There are several stickies you can read more info if you click onto the Lantus/biosimilars thread link. Lots of info there. Ask all the questions you like.... there is alot to learn when you first start and we are here to help.
Collecting the data for your spreadsheet, as you are doing, will help those here who can offer dosing advice.... by giving them insight as to the patterns.

 

[Bron and Sheba (GA)]

The spreadsheet looks pretty normal for a newly diagnosed cat. I see you are following SLGS. Could you put that into the SS please?
With SLGS you increase in increments of 0.25 units if the nadirs are blue or yellow, not 0.5 units.
The higher BGs are most likely from bouncing and this is very normal with newly diagnosed cats.
Here is a definition of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Are you giving snacks during the first half of all cycles?
It looks as if you are feeding a lot of fish meals. Will he eat any other food. I would not feed more than a couple of fish meals a week.

I would also recommend you get at least one test in during the PM cycles. A before bed test is a good habit to get into and if that test is lower than the preshot BG, I would get up and test a bit later to see that the BG is not still dropping.

 

[Catrina]

The spreadsheet looks pretty normal for a newly diagnosed cat. I see you are following SLGS. Could you put that into the SS please?
With SLGS you increase in increments of 0.25 units if the nadirs are blue or yellow, not 0.5 units.
The higher BGs are most likely from bouncing and this is very normal with newly diagnosed cats.
Here is a definition of bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Are you giving snacks during the first half of all cycles?
It looks as if you are feeding a lot of fish meals. Will he eat any other food. I would not feed more than a couple of fish meals a week.

I would also recommend you get at least one test in during the PM cycles. A before bed test is a good habit to get into and if that test is lower than the preshot BG, I would get up and test a bit later to see that the BG is not still dropping.

I give breakfast lunch and dinner, or breakfast, snack, snack and dinner. I have been giving all fish because the fish FF are 0-1% carbs, i don't know if it is a coincidence but i find if i even give him 2% carbs his BG rises, so i've been nervous/scared to give those meals, but the last couple of days i have given Turkey and 2% carbs since his numbers have lowered a bit.

 

[Bron and Sheba (GA)]

I have been giving all fish because the fish FF are 0-1% carbs, i don't know if it is a coincidence but i find if i even give him 2% carbs his BG rises, so i've been nervous/scared to give those meals, but the last couple of days i have given Turkey and 2% carbs since his numbers have lowered a bit

I would be very surprised if a change from 1 to 2% carbs would rise the BG. It is very normal for newly diagnosed cats to have BGs that are a bit all over the place while they get used to Insulin which is a hormone not a medication like an antibiotic that fixes the problem straight away.
I think you could safely give carbs under say 7%. We say under 10% but most feed around the 4-7% carbs.
Dont forget the PM cycle tests

 

[Catrina]

I would be very surprised if a change from 1 to 2% carbs would rise the BG. It is very normal for newly diagnosed cats to have BGs that are a bit all over the place while they get used to Insulin which is a hormone not a medication like an antibiotic that fixes the problem straight away.
I think you could safely give carbs under say 7%. We say under 10% but most feed around the 4-7% carbs.
Dont forget the PM cycle tests

Okay thanks!!
Yeah it seems like his morning and day time BG is decent but his PMPS is always so high so idk if I should increase his dose or not. Or maybe keep it the same for a while to see if his pre shots start to be more of the same?

 

[Bron and Sheba (GA)]

Okay thanks!!
Yeah it seems like his morning and day time BG is decent but his PMPS is always so high so idk if I should increase his dose or not. Or maybe keep it the same for a while to see if his pre shots start to be more of the same?

If you are following SLGS…and that is what your signature says…you hold the dose foe 7 days then do a curve. Then we can help you decide if an increase is needed. I would not do it sooner. It is not unusual to have a higher preshot either in the am or the pm. What you need to do is get some tests in during the on cycle to see what is going pm.

 

[Catrina]

If you are following SLGS…and that is what your signature says…you hold the dose foe 7 days then do a curve. Then we can help you decide if an increase is needed. I would not do it sooner. It is not unusual to have a higher preshot either in the am or the on. What you need to do is get some tests in during the on cycle to see what is going on.

Ok thanks I will start doing some pm tests to see!

 

[Diane Tyler's Mom GA]

@Catrina
Hi there I happened to be looking at your spreadsheet by the way can you add SLGS to your spreadsheet up top since that what you have in your signature
I see Molson dropped to 81 today during the day cycle , I think you should have reduced tonights dose to 1.25 units. Let's see what Bron says
I'm going by what the sticky says about the SLGS method
Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

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. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• 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

I would definitely get more than just one test in tonight , maybe get a +2 test ,if that is lower than the PMPS number I would get another test to see if the BG is still dropping ,maybe a +4
I'm going to tag Bron for you , I see that she was helping you here.
I just concerned and want Molson to be safe
@Bron and Sheba (GA)
@Catrina

 

[Bron and Sheba (GA)]

Yes, with a drop under 90 and following SLGS, you need to reduce the dose to 1.25 Units.
I see you have given the 1.5 Unit dose tonight so please monitor this cycle closely as Molson could drop lower again. And please reduce the dose in the am cycle and hold 7 days unless he drops under 90 again.

 

[Catrina]

Yes, with a drop under 90 and following SLGS, you need to reduce the dose to 1.25 Units.
I see you have given the 1.5 Unit dose tonight so please monitor this cycle closely as Molson could drop lower again. And please reduce the dose in the am cycle and hold 7 days unless he drops under 90 again.

@Diane Tyler's Mom
@Bron and Sheba (GA)

I just noticed this today unfortunately so i dint take your advice.

Thank you! Do you think I should maintain 1.25u or increase based on his numbers the last few days?
if he gets another BG below 5 should i reduce it again? i'm struggling with understanding what a safe dose is especially with his pre shot numbers, if his Pre shot BG is between 7-10 should i reduce it?
his numbers seem so all over the place, i don't know if its a mix between the dog food and the high carb food i gave him on sunday or if its him bouncing.. it's making me uncertain about his dose adjustment. today his last three numbers were 13, 13.9 and 10.1 which isnt terrible but also isn't great.

do you think i should do SLGS or TR? which one is better and more chance of remission? I'm so lost on which protocol to follow. i also don't fully understand TR, it says to reduce by 0.25u if he is below 2.7, or between 2.8-5.5 for a week. but what if he's 3, shouldn't i reduce it still? that just seems so low to me and i'm paranoid hell become hypo. I am very uncertain on what to do here and which protocol to follow.

 

[Bron and Sheba (GA)]

To follow TR you need to get at least 4 tests in a day….both preshots and at least one test in every cycle. At the moment you are not testing every cycle.I would stick with the SLGS until you are doing more testing. TR is a more aggressive protocol and you need to be test more than you are.
With the SLGS you reduce the dose if the BG drops under 5 (90). The BG dropped to 2.4 yesterday so you need to drop the dose to 1 unit at the next preshot.
Lantus dosing is based on the lowest point in the cycle not the preshot BG. We test the preshot BG to see it is safe to give the insulin.
Molson’s high BGs are due to bouncing, which is very common in newly diagnosed cats so don’t worry about it, just follow the SLGS dosing method to get good results.
Here is an explanation on bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Keep asking questions.

 

[Catrina]

To follow TR you need to get at least 4 tests in a day….both preshots and at least one test in every cycle. At the moment you are not testing every cycle.I would stick with the SLGS until you are doing more testing. TR is a more aggressive protocol and you need to be test more than you are.
With the SLGS you reduce the dose if the BG drops under 5 (90). The BG dropped to 2.4 yesterday so you need to drop the dose to 1 unit at the next preshot.
Lantus dosing is based on the lowest point in the cycle not the preshot BG. We test the preshot BG to see it is safe to give the insulin.
Molson’s high BGs are due to bouncing, which is very common in newly diagnosed cats so don’t worry about it, just follow the SLGS dosing method to get good results.
Here is an explanation on bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

Keep asking questions.

Thank you so much for clarifying everything. I did have a game plan (Plan A) but wondering now if i should follow Plan A or Plan B:

Plan A
Monday, Tuesday, and Wednesday this week 1.25U (unless he drops below 5 then I would reduce to 1u)
(i know you mentioned to give him 1u the next preshot, i feel like 1u is so low considering how high he has been.. i was hoping to keep a dose for a bit to see how it affects him since I just dropped him to 1.25 I thought i should keep that dose for a few days at least, to see how it affects him, please let me know if I am wrong, I don't know what the best to do is and am overwhelmed)

Thursday morning adjust his dose based on his mid-day tests Monday - Wednesday, if it's above 8.3 then increase by 0.25u. hold this dose from Thursday, Friday, Saturday, (unless he drops below 5 then i would reduce by 0.25u)

Sunday do a curve and see how his numbers are and adjust based on his nadir (increase if above 8.3, keep the same if between 5 - 8.3, and decrease if below 5)

OR

Plan B
You did mention if I follow SLGS I should keep the dose for 7 days unless he drops below 5, so should I keep 1.25u until Sunday, then on Sunday do a curve and adjust based on that? I might be getting impatient, but his high numbers are making me want to increase but if you think keeping 1.25u until Sunday is better please let me know.

Which plan do you think i should follow?

You mentioned that the purpose of doing a pre-shot test is to make sure it is safe to give the insulin, what would you say is a number that isn't safe to give insulin? and what is a number where i should reduce his insulin dose? I want to be prepared in the case that he gets a low number as his preshot. One day his preshot was 7 and now i am back tracking wondering if that was safe to give him his shot or not.

Thank you so much for your help, i have so many questions, it's all a lot and just want to make sure i am doing what is right for Molson...

 

[Bron and Sheba (GA)]

With a drop to 43 (2.4) you need to reduce the dose down to 1 unit. 43 is too low for TR as well as SLGS.
With SLGS you need to reduce the dose when the BG drops under 90. Remember Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot. If you ignore the low numbers and don’t reduce the dose, you are running the risk of a hypo.
You are seeing higher numbers because of the bouncing, which I explained in post 12. You don’t increase the dose when a cat is bouncing. You need to be patient and wait for the bounce to resolve which can take up to 6 cycles.
You need to be following the SLGS dosing method not a plan you have devised. Our two dosing methods work as long as you follow them and not try and change them.
I think you need to follow SLGS until you work out how you are going to get more tests in during all the cycles. TR is an aggressive dosing method and you have to be prepared to test during every cycle.

what would you say is a number that isn't safe to give insulin

When you first start out we say don’t shoot below 200 (11) until you get data. You have some data and have shot a 133 but he did drop to 43 that cycle. At the moment, if you get a preshot lower than 133, I would stall, don’t feed and test again in 20 minutes to see if the BG is rising. You can also post and ask for help. When you do shoot a lower preshot than normal, we always suggest getting a +2 to see what is happening in the cycle.
It is fine to keep asking questions.
Have you read The Basics

 

[Catrina]

With a drop to 43 (2.4) you need to reduce the dose down to 1 unit. 43 is too low for TR as well as SLGS.
With SLGS you need to reduce the dose when the BG drops under 90. Remember Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot. If you ignore the low numbers and don’t reduce the dose, you are running the risk of a hypo.
You are seeing higher numbers because of the bouncing, which I explained in post 12. You don’t increase the dose when a cat is bouncing. You need to be patient and wait for the bounce to resolve which can take up to 6 cycles.
You need to be following the SLGS dosing method not a plan you have devised. Our two dosing methods work as long as you follow them and not try and change them.
I think you need to follow SLGS until you work out how you are going to get more tests in during all the cycles. TR is an aggressive dosing method and you have to be prepared to test during every cycle.

When you first start out we say don’t shoot below 200 (11) until you get data. You have some data and have shot a 133 but he did drop to 43 that cycle. At the moment, if you get a preshot lower than 133, I would stall, don’t feed and test again in 20 minutes to see if the BG is rising. You can also post and ask for help. When you do shoot a lower preshot than normal, we always suggest getting a +2 to see what is happening in the cycle.
It is fine to keep asking questions.
Have you read The Basics

Okay so you think plan B is better i think this follows SLGS:
keep the dose until Sunday and do a curve on Sunday. Adjust based on the nadir following SLGS

After he got that one 43 on Sunday, i reduced him to 1.25u from 1.5u. since then he hasn't gotten that low based on my tests, you still think i should reduce him again to 1unit for tonights shot even if his mid day test today is higher?

oh wow okay i did not know that information about not shooting below 200 (11), if i ever get a pre shot number at or below 133 (7.4) i will take your advice to not feed, stall for 20 minutes, retest, if his BG rises then I will give him his regular dose, if it drops or stays the same then I will skip the dose.

 

[Bron and Sheba (GA)]

Okay so you think plan B is better i think this follows SLGS:

No. Your plan B says to keep the dose at 1.25 U. I think you need to follow SLGS and reduce the dose to 1unit.

After he got that one 43 on Sunday, i reduced him to 1.25u from 1.5u. since then he hasn't gotten that low based on my tests, you still think i should reduce him again to 1unit for tonights shot even if his mid day test today is higher?

If you look at the SS you will see that you gave 1.25 units and that dropped the BG to 43. At the next preshot you gave 1.5 units. And the next preshot after that you gave 1.25 units.
It was the 1.25 units dose that caused the BG to drop to 43 and therefore you need to drop the dose to 1 unit.
There is no midday test for today in the SS but if it is higher it will be because of bouncing.

if i ever get a pre shot number at or below 133 (7.4) i will take your advice to not feed, stall for 20 minutes, retest, if his BG rises then I will give him his regular dose, if it drops or stays the same then I will skip the dose.

As you gather more data you will be able to shoot lower preshots.

 

[Catrina]

No. Your plan B says to keep the dose at 1.25 U. I think you need to follow SLGS and reduce the dose to 1unit.


If you look at the SS you will see that you gave 1.25 units and that dropped the BG to 43. At the next preshot you gave 1.5 units. And the next preshot after that you gave 1.25 units.
It was the 1.25 units dose that caused the BG to drop to 43 and therefore you need to drop the dose to 1 unit.
There is no midday test for today in the SS but if it is higher it will be because of bouncing.

As you gather more data you will be able to shoot lower preshots.

oh okay i see what you are saying now.. sorry for my confusion. i just want to make sure I fully understand.

I am going to test him today around 1pm, but regardless of his BG level I should drop him to 1u tonight and continue that and on Sunday I will do a curve and adjust his Sunday PM shot based on SLGS protocal. Then i will hold that dose until the following Saturday or Sunday and do another curve. Unless he drops below 5 on any random test then I reduce by .25u and keep that dose, but continue with the curve on the weekend. Does this make sense? Am i understanding the SLGS protocol better now?


I was going to test him mid day every day this week (Tuesday, Wednesday, Thursday, Friday, Saturday). is that too much? as much as i want to test him a lot i also feel bad pricking his ear all the time and using so many test strips. i also think the numbers are discouraging me so then i wonder if it's useful to mid day test all week or if i should just stick with pre shot tests until Sunday when i do the curve. what are your thoughts? Maybe i could do a mid day test every other day this week instead of every day?

Again thank you SO much for all your help and for being patient with me.. I'm also 9 months pregnant and i am feeling the baby brain..

 

[Bron and Sheba (GA)]

am going to test him today around 1pm, but regardless of his BG level I should drop him to 1u tonight and continue that and on Sunday I will do a curve and adjust his Sunday PM shot based on SLGS protocal. Then i will hold that dose until the following Saturday or Sunday and do another curve. Unless he drops below 5 on any random test then I reduce by .25u and keep that dose, but continue with the curve on the weekend. Does this make sense? Am i understanding the SLGS protocol better now?

Yes

was going to test him mid day every day this week (Tuesday, Wednesday, Thursday, Friday, Saturday). is that too much? as much as i want to test him a lot i also feel bad pricking his ear all the time and using so many test strips. i also think the numbers are discouraging me so then i wonder if it's useful to mid day test all week or if i should just stick with pre shot tests until Sunday when i do the curve. what are your thoughts? Maybe i could do a mid day test every other day this week instead of every day?

i would get a test in each cycle if you can. It’s very good data. How can you tell if he’s dropping too low if you don’t test..
don’t be discouraged. It’s very common for newly diagnosed cats to bounce.

 

[Catrina]

Yes

i would get a test in each cycle if you can. It’s very good data. How can you tell if he’s dropping too low if you don’t test..
don’t be discouraged. It’s very common for newly diagnosed cats to bounce.

Okay yay thank you so much. i am feeling more confident about the plan and i will tell myself not to get discouraged if his numbers are still super high and i will only change the dose on Sunday based on his Nadir that i see during his curve. i am really hoping his curve on Sunday is good and not still high

 

[Catrina]

Yes

i would get a test in each cycle if you can. It’s very good data. How can you tell if he’s dropping too low if you don’t test..
don’t be discouraged. It’s very common for newly diagnosed cats to bounce.

one more question. Molson was on 1u for a while and it didn't seem to be making a difference, once i put him to 1.5u is when i started seeing improvement but the 1.5 was too high. If 1u didn't help his numbers really, should i really drop him down to 1u anyway instead of 1.25u? i didn't know if the 1.25u would be a good in between. i just tested him and he was 13 (243)

 

[Melinda and Kitkat]

Molson was on 1u for a while and it didn't seem to be making a difference, once i put him to 1.5u is when i started seeing improvement but the 1.5 was too high. If 1u didn't help his numbers really, should i really drop him down to 1u anyway instead of 1.25u?

Hi Catrina, we all understand how stressful it is in the beginning stages of treatment. The learning curve is huge... but the advice here is wonderful. Please keep in mind that the best dose for kitty will definitely change over time, as the insulin begins to work and do it's job, as Molson's body and pancreas adjust to the benefits of the insulin... as his numbers slowly come down into the healing green range and his pancreas starts to heal.... it is a very dynamic process (always changing). As Molson adjusts keep in mind that a dose that worked well 2 weeks ago (or poorly for that matter) may be the new perfect dose to bring him into normal range. Some cats do this quickly, others can take quite some time..... in a nutshell every cat is different (ECID) and those that offer advice on dosage will take all of this into account. High preshot numbers are very common as kitty adjusts, and they can be unnerving, but do not get too panicky if this happens.... just keep in mind that the Nadir is the critical number and what is important to keep Molson safe. Take a deep breathe... and congrats on your soon to be brand new family member.

 

[Catrina]

Hi Catrina, we all understand how stressful it is in the beginning stages of treatment. The learning curve is huge... but the advice here is wonderful. Please keep in mind that the best dose for kitty will definitely change over time, as the insulin begins to work and do it's job, as Molson's body and pancreas adjust to the benefits of the insulin... as his numbers slowly come down into the healing green range and his pancreas starts to heal.... it is a very dynamic process (always changing). As Molson adjusts keep in mind that a dose that worked well 2 weeks ago (or poorly for that matter) may be the new perfect dose to bring him into normal range. Some cats do this quickly, others can take quite some time..... in a nutshell every cat is different (ECID) and those that offer advice on dosage will take all of this into account. High preshot numbers are very common as kitty adjusts, and they can be unnerving, but do not get too panicky if this happens.... just keep in mind that the Nadir is the critical number and what is important to keep Molson safe. Take a deep breathe... and congrats on your soon to be brand new family member.

Thank you so much!
I do think I need to be more patient. The high preshot numbers are really making me question everything. Do you think those high preshot numbers will come down as he adjusts? It seems like since he’s started insulin he always has pretty high pre shot numbers, especially at night. So when I haven’t seen that improve it is discouraging. Although I do know the nadir is what’s important, I’m wondering when or how long it typically takes for him to level out. Or if he ever will..

 

[Melinda and Kitkat]

I’m wondering when or how long it typically takes for him to level out.

The goal of insulin therapy is to get those numbers down into the normal range, and so yes, ultimately, with treatment you should see those preshots come down,,,, but to be perfectly fair and honest, only a crystal ball will say when he will. . You are using Lantus, and it is a wonderful, gentle slow release insulin for cats, and I am sure you have read by now that Lantus is great to 'flatten the curve'. What this really means is that the preshot numbers drop down and start to level out lower, the curve you see becomes a gentle smile shape, and not so much like mountain peaks when you graph it. This takes time, and following dosing advice, you will begin to see these improvements (we sure hope) and start to see progress, and understand what that looks like in your spreadsheet. In the beginning, as you are fine tuning and adjusting his dosage he may jump around alot,,,, and "bounce". (So unnerving!) As he starts to become regulated, and as you gather data, (including some nighttime cycle tests) you will begin to see patterns (trends). I'm sure you read this statement as well on this site..... "diabetes can be a marathon, not a sprint".. But woory not,,,, we hand out patience pants to anyone who needs a pair,..... I got 2 of them.

 

[Bron and Sheba (GA)]

Thank you so much!
I do think I need to be more patient. The high preshot numbers are really making me question everything. Do you think those high preshot numbers will come down as he adjusts? It seems like since he’s started insulin he always has pretty high pre shot numbers, especially at night. So when I haven’t seen that improve it is discouraging. Although I do know the nadir is what’s important, I’m wondering when or how long it typically takes for him to level out. Or if he ever will..

Catrina, you need to give Molson time to get used to insulin. It is a hormone, not a medication like an antibiotic that gets to work and fixes the problem in 5 days. Feline diabetes is a marathon not a sprint. The one big thing I learnt with Sheba was patience. We all want our kitties to get better straight away...that is norma...but it is going to take time.
Molson's SS is typical of newly diagnosed cats. Some newly diagnosed cats don't get down to green BGs for months. He is doing really well.
Higher preshots is normal at this stage of the journey.
Have a look at other peoples SS.
Here are two SS and you can see over time the higher preshots come down. Every cat is different and they do it at their own pace. YOu cant rush them or it will go pear shaped. Just follow the dosing method

https://docs.google.com/spreadsheet...xsPm45JB4H0KMDN6kEFa0jMIM/edit#gid=1183721521

https://docs.google.com/spreadsheets/d/1h6McPoTi7fFJqRIkSsUkzm3xihg0VKyRu0rHqGWP9Gc/edit#gid=0

 

[Catrina]

Catrina, you need to give Molson time to get used to insulin. It is a hormone, not a medication like an antibiotic that gets to work and fixes the problem in 5 days. Feline diabetes is a marathon not a sprint. The one big thing I learnt with Sheba was patience. We all want our kitties to get better straight away...that is norma...but it is going to take time.
Molson's SS is typical of newly diagnosed cats. Some newly diagnosed cats don't get down to green BGs for months. He is doing really well.
Higher preshots is normal at this stage of the journey.
Have a look at other peoples SS.
Here are two SS and you can see over time the higher preshots come down. Every cat is different and they do it at their own pace. YOu cant rush them or it will go pear shaped. Just follow the dosing method

https://docs.google.com/spreadsheet...xsPm45JB4H0KMDN6kEFa0jMIM/edit#gid=1183721521

https://docs.google.com/spreadsheets/d/1h6McPoTi7fFJqRIkSsUkzm3xihg0VKyRu0rHqGWP9Gc/edit#gid=0

Thanks for sharing those spreadsheets!!

I’m so glad you gave me that advice and I listened and I gave him 1u. This morning he was 7.2. I am going to test him at +5 to see if I need to give him high carb food. I read the hypo sticky and it said if he’s between 3.3 and 2.2 (60-40) I should give him some higher carb food and keep an eye on him.

I’m hoping he’ll be ok also hoping I can test him. I have a hard time testing him sometimes. I need my husband to help me but he’s not home today so it’ll just be me.

 

[Bron and Sheba (GA)]

With SLGS you need to give some higher carb food if the BG drops under 5 (90)
I would also test before +5 if you are shooting a lower than normal preshot BG.

 

[Catrina]

With SLGS you need to give some higher carb food if the BG drops under 5 (90)
I would also test before +5 if you are shooting a lower than normal preshot BG.

I just tested him at +2.5 and he’s 18.1 his numbers are so confusing I thought forsure he would’ve gone a lot lower. Maybe he’s still bouncing? But he’s gotten a number lower than 7 before.. Should I test him again today before his preshot or am I okay to just test him at his PMPS?

 

[Bron and Sheba (GA)]

I just tested him at +2.5 and he’s 18.1 his numbers are so confusing I thought forsure he would’ve gone a lot lower. Maybe he’s still bouncing? But he’s gotten a number lower than 7 before.. Should I test him again today before his preshot or am I okay to just test him at his PMPS?

He looks like he is bouncing from the lower than normal preshot…this is very common. At the moment his body thinks the higher numbers are normal, so when they drop down into more normal numbers, his body panics and dumps the stored glucose and counter regulatory hormones into his system as he thinks he has to save himself. It is going to take time for his body to get used to the normal numbers again and until he does, he will continue to bounce. And this could take a couple of weeks or a couple of months or longer. Every cat is different.
The more times he can experience normal numbers the better. Some cats bounce all the way to remission.

 

[Catrina]

okay yeah maybe he is taking longer to bounce then! i just didn't think he would bounce again since on Sunday, April 9 he had his AMPS at 7.4 +2 was 4.2 +4 was 3.4 and +6 was 2.4.. so he didn't bounce that day until his PMPS which was 25.6 but i also gave him some medium carb food because of his 2.4. but maybe his body just decided to bounce today...

so no reduction for him.. unless he gets a number lower than 5 but i am thinking he likely won't. I will continue with the 1u tn. hopefully, his bouncing gets more under control, until then I will keep monitoring him and testing him when i can and try to ignore the high numbers and not let them affect me/discourage me. I was expecting the bouncing to last 3-5 days but if you are saying some cats take a couple of weeks or months then I will tell myself to be more patient!!!

I can't tell you how thankful i am for all your guidance!

 

[Bron and Sheba (GA)]

okay yeah maybe he is taking longer to bounce then! i just didn't think he would bounce again since on Sunday, April 9 he had his AMPS at 7.4 +2 was 4.2 +4 was 3.4 and +6 was 2.4.. so he didn't bounce that day until his PMPS which was 25.6 but i also gave him some medium carb food because of his 2.4. but maybe his body just decided to bounce today...

so no reduction for him.. unless he gets a number lower than 5 but i am thinking he likely won't. I will continue with the 1u tn. hopefully, his bouncing gets more under control, until then I will keep monitoring him and testing him when i can and try to ignore the high numbers and not let them affect me/discourage me. I was expecting the bouncing to last 3-5 days but if you are saying some cats take a couple of weeks or months then I will tell myself to be more patient!!!

I can't tell you how thankful i am for all your guidance!

I’m glad I can help. If it is any help, when Sheba fell out of remission and I hadn’t found this wonderful forum, I was very anxious about her every day for months as she was a champion bouncer and diver. I could not understand why she would be constantly in very high numbers and then low numbers and then high again. I remember my sister coming to visit and I spent the whole visit telling her how worried I was about Sheba. Then I find this forum and everything became clear.

 

[Catrina]

I’m glad I can help. If it is any help, when Sheba fell out of remission and I hadn’t found this wonderful forum, I was very anxious about her every day for months as she was a champion bouncer and diver. I could not understand why she would be constantly in very high numbers and then low numbers and then high again. I remember my sister coming to visit and I spent the whole visit telling her how worried I was about Sheba. Then I find this forum and everything became clear.

that's how i have been feeling.. i'm sure the pregnancy hormones aren't helping. I keep getting so confused with his low numbers then super high numbers. I also have a planned trip in August that i won't be able to take him on as well as in February and then i have a baby coming soon so i am thinking about all the times i won't be home to test him and give him his shot so i feel like i am subconsciously trying to speed up the process so i don't need to worry as much while i am away. i don't have anyone who can test him, unfortunately.

how long was Sheba bouncing for until she fell into remission?

 

[Bron and Sheba (GA)]

that's how i have been feeling.. i'm sure the pregnancy hormones aren't helping. I keep getting so confused with his low numbers then super high numbers. I also have a planned trip in August that i won't be able to take him on as well as in February and then i have a baby coming soon so i am thinking about all the times i won't be home to test him and give him his shot so i feel like i am subconsciously trying to speed up the process so i don't need to worry as much while i am away. i don't have anyone who can test him, unfortunately.

how long was Sheba bouncing for until she fell into remission?

The first time around she went into remission after 3 months and never bounced. She was in remission for 2 1/2 years. The the second time she bounced off and on for the next 4 years. I couldn’t get her back into remission. She was often in. Good numbers and then she would bounce. I got used to it.

Don’t try and speed up the process, that will not work. Just try and get your testing up to scratch and then you can swap to TR.
Who will do the insulin when you are in hospital? You might like to get a freestyle libre fitted for that time so the person can read the BGs.
Also if you are going away on a trip, I would look around sooner rather than later, and find someone who will come in and feed him and give the insulin.
You might want to look at getting an automatic timed feeder and get him used to that and the pet sitter could fill that twice a day so he can get food when no one is there. You could also get a freestyle libre fitted for a fortnight so the BG ps could be read.
The petsafe 2 or petsafe 5 are good feeders.

I’m heading to bed as I live in Australia so I’ll see you tomorrow​

 

[Catrina]

The first time around she went into remission after 3 months and never bounced. She was in remission for 2 1/2 years. The the second time she bounced off and on for the next 4 years. I couldn’t get her back into remission. She was often in. Good numbers and then she would bounce. I got used to it.

Don’t try and speed up the process, that will not work. Just try and get your testing up to scratch and then you can swap to TR.
Who will do the insulin when you are in hospital? You might like to get a freestyle libre fitted for that time so the person can read the BGs.
Also if you are going away on a trip, I would look around sooner rather than later, and find someone who will come in and feed him and give the insulin.
You might want to look at getting an automatic timed feeder and get him used to that and the pet sitter could fill that twice a day so he can get food when no one is there. You could also get a freestyle libre fitted for a fortnight so the BG ps could be read.
The petsafe 2 or petsafe 5 are good feeders.

I’m heading to bed as I live in Australia so I’ll see you tomorrow​

is the goal to switch to TR at some point?

 

[Bron and Sheba (GA)]

It is up to you and your lifestyle.
TR is a more aggressive dosing method and you have to be testing more and not feeding ant dry food. It usually gets cats into better numbers quicker. when you are ready you can try it and if it is not working out for you , you can swap back to SLGS

 

[Catrina]

It is up to you and your lifestyle.
TR is a more aggressive dosing method and you have to be testing more and not feeding ant dry food. It usually gets cats into better numbers quicker. when you are ready you can try it and if it is not working out for you , you can swap back to SLGS

I really want to try TR but I have issues testing him. I always try and half the time it works half the time it doesn’t. And when it doesn’t it really upsets me and ruins my whole day because I feel like a failure

I always have to get my husband to help me or wake him up to do it. I feel like I can’t depend on him for all the testing considering if he’s out or at work

his numbers still don’t seem to be getting better. It looks like he was doing better when he first started insulin he was getting yellow numbers. Now it’s so much purple I feel like I’m making him worse some how

mentally this is taking a toll on me and I can’t figure out how to relax a bit more. I feel like I’m failing him. And then I worry about when my baby arrives what I’m going to do, then I feel guilty that I’m more focused on molson and testing and his insulin and his blood sugar than getting excited about my baby.

 

[Bron and Sheba (GA)]

What you are feeling is perfectly normal. The first few weeks are always the hardest. You are in no way failing him. He is a lucky boy to have such a devoted mom. He is actually doing well. Many cats don't see blue and green BGs for months and you have both in the first month.
Don't forget the higher numbers are from bouncing which none of us can do much about and its perfectly normal in newly diagnosed cats.

Are you warming the ear first and massaging it towards the top?
It can take time for the ear to learn to bleed.
I was in the same position as you when Sheba fell out of remission. My husband was helping me test but not always there. So I worked out a way to test Sheba on my own.
What I did was, I got all the test equipment ready and checked how long it took after I pushed in the test strip for the meter to run out of time for me to collect the blood. I got a small low carb snack for her and had that ready too. I put it all on the floor. Then I knelt down on the floor and sat on my heels. I pushed in the test strip, and put Sheba between my knees so that she was facing the same way as I was. If she backed away she would just back into me. and I had one hand holding her chest gently and I talked to her. The other hand was free to do the testing. I put the food in front of her and while she ate, I had two hands free so I pricked her ear and collected the blood.

Try not to be tense doing the testing as Molsom will pick up on that. try humming or singing.
Here is Kyle testing his kitty. When he first started he was much like you.

When is your baby due?

 

[Catrina]

What you are feeling is perfectly normal. The first few weeks are always the hardest. You are in no way failing him. He is a lucky boy to have such a devoted mom. He is actually doing well. Many cats don't see blue and green BGs for months and you have both in the first month.
Don't forget the higher numbers are from bouncing which none of us can do much about and its perfectly normal in newly diagnosed cats.

Are you warming the ear first and massaging it towards the top?
It can take time for the ear to learn to bleed.
I was in the same position as you when Sheba fell out of remission. My husband was helping me test but not always there. So I worked out a way to test Sheba on my own.
What I did was, I got all the test equipment ready and checked how long it took after I pushed in the test strip for the meter to run out of time for me to collect the blood. I got a small low carb snack for her and had that ready too. I put it all on the floor. Then I knelt down on the floor and sat on my heels. I pushed in the test strip, and put Sheba between my knees so that she was facing the same way as I was. If she backed away she would just back into me. and I had one hand holding her chest gently and I talked to her. The other hand was free to do the testing. I put the food in front of her and while she ate, I had two hands free so I pricked her ear and collected the blood.

Try not to be tense doing the testing as Molsom will pick up on that. try humming or singing.
Here is Kyle testing his kitty. When he first started he was much like you.

When is your baby due?

it's so strange because sometimes I can test him first try and no issues and then other times I am pricking him multiple times and can't get enough blood. I might be siking myself out because I was the one who showed my husband how to do it, and now i just can't do it.. you would like practice makes perfect but I seem to be getting worse. Everytime I fail at testing him it really brings me down and then i have a build up of anxiety for the next time i have to test him. I have been trying to find a pattern but haven't figured it out. My husband never has issues, he puts the pricker at level 5 and gets more than enough blood, me on the other hand have issues with the level 6 and even level 7, and whenever i try, Molson's ear is so red after and bruised after, when my husband does it there's never a mark. I use a sock with rice and warm it up every time. i start to get discouraged after i prick him so many times and still don't get enough blood, or if i waste a test strip because i didn't get enough blood. I start to feel very guilty and that i'm hurting him after I prick him so many times and still need to hold him down to continue to try, and then I get frustrated if I use a test strip and it doesn't work because I didn't get enough blood, the test strips are not cheap.

you are right, maybe he isn't doing too bad considering he has had some greens and blues. i feel like time goes by so slow since his last numbers were pretty high but I try to keep reminding myself that it's him bouncing and to be patient. there was a good week or so that his numbers were consistently in the yellow so i keep looking at that and wondering

baby is due in 10 days. I don't have a plan yet for someone to come and give him his shot. I do have two people who would be willing to give him his shot, but they aren't able to test him and with his numbers all over the place i am nervous for him to get an insulin shot without knowing what his number is.. what if his BG is super low and they still give him the shot. I am debating on either lowering his dose while i'm in the hospital and have someone come, or skipping the shot. I am not too far from the hospital so there is also a possibility that I can have my husband run home quickly to test him and shoot him, but it's hard to say since i don't know how long i will be in labour and how long i will be at the hospital for.

 

[Bron and Sheba (GA)]

We can help you work out a vacation dose for when you are in hospital so don’t worry. Don’t skip the dose as you could run into other problems. Work out a plan so that he has access to food most of the time you are not there. Have you thought of automatic timed feeders?
You could try pricking the ear twice (at the same time) one beside the other and then you might get enough blood.
Have you ever shone a torch behind the ear to see where the vein is? You aim for between the vein and the edge of the ear.

 

[Catrina]

We can help you work out a vacation dose for when you are in hospital so don’t worry. Don’t skip the dose as you could run into other problems. Work out a plan so that he has access to food most of the time you are not there. Have you thought of automatic timed feeders?
You could try pricking the ear twice (at the same time) one beside the other and then you might get enough blood.
Have you ever shone a torch behind the ear to see where the vein is? You aim for between the vein and the edge of the ear.

i did purchase an automatic feeder, I have only used it once though since I have been able to work from home the last few days and feed him. I haven't yet figured out a schedule for the automatic feeder, if i change the schedule i need to re-set the times everytime so i was going to plan to use it while i'm in the hospital and set it before I leave. Until I figure out the schedule that I want to feed him and the times that the feeder will move I was going to wait to start using it. if that makes sense..

I also don't know if i should set the time for him to be fed before his insulin shot or after. I try to give him his shot around 6:30am and 6:30pm give or take some minutes. So do i set the feeder for those exact times? i don't want it to move while i am testing him cuz he gets so hungry he'll run towards it in the middle of the test. Right now i test him, give him his shot and then feed him. What is the best feeding schedule for the automatic feeder? and then when would be the best time to actually put the food in?

Should i wait until closer to my due date (April 25th) to figure out a dose to give him? i do still have a couple of weeks to see how his numbers are doing so i guess it is too early to make a decision on his dose, especially since his numbers are all over the place lol

 

[Bron and Sheba (GA)]

With the feeder, I would give him some meals in it now, so he associates the feeder with meals.
I would not use the feeder for the preshot meals, rather the snacks inbetween.
Maybe set the timer for snacks at +2 +4 and +6 each cycle. It is better to feed in the first half of the cycle when the insulin is strongest.
A snack is a teaspoon or two of low carb food.
I would put the snacks in after you have fed him his preshot meals.

For the vacation dose let us know about 2 days before you go in. If you find you need to go in sooner, post and let us know. we will also want to know if he is going to be tested beforehand and if he will be monitored at all.

 

[Catrina]

With the feeder, I would give him some meals in it now, so he associates the feeder with meals.
I would not use the feeder for the preshot meals, rather the snacks inbetween.
Maybe set the timer for snacks at +2 +4 and +6 each cycle. It is better to feed in the first half of the cycle when the insulin is strongest.
A snack is a teaspoon or two of low carb food.
I would put the snacks in after you have fed him his preshot meals.

For the vacation dose let us know about 2 days before you go in. If you find you need to go in sooner, post and let us know. we will also want to know if he is going to be tested beforehand and if he will be monitored at all.

Can you take a look at Molson's Spreadsheet? Do you think he is still somewhat bouncing? his preshot numbers have been decent, you would think after the insulin shot his BG number would drop but it rises?

I know you have said to make dose adjustments based on the nadir during a curve, when i did the curve yesterday, his nadir was the preshot so i was too nervous to increase him to 1.25 so i kept him at 1. this morning he was 8.9 so i kept him at 1 again.. should i increase him tonight to 1.25 even if his preshot number is 8 or what is a number that i should NOT increase his dose? i am so paranoid he'll become hypo so i am hesitent to increase when he has this pre shot number.. or should i keep him on 1? based on SLGS I increase by .25u if his nadir is above 8.3, which it is but his nadir has been his preshot.. i don't know if the protocol means the mid day nadir.. Or maybe his numbers are increasing after insulin because that's also when i feed him and i have been trying to stear him away from too much fish so i have been giving him 2%-4% carb Fancy Feast, which is higher than the fish ones i used to give him 0%-1%.


I want to be prepared because i get nervous when i see his pre shot numbers when they are either high or low. Lately when they are low I get super worried he'll drop too low... but he has only risen.. what does this mean and how should i react to preshot numbers. i have read the forums that say what to do during low preshot numbers, but sometimes i cannot stall 20 minutes and re-test, so what do i do if i get a preshot number of 8, or 7, or 6 or even 5!? I have also read somewhere on this to not give insulin if hes below 8.3? but i also read that with SLGS you should not shoot a preshot number below 5.. which one is correct i have read too many things and am getting confused.


what are your thoughts?

 

[Bron and Sheba (GA)]

If you are following SLGS you hold the dose for 7 days unless the BG drops below 90.
You are on day 6 today so you need to stay with 1 unit for another day and then evaluate. Post and ask for assistance would be a good idea at this stage in your FD journey.
The nadir is the lowest point in the cycle. That can be in the middle or at the preshot.
You need to be getting some tests in during the pm cycle if at all possible because cats often drop lower at night and we have no idea what is happening.
Molson is doing very well and responding to the insulin.
I would not be concerned if the carbs are 1% or 4%. They are all low carb and are fine. There is no need to give very low carbs around 1%. Cats often do bette if getting around 4 or 5% carbs.
The SLGS says
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. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• 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

In relation to when to shoot
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.

 

[Bron and Sheba (GA)]

have also read somewhere on this to not give insulin if hes below 8.3? but i also read that with SLGS you should not shoot a preshot number below 5.. which one is correct i have read too many things and am getting confused.

The ‘do not give insulin below 8.3’ is when you are new and learning and gathering data…as per the information I posted above. The ‘do not shoot under 5’ is for all people doing SLGS

 

[Catrina]

The ‘do not give insulin below 8.3’ is when you are new and learning and gathering data…as per the information I posted above. The ‘do not shoot under 5’ is for all people doing SLGS

Ok so I should follow the “do not shoot under 5”

so on day 7, even if his preshot is his nadir and it’s 8.5 say (slightly above the 8.3) I should still increase by 0.25? That makes me nervous but if that’s what people are doing and it’s okay then that’s what I will do!

what do you think of his BG going up after his insulin, is that normal/common?

you also say post and ask for assistance. Should I not post on this thread or create a new thread or do it in a new forum?

 

[Bron and Sheba (GA)]

Ok so I should follow the “do not shoot under 5”

You work down to 5. At the moment to lowest preshot you have shot is 7 so I would work you way down to the preshot of 5.

so on day 7, even if his preshot is his nadir and it’s 8.5 say (slightly above the 8.3) I should still increase by 0.25? That makes me nervous but if that’s what people are doing and it’s okay then that’s what I will do!

That is what I would do.
Always get a +1 or a +2 when you are shooting a lower than normal preshot to see what is happening

what do you think of his BG going up after his insulin, is that normal/common?

He is reacting to a lower than normal preshot and bouncing. Very common

you also say post and ask for assistance. Should I not post on this thread or create a new thread or do it in a new forum?

You can ask on this thread but you need to change the subject line to reflect the issue. So put something like "Preshot xx stalling need help"

I think you could start posting over on the Lantus page now as you are set up and are following a dosing method.
Read this link about the guidelines in posting on the Lantus page
https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

 

[Catrina]

You work down to 5. At the moment to lowest preshot you have shot is 7 so I would work you way down to the preshot of 5.

That is what I would do.
Always get a +1 or a +2 when you are shooting a lower than normal preshot to see what is happening

He is reacting to a lower than normal preshot and bouncing. Very common

You can ask on this thread but you need to change the subject line to reflect the issue. So put something like "Preshot xx stalling need help"

I think you could start posting over on the Lantus page now as you are set up and are following a dosing method.
Read this link about the guidelines in posting on the Lantus page
https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

What exactly do you mean by "you work down to 5"? How can i work down to a number?

That's good to know that you would still give the normal dose when the nadir is the pre-shot. If i get his nadir at his preshot BG i will give the dose, based on the SLGS protocol, if I am home to monitor him. If I am not home I may lower the dose but will make that decision when/if the time comes, but I do feel more prepared now. Would you say giving a lower dose is better than skipping a dose or is skipping a dose better? i have read mixed things on here...

Okay great! I will move over to the Lantus page, i have read a bit on how to post but will review it again. Thank you SO much for all your help in this thread

 

[Bron and Sheba (GA)]

What exactly do you mean by "you work down to 5"? How can i work down to a number?

By that I mean don’t go straight down to 5(90) and shoot that. At the moment your lowest preshot is 7 (126) so next time make your cut off to shoot say at 110 and see how that goes. I would not do it on a day you can’t be home to monitor though. Then maybe the next time it is lower you might have the cut off BG at 5 (90). Does that make sense?
Any time you shoot a lower than normal preshot always get a+1 and +2 to start with so you don’t get to +3 and find the BG has dropped a lot without you knowing.

Would you say giving a lower dose is better than skipping a dose or is skipping a dose better? i have read mixed things on here...

It is better to give a lower dose than skip if possible. But it depends on the circumstances and if you can be there to monitor the cycle.
Remember safety first always.

 

[Catrina]

By that I mean don’t go straight down to 5(90) and shoot that. At the moment your lowest preshot is 7 (126) so next time make your cut off to shoot say at 110 and see how that goes. I would not do it on a day you can’t be home to monitor though. Then maybe the next time it is lower you might have the cut off BG at 5 (90). Does that make sense?
Any time you shoot a lower than normal preshot always get a+1 and +2 to start with so you don’t get to +3 and find the BG has dropped a lot without you knowing.

It is better to give a lower dose than skip if possible. But it depends on the circumstances and if you can be there to monitor the cycle.
Remember safety first always.

yes that makes sense, hopefully his next lowest pre-shot isnt below 90 (5) so i can work my way down.

Thank you so much!! you have helped me immensely