Clarity on when BG is too low to give dose

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Elle & Luna

Elle & Luna

Member Since 2023
Hi! I am a new member here so please excuse any formatting or missing info in this post. Happy to provide additional details.

My Luna was diagnosed with diabetes in mid September. Since then, my vet and I have been working on the best dose for her.

Context on diagnosis/health history:
Not sure if this all matters but she is almost 10 years old - used to be overweight but got down to 13lbs in April of this year so that she could be put under gen anesthesia for a dental cleaning. Got the dental cleaning and during the months after, she started having some health issues like diarrhea and coughing. Each time I would bring her in to the vet to get a symptom checked out, I noticed her weight was dropping dramatically. She went from 13lbs to 9lbs and I raised that as a concern with my vet. She recommended a fructosamine test and an ultrasound (to rule out something else I can't remember), so I brought her in to get those tests done.
Around the same time I noticed Luna's weight loss, she was also starting to urinate in places other than the litter box, and I noticed that it was not at all like I would expect cat pee to smell like (weird sweet smell), and (sorry if TMI) it was like syrup when cleaning it off of the floor.
Found out a few days later that her levels are spiked and she does indeed have diabetes.

Context on treatment so far:
We started with Lantus insulin, 2 units per day, around 8am/8pm, with 2 cans, 5.5oz/each of Purina DM wet food as her two meals per day and no dry food. I do at home testing before she eats and gets her shot.

The 2 units were too much for her initially (her levels were getting dramatically low sometimes), so after a week of that we went down to 1 unit. I did an at-home curve on 9/22 which did not really show any great results as her lowest point was 237 down from 358 in the morning.

We went to 1.5 units for about a month (9/23-10/22ish) which also did not do a great job of improving the numbers overall. Additionally, her symptoms were not improving. She was having a lot of diarrhea and was still urinating in huge quantities and frequently. I brought her in for another fructosamine check and the results put her in the "poorly regulated" category.

As a result, we tried going back to 2 units on 10/22. I also took it upon myself to switch her food to FF chicken pate as I read more about the gravy-based foods and was shocked that a diabetic prescription food can be so high in carbs. She eats 1.5 3oz cans for each meal now.

It's been about a month and her numbers have been all over the place. Initially the numbers were around 230-430 with around 350 being the average. After about a week of that, since 11/1 it's basically been a pattern of 2 units -> 2 units -> skip -> repeat. File with more reading data is attached in a reply to this post, but these are some examples of her numbers just so you get an idea:

Morning - 386 (2 units)
Evening - 350 (2 units)
Morning - 49 (skip)
Evening - 500 (2 units)
Morning - 400 (2 units)
Evening - 59 (skip)
Morning - 260 (2 units)
Evening - 360 (2 units)
Morning - 59 (skip)

etc.

The good thing is, her symptoms have definitely subsided for the most part, and her fructosamine was checked last Wednesday and she is now in the "fair regulation" category.

We are now looking to move to a 2 unit in the morning, 1 unit in the evening treatment plan.

My vet has said that even if her levels are as low as they are, to still move forward with giving the dose if her energy and symptoms are overall seeming normal. She said if I felt uncomfortable doing that, that it would be beneficial to see an internist who is more of a specialist and might be able to suggest alternate treatment (different type of insulin maybe) since Luna's levels are not stabilizing with what would be a more "standard" treatment plan.

I worry about just injecting with low levels because I have read that cats in hypo don't necessarily show symptoms and can be normal one minute and having a seizure the next, and I would like to do whatever it takes to avoid that scenario as I live alone and am usually not home during the day to monitor after her morning dose. I had called an emergency vet one time when Luna's level was 60 and she said do not inject below 200. However my vet is advising me to try to consistently inject 1 unit in the evenings and base it on energy levels and not worry so much about the low glucose readings.

For example, right now her reading is at 100. She was at about 200 when I checked her two hours ago. I do not feel comfortable personally giving her the dose, so I don't know what to do. I will be home overnight and in the morning so I can monitor her, but my worst nightmare is her going into hypoglycemia.

Are there general guidelines that are agreed upon here? Or does it depend on the cat's history of treatment and how they respond to insulin?

Also, does anyone have experience going to an internist vs a regular vet? What types of "alternate treatment" might they offer?

Thanks so much!!!! Have been lurking for a while and the information here has been so incredibly helpful.
 
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Attached are some more reading results from 2 units twice a day since November 1st and more recently starting 2 units morning / 1 unit evening. As you can see it's super inconsistent and her numbers are all over the place, although her average is technically better than before and her symptoms have mostly subsided.
 

Attachments

Hi and welcome to you both.

First of all, you need to be reducing the dose of insulin. 2 units is too much and it looks like 3 units (a day ) is too much (attachment).
Dropping under 50 even with our tight regulation protocol means you must reduce the dose.
Please see post 5 below for new dose
It is better to have the same dose am and pm dose than to have different doses for the am and pm doses

Can you tell me what type of glucose meter are you using? Pet or human meter?

You have been doing a good job looking after Luna, despite getting some bad advice from you vet.
I don't think you need an internist at all.
I would recommend you have a look at both our dosing methods and follow one of them. We have a lot of people arrive here with a similar story to yours and once they settle down with one of the dosing methods, things fall into place.
DOSING METHODS
If you are only feeding wet food and can test at least 4 times a day, you can do the tight regulation. Otherwise start low go slow is the other one. You can change dosing methods.

FOOD
We recommend canned/wet low carb food for diabetic cate. 10% or under carbs
Here is a FOOD CHART
Also make sure you get a hypo kit set up in case of low numbers.
Are you giving snacks during the first half of all the cycles as well as the 2 main meals. A snack is a teaspoon or 2 of low carb food.

Setting up your spreadsheet and signature
Here is a link to information for new members. It includes the SS and signature and other useful information.
If you can set up the spreadsheet and add a couple of weeks data to it, we can help you with dosing.
If you are home testing, you do not need to get any more fructosamine tests done. Fructosamine tests are just an average of the last few weeks BGs. They don't give any highs or lows, so he could be dropping very low then bouncing up high and the test could say she is well regulated. Home testing gives you hour to hour results and is much more reliable and true.
HELP US HELP YOU

If she is still peeing out of the litter box, she could have a UTI so I would get that checked. Other wise it may get better when the BGs improve.
There is a lot more I could tell you but I don't want to overwhelm you.
Keep asking questions and if you have any trouble setting up the SS I can ask @Bandit's Mom to help you.
If I've missed anything let me know
Bron
 
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Luna and Phoebe's Mom said:
Hi! I am a new member here so please excuse any formatting or missing info in this post. Happy to provide additional details.

My Luna was diagnosed with diabetes in mid September. Since then, my vet and I have been working on the best dose for her.

Context on diagnosis/health history:
Not sure if this all matters but she is almost 10 years old - used to be overweight but got down to 13lbs in April of this year so that she could be put under gen anesthesia for a dental cleaning. Got the dental cleaning and during the months after, she started having some health issues like diarrhea and coughing. Each time I would bring her in to the vet to get a symptom checked out, I noticed her weight was dropping dramatically. She went from 13lbs to 9lbs and I raised that as a concern with my vet. She recommended a fructosamine test and an ultrasound (to rule out something else I can't remember), so I brought her in to get those tests done.
Around the same time I noticed Luna's weight loss, she was also starting to urinate in places other than the litter box, and I noticed that it was not at all like I would expect cat pee to smell like (weird sweet smell), and (sorry if TMI) it was like syrup when cleaning it off of the floor.
Found out a few days later that her levels are spiked and she does indeed have diabetes.

Context on treatment so far:
We started with Lantus insulin, 2 units per day, around 8am/8pm, with 2 cans, 5.5oz/each of Purina DM wet food as her two meals per day and no dry food. I do at home testing before she eats and gets her shot.

The 2 units were too much for her initially (her levels were getting dramatically low sometimes), so after a week of that we went down to 1 unit. I did an at-home curve on 9/22 which did not really show any great results as her lowest point was 237 down from 358 in the morning.

We went to 1.5 units for about a month (9/23-10/22ish) which also did not do a great job of improving the numbers overall. Additionally, her symptoms were not improving. She was having a lot of diarrhea and was still urinating in huge quantities and frequently. I brought her in for another fructosamine check and the results put her in the "poorly regulated" category.

As a result, we tried going back to 2 units on 10/22. I also took it upon myself to switch her food to FF chicken pate as I read more about the gravy-based foods and was shocked that a diabetic prescription food can be so high in carbs. She eats 1.5 3oz cans for each meal now.

It's been about a month and her numbers have been all over the place. Initially the numbers were around 230-430 with around 350 being the average. After about a week of that, since 11/1 it's basically been a pattern of 2 units -> 2 units -> skip -> repeat. File with more reading data is attached in a reply to this post, but these are some examples of her numbers just so you get an idea:

Morning - 386 (2 units)
Evening - 350 (2 units)
Morning - 49 (skip)
Evening - 500 (2 units)
Morning - 400 (2 units)
Evening - 59 (skip)
Morning - 260 (2 units)
Evening - 360 (2 units)
Morning - 59 (skip)

etc.

The good thing is, her symptoms have definitely subsided for the most part, and her fructosamine was checked last Wednesday and she is now in the "fair regulation" category.

We are now looking to move to a 2 unit in the morning, 1 unit in the evening treatment plan.

My vet has said that even if her levels are as low as they are, to still move forward with giving the dose if her energy and symptoms are overall seeming normal. She said if I felt uncomfortable doing that, that it would be beneficial to see an internist who is more of a specialist and might be able to suggest alternate treatment (different type of insulin maybe) since Luna's levels are not stabilizing with what would be a more "standard" treatment plan.

I worry about just injecting with low levels because I have read that cats in hypo don't necessarily show symptoms and can be normal one minute and having a seizure the next, and I would like to do whatever it takes to avoid that scenario as I live alone and am usually not home during the day to monitor after her morning dose. I had called an emergency vet one time when Luna's level was 60 and she said do not inject below 200. However my vet is advising me to try to consistently inject 1 unit in the evenings and base it on energy levels and not worry so much about the low glucose readings.

For example, right now her reading is at 100. She was at about 200 when I checked her two hours ago. I do not feel comfortable personally giving her the dose, so I don't know what to do. I will be home overnight and in the morning so I can monitor her, but my worst nightmare is her going into hypoglycemia.

Are there general guidelines that are agreed upon here? Or does it depend on the cat's history of treatment and how they respond to insulin?

Also, does anyone have experience going to an internist vs a regular vet? What types of "alternate treatment" might they offer?

Thanks so much!!!! Have been lurking for a while and the information here has been so incredibly helpful.
Click to expand...
Hi and welcome! I'm not experienced enough to offer dosing advice but I see that Bron has offered some and they're very knowledgeable. I'm sure others will be chiming in. I just wanted to say that you're doing a great job keeping track of your kitty"s blood glucose numbers and everything else going on with them. Lantus is an excellent insulin to be on and offers a better chance at remission than other insulins ike Vetsulin, so I'd stick with it.

You're right to be concerned about shooting too much when the number is low. Are you using a pet meter or a human meter? Does your vet really want you to give two units of insulin when their blood sugar is as low as 49?! That's crazy to me. I hope I misread that. Especially if you're using a pet meter. It would mean your cat was already low in blood sugar and going hypo. You wouldn't want to give insulin then, you'd give a high carb food and honey or corn syrup. Anyway, you're doing great, and more people will be along to offer advice. Just hang in there!
 
I just want to clarify the doses you have been giving. What was the date of the below data?
Morning - 386 (2 units)
Evening - 350 (2 units)
Morning - 49 (skip)
Evening - 500 (2 units)
Morning - 400 (2 units)
Evening - 59 (skip)
Morning - 260 (2 units)
Evening - 360 (2 units)
Morning - 59 (skip)

Looking at the attachment in post 2, that looks like later data? Is that correct?
If so, your new dose should be 1.25 Units each cycle as the combined daily total of the attached data is 3 units and that is too much as the BGs dropped to 49.
 
Bron and Sheba (GA) said:
I just want to clarify the doses you have been giving. What was the date of the below data?
Morning - 386 (2 units)
Evening - 350 (2 units)
Morning - 49 (skip)
Evening - 500 (2 units)
Morning - 400 (2 units)
Evening - 59 (skip)
Morning - 260 (2 units)
Evening - 360 (2 units)
Morning - 59 (skip)

Looking at the attachment in post 2, that looks like later data? Is that correct?
If so, your new dose should be 1.25 Units each cycle as the combined daily total of the attached data is 3 units and that is too much as the BGs dropped to 49.
Click to expand...

Thanks so much for the detailed response! I will set up a spreadsheet in the morning, I really appreciate the info provided. Thank you as well @Snickers and Chrissy, my vet was mostly referring to the 1 unit evening dose not 2 but even then it would be too much to give her. I'd always rather be on the side of caution.

I am using a human meter so I understand this may not be as accurate as a pet meter.

She has not been peeing outside of the box for a while now, probably for at least 6 weeks - that was the most extreme her symptoms got - then it went to peeing just in large quantities (from excessive drinking), and over the last 2 weeks or so she seems to be peeing normal amounts so I think that symptom has mostly subsided at this point so not super concerned about a UTI.

Sorry for the confusion. That snapshot of data is from the last week or so when I was supposed to be doing 2 units twice a day (4 units per day) but I had to skip a few doses as her reading was too low to give a dose, which yeah I guess technically lowers the overall daily average dosage since I had to skip a few completely.
I don't think 3 is too much only because a consistent 1.5 units twice a day (3 units daily) which I did for a month prior to going back to 2 didn't get her numbers in a good range, and more importantly her symptoms did not get better. Though I'm not sure why doing 2 in the morning and 1 in the evening would make any difference since that is also 3 per day. If it's not 3, and it's not 4, perhaps 3.5 (1.75 2x daily) would work better. I will look at the dosing guide link you sent.

It'll help a lot once I add the spreadsheet in the right format for this forum, so I will get to that asap so it'll be more helpful. Thanks so much again for the quick response!
 
Also to add:
- I am not currently giving any snacks to Luna. Vet recommended against any food other than her two meals per day, but I am open to figuring that out if it's helpful. Unfortunately I am at the office 3 days a week so it would be hard to follow a daily routine with additional smaller snacks built in.
- Perhaps the 1.5 units (3 daily) would be worth trying again since at the time I tried it, she was still eating Purina DM food, but now she is on a much lower carb diet of FF pate.
 
Feeding twice a day only is old fashioned advice and something that works for dogs who have a much slower metabolism than cats. Cats are also grazers and actually do much better with smaller meals or snacks throughout the day. It’s easier on their pancreas and it also helps avoid big sugar spikes. I suggest you start adding some meals or snacks. It can be smaller portions of the same food or low carb snacks. Most of us feed the 2 larger meals at shot times and 3-4 smaller ones or snacks throughout the day and overnight.
 
Luna and Phoebe's Mom said:
I am using a human meter so I understand this may not be as accurate as a pet meter.
Click to expand...
Absolutely it is as accurate as a pet meter. And our dosing methods are based on the human meter.

I would think about getting an automatic timed feeder for when you are at work. Then you can leave the number of snacks you need to in the feedeer and it will open when programmed. A lot of us use them.
Apart from being better for the pancreas, several snacks during the cycles will help stop the BGs from dropping too low.
I would suggest giving a snack at +3 and +5 to start with...both cycles. Just feeding 2 main meals is old thinking and was for old insulins...not lantus.

Lantus is a depot insulin.
What is a DEPOT INSULIN
So one dose can effect the next.

When you are having to consistently skip a dose because the preshot was too low...that is an indication the dose is too high. Then when it shoots up higher, that doesn't mean you need more insulin. That means the cat is bouncing.
BOUNCING

According to the data in post 2 towards the end when you were giving 2 units am and 1 unit pm...the BG dropped to 59. That is why I was suggesting dropping the dose to 1.25 U. What you were giving a month ago when you were giving 3 units a day, doesn't necessarily mean that dose will be best for now, especially if the BGs are telling you otherwise.
Are you getting any BGs during the cycle? Lantus dosing is based on the nadir or lowest point in the cycle, not the preshot.
 
Luna and Phoebe's Mom said:
Also to add:
- I am not currently giving any snacks to Luna. Vet recommended against any food other than her two meals per day, but I am open to figuring that out if it's helpful. Unfortunately I am at the office 3 days a week so it would be hard to follow a daily routine with additional smaller snacks built in.
- Perhaps the 1.5 units (3 daily) would be worth trying again since at the time I tried it, she was still eating Purina DM food, but now she is on a much lower carb diet of FF pate.
Click to expand...
I just wanted to second what Bron and Ale said about feeding multiple times a day. When my Snickers was first diagnosed our vet told us the same thing about only feeding twice a day, but it really helps with stabilizing the numbers if you feed more than that. I think most people here give the two biggest meals at shot times, and then smaller snacks throughout the day. I use an automatic cat feeder. I think the one I got is the one people on this forum recommended, here's a link to it if you're interested.

https://www.amazon.com/Cat-Mate-C500-Digital-Automatic/dp/B01AUYLVU8?th=1

It's called a Catmate and it comes with these ice packs to keep the food cool. I work from home so use mine mostly at night when I'm sleeping, or if I'm going out somewhere and will be gone for a while.

Also, although I'm not an expert on bouncing, I think that Bron is right about that. All those highs and lows you're seeing seem like a classic bounce. Picture a bouncy ball. You drop it on the ground, and then it bounces really high. That's what's happening with your cat right now. When their BG (blood glucose) drops to 49 or something, their body freaks out internally. It reacts by releasing a bunch of stored up glucose or glycogen or something (told you I'm not an expert :) ) which then pushes their blood sugar up way high.

I believe this cycle usually lasts for a few days, and then like a bouncy ball, it loses momentum. However, if your cat keeps getting too much insulin, the cycle keeps starting over. So it never gets the chance to lose momentum. In cases like this, I believe the correct course of action is to lower the dose, as others have suggested.

I don't want to confuse you, but I need to add that bounces can happen even if your cat's BG is in a more normal range. Let me explain. To create a bounce, all that needs to happen is for your cat to drop into numbers that are low for them.

Say that your cat is used to 300s. That's all they ever get. And then one day they drop into the 200s. The 200s are still high, but it's low for your cat. It's not a bad number, it's just a new number. Their body is used to 300s, not 200s. And so it reacts the same way, by releasing all that stored up glycogen or whatever. And then you get a higher than usual number next time you check. Maybe in the 400s. In this case, I believe the correct course is to keep giving the same insulin dose and wait it out as their body adjusts.

Like I said, I'm not an expert on bouncing, but I think I've got that right. If I've said anything wrong then Bron or Ale or someone can correct me. Maybe @Wendy&Neko or @Bandit's Mom? I feel like I've seen them post about bouncing before. Hope you and your kitty have a great day!
 
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Bron and Sheba (GA) said:
Elle, How are things going with Luna?
Do you need help with the spreadsheet?
Click to expand...

Hi! Thanks so much for checking in. My apologies on the delay in responding. I will spend some time this weekend reading up on bouncing and the TR dosing method, as well as coming up with a practical plan so I can feed her multiple times a day. It might take me some time but I'm going to start porting over some data from my current log into the new spreadsheet in my signature. I only have AM/PM pre-shot numbers in my current log, so I will also plan to test her more frequently so that I can start logging the nadir values as well.

My vet followed up today and said she consulted with an internist colleague of hers who said absolutely do not administer insulin if her levels are between 65-180 (duh! lol). She did say though that I should look into a Freestyle Libre so that there is more data to look at. I know people are fans of this but it would be a nightmare for me personally to keep up with (bringing her in every 2 weeks for the vet to replace it, also the financial aspect) and I have no problem doing more frequent pricks. It might be worth considering it though during this initial phase of figuring out the right dosage so that more numbers can be logged, especially while I am at work and overnight when I'm asleep.

I am going away on vacation from Dec 3 - 10 so my vet and I have a plan for my pet sitter to inject 2 units once a day.. I realize that this probably sound totally crazy to the experts on this forum. This is my first time hiring a professional sitter and she unfortunately does not have experience with pricking, only with giving insulin. I want to avoid all risk of Luna's levels going too low so that's our plan for that week, even if it's not the ideal treatment for Luna. I'm open to other suggestions I just am really stressed about leaving her - don't want a hypo and also don't want her symptoms to get worse while I am gone.

I will begin making changes to Luna's meal times/frequency and insulin dosing method once I am back from that vacation as I'm hesitant to make any significant changes and start self-managing her treatment plan when I'm about to leave for a week.

Is it alright if I follow up with you here once I am back from my vacation and have more data to talk through in my spreadsheet?

Thanks so much again for the detailed responses and recommendations everyone, I'm still quite new to all of this and having to manage it with no help so all of your expertise is really really appreciated and thank you for being patient with my response times.
 
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There is absolutely no need to use a freestyle libre if you can hometest. It would be a waste of money.
HOWEVER when you go away for the holiday in early December I would get a freestyle libre attached for that week so the sitter can monitor the BGs.

I completely disagree with your vet's idea to give 2 units once a day.
We have already seen that 2 units can drop the BGs to 49. So you don't want to be giving that dose when there is no-one there to monitor.
Can your sitter only come in once a day? Who is going to feed Luna at the other meal?
It is really very important that Luna eats well while you are away. Diabetic cats can run into a lot of trouble if they don't eat enough at all times.

Re the dose while you are away. It is too early to say yet what the dose should be for when you are away.
If Luna were my cat I would be trying to get the sitter to come in twice a day to give a dose that is going to keep Luna safe. That is far safer than giving a bigger dose once a day. We have a lot of cats whose care givers go on holidays and we suggest a vacation dose which is a bit lower than the normal dose.
Please keep posting so we can help you. I am concerned about the arrangement for your holiday.
 
Bron and Sheba (GA) said:
There is absolutely no need to use a freestyle libre if you can hometest. It would be a waste of money.
HOWEVER when you go away for the holiday in early December I would get a freestyle libre attached for that week so the sitter can monitor the BGs.

I completely disagree with your vet's idea to give 2 units once a day.
We have already seen that 2 units can drop the BGs to 49. So you don't want to be giving that dose when there is no-one there to monitor.
Can your sitter only come in once a day? Who is going to feed Luna at the other meal?
It is really very important that Luna eats well while you are away. Diabetic cats can run into a lot of trouble if they don't eat enough at all times.

Re the dose while you are away. It is too early to say yet what the dose should be for when you are away.
If Luna were my cat I would be trying to get the sitter to come in twice a day to give a dose that is going to keep Luna safe. That is far safer than giving a bigger dose once a day. We have a lot of cats whose care givers go on holidays and we suggest a vacation dose which is a bit lower than the normal dose.
Please keep posting so we can help you. I am concerned about the arrangement for your holiday.
Click to expand...


Sorry I didn't clarify, the sitter is absolutely coming twice a day! It is just the injection that I was recommended she administer once per day. I am open to the sitter giving injections during both visits in the day but I am not sure what dose would be safe to do blindly. It is not ideal I know.
 
Bron and Sheba (GA) said:
There is absolutely no need to use a freestyle libre if you can hometest. It would be a waste of money.
HOWEVER when you go away for the holiday in early December I would get a freestyle libre attached for that week so the sitter can monitor the BGs.

I completely disagree with your vet's idea to give 2 units once a day.
We have already seen that 2 units can drop the BGs to 49. So you don't want to be giving that dose when there is no-one there to monitor.
Can your sitter only come in once a day? Who is going to feed Luna at the other meal?
It is really very important that Luna eats well while you are away. Diabetic cats can run into a lot of trouble if they don't eat enough at all times.

Re the dose while you are away. It is too early to say yet what the dose should be for when you are away.
If Luna were my cat I would be trying to get the sitter to come in twice a day to give a dose that is going to keep Luna safe. That is far safer than giving a bigger dose once a day. We have a lot of cats whose care givers go on holidays and we suggest a vacation dose which is a bit lower than the normal dose.
Please keep posting so we can help you. I am concerned about the arrangement for your holiday.
Click to expand...

I am emailing my vet right now to ask about getting the monitor placed early next week so that I will have it on Luna in time for my holiday. Additionally I am going to propose doing a lower dose twice daily instead of 2 units once a day, though I am not sure what that number should be. 1.5 units twice daily never brought her below 280 (preshot), she was usually in the 300-500 range, so I just worry that will cause her symptoms to worsen but I'd rather be safe than sorry.
 
Luna and Phoebe's Mom said:
Sorry I didn't clarify, the sitter is absolutely coming twice a day! It is just the injection that I was recommended she administer once per day. I am open to the sitter giving injections during both visits in the day but I am not sure what dose would be safe to do blindly. It is not ideal I know.
Click to expand...
This is what happens when all care givers go away for a holiday. Not ideal but close to it!
I am so relieved to hear she is coming in twice a day.
So if you get the freestyle libre attached she can see what the BG is and if it is safe to give the dose.
We had someone who did this for about 6 weeks when she had to go to another country to see her mother and it worked out fine.
What I would suggest is, you try and organise to get the freestyle libre attached a day or two before you leave and show the sitter how it works. And then if you keep posting here and maintaining the spreadsheet, we will tell you what dose to give when you are away.
Make sure you have plenty of the same food you normally feed for Luna and also have some high carb food and honey or Karo in case the BG drops low. Clearly mark the high carb food and keep it in a different container with instructions.
 
Bron and Sheba (GA) said:
This is what happens when all care givers go away for a holiday. Not ideal but close to it!
I am so relieved to hear she is coming in twice a day.
So if you get the freestyle libre attached she can see what the BG is and if it is safe to give the dose.
We had someone who did this for about 6 weeks when she had to go to another country to see her mother and it worked out fine.
What I would suggest is, you try and organise to get the freestyle libre attached a day or two before you leave and show the sitter how it works. And then if you keep posting here and maintaining the spreadsheet, we will tell you what dose to give when you are away.
Make sure you have plenty of the same food you normally feed for Luna and also have some high carb food and honey or Karo in case the BG drops low. Clearly mark the high carb food and keep it in a different container with instructions.
Click to expand...

That sounds like a great plan, thank you! I will continue to share updates here as I have them.

Sorry if I missed this but what frequency of testing would you recommend in general? If I add +3 and +5 snacks to both cycles, would adding tests prior to feeding at those times be sufficient to capture the nadir?
 
Luna and Phoebe's Mom said:
That sounds like a great plan, thank you! I will continue to share updates here as I have them.

Sorry if I missed this but what frequency of testing would you recommend in general? If I add +3 and +5 snacks to both cycles, would adding tests prior to feeding at those times be sufficient to capture the nadir?
Click to expand...
I would swap around when you test. Nadirs are normally around +5 to +7 but can be earlier or later so any tests you can get during the cycles is good data. If you see it dropping lower, always get another test until you see it rising again, especially if it is on the low side.
 
Bron and Sheba (GA) said:
I would swap around when you test. Nadirs are normally around +5 to +7 but can be earlier or later so any tests you can get during the cycles is good data. If you see it dropping lower, always get another test until you see it rising again, especially if it is on the low side.
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Hi Bron, I've updated my spreadsheet with some data from my current log, including today's tests. I managed to get four extra readings in during the AM cycle. She dropped to 76 at +9 from AM (2 units), so I fed her her evening meal a couple of hours early. She is up to 97 at +11 after eating her evening meal so hasn't gone up very much.

I will continue to add to the spreadsheet but I definitely agree with your initial advice that 2 is too much for a single dose based on these mid-cycle numbers
 
Luna and Phoebe's Mom said:
Hi Bron, I've updated my spreadsheet with some data from my current log, including today's tests. I managed to get four extra readings in during the AM cycle. She dropped to 76 at +9 from AM (2 units), so I fed her her evening meal a couple of hours early. She is up to 97 at +11 after eating her evening meal so hasn't gone up very much.

I will continue to add to the spreadsheet but I definitely agree with your initial advice that 2 is too much for a single dose based on these mid-cycle numbers
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Fantastic getting those midcycle tests done. You can see why it is so important and gives us valuable information.
You have custom dosing in your signature…what do you mean by that?
I would have thought you would be doing SLGS.
With SLGS you will need to reduce the dose when the BG drops under 90.
As you have been giving 2 units in the am cycle, and 1 unit in the pm cycle or skipping the dose, most days Luna has been getting 3 units a day in total.
With Lantus being a depot insulin, one cycle can effect the next. So I would reduce the dose to 1.25 U each cycle.
Explanation… 3 units (daily total) divided by 2 is 1.5 units a cycle…so the reduced dose would be 1.25 U a cycle.
 
Bron and Sheba (GA) said:
Fantastic getting those midcycle tests done. You can see why it is so important and gives us valuable information.
You have custom dosing in your signature…what do you mean by that?
I would have thought you would be doing SLGS.
With SLGS you will need to reduce the dose when the BG drops under 90.
As you have been giving 2 units in the am cycle, and 1 unit in the pm cycle or skipping the dose, most days Luna has been getting 3 units a day in total.
With Lantus being a depot insulin, one cycle can effect the next. So I would reduce the dose to 1.25 U each cycle.
Explanation… 3 units (daily total) divided by 2 is 1.5 units a cycle…so the reduced dose would be 1.25 U a cycle.
Click to expand...

I just had that there for now as my dosage wasn't following either method really but you're right I'll change it to SLGS as I don't think TR will be realistic for me.

Thank you for the explanation, your recommendation makes sense. Just started this morning with 1.25 U so will see how that goes moving forward as her twice daily dose.
 
Hi @Bron and Sheba (GA) ! Hope you are having a nice weekend.

I have been giving Luna 1.25 units twice daily which is going well so far. Her PMPS reading just now is 182. Should I still give her her evening dose or skip?
 
Yes next time you get a lower than normal Preshot , stall and test again in 20 Minutes to see if the BG is rising.
I see you are not getting any tests in during the pm cycles which makes it hard to advise you about shooting. Even if you give a token dose, the first half of the cycle will be affected by the previous dose. I think I would skip the dose. But please try and get at least a before bed test in each pmcycle if you can :)
 
Bron and Sheba (GA) said:
Yes next time you get a lower than normal Preshot , stall and test again in 20 Minutes to see if the BG is rising.
I see you are not getting any tests in during the pm cycles which makes it hard to advise you about shooting. Even if you give a token dose, the first half of the cycle will be affected by the previous dose. I think I would skip the dose. But please try and get at least a before bed test in each pmcycle if you can :)
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Sounds good!! Will do. Thanks again for your help.
 
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