? 1/10 First time PM pre-shot at blue & high dose 5UI. Please advise?

Kokkinoulis

Kokkinoulis

Member
Previous post:
https://felinediabetes.com/FDMB/thr...d-dose-flat-curve-feeder.285407/#post-3140975

Dear Administrators,

@Bandit's Mom , @Marje and Gracie , @Wendy&Neko , @tiffmaxee , @Chris & China (GA), @Ale & Bobo & Minnie (GA), @Sienne and Gabby (GA)

I increased yesterday evening (PM shot) the dose by 0.5 unit from 4.5 to 5.0 unit and today in the morning for the first time Kokkinoulis has constantly lower BG levels in yellow and blow. The +10 BG was at 198 so, I suppose that the evening PM pre-shot BG it will be at blue.
As it will be my first time shooting blue and also insulin dose is high could you please advise me? I have not have many data as it is the first time he has BG numbers at blue. Moreover, it will be more difficult for me as it will be during the night. When should I monitor him and what should I take into consideration?
Thank you in advance.
 
I wouldn't assume that his PMPS will be blue. In all likelihood, his numbers will zoom back up. For a cat that is new to seeing better numbers, the liver and pancreas tend to overreact to the drop in numbers by releasing a stored form of glucose along with counterregulatory hormones. These cause the upward spike in numbers or what we less than affectionately term a "bounce." It can take several cycles for a bounce to clear.

Should it turn out that your cat stays in the blues over then next few hours, I would suggest getting a test at +11.5 and posting to ask for help. Getting a test and having a bit more than the usual amount of time before your PMPS will give members a chance to respond so you can pick the best option.
 
Hi Gabriella :)
So great to see Kokkinoulis breaking glucose toxicity and showing you some blues.

I'm sure one of the more experienced wise women here will jump in and give you advice.

I'm not one of them, just a fellow traveller like you. And I know how scary it feels when you're used to these alarming colours and all of a sudden you a calm colour like blue and need to shoot a higher dose.

I was with Fistuk in the same place. You can shoot anything above 50 but it's good to know if you're ready. did you read the post about getting ready for possible hypoglucmea?
You can read it here:
https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

Do you have medium carb/high carb/ honey if necessary?

I know it's scary but it could also be that Kokkinoulis will go higher up towards PS. And his body is still functioning on the depot of the previous dose, 4.5U

Perhaps you can add in your title the readings of today so it's easer for moderators to creen

Let me tag also @Angela & Cleo and @tiffmaxee so they could guide you.

You've got this! :bighug:
 
Sienne and Gabby (GA) said:
I wouldn't assume that his PMPS will be blue. In all likelihood, his numbers will zoom back up. For a cat that is new to seeing better numbers, the liver and pancreas tend to overreact to the drop in numbers by releasing a stored form of glucose along with counterregulatory hormones. These cause the upward spike in numbers or what we less than affectionately term a "bounce." It can take several cycles for a bounce to clear.

Should it turn out that your cat stays in the blues over then next few hours, I would suggest getting a test at +11.5 and posting to ask for help. Getting a test and having a bit more than the usual amount of time before your PMPS will give members a chance to respond so you can pick the best option.
Click to expand...
Hi Seene, I will test him again in 15 minutes. In general which are the guidelines for first time pre-shot at a low for the cat number in such a dose? How I will catch a possible hypo? Should I test him again at +2 and then every 2 hours except I saw a green or every hour?
 
Kokkinoulis said:
Hi Seene, I will test him again in 15 minutes. In general which are the guidelines for first time pre-shot at a low for the cat number in such a dose? How I will catch a possible hypo? Should I test him again at +2 and then every 2 hours except I saw a green or every hour?
Click to expand...
Gabriella

When members are shooting their first lower number 150 and below, we like to ease them into it. Here is a helpful post on shooting lows the first time. As Sienne said, it’s helpful if you test at +11.5 so you know what he’s doing. If he’s higher, then retest at normal PS time and shoot as you normally would. If he’s lower, post and ask for help and prepare to retest at PS time.

If, at PS time, he’s 150 or below, I would suggest you stall the shot without feeding him. Post here for help. Retest in 30 minutes after the initial PS test. The goal is to give his full dose of insulin as soon as he is on the rise after stalling. Once he’s on the rise and you know you are shooting, then the process is the same: feed him at shot time.
 
Sienne and Gabby (GA) said:
I wouldn't assume that his PMPS will be blue. In all likelihood, his numbers will zoom back up. For a cat that is new to seeing better numbers, the liver and pancreas tend to overreact to the drop in numbers by releasing a stored form of glucose along with counterregulatory hormones. These cause the upward spike in numbers or what we less than affectionately term a "bounce." It can take several cycles for a bounce to clear.

Should it turn out that your cat stays in the blues over then next few hours, I would suggest getting a test at +11.5 and posting to ask for help. Getting a test and having a bit more than the usual amount of time before your PMPS will give members a chance to respond so you can pick the best option.
Click to expand...
Hi again Sienne,

You were correct. His BG at +11.5 was 233. What should I do now?
 
Most of us don't consider 5u a large dose. It's helpful to keep in mind that the amount of insulin you're giving is the dose that your cat needs.

What I would suggest is that you test at +1 and see where Kokkinoulis' numbers are heading. Are they going down? If so, test in 30 min. If numbers are going up, I would get a test at +2. Typically, numbers will be going up after pre-shot due to the insulin from the previous cycle wearing off and because you just fed your cat. Lantus onset (when it starts to work) begins at +2 for most cats. So, if numbers are lower than what you can reasonably expect at +2, it may mean that it's going to be a cycle where you're going to have to stay up and test.

I would test again at your usual pre-shot time. If numbers are continuing to head upward, you're fine to give your usual shot. Since your cat's numbers are heading up, they will likely keep going up until at least +2. If my ability to predict what any of our cats will do, I suspect the numbers will be in the reds this cycle.

Please see Marje's post above. What she said is important.
 
Marje and Gracie said:
Gabriella

When members are shooting their first lower number 150 and below, we like to ease them into it. Here is a helpful post on shooting lows the first time. As Sienne said, it’s helpful if you test at +11.5 so you know what he’s doing. If he’s higher, then retest at normal PS time and shoot as you normally would. If he’s lower, post and ask for help and prepare to retest at PS time.

If, at PS time, he’s 150 or below, I would suggest you stall the shot without feeding him. Post here for help. Retest in 30 minutes after the initial PS test. The goal is to give his full dose of insulin as soon as he is on the rise after stalling. Once he’s on the rise and you know you are shooting, then the process is the same: feed him at shot time.
Click to expand...
Hi Marje, Ηis pre-shot is 231. Should I feed him and shot 5.0 unit and then retest at +1, & +2 as also @Sienne and Gabby (GA) proposed?
 
Sienne and Gabby (GA) said:
Most of us don't consider 5u a large dose. It's helpful to keep in mind that the amount of insulin you're giving is the dose that your cat needs.

What I would suggest is that you test at +1 and see where Kokkinoulis' numbers are heading. Are they going down? If so, test in 30 min. If numbers are going up, I would get a test at +2. Typically, numbers will be going up after pre-shot due to the insulin from the previous cycle wearing off and because you just fed your cat. Lantus onset (when it starts to work) begins at +2 for most cats. So, if numbers are lower than what you can reasonably expect at +2, it may mean that it's going to be a cycle where you're going to have to stay up and test.

I would test again at your usual pre-shot time. If numbers are continuing to head upward, you're fine to give your usual shot. Since your cat's numbers are heading up, they will likely keep going up until at least +2. If my ability to predict what any of our cats will do, I suspect the numbers will be in the reds this cycle.

Please see Marje's post above. What she said is important.
Click to expand...
Hi Sienne, His pre-shot is 231. Should I feed him and shot 5.0 unit and then retest at +1, & +2 as you proposed?
 
Gabriella -- I'm at work and it may be hard for me to check in. There's a sticky note at the top of the board on handling low numbers. You are likely not going to need it but it's helpful to know that it's there should you need the information.
 
Sienne and Gabby (GA) said:
Gabriella -- I'm at work and it may be hard for me to check in. There's a sticky note at the top of the board on handling low numbers. You are likely not going to need it but it's helpful to know that it's there should you need the information.
Click to expand...
Thanks again for the prompt reply! I am so sorry that I unterrupt you from work! I will check it. Have a nice day.
 
Whether you will need to rest every 2-3 hours depends on what the bg is at +2. If higher you can wait 2-4 hours. If dropping you might want to recheck in even 2 hours. If going a lot higher it’s likely not going to come down much. Just add the results to your subject and ask for help if not sure when to test again.
 
First of all, it's fantastic that Kokki finally spent some time in blues. That's real progress. :cool::cool:

I'm glad you shot his full dose. Lantus is really great at giving you much flatter cycles when you shoot lower preshots. My girl got over 5 units in dose, and I liked shooting lower preshots because the cycle was much more predictable. With higher preshots, you never know if they are going to do a steep dive when they onset.

The size of dose isn't important in shooting lower preshot numbers. A cat needs however much insulin they need. Shooting blue preshots (and eventually green) doesn't look any different if your cat is on 1 unit or 10 or even higher.
 
I’m sorry…. I had an appointment and had to leave but I felt sure he was just headed up. With that +2, you can get some sleep tonight. If you feel better about it, you can grab a before bed test but not necessary.

Great job today. Go Kokki!
 
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