Mia & Monica - Continued (part 3)

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So Mia just had a BG of 1.9 at +2. Should I not have given her insulin when her BG preshot was 5.5?
 
Hi Monica. You are experienced in handling these low numbers, I know. Keep checking every 20 minutes and giving the honey (HC food would help, too, in very small amounts as we talked about before when you were on vetsulin). As her BG comes up you can extend the time between tests gradually. Don’t stop testing until it’s been a full 2 hours after the last HC
 
Suzanne & Darcy said:
Hi Monica. You are experienced in handling these low numbers, I know. Keep checking every 20 minutes and giving the honey (HC food would help, too, in very small amounts as we talked about before when you were on vetsulin). As her BG comes up you can extend the time between tests gradually. Don’t stop testing until it’s been a full 2 hours after the last HC
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Hi @Suzanne & Darcy Yes I have given her honey and some of her old favorite treats. HC is high calorie? Will definitely continue testing. But not sure what you mean by full 2 hours after the last HC? What is that short for?
 
I am outside, but will try to keep checking on you every 15 minutes or so.
You could try to give her some of the shrimp with jelly if that bumped her up before. HC is over 15% carbs.
I'll be back to check on you.
 
Oh, and even if you have no high carb food available, you can mix a drop of honey into some of her regular food. Keep the amounts of food small in case you need to keep giving it to her for a long period of time — in case she doesn’t come up quickly or drops back down.
 
MonicaT said:
Hi @Suzanne & Darcy Yes I have given her honey and some of her old favorite treats. HC is high calorie? Will definitely continue testing. But not sure what you mean by full 2 hours after the last HC? What is that short for?
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That just means to test her periodically for two hours after whenever you have given her the final dose of honey or other high carb food. The reason for this is that the cats numbers can go up and then later can drop back down after the high carbohydrate, food or honey has worn off fully.
 
I'm glad she's up a little. I would contiunue to give her a little tiny bit of honey with a teaspoon of regular food or HC food and test again in 20 minutes.
 
Please remember that we don't want her to get so full that she doesn't want to eat any more. It is early in the cycle, and we may need to have her eating for a while.
Feed her a little food for now plus some honey and keep us updated.
 
Suzanne & Darcy said:
No more honey right now. Only a bit of food
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@Suzanne & Darcy ok thank you!

So for her am shot in 7,5 hours. So I am prepared, what numbers should I be looking at? What number do I not shoot or lower to the drop dose like you explained?

Now she was at 5.5 preshot, which apparently was too low. The lowest I have shot with til now is 6.4 which was this morning. The lowest bg in that cycle was 3.7 at +4
 
Suzanne & Darcy said:
Was there anything different about this evening in terms of what she ate for dinner or how much she ate?
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Yes infact I see she only ate a little bit when she got insulin. Around half of the usual, but then ate plenty, enough to make up for it and then some, around 1 hour after insulin.
 
Well since she was in the 30s, she has earned a reduction. I know she is on a small dose, but I would still reduce to a drop dose for the morning (even if her BG is high) and hold the drop dose and see how it goes.
 
Suzanne & Darcy said:
Well since she was in the 30s, she has earned a reduction. I know she is on a small dose, but I would still reduce to a drop dose for the morning (even if her BG is high) and hold the drop dose and see how it goes.
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@Suzanne & Darcy

Ok so no matter her BG for her next shot I go for a drop dose then?

And to be sure I understood the explanation. A drop dose is measured by just putting the syringe into the insulin pen and back out again, without drawing out anything into the syringe?
 
You take the syringe and fully press down on the plunger and insert the syringe into the insulin pen while the plunger is still depressed. After the needle is inserted, let go of the plunger. You can experiment with it tonight to see if you get a drop.
 
MonicaT said:
So for her am shot in 7,5 hours. So I am prepared, what numbers should I be looking at? What number do I not shoot or lower to the drop dose like you explained?
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Never shoot if a PS is under 50 (human meter). For some cats, the no-shoot number can be higher. It also depends on whether you’ll be around to test and intervene if she drops low again, as there can be some “hang time” with Lantus (meaning the insulin that’s already in her system can still affect tomorrow’s cycles).

Suzanne has already advised you to go to a “drop dose.” I concur. If you push the plunger down extra hard into the syringe (squishing the rubber to compress it), then take your finger off the plunger to let it retract, you’ll get a drop of insulin.

@Suzanne & Darcy, given Mia’s history, what do you think should be a no-shoot number?
 
JL and Chip said:
Never shoot if a PS is under 50 (human meter). For some cats, the no-shoot number can be higher. It also depends on whether you’ll be around to test and intervene if she drops low again, as there can be some “hang time” with Lantus (meaning the insulin that’s already in her system can still affect tomorrow’s cycles).

Suzanne has already advised you to go to a “drop dose.” I concur. If you push the plunger down extra hard into the syringe (squishing the rubber to compress it), then take your finger off the plunger to let it retract, you’ll get a drop of insulin.

@Suzanne & Darcy, given Mia’s history, what do you think should be a no-shoot number?
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That’s a good question. I am not sure at this point. We have so little history to fall back on. We don’t know how she will be doing in the morning. And I see no tests after the last 70 (3.9). If it’s at all questionable in the morning, given this evening’s 30s, then there’s no harm in skipping the dose to see how Mia does. Skipping could be very informative. @Gill & George will you be around in the morning to help advise? It’s going to be the middle of the night for me.
 
So her last test last night was done at +6, and was 4.4. my significant other took over as I had to get some sleep.

Will be doing her preshot test in a couple of minutes
 
One bit of advice. Just in case the situation arises again. When you shoot a number that's lower than usual, or where you see her numbers alling into the ps I would always recommend getting a +1.

A ps number that's lower say than the +10, can often be an advance warning of an active cycle.
 
Gill & George said:
One bit of advice. Just in case the situation arises again. When you shoot a number that's lower than usual, or where you see her numbers alling into the ps I would always recommend getting a +1.

A ps number that's lower say than the +10, can often be an advance warning of an active cycle.
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This is in regards to a situation with a lower than usual preshot number?
 
MonicaT said:
This is in regards to a situation with a lower than usual preshot number?
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Yes.

Thinking about lantus cycles,
By PS we are at the end of the cycle so there's not a lot of insulin available so usually when we do ps the number will be higher than the +10, if you are getting good duration (about 12hours) that PS number will be only a little higher or perhaps about the same.
If the PS number is lower, it may be a sign that you are getting longer duration, that's ok, it's still, in most circumstances ok to shoot. But when we do shoot we need to be aware that if the next shot onsets before the previous duration has finished we can see a sharp drop even though we have fed.

Mia has typically been onsetting before +2. Getting a +1 last night would have given you an advance warning, you may have caught her before the drop to 34 , a small feed at +1 may have kept her from dipping into the 30's. (Or not)
 
MonicaT said:
@Gill & George her +1 is 8.2
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Amps 145, +1 142.

Those numbers are about the same. She's not getting a found bump (slight raise in BG caused by the food you gave at Amos) She's probably going to have an active cycle ( she will drop down further today)
My guess will be that it will be active but not too active like last night.

So now you need to decide when you will do her next test....
You could leave her till +3, or as she may not have onset yet you could check at +2 (she seems to usually have onset by then) to see how much movement you get in the BG.

The depot of the 0.1u will still be affecting this part of the cycle, it can take up to 4 cycles to see the complete effect of the dose reduction. In the same way as when we take the dose up it takes up to six cycles to see the full effect of the dose, it's the same when we take the dose down.
 
Gill & George said:
Yes.

Thinking about lantus cycles,
By PS we are at the end of the cycle so there's not a lot of insulin available so usually when we do ps the number will be higher than the +10, if you are getting good duration (about 12hours) that PS number will be only a little higher or perhaps about the same.
If the PS number is lower, it may be a sign that you are getting longer duration, that's ok, it's still, in most circumstances ok to shoot. But when we do shoot we need to be aware that if the next shot onsets before the previous duration has finished we can see a sharp drop even though we have fed.

Mia has typically been onsetting before +2. Getting a +1 last night would have given you an advance warning, you may have caught her before the drop to 34 , a small feed at +1 may have kept her from dipping into the 30's. (Or not)
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Oh ok, this all makes sense! Thank you :bighug: will definitely keep in mind a +1 test next time the PS is lower than at +10
 
Gill & George said:
Amps 145, +1 142.

Those numbers are about the same. She's not getting a found bump (slight raise in BG caused by the food you gave at Amos) She's probably going to have an active cycle ( she will drop down further today)
My guess will be that it will be active but not too active like last night.

So now you need to decide when you will do her next test....
You could leave her till +3, or as she may not have onset yet you could check at +2 (she seems to usually have onset by then) to see how much movement you get in the BG.

The depot of the 0.1u will still be affecting this part of the cycle, it can take up to 4 cycles to see the complete effect of the dose reduction. In the same way as when we take the dose up it takes up to six cycles to see the full effect of the dose, it's the same when we take the dose down.
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@Gill & George from her previous cycles I don't expect her to drop into lime green numbers in this cycles either. Especially seeing I have reduced the dose now.

Will test at +2 and see what the number is, and then decide if I'll test at +3 too or then wait til +4
 
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