? Lower than normal pre-shot; withhold shot?

[k&b13]

Hi all,

I have never had to withhold a shot before, but Biggs' PM preshot was 104 and I have seen 150-200 as being the limit for newbies?

I had a personal emergency yesterday morning and was unable to give his morning shot on time. I read that if I can't give it on time within reason, to skip and proceed to the PM shot. His numbers last night were high but that is why. He seemed to be back to normal this morning but after the nadir, still dropped.

Should I be withholding his shot? I was supposed to give it about 30 min. ago. Thanks so much!

 

[k&b13]

I also wanted to add that I did happen to check his ketones at about +11 and the strip said there were none present.

 

[Blanche]

Hello Kelly,
try to put a ? to yours thread theme in order to let the people know that you have a question.

I'd hope I could assist you more...

 

[Mary & Jude]

Hi Keely, The guidelines say that until you have enough data on your cat to know how they respond to insulin, you should not shoot below 150. But first a few questions: I notice that Biggs was diagnosed in January. Has he been receiving insulin (and has it been Lantus?) during that time? I don't see any data on the spreadsheet for February and a portion of March. If you don't have it, that's fine. I'm just wondering why it's missing.

I've just looked back at your previous post (previous post linked here) which we always include with each daily post so that people can look at Biggs' history, and I notice that he has a history of DKA. With that important information in mind, I'm going to tag someone with more experience @Bandit's Mom @Sienne and Gabby (GA) @Marje and Gracie for guidance. When kitties have a history of DKA/ketones, we like to be extra careful with skipping a dose. Also, please note on your spreadsheet that Biggs has a history of DKA and ketones.

Is there any reason that you know of why his numbers would have dropped so significantly today? Like, have you changed his food or anything like that?

I also notice that you haven't decided on a dosing guideline to follow. I'm going to guess that you've read about the two dosing guidelines that most of us follow, but if you need for me to link that information for you, let me know. Decisions about increases/decreases, etc., are often contingent on the dosing guideline you are following.

 

[Mary & Jude]

@tiffmaxee

 

[Marje and Gracie]

Hi Keely, The guidelines say that until you have enough data on your cat to know how they respond to insulin, you should not shoot below 150. But first a few questions: I notice that Biggs was diagnosed in January. Has he been receiving insulin (and has it been Lantus?) during that time? I don't see any data on the spreadsheet for February and a portion of March. If you don't have it, that's fine. I'm just wondering why it's missing.

I've just looked back at your previous post (previous post linked here) which we always include with each daily post so that people can look at Biggs' history, and I notice that he has a history of DKA. With that important information in mind, I'm going to tag someone with more experience @Bandit's Mom @Sienne and Gabby (GA) @Marje and Gracie for guidance. When kitties have a history of DKA/ketones, we like to be extra careful with skipping a dose. Also, please note on your spreadsheet that Biggs has a history of DKA and ketones.

Is there any reason that you know of why his numbers would have dropped so significantly today? Like, have you changed his food or anything like that?

I also notice that you haven't decided on a dosing guideline to follow. I'm going to guess that you've read about the two dosing guidelines that most of us follow, but if you need for me to link that information for you, let me know. Decisions about increases/decreases, etc., are often contingent on the dosing guideline you are following.

Thanks Mary.

I’m looking at the SS. BRB.

@k&b13 How close to shot time are you….and you haven’t fed yet, right? If you haven’t, please stall the shot without feeding.

We can stall up to two hours if you haven’t fed and keep testing every 30 minutes. Because you don’t have much data, I’d really want to see a rise before you shoot. I’ll be waiting for an update from you.

 

[k&b13]

Hi Keely, The guidelines say that until you have enough data on your cat to know how they respond to insulin, you should not shoot below 150. I notice that Biggs was diagnosed in January. Has he been receiving insulin (and has it been Lantus?) during that time? I don't see any data on the spreadsheet for February and a portion of March. If you don't have it, that's fine. I'm just wondering why it's missing.

I've just looked back at your previous post (previous post linked here) which we always include with each daily post so that people can look at Biggs' history, and I notice that he has a history of DKA. With that important information in mind, I'm going to tag someone with more experience @Bandit's Mom @Sienne and Gabby (GA) @Marje and Gracie for guidance. When kitties have a history of DKA/ketones, we like to be extra careful with skipping a dose. Also, please note on your spreadsheet that Biggs has a history of DKA and ketones.

Is there any reason that you know of why his numbers would have dropped so significantly today? Like, have you changed his food or anything like that?

I also notice that you haven't decided on a dosing guideline to follow. I'm going to guess that you've read about the two dosing guidelines that most of us follow, but if you need for me to link that information for you, let me know. Decisions about increases/decreases, etc., are often contingent on the dosing guideline you are following.

Thank you, I was pretty sure I shouldn't be shooting when he is that low but wanted to double check.

I don't have much data, I had been having a very hard time testing him. I took him back to the vet last week to get another Libre sensor installed because testing has been difficult and it didn't stay on for even 24 hrs.
I actually finally started getting some luck with the "sweet spot" in the past few days. I bought some Ledum 30 to help with his ear care.

I have been feeding him Fancy Feast Pate since he was diagnosed (and even before that). His vet gave me a few cans of Hills prescription food for glucose support last week (I will double check the actually type) but he didn't eat it when I tried to introduce it with the Fancy Feast, so he is still on Fancy Feast Pate majority, 90%.

 

[k&b13]

Thanks Mary.

I’m looking at the SS. BRB.

@k&b13 How close to shot time are you….and you haven’t fed yet, right? If you haven’t, please stall the shot without feeding.

We can stall up to two hours if you haven’t fed and keep testing every 30 minutes. Because you don’t have much data, I’d really want to see a rise before you shoot. I’ll be waiting for an update from you.

Unfortunately I did feed him a few tablespoons but did not give the shot.

 

[Mary & Jude]

Thank you, I was pretty sure I shouldn't be shooting when he is that low but wanted to double check.

I don't have much data, I had been having a very hard time testing him. I took him back to the vet last week to get another Libre sensor installed because testing has been difficult and it didn't stay on for even 24 hrs.
I actually finally started getting some luck with the "sweet spot" in the past few days. I bought some Ledum 30 to help with his ear care.

I have been feeding him Fancy Feast Pate since he was diagnosed (and even before that). His vet gave me a few cans of Hills prescription food for glucose support last week (I will double check the actually type) but he didn't eat it when I tried to introduce it with the Fancy Feast, so he is still on Fancy Feast Pate majority, 90%.

Just so you know, the Hills M/D glucose support (I'm not sure if that's what you were given) contains 13% carbs, which is higher than we like to give our FD kitties on a regular basis (we like to give a food <10% in carbs). The prescription Hills M/D would be considered a medium carb food. I would stick with the FF Classic Pates, if that is what Biggs is eating. That brand/line is typically well under 10% carbs.

 

[Marje and Gracie]

Unfortunately I did feed him a few tablespoons but did not give the shot.

Whenever we have a low preshot, you always want to stall without feeding. Once you feed, the food will raise the BG and you could be shooting an artificial number.

For most cats, skipping a shot is not the end of the world. However, you skipped yesterday morning and this is a kitty which has had DKA. It takes two hours for food to leave the system and two hours is the maximum we will stall. Also, usually when we stall, we don’t shoot a reduced dose because stalling acts as a reduction.

We need to be cautious so you don’t shoot a false number influenced by feeding but I also hate to see you skip a shot. Did you feed him at what would normally be PMPS? Can you stall two hours knowing you have to slowly move back to your normal shot time (30 mins/day)?

 

[k&b13]

Whenever we have a low preshot, you always want to stall without feeding. Once you feed, the food will raise the BG and you could be shooting an artificial number.

For most cats, skipping a shot is not the end of the world. However, you skipped yesterday morning and this is a kitty which has had DKA. It takes two hours for food to leave the system and two hours is the maximum we will stall. Also, usually when we stall, we don’t shoot a reduced dose because stalling acts as a reduction.

We need to be cautious so you don’t shoot a false number influenced by feeding but I also hate to see you skip a shot. Did you feed him at what would normally be PMPS? Can you stall two hours knowing you have to slowly move back to your normal shot time (30 mins/day)?

I just tested and he is at 185 now. (PMPS +1.75) Yes, I fed him at his normal PMPS time. I can move him back this week, yes. Is it 30min/day or 30min/shot?

 

[Mary & Jude]

I just tested and he is at 185 now. Yes, I fed him at his normal PMPS time. I can move him back this week, yes. Is it 30min/day or 30min/shot?

Here is Marje's post on this that I have bookmarked: Info - Getting back on a 12/12 shot schedule

 

[Marje and Gracie]

I just tested and he is at 185 now. Yes, I fed him at his normal PMPS time. I can move him back this week, yes. Is it 30min/day or 30min/shot?

You can do it in 15 min increments each cycle or 30 mins one cycle a day. Also, if he’s really high in the morning, you could shoot an hour early and then you would just have one hour to make up but you couldn’t shoot early again tomorrow evening. If he wasn’t high in the morning but he zoomed up in the afternoon, you could then shoot one hour early provided you didn’t shoot early in the morning.

I just tested and he is at 185 now.

185 is likely a food influenced number. How long until you are at the PMBG +2 with PMBG being when you should have shot but fed him instead? Just so I know when to check back.

 

[k&b13]

You can do it in 15 min increments each cycle or 30 mins one cycle a day. Also, if he’s really high in the morning, you could shoot an hour early and then you would just have one hour to make up but you couldn’t shoot early again tomorrow evening. If he wasn’t high in the morning but he zoomed up in the afternoon, you could then shoot one hour early provided you didn’t shoot early in the morning.


185 is likely a food influenced number. How long until you are at the PMBG +2 with PMBG being when you should have shot but fed him instead? Just so I know when to check back.

185 was 10 min before +2

 

[Marje and Gracie]

185 was 10 min before +2

We have a rule here if we suggest someone shoot a lower number, then we stay up with them. Unfortunately, I can’t stay up with you tonight as I volunteer with the elephant team at our local zoo on Wednesdays and Saturdays but tomorrow they need me to work extra so I have to be up at 4 am.

@Mary & Jude are you available to help Keely if she shoots 1u and Biggs drops? If not, don’t worry. It’s ok.

Keely: if Mary can’t help, you’ll have to skip again. While I feel he won’t do much with 1u when you’ve stalled for two hours, without more data, I’m just not comfortable advising you to shoot and no one be there to help you if the BG drops. Be sure you test his ketones tonight and tomorrow and watch him for any symptoms.

If Mary is not able to stay with you, then you’ll just skip and shoot on time tomorrow or whatever time you’d like if you want to move your shot time. You’ll shoot the full 2u dose unless he’s still below about 150. If he is 150 or below, please stall without feeding and post for help.

You might want to talk to your vet about getting a continuous glucose monitor (Libre 3) for him because you really need data to control his diabetes especially with his DKA history. And I would also try and slowly change his wet food diet to something much lower in carbs.

 

[k&b13]

We have a rule here if we suggest someone shoot a lower number, then we stay up with them. Unfortunately, I can’t stay up with you tonight as I volunteer with the elephant team at our local zoo on Wednesdays and Saturdays but tomorrow they need me to work extra so I have to be up at 4 am.

@Mary & Jude are you available to help Keely if she shoots 1u and Biggs drops? If not, don’t worry. It’s ok.

Keely: if Mary can’t help, you’ll have to skip again. While I feel he won’t do much with 1u when you’ve stalled for two hours, without more data, I’m just not comfortable advising you to shoot and no one be there to help you if the BG drops. Be sure you test his ketones tonight and tomorrow and watch him for any symptoms.

If Mary is not able to stay with you, then you’ll just skip and shoot on time tomorrow or whatever time you’d like if you want to move your shot time. You’ll shoot the full 2u dose unless he’s still below about 150. If he is 150 or below, please stall without feeding and post for help.

You might want to talk to your vet about getting a continuous glucose monitor (Libre 3) for him because you really need data to control his diabetes especially with his DKA history. And I would also try and slowly change his wet food diet to something much lower in carbs.

Thank you so much, and I appreciate all of the help and completely understand having to get up early. (I have volunteered with wildlife rehabilitation; would love to volunteer with elephants as they are my favorite animal!)

I think I will skip again tonight and shoot on time tomorrow unless I hear otherwise from another member. Now I know to stall without feeding if he is below 150 -- thank you so much.

I actually have another Libre sensor on the way from Abbott, they sent me another one and I already have the reader devide. I am going to let his vet know tomorrow about staying with Fancy feast pate.

**the Hill's food they wanted me to switch to was multi-benefit**

 

[Mary & Jude]

We have a rule here if we suggest someone shoot a lower number, then we stay up with them. Unfortunately, I can’t stay up with you tonight as I volunteer with the elephant team at our local zoo on Wednesdays and Saturdays but tomorrow they need me to work extra so I have to be up at 4 am.

@Mary & Jude are you available to help Keely if she shoots 1u and Biggs drops? If not, don’t worry. It’s ok.

Keely: if Mary can’t help, you’ll have to skip again. While I feel he won’t do much with 1u when you’ve stalled for two hours, without more data, I’m just not comfortable advising you to shoot and no one be there to help you if the BG drops. Be sure you test his ketones tonight and tomorrow and watch him for any symptoms.

If Mary is not able to stay with you, then you’ll just skip and shoot on time tomorrow or whatever time you’d like if you want to move your shot time. You’ll shoot the full 2u dose unless he’s still below about 150. If he is 150 or below, please stall without feeding and post for help.

You might want to talk to your vet about getting a continuous glucose monitor (Libre 3) for him because you really need data to control his diabetes especially with his DKA history. And I would also try and slowly change his wet food diet to something much lower in carbs.

@k&b13 Sorry for the delay; I was getting my little clowder of five tucked in for the night.
I'm so sorry, but I also have to get up early for work tomorrow, and on top of that I'm a bit under the weather right now, so it needs to be an earlier than normal night for me.
Good luck with the dosing tomorrow morning, Keely. Fingers crossed that Biggs will not zoom too high between now and then.

 

[Marje and Gracie]

Thank you so much, and I appreciate all of the help and completely understand having to get up early. (I have volunteered with wildlife rehabilitation; would love to volunteer with elephants as they are my favorite animal!)

I think I will skip again tonight and shoot on time tomorrow unless I hear otherwise from another member. Now I know to stall without feeding if he is below 150 -- thank you so much.

I actually have another Libre sensor on the way from Abbott, they sent me another one and I already have the reader devide. I am going to let his vet know tomorrow about staying with Fancy feast pate.

**the Hill's food they wanted me to switch to was multi-benefit**

You’re welcome and I’m sorry I can’t help you this cycle. It’s a great retirement gig for me to help care for our six African s.

I’m glad you are getting a Libre. You can load the numbers from it onto the SS.

Most of us here are leery about prescription diets as they tend to have poor ingredients and be higher in carbs than what our diabetic cats need. It’s sad some vets push them so much.

 

[Marje and Gracie]

@k&b13 Sorry for the delay; I was getting my little clowder of five tucked in for the night.
I'm so sorry, but I also have to get up early for work tomorrow, and on top of that I'm a bit under the weather right now, so it needs to be an earlier than normal night for me.
Good luck with the dosing tomorrow morning, Keely. Fingers crossed that Biggs will not zoom too high between now and then.

Thank you, Mary. Feel better soon.

 

[k&b13]

@k&b13 Sorry for the delay; I was getting my little clowder of five tucked in for the night.
I'm so sorry, but I also have to get up early for work tomorrow, and on top of that I'm a bit under the weather right now, so it needs to be an earlier than normal night for me.
Good luck with the dosing tomorrow morning, Keely. Fingers crossed that Biggs will not zoom too high between now and then.

Thank you and I hope you feel better!

 

[k&b13]

You’re welcome and I’m sorry I can’t help you this cycle. It’s a great retirement gig for me to help care for our six African s.

I’m glad you are getting a Libre. You can load the numbers from it onto the SS.

Most of us here are leery about prescription diets as they tend to have poor ingredients and be higher in carbs than what our diabetic cats need. It’s sad some vets push them so much.

I would love to have that volunteer gig, sign me up! Haha.

I agree and understand about the prescription foods. My vet seems to be very understanding and cooperative, I will do the calculations and reach out to let them know my hesitancy in the prescription food. Biggs has been more than okay in the FF pate.

 

[k&b13]

Hi all, after skipping his PM dose yesterday, today his AMBG was 373 and I was able to give him his 2u dose and feed at his usual time. Thank you so much for jumping to help last night.