04/13/2022 Need clarification on handling lower pre-shots.

[Raven786]

Finally the antibiotic is kicking in. Princess' numbers are decreasing. My understanding is I give her the full dose even if the pre-shot is low? But if her numbers drop below 50 or 2.8, then decrease dose? The lowest I have shot is 9.1 but that was @ 1.00 unit. Tomorrow will be another dose increase from 1.50 to 1.75 units. Can I get clarification on shooting lower pre-shots.

 

[Hendrick Cuddleclaw]

hi Raven and Kitty

your sig says you're following TR, so this link would be good reading. I'm pretty new myself so don't really feel comfortable doing more than pointing you towards this, which you maybe already read!

https://felinediabetes.com/FDMB/thr...y-to-shoot-handle-lower-pre-shot-numbers.147/


maybe @tiffmaxee or @Bandit's Mom can add more insight

 

[Nathalie & Boris]

Hi Raven,
This is the info I was given when asking the other day, in addition to the stickie Hendrick posted. Now take into account they have changed over the numbers for me using Alphatrak2 at the moment. I'm about to switch to the human meter.

"The preshots don't matter for dosing because nadir is what is important - how low they go. On a pet meter following TR you want that in the 70s. The only time preshots matter are when Suzanne said - a lower than usual one can be a clue the dose needs to be looked at and you may need to do a temporary reduction.

When they drop lower and/or faster than they're used to, they bounce. The liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones into the blood stream and spikes the BG way up high - that's the high preshot you're seeing. It can take up to 6 cycles to clear that bounce

Reductions are any time you get a number below 68 on a pet meter. Following TR, you wait 4 cycles between reductions to allow the depot to drain."

"Also a low preshot could be the nadir"

 

[FrostD]

Elsie and Bhooma we're tagged, they'll be best to answer this. But -

The sticky does say when new and without a lot of data, the cutoff is 150 (8.3). Below that, you stall without feeding and ask for help.

Now, you have a lot of data. At this point, under normal circumstances, I would say you are good to shoot down to about 120 (6.7) as long as you can monitor. Below that, stall without feeding and ask for advice.

Now, the caveat - we know she has an infection and is on antibiotics that will likely start to lower her BG. And we know she saw green at 1U before the UTI came into play. So at this point, I would use the 150(8.3) cutoff - below that, stall without feeding and ask for advice - and make sure to note she's on antibiotics.

A request - can you please add the antibiotic she's on, the dose, frequency, and total # of days in your Remarks column? As an example, for each day she's on the med, there should be an entry in the Remarks column stating something like "Antibiotics X, dose 2 of 14, 0.5mL"

 

[FrostD]

Also, I personally would hold this dose at least one more day. For nadirs under 200 you hold for 3-4 cycles, and we tend to hold more towards the 5 when nadirs are lower blue. Additionally, we know she's got some movement in BG due to antibiotic.

 

[Raven786]

Elsie and Bhooma we're tagged, they'll be best to answer this. But -

The sticky does say when new and without a lot of data, the cutoff is 150 (8.3). Below that, you stall without feeding and ask for help.

Now, you have a lot of data. At this point, under normal circumstances, I would say you are good to shoot down to about 120 (6.7) as long as you can monitor. Below that, stall without feeding and ask for advice.

Now, the caveat - we know she has an infection and is on antibiotics that will likely start to lower her BG. And we know she saw green at 1U before the UTI came into play. So at this point, I would use the 150(8.3) cutoff - below that, stall without feeding and ask for advice - and make sure to note she's on antibiotics.

A request - can you please add the antibiotic she's on, the dose, frequency, and total # of days in your Remarks column? As an example, for each day she's on the med, there should be an entry in the Remarks column stating something like "Antibiotics X, dose 2 of 14, 0.5mL"

I added the information to the remarks column like you asked. Should I continue with the dose increase tomorrow or maybe wait a few more days? Thank you I appreciated your help.

 

[Raven786]

Also, I personally would hold this dose at least one more day. For nadirs under 200 you hold for 3-4 cycles, and we tend to hold more towards the 5 when nadirs are lower blue. Additionally, we know she's got some movement in BG due to antibiotic.

Ok, I will hold the dose 1.5 units for one more day. Thank you.

 

[FrostD]

I added the information to the remarks column like you asked. Should I continue with the dose increase tomorrow or maybe wait a few more days? Thank you I appreciated your help.

Perfect, thank you!

Have you checked ketones today? Or recently? It's a good idea to check them daily if you can while they have infections and are still fairly unregulated

 

[Raven786]

Perfect, thank you!

Have you checked ketones today? Or recently? It's a good idea to check them daily if you can while they have infections and are still fairly unregulated

I haven't checked. Unfortunately I am unable to get some ketone strips right now as we are having a major blizzard that's suppose surpass the last one we had in 1977. It's going to snow for two days. Travel is not advised. Once clear, I will get those strips.