10/1/11 Milo PMPS 102 +1 141 Can I still shoot?

[milo]

I have decided not to give Milo his shot again tonight, however I am conflicted about it because his BG seems to rise in the evening around 9 PM or so....but I feel very nervous doing it with a PMPS of 102. Any thoughts as to why this happens, and am I doing the right thing not shooting? +1 141, I am wondering if I should go ahead and shoot? Advise please.

 

[Libby and Lucy]

sorry nobody saw your post. It's a quiet night in Lantus Land for some reason.

Most cats are higher in the morning than at night, and the AMPS numbers are almost always the last ones to come down. My Lucy held onto pink AM numbers for what seemed like forever, even though she was getting nice lower numbers most of the rest of the time.

In Milo's case, it looks like the food change is making a difference in his numbers. You're at a bit of a disadvantage because the food change made his previous dose too high, and now you're trying to work downward to find a good dose. It's harder to work down from a good dose than it is to work up to a good dose. Milo is doing really, really well, but he didn't give you time to get used to these good numbers! If you're not comfortable shooting the numbers he is giving you on 2.5 units, you can try reducing a little more, maybe to 2 units. See where that leaves him, then if it's not enough you can work up from there. That's probably what I would do if I were in your shoes.

I don't think you have the data to shoot 102 yet, so your choices were to either skip or stall. Skipping is a valid choice at this point, especially if your schedule doesn't allow you to stall and shoot later.

 

[Sienne and Gabby (GA)]

Did you feed? If so, the rise in numbers is likely due to a food spike. If you are going to stall a shot, it's best to not feed. If you didn't feed, this is a good enough rise in the numbers that you could shoot. His BG rises at +9 because it's after the nadir. If you look at many of the spreadsheets here, you'll see that numbers start to go back up after some point in the cycle.

Part of why this is happening is because you are shooting one dose in the AM and a different dose in the PM. I will reiterate what I said several days ago. Shoot the average of the two doses twice a day. At this point, you are giving a total of 4.5u per day. Split this in half and shoot 2.25u in the AM and the PM. You need to be able to give insulin twice a day -- the same amount of insulin twice a day. If you think that 2.25u is too much, give 2.0u twice a day. You can give 1.5u as long as you give the same amount twice a day, 12 hours apart.

 

[milo]

I did end up skipping the dose tonight, I get the point of shooting the same amount in the 12 hr period, I based the lower evening dose off of what I read on shooting low numbers, not to mention I have major anxiety shooting when he is low even though I know it will rise tonight it always does and then in the AM it will be in the 300's. I look at others spreadsheets and they shoot when its in the 90's just to keep the shots consitant, so I know I need to get over the "fear" Its just hard to get the courage to shoot the same PM dose as the AM dose when there is such a diffrence in the 2 numbers, its hard to justify but logically I know its not that PM shot thats gonna make him go real low etc... I want to get more consistant with the numbers so I can get him more regulated, thank you so much for the advice, I know I'm driving you all crazy!! lol

 

[Sienne and Gabby (GA)]

First, you have to be data ready to shoot low. I don't think anyone would suggest you shoot in the 90s yet. Take a look at the info in the Shooting & Handling Low Numbers sticky. The second section discusses becoming data ready. That's where you are now. In the future, if you get a pre-shot test that's below 150, it would make sense to stall. With each time you get a low number, you can decrease the point at which you shoot until you are eventually shooting green numbers. Some people get comfortable quickly; it takes others a little longer.

Part of why you see such a difference in the AM and PM dose is that you are skipping shots. When you skip, you empty out the shed a bit and the next cycle or two are higher numbers.

One thought is to get a test at +11 and post if you are not sure what to do. The more time you can give people who are on the Board to lend you a hand, the better.

 

[milo]

Thanks, I will do that.

 

[julie & punkin (ga)]

i think everyone is nervous about shooting low numbers. don't worry about hesitating - it's not a race.

the key thing in all of this, shooting any numbers, is that you want to be available and ready if they go low. you always need to have a stash of test strips, realistically probably at least 15 extra strips & lancets, to be able to get through a low number event. when you get your next supply, might be a good idea to set aside a few - they have to be shut in their container, of course, i just mean mentally.

it helped me to understand how lantus works. when you inject the liquid in, it forms a micro-crystalline deposit under the skin. then that deposit, what we call a shed, dissipates slowly - which is what evens out the BG numbers compared to other insulins.

it also helped me to learn that just because a cat might drop from 300 to 200 on a dose doesn't mean that they will drop from 100 to 0 on the same dose. for whatever reason, the drops from the higher numbers are often more rapid than drops from lower numbers. every cat is different, and as you test milo, you are learning how milo's body works on the insulin.