Thank you Mogs. What am I missing in TR? I don't see anything about how to handle low pre shot numbers. Do you just follow the SLGS guidelines you've sent me for TR as well?Hi again, Adrienne.
From the Lantus SLGS / FDMB FAQ general guidelines:
How to handle a lower than normal preshot number:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
- Below 150 mg/dl (8.3 mmol/L), don't give insulin.
- Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
- a.) give nothing
- b.) give a token dose (10-25% of the usual dose)
- c.) feed as usual, test in a couple of hours, and make a decision based on that value
- Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
- In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
- Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:
If the preshot number is far below usual preshot numbers:------------------
- Do you need to stay on schedule? Then skip the shot.
- Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
- Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
You've got a double issue here:
* A non-fasting BG test result that is w-a-y lower than normal.
* Reasonable grounds to infer that a fasting BG reading could have been even lower.
You'd have to wait 2 hours after the food to get another fasting reading and that would throw your schedule way off. Since you're testing daily for ketones (so helpful to have this info in the spreadsheet!) and Dolly's values have been very low over the last number of days plus her appetite is much improved, I'd suggest skipping this dose.
I also suggest that you grab a couple of tests toward the end of this cycle, including one at +11.5. That way, if Dolly is still a bit lower than normal for preshot it would give you an extra bit of time to post for advice on the Lantus board about what to do if her PMPS test is still a bit on the low side. If +11.5 were to be lower than the PMPS it will show that BG levels were on the rise and that would be very helpful in making the dosing decision this evening.
So lovely to read in the spreadsheet that Dolly's back doing zoomies!
(((Adrienne and Dolly Girl)))
Mogs
.
With TR you want to shoot those preshot numbers.
Thank you for your response
She was 85 @+1. She’s a happy cat. Been eating fairly well.
Mogs, I am always grateful to see your posts. I’ve missed seeing your name. Thank you for your loving, caring support.Hi again, Adrienne.
From the Lantus SLGS / FDMB FAQ general guidelines:
How to handle a lower than normal preshot number:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
- Below 150 mg/dl (8.3 mmol/L), don't give insulin.
- Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
- a.) give nothing
- b.) give a token dose (10-25% of the usual dose)
- c.) feed as usual, test in a couple of hours, and make a decision based on that value
- Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
- In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
- Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Basaglar, and Levemir users following the Start Low Go Slow approach:
If the preshot number is far below usual preshot numbers:------------------
- Do you need to stay on schedule? Then skip the shot.
- Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
- Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
You've got a double issue here:
* A non-fasting BG test result that is w-a-y lower than normal.
* Reasonable grounds to infer that a fasting BG reading could have been even lower.
You'd have to wait 2 hours after the food to get another fasting reading and that would throw your schedule way off. Since you're testing daily for ketones (so helpful to have this info in the spreadsheet!) and Dolly's values have been very low over the last number of days plus her appetite is much improved, I'd suggest skipping this dose.
I also suggest that you grab a couple of tests toward the end of this cycle, including one at +11.5. That way, if Dolly is still a bit lower than normal for preshot it would give you an extra bit of time to post for advice on the Lantus board about what to do if her PMPS test is still a bit on the low side. If +11.5 were to be lower than the PMPS it will show that BG levels were on the rise and that would be very helpful in making the dosing decision this evening.
So lovely to read in the spreadsheet that Dolly's back doing zoomies!
(((Adrienne and Dolly Girl)))
Mogs
.
I'm always glad to hear from you too, Adrienne. It warms my heart - for both of you! - to read that Dolly's doing so much better. Long may that continue. I hope you're getting more sleep now too. I remember how hard things were for you a little while back.Mogs, I am always grateful to see your posts. I’ve missed seeing your name. Thank you for your loving, caring support.
Thank you Mogs. You've helped me so much and gave so much support. I always remember you being there for me and I am so grateful.I'm always glad to hear from you too, Adrienne. It warms my heart - for both of you! - to read that Dolly's doing so much better. Long may that continue. I hope you're getting more sleep now too. I remember how hard things were for you a little while back.
(((Adrienne and Dolly Girl)))
Mogs
.