Re: 12/15 J.D. PM +11.5 110 Dose Advise Please
maybe this will help you -- from the getting data ready to shoot lower ps sticky:
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. 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.
Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.
Lantus and Levemir users: Because Lantus and Levemir are gentler insulins, you may find that these guidelines are stricter than you need.
WHAT IF YOU ARE NOT A NEWBIE? Let's talk specifically for Lantus and Levemir. This is about fine tuning your curves.
Are you data ready to handle a lower preshot number?
This is where the very early cycle spot checks (those +1's, +2's) and those very late cycle spot checks (the +10's, +11's) come into play. Call them the "neglected" spot checks. Everyone gets those +6 spot checks, but there is a reason to collect data in the very early and very late part of the cycle.
Say you get a preshot of 150. Well if you've collected the data on the average time it takes the insulin to start having any effect for your cat and what happens after +12, then you might see that shooting a 150 is actually very safe in your cat. Kitty will be in the 200's before the insulin starts working. You are then using the lag time (aka overlap and carryover) between shooting and effect time to your advantage.
So why the +10's and +11's? Well say you are on day 5 of a dose increase change and your storage shed is now not only full, it is overflowing... and your +10 or +11 was way higher than your preshot. Good way to stay out of trouble cause now you know you would have shot a still dropping number, not a good idea. so what is the plan then?.... keep testing, and not 2 hours later, every 20-30 minutes would be better, so you can catch the minute it turns and do not loose all your overlap. If you miss the rise and cat is way up there BG wise before you shoot, remember the number is just going to continue to rise in those hours before the insulin has a chance to kick in, and you have a roller coaster curve going rather than the flat curve that is ideal.
Also some Lantus and Levemir users notice a dip at the end of the cycle, meaning that their preshot is always a bit lower than their +10 or +11. It is important to know if your cat is one of those because if you are not raising your dose because your PS doesn't seem to call for it, yet your nadir is not so hot... this could be the reason why.
To save cat's ears, really the +8's and +9's and the +4's and +5's are the numbers that yield the least amount of important data once you have well established the nadir in your cat. Yes, get them here or there on spot checks, but do not forget to get the "neglected" spot checks... the very early and very late parts of cycle. They are more useful than most realize.
Know thy cat. Be data ready to handle the situation.
~ written by jojo and bunny(GA) and Y