? 12/7- BEAR- amps 186- is this shootable? *new

Bear had a lower than usual amps.. weve never shot this low and bumped his insulin about 5 days ago. Weve always had to adjust his times because of recent ER visit for potassium.

Note: ketones were testing negative at ER vet on Wednesday
185 is a good number to shoot at. I know every low number is a bit scary. But Bear's gong in the right direction. Safe surfing today 💕
 
185 is a good number to shoot at. I know every low number is a bit scary. But Bear's gong in the right direction. Safe surfing today 💕
Thank you 🙏 we used to not shoot anything under 11.1 so its a bit different for us, but i believe we were told before that’s just before you have data. He does tend to come up after food and typically for the most part be higher throughout the day. Its just a bit nerve wracking as weve never shot this number before.

Does anyone know what a no shoot number would look like now that we are a bit further into this?
 
Thank you 🙏 we used to not shoot anything under 11.1 so its a bit different for us, but i believe we were told before that’s just before you have data. He does tend to come up after food and typically for the most part be higher throughout the day. Its just a bit nerve wracking as weve never shot this number before.

Does anyone know what a no shoot number would look like now that we are a bit further into this?
SLGS protocol says 150 is no shoot. I'm not qualified for dosing advice but that's what it says.
Hope you two have a great day and safe surfing Bear!
 
Good job shooting. You gradually lower the no shot or reduced dose number as you gain data until you can shoot above 100. Had tge BG been under 150 stall, don’t feed and retest the first time this happens to see if the BG is rising.

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.
  • 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 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.

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, Levemir, and Biosimilars 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.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
 
SLGS protocol says 150 is no shoot. I'm not qualified for dosing advice but that's what it says.
Thank you 🙏 we used to not shoot anything under 11.1 so its a bit different for us, but i believe we were told before that’s just before you have data. He does tend to come up after food and typically for the most part be higher throughout the day. Its just a bit nerve wracking as weve never shot this number before.

Does anyone know what a no shoot number would look like now that we are a bit further into this?
Just a point of clarification, SLGS has general guidelines when dealing with lower than usual preshots and has specific wording like “until you collect enough data”. With more data and experience with lower preshots, you will be able to lower the number you consider as shootable, eventually down to 90 (when you have enough data in how Bear responds to insulin and carbs).

This was your first blue preshot, so you could have stalled, not fed and retested again to see if the number was rising without food. That said, you did shoot 220 a few days ago, and with meter variance that’s pretty much around the same. Given that Bear has a history of ketones, you would not want to skip the shot.

When you shoot a number that is lower than usual, it is a good idea to follow-up with +2 and get an idea of where the cycle might be headed. If the +2 is much lower than preshot, you’ll probably want to keep an eye on the cycle, by getting at least another test somewhere between +3 to +5 or +6.

Hoping the potassium levels stabilize, the low K can make them feel quite poorly.
 
Just a point of clarification, SLGS has general guidelines when dealing with lower than usual preshots and has specific wording like “until you collect enough data”. With more data and experience with lower preshots, you will be able to lower the number you consider as shootable, eventually down to 90 (when you have enough data in how Bear responds to insulin and carbs).

This was your first blue preshot, so you could have stalled, not fed and retested again to see if the number was rising without food. That said, you did shoot 220 a few days ago, and with meter variance that’s pretty much around the same. Given that Bear has a history of ketones, you would not want to skip the shot.

When you shoot a number that is lower than usual, it is a good idea to follow-up with +2 and get an idea of where the cycle might be headed. If the +2 is much lower than preshot, you’ll probably want to keep an eye on the cycle, by getting at least another test somewhere between +3 to +5 or +6.

Hoping the potassium levels stabilize, the low K can make them feel quite poorly.
Thank you! We just did his +2 and he seems to have come down a bit , 173.. thought he would be higher after breakfast, not sure exactly where this cycle is going to take us, and am a bit nervous 😣
 
Good job shooting. You gradually lower the no shot or reduced dose number as you gain data until you can shoot above 100. Had tge BG been under 150 stall, don’t feed and retest the first time this happens to see if the BG is rising.

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.
  • 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 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.

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, Levemir, and Biosimilars 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.
If the preshot number is near kitty's usual preshot numbers:

Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
Thank you 🙏 it is a bit stressful as weve never shot this low before but trying to not be too conservative with the history of ketones. His +2 was 173 so thats a bit unusual for him, he usually ends up higher post meal, but we did up his dose recently
 
Thank you! We just did his +2 and he seems to have come down a bit , 173.. thought he would be higher after breakfast, not sure exactly where this cycle is going to take us, and am a bit nervous 😣
Don’t be nervous :), he’s still pretty flat actually, considering meter variance. Depending on your usual feeding schedule for snacks, you may want to give a couple of teaspoons here or around +3 since dose is now onsetting, and perhaps check again around +4 or +5. How has his appy been last couple of days post vet? Still ok?
 
Don’t be nervous :), he’s still pretty flat actually, considering meter variance. Depending on your usual feeding schedule for snacks, you may want to give a couple of teaspoons here or around +3 since dose is now onsetting, and perhaps check again around +4 or +5. How has his appy been last couple of days post vet? Still ok?
When you say meter variance, do you mean the human meter vs alpha track? I checked him at the vets the other day and he was 18, and then checked him on their AT and he was 22 something.

Appetite is better, not quite what he used to be but he was a free-fed kibble kitty and im sure the lower potassium hasnt been helping. But hes been eating and ate almost a full can of friskies this morning. I gave him a churu when i checked his +2 so he was happy about that 😄

Im sure his numbers are fine and probably where we want them to be, its just our first time seeing/shooting blue since dx so its new and scary lol
 
No, actually all meters can have an allowable 15-20% variance per FDA standards for accuracy and precision. So, using the same meter, functioning correctly, it can still yield BG that varies within this range.

A whole can of Friskies! Yup, I’d say appy all right :)
 
Hi Vanessa- I didn’t see a post for today, but by my count today would be 7 days on 0.75u. In looking at Bear’s numbers and considering you’ve had history with ketones in the picture recently, I would suggest you see how today’s cycle goes, and if you don’t see any drastic changes to his current BG ranges, I’d consider going up to 1u either tonight or tomorrow morning, if you wanted to see how this evening’s numbers appear as well. So far we haven’t seen anything better than 173 and with SLGS we want to see nadirs under 150. Ideally it would be helpful to see a test before bed each evening, just to be sure he’s not up to any shenanigans at night and going higher during the day, but I also understand some of this 7 day period Bear was at the vet. Of course it’s entirely up to you; I just thought I’d offer my 2 Canadian cents ;)
 
Hi Vanessa- I didn’t see a post for today, but by my count today would be 7 days on 0.75u. In looking at Bear’s numbers and considering you’ve had history with ketones in the picture recently, I would suggest you see how today’s cycle goes, and if you don’t see any drastic changes to his current BG ranges, I’d consider going up to 1u either tonight or tomorrow morning, if you wanted to see how this evening’s numbers appear as well. So far we haven’t seen anything better than 173 and with SLGS we want to see nadirs under 150. Ideally it would be helpful to see a test before bed each evening, just to be sure he’s not up to any shenanigans at night and going higher during the day, but I also understand some of this 7 day period Bear was at the vet. Of course it’s entirely up to you; I just thought I’d offer my 2 Canadian cents ;)

Thanks Christie! I was just actually discussing this with bear’s dad this morning 😆

Originally we had planned to go up today, pre ER stay lol. Then his schedule got thrown off- shooting late, shooting early- and god knows if they gave him the correct dosage while he was there.

I think I read somewhere that shooting late acts like a reduction and shooting early acts like an increase? (Not sure if that applies with bumping him 15 mins every shot?)
And weve been bouncing around a lot this week (times are in spreadsheet). Tonights dose will put us back to our 930 schedule.
Also not sure if you saw the note about him possibly getting into some kibble last night 🙄 my fault, my brain has been everywhere this week!
BUT i was pretty pleased with the numbers we got yesterday all things considered.

I was going to post and ask about an increase given all of the information from the last week etc.

Our trouble with pm testing is that we shoot late due to our schedules. So we shoot at 930pm typically so i try to get +2 in where i can but unfortunately its impossible to get anything too much later especially +6 in the evenings 😣
 
You don’t have to be concerned with shooting late/early in variances of 15-30 minutes.
Also not sure if you saw the note about him possibly getting into some kibble last night 🙄 my fault, my brain has been everywhere this week!
Completely understandable :bighug: Yes, I did see that comment…Pity you didn’t catch a kodak moment of Bear and his likely guilty face possibly getting into contraband :smuggrin:

Our trouble with pm testing is that we shoot late due to our schedules. So we shoot at 930pm typically so i try to get +2 in where i can but unfortunately its impossible to get anything too much later especially +6 in the evenings 😣

Ah ok, gotcha. +2s are still a good idea, they often can give you an indication that the cycle may be more active, and help either in case you need to leave higher carb food if you can’t test, or sometimes if needed set a timer for a later test. Is there any further flexibility to your 9:30 shot times where you could shoot perhaps even an hour or two earlier or is that basically what works the best for you?

You can certainly give it another day or two and see how things go as you gather a bit more data, sometimes the higher number like your preshot this morning can be a high before a break. Or…sometimes the threat of an increase on the horizon makes their ears perk up :cat::D
 
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