With the data you have, there is absolutely no reason why you couldn’t have shot the 158 on time with the full dose. You’ve shot lower at this dose
Stalling with a number like this only benefits you as the CG and not YoYo, right? The part of SLGS that advises what to do with a preshot between 150-200 and provides three options is for those members with little to no data. You have
tons of data and you should be able to shoot any number above 90 without stalling unless you don’t have supplies or cannot be available to test. When you do shoot a lower number but one above 90, you just need to be sure you get a +1 and +2.
I’m sure what factored into your thoughts was that it appeared you were shooting a dropping number. He was clearing a bounce so you most likely were. But this can be an advantage as long as you can test and feed because it allows you to take advantage of carryover and overlap and give him a better cycle.
I wanted to a address your question from last night:
You’re welcome and I’m always happy to help you. I”m glad you are letting me know when something seems confusing or doesn’t answer your question.
It will help if I explain the function of the pancreas in diabetics and non diabetics first. This is an oversimplification, but there’s no need to get into the weeds on the physiology.
In a non diabetic, after a meal is eaten, the BG rises within 30-60 minutes. The beta cells in the pancreas release insulin to “remove” the excess sugar from the blood. The BG drops roughly three hours later back to normal.
In an insulin-dependent diabetic, the beta cells are not working or cannot produce enough endogenous (from within) insulin to do the job. The process begins the same in that after a meal is eaten, the BG rises within 30-60 minutes. The exogenous (from without) insulin we give will then start to remove the sugar from the blood once the insulin onsets; different insulins have different onset times. The shorter acting insulins like Normalin/Humulin, Caninsulin, and Vetsulin onset immediately so food must be on board
before the shot is given. The longer duration insulins like Lantus and Levemir don’t onset for two hours so that gives you plenty of time at or after the shot to give food. Most of us feed at shot time because kitty has its face in the plate so it’s distracting to poke them with a needle. Plus, it does help to have some carbs on board when the insulin onsets.
Because insulin is a hormone, then when we give an insulin shot, it can affect the BG in different ways depending on whether it’s the right dose, how much the absorption rate is (it can vary up to 50% from shot to shot at the same dose), what the barometric pressure is, sometimes what the season is, etc. Lots of things can affect the BG of our diabetic cat on any given cycle when the same dose is shot. We use the carbs in the food to “work” with the insulin so the BG doesn’t drop dramatically when the insulin onsets. That’s why it’s really important that we know when our own kitty onsets. We want to be sure the appropriate amount of food is there for the insulin or else the insulin starts to remove sugar from the blood and that can potentially result in hypoglycemia depending on the number we shot. When we see kitties that don’t eat and insulin is given, we often see the BG drop at onset.
When you say “1/4 can” or “1/2 can”, that’s not a precise measurement that is consistent from cycle to cycle or even meal to meal. For example, I feed my kitties a balanced raw diet and my little one eats 2 oz a day in four meals. If I just estimate 1/2 of her 1 oz cube, I’ve found that one meal she might get 0.4 oz and the next one with the other half of the cube is 0.6 oz. I weigh her food out each morning to be sure each helping she gets is 0.5 oz. It keeps her from being hungry that way. I also weighed out Gracie’s food because she did better, on Lantus, if I gave her a larger portion at AMPS and +1.
When I said “food has no effect on drops at +3 and +4, only the insulin is allowing him to drop” what I meant was that if you are feeding his regular LC food and he has an active cycle with Lantus, the BG will drop until nadir based on the insulin; the food doesn’t cause the drop in a diabetic cat whose pancreas is not or is barely working. Have you ever seen this chart below?
However, if a diabetic cat is tightly regulated and is in all green and on a low dose (a drop to 0.1u), the pancreas is likely working. If that is the case, the food given at PS will affect the BG 3-4 hours later by dropping it. Do you see the difference between that scenario and a situation where a cat is not tightly regulated and not on a low dose (ergo the pancreas isn’t really working)? The drops are due to the insulin, not to the pancreas releasing insulin in response to food fed three hours earlier.
For many cats on Lantus, feeding at PS, +1, +2, +3 works great for them. For others, feeding at PS, +2, +3, +4 helps. It really takes experimentation on your part to figure out how many minimeals before nadir he needs and whether he will eat all the food.
You are correct when you say "I need to get his food intake into him before nadir and do not feed after nadir. Maybe when his pancreas starts working, then food will affect the drops, but not now”. However, the important part is that his pancreas isn’t going to start working until he’s spending long hours in green.
Please let me know if this helps. I’ll have more time this weekend to give you some specific examples of what I see on his SS but I’m short on time the next few days. My apologies.
