27/5 Kabaret PMPS 92 : to shoot or not to shoot

[kimouette]

Please take a look at Kabaret's spreadsheet (the link in my signature). We just got the lowest preshot we've ever had. Since we increased the dosage this morning I don't know if we should go back to 2.5U, or wait until he's above a certain number, or if we should give him the shot anyway (assuming that his nadir is gonna be in many hours)?

He's not regular (his nadirs happen anytime between +3 and +12), it's really hard for me to tell what we should do NOW for his evening shot.

Please help

 

[caringcdn]

Hi,

I'm very new to the group and have run into this situation so I just want to give you this link which explains how to handle low numbers. While you're reading it, I'm sure someone with more experience will post a message. HANDLING LOW NUMBERS - viewtopic.php?f=9&t=147

In the meantime, I'll go back and check the advice that was given to me. Perhaps it can be helpful. Good luck! Anne

 

[Tina & Rocky]

Hi, 92 is a pretty good BG number, in the normal, healthy cat range. We like to see those green numbers here, preferable a stretch of green numbers that are 50 and 99. :mrgreen:

I can't give you any shooting or dosing advice. What I can tell you is the motto often voiced here which is, "Shot low to stay low." Lantus is not very good at reducing BG numbers once they are high.. :roll: We are working at this to try and get our cat(s) regulated within the green numbers.

You have to do what you feel is safe for Kabaret and what makes you feel comfortable. If you do shot at your normal shot time, the same insulin dose, will you be there all day today to monitor Kabaret should his BG drop below 50 and you need to bring his numbers back up, possibly with a few LC, MC, or HC food interventions?

Another option is to stall the shot time until his BG is at a number that you feel safe with, for now. If you stall his shot time then you will need to give the next shot 12 hours after THIS shot, and not at your regularly scheduled AM shot time.

 

[kimouette]

We decided to skip the injection.. Too stressful for her, especially when knowing that after +3 tonight she will be sleeping.

 

[Sienne and Gabby (GA)]

What I suggest to people is begin to start thinking about where your comfort level is for shooting low numbers. You've shot a 133 with good results. What's the next lowest number you'd be comfortable shooting? The reality is that 133 is not terribly different than a 92 BUT you need to be comfortable shooting a lower number and be available to monitor as well as have supplies of strips and high carb food in stock in case they are needed. A lot of what goes into shooting lower numbers is the mental preparation.

I think you can take the "911" down since you decided to skip.

 

[kimouette]

I wouldnt mind shooting at 100 or even lower! Just not when the preshot is actually a nadir!
And especially not when a cat is having nadirs sometimes at +3 sometimes at +12 or +13... Its not like the other cats i've helped!
Even though Sylvie does many many tests, I feel like we'll never be completely data ready :cry:

 

[Sienne and Gabby (GA)]

A couple of things to think about...

You don't have enough data yet to know whether Kabaret has a late nadir. It's possible -- some cats have their nadir at shot time. It's a bit freakish to see but it does happen. Right now, you don't know if this is the case. (It's a tidbit to put away somewhere.)

What you're seeing is a dropping number. Kabaret's number have been dropping through out this cycle. When you're still new to Lantus, we don't encourage you to shoot a dropping number. There can be momentum due to the drop in numbers and if you give another shot, it can increase that momentum. Once you've had more experience with steering Kabaret's numbers with food, it's easier to deal with drops in numbers close to pre-shot time. I shoot dropping numbers all the time -- I also have a ton of data and I know my cat.

What is key to shooting lower numbers is what Tina pointed out -- you have to be ready. You'll need to monitor and have the supplies you need at home. For now, getting used to the idea of shooting a number around 100 is good. Just don't be upset in the morning if the numbers are high. An alternative, which isn't always feasible, is to stall. If you wait 20 min. and re-test (and DO NOT feed), you'll be able to see if numbers are rising. You may need to repeat the test and wait process but it will tell you when numbers are on the rise. The problem with this strategy is that you can end up being off schedule by a couple of hours and that may not work given that you need to work, etc.

 

[kimouette]

Many thanks for all the infos and suggestions! After reading all your answers I looked back at Kabaret's spreadsheet, and it's true, I did shoot at 133 and got good results. We are at +13 and it looks like it's officially going to be his nadir for this morning's injection! Talk about a late nadir!

I find it difficult to go from pink to green, especially after a first dose increase, and feel safe about it..that is probably the big difference between the 133 I shot cuple of days ago, and tonight's preshot: it wasnt right after a dose increase.

What is key to shooting lower numbers is what Tina pointed out -- you have to be ready. You'll need to monitor and have the supplies you need at home. For now, getting used to the idea of shooting a number around 100 is good.

We are ready.. but not at night. Sylvie is already putting her life on hold for her cat, i know she is tired, I cant ask her to take big risks at night cuz she will be sleeping 3 hours after the evening shot... and the cat wakes her up every morning at 5h30 for no reason! So she really have short nights of sleep!

Can we set a number like this (for exemple 100), and stick to it nomatter if the cat had his nadir at +3 or if we know he might have it at +13?
Again, like I said, I dont mind if he gets late nadir, I'll get used to it and shoot low numbers, but if he's not steady it doesnt seem right to ignore how important the overlap might be.

An alternative, which isn't always feasible, is to stall. If you wait 20 min. and re-test (and DO NOT feed), you'll be able to see if numbers are rising. You may need to repeat the test and wait process but it will tell you when numbers are on the rise. The problem with this strategy is that you can end up being off schedule by a couple of hours and that may not work given that you need to work, etc

If we do this, and see that the numbers are SLOWLY increasing after couple of minutes (like tonight for exemple), isnt'it possible with an unsteady cat like him, to have an early onset that makes the situation a little dangerous?

I just added a column to the spreadsheet trying to narrow the AM nadir... even though it's approximate, the difference from day to day is dramatic!