? 4/5 Happy Holiday from Gus

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elizabeth and gus

elizabeth and gus

Member Since 2015
We are mostly blue with some green for last two days I am happy but little bit nervous. Gus got 4 mg Cerenia this morning but we didn't see big improvement in his eating. He really liked liver shake so I will try again if he is not going to eat his other food.

For PM we planing to decrease from 1U to 0.75U since his nadir was 68 is this way we should go?

Thank you
Elizabeth and Gus
 
If you are using the SLGS approach (vs. Tight Regulation) and/or using an AlphaTrack meter, you would reduce Gus' dose. If you're following the TR protocol or using a human meter, then the dose is reduced if Gus' numbers drop below 50.

When you have a minute, it will be helpful if you indicate what brand of meter you're using and whether you're following SLGS or TR in your signature otherwise, at least I know I'll never remember! (Sorry!!)
 
Then you reduce if he goes below 90. From SLGS:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
​
By the way, last night when you reduced Gus' dose because you had a blue preshot - I want to encourage you to focus primarily on the low points (nadirs). Lantus dosing is based upon those low points, not the higher numbers. Think of a blue preshot as making huge progress! The dose you're giving is finally working and getting him into better numbers, so you don't usually want to back away from that dose unless you can't monitor him or he's not eating normally. In this group we encourage people to stick with the dose if it's over 150 preshot, and if it's less, the first time post and ask for advice on how to proceed. Someone will be able to help you with your choices and figure out what to do, and when they do that, they'll also stay with you through the cycle in case you see low numbers, or find someone who will. You won't have to go it alone!
 
julie & punkin (ga) said:
Then you reduce if he goes below 90. From SLGS:

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
  • As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but do decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change). Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.
Lather, Rinse, and Repeat!
​
By the way, last night when you reduced Gus' dose because you had a blue preshot - I want to encourage you to focus primarily on the low points (nadirs). Lantus dosing is based upon those low points, not the higher numbers. Think of a blue preshot as making huge progress! The dose you're giving is finally working and getting him into better numbers, so you don't usually want to back away from that dose unless you can't monitor him or he's not eating normally. In this group we encourage people to stick with the dose if it's over 150 preshot, and if it's less, the first time post and ask for advice on how to proceed. Someone will be able to help you with your choices and figure out what to do, and when they do that, they'll also stay with you through the cycle in case you see low numbers, or find someone who will. You won't have to go it alone!
Click to expand...

Julie

Thank you so much. I have to overcome my fear of hypo.

For PM should I do 0.75 since he was 68 earlier today.

Elizabeth and Gus
 
There is a difference between hypos and low numbers. Symptomatic hypos on Lantus or Lev are not common in people who have learned to hometest. I can only think of a couple in the 4 years I've been on here. Because Lantus is a "gentle" insulin, a cat might even get into the 30's or lower without showing any symptoms. If you are monitoring and testing, you'll be able to see the low numbers coming and pull him up by using carbs before there are symptoms. Punkin surprised me early on with a 32 but no symptoms - I didn't even realize how low that was and someone here helped me deal with it. You want to respect insulin, but as you understand more it will be less scary. Don't worry - we all get the fear - it would be a mistake not to take the whole thing seriously.

The good news is that Gus is doing well! Hang in there, Elizabeth - everything about this gets easier as you learn more. The first little while is definitely the scariest and most intense. It gets better.
 
Hi Elizabeth
Just wanted to let you know that not long ago I was in your shoes and scared out of my wits.
I followed what Julie and others told me to do all night long and Scooter is Off insulin now (OTJ).
Also tonight I am not freaked out that my Jack has gone low because I know what to do which starts with posting here and listening to Julie.

You are in great hands! :)
 
Dear wonderful people from FDMB Happy Holiday.

Your guidance is what helped me hang in there. I know we were doing better and I decreased his dose so this morning we got higher PS, we did 1s this morning. Going forward should I stay on this dose for several cycles until his nadirs are < 90???
Julie what you think is most appropriate dose for PM 0.75 or 1s ??????

Thank you
Elizabeth and Gus
 
going forward should I stay on this dose for several cycles until his nadirs are < 90???
Julie what you think is most appropriate dose for PM 0.75 or 1s ??????
Click to expand...
With Lantus, you want to hold the dose until you see a number that tells you it's time to reduce the dose. In the case of SLGS, you hold the dose for a week unless you see a drop in numbers below 90. You hold the dose regardless of the pre-shot numbers. It helps to always remember that with Lantus (or Lev), dosing is based on the lowest number in the cycle, not the pre-shot. The 68 yesterday, told you that you needed to reduce Gus' dose.

What you saw this morning is most likely a bounce off of the 68 from yesterday. Gus' pancreas and liver aren't used to spending all that much time in lower ranges. As a result, they "panic" and dump a stored form of glucose into his blood stream. This results in the numbers spiking upward. It can take several days for the effects of the bounce to resolve -- which is why you don't want to increase the dose during a bounce. Stick with the 0.75u dose.
 
Sienne and Gabby said:
With Lantus, you want to hold the dose until you see a number that tells you it's time to reduce the dose. In the case of SLGS, you hold the dose for a week unless you see a drop in numbers below 90. You hold the dose regardless of the pre-shot numbers. It helps to always remember that with Lantus (or Lev), dosing is based on the lowest number in the cycle, not the pre-shot. The 68 yesterday, told you that you needed to reduce Gus' dose.

What you saw this morning is most likely a bounce off of the 68 from yesterday. Gus' pancreas and liver aren't used to spending all that much time in lower ranges. As a result, they "panic" and dump a stored form of glucose into his blood stream. This results in the numbers spiking upward. It can take several days for the effects of the bounce to resolve -- which is why you don't want to increase the dose during a bounce. Stick with the 0.75u dose.
Click to expand...

Thank you

This is so helpful

Elizabeth and Gus
 
Let me edit my comment above. You do not want to shoot if it's an unsafe number. The more experienced you get, the more comfortable you will be with shooting low numbers. For example, if you look at Gabby's or Marje's Gracie's SS, you'll see that we'll shoot pretty much anything above 50. We also have a ton of data on our kitties and years of experience.

I typically tell newer members that you need to give thought to what is a "comfortable" number. The idea is that you will work your way down to shooting low.

My statement above should have better read that with Lantus and Lev, dosing is primarily based on the pre-shot number. There are, however, times when the pre-shot number is taken into consideration. You may want to review/print out the sticky notes, Shooting & Handling Low Numbers. While the instructions were written with the TR Protocol in mind, it will give you a feel for your options.
 
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