8/3/15 Lucy AMBG 77 +2 68 +3 59 +4 56 +5 58 +6 58 +9 63 +11 113 PMPS 124 +1 133 +3 185 +9 301

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Voula

Voula

Member Since 2014
Hi everyone. Lucy's BG was 10.5/189 at +10 and 7.7/139 at +11. Should I give insulin if numbers keep falling or wait? :nailbiting: It is unlikely that we will see a drop into green numbers past +12 and likely we will get into green numbers if I stay on schedule so what do you think? I think the drop in BG is Lucy's pancreas producing its own insulin as the 7.7/139 is about an hour and a half after food.
 
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As long as you are able to monitor you should go ahead and shoot. It is a myth that you shouldn't shoot a falling number. There's a great post around somewhere about why it can be a really good thing to do. Hopefully someone that knows where it is will be along to post it for you later but in the meantime I say shoot!
 
Thank you Serryn. It seems that Lucy had a bounce and now the bounce is clearing. I will be home all day today though my chocolate supply is low at the moment so I might pop out for a few minutes to restock to cope with the anxiety right now :).
 
The BG has dropped again after a snack. I have been slowly reducing the BG I will dose at by about .5 mmol/L or 9 mg/dl each time and now it is 6.8/122. :nailbiting: The lowest I have dosed at is 8.3/149 the other day so I don't know now if I feel confident to dose.
 
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I found some information on the sticky about dosing at low numbers and I think I will wait a bit as Lucy is clearing a bounce and she sometimes stays lower into the next cycle without insulin and also she sometimes drops fast in the first two hours after a dose.
From the sticky: Why the +10s and +11s? These spot checks will help keep you out of trouble. Again, let’s say that you have a lower than usual preshot. If your preshot ishigher than +10 or +11, you know the insulin from that cycle is waning, the cat is on his way up, and the number is probably shootable. If you have a preshot that is much lower than your +10 or +11, knowing why will help you decide whether or not to shoot. Some Lantus and Levemir users notice a dip at the end of the cycle, meaning that the preshot is always a bit lower than +10 or +11 (but usually still higher than the nadir – the cat dips to a nadir at mid-cycle, then rises, then dips again). If this is your cat’s pattern, then this type of dip is not a reason to delay a shot. On the other hand, if your cat has a bounce clearing and is still careening downhill at shot time (usually characterized by numbers that drop for the whole cycle, without a clear nadir), then you will want to take that into consideration as you make a decision about shooting. Know thy cat.
 
Remember...you're not shooting the number Lucy is now....You're shooting the number she'll be in 2-3 hours when Lantus has it's "onset"

She'll also be eating a full meal

If you can monitor, I'd shoot the scheduled dose and get a +1 and +2 just to see how she's doing

If she's going to earn a reduction, she'll earn it whether it's this cycle or another one
 
This is what I found for you on "shooting a dropping number"

Re: Tight Regulation Protocols: Myths Debunked

Here’s another misconception I have seen floating around LL from time to time:

“Don’t Shoot a Dropping Number”

I LOVE when I have an opportunity to shoot a dropping number! It’s a great way to take advantage of the overlap provided by Lantus and Levemir. Low or dropping preshots are a GIFT that helps us move our cats closer to tight regulation. This is a Tight Regulation forum, so grab it!

Remember, you are not shooting the number your cat is at now. You are shooting the number he will be at hours from now, when the insulin kicks in. You have probably noticed that once your cat starts to rise, he/she can rise very quickly. If you shoot, you will also be feeding, which can also contribute to the rise. If you wait for the rise to start before shooting, you might be behind before you even get started. When you have an opportunity to get the insulin in before the rise starts, rejoice and SHOOOOOOT!!! Feed as usual and monitor the beginning of the cycle. Feed strategically in the first couple of hours if you need to prop him up until the rise begins. He will still rise, but probably not as fast or as far because the insulin will be there beforehe needs it.

We do have guidelines for “Shooting Low Numbers,” but those guidelines are primarily an educational tool to help caregivers learn to shoot low. Once you know your cat’s response to food and insulin, then usually you will have the best results from shooting at +12, whether the number is high, low, rising, falling, whatever. Of course, common sense applies. 30s are not shootable, and 40s are not shootable unless you have TONS of data to show that it is ok for your cat (if you are wondering if that is you, it is not. ;-) Almost nobody should be shooting 40s and if you are in that category then you already know it). You do not want to shoot if there is any reason to believe you will not be able to keep your cat safe.

These insulins are not at their best when we ask them to pull down high numbers. They are GREAT at grabbing onto lower numbers and holding them flat. SHOOOOOOOOT!!!
 
Okay thank you Chris. I know I was thinking that too that I am dosing at what the number will be in a few hours from now. I guess I am anxious because sometimes Lucy drops fast early and other times she stays in blue numbers well beyond the next dose is due. The BG is dropping some more and we are almost in green numbers now.
 
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The BG is still falling and is now 4.3/77 without an insulin dose. So too low for me to dose with a falling green number as I am not yet confident enough to do so though I know more experienced and confident people would do so.
 
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Remember that if you shoot when you first get a safe, shootable PS number...like the 77...then you feed and the number might come up. That's why I'm not a fan of stalling once you get some experience. Also remember that she won't come down as much when she's in green as she will in pink.

She's doing great for a skipped shot but the depot is likely carrying her over now. When it drains, numbers will probsbly go up.
 
I am wondering what others think of this quote from the Roomp / Rand protocol document.

"If blood glucose at the time of the next insulin injection
is 2.8–5.5 mmol/L (50–100 mg/dL)
Initially test which of the alternate methods is best suited to the individual cat:
1. Feed cat and reduce the dose by 0.25–0.5 IU depending on if cat is on low or
high dose of insulin
2. Feed the cat, wait 1–2 h; when the glucose concentration increases
to >5.5 mmol/L (>100 mg/dL), give the normal dose.
If the glucose concentration does not increase within 1–2 h, reduce
the dose by 0.25 IU or 0.5 IU (as above).
3. Split the dose: feed cat and give most of dose immediately and
then give the remainder 1–2 h later, when the glucose
concentration has increased to >5.5 mmol/L (>100 mg/dL).
If all of these methods lead to increased blood glucose concentrations, give the
full dose if preinsulin blood glucose concentration is 2.8–5.5 mmol/L
(50–100 mg/dL) and observe closely for signs of hypoglycemia. In general for
most cats, the best results in phase 2 occur when insulin is dosed as consistent
as possible, giving the full normal dose at the regular injection time."
 
Marje and Gracie said:
Remember that if you shoot when you first get a safe, shootable PS number...like the 77...then you feed and the number might come up. That's why I'm not a fan of stalling once you get some experience. Also remember that she won't come down as much when she's in green as she will in pink.

She's doing great for a skipped shot but the depot is likely carrying her over now. When it drains, numbers will probsbly go up.
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Thank you Marje. I know the depot is depleting and it is a dilemma for me at the moment as I know when I have stalled the numbers go up and stay up. But then Lucy does have bounces after low numbers so it is hard to know if the glucose levels would have gone up anyway after the low numbers. According to the Roomp / Rand protocol which our vet wants us to follow I just read that I could give a lower dose at BG levels between 50 and 100. This might be a good next step for me seeing as I get very anxious about dosing at lower numbers and I might gain a little confidence.
 
Yes, you can shoot a reduced dose but each time you do that the cycle count starts over. For example, if her dose is 2.5u and you decide to shoot 1.25u as a reduced dose, then you have to start counting the cycles over again on the 2.5u. You can read more about this in Counting Cycles.

I can't recall anyone shooting a split dose as described above due to low numbers. And I think the last sentence really sums it up. Lucy will do the best if you learn to shoot her regulsr dose on time as long as her Bg is above 50, you have supplies, and will be home to monitor.

I know it's scsry...we've all been there....but you've been here long enough that it's time to take the big step and shoot a green number. You can do it and if you post first, someone should be around and stay with you to guide you. Since Lucy 's BG drops when she eats, you might need to feed a higher carb food when she's in green.
 
Thank you Marje. I think a reduced dose at numbers between 50 and 100 will be my next step. I won't do that today as I have delayed the dose too much and so I will give the full dose when the BG comes up a bit. But I think a reduced dose is something I could do with lower numbers and then gradually build up the dose each time we have lower numbers and so in this way gain confidence gradually as I am so anxious dosing at lower levels even though you and other very experienced people say it will be fine. Thank you again for your understanding and kindness.
 
It is the best way I think to gain confidence and make progress too. :D:cool: Lucy is still surfing along in good green numbers at +17. But next time I will give a reduced dose when I am too anxious to give the full dose so that Lucy has some insulin rather than none. I can imagine Serryn in particular with her keenness to bring Purrdy's glucose down to green numbers thinking you idiot give the dose! :rolleyes: Thank you again. :bighug:
 
I am very sure that Serryn wouldn't think that ;). We do all understand and I'm glad you've got a plan for next time.

Great surf, Lucy!
 
Thank you Marje. :bighug: Serryn gives me very gentle nudges into the right direction when I am very anxious. :)
 
He he he not you idiot, but I tell you, if I lived nearby I would have been on your doorstep to shoot her myself this morning! Even if I did have to cart you off to the coronary unit straight after :):):) I was a little :banghead: at the missed opportunity. At least you have a plan now to overcome your nervousness...

Nice surfing Lucy, she's not dropping anymore, I don't suppose you want to have a try at shooting her now... ;):D;)
 
Vyktors Mum said:
He he he not you idiot, but I tell you, if I lived nearby I would have been on your doorstep to shoot her myself this morning! Even if I did have to cart you off to the coronary unit straight after :):):) I was a little :banghead: at the missed opportunity. At least you have a plan now to overcome your nervousness...

Nice surfing Lucy, she's not dropping anymore, I don't suppose you want to have a try at shooting her now... ;):D;)
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Hi Serryn. Lucky you don't live closer then. :joyful: You got that right about the coronary unit straight after for sure if Lucy got insulin with a glucose level in the low green numbers. :D:cool: I will test again soon and see what the BG is then. Lucy was still at 3.2 a while ago but I fed her dinner and thought I would wait two hours after food to test again. I think the lowered dose is something I could do but seeing as I have stalled this long I think I should give the full dose now. I just want the BG to be a bit higher than the 50's as that makes me break out in a panic stricken sweat at the thought of giving an insulin dose at that reading. Thank you again. :bighug:
 
Definitely the full dose when you shoot, potentially you could have been shooting a reduced dose tonight but...

Tee hee I thought my suggestion that you shoot now might make you break out in a sweat, I'm trying to desensitise you ;):woot:
 
Hi Serryn. We are still at 3.5 at +21. I am waiting till the reading is above 5.5/100 to give the full dose or at least a rising BG before I give the full dose.
 
Voula said:
I just want the BG to be a bit higher than the 50's as that makes me break out in a panic stricken sweat at the thought of giving an insulin dose at that reading.
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Hi Voula, I've been watching your experience and have learned a lot from it, your quote struck a cord with me as that was exactly how I felt last night. It's scary stuff these low numbers but you are doing a great job. What would we do without the experienced eyes watching in the wings to help guide us in the right direction. I hope Lucy's numbers come up soon for you, good luck.

Suki & Crystal
 
suki & crystal said:
Hi Voula, I've been watching your experience and have learned a lot from it, your quote struck a cord with me as that was exactly how I felt last night. It's scary stuff these low numbers but you are doing a great job. What would we do without the experienced eyes watching in the wings to help guide us in the right direction. I hope Lucy's numbers come up soon for you, good luck.

Suki & Crystal
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Thank you. I have been reading your posts and read about your experience and how you felt last night. It is scary I know. Lucy's glucose is just starting to rise now and I will do another test soon and then I will give her insulin and some food. I hope Crystal continues to do well too. I stayed up all night last week with Lucy and it is exhausting I know. Most nights I get up and do BG tests. I won't relax much tonight and will get up and check on Lucy through the night but it is what we have to do as you are doing with your Crystal too. Though I wish I could have been braver today and not delayed Lucy's insulin dose I also feel very happy as we are at +23 now and the glucose level has just started rising so this is very good I think. I agree the experienced people on this board are a real blessing for us who are new to feline diabetes. All the very best to you and Crystal too. :bighug:
 
As Lucy is rising now, don't you go past +24 without shooting young lady - even if she's still green - you want to keep her there if you can :D although I'm not sure what she was at +23 since you haven't updated her spreadsheet or your subject line - hint, hint - maybe she is already in blues?
 
purrdydolly said:
As Lucy is rising now, don't you go past +24 without shooting young lady - even if she's still green - you want to keep her there if you can :D although I'm not sure what she was at +23 since you haven't updated her spreadsheet or your subject line - hint, hint - maybe she is already in blues?
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I am going to call you quick draw McGraw :D:cool: as you are so fast with your replies even before I updated our spreadsheet. Thank you for the laugh Serryn. I gave Lucy her insulin at +23 so I just made it under +24. :) Surely you have some sort of award you can give me for that achievement. :)
 
I would almost give you an award EXCEPT now that you've updated Lucy's SS I see she was over 100, which you said you'd shoot at, on the previous test. So instead you just get a little well done, you're going to have to work hard for that award or I think you will rest on your laurels :cat::cat::cat: ok maybe a medium sized well done because that is the lowest you've shot so far. I am the hard task master aren't I, luckily I don't have children!

I must say though, that was a lovely green surf (i hope Purrdy is watching!) :D now I'm just hoping you caught her in time to avoid the stinky pinkys....
 
The two tests were done close together as I tested again just before insulin to be sure. :) You are a hard task master yes. :D:cool: My guess is that Lucy will have a bounce and with a depleted depot I think we will have high numbers in this cycle and likely the next cycle after this one but you never know the lower numbers might continue. It is the lowest I have dosed at though so that is good. I hope Purrdy will have some more green numbers soon. Thank you Serryn for your support and guidance and sense of humour too.
 
We do have a very special award when you shoot your first green....so close today! But even I won't fudge and give it at 100.

You are the first member I have failed to assimilate into the collective (hope you are familiar with Star Trek). ;);) Even with Serryn pushing! You are lucky to have her there in Australia.
 
Marje and Gracie said:
We do have a very special award when you shoot your first green....so close today! But even I won't fudge and give it at 100.

You are the first member I have failed to assimilate into the collective (hope you are familiar with Star Trek). ;);) Even with Serryn pushing! You are lucky to have her there in Australia.
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Surely if I am the first member you have failed to assimilate into the collective then that deserves an award. :) I am not sure what that means. But I will research it. Thank you Marje. :) Yes I feel very lucky that Serryn is in Australia though probably thankful she does not live close by after her comment that if she did I might be in the coronary care unit by now. :D:cool::)
 
hahahahahahaha oh my gosh. I just read through this whole thread and am chuckling! You guys are hysterical - between you, Voula, Serryn and Marje you've got me rolling on the floor.

On Star Trek there is a Borg Queen - the Borg are a species (made up, of course) but the queen controls everything and everyone obeys her bidding. All the Borg have a collective thought, in other words, there is no independent thinking. Marje has been nicknamed the Borg Queen for getting people to shoot green numbers.

Personally, I'd give you the award for shooting 100 because I KNOW how big of a step that is for you! You're making awesome progress, and I think we can all see that miss Lucy is also making awesome progress. THAT'S FANTASTIC! :D:D:D:D
 
Here's a picture of the Borq Queen.....very fitting that she's green in this picture. Of course, I don't look like her ;);) I'm not that green hahahaha.

borg-queen.jpg
 
julie & punkin (ga) said:
hahahahahahaha oh my gosh. I just read through this whole thread and am chuckling! You guys are hysterical - between you, Voula, Serryn and Marje you've got me rolling on the floor.

On Star Trek there is a Borg Queen - the Borg are a species (made up, of course) but the queen controls everything and everyone obeys her bidding. All the Borg have a collective thought, in other words, there is no independent thinking. Marje has been nicknamed the Borg Queen for getting people to shoot green numbers.

Personally, I'd give you the award for shooting 100 because I KNOW how big of a step that is for you! You're making awesome progress, and I think we can all see that miss Lucy is also making awesome progress. THAT'S FANTASTIC! :D:D:D:D
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Thank you so much Julie. :) Thank you also for the explanation about Star Trek. Okay I am an independent thinker and not a nervous wreck whenever I think of dosing at green numbers. :D:cool:
 
purrdydolly said:
Doh - I see she's hit the stinky zone, but on the plus side she's giving your palpitations a chance to subside ;)
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Yes every time we get green numbers there is a bounce. Though delaying the dose no doubt has contributed to the purple number at +9. But I am amazed that Lucy stayed in green numbers up to +20 and I made progress in that I now can feel confidence in dosing between 100 and 150 and have a plan to give Lucy a reduced dose between 50 and 100 next time and then increase to a full dose at lower numbers gradually to gain confidence. Does lantus last 20 hours do you know? Thank you again Serryn yes my palpitations have subsided. :)
 
Lantus is a depot insulin - meaning that it builds up in the body and slow-releases. The dose you give this morning will still be having some lingering effects as long as 2-3 days later. So yes, your previous shots can still be influencing her blood sugar after 20 hours.
 
julie & punkin (ga) said:
Lantus is a depot insulin - meaning that it builds up in the body and slow-releases. The dose you give this morning will still be having some lingering effects as long as 2-3 days later. So yes, your previous shots can still be influencing her blood sugar after 20 hours.
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Thank you Julie. That is good to know. I know lantus is a depot insulin and after doing some reading today on the different types of insulins I think some of my anxiety about dosing at lower glucose levels has come from thinking of lantus as being like an in and out insulin even though I know it isn't. For example with caninsulin which is shorter acting and has no carry over effect and which can drop blood glucose very fast people seem to be more cautious about dosing at lower glucose levels which seem to be safe to dose at when using lantus it seems. Please correct me if I have not understood that. Thank you again.
 
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you have it absolutely right. Lantus actually works better at lower numbers than at higher blood sugar. When it is given lower numbers it can hold the blood sugar flat - i don't think you ever see that with Caninsulin. It drops the blood sugar fast and doesn't last too long, unlike Lantus.

Have you read the document on how exactly Lantus works? It's spelled out here in the Lantus vs Lev link. I think it really helps to explain how it works in the body.
 
julie & punkin (ga) said:
you have it absolutely right. Lantus actually works better at lower numbers than at higher blood sugar. When it is given lower numbers it can hold the blood sugar flat - i don't think you ever see that with Caninsulin. It drops the blood sugar fast and doesn't last too long, unlike Lantus.

Have you read the document on how exactly Lantus works? It's spelled out here in the Lantus vs Lev link. I think it really helps to explain how it works in the body.
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That was a very good document which explained how lantus works very clearly and I will keep that in mind next time we have a low pre-dose reading and I will be less anxious.
 
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