9/3 Cher's numbers dropped low - need advice please about shot

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Jancol & Cher

Jancol & Cher

Member Since 2017
Cher was due for her PM shot but her PMPS was 6.2 on the Alpha Trak 2.
Fed her ZD and retested 30 mins later @ 5.8 (104).
Gave more ZD and tested 30 mins later @ 6.9 (124)
Gave more ZD and tested 25 mins later @ 7.3 (131)

Could someone please advise if we should give her a shot tonight?

Please refer to her SS
 
Are you following the Tight Regulation (TR) or Start Low Go Slow protocol (SLGS)?

Are you properly stocked with supplies to manage potentially low numbers? Do you have a source of high carbs, like karo syrup or a gravy-based wet food? Do you have plenty of strips and testing supplies?

Can you stay up for some or all of the night if necessary?
 
I can stay up all night
I have plenty of strips and testing supplies
I don't really understand Tight Regulation or Start Low Go Slow protocol
 
One of the primary differences between the two protocols is the cutoff number to give a shot. For SLGS, if the cat is at or under 120, the general advice is to skip the shot. In contrast, TR generally recommends giving insulin for numbers above 50 for cats with plenty of data available. You don't have to choose protocols right this moment, but it is a decision you'll have to make soon after getting more advice from other members here.

If you choose to give a shot, are you prepared with plenty of high carb supplies to bring the numbers up in case Cher goes a little too low? That's probably the most important question when determining what to do at this moment.
 
I just reviewed your initial post. How much time has passed between when Cher was supposed to get a shot and now? It looks like it been 2 or more hours. Is that correct?
 
Thank you for your explanation of TR and SLGS
I have Cher's SS up to date - not sure if this is sufficient data to determine which one
On two previous occasions when she has been low, we have held the shot
She is on ZD HC (35%) but we do not have any karo syrup or gravy based wet food
Are we able to use ordinary syrup or honey? If not, we can go to the Pet Emergency to get some
 
@Jancol - Giving a shot three hours late is really going to mess up your shooting schedule. Lantus craves consistency, so it's important to make sure the shots are as close to 12 hours apart as possible. Shooting too early can act like a dose increase and shooting too late can act like a dose decrease. Because of this, it is recommended to adjust shot times, if necessary, in small increments - either by 15 minutes each cycle or by up to 30 minutes once a day. This means it would take you 5 or 6 days to return to your normal shot times from a shot given three hours late.

While it's not ideal, it is my opinion that too much time has passed so you should skip the shot tonight.

To better explain the timing, let me give you an example. Let's say that I give a shot at 8am and 8pm. If I then give a shot at 11pm one night (three hours late), here's what my schedule would look like for the next few days, moving each shot time back by 15 minutes (for a total of 30 minutes each day):

Day 1: AMPS 10:45am PMPS 10:30pm
Day 2: AMPS 10:15am PMPS 10:00pm
Day 3: AMPS 9:30am PMPS 9:15pm
Day 4: AMPS 9:00am PMPS 8:45pm
Day 5: AMPS 8:30am PMPS 8:15pm
Day 6: AMPS 8:00am (now we're back on schedule) PMPS 8:00pm

Make sense?
 
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AZJenks said:
@Jancol - Giving a shot three hours late is really going to mess up your schedule. Because we can only adjust shot times by up to 30 minutes each day, it would take you 5 or 6 days to get back on schedule to your normal shot times. While it's not ideal, it is my opinion that too much time has passed so you should skip the shot tonight.
Click to expand...
So there can be a variance of only 30 mins.
She came up to 6.9 after 30 mins, so would it have been safe to shoot then and continue monitoring throughout the night?
 
Sorry that previous information was incorrect ...
Her 7pm test was 6.2 and her next test 30 mins later was 5.8. Would you have recommended shooting then and continuing to monitor during the night.
 
@Jancol - I just edited my last post to better explain how adjusting shooting times works. Please go back and review it and ask any questions you might have.
 
AZJenks said:
@Jancol - Giving a shot three hours late is really going to mess up your shooting schedule. Lantus craves consistency, so it's important to make sure the shots are as close to 12 hours apart as possible. Shooting too early can act like a dose increase and shooting too late can act like a dose decrease. Because of this, it is recommended to adjust shot times, if necessary, in small increments - either by 15 minutes each cycle or by up to 30 minutes once a day. This means it would take you 5 or 6 days to return to your normal shot times from a shot given three hours late.

While it's not ideal, it is my opinion that too much time has passed so you should skip the shot tonight.

To better explain the timing, let me give you an example. Let's say that I give a shot at 8am and 8pm. If I give a shot at 11pm instead, here's what my schedule would look like for the next few days, moving each shot time back by 15 minutes (for a total of 30 minutes each day):

Day 1: AMPS 10:45am PMPS 10:30pm
Day 2: AMPS 10:15am PMPS 10:00pm
Day 3: AMPS 9:30am PMPS 9:15pm
Day 4: AMPS 9:00am PMPS 8:45pm
Day 5: AMPS 8:30am PMPS 8:15pm
Day 6: AMPS 8:00am (now we're back on schedule) PMPS 8:00pm

Make sense?
Click to expand...
Yes I understand that, thank you.
I have a question:
Knowing her PMPS was 6.2 @ 7pm and then 30 mins later it was 5.8, would you have suggested giving the shot then which was 30 mins past the shot time?
 
@Jancol - Typically, when deciding whether to shoot your lowest number ever, we recommend stalling and posting for help. That means not feeding the cat, and waiting 15 or 20 minutes before testing again. That way, we can see if the cat's numbers are continuing to decline, or if they're beginning to rise naturally.

If the numbers exhibit a rise, and the number is in the shootable range for whatever protocol you've chosen, then you would test, feed, and shoot as normal.

If the numbers look like they're dropping, then there are a number of things that can be done. You can offer a small amount of low carb food (less than 10% carbs) and then re-test in 15 or 20 minutes and continue to do this until the numbers are in the safe, shootable range for whatever protocol you've chosen for your cat. You can shoot a reduced dose of insulin. Or you can skip. The decision depends largely on your circumstances.

The point of offering a small amount of low carb food is that we want to make sure the cat is having a natural rise in blood sugar instead of one that is influenced by food. Because shooting a number that is artificially elevated by food could mean trouble when the carbs from the food wear off, the blood sugar drops accordingly, and the insulin kicks in and drops the number further. Does that make sense?

A 6.2 is around 120 for those of us in the US (I think). That's a perfectly shootable number for Tight Regulation. It's the cutoff number for Start Low Go Slow. If you were available to be up all night to monitor, had plenty of testing supplies on hand, and materials to deal with low numbers, then you most likely could've tried to shoot that number to see what happens.

If you shot that number, the recommended advice would be to get tests at +1 and +2, which would give you a good idea about how the cycle is going to progress. If the numbers go higher, you can lay off and test a little later. If instead, they're headed down, you can be prepared to intervene with some food earlier in the cycle to stabilize the numbers.

I know it's a lot of information to handle. So please feel free to ask any questions.
 
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@Jancol - Complicating matters is that Cher is eating food with 35% carbs. That's WAY too high. We need to get her on food that is under 10% carbs. Please review Dr. Pierson's excellent food chart to see if any of these lower carb selections are available in your country

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Keep in mind that a change in diet from high carb to low carb can have a dramatic impact on a cat's blood sugar. If you choose to do so, you need to be prepared to either drop the dose right away, or monitor very, very closely.

It's very possible that Cher's high numbers are due, in part, to the high carb food.
 
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AZJenks said:
@Jancol - Typically, when deciding whether to shoot your lowest number ever, we recommend stalling. That means not feeding the cat, and waiting 15 or 20 minutes before testing again. That way, we can see if the cat's numbers are continuing to decline, or if they're beginning to rise naturally.

If the numbers exhibit a rise, and the number is in the shootable range for whatever protocol you've chosen, then you would test, feed, and shoot as normal.

If the numbers look like they're dropping, then there are a number of things that can be done. You can offer a small amount of low carb food (less than 10% carbs) and then re-test in 15 or 20 minutes and continue to do this until the numbers are in the safe, shootable range for whatever protocol you've chosen for your cat. You can shoot a reduced dose of insulin. Or you can skip. The decision depends largely on your circumstances.

The point of offering a small amount of low carb food is that we want to make sure the cat is having a natural rise in blood sugar instead of one that is influenced by food. Because shooting a number that is artificially elevated by food could mean trouble when the carbs from the food wear off, the blood sugar drops, and the insulin kicks in and drops the number further. Does that make sense?

A 6.2 is around 120 for those of us in the US (I think). That's a perfectly shootable number for Tight Regulation. It's the cutoff number for Start Low Go Slow. If you were available to be up all night to monitor, had plenty of testing supplies on hand, and materials to deal with low numbers, then you most likely could've tried to shoot that number and see what happens.

If you shot that number, the recommended advice would be to get tests at +1 and +2, which would give you a good idea about how the cycle is going to progress. If the numbers go higher, you can lay off and test a little later. If instead, they're headed down, you can be prepared to intervene with some food earlier in the cycle if necessary to stabilize the numbers.

I know it's a lot of information to handle. So please feel free to ask any questions.
Click to expand...
I appreciate all of this information, thank you. I have a very long road to travel and much to learn on the journey. I didn't have a choice regarding this journey but I guess I will have to go along.

I understand what you are saying re the low carb foods being offered, however I have given her quite a substantial quantity of high carb food which eventually shot the BG up to 11.1 and now the last test which was done 15 mins ago has come down to 10.1.

Could you kindly advise if I should keep testing and continue feeding whilst the numbers are dropping?
 
@Jancol - An 11.1 is 200 and 10.1 is 182 for those of us in the United States. Meters have an acceptable variance of up to 20%, so those two numbers are essentially the same. There is no need to test every 15 minutes at those numbers.

If Cher didn't get a shot, then there's really no risk of her numbers falling. Check her in an hour. If her numbers are up (which they most likely will be), you can let her coast the rest of the cycle and not bother her again.
 
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AZJenks said:
@Jancol - An 11.1 is 200 and 10.1 is 182 for those of us in the United States. Meters have an acceptable variance of up to 20%, so those two numbers are essentially the same. There is no need to test every 15 minutes at those numbers.

If Cher didn't get a shot, then there's really no risk of her numbers falling. Check her in an hour. If her numbers are up (which they most likely will be), you're can let her coast the rest of the cycle and not bother her again.
Click to expand...
AZJenks said:
@Jancol - Complicating matters is that Cher is eating food with 35% carbs. That's WAY too high. We need to get her on food that is under 10% carbs. Please review Dr. Pierson's excellent food chart to see if any of these lower carb selections are available in your country

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Keep in mind that a change in diet from high carb to low carb can have a dramatic impact on a cat's blood sugar. If you choose to do so, you need to be prepared to either drop the dose right away, or monitor very, very closely.

It's very possible that Cher's high numbers are due, in part, to the high carb food.
Click to expand...
Yes since Cher's FD diagnosis, we have been concerned at the high percentage of carbs in the ZD diet but the vet does not want to change her food because of her IBD. We feel we need to try to find a replacement diet which is more suited to the FD but which will not exacerbate the IBD. Currently we are looking into this and will discuss it with the vet when her returns from leave. Some of the FDMD members have made suggestions to follow up regarding suitable low carb diets. I guess all we can do is try. I am familar with Dr Pierson's food chart and her warning regarding dropping the insulin dose and monitoring carefully.

Thank you again for your help tonight.
 
@Jancol - You're welcome. It's a holiday weekend in America, so the board will probably be slower until Tuesday. I recommend you make another introductory post at that time here in the Lantus forum for maximum exposure. There's a lot of ground to cover with Cher, including:

- Selecting either the Tight Regulation or Start Low Go Slow protocol
- Helping to reduce her carb intake while at the same time managing her IBD
- Understanding the complicating factor of the steroid
- Explaining why dose adjustments of 1 unit are not ideal, and helping you to source proper syringes and get instructions on how to make smaller dose adjustments

I know that this can be pretty overwhelming at first. Nobody expects you to take it all in right away. Even those of us who have been doing this for a while still are learning new things.

Take comfort from knowing that you've found an amazing, supportive, and deeply knowledgeable community who is willing to help you do whatever is necessary to take care of your cat. Trust in them. They won't steer you wrong.

Everyone here is wishing you and Cher the best!
 
AZJenks said:
@Jancol - You're welcome. It's a holiday weekend in America, so the board will probably be slower until Tuesday. I recommend you make another introductory post at that time here in the Lantus forum for maximum exposure. There's a lot of ground to cover with Cher, including:

- Selecting either the Tight Regulation or Start Low Go Slow protocol
- Helping to reduce her carb intake while at the same time managing her IBD
- Understanding the complicating factor of the steroid
- Explaining why dose adjustments of 1 unit are not ideal, and helping you to source proper syringes and get instructions on how to make smaller dose adjustments

I know that this can be pretty overwhelming at first. Nobody expects you to take it all in right away. Even those of us who have been doing this for a while still are learning new things.

Take comfort from knowing that you've found an amazing, supportive, and deeply knowledgeable community who is willing to help you do whatever is necessary to take care of your cat. Trust in them. They won't steer you wrong.

Everyone here is wishing you and Cher the best!
Click to expand...
Yes, there is a lot of ground to cover it seems and I am so grateful to have found this group in order to receive guidance. We have been flailing around through our own ignorance and our dear little Cher has probably suffered because of it. However, I can now see that there is possibly light at the end of the tunnel which is very uplifting.
We are very grateful. There is much reading and learning ahead.
Once again, thank you for your wonderful support!
 
It's hard to manage fd when IBD is in the mix. Have you ever tried a novel protein diet, one that contains one protein she has never eaten before such as kangaroo? Sometimes that's enough to control the IBD if you get lucky. The pred and if pancreatitis probably led her to fd. Feeding a food 35% carbs is already high carb but if it's the only way to handle the IBD you gave to give it.
 
tiffmaxee said:
It's hard to manage fd when IBD is in the mix. Have you ever tried a novel protein diet, one that contains one protein she has never eaten before such as kangaroo? Sometimes that's enough to control the IBD if you get lucky. The pred and if pancreatitis probably led her to FD. Feeding a food 35% carbs is already high carb but if it's the only way to handle the IBD you gave to give it.
Click to expand...
We suggested this to the vet but he felt it was best for Cher to stay on the ZD. We have consistently brought this up with him about the high carbs but it was suggested management of her IBD had priority over the FD. It was hoped with the reduction of pred, the BG would reduce and I guess it has a little but it still has a long way to go. We tell ourselves the vet is the professional and he probably knows what he is talking about. However, especially after being involved with this forum, we feel we have gained some strength and will have another shot at it.
 
I think it's true that managing IBD is the most important goal. I just wondered if other ways had been attempted to do that.
 
tiffmaxee said:
I think it's true that managing IBD is the most important goal. I just wondered if other ways had been attempted to do that.
Click to expand...
Once she received the pred and was on it for 7 days, the IBD seemed to stabilise but unfortunately the FD appeared on the 7th day also. Cher's vet is trying to reduce pred first to see if that helps the but he is reluctant to go chopping and changing more than one treatment element at a time. At the moment he is in England and is not back until the 25th Sept. He did say that treating the FD whilst she was on pred was very difficult.
 
those who have to use pred have to adjust the dose according to what is needed. Sometimes there is no way around the medication, such as with
asthma....

Shadow was going down the ibd/lymphoma path ( i wasn't putting her thru more surgeries) and I tried desperately to switch her to raw or to
a novel protein ( the only one she hadn't had was kangaroo)
She liked variety and since she had eaten all the other proteins, I wasn't sure which one was causing the inflammation.
 
rhiannon and shadow (GA) said:
those who have to use pred have to adjust the dose according to what is needed. Sometimes there is no way around the medication, such as with
asthma....

Shadow was going down the ibd/lymphoma path ( i wasn't putting her thru more surgeries) and I tried desperately to switch her to raw or to
a novel protein ( the only one she hadn't had was kangaroo)
She liked variety and since she had eaten all the other proteins, I wasn't sure which one was causing the inflammation.
Click to expand...
Did you put her on kangaroo and is she doing well?
 
she ate the kangaroo for 2 weeks straight.... and then didn't want it anymore. That was rare for her.
I usually had 5 open cans in rotation because she wouldn't eat the same thing twice in a row.
 
rhiannon and shadow (GA) said:
she ate the kangaroo for 2 weeks straight.... and then didn't want it anymore. That was rare for her.
I usually had 5 open cans in rotation because she wouldn't eat the same thing twice in a row.
Click to expand...
Cher is a fussy eater and will not even try canned foods. How we got her onto the Hills canned food was through the E-tube but when the tube was removed, she would not eat the canned food so in desperation we gave her the dry ZD. The wet food had the texture of rubber.

Eventually though she started eating the wet ZD but it is quite funny to watch her eat. We cut it into little cubed pieces smaller than the size of dry bikkies but because of the consistency, to me it is like eating thick crunchy peanut paste, which tends to stick in your throat. After eating a certain amount, she stretches her head up in the air and her tongue is constantly 'licking', moving in and out of the sides of her mouth, but she keeps eating it. By doing this, it must help the food move down her throat/esophagus. We put a bit of water with it to help it slide down her throat more easily.
 
just realized here's yesterday's post

@Bron and Sheba might have some food suggestions. She's down there in Oz.

all you can do is keep trying.

If you could find a freeze dried raw and Cher would eat it... that would probably be ideal.
I even let Shadow have it dry just because it was better for her.
She had other major issues, the FD was maneagable, and I would have worked thru the IBD. The problem for her was I had had cancer nipped off her 3 times
and she needed 3 surgeries right away. I couldn't put her thru it anymore. She had already had 7 surgeries in her lifetime. And she hated vets and the whole
routine.... I couldn't put her thru it anymore. I had promised her I wouldn't keep her here just for myself.
 
rhiannon and shadow (GA) said:
just realized here's yesterday's post

@Bron and Sheba might have some food suggestions. She's down there in Oz.

all you can do is keep trying.

If you could find a freeze dried raw and Cher would eat it... that would probably be ideal.
I even let Shadow have it dry just because it was better for her.
She had other major issues, the FD was maneagable, and I would have worked thru the IBD. The problem for her was I had had cancer nipped off her 3 times
and she needed 3 surgeries right away. I couldn't put her thru it anymore. She had already had 7 surgeries in her lifetime. And she hated vets and the whole
routine.... I couldn't put her thru it anymore. I had promised her I wouldn't keep her here just for myself.
Click to expand...
Oh, that is so sad, I don't know what I can say. You just can't let them suffer unnecessarily and as hard as it is to let them go, you have to consider them before yourself. I am sorry for your loss.

Thank you for your food suggestions, I will follow them up.
 
@AZJenks Thank you for the information regarding the 15/30 mins cycle differences. I didn't know about that.
I usually shoot between 7-8 am and pm, whenever I wake up and get back home from work. I didn't think that 15 minutes matter that much.
 
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