Advice needed on shooting low numbers

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Heather and Raja (GA)

Member Since 2009
Please have a look at rajas chart and help me figure out what to do to hopefully help her go back into remission.

My thoughts are to give her insulin below 150 over the weekend and see how she does. Do y'all think that's a good idea? And how much and how low can her bg be and still give her insulin?
 
I'd suggest taking a look at the sticky, Shooting and Handling Low Numbers. There's great information in that note in the section on low pre-shots.

How low you shoot really depends on you. Most people begin to get comfortable with shooting low by gradually shooting lower and lower numbers. Fundamentally, you don't want to shoot numbers lower than 50.
 
Heather and Raja said:
I've read the stickies over and over and over but still had questions.

I'll do it gradually and see how she handles it.
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Hi Heather,

Are you home regularly during the day and night to test? From your ss, it clearly looks like you have that ability, but you mentioned waiting until the weekend to shoot.....so please confirm or clarify if there's something about the weekend that will make you more comfortable. You definitely have choices and I just want to make sure I'm understanding your concerns.

I also re-read that you've been through a remission already and it sounds like your goal is the same now. As a reminder, the info below is very important in reaching that goal:

  • One of the most important things about Lantus is shooting on a 12/12 schedule. It's the shed that gets filled consistently that allows you to see how the dose affects Raja. Your recent dosing has been all over, which puts insulin in the shed with a shot, takes out when you don't shoot, puts more in at a different dose....etc. The end results is not really being able to tell what's causing what in the data because the shed always has different amounts of insulin in it.

It certainly looks like you understand the importance of home testing and I'd like to reiterate that again here. It's the only safe way to go down this path and at a minimum, you will need to test at AMPS, mid-cycle, PMPS, and a curve on the weekend. If you can do more...all the better for Raja and better decisions can be made!

We can help you get a game plan together based on your goals and your scheduling, so let us know what those are and please keep these handy and rereading often as you are: Tight Regulation Protocol and Shooting and Handling Low Numbers...because the advice you get here will be based on this information.
 
Heather --

Do you have specific questions? If so, we'll do our best to answer. From your first post, it seemed more like you were wanting general info on shooting low. How can we help?
 
I'm not home during the day for the most part so it does make it harder to test and that's why I was thinking of waiting until this weekend to shoot lower than 150. I'd hate to shoot lower and something happen while I'm not home. I work 10 hour days plus a 45 min commute to and from

I know I need to be consistent with giving her the same amount rather than switching up how much I give her. No excise for it or reasoning. Just not thinking.

I do understand the 'shed' but following the sticky that says don't shoot under 150 I haven't given her anything if her bg is lower than 150. Hence my questions today about shooting lower than 150.

So tonight if her bg is let's say 120 should I shoot? And how much? .25 or should I go back to .50 and stay there awhile?
 
Sienne and Gabby said:
Heather --

Do you have specific questions? If so, we'll do our best to answer. From your first post, it seemed more like you were wanting general info on shooting low. How can we help?
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I thought I was specific enough. She has gone under 150 several times and according to to sticky you quoted shooting under 150 isn't advised so I was asking if I could and where should her bg be if I do shoot lower than 150

Ive read all the stickies for the lantus board and still had questions. In fact the sticky you quoted I've read several times so at this moment it isn't helpful to me to read that sticky again.
 
I'm sorry I came across rude it was not my intention.

I joined this board 3 yr ago and got wonderful advice. I would ask a question and there would be ton of people who responded even if it was a stupid redundant question. That is no longer the case. I come to the message boards now o ask questions and I get a lot of 'read the stickies' which isn't very helpful.
 
Heather and Raja said:
I'm not home during the day for the most part so it does make it harder to test and that's why I was thinking of waiting until this weekend to shoot lower than 150. I'd hate to shoot lower and something happen while I'm not home. I work 10 hour days plus a 45 min commute to and from

I know I need to be consistent with giving her the same amount rather than switching up how much I give her. No excise for it or reasoning. Just not thinking.

I do understand the 'shed' but following the sticky that says don't shoot under 150 I haven't given her anything if her bg is lower than 150. Hence my questions today about shooting lower than 150.

So tonight if her bg is let's say 120 should I shoot? And how much? .25 or should I go back to .50 and stay there awhile?
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These are all very good questions and thank you for filling in the gaps about your schedule. Your concerns are very valid, so let's see how we can make some sense of this in a way that's healthy and safe for Raj and comfortable for you.

The biggest problem is going to be the lack of data in the middle of the day during the week (do you have any resource to help you with this?). If not, this means we will have to rely data you can gather during the weekends and at night to extrapolate with. Please advise on this and we'll go on.
 
The only person that could help is my boyfriend but hea actually out if the country and when he comes back to the states he has to go straight back to work and that's not anywhere near here.

I shoot at 7 and 7 so even when I get home i can test for 3 or 4 hours but then I need to go to bed. That's why I'm thinking the weekend is better. I can check every hour then because I'm home and font have to wake up for work in the morning.
 
Heather and Raja said:
The only person that could help is my boyfriend but hea actually out if the country and when he comes back to the states he has to go straight back to work and that's not anywhere near here.

I shoot at 7 and 7 so even when I get home i can test for 3 or 4 hours but then I need to go to bed. That's why I'm thinking the weekend is better. I can check every hour then because I'm home and font have to wake up for work in the morning.
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Then that sounds like a great start especially considering she hasn't had any insulin in a few cycles. You'll feel better about it and you'll be there to test as you begin. There probably isn't going to be much if any insulin in the shed by then, so you'll in essence be starting anew. As such, starting low is the best option especially knowing the shed could take up to a week to fill. So....based on the right regulation protocol, this week:
  • Kitty should be monitored closely the first three days when starting Lantus or Levemir (so this means for your start, Friday night at 7PM is the magic date/time. This will allow you to test Friday night, through Sunday night....yes Sunday night, for this new beginning - I get it will make Monday a bear, but it's the safe thing to do to get going.).
    Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9 (If you can get more, especially a +11 and a +1 or 2....it would be most helpful).
    More monitoring may be needed, (please post your numbers and others can help you with that decision).
    At nights, it will also be really key, especially in the beginning to test as often as you can - even setting an alarm to get some of the +5 through the +11s....not all of course each night, but enough to give more info. These first few week of data collection are really going to help you in the long run, so I can urge you enough to test whenever is feasibly possible.

Next is the dose consideration......normally the protocol says this:

  • Using a weight based formula for determining a starting dose of Lantus or Levemir:
    the formula is 0.25 unit per kg of the cat's ideal weight
    if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
I'm going to assume Raj is an average cat...BUT PLEASE CORRECT ME IF I'M WRONG AND DO SEND HIS WEIGHT JUST SO I CAN DOUBLE CHECK. Because you are not going to be home during the week to test, the safest thing to do right now...until you are more data ready, is to start low, probably lower than the formula (once I get the weight, I would anticipate it being either 0.5 or 0.25 units to start this week).

So you'll start Friday night, test like crazy through Monday morning at all AMPS and PMPS, at night sporadically and post like crazy.....and as long as their are no drops below 50, the dose will stay the same through next week based on this part of the protocol:

  • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles). (Plan on holding through next Friday unless crazy high numbers start or unsafe lows, in which we could revisit the plan)

So let us know about her weight so a good safe dose can be defined based on your circumstances and you should be good to go Friday night. You've read the Sticky's...make sure you have your hypo kit ready, have plenty of supplies (all listed) and post a lot!
 
Heather, I also want to encourage you to explore any and all options for help at getting a midcycle test in the very near future. I'm not sure if finances are an issue, but a lot of vet techs will be glad to do so for a small fee. If there just aren't any, we'll have to go from there, but take some time to explore.
 
Thanks for clarifying.

The suggestion regarding not shooting below 150 is for new members who don't have data (i.e., are not "data ready"). The question, then, is whether you feel you are data ready since you are an experienced caregiver.

There are a couple of things to consider. When you skip shots, the cycle count starts over. Jill recently wrote a post about counting cycles. Even with this, Raja's numbers look good -- very good, in fact. Ordinarily, I would point out that you will need to get your cat to cooperate with your plan regarding shooting low on the weekend. It is quite likely that Raja will comply, but there's no guarantee. Given that you've been skipping the AM shot on a pretty regular basis, it's hard to know just how Lantus is working during the PM times. It is making it easier for you to shoot int he evening. It does sound like you would be more confident shooting twice a day if you were home. I would feel the same way.

Based on what you see this weekend, an option may be to lower Raja's dose to 0.1u so you can shoot twice a day. Or, you could reduce now and, hopefully, this will allow you to give Lantus twice a day consistently.

You can shoot a reduced dose if you are concerned about low numbers. However, if you look closely at the guidelines in the sticky, we will usually suggest stalling as a means of getting prepared to shoot low. I realize this can create havoc with your schedule, though. Given that you have been skipping the AM shot, it generally looks like Raja's numbers are going up or there's a flat curve after you shoot in the evening.
 
I think the situation may have been that not everyone understood you had been a member longterm...
and i don't think you came across as being rude...
you're worried about Raja...and we can surely understand that!

Welcome back doesn't quite seem the right phrase...so i'll just say best of luck...
may Raja respond quickly and well!

celi & binks
 
hi heather!

i think everyone else has answered your questions so i'll just say welcome. i can assure you that people are incredibly helpful here - sometimes you hit a lag time where there aren't a lot of people online - and one of the things we all do is to refer people to the stickies and then clarify whatever isn't understood. it's just a way of making sure that we're giving accurate information. i know i read those stickies a hundred times and still it didn't seem like something would stick in my brain until i needed it and someone quoted the right part to me.

hang in there. i think the general answer to your question is what sienne said - the general "don't shoot under 150" advice is for new people who don't have enough tests yet for any of us to understand how their cat "works" with insulin. you're a returning person, so that doesn't really apply to you.

glad to have you here! hope we can help you help raja!
 
[quote="Jessica & Boo Radley

  • Using a weight based formula for determining a starting dose of Lantus or Levemir:
    the formula is 0.25 unit per kg of the cat's ideal weight
    if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
I'm going to assume Raj is an average cat...BUT PLEASE CORRECT ME IF I'M WRONG AND DO SEND HIS WEIGHT JUST SO I CAN DOUBLE CHECK. Because you are not going to be home during the week to test, the safest thing to do right now...until you are more data ready, is to start low, probably lower than the formula (once I get the weight, I would anticipate it being either 0.5 or 0.25 units to start this week).

[/quote]

Raja is at least 9lbs now, she dropped down when she was first re-diagnosed but she's at least 9.1 but I think it's actually 9.6 or higher.
 
Based on what you see this weekend, an option may be to lower Raja's dose to 0.1u so you can shoot twice a day. Or, you could reduce now and, hopefully, this will allow you to give Lantus twice a day consistently.
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What needles are yall using for this? I picked up some reli-on needles from walmart and it shows 1 units and .50 units. Can anyone show me a picture of what yall use? I tried looking for needles that show .25 or less and I've yet to find any. Right now when I shoot .25 it's a guesstimate because I try to get it in the middle of the 'starting line' and the .50
 
Hi, Heather & Raja!

A lot of us use the syringes that have the 1/2 unit markings on them, which makes it much easier to get the 1/4 unit doses correctly (if that makes sense). Some, if not most or all of us (myself included), use the 5/16" needles (8 mm.. the short ones), 3/10mL cc, 31 gauge syringes. I hope that helps. :smile:
 
i use syringes with .5unit markings too. the fine dose pictorial that sienne posted a link to shows what the .25 looks like. i think the main thing is to be consistent in what you do.

raja's numbers are looking great - looks like you might not be giving insulin too long this time either! you are one lucky person.
 
Sienne and Gabby said:
Didn't you have to do micro dosing when Raja went OTJ before?
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No I didn't. Raja was diagnosed as diabetic and the vet gave us lantus and U40 needles, at that time I didn't know there was a difference between U40 and U100 needles so instead of giving her 1 unit twice a day I was basically giving her 2.5 units (i think) of insulin twice a day. It really messed her up and almost killed her. I did that for a month without knowing when I met a wonderful lady from the board who gave me a newbie kit that included the right syringes. Once I started using the new syringes her blood sugar dropped dramatically and almost immediately she went into remission.

There is a lot I don't know because our first time was really messed up, that's why Im asking questions that as a returning member I should know. Plus advice has changed in the last 3 yrs.

I was also hoping for a picture of the package as well to make darn sure I'm getting the right needles, because of what happened in the past I'm extremely paranoid of screwing up and using the wrong needles
 
What brand of syringes are you using? I use Monoject and the paper packaging has info on the back about the syringe. I'm not at home to take a look at my syringes. ( can understand why you may be nervous given your past experience!!

If you change your subject line to something about syringes, someone who has a syringe in front of them can tell you where to look. If you have a box of syringes, though, they should clearly state U100.

Information hasn't really changed in the 2+ years I've been here. Changing your subject line or starting a new condo will help to get people responding. If the subject line is always the same, there's no way to know that you have an additional/new question. People also tend to "visit" when you post in their condos. We're a social group.
 
i don't have a picture of a box of syringes, but what you want is U100 3/10cc syringes with half unit markings. BD, Monoject, GNP, and ReliOn are some of the brands available with half unit markings. Needle gauge and length is your preference They come in ½ inch or 5/16 inch needle lengths. Needle gauges 29, 30 or 31 (31 being the thinnest).

here's a pic of U100 syringe scales: http://www.bddiabetes.com/resource.aspx?IDX=2210. you'll want syringes that look like the example on the left.

the above info can be found in the STICKY: LANTUS & LEVEMIR - NEW TO THE GROUP? PLEASE READ....

i use ReliOn Syringes from WalMart: 3/10cc - 31 gauge - 8mm (5/16") length - short needle
they're approximately $13 for a box of 100 syringes.
the number on the box is: 81131 - 0311 - 78

hope this helps...
 
julie1220 said:
my vet started punkin on ProZinc which uses u-40 syringes, then switched us to lantus without switching the syringes either. good think neither of our kitties died of an overdose!

you're on the right track now. i hear ya on the needle confusion - there's about 50 options out there.

this is what we use:

http://www.americandiabeteswholesale.com/product/monoject-ultra-comfort-insulin-syringes_1289_1.htm
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Thank you! That's exactly what I wanted. Going to order those as well as some other things I need like the lancets and alcohol pads
 
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