am pre shot in 100s to shoot or not?

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taran80

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last night before going to bed i tested gizmo's blood sugar and got reading of 177, first time in blue on spreadsheet as gizmo has usually been in 200s. this morning i was testing before morning shot and got reading of 122. waited 30 minutes and got reading of 128. decided not to give am shot. tested him a couple hours later and and reading was up to 223. now 2nd guessing skipping the shot this am. too late now anyways, but wondering what i should do if i get a number in the low 100s again. the relaxed forum says don't shoot under 150 so i think i did the right thing by skipping. was going to post in lantus forums but still new at this and not sure if i should post in tight or relaxed forum or even which one i am following. i have looked at both boards but still a little confused on the difference. are there general rules anywhere with numbers specifically listed showing when to skip or lower a dose by certain amounts especially for newbies in their first few weeks?

btw...it is gizmo's 12th birthday today!

thanks, tara
 
you did the right thing by skipping. in time yes, it's possible to shoot lower numbers, but ONLY after you have the data showing that it is ok, after kitty's body has figured out what to do with the insulin, and you have a pretty good grasp on your cat's reaction to each shot. soooooo, you did do the right thing.

and it happens from time to time. and yes, it kinda throws things off for a day or two, but, if we aren't willing to let things get thrown off for a couple days, we could harm our cats.

and when you skip a shot, don't give a shot as soon as you see a high enough number, unless your schedule is extremely flexible. the reason for that is the time lantus needs between shots. if you had shot a couple hours late this morning and then shot at the regular time tonight, you could cause an overdose of insulin because the first shot wouldn't be completely gone. always try to get as close to 12 hours between shots as possible. again though, once you have data and a little predictability in your kitty, that gets a little bit flexible.
 
Hi Tara,
Last night, when you got that 177, did you give Gizmo any insulin?
You did the right thing skipping this morning. If you aren't sure, and nobody is "here" to help you, do the safe thing. It is possible, and many people do it, to shoot numbers in the 100s. BUT not until you have collected a large amount of data that shows you how Gizmo reacts to a dose of insulin.
The rise that you saw two hours after deciding to skip the shot....if he ate when you tested him and got the 122/128, then that increase in BG was most likely due to the food he ate. What would have been interesting to see is what his BG was an hour or two after that test. If it had gone down some from that 223, that would be a very encouraging sign to see.
How low of a number you shoot is dependent on two things. One, you need to have a good bit of data first. And two, your comfort level with shooting into low numbers.
What you should do if you aren't sure the next time you get a number like that is post in the TR forum immediately, with a subject line something like AMPS 122, Need Dosing Advice!" If anyone is there (and someone usually is 24 hours a day) they will respond to the question quickly, whether you are using the TR protocol or any other protocol.

I will let someone who really understands Lantus and TR explain the differences between TR and any other method, because they know a lot more than I do about it.

Happy Birthday Gizmo!


Carl
 
Hi Tara - Happy Birthday Gizmo!!!!! I think I would list myself as a relaxed Lantus follower. I work so generally test am & pm before shooting. At first I didn't shoot under 200 but then as I got more data on Sitka I realized that not shooting at 200 meant she would be in the 400 range at the next shot and it would take days to get her back into the 200's. So then I started shooting a full dose even if she was in the 150's and it kept her numbers much steadier. So now I shoot full dose unless she is under 140 then she gets a .5 dose. If she is under 100 then I skip the shot altogether because I'm not comfortable with a possible hypo situation. I'd say go with whatever your comfort level is. Jan
 
Carl & Bob in SC said:
Hi Tara,
Last night, when you got that 177, did you give Gizmo any insulin?

Carl
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no, last night pre pm shot he was 291. i gave shot and then before going to bed checked again and it was 177. it was 122 this morning when i decided to skip am shot. it rose up to 223 when i checked a few hours later. will test again before 7pm shot tonight.

thanks for everyone's responses...i feel better about skipping the dose!
 
ok so after skipping the the am dose yesterday because of the reading of 122, his reading was 223 last night so i went ahead and gave him the 1 unit at 7pm. this morning he was 208 so have him his am dose of 1 unit at 7am. he was at 178 at +6 today. just took pre pm reading and got 152 and should be giving him his pm shot now but now i am thinking i should skip shot again?
 
would you be able to get any tests in tonight if you give him a shot tonight? if so, i'm thinking a reduced dose but let me see if i can round up some more lantus peeps before you do anything.

i think what's happening is the 1 unit is too much and after a couple shots of it, it's built up enough stockpile in his system that it's lasting longer, thus the lower numbers. then you skip, so he's higher, resume shots, then ta-da, low again.

i'm thinking something along the lines of going to 1/2 a unit twice a day and see how that works for him, so you have consistently shootable numbers.

let me see if i can get some more input for you
 
Cindy + Mousie said:
would you be able to get any tests in tonight if you give him a shot tonight? if so, i'm thinking a reduced dose but let me see if i can round up some more lantus peeps before you do anything.

i think what's happening is the 1 unit is too much and after a couple shots of it, it's built up enough stockpile in his system that it's lasting longer, thus the lower numbers. then you skip, so he's higher, resume shots, then ta-da, low again.

i'm thinking something along the lines of going to 1/2 a unit twice a day and see how that works for him, so you have consistently shootable numbers.

let me see if i can get some more input for you
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i would probably test a couple times to +4 then in the morning. probably want to do in next few minutes to stay on schedule or i may just skip.
 
Cindy + Mousie said:
i posted in LL. someone i'm sure will be here shortly
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just tested again and it was 149 so think i will just skip tonight to be safe. thinking maybe i should start tomorrow with a reduced dose. thank you so much for your help and i appreciate any thoughts. thanks!
 
yeah to be safe and since apparently no one else is around here or on facebook right now, might as well skip.
but yeah, i think reducing the dose some so you can give consistent shots is a good idea. maybe by tomorrow someone will have seen our posts and give their input.
 
From the looks of Gizmo's ss, your dose has been 1u or else skipped shots... I think you may be much better with a lesser dose.
If you go with .5u in the morning, provided the BG is high enough... it should be if you skipped tonite, then just let that .5u settle.

It's great to see that the 1u dose gets to be too much; maybe Gizmo's heading closer to OTJ, so you will need to be giving smaller doses.
 
I agree with Gayle--reducing to .5u is a good idea. His numbers were not that high before he started insulin, so it's possible he'll only need a small dose for short time before he becomes diet-controlled.
 
thanks for the responses. he did go up to 188 immediately after eating this morning but is now back down to 133. i am going to change from 1 unit twice a day to 1/2 unit twice a day and see how he responds. he is due for pm shot at 7pm so if numbers are ok will give the 1/2 unit, if not i guess will skip again. any opinion on what a safe pm pre shot number would be to go ahead and give the 1/2 unit considering his numbers have ranged from 130-188 since his last shot yesterday morning? thanks, tara
 
I would continue not to shoot if he's under 200. If he's mostly staying under 240, then you may not need to give insulin. If he goes back and forth between preshots under 200 and preshots over 200, you may need to do some very small dosing (.25u or less). The goal is to find a safe dose that you can shoot consistently twice a day.

If I recall correctly, Gizmo is rather overweight, right? If he stays under 200 on his own, he may just need weight loss/diet change in order to get his numbers down into a normal range. This is what is called sub-clinical diabetes or pre-diabetes. Do you have him on a healthy weight loss plan?
 
Julia & Bandit said:
I would continue not to shoot if he's under 200. If he's mostly staying under 240, then you may not need to give insulin. If he goes back and forth between preshots under 200 and preshots over 200, you may need to do some very small dosing (.25u or less). The goal is to find a safe dose that you can shoot consistently twice a day.

If I recall correctly, Gizmo is rather overweight, right? If he stays under 200 on his own, he may just need weight loss/diet change in order to get his numbers down into a normal range. This is what is called sub-clinical diabetes or pre-diabetes. Do you have him on a healthy weight loss plan?
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yes, gizmo is overweight at 28 pounds. he was previously eating fancy feast elegant medleys wet food, wellness indoor dry food and goodlife recipe cat treats. gizmo has always been a larger cat and not a huge eater. he was never really a big dry food eater, but he was obsessed with the cat treats which probably caused the high blood sugar and i shouldn't have been giving them to him. once i received the diabetes diagnoses, about 2 weeks ago, i stopped the dry food and cat treats slowly over a few days. i switched to only fancy feast classics. i will eventually try to find some other good options as well for variety. i also give him pieces of baked chicken breast (no skin or seasonings) a few times a day which is now his new obsession. i have another cat as well which is not diabetic but i have switched them both. i have been putting out 1 can about every 6 - 8 hours (about 4 cans a day), sometimes they eat all of it and sometimes only very little of a can. they dont usually eat it all at once...they typically take a few bites, leave and come back for more throughout the day. i would give them more but i doubt they would eat it. they prefer the chicken breast of course.

i am happy to hear his numbers aren't too bad. when he was diagnosed it was 520 at the vet office, but only 323 when i took it myself at home before ever giving insulin. it was 508 once after being on the insulin but besides that numbers seem pretty good in 100s-300s.

thanks!
 
I think you will definitely want to get him on a weight loss program. Bandit was only a lb overweight when he went off insulin, and the extra weight caused his blood sugar to average about 20-40 points higher than normal. Once he lost that lb, his BG was completely normal. And that was just one lb--you may find that Gizmo won't need insulin if you can get him down to a healthy weight. See this link: http://catinfo.org/?link=felineobesity#Implementing_a_Safe_Weight-Loss_Program. You will need to know his ideal weight, if you don't already. Your vet should be able to tell you what that should be. Here is a body condition chart to help you out: http://www.pet-health-care-gazette.com/cat body condition chart.jpg.

You will need to weigh him once a week. I weigh Bandit by weighing myself, then stepping on the scale with him and subtracting my weight from the total weight.

You can find the number of calories in the different FF classics here: https://docs.google.com/spreadsheet/ccc?key=0AmkyagqUb3nudHlidjRqZjYtdmFFcXlzZWt4WUYxYmc#gid=0, or on the old canned food list here: http://binkyspage.tripod.com/CanFoodOld.html.

If you have any questions, I went through major weight loss with Bandit so I'd be happy to help you out. From beginning to end, he lost 9 lbs, which was close to half his body weight.
 
As you keep him on the low carb canned, he may lose some weight from that alone - 2 of my civvies who were overweight lost about 2 pounds in 4 months when I switched everyone to canned low carb.

The autofeeders may be helpful to spread his food across the day, so he doesn't get too hungry at any point.

And note - when you reduce his calorie intake, this can and likely will reduce his insulin requirements, so make changes when you'll be around to monitor him.

Pick up a digital food scale and weigh the chicken you are using for treats, so you know how much he has eaten. Dr Pierson (Cat Info) states that up to 1/6 of the day's rations may be from supplemental meat only when feeding canned. You could make up pre-measured packages of the chicken to use for treats at one time, to streamline the process for a few days.

Make him work for any treats too. Cats are pretty smart, so you may be able to train him to jump up on or down from various surfaces, etc, if he is highly treat motivated. And its exercise for him, too.
 
BJM said:
Make him work for any treats too. Cats are pretty smart, so you may be able to train him to jump up on or down from various surfaces, etc, if he is highly treat motivated. And its exercise for him, too.
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So true! Part of Bandit's exercise is from running up and down his cat tree, because we will only give him treats at the very top. So all day long, he's up and down it, because he wants a treat pretty much whenever someone enters the living room. :-)
 
thank you for all the links and suggestions! great ideas!

gizmo appears to be eating normally...but again has never been a big eater. i hope i didn't transition from his old diet too quickly. i put out 3-4 cans out daily for my 2 cats to share (they usually don't eat it all) and give them a few tablespoons of chicken breast. they only used to get 1 can of wet food a day to share when i used to feed dry as well so they are getting a lot more wet food then they are used to. i will start with a weight loss plan soon when i feel a little more comfortable that they are used to the new food. i tested my other cat named oliver (non-diabetic average size cat) for the first time because i was curious what his numbers were and his blood sugar was only 51. i wish i would have taken it a couple weeks ago when i made the change in food so i knew if this was a normal number for him. seems so low to me.

i have not given gizmo any injections since monday night. i have skipped 6 doses now because his blood sugar numbers have stayed in the 100's without any insulin. i am happy to see him staying in the 100s...but watching closely because he was down to 113 this morning. i planned on lowering down to 1/2 unit or less once he has gone up to 200 but it hasn't happened yet. interesting every day to see these low numbers and wondering if they will start to go back up. not sure if diet change alone has caused the good numbers...i hope so! also, i read something about the insulin shed...and maybe he is still low from that and might rebound to higher numbers at some point? thanks, tara
 
I don't think this is a shed issue, because he would have gone back up by now. What it looks like to me is that you have a diet-controlled kitty, and he just needs to lose some weight to get him down into a normal range. Make sure that you're vigilant about testing and he gives you a full two weeks of mostly normal numbers before you stop testing daily. You don't want to miss it if he creeps back up on you and needs insulin.

I may have mentioned this already, but Bandit went off insulin and was ranging 100-160 until I got him to lose that extra lb, and now he ranges 70-120. I can understand wanting to let things settle for the time being, but I wouldn't wait too long to get him on diet plan. The sooner you can figure out and establish a routine, the better you and your cats will adjust. If you need help figuring out the logistics of portion controlled meals, please ask! It was hard managing the strict meals for two cats working two jobs and going to grad school, but thank god for automatic feeders. :-D

51 is a fine number for a cat on a human meter. Some people find their non-diabetic cats will test as low as 40, but generally the normal range is 50-120. As long as a cat is not on insulin, it can't have a hypoglycemic incident, so you're good.

Some helpful information for you for Gizmo's current situation:http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf

See the section starting on p. 216 where it says "Management of the cat with subclinical DM".
 
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