And now the gradual drop

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jmalasiuk

jmalasiuk

Member Since 2014
Yesterday's post: http://www.felinediabetes.com/FDMB/threads/question-about-gradually-elevating-bg-levels.132633/

So, as an update, Tonka has been dropping gradually but continuously all day. It's now past midight (+6.5 since last injection which I had to give an hour early tonight) and he's still dropping. Last reading was 3.4 (61), which might still be safe, especially since his insulin should be almost done peaking by now, but I chickened out and gave him a couple tablespoons of 8% carb food (Friskies chicken pate) which he gobbled up.

Considering he dropped that far on the 2.25 units, should I still be injecting him with that amount tomorrow if he starts out lower (hopefully he doesn't rebound again), or back it off to 2 units?
 
I see that the PM shot was given one hour early. Shooting early acts like a temporary dose increase. And Tonka was coming down from his bounce, so the action tonight could be from the combination. From the TR protocol sticky note:
Because of the cumulative nature of Lantus and Levemir, please be aware: Shooting an hour or two early *could* act like a slight dose increase. Shooting an hour or two late *could* act like a slight dose reduction. How your cat will react has a lot to do with what kitty is doing that day. For instance, if a bounce is breaking shooting early probably isn't the best idea because you'll have a little extra action on the dose from both the early shot and the bounce breaking simultaneously. The next shot is due 12 hours after the time of the early or late shot if you're shooting twice a day. Oftentimes the effects of an early or late shot will not be seen until the next cycle. Please monitor carefully when shooting early. Ask for guidance if you're unsure.
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I'd still test him again in 1/2 hour to an hour to make sure he's done dropping for the night.

If you are following the Start Low Go Slow (SLGS) method, reductions are earned below 90. The TR protocol has reductions earned below 50. But since it wasn't normal circumstances, I might stick with the same dose, unless he keeps going lower tonight.
 
Just tested him a few minutes ago. He's up a bit now (81 by US scale), and since it's been 7.5 hours since injection, that Should be it for the night. I'll test him once more before heading to bed.
 
So Tonka had a pretty decent number for his pre-shot today (9.2 or 166). I forced myself to give him the full 2.25 units, but wound up leaving out a few tablespoons of ~25% carb food on top of his regular food to give it something to work on in case he dropped to a low number mid day. And asked my catsitter to check in on him before noon to see how he was doing. Of course he'd eaten everything. But he didn't seem anxious for more food, in any case.

No idea whether he ate all that because he needed to and his reading of 20.e (355) is a rebound, or because he just felt like it (though he usually leaves a good chunk of his food until later in the cycle these days) and his high reading is because he got too many carbs today. Guess we'll see how he comes down tonight.

Is it better to leave out more carbohydrates for him than reducing his dose when I'm nervous about leaving him? Or same difference? On a shorter acting insulin, it would be same difference, but with Lantus, I'm thinking (mainly from the advice that I've received so far) that it takes longer to get his sugars back under control after too big a meal than too little insulin. Is that the trend?
 
There's really no way to know for sure how much is due to the higher carb food and how much is due to a "bounce" off the 61 last night

In the future, if you get a number you're not sure about shooting at Pre-shot time, you can "stall", DON'T feed, and retest in 20-30 minutes...if the numbers still coming up, it's probably going to be safe to shoot the scheduled dose.

I suspect Tonka would have continued to climb if you'd stalled this morning. If you look at the night of 2/1 when he dropped to the 30's (too low for sure!) he "bounced" up into the 500's by AMPS. He didn't drop as low last night, so probably won't be bouncing as high this time, but he may continue to climb tonight

Will your catsitter drop in any time you need her to? If he/she will, you could leave a little of his regular food down "next time" and then when the catsitter comes to check, if the food is gone, put more down and check again later. Most of the time, if they're dropping TOO low, they're really ravenous
 
Is it better to leave out more carbohydrates for him than reducing his dose when I'm nervous about leaving him? Or same difference? On a shorter acting insulin, it would be same difference, but with Lantus, I'm thinking (mainly from the advice that I've received so far) that it takes longer to get his sugars back under control after too big a meal than too little insulin. Is that the trend?
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It is generally better to leave out more carbs than take a BCS (big chicken shot). Lantus works best with consistent dosing and because of the depot effect reducing a shot in one cycle may not have an effect in that cycle anyway but the reduction may effect several more cycles going forward. Wet carbs on the other hand won't affect things for very long.
 
Oh, I was pretty confident that he was climbing -that wasn't the issue. My big thing right now is never having been home to check hims sugars midcycle after he starts at anything other than a high reading. I know everyone says that they don't drop nearly as far when you inject Lantus at a lower blood sugar reading, but I have to see it in him before I can trust that. I'm too used to how the fast acting insulins work.

My sitter could probably come in most days, just not necessarily at the time that would be best to check on him. And there's no guarantee that she'll be able to if I don't arrange with her in advance, so I don't want to have to rely on that option - although it gave me much more peace of mind once I made up my mind to cal her from work this morning.

Just hoping that he's at a good level in the morning and I can put this to the test without worrying about having to leave him.
 
Vyktors Mum said:
It is generally better to leave out more carbs than take a BCS (big chicken shot). Lantus works best with consistent dosing and because of the depot effect reducing a shot in one cycle may not have an effect in that cycle anyway but the reduction may effect several more cycles going forward. Wet carbs on the other hand won't affect things for very long.
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That's what I was hoping. Thanks for the confirmation
 
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