can low pre-shot be due to overlap

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Jodi & Jasmine

Jodi & Jasmine

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I have been continuing to get some low pre-shot numbers ranging from 99 to 167.4 where I skip Jasmine's insulin dose at the time because I am scared to give her a shot (for the last week or so). She has been on lantus for 17 days now. Her next readings have been in the range (after the missed shots) of 273.6 to 331.2. I don't want to miss shots. Is there a possibility that the lower numbers could be because the previous shot of insulin hasn't worn off yet? I check her blood glucose 12 hours after her shot. I am scared I am causing more damage and don't want to skip shots but don't want to take a chance with low numbers. Never had these lower readings for the first 10 days on lantus. Also, when a shot gets missed it causes higher numbers which is not good either. Please any advice??????
 
Hi there,

First of all you need to understand how Lantus works. There is a wealth of information here in the "stickys" at the top of this forum. Lantus works differently than other insulins in that it takes time to build up in the body before it begins controlling the glucose, we reffer to this as "the shed". It is best not to skip shots and to try and keep the dose the same every 12 hours. By skipping shots the "shed" effect gets reduced and you have to start over building it up each time.

Lantus does have an overlap and it is one thing that makes it very useful. When we talk about insulin there are several properties we consider. First is onset, this is how long it takes from the time of injection until the insulin begins lower the BG. Insulin that are fast working (bolus insulins like Humalin R) start working almost immediatly <30 minutes, immtermediate insulins like Vetsulin or Humalin N, begin working after about 1 hour, and basal insulins like Lantus take up to 3 hours before they begin having an effect.

Duration is how long the insulin works to keep the BG lower, fast-acting insulin works about 4 hours, intermediate insulin about 8 hours and Lantus upto about 16 hours (in cats). The nadir (when the blood glucose is lowest) is somewhat individual with Lantus but usually occurs between 6 and 12 hours after injection.

The importance of the overlap with Lantus is that you can acheive a steady lower BG all the time (the "curve" is more like a straight line) and often the lower the Preshot number the flatter the curve remains. Because Lantus takes about 3 hours before it starts working the preshot number will be rising before the insulin takes effect so it is usually safe to give a shot even at those lower numbers. In other words you are not "shooting" the number you have at +12 but rather what the BG will be in about 3 hours. Lantus doseage is based upon the nadir (the lowest BG measured during the 12 hours) which is why you need to measure the BG several times between shots in addition to the Preshot measurement. In the information about Lantus on the forum you can find the "Protocol for Lantus and Levemir" which gives guidlines about doseing based upon the results of your BG measurements.

By understanding how Lantus works and repeated testing of BG values on your cat you can consistantly give a shot every 12 hours and keep the BG in a healthy range which is benificial to preventing the negitive effects of diabetes and increases the chances of pancreatic healing which often leads to remission.
 
Very well written Monique.

Welcome Jodi and Jasmine! This is a wonderful forum. Ask all the questions you want, and ask them again, if you don't understand. There is a wealth of knowledge here, and we will help you and your cat.
 
Welcome to lantus land! There is so much info here!!!! There are so many people here to help too! Like Dyana said ask all the questions you need to and someone will come by with an answer! You are in the best place for your kitty! Welcome again!!!
 
Jodi
Do you have a spreadsheet that you can attach to your post?
It will help others to see, understand and comment on what's happening with the numbers.
You can look at my sheets in my signature for Shadoe and Oliver to see examples.
From our sheets, you will see that the numbers most important to see are the ones more in the middle of that 12 hour period because you are then able to see if the insulin is working, is enough or is too much. You can then make a good decision on what to do with the dose.
 
Hi Jodi! Welcome to Lantus Land! You have found the right place to be. I know there is an overwhelming amount of information here, and you are really worried about your Jasmine, but you've just taken a pretty great step towards getting her healthy again! I highly recommend you listen and learn (take lots of notes, create a folder in your bookmarks for diabetic kitty info, whatever will help you) and don't be afraid to ask questions and like Michelle said, ask again if something is unclear.

I ran across this forum months ago, picked up a little info, but due to life stuff I wasn't able to focus on Tugger like I should have. So for months, his dose was wrong, I gave it inconsistently, I wasn't testing BG regularly, I was feeding the wrong foods, the wrong treats, basically I was just doin' it all wrong. Tugger's numbers, when I bothered to test, reflected that. Eventually, life settled enough for me to focus so I came back. I started reading again. I switched Tugger's food and WHAM his numbers hit the floor. I panicked and came here and started posting. The first two days I still screwed a lot of things up, but his numbers have improved in a big way and he is already dropping his dose like you wouldn't believe. It's only been a little over a week, maybe a week and a half.

These folks have helped me get to this point, and they will help you too =) Do what they ask, build your spreadsheet, track the info, and follow the guidelines and very soon I bet you will see Jasmine acting like a frisky kitten again! Tugger is very happy and healthy now, so much more now than he's been in months and months and months.
 
Welcome back Jodi.

I'm linking your post from today to your post from 3/24: previous post

Much of what people are suggesting today is similar to the feedback you received in your prior post. You are looking at pre-shot data and not mid-cycle data and Lantus dosing is based on the nadir. Likewise, without a spreadsheet, it is next to impossible to answer your question knowledgeably. If you are able to set up a spreadsheet, start getting mid-cycle spot checks, and post regularly, we will be better able to help you sort out what to do when you are seeing low pre-shot numbers. As was suggested in the previous post, if you are getting numbers that you are uncomfortable shooting, one strategy is to start over and lower the dose so you can give a shot twice a day.
 
Jasmine's SS is up and running! Thank you for doing this.

If you've had a chance to look over the dosing protocol or the stickys at the top of the Board, you will read about how spot checks through out the 12-hour cycle are needed with Lantus. Monique referred to issues like onset and duration, as well as overlap. Likewise, Lantus dosing is based on the lowest point, or nadir, of the cycle. These are the reasons that spot checks are important. You have great pre-shot data and you've done a great job of getting those data on a consistent basis. As you start filling in the blanks on Jasmine's SS, you'll have a better sense of how Lantus is working and what Jasmine's numbers look like throughout the day and evening.

If you are getting numbers that you are not comfortable shooting, the best suggestion I can make is to reduce your current dose so you are getting pre-shot numbers that don't scare you. Also, if you post when you get low numbers, the people here can help you to look at the alternatives to skipping a shot.

I'm hoping others will stop by and offer some suggestions, as well.
 
Good Job on the SS.. You'll hear it a million times, so I'll make it a million and 1 (and we're only nagging you because we can tell you care about your cat and want the best for both of you).. more tests = more betterer..er... something :).

Great that you are getting those PS tests.. and you have been doing the right thing skipping shots on those lower numbers because you don't have enough data to know if it will be safe.

Not sure what your schedule is like.. assuming you can't test during the day.. try really hard to get a PM+3 and PM+6 (or +5 if you absolutely can't stay up until +6) on a daily basis ... and get a full AM cycle curve once each weekend .. optimally every 2 hours if possible, every 3 if not.

What you are noticing about skipping shots is correct.. it's not good for her (or your sanity either ;) ).. my suggestion (and I'm a big chicken, so you may get some flack for dropping so much.. be warned :) ).. drop to 0.5 and get those extra tests.. expect some weirdness while the new dose settles.. keep testing for keytones (hopefully you are doing that now, helpful to put it in your spreadsheet as well).

She'll probably ride a little high for a week, but in that time hopefully there's enough info for you to be able to go up to 0.75 without losing all your marbles.. and give her a steady shed.. you'll get enough data to keep your cat safe, but also get really good at testing, so more tests will be possible in the future..

Short term pain, long term gain.
 
Oh how right Dawn is, I struggled with testing at first. But after I came here and learned how important numbers are (oh how I hate numbers, I failed algebra. TWICE) so I started testing more. Then more. Then a curve or three. Now, I can do a test in under two minutes. From heating up the rice sock to typing his number on his ss =)
 
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