After surgery, when my cat's glucose was really alarmingly high to me, I wanted to increase the dosages immediately. The doctor let me know that sometimes, it can feel very counter-intuative approach. Because that high level may only be one snapshot in time. The dosing was increased gradually based on his curve numbers. On the opposite end, if his blood glucose is within lower normal range, I am horrified to give him a dose. We have specific instructions for this instance, but if I could only understand why I would give any dosage if the level was normal. I was informed that it is an emergency when it falls too low. That is what I do not want. Especially if I am asleep at night. All I am looking for is insight and knowledge as to how the disease may work (or how insulin may work) that would make sense to give him a dosage when the level is lower normal. I hope this made sense. I can't proceed confidently unless I understand more. I think I am going to check with the doc too. I just feel so ill at ease administering a dose if BG is normal.
There is an issue with most cats called stress induced hyperglycemia. When the cat is stressed there is a short term increase in blood glucose.
Yes, like every time they visit the vet, glucose usually goes up. After my cat's surgery, I feel perhaps he was stressed for a bit also.
Normal (without insulin) is 50-120. However, Lantus is a depot insulin - it is stored in the cat. So the times you did not shot, there was still some insulin at play. From: https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/ Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4: Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection? A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing b.) give a token dose (10-25% of the usual dose) c.) feed as usual, test in a couple of hours, and make a decision based on that value Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher. Keep in mind these are general guidelines, and they should be personalized to your own cat's response to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide. With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Lantus, Levemir, and Biosimilars users following the Start Low Go Slow approach: If the preshot number is far below usual preshot numbers: Do you need to stay on schedule? Then skip the shot. Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable. Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary. If the preshot number is near kitty's usual preshot numbers: Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot. We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat. If kitty is dropping faster or lower than you'd like, please see "Don't Panic! or How to Handle Low Numbers" and post for help or suggestions. Remission: Remission is reached when kitty can go 14 days without insulin. Most cats will remain in the range of a healthy cat 50 - 80mg/dL (2.7 - 4.4 mmol/L) with only sporadic higher or lower BG numbers. Occasionally, some will experience infrequent BG numbers higher than the norm. Continue feeding low carb food. Test the cat's BGs once per month. If BG numbers begin to trend upwards, it's time to bring kitty in to see your vet for a check-up. Common reasons for kitty falling out of remission include dental issues, infection, inflammation, pancreatitis, etc. Just about any illness or disease can do it.
My gosh! Thank you so much for this! Didn't know this was here 'til now. We've just snacked up and am about to retest because he just went to 63. I will surely be studying this tonight.
You had an absolutely beautiful cycle today. Do NOT increase the dose. In fact, depending upon which dosing method you would like to follow TR or SLGS, you may need to decrease. But you did have a beautiful cycle today and your cat was in very safe numbers throughout.
Yes and thank you . We will be decreasing. He's been napping, had pre-shot dinner and is at 143. Based on how he has reacted previously, he tends to take rather quick falls in his numbers when they start getting low down. I may need to hold tonight and come back to him in the morning. Not sure what he's up to.
He tends to go super high by morning when you skip. With the lower preshot tonight, I would have given a small amount (probably only.25 units the first time I did a reduced dose) of insulin instead of a complete skip. Then I would get a few tests. If he still rises too high on that, I would try a .5 token dose the next time he has a low preshot. And I would get a few tests in to make sure everything was all right.
So sorry I missed this yesterday, I was so worn out I went to sleep once I got everyone situated for the night. Okay! So, noting this recommendation for those rising numbers in the morning for the next time. Thank you so much.
No worries. Try to get some tests today- at least one at +6. It looks like bouncing from the green yesterday, but can’t tell without more information.
I got some tests. It was elevated today. I saw him eating more than usual today. He usually doesn't eat as much as I saw today. Perhaps this contributed to it. Update! 3/11/2024 - This morning it was 146 after eating breakfast. Today I will not be able to watch him all day. Most days 99% I can watch him all day. Today I am concerned with not being able to snack him if his numbers fall too low. So, just once, I am going to hold 1 dose since it's in a reasonable range and resume again with dinner tonight.
What does td mean on the spreadsheet? He seems to be doing well on the .75 units but can you get some more tests in? It would be so helpful to have a clearer picture. yesterday was a pretty good cycle it looks like. I can’t tell if any shot was given last night. I would have recommended shooting the .75 since he was at 206 PMPS.
Ah, thank you. "TD" is a token dose, meaning .5. Since he is so close to the normal zone. This is why I say "counter intuitive" because I am concerned he will drop while I am sleeping, but I could be wrong. I am probably wrong. I have seen him plummet from the 500's to the safe zone a while ago and that's what I keep thinking of every time I give him a dose. I keep thinking 'what if something goes wrong'. It's simply from lack of knowledge about this insulin and how it works. Once I understand something, I am free of the fear of it. After his surgery, when he was in the 500's , my intuition was to totally raise his dose, but the doctor warned against it. And on the other side of the spectrum, when it's lower, my first reaction is to reduce. Hence, this may be a counter intuitive reaction. Maybe he should have .75?
Can you please put .5 in the cell for the units so we know how much insulin was given (well, you do, of course, but it won’t be apparent to anyone else studying his spreadsheet). And please get a test or two in for these token dose cycles. If you give.5 units and then don’t test then we can’t see the effect of the reduced dose — was it too much, too little, just about right? That way the next time you are confronted with a similar preshot number you will have a much better idea of how much insulin would be best. The goal is to be able to shoot lower preshot numbers as you go along.
