Dosing advice for Nigel ASAP!
- Thread starter AmericanTemplar
- Start date
AmericanTemplar
Member Since 2019
Dinner is at 6 and then shot right after.
majandra
Member Since 2018
When you do your PS tests, it's before he eats right? Pretty sure you said it was, but want to make extra sure!
AmericanTemplar
Member Since 2019
Yep, I’ll test him at 6, then food, then I’ll post his results here while he eats.
MrWorfMen's Mom
Member Since 2015
Given what we are seeing right now from today's cycle, I'm in agreement with skipping tonight but let's see what the PMPS is.
AmericanTemplar
Member Since 2019
104. No shot?
MrWorfMen's Mom
Member Since 2015
Yup. I'd skip tonight. There is a depot that build up from Lantus insulin injections and with even the half unit shots the last couple of nights, there is still a depot in play. Nigel's numbers are definitely better than they were a few days ago so I suggest you skip tonight and we revisit the subject in the morning. It may be that the only way to make a definitive determination of his diabetic status is to withhold insulin for a few cycles and monitoring for a rising BG.
AmericanTemplar
Member Since 2019
Great, I’ll check in later. Thanks again for the help!
MrWorfMen's Mom
Member Since 2015
Grant, stick to the LC food, and under no circumstances do you need to give Nigel any karo. He will NOT go hypo without insulin. 
MrWorfMen's Mom
Member Since 2015
It would be helpful if you could grab one test before bed just so we have some extra data on which to base future decisions, Then you can sleep to your heart's content! 
AmericanTemplar
Member Since 2019
He’s at 97 now.
AmericanTemplar
Member Since 2019
MrWorfMen's Mom
Member Since 2015
Good morning. The depot can take a few days to drain so yes I think to some degree it is. Nigel according to the Prime readings has been in normal numbers all day yesterday, last night and again this morning although they are in the upper ranges of normal.
I would suggest skipping again this morning and test again about 3 hours after Nigel has eaten his breakfast. Let's see how much his BG has changed at that point post meal. I'd expect it to be down lower than the pre-shot test.
I would suggest skipping again this morning and test again about 3 hours after Nigel has eaten his breakfast. Let's see how much his BG has changed at that point post meal. I'd expect it to be down lower than the pre-shot test.
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MrWorfMen's Mom
Member Since 2015
Just peaked at the graph from the FL and while we were skeptical of the readings, it is making it quite easy to see that Nigel's BG has been coming down over the past few cycles which given the dose decrease and then skipped doses, is very encouraging. I think we can safely conclude the 1u dose was too high, the 0.5u dose was too high and it is looking promising that Nigel may not need insulin at all. 
AmericanTemplar
Member Since 2019
I very much hope that that’s the case!
So is insulin the kinda thing where one is typically weaned off or could a cat go from needing 1u to not needing any insulin without ever getting 0.5u or 0.25u?
So is insulin the kinda thing where one is typically weaned off or could a cat go from needing 1u to not needing any insulin without ever getting 0.5u or 0.25u?
MrWorfMen's Mom
Member Since 2015
Generally they are weaned off with ever diminishing doses of insulin to ensure the remission is a strong one and that the pancreas is rested and allowed to recover as much as possible. The difference here is that there is a concern that the diagnosis may have been incorrect all along. Giving insulin to a non diabetic cat could potentially be catastrophic so in this case, it is important to find out if Nigel needs insulin or not and to fast track it a bit. Normally we would reduce doses by 0.25u at a time but given the odd drops and rises Nigel displayed cutting the dose back to 0.5u seemed prudent to keep him safe.
Obviously Nigel's numbers have been improving with the reduced dose and the skipped shots and it's looking promising that he may not need insulin at all at this time however it is also possible that a very tiny dose might help him. Until he has been off insulin for a few days and we can be sure there is no residual effect in the picture from the depot, we can't jump to any final conclusions.
Just keep Nigel on LC food (under 10% and preferably 6 or under) to ensure we don't introduce anything high carb into the picture that might skew the numbers.
Obviously Nigel's numbers have been improving with the reduced dose and the skipped shots and it's looking promising that he may not need insulin at all at this time however it is also possible that a very tiny dose might help him. Until he has been off insulin for a few days and we can be sure there is no residual effect in the picture from the depot, we can't jump to any final conclusions.
Just keep Nigel on LC food (under 10% and preferably 6 or under) to ensure we don't introduce anything high carb into the picture that might skew the numbers.
MrWorfMen's Mom
Member Since 2015
Grant, FYI, I will not be around tonight when your 6pm pre-shot test is due as I am heading out of town this afternoon. @majandra has agreed to keep an eye out for your post as she's been following and helping out with Nigel and she knows the history. I'll check in when I get home which will be probably be around 8 pm your time to see how things have gone today. Fingers crossed!
AmericanTemplar
Member Since 2019
MrWorfMen's Mom
Member Since 2015
YEAH! That's a number I am happy to see.
Hi Grant
Looks like Nigel has been keeping you a bit busy. I popped in because another member asked me to do so as she was concerned about the number of skipped shots, etc.
I’ve read through all the condos you’ve posted including the introductory one as well as the one on the Main Health forum and studied his SS. I’m glad you are using the Prime now; it’s better to try and stick with one device for recording on the SS as Linda suggested. The Prime does have a history of reading lower than other meters so that might explain the large gap between it and the Libre although we don’t have a lot of info on the Libre, other than what has been posted in your threads, to know about its consistency. But sticking with one device and following trends is the best way to go.
The issue that concerns me is that information has been provided to you with no guidance as to how it fits in with SLGS which is what you stated you wanted to follow. I’d also like to point out that if you are following SLGS and you get a number lower than 90 on a human meter, you need to reduce the dose; more on that later.
It does appear the starting dose might have been a bit high for him and he actually even “earned” a dose reduction from 1u to 0.75u in the a.m. cycle of 1/30 with a 63. I’m not sure the basis for the 0.5u being suggested but it’s done and he’s hanging in there pretty well.
In regard to the AMBG of 118 on 1/31, SLGS does state that, starting out, if the PS is below 150, to not give insulin, but also remember these are guidelines, you had some data and had shot a lower number with the 0.5u dose even the night before, and the number wasn’t that far below 150 (it was basically within 20% meter variance range). Taking all that into consideration, it would have been fine to shoot the 118 and leave some HC food out when you had to leave but skipping was also fine if your comfort level was zero.
However, it should have been explained to you that because Lantus is a depot insulin, when you skip a dose or shoot a reduced dose, you are likely to see the same kind of cycle, at least for the first half of it, as you would if you had shot. Also, because the depot from a higher dose can affect the BG for up to six cycles, he likely had some depot from the 1u that day; in other words, it’s unlikely that shooting would have resulted in any difference in numbers with the exception that his PMPS likely wouldn’t have been so high. In summary, either way would have been fine but next time when faced with a number that is near or not too far below 150, you can perhaps take all that into consideration.
He earned another dose reduction the night of 1/31 when he dropped below 90. Since you had been shooting 0.5u, than according to SLGS, the next dose would be 0.25u. You were right to skip the dose on 2/1 a.m. cycle with an AMBG of 74 because below 90 with SLGS, we strongly discourage shooting. A 74 also would normally call for another reduction but with the L insulins, we often avoid taking back-to-back reductions because it’s often the depot talking; however, he’s had a lot of skipped shots, including last night, so his 0.5u depot probably really isn’t a “normal” 0.5u depot by this morning.
He dropped to 82 today which would normally constitute another dose reduction and that plus of three back-to-back skipped shots, IMHO, it would be a smart thing to take the reduction to 0.1u as you’ve probably drained the depot quite a bit by now.
It will be interesting to see what he does tonight; a +10 test would be good and if you are home to test tonight and if he’s above 90 at PMPS, I’d suggest you shoot 0.1u.
Is it possible he is a diabetic that can be diet controlled? Sure and we’ll keep our paws crossed for that. And even though I have seen cats go from 0.5u to no insulin, it’s not often that they do and stay permanently in remission. The numbers will guide us and it’s possible we will find as the depot really drains that he “might” need a little more support. Time will tell.
For all readers and the advice givers in this condo and the last one: I want to be sure and address the notion that if a shot is skipped, the cat cannot hypo. This is not correct. Depending on the depot, the insulin can continue to drop numbers quite low even with skipped shots so it’s important to be vigilant even when a shot is skipped or a reduced dose shot. As long as the kitty is past their normal onset and is either going up or is super flat, the chance for a hypo diminishes but I’ve seen cats who’ve had shots skipped drop into the 30s, no symptoms even though that number is definitely low enough to potentially see symptoms.
Looks like Nigel has been keeping you a bit busy. I popped in because another member asked me to do so as she was concerned about the number of skipped shots, etc.
I’ve read through all the condos you’ve posted including the introductory one as well as the one on the Main Health forum and studied his SS. I’m glad you are using the Prime now; it’s better to try and stick with one device for recording on the SS as Linda suggested. The Prime does have a history of reading lower than other meters so that might explain the large gap between it and the Libre although we don’t have a lot of info on the Libre, other than what has been posted in your threads, to know about its consistency. But sticking with one device and following trends is the best way to go.
The issue that concerns me is that information has been provided to you with no guidance as to how it fits in with SLGS which is what you stated you wanted to follow. I’d also like to point out that if you are following SLGS and you get a number lower than 90 on a human meter, you need to reduce the dose; more on that later.
It does appear the starting dose might have been a bit high for him and he actually even “earned” a dose reduction from 1u to 0.75u in the a.m. cycle of 1/30 with a 63. I’m not sure the basis for the 0.5u being suggested but it’s done and he’s hanging in there pretty well.
In regard to the AMBG of 118 on 1/31, SLGS does state that, starting out, if the PS is below 150, to not give insulin, but also remember these are guidelines, you had some data and had shot a lower number with the 0.5u dose even the night before, and the number wasn’t that far below 150 (it was basically within 20% meter variance range). Taking all that into consideration, it would have been fine to shoot the 118 and leave some HC food out when you had to leave but skipping was also fine if your comfort level was zero.
However, it should have been explained to you that because Lantus is a depot insulin, when you skip a dose or shoot a reduced dose, you are likely to see the same kind of cycle, at least for the first half of it, as you would if you had shot. Also, because the depot from a higher dose can affect the BG for up to six cycles, he likely had some depot from the 1u that day; in other words, it’s unlikely that shooting would have resulted in any difference in numbers with the exception that his PMPS likely wouldn’t have been so high. In summary, either way would have been fine but next time when faced with a number that is near or not too far below 150, you can perhaps take all that into consideration.
He earned another dose reduction the night of 1/31 when he dropped below 90. Since you had been shooting 0.5u, than according to SLGS, the next dose would be 0.25u. You were right to skip the dose on 2/1 a.m. cycle with an AMBG of 74 because below 90 with SLGS, we strongly discourage shooting. A 74 also would normally call for another reduction but with the L insulins, we often avoid taking back-to-back reductions because it’s often the depot talking; however, he’s had a lot of skipped shots, including last night, so his 0.5u depot probably really isn’t a “normal” 0.5u depot by this morning.
He dropped to 82 today which would normally constitute another dose reduction and that plus of three back-to-back skipped shots, IMHO, it would be a smart thing to take the reduction to 0.1u as you’ve probably drained the depot quite a bit by now.
It will be interesting to see what he does tonight; a +10 test would be good and if you are home to test tonight and if he’s above 90 at PMPS, I’d suggest you shoot 0.1u.
Is it possible he is a diabetic that can be diet controlled? Sure and we’ll keep our paws crossed for that. And even though I have seen cats go from 0.5u to no insulin, it’s not often that they do and stay permanently in remission. The numbers will guide us and it’s possible we will find as the depot really drains that he “might” need a little more support. Time will tell.
For all readers and the advice givers in this condo and the last one: I want to be sure and address the notion that if a shot is skipped, the cat cannot hypo. This is not correct. Depending on the depot, the insulin can continue to drop numbers quite low even with skipped shots so it’s important to be vigilant even when a shot is skipped or a reduced dose shot. As long as the kitty is past their normal onset and is either going up or is super flat, the chance for a hypo diminishes but I’ve seen cats who’ve had shots skipped drop into the 30s, no symptoms even though that number is definitely low enough to potentially see symptoms.
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You’re very welcome!Thank you for wrapping everything up into a concise explanation for Grant
AmericanTemplar
Member Since 2019
So I just tested him and he was at 69. Is that low of a number cause for alarm? He’s seems very normal though he didn’t do as much grazing today as normal.
majandra
Member Since 2018
@AmericanTemplar 69 is still safe right now. On a human meter, the take action number is 50.
Could you post your Libre graph for today?
Could you post your Libre graph for today?
AmericanTemplar
Member Since 2019
AmericanTemplar
Member Since 2019
Mandy & Rex (GA)
Member Since 2017
Nigel is looking great with no insulin!
Excellent. So right now, no insulin for him tonight but please be sure you test him no later than 2 hours after he eats or what would be 2 hours if you had shot. I just want to be sure he doesn’t continue down.
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majandra
Member Since 2018
Thanks!
I'm thinking tonight is a skip unless someone else thinks otherwise?
Do test him again in 2 hours.
Suggestion: for tomorrow, can you start a new thread? Title it as you see the others, with the date, name, and your preshot test. You can put up the ? prefix to get some more eyes on it. In the body of the post, start with a link to this convo for continuitiy.
I'm thinking tonight is a skip unless someone else thinks otherwise?
Do test him again in 2 hours.
Suggestion: for tomorrow, can you start a new thread? Title it as you see the others, with the date, name, and your preshot test. You can put up the ? prefix to get some more eyes on it. In the body of the post, start with a link to this convo for continuitiy.
AmericanTemplar
Member Since 2019
He’s at 80 now. Thanks again everyone for your help!
MrWorfMen's Mom
Member Since 2015
Delighted to see those beautiful numbers Grant! Give Nigel a scritch for me!