Ernest at 393BG -- forgot morning shot, dose advice

[LJ and Ernest]

Can't believe it, but I totally spaced on Ernest's AM 2u of Lantus. He has been ~200BG midway through the day, so I tested him as soon as I remembered what I forgot this morning.

He has been DKA before, so when I saw 393BG I gave him 2u. So now what? He is due for his PM shot in 7 hours. But, obviously, I can't give him his 2u then.

Do I skip this evening's shot? Do I give him a smaller shot later this evening? He's been doing so well, I don't want to mess that up.

 

[Sandy and Black Kitty]

Re: Ernest at 393BG -- forgot morning shot

I'm unable to offer much in the way of the advice you need - want to bump you up, so that someone more experienced can help with timings and dose.

One thing I can say is that whatever time you did shoot today has, for today, become your AM shot time, so you start counting from there. How far off (hours) your usual time did you shoot?

Don't be too hard on yourself LJ. You'll be able to get back on track.
(ETA - I'm sorry I can't see your ss - I'm at tbp and blocked from googledocs)

 

[jan and Hep and sara (GA)]

Re: Ernest at 393BG -- forgot morning shot

Hi LJ,

It will depend on what Ernest's # is later and when his nadir [lowest point in his cycle] is if you give him any insulin tonight. Take a +11 so you have an idea on where he's at. Don't beat yourself up about forgetting. I'm sure your not the first person that's done that. :smile: Hey I once gave myself the insulin after I fumbled it.

What you can do is add dose advice to your subject line. That way you will get the attention of people that can help you with that. You can also click on the ? at the top of the page when you add to the subject line.

Also put that you gave the 2 units at +6 in your message body.

Glad Ernest has been doing so good.

jan and sara

 

[Sandy and Black Kitty]

Your actual shot time was +18, because 18 hours passed since the previous shot.

Got a look at Ernests ss and it appears you have been "shooting blind" (no pre-shot testing). If that's the case it will be difficult for those who can help to do so.

 

[Sienne and Gabby (GA)]

Your PM shot time is 12 hours after you shot this morning. You can start to move shot times by 15 min. per shot or 30 min. per day. There are other options but I do not feel at all comfortable making any suggestions given that there is such limited test data.

If you have a cat with a history of DKA, you really need to be getting more tests in. It is your best way, along with testing for ketones, of keeping him safe.

 

[LJ and Ernest]

Thanks for all the advice everyone.

I have been testing less frequently for the past few weeks -- the curve took a lot out of us. But as you will see, I was testing twice daily for the past 2-3 months. So I have a sense of what is normal for him.

The main concern is when to give Ernest his next dose and how much. 12 hours will be 1am. So then we will be on a 1am and 1pm schedule. And that will not be good because I think I am much more likely to mess that up.

Thanks

 

[Sienne and Gabby (GA)]

You can skip a shot and get back on track. That's really the only other alternative but I have no idea if you're testing for ketones.

I'm going to be blunt. Testing twice a day is inadequate. You don't really have any idea of what is normal based on pre-shot tests only. Lantus dosing is based on the nadir, not on the pre-shot value. Ernest could easily be in red numbers at AMPS, drop to the 40s mid-cycle and be back into the 400s by PMPS. Many of us that have bouncy cats have had that experience. Not getting any mid-cycle tests, let alone shooting blind, is putting your cat at a considerable risk. The minimal amount of tests you need are both pre-shot tests and at least one test per cycle if you want to follow a tight regulation protocol.

 

[Ronnie & Luna]

Not getting any mid-cycle tests, let alone shooting blind, is putting your cat at a considerable risk. The minimal amount of tests you need are both pre-shot tests and at least one test per cycle if you want to follow a tight regulation protocol.

agrees!
do get the preshot numbers before giving insulin.
and testing for ketones is important too.
staying on a 12/12 schedule as best as you can is also ideal.

 

[Jill & Alex (GA)]

You can skip a shot and get back on track. That's really the only other alternative but I have no idea if you're testing for ketones.

i agree with sienne. skipping a shot is NOT ideal... especially in a ketone prone cat. however, it will get you back on track quickly. if you're not already, please routinely test ernest's urine for ketones.

I'm going to be blunt. Testing twice a day is inadequate. You don't really have any idea of what is normal based on pre-shot tests only. Lantus dosing is based on the nadir, not on the pre-shot value. Ernest could easily be in red numbers at AMPS, drop to the 40s mid-cycle and be back into the 400s by PMPS. Many of us that have bouncy cats have had that experience. Not getting any mid-cycle tests, let alone shooting blind, is putting your cat at a considerable risk. The minimal amount of tests you need are both pre-shot tests and at least one test per cycle if you want to follow a tight regulation protocol.

as you can see if you click on the spreadsheet links in our signatures, this is a data driven forum. like sienne has said, with minimal to no testing you have no idea how low this dose is taking ernest. you also have no way of knowing if the dose requires adjusting, whether that means a dose increase or dose reduction. please take sienne's testing advice to heart. the advice is given in the best interest of your kitty.

if you're having trouble with hometesting, please post on the Health forum for help (tips and tricks).

 

[julie & punkin (ga)]

i think you're thinking like i was about the insulin - it's like a mathematical equation. Take 1 cat, add so many units of insulin = a healthy cat. what i've learned is that insulin is a hormone - think 13 year old girl, sunny one moment and doors slamming the next. the cat's body doesn't always respond the same way to the same dose, so even though the dose might've been right at one point when you did a curve, over time you will see a whole different set of numbers with the exact same dose.

it's interesting to me from an intellectual standpoint, but when you realize the implications it has for your cat's body - it's stunningly clear that if you're going to use Lantus and keep your cat safe, you absolutely must test more frequently. no cat likes it, no human wants to do it, but we all get used to doing what has to be done. my cat, who i had to drag from under chairs and burrito in a beach towel for the first 2 weeks of testing, is right now sitting in the testing spot waiting to be tested so he can eat. food is a great motivator in a cat!

Click on Sienne's cat Gabby's spreadsheet - she's one of our zoomer kitties. Marjorie's gracie is another one. These cats might be, as Sienne mentioned, over 300 preshot and go plummeting down to hypoglycemic (under 50) by the nadir, then rise right back up and do it again. The trouble is if a cat goes hypo and you don't know it, the consequences are severe for the kitter - from brain damage to death. i'm not trying to scare you, but you have to understand the implications of using insulin. None of us wants ernest to be harmed and too often vets direct people to use lantus without the owner really understanding how critical it is to test your cat. lantus is such a gentle acting insulin that often a cat won't even show the signs of hypoglycemia until it's very severe.

Just take it as a " *whew* i've learned in time" experience! I don't want to make you feel badly or anything, but just want to make sure you know the implications of what you're doing and understand the importance of testing - especially those mid-cycle tests. they are critical to learn for appropriate dosage changes for ernest.