First green pre-shot number -- not sure what to do

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JacksonCatson

JacksonCatson

Member Since 2012
Hi to you all on this wonderful forum. I'm a newbie -- my 4.5 year old cat Jackson was diagnosed before Thanksgiving (at 424 from his bloodwork) and this site has been a wonderful source of information.

Jackson has been on Lantus since early December and is currently at 1.5 units. He is a 13.2 lb neutered male. I'm attaching his SS and profile. He's mainly been in the mid-200s pre-shot, with a few random 300s. He was switched to a wet food diet before beginning insulin, and we've recently found a feeding schedule and amount that is working for us, which amounts to 2.5 cans of FF with a little bit of EVO dry food as a distraction while I'm injecting him. I've also started feeding him about 30-60 minutes before I give him his shot, as he's starving otherwise (still testing, then feeding, then shooting).

Tonight I had a BIG surprise when I did his BG = 74! He was 327 this morning, so you can imagine my surprise. I immediately did another test and got 68. I also tested my own blood (we started a new pack of strips yesterday) and it seemed reasonable. I use the Relion Confirm meter.

I decided to skip his shot (thank goodness y'all have underscored the importance of preshot testing!), fed him his normal amount and tested him again 40 minutes later. He was at 100. I tested again (so +2 from the PMPS) and he was 140.

So my question is, should I completely skip the shot and wait for his AMPS? Give him a lower dose, even though it's now quite late from his normal time? Keep testing him till I go to bed?

Thanks for your help. I haven't ever seen numbers this low, so I'm a bit unprepared.

Sarah and Jackson
 
hi Sarah - welcome to the forum.

You did the right thing skipping the shot because you don't have much mid-cycle data so anything could happen at that number.
As that was pre-shot, ie. +12, he may have gone lower during the cycle.

Has anything changed that could account for that drop, eg. diet change, not eating etc..?
If not, then you could assume that his pancreas has kicked in and starting to respond - good news! So the next step is to figure out how to manage his insulin.

You will have to start getting more mid-cycle numbers. +6 is the standard/assumed nadir (lowest number) but that's not always true, for my cat its around +4. So its important to get test numbers from various points in his cycle.
Tonight's cycle is obviously out due to the skipped shot so start again tomorrow although he may need a cycle or 2 to recover from the skip.
I also think he's been on insulin long enough for you to do a curve (test every 2 hours) or mini-curve (test every 3 hours) for 1 cycle - that gives a wealth of info - but don't do this tomorrow due to the skipped shot, just do some spot tests, particularly at +3 and +6.

Also, why don't you start posting on the Lantus forums? There are 2, the Tight Protocol is very active.
 
Unless your shot schedule is flexible enough that you can be 2 hours off, I would just go ahead and give the next shot in the morning. He will probably be higher, just to warn you. We normally don't have people shoot under 150 unless you have plenty of data, and you're getting there.
For the future, here are a couple of links for you to read, or re-read, when you have a chance.
Dealing with Low Preshots
Don't Panic! or How to Handle Low Numbers
You're doing fine. :YMHUG:
 
Thanks all. I will wait until tomorrow morning for his shot.

As for any changes, the only thing is that in the past week, I think we've settled on a good amount of food (2.5 cans of FF and just a bit of EVO kibble during his shots) and a slightly different schedule (mainly that I test and feed him dinner between 6 and 6:30 and wait until 7 to shoot.). He has been eating well but doesn't seem to be as ravenous as he was.

I've started doing +6 tests in the evening and will keep doing so--I think his nadir is earlier than +6. I have been meaning to do a curve to send to the vet but wasn't able to this weekend because of my schedule -- but I will do so after things stabilize from the missed shot.

Hoping it's the pancreas kicking in -- we'll see! Thanks for the input.
 
Dyana said:
Unless your shot schedule is flexible enough that you can be 2 hours off, I would just go ahead and give the next shot in the morning. He will probably be higher, just to warn you. We normally don't have people shoot under 150 unless you have plenty of data, and you're getting there.
For the future, here are a couple of links for you to read, or re-read, when you have a chance.
Dealing with Low Preshots
Don't Panic! or How to Handle Low Numbers
You're doing fine. :YMHUG:
Click to expand...

Thanks! One more question -- when I shoot in the morning, should I stick with his normal 1.5 u dose even though he was so low at +11? I ask because I have a wedding to attend tomorrow and will be away from home from about +3 to +11. Or should I assume that without a shot tonight, he should be high enough that it will be OK?

Thanks again!
Sarah
 
You want a dose that is safe to give every 12 hours that won't take him lower than 50.

You could shoot the regular dose if he is high, then cut back on the next dose, or you could make a reduction of 0.25 units.

This, of course, assumes he is high enough to shoot in the morning. Maybe he'll surprise you.
 
If this dose has been working for him and he has stayed above 50, I would shoot your regular dose in the morning. You were wise to skip but I wouldn't change his dose unless you have had to do alot of stalling or skipping.

If you've had to stall and or skip more than a time or two, then yes, you should reduce his dose.

Eta: if he's not high and you have to be gone and are worried, you can shoot a reduced dose in the morning and pick up with his regular dose tomorrow night.
 
Thanks again, all!

Jackson was at 227 last night at +16 (aka, when I went to bed). This morning at +24, he is at 312. Obviously, that's high enough to shoot, but the newest surprise is that he doesn't seem to be very hungry! He ate a little bit of his FF and drank some of the water that I pour on top, then walked away. He's returned and has eaten another bite or two -- his brother did the same thing, so I think that it's fairly normal. But it's not normal for Jackson -- he is usually so hungry that he eats at least 2/3 of his can right away and then checks out his brother's dish.

So this makes me nervous to shoot at 1.5 units, as I'm going to be out of town all day for a wedding. I suppose he'll likely nibble on the food all day, but it's so different from his normal behavior -- AND I'm going to be away and will worry -- that I'm wondering what to do. Reduced dose, just to play it safe? If so, how reduced -- 1 u?

FYI, yesterday morning, he was at 327 and was at 74 by +11 (obviously, he hadn't had a skipped shot the night before, so it's not the same, but it has me wondering.

Thanks! I am hoping to shoot soon to keep him on a normal-ish schedule -- and would appreciate any advice if anyone is up and responding!
 
Hi,

I don't use your insulin so can't advise on specific dosage, but if it were my cat, and I was going out for the day, I would err on the side of caution and give the reduced dose. As the adage here goes: "Better high for a day than low for a minute".

Sorry I can't be more help...
 
Thanks, Elizabeth -- that is helpful advice and it is reassuring just to have another person considering the issue!

So I decided to shoot at .5 u. I know it's too low, but it's the dose at which I know I can go to the wedding without worrying. I'll be home all night tonight and all day tomorrow, so I can go back to his normal dose when I'm around to monitor him.

Thanks again! Will check back in when I get home and do his PMPS!
 
Hi all,

An update on Jackson and another question --

After decreasing his dose on Sunday because of his sudden low number and the fact that I was gone all day for a wedding, Jackson seems to have readjusted. You can see in his SS that I've been doing some more testing to understand how he's doing.

For the last two cycles, I've given him his normal 1.5 dose. This morning I did a +11 and found him at 146. I'm wondering how to respond to this, especially since a) it's just below the 150 threshold for newbies and b) how quickly he dropped a few days ago -- going from 327 to 74 in one cycle. Additionally, I'm going to be out of the house from +1 to +3 today, so I'd like to play it safe.

Thoughts?

Thanks! This drop into low numbers, while happy news, is quite unexpected so I'm trying to read up in preparation for dealing with low numbers!
 
Update -- he's at 183 AMPS (but I gave him a few treats after his first test, which may partially account for the rise). Thoughts on dose? Thanks!
 
Lantus works best when you can shoot consistent doses (meaning you're shooting the same dose both cycles without skipping), so you want to stick with a dose that you know you can shoot consistently both cycles. Jumping around with the dose tends to lead to wonky numbers. I would drop down to 1u and shoot that consistently for 3-5 days (unless you need another reduction, of course). Stick to that dose for several days, even if you see numbers in the 300s, and let the dose settle and see where it takes you. After several days, you can make the adjustment up to 1.25u if the 1u dose not give you any nadirs below 200.

As others have mentioned, you really need to be getting a daily mid-cycle test. I know it can be hard with a busy schedule (I was working two jobs and in grad school when Bandit was on Lantus), but with a little creative scheduling it is possible, and not that much of a pain. With Bandit, I was not able to run home and get a mid-cycle check in his AM cycle during the week because my commute didn't make a lunch trip home possible, so what I did was test before his 7am shot, work all day, get home and test before his 7pm shot, grab a test at 10-11pm before bed (+4 or +5), and then set an alarm to grab a 1am test (+6) and then go right back to bed. I did this M-F, and then I did a curve during the AM cycle on the weekend when I was home.

I know the alarm thing sounds like a pain, but your body will adjust just like parents getting up in the night to deal with young children. And the minor inconvenience is completely worth the payoff--those tests will allow you to better control Jackson's blood glucose, which in turn leads to much higher remission rates (84% when getting those daily mid-cycle tests, but only 26% if you don't).
 
One more thing that I forgot to mention--I saw that you mentioned you're still giving him a few pieces of EVO dry when you shoot as a distraction. With some diabetic cats, even the lower carb dry food will still raise blood glucose levels and cause problems with regulation. Bandit can't eat any of the EVO dry food, or the EVO crunchy treats even though they are both lower carb, because low carb doesn't necessarily mean low glycemic, especially with highly processed dry foods. They raise his his BG 50-100 points with just a few pieces. I would recommend ditching the dry completely, and use treats or canned food to distract him at shot time. I always fed Bandit, and then just gave him the shot while he was eating. I don't think he ever even noticed me giving him the shot.

What size syringes are you using? I started out with 1/2" needles and had all sorts of difficulty with injections, but when I switched to the 5/16" it was so much easier and faster doing the shot.

There's lots of treats you can use as a distraction--I personally use Fancy Feast Appetizers, which are just shredded meat and fish (all are low carb), and Beefeaters freeze dried cat treats from Petsmart (they come in chicken or salmon flavors): http://www.petsmart.com/product/index.jsp?productId=2751598&f=PAD/psNotAvailInUS/No.
 
Thanks for the advice, Julia. It's really helpful.

I really would like to get him to a steady dose, I just wasn't sure how low to go and how to handle, especially given that big dip.

I've started doing more mid-cycle testing and am trying to find a balance with it all, but I think the low numbers are necessitating it.

I shot at 1 u this morning and will plan to do so for the next few days and see how things go.

Thanks again!
Sarah
 
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