Fluffmiester
Member
It was 153 Do you think I should skip insulin this morning?
Fluff's level today
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Charliemeow
Very Active Member
I think you should either skip it or give a very small token dose of maybe .5 u. But only if you'll be around to test a couple times. Beautiful number Fluffy!!!
Sue and Oliver (GA)
Very Active Member
Rose, let's wait 30 minutes and test again to see if he comes up above 200. If you skip completely this am, we get back to the high cycles. Maybe you can give a reduced dose when he gets a little higher.
Fluffmiester
Member
At + 2 it is 279
Sue and Oliver (GA)
Very Active Member
Rose,
Here is a bit of a game plan when you get a lower number:
Option 1) Wait and test.
When you get a Pre-Shot ["PS"] number under your no shoot of say 200 and you have very little data to support shooting at that number, you can "wait and test" instead of giving the usual dose or simply no shooting. Wait 30 minutes and test again. If the cat is over your chosen no shoot, 200 in this case, representing a rise in blood sugar values, you can shoot. It is best to avoid feeding during this wait time, so you do not get a rise in values due to the food. This will be a cycle when you do want to get some extra tests in to see if the low number is part of a pattern of lower BG values. Be sure to get a mid cycle test/number at your cat’s nadir if known. If not known, around 6 hours after the shot was given. If you get a low number at the preshot (80-150), you would follow the same procedure, but you would want to reduce the dose of insulin by as much as one half when the number has risen to 200. Also, if you are consistently needing to wait and test you may be time for a dose reduction. If you shoot late or early one cycle then likely you will be shooting early or late respectively the next cycle. Waiting and testing is a good compromise in safety and utility.
Option 2) No shoot.
This is just like it sounds. Don't shoot any insulin that cycle. The advantages of this is that it is simple and normally a pretty safe thing one can do [but is your cat "normal?"]. The disadvantages are that without insulin that cycle the kitty's blood glucose ["BG"] values will likely zoom up for the next cycle. This may slightly slow the regulation process by a few cycles as you try to bring the numbers back down from where they zoomed off too the next few cycles. Also, if one has a kitty with a history of ketones it can be important to keep at least some insulin going in their system. In the beginning this tactic can also lead to seesaw effects between cycles were they go to high then too low then to high etc. For more thoughts on not shooting any insulin read here.
Option 3) Shoot a reduced dose.
In the beginning this is the most "risky" option. Risky because you may not really have the data to know what your cat will do at any dose. Roughly conservative guidelines for this would be to shoot at least 1/3 the dose you would normally shoot under 200 and at least 1/4 the dose you would shoot under 150. And by all means, as a beginner, do not shoot any insulin below a BG value of 100. It is best to consult with someone first though before you do this just to make sure this tactic would be right for your situation. If you choose this option it would be good to get at least a +3 test and a +6 test so you can watch for any dangerous lows) you know if your kitty will not be going too low that cycle and b) that you can use that data for later and maybe increase the guidelines the next time. Especially as a beginner it is important to try to shoot on a rising number, and with this strategy it can be sometimes difficult to tell if the number is really rising if you have not gotten any previous tests that cycle. This tactic is meant to reduce the amount seesaw effect of no shooting and slow any zooming up in BG values the next cycle. Using U100 syringes with U40 insulin and doing the conversion can assist with finding more consistent dose reduction increments.
Here is a bit of a game plan when you get a lower number:
Option 1) Wait and test.
When you get a Pre-Shot ["PS"] number under your no shoot of say 200 and you have very little data to support shooting at that number, you can "wait and test" instead of giving the usual dose or simply no shooting. Wait 30 minutes and test again. If the cat is over your chosen no shoot, 200 in this case, representing a rise in blood sugar values, you can shoot. It is best to avoid feeding during this wait time, so you do not get a rise in values due to the food. This will be a cycle when you do want to get some extra tests in to see if the low number is part of a pattern of lower BG values. Be sure to get a mid cycle test/number at your cat’s nadir if known. If not known, around 6 hours after the shot was given. If you get a low number at the preshot (80-150), you would follow the same procedure, but you would want to reduce the dose of insulin by as much as one half when the number has risen to 200. Also, if you are consistently needing to wait and test you may be time for a dose reduction. If you shoot late or early one cycle then likely you will be shooting early or late respectively the next cycle. Waiting and testing is a good compromise in safety and utility.
Option 2) No shoot.
This is just like it sounds. Don't shoot any insulin that cycle. The advantages of this is that it is simple and normally a pretty safe thing one can do [but is your cat "normal?"]. The disadvantages are that without insulin that cycle the kitty's blood glucose ["BG"] values will likely zoom up for the next cycle. This may slightly slow the regulation process by a few cycles as you try to bring the numbers back down from where they zoomed off too the next few cycles. Also, if one has a kitty with a history of ketones it can be important to keep at least some insulin going in their system. In the beginning this tactic can also lead to seesaw effects between cycles were they go to high then too low then to high etc. For more thoughts on not shooting any insulin read here.
Option 3) Shoot a reduced dose.
In the beginning this is the most "risky" option. Risky because you may not really have the data to know what your cat will do at any dose. Roughly conservative guidelines for this would be to shoot at least 1/3 the dose you would normally shoot under 200 and at least 1/4 the dose you would shoot under 150. And by all means, as a beginner, do not shoot any insulin below a BG value of 100. It is best to consult with someone first though before you do this just to make sure this tactic would be right for your situation. If you choose this option it would be good to get at least a +3 test and a +6 test so you can watch for any dangerous lows) you know if your kitty will not be going too low that cycle and b) that you can use that data for later and maybe increase the guidelines the next time. Especially as a beginner it is important to try to shoot on a rising number, and with this strategy it can be sometimes difficult to tell if the number is really rising if you have not gotten any previous tests that cycle. This tactic is meant to reduce the amount seesaw effect of no shooting and slow any zooming up in BG values the next cycle. Using U100 syringes with U40 insulin and doing the conversion can assist with finding more consistent dose reduction increments.
Fluffmiester
Member
At +5 level was 365 No insulin so far today
Morning level was 153
Morning level was 153
Sue and Oliver (GA)
Very Active Member
It looks like you may be back in the 300-400s by pmps.
Maybe it would be good to have a plan for the days you get under that 200 mark, so you don't go back into the high numbers. I like the Wait 30 minutes option because if he goes back up into shootable numbers, you don't have to skip the whole cycle. What do you think?
Rose, whatever you do is fine. You have to do what makes you comfortable. I am sort of thinking out loud.
And this is a scary dance in that you shoot and can't be quite sure what will happen. The goal is to get him down in regulated numbers - on insulin under 300 at ps with a nadir near 100 (with the caveat that every cat is different) When you reach those numbers on a pretty consistent basis, then you make mini adjustments to try to get him lower.
Maybe it would be good to have a plan for the days you get under that 200 mark, so you don't go back into the high numbers. I like the Wait 30 minutes option because if he goes back up into shootable numbers, you don't have to skip the whole cycle. What do you think?
Rose, whatever you do is fine. You have to do what makes you comfortable. I am sort of thinking out loud.
And this is a scary dance in that you shoot and can't be quite sure what will happen. The goal is to get him down in regulated numbers - on insulin under 300 at ps with a nadir near 100 (with the caveat that every cat is different) When you reach those numbers on a pretty consistent basis, then you make mini adjustments to try to get him lower.
A
Anonymous
Guest
yes Rose, no point in letting him go all the way back up there. 1/2 hour should tell you if Fluff is on the rise and you can always shoot a token dose if the # is still under 200 ok.
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