Help with low preshot lantus

Nathalie & Boris

Nathalie & Boris

Member Since 2022
Boris has been on 2u past few days reduced form 3 after vet tried to raise and he started getting hypo.

Was starting to stabilize it seemed but got a curve today. Typically 3-5 after shot is his low and he goes up today.

Today 3+ = 128, 8+ = 90, preshot = 61. Fed him a little bit of food for moment. It's now dinner time. Do I bring next shot down to 1.5 or wait?
 
Suzanne & Darcy said:
With the pet meters reductions are if the BG is under 68 and you're already below that point.
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Thanks! I found another forum thread where someone had something similar and their vet told them to hold off on the shot then check the BG levels in the 3-5 hour range. If levels go up, in the am take a preshot and decide if I should give a lower dosage or see if we are going into an OTJ trial.

Found that trying to figure out what OTJ meant in the TR Stickie. lol

I put a call into the vet as well, although I think I trust the info here better than what they are going to give. ;)
 
Nathalie said:
I found another forum thread where someone had something similar and their vet told them to hold off on the shot then check the BG levels in the 3-5 hour range. If levels go up, in the am take a preshot and decide if I should give a lower dosage or see if we are going into an OTJ trial.
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Do you mean you plan to skip the shot entirely?
 
Here, if we get a low pre-shot number, we stall (do NOT feed, which will influence your next test) and retest in 20-30 minutes to see if the kitty is rising or falling in BG. Then post for help on the forum with the results.
 
Also, if you get an unexpectedly low number (any time -- not just at pre-shot, it's a good idea to use a fresh strip and retest... to make sure you didn't have a bad strip. You shouldn't need to do that now since you can test again 20-30 minutes since you got that 61
 
Suzanne & Darcy said:
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Keep in mind those numbers are for pet meters.
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I use the AlphaTrak2. Vet told me to hold off insulin and leave food out for him, and wait until my appointment Thursday. In the meantime told me to do what I felt comfortable with dosing since I'm watching his numbers. Dosing in am, etc and let them know what I give him. rolling eyes

I feel like we are in a warped experimentation right now. Guess I'll go with my gut and the info I get here. Prayers please. I just don't want him to go hypo.
 
Oops. I mean to say that the numbers in the protocol are for HUMAN meters and not pet meters. That's why I said the reduction point for a person using a pet meter (such as AT) is 68. It would be 50 for a human meter. That's my mistake. I'd better go back and correct it.
 
Suzanne & Darcy said:
Also, if you get an unexpectedly low number (any time -- not just at pre-shot, it's a good idea to use a fresh strip and retest... to make sure you didn't have a bad strip. You shouldn't need to do that now since you can test again 20-30 minutes since you got that 61
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Every time I get a low number I retest, feed a little, and retest over the next few hours to watch it. He's had a few low 40's and 50's since they started to try and change his insulin dosage. Tried to go up and since then have continually been dropping every 1-3 days due to hypo almost setting in.
 
Nathalie said:
I use the AlphaTrak2. Vet told me to hold off insulin and leave food out for him, and wait until my appointment Thursday. In the meantime told me to do what I felt comfortable with dosing since I'm watching his numbers. Dosing in am, etc and let them know what I give him. rolling eyes

I feel like we are in a warped experimentation right now. Guess I'll go with my gut and the info I get here. Prayers please. I just don't want him to go hypo.
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Nathalie said:
Every time I get a low number I retest, feed a little, and retest over the next few hours to watch it. He's had a few low 40's and 50's since they started to try and change his insulin dosage. Tried to go up and since then have continually been dropping every 1-3 days due to hypo almost setting in.
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You've done a great job being on top of his numbers. You've got this! You're doing really well with the checking, retesting, etc. And, obviously you have reduced for 40s and 50s. 40s are scary with any meter, but on an Alpha Trak ... really alarming. I would have done a larger than normal reduction too. You know, you can always go back up in dose, but if you give too much you can't take it out... so better to be safe than sorry... so you are doing well.
 
I did want to ask, though, where are the AMPS tests? I don't see any on your spreadsheet. It's important to know where he is before giving insulin so you know if it's even safe to shoot. Am I missing something on the spreadsheet?
 
Wendy told you to reduce to 1.75. I explained why you need to test before every shot. Yet neither preshot tests or a reduction have been taken. I would skip tonight. 2.0 is too much insulin for Boris.
 
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Sounds good. I would take @tiffmaxee advice! It definitely does appear that 2 is too much, I was not aware of what Wendy said since I did not see it on this condo (should have checked previous condo, I guess!) Thanks, Elise. And thanks for linking the previous condo. I was just going to tag you!! And here you are!
 
Suzanne & Darcy said:
Sounds good. I would take @tiffmaxee advice! It definitely does appear that 2 is too much, I was not aware of what Wendy said since I did not see it on this condo (should have checked previous condo, I guess!) Thanks, Elise. And thanks for linking the previous condo. I was just going to tag you!! And here you are!
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My pleasure. Thanks Suzanne for giving her such good advice.
Nathalie, you can see from today’s experience why it’s important to link your previous condo. I went back and found it because I remembered you but people looking to help don’t always have the time to do that. That’s why we ask you to post in a particular format.

I will link some reading for when you have time.
https://felinediabetes.com/FDMB/threads/posting-guidelines-please-read.231511/

https://www.felinediabetes.com/FDMB...ir-biosimilars-land-experience-updated.46014/
 
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Suzanne & Darcy said:
You've done a great job being on top of his numbers. You've got this! You're doing really well with the checking, retesting, etc. And, obviously you have reduced for 40s and 50s. 40s are scary with any meter, but on an Alpha Trak ... really alarming. I would have done a larger than normal reduction too. You know, you can always go back up in dose, but if you give too much you can't take it out... so better to be safe than sorry... so you are doing well.
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Thank you! I needed that!
 
tiffmaxee said:
Wendy told you to reduce yo 1.75. I explained why you need to test before d wet shot. Yet neither preshot tests or a reduction have been taken. I would skip tonight. 2.0 is too much insulin for Boris.
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What is reduction test? As for am preshot, I try, I fail, I have to move on after so many failed attempts.

Sometimes the replies seem chastising and I'm doing my best managing a construction business, tying to hire people to help me with what I've done on my own for the past 6 years, and trying to keep him safe and alive. I didn't see the 1.75 msg until today. Trying to be on here and keep up is just another thing on my plate.
 
Nathalie said:
What is reduction test? As for am preshot, I try, I fail, I have to move on after so many failed attempts.

Sometimes the replies seem chastising and I'm doing my best managing a construction business, tying to hire people to help me with what I've done on my own for the past 6 years, and trying to keep him safe and alive. I didn't see the 1.75 msg until today. Trying to be on here and keep up is just another thing on my plate.
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The preshots don't matter for dosing because nadir is what is important - how low they go. On a pet meter following TR you want that in the 70s. The only time preshots matter are when Suzanne said - a lower than usual one can be a clue the dose needs to be looked at and you may need to do a temporary reduction.

When they drop lower and/or faster than they're used to, they bounce. The liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones into the blood stream and spikes the BG way up high - that's the high preshot you're seeing. It can take up to 6 cycles to clear that bounce

Reductions are any time you get a number below 68 on a pet meter. Following TR, you wait 4 cycles between reductions to allow the depot to drain.

If testing is a struggle for you, I might suggest switching to SLGS for the time being to keep him safe and give you time to get settled.
 
Suzanne & Darcy said:
I did want to ask, though, where are the AMPS tests? I don't see any on your spreadsheet. It's important to know where he is before giving insulin so you know if it's even safe to shoot. Am I missing something on the spreadsheet?
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FrostD said:
The preshots don't matter for dosing because nadir is what is important - how low they go. On a pet meter following TR you want that in the 70s. The only time preshots matter are when Suzanne said - a lower than usual one can be a clue the dose needs to be looked at and you may need to do a temporary reduction.

When they drop lower and/or faster than they're used to, they bounce. The liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones into the blood stream and spikes the BG way up high - that's the high preshot you're seeing. It can take up to 6 cycles to clear that bounce

Reductions are any time you get a number below 68 on a pet meter. Following TR, you wait 4 cycles between reductions to allow the depot to drain.

If testing is a struggle for you, I might suggest switching to SLGS for the time being to keep him safe and give you time to get settled.
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thank you, this is very helpful!
 
FrostD said:
The preshots don't matter for dosing because nadir is what is important - how low they go. On a pet meter following TR you want that in the 70s. The only time preshots matter are when Suzanne said - a lower than usual one can be a clue the dose needs to be looked at and you may need to do a temporary reduction.

When they drop lower and/or faster than they're used to, they bounce. The liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones into the blood stream and spikes the BG way up high - that's the high preshot you're seeing. It can take up to 6 cycles to clear that bounce

Reductions are any time you get a number below 68 on a pet meter. Following TR, you wait 4 cycles between reductions to allow the depot to drain.

If testing is a struggle for you, I might suggest switching to SLGS for the time being to keep him safe and give you time to get settled.
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The am short is the hardest because I wake at 530 just to feed and give him a shot.

he’s a bit antsy at that time, ready for breakfast. I’ve started trying to give a couple of treats to calm him as mentioned, but most test unsuccessful.
I’m down for learning, I’ve read so much my brain wants to explode. If I can start on TR I prefer to.
I just need to tighten up a few areas as I learn more.
 
Nathalie said:
The am short is the hardest because I wake at 530 just to feed and give him a shot.

he’s a bit antsy at that time, ready for breakfast. I’ve started trying to give a couple of treats to calm him as mentioned, but most test unsuccessful.
I’m down for learning, I’ve read so much my brain wants to explode. If I can start on TR I prefer to.
I just need to tighten up a few areas as I learn more.
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When is the last time he eats before the morning shot?

We know, it's a lot!
 
Nathalie said:
What is reduction test? As for am preshot, I try, I fail, I have to move on after so many failed attempts.

Sometimes the replies seem chastising and I'm doing my best managing a construction business, tying to hire people to help me with what I've done on my own for the past 6 years, and trying to keep him safe and alive. I didn't see the 1.75 msg until today. Trying to be on here and keep up is just another thing on my plate.
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The replies arent meant to be chastising at all. It is just all of us trying to make sure you understand. We all want Boris to be safe and for both of you to be successful. It's a lot to wrap your brain around and a lot to manage. The learning curve is super steep!

Treats to answer one of your other questions. Most of us use a freeze dried meat like purbites. It's just chicken or just beef liver or just salmon. So should affect bg levels like the other bad no no treats (which is literally everything else LOL)

Your doing a great job! Like I said it's a learning curve a big one! :bighug::bighug:
 
If you could feed him at about +8 or +9 at night using an auto feeder then maybe he would not be so hungry in the morning. Just a thought. You may already be feeding. You can give him some treats-low carb - before or after you test
 
Honestly, I think when I first started that I let Darcy eat his canned food while I got blood. I got the blood within seconds/minutes of him eating.
 
It takes about 20 minutes for the food to effect the bg so if he’s too hungry in the morning feed him a little and then test. We just want him to be safe. We aren’t chastising you. I’d rather see a test after eating a little than no test at all. The first low green amps I got was after going to bed at +5-6 with a bg of 150. Had I not tested at amps Max could have gone hypo.
 
FrostD said:
When is the last time he eats before the morning shot?

We know, it's a lot!
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It has been 530pm because he has only been on twice a day feeding per vet since Jan. He's started to acclimate to that, and is no longer opening my cabinets etc. Plus he sleeps through the night more than he does the day. He used to be a free feeder.

I may try the smaller portions throughout the day, just need more help with how often etc and need to be able to do it on a day when I am here to take constant BG's.

What was previously mentioned was small amounts at certain intervals but not on the last 1/2 of the 12hr curve. so splitting up his morning portion between 3 morning feedings? I don't think he'll be happy with that either considering he already looks at me wanting more after he eats.
 
Suzanne & Darcy said:
If you could feed him at about +8 or +9 at night using an auto feeder then maybe he would not be so hungry in the morning. Just a thought. You may already be feeding. You can give him some treats-low carb - before or after you test
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I might try the pm feeding before I go to bed. I've tried the freeze dried treats in the am and they do not settle him. I had to fight this am, 3 tries to get that preshot test.

He used to sit and high five for treats, now I have to watch my hand as he tries to attack it before I can even put the treats down.
 
tiffmaxee said:
Wendy told you to reduce to 1.75. I explained why you need to test before every shot. Yet neither preshot tests or a reduction have been taken. I would skip tonight. 2.0 is too much insulin for Boris.
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Is there a needle that allows a .75 because as of now I have not had one? The needles I have only show full units, or in between being .5. Currently I have 1.0ml and .5cc syringes (just got those when I told the vet to show me how to get 1/2 units on the 1.0 syringes).
 
oh yeah I forgot you're using the AT2. That's the main reason I switched to a human meter actually

the "don't shoot" number, if doing TR with an AT2 is 68.

sticky post said:
New members without much data collected, but are following the TR Protocol in the Lantus, Levemir, and Biosimilars Insulin Support Group should ask for guidance when presented with a preshot number less than 150 mg/dL. Once you've collected data to support your decisions, the TR "no shoot" number is 50 mg/dL.
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for an AT2, when following the above, instead of 150 it is 200, and the "no shoot" number is 68
 
Hendrick's mom and dad said:
would you be open to switching to a human meter?
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I started with a human meter but my vet refused to let me do BG tracking and take the numbers into consideration unless I used the AlphaTrak2. So I caved to keep from having to go every week and let them take the sample since they weren’t listening to me when I was worried about his numbers when this first started.

this is what makes everything so hard.
 
Nathalie said:
I started with a human meter but my vet refused to let me do BG tracking and take the numbers into consideration unless I used the AlphaTrak2. So I caved to keep from having to go every week and let them take the sample since they weren’t listening to me when I was worried about his numbers when this first started.

this is what makes everything so hard.
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Truthfully they just wanted me to buy a freestyle libre and put it on him. By the excitement she showed when mentioning it, I assumed it was going to be her first rodeo with it and an upsale.
 
Nathalie said:
I started with a human meter but my vet refused to let me do BG tracking and take the numbers into consideration unless I used the AlphaTrak2. So I caved to keep from having to go every week and let them take the sample since they weren’t listening to me when I was worried about his numbers when this first started.

this is what makes everything so hard.
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well if you're doing TR, human meter is probably easier for you. Lots of BG testing is a major component of TR and your vet isn't necessarily involved in dosing adjustments. Any reason not to switch back to the human meter at this point?
 
Hendrick's mom and dad said:
well if you're doing TR, human meter is probably easier for you. Lots of BG testing is a major component of TR and your vet isn't necessarily involved in dosing adjustments. Any reason not to switch back to the human meter at this point?
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To be honest, it would most likely be easier on me since test strips etc are available locally and not as expensive.
I had the ReliOn premier classic, but when I went to get it calibrated they gave me a hard time and told me it was approx 60+ points off. Is there a meter that you all prefer that is reliable?
 
the Relion is the single most popular and commonly used meter here, what do you mean you went to get it calibrated? Where, at the vet?

I have not heard of anyone doing that with a human meter, most just use them right out of the box as far as I know.

I use a Nova Max Plus to test ketones and also use it for BG tests from time to time, just as a comparison to BG tests with the meter we mainly use: the Care Sens N.
 
I also use a relion. No calibration needed works right out of the box. That vet either a knows very little. Or b just wants to charge you more. Or c all of the above.

I actually left and got a new vet shortly after dx because of all the little things adding up to hey you dont really know what you're doing do you dr....

Having said that I will say this. A vet is a necessary person in your life. You need regular labs and if something else happens. I look at the relationship like a dance. You need to find someone that is ok with you dosing on your own and using a human meter. It really comes down to cost for me especially. Our vet has said she doesnt care for the way I do the dosing but is willing to be his vet. She understands the need for a vet bit understands my need to do what's right. I know Elise in particular did her thing and her vet praised her for it. So in the end if they are improving what does a vet have to say about it really.

LM was also very agitated at first during testing especially in am. I took to giving a small spoonful of food before test helped to calm him some. It will take Boris a bit to adjust to a new schedule. Eating more often has really helped us and his weight and numbers. It took a little time though be patient with him and yourself. Since he is so food centric it will be easy to shave off just a tad at his preshot meal and give a little an hour later. Not much baby steps to move him off the huge meal. I think you will see an improvement in not only his numbers but his overall attitude.:bighug:
 
Please feed him more than twice a day. I don't have time to read through all of the new posts here this morning. I'm probably already repeating what others have said. But please let him eat! Your vet is misinformed. We usually only advise not feeding for two hours prior to the AMPS and PMPS tests for new people who don't have a whole lot of data on how their cats respond to carbs. The purpose of not feeding, as I am sure you have read, is so that the AMPS and PMPS numbers won't be influenced by the food. As Elise said, we would rather see a test after he's eaten some food than no test at all (just notate what you fed and how many minutes prior).
 
I also used the Nova Max Plus to test ketones. Strips are expensive, but so worth it to not have to stalk you cat to the litter box. Ketones also show up in blood before they show up in urine.
 
I've been thinking about this horse-manure calibration thing and my theory is they compared it to an AT2 and declared it 60 points off. :banghead:


Suzanne & Darcy said:
Thanks, Kyle @Hendrick's mom and dad
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Hendrick's mom and dad said:
I've been thinking about this horse-manure calibration thing and my theory is they compared it to an AT2 and declared it 60 points off. :banghead:
They didn't let me see the calibration so I suppose they could tell me what they want.

I may just do my own test between the two if Boris will let me get two samples from 1 blood drop. Then I'll really know the difference. Assuming it would work with the calibration juice the Alphatrak comes with. Put it on both meters and see what happens. Science project! :)




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