Help with low preshots

[Diane and Sheldon]

Hoping someone can shed some light on Sheldon's spreadsheet. It's a very pretty rainbow of colors but I'm pretty sure that's not what we are aiming for!! we are relatively new users of Lantus, previously on caninsulin (early december). I'm working with the SLGS protocol. What I'm running into and is confusing me is the low preshots. They were happening pretty consistently in the am for a while (late Jan early Feb). My big question I guess is Am I being too conservative or not conservative enough in dosing those? the following preshot is always high, but often higher if I dose higher. We lowered the pm dose thinking that since he doesn't eat at night (feed 4 meals, 1/2 can friskies pate, throughout the day, 7am to 10:30pm) it was dropping his numbers too low. Just when i think I've figured something out, he throws my theories out the window! Now he's back in the reds! Here'shis spredsheet. hope you can access it.

https://docs.google.com/spreadsheets/d/1p5FrXnpS5pe8mbPkVgNo0VbuSTJoloBG8r0EcAyKCRQ/edit?usp=sharing

 

[Chris & China (GA)]

First thing I notice is that you're changing the dose too often. Lantus craves consistency so the AM and PM dose should be the same (unless there's a reason like dropping too low so you'd reduce the next shot)

Lantus dosing is based on how LOW it takes them, not the Pre-shot number.

Between the skipped shot 2 nights ago and the .5 last night, his depot is all wonky so you're not getting the best results. With that 54 a few days ago, I think I'd try giving 1.5U EVERY cycle and see how he does. If his Pre-shot is below 150 (with a human meter) try stalling, don't feed and test again in 20-30 minutes and use that time to post for help. If the number goes up without food, it's probably fine to go ahead and shoot, but we like to have someone with experience watch out for you the first few times you shoot a lower Pre-shot number.

You also really need to be getting at least a "before bed" test on the PM cycle. Most cats go lower at night so it's important for safety. Also, without getting tests on the PM cycle, you're missing half the data on what's going on. If you think of your spreadsheet like it's a puzzle and you only have the pieces filled in on one side, you don't have any idea what the other side of the puzzle looks like!

What type of meter are you using? Human or Pet? (it's good to add that information to your signature)

 

[Bobbie And Bubba]

Hi there and welcome to the L, B, and L forum. Looking at your SS , I noticed a few things. We recommend that the doses are raised and lowered in increments of .25 of a unit. That way you don't go over the best dose. If you are following SLGS then reductions are taking when Sheldon falls below 90. He got a 54 on 2/7 and earned a reduction, but only to 1.75. Also, after that 54 @ +6 I would have fed a little LC food since it was mid cycle and grabbed another test 30 minutes later to make sure he was safe.

Also, there are no test during the PM cycle. Please keep in mind that most kitties go lower in the PM cycle so getting test during it is very important. At lest get one before you go to bed to make sure he is safe. He was 176 last night and no more test. You dropped the dose to .50 but keep in mind that the depot is still working from the higher dose and it doesn't necessarily mean he is going to stay safe ; some more test would have been prudent. Please don't think I am beating you up, I am just trying to help you.

Lantus needs consistency. Your dosing has been all over the place. With SLGL method you would hold the dose for 7 days before changing it. Of course if he goes under 90 if you are using a human meter or 68 if you are using a pet meter, you would reduce by .25 of a unit. Lantus is dosed on the nadir ( the lowest point of the cycle) rather than the preshot number. That is very different from caninsulin. Please take some time to read all the Lantus stickies about the depot and the SLGS method.

So, what is the right dose for him right now? I am thinking 1.5 units. I am tagging some peeps to look at the SS and see what they think, @Gill & George , @Sienne and Gabby (GA) , @Marje and Gracie , @Chris & China (GA)

Please add to your signature when he was DX, what type meter you are using, human or pet, as that will influence the advice people give you. Age, how much he weighs and any medical problems, age, any history of DKA and anything else you feel is important for us to know.

 

[Bobbie And Bubba]

@Chris & China (GA) , we crossed posted. 1.5 is kind of where I was leaning too. Thanks for weighing in.

 

[Diane and Sheldon]

First thing I notice is that you're changing the dose too often. Lantus craves consistency so the AM and PM dose should be the same (unless there's a reason like dropping too low so you'd reduce the next shot)

Lantus dosing is based on how LOW it takes them, not the Pre-shot number.

Between the skipped shot 2 nights ago and the .5 last night, his depot is all wonky so you're not getting the best results. With that 54 a few days ago, I think I'd try giving 1.5U EVERY cycle and see how he does. If his Pre-shot is below 150 (with a human meter) try stalling, don't feed and test again in 20-30 minutes and use that time to post for help. If the number goes up without food, it's probably fine to go ahead and shoot, but we like to have someone with experience watch out for you the first few times you shoot a lower Pre-shot number.

You also really need to be getting at least a "before bed" test on the PM cycle. Most cats go lower at night so it's important for safety. Also, without getting tests on the PM cycle, you're missing half the data on what's going on. If you think of your spreadsheet like it's a puzzle and you only have the pieces filled in on one side, you don't have any idea what the other side of the puzzle looks like!

What type of meter are you using? Human or Pet? (it's good to add that information to your signature)

First thing I notice is that you're changing the dose too often. Lantus craves consistency so the AM and PM dose should be the same (unless there's a reason like dropping too low so you'd reduce the next shot)

Lantus dosing is based on how LOW it takes them, not the Pre-shot number.

Between the skipped shot 2 nights ago and the .5 last night, his depot is all wonky so you're not getting the best results. With that 54 a few days ago, I think I'd try giving 1.5U EVERY cycle and see how he does. If his Pre-shot is below 150 (with a human meter) try stalling, don't feed and test again in 20-30 minutes and use that time to post for help. If the number goes up without food, it's probably fine to go ahead and shoot, but we like to have someone with experience watch out for you the first few times you shoot a lower Pre-shot number.

You also really need to be getting at least a "before bed" test on the PM cycle. Most cats go lower at night so it's important for safety. Also, without getting tests on the PM cycle, you're missing half the data on what's going on. If you think of your spreadsheet like it's a puzzle and you only have the pieces filled in on one side, you don't have any idea what the other side of the puzzle looks like!

What type of meter are you using? Human or Pet? (it's good to add that information to your signature)

First thing I notice is that you're changing the dose too often. Lantus craves consistency so the AM and PM dose should be the same (unless there's a reason like dropping too low so you'd reduce the next shot)

Lantus dosing is based on how LOW it takes them, not the Pre-shot number.

Between the skipped shot 2 nights ago and the .5 last night, his depot is all wonky so you're not getting the best results. With that 54 a few days ago, I think I'd try giving 1.5U EVERY cycle and see how he does. If his Pre-shot is below 150 (with a human meter) try stalling, don't feed and test again in 20-30 minutes and use that time to post for help. If the number goes up without food, it's probably fine to go ahead and shoot, but we like to have someone with experience watch out for you the first few times you shoot a lower Pre-shot number.

You also really need to be getting at least a "before bed" test on the PM cycle. Most cats go lower at night so it's important for safety. Also, without getting tests on the PM cycle, you're missing half the data on what's going on. If you think of your spreadsheet like it's a puzzle and you only have the pieces filled in on one side, you don't have any idea what the other side of the puzzle looks like!

What type of meter are you using? Human or Pet? (it's good to add that information to your signature)

 

[Diane and Sheldon]

Sorry i somehow quoted Chris over and over. I hate this phone. Thanks everyone. You're all saying what I'm needing to hear. I think I'm focusing on the preshots too much as opposed to the nadirs. I was very consistent then started losing my mind with these new low preshots. My schedule as a bus driver has made finding a best time to shoot interesting. I'm now testing at 7am but that means if I put it off I can't dose till 9. But it would allow me to get a +3 or +4 after the 7PM shot. I'm using the bravo, a human meter. He was diagnosed in late August 2018. He's an 8yr old fixed Male, probably should be 11lbs, but only 10.5lbs. Doing much better on lantus then he was behavior wise. Ended up with hindquarter neuropathy on caninsulin but has since resolved. I'll try to add all that to my signature.

 

[Bobbie And Bubba]

Sorry i somehow quoted Chris over and over. I hate this phone. Thanks everyone. You're all saying what I'm needing to hear. I think I'm focusing on the preshots too much as opposed to the nadirs. I was very consistent then started losing my mind with these new low preshots. My schedule as a bus driver has made finding a best time to shoot interesting. I'm now testing at 7am but that means if I put it off I can't dose till 9. But it would allow me to get a +3 or +4 after the 7PM shot. I'm using the bravo, a human meter. He was diagnosed in late August 2018. He's an 8yr old fixed Male, probably should be 11lbs, but only 10.5lbs. Doing much better on lantus then he was behavior wise. Ended up with hindquarter neuropathy on caninsulin but has since resolved. I'll try to add all that to my signature.

Okay, if you are testing at 7 AM and 7 Pm, then getting a +3,and 4 is great! Here is a great test to get in both cycles, the +2. If it is the same of lower than the pre shot number, then you know it's going to be an active cycle meaning that he could drop into some green numbers and some more testing would be required. Knowing that, and if you have to leave at +3 or so, you can feed him some lower carb ( LC) or medium carb ( MC ) food to boost him up a bit to keep him safe.

Thanks in advance for adding all pertinent information to your signature.

Keep posting each day with a new thread. Put your name, the date, and his amps number and we will be here to help you.

So glad you posted. Keep asking questions. That is how we all learned!

 

[Diane and Sheldon]

I think where I've missed the idea is when the NADIR (not preshot) is low, reduce dose, permanently, not just that shot. I'm not thinking long term enough, more knee jerk reaction. He was at 13.1 (236) so he got 1.5, which is the dose I plan on holding for the forseable future. Anytime his preshot is under 11 (200), I'll either stall or not dose at all. Over 11 (200) the usual dose. Is that right? Then keep testing midday as well as get some post PM readings. I feed when I test, (7am- 1pm-7pm) then a last feeding before bed. Over the weekend I'll try to get a +6 overnight.

 

[Chris & China (GA)]

Anytime his preshot is under 11 (200), I'll either stall or not dose at all. Over 11 (200) the usual dose. Is that right?

No.....we use 150 (8.3) once you have some data and experience. And it's almost always better to stall and see if it's going to be safe to shoot instead of skipping. Skipping disrupts the depot and leads to wonky numbers. If you get a PS you're not sure about, stall and post here. Make sure your subject line is clear (say something like "STALLING--NEED HELP!!") …...We have an unwritten "rule" that if someone signs on and advises you to shoot a lower number, they will stay online as long as necessary to make sure everything goes OK (or they will find someone else with experience who can take over) We will never tell you to shoot and then leave you alone!

You might want to re-read the SLGS method guidelines again. Once you start to get the "hang of it", re-reading the dosing methods can really be beneficial. You'll see things you might have glossed over the first time or two.

 

[Diane and Sheldon]

Thanks Chris. I agree, I really hate skipping, hence why I was giving smaller doses, but I'm beginning to realize it should be full dose or stall till I can give full dose. Get him off this rollercoaster I've thrown him on. And he's rarely under 150 preshot, so it's doable. I definitely will reread the SLGS method. I have read it many times but with a major misconception skewing everything. Thank you very much!

 

[Bobbie And Bubba]

Thanks Chris. I agree, I really hate skipping, hence why I was giving smaller doses, but I'm beginning to realize it should be full dose or stall till I can give full dose. Get him off this rollercoaster I've thrown him on. And he's rarely under 150 preshot, so it's doable. I definitely will reread the SLGS method. I have read it many times but with a major misconception skewing everything. Thank you very much!

Don't get discouraged, Diane. I have read and reread and still read and reread the stickies......it is such a learning curve.

Keep posting here so we can share our knowledge with you.

 

[Diane and Sheldon]

Good morning all ang happy Valentine's day. I did get a +3 after his PM shot. It was 5.8 (104) yikes that was surprising. He had a meal at right after. Sheldon was at 5.4 (97) this am so I didn't shoot. Now 2 hrs later, after a meal, he's at 9.9 (178). Do I shoot, reduce the dose, or stall longer. I've got nowhere to be today other than 3 to 5.

 

[Bobbie And Bubba]

If you were to shoot now then it would change your shot time by 2 hours. Can your schedule be that flexible?

What time zone are you in? When you say 3 to 5 that you are out, where does that fall in the SS?

 

[Diane and Sheldon]

In Manitoba Right now its 9:20. If I shoot at 10, 3pm would be my +5. We were originally shooting 9am 9pm so it wouldn't be a problem. I could step it back over the weekend if need be. 10 is really the latest I'd want to push it.

 

[Diane and Sheldon]

On the 31 of jan I dosed 1.5 when he was 10.7(192) and I did a curve. His numbers weren't bad but they really jumped at +9 then ended high. Didnt like that too much, thought it might be a bounce from too much insulin

 

[Diane and Sheldon]

Yikes!! So I retested st 10:15, he's at 23.2 (417)! So he got his 1.5 shot!! Is it normal to go up that much that quickly? From 9.9 to 23.2 in an hour?!? I'm beginning to see why stalling is a much better option than skipping. I'll test again at +2, to see how quickly the insulin takes effect, then again at + 6.

 

[Chris & China (GA)]

Is it normal to go up that much that quickly?

That's a "bounce"......I would have suggested getting another test in last night when he dropped from 236 to 104 in only 3 hours....that's a pretty huge drop and I wonder just how much further he dropped.

Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3)

The liver releases stored sugars and hormones to bring them back up quickly.

I suspect he dropped lower last night and the 97 you got this morning was when he was "on his way back up" and now the stored sugars/hormones have really kicked in and sent him to the moon

 

[Diane and Sheldon]

I'm thinking I've been doing this to him a few times now poor guy. It's been my concern when I get low amps, but his curves suggests he often continues to go down so that his next preshot number is very close to the lowest. I hope so, otherwise he may have been near to hypo without my knowing it. What's the fix other than finding the sweet spot dose wise, and monitoring frequently?