High pre shot #s; raise dose?

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Team Pavel

Team Pavel

Member Since 2014
Hi, everyone,

I'm hoping some of the experienced folks on the board will be willing to look at Pavel's SS and give me some advice. Pavel often has high pre-shot numbers, but sometimes reaches numbers close to 100 around nadir. Should we raise his dose? We did try going up .25 a week or so ago, but he had some low numbers that concerned us (we can't be around during the day to watch him) so we dropped it back down.

He's currently on 1.25.

Also, are some syringes better than others? We're using Walgreen syringes, and sometimes it seems the markings are so vague, it's hard to measure by .25 increments.

Thanks!
 
I use BD Ultrafine Elite II syringes . The needle is shorter, easier to inject, and they have 1/2 unit markings.
 
I would go the other way and reduce him. First off, increases are based on nadir, not preshot numbers. Secondly, his low numbers are about the same, regardless of what you do, but those preshots are not getting better. So he is bouncing, constantly. If he were mine, I would roll him back to 1 unit and hold that for at least 4 days, see if those preshots get better. You may find that his nadir also drops, because he doesnt have to work so hard to get a low preshot knocked down.

My 2 cents. Others may have other thoughts. Good luck.
 
Linda and Mel--interesting idea, and definitely worth a try--thank you for your input!

Generally his nadir has seemed ok, and I get that that should be the basis for a dose change, but those pre-shot numbers have seemed much too high. I've thought that if we could put him on an 8 hour schedule, it might be ideal, but there's no way to do this without one of us quitting our jobs.

Linda, you said "You may find that his nadir also drops, because he doesnt have to work so hard to get a low preshot knocked down." I think I'm not following what you mean. His pre-shots have mostly seemed high to me, except when we were at 1.5, then they seemed low, and we backed off. Is there something I'm not getting?

Many thanks!
Juliet
 
Well, lets look at the math. If the cat is at 300, and you get a nadir of 100, you dropped 200 points. If you can get that preshot to stay lower (be less bouncy/reactive), and he starts out at 250, even if you figure that you are giving slightly less insulin, that cat has to drop far fewer points to get to that same 100. What if the cat is able to ease down to lower numbers more easily on less insulin because they are not fighting the rebound response? Then your nadir could be quite a low surprise.

The point is to stay vigilant, especially when you make a dose change. Also, remember, New Dose Wonkiness is to be expected for the first few days, so dont jump too fast to conclusions if you dont see a positive change right away.

As for 8 hour dosing, I am not familiar with any protocol for that with Lantus, so cant speak to that.
 
An explanation on Bouncing that Wendy posted some time ago:

"Bounces - what are they and is my cat doing them?
When a cat isnt regulated, the blood glucose has probably been high for a while. As the insulin starts to take effect and numbers start to come down, the liver has to learn to adjust to the lower numbers. We call this "liver training school". But before it relearns that low numbers are ok, when the BG drops to a number lower than the liver is accustomed, or if BGs drop low, or if the BG drops suddenly, the liver”panics” and reacts by releasing counterregulatory hormones and glucagon. This drives the BG back up. This is what we call a "bounce". Bounces can take up to 72 hours to clear so we are generally careful about increasing doses during the bounce. Once the bounce clears, then you can see the "real" numbers and determine if the dose needs to go up or down."
 
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