Is my most recent shooting numer accurate?

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Chrisa Hotchkiss

Chrisa Hotchkiss

Member Since 2023
Hi.

We have a Freestyle Libre (as of the afternoon of May 1), so I've done a curve today and tested more randomly the last couple days. I've updated Jackson's spreadsheet. Seems I was overshooting because his numbers were dropping dramatically to the point where I fed him dry food twice recently to make sure he didn't bottom out. (He exhibits no symptoms when his BG is low except for sleeping a lot--which isn't helpful because that's a normal 15-year-old cat habit.)

I just reduced his dosage to .75 based on the bouncing. Does that seem right? (I'm new to using syringes and hope I'm doing it correctly. )

Note: our spreadsheet is all over the map (I haven't been able to test consistently), and the early readings are out of whack b/c there was an error with the pen and I don't think he was getting any insulin for a few weeks--in case you need some context.
 
Haven’t looked at the spreadsheet yet but for future reference, dry food is not a good way to bring the bg up because it takes a while to kick in. Your hypo kit should have high carb and medium carb foods like fancy feast gravy lovers or medleys primavera. You can also put a few drops of honey or Karo in his gums.
 
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You lowered to .75 then went back up to 1 and had to lower again so once he’s earned a decrease, you need to hold it for a few cycles since Lantus needs consistency. I also see you increased from 1 to 2 units and we don’t increase by more than 1/4 unit at a time. Have you been posting on the Lantus forum?

And since you’re following SLGS, he earned another reduction today since he went under 90. What syringes are you using? Are they 1/2 unit marked? Tagging @Bron and Sheba (GA) for a second opinion.
 
Ale & Bobo & Minnie (GA) said:
You lowered to .75 then went back up to 1 and had to lower again so once he’s earned a decrease, you need to hold it for a few cycles since Lantus needs consistency. I also see you increased from 1 to 2 units and we don’t increase by more than 1/4 unit at a time. Have you been posting on the Lantus forum?

And since you’re following SLGS, he earned another reduction today since he went under 90. What syringes are you using? Are they 1/2 unit marked? Tagging @Bron and Sheba (GA) for a second opinion.
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Thank you! Yes, the syringes are 1/2 unit marked. I find it very tricky to find the right dosage on the syringes. I'm not sure if I'm doing it right. I haven't been posting on the Lantus forum. I am still struggling to make sense of how the two forums work and the best place to post. And retaining the information that I am reading. My brother-in-law is in hospice with possibly only a few days to live, so I haven't been able to give Jackson the kind of focused attention I would like. I get confused when I read the guides, then I tear up, then I sort of give up. Sorry for the sob story. I have way too many stressors in my life. :(

So the upshot is, I should be giving him .5 now? And not .75?
 
When you’re following SLGL, every time your cat goes below 90, it earns a reduction. Tagging one more person to confirm this is correct @tiffmaxee

I also want to mention that you have a few NS. It’s best to give a token dose instead of skipping the shot completely. You can also stall, not feed, retest in 20 minutes to see if the bg is going up and make a decision to give the regular dose or the token dose. When you’re unsure, you can post on the Lantus forum and ask for help.

I’m very sorry to hear about your brother in law. I understand being overwhelmed. Do you understand the dosing protocol and when to increase/decrease?
 
SLGS

https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Don't be tempted to rush the process along by increasing the dose more quickly or in larger increments-- no matter how high your cat's blood glucose is! Rushing towards regulation will cost you time in the long run, because you may shoot past the right dose.

Lather, Rinse, and Repeat!

How to handle a lower than normal preshot number:

Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
First, so sorry about your brother in law. For now we need to make this as easy as possible fior you.

With SLGS the new dose is .50 and you will stick with that for 7 days unless there’s another drop under 90 which would call for another reduction.

The Libre reads lower than the AT and sometimes throws out an odd low bg that just doesn’t fit in which case an ear prick to recheck is strongly recommended.

You will want to have your spreadsheet fixed as you switched to a human meter. Tagging Bhooma who can fix it for you easily. @Bandit's Mom

It is really important to test before every shot to make sure it’s safe to shoot.

Keep asking questions.
 
I'm sorry about your brotner-in-law .
Yes Bhooma can fix your SS , signature and put a line above the date you switched to the human meter on your SS and also fix it up top where you have Alpha Trak.
@Bandit's Mom
 
Thanks, everyone! I intended to spend a lot of time while Jackson has his Freestyle Libre reading up on everything and honing my skills. I have read many of the guides in the past, but it didn't stick. For now, I am using a syringe (just switched over from the pen, which explains why I couldn't follow accurate dosing protocol) and am fairly confident I gave him .75 last night and this morning. It sounds like I should reduce that to .5. The good news is, he didn't bottom out, though. I will add the next set of numbers to the spreadsheet. Thanks very much for your help with that, Bhooma!

I recently switched him completely off dry food to high protein canned, and it seems like it's having positive results. He went into remission once before (last summer), so I'm hoping it can happen again. I will pay more attention to the numbers and not just skip the insulin when he is low. Now that we have the monitor, it's easy to check his BG. Yay! We have had absolutely no issues with that device. He is such a chill cat!
 
tiffmaxee said:
Since you are feeding only wet food, once things settle down for you and if you want to , you could switch to TR.
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Sorry, I don't know what TR means and can't remember where to find the glossary of terms. I find the message board tricky to navigate. I do bookmark things in my Jackson folder (on my computer), but that's starting to overflow. I wonder if other newbies struggle with the acronyms like I do?

Thanks for your support!
 
The two dosing methods we use here are SLGS and TR. TR is more aggressive but will get your cat into better numbers more quickly. I’ll attach a few links for you that explain everything. They are all on the lantus forum at the top. The stickies contain so much information so don’t get overwhelmed. Just keep asking questions.
 
Thank you! I've bookmarked them both and will make time to review them later today. I just added his numbers to the spreadsheet from yesterday and this morning. I have kept the dose at .75 because I am not confident that when I try to load the syringe for .5, he is getting any insulin at all! (Still new to using syringes.)

The .75 dosage seems to be too low anyway, but I understand the method and will keep it at .75 for a week unless folks think otherwise.

Thank you, thank you, thank you!
 
Okay, Jackson's numbers are super high. So high, in fact, that they didn't even register on the Freestyle Libre twice today. This is where I struggle with staying at .75. But if I move up to 1, he will likely bottom out. Is this normal? I keep thinking maybe there's some underlying health issue. I have such a hard time seeing these high numbers and keeping the dosage so low. I realize this is where I get into trouble with the bouncing. It's all so confusing and frustrating. When I wasn't testing him so much, honestly, I was much less stressed.
 
He’s still bouncing from that low line. Hopefully tonight is the high before the bounce clears. When they clear there can be extra momentum so you want to feed him to prevent big drops or going low again. It’s frustrating I know but follow the method and it will get better. :bighug:
 
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tiffmaxee said:
He’s still bouncing from that low line. Hopefully tonight is the high before the bounce clears. When they clear there can be extra momentum so you want to feed him to prevent big stops or going low again. It’s frustrating I know but follow the method and it will get better. :bighug:
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That's reassuring. Thank you!
 
It turns out I've had to switch Jackson to a food sensitivities diet, so I'm losing hope of ever getting him into remission. The vet recommended this a while ago after he had an ultrasound and inflammation was found in his organs. (At that time, I thought it he was just sensitive to his dry food so I switched him to Hill's and that did the trick--for a while.)

He has been throwing up every few days. So he is now on Hill's wet, and I just started adding Hill's dry back in because this morning, he's not too impressed with the wet food. Yesterday, he gobbled it up but this morning, it's a no go. He usually waits for his food to warm up (if it's been refrigerated), so maybe I need to heat it up before feeding him. I don't like microwaves, though. I could heat it up in a pan. I'm going to pose the question to the forum about what food other folks use with cats with food sensitivities if they won't eat Hill's. (Sigh.)

I will need to gradually increase his insulin dosage as his numbers have been so high (even before switching to the Hill's diet) that half the time they don't even register on the Freestyle Libre. I've upped his dosage to 1 IU. How should I proceed with increasing it over the next few weeks? Up by .25 for a few days, then another .25? Sorry, my bro-in-law is still in hospice and I haven't had a chance to read any of the guides or keep his spreadsheet updated. Soon, I will go back to testing him manually because the FL is almost at the end of its life.
 
Sorry about your BL. It’s hard I know. Did you ever try an elimination diet to see if perhaps that will help him? We can talk about that later when you have time and can think clearly.

Unfortunately we can’t give dosing advice without the most recent bg on a spreadsheet. If you could manually add the preshots and lowest bg for each cycle that will be all that’s needed.
 
Okay, thanks. I'll try to do that tonight (update spreadsheet). As of right now, I will need to test him manually because the device just keeps reading HI. (Sigh.) Changing his diet is the culprit, I believe, but even before that his numbers have just never stabilized, as you will see. I am so disheartened and so exhausted.
 
There’s nothing magical about RX foods and they are high carb for the most part. Often it’s tge protein causing the issues if food is the cause. I’d try switching to a wet food that is limited ingredient and. Protein never eaten before. There are lots of novel proteins You just need to read tge labels carefully to make sure there’s only one protein. There pork, venison, duck, lamb, rabbit.
 
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